If your agency trains your staff about DSM 5 diagnosis, one key point for them is the old question. Which comes first the chicken or the egg? Clients present with multiple problems, behaviors, and symptoms. The clinician must first take the information down about the length of these problems and how long they have experienced them. Then the client describes how frequently the symptoms occur, whether daily, weekly or occasionally. The intensity of the symptoms differentiates between whether the condition is mild, moderate, or severe. The clinician then determines whether the condition is affecting the client’s functioning. Does it affect their ability to work, go to school, be at home, or live in the community?
Then the question is what is the DSM 5 diagnosis? Out of all the behaviors, history, and conditions the client presents, how does the clinician make a decision? It’s not easy, since clients with a long history of problems present with an array of choices. One approach is to rule out possible diagnoses. This can be done by looking at all possibilities and then figuring out which doesn’t fit with the symptoms.
Then the next approach is to use differential diagnoses. These choices are listed in the DSM 5 diagnosis Manual for a specific condition. For example, with attention deficit disorder (ADD), other possibilities are oppositional defiant disorder (ODD), intellectual disability (ID), or autism spectrum disorder (ASD). Then the manual will discuss how the other conditions are characterized and differ from the selected one. In the case of ADD, it is an issue of organization vs. hostility (ODD), reduced cognition (ID), or social disengagement (ASD).
But how do the chicken and egg come in? Because a major characteristic of diagnosis is what generates the maladaptive behavior. What is the origin of the condition? For example, a client presents with anxiety, due to a traumatic event. The client experiences flashbacks of the event. Is it anxiety or post-traumatic stress disorder (PTSD))? Most probably PTSD, because the anxiety comes from the trauma. In the DSM 5 differential diagnosis, the manual would also examine the cause or source of the problem.
Suppose an adult client tells the clinician they have a long history of depression and anxiety. They explain they also have delusions and hallucinations, worry about people harming them, and have difficulty concentrating. From this brief description, the client could have four diagnoses; major depressive disorder, bipolar disorder, generalized anxiety disorder, or schizophrenia, not to mention others. The clinician must uncover the origin of the discomfort. Is it from moods, thoughts, or both? What do delusions and hallucinations look like? If the client is driven by their moods and thoughts, a DSM 5 diagnosis of schizoaffective disorder may cover most of the symptoms.
The clinician in doing their DSM 5 diagnosis must take out extraneous information and boil all symptoms down to a simple question: what problem or chicken/egg came first?
Praxes provides training on Diagnosis for behavioral health agencies. For more information, please contact us.
Got questions? We've got answers.
PRAXES is a nationwide behavioral health software, consulting, and training company. No one in the behavioral health industry has a better reputation, and if you give us the chance, we’ll show you why! At PRAXES, our services improve the efficiency and structure of behavioral health agencies serving children and families nationwide. PRAXES brings over 45 years of administrative and clinical expertise. With more than 100 client companies nationwide, we offer the expertise to advance the quality of behavioral health services. We accomplish these goals through our new clinical decision software, our training of best practices, and helping companies meet regulatory standards. At PRAXES, we believe in being creative and fostering new ways to serve children and their families. Our vision is to empower the families our agencies serve with skills that not only improve their functioning, but help them to thrive in their everyday lives. When you give us the chance, you’ll be connected directly to our friendly staff, so you can expect immediate attention to your inquiry. So, don’t wait, call now!
Dan Thorne has unique perspectives on the field of mental health. As a clinician, he has had over 40 years of experience working with clients in the Southern California area. After obtaining his Bachelor’s degree from the University of California at Irvine, he worked with children in the Orange County Juvenile Hall. Here he honed his earliest techniques on at-risk children. After that, he obtained his Master’s degree in Counseling from California State University, Fullerton.
In the 1990’s, Dan turned his attention to the clinical and administrative side of behavioral health organizations. For three years, he was the Assistant Administrator of Starting Point, a chemical dependency facility in Costa Mesa, CA. In 2001, he took an opportunity to be the Director of Harbor View Community Services Center in Long Beach. When he arrived, the Center had only 80 clients and 13 staff. When he left, there were over 400 clients and 75 staff. Dan created several programs through their contract with the Los Angeles County Departments of Mental Health and Child and Family Services. Under his guidance, Harbor View became one of the leading providers of children’s services in Los Angeles County.
While improving the results of the client’s parents at the Center, Dan reflected on his experiences as a parent. His children themselves had special needs such as mental and intellectual challenges, and Dan knew the toll it takes on the parent. In order to help the child, the parent has to be healthy. From this concept, he created his parenting program. After years of refining it, teaching it to his staff at the Center, and then taking the results and comments from these efforts, he became the developer of the current PRAXES program. It is a culmination of Dan’s personal trials and tribulations as a parent along with empirical results and research of over 40 parenting programs.
Our vision at PRAXES is to advance the strength of parents and caregivers of children with special needs (mental health, intellectual, or physical) through education, support, and empowerment. Thus, they can live healthy and functional lives while caring for the child.
Apogee is a clinical decision software designed to help behavioral health practitioners with their treatment and patient engagement. It provides evidence-based and research-based components. Not only do they consist of elements from such practices as Cognitive Behavior Therapy, Seeking Safety, Dialectical Behavior Therapy, Motivational Interviewing, Functional Behavior Analysis, but also the Intensive Models for Parents, Youth, and Children.
PRAXES has over 30 years of accreditation experience. We know what it takes to get your organization accredited. Whether it’s Joint Commission, CARF, or COA, our team can provide an evaluation of your current status and review the standards which need improvements. We will assist you with the policies, documentation, and training required to be accredited.
All Rights Reserved | Praxes