Gary G. Gintner, Ph.D., LPC-S, Bezdek Candidate, Smith, S ...

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Gary G. Gintner, Ph.D., LPC-S, Bezdek, M. T., Master’s Candidate, Smith, S. E., Master’s Candidate, & Mecholsky, S., Master’s Candidate Louisiana State University, Baton Rouge, LA

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Transcript of Gary G. Gintner, Ph.D., LPC-S, Bezdek Candidate, Smith, S ...

DSM-5: New DisordersGary G. Gintner, Ph.D., LPC -S, Bezdek, M. T., Master’s Candidate, Smith, S. E., Master’s Candidate, & Mecholsky, S., Master’s Candidate
Louisiana State University, Baton Rouge, LA
• Why add new disorders and specifiers?
• Poor coverage
• DSM-5 Work Group reviews the extant data on the topic
• A rationale for the addition is provided based upon the data
• DSM-5 field trial data is reviewed
• Two outside committees review the evidence
• APA’s Board of Trustees vote (November, 2012)
Steps in Adding a New Disorder
Winners Losers
Nonsuicidal Self-Injury
Binge-Eating Disorder
Neurocognitive Disorders
• Essential Features: Persistent difficulty discarding or parting with possessions, regardless of value
• Perceived need to save items and distress about discarding
• Clutter takes up active living area
• Clinically significant
• Not due to a medical problem or other mental disorder
• Specifiers
• Maladaptive cognitive processes
• Frequent stressful events
• Chronic stress
• Perpetuating factors
• Behavioral avoidance
• Behavior therapy (exposure and response prevention)
• SSRI’s
• Psychoeducation
• Identifying barriers and reinforcing successive approximations
• Relapse prevention
Treating Hoarding Disorder (Tolin, 2011; Muroff et al., 2013; )
• Essential feature: Recurrent episodes of binge eating in which there is a sense of lack of control • At least three ways eating is
disturbed • Not part of Anorexia or
Bulimia and no compensatory behaviors
• Severity rating based upon the number of binges per week
Binge-Eating Disorder (BED)
• Perpetuating factors
• Metabolic syndrome
• Psychoeducation: Dieting, healthy eating and exercise
• Self-monitoring binges/urges
• Relapse prevention
• Essential feature: Severe temper outbursts with underlying persistent angry or irritable mood
• Outburst frequency: 3x or more a week
• Duration: At least 12 months
• Severity: Present in two settings and severe in at least one
• Onset: Before 10 but do not diagnose before age 6
• Rule-outs: Bipolar, ASD, ODD, CD and Intermittent Explosive Disorder
Disruptive Mood Dysregulation Disorder
• Family Stress
What are the treatment implications?
• No empirically supported treatments
• Avoid bipolar medications
• Consider CBT treatments used for depression in children (Waxmonsky et al., 2012):
• Coping skills for thoughts, feelings and behavior
• Parent training
• Parent support group
• Essential feature: Depression that persists for two years or longer (one year or longer in children and adolescents)
• May include major depressive episodes
• Course specifiers:
• With intermittent major depressive episodes, with current episode
• With intermittent major depressive episodes, without current episode
Persistent Depressive Disorder
• Predisposing factors for PDD
• Personality traits (Negative affectivity, introversion)
• Depressogenic thinking
• Precipitating factors
• Loss event
• Perpetuating
• Acute Phase Treatments
• Combination of psychotherapy plus meds are superior to either alone
• Indications for psychotherapy:
• Onset due to a stressful life event or interpersonal problems
• Empirically supported psychotherapies for chronic depression
• Why note subtypes and specifiers?
• New specifiers for Bipolar Disorders and Depressive Disorder:
• With Anxious Distress
• With Mixed Features
• With Peripartum Onset
• Sources for practice guidelines:
• Keep up with the changes
Final Comments
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