2.1 Diagnostic and Statistical Manual of Mental Disorders

How to use the Diagnostic and Statistical Manual of Mental Disorders 5ed

The American Psychiatric Association who publishes the Diagnostic and Statistical Manual of Mental Disorders focused on enhanced clinical utility. This DSM 5 is organized on a development and lifespan model. This manual begins with and reflects those diagnoses that manifest early in life (Neurodevelopmental and schizophrenia spectrum) followed by diagnoses that are identified or manifest in adolescence an young adulthood (bipolar, depressive etc) followed by disorders diagnoses in adulthood or later life.

Diagnostic and Statistical Manual of Mental Disorders

Online Assessment Measures

The DSM 5 (Diagnostic and Statistical Manual of Mental Disorder, 5th Ed.) is the handbook used by behavioral and mental healthcare professionals to make clinical diagnoses. DSM providing descriptions and classifications of mental disorders, including their symptoms and other criteria required for diagnosis. DSM 5 provides Human Service Professionals common language to use when communicating information about patients while assisting researchers a common basis to study disorders and recommend potential revisions. The American Psychiatric Association who publishes the DSM has been instrumental in driving advanced research on every aspect of mental and behavioral health.

The first DSM manual was published in 1952 and has undergone multiple revisions as we learned more about each mental disorder, enhance the importance with ongoing research about each of the disorders. The current DSM 5 was published in 2014 that incorporated five key changes meant to make diagnostics easier and more accurate for clinicians. This manual is structured with 1). Development and Life Span Focus, places those disorders according to the age at which they are MOST likely to appear. Starting in childhood and ending with those disorders that usually occur later in life. 2). New diagnostic criteria: Criteria for some disorders has changed, including the addition of new disorders and removal of subtypes of schizophrenia. 3). Dimensional measures: DSM-5 includes measures of how severe a disorder is, in order to help Human Service Professional, think about what dimensions of disorders are similar. This is intended to benefit patients with multiple diagnoses by providing more nuanced insight into their continuum of symptoms.4). Culture and gender emphasis: We know that there are a multitude of cultural and social factors that can impact diagnosis. DSM-5 has a new section describing cultural syndromes, their potential causes and how they are expressed and finally 5). Further research: The DSM now contains a section that describes conditions that need further research to be fully incorporated into the manual.

The DSM 5 has become more consistent with the World Health Organization (WHO’S) International Classification of Disease 10 (ICD 10). Upon review of your manual you will notice that the classifications are listed with the ICD 10/11 Code and the related page number in parentheses.

Section I: Basic introduction on how to use the manual

New definitions of a mental disorder— “a syndrome that causes clinically significant problems with cognition, emotional regulation, behavior—resulting in dysfunctional and are “associated with significant distress or disability in social occupational, or other important activities.” APA, 2013, p. 20)

As stated in the manual page 19 “the goal of a clinical case formulation is to use the available contextual and diagnostic information in developing a comprehensive treatment plan that is informed by the individual’s culture and social context.

• In addition, section I introduces the elements of a diagnosis which includes an overview of diagnostic criteria, subtypes and specifiers. New to the DSM 5, is the use of “specifiers”—when provided in the DSM 5, specifiers apply to the client’s current presentation and ONLY when full criteria for a disorder have been met.  Both subtypes and specifiers adds specificity to a diagnoses, however subtypes are mutually exclusive while being jointly exhaustive. Mutually exclusive means a person can only have 1 of those subtypes, if 1 is present the other CAN NOT be present. Where as jointly exhaustive means the two subtypes together represents ALL of the subtypes. Look for the phrase “specify whether”
  • Course— e.g., in partial remission
  • Severity—e.g., mild, moderate, severe
  • Frequency—e.g., two times per week
  • Duration—e.g., minimum duration 6 months
  • Descriptive., features—with poor insight
    • Two alternative catchall specifiers
      • Other Specified Disorders—symptoms are clinically significant but DO NOT MEET full criteria for a disorder (must give reason)
      • Unspecified Disorder—presentation is clinically significant and does NOT MEET the full criteria for a disorder, and the clinician chooses not to specify the reason—insufficient information

Section II

Provides 20 classifications of disorders that focus on diagnostic criteria and codes with an organized structure.

•  Each chapter is organized with the same structure that includes several subtitles which include the following sections:
  • Diagnostic Criteria for each disorder
    • Subtypes and specifiers
    • Diagnostic Codes which includes the DSM 5 (315.39)  in addition to the ICD 11 codes in parenthesis (F80.80)
  • The DSM 5 also provides several sections explaining the specific disorder:
    • Diagnostic features
    • Associated features
    • Prevalence
    • Developmental and Course
    • Risk and Prognostic factors
    • Culture related diagnostic concerns
    • Gender related diagnostic concerns
    • Suicide risk
    • Functional implications
    • Differential diagnoses–is a list of possible conditions that could be causing symptoms based off information gathered, starts eliminating other disorders one by one
    • Comorbidity

 Section III

Emerging measures and models, assessments measures, cultural formulations and an alternative for personality disorders, and other conditions for additional studies. Which includes:

• Assessments, Self-Report Measures, and Interviews
  • WHODAS 2.0—can be used as an assessment scale, can be used at regular intervals to track progress
  • Cross-cutting Symptoms measures by age
  • Online measures to determine symptom severity
  • Clinician-rated dimensions of severity for psychotic symptoms
  • The Early Development and Home Background (EDHB)
    • Two versions:
      • One to be completed by the parent/guardian
      • One to be completed by the Clinician
    • The Cultural Formulation Interview (CFI) 16 questions that clinicians may use to obtain information during a mental health assessment about the impact of culture
    • The Cultural Formulation Interview –Informant Version collects collateral information’s on the CFI from family members perspectives
    • An Alternative model for diagnosing personality disorders

Appendix

Includes Glossary of Technical Terms, Glossary of Cultural Concepts of distress, Alphabetical listing of DSM-5 Diagnosis and Codes, Numerical listing of DSM-5 Diagnoses and Codes

The DSM 5 is now using a Nonaxial System in which Human Service Professional can document their clinical diagnoses:

Listing as many diagnoses as necessary to provide a clinical picture, Principal diagnosis the one listed first and reflects either reason for the visit or focus of treatment. EX: 296.51 Bipolar 1 disorder, mild, most recent episode depressed, 301.83 Borderline Personality Disorder (What is the focus of treatment for this person?)

•  In keeping with the WHO guidelines other conditions may be the focus of clinical attention will be listed along with the diagnosis to highlight relevant factors that affect the client’s presenting problem
• WHO’S Disability Assessment Schedule (WHODAS) is a measure of functioning, can be found in Section III