The Advocate Magazine 2022 Issue 3 - Page 12

DSM-5-TR : What Do You Need to Know ?
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dominated by intense yearning / longing for the loved one as well as other symptoms such as intense emotional pain , intense loneliness , and difficulty moving on with one ’ s life . Importantly , these symptoms must be present most days following the loss to a clinically significant degree . The disorder is located in the Trauma- and Stressor-Related Disorders chapter .
Potential risk factors for Prolonged Grief Disorder include “ unnatural loss ” ( e . g ., suicide , homicide , accidents , and disasters ), death of a child , and high levels of dependency on the deceased loved one . Interestingly , research shows that antidepressants are not effective for the treatment of grief symptoms . However , one treatment approach with some data to support its effectiveness is Prolonged Grief Disorder Therapy , which focuses on loss-oriented and restoration-oriented treatment modules ( see Additional Resources box on page 14 ). Conditions that would rule out this diagnosis are normal bereavement , of course , as well as major depression and PTSD .
Bereavement and the DSM have had a stormy relationship . In DSM-IV , an exclusion did not allow the diagnosis of major depression within two months of the death of a loved one . The only exceptions were if the clinical picture included symptoms like worthlessness , marked psychosocial impairment , suicidality , or psychotic features . In the development of DSM-5 , evidence for this position was reviewed by one of APA ’ s committees . The committee concluded that there did not appear to be sufficient evidence to support the exclusion : Many major life stressors had significant “ grief reactions ,” so why should death of a loved one be signaled out ?
AMHCA ’ s DSM-5 Committee , which I chaired , was charged with providing feedback to the American Psychiatric Association on each of its DSM-5 drafts , and we recommended that the exclusion be broadened to include these major loss stressors . In the end , the DSM-5 dropped the exclusion , but added a prominent note in the criteria outlining some differences between normal grief following a major life loss and major depression . The review process for adding Prolonged Grief Disorder was rigorous , and the caveat for clinicians is to be sure to follow the criteria closely so that normal bereavement is not pathologized .
Unspecified Mood Disorder
You may remember Unspecified Mood Disorder , which appeared in the DSM-IV . It was not included in the DSM-5 , but was revived in the new Text Revision version of the manual . It is intended to address times when significant mood symptoms are present but it is difficult to determine whether they are more depressed or manic-like . The disorder is listed as a residual diagnostic category both in the Bipolar and the Depressive Disorder chapters .
Stimulant-Induced Mild Neurocognitive Disorders
Stimulant-Induced Mild Neurocognitive Disorders was added because of an oversight in DSM-5 . It is now listed in the Neurocognitive Disorder chapter along with the other substances that can induce cognitive impairment ( e . g ., alcohol , inhalants , and sedatives ). Stimulants can cause a range of neurocognitive symptoms that adversely impact memory , learning , and executive function .
Suicidal and Non-Suicidal Behavior
Suicidal Behavior and Non-Suicidal Self-Injury were added in the section for Other Conditions That May Be the Focus of Clinical Attention . Remember , this is where the Z codes are housed , but other codes — such as those for abuse — are also located here . Suicidal Behavior can be coded if the individual engages in self-injurious behaviors with the intent to die . It has three possible variations :
• Current suicidal behavior ( initial encounter ),
• Subsequent encounter ( follow-up after the initial encounter ), and
• History of suicidal behavior ( past suicidal behavior ).
In contrast , Non-Suicidal Self-Injury also includes self-injurious acts ( e . g ., cutting , burning ), but without suicidal intent . It can be coded as either current or history of non-suicidal self-injury . Both of these conditions are not considered mental disorders , but rather important symptoms to code because they may require special attention and more continuous monitoring .
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12 The Advocate Magazine 2022 , Issue # 3 American Mental Health Counselors Association ( AMHCA ) www . amhca . org