Navigating the DSM-V By Michael H. Hejazi


The fifth edition of the Diagnostic and Sta- tistical Manual of Mental Disorders (DSM) has been in print since May 22nd, 2013. The timing of the release seemed altogether poi- gnant to readers of this newsletter given the ongoing regulation of the counselling and psychotherapy professions process taking place in Ontario. With governmental regu- lation of the profession there will be new and additional expectations to standardize practices, communicate systematically, and evaluate data in accordance with statistical guidelines for third party payers and public- accountability purposes. It seems useful to determine to what extent professionals who work as counsellors and psychotherapists should be expected to know about and work with the changes found in the new edition. It would take far too much space and time to describe and compare all the individual changes found in the revised fifth edition of the DSM in comparison to the earlier fourth. Moreover, such a discussion would be unnecessarily descriptive. Rather, to introduce readers to the changes that they will encounter in their work, and provide a road map with which clinicians can navigate and make sense of the overall revisions, this article aims to elaborate on the new aware- ness about the contextual nature of distress, the adoption of a dimensional approach over an axial approach, and the usage of disease specifiers in the DSM-5. In most, if not all other ways the DSM-5 is similar to the DSM- IV.


Diagnostics have always played a role in therapy. Counsellors and psychotherapists work through realized and emphasized dis- tinctions between the mind and body within all their casework. By working through their various methods and diagnostic determina- tion formulation processes therapists pro- voke new ways of understanding and theo- rizing about the experiences of individuals and groups. Thereby a diagnosis appears to have an important role in the curative pro-


cess, through naming, hypothesizing, treat- ing, and communicating meanings associ- ated with symptoms and experiences. For example, what is described as ‘Binge-Eating Disorder, 307.51’ is known to be different in certain important ways from ‘Dissocia- tive Identity Disorder, 300.14’.The intention described by the authors of the DSM-5 is an aspiration to move away from speculat- ing. Readers may apprehensively expect a systematic rigidity to go hand in hand with such a program. Surprisingly the very same manual makes a series of marked turns to- ward contextualizing information and expe- riences, expressed as an appreciation for the fluidities between illness nomenclatures, cultural experiences of adversity, and the apparent clustering of symptoms over syn- dromes. People involved in the profession have worked hard to ensure that the authors of the DSM recognize that ultimately all diagnoses are conventionally composed. The new edition contains meta-awareness about cultural influences, which should be encour- aging for therapists interested in a phe- nomenological approach to clinical framing. A person may be diagnosed in the DSM-5 framework as having a primary diagnosis of Binge-Eating Disorder, as a principal clinical concern, and secondary Dissociative Identity Disorder that is partial and not altogether pervasive, but clinically significant.


Any positive or negative outcome concern- ing the therapeutic problem-solving gaze given in the DSM-5 must be unintentional and only later ascribed through practices. The authors of the DSM-5 intended to streamline psychiatry into step with other medical disciplines. For example, by replac- ing the phrase ‘general medical condition’ with ‘another medical condition’ the DSM- 5 has opened the possibility for clinicians to reach principle diagnoses and multiple diagnoses from among the same symptoms, and to ascribe specifications to diagnoses, effectively creating new and expanded


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