Answer & Explanation:In this assignment, you will refer to the DSM-5 Learning Companion for Counselors and a video about autism to answer questions.Learn more about the symptoms of autism in the DSM-5 Learning Companion for Counselors. Watch Part 1 of Dr. Oz’s seven-part television series “What Causes Autism?” (http://www.doctoroz.com/videos/what-causes-autism-pt-1)Answer questions about the cases.
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Copyright © 2014. American Counseling Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted
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Introduction and Overview
To understand changes from the DSM-IV-TR (APA, 2000) to the DSM-5 (APA, 2013),
we believe it is important for the reader to first understand the revision process. In the
following section, we describe the revision process of the DSM-5 and the role counselors
took in its inception. Readers will find a comprehensive description of structural and
philosophical changes to the manual, including a history of the manual’s iterations, in
Chapter 2.
The Revision Process
The DSM-5, after 14 years of debate and deliberation, was intended to be the most radical revision to date (Frances & First, 2011; Jones, 2012b; Miller & Levy, 2011). Beginning
in 1999, a year before the DSM-IV-TR was published, APA began collaboration with the
National Institute of Mental Health (NIMH) on a new edition. The intent of these meetings was to develop a more scientifically based manual that would increase clinical utility
while maintaining continuity with previous editions (APA, 2012a). The process began with
an initial DSM-5 Research Planning Committee Conference, held in 1999, in which APA
and NIMH deliberated on a research agenda and priorities for the new manual. Additional
conferences, sponsored by APA, NIMH, and WHO, took place in 2000 and resulted in
the formation of six work groups. These initial work groups focused on nomenclature,
neuroscience and genetics, developmental issues and diagnosis, personality and relational
disorders, mental disorders and disability, and cross-cultural issues. In 2002, a series of six
white papers was published with the intent of “providing direction and potential incentives for research that could improve the scientific basis of future classifications” (Kupfer,
First, & Regier, 2002, p. xv). Two final manuscripts were published in 2007. One focused
on mental disorders in infants, young children, and older persons and the other on gender,
cultural, and spiritual issues.
After the release of the initial research agenda for the DSM-5, it became clear that further
deliberation was needed with regard to nomenclature, neuroscience, developmental science, personality disorders, and the relationship between culture and psychiatric diagnoses
(APA, 2000; Kupfer et al., 2002). Steered by APA, NIMH, and WHO, 13 conferences were
held between 2004 and 2008 in which participants discussed relevant diagnostic questions
and solicited feedback from colleagues and other professionals regarding potential changes.
Findings from these conferences facilitated the research base for proposed revisions for
the DSM-5 and fueled the agenda of the DSM-5 work groups (see Kupfer et al., 2002, for
the full DSM-5 research agenda).
In 2007, APA officially commissioned the DSM-5 Task Force, made up of 29 members,
including David J. Kupfer, MD, chair, and Darrel A. Regier, MD, MPH, vice-chair (APA,
2012a). The DSM-5 Task Force expanded the work groups from six to 13. These included
attention-deficit/hyperactivity disorder (ADHD) and disruptive behavior disorders; anxiety,
obsessive-compulsive spectrum, posttraumatic, and dissociative disorders; childhood and
adolescent disorders; eating disorders; mood disorders; neurocognitive disorders; neurodevelopmental disorders; personality disorders; psychotic disorders; sexual and gender
identity disorders; sleep-wake disorders; somatic symptoms disorders; and substancerelated disorders. Although each of these work groups investigated specific disorders,
cross-collaboration was common. Kupfer and Regier provided clear direction to the work
groups to, among other things, eradicate the use of not otherwise specified (NOS) diagnoses within categories, do away with functional impairments as necessary components
of diagnostic criteria, and use empirically based evidence to justify diagnostic classes and
specifiers (Gever, 2012; Regier, Narrow, Kuhl, & Kupfer, 2009). With these marching orders,
each work group proposed draft criteria and changes for the new manual.
Three rounds of public comment regarding proposed changes took place between April
2010 and June 2012. An estimated 13,000 mental health professionals commented on the
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Introduction and Overview
proposed criteria (APA, 2012c, 2012d). Additionally, mental health professionals conducted field trials to “assess the feasibility, clinical utility, reliability, and (where possible)
the validity of the draft criteria and the diagnostic-specific and cross-cutting dimensional
measures being suggested for DSM-5” (APA, 2010, p. 1). Two field trial study designs were
administered (APA, 2010, 2011b). The first trial, held between April 2010 and December
2011, took place in 11 large academic or medical centers and involved a total of 279 clinicians (APA, 2012b, 2012c). The second trial, which included solo or small group practices,
took place between October 2010 and February 2012. APA recruited a volunteer sample of
psychiatrists, psychologists, licensed clinical social workers, licensed counselors, licensed
marriage and family therapists, and licensed psychiatric mental health nurses to participate
in the second field trial (APA, 2012b, 2012c). Feedback from public comment periods and
field trials was shared with work group members, who edited proposed criteria as indicated. The final version of the DSM-5 went before the APA Board of Trustees in December
2012 and was released in May 2013. The following outlines the complete timeline of the
development of the DSM-5.
Timeline of DSM-5
1999–2001
Development of the DSM-5 research agenda
2002–2007
APA/WHO/NIMH DSM-5/ICD-11 research planning conferences
2006
Appointment of DSM-5 Task Force
2007
Appointment of DSM-5 work groups
2007–2011
Literature review and data reanalysis
2010–2011
First phase field trials
2010–2012
Second phase field trials
July 2012
Final draft of DSM-5 for APA review
May 2013
DSM-5 released to the public
Revision Feedback
Although no professional counselor was invited to serve on the DSM-5 Task Force, ACA
served as an important advocate for professional counselors during the revision process.
Through advocacy efforts of the ACA Professional Affairs Office and the ACA DSM-5
Revisions Task Force, two ACA presidents sent letters to APA indicating concern over
proposed changes. The first was sent by Dr. Lynn E. Linde, ACA 2009–2010 president,
to Dr. David J. Kupfer, DSM-5 Task Force chair. The letter indicated that ACA members
had concerns regarding five areas of particular importance to professional counselors: (a)
applicability across all mental health professions, (b) gender and culture, (c) organization
of the DSM-5 multiaxial system, (d) lowering of diagnostic thresholds and combining
diagnoses, and (e) use of dimensional assessments. The second letter was sent by Dr. Don
W. Locke, ACA 2011–2012 president, informing Dr. John Oldham, APA president, that
licensed professional counselors were the second largest group to routinely use the DSMIV-TR. He noted uncertainty among professional counselors about the quality and credibility of the DSM-5 and included a prioritized list of concerns APA should consider before
publishing the DSM-5. APA responded to this letter on November 21, 2011 (APA, 2011a).
In addition to feedback provided by ACA, several divisions of the American Psychological Association voiced concern about the writing process of the DSM-5 (Jones, 2012a). As
a result, the Society for Humanistic Psychology, Division 32 of the American Psychological
Association, sponsored a petition outlining its concerns and inviting other mental health
professionals, including counselors, to sign this petition (for a review of these concerns,
see British Psychological Society, 2011). It is important to note that nine out of 19 ACA
divisions endorsed this petition, including the Association for Adult Development and
Aging; Association for Creativity in Counseling; American College Counseling Associa4
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Introduction and Overview
tion; Association for Counselor Education and Supervision; Association for Humanistic
Counseling; Association for Lesbian, Gay, Bisexual and Transgender Issues in Counseling;
American Rehabilitation Counseling Association; Association for Specialists in Group
Work; and Counselors for Social Justice.
Professional counselors are responsible for understanding changes and using the DSM5 in a manner consistent with the mission of our profession and the ACA Code of Ethics
(ACA, 2014). A thorough understanding of the revision process, changes, rationale for
changes, and impact of changes will help professional counselors decide how they would
like to continue to use the DSM-5 in practice, consider possibilities for future revisions,
and ensure advocacy so counselors have a greater voice in the next revision of the DSM.
Organization of the
DSM-5 Learning Companion for Counselors
In Chapter 2 of this Learning Companion, we outline major structural and philosophical
changes adopted for the DSM-5, such as the elimination of the multiaxial system. We also
outline major diagnostic changes, such as the removal of the bereavement clause from
major depressive disorder. In addition, we discuss major changes that influence numerous
chapters within the DSM-5, for example, the removal of NOS and the inclusion of other
specified and unspecified disorders to replace all NOS diagnoses.
Following Chapter 2, this Learning Companion includes four separate parts, grouped
by diagnostic similarity and relevance to the counseling profession. In each of the four
parts, we provide a basic description of the diagnostic classification and an overview of the
specific disorders covered, highlighting essential features as they relate to the counseling
profession. We also provide a comprehensive review of specific changes, when applicable,
from the DSM-IV-TR to the DSM-5. When specific or significant changes to a diagnostic
category or diagnosis have not been made, we provide a general review of either the category
or the diagnosis, but we refrain from providing the reader with too much detail because
the purpose of this Learning Companion is to focus on changes from the DSM-IV-TR to
the DSM-5. For example, we do not go into great detail about personality disorders, found
in Part Four, because the diagnostic criteria for these disorders have not changed. What
we do focus on, however, is the proposed model for diagnosing personality disorders that
may significantly affect how counselors diagnose personality disorders in future versions
of the DSM.
Readers will find, within each part of the book, individual chapters that highlight key
concepts of each disorder (including differential diagnoses), new or revised diagnostic
criteria, and implications for professional counseling practice. We provide “Notes” to
highlight significant information and include case studies to assist counselors in further
understanding and applying the new or revised diagnostic categories. All case studies are
fictitious composites and do not depict real clients. Any similarity to any person or case
is simply coincidental.
Readers should also note that we provide more detail for disorders that counselors are
more likely to see in their clients. Therefore, because this Learning Companion is organized in order of diagnoses counselors are most likely to diagnose, each consecutive part
of the book provides the reader with less specific detail about each diagnostic grouping.
For example, Part One includes a detailed synthesis for key disorders, including cultural
considerations, differential diagnosis, and special considerations for counselors. We have
also included a description of other specified and unspecified diagnoses for each diagnostic class. Conversely, Part Three provides less detail about neurodevelopmental disorders
because these diagnoses are typically made by other professionals.
Part One, Changes and Implications Involving Mood, Anxiety, and Stressor-Related
Concerns, includes chapters regarding depressive disorders, bipolar and related disorders,
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Introduction and Overview
anxiety disorders, obsessive-compulsive and related disorders, trauma- and stressor-related
disorders, and gender dysphoria. We listed this section first because these disorders, both
within and outside of the counseling profession, are some of the highest reported mental
disturbances within the United States (Centers for Disease Control and Prevention [CDC],
2011). Readers will note that this is the only section in which other specified and unspecified diagnoses are listed.
Part Two, Changes and Implications Involving Addictive, Impulse-Control, and Specific
Behavior-Related Concerns, includes chapters focused on behavioral diagnoses such as
substance use and addiction disorders; impulse-control and conduct disorders; and specific
behavioral disruptions consisting of feeding and eating, elimination, sleep-wake, sexual
dysfunction, and paraphilic disorders. Similar to the disorders found in Part One, counselors are often exposed to the disorders listed in Part Two within clinical practice, but these
disorders frequently manifest through more visible, external behavioral concerns rather
than less visible, internal experiences (i.e., depression vs. sexual dysfunction). Moreover,
counselors may or may not diagnose these disorders. This is not to say that counselors do
not frequently diagnose substance use disorders. However, compared with depression and
anxiety disorders, substance use disorders are more often diagnosed by a combination of
counselors and other health professionals.
Part Three, Changes and Implications Involving Diagnoses Commonly Made by Other
Professionals, includes chapters focused on neurodevelopmental, schizophrenia spectrum,
and other psychotic, dissociative, neurocognitive, and somatic disorders. Many of these
disorders, specifically neurodevelopmental and somatic issues, require highly specialized
assessment or extensive medical examination by physicians or other qualified medical
professionals. These chapters focus on helping professional counselors understand major
changes and the potential impact of these changes on the clients counselors serve. We do
not provide a detailed description of each disorder in this chapter; rather, we address major
changes, if applicable, and considerations for counselors.
Part Four, Future Changes and Practice Implications for Counselors, addresses future
changes to the DSM as well as clinical issues related to professional counseling. Whereas
all parts of the book focus on professional counselors, this part highlights clinical utility of the DSM-5 as well as future changes that may affect the counseling profession. For
example, Chapter 16 addresses the personality disorders section of the DSM-5. Although
personality disorders did not change from the DSM-IV-TR to the DSM-5, proposed changes
were included in Section III of the DSM-5. If these changes were implemented, they would
significantly alter the way counselors diagnose and treat clients with these disorders.
Chapter 17 addresses issues such as the diagnostic interview, the nonaxial system,
cultural inclusion, and assessment instruments such as the WHO Disability Assessment
Schedule (Version 2.0; WHO, 2010). This chapter also contains information regarding
diagnostic coding and changes counselors can expect with the October 2014 revision to
the ICD-10-Clinical Modification (ICD-10-CM; CDC, 2014) coding required for Health
Insurance Portability and Accountability Act of 1996 (HIPAA) purposes. We also explore
ways in which counselors can continue to be an active part of future revisions of diagnostic
nomenclature systems.
References
American Counseling Association. (2012). Licensure requirements for professional counselors: A
state-by-state report. Alexandria, VA: Author.
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www.counseling.org/learn-about-counseling/what-is-counseling
American Counseling Association. (2014). ACA code of ethics. Alexandria, VA: Author.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th
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under U.S. or applicable copyright law.
Introduction and Overview
American Psychiatric Association. (2010). Protocol for DSM-5 field trials in academic/large clinic
settings. Retrieved from http://www.DSM5.org/Research/Documents/Forms/AllItems.aspx
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