Los Consejeros No Se Beneficiarán del DSM-5 Revisado

Counselors Won’t Benefit from Revised DSM-5

Posted on June 20, 2011, 1:09 pm | ACA Blog

Dayle Jones

I’ve written about my concerns on the overall lowering of diagnostic thresholds in DSM-5, as well as the addition of “subthreshold” disorders. This means that many disorders will require fewer or sub-clinical symptoms to be diagnosed. Many consequences will result from this, including increased stigma, unnecessary treatments (including needless psychiatric drugs), or even overdiagnosis to the point of creating false epidemics.

Examples of “Lowered Threshold” or
“Subthreshold” DSM-5 Disorders

• Major Depression: removes the bereavement exclusionary criterion.
• Substance Use Disorder: requires only 2 of 11 symptoms.
• Generalized Anxiety Disorder: requires fewer symptoms and less duration.
• ADHD: reduces the number of symptoms required for adults.
• Attenuated Psychosis Syndrome (psychosis risk syndrome): identifies teenagers at risk for developing future psychosis.
• Mild Neurocognitive Disorder: would diagnose many people with no more than expected memory problems of aging.
• Disruptive Mood Dysregulation Disorder: will label irritable people (and children) who throw temper tantrums as mentally disordered.
• Mixed Anxiety Depression: includes nonspecific symptoms that most people experience at some point.

I’ve heard from a few private practice counselors who feel positive about the proposed DSM-5 changes. Their rationale is that if you’re in private practice and rely on third party reimbursements for income, these revised disorders (that require fewer symptoms to diagnose) will make it easier to give a client a diagnosis, which will be more readily reimbursed by insurance companies. In other words, private practitioners will make more money.

I hate to burst their bubble, but…

The DSM-5 will most likely not make insurance reimbursement easier or increase counselors’ income. Because, “medication therapy” has become the favored treatment modality of managed care insurance companies – regardless if counseling is viewed a viable alternative. Although reimbursements for medication are much more expensive in the long run, they are less than the costs of psychotherapy in the short run. And insurance companies think short. In fact, since 1998, coverage for psychiatric drugs has increased, while significant limits have been placed on psychotherapy services.

This shift from “talk therapy” to drugs as the primary treatment mode coincides with the theory that mental illness is caused primarily by brain chemical imbalances that can be corrected by specific drugs. This view was intensified after the emergence of Prozac in 1987, which intensely promoted that treatment for depression involved correcting a serotonin deficiency in the brain. The number of people treated for depression tripled over the next decade – and the treatment mode was medication. An astounding 10 percent of Americans over age 6 now take antidepressants. The increased use of antipsychotic medication is even more dramatic – the new atypical antipsychotics (e.g., Risperdal, Zyprexa, and Seroquel) have replaced cholesterol-lowering medications as the top-selling class of drugs in the U.S.

The pharmaceutical companies are cashing in on the mental health prescription drug boon. Currently, they are developing more than 300 new drugs to treat mental illness, with the top medications for dementias, depression, schizophrenia, anxiety disorders, eating disorders, addictive disorders, and ADHD. Ironically, many of these drugs correspond to the proposed DSM-5 disorders with lowered or subthreshold symptoms. I guess the pharmaceutical companies are anticipating an increase in demand.

Psychiatrist-researchers favor the trend toward drug treatment because many have professional relationships with drug companies (Singer, 2007) and thus share in the financial windfall. In fact, between 2000 and 2004, at least 530 government scientists at the National Institutes of Health (NIH) (i.e., the federal government’s major distributor of dollars for medical research) took fees, stocks or stock options from biomedical companies (Willman, 2004). Note that these fees or stocks range in value from a few thousand to millions of dollars.

The increased use of psychiatric drugs corresponds with a 20% reduction in the number of insurance-covered psychotherapy visits (between 1997 and 2007). During that same time period, there was a 23% decrease in the average therapy fees per visit. And, the overall average expenditures for therapy visits declined by 27% for private insurance, 17% for self-pay clients, and 17% for Medicaid.

So, will the new lax criteria for DSM-5 disorders help counselors generate more fees for their services? Since the psychotropic medication movement seems well-entrenched in the U.S., the answer is most likely no. The only beneficiaries of the DSM-5’s easier-to diagnose disorders will be the pharmaceutical companies and the scientists/researchers who are in alliance with them.

K. Dayle Jones is a counselor and associate professor at the University of Central Florida. She is acting chair of the American Counseling Association’s DSM Task Force, which was formed to provide feedback to the American Psychiatric Association on proposed revisions to the DSM-5. Contact her at daylejones@ucf.edu.

Se Busca Colaboradores para Consejería Práctica

Consejería Práctica es un blog para fomentar el diálogo entre los profesionales de la salud mental así como promover al Consejero Profesional como un proveedor de servicios legítimo dentro de la salud mental. Mantener un blog como este es una responsabilidad grande y un trabajo monumental por lo que estoy buscando colaboradores que escriban artículos cortos y ayuden a mantener la información de Consejería Práctica al día.

Aceptamos colaboraciones de todo tipo de proveedor de salud mental y de estudiantes de Consejería Profesional. Si le interesa publicar artículos o información en este blog, puede comunicarse con esta servidora a mhernandez@consejeriapractica.com para más información.

Gracias a todos los que se han comunicado y nos han dejado saber la importancia de esta iniciativa para la consejería profesional y la salud mental en Puerto Rico.

RE: Reválida de Consejeros Profesionales y Repasos

En contestación a los comentarios recibidos en los últimos días.
La Junta Examinadora ni el NBCC han publicado la fecha del examen de reválida de Consejeros Profesionales ni del último día para entregar documentos. Tan pronto la Junta Examinadora nos facilite esta información, les estaremos dejando saber. Le recomendamos que se suscriba a nuestro blog para que reciba esta y otra información tan pronto esté disponible.

Sobre repasos para la reválida: Hemos incluido en el “sidebar” de la página Excelente Repaso para la Reválida de Consejeros Profesionales algunos de los recursos disponibles a través de Amazon. Al comprarlo de Amazon a través de Consejería Práctica, estarías haciendo una aportación a nuestro blog también.