A Social Worker's Response to DSM5

Vicki DuBose LGSW
May 3, 2012 — 1,283 views  
Become a Bronze Member for monthly eNewsletter, articles, and white papers.

I applaud the DSM members and affiliates for having a classification of diagnoses. This will allow the therapist, psychologist, social worker, physician, or psychiatrist to write down a subjective diagnostic proposal after conducting a Mental Status Exam and/or other necessary assessment, in collaboration with client's history of the presenting problem(s), as well as any other ways to collect information (ie. collateral sources) to assist the client in goals, contracting, and interventions pertaining to the related problem(s). 

In my opinion, the DSM5 does not completely represent the core values of social work which are service, importance of human relationships, social justice, respect for others, being competent, and having integrity.

Service is our fundamental mission within the social work profession and the DSM5 undermines it in several ways: by lowering thresholds for certain diagnoses (i.e. ADHD), reclassification of some disorders, and the emphasis on Medico-physiological theory. 

DSM5 has lowered diagnostic thresholds which could lead to over diagnosis and over prescribed drugs in children and adults. A prime example is ADHD. It is one of the mentioned diagnostic criteria that will be lowered with the new manual. Studies have shown that ADHD diagnoses have been rising. What does this mean? It could mean that more children and adults will be diagnosed with these disorders. More medicines, more diagnoses. How can this be helpful to my clients?

In terms of reclassification, ADHD will also re-categorize as a neurodevelopmental disorder. This implies that ADHD is largely based on a person’s brain chemistry. Aren’t there other variables involved with ADHD, such as parenting styles or other environmental variations? Because of the association of ADHD listed under the neurodevelopmental disorder, this also implies that a medication regime will be the first line of defense due to the new Medico-physiological theory stance from the APA.

New diagnoses concern me due to lack of empirical evidence. Disruptive Mood Dysregulation Disorder and Attenuated Psychosis Syndrome are two new diagnoses. Where is the research on these disorders in our profession? In addition to the evidence, both disorders may need to be treated with neuroleptics. Short term use is acceptable but growing evidence states that long term effects can affect a person's health. Selected evidence includes weight gain, lower sex drive or inhibition, tardive dyskinesia, diabetes, and neuroleptics could possibly change the structure of the brain.

As a social worker, I will continue to look at a client’s strengths versus the deficits. I will continue to service my clients and provide honest, respectable, competent clinical services, while respecting their self-determination in the therapeutic context and in regards to the Code of Ethics and regulated laws or governing bodies.

To judge for yourself, log onto www.DSM5.org.

Vicki DuBose LGSW

VOAD

I'm a newly licensed social worker that resides in AL. I've had experience working with FEMA and the local mental health center as a therapist, case manager, and disaster service crisis counselor.