Abnormal Psychology and DSM-5

IP Unit 1

Professor Name Here

Submitted in Partial Fulfillment of the Requirements for

Abnormal Psychology in the Workplace

By

Reanna Leonard Waugh

May 2018
 Abnormal Psychology and DSM-5

The APA has published three separate drafts of the DSM on their website. (John M.

Grohol, 2018) This was a result of over 13,000 comments, emails and letters dating from the

years 2010 – 2012. (John M. Grohol, 2018) Each statement was said to have been adequately

assessed. (John M. Grohol, 2018) This was an extraordinary situation of candidness that has at

no time witnessed in the modification of a diagnostic manual. (John M. Grohol, 2018)

The changes made to Autism.

“There is now a single condition called autism spectrum disorder, which incorporates four

previous separate disorders. As the APA states:

ASD now encompasses the previous DSM-IV autistic disorder (autism), Asperger’s disorder,

childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified.

ASD is characterized by 1) deficits in social communication and social interaction and 2)

restricted repetitive behaviors, interests, and activities (RRBs). Because both components are required

for the diagnosis of ASD, social communication disorder is diagnosed if no RRBs are present.” (John M.

Grohol, 2018)

With regards to the Disruptive Mood Dysregulation Disorder the DSM-5 states:

“Childhood bipolar disorder has a new name — “intended to address issues of over-diagnosis

and overtreatment of bipolar disorder in children.” This can be diagnosed in children up to age 18 years

who exhibit persistent irritability and frequent episodes of extreme behavioral dyscontrol (e.g., they are

out of control).” (John M. Grohol, 2018)

ADHD

“Attention deficit hyperactivity disorder (ADHD) has been modified somewhat, especially to

emphasize that this disorder can continue into adulthood. The one “big” change (if you can call it that) is

that you can be diagnosed with ADHD as an adult if you meet one less symptom than if you are a child.

While that weakens the criteria marginally for adults, the criteria are also strengthened at the same

time. For instance, the cross-situational requirement has been strengthened to “several” symptoms in

each setting (you can’t be diagnosed with ADHD if it only happens in one setting, such as at work). The

criteria were also relaxed a bit as the symptoms now have to had appeared before age 12, instead of

before age 7.” (John M. Grohol, 2018)

Bereavement Exclusion Removal

“In the DSM-IV, if you were grieving the loss of a loved one, technically you couldn’t be

diagnosed with major depression disorder in the first 2 months of your grief. (I’m not sure where this

arbitrary 2-month figure came from, because it certainly reflects no reality or research.). This exclusion

was removed in the DSM-5. Here are the reasons they gave:

The first is to remove the implication that bereavement typically lasts only 2 months when both

physicians and grief counselors recognize that the duration is more commonly 1–2 years. Second,

bereavement is recognized as a severe psychosocial stressor that can precipitate a major depressive

episode in a vulnerable individual, generally beginning soon after the loss. When major depressive

disorder occurs in the context of bereavement, it adds an additional risk for suffering, feelings of

worthlessness, suicidal ideation, poorer somatic health, worse interpersonal and work functioning, and

an increased risk for persistent complex bereavement disorder, which is now described with explicit
criteria in Conditions for Further Study in DSM-5 Section III. Third, bereavement-related major

depression is most likely to occur in individuals with past personal and family histories of major

depressive episodes. It is genetically influenced and is associated with similar personality characteristics,

patterns of comorbidity, and risks of chronicity and/or recurrence as non–bereavement-related major

depressive episodes. Finally, the depressive symptoms associated with bereavement-related depression

respond to the same psychosocial and medication treatments as non–bereavement-related depression.

In the criteria for major depressive disorder, a detailed footnote has replaced the more simplistic DSM-

IV exclusion to aid clinicians in making the critical distinction between the symptoms characteristic of

bereavement and those of a major depressive episode.” (John M. Grohol, 2018)

What is DSM and why do we need to use it?

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the guidebook used by

healthcare specialists in the US and most of the world. ("DSM-5 FAQ", 2018) The DSM guide is the

imposing controller to the diagnosis of most mental disorders. ("DSM-5 FAQ", 2018) The DSM

encompasses accounts, indications, and other standards for diagnosing mental disorders. ("DSM-5 FAQ",

2018) It also delivers a language that is common to all clinicians for communication for their patients

and creates reliable and consistent diagnoses that can be used in the exploration of mental disorders.

("DSM-5 FAQ", 2018) In addition to this, it provides a shared language for researchers to exercise the

standards for probable future amendments and to support the development of medications and other

intercessions. ("DSM-5 FAQ", 2018)

The purpose of a conducting a clinical assessment.

The purpose of doing a clinical evaluation is to gather material to enable the clinician to control

a diagnosis. This sets up a treatment plan that is articulated by treatment intercessions. Assessments

can typically be completed in about one hour, yet the full assessment at times can’t always do. There
are many factors to consider. The client may not be cooperative, may be overwhelmed with shock,

anguish or suffering. ("Clinical Assessment Questions", 2018) It’s common for the clinician to want a few

sessions to feel they understand the entirety of the client’s complications. ("Clinical Assessment

Questions", 2018) This can be even further accurate when seeing couples. ("Clinical Assessment

Questions", 2018)

Some Problem identification to ask may be:

“What is the presenting problem?

What brings you here today?

How long has this been a problem?

Have you noticed times when the problem isn’t as bad?

Has anything like this happened before?

If so, how? How did you try to resolve this problem the last time?

How often has this problem occurred?

Who is involved or affected by this current problem/situation?” ("Clinical Assessment Questions", 2018)

Some goals to consider may include:

“What is your goal in coming to counseling?

What would you like to get out of this appointment time?

What changes would you like to see happen?

What are some things in your current situation you would like to keep or stay the same?
How will you know (what will you be thinking and doing differently) such that you won’t need to come

back to a place like this anymore?” ("Clinical Assessment Questions", 2018)

Some Symptoms questions to as may include:

“Have you experienced any recent changes in eating, sleeping, mood or concentrating?

Have you gained or lost any weight recently?

What is your level of alcohol or drug use? See C/D Assessment.

Have you had any thoughts currently, or in the past, of wanting to do anything to hurt yourself or

someone else? See Safety Assessment.

Has your current problem or difficulty been affecting your health?

Has your current concern(s) affected your ability to perform your duties at work, school or home?”

("Clinical Assessment Questions", 2018)

Additional clinical assessment questions may include:

“Do you have important people in your life to talk to, or do you tend to keep your problems to yourself?

Have you had any recent problems with the police?

When was your last physical exam? Any concerns?

Are you taking any medications?

Have you had any recent hospitalizations?

Do you have any history of physical or sexual abuse?

Do you see or hear things others might not?

Have you ever been in therapy before?” ("Clinical Assessment Questions", 2018)

A Clinical Scenario Example:

“Walter, a 22-year-old male, was referred to counseling by the State Office of Rehabilitation for

career and vocational assistance, with a special focus on his mental health needs and confirming the

presence of his previous diagnosis of Asperger’s disorder given in 2004.” (One, 2018)

Some of the additions added to the revised DSM 5 include:

Additions to the DSM 5 to assist in understanding adults like Walter, who: “Must show

persistent symptoms from early childhood across multiple contexts. Display difficulties are processing

and responding to complex social cues; Suffer from anxiety because of purposefully calculating what is

socially intuitive for other adults; Express difficulty in coordinating nonverbal communication with

speech; Struggle to comprehend what behavior is considered appropriate in one situation but not

another and Learn to suppress repetitive behavior in public.” (One, 2018)

“Following assessment procedures outlined in the DSM-5 to use “standardized behavioral

diagnostic instruments with good psychometric properties, including caregiver interview, questionnaires

and clinician observation measures” (APA, 2013, p. 55) and by Jones (2010), clinical assessment of

Walter included the following:” (One, 2018)

“Biopsychosocial clinical interview of Walter with his mother as an additional informant

Level 1 Cross-Cutting Symptom Measure (see APA, 2013, pp. 733–744 or www.psychiatry.org/dsm5)

The Clinician-Rated Severity of Autism Spectrum and Social Communication Disorders (see APA, 2013, p.

52 or www.psychiatry.org/dsm5) Historical evaluations (prior psychological testing results) Collateral

reports from the referring vocational rehabilitation counselor Simon Baron-Cohen’s Autism Spectrum
Quotient (Baron-Cohen, Wheelwright, Skinner, Martin, & Clubley, 2001; Ketelaars et al., 2008)” (One,

2018)

Following the DSM 5 along with the current revisions diminishes the chances of misdiagnosing

the client. Accurate follow up after the diagnosis will provide a more precise assessment to assure its

accuracy.
References:

John M. Grohol, P. (2018). DSM-5 Released: The Big Changes. Retrieved from

https://psychcentral.com/blog/dsm-5-released-the-big-changes/

DSM-5 FAQ. (2018). Retrieved from https://www.psychiatry.org/psychiatrists/practice/dsm/feedback-

and-questions/frequently-asked-questions

Clinical Assessment Questions. (2018). Retrieved from http://www.become-an-effective-

psychotherapist.com/clinical-assessment-questions.html

One, T. (2018). Clinical Application of the DSM-5 in Private Counseling Practice. Retrieved from

http://tpcjournal.nbcc.org/clinical-application-of-the-dsm-5-in-private-counseling-practice/