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 1Provide a brief summary of the process of development of the DSM system of diagnosis.  Share something that surprised you about the development of the DSM-5 .  Describe one example of how the classification system of disorders in the DSM- 5 has marginalized or pathologized diagnosed populations historically or currently. In the United States, a census in 1840 was the first official attempt to record the frequency of some mental disorders (American Psychiatric Association, n.d.). The categories on the census for mental health disorders were “mania, melancholia, monomania, paresis, dementia, dipsomania, and epilepsy (APA, n.d.). After World War II, the Veterans Administration and the U.S. Army developed a broad classification system of mental disorders which influenced the mental health disorders section of the ICD-6 (APA, n.d.). As a variant of the ICD-6, the APA Committee on Nomenclature and Statistics developed the first edition of DSM in 1952 (APA, n.d.). The second revision of the DSM, the DSM-II, eliminated the term “reaction” from the first version (APA, n.d.). The DSM-III introduced “explicit diagnostic criteria, a multiaxial diagnostic assessment system, and an approach that attempted to be neutral with respect to the causes of mental disorders” (APA, n.d.). In 1994, the DSM-IV was published, which had numerous changes from the DSM-III after a six-year effort of comprehensive review of the literature (APA, n.d.). In 2013, the DSM-5 was published after 13 years of research and revisions (APA, n.d.). In March 2022, the DSM-5-TR was published after more than 200 experts conducted literature reviews and reviewed the text for out-of-date material (APA, n.d.). One thing that surprised me about the development of the DSM-5 was the number of revisions that have been made on the same text to end up with the DSM-5. Specifically, I was most surprised that between the DSM and the DSM-II the major change was the elimination of the word “reaction.” In my opinion, I feel like a new version of the DSM should have very specific and significant changes to justify the release of an entire new text.

One example of how the classification system of disorders in the DSM-5 has marginalized or pathologized diagnosed populations historically is the diagnosis of homosexuality as a mental disorder in the DSM-II. In the DSM-II, homosexuality was designated as a pathology (Spiegal, 2004). After gay activists began protesting the designation, Spietzer brokered a compromise that led to the removal of homosexuality from the DSM (Spiegal, 2004). Resources American Psychiatric Association. (n.d.). DSM history. Retrieved December 10, 2019, from https://www.psychiatry.org/psychiatrists/practice/dsm/history-of-the-dsm Spiegal, A. (2004). The dictionary of disorder: How one man revolutionized psychiatry. The New Yorker . Retrieved from https://www.newyorker.com/magazine/2005/01/03/the-dictionary-of-disorder Please remember to offer thoughts within your responses to peers that touch on a population that has been marginalized or pathologized by the DSM classification system and discuss how culturally sensitive practices could reduce the stigma of mental illness. Sneha, I enjoyed reading your post. After reading your post and seeing what you thought was surprising, I looked up what drapetomania was as I had never heard of it. The fact that enslaved people were diagnosed with a mental disorder for wanting to be freed blows my mind! I also wrote about the LGBTQ+ community being marginalized by the DSM system. Spiegal (2004) explained that homosexuality was named a mental disorder in the DSM-II, but that was changed after gay activists protested. I believe if counselors have an insight on culturally sensitive issues and how to broach those topics with their clients, it could make a world of difference for that client to feel like they don’t belong or aren’t as good as someone else.

Resource Spiegal, A. (2004). The dictionary of disorder: How one man revolutionized psychiatry. The New Yorker . Retrieved from https://www.newyorker.com/magazine/2005/01/03/the-dictionary-of-disorder Case Conceptualization Andrew is a 15-year-old male that is currently in the ninth grade. Andrew was involved in a physical altercation with a peer where he threatened to kill another student (Kress & Paylo, 2019). After authorities found a small knife on Andrew at school, he was expelled for the remainder of the school year and “transferred to a secure residential intensive treatment center for psychiatric assessment” (Kress & Paylo, 2019, p. 386). As early as the age of 5, Andrew has displayed symptoms like “anger, disobedience, stubbornness, tantrums, lying, stealing, and aggressive behaviors” (Kress & Paylo, 2019, p. 386). At the age of 6, Andrew caught a frog and killed it, per his mother’s report, Andrew did not show any emotion after the incident and the behavior escalated to killing larger animals (Kress & Paylo, 2019). Educational/Academic Concerns The behaviors that Andrew is exhibiting have impacted his academic progress in the school setting (Kress & Paylo, 2019). Andrew’s behavior has resulted in him receiving school suspensions and admission into residential treatment facilities (Kress & Paylo, 2019). In late elementary school, Andrew’s grades began to drop and he started exhibiting more aggressive behaviors (Kress & Paylo, 2019). At age 11, Andrew assaulted a girl at school, which resulted in his first admission to a residential treatment facility (Kress & Paylo, 2019). Andrew’s behavior has resulted in many suspensions from school, which have hindered his academic progress.

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Diagnostic Impressions After conducting the interview with Andrew, a diagnosis of 312.81 (F91.1) Conduct disorder: childhood-onset type can be rendered (American Psychiatric Association, 2022). Rationale for Diagnostic Impressions According to the diagnostic criteria for conduct disorder, a diagnosis of conduct disorder can be rendered if the presence of three of the fifteen criteria has been met in the last 12 months, with at least one present within the last 6 months (American Psychiatric Association, 2022). Andrew has met the following criteria for a diagnosis of conduct disorder: “often bullies, threatens, or intimidates others,” “often initiates physical fights,” “has been physically cruel to people,” and “has been physically cruel to animals” (APA, 2022, p. 531). Of these criteria, the following criteria have been met within the last 6 months: “often initiates physical fights,” “has been physically cruel to people,” and “often bullies, threatens, or intimidates others” (APA, 2022, p.531). Other criteria for this diagnosis states “the disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning” (APA, 2022, p.531). Andrew meets this criterion because he has repeatedly been expelled from school and transferred to residential treatment centers. For the specifier for the diagnosis of childhood-onset type, the criteria states that “individuals show at least one symptom characteristic of conduct disorder prior to age 10 years” (APA, 2022, p. 531). Andrew meets this criterion because he started exhibiting behaviors as early as five years old. Resources American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5 th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu? url=https://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425787

Kress, V. E., & Paylo, M. J. (2019). Treating those with mental disorders: A comprehensive approach to case conceptualization and treatment (2nd ed.). New York, NY: Pearson. Hello Chelsea, Well done on your post, I agree that Conduct Disorder is the closest diagnosis that meets Andrew's symptoms. A possible altertnative I can think of is F63.81 Intermittent Explosive Disorder (IED). IED is very similar to Conduct Disorder, with key differences being that the aggression is more impulsive or not premetitated, as well as not to achieve a specific objective (e.g. power, money, intimidation). It is possible to have both IED and CD. I think further investigation into the motives behind Andrew's behaviors would provide some clarification. For a cultural consideration, I think investigating whether toxic masculinity has some role in Andrew's behaviors. For example, Andrew may believe that men are supposed to be aggresive and intimidating. His experiences with his abusive father may play a role as well.  Other diagnoses that your colleague should consider further in their ongoing work (i.e., potential differential diagnostic considerations)  Either a cultural or ethical consideration that may be pertinent to the diagnosis Hi, Elizabeth! I enjoyed reading your case conceptualization for Andrew. The diagnosis that I rendered for my post was Conduct Disorder: childhood-onset type. Andrew has met the following criteria for a diagnosis of conduct disorder: “often bullies, threatens, or intimidates others,” “often initiates physical fights,” “has been physically cruel to people,” and “has been physically cruel to animals” (APA, 2022, p. 531). For a cultural consideration into Andrew’s case, I believe it would be important to consider if Andrew’s home

life and family dynamic would impact his behavior/diagnosis. If Andrew wasn’t in a home with an abusive father and a mother who keeps mostly to herself, would he have the behaviors that warrant a conduct disorder diagnosis? Resources American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5 th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu? url=https://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425787 Case Conceptualization Ka-Sean is a 25-year-old lesbian that is presenting with excessive anxiety (Kress & Paylo, 2019). Ka-Sean is the youngest child of three in her family, but has not talked with her brother for a number of years (Kress & Paylo, 2019). Ka-Sean’s support system includes her partner, her older sister, and her father (Kress & Paylo, 2019). She worries excessively about things that she can and can’t control (Kress & Paylo, 2019). Ka-Sean has a history of difficulty sleeping, restlessness, stomach ulcers, fatigue, and muscle tension (Kress & Paylo, 2019). She frequently overthinks to the point of analysis paralysis (Kress & Paylo, 2019). In addition to procrastinating, she often experiences flooding of questions, where she will question everything extensively (Kress & Paylo, 2019). When she begins questioning things, she experiences tightness in her chest, heart palpitations, shortness of breath, thoughts of losing control, and trembling of her hands (Kress & Paylo, 2019). Ka-Sean does have a history of self-injurious behavior

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that she used as a coping mechanism when her mother died (Kress & Paylo, 2019). Ka-Sean is currently taking alprazolam (Kress & Paylo, 2019). Educational/Academic Concerns Ka-Sean struggles with completing assignments because of her procrastination (Kress & Paylo, 2019). Ka-Seans classmates think she is a perfectionist because she often seeks reassurance before completing any papers or assignments after conducting copious amounts of research (Kress & Paylo, 2019). When doing group assignments, Ka-Sean is unwilling to delegate tasks to others (Kress & Paylo, 2019). Diagnostic Impressions The diagnostic impression rendered after interviewing Ka-Sean would be a diagnosis of 300.02 (F41.1) Generalized Anxiety Disorder (American Psychiatric Association, 2022). Rationale for Diagnostic Impressions According to the DSM-V TR, the first diagnostic criteria for a diagnosis of Generalized Anxiety Disorder (GAD) is “excessive anxiety and worry, occurring more days than not for at least 6 months, about a number of events or activities” (APA, 2022). Ka-Sean meets this criteria because she has experienced overwhelming anxiety and worry in many situations (school, work, relationships) for a few years (Kress & Paylo, 2019). The second criteria for GAD is “the individual finds it difficult to control the worry” (APA, 2022). Ka-Sean’s anxiety reaches debilitating levels when she is extremely stressed to the point that she can’t control the worry (Kress & Paylo, 2019). For the third diagnostic criteria of GAD, Ka- Sean exhibits the following symptoms: restlessness, being easily fatigued, muscle tension, and sleep disturbance (APA, 2022). The symptoms that cause Ka-Sean to meet criteria for GAD cause impairment in social, occupational, and personal areas of her life, which is the fourth criteria for a diagnosis of GAD (APA, 2022). Since Ka-Sean does not use or abuse any substances, the diagnosis of GAD would be the best fit for her situation at this time (APA, 2022).

Resources American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5 th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu? url=https://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425787 Kress, V. E., & Paylo, M. J. (2019). Treating those with mental disorders: A comprehensive approach to case conceptualization and treatment (2nd ed.). New York, NY: Pearson. Jordan, I agree with your diagnosis of Generalized Anxiety Disorder. I also rendered this diagnosis for Ka-Sean; however, after thinking about it more after submitting my post and reading some of the other posts, I believe a panic attack specifier would be appropriate (American Psychiatric Association, 2022). Since Ka- Sean has showed the criteria for the specifier during her panic attacks (APA, 2022). Although Ka-Sean never called them a panic attack, it is obvious that the symptoms she feels during those times are panic attacks based on the criteria in the DSM-5-TR (APA, 2022). Resources

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5 th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu? url=https://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425787 Kress, V. E., & Paylo, M. J. (2019). Treating those with mental disorders: A comprehensive approach to case conceptualization and treatment (2nd ed.). New York, NY: Pearson.

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