The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) includes numerous alterations to specific disorders, as well as fundamental conceptual and organizational changes. The purpose of this article is to review three fundamental conceptual changes in DSM-5: the harmonization of the manual with the International Statistical Classification of Diseases and Related Health Problems, the introduction of spectrum disorders and dimensional ratings, and the new organization of the manual. For each change, potential benefits and shortcomings are discussed in terms of innovation, limitations and clinical implications.
With the advent of the DSM-5 in 2013, the American Psychiatric Association eliminated the longstanding multiaxial system for mental disorders. The removal of the multiaxial system has implications for counselors' diagnostic practices. In this article, the removal of the multiaxial system in the DSM-5 is discussed, and counselor practice suggestions related to each of the five Axes are provided. Additionally, ways in which counselors can sustain their current diagnostic skills while developing updated practices that align with the new streamlined system will be discussed.
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; APA, 2013) continues its 60-year legacy as a standard reference for clinical practice in the mental health field. Six mental health disorders are reviewed with a focus on changes between the DSM-IV-TR and the DSM-5 that represent the new landscape for each of these disorders, respectively. Following the summary of changes, a clinical scenario is presented so that counselors can capture the vision of using the DSM-5 in their counseling practice. Clinical formulation (sample diagnosis) using the DSM-5 is also presented for each disorder classification.
The American Psychiatric Association introduced emerging measures to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) classification system. The authors present a primer on dimensional assessment and a review of the emerging measures endorsed by the American Psychiatric Association. The development of the emerging measures is discussed in light of the 1999 Standards for Educational and Psychological Testing and the DSM-5 criteria, showing that the measures lack conformity to various evidences of validity and lack alignment with the DSM-5 criteria. Hence, counselors should be cautious in the adoption of such measures because the measures may not augment comprehensively the categorical system of diagnosis currently endorsed by the American Psychiatric Association.
Major depressive disorder, bipolar I disorder and schizophrenia are chronic conditions, and adults who have these diagnoses often benefit from mental health treatment throughout their lives. The recent fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) included changes to many diagnoses. Consequently, counselors need to understand the changes and revise their diagnostic practices accordingly. Changes affect new clients being diagnosed for the first time as well as long-term clients who were initially diagnosed many years ago. This manuscript provides an explanation of changes to major depressive disorder, bipolar I disorder and schizophrenia. Case examples illustrate implications for counselors who work with clients who have these three serious and chronic mental illnesses. Counselors, following best practice guidelines and the American Counseling Association's ethical mandate, can take advantage of this opportunity to ensure that clients understand their mental health conditions and that documented diagnoses are accurate and thorough.
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) introduced a chapter titled "Feeding and Eating Disorders," which takes a life-span approach to diagnosing eating disorders and contains all related diagnoses. Rather than appearing throughout the text, all eating disorders are now contained within their own chapter for ease of review and comparison. Changes to the feeding and eating disorders include diagnostic revisions and the addition of several new disorders, including avoidant/restrictive food intake disorder and binge-eating disorder. While pica and rumination disorder remain unchanged, anorexia nervosa and bulimia nervosa experience some criteria changes. There is now a system for classifying the severity of several eating disorders (mild, moderate and severe) and an emphasis on body mass index for the diagnosis of anorexia nervosa. The DSM-5 also attempted to address the number of cases of eating disorders that did not meet criteria in any one category (e.g., eating disorder not otherwise specified), and the authors discuss the result of this attempt in examining two new disorders. This paper examines these changes and addresses clinical implications, while alerting counselors to important diagnostic information.
Trauma survivors are a unique population of clients that represent nearly 80% of clients at mental health clinics and require specialized knowledge on behalf of counselors. Researchers and trauma theorists agree that, with the exception of dissociative identity disorder, no other diagnostic condition in the history of the Diagnostic and Statistical Manual of Mental Disorders (DSM) has created more controversy with respect to the boundaries of the condition, diagnostic criteria, central assumptions and clinical utility than post-traumatic stress disorder. However, this mutable conceptualization of trauma and its aftermath have considerable implications for counseling practice. With the recently released fifth edition of the DSM (DSM-5), the definition of trauma and the diagnostic criteria for post-traumatic stress disorder have changed considerably. This article highlights the changing conceptualization of trauma and how the DSM-5 definition impacts effective practices for assessing, conceptualizing and treating traumatized clients.
The 2013 publication of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) marked the reemergence of issues related to the appropriateness of diagnosis and the uses of the DSM-5 within the counseling profession. Concerns focus on the implications of the DSM-5 for counseling professionals whose professional identity is grounded in a prevention and wellness model, and the impact of the diagnostic process on counseling ethical practice. In this article, the authors explore the use of the DSM-5 in counseling training and practice. The authors also discuss integrating DSM-5 diagnosis into a counselor training framework while maintaining a wellness orientation. Multicultural and strength-based considerations are recommended when using the DSM-5 in counseling training and practice, while maintaining consistency with a philosophical orientation focused on development and wellness and delivering services that are indicative of a unified counseling professional identity.
Let us start with two important disclaimers. First, I will be identifying the many ways that the Diagnostic
and statistical manual of mental disorders (DSM) system has been detrimental to psychotherapy and how the
fifth edition (DSM-5; American Psychiatric Association [APA], 2013) will make the current situation even worse.
However, this does not mean that I consider DSM diagnosis irrelevant to psychotherapy and counseling, nor do
I believe that psychotherapists and counselors should neglect learning about diagnosis. I do not trust therapists
who focus their contact with the client exclusively around the DSM diagnosis. Hippocrates believed that it is
more important to know the person who has the disease than the disease the person has. Nevertheless, I also do
not trust therapists who are completely free-form, impressionistic and idiosyncratic in their approach to clients.
DSM diagnosis is only a small part of what goes into therapy, but it is often a crucial part. We need to know
what makes each person different and unique; on the other hand, we also need to group clients with similar
problems as a way of choosing interventions and predicting the treatment course.