The DSM-5 Summary

Journal Activity 3.1: Introduction to the DSM-5
In 2013, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (American Psychiatric Association [APA], 2013) was reorganized, and by this reorganization, the manual provides mental health care professionals in the United States with a standard classification of every psychiatric disorder that the United States healthcare system recognizes (APA, 2014). A newcomer to the field of mental health and wellness may not recognize that the changes included in the DSM-5 represent a wealth of new research and knowledge about mental health issues as well as common language for professionals to communicate about patient concerns (APA, 2014). As one of those newcomers, DSM-5 was found to be very

effective in the way it provided information for assessment and diagnosis. Without having worked with the previous manual, it is difficult to compare the extent to which the changes have improved this resource. This is especially true when one is new to the field of mental health and wellness and has developed the practice of referring complex cases to more experienced health care professionals.
Given this lack of knowledge, there is a sense of urgency to learn more about the DSM-5 manual and how to use it appropriately. Professionals working with children and youth must know how to use the DSM-5 categories of mental health disorders for the benefit of their clients’ health. As an educator working with children and youth regularly, it is critical that one gain a solid working knowledge of DSM-5 categories of mental health disorders. This manual provides useful information and is very comprehensive, yet it acknowledges the inherent role that subjectivity plays when assessing mental health concerns.
In general, the use the manual enhances the professional’s ability to understand behaviour broadly, across the adaptive-maladaptive continuum (Tomlinson-Clarke & Georges, 2014). By using the manual, counsellors working with children and youth can access managed care for their clients because they will be able to communicate effectively with other professionals in the field (Tomlinson-Clarke & Georges, 2014). Knowledge and use of the manual will also help clients to access financial support because insurance companies require the standardized diagnostic codes (Thomason, 2014). By using appropriate diagnostic labels, those working with children and youth can help patients gain a better understanding of their condition, learn that they are not alone in their situation, and find out more about possible treatments (Thomason, 2014). Helping clients learn about their condition can minimize the potential of being stigmatized, improving the situation and lower distress associated with troubling symptoms.
The revised version of the DSM has been met with some controversy. Critics stated that efforts to increase the practical use of the DSM to promote preventive psychiatry will result in harmful and unwarranted diagnosis (Rief, Wittchen, & Frances, 2013). Because the revised version includes new diagnoses and the reduces the thresholds for existing ones, critics question the standards used by the authors of DSM-5 to ensure reliability and validity (Chmielewski, Clark, Bagby, Watson, 2015; Paris, 2015; Rief, Wittchen, & Frances, 2013). There exist concerns about increased false positives because the manual is thought to lack a valid boundary between disorder and normal variation (Paris, 2015, Wakefield, 2016). In open letter to APA, critics state concern that the most vulnerable (that is, children and elderly) will be negatively impacted by unnecessary and dangerous side-effects if neuroleptics are used to treat the newly proposed disorders (Coalition for DSM-5 Reform, 2015). For educators and parents alike, critics state that the incorporation of Asperger's Syndrome/Disorder within the Autism Spectrum Disorder will result in decreased levels of understanding, increased stigma, and lack of educational support for these children who were previously labeled with Asperger (Hazen, McDougle, & Volkmar, 2013; Pickersgill, 2014).
Much of the criticism stems from the heightened anticipation for the release of the revised DSM-5 and the expectation that it would be a ‘Bible’ for the psychiatry field where, “it is, at best, a dictionary, creating a set of labels and defining each . . . the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure” (Insel, 2013, para. 2). For someone new to the field, it would seem that criticism of the DSM-5 is less about the manual itself but more about the gap that exists between psychiatry and other areas of medicine that can access blood tests, genetic markers, and other tools to support a diagnosis (Paris, 2015). Those those working with the manual must understand than that diagnosis of mental disorder is not the same as a legitimate medical diagnosis of disease. If one does not understand this simple fact, there is a risk of harming those people who need the most help. Given that the APA prepared for the revision of DSM for almost ten years (APA, 2014), it is not surprising that critics are disappointed that it is not any more scientific than the earlier versions of the manual despite its change in reorganization and functional practicality (Nemeroff et al., 2013; Paris, 2015).
To the authors’ credit, the structural changes to the DSM-5 corrected the pessimism that was created by the distinction between Axis I and Axis II disorders (Schneider, 2014). Concerns involving the use of the Autism Spectrum Disorder as an umbrella term for Asperger's Syndrome/Disorder, may be tempered by knowing this change to DSM-5 may result in a stronger descriptive diagnosis and increased client individualization as it provides more detail about language level, IQ, adaptive skills, and other medical problems (Kanne, 2013). It is possible to realize the benefits of the DSM-5 once one accepts that the it is not a bible but rather a practical manual with a classification system that brings order (Nemeroff et al., 2013; Paris, 2015; Thomason, 2014).
The practicality of the DSM-5 manual is appealing for someone like me to wants to be able to provide more support to children and youth within a school setting.

It is appealing that the DSM-5 is organized using a developmental and lifespan approach (Thomason, 2014), something familiar to an educator who understands growth and development. As well, the way that the DSM-5 integrates gender and culture issues (Thomason, 2014) matches the current beliefs and values within the educational field. Having not used previous editions of the DSM, the structural changes do not impact me as much as it would for someone who had mastered the navigation of the previous Axis format. Similarly, I am less likely to notice that some diagnoses are new in the DSM-5, some are revised, and others are omitted. Instead, it is likely that the manual will prove useful when supporting children and youth for other reasons. For example, the DSM-5 offers users with common language diagnostic criteria for bipolar and depressive disorders, includes Asperger’s disorder within the autism spectrum disorder for easier individualized programming, and clarifies the list of substance use disorders (Thomason, 2014). Finally, the best advice for someone using the DSM-5 to help children and youth is to remember that the manual is a practical tool. It does not provide scientifically-based definitions of mental disorders, and it is not a scientific document that one might find in other fields. For the responsible use of the DSM-5, one must understand both the limitations and the benefits this manual, the only classification system addressing mental disorders in current widespread

use.