This page provides an overview of the changes made to the text of DSM-IV-TR.   It should be noted that the following is not an exhaustive guide--changes in wording made for clarity and expansions of the differential diagnosis sections of the text are not included here.  It should also be noted that the majority of paragraphs in DSM-IV were revised indicating that, even after the literature review, most of the information in the original DSM-IV text was up-to-date.

Introduction

Several paragraphs were added describing the DSM-IV text revision process, and additional clarifying text was added to the Use of Clinical Judgment section regarding the importance of the method of data collection in determining whether diagnostic criteria have been met.

Multiaxial Assessment

The instructions for making a Global Assessment of Functioning (GAF) rating was greatly expanded.   Discussions about applying the GAF to the current time frame, the elements of the scale were added and a four-step method for determining the GAF was provided.  

Disorders Usually First Diagnosed In Infancy, Childhood, or Adolescence

Mental Retardation

Additional information was added regarding the association of certain etiological factors and comorbid symptoms and disorders (e.g., Fragile-X syndrome and Attention-Deficit/Hyperactivity Disorder).

Communication Disorders

Text was added to indicate that a thorough functional assessment of the individual's language ability can be made when standardized tests are unavailable or inappropriate (e.g., because the available tests were standardized only in limited populations).   Prevalence and Course sections for Expressive Language Disorder, Mixed Receptive-Expressive Language Disorder, and Phonological Disorder were updated as well as the Course section for Stuttering.

Autistic Disorder

The text in the Diagnostic Features section was modified to highlight difficulties in the pragmatic aspects of language, which are especially important in higher functioning individuals. In addition, better examples of restricted, repetitive, and stereotyped patterns of behavior, interests, and activities were added.  The text was also modified to reflect evidence that in up to a fifth of cases, parents retrospectively report relatively normal development for the first 1 or 2 years.  The section about associated cognitive deficits and associated general medical conditions was updated.  The range of prevalence figures was revised to reflect a number of more recent studies suggesting a higher prevalence.  More specific information regarding sibling risk was added to Familial Pattern.

Rett's Disorder

Text was added reflecting the finding that some cases of Rett's Disorder are associated with a specific genetic mutation.

Asperger's Disorder

Because of the limited data available about this newly introduced disorder, the DSM-IV text for Asperger's Disorder provided little more than a restatement of the diagnostic criteria.  Accordingly, the text for Asperger's Disorder was extensively revised in DSM-IV-TR.  Specific examples of the typical manifestations of the impairment in reciprocal social interaction and in restricted, repetitive behavior and interests was provided in order to better differentiate these individuals from those with Autistic Disorder.  In addition, text was added to clarify that the requirement for no clinically significant delays in language does not imply that individuals with Asperger's Disorder have no problems with communication.  The Associated Features, Specific Age Features, Course, and Differential Diagnosis sections were greatly expanded. 

Pervasive Developmental Disorder Not Otherwise Specified

The definition was changed to correct an error that inadvertently allowed this diagnosis to be made in cases in which there was a pervasive impairment in only one developmental area (i.e., in the development of reciprocal social interaction, communication skills, or stereotyped behaviors, interests, or activities).   The definition now requires that there be impairment in reciprocal social interaction, which is associated with an impairment in communication skills or the presence of stereotyped behaviors, interests, or activities.

Attention-Deficit/Hyperactivity Disorder

Many of the changes highlighted differences among the subtypes.  For example, individuals with the Predominantly Inattentive and Combined Types tend to have academic deficits and school-related problems, whereas those with the Predominantly Hyperactive-Impulsive Type tend to have more peer rejection and accidental injuries, and gender ratio is less predominantly male in the Predominantly Inattentive Type.  Additional information about Associated Features (e.g., variability in IQ, presence of family discord) and Specific Age Features (especially Attention-Deficit/Hyperactivity Disorder in adults) was included.  Estimates of prevalence rates were revised upward, reflecting increased prevalence due to the inclusion of the Predominantly Hyperactive-Impulsive and Predominantly Inattentive Types in DSM-IV. 

Conduct Disorder

The list of risk factors for developing Conduct Disorder was expanded.  The relationship between Oppositional Defiant Disorder and the subsequent development of Childhood-Onset Type of Conduct Disorder is noted in Course.

Oppositional Defiant Disorder

The Course section of the text clarified that although Childhood-Onset cases of Conduct Disorder are often preceded by Oppositional Defiant Disorder, many children with Oppositional Defiant Disorder do not go on to develop Conduct Disorder.

Pica

Prevalence data were provided and comorbidity with Pervasive Developmental Disorders was noted.

Feeding Disorder of Infancy or Early Childhood

Changes were made in Prevalence (community prevalence is noted) and Course sections  (persistence of decreased height and weight as compared to peers into adolescence).

Tic Disorders

The DSM-IV criteria set for Tic Disorders wass corrected by eliminating the requirement for “clinically significant distress or impairment” which was added to the majority of disorders in DSM-IV (Tic Disorders among them).  There are a number of reasons why this criterion had been problematic in Tic Disorders, including that fact that it was at variance with clinical experience (i.e., most children with Tourette's do not experience marked distress or impairment) and that it hindered epidemiological research and family studies. Other changes in the text included an expanded description of the types of tics as well as an expansion of the Differential Diagnosis between tics and other types of movements, Associated Features (including comorbidity patterns), Specific Age Features (gender ratio), Prevalence, Course, and Familial Pattern. 

Encopresis

Encopresis with functional constipation is the most common form.  Text regarding physiological predispositions to constipation was updated and expanded. 

Enuresis

New information about different mechanisms underlying the Diurnal Only Type was added.  Associated Features (particularly predisposing factors), Prevalence, and Familial Pattern were updated.

Separation Anxiety Disorder

Prevalence and Course sections were updated to indicate a decrease in prevalence from childhood through adolescence and to indicate that most children with separation anxiety are free of an impairing Anxiety Disorder at extended follow-up. 

Reactive Attachment Disorder

Associated Features (risk factors such as extreme neglect and institutional care) and Course  (persistence of indiscriminant sociability) were updated.

Stereotyped Movement Disorder

Pathological skin picking was removed from the list of examples--such cases should be diagnosed as Impulse Control Disorder Not Otherwise Specified.  Associated Features (i.e., clarification that the disorder can occur in non-developmentally-delayed populations) were modified.

Delirium, Dementia, Amnestic Disorder, and Other Cognitive Disorders

Delirium

The Associated Features section was modified to emphasize the presence of two varieties of delirium—hyperactive and hypoactive.  Text was also added to the Specific Age Features section to reflect the finding that advanced age has been found to be a risk factor for delirium in a variety of study populations, even after controlling for other risk factors (like concomitant illness). Prevalence data on delirium in a variety of medically-ill populations are now available (e.g., up to 60% of nursing home residents aged 75 or older may develop delirium).   The importance of early recognition and treatment of delirium is highlighted in the substantial additions to the Course section of the text (e.g., individuals with better premorbid cognitive and physical functioning have a better recovery).

Delirium Due to a General Medical Condition

The list of associated general medical conditions was reorganized and updated.

Substance-Induced Delirium

Text was added to clarify that the onset and offset may be affected by various factors such as brain damage, older age, substance half-life, the presence of multiple substances, and poor clearance.

Dementia

DSM-IV-TR includes new diagnostic codes for the dementias (with the exception of Vascular Dementia which remains unchanged).  The code for all types of dementia (except Vascular) is 294.10 if the subtype is  “Without Behavioral Disturbances,” and 294.11 if the subtype is “With Behavioral Disturbances.”   Codable subtypes that previously applied to Dementia of the Alzheimer's Type (e.g., With Depressed Mood) no longer apply.  Instead, the corresponding Mental Disorder Due to a General Medical Condition (e.g., 293.83 Mood Disorder Due to Alzheimer's disease) should be coded on Axis I. Because of ICD-9-CM coding conventions, Vascular Dementia codes and subtypes remained unchanged.

The list of causes of dementia was updated to reflect that the most common cause, after Alzheimer's disease, is another neurodegenerative process, such as Lewy body disease or frontotemporal degeneration, two etiologies which are not specifically listed in DSM-IV.  Prevalence figures were updated to reflect more recent epidemiological data (i.e., around 1.5% for individuals ages 65-69 years,  rising to 16% to 25% for those over age 85 years).

Dementia of the Alzheimer's Type

Although an enormous effort has gone toward the development of biological markers for Alzheimer's disease, none of these markers are as yet widely accepted.  Text was added to the Associated Laboratory Features section (as well as the differential diagnosis section for Dementia) acknowledging that Alzheimer's disease remains a diagnosis of exclusion.  The section on Course was updated to highlight the development of personality changes.  Prevalence estimates were revised based on the United States General Accounting Office's 1998 report on the prevalence of Alzheimer's.  Finally, the Familial Pattern section was updated to reflect current data on chromosomal linkage and the role of the genetic marker APO-E4 as a risk factor for the development of late-onset cases.

Dementia Due to Parkinson's Disease/Dementia Due to Pick's Disease

Two of the most common forms of dementia are Lewy body dementia (an example of which is Dementia Due to Parkinson's disease) and frontotemporal dementia (of which Dementia Due to Pick's Disease is an example).  Although there was insufficient evidence to justify a radical reorganization of this section, text was added to the sections on Dementia Due to the Other General Medical Conditions,  Dementia Due to Parkinson's Disease, and Dementia Due to Pick's Disease to clarify how such cases should be classified.

Dementia Due to Creutzfeldt-Jakob Disease

Text was added regarding the cross-species transmission of prion infections, reflecting the outbreak of a human variant of bovine spongiform encephalopathy in the United Kingdom in the mid-1990s.

Mental Disorders Due to a General Medical Condition

Personality Change Due to a General Medical Condition 

A change was made to correct an error in the exclusion criterion, which did not allow a diagnosis of Personality Change Due to a GMC to be given comorbidly with a diagnosis of dementia.  This criterion was an unintended carryover from DSM-III-R which excluded personality change in the presence of dementia because personality change was included in the diagnostic criteria for dementia. Clinically significant symptoms occurring along with dementia are diagnosed by coding the specific mental disorder due to a GMC on Axis I alongside the dementia.  Thus, this exclusion was removed, allowing, for example, an individual with Alzheimer's disease who develops a change in personality to be given a comorbid diagnosis of Personality Change Due to Alzheimer's Disease.  

Substance-Related Disorders

Substance Dependence

The Diagnostic Features were updated to indicate that varied degrees of tolerance may develop to the different central nervous system effects of a substance, that tolerance may develop to phencyclidine, and that a past history of tolerance or withdrawal is associated with a worse clinical course (i.e., earlier onset, higher levels of substance intake, and greater numbers of substance-related problems).

Familial Pattern for Dependence/Abuse/Intoxication/Withdrawal

The text was updated to clarify that individuals who may be at higher risk for Alcohol Dependence because of a family history of Alcohol Dependence do not necessarily have a higher risk of developing Dependence on other substances. 

Substance-Induced Disorders

Examples were added to help clarify when it is appropriate to diagnose Substance Intoxication or Substance Withdrawal versus a Substance-Induced Disorder With Onset During Intoxication or With Onset During Withdrawal.

Alcohol-Related Disorders

The Associated Features section (e.g., risk of alcohol-related accidents, comorbidity with other disorders) was updated.   A discussion of the laboratory test carbohydrate deficient transferrin (CDT), a widely-used state marker for heavy drinking, was added.  In the Specific Culture, Age, and Gender Features section, the text concerning the low rates of Dependence in Asians and the clinical course in women was expanded.  Text regarding the prevalence of alcohol use, prevalence of alcohol-related complications, and the prevalence of Alcohol Dependence was expanded and updated. 

Amphetamine-Related Disorders

Text regarding the prevalence of amphetamine use across different age groups and the prevalence of Dependence was expanded and updated. 

Caffeine-Related Disorders

Specific Age Features was expanded to include information about the increased sensitivity of the elderly to the effects of caffeine.  A Prevalence section was added that describes patterns of caffeine use, and the Course section has been expanded and updated.

Cannabis-Related Disorders

Updated information regarding mechanisms of action was added to the introductory section.  The text for Cannabis Dependence was updated to clarify that evidence of physiological dependence is seen in chronic users and may be associated with more severe cannabis-related problems. Text regarding the prevalence of cannabis use across different age groups and the prevalence of Dependence was expanded and updated.  A discussion regarding whether cannabis use is a precursor to other drug use (i.e., its role as a “gateway drug”) was added to the Course section.

Cocaine-Related Disorders

The complications of severe Cocaine Intoxication were updated and expanded and Specific Culture and Gender Features were also updated. Text regarding the prevalence of cocaine use across different age groups and the prevalence of Dependence and Abuse was expanded and updated.

Hallucinogen-Related Disorders

A discussion of the physiological changes associated with intoxication (e.g., increases in blood glucose) was added. Text regarding the prevalence of hallucinogen use across different age groups and the prevalence of Dependence and Abuse was expanded and updated.

Inhalant-Related Disorders

Additional information was added to the sections on Associated Laboratory Findings (i.e., urine assay for a metabolite of toluene) and Associated Physical Examination and General Medical Conditions (i.e., an expanded list of respiratory complications and possible association between benzene and acute myelocytic leukemia).  Text regarding the prevalence of different types of inhalant use among different age and other demographic groups was added.

Nicotine-Related Disorders

Specific Culture, Age, and Gender Features were updated (e.g., data about increased nicotine blood levels in African-Americans were added).  Text regarding the prevalence of smoking and other tobacco use in various groups and the prevalence of Nicotine Dependence was updated.  The Course section was also revised based on new data.

Opioid-Related Disorders

Text regarding hepatitis screening tests was added to Associated Laboratory Findings, and death rates from medical complications were added to Associated General Medical Conditions.  Specific Gender Features (i.e., gender ratio), and Course (i.e., remission rates) were updated. Text regarding the prevalence of different patterns of opioid use among different age and other demographic groups was updated and expanded.

Phencyclidine-Related Disorders

Text regarding the prevalence of different patterns of phencyclidine use among different age groups was updated and expanded.   

Sedative, Hypnotic, and Anxiolytic-Related Disorders

Text regarding patterns of use among different age groups and the prevalence of Dependence and Abuse was updated.

Polysubstance Dependence

Examples were added to clarify the appropriate use of this category.

Schizophrenia and Other Psychotic Disorders

The introduction was updated to emphasize that psychotic symptoms are not necessarily considered to be core features of the disorders included in this section, nor do they necessarily have a common etiology.

Schizophrenia

The Associated Features section was updated and expanded to include additional information about anosognosia (lack of insight), risk factors for suicidal and violent behavior, and comorbidity with other mental disorders.  The Associated Laboratory Findings section was also updated to include separate discussions of structural and functional neuroimaging, neuropsychological deficits, and neurophysiological abnormalities.  The Specific Culture, Age, and Gender Features section was updated to include an expanded discussion concerning overdiagnosis of Schizophrenia in certain racial groups, updated information regarding late-onset cases, and updated text regarding gender differences.  The Prevalence section of the text was updated to include additional information and geographic and historical variations in incidence.  The Familial Pattern section introduced the concept of “schizophrenia spectrum" (i.e., the range of disorders that are more likely in the relatives of individuals with Schizophrenia)

Schizophrenia Subtypes

The introduction was updated to indicate limited stability and prognostic value of the subtypes. 

Schizophreniform Disorder

Updated prevalence information was provided, including contrasting rates in developed and developing countries.  A brief Familial Pattern section was added, indicating a possible increased risk of Schizophrenia in relatives of individuals with Schizophreniform Disorder.

Schizoaffective Disorder

Specific Gender Features (i.e., elevated rates in woman are mostly accounted for by increased incidence of the Depressive Type) and Course (i.e., association of stressors with a better prognosis) were updated.

Delusional Disorder

The Course section was updated.

Brief Psychotic Disorder

The Prevalence section was updated to note that although this disorder is rarely seen in developed countries, psychotic episodes of slightly longer duration (1 to 6 months) are more common in developing countries.

Psychotic Disorder Due to a General Medical Condition

The list of etiological general medical conditions has been updated and new sections were added for Prevalence and Course.

Mood Disorders

Major Depressive Episode

The Associated Laboratory Findings section of the text was updated and expanded to include additional neurobiological abnormalities (e.g., alterations in neuropeptides and other hormones in response to challenge tests) and functional brain imaging results.  The Specific Gender Features section was updated to clarify that increased risk in women emerges during adolescence and may coincide with puberty.

Major Depressive Disorder

Associated General Medical Conditions text was updated to emphasize that comorbid general medical conditions worsen the course of Major Depressive Disorder.  The Specific Age Features section was expanded to include information about laboratory findings (e.g., evidence of subcortical white matter hyperintensities) in late-onset depression.  Changes in the Familial Pattern section indicate increased risk of Anxiety Disorders in offspring of those with depression.

Dysthymic Disorder

The Course section was updated to indicate that the outcome of Dysthymic Disorder is significantly better with active treatment.  Changes to Familial Pattern indicate elevated rates of both Dysthymic Disorder and Major Depressive Disorder in relatives of those with Dysthymic Disorder.

Bipolar I and Bipolar II Disorder

The Associated Mental Disorders section was expanded to include information on the comorbidity of Bipolar I Disorder and Alcohol and other Substance Use Disorders. The Associated Laboratory Findings were updated to reflect increased rates of certain brain lesions in individuals with Bipolar I Disorder as a group.  The Associated General Medical Conditions section was expanded to clarify the relationship between Bipolar I and Bipolar II Disorder and thyroid dysfunction (i.e., association between hypofunction and rapid cycling, and hyperthyroidism precipitating episodes in those with pre-existing Mood Disorder).   Specific Gender Features were updated to reflect gender differences in Rapid Cycling, types of episodes, and risk for mixed episodes.  The relationship between age at onset and family history was noted in Familial Pattern of Bipolar I Disorder.

Bipolar Disorder NOS

An additional example was added to clarify that individuals with chronic dysthymia who also experience occasional hypomanic episodes do not qualify for a diagnosis of either Dysthymic Disorder (because of the hypomanic episodes) or Cyclothymic Disorder (because the hypomanic episodes are too infrequent).

Catatonic Features

The text was expanded to provide a breakdown of the causes of catatonia. 

Melancholic Features

The original statement that individuals with Melancholic Features are more likely to respond to somatic treatment was incorrect and was replaced by text that emphasizes the need for active treatment given the low placebo response rate.

Postpartum Onset

The Associated Features section was updated and text was added to highlight the differentiation of this subtype from “baby blues.”

Rapid Cycling

Updated text included prevalence data and the potential association between cycling rate and antidepressant therapy.

Anxiety Disorders

Panic Attack

The text describing the three types of panic attacks (i.e., unexpected, situationally-bound, and situationally-predisposed) was updated to clarify the nature of the triggers, the association between the types of and particular Anxiety Disorders, and Differential Diagnosis.

Panic Disorder

The relationship between panic attacks and potential triggers in Panic Disorder was updated (i.e., situational triggers may be either external or internal and "unexpected" means that the individual does not immediately associate the attack with a situational trigger).   The list of associated general medical conditions was expanded, the Prevalence section was expanded to include rates in clinical samples, and the Familial Pattern section was updated to include information from more recent studies (e.g., relationship between age at onset of proband and risk in first-degree relatives).  Finally, the differential diagnosis section was expanded to include situations in which the person may not be able to identify the cues triggering a Panic Attack (e.g., cognitions or physiological symptoms similar to those that occurred at the time of the traumatic event in Posttraumatic Stress Disorder).

Specific Phobias

Additional information regarding comorbidity, relative frequency of subtypes in community settings, gender ratio, course (e.g., having  Specific Phobia in adolescence increases the chance of having Specific Phobia in adulthood but not other mental disorders), and Familial Pattern was provided. 

Social Phobia

Sections on Associated Features (i.e., suicidal ideation) and comorbidity with other mental disorders were updated.  The Associated Laboratory Findings section was updated to clarify that no laboratory test has been found to be diagnostic of Social Phobia (i.e., original text suggesting a differential response to lactate infusion has been deleted).

Obsessive-Compulsive Disorder

Information regarding comorbidity with other mental disorders was updated.  The Specific Age Features section was updated to include a brief section on the subset of children who develop Obsessive-Compulsive Disorder in association with Group A beta-hemolytic streptococcal infections.  Additional information was added to draw on the increased body of data regarding children with Obsessive-Compulsive Disorder (e.g., comorbid disorders, prevalence).   The Prevalence section was updated and expanded to include prevalence rates in children. 

Posttraumatic Stress Disorder

Associated features, comorbidity with other mental disorders, associations with general medical conditions, prevalence rates, and course (e.g., symptom reactivation in response to reminders of trauma, life stressors, or new traumatic events) were updated.  A brief Familial Pattern section was added, describing evidence of a heritable component to the transmission of Posttraumatic Stress Disorder and the relationship between having a history of depression in first-degree relatives and increased vulnerability to developing Posttraumatic Stress Disorder.

Acute Stress Disorder

Additional information regarding progression to Posttraumatic Stress Disorder and a range of prevalence rates in individuals exposed to severe traumas were provided.

Generalized Anxiety Disorder

Prevalence in clinical settings and Familial Pattern (i.e., evidence from twin studies suggesting a genetic contribution) were updated.

Somatoform and Factitious Disorders

Somatization Disorder

Associated General Medical Conditions was updated to clarify that some individuals with Somatization Disorder have objective signs that are part of a comorbid medical condition.

Conversion Disorder

The Prevalence section was expanded to include rates in certain general medical settings.

Pain Disorder

The Associated Features text section on the risk of iatrogenic Substance Dependence was updated and expanded to include factors that minimize the likelihood of developing iatrogenic Substance Dependence.  In addition, text on associated sleep problems was also expanded.  Text addressing the prevalence of Pain Disorder in clinical settings as well as additional information about Course Features was included.

Hypochondriasis

Associated Features and Disorders, Prevalence and Course (i.e., factors associated with better prognosis) were updated.

Body Dysmorphic Disorder

Body build and muscularity were added to the list of body site preoccupations.  The Associated Features section was updated to include additional information about lack of insight and efforts to correct or hide the defects.  Reported prevalence rates in clinical settings were included.

Factitious Disorder

The revised text for the Predominantly Physical Signs and Symptoms Type more clearly differentiates Munchausen's syndrome (the most severe and chronic form of Factitious Disorder) and less severe, more transient forms.   Specific Gender Features, Prevalence and Course features were updated.

Dissociative Disorders

Dissociative Identity Disorder

The text was modified to indicate that cases of Dissociative Identity Disorder have been documented in a variety of cultures around the world.

Depersonalization Disorder

Associated Features and Course sections were updated.

Sexual and Gender Identity Disorders

Introductory text was added to clarify the definitions of the terms gender identity, gender dysphoria, and sexual orientation. 

Sexual Dysfunctions

Associated Features and Prevalence data were expanded and updated.

Paraphilias

The clinical significance criteria were revised to clarify that, for Pedophilia, Voyeurism, Exhibitionism, and Frotteurism, if the person has acted on these urges, or the urges or sexual fantasies cause marked distress or interpersonal difficulty, then by definition there is clinical significance.  For Sexual Sadism, if the person has acted on these urges with a non-consenting person, or the urges, sexual fantasies, or behaviors cause marked distress or interpersonal difficulty, then the clinical significance criterion is met.  For the remaining Paraphilias, the clinical significance criterion is met if the behavior, sexual urges, or fantasies cause clinically significance distress or impairment in social, occupational or other important areas of functioning.   Of course, to qualify for the specific diagnosis, the particular pattern of paraphilic arousal must also be present.

Gender Identity Disorder

Additional information was included to clarify how the subtypes (based on sexual attraction) differ in terms of Associated Features and Course.

Eating Disorders

Anorexia Nervosa

Associated Features were updated to include comorbidity with Personality Disorders.  Prevalence were updated to include figures for males. Course features were updated to clarify the relationship between Anorexia Nervosa and Bulimia Nervosa.

Bulimia Nervosa

The Course section were updated to include some information regarding the long-term outcome of Bulimia Nervosa. 

Sleep Disorders

Primary Insomnia

Associated Descriptive Features (e.g., functional impairment), Associated Laboratory Findings (e.g., lack of daytime sleepiness as measured by MSLT, presence of substantial discrepancies between subjective report and polysomnographic measures of sleep quality), Specific Age Features (e.g., in the elderly), Prevalence (e.g., rates of the disorder in the general population), Course (text on chronicity), and Familial Pattern sections were updated.

Primary Hypersomnia

Specific Age Features (e.g., in children), Prevalence, and Course were updated.

Narcolepsy

Text was added to clarify that some of the symptoms (i.e., hypnagogic and hypnopompic hallucinations and sleep paralysis) also occur in normal sleepers. The Associated Laboratory Findings (including HLA typing) and Course (age at onset vs. age at presentation) were also updated. A Specific Age Features section was added to address issues in the diagnosis of Narcolepsy in children.

Breathing-Related Sleep Disorder

Associated Laboratory Findings, Physical Examination Findings (i.e., association between neck size and risk for obstructive sleep apnea), and Specific Age Features (i.e., in children) were updated.

Circadian Rhythm Sleep Disorder

Additional subtype-specific information regarding Associated Features, Associated Laboratory Findings, Associated General Medical Conditions, Specific Age Features, Prevalence, Course, and Familial Pattern were provided.

Dyssomnia Not Otherwise Specified

Greatly expanded descriptions of Restless Legs Syndrome and Periodic Limb Movements, two well-established Sleep Disorders included in the International Classification of Sleep Disorders, are now included.

Nightmare Disorder

Associated Descriptive Features (i.e., an association between frequent chronic nightmares and increased symptom measures of other psychopathology), Prevalence (i.e., rates of frequent nightmares in young adults) and Course information was updated.

Sleepwalking Disorder

Associated Laboratory Findings, Specific Gender Features, Prevalence, Course, and Familial Pattern sections were updated.

Sleep Disorders Related To Another Mental Disorder

Associated Laboratory Features were updated. 

Impulse Control Disorders

Intermittent Explosive Disorder

Text was added clarifying that serious assaultive acts include verbal threats of physical assault to another individual.   Associated Features (e.g., symptoms that precede or accompany the aggressive acts, such as tingling or tremors, as well as accompanying affect), Associated Mental Disorders, and Course sections were updated.  A Familial Pattern section was added indicating those disorders that may be more common among the first-degree relatives of individuals with Intermittent Explosive Disorder as compared to the general population.

Kleptomania

Associated Features and Disorders, Specific Gender Features (i.e., gender ratio), and Familial Pattern (i.e., possible family history of Obsessive-Compulsive Disorder in first-degree relatives of individuals with Kleptomania) were updated.

Pathological Gambling

Associated Features (e.g., childhood history of inattentive or hyperactive symptoms), Laboratory Findings (e.g., a variety of abnormalities reported in samples of males), and Prevalence sections (e.g., influence of availability of legalized gambling on the prevalence of Pathological Gambling) were updated.

Trichotillomania

Associated Disorders, Prevalence, and Course sections were updated.

Personality Disorders

Introductory Text for Personality Disorders

The text describing dimensional models were updated, presenting the dimensions in terms of some of the more important models.

Antisocial Personality Disorder

Associated Features text was updated to clarify that features that are part of the traditional conception of psychopathy may be more predictive of recidivism in settings (e.g., prisons) where criminal acts are likely to be non-specific. 

Dependent Personality Disorder

The text for Gender-Associated Features was changed to remove the suggestions that reported gender difference is largely artifactual.

Borderline Personality Disorder

Text was added to the Course section to emphasize the fact that, contrary to many clinicians' preconceived notions, the prognosis for many individuals with Borderline Personality Disorder is good.  

Obsessive-Compulsive Personality Disorder

The Associated Features section was updated to further clarify the relationship between Anxiety Disorders (especially Obsessive-Compulsive Disorder) and Obsessive-Compulsive Personality Disorder.

Adjustment Disorders

Associated Features text was updated to clarify comorbidity with other disorders.  Prevalence was expanded to include rates in children and in particular clinical settings.  Course now includes text about the risk of progression to other disorders.

Appendices

Changes were made to several of the appendices.  Small changes were made in the descriptive text for some of the research categories in Appendix B (e.g., postpsychotic depressive disorder of Schizophrenia, premenstrual dysphoric disorder, mixed anxiety depressive disorder) and the text for Medication-Induced Movement Disorders was updated to include atypical neuroleptics.  Appendices E, F, and G were updated to correct for ICD-9-CM coding changes that have taken place over the past several years.  A new Appendix K, containing the names of the DSM-IV text revision advisors, was also added.