Welcome back to Part 2, as we review the most recent DSM-5-TR updates. If you have not done so already, please be sure to review Part I of this blog as it describes important additions to the DSM. In this part, we are going to focus on some of the minor changes made to the description of several disorders, as well as on the issues of culture, equity and inclusion. Let’s dive in.
Two different committees looked at issues of culture, equity, and inclusion in the DSM 5 and added important and long overdue changes. Here are some of the changes they came up with:
o Changed language in the criteria and the data to be more inclusive.
o The term “racialized” replaces “race/racial” to highlight the socially constructed nature of the term race.
o The term “ethnoracial” denotes the U.S. Census categories, such as Hispanic, White, or African American, that combine ethnic and racialized identifiers.
o The terms “minority” and “non-White” are avoided because they describe social groups in relation to a racialized “majority,” a practice that tends to perpetuate social hierarchies.
o The term “Latinx” is used to replace Latino/Latina to promote gender-inclusive terminology.
o The term “Caucasian” is not used because it is based on obsolete and erroneous views about the geographic origin of a prototypical pan-European ethnicity.
o Removed male / female box on cross cutting symptom measures.
Changes related to gender identity and sexual orientation
In addition to cultural changes, APA committee members worked hard to make appropriate changes related to gender identity and sexual orientation. You’ll notice that Gender Dysphoria is one of the only diagnoses in the DSM that does not have “disorder” after it. There are also a number of terminology updates describing gender dysphoria based on culturally sensitive language. The term “desired gender” is now replaced with “experienced gender,” the term “cross-sex medical procedure” is now “gender-affirming medical procedure,” and the term “natal male”/ “natal female” is now “individual assigned male/female at birth.” The entire text of the Gender Dysphoria chapter has also been updated based on the literature.
Minor Changes and Clarifications
The DSM-5-TR updates the wording of several disorders for greater clarity. Here are some of the most noteworthy updates:
Criterion A was revised to be clearer. Rather than “as manifested by the following”, it now states “As manifested by all of the following”:
- Deficits in social-emotional reciprocity
- Deficits in nonverbal communication
- Deficits in developing and maintaining relationship
Bipolar I and II
- Placed between Schizophrenia Spectrum/Other Psychotic Disorders and Depressive Disorders and seen as a bridge between the two
- Clarified language: “At least one manic episode is not better explained by schizoaffective disorder and is not superimposed on [another psychotic disorder]
- Bipolar II is no longer viewed as less severe than Bipolar I due to the burden of depressive symptoms and impairment in work and social functioning due to mood instability.
- Added Severity Specifiers for Manic Episodes:
- Mild: minimum symptom criteria are met for manic episode
- Moderate: Very significant increase in activity or impaired judgment
- Severe: Continual supervision required to prevent harm
Functional Neurological symptom Disorder
Formerly known as “conversion disorder”, but that term is no longer used.
Social Anxiety Disorder
Social Phobia is no longer used.
Persistent Depressive Disorder
Removed “dysthymia” from the title.
Specifiers indicating the duration of symptoms in Adjustment Disorder were left out of DSM-5 and have now been reinstated:
- “Acute” if symptoms have persisted for less than 6 months
- “Persistent” if symptoms have persisted for 6 months or longer after the termination of the stressor or its consequences.
Implications for the licensing exams
As you can see, the changes made to the DSM-5-TR are rather minor. Aside from learning a couple of new disorders and some updated language, the information that you have received from your TDC exam prep course will carry you through whether you are taking the National MFT, the CA Clinical, or the ASWB Clinical or Masters level exams. If you have any further questions about this or any other aspect of your test prep, please be sure to reach out to your coach. We have helped thousands of therapists pass their licensing exams and we are ready to help you pass with confidence.