1. DSM 5 & BSW Education: Why? What? & How Much? Lloyd L. Lyter, Ph.D., LSW Marywood University East Stroudsburg University of PA BPD March 2015 1

2. Why? DSM is the system used to classify mental disorders in the United States Social Workers are the primary providers of mental health services in the United States 2

3. The Primacy of Social Work Mental Health Professionals Social Workers 45% Psychologists 15% Psychiatrists 5% Counseling 23% (SAMHSA 2010) 3

4. What? History of diagnosing – pre-history to today. American Psychiatric Association history of diagnosing. DSM I through DSM 5 4

5. Pre-History Caveman Trepanning Trephination 5

6. Trepanning/Trepanation “Trepanation is perhaps the oldest surgical procedure for which there is forensic evidence, and in some areas may have been quite widespread. Out of 120 prehistoric skulls found at one burial site in France dated to 6500 BC, 40 had trepanation holes.” Wikipedia 6

7. Ancient Civilizations Ancient civilizations described and treated a number of mental disorders. The Greeks coined terms for melancholy, hysteria and phobia and developed the humorism theory. Psychiatric theories and treatments developed in Persia, Arabiamelancholyhysteria phobiahumorism and the Muslim Empire….. from the 8th century, where the first psychiatric hospitals were built. wikipediapsychiatric hospitals 7

8. Late 19 th Century 1874 - -- Emil Kraeplin “…is specifically credited with the classification of what was previously considered to be a unitary concept of psychosis,psychosis into two distinct forms: manic depression, and dementia praecox.” wikipediamanic depressiondementia praecox 8

9. 1840 U.S. Census 1840 Census – “What might be considered the first official attempt to gather information about mental illness in the United States was the recording of the frequency of one category – “idiocy/insanity” in the 1840 census.” DSM IV TR 9

10. 1880 U.S. Census “By the 1880 census, seven categories of mental illness were distinguished – mania, melancholia, monomania, paresis, dementia, dipsomania, and epilepsy.” DSM IV TR 10

11. History of Diagnosing: APA – pre-DSM In 1917, a "Committee on Statistics" from “…..American Psychiatric Association (APA), together with the National Commission on Mental Hygiene, developed a new guide for mental hospitals called the "Statistical Manual for the Use of Institutions for the Insane", which included 22 diagnoses.” DSM IV TR 11

12. History of Diagnosing: DSM I 1952 -- DSM I 106 diagnoses 12

13. History of Diagnosing: DSM II 1968 -- DSM II 182 diagnoses 13

14. History of Diagnosing: DSM III 1980 -- DSM III 265 diagnoses 14

15. History of Diagnosing: DSM III R 1987 -- DSM III R 292 diagnoses 15

16. History of Diagnosing: DSM IV 1994 -- DSM IV 374 diagnoses 16

17. History of Diagnosing: DSM IV TR 2000 -- DSM IV TR 374 diagnoses 17

18. History of Diagnosing: DSM 5 18 May 2013 -- DSM 5 Approximately 374 diagnoses 3 Sections – DSM 5 Basics – Diagnostic Criteria & Codes – Emerging Measures & Models, Cultural Formulation Interview 18

19. How Much? Structure of DSM 5 Changes from DSM IV/IV TR Why the revisions matter Mental Disorders as Medical Conditions Basics of diagnosing – differential diagnosis Diagnostic categories The “spectra” approach “Living Document” 19

20. DSM 5 Revision Principles Changes made for DSM-5 must be implementable in routine specialty practices Continuity with previous editions should be maintained when possible (maintaining good qualities of DSM-IV) Unlike DSM-IV, there were no a priori constraints on the degree of change between DSM-IV and DSM-5 20

21. DSM 5 Revision Principles Development – across the life span Dimensional concepts – measurement of distress, disability, and severity Incorporation of new knowledge – risk factors, prevention, new syndromes “Living document” DSM 5 DSM 5.1 21

22. Why do DSM-5’s Revisions Matter? Revisions are designed to produce more accurate diagnostic criteria and nosology Earlier diagnosis Earlier treatment More accurate treatment 22

23. The Context of Development in DSM-5 Within the diagnostic criteria Examples of how criteria may present in children and adolescents Within the organization of chapters Diagnoses arranged in lifespan fashion, with disorders usually diagnosed earlier in life placed first 23

24. Diagnostic Categories in DSM-5 Revised organization of DSM’s diagnostic categories o Use of dimensions/spectra, as opposed to the categorical approach o The “spectra” approach Autism Spectrum Disorder Schizophrenia Spectrum Disorders 24

25. Highlights of Changes from DSM- IV-TR to DSM 5 Naming and Numbering Convention – e.g. Communication Disorders – Childhood-Onset Fluency Disorder (Stuttering) – 315.35 (F80.81) – Note: Later-onset cases are diagnosed as 307.0 (F98.5) adult-onset fluency disorder. – Everything not in parentheses represents ICD 9 – Everything in parentheses represents ICD 10 – 1 October 2014 25

26. Highlights of Changes from DSM- IV-TR to DSM 5 DSM 5 – Non-axial assessment system – Axes I, II, and III from DSM IV are collapsed into one category – Separate notations for important psychosocial and contextual factors and disability – WHO Disability Assessment Schedule under further study 26

27. Changes re: Children from DSM-IV-TR to DSM 5 Disorders Usually First Diagnosed in Infancy, Childhood, and Adolescence Neurodevelopmental Disorders – Intellectual Disability (Intellectual Developmental Disorder) – Autism Spectrum Disorder – Learning Disorders 27

28. Intellectual Disability (Intellectual Developmental Disorder) The term mental retardation was used in DSM-IV. However, intellectual disability is the term that has come into common use over the past two decades among medical, educational, and other professionals, and by the lay public and advocacy groups. Moreover, a federal statue in the United States (Public Law 111-256, Rosa’s Law) replaces the term “mental retardation with intellectual disability. Despite the name change, the deficits in cognitive capacity beginning in the developmental period, with the accompanying diagnostic criteria, are considered to constitute a mental disorder. 28

29. Personality Disorders Cluster A – Paranoid, Schizoid, Schizotypal Cluster B – Antisocial, Borderline, Histrionic, Narcissistic Cluster C – Avoidant, Dependent, Obsessive-Compulsive Section III – A 6 category model 29

30. Section III Emerging Measures and Models Assessment Measures Cultural Formulation Interview Alternative DSM 5 Model for Personality Disorders Conditions for Further Study 30

31. APA - Major Changes from DSM IV TR to DSM 5 “Highlights of Changes from DSM-IV-TR to DSM-5” – APA document Does not address minor changes in wording in individual sections http://www.dsm5.org/Documents/changes%2 0from%20dsm-iv-tr%20to%20dsm-5.pdf 31

32. The End Comments Question and answer Thank you! 32