Assignment

  ©  2014  Laureate  Education,  Inc.     Page  1  of  2  

Sex, Sexuality, and Substance Abuse In the DSM-IV, the chapter titled “Sexual and Gender Identity Disorders” included a diagnosis of gender identity disorder. This diagnosis has been eliminated and recategorized into its own diagnostic class. The new grouping—gender dysphoria— reflects substantial changes in conceptualization.

Substance-related disorders have also been substantially changed in the DSM-5. The most significant changes are related to diagnostic labels, criteria, and defining terminology.

A brief summary of key changes in these two diagnostic classification groups are provided below.

Gender Dysphoria

This new DSM-5 classification represents an evolution in the understanding of the interrelationship between sex and gender. The diagnostic group is categorized by an incongruence between assigned gender and the experience of gender. There are only three diagnoses in this group: gender dysphoria, other specified gender dysphoria, and unspecified gender dysphoria.

Both other specified gender dysphoria and unspecified gender dysphoria include significant clinical distress or impairment in their diagnostic criteria but do not meet full criteria for a specific diagnosis in this class. Clinicians should use other specified gender dysphoria and add the specific reason for the more general diagnosis (e.g., insufficient duration to meet gender dysphoria diagnosis). The latter diagnosis— unspecified gender dysphoria—is used when clinicians cannot (or choose not to) identify reasons for the inability to make a more specific diagnosis, yet clearly observe multiple criteria from the gender dysphoria criteria.

Gender Dysphoria Distinct criteria sets for the presence of this disorder in children, adolescents, or adults are outlined in the DSM-5. Language has been altered to include and clarify cultural and environmental influences as well. The resulting gender dysphoria diagnosis is more narrow and specific than the former gender identity disorder. In addition, specifiers have changed dramatically. Those pertaining to sexual orientation previously part of the gender identity disorder diagnosis have been removed, as it was determined they were not relevant to the diagnosis of gender dysphoria. A developmental specifier addressing the potential influence of a biological component was added. In addition, a specifier reflecting the stage or status of transition was added.

Substance-Related and Addictive

Disorders There are significant differences in this classification, most prominently in the

  ©  2014  Laureate  Education,  Inc.     Page  2  of  2  

conceptualization and association of criteria. This category of disorders is marked by activation of the brain reward system—an intensive experience that may interfere with desire to partake in normal activities and/or make pro-social or healthy decisions. This diagnostic classification is divided into substance-related disorders and non-substance- related disorders. The former is further divided into substance use disorders and substance-induced disorders. These categorizations aid in the clinician’s conceptualization of the diagnosis itself as well as treatment planning options. This chapter includes specific reference to 10 classes of drugs as well as a new behaviorally based addition—gambling addiction. The DSM-5 also makes reference to other addictive behaviors, though notes that at this time, insufficient research exists to support a firm diagnosis of these.

As in the DSM-IV, the DSM-5 provides a descriptive table identifying associations between specific substance use and other DSM-5 disorders, such as the potential relationship between caffeine abuse and sleep disorders. Additional clarifying language has been added to this table to aid in diagnosis, helping to clarify not only comorbid diagnoses but also applicable specifiers for the substance use diagnosis

The most significant change to this diagnostic group has been the elimination of the two-tiered abuse and dependence diagnoses. These have been merged into a single use diagnosis, with severity and frequency specifiers. The criteria for recurring substance-related legal problems has been deleted, and a criteria regarding presence of craving or urge to use the substance has been added. Severity and frequency specifiers include mild (2–3 symptoms present), moderate (4–5 symptoms present, and severe (6 or more symptoms present). In addition, new specifiers have been added to reflect remission status and circumstances, such as being in early remission and in a controlled environment (limited access).

Lastly, polysubstance abuse—present in the DSM-IV—has been deleted. New diagnoses include cannabis withdrawal, caffeine withdrawal, and tobacco use.

Reference:

• American Psychiatric Association (2013). Highlights of changes from DSM-IV- TR to DSM-5. Retrieved from http://www.dsm5.org/Documents/changes%20from%20dsm-iv- tr%20to%20dsm-5.pdf