TPC-Journal-V4-Issue3

The Professional Counselor \Volume 4, Issue 3 243 but with additional information a more defined diagnosis is often possible. The DSM-5 authors also called on clinicians to attend carefully to the use of specifiers (e.g., Coryell, 2013; Goldberg, 2013). Many of the revisions to specifiers were made because of the potential impact on client treatment. For example, the presence of anxious distress (as in Martha above) complicates the treatment of depression. Noting the anxious distress in the diagnosis itself brings attention to those symptoms and reduces the likelihood that they will be overlooked. For Martha, it seems that when she is able to rise up out of her depression enough to engage in life, her anxiety surges and discourages her from attempting engagement again. It may be that her anxiety needs to be addressed before she can effectively work on her depression. The DSM-5 authors also cautioned clinicians that one of the limitations of the DSM-IV-TR was that too many diagnostic criteria overlapped, leading to what is called “artificial co-morbidity” (Tandon, 2013). Individuals may be diagnosed with multiple disorders because of shared criteria. For example, a client’s irritability, social withdrawal and anger outbursts may have underlying depression, mania, delusional thinking or anxiety. These are features of bipolar disorder, major depressive disorder, schizoaffective disorder and post-traumatic stress disorder, and the convolution can lead to overdiagnosis and, ultimately, improper treatment. Arriving at more accurate diagnoses quickly will lead to better care for clients, and DSM-5 includes a new tool to help counselors do just that. The Cross-Cutting Symptoms Measures allow a counselor to assess for the presence of symptoms that are related to multiple diagnoses and consider whether a specifier or comorbid diagnosis is appropriate (APA, 2013). Accurate diagnoses also are essential to ongoing research on these and other mental health conditions. Medical record research is increasingly common, particularly with the adoption of electronic medical records and the conglomeration of large managed care companies. That means that the diagnoses counselors record on billing documentation or enter into client medical records are likely to become part of a behind-the-scenes research project. Often these projects use data points such as diagnosis, number of hospitalizations, frequency of outpatient sessions and medication dosages to conduct large-scale analyses of trends or outcomes in treatment. Research like this does not require client or clinician consent because the existing data is anonymized and permission is granted en masse by the organization. Important evidence-based practice recommendations come from this type of study; therefore, using the most accurate documentation, whether the counselor intends to participate in research or not, is important for valid studies. In sum, the DSM-5 has set forth changes in criteria and terminology used to describe major depressive disorder, bipolar I disorder and schizophrenia. Counselors can take advantage of this opportunity to help clients develop a healthy, accurate understanding of their diagnoses. The release of the DSM-5 also is an opportunity to revise diagnoses, paying careful attention to specifiers, in order to adhere to the common language it establishes. Thorough, accurate diagnoses support the selection of effective treatments and ongoing research on the treatment of these conditions. All counselors, supervisors and counselor educators can work together as we address these important goals. Conflict of Interest and Funding Disclosure The author reported no conflict of interest or funding contributions for the development of this manuscript.