Part Two
Changes and Implications Involving Addictive, Impulse-Control, and Specific Behavior-Related Concerns

Part Two Introduction

The disorders covered in Part Two are divided into three chapters: Chapter 9: Substance-Related and Addictive Disorders; Chapter 10: Disruptive, Impulse-Control, and Conduct Disorders; and Chapter 11: Specific Behavioral Disruptions. As with Part One, Part Two includes diagnoses commonly seen by most counselors. However, the difference between this section and the previous section is that disorders in Part Two frequently manifest through more visible, external behavioral concerns (e.g., sexual dysfunction) rather than less visible, internal experiences (e.g., depression). The frequency with which counselors work with these concerns varies widely; therefore, we provide detailed information for those diagnoses counselors are more likely to diagnose in practice, such as substance use or disruptive behavior disorders, and provide less detail for those disorders that counselors are less likely to diagnose, such as sleep disorders or sexual dysfunctions. Readers should assume diagnoses that do not include a heading detailing “Major Changes From DSM-IV-TR to DSM-5” have had no significant changes. Likewise, instances in which differential diagnoses or cultural considerations are sparse or not included indicate a dearth of research on the topic.

Major changes to look for in Chapter 9 include the collapsing of substance abuse and substance dependence into one category. Previous differentiation between abuse and dependence insinuated that abuse was less severe than dependence. In this chapter, readers will find one overarching substance use disorders section with specifiers to indicate the extent of impairment. Another substantive change to substance use and addiction processes in the DSM-5 is the inclusion of other addictive disorders, such as gambling disorder. Although the manual only identifies one process addiction at this time, this change represents a significant shift in the way in which the mental health community conceptualizes addictive disorders.

Major changes from the DSM-IV-TR to the DSM-5, including reconceptualization and reorganization of disruptive, impulse-control, and conduct disorders, are highlighted in Chapter 9. Whereas conduct disorder, oppositional defiant disorder, intermittent explosive disorder, kleptomania, and pyromania were included under either the Impulse-Control Disorders Not Elsewhere Specified or the Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence chapters of the DSM-IV-TR, the DSM-5 now includes these under the new Disruptive, Impulse-Control, and Conduct Disorders chapter. Furthermore, the “not elsewhere specified” section has been removed and other specified disruptive, impulse-control, and conduct disorders and unspecified disruptive, impulse-control, and conduct disorders have been added. Noteworthy is that, for the first time, all mental health disorders evidenced by disruptive behavior and impulse-control problems, including those that go against social norms (i.e., pyromania and kleptomania), have been clustered together in the same chapter.

Finally, as with other parts of this Learning Companion, readers will find a description of each disorder or group of disorders that includes essential features and major changes from the DSM-IV-TR to the DSM-5, special considerations, and case examples to help counselors better apply diagnoses to work with clients. Note, that unlike in Part One, we have not included information for specified or unspecified disorders for each disorder in this section, because the criteria for these diagnoses are similar to those found in Part One. For more detailed information regarding specified and unspecified diagnoses, see Chapter 17.