TPC-Journal-V4-Issue3

179 The DSM is probably one of the most widely referenced texts in the mental health field. Considering this scope of influence, the release of its latest edition, DSM-5 (American Psychiatric Association [APA], 2013), has garnered considerable interest among professionals, patient advocacy groups and the public alike (Paris, 2013). Reactions have ranged from enthusiastic support (McCarron, 2013) to concern (Welch, Klassen, Borisova, & Clothier, 2013) and even calls to reject the manual’s use outright (Frances, 2013; Frances & Widiger; 2012). The strength of this reaction—both positive and negative—reflects the scope of change. DSM-5 attempts to integrate almost 20 years of burgeoning research in psychopathology, classification and treatment outcomes that have emerged since the publication of DSM-IV (APA, 1994), the last major revision of the manual’s criteria sets. While DSM-5 has made numerous alterations to specific disorders, fundamental conceptual and organizational changes have had the most substantial impact on reshaping the manual (APA, 2013; Regier, Kuhl, & Kupfer, 2013). The purpose of this article is to review three of these fundamental conceptual changes: the harmonization of the manual with the ICD , the introduction of spectrum disorders and dimensional ratings, and the new organization of the manual. For each of these innovations, three questions will be addressed. First, what was the basis for introducing the change as an innovation to the manual? Here the rationale and potential contribution of the change will be discussed. Special attention will be paid to issues such as enhanced diagnostic accuracy, coverage and clinical utility. Second, does the innovation have any potential drawbacks or limitations? For example, to what extent could the innovation contribute to over or underdiagnosis, limit access to treatment, or pose some harm like increased stigmatization? Third, what are the practical consequences of the innovation relative to how clinical mental health counselors provide care for their clients? This section considers the impact on day-to-day practice and how the diagnostic process itself may be transformed. The conclusion section ties these three threads of innovations together and discusses implications for mental health practice in the 21st century. The Professional Counselor Volume 4, Issue 3, Pages 179–190 http://tpcjournal.nbcc.org © 2014 NBCC, Inc. and Affiliates doi:10.15241/ggg.4.3.179 Gary G. Gintner is an Associate Professor of Counselor Education at Louisiana State University, Baton Rouge. Correspondence can be addressed to Gary G. Gintner, 122 Peabody Hall, School of Education, Louisiana State University, Baton Rouge, LA 70803, gintner@lsu.edu . 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. Keywords: DSM-5 , ICD-10 , classification, diagnosis, spectrum disorders Gary G. Gintner DSM-5 Conceptual Changes: Innovations, Limitations and Clinical Implications