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DSM-5 Changes – Bipolar, Depression and Schizophrenia

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is updating schizophrenia, depressive and bipolar disorders in the DSM-5. While both depression and bipolar disorder are considered affective disorders, they are no longer in the same category. Previously, both depressive and bipolar disorder had been in the mood disorder category, but these disorder types are now in their own chapters. The bipolar disorder category is now called Bipolar and Related Disorders and the depressive disorders category is simply Depressive Disorders. Schizophrenia is contained in the Schizophrenia Spectrum and Other Psychotic Disorders chapter of the DSM-5.

Bipolar and Related Disorders DSM-5 Updates

(You can find detailed on the page Bipolar Information Articles.) The Bipolar and Related Disorders chapter contains information on:

A new emphasis in mania and hypomania is now placed on changes in activity and energy as well as mood. Additionally, mixed episodes are no longer reserved for bipolar type 1.

Other Specified Bipolar and Related Disorders is a new diagnosis which is available for those who have a past history of major depressive disorder and who meet all the criteria for hypomania except the duration (four consecutive days). This diagnosis can also be made for those who do not have all the hypomania symptoms but have had them for the requisite four days.

There are now specifiers for bipolar and depressive disorders which indicate components of the disorder. These specifiers include:

  • With mixed features – replaces the mixed episode diagnosis. Can be specified for bipolar or depressive episodes when symptoms of the opposite pole (depression symptoms in mania/hypomania, or mania/hypomania symptoms in depression) are present.
  • With anxious distress – can be specified for depressive or bipolar disorders. This is intended to indicate patients with anxiety symptoms that are not part of the bipolar or depressive disorder.

Depressive Disorder DSM-5 Changes

(Read comprehensive Depression information Articles.) There are two new depressive disorders in the DSM-5, they include:

Two disorders have also been combined. Chronic major depressive disorder and dysthymia are now under the heading of persistent depressive disorder.

One important exclusion criteria have been removed from the DSM-5: the bereavement exclusion. Previously, if a depressive episode occurred within two months following the death of a loved one, depression could not be diagnosed. Now there is the recognition that bereavement can last up to two years or longer so the simple two-month exclusion was removed.

As mentioned above the "with anxious distress" and "with mixed features" specifiers can now be used with depressive disorders.

Schizophrenia and Other Psychotic Disorders DSM-5 Changes

The diagnostic criteria for schizophrenia have changed in the DSM-5. In one case, there is the inclusion of a new criterion. An individual now must have one of delusions, hallucinations or disorganized speech. In the other case, two special criteria have been removed. While previously, only one of the following symptoms were needed for diagnosis:1

  • Bizarre delusions,
  • Two or more voices are talking with each other (Schneiderian first-rank auditory hallucinations),
  • Auditory hallucinations occur in which the voices comment in an ongoing manner on the person's behavior,

In the DSM-5, the first two special attributions are being removed.

All schizophrenia subtypes like paranoid and disorganized are also being removed from the DSM-5. Instead, symptom severity will now be considered.

Other changes to psychotic disorders include:

For schizoaffective disorder, the requirement that "Symptoms that meet the criteria for mood episodes are present for a substantial portion of the total active and residual periods of illness"2 is being removed as recognition that psychotic and mood symptoms can occur concurrently or at different points in the illness.

In delusional disorder, the DSM-5 no longer requires that delusions are non-bizarre and the DSM-5 no longer separates delusional disorder from shared delusional disorder. There is also a new exclusion criterion for delusional disorder that states that the symptoms are not better explained by conditions such as obsessive-compulsive disorder or body dysmorphic disorder.

In the DSM-5 the same criteria is used to diagnose catatonia whether it be in the context of bipolar, psychotic, depressive or other medical disorder. Now, three of 12 characteristic symptoms (such as mutism, rigidity, and withdrawal)3 must be present for a diagnosis. Catatonia may be used as a specifier in depressive, bipolar and psychotic disorders or as a separate diagnosis in the context of another medical condition.

APA Reference
Tracy, N. (2013, May 27). DSM-5 Changes – Bipolar, Depression and Schizophrenia, HealthyPlace. Retrieved on 2019, September 16 from https://www.healthyplace.com/other-info/mental-illness-overview/dsm-5-changes-bipolar-depression-and-schizophrenia

Last Updated: July 3, 2019
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Medically reviewed by Harry Croft, MD

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