What to Know About the DSM-5-TR

The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition Text Revision (DSM-5-TR) substantially updates the DSM-5, which was originally published in 2013.

The changes can be classified into four categories: cultural, criteria for children's diagnoses, addition of new disorders, and changes to existing criteria.

Cultural Changes to the DSM-5-TR

Members of the American Psychiatric Association—which publishes the DSM—as well as other mental health professionals were calling for race, racism, and discrimination to be handled more appropriately in the DSM.

The Cross-Cutting Review Committee on Cultural Issues and an Ethnoracial Equity and Inclusion Work Group collaborated on the following changes:

• The term "racialized" is used instead of "race/racial" to underscore that race is a social construct
• "Ethnoracial" is used to define and combine the U.S. Census categories that encompass both ethnicity and race, such as White, African-American, and Hispanic
• "Minority" and "non-White" are no longer used, as they are thought to describe racial groups in relation to White people, creating a social hierarchy
• "Latinx" is used instead of "Latino" or "Latina" in an effort to promote gender equality
• "Caucasian" is no longer used because of its obsolete description of the origins of the pan-European ethnicity
• Data about the prevalence of certain disorders in specific ethnoracial groups was added when existing research included reliable data

Gender and Sexuality Updates

For example, in entries related to gender dysphoria, “desired gender,” used in the DSM-5, is now written as “experienced gender.”

Similarly, the DSM-5 used “cross-sex medical procedure,” but the TR has updated this term to "gender-affirming medical procedure.”

Updated DSM-5-TR Criteria for Children

The DSM criteria updates for children are largely semantical. Clarifying language is used to reduce confusion for the following disorders:

• Autism spectrum disorder
• Disruptive mood regulation disorder
• Post-traumatic stress disorder 
• Prolonged grief disorder

Updated DSM-5-TR Criteria for Adults

The updates in the entries for adult disorders fall into two categories: additions and changes within existing diagnoses.

Additions

Several disorders or conditions have been added in this edition to reflect a continued understanding of their possible impact on one's mental health. Many of these diagnoses had previously been in a section of the DSM reserved for conditions that "may be a focus of clinical attention."

Inclusion of a topic in this section means that it is recognized that they are significant enough to have a clinical impact but the DSM may not yet have enough information to consider it a full-blown disorder.

Prolonged Grief Disorder

Prolonged grief disorder (removes persistent complex bereavement) is one of the major additions to the DSM-TR. This diagnosis is used when someone close to you has died—at least six months ago for children and a year ago or more for adults. 

The diagnosis was added to address the kind of enduring struggle that leads a total inability to move forward and a heightened risk for self-harm and suicide. While this diagnosis has been criticized for pathologizing grief (i.e., implying that grief is not normal), it separates grief symptoms from depression or PTSD symptoms in order to observe patterns and design treatment.

Unspecified Mood Disorder

This isn’t the first time unspecified mood disorder has been in the DSM, but when the DSM-5 reclassified the types of disorders, removing the mood disorder section, unspecified mood disorder fell by the wayside. Its restoration places it in both a section about depressive disorders as well as a section about bipolar disorders in order to capture a better representation of mixed cases.

This diagnosis is used when symptoms are predominantly in line with a depressive disorder’s diagnosis but they do not meet the full diagnostic criteria of any of the depressive or adjustment disorders.

It may be used either in situations where a mental health provider decides not to specify the reason criteria aren’t met—or in a situation such as in an emergency room where there isn’t enough information to accurately give a full diagnosis because a provider has only met with someone once and for a short amount of time.

Stimulant-Induced Mild Neurocognitive Disorder

In the DSM-5, there is already a section for substance-induced mild neurocognitive disorders. That designation included alcohol, inhalants, sedative, hypnotic and anxiolytic substances.

This edition adds those disorders induced by stimulants such as cocaine or methamphetamine, recognizing the neurocognitive symptoms stimulants may cause, such as problems with learning, memory and executive function.

This addition comes following ongoing research showing the lingering neurocognitive effects that the chronic use of stimulants can cause.

Suicidal Behavior and Nonsuicidal Self-Injury (NSSI)

Non-suicidal self-injury is defined as the purposeful self-inflicted destruction of one’s body without the goal of suicide. Research shows that the incidence of these behaviors may be as high as 40% among adolescents, absolutely warranting clinical attention.

The designation of this gives clinicians the ability to flag these behaviors independent of a specific diagnosis so that one may get the proper care. Additionally, these behaviors have been isolated clinically and diagnostically to encourage research on treating them specifically, rather than just addressing their manifestation in other disorders.

NSSI, specifically, had previously only been included as a symptom in borderline personality disorder, which means that it failed to capture those with other disorders or no diagnosable disorder who engaged in self-mutilation. This may also help clinicians to estimate risk factors for future suicide attempts or death.

Attenuated Psychosis Syndrome (APS)

This is a state where one is not in full-blown psychosis,but some psychotic criteria may exist, known as meeting the subclinical threshold for a full diagnosis. 

The purported reasoning behind this is to eliminate over/misdiagnosis, which could lead to harmful use of anti-psychotic medication for people who would not develop psychosis. This diagnosis is meant to capture and treat a person’s current state, not what state may develop.

One of the key differences is that someone with APS is aware that their perceptions are altered, whereas someone in full-blown psychosis meeting all diagnostic criteria is not. APS is new to this version of the DSM and classified as a condition for further study.

Changes Within Existing Diagnoses

Changes were made in diagnostic criteria for a handful of disorders, generally to provide a bit more clarity in the language. These revisions affect the following disorders:

• Autism spectrum disorder
• Manic episode
• Bipolar I and bipolar II disorder
• Cyclothymic disorder
• Major depressive disorder
• Persistent depressive disorder
• PTSD in children
• Avoidant-restrictive food intake disorder
• Delirium
• Substance/medication-induced mental disorders
  

A Word From Verywell

The last time the DSM was updated was 2013—nearly ten years ago—so, many things have shifted both culturally and scientifically in our understanding of the mind. Updates like this are meant to reflect improved cultural and scientific understanding. If you're seeking mental health treatment, these updates help to ensure that you receive the most accurate diagnosis possible so that you can receive the treatment most appropriate for your needs.