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The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) isa major revision of the American Psychiatric Association's diagnostic manual. There are five major changes with which school social workers should be familiar: the elimination of the multiaxial system, the addition of dimensional specifiers, the deletion of "not otherwise specified" disorders, a reduction of the bereavement exclusion, and the removal of the chapter on disorders first identified in infancy, childhood, or adolescence.
Keywords: diagnosis, disorders, DSM-5, psychiatry
As noted by Corcoran and Walsh (2010), social workers have always experienced mixed feelings about using the Diagnostic and Statistical Manual (DSM) of Mental Disorders. Changes from the DSM-IV-TR to the DSM-5 are not difficult to find. They start with the title, which formerly used Roman numerals and now uses Arabic numerals, and go on from there. Additionally, incremental changes to the new manual will be identified by decimal number (i.e., 5.1) until a completely new version is deemed necessary. This small change is only a hint at the major changes to follow.
The first major change is the discontinuation of the multiaxial system. The DSM-5 combines the first three axes into one list that contains all mental disorders (including personality disorders and intellectual disability) as well as other medical diagnoses (American Psychiatric Association, 2013). Axes IV and V have simply disappeared. Although this change probably follows from psychiatrists' tendency to ignore Axes IV and V, it poses a problem for many social workers. Axis IV offered the only opportunity to discuss psychosocial or environmental factors that caused or contributed to a mental disorder, and Axis V the only opportunity to identify strengths (functioning) of the individual being diagnosed. Without these two axes, the DSM-5 reverts to a biologically driven, deficitbased model of mental illness. The Society for Humanistic Psychology (Division 32 of the American Psychological Association) wrote an online open letter about similar concerns and garnered 15,000 individual signatures and the official support of 53 professional associations. Following is an excerpt from the petition:
In light of the growing empirical evidence that neurobiology does not fully account for the emergence of mental distress, as well as new longitudinal studies revealing long-term hazards of standard neurobiological (psychotropic) treatment, we believe that these changes pose substantial risks...