In this second of our three-part series on the changes to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5), our Boston Social Security Disability Insurance Lawyers continue to parse those details and what they mean for applicants seeking disability benefits.
In our previous entry, we discussed Neurodevelopmental Disorders and Schizophrenia and related disorders.
Here, we want to start with Bipolar and related disorders. The association has relaxed its criteria on bipolar disorder ,which is listed in the Social Security Disability Impairment Section 12.04 Affective Disorders. Now, a diagnosis focuses as much on fluctuations of mood as it does on dramatic changes in energy and activity. Additionally, the requirement that someone with a diagnosis of bipolar I disorder had to meet the full criteria for both a major depressive and mania episode has been removed. There is now a new specifier of “mixed features,” so that a patient doesn’t necessarily need to strictly fit into one category or the other.
Next with regard to Depressive Disorders, DSM-5 actually added a number of new ones, including: disruptive mood dysregulation disorder and premenstrual dysphoric disorder. Additionally, dysthymia, formerly known as a type of neurotic depression, now simply falls under the category of major depressive disorder. This could be good news for dysthymia sufferers, as major depressive disorder is among the specific SSDI impairment listings, while dysthymia is not.
Another interesting change on the subject of Depressive Disorders was the removal of the Bereavement Exclusion. Before, you couldn’t be diagnosed with depression in the two months following the death of a loved one. This criteria was removed, the APA said, to first of all belie the myth that bereavement only lasts two months. (Physicians and grief counselors say it is closer to one to two years.) But secondly, bereavement should be given recognition as a severe psychosocial stressor, which can certainly precipitate a major depressive episode, beginning soon after the loss. This is important for those applying for SSDI on the basis of depression because usually the condition has to have lasted for at least a year. If you have to chop off two months of that time because you lost a loved one right around the time your depression began, that’s more time you have to wait to receive benefits – which isn’t fair.
Next were the changes to the Anxiety Disorders, which are found in Section 12.06 of the Social Security Disability Insurance Impairment Listings. These included Social Phobias, Panic Attacks, Separation Anxiety Disorder and Selective Mutism.
With regard to the social phobias, the APA deleted the requirement that patients over the age of 18 must realize that their anxiety is unreasonable or excessive. This change is based on the fact that most people with these disorders inherently overestimate the dangers associated with these situations. All that is now required is that the anxiety be out of proportion to the actual danger or threat. In one way, it is more restrictive in that it must now last a minimum of six months. That won’t likely affect SSDI applicants, as qualifying for disability benefits means the condition has to have been ongoing for at least a year anyway.
And finally for this entry were the changes made to Obsessive-Compulsive and other related disorders. This includes Body Dysmorphic Disorder, Hoarding Disorder and Substance or Medication-Induced Obsessive Compulsion. Previously, it was a requirement for a diagnosis of obsessive-compulsive disorder that individuals have poor insight into the fact that the condition was delusional. However, that is no longer necessary. Individuals can understand that the condition is not normal, and still have limited power to change it.
These kinds of obsessions can include everything from hoarding trash to pulling out hair to skin picking to hand washing to delusional jealousy.
Many of these conditions can be treated, but sometimes they can’t. When they begin to severely inhibit a person’s ability to work and carry out normal social functions, the patient may qualify for SSDI benefits.
In our final entry on the DSM-5 changes, we’ll focus on Trauma Disorders, Dissociative Disorders, Somatic Symptom Disorders, Eating Disorders, Sleep Disorders and finally Disruptive and Impulse-Control Disorders.
If you are considering filing for SSDI in Boston, call for a free and confidential appointment at (617) 777-7777.
Highlights of Changes from DSM-IV-TR to DSM-5, May 2013, American Psychiatric Association
More Blog Entries:
SSDI for Mental Disorders Involves Complex, Intensive Analysis, May 18, 2013, Boston Social Security Disability Lawyer Blog