Wednesday, November 6, 2013

Everything I Once Learned Is Irrelevant Now; Or, A Reaction To The DSM-V.

Have you ever had a moment when you realized, 

"Huh. Everything I learned is irrelevant now."

For me, that moment occurred hearing the (awesome) guest speaker at last month's Dallas Metro Counselor Association meeting, Justin K. Hughes, MA, LPC, NCC. His topic? DSM-V: Top Ten Changes

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Don't get me wrong - his presentation was great. In fact, he's provided a link to a video of it on his website, and I highly recommend you check it out for yourself. (He has a great sense of humor.) But the changes...oh, the changes. 

Hypochondria? Now Illness Anxiety Disorder.

Coding on Axes 1-5? Axes 1-3 are now combined into one. IV & V are covered by a separate notation system. GAF? Gone. 

While I have to admit, not all the changes are ones I disagree with - who gained any value from assigning a Global Assessment of Functioning, really? - the sheer number of changes are absolutely overwhelming.

Here's a few more highlights:

  • Asperger's no longer exists. Instead, Autism Spectrum Disorder now encompasses what was Autism, Asperger's, PDD NOS, Childhood Disintegrative Disorder, and Rett's.
  • We now have an official code to diagnose PMDD (Premenstrual Dysphoric Disorder) Hoarding, and Excoriation, a disorder based on skin-picking. 
  • OCD is no longer an anxiety disorder.
  • The DSM-V includes the first-ever behavioral addiction, Gambling Disorder.
  • A new category, Depressive Mood Dysregulation Disorder, was developed to reduce the overdiagnosis of bipolar disorder in children. It is appropriate for children under 18 without major mood swings, but persistent irritability and behavioral concerns.
  • Reactive Attachment Disorder is now collected alongside Stress & Trauma Disorders.
And that barely scratches the surface.  
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Not surprisingly, many people haven't embraced the change with open arms. 

But we know any change comes with its' detractors. And every iteration of the DSM has made massive changes, some controversial, but many that people would consider long overdue. So is this really any different than changes than the past?

It is, and for one, simple, narcissistic reason.

It's happening during our timeline.

The adoption of the DSM-V is happening as we are growing into our identity as a counselor. It will impact how we receive reimbursement from insurance panels, and how we classify appropriate methods of treatment. Therefore this change is something we have to react to. 

The diagnoses I learned about in Abnormal Psych may no longer be as valid. 

Sessions that would normally qualify for reimbursement now may not, but there are new disorders now that will.

What are you going to do about it? When it comes down to it, I think that's the only question a new counselor must answer when it comes to the many, many changes in the DSM-V.

How will the DSM-V impact your practice?