What We ll Cover. Why Do We Have a DSM? 10/6/2013

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1 1 Aaron Norton, LMHC, CAP, CRC President Elect, Suncoast Mental Health Counselors Association Licensed Mental Health Counselor Henry Tenenbaum, Ph.D. Licensed Psychologist Licensed School Psychologist Changes in : An Update for Counselors and Counseling Students What We ll Cover 2 Brief Snapshot: Overview of Changes Overview of Section II Chapter Changes Overview of Section II Changes Overview of Section III Changes Resources Question & Answer Session Why Do We Have a DSM? 3 to assist trained clinicians in the diagnosis of their patients mental disorders as part of a case formulation assessment that leads to a fully informed treatment plan for each individual. (APA, 2013) 1

2 Counselors and DSM 4 Although professional counselors may espouse different theoretical orientations, they all tend to work from a preventive, developmental, holistic framework, building on clients strengths and assets. Counselors help clients with issues ranging from developmental concerns and problems in living to issues associated with pathology. Thus, although counselors are trained to work with clients from a developmental, wellness-oriented perspective, they often are involved in diagnosing and treating mental and emotional disorders, including addictions. I treat everyone developmentally, but I want to recognize pathology when it is in the room with me. Robin Daniel, Ph.D., LPC, Dean of Student Life, Greensboro College (Newsome & Gladding, 2013) 5 The : A Product of a Human Institution; Not a Clinical Gospel [Christians], at their best, know that often they don t know. They do not have all the answers. They do not have God in their pocket. We cannot answer every question that any bright boy in the back row might ask. We have only light enough to walk by. Howard A. Johnson ( ), The Vocation of the Anglican Communion (Theme Address), included in Anglican Congress 1963: Report of Proceedings The Paradigm Shift : DSM-I 1968: DSM-II 1980: DSM-III 1987: DSM-III-R 1994: DSM-IV 2000: DSM-IVTR 2013: 2

3 The Paradigm Shift 7 Conceptualize similar disorders (based on common etiology) as one disorder on a spectrum of severity Recognize the overlap between physical and psychological domains A Physical Psychological B C 8 The Paradigm Shift Specify why a client s symptoms do not neatly fit into the criteria for a disorder The Paradigm Shift 9 Enhance understanding of cultural and developmental life span influences 3

4 The Paradigm Shift 10 De-pathologize abnormal behaviors that do not constitute a disorder Overview of Changes 11 Item General Medical Condition Change Another Medical Condition Multi-axial Classification System Global Assessment of Functioning (GAF) Discontinued Added more options for indicating Discontinued severity World Health Organization Disability Assessment Scale (WHODAS) Section III Recommended Definition of a Mental 12 A mental disorder is a syndrome characterized by clinically significant disturbance in an individual s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities. An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behavior (e.g. political, religious, or sexual) and conflicts that are primarily behavior (e.g. political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above (APA, 2013; p. 20) 4

5 13 What might a diagnosis look like? Sample Diagnosis V62.21 Problem Related to Current Military Deployment Status Other Specified Personality (mixed personality features dependent and avoidant symptoms) Comorbid Sleep-Related Hypoventilation Persistent Depressive (Dysthymia), With anxious distress, In partial remission, Early onset, With pure dysthymic syndrome, Moderate V62.89 Victim of Crime Overweight or Obesity WHODAS: 63 Source: King, J.H. (2013, August). Understanding and using the. Counseling Today, 56(2). and ICD 14 Codes in the DSM-IVTR were ICD-9CM codes e.g. Generalized Anxiety (300.02) Because U.S. healthcare providers will be required to use DSM-10CM (alphanumeric) codes effective October 1, 2014, the includes ICD-10CM codes in parentheses e.g. Generalized Anxiety (F41.1) 15 Overview of Changes Added Reordered Renamed Removed Reclassified Discontinued 5

6 Overview of Changes 16 Item Chapters Categories Change Renamed Restructured Order Names Eliminated Removed Added New Revised Renamed Removed Re-categorized as subtype Reclassified Spectrum Classifications Overview of Changes 17 De-pathologizing e.g. Paraphilias vs. paraphilic disorders New Classifications to capture individuals who need treatment but were technically just shy of meeting diagnostic criteria e.g. Mild Neurocognitive, Binge-Eating Reducing the Not Otherwise Specified category due to greater depth of detail about symptoms Other Specified or Unspecified 18 Structure 6

7 Table of Contents 19 Section I: Basics Introduction Use of Cautionary Statement for Forensic Use of Section II: Essential Elements: Diagnostic Criteria and Codes Section III: Emerging Measures and Models Assessment Measures Cultural Formulation Alternative Model for Personality Conditions for Further Study Appendix Section II: 22 Chapters Neurodevelopmental 2. Schizophrenia Spectrum and other Psychotic 3. Bipolar and Related 4. Depressive 5. Anxiety 6. Obsessive-Compulsive and Related 7. Trauma-and Stressor-Related 8. Dissociative 9. Somatic Symptoms and Related 10. Feeding and Eating 11. Elimination 12. Sleep-Wake 13. Sexual Dysfunctions 14. Gender Dysphoria 15. Disruptive, Impulse-Control and Conduct 16. Substance-Related and Addictive 17. Neurocognitive - Binge-Eating 18. Personality 19. Paraphilic, Gender Dysphoria 20. Other Mental 21. Medication-Induced Movement and Other Adverse Effects of Medication 22. Other Conditions that May be a Focus of Clinical Attention (V and Z Codes) 21 Section II Chapter Changes 7

8 22 Section II Chapter Comparison: DSM-IVTR to first diagnosed in infancy, childhood or adolescence Delirium, Dementia and Amnestic and Other Cognitive Deleted reorganized under other chapters Renamed Neurocognitive 23 Section II Chapter Comparison: DSM-IVTR to Mental due to a General Medical Condition Not Elsewhere Classified Substance-related Deleted Renamed Substance Use and Addictive (includes Gambling ) 24 Section II Chapter Comparison: to Schizophrenia and Other Psychotic Mood Somatoform Sexual and Gender Identity Renamed Schizophrenia Spectrum and Other Psychotic Split into 2 chapters Bipolar and Related Depressive Renamed Somatic Symptom and Related Broken into 3 chapters Sexual Dysfunctions Gender Dysphoria Paraphilic 8

9 25 Section II Chapter Comparison: to Adjustment Other Conditions that May Be a Focus of Clinical Attention Chapter Eliminated Moved to Trauma and Stress-related Several Shifted to Other Mental 26 Section II Changes Mental Retardation vs. Intellectual Disability 27 Mental Retardation Severity Renamed Intellectual Disability (Intellectual Developmental ) Determined By Adaptive Functioning not IQ score 9

10 Communication 28 Expressive Language D/O & Mixed Receptive- Expressive Language D/O Phonological Stuttering Combines both disorders into one Language Renamed Speech Sound Renamed Childhood-Onset Fluency 29 Communication New Diagnosis: Social (Pragmatic) Communication Persistent difficulties in the social cues of verbal and nonverbal communication not to overlap disorders in the Autistic Spectrum classification Social (Pragmatic) Communication 30 IN ORDER TO HONOR THE APA S COPYRIGHT ON THE, SPECIFIC DIAGNOSTIC CRITERIA OF 10

11 Social (Pragmatic) Communication 31 IN ORDER TO HONOR THE APA S COPYRIGHT ON THE, SPECIFIC DIAGNOSTIC CRITERIA OF Autism Spectrum 32 Autism Asperger s Childhood Disintegrative Pervasive Developmental Single Condition (Different levels of symptom severity - 2 Core Domains) Deficits in social communication and social interaction Restricted repetitive behaviors, interests, and activities Autism Spectrum 33 IN ORDER TO HONOR THE APA S COPYRIGHT ON THE, SPECIFIC DIAGNOSTIC CRITERIA OF 11

12 Autism Spectrum 34 IN ORDER TO HONOR THE APA S COPYRIGHT ON THE, SPECIFIC DIAGNOSTIC CRITERIA OF Autism Spectrum 35 IN ORDER TO HONOR THE APA S COPYRIGHT ON THE, SPECIFIC DIAGNOSTIC CRITERIA OF Will Some Folks be Left Out? 36 Individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger s disorder, or pervasive developmental disorder not otherwise specified should be given the diagnosis of autistic spectrum disorder. Individuals who have marked deficits in social communication, but whose symptoms do not otherwise meet criteria for autism spectrum disorder, should be evaluated for social (pragmatic) communication disorder (APA, 2013; p. 51) 12

13 Autism Spectrum 37 IN ORDER TO HONOR THE APA S COPYRIGHT ON THE, SPECIFIC DIAGNOSTIC CRITERIA OF Attention-Deficit/Hyperactivity 38 Criterion Items Cross-situational requirement Onset Criterion Before Age 7 Examples Added to facilitate application across the life span Strengthened several symptoms in each setting Changed Before age 12 Attention-Deficit/Hyperactivity 39 Subtypes Replaced Presentation specifiers that map directly to prior subtypes Comorbidity with Autistic Spectrum now allowed Criteria Adults must meet 5 symptoms Children still require 6 13

14 Specific Learning 40 Reading Mathematics of Written Expression Learning, NOS Combined into One Rationale: Learning Deficits co-occur 41 Motor first diagnosed in infancy, childhood or adolescence (e.g.) Developmental Coordination Stereotypic Movement Tourette s Persistent (Chronic) Motor of Vocal Tic Provisional Tic Other Specified Tic Unspecified Tic Moved Under Motor Motor 42 Tic Criteria Stereotypic Movement Standardized: Across all disorders Differentiated from Body-Focused Repetitive Behaviors that are new in the Obsessive-Compulsive Chapter 14

15 Schizophrenia 43 Differentiations between bizarre and non-bizarre delusions Removed And Two or more voices conversing with each other Schizophrenia 44 Requirements Subtypes (paranoid, disorganized, catatonic, undifferentiated, residual) New Individual must have at least 1 of 3 positive symptoms (delusions, hallucinations, and disorganized speech) Eliminated from Body-Focused Repetitive Behaviors that are new in the Obsessive-Compulsive Chapter 45 Schizoaffective & Delusional Requirement Delusional New A major mood episode must be present for a majority of the disorder s total duration after Criterion A symptoms of Schizophrenia (positive and negative symptoms) has been met Removed Non-bizarre delusions no longer a requirement 15

16 Catatonia 46 Criteria Used to Diagnose Symptom Requirements Same Regardless of whether context is a psychotic, bipolar, depressive, other medical disorder, or unidentified medical condition 3 of 12 Catatonia 47 May be diagnosed as a specifier for Depressive Bipolar psychotic disorders as a separate diagnosis in the context of another medical condition Or, as an other specified diagnosis Bipolar & Related 48 Criterion A for Manic and Hypomanic Episodes Mixed Episode Now includes Emphasis on changes in activity and energy as well as mood Removed Replaced with a specifier With Mixed Features 16

17 Bipolar & Related 49 Diagnosis Specifier New Diagnosis Other Specified Bipolar and Related New Anxious Distress Depressive 50 Diagnoses Dysthymic and Major Depressive, Chronic New Disruptive Mood Dysregulation Premenstrual Dysphoric Merged into one disorder Persistent Depressive Disruptive Mood Dysregulation 51 IN ORDER TO HONOR THE APA S COPYRIGHT ON THE, SPECIFIC DIAGNOSTIC CRITERIA OF 17

18 Disruptive Mood Dysregulation 52 IN ORDER TO HONOR THE APA S COPYRIGHT ON THE, SPECIFIC DIAGNOSTIC CRITERIA OF Disruptive Mood Dysregulation 53 IN ORDER TO HONOR THE APA S COPYRIGHT ON THE, SPECIFIC DIAGNOSTIC CRITERIA OF Premenstrual Dysphoric 54 IN ORDER TO HONOR THE APA S COPYRIGHT ON THE, SPECIFIC DIAGNOSTIC CRITERIA OF 18

19 Premenstrual Dysphoric 55 IN ORDER TO HONOR THE APA S COPYRIGHT ON THE, SPECIFIC DIAGNOSTIC CRITERIA OF previous year. Premenstrual Dysphoric 56 IN ORDER TO HONOR THE APA S COPYRIGHT ON THE, SPECIFIC DIAGNOSTIC CRITERIA OF Depressive 57 Specifier for Major Depressive Episode New With Mixed Features Designed for people who have at least 3 manic symptoms within a depressive episode (insufficient for label of manic episode ) Bereavement Exclusion Removed 19

20 Anxiety 58 Obsessive Compulsive (OCD) Post Traumatic Stress (PTSD) Acute Stress Moved Out of this category and into others Anxiety 59 Diagnosis Requirements of Agoraphobia, Specific Phobia or Social Anxiety (Social Phobia) No Longer Required Recognition that one s anxiety is excessive or unreasonable 6 Month Duration Requirement for those under 18 years of age Extended To include all individuals to minimize diagnosis of transient fears Anxiety 60 Panic Attacks Panic and Agoraphobia Social Phobia Specifiers Minor Verbiage Changes Made to simplify Can be used as a specifier in other disorders Unlinked Now separate disorders that can be co-occurring Verbiage Change 20

21 Anxiety 61 Separation Anxiety Requirement (recruited from the old childhood disorders chapter of DSM-IV) Selective Mutism Changed No longer requires that onset be during childhood Recruited from DSM-IV s old childhood disorders chapter 62 Obsessive Compulsive and Related Chapter New! New! Hoarding Excoriation (Skin-Picking ) Substance/Medication-Induced Obsessive-Compulsive and Related Obsessive-Compulsive and Related Due to Another Medical Condition Hoarding 63 IN ORDER TO HONOR THE APA S COPYRIGHT ON THE DSM- 5, SPECIFIC DIAGNOSTIC CRITERIA OF NEW DISORDERS WILL NOT BE PRINTED OR DUPLICATED IN ANY FORM. HOWEVER, THEY 21

22 Hoarding 64 IN ORDER TO HONOR THE APA S COPYRIGHT ON THE, SPECIFIC DIAGNOSTIC CRITERIA OF Excoriation (Skin-Picking ) 65 IN ORDER TO HONOR THE APA S COPYRIGHT ON THE, SPECIFIC DIAGNOSTIC CRITERIA OF 66 Obsessive Compulsive and Related Impulse- Control Recruited Trichotillomania (Hair-Pulling ) 22

23 67 Obsessive Compulsive and Related Specifiers Refined Poor Insight Includes good or fair insight, poor insight, and absent /delusional beliefs New Tic-related specifier for OCD 68 Obsessive Compulsive and Related Body Dysmorphic Diagnostic Criterion Added Describes repetitive behaviors or mental acts in response to preoccupations with perceived defects or flaws in physical appearance New Specifier With Muscle Dysmorphia Acute Stress & PTSD 69 Qualifying Traumatic Events Criterion regarding the subjective reaction to the traumatic event (intense fear, helplessness, or horror) Must now be explicit Were events experienced directly, witnessed or experienced indirectly? Removed 23

24 Acute Stress & PTSD 70 PTSD: 3 symptom clusters PTSD Diagnostic Thresholds Added a 4 th symptom cluster by dividing the avoidance/numbing cluster into 2 separate clusters (avoidance and persistent negative alterations in cognition and mood) Lowered for Children and Adolescents More developmentally sensitive, and Separate Criteria Added for children under 6 Reactive Attachment 71 2 Subtypes ( emotionally withdrawn/inhibited and indiscriminately social/disinhibited ) Now defined as distinct separate disorders Reactive Attachment and Disinhibited Social Engagement Dissociative 72 Depersonalization Changed to Depersonalization/Derealization Dissociative Fugue Now a specifier Instead of a separate disorder 24

25 Dissociative 73 Criterion A for Dissociative Identity Expanded To include certain possession-from phenomena and functional neurological symptoms. Also, transitions in identity may be observable by others or self-reported and recurrent gaps in memory can be for everyday events, not just for traumatic experiences. Somatic Symptoms and Related 74 Somatization and Undifferentiated Somatoform Somatic Distinct and Separate Merged into Somatic Symptom disorder No specifier required Somatic disorder can accompany diagnosed medical disorders New recognition Now thought of as a spectrum instead of a separate disorder Somatic Symptoms and Related 75 Hypochondriasis Pain Eliminated Most clients would meet criteria for Somatic Symptom ; some Illness Anxiety Less emphasis on separating from medical Now Diagnosed for people with chronic pain that can be medically explained 25

26 Somatic Symptom 76 IN ORDER TO HONOR THE APA S COPYRIGHT ON THE, SPECIFIC DIAGNOSTIC CRITERIA OF Somatic Symptom 77 IN ORDER TO HONOR THE APA S COPYRIGHT ON THE, SPECIFIC DIAGNOSTIC CRITERIA OF Illness Anxiety 78 IN ORDER TO HONOR THE APA S COPYRIGHT ON THE, SPECIFIC DIAGNOSTIC CRITERIA OF 26

27 Illness Anxiety 79 IN ORDER TO HONOR THE APA S COPYRIGHT ON THE, SPECIFIC DIAGNOSTIC CRITERIA OF Feeding and Eating 80 Feeding and Eating Childhood Chapter Anorexia Nervosa and Bulimia Nervosa Recruited disorders from DSM-IV Now modified to include adults Minor Changes Frequency of compensatory behavior and binge eating decreased for Bulimia Feeding and Eating 81 New Binge-Eating (in essence, Bulimia Nervosa without recurrent inappropriate compensatory behavior, such as purging and driven exercise) 27

28 Binge-Eating 82 IN ORDER TO HONOR THE APA S COPYRIGHT ON THE, SPECIFIC DIAGNOSTIC CRITERIA OF Binge-Eating 83 IN ORDER TO HONOR THE APA S COPYRIGHT ON THE, SPECIFIC DIAGNOSTIC CRITERIA OF Sleep-Wake 84 Medical vs. Mental Breathingrelated Sleep Recognition of co-existence Of medical and mental conditions vs. separating the two Divided into 3 Distinct Obstructive Sleep Apnea Hypopnea Central Sleep Apnea Sleep-Related Hypoventilation 28

29 Sleep-Wake 85 Circadian Rhythm Sleep-Wake NOS Category Expanded subtypes Reduced By adding Rapid Eye Movement Sleep Behavior and Restless Legs Syndrome 86 Rapid Eye Movement Sleep Behavior IN ORDER TO HONOR THE APA S COPYRIGHT ON THE, SPECIFIC DIAGNOSTIC CRITERIA OF 87 Rapid Eye Movement Sleep Behavior IN ORDER TO HONOR THE APA S COPYRIGHT ON THE, SPECIFIC DIAGNOSTIC CRITERIA OF 29

30 Sexual Dysfunctions 88 Dyspareunia and Vaginismus Subtypes Merged into Genito-pelvic Pain/Penetration Reduced Gender Dysphoria 89 Category New Category because gender dysphoria is neither a paraphilia nor a sexual dysfunction. Gender Identity verbiage is perhaps misleading and/or outdated New paradigm shift away from cross gender identification per se to gender incongruence Gender Dysphoria 90 Gender verbiage Repeatedly stated desire Subtyping based on sexual orientation Versus sex verbiage Replaced By Strong desire to be of the other gender in order to be more developmentally sensitive Removed Not clinically useful 30

31 Why the Name Change? 91 It is important to note that many people do not believe that GID should be classified as a mental health disorder. In the upcoming, gender identity disorder is referred to as gender dysphoria Some experts maintain that the term should be removed from the list of diagnoses in the. As stated by Dr. Madeline Wyndzen (2008), transgender individuals and many clinicians find the mental illness labels imposed on transgenderism just as disquieting as the label that used to be imposed on homosexuality. (Newsome & Gladding, 2013; p. 160) 92 Disruptive, Impulse Control, and Conduct Oppositional Defiant New Chapter Consists of disorders that were linked due to their close association with Conduct 4 Changes 1. Symptoms now grouped into 3 types a. Angry/irritable mood b. Argumentative/defiant behavior c. Vindictiveness 2. Exclusion criteria for Conduct removed 3. More guidance regarding frequency requirements 4. Severity rating added 93 Disruptive, Impulse Control, and Conduct New Chapter Consists of disorders that were linked due to their close association with Conduct 31

32 94 Disruptive, Impulse Control, and Conduct Oppositional Defiant 4 Changes 1. Symptoms now grouped into 3 types a. Angry/irritable mood b. Argumentative/defiant behavior c. Vindictiveness 2. Exclusion criteria for Conduct removed 3. More guidance regarding frequency requirements 4. Severity rating added 95 Disruptive, Impulse Control, and Conduct Specifier for Conduct New With Limited Pro-Social Emotions Denotes a more severe clinical presentation 96 Disruptive, Impulse Control, and Conduct Intermittent Explosive Required physical aggression, verbal aggression and nondestructive/noninjurious physical aggression Now Permissible More guidance regarding frequency of symptoms Minimum age of 6 years now required 32

33 97 Substance-Related and Addictive Category Pathological Gambling Polysubstance Dependence Expanded May increasingly include nonsubstance-related addictive disorders that are similar in terms of neurobiological processes Renamed Gambling Deleted 98 Substance-Related and Addictive Substance Abuse and Dependence Threshold for a Substance Use (1 sx) Merged in 1 Substance Use with a spectrum from Mild to Severe 2-3 sx = mild; 4-5 sx = moderate; 6 or more sx = severe. Legal problems criteria removed and craving added Increased to 2 sx DSM 5 s Substance Use, Mild 99 Substance-Related and Addictive New Cannabis Withdrawal & Caffeine Withdrawal No Nicotine Abuse present New Tobacco Use uses same criteria as other substances in 33

34 Cannabis Withdrawal 100 IN ORDER TO HONOR THE APA S COPYRIGHT ON THE DSM- 5, SPECIFIC DIAGNOSTIC CRITERIA OF NEW DISORDERS WILL NOT BE PRINTED OR DUPLICATED IN ANY FORM. HOWEVER, THEY Cannabis Withdrawal 101 IN ORDER TO HONOR THE APA S COPYRIGHT ON THE, SPECIFIC DIAGNOSTIC CRITERIA OF Caffeine Withdrawal 102 IN ORDER TO HONOR THE APA S COPYRIGHT ON THE, SPECIFIC DIAGNOSTIC CRITERIA OF 34

35 Proverbs 23: Who has woe? Who has sorrow? Who has strife? Who has complaints? Who has needless bruises? Who has bloodshot eyes? 30 Those who linger over wine, who go to sample bowls of mixed wine. 31 Do not gaze at wine when it is red, when it sparkles in the cup, when it goes down smoothly! 32 In the end it bites like a snake and poisons like a viper. 33 Your eyes will see strange sights and your mind imagine confusing things. 34 You will be like one sleeping on the high seas, lying on top of the rigging. 35 "They hit me," you will say, "but I'm not hurt! They beat me, but I don't feel it! When will I wake up so I can find another drink? 104 Substance-Related and Addictive Early Remission as 1- less than 12 months of no sx New Definition 3-less than 12 months of no sx (excluding Craving) With or Without Physiological Dependence specifiers Removed SUD Symptoms Reordered 105 IN ORDER TO HONOR THE APA S COPYRIGHT ON THE, SPECIFIC DIAGNOSTIC CRITERIA OF NEW DISORDERS WILL NOT BE PRINTED OR DUPLICATED IN ANY FORM. HOWEVER, THEY WILL BE REVIEWED DURING THE PRESENTATION. 35

36 Abuse vs. Dependence? 106 DSM-IVTR Alcohol Abuse Alcohol Dependence (F10.10) Mild Alcohol Use (F10.20) Moderate Alcohol Use (F10.20) Severe Alcohol Use Neurocognitive 107 Diagnoses of Dementia and Amnestic Level of Cognitive Impairment Combined Into New Diagnosis Major Neurocognitive Now recognizes a less severe level Mild Neurocognitive D/O Neurocognitive

37 Personality 109 Diagnostic Criteria No Changes Method of Diagnosing Personality Alternative Method Included in Section III A model for further study Called Hybrid dimensionalcategorical model Almost adapted into the but was not May replace the current system in future revision Paraphilic 110 Course Specifiers Paraphilias New Course Specifiers Added In a Controlled Environment and In Remission. Names of disorders changed to add (e.g. Pedophilia is now Pedophilic ) Recognizes Paraphilias are not necessarily Paraphilic Paraphilic 111 Criterion Must now meet Criterion A and Criterion B for diagnosis Diagnosis (A=qualitative nature of the disorder; B=negative consequences, i.e. distress, impairment, harm/risk of harm to self/others)de-pathologizing? Differentiating non-normal behavior from disordered behavior 37

38 112 Section III Changes Emerging Measures and Models Section III Changes 113 Assessment Measures Cross-Cutting Symptoms Measure, Levels 1 and 2 World Health Organization Disability Assessment Schedule 2.0 Cultural Formulation Interview Alternative Model for Personality Section III Changes 114 Conditions for Further Study Attenuated Psychosis Syndrome Depressive Episodes With Short-Duration Hypomania Persistent Complex Bereavement Caffeine Use Internet Gaming Neurobehavioral Associated with Prenatal Alcohol Exposure Suicidal Behavior Non-suicidal Self-Injury 38

39 Resources Resource Page (visit click on Resources, then on Resource Page ) There s an app for that! Online Assessment Measures Level 1 and Level 2 Cross Cutting Measures World Health Organization Disability Assessment Scale (WHODAS 2.0) Cultural Formulation Interview Q&A Session 116 Aaron Norton, LMHC, CAP, CRC Mr. Norton is a Licensed Mental Health Counselor, Certified Addictions Professional, and Certified Rehabilitation Counselor working in private practice at Integrity Counseling & Coaching, Inc. in Largo, FL, where he specializes in addictive disorders, depression, and anxiety. He is the President Elect of the Suncoast Mental Health Counselors Association, a chapter of the Florida Mental Health Counselors Association, and an Adjunct Professor at the University of South Florida s Department of Rehabilitation and Mental Health Counseling. Henry Tenenbaum, Ph.D. Dr. Tenenbaum is a Licensed Psychologist and School Psychologist working in his own private practice in Pinellas County, Sarasota, Palmetto/Bradenton and Sebring. He specializes in psychological evaluations (Neuropsychology, school related evaluations, disability evaluations and forensic psychology). drdad7@comcast.net 39