What’s in a name? DSM-5 categories and disorders

Before we delve into the different categories and disorders, it may be wise to pause and reflect on the impact of names. To some, changing the name of a particular category or disorder, is merely a superficial change, however, changing a name has a wide reaching impact on how we view and conceptualize a cluster of disorders, or disorders themselves. Barret (2009) states that words are powerful in science. She states that: …”[if] scientists understand and use the word in a similar way, they agree on what to search for” (Barret, 2009, 329). In the table below I summarize, and analyse examples of how significant changes in names (of both categories and names) in the DSM-5, have changed the categorization of disorders, as well as how this may change our conceptualisation of disorders.

Table 1: Examples of name changes in DSM-5

Old name	New name	Implication
Disorders first identified in infancy, childhood and infancy	Neurodevelopmental Disorders	Only disorders with a clear underlying maturational lag or –deviation are included here. The artificial split between childhood and adult disorders no longer exists The category now makes provision with disorders that clearly start in early life, however, these disorders must meet the criteria stated in (1) above. Disorders that do not meet the principal category needed to find a home elsewhere
Schizophrenia Spectrum and other Psychotic Disorders	Schizophrenia Spectrum and other Psychotic Disorders	All Psychotic disorders share the same cluster of symptoms These symptoms differ only in severity and duration, therefore, clustering the symptoms together in terms of unique disease entities makes little sense It is scientifically, and pragmatically, more sound to distinguish between disorders based on duration and severity, hence *spectrum disorders.*
Mood Disorders	Bipolar and Related Disorders Depressive Disorders	Grouping the Bipolar and Depressive disorders into one category implies shared symptoms, as well as shared etiology. They loosely share some symptoms, but do not share the same etiology, therefore Split them into two distinct categories
Anxiety Disorders	Anxiety Disorders Obsessive-Compulsive and related disorders Trauma- and Stressor-Related disorders	Grouping Anxiety, OCD and trauma together implied a shared etiology, and shared symptoms There is very little scientific evidence that these clusters of disorders share the same etiology

The decision for inclusion of disorders in a specific category was based on a number of shared criteria, i.e.: genetic and environmental risk factors; neural substrates; biomarkers; temperamental antecedents; abnormalities of cognitive or emotional processing and symptoms. In addition to these co-morbidity, course of illness as well as treatment responses were also considered. For many the name changes in DSM-5 are merely cosmetic, however, the name of a category influences the way that view and describe particular disorders, as well as the questions we ask about them. Barret (2009) states that science always starts with common sense categories, and arguably previous editions of the DSM reflected common sense, rather than scientifically based categories. The progress made in Neuroscience necessitates that we re-think these categories and that we start including new findings in the way that we categorise and describe disorders. As we continue our exploration of the DSM-5, the rationale of the name changes will become clearer.

References

Barret, L.F. (2009). The Future of Psychology: Connecting Mind to Brain. Perspectives on Psychological Science, 4 (4), 326 – 339.

About the Author:

Alban Burke is a Professor in the Department of Psychology, University of Johannesburg. He is also the editor of Abnormal Psychology: A South African perspective (2nd Ed.). Oxford University Press: Cape Town (ISBN 978019598375).

Table 1: Examples of name changes in DSM-5

Old name

New name

Implication

References

About the Author: