ACA Blog

Deb Legge
Feb 17, 2010

The Impact of “Pathology” and “Diagnosis”: Here’s Your Chance to Be Heard…

The DSM-5 Task Force recently posted the proposed draft revisions for the DSM disorders and criteria. From now until April 20th, the general public (including consumers and clinicians) are welcome to review the revisions and make comments and suggestions ( ). The concepts of “pathology” and “diagnosis” generate quite a stir whenever they are the topics of discussion with my masters level counseling students. These issues, often spark debates that move into other controversial topics including: the role of pharmaceutical companies (money spent and commercial advertising) on stigma and the cost of medication; the use of psychiatric medication for children; the risks and benefits of client access to their diagnosis and clinical information regarding that diagnosis; and the implications of diagnosis on a consumer’s permanent medical file.

Although the DSM has been around since 1952, the idea of categorizing clients according to pathology is a tough pill to swallow for many eager, new helping professionals. The five revisions (DSM-II, DSM-III, DSM-IIIR, DSM-IV, DSM IV-TR) have addressed many of the concerns and questions of clinicians and researchers throughout the years. Concerns regarding the structure of the diagnostic process as well as concerns about the criteria and what we name and how we categorize the various disorders have been tweaked in efforts to improve the system on which we rely heavily (for diagnostic or billing purposes).

Most of us who have been around the DSM for awhile are able to recognize the benefits that exist despite any frustration we may find due to the focus on disability rather than ability. We realize that it is helpful to have a common language with which we are able to communicate regarding our clients. We acknowledge that creating a treatment plan with goals, objectives, and expected outcomes comes from first determining what is “wrong” or “missing’ and planning for rehabilitation or support.

Still, most of us have our pet peeves and downright disagreements with the at least one of the disorders or criteria. It seems no matter what system the APA (or other source) defines for the diagnosis of our clients, it will continue to be a wonderful source of passionate discussion for students and professionals for years to come. So… here is our chance to chime in on the upcoming DSM-V before it is zipped up and delivered to us in 2013. The document will be open for comments until April 20, 2010 and after that will be available for “viewing only” on the same webpage: .

Deborah Legge is a counselor, an assistant professor, the founder of, and specializes in coaching counselors in private practice

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