DSM-5 in Action

SOPHIA F. DZIEGIELEWSKI, PHD, LCSW is Professor and Associate Director for Research in the School of Social Work at the University of Central Florida where she also serves as Chair of the University Institutional Review Board. She is also the Editor of the Journal of Social Service Research. She is the recipient of numerous awards and supports her research and practice activity with over 120 publications, including seven textbooks, seventy-nine articles, numerous book chapters, and over 400 workshops and community presentations. Her research focuses on the areas of health and mental health. As a licensed social worker, she also remains active in clinical practice.

Preface xiii

Acknowledgments xvii

Quick Reference List xix

SECTION I

Utilizing the DSM-5: Assessment, Planning, and Practice Strategy

Chapter 1 Getting Started 3

Introduction 3

Beginning the Process 3

Making the Diagnostic Assessment: Tools That Facilitate the Assessment Process 4

Role of Social Workers and Other Mental Health Professionals 4

Development of the DSM Classification System: History and Reservations 6

Diagnostic Labels 14

Another Mental Health Assessment Measure 16

Professional Training in the Professional Counseling Fields 18

Summary 19

Questions for Further Thought 20

References 20

Chapter 2 Basics and Application 23

Utilizing the DSM-5 in the Practice Setting 23

Working as Part of a Team: Connections and Collaborations 25

Diagnosis and Assessment: Is There a Difference? 28

A Combination Approach: The Diagnostic Assessment 33

DSM-5 Updates and Structural Changes 35

DSM-5: Sections and Appendices 39

Important Sections in the DSM-5 45

Culture, Age, and Gender-Related Information 47

Concepts of Distress 53

Culture and Other Diagnostic Assessment Factors Related to Age 57

Culture and Other Diagnostic Assessment Factors Related to Gender 59

Summary 66

Questions for Further Thought 67

References 67

Chapter 3 Completing the Diagnostic Assessment 70

Basics for Completing a Comprehensive Diagnostic Assessment 70

DSM-5 and Completing the Diagnostic Assessment 74

The Principal Diagnosis 76

Subtypes and Course Specifiers 86

Ethical and Legal Considerations 101

Pulling It All Together 102

Summary 104

Questions for Further Thought 105

References 105

Chapter 4 Applications 107

Documentation, Treatment Planning, and Practice Strategy 107

Treatment and Intervention Planning 116

Developing the Treatment Plan 120

Selecting an Intervention Framework 123

Practice Strategy and Application 127

Types of Time-Limited Therapy in Mental Health Practice 131

Summary 140

Questions for Further Thought 143

References 143

SECTION II

Diagnostic and Treatment Applications

Chapter 5 Schizophrenia Spectrum and the Other Psychotic Disorders 149
Sophia F. Dziegielewski

Introduction 149

Toward a Basic Understanding of the Conditions 150

Understanding Individuals Who Suffer From the Psychotic Disorders 151

Important Features Related to the Psychotic Disorders 153

DSM-5: Assessment of Symptoms Measurement 157

Overview of Schizophrenia Spectrum and Other Psychotic Disorders 160

Schizophrenia 167

Beginning the Diagnostic Assessment 173

Schizophrenia and Factors for Consideration in the Diagnostic Assessment 174

Case Application of the Diagnostic Assessment 181

Treatment Planning and Intervention Strategy 186

Special Topics 195

Summary and Future Directions 196

References 197

Chapter 6 Bipolar and Related Disorders 202
Sophia F. Dziegielewski and Olga Molina

Introduction 202

Toward a Basic Understanding of the Bipolar and Related Disorders 202

Understanding Individuals Who Suffer From Bipolar and Related Disorders 204

Overview of the Bipolar and Related Disorders 212

Summary of Bipolar Disorders 221

Diagnostic Assessment in Adults With Bipolar Disorder 222

General Intervention Strategies: Models and Treatment Modalities for the Bipolar Disorders 232

Special Topics 236

Summary and Future Directions 238

References 239

Chapter 7 Depressive Disorders 242
Sophia F. Dziegielewski

Introduction 242

Toward a Basic Understanding of the Disorders 243

Important Features Related to the Depressive Disorders 244

Endogenous and Exogenous Depression: Making a Distinction 246

Overview of the Depressive Disorders 247

The Depressive Disorders and the Diagnostic Assessment 259

Special Topics 270

Assessment of Danger to Self or Others 271

Summary and Future Directions 272

References 273

Chapter 8 Obsessive-Compulsive and Related Disorders 278
Sophia F. Dziegielewski and Barbara F. Turnage

Introduction 278

Toward a Basic Understanding of the Obsessive-Compulsive and Related Disorders 278

Understanding Individuals Who Suffer From the OCD Spectrum Disorders: When Urges Become Overwhelming 280

Important Features Related to the Obsessive-Compulsive and Related Disorders 281

Overview of the Obsessive-Compulsive and Related Disorders 283

Toward a Better Understanding of Obsessive-Compulsive Disorder 289

Obsessive-Compulsive Disorders and the Factors for Consideration in the Diagnostic Assessment 291

Summary and Future Directions 306

References 306

Chapter 9 Trauma- and Stressor-Related Disorders 309
Sophia F. Dziegielewski and Barbara F. Turnage

Introduction 309

Toward a Basic Understanding of Trauma- and Stressor-Related Disorders 309

Understanding Individuals Who Suffer From the Trauma- and Stressor-Related Disorders 310

Important Features Related to the Trauma- and Stressor-Related Disorders 311

Overview of the Trauma- and Stressor-Related Disorders 313

Beginning the Diagnostic Assessment 321

Pulling It All Together: An Integrated Approach 333

Summary and Future Directions 335

References 335

Chapter 10 Sexual Dysfunctions 338
Sophia F. Dziegielewski and Joshua Kirven

Introduction 338

Toward a Basic Understanding of the Sexual Dysfunctions 338

Individuals Who Suffer From a Sexual Dysfunction 340

Important Features and Terms Related to the Sexual Dysfunctions 341

Overview of the Sexual Dysfunctions 343

Sexual Dysfunctions and the Diagnostic Assessment 353

Completing the Diagnostic Assessment 353

Overview of Treatment Methods for the Sexual Disorders 358

Selected Assessment Scales and Methods for Treating the Sexual Disorders 361

Special Topics 364

Applying a Cultural Competence Lens to Diagnosis 367

Summary and Future Directions 369

References 370

Chapter 11 Disruptive Impulse-Control and Conduct Disorders 375
Sophia F. Dziegielewski and Ana M. Leon

Introduction 375

Living With Problematic Self-Control of Emotions and Behavior 376

Overview of the Disruptive, Impulse-Control, and Conduct Disorders 377

The Diagnostic Assessment: Application Basics 387

General Intervention Strategies: Models and Treatment Modalities 403

Summary and Future Directions 411

References 412

Chapter 12 Substance-Related and Addictive Disorders 417
Sophia F. Dziegielewski

Toward a Basic Understanding of the Substance-Related and Addictive Disorders 418

Understanding the Individuals Who Suffer From the Substance Disorders 419

Overview of the Substance-Related and Addictive Disorders 425

Beginning the Diagnostic Assessment: Alcohol-Related Disorders 436

Treatment Planning and Intervention Strategy 445

Brief Interventions in Primary Care Settings 453

Topics of Interest 456

Misuse of Prescription Medications 461

Summary and Future Directions 462

References 463

Chapter 13 Personality Disorders 467
Sophia F. Dziegielewski and George A. Jacinto

Introduction 467

Toward a Basic Understanding of the Personality Disorders 468

Understanding Individuals Suffering From a Personality Disorder 468

What Is a Personality Disorder? 471

Cluster A Personality Disorders 471

Cluster B Personality Disorders 475

Cluster C Personality Disorders 482

Other Personality Disorders 485

Summary of the Personality Disorders 487

Borderline Personality Disorder (BPD) 487

Strategies for Individual Therapy and Intervention 500

Section III: Alternative DSM-5 Model for the Personality Disorders 502

Summary and Future Directions 503

References 504

Appendix: Quick References: Selected Disorders—Criteria and Treatment Plans 507

Author Index 545

Subject Index 561

About the Author 583