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Psychopathology Review
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 Volume 2, Issue 1, 30-51, 2015
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DSM-5 and the Assessment of Childhood Anxiety Disorders: Meaningful Progress, New Problems, or Persistent Diagnostic Quagmires?

Authors
  Tommy Chou - Florida International University, Department of Psychology
  Danielle Cornacchio - Florida International University, Department of Psychology
  Christine Cooper-Vince - Boston University, Department of Psychology
  Kathleen Crum - Florida International University, Department of Psychology
  Jonathan Comer - Florida International University, Department of Psychology

Volume 2, Issue 1, 2015, Pages 30-51
DOI: http://dx.doi.org/10.5127/pr.036214

Abstract
Having passed the one-year anniversary of the initial DSM-5 publication, this paper presents a guiding summary of key areas of change—and lack thereof—across DSM definitions of disorders affecting anxious youth, and offers data-informed evaluations and commentaries clarifying the areas in which DSM-5 should be celebrated as a meaningful advancement in the assessment of child anxiety, diagnostic dilemmas in child anxiety assessment from previous DSM editions that remain unresolved in DSM-5, and areas in which DSM-5 may have actually introduced new problems into the assessment of child anxiety. We organize our review and commentary around five of the meaningful changes in DSM-5 with implications for the assessment of anxious youth: (1) the new classification of selective mutism as an anxiety disorder; (2) the removal of the social anxiety disorder “generalized” specifier and the new addition of a “performance-only” specifier; (3) the revised operationalization of agoraphobia and the decoupling of agoraphobia from panic disorder; (4) the creation of a new category—disruptive mood dysregulation disorder—for diagnosing youth presenting with chronic irritability and severe temper outbursts; and (5) the revised classification of anxiety disorders not otherwise specified in the DSM. We then turn our attention to discuss four areas of noted diagnostic dilemmas in the assessment of child anxiety from DSM-IV that remain unresolved in the new DSM-5: (1) the phenomenological overlap between the OCD and generalized anxiety disorder (GAD) definitions; (2) the phenomenological overlap between GAD and major depressive disorder (MDD) definitions; (3) differential diagnostic utility across the separation anxiety disorder symptoms; and (4) the extent to which youth presenting with multiple marked and persistent fears should be assigned multiple distinct diagnoses of specific phobia.

Table of Contents
Introduction
Meaningful changes in DSM-5 affecting the classification of anxious youth
 Selective mutism (SM) is now classified as an anxiety disorder
 The social anxiety disorder “generalized” specifier has been removed, and a new “performance-only” specifier has now been added
 Agoraphobia has been decoupled from panic disorder, and the operationalization of agoraphobia has been revised
 A new category—disruptive mood dysregulation disorder (DMDD)—has been introduced to diagnose youth presenting with chronic irritability and severe temper outbursts
 The diagnosis “anxiety disorder not otherwise specified” (ADNOS) has been removed, and two new residual anxiety diagnoses have been added
Persistent diagnostic quagmires in DSM-5 affecting the classification of anxious youth
 OCD and generalized anxiety disorder (GAD) remain difficult to distinguish
 GAD and major depressive disorder (MDD) remain difficult to distinguish
 Separation anxiety disorder (SepAD) symptoms possess differential diagnostic utility properties, yet DSM still conceptualizes each symptom as contributing equally to SepAD diagnosis
 It remains unclear whether youth presenting with multiple marked or persistent fears should be assigned multiple distinct specific phobia diagnoses
Discussion
Acknowledgements
References

Correspondence to
Jonathan S. Comer, Ph.D., Mental Health Interventions and Technology (MINT) Program, Center for Children and Families, Department of Psychology, Florida International University, 11200 S.W. 8th Street, Miami, FL 33199

Keywords
DSM, taxonomy, anxiety, anxiety disorders, assessment

Dates
Received 4 Mar 2014; Revised 19 May 2014; Accepted 29 May 2014; In Press 14 Feb 2015







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