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Changing Perspectives: DSM-IV: make way for DSM-5

DSM-IV: make way for DSM-5

As of 2017 the fifth edition of the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5) will be the leading classification system for psychiatry in the Netherlands. It succeeds its predecessor DSM-IV, which has been around since the ‘90s and was known for adding the required ‘clinically significant impairment in functioning’ criterion to many disorders.

One of the biggest changes is the removal of the multiaxial system. Sixteen new classifications have been added and some disorder groups have changed radically. Most notably, the diagnosis ‘Autism Spectrum Disorder’ now encompasses autism, Asperger’s disorder, childhood disintegrative disorder and pervasive developmental disorder not otherwise specified and it is categorized in severity. Another notable change is the reorganization of the former anxiety disorders into separate anxiety, obsessive-compulsive-related and trauma- and stressor-related disorders.

Not all changes have been met with enthusiasm. For example, there has been much debate about the removal of the bereavement exclusion in major depressive disorder. This criterion was used to exclude the possibility of diagnosing someone with a depression in the first two months of grief. Some fear that this removal may lead to unnecessarily medicalizing normal grief.

According to Edith Schippers, Minister of Health, Welfare and Sport, the change to DSM-5 will not have any noticeable effect, insurance-wise. It will be interesting to see how much impact this DSM update will have in the everyday clinical setting.

A.G.E. van Aken & P.P. de Koning

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