TPC-Journal-V4-Issue3

The Professional Counselor \Volume 4, Issue 3 160 DSM-5 task force, which submitted position statements and recommendations to the APA. Various mental health professionals participated directly in the formulation of the DSM-5 , primarily in field trials which “supplied valuable information about how proposed revisions performed in everyday clinical settings” (p. 8). Much of the data supports the use of more than 60 cross-cutting and severity symptom measures (see http://www.psychiatry. org/practice/dsm/dsm5/online-assessment-measures ) . Clinical Utility First (2010) reported that utilizing broad and diverse populations of mental health professionals provides rigor for clinical utility. Achieving clinical utility within the DSM diagnostic processes meets the following four objectives: 1. to help clinicians communicate clinical information to other practitioners, to patients and their families, and to health care systems administrators; 2. to help clinicians implement effective interventions in order to improve clinical outcomes; 3. to help clinicians predict the future in terms of clinical management needs and likely outcomes; and 4. to help clinicians differentiate disorder from non-disorder for the purpose of determining who might benefit from disorder-based treatments. (First, 2010, p. 466) Any changes to the DSM were framed within the context of how they might be utilized by all mental health professionals, including revisions to definitions of diagnoses and symptoms, proposed diagnostic categories, dimensional assessment (including cross-cutting ), and a renewed emphasis on severity specifiers. Ultimately, the consideration was whether the revised manual would be accepted and utilized by the practitioners it proposed to serve (APA, 2013; First, 2010). First (2010) noted that no mandate exists requiring the use of the DSM by any professional, and that other tools used to arrive at an ICD diagnosis exist or are in development (e.g., the NIMH Research Domain Criteria initiative; APA, 2013; Nussbaum, 2013). The DSM-5 workgroups were challenged to revise the manual in order to make it user-friendly and maintain its relevance among mental health professionals. Even though the manual is an imperfect resource, the goal was to enhance clinical utility. Determining a Differential Diagnosis In his primer on diagnostic assessment focused on the DSM-5 , Nussbaum (2013) offers six considerations in determining a differential diagnosis that serve as an important basis for practice. These considerations or steps include the following: • to what extent signs and symptoms may be intentionally produced; • to what extent signs and symptoms are related to substances; • to what extent signs and symptoms are related to another medical condition; • to what extent signs and symptoms are related to a developmental conflict or stage; • to what extent signs and symptoms are related to a mental disorder; and • whether no mental disorder is present. Each of these process steps serves as important reminders for getting back to the basics of rendering diagnoses that help inform treatment. When working with clients, these steps function as points of reference to rule out potential factors influencing misdiagnosis. Additionally, client cultural factors are essential at capturing comprehensive context for assessment and diagnosis. Consider to what extent signs and symptoms may be intentionally produced . Signs and symptoms may be purposely feigned on the part of a client for secondary gain (e.g., financial benefits, drug seeking, disability status, attention from others, reinforcement of an identity of pathology, avoiding incarceration). Counselors