understanding_dsm_5 (1).pdf - Deconstructing the DSM-5 By...

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I recognize that many counselors have anxiety about using the newly released fifth edition of the Diagnostic and Statistical Manual of Mental Disorders(DSM-5), especially because it no longer requires use of the DSM-IVmultiaxial system. For this month’s article, I would like to focus on this, and other important changes, in an effort to help counselors feel more comfortable in using the DSM-5.My recommendation as counselors begin using the DSM-5is to first read Section I: DSM-5Basics (introduction, use of the manual and cautionary statement for forensic use of the DSM-5). Second, read “Highlights of Changes From DSM-IVto DSM-5” in the appendix and, third, read Section II: Diagnostic Criteria and Codes. I am confident that if you read the DSM-5in this order, you will better understand the new organizational changes and the expanded conceptualization of mental disorders. I consider Section I to be a gold nugget of helpful information that greatly assists the user with general orientation to the new diagnostic landscape. In the introductory chapter, you are provided with a brief history of the DSM-5, aspects of the DSM-5revision process, the new organizational structure, how issues of culture and gender differences affect diagnostic practice, correct use of other specified and unspecified disorders, and the rationale for elimination of the multiaxial system. In addition, you are given direction on accessing online enhancements, such as assessment measures and insurance implications. As I read this chapter, I learned that the DSM-5classification system is meant to stimulate new clinical perspectives — just as I encourage my clients to develop new perspectives in their lives. “New clinical perspectives” means that I challenge the status quo, critically analyze client symptoms and am open to cognitive dissonance within myself. As you read this chapter, you will also learn about the new clustering of disorders presented in a framework of “internalizing” factors (anxiety, depression and somatic symptoms) and “externalizing” factors (impulsive, disruptive and addictive symptoms) that influence clinical formulation. Most important, you will understand the new developmental and life span considerations that organize disorders in a framework beginning with those that occur in early life (neurodevelopmental and schizophrenia spectrum and other psychotic disorders). This is followed by disorders that occur in adolescence and young adulthood (depressive, bipolar and anxiety disorders) and ends with diagnoses more relevant to adulthood and later life (personality disorders and neurocognitive disorders). Moving to the next chapter on use of the manual, you will read about important guidelines for clinical case formulation. This chapter discusses the need to obtain a “careful clinical client history and concise summary” surrounding client biopsychosocial factors. I appreciate the DSM-5’s focus on my need for clinical judgment, clinical training and the importance of

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