Chapter 5. Anxiety Disorders. Chapter 6. Obsessive-Compulsive and Related Disorders. Chapter 7. Trauma- and Stressor-Related Disorders. Chapter 8. Case 1 DSM-5™ Clinical Cases by Michael Gitlin, M.D.. Adapted. Nancy Ingram, a year old stock analyst and married mother of two children, was brought to. PDF | On Jan 10, , John W Barnhill and others published DOWNLOAD PDF DSM-5 Clinical Cases by.
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the book DSM-5 Clinical Cases, John W. Barnhill ebook DSM-5 Clinical Cases, DSM-5 Clinical Cases Ebooks, DSM-5 Clinical Cases PDF, PDF DSM-5 Clinical . Each section continues with a number of cases illustrating the main rotations and psychiatry residents will derive the most benefit from DSM-5 Clinical Cases. Get this from a library! DSM-5 clinical cases. [John W Barnhill; American Psychiatric Association,;] -- "These cases exemplify the mental disorders categorized in.
There is a difference between mental disorder and normal-range problems of living. There is impressive agreement by clinicians and lay people on many judgments of which problems represent disorders and which are part of normal distress and problems of living Wakefield et al.
However, nothing in the concept of disorder determines that every psychological dysfunction—that is, every failure of mental processes to operate as they were biologically designed to do—must be a brain dysfunction rather than a problem strictly at the level of the interaction of thoughts, emotions, and other meanings.
The primary argument put forward for the brain-disease model of mental disorder is that psychological disturbances must be brain diseases because psychological processes take place in the brain. This argument, advanced by leaders in the field including Nobel Prize winners Weir , is manifestly unsound and without conceptual foundation. Psychological processes in the brain can go astray at the psychological level without the brain itself having anything wrong with it Wakefield If somebody sent to help you with a computer software glitch claimed that every software problem on your computer must be a hardware problem—after all, all software runs in hardware—so replacing the hardware is called for, you would laugh and assume the person is trying to sell you some hardware, because of course there can be software problems that are not hardware problems.
The argument that every psychological disorder must be a brain disease is equally misguided, yet taken seriously. Some new schemes for conceptualizing mental disorders as brain disorders do take psychosocial factors into account as part of the overall mix of causal factors Insel et al. It is often argued that classifying psychological disorders as brain diseases, even if inaccurate, is justified on humanitarian grounds because it reduces stigma, but recent studies demonstrate that when mental problems come to be seen as brain diseases, stigma sometimes increases or remains the same Angermeyer and Matschinger ; Schnittker ; Schomerus et al.
The brain disease model does none of good things it is advertised to do in return for the mischief it causes. The combination of an invalidly expansive approach to labeling human suffering as mental disorder with an ideological fixed idea that mental disorder is brain disease has the consequence of overuse of medication for problems of living. Depression provides an apt example of the distorted treatment profile that derives from the brain disease model.
So, about one in ten depression patients received psychotherapy as their sole treatment. This lopsided approach is not at all warranted by the existing empirical evidence. For social workers, even from a purely practical perspective that is, ethical issues of misdiagnosis aside; see below for those , this situation presents a dilemma. If more conditions are diagnosable, that allows more individuals to be helped.
However, those individuals are likely to be targeted for drug development and end up being helped by general medical practitioners. The above example of depression is illustrative. The flawed DSM diagnostic criteria for depression criteria create an inflated number of potential diagnoses Horwitz and Wakefield , so that over half of the population likely qualifies at some point in life Eaton et al.
Moreover, as noted, this is an ideal condition to be treated by social workers. Yet, by far most depression is treated by physicians. Similar considerations apply to many other conditions, such as anxiety disorders Horwitz and Wakefield Psychological Justice as a Goal of Clinical Social Work We need to start proactively moving past the limitations of disorder and to more fully conceptualize the nondisordered conditions that we treat and the reasons why they merit reimbursement.
Social norms and then reimbursers may eventually follow. The mental health professions do many desirable things other than treat mental disorder. They relieve psychological suffering, provide psychological enhancement e. However, from a social perspective, there is one function of the mental health professions that is as fundamental as the treatment of mental disorder itself in terms of the social mission of the professions.
Social justice inherently involves a mind-in-person-in-role-in-environment perspective.
Hence, a justice-oriented profession such as social work Wakefield a , b also simultaneously and quite consistently can be the largest mental health profession except of course for general physicians, who in this medication-oriented era treat more mental health problems than all the dedicated mental health professions combined.
It is a cruel and shortsighted policy that our society currently refuses to be as generous in supporting help for the nondisordered as for the disordered. In the medical realm, many nondisorders are socially mandated to be treated and reimbursed because that is seen as just and necessary—from provision of birth control to relief of the normal pain of childbirth—and the same should be true of some nondisordered psychological problems.
Many people have normal variations that make them less able to function adequately in the novel social environments we as a society have constructed around them, and they deserve our help.
This trend was especially of concern due to the likelihood, as noted, that once conditions are classified as disorders they would become the target of drug development efforts. Indeed, the rationale for several additions to the Manual was that medication exists to improve the condition—although this argument for something being a disorder is manifestly fallacious, and the evidence for medication effectiveness was in some cases laughably weak Wakefield b.
The net result of all this controversy is that psychiatry itself is divided about whether the DSM-5 provides an improved guide to diagnosing mental disorder, and critics from within psychiatry are advising clinicians to use their own judgment Frances The new system is first outlined with admirable lucidity by Lanier et al. One of the coauthors of this paper, Robert Krueger, a psychologist, has been heavily involved in the research that provided the foundation for the new approach.
The system is based on the idea is that each PD essentially consists of extreme personality traits, and thus the best way to diagnose PD is to rate the individual patient on a comprehensive set of personality traits and use those ratings as the diagnosis. A caveat is critical here.
At the time these papers were accepted, it appeared that this proposed new system would entirely or partially replace the current PD categories.
However, despite several comprehensive revisions, continued vigorous objections from personality disorder experts due to the complexity and untried nature of the proposed system caused the proposal to be sidelined.
Further research on the new system is proceeding, and it is expected that this system, or something very similar, will formally replace the current categories. He notes that an eminent member of the PD work group, John Livesley, withdrew and penned a scathing critique of the proposal Livesley Because this standard system of trait analysis did not seem to adequately capture some forms of pathology, the alternative PD system was constructed somewhat differently, to include more pathology-related dimensions and traits.
The jerry-rigged nature of this system is critiqued by Widiger as it was by Livesley , who prefers the more research-based five-factor structure. Note that all these researchers prefer a trait-based dimensional system, but disagree about its precise nature based on their own research programs.
One might worry that this is a case of too many researchers spoiling the clinical broth.
I have argued elsewhere that in fact personality is the overall interaction among traits and that personality disorders cannot and should not be atomized into sets of traits One concern is that, unlike categories with their symptom thresholds, the trait approach to PD, being dimensional, does not come with any automatic thresholds for diagnosis built into it.
Thus, in effect, a personality disorder could be any configuration of personality traits that had high ratings on some negative traits. Such a category could potentially include almost everyone Wakefield To try to address this worry, the alternative PD system precedes the trait analysis by an evaluation of whether the person satisfies the general definition of PD, which is strengthened from its weak DSM-IV version. In my commentary on the alternative PD system, I detail the history and structure of the new general definition of personality disorder Wakefield c.
She specifically explores how social workers negotiate the tension between the mental-disorder perspective of the DSM with the person-in-environment perspective of the social work profession. Once the clinician diagnoses disorder and locates the primary source of the problem within the individual, this tends to constrain treatment choices Garb Whether someone has a mental disorder or not, matching the individual to a social niche that fits their needs and capacities should be an integral part of any intervention strategy.
Some problems need individual change, some environmental change, and many some mixture of both. For each problem domain, domain-specific causal theories are needed to guide understanding of that particular domain.
Probst documents how social workers face challenging dilemmas in using the DSM. A common and appealing solution is to play the DSM game to obtain reimbursement, but keep your head about what is really going on with your client.
This requires recording diagnoses that may not be what the clinician really thinks. In one study Rost et al. We obviously need distinctions, not one-size-fits-all ideology. The diagnostic situation is perplexing, to say the least. Is it fraud to classify a condition as a reimbursable mental disorder if it does actually satisfy the diagnostic criteria of a DSM category of disorder, yet the category itself is defined in an overly expansive style that, the clinician truly believes, mistakenly classifies problems in living as mental disorders?
Can two wrongs make a right when it comes to helping a patient? The DSM uses descriptive rather than etiology-based categories in which disorders are defined mostly at the symptom level rather than in terms of deeper processes including unconscious processes. The result is lack of student sensitivity to the importance of empathy, affect, and unconscious processes.
Krohn explores the resulting changes that, he argues, are one-dimensionalizing clinical education and practice. That said, one must remain wary of the inflated faith among some analysts in countertransference as a conduit to the truth about the patient.
However, cognitive theorists on the anxiety disorders work group during a DSM revision noticed that this classic conception does not fit their theory; for them, all affect must be immediately aroused by a cognition, by which they generally mean conscious cognition.
Our grappling with diagnostic dilemmas in this issue of CSWJ closes with two invited commentaries. The first is by Phillips on the ethical and legal dimensions of misdiagnosis. In fact, with the DSM-5 controversies, the situation is even more complex.
In DSM-5, many conditions classified as mental disorders are likely not genuine disorders. Thus, even by faithfully following the rules i. They distinguish those with focal eating problems from those with broader psychological determinants of disordered eating, an essential distinction that is lost within the DSM categorical diagnosis but must be brought into case formulation.
Frances objects that the BED category will simply pathologize normal gluttony. From an evolutionary perspective on normality, one might argue that, having been evolutionarily shaped at a time when food calories were difficult to come by, human beings naturally tend to have a taste preference for high-calorie sweets and fat and are inclined to overeat when good-tasting food is available, for in natural environments food might not be available later on.
Or, is such behavior simply an imbalance between a normal variant of the way human nature is biologically designed and the novel environment we have created of readily available plentiful high calorie good-tasting food all around us? Whichever it is—mental disorder or socially disvalued consequence of normal human variation interacting with the social environment—people who have this problem deserve help.
We will clearly be living with both the challenges and opportunities presented by the DSM-5 for some time. Allow me, however, to close with a broadly optimistic speculation about the future. The ICD comes online in , and then not too far in the future the new ICD, which is now in process of being created, will also be published and eventually adopted in the U.
One can hope that such developments would allow a resolution of some of the conflicts that social workers now experience in using the DSM. References Angermeyer, M. Schizophrenia Spectrum and Other Psychotic Disorders. Chapter 3. Bipolar and Related Disorders.
Chapter 4. Depressive Disorders. Chapter 5. Anxiety Disorders. Chapter 6. Obsessive-Compulsive and Related Disorders. Chapter 7. Trauma- and Stressor-Related Disorders. Chapter 8. Dissociative Disorders. Chapter 9. Somatic Symptom and Related Disorders. Chapter Feeding and Eating Disorders.
Elimination Disorders. Sleep-Wake Disorders. Sexual Dysfunctions. Gender Dysphoria. Disruptive, Impulse-Control, and Conduct Disorders. Substance-Related and Addictive Disorders. Neurocognitive Disorders.