Download DSM-5 - Appalachian State University

An Introduction to the
DSM-5
Mark Schwarze, PhD, LPCS, NCC, LCAS, CCS
Assistant Professor & Program Director
Clinical Mental Health Counseling Program
Appalachian State University
History
Improving Research
•
DSM I (1952) & DSM II (1968) – very
brief manuals, guided by
psychoanalysis, gross categories (e.g.,
neurosis, psychosis), lack of reliability,
no research base
•
DSM III (1980), DSM IV (1994), DSM
IV TR (2000) – field trials to improve
reliability, better research base,
multiaxial classification
History
• Each DSM has tried to resolve problems in previous versions.
• Problems in DSM-IV-TR
•
•
•
•
DZ
Not very user friendly.
9 categories for diagnostic uncertainty.
NOS predominated.
Insufficient on culture.
3
Intent of the DSM-5
 David Kupfer, MD DSM-5 Task Force Chair
 1. “incorporation of a developmental approach to psychiatric
disorders”
 2. “a move toward the use of dimensional measures to rate
severity and disaggregate symptoms that tend to occur across
multiple disorders”
 3. “harmonization of the text with ICD”
 4. “integration of genetic and neurobiological findings by
grouping clusters of disorders that share genetic or
neurobiological substrates”
Principles for Revision
•
Four principles for revision
1.
insure DSM-5 has clinical utility
2.
evidence will inform DSM-5
3.
maintain continuity with DSM-IV
4.
but revise where the evidence requires doing so
•
Intended to address frequently co-occuring disorders
such as depression and anxiety
•
•
Reduce use of NOS
Introduction of dimensional assessments
Big Changes Summarized
• Representation of developmental issues related to
diagnosis
• Integration of scientific findings from the latest
research in genetics and neuroimaging
• Consolidation of autistic d/o, Asperger’s d/o, and
pervasive development d/o in autism spectrum d/o
• Streamlined classification of bipolar and depressive
d/o’s
Big Changes Summarized
• Restructuring of substance use d/os for consistency
and clarity
• Enhanced specificity for major and mild
neurocognitive d/os
• Transition in conceptualizing personality d/os
• Section III added: New d/os and assessment
features
• Online enhancements – www.psychiatry.org/dsm5
Criticisms of the DSM-5
•
Allen J. Frances, M.D. @ Huffington Post on 5/1/13
DSM-5 represents a wholesale, imperial medicalization of normality
•
Sachdev, P. S. (2013). Is DSM-5 defensible? Australian and New Zealand Journal of Psychiatry, 47(1), 1011. doi: http: //dx. doi. org/10. 1177/0004867412468164
•
DSM-5 is lowering the thresholds of various diagnoses, resulting in the medicalization of normal
human experience and the creation of spurious epidemics of mental illness.
•
DSM-5 work group members are compromised by their declared and undeclared conflicts of interest.
•
DSM-5 continues to inappropriately impose categorical constructs on dimensional mental states or
conditions.
•
DSM-5 is creating new mental disorder diagnoses for the benefit of the profession and the
pharmaceutical industry.
Of the DSM-5 task
force members, 69%
report having ties to the
pharmaceutical industry
Cosgrove, L. & Drimsky, L. (2012).
Sections and General Content
I: DSM-5 Basics
 SectionIntroduction
Use of the Manual
Cautionary Statement for Forensic Use of DSM-5
II: Diagnostic Criteria and Codes
 SectionPresent
the categorical diagnoses according to a revised 20 chapter
organization that eliminates the multiaxial system
 Section III: Emerging Measures and Models
Assessment Measures
Cultural Formulation
Alternative DSM-5 Model for Personality Disorders Conditions for
Further Study
• Appendix
of Changes From DSM-IV to DSM-5
• Highlights
of Technical Terms
• Glossary
• Glossary of Cultural Concepts of Distress
•
DSM-5 Diagnoses and Codes (ICD-9-CM and ICD-10-CM)
Diagnostic Categories
Major Diagnostic Classifications
•
•
1. Neurodevelopmental Disorders
2. Schizophrenia Spectrum and Other
Psychotic Disorders
•
10. Feeding and Eating Disorders
•
11. Elimination Disorders
•
12. Sleep-Wake Disorders
•
13. Sexual Dysfunctions
•
3. Bipolar and Related Disorders
•
4. Depressive Disorders
•
14. Gender Dysphoria
•
5. Anxiety Disorders
•
15. Disruptive, Impulse- Control, and
Conduct Disorders
•
16. Substance-Related and Addictive
Disorders
•
17. Neurocognitive Disorders
•
18. Personality Disorders
•
19. Paraphilic Disorders
•
20. Other Disorders
•
6. Obsessive-Compulsive and Related
Disorders
•
7. Trauma and Stressor- Related Disorders
•
8. Dissociative Disorders
•
9. Somatic Symptom and Related Disorders
Diagnostic Category
Examples of Specific Disorders
Neurodevelopmental Disorders
Autism Spectrum Disorder
Specific Learning Disorder
Communication Disorders
ADHD, Motor Disorders, etc.
Schizophrenia Spectrum and Other
Psychotic Disorders
Schizophrenia
Schizophreniform Disorder
Schizoaffective Disorder
Delusional Disorder
Schizotypal Personality Disorder
Bipolar and Related Disorders
Bipolar I Disorder, Bipolar II Disorder
Cyclothymic Disorder
Depressive Disorders
Disruptive Mood Dysregulation
Disorder
Major Depressive Disorder
Persistent Depressive Disorder
Premenstrual Dysphoric Disorder
Diagnostic Category
Examples of Specific Disorders
Anxiety Disorders
Specific Phobia
Social Anxiety Disorder (Social Phobia)
Panic Disorder
Agoraphobia
Generalized Anxiety Disorder
Separation Anxiety Disorder
Selective Mutism
Obsessive-Compulsive and Related
Disorders
Obsessive-Compulsive Disorder
Body Dysmorphic Disorder
Hoarding Disorder
Hair-Pulling Disorder (Trichotillomania)
Excoriation (Skin-Picking) Disorder
Trauma and Stressor Related Disorders
Adjustment Disorders
Acute Stress Disorder
Posttraumatic Stress Disorder
Reactive Attachment Disorder
Disinhibited Social Engagement Disorder
Diagnostic Category
Examples of Specific Disorders
Dissociative Disorders
Dissociative Identity Disorder
Dissociative Amnesia
Depersonalization/Derealization Disorder
Somatic Symptom and Related
Disorders
Somatic Symptom Disorder
Illness Anxiety Disorder
Conversion Disorder (Functional Neurological
Symptom Disorder)
Factitious Disorder
Feeding and Eating Disorders
Anorexia Nervosa
Bulimia Nervosa
Binge Eating Disorder
Pica, Rumination Disorder
Avoidant/Restrictive Food Intake Disorder
Elimination Disorders
Enuresis
Encopresis
Diagnostic Category
Examples of Specific Disorders
Sleep-Wake Disorders
Insomnia Disorder
Hypersomnolence Disorder
Narcolepsy
Breathing-Related Sleep Disorders
Circadian Rhythm Sleep-Wake Disorders
Parasomnias: Sleepwalking, Sleep Terrors,
Nightmare Disorder, Rapid Eye Movement
Sleep Behavior Disorder
Restless Legs Syndrome
Sexual Dysfunctions
Delayed Ejaculation
Erectile Disorder
Female Orgasmic Disorder
Female Sexual Interest/Arousal Disorder
Genito-Pelvic Pain/Penetration Disorder
Male Hypoactive Sexual Desire Disorder
Premature (Early) Ejaculation
Diagnostic Category
Examples of Specific Disorder
Gender Dysphoria
Gender Dysphoria
Disruptive, Impulse-Control,
and Conduct Disorders
Oppositional Defiant Disorder
Intermittent Explosive Disorder
Conduct Disorder
Antisocial Personality Disorder
Pyromania
Kleptomania
Substance-Related and Addictive Substance Use Disorders
Disorders
Substance-Induced Disorders
Gambling Disorder
Neurocognitive Disorders
Delirium
Major & Mild Neurocognitive Disorders
Diagnostic Category
Personality Disorders
Examples of Specific Disorders
Paranoid Personality Disorder
Schizoid Personality Disorder
Schizotypal Personality Disorder
Antisocial Personality Disorder
Borderline Personality Disorder
Histrionic Personality Disorder
Narcissistic Personality Disorder
Avoidant Personality Disorder
Dependent Personality Disorder
Obsessive-Compulsive Personality Disorder
Diagnostic Category
Examples of Specific Disorders
Paraphilic Disorders
Voyeuristic Disorder
Exhibitionistic Disorder
Frotteuristic Disorder
Sexual Masochism Disorder
Sexual Sadism Disorder
Pedophilic Disorder
Fetishistic Disorder
Transvestic Disorder
Other Mental Disorders
Other Specified Mental Disorder due to
Another Medical Condition
Substance-Related and
Addictive Disorders
Substance-Related and
Addictive Disorders
 Substance Use Disorders
No more Substance Abuse and Substance Dependence

Criteria
•
Nearly identical to the DSM-IV substance abuse and dependence criteria combined into a single list
•
Nearly all substances are diagnosed based on the same overarching criteria
•
Criteria for intoxication, withdrawal, substance/medication-induced disorders, and unspecified
substance-induced disorders
•
Threshold = 2 of 11 symptoms
•
Impaired control (criteria 1-4)
Social impairment (criteria 5-7) Risky use (criteria 8-9)
•
Removed: recurrent legal problems criterion
•
Added: craving or a strong desire or urge to use a substance
Pharmacological criteria (criteria 10-11)
SUD Criteria
Impaired control (criteria 1-4)
Social impairment (criteria 5-7) Risky use (criteria 8-9)
criteria (criteria 10-11)
Pharmacological
•
______ is often taken in larger amounts or over a longer
period than was intended.
•
Recurrent _____ use in situations in which it is
physically hazardous.
•
There is a persistent desire or unsuccessful efforts to cut
down or control _____ use.
•
____ use is continued despite knowledge of having a
persistent or recurrent physical or psychological problem
that is likely to have been caused or exacerbated by
_____.
•
A great deal of time is spent in activities necessary to
obtain ______, use _____, or recover from its effects.
•
Tolerance, as defined by either of the following:
•
Craving, or a strong desire or urge to use ____.
•
Recurrent _____ use resulting in a failure to fulfill major
role obligations at work, school, or home.
•
•
Continued _____ use despite having persistent or
recurrent social or interpersonal problems caused or
exacerbated by the effects of _____.
Important social, occupational, or recreational activities
are given up or reduced because of _____use.
A need for markedly increased amounts of
_____ to achieve intoxication or desired effect.
A markedly diminished effect with continued
use of the same amount of ____.
•
Withdrawal, as manifested by either of the following:
____
symptoms.
The characteristic withdrawal syndrome for
____ is taken to relieve or avoid withdrawal
Substance-Related and Addictive Disorders
•
•
•
Remission specifiers
No more partial and full
Early remission = at least 3 but less than 12
months without substance use disorder criteria
(except craving)
•
Removed
•
Polysubstance Abuse/Dependence
•
Amphetamine
•
Cocaine
•
Sustained remission = at least 12 months without
criteria (except craving)
•
Specifier for a physiological subtype
•
Severity ratings
•
On agonist therapy
•
2–3 criteria indicate = a mild disorder
•
•
4–5 criteria = moderate disorder
Added:
Cannabis & Caffeine Withdrawal
Tobacco Use Disorder
•
6 or more = a severe disorder
•
In a controlled environment specifier
•
On Maintenance therapy specifier
Substance-Related and Addictive Disorders
• Gambling Disorder
•
“This change reflects the increasing and consistent
evidence that some behaviors, such as gambling, activate
the brain reward system with effects similar to those of
drugs of abuse and that gambling disorder symptoms
resemble substance use disorders to a certain extent”
•
Lowering of the pathological gambling threshold to 4
symptoms
•
Removal of the ‘‘illegal acts’’ criterion for the disorder
Depressive Disorders
Depressive Disorders
• Bereavement Exclusion
•
In DSM-IV, there was an exclusion criterion for a major depressive episode that was
applied to depressive symptoms lasting less than 2 months following the death of a loved
one (i.e., the bereavement exclusion).
•
This exclusion has been omitted in DSM-5.
- bereavement can be long lasting and persistent
- it is a severe psychosocial stressor that can initiate depressive episodes
- genetic connection
- bereavement-related depression and non-bereavement depression respond to same
treatments
Grief vs MDE in DSM-5
Grief
Major Depression
•
Dominant affect is feelings of
emptiness and loss
•
Dominant affect is depressed
mood
•
Dysphoria occurs in waves,
vacillates with exposure to
reminders and decreases with
time
•
Persistent dysphoria that is
accompanied by self-critical
preoccupation and negative
thoughts about the future
•
Capacity for positive emotional
experiences
•
Limited capacity to experience
happiness or pleasure
•
Self-esteem preserved
•
Worthlessness clouds esteem
•
Fleeting thoughts of joining
deceased
•
Suicidal ideas about escaping life
versus joining a loved one
Specifiers for MDD
•
With anxious distress
•
With mixed features
•
With melancholic features
•
With atypical features
•
With mood-congruent psychotic features or with mood-incongruent
psychotic features
•
With catatonia (code separately)
•
With peripartum onset
•
With seasonal pattern
Disruptive Mood Dysregulation Disorder
(DMDD)
•
Essential feature: Severe temper outbursts with underlying persistent
angry or irritable mood
• – Temper outburst frequency: Three or more time a week
• – Duration: Temper outbursts and the persistently irritable
• mood between outbursts lasts at least 12 months
• – Severity: Present in two settings and severe in at least one
• – Onset: Before age 10 but do not diagnose before age 6. Can not
diagnose for the first time after age 18.
• – Common rule-outs:
• Bipolar disorder, intermittent explosive disorder, depressive
disorder, ADHD, ASD, separation anxiety disorder
• If ODD present, do not dx
Persistent Depressive Disorder
(formerly Dysthymia)
• Essential feature: Depressed mood plus at least two
other depressive symptoms
• Duration: The symptoms persist for at least two
years (one year for children and adolescents)
• May include periods of major depressive episodes
(double depression)
• Rule outs: Be sure it is not due to another psychotic
disorder, substance, medication or medical condition
Premenstrual Dysphoric
Disorder (PMDD)
• Essential feature: Significant affective symptoms that emerge in
the week prior to menses and quickly disappear with the onset
of menses
• Symptom threshold: At least five symptoms which include
marked affective lability, depressed mood, irritability, or
tension
• Duration: Present in all menstrual cycles in the past year and
documented prospectively for two menstrual cycles
• Impairment: Clinically significant distress or impairment
• Rule outs: An existing mental disorder (e.g., MDD), another
medical condition (e.g., migraines that worsen during the
premenstrual phase) or substance or medication use
Bipolar and Related
Disorders
Bipolar Disorders
• the primary criteria for manic and hypomanic episodes
(Criterion A) now includes an emphasis on changes in
activity and energy — not just mood.
• a new specifier, “with mixed features,” has been added,
that can be applied to episodes of mania or hypomania
when depressive features are present.
• A specifier for anxious distress is now defined. This
specifier is intended to identify patients with anxiety
symptoms that are not part of the bipolar diagnostic
criteria
Anxiety Disorders
Changes from IV-TR to 5
• 1. Including Selective Mutism and Separation Anxiety
Disorder into Anxiety Disorders
• 2. Changing the name of Social Phobia to Social Anxiety
Disorder.
• 3. Removing Panic Attack as a specifier for Agoraphobia.
• 4. Assigning Panic Attack as a specifier that may be
applied to a wide array of DSM-5 diagnoses.
• 5. Removing OCD, PTSD, ASD from this category
Separation Anxiety Disorder
• Separation Anxiety Disorder was moved from
Disorders Usually First Diagnosed in Infancy, Childhood,
or Adolescence (DSM-IV-TR) to the Anxiety Disorders
chapter.
• The age-of-onset requirement (‘‘before age 18
years’’) was been dropped; thus allowing for
diagnosis of Separation Anxiety Disorder in adults
(Mohr & Schneider, 2013).
Social Anxiety Disorder
(SAD)
•
Social phobia was originally classified as a mental disorder in the DSM-III
and has been renamed Social Anxiety Disorder (SAD) in the DSM-5.
•
The main feature of SAD is ongoing fear and worry surrounding myriad
social situations (Kerns, Corner, Pincus, & Hofmann, 2013).
•
It is one of the most common mental disorders with a lifetime prevalence
rate of slightly greater than 10%.
•
The majority of diagnoses are made during childhood or early
adolescence (Kerns et al., 2013; Marques et al., 2011).
•
SAD is often seen in conjunction with Major Depressive Disorders, other
Anxiety Disorders, and Substance Use Disorders (APA, 2013).
SAD
• Individuals with SAD often fear negative evaluation
(e.g., being humiliated, embarrassed, or rejected) by
others (either unfamiliar or familiar) in performance,
interaction, or observation situations.
• A Performance only specifier has been added for SAD
in the DSM-5 and includes a minimum duration of 6
months.
• Children, adolescents, and adults now share the
same criteria for duration, and the criterion for adult
insight has been dropped (Mohr & Schneider, 2013).
Trauma & StressRelated Disorders
PTSD
•
Instead of three major symptom clusters for PTSD, the DSM-5 now lists
four clusters:
•
Re-experiencing the event — For example, spontaneous memories of the
traumatic event, recurrent dreams related to it, flashbacks or other intense
or prolonged psychological distress.
•
Heightened arousal — For example, aggressive, reckless or self-destructive
behavior, sleep disturbances, hyper-vigilance or related problems.
•
Avoidance — For example, distressing memories, thoughts, feelings or
external reminders of the event.
•
Negative thoughts and mood or feelings — For example, feelings may vary
from a persistent and distorted sense of blame of self or others, to
estrangement from others or markedly diminished interest in activities, to
an inability to remember key aspects of the event.
PTSD Subtypes
• Children 6 and Younger Subtype, which is used to diagnose
PTSD in children younger than 6 years. Post-traumatic
stress disorder is also now developmentally sensitive,
meaning that diagnostic thresholds have been lowered for
children and adolescents.
• PTSD Dissociative Subtype. It is chosen when PTSD is seen
with prominent dissociative symptoms. These dissociative
symptoms can be either experiences of feeling detached
from one’s own mind or body, or experiences in which
the world seems unreal, dreamlike or distorted.
Other TSRDs
• Adjustment disorders are reconceptualized in the
DSM-5 as a stress-response syndrome. This takes
them out of their residual, catch-all category and
places them into a conceptual framework that these
disorders represent a simple response to some type
of life stress (whether traumatic or not).
Obsessive-Compulsive
and Related Disorders
Hoarding Disorder
• Hoarding graduates from being listed as just one
symptom of obsessive-compulsive personality
disorder in the DSM-IV, to a full-blown diagnostic
category in the DSM-5.
• Hoarding disorder is characterized by the persistent
difficulty discarding or parting with possessions,
regardless of the value others may attribute to these
possessions
Autistic Spectrum
Disorder
Pervasive Developmental
Disorders (DSM-IV-TR)
• Autistic Disorder
• Childhood Disintegrative Disorder
• Asperger’s Disorder
• Pervasive Developmental Disorder, NOS
Autism Spectrum Disorder
• A. Persistent deficits in social communication and
social interaction across multiple contexts, as
manifested by the following, currently or by history
• Deficits in social-emotional reciprocity Deficits in
nonverbal communicative behaviors uses for social
interactions
• Deficits in developing, maintaining, and
understanding relationships
Autism Spectrum Disorder
• B. Restricted, repetitive patterns of behavior, interests, or
activities, as manifested by at least two of the following,
currently or by history
• ∗
Stereotyped or repetitive motor movements, use of
objects, or speech
• ∗
Insistence on sameness, inflexible adherence to routines,
or ritualized patterns of verbal or nonverbal behavior
• ∗
Highly restricted, fixated interests that are abnormal in
intensity or focus
• ∗
Hyper- or hyporeactivity to sensory input or unusual
interest in sensory aspects of the environment
Specifiers/Modifiers
• With or without accompanying intellectual impairment
• ∗ With or without accompanying language impairment
• ∗ Associated with a known medical or genetic condition
or environmental factor
• ∗ Associated with another neurodevelopmental, mental,
or behavioral disorder
• ∗ With catatonia
Level of Severity
• Level 1: Requiring Support
• Level 2: Requiring Substantial Support
• Level 3: Requiring Very Substantial Support
Example Diagnoses
• Autism Spectrum Disorder, Level 2, with mild
intellectual disability and language impairment onset
age 20 months loss of previously acquired language
• ∗ Autism Spectrum Disorder, Level 1, associated
with ADHD without intellectual disability and
without language impairment
• ∗ Autism Spectrum Disorder, Level 2, associated
with Cerebral Palsy, mild intellectual impairment
and stuttering
Personality Disorders
New Hybrid Personality Model
•
In the new proposed model, clinicians would assess personality and diagnose a
personality disorder based on an individual’s particular difficulties in personality
functioning and on specific patterns of those pathological traits.
•
The hybrid methodology retains six personality disorder types:
•
Borderline Personality Disorder
•
Obsessive-Compulsive Personality Disorder
•
Avoidant Personality Disorder
•
Schizotypal Personality Disorder
•
Antisocial Personality Disorder
•
Narcissistic Personality Disorder
New Hybrid Personality Model
• Criterion A includes assessment of personality
functioning towards self (identity, self-direction),
and interpersonally (empathy, intimacy).
• Criterion B includes Pathological Personality Traits
Five broad traits- Negative Affectivity, Detachment,
Antagonism, Disinhibition, and Psychotisim. (and
25 trait facets)
Assessment & Diagnosis
Purpose of a DSM-5 Diagnosis
• “If the disorder does not usefully inform that
person’s diagnosis, treatment, or prognosis, then the
diagnosis is considered inappropriate” (Nussbaum,
2013, p. 10)
• The diagnosis should have clinical utility:
Prognosis, Plan and Outcome
Approach to Clinical Case Formulation
Diagnostic content
 Diagnostic Features
 Associated Features
 Prevalence
 Development and Course
 Risk and Prognostic Factors
(Environment, Genetic and physiological, Temperamental, Course modifiers)
 Culture-Related Diagnostic Issues
 Gender-Related Diagnostic Issue
 Suicide Risk
 Functional Consequences
 Differential Diagnosis
 Comorbidity Subtypes
Specifiers – course, severity, descriptive, In Full/Partial Remission
Mild/Moderate/Severe/Extreme/Profound, Single/Recurrent/Episodic/ Persistent
Acute/Subacute Generalized/Situational Lifelong/Acquired
No More 5 Axes Diagnosis.
• Axis I
• Axis II
Collapsing Axis I/II/III
• Axis III
• Axis IV
• Axis V
examining codes in the ICD-10 that might be
comparable to the concepts in DSM-IV - allows
DSM to more closely parallel the ICD
goals is to operationalize disability to be more
consistent with the WHO’s approach in the
International Classification of Functioning,
Disability and Health (ICF)
DSM 5 Diagnosis
• Primary Diagnosis:
• The most acute condition
that requires the most
intensive skilled services
More Psychosocial Stressor
Options (pp.715-727)

Relational Problems

Adult maltreatment and neglect problems

Problems related to family upbringing

spouse or partner violence, physical

Other problems related to primary support
group

spouse or partner violence, sexual

spouse or partner neglect spouse of
partner abuse, psychological

Adult abuse by nonspouse or nonpartner

Abuse and Neglect

Child maltreatment and neglect problems

child physical abuse

child sexual abuse

child neglect

child psychological abuse
More Psychosocial Stressor
Options (pp.715-727)
 Educational and Occupational
Problems

Educational Problems

Occupational Problems
 Housing and Economic Problems

Housing Problems

Economic Problems
 Other Problems Related to the Social
Environment

Problems Related to Crime or
Interaction with the Legal System
 Other Health Service Encounters for
Counseling and Medical Advice

Problems Related to Other
Psychological, Personal, and
Environmental Circumstances

Other Circumstances of Personal
history

Problems Related to Access to Medical
and Other Health Care

Nonadherence to Medical Treatment
Assessment Measures
•
Cross-Cutting Symptom
•
Depression
•
Anger
•
Mania
•
Anxiety
•
Level 1 Cross-Cutting Symptom Measure
•
Treatment, prognosis, and track changes
•
For substance use, suicidal ideation, and
psychosis, a rating of slight or greater on any
item within the domain may serve as a guide
for additional inquiry and follow-up to
determine if a more detailed assessment is
needed
•
Somatic symptoms
•
Suicidal ideation
•
Psychosis Sleep problems
•
Memory
•
Adult version 13 psychiatric domains
•
Repetitive thoughts and behaviors
•
Parent/guardian-rated version For children
ages 6-17 12 psychiatric domains
•
Dissociation
•
Personality functioning
•
Substance use
•
Clinician-Rated Dimensions of Psychosis
Symptom Severity- Help with treatment
planning and prognostic decision-making
•
Level 2 Cross-Cutting Symptom Measure
More in-depth information on potentially
significant symptoms to inform diagnosis,
treatment planning, and follow-up
Assessment Measures
WHODAS 2.0
•
•
World Health Organization Disability
Assessment Schedule (WHODAS 2.0)
•
Covers six domains
•
Average domain score
Provided in Section III (pp.745-748) as
the best current alternative for
measuring disability: various disorderspecific severity scales
•
Average general disability score
•
Cognition – understanding & communication
•
Mobility – moving & getting around
•
Self-care – hygiene, dressing, eating & staying
alone
•
Getting along – interacting with other people
•
Life activities – domestic responsibilities, leisure,
work & school
•
Participation – joining in community activities
•
Scoring for 36 item full version: 0 = no
disability; 100 = full disability
•
Adults age 18 years and older Areas of
functioning past 30 days
•
Self administered or interview
administered
Cultural Formulation
•
Outline for Cultural Formulation
Identity, conceptualization, psychosocial stressors, therapy relationship, and overall assessment
•
Cultural Formulation Interview (CFI)
In the CFI, culture refers primarily to the values, orientations, and assumptions that individuals derive
from membership in diverse social groups (e.g., ethnic groups, the military, faith communities), which
may conform or differ from medical explanations
•
Set of 14 questions that clinicians may use to obtain information during a mental health
assessment about the impact of culture on key aspects of care
Cultural Definition of the Problem - Cultural Perceptions of Cause, Context, and Support - Cultural
Factors Affecting Self Coping & Past Help Seeking Current Help Seeking
•
Cultural Concepts of Distress
To avoid misdiagnosis, obtain useful clinical information, improve clinical rapport and engagement,
improve therapeutic efficacy, guide clinical research, and clarify cultural epidemiology
Web Resources
• www.psychiatry.org/dsm5
Sample Diagnosis
•
Sample DSM-5 Diagnosis
F34.1 Persistent Depressive Disorder, mild severity, early onset
F60.7 Dependent Personality Disorder
G47.35 Comorbid Sleep-Related Hypoventilation
E66.9 Overweight or Obesity
WHODAS 2.0
•
Score of 53 with Severe deficiencies in getting around domain (standing
up from sitting down, moving around house) and in getting along with
people domain (dealing with people he does not know); moderate
deficiencies in life activities domain (getting work done); mild deficiencies
in participation in society domain (family problems because of health
problems)
References
• ACA DSM-5 Webinar Series
• American Psychiatric Association. (2013). Diagnostic
and statistical manual of mental disorders (5th ed.).
Arlington, VA: American Psychiatric Publishing.
Questions?
Contact Info
Dr. Mark Schwarze
[email protected]