Diagnostic and Statistical Manual of Mental Disorders DSMIV TR

1
Diagnostic and Statistical Manual of Mental
Disorders (DSM-IV TR)

• BCE 548
• Meeting 1
• January 13, 2003

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The DSM and Diagnosis

•  DSM is a manual for diagnosis of mental
  disorders.
•   Diagnoses are assigned as three, four or
  five- digit codes (xxx.xx) (for example, Alcohol
  Abuse is 305.00). In general, these are the
  same as ICD-9 (International Classification of
  Diseases) codes used for diagnosis of any other
  (physical) condition.
•  Diagnosis is provided multiaxially, with five
  dimensions

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Axis I Clinical Disorders Other Conditions that
may be a Focus of Clinical Concern

• The diagnostician (usually a psychiatrist or
  psychologist) will indicate all specific mental
  disorders that are observed or suspected from
  clinical observation in Axis I the exceptions
  are Personality Disorders and Mental Retardation,
  which are indicated in Axis II.
• Other Conditions that may be a Focus of Clinical
  Concern include such issues as specific
  interpersonal relationship difficulties,
  antisocial behavior, and noncompliance with
  psychotherapy. These conditions are also
  assigned a three, four or five-digit code, many
  of which begin with a V (Vxx.xx) (See pages
  13-26).

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Axis II Personality Disorders, Mental
Retardation

• Personality Disorders are specific types of
  mental conditions that are indicative of
  maladaptive idiosyncrasies in individual behavior
  patterns. The DSM assigns these disorders to a
  separate Axis. Also in this Axis would be found
  the diagnosis of Mental Retardation, if present.

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Axis III General Medical Conditions

• This Axis includes any General Medical Conditions
  that an individual may have, indicated by an
  ICD-9 code (example 278.00 is Obesity) (see
  pages 867-882).

6
Axis IV Psychosocial and Environmental Problems

• This Axis is used to identify any concerns that
  may arise from the individuals environment or
  psychosocial situation that could affect
  functioning. They are not given an ICD-9 code
  but rather are indicated as statements (Example
  Job Dissatisfaction). Educational, legal,
  vocational, familial, economic and other such
  problems are indicated in this Axis (see pages
  31-32).

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Axis V Global Assessment of Functioning (GAF)

• This Axis is an assessment of how well the
  individual is functioning in his or her
  lifeessentially, how bad is their situation as
  a result of their mental health problems? The
  GAF is a score from 1-100 with separation into
  bands of ten for diagnostic purposes. For
  example, 91-100 would indicate an individual who
  has few if any serious problems, anxieties or
  concerns and no symptoms of mental illness. A
  score of 1-10 would indicate an individual who is
  not capable of taking care of basic daily
  activities of life (i.e., personal hygiene), who
  is actively and sincerely suicidal, or who may
  pose a threat of physical harm to other persons.
  A score of 0 indicates inadequate information for
  the psychologist to assign a clinical score on
  this Axis.

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Modifiers

• Diagnostic codes and descriptions indicate only
  the clinical presence of a mental health concern
  without indicating its severity. Therefore, the
  mental health professional may assign a modifier
  (Mild, Moderate, Severe) to the diagnosis to
  indicate its severity. In addition, diagnoses
  that are in remission (getting better) may also
  be indicate with the modifiers Partial Remission
  or Full Remission. A history of previous
  diagnosis may be indicated with the modifier
  Prior History.

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Example of a DSM Diagnosis Using the Multiaxial
System

• Axis I 296.90 Mood Disorder NOS (Moderate)
• 309.81 Posttraumatic Stress Disorder (Mild)
• V15.81 Noncompliance with Treatment
•  
• Axis II 301.83 Borderline Personality Disorder
  (Severe)
•  Axis III 401.9 Hypertension, Essential
•  Axis IV Disruption of Family by Separation,
  Divorce, or Estrangement
• Discord with Boss or Co-Workers
• Threat of Job Loss
•  Axis V Global Assessment of Functioning 48

10
Using Psychological Information in Rehabilitation
Counseling
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A Rehabilitation Counselors Role

• To help individuals with disabilities improve
  their quality of lifeprimarily through 1)
  employment and 2) improvement in activities of
  daily living.
•  
• In order to fulfill your role as a rehabilitation
  counselor, you need to know what are the
  functional limitations that a disability may
  causei.e., what are the specific concerns
  precipitated by the disability that you will need
  to address when you write a rehabilitation plan
  aimed at helping an individual to obtain the goal
  they desire?

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Disabilities may be either/both physical or
cognitive/emotional in nature

• Physical Disabilities are often easier to
  classify in terms of functional limitations
  lifting, sitting, standing, talking, hearing,
  speaking, etc. These things are easily
  measuredboth in terms of the individuals
  capacities as well as in the demands of
  occupations and other environmental situations.
•  
• Cognitive and emotional disabilities are not as
  easily defined because the problems that they
  cause may be more abstract and difficult to
  measure (i.e., inability to deal with stressful
  situations).

13
Capacity and Environment

• With any disabling condition, you need to have
  good information. With cognitive/emotional
  disabilities, it may not be as easy to generalize
  functional capacities to specific environmental
  situations.

14
Rehabiltiations Goal Improve Quality of Life

• Success in rehabilitation is obtained if an
  individual attains goals that improve quality of
  life. To facilitate this outcome the
  rehabilitation counselor should
• Have a strong understanding of cognitive/emotional
  disabilities in general and an especially acute
  understanding of those disabilities seen most
  often in your caseload.
• Have a strong understanding of treatment
  modalities for these conditions (but rarely will
  you be directly involved in treatment yourself!)
•   Understand the individual through good
  counseling and interviewing skills.
• Be able to discuss concerns and gather
  information from the individuals treating mental
  health professional.
• Be able to understand the cognitive and emotional
  demands of occupations and understand potential
  conflict in these demands and the functional
  assets/limitations of persons with cognitive and
  emotional disabilities.
• Be able to provide services or modifications to
  occupations in situations where this may be
  possible.