Discuss strengths and weaknesses of the diagnostic system

 

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

Submit a 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?

 

Required Readings

American Psychiatric Association. (2013i). Introduction. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.Introduction

Barsky, 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 Press

Chapter 6, “Dimensionality” (pp 84–101)

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=139

Singer, 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. (2013n). Preface. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.x00preface

American Psychiatric Association. (2013s). Use of the manual. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.UseofDSM5

Lasalvia, 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/S2045796015000256

Paris, J. (2015). The intelligent clinician’s guide to the DSM-5 (2nd ed.). New York, NY: Oxford University Press

Chapter 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/s10615-013-0445-2