DSM–5

View and Comment on Recently Proposed Changes to DSM–5

The following proposal was approved by the DSM Steering Committee and is being posted for a 45-day public comment period.

Comment Period Opens: July 1, 2019

Comment Period Closes: August 14, 2019

Comment on Proposal

Text Change to the Diagnostic Features Section of Intellectual Disability (Intellectual Developmental Disorder)

Issue

The proposal addressed concerns related to a sentence that appears on page 38 in the Diagnostic Features section of the DSM-5 text regarding Intellectual Disability. The concerning sentence states, "To meet criteria for intellectual disability, the deficits in adaptive functioning must be directly related to the intellectual impairments described in Criterion A." The proposal requested that this sentence be removed from the text due to the belief that the added text has "inadvertently" changed criteria for the disorder. The proposal suggests that the requested change is a "Type 1D Change," involving changes to criteria; however, the substance of the proposal does not involve any change in criteria but rather only removal of text (Type 5). The rationale for the proposed change arises from the fact that the proposal suggests that the objectionable sentence has the potential to limit patients’ access to supports and services, including educational services, and increase the potential for deleterious consequences involving criminal and civil justice symptoms. The data presented to support these concerns arise from a Court of Criminal Appeals (CCA) of Texas decision in 2018. The proposed change is aimed at clarifying the relationship between Criterion A and Criterion B.

The Fix

DSM-5, p. 38:

Criterion B is met when at least one domain of adaptive functioning—conceptual, social, or practical—is sufficiently impaired that ongoing support is needed in order for the person to perform adequately in one or more life settings at school, at work, at home, or in the community. To meet diagnostic criteria for intellectual disability, the deficits in adaptive functioning must be directly related to the intellectual impairments described in Criterion A. Adaptive functioning is understood to be the application of intelligence to functioning in everyday life. Criterion A (deficits in intellectual functions) and Criterion B (deficits in adaptive functions) are related in that the deficits in adaptive functioning are a consequence of intellectual deficits defined in Criterion A and are not the result of a co-occurring DSM-5 mental disorder. Criterion C, onset during the developmental period, refers to recognition that intellectual and adaptive deficits are present during childhood or adolescence.

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