Changes in DSM-5 Relevant to Juvenile Justice Populations
| Diagnosis | DSM-IV-TR Criteria | DSM-5 Criteria | Potential Impact |
|---|---|---|---|
| Internalizing disorders | |||
| Bipolar disorder I/II | Manic episode described as period of “abnormally and persistently elevated, expansive, or irritable mood” | Manic episode described using abnormalities in mood and goal-directed activity or energy | Youths exhibiting elevated or irritable mood alone (i.e., without increased energy) may be less likely to receive a bipolar disorder diagnosis |
| No indication of behavior representing a distinct change. | Manic behavior must “represent a noticeable change from usual behavior.” | May result in fewer bipolar diagnoses among youths with comorbid diagnoses resulting in high energy and irritable mood | |
| Disruptive mood dysregulation disorder (DMDD) | N/A (new diagnosis in DSM-5) | Characterized by recurring severe temper outbursts and persistently irritable mood between outbursts; excludes coexisting ODD, IED, or bipolar disorder | May result in fewer bipolar disorder diagnoses and therefore reduce use of atypical antipsychotic medications in this population |
| Major depressive disorder (MDD) | Depressed mood described as feeling sad or empty | Depressed mood described as feeling “sad, empty, or hopeless” | May increase MDD diagnosis among youths who suppress the appearance of sadness to better survive in hostile environments |
| N/A | Added new specifier: “with anxious distress” | May increase attention to anxiety symptoms in youths with MDD, which has been linked to increased suicide risk | |
| N/A | Added new specifier: “with peripartum onset” | May be particularly relevant for diagnosing depression in female justice-involved youths, a growing group in the juvenile justice system | |
| Persistent depressive disorder (PDD) | N/A (new diagnosis in DSM-5) | Consolidates dysthymic disorder and chronic MDD from DSM-IV; MDEs can be noted via specifier | Overlapping criteria for MDD and PDD may complicate diagnostic picture for youths who lack insight into how long they have experienced these symptoms |
| Posttraumatic stress disorder (PTSD) | Classified as an anxiety disorder | Classified as a trauma- and stressor-related disorder | Appears to emphasize the unique characteristics of trauma-related disorders |
| Traumatic event must be accompanied by reactions of intense fear, helplessness, or horror | This requirement has been removed in DSM-5 | May promote PTSD diagnosis among youths who demonstrate varied immediate reactions to trauma, especially those with repeated exposure | |
| Included three symptom clusters: re-experiencing, avoidance/numbing, arousal | Separated avoidance and numbing clusters; added persistent negative emotional states | May better contextualize apparent externalizing behaviors (e.g., substance use) that often arise after exposure to trauma | |
| Arousal symptom cluster did not include “reckless or self-destructive behavior” | DSM-5 has added “reckless or self-destructive behavior” to arousal and reactivity cluster | ||
| Separation anxiety disorder | Onset before age 18 | Onset can be after 18 | May improve diagnostic accuracy for young adults (18–21) under juvenile court supervision for delinquent acts they committed before age 18 |
| Somatic symptom disorder (SSD) | Somatization disorder; hypochondriasis; pain disorder | No longer requires a specific number of complaints; somatic symptoms no longer must be medically unexplained | May increase the number of SSD diagnoses among justice-involved youths |
| Externalizing disorders | |||
| Attention-deficit hyperactivity disorder (ADHD) | Onset before 7 years of age | Onset before 12 years of age | Given potentially confounding influence of other major life events (i.e., puberty, transition to secondary school) occurring around the same stage in development, may promote false positive diagnoses among justice-involved youths |
| Excluded autism as a comorbid diagnosis | Allows comorbid autism diagnosis | May promote a better understanding of justice-involved youths' social dysfunction, disengagement, and inattention to authority; may also allow for more effective management of youths' disruptive behavior during justice system transitions | |
| Symptoms must be present in two or more settings (i.e., school, work, home) | Allows for symptom observation in additional situations (e.g., with relatives or friends) | Reduces emphasis on particular settings where stressors like trauma may better account for symptoms | |
| N/A | Adds severity specifiers (i.e., mild, moderate, severe) | May provide more clinically relevant information and assist in identifying treatment needs | |
| Conduct disorder (CD) | N/A | Adds “with limited prosocial emotions” specifier | May impress upon juvenile justice decision makers that youths with such a specifier are not amenable to treatment |
| Intermittent explosive disorder (IED) | Emphasized physical acts of aggression in description of behavioral outbursts | Includes physical, verbal and noninjurious/nondestructive aggression in description | May improve understanding of the increasingly high rates of female youths, who may be more likely than males to engage in other forms of aggression, entering the juvenile justice system for anger-based, violent crimes, such as robbery, aggravated assault, and murder |
| Outbursts must be of low frequency/high intensity | Outbursts may also be of high frequency/low intensity | May increase IED diagnosis among justice-involved youths; may also improve understanding and treatment of youths who chronically reoffend through aggressive acts not better explained by situational factors (e.g., attainment of basic human needs such as food, money, shelter) | |
| Oppositional defiant disorder (ODD) | N/A | Problematic behaviors must occur with at least one nonsibling individual | Disregards context-specific variables that may promote delinquency |
| Required a pattern of negativistic, hostile, and defiant behavior | Groups symptoms into three types: angry/irritable mood, argumentative/defiant behavior, and vindictiveness | Emphasizes oppositional mood or attitude in addition to behavior; increases likelihood of ODD diagnosis | |
| Required frequency not discussed | Requires that symptoms occur at least once per week | Decreases likelihood of ODD diagnosis for youths who occasionally exhibit oppositional behavior | |
| N/A | Adds severity specifiers (i.e., mild, moderate, severe) based on the number of settings in which symptoms occur | May provide more clinically relevant information and assist in identifying treatment needs | |
| Substance use disorders (SUDs) | Recurrent substance use must contribute to distress or impairment in several situations (e.g., legal problems); separate abuse and dependence criteria | Removes legal difficulties requirement and combines abuse and dependence criteria | May result in overdiagnosis in justice-involved youths, given that changes do not include specifiers that recognize adolescent physiological sensitivity to, and heterogeneous, subtle patterns of, tolerance and withdrawal |
| N/A | Adds “risky use” criterion (“recurrent use in situations in which it is physically hazardous”) | May overemphasize developmentally normative sensation-seeking and experimentation; may result in overdiagnosing SUDs in justice-involved youths | |
| Requires the presence of three symptoms in a 12-month period | Requires the presence of two symptoms in a 12-month period | ||