Responses to DSM-5. DSM-5 and Malingering. DSM-5: Development and Implementation. Oxford Medicine Online

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1 Oxford Medicine Online You are looking at 1-10 of 2272 items for: DSM Responses to DSM-5 Joel Paris Print Publication Year: 2015 Published Online: Apr 2015 ISBN: eisbn: DOI: /med/ The publication of DSM-5 was a major media event. Some attacked the manual for medicalizing distress. Others, such as the National Institute of Mental Health, said it did not go far enough and proposed an alternate system that aims to be totally dimensional and rooted in neurobiology. Critics and supporters tend to lose sight of the fact that DSM-5 is only a provisional system. Even a perfect model of the brain could never be the basis for a complete theory of mental illness. There are decades of research ahead, and the answers to some questions may only emerge in the twenty-second century. DSM-5 and Malingering DOI: /med/ The assessment of malingering is a critical component of a forensic evaluation, where external incentives can be substantial. Although malingering was removed from the index in the DSM-5, it remains as a V code and the criteria for when to consider malingering remain unchanged. Interestingly, malingering has been removed from the differential of a number of diagnoses, including several of the somatoform disorders, which are called somatic symptom and related disorders in DSM-5. One striking exception to this is dissociative identity disorder. In this particular diagnosis, DSM-5 provides specific criteria for evaluating if the disorder was feigned, not found in DSM-IV TR or with any other diagnosis in DSM-5. In addition, the criteria for several diagnoses have changed, which may increase (or decrease) the likelihood of malingering. This chapter outlines the changes to several diagnoses that have been most prone to malingering and provide guidelines for how to assess whether the disorder has been feigned. DSM-5: Development and Implementation Page 1 of 5

2 DOI: /med/ Beginning with the first edition in 1952, the Diagnostic and Statistical Manual of Mental Disorders (DSM) has been the primary reference for the assessment and categorization of mental disorders in the United States. The revision of the DSM-IV-TR began in 1999 when the DSM-5 Research Planning Conference was convened, and it culminated in the publication of the new edition of the manual in May, DSM-5 sought to incorporate the most current neurobiology, developmental neuroscience, and genetics to influence psychiatric classification in the first comprehensive revision of psychiatric nomenclature in two decades. Like all preceding editions of the DSM, the development of the DSM-5 attracted considerable controversy, criticism, and a robust debate about the meaning and nomenclature of the diagnosis of mental disorders. This chapter highlights the significant conceptual changes in psychiatric diagnosis and nomenclature in the DSM that have important implications for the intersection of psychiatry and the law. DSM-5 and Personal Injury Litigation DOI: /med/ Civil litigation is a major aspect of the legal system in the United States, marked by a vast number and variety of cases. This chapter focuses on two common types of civil litigation: medical malpractice and personal injury. Both of these categories often usually involve claims of emotional distress or psychiatric injury. This chapter reviews DSM-5 diagnostic changes that are likely to impact the evaluation of mental harms in a civil forensic context. In particular, this chapter highlights the DSM-5 discussions on suicide risk and changes to medication-induced disorders. Major revisions to the Trauma- and Stressor-Related Disorders, Somatic Symptom and Related Disorders, and Neurocognitive Disorders that will likely impact personal injury claims are also emphasized. the impact of DSM-5 substance use disorder criteria on civil litigation involving addiction is highlighted. DSM-5 and Disability Evaluations DOI: /med/ Mental health providers are often asked to evaluate a person s disability, either in their role as a treatment provider or as a forensic evaluator. The definition of disability varies depending on the circumstances and context of the evaluation. Despite the range of disability definitions, they generally have one factor in common: a reliance and emphasis on using the Diagnostic and Statistical Manual (DSM). This chapter focuses on the relationship of the Diagnostic and Statistical Manual, Fifth Edition (DSM-5) to three common types Page 2 of 5

3 of disability evaluations: workers compensation claims; Americans with Disability Act (ADA) claims, and Social Security Disability Insurance (SSDI) evaluations. The appropriate use of disability assessment instruments, such as the Global of Assessment of Functioning (GAF) scale and the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), is also reviewed. Using DSM-5 in Clinical Practice Joel Paris Print Publication Year: 2015 Published Online: Apr 2015 ISBN: eisbn: DOI: /med/ The popularity of the DSM system led to it being used in ways for which it was never intended. DSM-5 can be misused as a guide to treatment, which it is not. Moreover, rapid symptom checks based on its criteria do not provide an adequate framework for either diagnosis or understanding patients. DSM-5 should be consulted before writing anything down on a patient chart. When completing a formal report, one should confirm that one s conclusions correspond to the criteria in the manual. The best way to use DSM-5 is to confirm diagnoses that have been made clinically. The manual has to be a check, not a checklist. DSM-5: Diagnosing and Report Writing DOI: /med/ DSM-5 profoundly changes how diagnoses are listed and described. This chapter provides eight practical steps to assist clinicians and forensic evaluators in accurately recording and describing DSM-5 diagnoses in clinical records and forensic reports. These eight important steps include the following: understanding the difference between a diagnosis and disorder ; evaluating criteria relevant to making a diagnosis; evaluating applicability of subtypes and specifiers; applying the correct International Classification of Disorders Code (ICD) if required; evaluating which diagnoses are current ; explaining diagnoses in a forensic report; and determining if and how disability is assessed under DSM-5. In addition, this chapter reviews the use of severity rating instruments with a particular focus on quantitative assessments of psychotic symptom severity. DSM-5 and Civil Competencies DOI: /med/ Page 3 of 5

4 Psychiatrists and other mental health professionals are often asked to evaluate a person s mental capacity (competence) to perform important tasks, such as making medical decisions, executing a will, or managing their finances, among others. This chapter reviews the role of the mental disorder requirement in civil commitment and other civil assessments. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) has resulted in significant changes to diagnostic criteria for many diagnoses that are likely to influence civil competence assessments. A sampling of types of common civil competence assessments is provided with an emphasis on how DSM-5 changes will likely impact these assessments. Practical guidance on how to conduct these civil competence assessments is also provided. The DSM-5 and Major Diagnostic Changes DOI: /med/ Numerous changes occurred to the diagnostic criteria of many mental disorders in the transition from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) to the Diagnostic and Statistical Manual, Fifth Edition (DSM-5). Because DSM-5 criteria will impact both clinicians and forensic evaluations, understanding the new criteria and the rationale for the changes from DSM-IV-TR to DSM-5 is necessary. This chapter focuses on the six DSM-5 chapters with the most prominent changes, namely Neurodevelopmental Disorders; Depressive Disorders; Traumaand Stressor-Related Disorders; Somatic Symptom and Related Disorders; Disruptive, Impulse- Control, and Conduct Disorders; and Substance-Related and Addictive Disorders. In addition, the chapter highlights potentially important forensic issues with case examples. Finally, the chapter summarizes changes to the other diagnostic categories in DSM-5. DSM-5: Competencies and the Criminal Justice System DOI: /med/ Mental health professionals are frequently called upon to evaluate a criminal defendant s ability to competently participate in one or more phases of the process of a criminal investigation, trial, sentencing, and/or appeal. Competence is a general term meaning the ability or capacity to understand a concept and rationally proceed through a decisionmaking process. This chapter reviews the evaluation of various criminal competencies, including competence to stand trial; to confess to a crime; to plead guilty; to waive counsel; to waive a jury trial; to testify; to waive extradition; to be sentenced; to waive appeals (and in capital cases) to be executed. Because competency to stand trial evaluations represent one of the most commonly ordered forensic evaluations in the United States, this chapter Page 4 of 5

5 provides a detailed discussion of this specific competency. Potential implications of DSM-5 s diagnostic changes and new diagnoses on in regard to assessing a defendant s competency are emphasized. Page 5 of 5