DSM-5 in the context of Delayed ejaculation


DSM-5 in the context of Delayed ejaculation

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⭐ Core Definition: DSM-5

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), is the 2013 update to the Diagnostic and Statistical Manual of Mental Disorders, the taxonomic and diagnostic tool published by the American Psychiatric Association (APA). In 2022, a revised version (DSM-5-TR) was published. In the United States, the DSM serves as the principal authority for psychiatric diagnoses. Treatment recommendations, as well as payment by health insurance companies, are often determined by DSM classifications, so the appearance of a new version has practical importance. However, some providers instead rely on the International Statistical Classification of Diseases and Related Health Problems (ICD), and scientific studies often measure changes in symptom scale scores rather than changes in DSM-5 criteria to determine the real-world effects of mental health interventions. The DSM-5 is the only DSM to use an Arabic numeral instead of a Roman numeral in its title, as well as the only living document version of a DSM.

The DSM-5 is not a major revision of the DSM-IV-TR, but the two have significant differences. Changes in the DSM-5 include the re-conceptualization of Asperger syndrome from a distinct disorder to an autism spectrum disorder; the elimination of subtypes of schizophrenia; the deletion of the "bereavement exclusion" for depressive disorders; the renaming and reconceptualization of gender identity disorder to gender dysphoria; the inclusion of binge eating disorder as a discrete eating disorder; the renaming and reconceptualization of paraphilias, now called paraphilic disorders; the removal of the five-axis system; and the splitting of disorders not otherwise specified into other specified disorders and unspecified disorders.

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DSM-5 in the context of Agoraphobic

Agoraphobia is an anxiety disorder characterized by symptoms of anxiety in situations where the person perceives their environment to be unsafe with no way to escape. These situations can include public transit, shopping centers, crowds and queues, or simply being outside their home on their own. Being in these situations may result in a panic attack. Those affected will go to great lengths to avoid these situations. In severe cases, people may become completely unable to leave their homes.

Agoraphobia is believed to be due to a combination of genetic and environmental factors. The condition often runs in families, and stressful or traumatic events such as the death of a parent or being attacked may be a trigger. In the DSM-5, agoraphobia is classified as a phobia along with specific phobias and social phobia. Other conditions that can produce similar symptoms include separation anxiety, post-traumatic stress disorder, and major depressive disorder. The diagnosis of agoraphobia has been shown to be comorbid with depression, substance abuse, and suicidal ideation.Without treatment, it is uncommon for agoraphobia to resolve. Treatment is typically with a type of counselling called cognitive behavioral therapy (CBT). CBT results in resolution for about half of people. In some instances, those with a diagnosis of agoraphobia have reported taking benzodiazepines and antipsychotics. Agoraphobia affects about 1.7% of adults. Women are affected about twice as often as men. The condition is rare in children, often begins in adolescence or early adulthood, and becomes more common at age 65 or above.

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DSM-5 in the context of Abnormality (behavior)

In psychology, abnormality (also dysfunctional behavior, maladaptive behavior, or deviant behavior) is a behavioral characteristic assigned to those with conditions that are regarded as dysfunctional. Behavior is considered to be abnormal when it is atypical or out of the ordinary, consists of undesirable behavior, and results in impairment in the individual's functioning. As applied to humans, abnormality may also encompass deviance, which refers to behavior that is considered to transgress social norms. The definition of abnormal behavior in humans is an often debated issue in abnormal psychology.

Abnormal behavior should not be confused with unusual behavior. Behavior that is out of the ordinary is not necessarily indicative of a mental disorder. Abnormal behavior, on the other hand, while not a mental disorder in itself, is often an indicator of a possible mental or psychological disorder. A psychological disorder is defined as an "ongoing dysfunctional pattern of thought, emotion, and behavior that causes significant distress, and is considered deviant in that person's culture or society". Abnormal behavior, as it relates to psychological disorders, would be "ongoing" and a cause of "significant distress". A mental disorder describes a patient who has a medical condition whereby the medical practitioner makes a judgment that the patient is exhibiting abnormal behavior based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria. Thus, simply because a behavior is unusual it does not make it abnormal; it is only considered abnormal if it meets these criteria. The DSM-5 is used by both researchers and clinicians in diagnosing a potential mental disorder. The criteria needed to be met in the DSM-5 vary for each mental disorder.

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DSM-5 in the context of Panic attack

Panic attacks are sudden periods of intense fear and discomfort that may include palpitations, otherwise defined as a rapid, irregular heartbeat, sweating, chest pain or discomfort, shortness of breath, trembling, dizziness, numbness, confusion, or a sense of impending doom or loss of control. Typically, these symptoms are the worst within ten minutes of onset and can last for roughly 30 minutes, though they can vary anywhere from seconds to hours. While they can be extremely distressing, panic attacks themselves are not physically dangerous.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) defines them as "an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes and during which time four or more of the following symptoms occur." These symptoms include, but are not limited to, the ones mentioned above.

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DSM-5 in the context of Specific phobia

Specific phobia is an anxiety disorder, characterized by an extreme, unreasonable, and irrational fear associated with a specific object, situation, or concept which poses little or no actual danger. Specific phobia can lead to avoidance of the object or situation, persistence of the fear, and significant distress or problems functioning associated with the fear. A phobia can be a fear of anything.

Although fears are common and normal, a phobia is an extreme type of fear where great lengths are taken to avoid being exposed to the particular danger. Phobias are considered the most common psychiatric disorder, affecting about 10% of the population in the US, according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), (among children, 5%; among teens, 16%). About 75% of patients have more than one specific phobia.

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DSM-5 in the context of Dementia

Dementia is a syndrome associated with many neurodegenerative diseases, characterized by a general decline in cognitive abilities that affects a person's ability to perform everyday activities. This typically involves problems with memory, thinking, behavior, and motor control. Aside from memory impairment and a disruption in thought patterns, the most common symptoms of dementia include emotional problems, difficulties with language, and decreased motivation. The symptoms may be described as occurring in a continuum over several stages. Dementia is a life-limiting condition, having a significant effect on the individual, their caregivers, and their social relationships in general. A diagnosis of dementia requires the observation of a change from a person's usual mental functioning and a greater cognitive decline than might be caused by the normal aging process.

Several diseases and injuries to the brain, such as a stroke, can give rise to dementia. However, the most common cause is Alzheimer's disease, a neurodegenerative disorder. Dementia is a neurocognitive disorder with varying degrees of severity (mild to major) and many forms or subtypes. Dementia is an acquired brain syndrome, marked by a decline in cognitive function, and is contrasted with neurodevelopmental disorders. It has also been described as a spectrum of disorders with subtypes of dementia based on which known disorder caused its development, such as Parkinson's disease for Parkinson's disease dementia, Huntington's disease for Huntington's disease dementia, vascular disease for vascular dementia, HIV infection causing HIV dementia, frontotemporal lobar degeneration for frontotemporal dementia, Lewy body disease for dementia with Lewy bodies, and prion diseases. Subtypes of neurodegenerative dementias may also be based on the underlying pathology of misfolded proteins, such as synucleinopathies and tauopathies. The coexistence of more than one type of dementia is known as mixed dementia.

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DSM-5 in the context of Substance dependence

Substance dependence, also known as drug dependence, is a biopsychological situation whereby an individual's functionality is dependent on the necessitated re-consumption of a psychoactive substance because of an adaptive state that has developed within the individual from psychoactive substance consumption that results in the experience of withdrawal and that necessitates the re-consumption of the drug. A drug addiction, a distinct concept from substance dependence, is defined as compulsive, out-of-control drug use, despite negative consequences. An addictive drug is a drug which is both rewarding and reinforcing. ΔFosB, a gene transcription factor, is now known to be a critical component and common factor in the development of virtually all forms of behavioral and drug addictions, but not dependence.

The International Classification of Diseases classifies substance dependence as a mental and behavioural disorder. In the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (released in 2013), substance abuse and substance dependence were eliminated and replaced with the single diagnosis of substance use disorders. This was done because "the tolerance and withdrawal that previously defined dependence are actually very normal responses to prescribed medications that affect the central nervous system and do not necessarily indicate the presence of an addiction."

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DSM-5 in the context of Alcohol dependence

Alcohol dependence is a previous (DSM-IV and ICD-10) psychiatric diagnosis in which an individual is physically or psychologically dependent upon alcohol (also chemically known as ethanol).

In 2013, it was reclassified as alcohol use disorder in DSM-5, which combined alcohol dependence and alcohol abuse into this diagnosis.

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DSM-5 in the context of Conversion disorder

Conversion disorder (CD) was a formerly diagnosed psychiatric disorder characterized by abnormal sensory experiences and movement problems during periods of high psychological stress. Individuals diagnosed with CD presented with highly distressing neurological symptoms such as numbness, blindness, paralysis, or convulsions, none of which were consistent with a well-established organic cause and could be traced back to a psychological trigger. CD is no longer a diagnosis in the WHO's ICD-11 or APA's DSM-5 and was superseded by functional neurologic disorder (FND), a similar diagnosis that notably removed the requirement for a psychological stressor to be present.

It was thought that these symptoms arise in response to stressful situations affecting a patient's mental health. Individuals diagnosed with conversion disorder have a greater chance of experiencing certain psychiatric disorders including anxiety disorders, mood disorders, and personality disorders compared to those diagnosed with neurological disorders.

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DSM-5 in the context of Compulsive buying disorder

Compulsive buying disorder (CBD) is characterized by an obsession with shopping and buying behavior that causes adverse consequences. It "is experienced as a recurring, compelling and irresistible–uncontrollable urge, in acquiring goods that lack practical utility and very low cost resulting in excessive, expensive and time-consuming retail activity [that is] typically prompted by negative affectivity" and results in "gross social, personal and/or financial difficulties". Most people with CBD meet the criteria for a personality disorder. Compulsive buying can also be found among people with Parkinson's disease or frontotemporal dementia.

Compulsive buying-shopping disorder is classified by the ICD-11 among "other specified impulse control disorders". Several authors have considered compulsive shopping rather as a variety of dependence disorder. The DSM-5 did not include compulsive buying disorder in its chapter concerning substance-related and addictive disorders, since there is "still debate on whether other less recognized forms of impulsive behaviors, such as compulsive buying [...] can be conceptualized as addictions."

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DSM-5 in the context of Problem gambling

Problem gambling, also known as pathological gambling, gambling disorder, or ludomania, is repetitive gambling behavior despite harm and negative consequences. Problem gambling may be diagnosed as a mental disorder according to DSM-5 if certain diagnostic criteria are met. Pathological gambling is a common disorder associated with social and family costs.

The DSM-5 has re-classified the condition as an addictive disorder, with those affected exhibiting many similarities to those with substance addictions. The term gambling addiction has long been used in the recovery movement. Pathological gambling was long considered by the American Psychiatric Association to be an impulse-control disorder rather than an addiction. However, data suggests a closer relationship between pathological gambling and substance use disorders than exists between PG and obsessive–compulsive disorder, mainly because the behaviors in problem gambling and most primary substance use disorders (i.e., those not resulting from a desire to "self-medicate" for another condition such as depression) seek to activate the brain's reward mechanisms, while the behaviors characterizing obsessive–compulsive disorder are prompted by overactive and misplaced signals from the brain's fear mechanisms.

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DSM-5 in the context of Neurodevelopmental disorder

Neurodevelopmental disorders are a group of mental conditions negatively affecting the development of the nervous system, which includes the brain and spinal cord. According to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) published in 2013, these conditions generally appear in early childhood, usually before children start school, and can persist into adulthood. The key characteristic of all these disorders is that they negatively impact a person's functioning in one or more domains of life (personal, social, academic, occupational) depending on the disorder and deficits it has caused. All of these disorders and their levels of impairment exist on a spectrum, and affected individuals can experience varying degrees of symptoms and deficits, despite having the same diagnosis.

The DSM-5 classifies neurodevelopmental disorders into six overarching groups: intellectual, communication, autism, attention deficit hyperactivity, motor, and specific learning disorders. Often one disorder is accompanied by another.

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DSM-5 in the context of Pornography addiction

Pornography addiction is the scientifically controversial application of an addiction model to the use of pornography. Pornography use may be part of compulsive behavior, with negative consequences to one's physical, mental, social, or financial well-being. While the World Health Organization's ICD-11 (2022) has recognized compulsive sexual behavior disorder (CSBD) as an impulse-control disorder, CSBD is not an addiction, and the American Psychiatric Association's DSM-5 and the DSM-5-TR do not classify compulsive pornography consumption as a mental disorder or a behavioral addiction.

Problematic Internet pornography viewing, also known as problematic pornography use (PPU), is the viewing of Internet pornography that is problematic for an individual due to personal or social reasons, including the excessive time spent viewing pornography instead of interacting with others and the facilitation of procrastination. Individuals may report depression, social isolation, career loss, decreased productivity, or financial consequences as a result of their excessive Internet pornography viewing impeding their social lives.

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DSM-5 in the context of Child psychopathology

Child psychopathology refers to the scientific study of mental disorders in children and adolescents. Oppositional defiant disorder, attention-deficit hyperactivity disorder, and autism spectrum disorder are examples of psychopathology that are typically first diagnosed during childhood. Mental health providers who work with children and adolescents are informed by research in developmental psychology, clinical child psychology, and family systems. Lists of child and adult mental disorders can be found in the International Statistical Classification of Diseases and Related Health Problems, 10th Edition (ICD-10), published by the World Health Organization (WHO) and in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), published by the American Psychiatric Association (APA). In addition, the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC: 0-3R) is used in assessing mental health and developmental disorders in children up to age five.

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DSM-5 in the context of Schizophrenia

Schizophrenia is a mental disorder characterized variously by hallucinations (typically, hearing voices), delusions, disorganized thinking or behavior, and flat or inappropriate affect. Symptoms develop gradually and typically begin during young adulthood and rarely resolve. There is no objective diagnostic test; diagnosis is based on observed behavior, a psychiatric history that includes the person's reported experiences, and reports of others familiar with the person. For a formal diagnosis, the described symptoms need to have been present for at least six months (according to the DSM-5) or one month (according to the ICD-11). Many people with schizophrenia have other mental disorders, especially mood, anxiety, and substance use disorders, as well as obsessive–compulsive disorder (OCD).

About 0.3% to 0.7% of people are diagnosed with schizophrenia during their lifetime. In 2017, there were an estimated 1.1 million new cases and in 2022 a total of 24 million cases globally. Males are more often affected and on average have an earlier onset than females. The causes of schizophrenia may include genetic and environmental factors. Genetic factors include a variety of common and rare genetic variants. Possible environmental factors include being raised in a city, childhood adversity, cannabis use during adolescence, infections, the age of a person's mother or father, and poor nutrition during pregnancy.

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DSM-5 in the context of Intellectual disability

Intellectual disability (ID), also known as general learning disability (in the United Kingdom), and formerly mental retardation (in the United States), is a generalized neurodevelopmental disorder characterized by significant impairment in intellectual and adaptive functioning that is first apparent during childhood. Children with intellectual disabilities typically have an intelligence quotient (IQ) below 70 and deficits in at least two adaptive behaviors that affect everyday living. According to the DSM-5, intellectual functions include reasoning, problem solving, planning, abstract thinking, judgment, academic learning, and learning from experience. Deficits in these functions must be confirmed by clinical evaluation and individualized standard IQ testing. On the other hand, adaptive behaviors include the social, developmental, and practical skills people learn to perform tasks in their everyday lives. Deficits in adaptive functioning often compromise an individual's independence and ability to meet their social responsibility.

Intellectual disability is subdivided into syndromic intellectual disability, in which intellectual deficits associated with other medical and behavioral signs and symptoms are present, and non-syndromic intellectual disability, in which intellectual deficits appear without other abnormalities. Down syndrome and fragile X syndrome are examples of syndromic intellectual disabilities.

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DSM-5 in the context of Hypersomnia

Hypersomnia is a neurological disorder of excessive time spent sleeping or excessive sleepiness. It can have many possible causes (such as seasonal affective disorder) and can cause distress and problems with functioning. In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), hypersomnolence, of which there are several subtypes, appears under sleep-wake disorders.

Hypersomnia is a pathological state characterized by a lack of alertness during the waking episodes of the day. It is not to be confused with fatigue, which is a normal physiological state. Daytime sleepiness appears most commonly during situations where little interaction is needed.

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DSM-5 in the context of Dysthymia

Dysthymia (/dɪsˈθmiə/ dihss-THY-mee-ə), known as persistent depressive disorder (PDD) in the DSM-5-TR and dysthymic disorder in ICD-11, is a psychiatric condition marked by symptoms that are similar to those of major depressive disorder, but which persist for at least two years in adults and one year among pediatric populations. The term was introduced by Robert Spitzer in the late 1970s as a replacement for the concept of "depressive personality."

With the DSM-5's publication in 2013, the condition assumed its current name (i.e., PDD), having been called dysthymic disorder in the DSM's previous edition (DSM-IV), and remaining so in ICD-11. PDD is defined by a 2-year history of symptoms of major depression not better explained by another health condition, as well as significant distress or functional impairment.

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DSM-5 in the context of Anorexia nervosa

Anorexia nervosa (AN), often referred to simply as anorexia, is an eating disorder characterized by food restriction, body image disturbance, fear of gaining weight, and an overpowering desire to be thin.

Individuals with anorexia nervosa have a fear of being overweight or being seen as such, despite the fact that they are typically underweight. The DSM-5 describes this perceptual symptom as "disturbance in the way in which one's body weight or shape is experienced". In research and clinical settings, this symptom is called "body image disturbance" or body dysmorphia. Individuals with anorexia nervosa may also deny that their symptoms or behaviors are indicative of illness. They may weigh themselves frequently, eat small amounts, and only eat certain foods. Some patients with anorexia nervosa binge eat and purge to influence their weight or shape. Purging can manifest as induced vomiting, excessive exercise, and/or laxative abuse. Medical complications may include osteoporosis, infertility, and heart damage, along with the cessation of menstrual periods. Complications in men may include lowered testosterone. In cases where the patients with anorexia nervosa continually refuse significant dietary intake and weight restoration interventions, a psychiatrist can declare the patient to lack capacity to make decisions. Then, these patients' medical proxies decide that the patient needs to be fed by restraint via nasogastric tube.

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DSM-5 in the context of Sexual dysfunction

Sexual dysfunction is difficulty experienced by an individual or partners during any stage of normal sexual activity, including physical pleasure, desire, preference, arousal, or orgasm. The World Health Organization defines sexual dysfunction as a "person's inability to participate in a sexual relationship as they would wish". This definition is broad and is subject to many interpretations. A diagnosis of sexual dysfunction under the DSM-5 requires a person to feel extreme distress and interpersonal strain for a minimum of six months (except for substance- or medication-induced sexual dysfunction). Sexual dysfunction can have a profound impact on an individual's perceived quality of sexual life. The term sexual disorder may not only refer to physical sexual dysfunction, but to paraphilias as well; this is sometimes termed disorder of sexual preference.

A thorough sexual history and assessment of general health and other sexual problems (if any) are important when assessing sexual dysfunction, because it is usually correlated with other psychiatric issues, such as mood disorders, eating and anxiety disorders, and schizophrenia. Assessing performance anxiety, guilt, stress, and worry are integral to the optimal management of sexual dysfunction. Many of the sexual dysfunctions that are defined are based on the human sexual response cycle proposed by William H. Masters and Virginia E. Johnson, and modified by Helen Singer Kaplan.

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