DSM-5 Proposed Draft

[moxie]

Originally Posted by DapperButch

Hey, AtLastHome, I really enjoyed your post.



As a clinician, I get what you are saying throughout this whole post and have felt all of the same things. I wanted to highlight a couple of things that you said and comment. The colors match the responses:

What I have always done is unless the person is seeking surgery and needs the GID diagnosis, I just diagnose them with the correct code (but, yes, of course this sometimes means giving them an adjustment diagnosis since v. codes aren't accepted by insurance companies.). I never use the GID diagnosis unless the person needs it. I suppose I just happen to "miss" that someone meets the criteria of a "diagnosis" that the establishment deems a mental illness.


Fortunately, I have never been faced with this situation where a client's records had to be handed over to someone my client did not want the records to go to. However, this is the reason why I document as little information as possible about my client. I document only what is necessary.


Yes, and now that insurance companies have the whole parity vs. nonparity diagnoses, with clients receiving more visits per year if they have a "parity diagnosis" (i.e. a diagnosis indicating having more severe difficulties than some other diagnoses), some clinicians may be more apt to give a client this type of diagnosis (if the person's symptoms could qualify for either type of dx), just so that the client can get the number of visits they need in order to get better. I have actually said to a client once or twice, "Hey, your symptoms fit under a "Major Depression" diagnosis, but typically I would "diagnose" you with the "lighter" diagnosis of "Depressive Disorder, Nonspecific" (I always send the "lightest diagnosis" that I can feel ethically comfortable with, to the insurance company). You get 20 visits a year for the second diagnosis, but would get unlimited visits for the more "serious" diagnosis. Which would you prefer I send to your insurance company?" I present them with this since my diagnosis impacts their treatment and my usual, "give them the lightest diagnosis I can get away with ethically", actually works AGAINST them in this situation. The whole thing just SUCKS.

DISCLAIMER: I don't deal with private insurance. I have always worked in community mental health with it's own billing department that deals with all the approvals/billing stuff. For the past 3 years our agency has not accepted private insurance (unless it is in conjunction with Medicaid, then when the private insurance kicks it we send it to Medicaid) due to the excessive need for services and lack of providers for those with Medicaid along with those without insurance. Medicaid has it's own headaches that I won't get into when it comes to billing and recordkeeping.

I go to court with every single client of mine while I am open for services with them and sometimes I get subpoenaed to testify because it changes what I can and cannot say in court. When I don't testify because I am no longer involved with the client they use my records. There is SO much stuff that I don't put in my notes. I put enough in to satisfy Medicaid standards for my treatment plan goals and objectives and for other practitioners to understand what is going on with the client and skills/techniques I use and teach and that is it. I have seen fellow clinicians put things in records like incessant amounts of dialogue that don't need to be there and has been used in court for the abusive parent to get custody of the kids.

I don't have to deal with the diagnosis correlating with the number of sessions. The insurance stuff is one of the reasons I won't go into private practice. I ALWAYS go with the least-stigmatizing diagnosis and I am very fortunate to be able to do that due to not dealing with the private insurance industry. I used to work in conjunction with a state-run inpatient psychiatric facility as a liason and I can't tell you how many times personality disorder diagnoses would be given while the client was hospitalized for 3 days with no access to previous records or hospitalizations. Three days?!?! Diagnoses follow people around and sometimes people don't remember that. I am fortunate to be able to use V-codes and adjustment disorder diagnoses and change diagnoses as needed. Nowadays Bipolar Disorder and ADHD are the diagnoses du jour.

Okay, back to the DSM. More personality disorders are being added, including passive-aggressive (negativistic) personality disorder. This bothers me because I see them used way too often and I fear that with more being added that it will give practitioners even more reason to use them. I see Borderline Personality Disorder diagnosed way too much and way to soon. I see the stigma associated with diagnoses daily. You walk into a room and talk about a client that has been diagnosed with a personality disorder and people cringe and don't want them as a client. The diagnostic criteria for Personality Disorders have been proposed to be changed also and I am not quite sure yet what to think about it.

Adjustment disorders are also being changed with the addition of PTSD-Like or ASD-Like symptoms, which I think could be beneficial.

They are also adding some diagnoses and specifiers to the Schizophrenia and other Psychotic Disorders category. These changes include removing subtypes with schizophrenia...all I have to say is wow. Schizophrenia exhibits itself in different ways with people and they are wanting to remove the specifiers. I need to find some literature as to why they are proposing this because I am just dumbfounded.