Counseling Today

Special Series: DSM-5

K. Dayle Jones December 20, 2010

Should counselors be involved in the DSM-5 field trials? Considering that licensed professional counselors regularly utilize the Diagnostic and Statistical Manual of Mental Disorders (DSM), the logical answer is "yes."

More than a decade after the American Psychiatric Association (APA) began developing the fifth edition of the DSM, the field trial stage has begun. Field trials will help evaluate the practical use of the proposed DSM-5 diagnostic criteria in real-world clinical settings. Specifically, the field trials will evaluate the clinical utility and feasibility of draft diagnostic criteria as well as the reliability of the new dimensional and cross-cutting assessments.

APA is conducting two versions of field trials. The first version is taking place in academic and large clinical settings, including such well-known institutions as Stanford University, Columbia University/New York State Psychiatric Institute and the Mayo Clinic. The second version will focus on clinicians from solo practices and smaller routine clinical practice settings who volunteer to participate in the field trial. APA plans to randomly select a total of 2,500 clinicians from the volunteer sample.

Although the field trials mainly involve psychiatrists, other mental health professionals will also be included. APA chose to include clinicians from related mental health professions so the field trials would reflect the heterogeneity of professionals who use the DSM.

The DSM-5 field trials are the final opportunity to evaluate proposed new diagnostic criteria that have a great potential to change clinical practice. Among the new criteria:

  • Collapsing four separate autism-related disorders from the DSM-IV-TR into a single disorder: autism spectrum disorder
  • Introducing new eating disorder categories, including binge eating as separate from bulimia
  • Collapsing substance dependence and substance disorders into substance use disorder
  • Adding the new "temper dysregulation disorder with dysphoria," which is expected to dramatically reduce the number of children diagnosed with bipolar disorder
  • Introducing new scales for assessing suicide risk in adults and adolescents

Also to be tested are the so-called dimensional assessments, which may be the most drastic proposed change in the DSM-5. Dimensional assessments are five-point rating scales designed to help clinicians evaluate the severity of a client’s symptoms. APA is proposing two types of dimensional assessments. One is a set of cross-cutting items that would be used with almost any client, regardless of the specific disorder. The second type includes specific severity measures that would be used with specific disorders. Both types would be used initially to establish a baseline and later to monitor client progress in treatment.

As professional counselors, what is our role and responsibility in the DSM-5 field trials? With more than 115,000 licensed professional counselors and more than 53,000 licensed marriage and family therapists in the United States, we represent a large contingent vested in the DSM-5 development process. Counselors work in a variety of settings such as behavioral health care centers, substance abuse treatment agencies, psychiatric hospitals, private practices and schools, and are trained to assess, diagnose and provide treatment for diverse clinical populations. As such, counselors can provide important feedback to APA about the clinical utility and feasibility of the proposed DSM-5 modifications. As part of the field trials for solo practitioners and routine clinical practices, counselors can help answer the following questions:

  • Are the proposed diagnostic criteria and dimensional assessments easy for clinicians to understand and use?
  • Do clinicians find that the proposed diagnostic criteria accurately reflect or capture their clients’ symptom presentations?
  • Are the proposed diagnostic criteria and dimensional assessments useful/helpful to clinicians’ treatment planning?

For more information about volunteering to participate in the DSM-5 field trials, visit psych.org/dsm5-rcp-fieldtrials. APA will randomly select 2,500 volunteer clinicians who, in order to participate in the study, will be required to complete a DSM-5 web-based training seminar, complete evaluation questionnaires and follow defined procedures for assessing and diagnosing clients. Counselor participation is vital so our voices can be heard in the DSM-5 development process.

K. Dayle Jones is a licensed mental health counselor and associate professor and coordinator of the Mental Health Counseling Program at the University of Central Florida. She served as a member of the American Counseling Association’s DSM Task Force that provided feedback to the American Psychiatric Association on proposed revisions to the DSM-5. Contact her at kjones@mail.ucf.edu.

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