Diagnostic and Statistical Manual of Mental Disorders 5 th Edition

Section I

This introductory section describes the process of DSM revision, including field

trials, public and professional review, and expert review. It states its goal is to

harmonize with the ICD systems and share organizational structures as much as is

feasible. Concern about the categorical system of diagnosis is expressed, but the

conclusion is the reality that alternative definitions for most disorders are scientifically

premature.

The new version replaces the NOS (Not Otherwise Specified) categories with

two options: other specified disorder and unspecified disorder to increase the utility to

the clinician. The first allows the clinician to specify the reason that the criteria for a

specific disorder are not met; the second allows the clinician the option to forgo

specification.

DSM-5 has discarded the multi-axial system of diagnosis (formerly Axis I, Axis

II, Axis III), listing all disorders in Section II. It has replaced Axis IV with significant

psychosocial and contextual features and dropped Axis V (Global Assessment of

Functioning, known as GAF). The World Health Organization's (WHO) Disability

Assessment Schedule is added to Section III (Emerging measures and models) under

Assessment Measures, as a suggested, but not required, method to assess

functioning.
Section II: Diagnostic Criteria and Codes

Bipolar I Disorder is the more serious of the two types of Bipolar Disorder. This

is due to the presence of Manic Episodes in the criteria for Bipolar I Disorder. There is

an absence of Manic Episodes in the criteria for Bipolar II Disorder; rather it involves a

history of hypomania. Hypomania is similar to mania; however, it is not serious

enough to cause social or occupational impairment, hospitalization, or psychotic

features (American Psychiatric Association, 2000).

Bipolar I Disorder may be described as occurring on a continuum of severity ranging

from mild forms of depression with brief mania to severe depression with rapid cycling

mania. Psychotic features may also accompany episodes of severe mania and

depression (Thomas, 2004).

Diagnostic Criteria:

The criteria is presented for the mood episodes that are significant in the diagnosis

of Bipolar I Disorder (Manic Episode, Major Depressive Episode, Mixed Episode).

Although the various episodes are central for the disorder diagnosis, they cannot be

diagnosed as separate entities (American Psychiatric Association, 2000).

Diagnostic Criteria for Bipolar I Disorder - (American Psychiatric Association,

2000)

Criteria have been met for at least one Manic or Mixed Episode.

The symptoms cause social/occupational distress or impairment.

The symptoms are not better accounted for by Schizoaffective Disorder, and

are not superimposed on Schizpophrenia, Schizophreniform Disorder, Delusional

Disorder, or Psychotic Disorder Not Otherwise Specified.

Justification: Miss Red met the criteria for bipolar I disorder but did not meet

the criteria for schizophrenia because for 2 weeks that she became our client she

did not have fixed delusion. Most of the time, she is hyperactive and seldom

depressed.

Diagnostic Criteria for a Manic Episode - (American Psychiatric

Association, 2000)

Persistent elevated, expansive, or irritable mood for at least one week 

(unless hospitalization is required).

Justification: Present. Miss Red is mostly hyperactive but seldom irritable

when she was with us for two weeks. She is very active and is always participating

to all our activities.

 At least three of the following symptoms are present during mood

.disturbance 

(four if mood is irritable):

• inflated self-esteem or grandiosity

• decreased need for sleep

• increased talkativeness

• flight of ideas or racing thoughts

• distractibility

• increase in goal-directed activity or psychomotor agitation

• increase in risky behavior

Justification: Through observations, Ms. Red is observed to become more

talkative than usual. She also has a flight of ideas and she claimed that she

unstoppable whenever she is hyperactive. She also claimed that when she is

hyperactive she can memorize easily. She was also easily distracted with other

stimuli around the room during interview.

Symptoms don't meet criteria for a Mixed Episode.

. Justification: Miss Red did not meet the criteria for mixed episode because

when she is always active and lively al throughout the activity.

Level of severity sufficient to cause social or occupational impairment,

.hospitalization, or psychotic features.

Justification: Not present. Client manipulates others and wants to be always

the center of attraction.

Symptoms are not due to a substance or medical condition.

Justification: Present. Client claimed that she never tries to use illegal

substance or drug even before her symptoms manifested but she was taking up

lithium as her maintenance for bipolar even before she was admitted here at NDRC

for the fifth time.

Diagnostic Criteria for a Mixed Episode - (American Psychiatric

Association, 2000)

Criteria for both Manic and Major Depressive Episode are met (excluding

.duration) almost every day for at least one week.

Justification: Miss Red is hyperactive all throughout the activity from day 1

to day 9.

Level of severity sufficient to cause social or occupational impairment,

.hospitalization, or psychotic features.

Justification: Not present. Client manipulates others and wants to be always

the center of attraction.

Symptoms are not due to a substance or medical condition.

. Justification: Present. Client claimed that she never tries to use illegal

substance or drug even before her symptoms manifested but she was taking up

lithium as her maintenance for bipolar even before she was admitted here at NDRC

for the fifth time.

Diagnostic Criteria for Major Depressive Episode 

- (American Psychiatric Association, 2000)

At least five of the following symptoms present during a two-week period

.nearly every day; at least one symptom is either depressed mood or loss of

interest/pleasure:
• depressed mood most of the day

• diminished interest in nearly all activities most of the day

• significant change in weight or appetite

• insomnia or hypersomnia

• psychomotor agitation or retardation

• fatigue or decreased energy

• inappropriate guilt or feelings of worthlessness

• difficulty concentrating or making decisions

• recurrent thoughts of death, suicidal thoughts, plans, or attempts

Justification: Miss Red did not manifest any symptoms for depressive

disorder. She was mostly hyperactive throughout the day when she became our

client.
 Symptoms don't meet criteria for a Mixed Episode.

. Justification: Miss Red did not meet the criteria for mixed episode because

when she is always active and lively al throughout the activity.

Symptoms cause significant social/occupational impairment or distress.

Judgment: Not present. Miss Red told us that she has many friends within the

hospital.

Symptoms are not due to a substance or medical condition.

Justification: Present. Client claimed that she never tries to use illegal

substance or drug even before her symptoms manifested but she was taking up

lithium as her maintenance for bipolar even before she was admitted here at NDRC

for the fifth time.

Symptoms are not better accounted for by Bereavement.

Judgment: Present. Miss red and Mr. Grey separated and she was also

separated from her only son. And she always told us that she is misses her son.
 Codes as per 2013 DSM-5.

Bipolar I disorder

Current or most manic hypomanic depressed

recent episode:

Mild 296.41 NA 296.51

Moderate 296.42 NA 296.52
Severe 296.43 NA 296.53
With psychotic 296.44 NA 296.54

features
In partial remission 296.45 296.4 296.55
In full remission 296.46 296.4 296.56
Unspecified 296.40 296.4 296.50

Section III: Emerging Measures and Models

Alternative DSM-5 model for personality disorders

An alternative hybrid dimensional-categorical model for personality disorders is

included to stimulate further research on this modified classification system.