By: SOPHIA F. DZIEGIELEWSKI
A brief summary of the controversy and changes related to the DSM-5 is provided here.
Similar to previous versions, the
American Psychiatric Association continues to develop the DSM to reflect clinical approaches to diagnosis
and training. Furthermore, similar to its history, the DSM continues to strive to be compatible with (but not identical
to) the issues presented in the International Classification
of Diseases (ICD-10) and, to be preemptive, also includes
the codes for the ICD-11
scheduled to be
published in 2017.
Prior to the publication of this latest
version, DSM-5,
criticism remained
strong. Debates were extensive about what changes needed to occur. Hoffer (2008) encouraged
inclusion of additional supportive information, such as medical and diagnostic tests,
that could better clarify the diagnoses identified. Sadler, Fulford, and Phil (2004) requested
a more comprehensive approach that would take into account the perspective of
patients and their families to support both sound policy and public concerns. Shannon
and Heckman (2007) warned about the continued danger of being too quick to “pathologize” behaviors
and label them. In the midst of this discussion related to the expected
changes, Zachar and Kendler (2007) stated it was probably best to just accept
that mental disorders are highly complicated concepts that need to be
determined. From this perspective, it becomes possible to accept that some
aspects of this mental disorder taxonomy will need to be determined (as opposed
to discovered) with practical goals and concerns at the forefront of the
diagnostic assessment (Ahn & Kim, 2008). Last were the concerns written in open
letters to the APA discussing the long-term hazards that can occur when
highlighting neurobiology as the standard basis for treatment, while de-emphasizing
sociocultural variations and how they can affect the completion of a
comprehensive diagnostic impression.
To support this controversy, Caplan
(2012) warned that just having the word statistical in
the title could give professionals and the lay public alike a false sense of hope
that the professionals who used the book could do so with scientific
precision. Because making a mental health diagnosis remains an unregulated
diagnostic category, significant differences in professional acumen
and judgment would continue. These differences could easily result in
differential diagnostic criteria in research and clinical practice and, similar
to previous versions of the DSM,
could affect problem
awareness, knowledge, reporting, and subsequent generalizability of the
clinical diagnostic assessments made. Bernstein (2011) questioned how the DSM-5 work groups would recognize the
importance of facilitating communication across what could be considered “restrictive
diagnostic silos”
(p. 29). Yet she
remained optimistic that this could be addressed at least to some degree by
recognizing the clusters of symptoms that might best characterize what a client
is feeling.
Listening carefully to these concerns,
the American Psychiatric Association made some significant changes in the DSM-5 to both form and content. Consistent
with the professional call for modification, to start this process, major
changes were made to the structure and the format of the book, resulting in all
chapters being organized in the life span order.
For example, within this new
organizational structure, the mental disorders that can occur in infants, children and adolescents are now listed first
in each chapter. This led to the elimination of the Child Disorders section
outlined in DSM-IV
and DSM-IV-TR.
Also, relative to Bernstein’s (2011) request for clustering of
symptoms, crosscutting was introduced, where symptoms relative to a closely related
disorder could be taken into account without formulating a new diagnostic condition.
In addition, the introduction of the
dimensional approach may also help with firming up the diagnosis. This change was one of the revision’s
most active debates, as it directly surrounded extending the categorical approach to a more dimensional approach (Helzer et
al., 2008). The work groups for DSM-5
hope that the
dimensional approach will allow greater flexibility and recognition that mental disorders cannot be easily described by a single
diagnostic category (Helzer et al., 2008). Dimensional assessments also appear to
permit the practitioner to assess the severity of the symptoms in a particular
client while crosscutting or taking into account symptoms relative to a number
of different diagnoses that can influence current presentation and
behavior.
Despite much controversy, the newest
edition of the DSM
was unveiled at the
APA conference at the end of May 2013 and has been restructured and divided
into three sections:
Section One provides an introduction to
the manual, some rationale for the changes, and instructions on how to use the
updated manual. It is followed by 21 chapters that outline the documented
mental disorders found in Section Two (see Quick Reference 1.5). The last
section of the manual, Section Three, outlines the conditions that require
future research, cultural formulations, and other information.
These proposed revisions within the DSM-5 were supported by a task force of more
than 160 world-renowned practitioners and researchers who were selected members
of 13 work groups. These work groups reviewed the research literature, consulted
with a number of experts, and for the first time sought public comment.
References
SOPHIA F.
DZIEGIELEWSK, 2015, DSM-5TM
in Action, by John Wiley & Sons, Inc.
Read Also
Making the Diagnostic Assessment
Diversity and the Interviewing Process
Brief History of the DSM
The Person-in-Environment Classification System (PIE)
The official nomenclature used in mental health and other health-related facilities
Diversity and the Interviewing Process
Brief History of the DSM
The Person-in-Environment Classification System (PIE)
The official nomenclature used in mental health and other health-related facilities
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