Making Sense of the DSM-5: Changes and Changing Perspectives

Name: Making Sense of the DSM-5: Changes and Changing Perspectives
Uploaded: 2017-10-17T08:42:54+00:00
Duration: PTM31S58
Channel: Elfreda Newman
Description: Making Sense of the DSM-5: Changes and Changing Perspectives

Making Sense of the DSM-5: Changes and Changing Perspectives
Chasity S. Norris, MLT, MA, FDEX, NCC

Making Sense of the DSM-5
This workshop is designed to cover the basic changes and practical implications of the DSM-5 regarding mental health assessment treatment planning, and evidence-based practice strategy. Particular emphasis is placed on understanding the rationale for the changes and the implications these changes can have on developing best practices. An overview of selected diagnostic categories will be reviewed stressing assessment as it is linked to behavior-based practice strategy. Copyright Chasity Norris

Copyright 2013 Chasity Norris
Who is Your Speaker? Chasity S. Norris, MLT, FDEX, MA, NCC, has a love for therapy and teaching, and has found ways to combine those passions, in ways she hopes will be as meaningful to others as they are to her. She delivers practical information in an entertaining, fast-paced style that is often filled with examples from her experiences both in the classroom, and in mental health. She attended East Tennessee State University from , receiving degrees in the areas of medical laboratory technology, epidemiology, forensic document examination, criminology, and counseling. She has published research and education training manuals including: Psychopathy and Gender: A Comparison Using the PCL-R, and Ethics in Policing: Instructor’s Manual 6th ed. Her research includes investigations of psychopathy, personality disorders, deviant behaviors, stress and coping, and dialectical behavior therapy. Chasity Norris is currently an adjunct professor of criminology at East Tennessee State University, and primary therapist at the Crisis Stabilization Unit in Johnson City, Tennessee. Copyright Chasity Norris

What Is The DSM Used For? –“Primarily designed to assist clinicians in conducting clinical assessment, case formulation, and treatment planning” (pg. 25, DSM-5) To help professionals understand the problem(s) and know how to treat the client. Diagnostic guidelines also provide some criteria for future mental disorder research. Copyright Chasity Norris

Why a New Edition? We have begun to be more mindful of the language we use to describe our clients in order to help influence the way we think about our clients, the way society thinks about our clients, and ultimately, the way our clients view themselves. The diagnosis we apply, often become “labels’ that can help mold perceptions in positive ways, or negative ways, depending on their intention and delivery. Copyright Chasity Norris

Why a New Edition? This can influence a client’s willingness to seek help. If a client is fearful of certain diagnoses, or more appropriately, of being “labeled” with a certain disorder, they can be much less likely to seek help when needed. Copyright Chasity Norris

Why a New Edition? This issue is one of the driving forces behind the movement for a new edition. The DSM-5 now includes many updated diagnostic names that are more sensitive and less stigmatic than previous editions. Ex. (“Mental Retardation” is now titled (“Intellectual Disorder”) Copyright Chasity Norris

Why a New Edition? There has been widely inconsistent use of the multiaxial system previously used in the DSM-IV-TR. The DSM must consider as many conditions as possible because insurance companies will not reimburse for conditions not listed in the DSM’s ICD. This factor was a huge influence on the task forces decision to include some previously omitted disorders such as: Gender Dysphoria (previously Gender Identity Disorder) Gambling Disorder Copyright Chasity Norris

Why a New Edition? More effective and thorough in judicial proceedings to determine insanity, and competence to stand trial. Aid in determining disabilities for protection against discrimination in the workplace, or for accessing accommodations in work or school settings. Ability to aid in research for medications geared toward specific disorders. Copyright Chasity Norris

Brief History 28 member task force created in 2007, and worked in working groups for 6 years. Guided by the ideas that the new edition had to be useful for routine clinical practice, and any new changes had to be guided by research evidence. APA developed website in 2010 to gather input from the public and other professionals. Final approval for publication in December 2012 Copyright Chasity Norris

Cultural Concerns Addressed
Section III now contains tools for extensive cultural assessment. Topic of Culture Bound Syndromes addressed Describes three types of culture-bound syndromes: Copyright Chasity Norris

Cultural Syndrome- group of symptoms found in specific cultural groups that are not recognized as illness within the culture, but is recognizable to outside observers. Cultural Idiom of Distress- way of talking about suffering among individuals within a group . (“I’ve got nerves”) Cultural Explanations or Perceived Cause- model that provides a culturally determined etiology. Copyright Chasity Norris

Why a New Edition? To be more culturally aware and considerate Stay current with research Ability to integrate information with social networking DSM-5 online subscription: *Also have E-Book and Mobile App Copyright Chasity Norris

Changes from DSM-IV-TR To DSM-5
Copyright Chasity Norris

Major Structural Changes: Discontinuation of Multiaxial System
Axis I: Clinical Disorders Other Conditions that May Be a Focus of Clinical Attention Axis II: Personality Disorders Mental Retardation Axis III: General Medical Conditions Axis IV: Psychosocial & Environmental Problems Axis V: Global Assessment of Functioning Copyright Chasity Norris

Discontinuation of Multiaxial System
Instead of using the prior system of organization, the DSM-5 actually combines the first three axes (mental disorders, intellectual disabilities, and personality disorders) into section II. They are now all regarded as equally important in achieving a correct diagnosis, so they are listed together, in the particular order the clinician feels they are affecting the client. Copyright Chasity Norris

The axis system was originally used to separate out the disorders that had been heavily researched and confirmed (organic disorders) from those needing more research to be acknowledged (personality disorders), however, the APA now agrees there is no fundamental difference between the disorders on Axis I and Axis II. Copyright Chasity Norris

Section II also contains much of the information formerly listed under Axis IV. Any of the environmental factors or other conditions in life that could hinder treatment are now listed at the end of this section, instead of being separated. The rational for this change is that all of these factors are equally important when making and treating a specific diagnosis, so they should all be listed and considered together, forming a more holistic picture of the presenting issues. Copyright Chasity Norris

Global Assessment Functioning Score (GAF) dropped completely from DSM-5 Physicians and Clinicians are still encouraged to assess suicidal and homicidal behavior with standard assessments for severity, according to symptoms. Disability now measured using the World Health Organization’s Disability Assessment Schedule (WHODAS). Can also use other information under section III of DSM-5 Copyright Chasity Norris

Integrational Approach to Diagnosis
Rather than the prior Axis system, the new chapter order is organized in “Clusters”. This allows for disorders that are relatable or share similar symptoms and characteristics to be looked at together. Copyright Chasity Norris

Neurodevelopmental Cluster
This includes all Neurodevelopmental Disorders and Schizophrenia Spectrum & Psychotic Disorders Copyright Chasity Norris

Internalizing Cluster
Includes: Bipolar Disorder Depressive Disorder Obsessive-Compulsive and Related Disorders Anxiety Disorder Trauma & Stressor Disorders Dissociative Disorder Copyright Chasity Norris

Somatic Cluster Includes: Somatic Symptom Disorders Feeding & Eating Disorders Gender Dysphoria Sexual Dysfunctions Elimination Disorders Sleep Disorders Copyright Chasity Norris

Externalizing Cluster
Disruption, Conduct, and Impulse-Control Disorders Substance and Addictive Disorders Copyright Chasity Norris

Neurocognitive Disorders
Copyright Chasity Norris

Personality Cluster Personality Disorders Copyright Chasity Norris

Other Paraphilias Medication-Induced Movement Disorders Conditions for Further Study Copyright Chasity Norris

Sensitivity to Stability of Disorders
Chapter in DSM-IV-TR describing “Disorders Usually Diagnosed During Infancy, Childhood, and Adolescence has been eliminated and the subsequent disorders have been divided up into the chapters they relate to by symptomology. This is due to research showing most of these disorders are stable into adulthood, and can also present during adulthood, not just childhood. (Pica, ADHD). Copyright Chasity Norris

No More NOS! The NOS (not otherwise specified) category has been eliminated all together. Options now include: Other Specified Disorder Unspecified Disorder *Condition deferred still available, but is not listed. Copyright Chasity Norris

DSM-5 Specific Disorders
Neurodevelopmental Disorders including: Internalizing Cluster Somatic Cluster Externalizing Cluster Neurocognitive Cluster Personality Cluster Other Cluster Copyright Chasity Norris

Neurodevelopmental Disorders
Intellectual Disability (formerly “Intellectual Development Disorder”) Global Developmental Delay Unspecified Intellectual Disability (formerly “Intellectual Development Disorder) Copyright Chasity Norris

A federal state statute “Rosa’s Law” (public Law ), determined “mental retardation” was now to be termed “intellectual disability” Copyright Chasity Norris

Neurodevelopmental cont.
Communication Disorders Language Disorder- a combo of DSM-IV’s expressive and mixed-receptive expressive language disorders. Speech Sound Disorder- Previously Phonological Disorder. Copyright Chasity Norris

A new diagnosis of Social Communication Disorder has been added. SCD- is persistent difficulty in the social use of verbal and nonverbal communication that is not caused by low cognitive ability. Copyright Chasity Norris

Autism Spectrum Disorder Combines: Autistic Disorder Asperger's Childhood Disintegrative Disorder Pervasive Developmental Disorder **Requires both social communication and social interaction, and restricted repetitive behaviors, interests, and activities. Copyright Chasity Norris

Attention Deficit Hyperactivity Disorder Now has symptoms added to help diagnose in adults Children still need to have at least 6 symptoms, but older adolescents and adults need 5 Symptoms must have presented before age 12, not age 7 as previously held in DSM-IV Copyright Chasity Norris

Schizophrenia Schneiderian first-rank auditory hallucinations eliminated. Symptom threshold raised form 1 to 2 specific symptoms to qualify for diagnosis Includes requirements for symptoms of delusions, hallucinations, or disorganized speech. Also eliminated subtypes (paranoid, disorganized, catatonic, undifferentiated, etc. ) Copyright Chasity Norris

Schizoaffective Disorder
Now must have presence of a mood dysregulation for the majority of time the schizophrenic symptoms present. Makes it more longitudinal DX. Copyright Chasity Norris

Delusional Disorder Criteria for delusions to be “non-bizarre” eliminated. Shared Delusional Disorder no longer separated from delusional disorder Now is “other specified schizophrenia spectrum and other psychotic disorder” Copyright Chasity Norris

Bipolar and Related Disorders
Now includes changes in activity level or energy level, not just mood. BP I, mixed episode has been removed Replaced with ‘With Mixed Features” Qualifier can be used in either BP I or II “with anxious distress” also new qualifier for those exhibiting anxiety along with BP symptoms. Copyright Chasity Norris

Depressive Disorders New diagnoses added: Disruptive Mood Dysregulation Disorder – violent temper outbursts manifested verbally Premenstrual Dysphoric Disorder Copyright Chasity Norris

Persistent Depressive Disorder
Combines Chronic Major Depressive Disorder and Dysthymic Disorder. Copyright Chasity Norris

Anxiety Disorders Disorders no longer included in this section include: Obsessive-Compulsive Disorder Post Traumatic Stress Disorder Acute Stress Disorder Now listed under new chapter (obsessive-compulsive and trauma-stressor disorders) Copyright Chasity Norris

Panic Disorder and Agoraphobia are now tow-separate disorders under the DSM-5. If there is a co-occurrence of panic and agoraphobia, they are coded as two separate diagnoses. Copyright Chasity Norris

Social Anxiety Disorder (social phobia)
Now has “generalized” and “performance only” qualifiers. Copyright Chasity Norris

Separation Anxiety Disorder
Now moved out of section describing childhood or adolescent disorders, and is now in with the anxiety disorders This is due to research showing it can occur after age 18 Must still be present for >6 months Selective Mutism also moved to anxiety disorders for same reason. Copyright Chasity Norris

Obsessive-Compulsive & Related Disorders
New chapter to the DSM includes: Obsessive-Compulsive Disorder Body Dysmorphic Disorder Trichotillomania (hair-pulling) Excoriation (skin-picking) Hoarding Disorder Substance-Medication Induced OCD OCD related to other medical conditions Copyright Chasity Norris

Body Dysmorphic Disorder
Somatic disorder with repetitive behaviors and mental acts responding to their preoccupation with their perceived physical defects or flaws. Now has “with muscle dysmorphia” and “absent insight/ delusional” specifiers. Copyright Chasity Norris

Hoarding Disorder NEW!! Related to OCD, but not a variant of Patient presents with persistent difficulty discarding or parting with possessions and noted distress associated with discarding them. Copyright Chasity Norris

Excoriation Disorder NEW!! Skin Picking causing dermatological damage Copyright Chasity Norris

Trauma & Stressor Related Disorders
New Category! PTSD now has a list of traumatic event qualifiers and “second-hand exposure” allowance (first-responders collecting human remains) Copyright Chasity Norris

Includes: Reactive Attachment Disorder as a distinct disorder Also includes Disinhibited Social Engagement Disorder Both outcome of social neglect and denial of healthy attachment Copyright Chasity Norris

Somatic Symptom and Related Disorders
Previously called “Somatoform Disorders” Reduced subcategories Copyright Chasity Norris

Somatic Symptom Disorder
Combines previous “somatization disorder’ and “undifferentiated somatoform disorder”. Designed to diagnose those with maladaptive thoughts, feelings, and behaviors with somatic symptoms that may or may not be related to medical conditions. Requirement that medically unexplained symptoms be present removed. Psychological stress more important. Copyright Chasity Norris

Hypochondriasis and Illness Anxiety Disorder
Hypochondriasis removed from DSM-5 Copyright Chasity Norris

Sexual Dysfunctions Genito-Pelvic Pain/ Penetration Disorder- NEW!! Replaces Vaginismus and Dyspareunia Sexual Aversion Disorder Removed Copyright Chasity Norris

Gender Dysphoria NEW!! No longer associated with sexual dysfunction. “strong desire to be the other gender” replaces “repeatedly stated desire to be the other gender” in children. Copyright Chasity Norris

Disruptive, Impulse-Control, & Conduct Disorders
NEW CHAPTER!! Characterized by difficulties in behavioral and emotional self-control. Due to high co-morbidity, antisocial personality disorder is listed here and in personality disorder chapter. Copyright Chasity Norris

Includes: Oppositional Defiant Disorder Conduct Disorder (limited pro-social emotions”) Intermittent Explosive Disorder Copyright Chasity Norris

Substance-Related & Addictive Disorders
NEW Disorder!! Gambling Disorder Substance Abuse and Substance Dependence Disorders now combined into “Substance Use Disorder” Cannabis Withdrawal & Caffeine Withdrawal also added! Copyright Chasity Norris

Neurocognitive Disorders
Delirium now all listed together instead of being 5 different diagnoses. Dementia and Amnestic Disorders now combined into “Major and Mild Neurocognitive Disorders” Copyright Chasity Norris

Personality Disorders (Section II)
Updates in terminology Added “Personality Change Due to Another Medical Condition” Now listed alongside other mental disorders rather than separately Copyright Chasity Norris

PD (Section III) Replaces NOS with Personality Disorder-Trait Specified (PD-TS) Provides more specific, individual diagnosis Copyright Chasity Norris

Criterion A -Level of personality functioning Shows disturbances of self (identity), and interpersonal functioning (empathy & intimacy) Criterion B -one or more pathological personality traits Criterion C -inflexibility and pervasiveness of impairment and traits. Criterion D: -Stability of impairment and traits Criterion E: -not better accounted for by another mental disorder Criterion F: -Not due to the effects of a substance Criterion G: - not normal for their developmental stage or socioculurall environment. Copyright Chasity Norris

Paraphilias and Paraphilic Disorders
Distinction made between the two Paraphilic Disorders causing “marked distress and impairment”. Copyright Chasity Norris

Controversy Copyright Chasity Norris

What Should You Know if You’re a Social Worker?
No social workers were formally invited to participate in the Task Force or Work Groups for the fifth edition of the DSM!! This is not a recent occurrence There was only one social worker on the Task Force for the DSM-IV-TR. Copyright Chasity Norris

Bibliography Diagnostic and statistical manual of mental disorders: DSM-5. (5th ed.). (2013). Washington, D.C.: American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-IV-TR. (4th ed.). (2000). Washington, DC: American Psychiatric Association. Copyright Chasity Norris

Making Sense of the DSM-5: Changes and Changing Perspectives

Similar presentations

Presentation on theme: "Making Sense of the DSM-5: Changes and Changing Perspectives"— Presentation transcript:

Similar presentations

About project

Feedback

Log in

Auth with social network:

Making Sense of the DSM-5: Changes and Changing Perspectives

Similar presentations

Presentation on theme: "Making Sense of the DSM-5: Changes and Changing Perspectives"— Presentation transcript:

Similar presentations

About project

Feedback