Anyone who’s experienced mental health challenges or taken an interest in psychology has likely heard of the DSM-5, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, which is the American Psychiatric Association’s definitive text for defining over 300 psychiatric diagnoses.
Professor Cheree Hammond, who teaches in the master’s counseling program at Eastern Mennonite University (EMU), identified a number of areas where practitioners and students could benefit from additional information outside of the DSM-5. The result was just published: a textbook titled Diagnostic Essentials of Psychopathology: A Case-Based Approach (SAGE Publications, 2021). It contains about 200 fictional case studies that Hammond wrote based on her 11 years of experience as a counselor educator.
“My first aim was to create a model and a platform for honing diagnostic skills that would be student-focused and would have the potential to raise accuracy in diagnosis,” Hammond said. She explained that two different practitioners will often arrive at different diagnoses for a single client, which directly affects what treatments that person will be offered.
Expanding upon these diagnoses with case studies helps students and faculty become familiar with how disorders can present differently in different people.
“There also seemed to be a need for case studies that reflected the general population – cases that depicted the diversity of our clients in race and ethnicity, sexuality, religion, age and so on,” Hammond said.
Hammond also wanted to humanize these diagnoses, and include the social forces in a person’s life that can and do contribute to their mental health concerns. She’s actually not a “huge fan” of the DSM or the diagnostic process in general.
“I worry a lot about the potential of the diagnostic process to concretize emotional experiences or even to create an identity of brokenness, for instance when a person describes themselves in this way, ‘I am bipolar,'” she said. “I worry, too, about the potential for diagnosis to objectify people and reduce complex lives, circumstances and experiences into ways of organizing and responding to others or even ourselves.”
“It feels important that clinicians in training have resources that both reflect the complexity and weight of making an accurate diagnosis while at the same time retaining what brought them to the profession in the first place, a desire to sincerely understand and be a support to the person seeking help,” Hammond explained.
Those circumstances and experiences can include systems of oppression that negatively affect mental health and wellbeing, such as racism or homophobia. Hammond worries that the medical model of diagnosing disorders tends to focus solely on the individual, rather than the individual in the context of what they go through in life.
Also, she pointed out, clinicians’ unconscious bias can affect how they choose to apply the DSM-5. For example, even when two children show identical symptoms, research shows that white children are more likely to be diagnosed with ADHD, while Black children are more likely to be diagnosed with oppositional defiant disorder.
“Misdiagnosis impacts long-term wellness and can impair a person’s relationships, education, employment and overall happiness,” Hammond said. “Consequently, it is essential that counselors have well-honed diagnostic skills, and cultural competence is an essential component of that process.”