For example, an autism diagnosis will still require “symptoms [that] together limit and impair everyday functioning.” Similarly, proposed criteria for PTSD include “the disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.”

Regier acknowledged to MedPage Today that impairments are part and parcel of some disorders, particularly those defined by neuropsychiatric deficits. But for many categories - especially the personality disorders - functional impairments were transferred from the checklist criteria into the dimensional assessments.

Disruptive Mood Dysregulation Disorder. This is the controversial new designation for children showing persistent foul temper punctuated by bursts of rage. When first proposed, it was widely derided as an attempt to medicalize “toddler tantrums” (even though the criteria clearly stated it was for children older than 5.)

But the workgroup stuck to its guns, although it did drop the name “temper dysregulation with dysphoria” that they had initially proposed.

Autism Spectrum Disorder. This was another controversial move, insofar as it combined Asperger’s syndrome with overt autism, as well as two other DSM-IV categories, into a single disorder. Many in the autism community have been unhappy with the proposal - one member of the workgroup in this area quit in protest - but the remaining members were adamant that the change was justified and that many of the criticisms were simply wrong.

“Craving.” A key innovation in the diagnosis of substance use disorders is a requirement that the patient report or demonstrate craving for the particular substance. Workgroup chairman Charles O’Brien, MD, of the University of Pennsylvania, said this is the key symptom that separates addiction from mere heavy use.

He added that a wealth of recent research has established that craving can be measured - he had hoped that an objective test might be included in the DSM-5 criteria, but his workgroup felt it was not ready quite yet.

Premenstrual Dysphoric Disorder. Promoted from DSM-IV’s appendix to be a full-fledged diagnosis in the depressive disorders family.

Binge Eating Disorder. Promoted from the DSM-IV appendix into the eating disorders.

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By John Gever, Senior Editor, MedPage Today