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Changes in the DSM V Compared to DSM IV

In the field of mental health, psychiatrists use the Diagnostic and Statistical Manual of Mental Disorders when assessing, reviewing eligible symptoms, and making a diagnosis of a mental health disorder. Currently, the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition is the newest version of the publication, which was released by the American Psychiatric Association at an annual meeting in May 2013. In the past, the Diagnostic and Statistical Manual of Mental Disorders addressed a five Axis system of defining each type of mental illness and how it relates to other mental or physical illnesses. However, previous versions failed to address the importance of treating other mental health conditions besides clinical syndrome due to their listing as Axis II, III, IV, and V. Furthermore, it did not provide a means of dual diagnosis without revisiting the initial mental and physical presentation in a clinical setting through the Axis I and II diagnoses.

In order to understand the impact the new edition of the Diagnostic and Statistical Manual of Mental Disorders upon accurate diagnosis, a person must have a comprehension of how diagnoses were organized in previous versions.

Axis I of the previous version identified all psychological problems except for personality disorders and Inter-Developmental disabilities. Per the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition TR, the primary Axis I disorders included depression, anxiety disorders, bipolar disorder, Autism Spectrum Disorders, eating disorders, and Schizophrenia.

Axis II explained the criteria for personality disorders and Inter-Developmental disabilities. Inter-Developmental disabilities were previously referred to as mental retardation, but they were given an alternative name to remove the negative connotation associated with mental retardation. The range of personality disorders ranges vastly and includes Schizoid personality disorder, Schizotypal personality disorder, Antisocial personality disorder, Histrionic personality disorder, Narcissistic personality disorder, Dependent personality disorder, Obsessive compulsive disorder, Paranoid personality disorder, and Avoidant personality disorder. However, it should be noted that Obsessive-Compulsive disorder became an Axis II diagnosis rather than being identified within other anxiety disorders of Axis I.

Axis III allowed for assessment of a general medical or physical condition that caused additional complications for the respective mental illness. For example, a mental health condition, such as schizophrenia, could be misdiagnosed in persons with untreated syphilitic symptoms. In addition, diabetes, poor circulation, or poor digestive absorption could be the underlying causes of the psychological conditions defined in Axis I or Axis II.

Axis IV accounted for the socioeconomic factors affecting the mental health disorder. Although the environmental factors play a role in the development and progression of mental health disorders, genetics influence how a person’s mind responds in differing situations, which explained how those without any negative socioeconomic factors still developed a mental health disorder, especially when family history of a mental illness was present. In many treatment settings, the environmental factors contributing to the deterioration of mental health are treated through psychotherapy, such as Cognitive Behavioral Therapy. Cognitive Behavioral Therapy seeks to change irrational, negative thought processes from false pretenses into factual, rational thoughts.

Axis V allowed for a Global Assessment of Function (GAF) score to identify how well a patient would be able to react in normal situations and behave in an appropriate manner throughout daily activities. This score was often used to determine whether a person would be able to respond to treatment after discharge from a supervised setting. Would he be able to take medications as requested, or would he or she be able to maintain employment? This score further evaluates whether a person should receive additional case management services, which include home visits, assistance with financial health costs, and getting to appointments.

The World Health Organization uses a single-axis diagnostic set of criteria to assess all mental and physical issues. When the American Psychiatric Association began work on the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders, the need became apparent for a set of diagnostic criteria in sync or close proximity to the standards used around the globe. As a result, a study group advised the American Psychiatric Association to combine Axis I, II, and III into a single Axis while dropping Axis IV to Axis II and Axis V to Axis III.

The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition solves the challenges of grouping mental health disorders separately without respect to one another. The new version allows psychiatrists to evaluate the total health condition, including body and mind, without becoming overly concerned about which mental health disorder will fit into the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition requirements for Axis I or Axis diagnoses. This combinations provides for a more positive approach to addressing mental health concerns by streamlining the diagnostic process, more clearly defining the criteria for diagnosis, and identifying additional diagnoses in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition.

Rather than perform an assessment for each type of diagnosis in Axis I and Axis II, psychiatrists can now use a broader assessment to identify patterns and symptoms for all of the mental health disorders at once. In addition, some disorders were given differing names or additional guidelines for diagnosis per the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition. For example, previous versions of the Diagnostic and Statistical Manual required the presence of two or more criterion for an accurate personality disorder diagnosis; however, some symptoms were attributable to other co-existing, or comorbid, disorders. The newer edition allows symptoms of multiple disorders to be used as the diagnostic criteria for another disorder, which opens a larger array of treatment recommendations in terms of medications, therapy, hospitalization, or ongoing treatment.

In addition to the clearly defined ability to use criteria for diagnosis of other mental health disorders, several other diagnoses were added to the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition. This version included a diagnosis of Gambling, in which the behavior becomes a necessary component of life in order to function in an appropriate manner. Furthermore, those with a gambling addiction must experience withdrawal symptoms, such as severe anxiety, depression, tremors, or inability to stop successfully, when trying to remove themselves from gambling. In addition, the names of personality disorders were changed. Specifically, Personality disorder not otherwise specified was changed to personality disorder “specified with this symptom.” This allowed for a greater accuracy in continuity of care as other providers will be able to correctly identify the exact nature of the mental health illnesses presented.

The Diagnostic and Statistical Manual of Mental Disorders began its history following the aftermath and mental chaos of World War II, and today the publication is in its Fifth Edition. However, several sub-editions were created for the Diagnostic and Statistical Manual of Mental Health Disorders Fourth Edition. Unfortunately, the five Axis system of the previous versions of the publication caused confusion and inaccuracy and diagnosis while departing from the worldwide trend towards a more precise, defined diagnosis criterion. The Diagnostic and Statistical Manual of Mental Disorders clarifies the criteria necessary for each diagnosis and combines Axis I, II, and III into a single Axis I portion of assessment and diagnosis. This gives mental health professionals the capacity to quickly identify the problems a person experiences as these problems interact with other mental or physical health conditions. Furthermore, the Diagnostic and Statistical Manual of Mental Disorders created additional diagnoses to address problems arising from advancements in civilization, such as the specification of previously unspecified personality disorders. Although some may want to purchase the Diagnostic and Statistical Manual of Mental Disorders to understand the criteria and processes involved in mental health diagnoses, the American Psychiatric Association continues to warn that the publication should only be used by trained, licensed mental health professionals.

Pasadena Villa Orlando and Pasadena Villa’s Smoky Mountain Lodge are adult intensive psychiatric residential treatment centers for clients with serious mental illnesses.  Our licensed mental health professionals observe situations relevant to our residents such as recreational, social and life skills activities then intervene as appropriate. Our resort styled facilities are designed to be luxurious, artfully decorated and meet the highest safety standards.

We also provide other less intensive mental health services, such as Life Skills training at our Transitional Living and Learning Center and also provide other individualized therapy programs. Pasadena Villa’s outpatient center is located in Raleigh, North Carolina and offers partial hospitalization (PHP) as well as an intensive outpatient program (IOP). If you or someone you know may need counseling on mental health services, please contact us. As one of the very first programs in the country to base its treatment upon Social Integration, our mental health facilities offer help through individualized therapy and group residential programs with a focus towards achieving more independent living. Pasadena Villa Residential Psychiatric Services not only meets specific local, state, and federal regulations, but we work hard to exceed them.  We also voluntarily choose to meet or exceed the higher standards required for the prestigious Joint Commission Accreditation.  All Pasadena Villa programs and locations are Joint Commission Accredited.

We also provide other individualized therapy programs, step-down residential programs, and less intensive mental health services, such as Community Residential Homes, Supportive Housing, Day Treatment Programs and Life Skills training. If you or someone you know may need counseling on mental health services, please fill out our contact form or call us at 877-845-5235 for more information.



If you think that you or a loved one may be struggling with a mental health disorder, Pasadena Villa can help. We are here to answer questions and connect to care. Pasadena Villa currently offers treatment at two residential locations in both Orlando, Florida and Knoxville, Tennessee, and outpatient services in Cary, North Carolina and Charlotte, North Carolina. To learn more about our program, call us at
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