Umbrales Diagnsticos Ms Bajos Para Muchos Desrdenes Existentes
El DSM5 podría crear decenas de millones de nuevos mal identificados pacientes falsos positivos exacerbando así, en alto grado, los problemas causados por un ya demasiado inclusivo DSM-IV. Habría excesivos tratamientos masivos con medicaciones innecesarias, caras, y a menudo bastante dañinas. El DSM-5 aparece promoviendo lo que más hemos temido:la inclusión de muchas variantes normales bajo la rúbrica de enfermedad mental, con el resultado de que el concepto central de trastorno mental resulta enormemente indeterminado.
Trastornos Relacionados Con Sustancias
Son los que se relacionan con el consumo de drogas de abuso, con los efectos secundarios de medicamentos y con la exposición a sustancias tóxicas. En cuanto al consumo de sustancias, es importante la distinción entre «abuso de sustancias» y «dependencia de sustancias».
- El abuso de sustancias ocurre cuando, durante al menos 1 año, la persona que consume incurre en actitudes como: es incapaz de cumplir con sus obligaciones , debido al consumo consume la sustancia en condiciones físicamente riesgosas tiene problemas legales recurrentes debido al uso de sustancias o sigue consumiendo a pesar de problemas persistentes de tipo social o interpersonal.
- La dependencia de sustancias ocurre cuando, durante al menos 1 año, la persona experimenta un efecto de tolerancia , el efecto de abstinencia , intenta disminuir el consumo y no puede o bien consume más de lo que quisiera y deja de hacer actividades importantes debido al consumo. Además, la persona sigue consumiendo a pesar de padecer un problema físico o psicológico persistente que dicha sustancia exacerba.
Sin embargo, el DSM-IV recoge una mayor cantidad de trastornos que pueden ser producidos por sustancias, y los clasifica por cada sustancia psicoactiva, o grupo de sustancias psicoactivas. Estos pueden ser:
What Is The Dsm
The DSM-5 is organized into sections. Section one contains information about how to use the manual. Section two includes common signs and symptomscalled “diagnostic criteria”for specific mental disorders.
The third section of the manual includes assessment measures, a guide to cultural formulation, and alternative ways to conceptualize personality disorders to help mental health professionals in the decision-making process. This section also talks about conditions that need to be researched more in the future.
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Trastornos De La Personalidad
Consisten en un patrón permanente e inflexible de experiencia interna y de experiencia de la persona, que se aleja demasiado de lo que la cultura en que está inmersa espera. Se inicia en la adolescencia o principio de la edad adulta, no varía con el tiempo, y causa malestar en el sujeto y prejuicios contra él. Se clasifican como sigue:
Grupo A:
- Trastorno de la personalidad no especificado
Trastornos De La Conducta Alimentaria
Los conforman alteraciones graves de la conducta alimentaria, acompañadas o causadas por una distorsión de la percepción de la propia imagen corporal. Son:
Es el desarrollo de síntomas emocionales o de comportamiento relacionados con un estrés psicosocial que es identificable en forma clara. La reacción es mayor o causa un malestar superior al esperado en relación con la causa. Se clasifican según la reacción sea un estado de ánimo depresivo, ansiedad, o un trastorno del comportamiento.
Clínicamente se los clasifica en:
- Trastorno adaptativo con estado de ánimo depresivo
- Trastorno adaptativo con estado de ánimo ansioso
- Trastorno adaptativo mixto con estado de ánimo depresivo y ansioso
- Trastorno adaptativo con trastorno del comportamiento
- Trastorno adaptativo con alteración mixta del comportamiento y de las emociones.
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How Do The Dsm
Overall, the symptoms of PTSD are generally comparable between DSM-5 and DSM-IV. A few key alterations include:
- The revision of Criterion A1 in DSM-5 narrowed qualifying traumatic events such that the unexpected death of family or a close friend due to natural causes is no longer included.
- Criterion A2, requiring that the response to a traumatic event involved intense fear, hopelessness, or horror, was removed from DSM-5. Research suggests that Criterion A2 did not improve diagnostic accuracy .
- The avoidance and numbing cluster in DSM-IV was separated into two criteria in DSM-5: Criterion C and Criterion D . This results in a requirement that a PTSD diagnosis includes at least one avoidance symptom.
- Three new symptoms were added:
- Criterion D : Overly negative thoughts and assumptions about oneself or the world and, negative affect
- Criterion E : Reckless or destructive behavior
Continuing Education
PTSD Overview and Treatment
The course describes the DSM-5 diagnostic criteria for PTSD and evidence-based treatments. Videos of Veterans with PTSD and clinicians are included.
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Medicalization And Financial Conflicts Of Interest
There was extensive analysis and comment on DSM-IV in the years leading up to the 2013 publication of DSM-5. It was alleged that the way the categories of DSM-IV were structured, as well as the substantial expansion of the number of categories within it, represented increasing medicalization of human nature, very possibly attributable to disease mongering by psychiatrists and pharmaceutical companies, the power and influence of the latter having grown dramatically in recent decades. In 2005, then APA President Steven Sharfstein released a statement in which he conceded that psychiatrists had “allowed the biopsychosocial model to become the bio-bio-bio model”. It was reported that of the authors who selected and defined the DSM-IV psychiatric disorders, roughly half had financial relationships with the pharmaceutical industry during the period 19892004, raising the prospect of a direct conflict of interest. The same article concluded that the connections between panel members and the drug companies were particularly strong involving those diagnoses where drugs are the first line of treatment, such as schizophrenia and mood disorders, where 100% of the panel members had financial ties with the pharmaceutical industry.
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Who Developed The Dsm
According to the APA, information about mental health disorders has been collected since the mid-1800s to track the number of people with these conditions. After World War II, the U.S. Army came up with a new system to better describe mental health conditions in veterans.
Around the same time, the World Health Organization also included a section on mental health disorders in its International Classification of Diseases and Related Health Problems a resource that collects information about diseases and health conditions across the globefor the first time.
The first edition of the DSM was published in 1952 by the APA Committee on Nomenclature and Statistics. This was the first official manual of mental disorders designed for use by healthcare professionals.
Since 1952, updates have been made to the DSM, leading up to its most recent publication in 2013 as the 5th edition. In March of 2022, a text revision for the DSM-5 was published. On its website, the American Psychiatric Association also provides updates to the DSM-5 as they occur.
Criticisms Of The Dsm
Criticisms of the DSM are many and various. At the most general level, some think that the DSM fundamentally misunderstands the nature of mental distress. Implicitly, the DSM assumes that psychopathology falls into distinct disease entities. Some take issue with the DSM at this level.
5.1. The DSM is insufficiently scientific
Many critics hold that the DSM is insufficiently scientific and does not accurately represent the domain of psychopathology. Such critics come from a range of orientations. For example, some psychoanalytically-oriented critics see the DSMs focus on observable symptoms as a superficial replacement for true diagnosis, which would require careful attention to internal mental conflicts .
In recent years, the criticism that the DSM is insufficiently scientific has also commonly been voiced by biologically-oriented researchers . In 2008 the US National Institute of Mental Health launched the Research Domain Criteria project . The aim is start psychiatric classification afresh. The RDoC will define basic dimensions of functioning to be studied across multiple units of analysis, from genes to neural circuits to behaviors, cutting across disorders as traditionally defined . The RDoC system relies far more on dimensions and is more biologically-focussed than the DSM.
5.2 Mental distress should not be classified
5.3 Mental disorders are not states of individuals
5.4 Concerns about medicalization
5.5 Concerns about cross-cultural adequacy
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Is The Dsm Helpful For Clinicians
Diagnostic criteria help students and early-career professionals build templates of mental disorders that go beyond a laypersons impressionsfor instance that bipolar disorder describes abnormal moods sustained over weeks or months, not moods that shift over an hour or a day. The DSM establishes a common language for professional communication and research, not to mention insurance codes.
However, there are also ways in which mental health professionals dont view the DSM as clinically useful. After seeing many patients, clinicians gradually form their own mental models of common diagnoses that might differ from the DSM, for example that the published criteria for a particular diagnosis is a little too wide or too narrow. In the end, clinicians may privilege the nosology of their own experience over the official manual that approximates it.
How Was The Dsm
To create the DSM-5, the APA gathered more than 160 mental healthcare professionals from around the world, including psychiatrists, psychologists and experts from many other professional fields. Hundreds of other professionals contributed and assisted as advisers on specific topics. The creation of the DSM-5 also involved field trials and tests.
For the DSM-5-TR, the APA called on many of those involved in the initial DSM-5 release. In all, more than 200 professionals directly contributed to the DSM-5-TR.
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Axis Ii Personality Disorders And Mental Retardation
Axis II was reserved for what we now call intellectual development disorders and personality disorders, such as antisocial personality disorder and histrionic personality disorder. Personality disorders cause significant problems in how a person relates to the world, while intellectual development disorders are characterized by intellectual impairment and deficits in other areas such as self-care and interpersonal skills.
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How Were Decisions Made About What Would Be Included Removed Or Changed
APAs goal in revising DSM-5 was to thoroughly update the text of the manual to incorporate new research findings that have appeared since DSM-5 was published in 2013. Text changes were proposed by subject matter experts and then reviewed by the DSM-5-TR editors and the DSM Steering Committee. The DSM-5-TR also includes changes to criteria sets generated through the iterative revision process in place that allows mental health professionals to propose evidence-based additions or deletions of diagnostic categories, or changes to existing criteria. In some cases, adjustment to the wording of diagnostic criteria were made because of issues identified during the text revision process. All changes to diagnostic criteria were approved by the DSM Steering Committee and APA Assembly and Board of Trustees.
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Who Was Involved In The Development Process
APA recruited more than 200 of the top researchers and clinicians from around the world to be members of our DSM-5-TR review groups. These are experts in neuroscience, biology, genetics, statistics, epidemiology, social and behavioral sciences, nosology, and public health. These members participate on a strictly voluntary basis and encompass several medical and mental health disciplines including psychiatry, psychology, pediatrics, nursing, and social work.
Limitaciones Del Sistema Categorial
El principal inconveniente es que se trata de un sistema categorial, es decir, establece categorías que se supone que han de corresponder con trastornos, cuando en realidad, la mayoría de los trastornos mentales son dimensionales y no categóricos. De alguna manera, esto era advertido ya en la edición de 1994, cuando en la introducción se decía que no debía ser usado como un “recetario”, y que el diagnóstico que se base en este manual ha de ser llevado a cabo por especialistas con amplia experiencia clínica, para evitar reduccionismos.
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What Are The Current Disorder Categories In The Dsm
The DSM-5 organizes mental disorders into the following chapters: Neurodevelopmental Disorders, Schizophrenia Spectrum and Other Psychotic Disorders, Bipolar and Related Disorders, Depressive Disorders, Anxiety Disorders, Obsessive-Compulsive and Related Disorders, Traumaâ and Stressor-Related Disorders, Dissociative Disorders, Somatic Symptom and Related Disorders, Feeding and Eating Disorders, Elimination Disorders, Sleep-Wake Disorders, Sexual Dysfunctions, Gender Dysphoria, Disruptive, Impulse-Control, and Conduct Disorders, Substance-Related and Addictive Disorders, Neurocognitive Disorders, Personality Disorders, Paraphilic Disorders, Other Mental Disorders, Medication-Induced Movement Disorders and Other Adverse Effects of Medication, and Other Conditions That May Be a Focus of Clinical Attention.
What Is Major Depression
The Diagnostic and Statistical Manual of Mental Disorders IV classifies MDD as a mood disorder, which relates to disorders that exhibit extreme ranges in mood. In MDD, mood extremes can include a loss of energy, sadness, anhedonia , thoughts of suicide, and a general impairment of sleep, concentration, attentiveness, or decision making. MDD diagnosis requires a major depressive episode , defined as a discrete and pervasive period of these symptoms however, heterogeneity exists in the context in which MDEs occur, and the specific symptoms inherent in each may differ, suggesting that considerable heterogeneity may exist in the underlying architecture of the DSM-IV classification of MDD. For example, up until puberty the rates of MDD are relatively equivalent between males and females, after which rates for females double or triple . Postpartum depression is a specific class of female-specific mood disorder where MDE occurs within 4 weeks of giving birth. The onset of MDD after the age of 50 to 60 has been termed late-life depression . These separate classes of depression may share common genetic and environmental foundations to confer risk, but they may also have distinct etiologies resulting in their different presentation. Where applicable throughout the chapter, evidence to this effect will be highlighted.
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How The Dsm Has Changed Over Time
The DSM has always been a lightning rod for debate about psychiatric diagnosis and classification. Since the 1950s, various categories of disorders have been added to the manual, altered, or removed altogether based on evolving clinical expertise and research and changes in the field of psychiatry, including a pivot away from psychoanalysis.
As the DSM is the dominant text for making mental health diagnoses in America, many of these changes are considered historically significant, such as when the DSM ceased to classify homosexuality as a form of mental illness in 1973. Other shifts have been controversial, including the omission of Aspergers disorder from the DSM-5 in favor of a broader autism spectrum disorder category.
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Drug Companies And Medicalization
It has also been alleged that the way the categories of the DSM are structured, as well as the substantial expansion of the number of categories, are representative of an increasing medicalization of human nature, which may be attributed to disease mongering by pharmaceutical companies and psychiatrists, whose influence has dramatically grown in recent decades. Of the authors who selected and defined the DSM-IV psychiatric disorders, roughly half had had financial relationships with the pharmaceutical industry at one time, raising the prospect of a direct conflict of interest. In 2005, then American Psychiatric Association President Steven Sharfstein released a statement in which he conceded that psychiatrists had “allowed the biopsychosocial model to become the bio-bio-bio model”.
However, although the number of identified diagnoses has increased by more than 200% , psychiatrists such as Zimmerman and Spitzer argue it almost entirely represents greater specification of the forms of pathology, thereby allowing better grouping of more similar patients.
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Trastornos Sexuales Y De La Identidad Sexual
Son los relacionados con la sexualidad. Son de tres tipos:
- Trastornos sexuales: las llamadas disfunciones sexuales, entendidas como alteraciones del deseo, cambios psicofisiológicos en la respuesta sexual normal, malestar o problemas interpersonales relacionados con el tema:
- Trastornos del deseo sexual
- Trastornos de la excitación sexual
La homosexualidad fue descartada en 1973 por la APA, como trastorno mental, y en 1974 la séptima edición del DSM-II la califica como desorden de la orientación sexual. El 17 de mayo de 1990, la OMS la elimina del listado de trastornos mentales, fecha considerada como Día Internacional contra la Homofobia y la Transfobia. De la misma forma, en junio de 2018 la OMS saco la “incongruencia de género” de la categoría de trastorno psicológico, para pasar a ser un problema físico basado en la falta de adecuación del cuerpo al género que siente la persona.
What Is The Diagnostic And Statistical Manual
The Diagnostic and Statistical Manual of Mental Disorders is the handbook widely used by clinicians and psychiatrists in the United States to diagnose psychiatric illnesses. Published by the American Psychiatric Association , the DSM covers all categories of mental health disorders for both adults and children.
It contains descriptions, symptoms, and other criteria necessary for diagnosing mental health disorders. It also contains statistics concerning who is most affected by different types of illnesses, the typical age of onset, the development and course of the disorders, risks and prognostic factors, and other related diagnostic issues.
Just as with medical conditions, certain government agencies and many insurance carriers require a specific diagnosis in order to approve payment for support or treatment of mental health conditions. Therefore, in addition to being used for psychiatric diagnosis and treatment recommendations, mental health professionals also use the DSM to classify patients for billing purposes.
This article discusses the history of the DSM and how the most recent edition compares to past editions.
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