Tag Archives: DSM

APA accepting feedback for DSM revision

By Bethany Bray February 6, 2017

The American Psychiatric Association has created an online portal for the public to submit suggested changes to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Launched this winter, the portal allows clinicians, scholars and members of the public to submit suggested additions, deletions or modifications to the DSM.

Often called the “psychiatric bible,” the DSM-5 is a go-to resource for many practitioners when it comes to the classification and diagnosis of mental disorders. APA released this most recent version of the DSM in May 2013, after more than a decade of planning, research and review.

The online portal creates a way to keep the DSM updated in a more timely manner and make changes incrementally, as new information and research is available, according to the APA website.

This new medium offers an important and much-needed chance to have counselors voices considered in what has traditionally been an arena dominated by psychiatrists, says Stephanie Dailey, who was involved with the American Counseling Association’s DSM-5 Task Force and co-author of the ACA-published book DSM-5 Learning Companion for Counselors.

However, Dailey, a licensed professional counselor and associate professor and director of counseling training programs at Argosy University, Washington, D.C., expresses some skepticism about which submissions might actually be considered for changes to the DSM. She contributed some thoughts, via email, to Counseling Today:


“The Diagnostic and Statistical Manual of Mental Disorders (DSM) has long been criticized, amongst other things, for poor utility; inadequate psychometric evidence for diagnostic categories and specifiers; comorbidity issues; overutilization of ‘catch all’ diagnoses (e.g., not otherwise specific [NOS] and generalized anxiety disorder [GAD]); and underutilization of emergent genetic, neuroscientific and behavioral research.

While APA’s DSM-5 Task Force attempted to rectify many of these issues, there are still considerable challenges in regard to validity, reliability and clinical utility within the DSM-5. Clarification of diagnostic descriptions, criteria, subtypes and specifiers is needed and there is a significant dearth of information regarding sociocultural, gender and familial patterns for diagnostic classifications. There is also a lack of rigorous psychometric validation for suggested dimensional and cross-cutting assessments (introduced in the DSM-5) and no consensus was made during the last revision to the DSM in terms of modifications needed for the personality disorders category. Thus, this diagnostic category has remained unchanged and clinicians (and clients) are facing the same challenges as they did 20 years ago when the DSM-IV was released.

In terms of the new portal, it is important for individuals to understand the revision process of previous iterations of the DSM to really appreciate the magnitude of an ‘open’ call for revisions. The revision process of the DSM-IV to DSM-5 was a 14-year process, beginning in 1999, which originated with a research agenda primarily developed by the American Psychiatric Association

Image via Flickr http://bit.ly/2lfWuka

(APA), the National Institute of Mental Health (NIMH) and the World Health Organization (WHO). In 2007, APA officially commissioned a DSM-5 Task Force which formed 13 work groups on specific disorders and/or diagnostic categories. While the scope was broad, the intent of the workgroups was to improve clinical utility, address comorbidity, eradicate the use of not otherwise specified (NOS), do away with functional impairments as necessary components of diagnostic criteria and use current research to further validate diagnostic classes and specifiers. Having released the draft proposed changes, three rounds of public comment and field trials were conducted between 2010 and 2012. During this time, numerous professional organizations, including ACA, voiced significant concerns (See ACA’s 2011 letter to APA: bit.ly/2kxJBVY).

Despite attempts to become involved, at no time has any professional counselor ever served on APA’s DSM Task Force. In regards to the new portal, our time to have a foothold in changes to current diagnostic classifications is now.

In looking at the portal which lists specific kinds of revisions sought, one can easily see that APA is looking to remedy the long-term critiques of the manual, specifically validity, reliability, utility and the need to capture emerging research.

However, what proposals (and by whom) that are selected for inclusion remains to be seen. While the portal allows anyone to submit a proposal, there is a long history of bias in the type of research which is deemed appropriate for consideration by APA. While there is no dispute in terms of the need for rigorous research designs and large scale studies to validate criterion, these studies are not likely going to be conducted by anyone outside of APA, NIMH, WHO and other large scale ‘think tanks.’

The problem, particularly for counselors, is both philosophical and practical. First, the psychiatric profession as a whole is trained in the medical model, while counselors tend to operate on a more humanistic, holistic perspective. Next, while Paul Appelbaum, chair of the DSM Steering Committee, stated that acceptance thresholds will be high, reports from Appelbaum and others have ensured scrutiny for submissions which don’t provide ‘clear evidence.’ This is not only vague, but likely slanted towards the psychiatric community.

No one is disputing the need for the best available scientific evidence or the ability of the counseling profession to produce substantive outcome research for the mental health community. The American Counseling Association has members who have significant, scientific-based expertise in areas relevant to the DSM and strong research agendas which can support evidence-based changes. However, our seat at the table in these discussions has been scant.

Thus, counselors are strongly urged to contribute to the revision process by submitting proposals and working towards serving as unique contributors to the next edition. This is particularly relevant to counselors whose focus is on marginalized populations and underserved groups. Outcome-based research is needed, specifically that which has been repeatedly shown to improve treatment outcomes.

This is the time for counselors to become involved and make our experience known, and more importantly, our clients’ voices heard.”




Find out more


Visit APA’s DSM portal at https://psychiatry.org/psychiatrists/practice/dsm/submit-proposals


See Counseling Today’s Q+A with Dailey: “Behind the Book: DSM-5 Learning Companion for Counselors





Bethany Bray is a staff writer for Counseling Today. Contact her at bbray@counseling.org


Follow Counseling Today on Twitter @ACA_CTonline and on Facebook at facebook.com/CounselingToday.






Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

ACA launches six-webinar series on the DSM-5

By Heather Rudow June 18, 2013

Counselors are still working to digest the fifth edition of the Cover_of_Diagnostic_and_Statistical_Manual_of_Mental_Disorders (DSM-5), released by the American Psychiatric Association (APA) last month. To help counselors better understand the revisions and additions and how those changes will impact them, the American Counseling Association is offering six webinars focused on the DSM-5.

Rebecca Daniel-Burke, ACA’s director of professional projects and staff liaison to ACA’s DSM-5 Task Force, says the information in the DSM’s latest edition, its first since 2000, is crucial for counselors to learn. While it may seem overwhelming at first glance, Daniel-Burke says, “the DSM-5 is different, but not bigger. There are [actually] 15 fewer diagnoses.”

The webinar series will kick off on Wednesday, June 26 at 1 p.m. ET and will continue weekly on Wednesdays at the same time through July 31. ACA members may purchase the series for $119 (non-member price is $159) and earn six CE credits. Each one-hour webinar will be hosted by an ACA member who is an expert regarding a specific area of the DSM-5. Each webinar will be available for replay within 24 hours of the live broadcast.

The first webinar will be hosted by Jason King, who will give a general overview of the DSM and discuss the changes to addictive disorders in the new edition. King served as a DSM-5 Revision Task Force committee member for ACA, giving national presentations on the revision process and proposed diagnostic changes. He also completed a podcast on the DSM-5 for ACA to help members prepare for potential changes.

King says he is looking forward to giving members “background into the evolution of the DSM [and] the whole political process [because] there’s been a lot in the media about [it being] a secret, backdoor process, and I’m going to dispel a lot of the myths.”

King will also talk about the edition’s new definition of “mental disorder,” changes to coding and diagnostic structure, and the newly created “addictions and related disorders” category.

He believes it is important for counselors to understand the how to utilize the DSM-5 “so they can understand how they can work with clients and conceptualize a client. It is a CACREP requirement for a few of the [categories of counselors], and if counselors want licensure portability and to be reimbursed by insurance, Medicare and Medicaid, they have to know the DSM.”

School counselors, specifically, will be directly impacted by new edition, King says. “They are going to be coordinating treatment with other professionals, such as social workers and school psychologists who will be providing diagnoses, and they’re going to be having kids in their schools with these new diagnoses. They’ve got to know what these new changes are so they can diagnose properly.”

King has been involved with the DSM for many years. He owns and directs an outpatient mental health and substance abuse treatment clinic that collected data for the APA’s clinical field trials, which helped inform the DSM-5 revision process. He is looking forward to discussing the DSM’s changes with counselors.

“It really simulates a whole new way to think about disorders and clients, and the push is to do more biologically based understanding,” King says. “The disorders are complex, so I think it overall causes us to shift our thinking and how we look at people with mental disorders.”



Visit counseling.org/continuing-education/webinars for more information on the webinar series.