Download Communicating

Communicating Symptoms &
Disorders to Other
Professionals
What do counselors need to know about the
DSM?
Charles Pemberton, Ed.D.,LPCC
www.pembertoncounseling.com
History of the DSM?


The first edition (DSM-I) was published in
1952, and had about 60 different disorders.
DSM-II was published in 1968.

Among the most noted examples of controversial
diagnoses is the classifying in the DSM-II of
homosexuality as a mental disorder, a
classification that was removed by vote of the
APA in 1973 (see also homosexuality and
psychology).





In 1980, with DSM-III, the psychodynamic view was
abandoned and the biomedical model became the primary
approach, introducing a clear distinction between normal and
abnormal. The DSM became atheoretical since it had no
preferred etiology for mental disorders.
In 1987 the DSM-III-R appeared as a revision of DSM-III.
Many criteria were changed.
In 1994, it evolved into DSM-IV. This work is currently in its
fourth edition.
The most recent version is the 'Text Revision' of the DSM-IV,
also known as the DSM-IV-TR, published in 2000. The vast
majority of the criteria for the diagoses were not changed
from DSM-IV. The test in between the criteria was updated.
DSM-V, is not scheduled for publication until 2011 or
possibly later. The APA Division of Research does not expect
to begin forming DSM development workgroups until 2007
or later.
Why do we need this book?




Communication
Classification
Research
Payment
Conceptualization of DSM





Syndromes
Criteria
Normal vs. Abnormal
Dimensional vs. Categorical
Problems/Ethics



Labeling
Meeting some criteria
Impairment??
Organization of DSM

Major Groupings








Childhood*
Dementia
Substance
Schizophrenia
Mood
Anxiety
Somatoform
Factitious






Dissociative
Sexual and Gender
Eating
Sleep
Adjustment
Personality
Organization of each D/O

Diagnostic Features







Episode
Associated
Culture, Age and Gender
Prevalence
Familial Pattern
Differential Diagnosis
Criteria
General Criteria of DSM
(these apply to all disorders)



Disorder not due to direct effects of a
substance.
Disorder not due to direct effects of a general
medical condition.
Disorder causes clinically significant distress
or impairment in social, occupational, or other
important areas of functioning.
Precedence of Dx





“not due to the direct effects of a
substance…”
“has never met the criteria for…”bipolar vs. MDD
“does not meet the criteria for…”ODD vs. CD
“does not occur exclusively during the course
of ….”ADHD vs. PDD
“not better accounted for by…”ADHD vs.
Mood/Anxiety
AXIS





Axis I : Clinical Disorders
Axis II: Personality Disorder and Mental
Retardation
Axis III: General Medical Condition
Axis IV: Psychosocial and Environmental
Problems
Axis V: Global Assessment of Functioning
Numbering System and Specifiers

Numbers




Follows ICD 10 format
First three numbers
Last two numbers
Text Specifiers


Severity (Mild, Moderate, Severe)
Timing (Seasonal, Rapid Cycling, Partial/Full
Remission)
Attention Deficit Hyperactivity Disorder
•
Within the “Disorders Usually First Diagnosed in
Infancy, Childhood, or Adolescence” grouping, then
subgrouped by the category of “disruptive or self
injurious behavior”
ADHD, Major Diagnostic Features







Often will not complete tasks
Easily distracted by minor stimuli
Work often messy and completed w/o thought
Forgetful in day-to-day activities
Impulsive (interrupting others, cannot wait
turn, etc.)
Fidgetiness
Excessive talking
Prevalence of ADHD



Estimated at 3-7% of school age children
More common in males than females
Often diagnosed during elementary school
years.
Differential Diagnosis of ADHD






Must distinguish from age-appropriate
behaviors
Mental Retardation or Learning Disability
Oppositional behavior (ODD, Conduct D/O)
Stereotypic Movement D/O
Behavior due to medications
Mood or Anxiety D/O
Subtypes of ADHD

314.01 ADHD, Combined Type


314.00 ADHD, Inattentive Type


Criteria A1 met, but not A2
314.01 ADHD, Hyperactive-Impulsive Type


Criteria A1 & A2 both met for past 6 months
Criteria A2 met, but not A1
314.9 ADHD NOS

Prominent symptoms but do not meet diagnostic criteria
Diagnostic Criteria for ADHD


A 1. Must exhibit 6 or more symptoms of
inattention, persisting for minimum of 6
months: from list of 9 items, a through i.
A 2. Must exhibit 6 or more symptoms of
hyperactivity-impulsivity, persisting for
minimum of 6 months, from list of 9 items, a
through i.
Diagnostic Criteria, cont’d:




B. symptom onset PRIOR to age 7 years
C. impairment present in two or more
environments
D. clear clinically significant impairment in
functioning
E. cannot be accounted for by other mental
disorder
Diagnostic Presentation of ADHD




Symptoms will vary based on age.
More common in males than females.
Hyperactivity may manifest as internal feeling of
restlessness for older individuals, versus
fidgeting.
No test exists to “diagnose” ADHD. Several
instruments measure symptomatology that is
associated with ADHD, but only way to diagnose
is through clinical impression and observation.
Autism vs. Asperger’s



http://www.behavenet.com/capsules/disorders
/dsm4TRclassification.htm
http://BehaveNet® Clinical Capsule™
Asperger's Disorder.htm
http://www.behavenet.com/capsules/disorders
/autistic.htm
References



American Psychiatric Association: Diagnostic and
Statistical Manual of Mental Disorders, Fourth
Edition, Text Revision. Washington, DC, American
Psychiatric Association, 2000.
Fauman, M. A. (2002). Study Guide to DSM-IV-TR.
Washington, DC: American Psychiatric Publishing,
Inc.
www.pembertoncounseling.com