TPC-Journal-V4-Issue3

The Professional Counselor \Volume 4, Issue 3 211 The DSM-5 contains 10 etiological specifiers (formally referred to as subtypes in the DSM-IV-TR ). The DSM-5 changed the title of the DSM-IV-TR Pick’s disease to frontotemporal lobar degeneration and changed the DSM-IV-TR ’s Creutzfeldt–Jakob disease to Prion disease so as to more objectively communicate the active pathophysiological mechanisms responsible for the neuronal degeneration and resulting cognitive disturbances (APA, 2013). The DSM-5 added Lewy body disease and multiple etiologies as etiological specifiers and merged the DSM-IV-TR dementia due to head trauma and postconcussional disorder (found in Appendix B: Criteria Sets and Axes Provided for Further Study) to become traumatic brain injury (TBI). Counselors will appreciate the table listed on page 626 (APA, 2013) that presents severity ratings for TBI, and will find that Jones, Young, and Leppma’s (2010) article complements the DSM-5 conceptualization of TBI and offers additional assessment and diagnostic assistance. Clinical Scenario Jaxson, a male client in his mid-40s who suffered three TBIs, each resulting from independent automobile accidents, presented for counseling. He presented with post-concussion syndromes reflected in physical symptoms (headaches, dizziness, fatigue, noise/light intolerance, insomnia, nausea, physical weakness), cognitive symptoms (memory complaints, poor concentration), and emotional symptoms (depression, anxiety, irritability, increased aggression, mood lability). Textual additions to the DSM-5 further explained the causal relationship between TBIs and major depressive episodes, facilitating a more accurate clinical formulation. The most salient DSM-5 (APA, 2013) diagnostic guidelines included the following: • With moderate and severe TBI, in addition to persistence of neurocognitive deficits, there may be associated neurophysiological, emotional, and behavioral complications. These may include . . . depression, sleep disturbance, fatigue, apathy, inability to resume occupational and social functioning at pre-injury level, and deterioration in interpersonal relationships. • Moderate and severe TBI have been associated with increased risk of depression. (p. 626) • Individuals with TBI histories report more depressive symptoms, and these can amplify cognitive complaints and worsen functional outcome. (p. 627) • There are clear associations, as well as some neuroanatomical correlates, of depression with . . . traumatic brain injury. (p. 181) Using the DSM-5 ’s Severity Ratings for TBI, three previously administered clinical neuropsychological tests and the DSM-5 ’s Table 1 Neurocognitive Domains, Jaxson received the following dimensional diagnostic formulation per the DSM-5 (APA, 2013): • 293.83 Moderate-severe depressive disorder due to TBI, with major depressive-like episode (p. 181; coding rules require that a mental disorder due to another medical condition be listed first; pp. 22–23); • Moderate-mild disability (87 per self-administered World Health Organization Disability Assessment Schedule [WHODAS] 2.0; pp. 745–748); • 331.83 Probable mild neurocognitive disorder (NCD) due to TBI (pp. 624–627); • V62.29 Other problem related to employment (recent change of job, underemployment and psychosocial stressors related to work due to TBI; p. 723); and • V61.29 Relationship distress with spouse (due to TBI; p. 716). This approach to clinical case formulation also is demonstrated in the assessment and diagnosis of post- traumatic stress disorder and excoriation (skin-picking) disorder.