TPC-Journal-V4-Issue3

The Professional Counselor \Volume 4, Issue 3 168 editions (APA, 2014a). APA released an initial research agenda focused on nomenclature, neuroscience, developmental science, personality disorders, and the relationship between culture and psychiatric diagnoses (APA, 2000; Kupfer, First, & Regier, 2002). The APA, the National Institute of Mental Health (NIMH), and the WHO held 13 conferences between 2004 and 2008 in which stakeholders discussed relevant diagnostic questions and solicited feedback regarding potential changes in nosology. Resulting themes facilitated the research base and fueled the agenda of the DSM-5 working groups (see Kupfer et al., 2002 for the full DSM-5 research agenda). In 2007, the APA officially commissioned the DSM-5 Task Force, made up of 29 members including David J. Kupfer, M.D., Chair; and Darrel A. Regier, M.D., M.P.H., Vice-Chair (APA, 2014a). Kupfer and Regier provided clear direction to eradicate the use of NOS diagnoses, eliminate functional impairment as necessary components of diagnostic criteria, and use empirically based evidence to justify diagnostic revisions (Gever, 2012; Reiger, Narrow, Kuhl, & Kupfer, 2009). With these marching orders, each working group proposed draft criteria and justification for changes. Between April 2010 and June 2012, the DSM-5 Task Force facilitated three rounds of public comment and two field trials (Clarke et al., 2013; Jones, 2012a; Narrow et al., 2013; Regier et al., 2013). The APA Board of Trustees reviewed final revisions in December 2012 and published the DSM-5 in May 2013. Although no professional counselors were invited to serve on the DSM-5 Task Force, several professional counseling associations served as important advocates during the revision process (Dailey, Gill, Karl, & Barrio Minton, 2014). Major Structural Changes The general format of the DSM-5 (APA, 2013) is quite different from that of the DSM-IV-TR (APA, 2000). Although roughly the same number of disorders is included in both editions, structural similarities end here. The DSM-5 (APA, 2013) includes three major sections, revised chapter organization, cross-cutting symptom and severity measures, adoption of a nonaxial system and enhanced coverage of cultural considerations (Dailey et al., 2014). As with previous versions, the text includes a number of appendices related to terminology and coding. Section I: DSM-5 Basics Section I of the new manual includes an introduction to the DSM-5 (APA, 2013) and general instructions on how to use the updated manual, including attention to nonaxial diagnosis and coding considerations. Counselors who diagnose in accordance with the DSM-IV-TR (2000) may be surprised to see that the APA eliminated both the multiaxial classification system and the Global Assessment of Functioning (GAF) scale. Never required for diagnosis, the APA removed the multiaxial system on the premise that it may lead to inaccurate, oversimplified conceptualization regarding complexities of physical, biological and emotional concerns. Furthermore, removal of the GAF was due to claims of insufficient clinical utility and reliability. Less radical structural changes discussed in Section I include harmonization of language with the forthcoming ICD-11 . The DSM-5 (APA, 2013) incorporates two sets of ICD codes: ICD-9 codes (for immediate use, presented in black print) alongside ICD-10 codes (for use upon nationwide conversion to ICD-10-CM coding expected October 1, 2015, presented in parentheses and in gray print). In addition, authors address consideration for implementing new other specified and unspecified disorder criteria, which present more specific alternatives to previous NOS diagnoses.