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Demystifying The DSM-5
I had the opportunity to attend a DSM-5 (Diagnostic and Statistical Manual 5th Edition) training. In my humble opinion, all negative myths about it have been dispelled. There are so many changes; I recommend that all professionals in the mental health field attend this training. The DSM-5 will not come into effect until October 1, 2014, when the old classification system of the DSM-IV-TR will be synchronized with the ICD-10 classifications. The ICD-10 classification system is used worldwide and includes codes for medical and mental disorders. We are moving towards a universal classification system. This new classification system is now in the new DSM-5.
The DSM-5 was compiled through rigorous scientific testing around the world. The new changes have the advantage of taking into account age, gender and cultural circumstances – unlike DSM-IV-TR. Disorders are now being looked at across the lifespan, not just how they present in adults, but also what the disorders look like in children and vice versa (especially ADHD, bipolar disorder, and depression).
DSM-5 eliminated the five axis diagnoses. The reason for this is that we write the four axes, but during the treatment we only focus on axis I. They try to go beyond that and treat the whole person. Axis V (GAF) was omitted as it was an arbitrary number and depending on who treated the individual the number would vary. It was unreliable. Now there is the primary diagnosis we are treating, and then all other diagnoses or problems are coded below in order of importance. We may be handling different things at the same time – nothing is lost. WHODAS replaces GAF. This is collected by giving questionnaires (standardized measurements), which you fill out in cooperation with the specialist. Most questionnaires are filled out only with adults/adolescents. This provides a score that is converted to a scale of 1 to 100. The higher the number, the more severe the problem. It is mild, moderate or severe. The specialist writes a summary of the results and uses a strengths-based approach, listing strengths and what needs improvement. What the insurance companies want is still up for grabs. Diagnoses rely heavily on client reports and clinician judgment. The DSM-5 is only a guide. This is not a cookbook that gives answers to the professional, as it now allows for professional judgement. It is a collaborative measure that works with the client. It does not prescribe treatment or medications.
A diagnosis of autism spectrum disorder doesn’t have to sound scary anymore. Autism spectrum disorder is classified on a continuum. The way the specialist codes this now differentiates him from simply being autistic. All aspects of the individual are examined (there is a questionnaire that determines the disorder and level of severity). The WHODAS describes an individual’s strengths and what they are not so good at – again the professional works with the caregiver to choose a diagnosis. However, it gives a more accurate diagnosis than a diagnosis than say Asperger’s can give. Takes into account speech, bonding, daily activities, etc. The specialist can give you, the layman, a comprehensive picture of your child/adolescent/adult. This is exciting because the treatment can be made more specific.
Diagnosis will be more time-consuming, but more accurate because it is a collaborative effort and therefore more personalized than what professionals currently do. Measures can be administered multiple times and can show progress and results from therapy.
Again, you can ignore the buzzwords and feel at ease that the myths have been debunked. I left the seminar very confident and rejuvenated. In my professional opinion, all the bad publicity was for nothing. Talk to a DSM-5 expert, dispel your own myths, and learn how mental health is evolving worldwide.
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