What’s New in the DSM-5-TR? An interview with Dr. Michael B. First

What’s New in the DSM-5-TR?

Curt and Katie interview Dr. Michael B. First, MD, editor and co-chair of the American Psychiatric Associations’ DSM-5 Text revision, coming out March 2022. We explore: What are the differences between a full update and a text revision? What changes have been made (and how were these changes decided)? What new diagnoses can we expect? Can clinicians continue to use the older DSM-5? How can clinicians advocate for changes in future versions of the DSM? All of this and more in the episode.

Interview with Dr. Michael B. First, MD

What changes have been made in the new DSM-5-TR?

• Text revisions occur to avoid letting the text become stale while supporting ongoing updates.
• New disorders, specifically Prolonged Grief Disorder, have been added.
• New codes, modeled off symptom codes, created for documenting suicidality and non-suicidal self-injury with another diagnosis.
• New categories of Unspecified Mood Disorder.
• New Criteria set for Autism Spectrum Disorder which is more conservative.

How are cultural differences addressed in the DSM-5-TR?

• Starting with DSM-IV, there has been a special committee created for culture and culture related issues
• Hypothetically, the criteria sets should apply to everyone, but in the text, there is a section on Culture Related Features which is more specific.
• The impact of the George Floyd protests inspired the creation of a new committee to look for systemic racism, lack of nuances, and prevalence issues within the DSM.
• There are conflicting opinions if “transness” should be included in the DSM and if it’s even a mental disorder.
• As the DSM is a diagnostic tool to code for insurance, the DSM takes the stance that the Gender Dysphoria diagnosis stay included so individuals can have access to medical intervention and treatment.
• The Steering Committee for new diagnosis is small, but there is diversity.
• Before a diagnosis is approved, it is posted for 45 days on the DSM website for all, including people with lived experience, to comment and advocate for diversity

What is the Process for Accepting New Diagnose?

• The steering committee accepts proposals through the DSM portal for new diagnosis
• Some diagnoses are qualified based on the United States’ continued use of ICD-10, whereas the ICD-11 is more progressive.
• With Complex Post Traumatic Stress Disorder, some of the criteria from the ICD have been incorporated into the DSM diagnosis of PTSD
• Proposals are floated around often, but they often don’t have enough empirical research yet.
• Proposals need to show a pool of patients who don’t fit other diagnoses, a gap in treatment, and a difference from other possible similar diagnoses.
• New diagnoses will be approved on a continuum, making the electronic DSM-V-TR the most up to date resource.