DSM-5 Criteria for. . . Schizophrenia

 DSM-5 Criteria for. . .

Schizophrenia

• A) Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least one of these must be (1), (2), or (3):

1. Delusions.
2. Hallucinations.
3. Disorganized speech (e.g., frequent derailment or incoherence).
4. Grossly disorganized or catatonic behavior.
5. Negative symptoms (i.e., diminished emotional expression or avolition).

• B) For a significant portion of the time since the onset of the disturbance, the level of functioning in one or more major areas, such as work, interpersonal relations, or self-care, is markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, there is failure to achieve the expected level of interpersonal, academic, or occupational functioning).
• C) Continuous signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or by two or more symptoms listed in Criterion A present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).
  
• D) Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either (1) no major depressive or manic episodes have occurred concurrently with the active-phase symptoms, or (2) if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of the illness.
• E) The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.
• F) If there is a history of autism spectrum disorder or a communication disorder of childhood onset, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations, in addition to the other required symptoms of schizophrenia, are also present for at least 1 month (or less if successfully treated).

References

Hooley, Jill, M. et al. Abnormal Psychology. Available from: VitalSource Bookshelf, (18th Edition).

             Pearson Education (US), 2019.

 

DSM-5 Criteria for Borderline Personality

 Borderline Personality Disorder

A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by five or more of the following:

1. Frantic efforts to avoid real or imagined abandonment. (Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5)
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
3. Identity disturbance: markedly and persistently unstable self-image or sense of self.
4. Impulsivity in at least two areas that are potentially self-damaging(eg. spending, sex, substance abuse, reckless driving, binge eating). (Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.)
5. Recurrent suicidal behavior, gestures,
   
   threats, or self-mutilating behavior.
6. Affective instability due to a marked reactivity of mood (eg. intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days.)
7. Chronic feelings of emptiness.
8. Inappropriate, intense anger or difficulty controlling anger (e.g. frequent displays of temper, constant anger, recurrent physical fights).
9. Transient, stress-related paranoid ideation or severe dissociative symptoms.

2 Big Changes to the DSM in the 1980's

 In the 1980s, the American Psychiatric Association added PTSD into the DSM and phased out homosexuality as a diagnosis. Today the DSM does not even list homosexuality as a disease, and the DSM has revised the criteria for PTSD and reclassified it. And while the LGBTQ community and PTSD victims benefit from these changes, they did not occur overnight. 

  This change in the DSM regarding homosexuality occurred from conflicting theories about homosexuality throughout history. Pathology, Immaturity, and normal variation were the main categories of theories about homosexuality (Drescher, 2015a). Pathology saw homosexuality as a disease. Richard von Krafft-Ebbing was a German psychiatrist who stated that homosexuality was the result of a disorder. His theory stated that people could have a predisposition to being gay, but the tendencies of homosexuality constituted a disease. He wrote Psychopathia Sexualis in 1886, and this defined the framework for deviant human sexual behavior diagnostic manuals of the mid-twentieth century.  

Sigmund Freud believed in the immaturity theory which stated that homosexual feelings at an early age were a normal step toward adult development of sexuality (Drescher,2015). With this theory, homosexuality resulted from stunted growth and the development of adult heterosexuality. Mid-nineteenth century Karl Heinrich Ulrichs, Magnus Hirschfeld, and Hungarian journalist Karl Maria Kertbeny all believed there was some normal variation in nature. Kertbeny coined the phrase homosexual and homosexuality (Drescher, 2015a). After Freud died in 1939, Sandor Rado impacted the mid-twentieth century with his theory that homosexuality was a phobia of heterosexuality and pathological. Rado stated that this was caused by inadequate parenting. In 1952 homosexuality was classified as a “sociopathic personality disturbance” (Drescher, 2015a). Psychiatrists reclassified homosexuality as a sexual deviation in 1968. The pendulum swung back and forth on the topic until finally in 1973 gay activists disrupted the 1970 and 1971 APA meetings. This led to the APA removing homosexuality from the DSM in 1973; however, they only changed the name to sexual orientation disturbance diagnosis. This allowed for insurance-endorsed sexual conversion therapies if the individual’s same-sex attractions caused self-distress. In 1973 the DSM-III replaced it with Ego-dystonic homosexuality disorder and in 1987 the DSM-III-R finally removed this diagnosis. 

When the APA added PTSD to the DSM-III, it only applied to victims of such events such as war, torture, the Nazi holocaust, major war bombings, natural disasters, and human-caused disasters such as mass shootings, crashes, and bombings (PTSD History and Overview - PTSD: National Center for PTSD, n.d.). Since the APA separated traumatic events from life stressors such as divorce, rejection, failure, etc..., they categorized these life stressors as adjustment disorders instead of PTSD. In 1987 and 1994 the DSM-IIIR and the DSM-IV revised PTSD diagnostic criteria. The 1994 DSM-IV stated that the patient had exhibited a history of traumatic event exposure and symptoms from the following three clusters: intrusive recollections, avoidant/numbing symptoms, and hyperarousal symptoms (PTSD History and Overview - PTSD: National Center for PTSD, n.d.). The fifth criterion defined the duration of symptoms and the sixth criterion stated that the severity of the symptoms must cause a lot of distress and/ or impairment of necessary functions. The DSM-IV-TR also revised PTSD diagnosis. In 1980 no one knew the actual prevalence of PTSD, so the DSM-5 made evidence-based revisions to PTSD (PTSD History and Overview - PTSD: National Center for PTSD, n.d.). The American Psychiatric Association categorized PTSD as a Trauma-stressor-related disorder with the DSM-5 in 2013. The DSM expanded diagnostic criteria to include disruptive behaviors such as anger, impulsiveness, recklessness, and self-destruction. Also, the patient can experience trauma directly or indirectly. A dissociative subtype was added to the DSM-5, along with a preschool subtype for children up to six. Due to these changes in the DSM, there are more effective treatments including the FDA-approved use of SSRIs. There is also a psychological first aid kit online (Psychological First Aid: Field Operations Guide - PTSD: National Center for PTSD, 2014). 

Research trends in the DSM include changes to the DSM on homosexuality and the addition and revision of PTSD. Due to these research trends, public emotional intelligence regarding these topics increased and public stigmas surrounding them decreased. Social justice is also achieved when public stigma and discrimination are reduced. 

References 

Drescher, J. (2015a). Out of DSM: Depathologizing Homosexuality. Behavioral Sciences, 5(4), 565–575. https://doi-org.ezproxy.snhu.edu/10.3390/bs5040565 

Psychological First Aid: Field Operations Guide - PTSD: National Center for PTSD. (2014). Va.gov. https://www.ptsd.va.gov/professional/treat/type/psych_firstaid_manual.asp 

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PTSD History and Overview - PTSD: National Center for PTSD. (n.d.). Www.ptsd.va.gov. https://www.ptsd.va.gov/professional/treat/essentials/history_ptsd.asp#:~:text=In%201980%2