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Learning outcomes
By completing this module, you will be able to:
- Describe the origins of the Diagnostic and Statistical Manual.
- Identify common symptoms related to frequent mental health diagnoses.
- Determine the role of a BSW-level social worker in using mental health diagnoses.
Foundational ethical principles and standards
When working with clients, we’ve discussed the importance of the strengths perspective in social work and the crucial values of self-determination and human dignity related to those strengths (NASW Code of Ethics, 2017). However, identifying and supporting strengths does not mean that we disregard the presenting issues and concerns in a client’s life. Presenting issues includes mental health and understanding of mental disorders and the method used to diagnosis.
While BSW-level social workers do not diagnose nor treat clients with mental health disorders, they commonly provide services as case managers, group facilitators, educators, and advocates. The Association for Social Work Boards determined in a North American social work job analysis that understanding mental health disorders and the use of the DSM-5 was common to BSW-level social workers. Thus, it’s included in the licensure test outline for the BSW-level (see IIB – Assessment Methods and Techniques).
The Diagnostic and Statistical Manual of Mental Disorders was first published by the American Psychiatric Association in 1958 (Birkenmaier, 2017, pg. 83). This reflected the shift across helping professions to pathology rather than strengths. A more clinical and deficit-based approach was used for the DSM focusing on the existence of “non-conforming” symptoms. For example, originally homosexuality was included as a diagnosis then removed in 1973 as a result of advocacy by members of the GLBT community, social workers and others.
The DSM has been challenged as lacking in cultural competency, as symptoms and behaviors are more reflective of the dominant society. In the most recent addition (5), some information was included which allowed for cultural variation, including a cultural formation interview for assessment.
Currently, the DSM-5 is one of the most common tools used in the diagnosis and treatment for clients with presenting mental health concerns. Many insurance companies require a formal diagnosis for a client in order to approve and pay for services for both adults and children (Birkenmaier, 2017, pg. 148).
Rather than diving in-depth to the DSM-5, it’s important to understand the diagnoses from the perspective of community members living with those diagnoses, supporting a strengths approach. The National Alliance on Mental Illness is an organization founded in 1979 through a grassroots movement and provides information on common mental health disorders.
Other organizations that provide clear information on DSM-5 diagnosis and their meaning to community members include the Alzheimer’s Association (particularly in relation to dementia), the Substance Abuse and Mental Health Services Administration, and the National Institute on Drug Abuse.
CONTENT
Attention deficit hyperactivity disorder (ADHD) is characterized by behaviors related to inattention, hyperactivity and impulsivity. While it is most commonly diagnosed in children, it is also diagnosed in adults. Medication, behavioral therapy and self-management are common interventions.
Autism is diagnosed when a person’s ability to socialize and communicate with others is affected. It’s more commonly diagnosed in children, with boys 4 times more likely than girls to display symptoms. There is a range of symptoms, most related to patterns of behavior, communication, and socialization, with a wide range of severity. Common interventions include education and development and behavioral treatments.
- Depression
It’s not uncommon to feel sad at times in our lives, particularly related to trauma, loss and stress. Diagnosable depression is much more than sadness and while the symptoms may be similar, depressive disorder is marked by the length of symptoms lastly more than 2 weeks, including: decreased pleasure in activities; changes in sleep, eating, and concentration; and feelings of low self-worth and suicidal thoughts or intentions. Common interventions include therapy, medications, and exercise.
Anxiety is a natural emotion that comes at uncomfortable moments in our lives, such as performing in front of a group or interviewing for a job. Generalized Anxiety Disorder includes much more than natural anxiety and it marked for feelings of intense fear and distress that prevent participation in daily activities. Anxiety disorders are the most common in the United States, with over 40 million adults diagnosed. Children can be diagnosed as most symptoms begin before age 21. Common interventions include therapy, medications and health approaches such as mindfulness.
As we know from research and experiences shared by community members, trauma can have a lasting impact on mental and emotional health. While some people experience short-term impacts, others experience long-lasting symptoms such as distressing and intrusive memories, flashbacks, changes in mood and emotions (including sadness and anxiety), and hypervigilance. Both adults and children can be diagnosed with PTSD. Interventions include therapy, medication, and self-management strategies.
The use of substances to alter cognition and behavior is historical and common in our society; think of how many people consume alcohol and caffeinated coffee, for example. Substance abuse is diagnosed when a person continues to use drugs despite experiencing serious negative consequences of its use. Behavioral, physical and other changes occur that impact roles and responsibilities. Substance abuse disorders can co-occur with other disorders, such as PTSD or Major Depressive Disorder, as people who are experiencing mental health disorders turn to self-medication to try to manage the disorder. When disorders co-occur, it is called dual diagnosis.
Dementia is the general term used for changes in memory, problem-solving, language and other skills that negatively impact a person’s daily life. Alzheimer’s disease is closely associated with dementia, but there are numerous causes including Huntington’s disease, Korsakoff’s syndrome, and Parkinson’s disease. While older adults are more commonly diagnosed with dementia, it can impact children as well as adults. Treatment depends on the cause of the dementia.
