Discussion: diagnostic labels as powerful communications

A diagnosis is powerful in the effect it can have on a person’s life and treatment protocol. When working with a client, a social worker must make important decisions—not only about the diagnostic label itself but about whom to tell and when. In this Discussion, you evaluate the use and communication of a diagnosis in a case study.

To prepare: Focus on the complex but precise definition of a mental disorder in the DSM-5 and the concept of dimensionality both there and in the Paris (2015) and Lasalvia (2015) readings. Also note that the definition of a mental disorder includes a set of caveats and recommendations to help find the boundary between normal distress and a mental disorder.

Then consider the following case:

Ms. Evans, age 27, was awaiting honorable discharge from her service in Iraq with the U.S. Navy when her colleagues noticed that she looked increasingly fearful and was talking about hearing voices telling her that the world was going to be destroyed in 2020. With Ms. Evans’s permission, the evaluating [social worker] interviewed one of her closest colleagues, who indicated that Ms. Evans has not been taking good care of herself for several months. Ms. Evans said she was depressed.

The [social worker] also learned that Ms. Evans’s performance of her military job duties had declined during this time and that her commanding officer had recommended to Ms. Evans that she be evaluated by a psychiatrist approximately 2 weeks earlier, for possible depression.

On interview, Ms. Evans endorsed believing the world was going to end soon and indicated that several times she has heard an audible voice that repeats this information. She has a maternal uncle with schizophrenia, and her mother has a diagnosis of bipolar I disorder. Ms. Evans’s toxicology screen is positive for tetrahydrocannabinol (THC). The evaluating [social worker] informs Ms. Evans that she is making a tentative diagnosis of schizophrenia.

Source: Roberts, L. W., & Trockel, M. (2015). Case example: Importance of refining a diagnostic hypothesis. In L. W. Roberts & A. K. Louie (Eds.), Study guide to DSM-5 (pp. 6–7). Arlington, VA: American Psychiatric Publishing.

Study Guide to DSM-5(r), by Roberts, M.; Louie, A.; Weiss, L. Copyright 2015 by American Psychiatric Association. Reprinted by permission of American Psychiatric Association via the Copyright Clearance Center.

By Day 3

Post a 300- to 500-word response in which you discuss how a social worker should approach the diagnosis. In your analysis, consider the following questions:

• Identify the symptoms or “red flags” in the case study that may be evaluated for a possible mental health disorder.
• Should the social worker have shared this suspected diagnosis based on the limited assessment with Ms. Evans at this time?
• Explain the potential impact of this diagnosis immediately and over time if the “tentative” diagnosis is a misdiagnosis.
• When may it be appropriate to use a provisional diagnosis? 
• When would you diagnosis as other specified and unspecified disorders?

Required Readings

American Psychiatric Association. (2013i). Introduction. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.Introduction

Barsky, A. (2015). DSM-5 and the ethics of diagnosis. The New Social Worker. Retrieved from https://www.socialworker.com/feature-articles/ethics-articles/dsm-5-and-ethics-of-diagnosis/

Neukrug, E. S., & Fawcett, R. C. (2015). Diagnosis in the assessment process. In E. S. Neukrug & R. C. Fawcett, Essentials of testing and assessment: A practical guide for counselors, social workers, and psychologists (3rd ed., pp. 43–58). Stamford, CT: Cengage Learning.
Neukrug, E. S., & Fawcett, R. C. (2015). Diagnosis in the assessment process. In E. S. Neukrug & R. C. Fawcett, Essentials of testing and assessment: A practical guide for counselors, social workers, and psychologists (3rd ed., pp. 43–58). Stamford, CT: Cengage Learning.
 

Paris, J. (2015). The intelligent clinician’s guide to the DSM-5 (2nd ed.). New York, NY: Oxford University Press

Chapter 6, “Dimensionality” (pp 84–101)

Required Media

Accessible player –Downloads–Download Video w/CCDownload AudioDownload TranscriptLaureate Education (Producer). (2018d). Impact of the DSM-5: Organization, Develpment, Strengths and Limitations [Audio podcast]. Baltimore, MD: Author.

University at Buffalo School of Social Work (Producer). (2014). Episode 139—Dr. Robert Keefe and Dr. Barbara Rittner: The Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders: A conversation [Audio podcast]. Retrieved from http://www.insocialwork.org/episode.asp?ep=139

Singer, J. B. (Producer). (2016, January 25). Critiques of the DSM-5: Interview with Jeffery Lacasse, Ph.D. [Audio podcast]. Retrieved from http://www.socialworkpodcast.com/2016/01/DSM5critique.html/p> 

Optional Resources

American Psychiatric Association. (2013n). Preface. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.x00preface

American Psychiatric Association. (2013s). Use of the manual. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.UseofDSM5

Lasalvia, A. (2015). DSM-5 two years later: Facts, myths and some key open issues. Epidemiology and Psychiatric Sciences, 24(3), 185–187. doi:10.1017/S2045796015000256

Paris, J. (2015). The intelligent clinician’s guide to the DSM-5 (2nd ed.). New York, NY: Oxford University Press

Chapter 3, “How Diagnostic Manuals Are Made” (pp. 33–55)

Wakefield, J. C. (2013b). DSM-5: An overview of changes and controversies. Clinical Social Work Journal, 41(2), 139–154. doi:10.1007/s10615-013-0445-2