TPC-Journal-V4-Issue3

The Professional Counselor \Volume 4, Issue 3 213 • Intrusion symptoms; • Persistent avoidance of stimuli; • Negative alterations in cognitions and mood (new to the DSM-5 ); and • Marked alterations in arousal and reactivity. Fifth, the DSM-IV-TR specifier “delayed onset” is renamed to “delayed expression” in the DSM-5 so as to communicate whether the full diagnostic criteria are not met until at least 6 months after the trauma-causing event (APA, 2013, p. 272). Sixth, “with dissociative symptoms” (Dalenberg & Carlson, 2012) is a new descriptive specifier that can include either depersonalization (e.g., feeling as though one were in a dream; feeling a sense of unreality of self or body or of time moving slowly) or derealization (e.g., the world around the individual is experienced as unreal, dreamlike, distant or distorted; APA, 2013). Seventh, separate diagnostic criterion exist for children ages 6 years and younger. Counselors are encouraged to read van den Heuvel and Seedat (2013) for a detailed review of screening measures and diagnostic instruments for post-traumatic stress disorder in preschool populations. Clinical Scenario Mary, a female in her mid-50s, presented with an extensive history of sexual trauma resulting in post- traumatic stress disorder and excoriation. To verify the presence and severity of her trauma and excoriation, Mary was administered the DSM-5 Level 1 cross-cutting symptom measure. Elevated responses (i.e., feeling nervous, anxious, frightened, worried, or on edge and feeling driven to perform certain behaviors or mental acts over and over again ) triggered administration of the DSM-5 Level 2 cross-cutting symptom measures (i.e., the Repetitive Thoughts and Behaviors Scale, the National Stressful Events Survey PTSD Short Scale, and the Modified Brief Dissociative Experiences Scale). Adhering to the DSM-5 dimensional classification, Mary’s diagnostic formulation was conceptualized in the following format: • 309.81 Moderate post-traumatic stress disorder, with mild depersonalization • 698.4 Excoriation (skin-picking) disorder. This diagnostic formulation contains a layered intensity description as both the disorder and the descriptive specifier have a severity rating; hence promoting clinical utility by informing Mary’s treatment plan and assisting with prognostic and outcome factors (APA, 2013). For example, this level of diagnostic precision targeted Mary’s cognitive, affective and behavioral post-traumatic and depersonalization symptoms individually, rather than globally. Conclusion The DSM-5 represents 12 years of culminating work among hundreds of medical and mental health professionals. The manual was revised in a manner so as to stimulate new clinical perspectives, to promote a new generation of research into the biological markers of mental health disorders and to facilitate more reliable diagnoses of the disorders (APA, 2013). This article presented clinical scenarios from actual clients the author worked with in an outpatient counseling private practice. The intent is that counselors feel more comfortable and confident in their use of the DSM-5 to develop a counseling professional identity that stimulates client growth and development (Erikson & Kress, 2006; King, 2012).