Week 2: Impact of the DSM-5: Organization, Development, Strengths, and Limitations Social work advocates for the biopsychosocial model of mental health and illness. Therefore, when making a diagnosis

Week 2: Impact of the DSM-5: Organization, Development, Strengths, and Limitations

Social work advocates for the biopsychosocial model of mental health and illness. Therefore, when making a diagnosis a social worker should always consider biological factors such as genetics, psychological factors such as personality and strengths, and social factors such as culture and environment.

Despite dialectics between various mental health professions about the role of diagnosis, there is widespread acceptance of the practical need to have a common comparison point for different syndromes—a common language and a shared knowledge of what is known about the course of illnesses. That shared knowledge is held in the DSM-5.

This week, you explore how the DSM-5 is organized and why. This exploration begins providing the tools for its effective use.

Learning Objectives

Students will:

• Analyze use and communication of a diagnosis in a case study
• Analyze strengths and limitations of the DSM-5 diagnostic system
• Differentiate between normal behavior and diagnosable symptoms using the concepts of dimensionality and spectrum

Learning Resources

Required Readings

American Psychiatric Association. (2013j). Introduction. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.IntroductionBarsky, A. (2015). DSM-5 and the ethics of diagnosis. The New Social Worker. Retrieved from https://www.socialworker.com/feature-articles/ethics-articles/dsm-5-and-ethics-of-diagnosis/Neukrug, E. S., & Fawcett, R. C. (2015). Diagnosis in the assessment process. In E. S. Neukrug & R. C. Fawcett, Essentials of testing and assessment: A practical guide for counselors, social workers, and psychologists (3rd ed., pp. 43–58). Stamford, CT: Cengage Learning.Neukrug, E. S., & Fawcett, R. C. (2015). Diagnosis in the assessment process. In E. S. Neukrug & R. C. Fawcett, Essentials of testing and assessment: A practical guide for counselors, social workers, and psychologists (3rd ed., pp. 43–58). Stamford, CT: Cengage Learning. Paris, J. (2015). The intelligent clinician's guide to the DSM-5 (2nd ed.). New York, NY: Oxford University PressChapter 6, “Dimensionality” (pp 84–101)Document: How to Write a Diagnosis According to the DSM-5 (PDF)

Required Media

Accessible player --Downloads--Download Video w/CCDownload AudioDownload TranscriptLaureate Education (Producer). (2018d). Impact of the DSM-5: Organization, Develpment, Strengths and Limitations [Audio podcast]. Baltimore, MD: Author.University at Buffalo School of Social Work (Producer). (2014). Episode 139—Dr. Robert Keefe and Dr. Barbara Rittner: The Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders: A conversation [Audio podcast]. Retrieved from http://www.insocialwork.org/episode.asp?ep=139Singer, J. B. (Producer). (2016, January 25). Critiques of the DSM-5: Interview with Jeffery Lacasse, Ph.D. [Audio podcast]. Retrieved from http://www.socialworkpodcast.com/2016/01/DSM5critique.html/p>

Optional Resources

American Psychiatric Association. (2013o). Preface. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.x00prefaceAmerican Psychiatric Association. (2013t). Use of the manual. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.UseofDSM5Lasalvia, A. (2015). DSM-5 two years later: Facts, myths and some key open issues. Epidemiology and Psychiatric Sciences, 24(3), 185–187. doi:10.1017/S2045796015000256Paris, J. (2015). The intelligent clinician's guide to the DSM-5 (2nd ed.). New York, NY: Oxford University PressChapter 3, “How Diagnostic Manuals Are Made” (pp. 33–55)Wakefield, J. C. (2013b). DSM-5: An overview of changes and controversies. Clinical Social Work Journal, 41(2), 139–154. doi:10.1007/s10615-013-0445-2Document: Suggested Further Reading for SOCW 6090 (PDF)Note: This is the same document introduced in Week 1.

Discussion: Diagnostic Labels as Powerful Communications

A diagnosis is powerful in the effect it can have on a person’s life and treatment protocol. When working with a client, a social worker must make important decisions—not only about the diagnostic label itself but about whom to tell and when. In this Discussion, you evaluate the use and communication of a diagnosis in a case study.

To prepare: Focus on the complex but precise definition of a mental disorder in the DSM-5 and the concept of dimensionality both there and in the Paris (2015) and Lasalvia (2015) readings. Also note that the definition of a mental disorder includes a set of caveats and recommendations to help find the boundary between normal distress and a mental disorder.

Then consider the following case:

Ms. Evans, age 27, was awaiting honorable discharge from her service in Iraq with the U.S. Navy when her colleagues noticed that she looked increasingly fearful and was talking about hearing voices telling her that the world was going to be destroyed in 2020. With Ms. Evans’s permission, the evaluating [social worker] interviewed one of her closest colleagues, who indicated that Ms. Evans has not been taking good care of herself for several months. Ms. Evans said she was depressed.

The [social worker] also learned that Ms. Evans’s performance of her military job duties had declined during this time and that her commanding officer had recommended to Ms. Evans that she be evaluated by a psychiatrist approximately 2 weeks earlier, for possible depression.

On interview, Ms. Evans endorsed believing the world was going to end soon and indicated that several times she has heard an audible voice that repeats this information. She has a maternal uncle with schizophrenia, and her mother has a diagnosis of bipolar I disorder. Ms. Evans’s toxicology screen is positive for tetrahydrocannabinol (THC). The evaluating [social worker] informs Ms. Evans that she is making a tentative diagnosis of schizophrenia.

Source: Roberts, L. W., & Trockel, M. (2015). Case example: Importance of refining a diagnostic hypothesis. In L. W. Roberts & A. K. Louie (Eds.), Study guide to DSM-5 (pp. 6–7). Arlington, VA: American Psychiatric Publishing.

Study Guide to DSM-5(r), by Roberts, M.; Louie, A.; Weiss, L. Copyright 2015 by American Psychiatric Association. Reprinted by permission of American Psychiatric Association via the Copyright Clearance Center.

By Day 3

Posta 300- to 500-word response in which you discuss how a social worker should approach the diagnosis. In your analysis, consider the following questions:

• Identify the symptoms or “red flags” in the case study that may be evaluated for a possible mental health disorder.
• Should the social worker have shared this suspected diagnosis based on the limited assessment with Ms. Evans at this time?
• Explain the potential impact of this diagnosis immediately and over time if the “tentative” diagnosis is a misdiagnosis.
• When may it be appropriate to use a provisional diagnosis?
• When would you diagnosis as other specified and unspecified disorders?

By Day 6

Respond to at least two colleagues who had a different position than your own in the following way:

• Explain why you agree or disagree with whether the client meets diagnostic criteria and should be told about a “tentative” diagnosis, approach to diagnosis, or impact of diagnosis.
• Explain how the social worker could have worked with a supervisor to make an initial diagnosis.

Note:You are required to create a thread for your initial Discussion post before you will be able to view other colleagues’ postings in this forum.If you have not yet visited the weekly resources and assignments, you should visit that area now to access the complete set of directions and guidelines for this discussion.

Submission and Grading Information

Grading Criteria

To access your rubric:Week 2 Discussion Rubric

Post by Day 3 and Respond by Day 6

To participate in this Discussion:Week 2 Discussion

Assignment: Video Role-Play: Strengths and Weaknesses of the DSM-5

Though the DSM-5 is the standard manual for mental illness diagnoses, it is not without weakness. In this Assignment, you analyze the strengths and limitations of the DSM-5 diagnostic system, and you differentiate between normal behavior and diagnosable symptoms using the concepts of dimensionality and spectrum.

To prepare: Review the concept of the dimensional approach with the DSM-5 and review the methods that the DSM-5 recommends to individualize where a person fits on a continuum of their illness in terms of subtypes, severity, and functional impairments. You will find these classifications in different parts of the manual and begin to be comfortable looking through it.

Next, imagine the following scenario:

You are a school social worker who has been asked to address a parent-teacher association meeting. Many parents in the audience have children who have been identified for special education services. They are confused about how to understand the diagnoses they are seeing. Others have worries about overdiagnosis. You have been advised that while these parents are generally well-informed, many don’t understand the dimensional or spectrum aspects. All are worried.

You will start your video with your introductory talk to the parents on these factors. After you provide your explanation, imagine that you open the meeting to questions. You will address the question noted below that is posed by a parent in the audience. Consider your audience, and practice explaining in terms a non-professional might understand. Do NOT read from the book.

Review the questions (in the Assignment instructions below) ahead of time and plan your answer before recording, as you will need to look up and integrate materials to answer the chosen question.

By Day 7

Submita 3- to 5-minute video, considering the parents as your audience, in which you do the following:

• Briefly describe what the DSM-5 is and how it is organized. In your description, define the concepts of spectrum and dimensionality as explained by Paris and in the DSM-5 introduction.
• Explain why social workers and mental health professionals use diagnoses and what receiving a diagnosis means (and does not mean).
• Explain general concerns about the risks of overdiagnosis and misdiagnosis versus not diagnosing. Also explain how diagnosis is connected to services.
• Explain other details that might help your audience understand the strengths and weaknesses of the diagnostic system.
• Provide a response to the following parental questions:
  • My teenager’s best friend died by suicide this year. It’s been months, and she doesn’t seem over it. Her teachers tell me she should get help for depression, but I think it’s just grief. She talks about her friend all the time and gets very upset. I am worried about her. Is it normal for her to still be feeling this way? I don’t want to put her on medication for normal feelings. What is the difference between grief and depression?

Include a transcript and/or edit closed captioning on your video to ensure your presentation is accessible to viewers of differing abilities.