Gary G. Gintner, Ph.D., a nationally recognized expert on the DSM, reviewed an advance copy of the DSM-5 and concludes that many criticisms of the latest update of the Diagnostic and Statistical Manual of Mental Disorders are overstated.
There are strengths and weaknesses but positive aspects have gotten very little attention, creating a skewed view of the manual. Gintner hopes to bring a more balanced perspective based upon available empirical evidence.
Gintner conducted many workshops on the DSM-IV-TR and led a training session on the DSM-5 on June 28 in Columbus, Ohio. The National Psychologist and the Ohio Psychological Association co-hosted the session attended by nearly 250 people who each received 6 CE credits.
“Let’s hope the critics take the time to read the manual.” Gintner said.
Gintner, an associate professor and program leader of the counseling program at Louisiana State University, is a past president of the American Mental Health Counselors Association. He chairs its DSM-5 Task Force.
Gintner received his copy of the manual when he attended an all-day workshop on the DSM-5 on May 18 at the annual convention of the American Psychiatric Association (ApA) in San Francisco. The workshop was led by David J. Kupfer, M.D., chair of the ApA’s DSM-5 Task Force, and included overviews from chairs of each of the work groups that prepared changes for the updated version.
“It strikes me that people were highly critical of something that was not out yet — all that was available were proposed criteria sets which have undergone changes since their last posting in September 2012. The manual provides succinct reviews of clinically relevant background information for each disorder,” Gintner said.
He said it is clear that the drafters took great pains to be empirical in promoting accurate diagnoses that do not unduly pathologize. “If you read the actual manual, that will become clear. There are ‘Notes’ within many of the criteria sets cautioning readers about normal reactions that can mimic the symptoms profile.”
He said the manual includes the ICD-9-CM codes that can be used right away as well as the ICD-10-CM codes that go into effect in October 2014.
Gintner said adjusting to the new manual will require training for most providers. The criteria sets are somewhat more intricate, especially in regard to the availability of specifiers which are tied to onset, course and treatment response factors. “One concern I have is feasibility and clinical utility – will individuals take the time to use the manual?”
He said data to date suggest that diagnostic thresholds actually have raised for many disorders. “Disorders like Autism Spectrum Disorder, Substance Use Disorders and PTSD will probably not diagnose some individuals who would have met DSM-IV-TR criteria.
This will tend to occur for individuals with milder symptoms and impairment. However, DSM-5 has simplified the overall diagnostic presentation by abandoning the multiaxial system in favor of a single axis system similar to the ICD.”
Gintner found the new manual much richer in narrative portions that discuss issues such as development and course, risk factors, suicide risk, culture and gender differences and differential diagnosis. A lifespan perspective has been infused into the manual both in terms of how disorders are listed within chapters as well how symptoms are described in terms of their particular developmental presentation.