DSM-5 Changes and the Law


Up to Date with DSM-5

The field of psychiatry is ever evolving, with new information and updates persistently reshaping various aspects of clinical practice. This evolution also affects the interaction between psychiatry and the law, with many attorneys and courts requesting (and often requiring) experts to be well versed in changes affecting the field. Perhaps one of the biggest updates recently has been the transition from the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) to the newest version, DSM-5.

The American Psychiatric Association released the DSM-5 in May of 2013, though many hospitals and clinicians have not yet implemented its use. Transitioning to DSM-5 can be a daunting task, due to numerous changes in the structure of how to make a diagnosis and even the diagnoses themselves. While the switch to this new version of the primary diagnostic manual that most psychiatrist use is still occurring, it is important to consider how these changes affect psychiatry and the law.

One major change in the DSM-5 was the removal of the multi-axial system. Often, attorneys and courts require a multi-axial assessment, which was utilized heavily in the DSM-IV-TR. This was usually reported as Axis I through Axis V, which contained the relevant diagnoses in separate sections. For instance, you might put Major Depressive Disorder on Axis I, Mental Retardation on Axis II, and non-psychiatric medical issues on Axis III. DSM-5 discarded this approach and instead utilizes a list of current diagnoses, with disorders ranked based on importance related to the presenting problem. In addition, the DSM-5 did not recommend continued use of the Global Assessment of Functioning (GAF) score, though debate continues in the literature about what, if any, replacement would be appropriate. The removal of these two components will likely affect how forensic reports are generated and how the results of an evaluation are documented. In fact, it may change how attorneys and courts phrase the question for the expert to answer, as many legal professionals specifically request these multi-axial assessments and will need to revise their request to accommodate the recent updates.

Another area of change in the DSM-5 was the alteration of diagnostic criteria themselves. While some, like Major Depressive Disorder, had relatively few changes, other disorders, such as Posttraumatic Stress Disorder (PTSD) underwent more substantial revisions. As the criteria change, either expanding or narrowing the definitions of disorders, their impact on the legal system will also correspondingly change. For instance, the expansion of what defines a trauma in PTSD in DSM-5 may increase the importance of this diagnosis in legal arenas where it is often seen, such as personal injury and disability litigation. These changes in diagnostic criteria also affect the reports and testimony an expert provides, since it could change what diagnosis is used from one edition to another.

When retaining an expert to evaluate a case, it is important to consider if that expert has the up to date knowledge to provide the best consultation possible. With the release of the DSM-5, the field of psychiatry will continue to move toward implementing this new edition across the realm of clinical work. In forensic psychiatry, though, it is possible that juries and courts will quickly begin to demand use of the most recent manual in the evaluation and diagnosis of cases in both the criminal and civil arenas. When considering an expert in psychiatry, you should ask if the expert has begun to use DSM-5 and (if they haven’t) their reasons for not doing so. In some specific circumstances, use of the DSM-5 is not warranted; however, the reasons for the choice should be explored at the beginning of the process, not when the forensic report has already been generated. In addition, the expert’s experience with the DSM-5 should also be a consideration, particularly when in the early stages of its implementation. As you may guess, there is a large difference between being aware of the new manual and being experienced in its use. http://igrovye-online-avtomaty.com/royal-treasures-mobile/

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