Revised Criteria, Incorporating Diversity, Equity, and Inclusion in DSM-5 Revision

Revised Criteria, Inclusion, and Racial Fairness in DSM-5 Revision

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) received a Text Revision (DSM-5-TR) in March 2022, marking a significant step forward in mental health care. The updated manual aims to promote inclusivity for People of Color and marginalized groups, as well as refine some of its diagnostic criteria and codes.

Roberto Lewis-Fernandez, a professor at Columbia University, highlighted the priority given to reviewing the DSM through a lens of equity and inclusion by the committees. He also suggested that future iterations of the DSM will likely incorporate changes around how social, sociocultural, and genetic disorder causations intersect.

One of the key changes in the DSM-5-TR is the reinstatement of "unspecified mood disorder." This move is intended to help clinicians avoid potential misdiagnoses, especially in cases where a specific mood disorder may not be immediately apparent.

The DSM-5-TR has also made changes to its language around gender and gender identity to reduce stigma. Furthermore, it acknowledges how race and discrimination have historically impacted mental health care, a crucial step towards creating more safe and inclusive environments for those who have been marginalized.

In terms of specific conditions, the DSM-5-TR includes the addition of prolonged grief disorder. This condition is characterized by a persistent grief response for a duration of longer than 12 months (6 months for a child), symptoms that significantly interrupt a person's day-to-day functioning, and experiences that can't be attributed to another condition like major depressive disorder (MDD) or post-traumatic stress disorder (PTSD).

Another notable addition is the diagnosis of nonsuicidal self-harm. Symptom codes for suicidal behavior and nonsuicidal self-injury have also been added.

However, it's important to note that the DSM-5-TR does not include specific diagnostic criteria or changes directly addressing racism or discrimination as diagnosable mental health conditions. Barriers to quality mental health care still exist, such as cost factors, health insurance, and access to culturally competent counselors and therapists.

Debra Rose Wilson, a professor and Psych Central Advisory Board member, praised the addition of racial and cultural perspectives in the DSM-5-TR, stating that it is beneficial.

The ongoing updates to the DSM are necessary due to the varied opinions and shifting cultural dynamics within the mental health field, as research in the field continues to evolve. The DSM-5-TR's commitment to inclusivity and refinement is a testament to this ongoing effort to improve mental health care for all.