There’s an onetime saying, “What’s the fastest means to cure mental affliction inwards an entire grouping of people? Get rid of the diagnosis.” The proposed changes to DSM-5 learn rid of some diagnoses too add together others. But that's non all. If you're similar me, yous receive got lots of questions nigh changes to DSM-5. 
When I posted the inquiry “what would yous similar to know nigh the DSM-5” to the Social Work Podcast Facebook page 11 people responded inwards less than an hr too xx people responded past times the halt of the day. So, what did they desire to know? Jessica, Shelly, Sandy, Spring, Paul, too Suzannah wanted to know nigh autism, depression, too personality disorders. Shylah too Jen wanted to know nigh addictions. Lisa wanted to know what was upwardly amongst ADHD. Ciarrai too Lyndon posed some dandy questions nigh the merits of DSM diagnosis inwards social piece of work practice.
In today's Social Work Podcast, I speak amongst Micki Washburn, MA, LPC-S, NCC too Danielle Parrish, Ph.D. nigh proposed changes inwards DSM-5. We talked nigh the cross-cutting dimensional assessment, changes inwards the arrangement of the DSM-5, too changes inwards diagnoses such every bit ADHD, Asperger’s, Autism, Depression, Substance Use, too personality disorders. We talked nigh some of the intended consequences such every bit greater accuracy for diagnosis, too some of the possible unintended consequences such every bit loss of funding for diagnostic-specific services. We halt amongst some thoughts nigh social work’s role inwards the novel DSM.
Update: DSM-5 was published on May 27, 2013. Social piece of work licensure exams inwards the USA (ASWB) required DSM-5 starting inwards 2015.
Download MP3 [20:31]
Micki Washburn, MA, LPC-S, NCC
Danielle Parrish, Ph.D.
When I posted the inquiry “what would yous similar to know nigh the DSM-5” to the Social Work Podcast Facebook page 11 people responded inwards less than an hr too xx people responded past times the halt of the day. So, what did they desire to know? Jessica, Shelly, Sandy, Spring, Paul, too Suzannah wanted to know nigh autism, depression, too personality disorders. Shylah too Jen wanted to know nigh addictions. Lisa wanted to know what was upwardly amongst ADHD. Ciarrai too Lyndon posed some dandy questions nigh the merits of DSM diagnosis inwards social piece of work practice.In today's Social Work Podcast, I speak amongst Micki Washburn, MA, LPC-S, NCC too Danielle Parrish, Ph.D. nigh proposed changes inwards DSM-5. We talked nigh the cross-cutting dimensional assessment, changes inwards the arrangement of the DSM-5, too changes inwards diagnoses such every bit ADHD, Asperger’s, Autism, Depression, Substance Use, too personality disorders. We talked nigh some of the intended consequences such every bit greater accuracy for diagnosis, too some of the possible unintended consequences such every bit loss of funding for diagnostic-specific services. We halt amongst some thoughts nigh social work’s role inwards the novel DSM.
Update: DSM-5 was published on May 27, 2013. Social piece of work licensure exams inwards the USA (ASWB) required DSM-5 starting inwards 2015.
Download MP3 [20:31]Micki Washburn, MA, LPC-S, NCC
Micki Washburn is a doctoral pupil too clinical teacher at the Graduate College of Social Work inwards Houston Texas. She is also a Licensed Professional Counselor- Supervisor who plant extensively amongst Houston’s LGBTQ communities. Her enquiry interests include clinicians’ application of the Evidence-Based Practice Process, the integration of applied scientific discipline inwards social piece of work teaching too culturally competent do amongst various communities. She has conducted a numerous educational seminars for social workers too other mental wellness professionals on the topics of gender identity too DSM-V.
Email: mewashburn@uh.edu
University of Houston Graduate College of Social Work
Houston, TX 77204-4013
Phone: 832-498-1015
Danielle Parrish, Ph.D.
Dr. Parrish’s enquiry broadly focuses on the evolution too implementation of evidence-based behavioral wellness interventions for adolescents too adult females. Specifically, she conducts enquiry that tests the efficacy of interventions to trim the prevalence of pregnancies affected past times alcohol, HIV/AIDS, smoking, too illicit drug utilisation inwards high-risk populations too settings. Her piece of work has been funded through foundation too federal grants. Dr. Parrish’s prior clinical experience includes working inwards the next world mental wellness settings amongst children, adolescents, adults too families: juvenile jurist mental health, babe mental health, too outpatient mental health. She was interviewed for the Social Work Podcast inwards 2011 talking nigh the Process of Evidence-Based Practice.
Email: dparrish@uh.edu
University of Houston Graduate College of Social Work
Phone: 713-743-8105
University of Houston Faculty Page
TRANSCRIPT
Introduction
Jonathan Singer: There’s an onetime saying, “What’s the fastest means to cure mental affliction inwards an entire grouping of people? Get rid of the diagnosis.” In 1973 the American Psychiatric Association did simply that. They removed diagnostic code 302.00 from the DSM-II. Overnight, homosexuality went from beingness a deviant psychopathology to… not. The total story nigh how this came to move tin give notice move heard inwards the bright This American Life episode, “81 Words.” The championship is a reference to the number of words that defined homosexuality every bit a mental affliction inwards DSM-II. Today’s episode of the Social Work Podcast is nigh a different, but related, story. Today’s episode is nigh a story that is going to press at the halt of Nov 2012 too is scheduled to move available to the world inwards May of 2013. But the ending to this story? We in all likelihood won’t know how this story ends for years. The story is non nigh the controversies that receive got surrounded the evolution of the DSM-5, although at that spot receive got been many. The story is non nigh the irony of the DSM-5 eliminating the 5 axis scheme inwards favor of the unmarried axis scheme used past times the ICD. No. The story amongst the unknown ending is the story of how the changes inwards the DSM-5 volition redefine reality for hundreds of millions of people. I’m non simply talking nigh consumers of mental wellness services. I’m talking nigh providers, parents, insurance companies, mass publishers, comedians, too of class pharmaceutical companies.
Ok. So receive got I piqued your involvement yet? Good. My involvement inwards DSM-5 has been piqued for a span of years. Mainly because, to move totally honest, I’ve been totally confused past times all the proposed changes to the DSM. It seemed similar every span of months they’d add together a diagnosis too and then take away another, too and then the diagnoses would move back. The criteria for diagnoses kept changing. They proposed changes to the arrangement too construction of the DSM-5. And on top of all that, the guys who headed upwardly DSM-III too DSM-IV, Robert Spitzer too Allan Frances kept coming out amongst editorial afterward editorial slamming the DSM-5 procedure too product. I didn’t know what to think. I knew I wasn't lone inwards my confusion. When I posted the inquiry “what would yous similar to know nigh the DSM-5” to the Social Work Podcast Facebook page, eleven people responded inwards less than an hour, too xx people responded past times the halt of the day. So, what did they desire to know? Jessica, Shelly, Sandy, Spring, Paul, too Suzannah wanted to know nigh autism, depression, too personality disorders. Shylah too Jen wanted to know nigh addictions. Lisa wanted to know what was upwardly amongst ADHD. Ciarrai too Lyndon posed some dandy questions nigh the merits of DSM diagnosis inwards social piece of work practice. So, when I read Danielle Parrish's editorial on Changes to DSM-5, co-authored amongst UT-Austin's Beth Pomeroy too published inwards the Fall 2012 number of Social Work, I thought, "I gotta utter to her." (Some of yous mightiness recollect my 2011 interview amongst Danielle nigh the Process of Evidence-Based Practice). So, I sent Danielle an electronic mail inviting her to utter nigh DSM-5 too she said yes right away. And too then she recommended that nosotros include an goodness inwards the proposed changes to DSM-5, Micki Washburn (Micki's article, "What social workers should know nigh DSM-5" is forthcoming inwards Social Work). In today's Social Work Podcast, Micki, Danielle too I encompass a lot of Blue Planet inwards xv minutes. We speak nigh the cross-cutting dimensional assessment, changes inwards the arrangement of the DSM-5, too changes inwards diagnoses such every bit ADHD, Asperger’s, Autism, Depression, Substance Use, too personality disorders. We talked nigh some of the intended consequences such every bit greater accuracy for diagnosis, too some of the possible unintended consequences such every bit loss of funding for diagnostic-specific services. We halt amongst some thoughts nigh social work’s role inwards the novel DSM. One Federal Reserve annotation nigh this interview. The information on DSM-5 discussed inwards this episode is based on the proposed changes. Social piece of work students, practitioners, too educators should consult the finally version of DSM-5 for authoritative information nigh diagnostic criteria, categories, too other issues discussed inwards this episode. And now, without farther ado, on to episode 75 of the Social Work Podcast. Proposed Changes inwards DSM-5: Interview amongst Micki Washburn, LPC-S too Danielle Parrish, Ph.D.
Interview
Jonathan Singer: Danielle too Micki, give thank yous you hence much for beingness hither too talking amongst us nigh DSM-5. What is the divergence hither betwixt diagnosis too this cross-cutting dimensional assessment?
Micki Washburn: Well, diagnosis of class needs to move done past times a trained too license clinician. The cross-cutting assessment is a customer self-report tool that helps us to constitute a baseline too evaluate efficacy of treatments inwards damage increment or decrease inwards sure symptomology similar depressed mood or anger or anxiety levels.
Jonathan Singer: So, if I've got a customer that I've diagnosed amongst ADHD I would soundless utilisation this cross-cutting dimensional assessment?
Micki Washburn: If yous would similar to learn ahead too learn that information from your customer hence that yous tin give notice peradventure capture some things from the client’s perspective that yous don’t brand it your diagnostic interview, it's some other slice of information to fill upwardly out the puzzle for you.
Jonathan Singer: Okay. I tin give notice encounter that because I've had clients who receive got been diagnosed amongst ADHD, but they do learn angry right, they’ve been angry, they’ve been depressed, they’ve been suicidal too that’s non captured inwards the diagnosis. So, that’s what yous sympathise it’s used for?
Micki Washburn: Yes. As I understand, that’s how it's used, that it's non supposed to move a pre-screening tool or a diagnostic instrument, but rather to give us to a greater extent than sources of information hence that nosotros tin give notice accurately learn to the core of what's going on amongst the customer too how to best assist them based on these symptoms too the severity.
Jonathan Singer: So, i of the other things that I've seen is changing is that it's – DSM-5 is going to move organized differently. Like, for example, I piece of work amongst children, adolescents primarily too my learn to was that department which was called Disorders Usually Found inwards Infancy too Childhood, but I looked on the website and... that is gone. So, what's the deal?
Danielle Parrish: Yeah. It's all gone. They're genuinely – they’ve changed the arrangement of the manual too they receive got basically arranged it into categories of shared etiology or crusade I think to cause enquiry inside those areas. They’ve arranged them past times when they're believed to develop or manifest hence things that would hap inwards childhood typically, or present upwardly inwards childhood, would start foremost too and then things inwards adulthood too hence on.
Jonathan Singer: Yeah, hence similar Pica too eating disorders are right away inwards the same category where Pica used to move a disorder of childhood but eating disorders wasn’t, because Pica too eating disorders are sort of etiologically the same. Is that what you're saying?
Danielle Parrish: Exactly.
Jonathan Singer: Yeah.
Danielle Parrish: Yeah.
Micki Washburn: Yeah. The means that they receive got things structured right away is – past times the way, yous tin give notice discovery most of the things that yous used to discovery inwards the disorders of childhood too adolescents inwards your neuro-developmental disorders, that’s form of the analogous category that has a lot of those diagnoses soundless inwards it. And hence at the get-go of the manual, you'll discovery these things, too and then throughout the manual you'll receive got things grouped based upon form of a crossover of symptoms. So, for example, your mood disorders: What used to move mood disorders is right away unipolar disorders too bipolar disorders too they’ll move organized side past times side to each other. Same affair amongst the anxiety disorders which is right away beingness broken into 3 groups. You receive got your anxiety disorders. You receive got your trauma-related disorders, too your obsessive compulsive-related disorders which, inside the class of the manual, volition move unopen to each other too and then towards the end, disorders that genuinely form of manifest themselves to a greater extent than oft inwards adulthood or belatedly adulthood, for representative your slumber disorders, volition move to a greater extent than towards the halt of the manual, hence it’s supposed to receive got a developmental type progression too feel.
Jonathan Singer: So, Micki, yous were simply alluding to the fact that at that spot are going to move changes inwards diagnosis too i of the big diagnoses that I worked amongst was ADHD too I know that at that spot are going to some changes to the diagnostic criteria for that. What are they?
Micki Washburn: Well, foremost of all, it's going to move inwards the category of neuro-developmental disorders too the major alter – too there's a span of small-scale ones, but the major alter is establishing that the symptom profile has been acquaint prior to historic catamenia 12 rather historic catamenia 7.
Jonathan Singer: That’s huge because I know that that’s i of the things that was a big electrical charge of a lot of the parents that talked I with. You know similar good hence my kid was 9, does that hateful my kid doesn’t receive got ADHD? What's my kid have?
Micki Washburn: Yes, too I think that you're right nigh that, that this is an offshoot of peradventure the enquiry testify showing that 95% of the cases of ADHD tin give notice move accurately captured prior to historic catamenia 12, but every bit nosotros learn younger too younger that per centum gets lower.
Jonathan Singer: All right. So speaking nigh kids, yous know, what's the bargain amongst Asperger’s disorder too pervasive developmental disorder, NOS? Why receive got they been subsumed nether this autistic spectrum disorder? So, I've got a customer who’s diagnosed amongst Asperger’s disorder, does this hateful that inwards 2013 my customer volition no longer receive got Asperger’s disorder?
Micki Washburn: I think that’s right that your customer volition no longer receive got Asperger’s, however, the diagnosis would move consistent amongst that of beingness on the autistic spectrum, hence that would move the updated diagnosis for your client.
Jonathan Singer: So, my Asperger’s customer volition right away move autistic.
Micki Washburn: That’s right too hopefully every bit an offshoot of that peradventure the stigma attached to the diagnosis of autism every bit beingness this pervasive too severe affliction mightiness move lessened when nosotros encounter that it's a gain or a spectrum of levels of functioning too that at that spot are real high functioning people that could autumn into this spectrum every bit good every bit people that are non functioning at such a high level.
Danielle Parrish: Let me outflow inwards here. So, I think a lot of the consequences of this alter are yet to move seen. We don’t know for instance, for someone who’s had an Asperger’s diagnosis their entire life, what it's going to hateful for them inwards damage of having all of a precipitous beingness diagnosed autistic. You know whether or non they're going to perceive a stigma attached to that too if they're going to convey that. You know, the other consequences that nosotros don’t know nigh are how that’s going to impact services too what's going to move funded. Are sure people going to lose services because they're on the milder halt of the spectrum? Are they going to soundless qualify too yous know. So, I think a lot of the consequences rest to move seen.
Jonathan Singer: And I think that’s in all likelihood an of import affair for social workers to move on the lookout. You know, DSM is coming too whether the anticipated consequences too the unanticipated consequences of collapsing a bunch of diagnoses into a spectrum disorder. So, Micki, yous were a span of minutes agone nigh changes to depressive disorders, could yous utter a niggling fleck to a greater extent than nigh that too some of the other changes that are happening to mood disorders?
Micki Washburn: Sure. The category that used to move mood disorders genuinely is broken downwards into depressive disorders too bipolar disorders on which clinically is a prissy distinction. I think that’s going to move helpful on the things that I think a lot of people inwards social piece of work are concerned amongst every bit a content of some newly added diagnosis inwards the depressive disorders, primarily the diagnosis of premenstrual dysphoric disorder (PDD). This is the only diagnosis that has been or currently is gender-specific.
Jonathan Singer: Okay. So, what's going on amongst the bereavement exclusion?
Danielle Parrish: Yeah. So, amongst the bereavement exclusion, it used to move amongst major depressive disorder that yous would consider if somebody is grieving a loss that at that spot volition move a longer fourth dimension frame. There volition move 3 months that yous would hold off to brand a diagnosis. Well right away they’ve gotten rid of the bereavement exclusion.
Jonathan Singer: So, let's tell somebody unopen to me dies too all of a precipitous I brand criteria for ii weeks for major depressive disorder. It used to move that I couldn’t move diagnosed amongst major depressed disorder because of bereavement, but right away I tin give notice be.
Danielle Parrish: Right, right. And I think i of the concerns amongst that from a social piece of work perspective is that culturally people grieve inwards a lot of dissimilar ways too nosotros would consider that to move a normal reaction for some people to receive got – to manifest those symptoms afterward a loss inside ii weeks or 3 weeks, peradventure fifty-fifty iv too hence I think, yous know, it's genuinely of import non to pathologize grief too loss... And yous know the implications also for people seeking services. You know people may non desire to seek services if they're going to move labeled amongst a mental disorder because they're grieving a loss too I think it also has implications for helping people learn through the grief too loss process. What sort of message are nosotros giving if we're proverb that people should utilisation medication because they're grieving a loss too non experience the loss too learn through the normal process? So, I think it has implications for handling every bit well.
Jonathan Singer: All right, something else for social workers to await into. Okay. And what's going on amongst pith utilisation disorders?
Micki Washburn: Well, right right away when we're talking nigh pith we're talking nigh abuse too dependence too I think the terminology too the means that we're talking nigh it inwards DSM-5 is different. There's a render of the terminology of addiction inwards form of the cognitive behavioral too physiological components of that related to pith too the utilisation of substances, hence we're talking nigh pith utilisation disorders now.
Jonathan Singer: So, the dichotomy betwixt abuse too dependence is gone.
Micki Washburn: That’s correct.
Jonathan Singer: And it also opens upwardly room for other types of addictions, right?
Micki Washburn: That’s right too genuinely at that spot was going to move a category that was specific to form of what nosotros volition telephone shout out upwardly procedure addictions, however, that–
Jonathan Singer: Like for representative similar nutrient too sexual practice too coin and–
Micki Washburn: Gambling too things of that nature too genuinely pathological gambling is characterized underneath the pith category right away too and then something similar nosotros volition telephone shout out upwardly network addiction every bit inwards the appendix for i of the disorders for farther study.
Jonathan Singer: So, peradventure DSM-6?
Micki Washburn: Maybe.
Jonathan Singer: Something to await forrad to... All right. So, personality disorders, these receive got gone a huge makeover, reducing the number of disorders too putting inwards a dimensional assessment. Can yous utter nigh these?
Micki Washburn: Yes, too this is something that’s form of been kicked around inwards the personality circular for a number of years too basically nosotros are eliminating disorders that do non receive got a potent empirical enquiry back upwardly base of operations to receive got them move diagnostically specific on their ain amongst the exception of narcissistic personality disorder, which nosotros are retaining due to the clinical utility of that detail diagnosis. But of the other 5 personality disorders that are beingness retained, they map on to dissimilar what nosotros telephone shout out upwardly dimensions of personality that are feature of a detail disorder. One other diagnosis that is beingness eliminated is histrionic personality disorder.
Jonathan Singer: [joking inwards a histrionic tone] No way. Oh my God, I can't believe it.
Micki Washburn: Yes [smiling], that’s real troubling for some people I'm sure. One of the ones that we're retaining is borderline personality disorder too if we're looking at dimensional assessment, nosotros would tell that this detail diagnoses or grouping of symptoms, something they receive got inwards mutual is this negative affectivity that they are real emotionally labile which is truthful of a number of dissimilar disorders but particularly feature of this one. And so, we're looking at dimensions of personality that may receive got earlier been hence overlapping that a customer would halt upwardly amongst i or ii or 3 personality disorder diagnosis or our favorite NOS [not otherwise specified] diagnosis too we're trying to learn ahead too cutting downwards on the number of diagnoses too genuinely learn to a greater extent than specific of okay, what are the traits associated amongst these things? What is the impairment of functioning inwards relation to the self too to others too how do nosotros best care for these?
Jonathan Singer: So, when I was interviewing Jennifer Muehlenkamp nigh non-suicidal self-injury, she talked nigh that becoming a disorder inwards the DSM-5. But self-injury too cutting has ever been associated amongst borderline personality disorder which we're simply talking about. So how does that alter things?
Micki Washburn: Well, hopefully that is going to Pb to a reduction inwards an overdiagnosis of borderline personality disorder. I think some clinicians wrongly assign that diagnosis amongst the presence of whatsoever type of self-injury conduct but non necessarily looking at the total criteria of these other aspects of things associated amongst what nosotros volition telephone shout out upwardly a diagnosis of borderline too hence this hopefully, we'll endeavor to tease that out simply because somebody is engaging inwards form of mellowed upwardly coping mechanism, it doesn’t hateful that they receive got this pervasive means of interacting amongst their Blue Planet which is to a greater extent than consistent amongst a existent borderline diagnosis. So, I'm hoping that this alter is genuinely going to form of tease those ii things apart.
Jonathan Singer: So, a lot of the things yous guys receive got been talking about, it sounds similar it's genuinely trying to specify diagnosis, similar genuinely clarify what is problematic too what's non problematic. Do yous encounter this every bit beingness a pace forrad or a pace dorsum particularly when yous think nigh it for social workers?
Danielle Parrish: Well, I think that that has yet to move seen every bit well. I think it's of import that nosotros receive got specificity inwards our diagnoses too that nosotros are real clear nigh what it is that we're trying to care for too how to best learn nigh that. But on the other hand, I think i of the concerns inwards full general amongst some of the changes is that we're lowering the threshold for diagnosis. We also receive got a lot of novel disorders. So, I think nosotros don’t know yet what the implications are going to move but I think every bit social workers nosotros postulate to consider some of the changes, what they hateful for our clients, yous know, learn familiar too gear upwardly for that.
Micki Washburn: I think Danielle is absolutely right nigh that, that the jury is soundless out on a lot of the implications of these changes too we'll receive got to hold off too encounter too hopefully it's going to Pb to meliorate customer outcomes amongst this increased, hopefully increased validity of diagnosis too also trying to base of operations things on the enquiry testify that has accumulated over the finally xx years sure enough hoping that’s the direction that’s going in, but nosotros genuinely can't tell right now. Jonathan Singer: Well, Danielle too Micki, give thank yous you hence much for beingness hither today on the Social Work Podcast talking nigh DSM-5.
Micki Washburn: Thanks for having us. I think it's genuinely of import for social piece of work to move talking nigh this right now.
Danielle Parrish: A pleasance Jonathan. Thank yous hence much.
END
References too Resources (provided past times Micki Washburn)
APA (6th ed) citation for this podcast:
Singer, J. B. (Host). (2012, Nov 16). Proposed Changes inwards DSM-5: Interview amongst Micki Washburn, LPC-S too Danielle Parrish, Ph.D. [Episode 75]. Social Work Podcast. Podcast retrieved Month Day, Year, from /search?q=process-of-evidence-based-practice
TRANSCRIPT
Introduction
Jonathan Singer: There’s an onetime saying, “What’s the fastest means to cure mental affliction inwards an entire grouping of people? Get rid of the diagnosis.” In 1973 the American Psychiatric Association did simply that. They removed diagnostic code 302.00 from the DSM-II. Overnight, homosexuality went from beingness a deviant psychopathology to… not. The total story nigh how this came to move tin give notice move heard inwards the bright This American Life episode, “81 Words.” The championship is a reference to the number of words that defined homosexuality every bit a mental affliction inwards DSM-II. Today’s episode of the Social Work Podcast is nigh a different, but related, story. Today’s episode is nigh a story that is going to press at the halt of Nov 2012 too is scheduled to move available to the world inwards May of 2013. But the ending to this story? We in all likelihood won’t know how this story ends for years. The story is non nigh the controversies that receive got surrounded the evolution of the DSM-5, although at that spot receive got been many. The story is non nigh the irony of the DSM-5 eliminating the 5 axis scheme inwards favor of the unmarried axis scheme used past times the ICD. No. The story amongst the unknown ending is the story of how the changes inwards the DSM-5 volition redefine reality for hundreds of millions of people. I’m non simply talking nigh consumers of mental wellness services. I’m talking nigh providers, parents, insurance companies, mass publishers, comedians, too of class pharmaceutical companies.
Ok. So receive got I piqued your involvement yet? Good. My involvement inwards DSM-5 has been piqued for a span of years. Mainly because, to move totally honest, I’ve been totally confused past times all the proposed changes to the DSM. It seemed similar every span of months they’d add together a diagnosis too and then take away another, too and then the diagnoses would move back. The criteria for diagnoses kept changing. They proposed changes to the arrangement too construction of the DSM-5. And on top of all that, the guys who headed upwardly DSM-III too DSM-IV, Robert Spitzer too Allan Frances kept coming out amongst editorial afterward editorial slamming the DSM-5 procedure too product. I didn’t know what to think. I knew I wasn't lone inwards my confusion. When I posted the inquiry “what would yous similar to know nigh the DSM-5” to the Social Work Podcast Facebook page, eleven people responded inwards less than an hour, too xx people responded past times the halt of the day. So, what did they desire to know? Jessica, Shelly, Sandy, Spring, Paul, too Suzannah wanted to know nigh autism, depression, too personality disorders. Shylah too Jen wanted to know nigh addictions. Lisa wanted to know what was upwardly amongst ADHD. Ciarrai too Lyndon posed some dandy questions nigh the merits of DSM diagnosis inwards social piece of work practice. So, when I read Danielle Parrish's editorial on Changes to DSM-5, co-authored amongst UT-Austin's Beth Pomeroy too published inwards the Fall 2012 number of Social Work, I thought, "I gotta utter to her." (Some of yous mightiness recollect my 2011 interview amongst Danielle nigh the Process of Evidence-Based Practice). So, I sent Danielle an electronic mail inviting her to utter nigh DSM-5 too she said yes right away. And too then she recommended that nosotros include an goodness inwards the proposed changes to DSM-5, Micki Washburn (Micki's article, "What social workers should know nigh DSM-5" is forthcoming inwards Social Work). In today's Social Work Podcast, Micki, Danielle too I encompass a lot of Blue Planet inwards xv minutes. We speak nigh the cross-cutting dimensional assessment, changes inwards the arrangement of the DSM-5, too changes inwards diagnoses such every bit ADHD, Asperger’s, Autism, Depression, Substance Use, too personality disorders. We talked nigh some of the intended consequences such every bit greater accuracy for diagnosis, too some of the possible unintended consequences such every bit loss of funding for diagnostic-specific services. We halt amongst some thoughts nigh social work’s role inwards the novel DSM. One Federal Reserve annotation nigh this interview. The information on DSM-5 discussed inwards this episode is based on the proposed changes. Social piece of work students, practitioners, too educators should consult the finally version of DSM-5 for authoritative information nigh diagnostic criteria, categories, too other issues discussed inwards this episode. And now, without farther ado, on to episode 75 of the Social Work Podcast. Proposed Changes inwards DSM-5: Interview amongst Micki Washburn, LPC-S too Danielle Parrish, Ph.D.
Jonathan Singer: Danielle too Micki, give thank yous you hence much for beingness hither too talking amongst us nigh DSM-5. What is the divergence hither betwixt diagnosis too this cross-cutting dimensional assessment?
Micki Washburn: Well, diagnosis of class needs to move done past times a trained too license clinician. The cross-cutting assessment is a customer self-report tool that helps us to constitute a baseline too evaluate efficacy of treatments inwards damage increment or decrease inwards sure symptomology similar depressed mood or anger or anxiety levels.
Jonathan Singer: So, if I've got a customer that I've diagnosed amongst ADHD I would soundless utilisation this cross-cutting dimensional assessment?
Micki Washburn: If yous would similar to learn ahead too learn that information from your customer hence that yous tin give notice peradventure capture some things from the client’s perspective that yous don’t brand it your diagnostic interview, it's some other slice of information to fill upwardly out the puzzle for you.
Jonathan Singer: Okay. I tin give notice encounter that because I've had clients who receive got been diagnosed amongst ADHD, but they do learn angry right, they’ve been angry, they’ve been depressed, they’ve been suicidal too that’s non captured inwards the diagnosis. So, that’s what yous sympathise it’s used for?
Micki Washburn: Yes. As I understand, that’s how it's used, that it's non supposed to move a pre-screening tool or a diagnostic instrument, but rather to give us to a greater extent than sources of information hence that nosotros tin give notice accurately learn to the core of what's going on amongst the customer too how to best assist them based on these symptoms too the severity.
Jonathan Singer: So, i of the other things that I've seen is changing is that it's – DSM-5 is going to move organized differently. Like, for example, I piece of work amongst children, adolescents primarily too my learn to was that department which was called Disorders Usually Found inwards Infancy too Childhood, but I looked on the website and... that is gone. So, what's the deal?
Danielle Parrish: Yeah. It's all gone. They're genuinely – they’ve changed the arrangement of the manual too they receive got basically arranged it into categories of shared etiology or crusade I think to cause enquiry inside those areas. They’ve arranged them past times when they're believed to develop or manifest hence things that would hap inwards childhood typically, or present upwardly inwards childhood, would start foremost too and then things inwards adulthood too hence on.
Jonathan Singer: Yeah, hence similar Pica too eating disorders are right away inwards the same category where Pica used to move a disorder of childhood but eating disorders wasn’t, because Pica too eating disorders are sort of etiologically the same. Is that what you're saying?
Danielle Parrish: Exactly.
Jonathan Singer: Yeah.
Danielle Parrish: Yeah.
Micki Washburn: Yeah. The means that they receive got things structured right away is – past times the way, yous tin give notice discovery most of the things that yous used to discovery inwards the disorders of childhood too adolescents inwards your neuro-developmental disorders, that’s form of the analogous category that has a lot of those diagnoses soundless inwards it. And hence at the get-go of the manual, you'll discovery these things, too and then throughout the manual you'll receive got things grouped based upon form of a crossover of symptoms. So, for example, your mood disorders: What used to move mood disorders is right away unipolar disorders too bipolar disorders too they’ll move organized side past times side to each other. Same affair amongst the anxiety disorders which is right away beingness broken into 3 groups. You receive got your anxiety disorders. You receive got your trauma-related disorders, too your obsessive compulsive-related disorders which, inside the class of the manual, volition move unopen to each other too and then towards the end, disorders that genuinely form of manifest themselves to a greater extent than oft inwards adulthood or belatedly adulthood, for representative your slumber disorders, volition move to a greater extent than towards the halt of the manual, hence it’s supposed to receive got a developmental type progression too feel.
Jonathan Singer: So, Micki, yous were simply alluding to the fact that at that spot are going to move changes inwards diagnosis too i of the big diagnoses that I worked amongst was ADHD too I know that at that spot are going to some changes to the diagnostic criteria for that. What are they?
Micki Washburn: Well, foremost of all, it's going to move inwards the category of neuro-developmental disorders too the major alter – too there's a span of small-scale ones, but the major alter is establishing that the symptom profile has been acquaint prior to historic catamenia 12 rather historic catamenia 7.
Jonathan Singer: That’s huge because I know that that’s i of the things that was a big electrical charge of a lot of the parents that talked I with. You know similar good hence my kid was 9, does that hateful my kid doesn’t receive got ADHD? What's my kid have?
Micki Washburn: Yes, too I think that you're right nigh that, that this is an offshoot of peradventure the enquiry testify showing that 95% of the cases of ADHD tin give notice move accurately captured prior to historic catamenia 12, but every bit nosotros learn younger too younger that per centum gets lower.
Jonathan Singer: All right. So speaking nigh kids, yous know, what's the bargain amongst Asperger’s disorder too pervasive developmental disorder, NOS? Why receive got they been subsumed nether this autistic spectrum disorder? So, I've got a customer who’s diagnosed amongst Asperger’s disorder, does this hateful that inwards 2013 my customer volition no longer receive got Asperger’s disorder?
Micki Washburn: I think that’s right that your customer volition no longer receive got Asperger’s, however, the diagnosis would move consistent amongst that of beingness on the autistic spectrum, hence that would move the updated diagnosis for your client.
Jonathan Singer: So, my Asperger’s customer volition right away move autistic.
Micki Washburn: That’s right too hopefully every bit an offshoot of that peradventure the stigma attached to the diagnosis of autism every bit beingness this pervasive too severe affliction mightiness move lessened when nosotros encounter that it's a gain or a spectrum of levels of functioning too that at that spot are real high functioning people that could autumn into this spectrum every bit good every bit people that are non functioning at such a high level.
Danielle Parrish: Let me outflow inwards here. So, I think a lot of the consequences of this alter are yet to move seen. We don’t know for instance, for someone who’s had an Asperger’s diagnosis their entire life, what it's going to hateful for them inwards damage of having all of a precipitous beingness diagnosed autistic. You know whether or non they're going to perceive a stigma attached to that too if they're going to convey that. You know, the other consequences that nosotros don’t know nigh are how that’s going to impact services too what's going to move funded. Are sure people going to lose services because they're on the milder halt of the spectrum? Are they going to soundless qualify too yous know. So, I think a lot of the consequences rest to move seen.
Jonathan Singer: And I think that’s in all likelihood an of import affair for social workers to move on the lookout. You know, DSM is coming too whether the anticipated consequences too the unanticipated consequences of collapsing a bunch of diagnoses into a spectrum disorder. So, Micki, yous were a span of minutes agone nigh changes to depressive disorders, could yous utter a niggling fleck to a greater extent than nigh that too some of the other changes that are happening to mood disorders?
Micki Washburn: Sure. The category that used to move mood disorders genuinely is broken downwards into depressive disorders too bipolar disorders on which clinically is a prissy distinction. I think that’s going to move helpful on the things that I think a lot of people inwards social piece of work are concerned amongst every bit a content of some newly added diagnosis inwards the depressive disorders, primarily the diagnosis of premenstrual dysphoric disorder (PDD). This is the only diagnosis that has been or currently is gender-specific.
Jonathan Singer: Okay. So, what's going on amongst the bereavement exclusion?
Danielle Parrish: Yeah. So, amongst the bereavement exclusion, it used to move amongst major depressive disorder that yous would consider if somebody is grieving a loss that at that spot volition move a longer fourth dimension frame. There volition move 3 months that yous would hold off to brand a diagnosis. Well right away they’ve gotten rid of the bereavement exclusion.
Jonathan Singer: So, let's tell somebody unopen to me dies too all of a precipitous I brand criteria for ii weeks for major depressive disorder. It used to move that I couldn’t move diagnosed amongst major depressed disorder because of bereavement, but right away I tin give notice be.
Danielle Parrish: Right, right. And I think i of the concerns amongst that from a social piece of work perspective is that culturally people grieve inwards a lot of dissimilar ways too nosotros would consider that to move a normal reaction for some people to receive got – to manifest those symptoms afterward a loss inside ii weeks or 3 weeks, peradventure fifty-fifty iv too hence I think, yous know, it's genuinely of import non to pathologize grief too loss... And yous know the implications also for people seeking services. You know people may non desire to seek services if they're going to move labeled amongst a mental disorder because they're grieving a loss too I think it also has implications for helping people learn through the grief too loss process. What sort of message are nosotros giving if we're proverb that people should utilisation medication because they're grieving a loss too non experience the loss too learn through the normal process? So, I think it has implications for handling every bit well.
Jonathan Singer: All right, something else for social workers to await into. Okay. And what's going on amongst pith utilisation disorders?
Micki Washburn: Well, right right away when we're talking nigh pith we're talking nigh abuse too dependence too I think the terminology too the means that we're talking nigh it inwards DSM-5 is different. There's a render of the terminology of addiction inwards form of the cognitive behavioral too physiological components of that related to pith too the utilisation of substances, hence we're talking nigh pith utilisation disorders now.
Jonathan Singer: So, the dichotomy betwixt abuse too dependence is gone.
Micki Washburn: That’s correct.
Jonathan Singer: And it also opens upwardly room for other types of addictions, right?
Micki Washburn: That’s right too genuinely at that spot was going to move a category that was specific to form of what nosotros volition telephone shout out upwardly procedure addictions, however, that–
Jonathan Singer: Like for representative similar nutrient too sexual practice too coin and–
Micki Washburn: Gambling too things of that nature too genuinely pathological gambling is characterized underneath the pith category right away too and then something similar nosotros volition telephone shout out upwardly network addiction every bit inwards the appendix for i of the disorders for farther study.
Jonathan Singer: So, peradventure DSM-6?
Micki Washburn: Maybe.
Jonathan Singer: Something to await forrad to... All right. So, personality disorders, these receive got gone a huge makeover, reducing the number of disorders too putting inwards a dimensional assessment. Can yous utter nigh these?
Micki Washburn: Yes, too this is something that’s form of been kicked around inwards the personality circular for a number of years too basically nosotros are eliminating disorders that do non receive got a potent empirical enquiry back upwardly base of operations to receive got them move diagnostically specific on their ain amongst the exception of narcissistic personality disorder, which nosotros are retaining due to the clinical utility of that detail diagnosis. But of the other 5 personality disorders that are beingness retained, they map on to dissimilar what nosotros telephone shout out upwardly dimensions of personality that are feature of a detail disorder. One other diagnosis that is beingness eliminated is histrionic personality disorder.
Jonathan Singer: [joking inwards a histrionic tone] No way. Oh my God, I can't believe it.
Micki Washburn: Yes [smiling], that’s real troubling for some people I'm sure. One of the ones that we're retaining is borderline personality disorder too if we're looking at dimensional assessment, nosotros would tell that this detail diagnoses or grouping of symptoms, something they receive got inwards mutual is this negative affectivity that they are real emotionally labile which is truthful of a number of dissimilar disorders but particularly feature of this one. And so, we're looking at dimensions of personality that may receive got earlier been hence overlapping that a customer would halt upwardly amongst i or ii or 3 personality disorder diagnosis or our favorite NOS [not otherwise specified] diagnosis too we're trying to learn ahead too cutting downwards on the number of diagnoses too genuinely learn to a greater extent than specific of okay, what are the traits associated amongst these things? What is the impairment of functioning inwards relation to the self too to others too how do nosotros best care for these?
Jonathan Singer: So, when I was interviewing Jennifer Muehlenkamp nigh non-suicidal self-injury, she talked nigh that becoming a disorder inwards the DSM-5. But self-injury too cutting has ever been associated amongst borderline personality disorder which we're simply talking about. So how does that alter things?
Micki Washburn: Well, hopefully that is going to Pb to a reduction inwards an overdiagnosis of borderline personality disorder. I think some clinicians wrongly assign that diagnosis amongst the presence of whatsoever type of self-injury conduct but non necessarily looking at the total criteria of these other aspects of things associated amongst what nosotros volition telephone shout out upwardly a diagnosis of borderline too hence this hopefully, we'll endeavor to tease that out simply because somebody is engaging inwards form of mellowed upwardly coping mechanism, it doesn’t hateful that they receive got this pervasive means of interacting amongst their Blue Planet which is to a greater extent than consistent amongst a existent borderline diagnosis. So, I'm hoping that this alter is genuinely going to form of tease those ii things apart.
Jonathan Singer: So, a lot of the things yous guys receive got been talking about, it sounds similar it's genuinely trying to specify diagnosis, similar genuinely clarify what is problematic too what's non problematic. Do yous encounter this every bit beingness a pace forrad or a pace dorsum particularly when yous think nigh it for social workers?
Danielle Parrish: Well, I think that that has yet to move seen every bit well. I think it's of import that nosotros receive got specificity inwards our diagnoses too that nosotros are real clear nigh what it is that we're trying to care for too how to best learn nigh that. But on the other hand, I think i of the concerns inwards full general amongst some of the changes is that we're lowering the threshold for diagnosis. We also receive got a lot of novel disorders. So, I think nosotros don’t know yet what the implications are going to move but I think every bit social workers nosotros postulate to consider some of the changes, what they hateful for our clients, yous know, learn familiar too gear upwardly for that.
Micki Washburn: I think Danielle is absolutely right nigh that, that the jury is soundless out on a lot of the implications of these changes too we'll receive got to hold off too encounter too hopefully it's going to Pb to meliorate customer outcomes amongst this increased, hopefully increased validity of diagnosis too also trying to base of operations things on the enquiry testify that has accumulated over the finally xx years sure enough hoping that’s the direction that’s going in, but nosotros genuinely can't tell right now. Jonathan Singer: Well, Danielle too Micki, give thank yous you hence much for beingness hither today on the Social Work Podcast talking nigh DSM-5.
Micki Washburn: Thanks for having us. I think it's genuinely of import for social piece of work to move talking nigh this right now.
Danielle Parrish: A pleasance Jonathan. Thank yous hence much.
END
References too Resources (provided past times Micki Washburn)
- American Psychiatric Association (2000) The Diagnostic too Statistical Manual of Mental Disorders (4th ed., text rev). Washington, DC: Author
- American Psychiatric Association (2010). DSM-5 Clinician’s Personality Trait Rating Form. Retrieved from: http://www.dsm5.org/Proposed%20Revision%20Attachments/APA%20Clinician%20Trait%20Rating%20Form.pdf
- American Psychiatric Association (2013) The Diagnostic too Statistical Manual of Mental Disorders (5th ed.). Washington, DC: Author
- American Psychiatric Association (2012). Levels of Personality Functioning Scale. Retrieved from: http://www.dsm5.org/ProposedRevisions/pages/proposedrevision.aspx?rid=468
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APA (6th ed) citation for this podcast:
Singer, J. B. (Host). (2012, Nov 16). Proposed Changes inwards DSM-5: Interview amongst Micki Washburn, LPC-S too Danielle Parrish, Ph.D. [Episode 75]. Social Work Podcast. Podcast retrieved Month Day, Year, from /search?q=process-of-evidence-based-practice
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