Part One
Changes and Implications Involving Mood, Anxiety, and Stressor-Related Concerns

Part One Introduction

The disorders covered in Part One are divided into six chapters: Chapter 3: Depressive Disorders; Chapter 4: Bipolar and Related Disorders; Chapter 5: Anxiety Disorders; Chapter 6: Obsessive-Compulsive and Related Disorders; Chapter 7: Trauma- and Stressor-Related Disorders; and Chapter 8: Gender Dysphoria in Children, Adolescents, and Adults. This part includes diagnoses, such as major depressive disorder (MDD) and PTSD, that involve affective distress commonly seen by counselors across various work settings and client populations. In each chapter, readers will find a basic description of the diagnostic classification, an overview of specific disorders covered, highlights and essential features of each disorder (including differential diagnoses), and a comprehensive review of specific changes, when applicable, from the DSM-IV-TR (APA, 2000) to the DSM-5 (APA, 2013a). For newly minted disorders and disorders commonly seen by counselors, we present case studies to help counselors understand and apply diagnoses. In keeping with our intent to discuss conditions relevant to counselors, we discuss pervasiveness of disorders among the general population as well as etiology and treatment. Unless explicitly stated, prevalence rates are based on DSM-IV-TR criteria.

Major changes to look for in Part One include the removal of the DSM-IV-TR major depression “bereavement exclusion” (APA, 2013d, p. 1). This change recognizes recent research revealing little to no systematic differences between individuals who develop a major depression in response to bereavement and those who develop major depression in response to other severe stressors, such as being physically assaulted or betrayed by a spouse (Wakefield & First, 2012; Zisook, Shear, & Kendler, 2007). Removal is consistent with the ICD, which has never had a grief exclusion criterion for major depression. Counselors will also see changes to traumatic stress disorders such as PTSD and acute stress disorder, which have added exposure criteria and taken away the requirement for individuals to experience extreme fear reactions such as horror and helplessness.

Major additions to look for in this section include the addition of disruptive mood dysregulation disorder, addition of premenstrual dysphoric disorder, and renaming dysthymic disorder to persistent depressive disorder within the chapter on depressive disorders. Also look for the addition of hoarding disorder, excoriation (skin-picking) disorder, and disinhibited social engagement disorder under the chapter on trauma and stressor-related disorders. As with the DSM-IV-TR, panic attack criteria are provided. However, counselors can now use this specifier for disorders throughout the DSM-5. Finally, readers will note gender dysphoria replaces the previously termed gender identity disorder, and separate criteria are listed for children. Readers will also notice the separation of gender dysphoria from paraphilias and sexual dysfunctions, which strongly supports the idea that this diagnosis is not a pathological disorder. For gender dysphoria, the separation of criteria sets for children from those for adolescents and adults more accurately captures the experience of children, adolescents, and adults struggling with gender identity issues.