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DSM-III-R: Professional Implications and Revisions for Mental Health

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DSM-III-R: Professional Implications and Revisions for Mental Health DOCUMENT RESUME ED 318 969 CG 022 516 AUTHOR Hinkle, J. Scott TITLE DSM- ?II -R: Professional Implications and Revisions for Mental Health Counselors. PUB DATE 87 NOTE 22p. PUB TYPE Reports - General (140) EDRS PRICE MF01/PC01 Plus Postage. DESCRIPTORS Change; *Classification; *Counseling; *Mental Disorders; Vocabulary IDENTIFIERS *Diagnostic Statistical Manual of Mental Disorders ABSTRACT Major modifications in the diagnostic nomenclature used in the Diagnostic and Statistical Manual of Mental Disorders -III- Revised (DSM-III-R). Discussions of the modifications is preceded by an irtroduction to diagnosis in counseling anda brief introduction to the DSMs. The process for revising the DSM is described. Modifications in these classifications are described: (1) disorders usually first evident in infancy, childhood, or adolescence; (2) organic mental syndromes and disorders; (3) psychoactive substance use disorders; (4) schizophrenia; (5) delusional (paranoid) disorder; (6) psychotic disorders notelsewhere classified; (7) mood disorders; (8) anxiecl disorders; (9) somatoform disorders; (10) dissociative disorders; (11) sexual disorders; (12) sleep disorders; (13) factitious disorders; (14) impulse control disorders not elsewhere classified; (15) adjustment disorder; (16) psychological famors affecting physical condition; (17) personality disorders; (18) V codes; and (19) additional codes. The Multiaxial Diagnosis system is described. The report concludes that it is imperative fol mental health counselors to keep appraised of diagnostic revisions and the appropriate use of the multiaxialsystem in order to provide accountable professional counseling services. (ABL) *********************************************************************** * Reproductions supplied by EDRS are the best thatcan be Aade * * from the original document. * ************************************-********************************** DSMTITR 1 DSM-III-P: Professional Implicationsand Revisions for Mental Health Counselors J. Scott Hinkle University of Nrrth Carolina at Greensboro t;.1 1r 1: (31)00 s'n L t owl)to plcdettr:' jtglpAdoo /q lakfliire fiq4111 IC!r:idli siyl 1)..Code) a2i1-Ga Mail to: J. Scott Hinkle, Ph.D. School of Education University of North Carolina at Greensboro Greensboro, North Carolina 27412-5001 The author expresses appreciation to Dr. Nicholas Vacc for his editorial comments of an earlier draft of this paper. "PERMISSION TO REPRODUCE THIS U.S. DEPARTMENT OF EDUCA'ION MATERIAL HAS BEEN GRANTED BY Office of Educational Researchend Improvement EDUCATIONAL RESOURCESINFORMATION .J, Scott hK.le, CENTER (ERIC; Running 'Head: DSM-III-R 10/this document has been reproduced an received from the personor orga lization originating it El Minor e.hangsts liaebean made to improve reproduction Quality. TO THE EDUCATIONAL RESOURCES staled in this docu- 0 Points of view or opininns INFORMATION CENTER (ERIC)." ment do nut necessarilyrepresent Oficial OEM position or policy. a BEST COPY AVAiLtii,L, LGSM -- III- -R 2 Abstract Major revisions to DSM -111 and changes in the multiaxial diagnostic systemare presented. DSM-III-R 3 DSM-III-R: Professional Implications and Revisions for Mental Health Counselors Mental health counselorsare increasingly seeking and receiving licensure at the independentpractice level, setting the stage formore accountability and third-party insurance reimbursements. This professional recognition and responsibility will require counselorsto have knowledge in the use of the Diagnostic and Statistical Manual of Mental Disorders- Revised (DSM- III-R) of the American Psychiatric Association(APA) (1987). The DSM-III was first introduced in the counseling literature by Seligman (1983) following threeyears of instituted use in clinical settings.Four years later the DSM -I-II was revised. This article presents the major modifications in the diagnostic nomenclature preceded by an introduction to diagnosis in counseling and a brief introduction to the DSMs. Rationale for Diagaggis A current trend in counseling reflects that approximately 50% of counselor education studentsare enrolling in community agency counselingprograms, and about 70% are seeking employment in non-school settings such as community mental health centers, social agencies, and substance abuse clinics (Richardson & Bradley, 1983). Such settings often require DSM-III-R diagnoses for 1 DSM-III-R 4 accountability, record keeping,treatment planning, research and evaluation, andquality assurance. Seligman (1983) indicated that counselorsin private practice must also provide a diagnosis forthose clients with reimburseable insurancecoverage. Utilization of the DSM-III-R The fact that the DSM-III-R isa manual indicates much about its intendeduse. Like other manuals, the DSM-III-R is best utilizedas a reference text. Seligman (1983) suggested that comfortableuse will require several months of frequent diagnosing. The neophyte user can enhance the diagnostic learning process by attending a workshop or seeking assistance froma clinician with seasoned experience. College coursework in abnormal psychology is also helpful (and fortunatelyrequired of many community agency and mental health counseling students). Overview of the DSMs The DSM-III was published in 1980, following almost thirty years of utilization of theDSM-I and DSM-II (APA, 1962; 1968). Descriptions of mental disorders and their diagnostic categories first appeared in DSM-I, which focused on Adolf Meyer's psychobiologicviews. The DSM- II featured a diagnostic system that for themost part did not adhere to a particulartheoretical framework. The DSM-III reflected the mostcurrent research knowedge DSM-III-R 6 regarding mental disorders and maintainedcompatibility with the InternationalClassification of Diseases- Ninth Edition (ICD-9). The DSM-III's major contributionwas the use of a multiaxial approachto evaluation and its usefulness in various settings by clinicians, researchers, and administrators with varyingtheoretical orientations. The Revision Process Over 200 advisory committee members of theAPA implemented similar goals which guidedthe development of DSM -III. These included: (1) clinical usefulness for makingtreatment and management decisions in varied clinical settings; (2) reliability of the diagnosticcategories; (3) acceptability to clinicians andresearchers of varying theoretical orientations; (4) usefulness for educating health professionals; (5) maintenance of compatibility withICD-9-CM codes; (6) avoidance of new terminology andconcepts that break with tradition except when clearly needed; (7) attempting to reachconsensus on the meaning of necessary diagnostic terms that have been used inconsistently, and avoidance of terms that have outlived their usefulness; (8) consistency with data from research studies hearing on the validity of diagnostic categories; (9) suitability for describing subjects in research studies; DSM-III -R 6 (10) responsiveness, duringthe development of DSM-III-R, to critiques by cliniciansand researchers (APA, 1987,pp. xix-xx). A majority of the revisionsto the DSM-III were made on the basis of experts'actual clinical experiences with the manual. Imprecise data were reconsidered makingthe diagnostic categoriesmore consistent with research findings and historical and clinicalconcepts. It is important to note that, accordingto the APA (1987), the impact of a particular revisionon the possibility of reimbursement for treatmentwas rarely mentioned during the revision process. The Revised Diagnostic Classifications In this section, each of the diagnosticcategories is discussed in the order of presentationin the DSM-III- R. All major changes, alterations, andadditions to the classification are shown in italics. Disorders Usually First Evident inInfanc Childhoodor Adolescence The most significant revisionsin the DSM-III are in this category. Mental Retardation and Specific and Pervasive Developmental Disorders havebeen combined under a new classification,Developmental Disorders. This is now a more logicalclassification since these disorders are all first evident earlyin life. Intelligence levels usedas guides for distinguishing the Mental Retardation diagnoses have beenrevised to reflect DSM-III-R some degree of overlap between IQs. Autistic Disorder replaces InfantileAutism. This new diagnosis includes a more comprehensive manifestation of the disorder at differentdevelopmental levels. Childhood Onset Pervasive DevelopmentalDisorder has been excluded. When a child's impairment does notmeet the criteria for Autistic Disorderor any of the schizophrenic-type disorders, Pervasivennental Disorder Not Otherwise should be used. Other diagnoses throughout the infant,child, and adolescent classifications have been alteredin order to include larger age ranges and similaror associated psychological or behavioral features.Additionally, many Axis I and II diagnoses now include timeframe criteria. Many of the diagnoses under Specific Developmental Disorders have been reworded. For example, Developmental Language Disorder: ExpressiveType Is now listed as Developmental ExpressiveLanguage Disorder. A new category within this area, Developmental Coordination Disorder, has also been added. This diagnosis refers to motor coordination difficulites that interfere with academic achievement or daily living activities. Attention Deficit Disorder with Hyperactivity isnow indexed as Attention Deficit HyperactivityDisorder or ADHD. The Attention Deficit Disorder without Hyperactivity diagnosis has been discontinued since, DSM-III-R
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