DSM-5 disorder

Problems arising in the translation of the name of the section (Substance-Related and Addictive Disorders) are due to the fact that in DSM-5 the term “substance” is used without the usual “psychoactive” (SAA) specification. And although there are certain substantive reasons for this, the literal translation of “substance-related disorders” sounds clearly unsatisfactory. The wording of “substance use disorders” sounds better, but there is still a lack of clarifying definition. What substance? Of course, in almost all cases it is a matter of substances with psychotropic effects, but only in the narrative part of the manual is it indicated mainly in psychoactive substances.

The entire section of substance-related disorders in DSM-5 is proposed to be divided into substance use disorders (Substance Use Disorder),   and disorders induced by this use (Substance-Induced Disorder). At the same time, eating disorders are defined as problematic use, leading to clinically significant harm or distress.

Diagnostic headings in DSM-5

	Disorders associated with the use of surfactants and gambling	Intoxication	The withdrawal syndrome
Alcohol	+	+	+
Caffeine	–	+	+
Cannabis	+	+	+
Hallucinogens (including PCP)	+	+	–
Inhalants	+	+	–
Opioids	+	+	+
Sedatives, hypnotics, anxiolytics	+	+	+
Stimulants	+	+	+
Tobacco	+	–	+
Other/unknown substances	+	+	+
Combined use	–	–	–
Gambling	+	–	+

Instead of individual criteria for abuse and dependence, the DSM-5 has 11 common criteria. At the same time for the diagnosis of the disorder associated with the use of surfactants, you must have at least 2 criteria within 12 months.

1. The substance is often taken in large quantities or for a longer time than anticipated.

2. There is a constant desire or unsuccessful attempt to reduce or control the use of the substance.

3. The amount of time spent searching for, using substances, and overcoming the consequences of intoxication is greatly increased.

4. An irresistible attraction to substance use.

5. Repeated use of substances, leading to a loss of ability to fulfill basic obligations at work, at the place of study, and in the family (absenteeism, deterioration in the quality of work, and declining academic performance).

6. Continuation of the use of the substance, despite the constant or recurring social or interpersonal problems caused or exacerbated by the effects of the substance (family conflicts, quarrels with others, etc.).

7. As a result of the use of substances, important manifestations of social, professional, and leisure activity cease or diminish markedly.

8. Repeated use of the substance in situations involving physical hazards (for example, when driving, resting on water, etc.)

9. The use of substances continues, despite the knowledge of permanent or recurring problems with physical or mental health, caused or aggravated by the ingestion of the substance.

10. Signs of tolerance, determined by any of the following phenomena: a) the need for a marked increase in the amount of substance to achieve intoxication or the desired effect;

b) A marked decrease in the effect when the same amount of substance is used (it does not apply to cases of taking medication under medical supervision).

11. Presence of withdrawal syndrome, manifested by one of the following phenomena: a) the appearance of physical symptoms when the dose is reduced or substance is withdrawn;

b) Use of a substance to alleviate or avoid withdrawal symptoms (does not apply to cases of taking medication under medical supervision).

It is easy to see that the first 4 criteria reflect the loss of control over consumption. In this case, the need to introduce the 4th criterion (an irresistible attraction), which was not in the DSM-IV, was actively challenged.

Personality disorders are a kind of mental disorder that affects how people manage their emotions, behaviors and attitudes. Personality disorders can be diagnosed in 40-60% of cases, and they are characterized by a steady collection of behavioral patterns, often associated with significant personal, social and occupational disorders. This behavior can lead to non-adaptive coping skills and personal problems that cause extreme anxiety, malaise or depression.

1. Paranoid personality disorder
2. Schizoid personality disorder
3. Schizotypal personality disorder
4. Antisocial personality disorder
5. Borderline personality disorder
6. Hysterical personality disorder
7. Narcissistic personality disorder
8. Avoiding personality disorder
9. Dependent personality disorder
10. Obsessive-compulsive personality disorder

The concept of personality disorder itself is much later and tentatively appeared in 1801, described by psychiatrist Philippe, as a state of an outbreak of rage and violence in the absence of any symptoms of psychosis, such as delirium and hallucinations.

According to the Diagnostic and Statistical Manual for the 5th Revision of Mental Disorders (DSM-5), there are ten types of personality disorders, and they can be grouped into three clusters:

Cluster a (unusual, strange, eccentric)

Paranoid, schizoid, schizotypic

Cluster B (dramatic, unstable)

Antisocial, borderline, hysterical, narcissistic

Cluster C (anxious, fearful)

Avoiding, dependent, obsessive-compulsive

A personality disorder is a personality type or behavioral tendency characterized by considerable discomfort and deviations from the norms accepted in the given culture. This is a serious violation of the character’s logical constitution and behavioral tendencies of the individual, involving usually several spheres of the personality and almost always accompanied by personal and social disintegration.

Diagnosis by DSM-IV 

Only when the individual personality traits are not adaptable, not adaptable and lead to a significant deterioration in life, they can be called personality disorder:

1. Internal experience and behavior deviate significantly from the requirements imposed by the culture to which the person belongs, and this manifests itself in two or more of the following areas:
   1. Cognitive (that is, the path of comprehension, interpretation of oneself, other people, or events).
   2. Affective (degree, intensity, liability, and adequacy of emotional reactions).
   3. In the features of the internal functioning of the personality.
   4. In control of impulsivity.
2. Patterns demonstrate inflexibility and extend to a wide range of personal and social situations.
3. Patterns lead to serious clinical distress or problems in the social, professional or another important area of life.
4. Patterns are stable over time and can be traced back to early adolescence or maturity.
5. Patterns cannot be considered a manifestation or consequence of another mental disorder.
6. Patterns are not the result of direct exposure to substances or general health, such as head trauma.

Persons under the age of 18 who meet the criteria cannot be diagnosed with the corresponding disorder. To diagnose at this age, symptoms should be recorded for at least one year. Antisocial personality disorder in general cannot be diagnosed before age 18.