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Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (Englisch) Taschenbuch – 22. Mai 2013

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Format: Taschenbuch Verifizierter Kauf
Obwohl die Autoren darauf hinweisen, dass ihre Übersetzung des englischen WHO-Textes von der WHO autorisiert sei, enthält der Text gravierende sprachliche Ungenauigkeiten, die den WHO-Fachleuten offenbar nicht aufgefallen sind, vermutlich weil sei die Deutsche Sprache nur unzureichend beherrschen.
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Von AM am 20. Februar 2014
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Kaum ein Klassifikationssystem wurde vor seiner Einführung heftiger kritisiert. Beim Lesen ist man dann enttäuscht, es ist keine Revolution sondern bestenfalls eine Evolution.
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Von der ersten Ausgabe von Menninger bis zur aktuellen Ausgabe nicht wissenschaftlicher geworden. Sollte umgehend verboten werden ! Aber dass wäre für die internationale Psychiatrie ja nicht hilfreich...
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HASH(0xa2694594) von 5 Sternen The more things change... 14. Juni 2013
Von Shrink - Veröffentlicht auf Amazon.com
Format: Taschenbuch
There are a few minor and almost no major changes in DSM-5 that the patients and professional need to be aware of.

1. The most remarkable structural change of the Fifth Edition is getting rid of 5-axial system. Good riddance!
The old classification grouped diagnoses down into independent dimensions called axes:
Axis I: all diagnoses except mental retardation and personality disorder
Axis II: personality disorders and mental retardation
Axis III: acute medical conditions
Axis IV: psychosocial and environmental factors making things worse
Axis V: Global Assessment of Functioning (GAF), or a number between 0 and 100 that reflects patients' well-being.
The new classification combines the axes together and let them rate the disorders by severity. In addition the NOS (not otherwise specified) label is changed to NED (not elsewhere defined).
2. The diagnosis Mental Retardation is changed to intellectual disability (intellectual developmental disorder)
3. Autism Spectrum Disorder is the new name and a single category for autistic disorder, Asperger disorder, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified (PDD-NOS). Probably a bad idea, in my opinion, as the same diagnosis will be given to a child with mild social deficit and severely autistic, nonverbal, and not functional one. In addition, it would be impossible to find out that there might be more than one disorder in this group, as all of them will carry the same name.
4. Binge Eating Disorder is a newcomer to the group - anorexia nervosa, bulimia nervosa, and eating disorder NOS - three different conditions which ended up in the Eating Disorders group only because they have something to do with food. There does not seems to be a good reason to add another one.
5. Disruptive Mood Dysregulation Disorder (DMDD) is a new category and infact a welcome addition. Moodiness, anger, and emotional outbursts in children have been subject of diagnostic controversy for the last two decades. Unfortunately, the issue was hijacked by some unscrupulous members in academia in tandem with a couple of profit seeking pharmaceutical companies. Previous decade saw forty fold increase in diagnosis of pediatric bipolar disorders. While some children develop bipolar illness as they grow up, overwhelming majority do not. In children, common reason for "manic behavior" is immaturity of the brain, partly responsible for control of emotions (Executive Function Network located mostly, but not exclusively, in pre-frontal area of the brain), while emotions themselves are mild or moderate. By analogy, a car collision might be explained either by revved up engine or failed breaks, but rarely by two failures at a time. Children's "breaks" are commonly weak, while extremes of emotions (frequently diagnosed in adults as Intermittent Explosive Disorder or Mania) are relatively rare. DMDD brings "sanity" into the insane world of pediatric bipolar disorders and redirects our focus on weak inhibition vs. excessive "excitation".
6. New to the DSM-5 is bringing together obsessive-compulsive and other disorders previously found under category of Impulse Control Disorder (OCD, Body Dysmorphic Disorder, trichotillomania - hair pulling, Intermittent Explosive disorder, etc.) into a broader class of disorders. Two new conditions which also include adding excoriation (skin-picking) and hoarding disorder to the group. In my opinion, that was a premature move. Compulsion (an irresistible urge to behave in a certain way) and impulsiveness (acting suddenly on impulse without reflection) are not the same: one can have, the other, both, or neither one. Lumping these distinctly different disorders into one category is premature and unfounded.
7. In personality Disorders category, all 10 original (DSM-IV) disorders remained, but the axes boundaries separating them from other psychiatric disorders were removed. Sharp division between personality disorders has always been seen as artificial, nevertheless, the committee, after long deliberation, left them intact. To my regret, Depressive Personality Disorder (DPD), so common in clinical practice was not resurrected. Originally included in DSM II, DPD was never recognized as a distinct entity in subsequent editions, and only showed up in the Appendix B of DSM-IV TR for consideration for later studies.
8. The new umbrella category, or chapter, in DSM-5 is titled Trauma- and Stressor-Related Disorders and includes posttraumatic stress disorder (PTSD) and a new diagnostic sub-type for pre-school children. The significance and reliability of the new subtype will take time to validate.
9. The new specifier "with mixed features" can be used now with bipolar disorders and Major Depressive disorder (MDD). Mood is divided into predominant (depression, mania, or hypomania) and secondary (subclinical). This development, in my view, will broaden the application of mood disorder diagnosis and will allow flexibility in description of nuances of mood fluctuation. Bereavement exclusion, reserved for depressive symptoms lasting less than 2 months after a loss, has been removed from MDD criteria in DSM-5. Although depression is almost universal and predictable reaction to death of a loved one, it is virtually impossible to separate it from a any other stress induced depressive episode.
10. Substance abuse and substance dependency, separate criteria in the previous edition, were combined in to substance use in DSM-5, each substance use divided into mild, moderate, and severe subtypes.
11. To avoid stigmatizing patients with dementia, DSM-5 introduced neurocognitive disorders in its place. The new edition distinguishes different types of these disorders: Alzheimer disease, Lewy body disease, Parkinson disease, HIV infection, and vascular disease. The disorders are divided into mild and major degree of impairment. I believe it is a move in the right direction. As the population ages, we need better understanding of various types of amnesia, cognitive decline and neuronal degeneration. Studying these diseases will allow better understanding and, prediction of natural course, prevention and treatment.
12. DSM manual, probably in reverence to the psychoanalytical past, always paid excessive attention to sexual perversions, disproportionate to their prevalence and impact. In this edition, while keeping criteria unchanged, the committee advised to discriminate between paraphilic behavior and paraphilic diseases.
13. During the DSM -5 writing other disorders were considered. Among them were Relational disorder, Developmental Trauma Disorder, Parental Alienation Syndrome, Internet Addiction Disorder, Male-to-Eunuch Gender Identity Disorder, Disorders of Extreme Stress, Not Otherwise Specified, etc. Thankfully, they didn't make it.

DSM, despite its new Arabic vs. Roman numeral - 5, is still the same hodge-podge of random symptoms, syndromes, and their clusters with various labels, grouped not by their intrinsic similarities but superficial likeness, e.g. having to do with eating, eliminating, having childhood onset, related to sex, happening soon after "an event", etc. Until the committee and the APA recognize fundamental weakness and confusion of their approach to classification, professionals and patients alike will keep using the document, as Allen Frances, M.D (the chair of the DSM-IV edition) put it, "cautiously, if at all."

In conclusion, I would like share a classification from "certain Chinese Encyclopedia" from Jorge Luis Borges `s The Celestial Emporium of Benevolent Knowledge which, in my opinion, accurately reflects the DSM committee's attempt to organize psychiatric disorders:
"The animals are divided into: those that belong to the Emperor, embalmed, those that trained, suckling pigs, mermaids, fabulous, stray dogs, those that are included in the present classification, those that tremble as if they were mad, innumerable ones, those drawn with a very fine camel hair brush, et cetera, those that have just broken a pitcher, those that from a long way off look like flies."
69 von 73 Kunden fanden die folgende Rezension hilfreich
HASH(0xa238a12c) von 5 Sternen Flip-flopped pages 25. Februar 2014
Von Aryx Orthian - Veröffentlicht auf Amazon.com
Format: Gebundene Ausgabe Verifizierter Kauf
I ordered this book, and the book I received had about 40 pages that were upside down. This was disappointing. I would not recommend.
Here is a picture of the book I received: [...]
623 von 720 Kunden fanden die folgende Rezension hilfreich
HASH(0xa3bc8660) von 5 Sternen The Next Phase of the DSM Evolution is Here 26. Mai 2013
Von Christopher Alexander - Veröffentlicht auf Amazon.com
Format: Taschenbuch
Ok, I have taken some time to actually read through DSM 5. While DSM has often been scrutinized--both for what it includes, as well as what it doesn't--the back-lash against the newest edition has been particularly pronounced these past few months. Part of this stems from the micro-analysis that happens with many things in our modern world, though we have to admit that ego, resentment, and a misunderstanding of the process also plays a part. In addition, historical debate over DSM typically took place in-house; that is, by clinicians. With DSM 5, this has broadened to people who have little- to no understanding of the diagnostic process, its purpose, and its strengths/limitations. Thus, there has been a lot of negative press about DSM 5 in Huffington Post, NY Times, and other sources, often by people with practically no understanding of mental health.

Why 5 stars, you might ask? Because my review is based on DSM 5 as a book, not anything else having to do with DSM as a concept or tool. This particular edition 'reads' well, in that the text and lay-out is clear. In contrast to previous editions, the reader will be given more orientation to the book and how to use it. The diagnostic criteria is familiar and through the Table of Contents, Index, and quick-view pages, it is easy to find the diagnosis or category you're looking for. Yes, it's bulky and expensive, but you should have the large edition in your library for now; later, when you're more familiar with the changes, you can buy the quick-reference guide.

As a child psychologist who conducts psychological and neuropsychological evaluations--for social service agencies, schools, the courts, and for families--DSM plays a prominent role in my work. In addition, I have taught a course on DSM to masters-level graduate students for the past 10 years. In my role as a psychologist, I have witnessed first-hand how a DSM diagnosis is formulated, applied, and interpreted. I have also seen the benefits and limitations of assigning a DSM diagnosis to a client. In the end, however, most people are less concerned about the diagnosis, per se, and more about how to facilitate services, treatment or quality of life/education for the individual to whom it is assigned. This will still be the case now that DSM 5 is published.

Through the years, DSM has attempted to reflect our understanding of mental health symptomatology and how it impacts people across the lifespan. This continues to be the case with DSM 5, though admittedly, mental health is a `young' science, and there is much about the human condition we don't fully understand (neither DSM nor any other classification system can help us account for the Sandy Hook shootings; the Cleveland kidnapping case; the Boston bombing; or many other actions our fellow human beings engage in).

With DSM 5, there are some noteworthy modifications to how we code a mental health diagnosis. Thus, users will need to read the introductory chapter in order to make sure their work reflects these changes. In contrast to what has been hyped in the popular media, DSM 5 does not pathologize grief or childhood tantrums. It doesn't randomly lower thresholds, to make it such that more people will now be diagnosed with ADHD, depression, or Bipolar Disorder. And it doesn't eliminate most of the diagnoses that were previously applicable. Rather, DSM 5 reframes some criteria, clarifies various symptom presentations, and tries to shape our perspective on clinical diagnosis. In particular, DSM 5--in contrast to earlier editions--helps to reinforce that we should view most diagnoses from a lifespan perspective, while staying mindful of the fact that its presentation can vary in severity or magnitude. As with previous editions, DSM 5 provides a classification of mental health disorders, but it doesn't make inference about how these should be treated.

In my opinion, DSM is simply one tool we as clinicians use to formulate an understanding of what is happening with a client at any given time. It also serves to provide us with a `common' language, since a diagnosis will be assigned to most of the clients with whom we work. Much of this language, as used in DSM 5, will be familiar, and those of you who have used DSM thus far won't find that the content has changed that much. When you skim the Table of Contents, for example, you won't see a lot of new diagnoses, but you will see a re-working of where some of them are placed (PTSD and OCD, for example, are no longer in the Anxiety Disorders classification).

In particular, I like the expansion we see portrayed in DSM 5 of neurodevelopmental disorders; better clarification for avoiding a mis-diagnosis of Bipolar Disorder with children; the placement of Autism on a spectrum; and distinctions of how PTSD manifests in young children versus adults. What we've previously known as Reactive Attachment Disorder is now split into two separate classifications (to reflect discriminate and indiscriminate manifestations, accordingly). DSM 5 no longer has the classification, `Disorders First Evidenced in Infancy and Early Childhood.' Instead, the classifications are supposedly arranged by manner in which they appear in the lifespan. This rationale doesn't really fit, however, as many of the kids I see in my practice have substance use and/or neurocognitive disorders, which--using this rationale--the authors put later on in the book.

Overall, DSM 5 reflects the evolution we are all involved in, as we try to understand and account for the mental health symptoms
which impact large numbers of the population. People are much more complex than the diagnoses we assign to them, but DSM at least provides us with a place to start. What happens after that depends upon the skill of the clinician; ultimately, isn't that what most of our clients are concerned with?
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HASH(0xa29feb4c) von 5 Sternen Relax, it's not as awful as people fear- but it still is disappointing, and somewhat problematic. 31. Mai 2013
Von David - Veröffentlicht auf Amazon.com
Format: Taschenbuch Verifizierter Kauf
Nearly all of the media criticisms of DSM-5 are fairly wide off the mark. The main critique is that psychiatry is trying to pathologize increasing amounts of normal human behavior with the DSM-5. The new diagnoses in DSM-5 are modest, evidence-based, and are ways of better describing the types of problems that people come into psychiatrists' and psychologists' offices asking for help with.
For example, the diagnosis of Body Dysmorphic Disorder makes a distinction from "dysmorphic concern" (which is largely normative) and requires that the preoccupation interferes with social or occupational functioning, or causes clinically significant distress. That means: it is already a problem for the person, whether or not anyone makes it a diagnosis.

The main problem with the manual is actually that the changes were not bold enough, not forward thinking enough, and have resulted in very few improvements considering the huge amount of effort put into the enterprise.

There was a goal to improve certain diagnoses, and address problems such as the rampant overuse of bipolar diagnosis in youth. Certain problems are significant in the execution of the goal. First, the diagnosis of Disruptive Mood Dysregulation Disorder is actually very narrow, and contains to specifiers that make it not apply to many of the kids that have been incorrectly diagnosed "bipolar". It requires irritable or angry mood most of the day, nearly every day. Many of the kids, if not most, that are engaging in rages actually have a mood that is fine whenever you are giving them whatever they want, or things are going their way. The disturbance has to be in 2 settings, and sometimes kids are able to suppress rages outside the home. The disturbance must also be enduring for 3 months. So, what do you diagnose if they are the narrow criteria aren't met? Mood Disorder NOS is no longer available, so then do you do depression NOS? That hardly seems descriptive to what is occurring. Intermittent explosive disorder accurately describes the raging of these youth, but misses the mood reactivity that we commonly see, and the text asserts that IED (those are initials that should have been terrible/stigmatizing enough to cause a name change) is rare in youth. Data? The diagnosis of DMDD also moves in the opposite direction of the rest of the DSM, which is allowing coding of ADHD in Autism, etc., and not shooting for complete syndromes, but more "modules" of behavioral problems that can be put together to describe a person. For DMDD, ODD and Conduct Disorder are not allowed-- which leads me to the conclusion that what we see in the DMDD diagnosis is the result of an inter-committee turf war. The DMDD decision, and placing it within depressive disorders and suppressing clinically meaningful comorbidities of ODD and CD, suggests that the child mood people have a lot of sway in the APA. This disorder of mood regulation does have real relationships to depression, but it also is not dominated by the typical depressed mood, and is not episodic and tempermental. The construct of Severe Mood Dysregulation seems to be a lot more serviceable, and the rationale for preferring DMDD is not convincing. The Deficient Emotional Self-Regulation concept, that came-out of the Achenbach (I believe) also may be a better foundation. The syndrome does have validity, but it is not encompassing of all (or in narrow definition, most) of the kids with rages and mood reactivity/dysphoria. And... there is not a category like Mood NOS to capture them.

Other problems with the DSM are indicative of some of the compromises it was trying to achieve, such as integration with ICD-10/11. For opioid withdrawal, it says that the disorder cannot be coded with a mildopioid use disorder, "refelcting the _fact_ that opioid withdrawal can occur only in teh presence of a moderate or severe opioid use disorder". This demonstrably false statement (opioid withdrawal can take place in pain patients that _don't even have a disorder) might have escaped my attention if it didn't say the word "fact". How this got past such a large committee reviewing for so many years is beyond me (the severity of the disorder is not based on the pharmacologic definition, but on the behavioral one) and it shows the committee may have been over-eager to pursue ICD-10 synthesis-- when they should have just focused on the already very difficult job of classifying reality. Cannabis-induced anxiety disorder is not allowed with onset during withdrawal, despite numerous case reports and data from the data on cannabis withdrawal. Although, cannabis-induced sleep disorders was appropriately added.
Of course, much of the criticism has been placed on using the "judgmental" term addiction-- but the word addiction is not going to disappear for treatment centers because some people might get their feelings hurt-- and recovering from addiction requires facing-down some uncomfortable concepts.
I think that the current substance use disorder classifications also miss a very important group-- that is adolescents who are using at _considerable_ risks to themselves, but may not be on an addiction continuum. The significant risks involve OD, DUI, and being victim of sexual assault-- and high-risk adolescent users may not be making significant progress on the addiction continuum, but might kill themselves before they ever get there. This is what they were going for with the Abuse/Dependence distinction, but it was found that most people progressed through all of the symptoms of both disorders on one dimensional line-- but high-risk use in adolescence may be a different class. This group may still have some concerning addiction pathology, but it is the amplification of adolescent risk-taking that is most concerning. The lumping of NMDA antagonists with other hallucinogens does not make a lot of sense, due to the mechanism of action being different, and calling verything phencyclidine without mentioning ketamine or dextromethorphan may confuse some. A better job was done separating nitrous from volatile hydrocarbon "inhalants". The manual was so slow in development, that there is no mention of synthetic cannabinoids. Finally, the use of "mild" as a descriptor of Substance Use Disorder pathology is not a wise choice in words for a disease that features rationalization and lack of insight as part of its phenomonology.

Binge-eating disorder was also criticized, but if we are talking about 3000 calorie-binges once a week with a sense of lack of control, eating rapidly, alone, until uncomfortable, and when not hungry really seems like a problem to me. Criticism is sure to come that more people will be seen as having a psychiatric diagnosis because of this, but we are a culture whose availability of food and other changes may be leading to more people with disordered behavior. So, an increase in prevalence doesn't increase a power-grab by psychiatry, just as the rise in obesity doesn't mean that the rest of medicine is inappropriately expanding its range-- the problem is just increasing.

The merger of Asperger's and Autism into Autism Spectrum really does go against some of the utility of having a diagnostic manual, in the first place. Studies have found the two to not be genetically distinguishable (most of the time), but that doesn't mean there is no distinction, because the data could just be noisy. The DSM committee admitted there were significant differences, but said these were mainly accounted for differences in IQ scores and subscores. Okay, that shows there is a difference-- so why lump them together? Possibly the answer is politics, and the pragmatics of getting FDA drug approval-- if you can lump the Aspergers and Autistic kids together in one group, then an FDA indication has broader reach. The politics comes-in with parents complaining their Aspeger kids have been denied services provided to autistic individuals, but that is probably did not sway the committee. One sad answer may be that they followed flawed data over the cliff of clinical significance. The distinction works for clinicians and parents-- and there are different treatments for Asperger's and even high-functioning autistic kids.

The lack of a go-live on the bold classification of personality disorders is sad-- but was probably necessary due to the manual's biggest short-coming: the lack of progress in dimensional/biologically-based/empirical classification of the other Axis I disorders. This is what the NIMH director was complaining about. The idea that we should junk DSM in favor of Research Domain Criteria is almost as laughable for research as it is for clinical science, but I understand the impulse- as remarkably little has been done, despite the explosion of knowledge in neuroscience. Efforts were made to make the diagnoses more biological, and the ADHD work-group initially was looking at incorporating brain-imaging into the diagnosis of ADHD, but found they just could not make it work. The same problem will probably befall the Research Domain Criteria, as we may have difficulty finding all the endophenotypes that make-up the clinical reality of a disorder. Researchers frustration may not be due to DSM, but are probably due to the reality of psychiatric illnesses-- the complexity of the brain means that these are subtle disorders, affected by differential expressions and interactions between multiple genes, all of small effect-- leading to an large number of underlying conditions that do seem to lead to some final common pathways.

The overuse of medications may be due to the fact that we do not have enough diagnoses in the manual, rather than too many. When you think everything is a nail, you are likely to use a lot of the hammer. The medication overuse is most likely related to the other problem of psychiatry-- the lack of evidence-based therapy-based interactions that are rewarded by government and insurers.

The best thing about DSM-5 is that the use of Arabic numerals allows the easier modification of criteria-- that means many of the problems may be corrected in DSM 5.1. And, possibly the monumental size of this task lead to a compressed period of evaluation and synthesis of data-- and the future evolution of the manual will need to take place continuously, one module at a time, so there is continuous forward progress. This will keep psychiatry from getting 20 years out-of-date with its diagnostic systems, and allow the DSM to more strongly guide clinical care.
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HASH(0xa2414d38) von 5 Sternen It's a technical Manual and requirement in the field service 30. Juli 2013
Von S. C. Hunsaker - Veröffentlicht auf Amazon.com
Format: Gebundene Ausgabe
I don't get the hate for this book. There are a lot of personal issues being taken out on a technical manual. I disagree with some things, sure. There are some parts that are a result of public pressure and campaigning. The world of Mental Health is not black and white, but no medical discipline is, in fact no science is clear only shades of gray. Yes, it is a science, a behavioral science. There is no blood test for Autism, ADHD, or Depression. You identify disorders through symptoms. To make relevant psychological diagnosis, to research and study current diagnosis in the academic setting, and to communicate with your peers, you'll need this book. To hate this book would be like a carpenter hating the necessity of hammers and nails. It's simply illogical.

Get the hardback, My previous one lasted for 15 years of heavy use. From experience, the paperback will fall apart. Yes, I look forward to a kindle version but I always go back to the hard copy.
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