DSM 5 Changes: How the DSM 5 compares to the DSM IV

By Amanda Rowan on June 19, 2014

What's new in the field of mental health? The DSM 5! And while we all transition from the DSM IV to the DSM 5, it is good to take a look at what has changed. If you are preparing for the Social Work Exams or MFT Exams, the ASWB, the BBS, and the AAMTRB have all announced that the DSM 5 will not be tested until 2015.


Published in May of 2013, the DSM 5 was a 15-year work in progress. Overall, the DSM 5 is not very different from the DSM IV. If you compared the two, like I have done, I think it is safe to say that most of it is the same and about 10% is different. The changes that were made were both major and minor.

The major changes are:

  • The elimination of the multiaxial system (goodbye “the client is axis II” references)
  • The organization of the different groupings of related disorders (for example, the creation of Trauma- and Stress- Related Disorders category)
  • Switching from Roman Numerals to numbers (IV to 5 instead of V)

The minor changes include:

  • New diagnoses that did not appear in DSM IV
  • Changing the name of DSM IV diagnoses
  • Changing the criteria of DSM IV diagnoses

Let's start with the 11 new DSM V diagnoses:

1) Social (Pragmatic) Communication Disorder: Defined by Impairments in the use of conversation. Use of vocabulary and sentence structure is intact, onset early childhood.

2) Catatonia Due to Another Medical Condition: Defined by cataplexy, waxy flexibility, stupor, agitation, mutism, negativism, posturing, mannerisms, stereotypies, grimacing, echolalia or echopraxia due to medical condition.

3) Catatonia Due to Another Mental Health Condition: Defined by cataplexy, waxy flexibility, stupor, agitation, mutism, negativism, posturing, mannerisms, stereotypies, grimacing, echolalia or echopraxia due to mental health condition.

4) Disruptive Mood Dysregulation Disorder: Defined bytemper tantrums, chronic irritability, and dysphoric mood. Onset age 6-10, but may be diagnosed up to age 17.

5) Premenstrual Dysphoric Disorder: Defined by depressivesymptoms that are most severe in the week before menses, and minimize or disappear during and after menses.

6)  Agoraphobia: Defined by fear of at least two situations in which escape may be impossible or help will not be available.

7)  Hoarding Disorder: Defined byurges to save objects which have little or no value; clutter makes living or working increasingly difficult; strong distress related to discarding objects.

8)  Excoriation (Skin-picking) Disorder: Defined by picking at the skin that results in lesions.

9)  Binge-Eating Disorder: Defined by eating more than a normal person would in the same span of time, feeling guilty about doing so. No purging.

10)  Obstructive Sleep Apnea Hypopnea, Central Sleep Apnea and Sleep-Related Hypoventilation: Defined by specific sleep distubances and confirmed by Polysomnography.

11)  Restless Legs Syndrome: Defined by sensations of discomfort in the legs that occur at night, when trying to relax or sleep.

Here are the 17 diagnoses from the DSM IV that have new names in the DSM 5:

1) Intellectual Disability (Intellectual Developmental Disorder): Replaced Mental Retardation. Defined by global intellectual delays.

2)  Autism Spectrum Disorder: Defined byimpairments in two domains: social communication and repetitive/restrictive behavior. Severity is determined by the support needed for daily functioning. Replaced Aspergers, Autism and Pervasive Developmental Disorder NOS.

3)  Language Disorder: Defined by deficits in spoken and written language production and comprehension, onset in early childhood. Replaced Expressive and Mixed Receptive-Expressive Language Disorders.

4)  Speech Sound Disorder: Defined by Omitted sounds, distorted sounds and pronunciation, onset in early childhood. Replaced Phonological Disorder.

5)  Specific Learning Disorder: Defined by Difficulties in academic learning or performance. Replaced Reading and Mathematics Disorders and Disorders of Written Expression

6)  Childhood-Onset Fluency Disorder: Defined by Disturbances in fluency and time patterning of speech. Replaced Stuttering.

7)  Persistent Depressive Disorder: Defined by symptoms of depression lasting >1 year for children and >2 years for adults. Replaced Dysthymia.

8)  Disinhibited Social Engagement Disorder: Defined by child’s willingness to attach to strangers and lack of checking back with regular caregivers. Onset before age 5. Result of multiple caregivers and harsh or abusive parenting. Replaced a specifier for Reactive Attachment Disorder.

9)  Illness Anxiety Disorder: Defined by a belief in illness or impending condition. Somatic symptoms are mild or absent. Replaced Hypochondriasis.

10)  Non-Rapid Eye Movement Sleep Disorder - Occurs during non-REM period of sleep or the first 1/3 of sleep time. Person has incomplete awakening and is difficult to comfort. Subtypes: Sleepwalking and Sleep terrors.

11)  Insomnia Disorder: Defined by Inadequate sleep quality or quantity that occurs at least 3 nights a week for at least 3 months. Replaced Primary Insomnia.

12)  Hypersomnolence Disorder: Defined by Excessive sleepiness with lapses into sleep within a day, 9+ hours of sleep, or difficulty being fully awake. Replaced Primary Hypersomnia.

13)  Genito-Pelvic Pain/Penetration Disorder: Defined by difficulties with vaginal intercourse/penetration, presence of vaginal or pelvic pain during intercourse/penetration attempts, fear or anxiety either about vaginal or pelvic pain or vaginal penetration, tensing or tightening of the pelvic floor muscles during attempted penetration. Replaced Dyspareunia and Vaginismus.

14)  Gender Dysphoria: Defined by A subjective sense of incongruence between the biological gender at birth and expressed or socially assigned gender. Replaced Gender Identity Disorder.

15)  Substance Use Disorder: Defined by Behavioral or physiological symptoms (tolerance or withdrawal). Craving is a new symptom. Replaced Substance Abuse and Substance Dependence.

16)  Mild/Major Neurocognitive Disorder: Defined by Progressive decline in functioning. Replaced Dementia.

17)  Depersonalization/Derealization: Disorder: Defined by feeling detached from one’s surroundings, mental processes, or body. Change: Previously called Depersonalization. Derealization was add to the title.

These 4 diagnoses appeared in DMS IV and were changed in the DSM V:

1) Reactive Attachment Disorder: Defined by social with Result of multiple caregivers, child is withdrawal, lack of social reciprocity, lack of comfort seeking, onset before age 5. Change: Previously RAD included both inhibited and disinhibited types. Now RAD is only the inhibited type and the disinhibited type is Disinhibited Social Engagement Disorder.

2) Major Depressive Disorder: Defined by depressed mood or apathy which lasts at least 2 weeks. Change: The bereavement exclusion has been removed so MDD can now be diagnosed within the 2 months post death. Previously, there was s 2 month period after the death that MDD was not diagnosed.

3) Attention Deficit Hyperactivity Disorder: Defined by disruptive behaviors due to inattention and/or hyperactivity and impair home, school and/or social functioning. Change: Now must be diagnosed before age 12. Previously it had to be diagnosed before age 7. Threshold for diagnosing adults has dropped from 7 to 6 symptoms.

4)  Bulemia Nervosa: Defined by binge eating, sense of lack of control and purging to prevent weight gain. Change: Previously, purging was not required. Now Binge Eating Disorder has only the binge eating.

We hope you enjoyed our summary of changes in the DSM 5.  If you have ideas for other topics, you cna contact us anytime and let us know.

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Commenter Name
June 20, 2015

Thank you Amanda!! Your blog on these important changes and issues are extremely helpful to me.. I am using TDC again as I am retaking the CVE in August. I missed it by one point!

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