Academic journal article Journal of Counseling and Development : JCD

Dimensional and Cross-Cutting Assessment in the DSM-5

Academic journal article Journal of Counseling and Development : JCD

Dimensional and Cross-Cutting Assessment in the DSM-5

Article excerpt

With the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; hereinafter referred to as the DSM when used in the general sense) set for release in May 2013, counselors are awaiting changes that may affect how they diagnose. A significant proposed change to the DSM-5 is the addition of dimensional assessments to the categorical diagnoses (American Psychiatric Association [APA], n.d.).

The current edition of the DSM (4th ed., text rev.; DSMIV-TR; APA, 2000) uses a categorical classification system. A categorical diagnosis has only two values: the presence or absence of a disorder. Categorical diagnostic systems assume that mental disorders are discrete entities, with relatively homogeneous populations that display similar symptoms and attributes of a disorder. Because client populations are typically heterogeneous and do not fall neatly into diagnostic categories, this assumption has led to many problems and shortcomings with the categorical system (Regier, 2008). Problems such as excessive comorbidity, irresolvable boundary disputes, and excessive use of the not otherwise specified (NOS) categories have become endemic to the manual (First, 2010a, 2010b).

To address the limitations of the DSM-IV-TR (APA, 2000) and improve clinical utility, the DSM-5 Task Force is proposing the addition of dimensional assessments to every categorical diagnosis in the DSM. Dimensional assessments are rating scales that measure frequency, duration, severity, or other characteristics of a disorder. The assessments provide additional information to assist counselors with diagnosis, treatment planning, and treatment monitoring. In addition to including dimensional assessments for individual disorders, the DSM-5 Task Force is also proposing cross-cutting assessments to measure diagnostic symptoms commonly seen in clients, regardless of their presenting problem or subsequent diagnosis (APA, n.d.). The assessment is intended for use during an initial clinical interview to measure symptoms commonly seen and monitored in most clients (e.g., depressed mood, anxiety, and substance use) regardless of their initial presenting problems or diagnosis.

To fully understand and utilize the proposed dimensional and cross-cutting assessments, counselors need to be knowledgeable about the difference between categorical and dimensional approaches to diagnostic classification. Research about diagnostic classification systems is scarce in the counseling literature; thus, the purpose of this article is to present information about the propounded DSM-5 dimensional and cross-cutting assessments. In this article, I review the DSM-IVTR's (APA, 2000) categorical classification system, describe the proposed dimensional and cross-cutting assessments, and provide implications about clinical utility and user acceptability of a dimensional diagnostic approach.

* The DSM Classification System

The purpose of classification in the sciences is to guide the observation and interpretation of the natural world (Millon, 1991). Classification (i.e., taxonomy) is defined as the "activity of ordering or arranging objects into groups or sets on the basis of their relationships" (Sokal, 1974, p. 1116). Constructing a diagnostic classification system is a way of finding order for the otherwise complex, intricate, and unorderable phenomena of psychopathology. It also helps counselors communicate, select effective interventions, predict course and prognosis, and differentiate between disorders and nondisorders (First, 2010a).

The DSM-IV-TR (APA, 2000) uses a categorical classification system that "divides mental disorders into types based on criterion sets with defining features" (p. xxxi). A categorical diagnosis has only two values: the presence or absence of a disorder. It assumes that members of a diagnostic group are relatively similar, having specific symptoms that reflect the particular diagnosis. Using this framework, counselors assess clients using a polythetic (i. …

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