Session-5 Other Conditions that May be a Focus of Clinical Attention (including the V-Codes), Additional Codes, Adjustment Disorders, and Culture

Question 1

DSM-IV-TR; (Group #1 of DSM-Disorders) What are the three types of “Other Conditions that may be a focus of clinical attention (including the V-codes)”?

Answer 1

(1) the problem (“other condition”) is the focus of diagnosis or treatment and the individual has no other mental disorder;
(2) the individual has a mental disorder but it is unrelated to the problem (“other condition”);
(3) the individual has a mental disorder that is related to the problem (“other condition”), but the other condition is sufficiently severe to warrant independent attention.

Question 2

DSM-IV-TR; What are examples of the three types of “Other Conditions”?

Answer 2

Example: One of these would be something like, narcoleptic induced tartive dyskenesia; basically what that is is that’s a psychiatric medication that is causing tartive dyskenesia, these are medication induced problems/issues. A person comes for some psychiatric condition and they get medicated with a narcoleptic which then causes the tartive dyskenesia.

Example: Relational problems, part of the V code section. Why V code, no one knows? Parent child relational problem, father comes in and daughter is using coc, x, etc. I need help with dealing with her, this would be a V code section. A relational, problem relational problem.

Example: Abuse or neglect, sexual/ physical, all of those are part of the V codes, non compliance with treatment—can get a v-code

Example: Bereavement, acculturation, academic, phase of life problems (kid going off to college and getting homesick)- that is in this group, disorders that are not like bipolar II, more like general stress and general family things.

Example: Pg. 743 on DSM-IV-TR, there is a set of codes that you put when you don’t put a diagnosis, where you defer a diagnosis, for example if you put no diagnosis on axis one, on this page they give you, you put the 71.09 which means no diagnosis or condition on axis one, just a number you put for no diagnosis.

Example: Say someone came in with a straight axis II borderline disorder, for axis I you can put 71.09 (no disorder) axis II borderline.

Example: Another thing you can put on axis I after the first interview, number for diagnosis differed, client comes late and at the end you have to enter in the computer, you would probably put deferred because you didn’t have enough time to get to know them.

Question 3

DSM-IV-TR: When should “Other Conditions” be listed on Axis I?

Answer 3

When the problem (“Other condition”) is the principal focus of clinical attention, which is most of the time.

Example: These other conditions, all these other conditions, phase of life, etc. when that is the principal focus on the persons problems, you put them on axis I.

Example: If someone comes in with diabetes and fighting with their partner, and their emphasis is the problems with their wife. Diabetes will go in axis III, partner problem goes in Axis I. patients often come in with medical disorders, learn about the disorder and put in the Axis III.

Example: “I have a spiritual and a relationship problem- I am going to get divorced anyway, I want to know whether I am going to be a jew or muslim” spiritual goes in Axis I and relationship in Axis IV.

Example: An empty nester, my last kid went off to college, my body, I hate my husband, im here cuz I feel blah—a phase of life problem (axis I) oh and I have hypertension (axis III)

Example: DSM-IV; I am here because my mother died, I cant sleep- they would get a bereavement diagnosis and it would go in Axis I.

DSM-5 doesn’t work this way. In the DSM-IV TR we get into the trauma disorders, a trauma disorder in DSM-IV TR is like if you were raped, you get PTSD. In DSM 5 you can get a trauma disorder if your wife comes home and says I saw someone get shot and killed at the corner, the husband hearing that can get the disorder and go to an attorney and say I have a trauma disorder and sue the perpetrator of the crime—it gets very tricky. The movement to 5, there are more ways to get disorders. IV-TR was actually more conservative.

Question 4

DSM-IV-TR: When should “Other Condition” be listed on Axis IV?

Answer 4

When the “Other Condition” is present but NOT the principal focus of clinical attention, it should be listed on Axis IV.

Example: they are clinically depressed, they need a psychiatric consultation. But as they are talking to you, they emphasize that they are there for the problems with their wife. In Axis I you would not both disorders, clinically the partner problem is just as or more of an issue to focus on as the major depressive disorder.

Question 5

DSM-IV-TR: What are the 5 major groups of “Other Conditions that may be a focus of clinical attention (including the V-codes)”?

Answer 5

1. psychological factor affecting medical condition
2. medication-induced movement disorders
3. relational problems
4. problems related to abuse or neglect
5. additional conditions that may be a focus of clinical attention

Question 6

DSM-IV-TR: What is included in “Psychological Factor Affecting Medical Condition”?

Answer 6

316 Psychological Factor Affecting Medical Condition

Major differentials include Somatoform Disorders.

Example: pg. 732-733: first time you see a differential diagnosis, look at the DSM-IV-TR and read it! You see somatoform disorders, they are known as a differential diagnosis class (a whole other group of disorders down the road). If you have some physical stuff going on and there is no distinct medical condition you would think it is somatoform. What he is saying is, this is how to think about differentials. I have a cancer diagnosis and I don’t go to my treatment, I don’t cope with it. If there is no medical condition like cancer, then you would think of these other group of disorders.

Question 7

DSM-IV-TR: What is included in “Medication-Induced Movement Disorders”?

Answer 7

332. 1 Neuroleptic-Induced Parkinsonism
333. 92 Neuroleptic Malignant Syndrome
334. 7 Neuroleptic-Induced Acute Dystonia
335. 99 Neuroleptic-Induced Acute Akathisia
336. 82 Neuroleptic-Induced Tardive Dyskinesia
337. 1 Medication-Induced Postural Tremor
338. 90 Medication-Induced Movement Disorder NOS
339. 2 Adverse Effects of Medication NOS

Question 8

DSM-IV-TR: What is included in “Relational Problems”?

Answer 8

V61.9 Relational Problem Related to a Mental Disorder or General Medical Condition

V61.20 Parent-Child Relational Problem

V61.10 Partner Relational Problem

V61.8 Sibling Relational Problem

V62.81 Relational Problem NOS

Question 9

DSM-IV-TR: What is included in “Problems related to abuse or neglect”?

Answer 9

Note different codes when the perpetrator is being diagnosed vs. when the victim is being diagnosed

V61.21 Physical Abuse of Child vs. 995.54

V61.21 Sexual Abuse of Child vs. 995.53

V61.21 Neglect of Child vs. 995.52

Physical Abuse of Adult (V61.12 vs. V62.83 vs. 995.81)

Sexual Abuse of Adult (V61.12 vs. V62.83 vs. 995.83)

Question 10

DSM-IV-TR: What is included in “Additional Conditions”?

Answer 10

V15.81 Noncompliance with Treatment

V65.2 Malingering

V71.01 Adult Antisocial Behavior

V71.02 Child or Adolescent Antisocial Behavior

V62.89 Borderline Intellectual Functioning (IQ 71-84)

780.93 Age-Related Cognitive Decline

V62.82 Bereavement

V62.3 Academic Problem

V62.29 Occupational Problem

313.82 Identity Problem

V62.89 Religious or Spiritual Problem

V62.4 Acculturation Problem

V62.89 Phase of Life Problem

Question 11

DSM-IV-TR: Additional Codes

Answer 11

pg. 743
300. 9 Unspecified Mental Disorder

V71.09 No Diagnosis or Condition on Axis I

799.9 Diagnosis or Condition Deferred on Axis

V71.09 No Diagnosis on Axis II

799.9 Diagnosis Deferred on Axis II

(NOTE THAT THESE 5 CODES ARE DISTINCT FROM the “Other Conditions that May be a Focus of Clinical Attention” Diagnostic Category)

These are just the way you put things, at the end of a practicum sight you describe the presenting symptom, and at the end you give the diagnosis. If the person was late and they couldn’t stay, and you had to write a note, what would you put for Axis I. you would put Diagnosis Deferred 799.9 on Axis II.

Question 12

DSM-5: Changes regarding “Other Conditions that may be a focus of clinical attention (including the V-codes)”

Answer 12

While most of these codes remain the same or are very similar in DSM-5, they re-shuffled and elaborate them into 3 diagnostic categories in DSM-5 (they did not change the name of the family group. We went from 5 groupings of these to 3);

(1) Other Mental Disorders
(2) Medication-Induced Movement Disorders and Other Adverse Effects of Medication
(3) Other Conditions That May Be a Focus of Clinical Attention

Question 13

DSM-5: What are (1) Other mental disorders?

Answer 13

Other Specified Mental Disorder Due to Another Medical Condition

Unspecified Mental Disorder Due to Another Medical Condition

Other Specified Mental Disorder

Unspecified Mental Disorder

Question 14

DSM-5: What are (2) Medication- Induced Movement disorders and other adverse effects of medication?

Answer 14

These disorders include medication-induced syndromes and symptoms resulting from the abrupt or inappropriate discontinuation of psychopharmacological agents.

Question 15

DSM-5: What are (3) Other conditions that may be a focus of clinical attention?

Answer 15

“These conditions and problems listed in this chapter are not mental disorders. Their inclusion in the DSM-5 is meant to draw attention to the scope of additional issues that may be encountered in routine clinical practice and to provide a systematic listing that may be useful to clinicians in documenting these issues.”

Example: In DSM-IV TR the other conditions that may be a focus of clinical attention are not actually mental disorders; they said if you have a spiritual problem you get this diagnosis. What they are saying is, technically this is not a psychiatric condition like bipolar II, etc. they are saying it is not those it is just a life problem that we can an other condition. Not a psychiatric problem it is an other condition. In DSM-5 we make a note of this.

This slide is really important, they are saying they are not mental disorders but by the sheer fact that they are in this manual, it suggests to the public that they are mental disorders.

Someone punches someone in the church because they are a Jew, someone goes and says look I have a spiritual problem. Attorney says well it is not an actual disorder and the other may argue that it is not.

DSM, is trying to play both sides of the fence, it is fuzzy and problematic. Influences why our field is looked at in a derogatory way.

V-codes and other conditions are one in the same. But in both manuals they are not considered mental disorders.

Question 16

What is grooming?

Answer 16

When a person begins to approach a person “grooming” in luring their victim. A mans wife dies and the next door neighbor is a teen, a man asks the teen can you come in and help me kind of cook. He starts to get her into the house, build trust, all that is grooming behavior to finally perpetrate against her.

Question 17

DSM-5: What issues are covered by (3) Other conditions that may be a focus of clinical attention?

Answer 17

These conditions cover a range of issues including family upbringing issues, child maltreatment and neglect, adult maltreatment and neglect, spouse/partner abuse, education, housing, and occupational problems, legal issues, and nonadherence to medical treatment (this last issue we talked about numerous times re: the importance to safeguard against in your Informed Consent paperwork).

Example: You can tell that they added a lot more of them in, there is more of them. This is the general DSM-5 theme, they were categorized- any symptom you have there could be a diagnosis in the DSM.

Book: Saving Normal, criticizes the DSM-5 saying we are going way overboard with diagnosing everything under the sun. anything about the human condition can probably by like 17 of these disorders.

A lot of people who present clinically or who don’t, if they were asked they could report a lot of these conditions actively influenced in their life right now. Saving Normal goes into how this can be very damaging.

Question 18

DSM-IV-TR: What are Group 1 DSM disorders?

Answer 18

“Other Conditions that may be a focus of clinical attention (including the V-codes)”

Question 19

DSM-IV-TR: What are Group 2 DSM disorders?

Answer 19

Adjustment Disorders

Question 20

DSM-IV-TR: Diagnostic Criteria for Adjustment Disorders (Group 2)?

Answer 20

A. The development of emotional or behavioral symptoms in response to an identifiable stressor(s) occurring within 3 months of the onset of the stressor(s).

B. These symptoms or behaviors are clinically significant as evidenced by either of the following:

1. Marked distress that is in excess of what would be expected from exposure to the stressor
2. Significant impairment in social or occupational (academic) functioning

C. The stress-related disturbance does not meet the criteria for another specific Axis I disorder and is not merely an exacerbation of a preexisting Axis I or Axis II disorder.

D. The symptoms do not represent bereavement.

E. Once the stressor (or its consequences) has terminated, the symptoms do not persist for more than an additional 6 months

Note: A reaction to a stressor that is normal or expectable. These are technically psychiatric conditions. The letters are diagnostic criteria. Stressor is anything that you experience as a stress. Moving can be a stressor.

They go in Axis I and not in Axis IV.
D, they are saying that if you have bereavement you do not have an adjustment disorder.

Question 21

DSM-IV-TR: What are the subtypes for Adjustment Disorders?

Answer 21

309. 0 With Depressed Mood
     - Predominant manifestations are symptoms such as depressed mood, tearfulness, or feelings of hopelessness.
310. 24 With Anxiety
     - Predominant manifestations are symptoms such as nervousness, worry, or jitteriness or, in children, fears of separation from major attachment figures
311. 28 With Mixed Anxiety and Depressed Mood
     - Combination of anxiety and depressed mood
312. 3 With Disturbance of Conduct
     - Disturbance in conduct in which there is a violation of the rights of others or of major age-appropriate societal norms and rules (e.g., truancy, vandalism, reckless driving, fighting, defaulting on legal responsibilities)
313. 4 With Mixed Disturbance of Emotions and Conduct
     - Both emotional symp (depression, anxiety) and disturbance of conduct
314. 9 Unspecified
     - Maladaptive reactions (e.g., physical complaints, social withdrawal, or work or academic inhibition) to stressors that are not classifiable as one of the specific subtypes of adjustment disorder

Note: Subtypes are mutually exclusive, specifiers are not.

You write adjustment disorder with depressed mood, anxiety or with mixed anxiety, etc. Each subtype has a different numerical code, the appendix has all disorders listed by code number. So if your trying to get a disorder fast, you can look in the back and see all the subtypes listed.

Question 22

DSM-IV-TR: What are specifiers for Adjustment Disorders?

Answer 22

Acute
-Symptoms have persisted for less than 6 months

Chronic

• Symptoms have persisted for 6 months or longer
• By definition, sxs cannot persist for more than 6 months after the termination of the stressor or its consequences
• Thus, “chronic” specifier applies when duration of disturbance is longer than 6 months in response to a chronic stressor or a stressor with enduring consequences

Question 23

Example of a DSM-IV-TR diagnosis:

Answer 23

Axis I: 309.28 Adjustment disorder with Mixed Anxiety 	and Depressed Mood, Acute
Axis II: V71.09 No diagnosis on Axis II
Axis III: None
Axis IV: Relational, occupational
Axis V: 60

Question 24

DSM-IV-TR: what is an adjustment disorder?

Answer 24

Adjustment disorder is a residual category used to describe presentations that represent a response to an identifiable stressor that do not meet criteria for another specific Axis I disorder

Question 25

DSM-IV-TR: Major Depressive Disorder differential for Adjustment Disorder?

Answer 25

In example, if someone meets criteria for Major Depressive Disorder in response to a particular stressor, the diagnosis of Adjustment Disorder is not applicable.

However, Adjustment Disorder can be assigned as an additional diagnosis on Axis I provided the other diagnosis does not account for the symptoms that occur in reaction to the identified stressor; e.g., OCD.

note: Say someone has major depressive disorder because they have a horrible boss they meet criteria for Axis I disorder, but you can say it doesn’t account for all the hardship of dealing with a horrible boss. The specifier would be chronic, it is the chronic distress.

Question 26

DSM-IV-TR: Personality Disorders differential for Adjustment Disorders?

Answer 26

Personality disorders are often exacerbated by stress. If symptoms characteristic of the existing personality disorder are exacerbated, the additional diagnosis of adjustment disorder is not made.

If, however, symptoms not characteristic of an existing PD are present, then additional diagnosis of adjustment disorder may be justified

Question 27

DSM-IV-TR: NOS differential for Adjustment Disorders?

Answer 27

Not Otherwise Specified (NOS)

The diagnosis of adjustment disorder is predicated on the presence of a clearly identifiable stressor

Question 28

DSM-IV-TR: Acute Stress Disorder and Posttraumatic Stress Disorder differentials for Adjustment Disorders?

Answer 28

Acute Stress Disorder and Posttraumatic Stress Disorder are often confused with an Adjustment Disorder.

All 3 require the presence of a stressor. However, you diagnose ASD or PTSD if there is the presence of an extreme stressor and a specific constellation of symptoms.

Diagnose Adjustment Disorder if there is a stressor of any severity and “a wide range of possible symptoms.”

note: This is about like if you ruminate, if your hit by a car you will ruminate, there is hypersensitivity, what will you do, you have a specific trauma constellation. You go that way if you have them, if you don’t know your trigger than you go to adjusment disorder.

Major trauma- trauma hypersensitive/ particular profile, nervousness around noises, fearfulness about looking at news events- acute stress or ptsd
Run of the mill, not a particular profile, irritability due to an asshole boss- adjustment disorder

Question 29

DSM-IV-TR: Bereavement differential for Adjustment Disorder?

Answer 29

This diagnosis is assigned instead of Adjustment Disorder when the reaction is an expectable response to the death of a loved one

If reaction is in excess of, or more prolonged than, what would be expected, a diagnosis of Adjustment Disorder may be appropriate.

Adjustment Disorder is not diagnosed if symptoms are due to the direct physiological effects of a General Medical Condition, e.g., functional impairment associated with chemotherapy.

note: Your mother dies, your upset for two months. What would it be? A V code in group #1; If you have it for 8 months, grieving and suffering then it would be adjustment disorder with chronic specifier. Usually with depressed mood or mixed anxiety, etc. or when it is really bad is “unspecified”
Comps question: the worst case scenario of difficulty with death, well the easiest thing is that they are sad for a few months, DSM-IV-TR doesn’t even meet criteria for psych, if more than that then it is an adjustment disorder, that is better than it being unspecified. Why would it be better for someone to have it be with depression rather than unspecified? Why is it worse for a patient to come in? because they have not built a specific defense mechanism. All psychological symptoms are adaptations, so if somebody’s partner died 8 months ago and they are still grieving, they would move up to an adjustment disorder. If they are depressed and they can tell you they are not eating or sleeping they are telling you they have a defense, even though it is causing them distress they have a defense. Someone else comes in and tells you their partner died and they are like this -_- that is a real danger problem, as a clinician you would be very concerned. They have yet to even transform their psychological stuff into defense, a pre defense person is in much more trouble than someone whom has a defense. That is really worrisome, adjustment disorder with depression or depressed mood is concerning because they may commit suicide. But this is even worse, this is pre-defense.

Many patients come to us with defenses already and the defenses are problematic, if you have a crystal meth patient they use the crystal meth, as long as they keep using it, they have a defense. Usually the crystal meth keeps what they are defending together, someone who doesn’t even have a defense you have to build one in, that’s even harder.

A victim of rape with ptsd, the ptsd is a defensive response to her stressor. The symptoms are effin up her life but they are holding her together. The opposite presentation of that would be known as flooding. The patient comes in, sometimes you don’t even have to say anything, you start to look at them and they fall to the ground in a fetal position. They are flooded, they are regressed.

Example, the blank VOID in teens, then they look at their phone ,the phone is the only thing keeping them alive, it is a HUSK personality, very hard to treat because they are voidant. Some clinical work involves putting in a defense. Sometimes you might have to tell a patient, have you ever thought about using cocaine again?

Question 30

DSM-5: What revisions were made to Adjustment Disorder?

Answer 30

In DSM-5, Adjustment Disorders are no longer a separate diagnostic category (that category was deleted), but were moved to a group of disorders within the new “Trauma and Stressor-Related Disorders” diagnostic category.

See pp. 286-289 of DSM-5 to review the Adjustment Disorders. You will see that on p. 287 the Adjustment Disorder subtypes of DSM-IV-TR have been retained in DSM-5.

Note that if a patient evidences a specific set of bereavement-related symptoms, you will diagnose with “Persistent Complex Bereavement Disorder”(see p. 289).

Note: Maybe they are not as different as we thought. Lets put them together.

Basically if you loose your dog or your pet rock dies, it does not frequent matter, you will get the persisten complex bereavement disorder. The take away you should have about grief or mourning is that our field doesn’t really know what to do with that event.

Question 31

DSM-IV-TR: What does Hedges say on culture?

Answer 31

“A clinician who is unfamiliar with the nuances of an individual’s cultural frame of reference may incorrectly judge as psychopathology those normal variations in behavior, belief or experience that are particular to the individual’s culture” (American Psyschiatric Association, 1994, DSM-IV, p. xxiv).

Note: Hedges- listening perspectives, book of practicing defensively. He has an ethical book of practicing defensively (best ethical text around), he also has several books on cultural and sue and sue are also experts.

Dsm-IV first place where the DSM commented on culture. TR added the cultural formulation outline

Basically is saying if you just assess a patient from your own cultural perspective your messing up in a huge way. If you don’t take in their particular culture, like in the Greek culture- the Greeks love to mourn, traditional Greek culture the woman is expected to wear black for like a year. This woman would not be diagnosed with bereavement, because it is culturally acceptable.

Clinicians were previously overdiagnosing things, this was the first cross cultural mandate. We can not diagnosis without any attention to the cultural they are embedded in.

Question 32

Where did DSM-IV-TR attempt to address cultural issues?

Answer 32

DSM-IV-TR attempted to address cultural issues in Appendix I, where they provide the “Outline for Cultural Formulation” and a “Glossary of Culture-Bound Syndromes.”

Question 33

DSM-IV-TR: What are the 5 components included in the “Outline for cultural formulation”?

Answer 33

The “Outline for Cultural Formulation” included 5 components that are to be noted or conceptualized when assessing a patient: the cultural identity of the individual, cultural explanations of the individual’s illness, cultural factors related to the psychosocial environment and levels of functioning, cultural elements of the relationship between the individual and the clinician, and the overall cultural assessment for diagnosis care.

note: Outline- 5 step thing that tells you you should do a cultural evaluation of the person

Question 34

DSM-IV-TR- Culture: What did the Glossary feature?

Answer 34

This section was then followed by the Glossary, which featured interesting manifestations of symptoms/syndromes throughout the world.

Question 35

DSM-IV-TR- Culture: What did Hedges argue?

Answer 35

Hedges, however, argued that “The Outline for Cultural Formulation introduced in the DSM-IV provided a framework for assessing information about cultural features of an individual’s mental health problem and how it relates to a social and cultural context and history.”

Question 36

DSM-5: on behalf Hedges, culture now includes (2: sought to…& now states…)?

Answer 36

DSM-5 sought to beef up issues of culture and culture sensitivity when diagnosing patients.

DSM-5 now states that, “Understanding the cultural context of illness experience is essential for effective diagnostic assessment and clinical management.”

note: It is emphasizing cultural more, in the way they write about it.

Based in Orange, buy his book, practicing defensively (how we are aware of ethical issues) and several books on cross cultural

Question 37

In the DSM-5, Culture from Hedges refers to…?

Answer 37

Culture: refers to systems of knowledge, concepts, rules, and practices that are learned and transmitted across generations. Culture includes language, religion, and spirituality, family structures, life-cycle stages, ceremonial rituals, and customs, as well as moral and legal systems (notice that sexual orientation is not included here).

note: Culture and race are different. Internship interviews: person came in and said are you all interested in cross cultural factors, the person said define cultural! Ethnicity is rooted in genetics.

Question 38

DSM-5: Race is a culturally…?

Answer 38

Race is a culturally-constructed category of identity that divides humanity into groups based on a variety of superficial physical traits attributed to some hypothetical intrinsic, biological characteristics; the concept of race has no consistent biological definition, but it is socially important because it supports racial ideologies, racism, discrimination, and social exclusion, which can have strong negative effects on mental health.

There is evidence that racism can exacerbate many psychiatric disorders, contributing to poor outcome, and that racial biases can affect diagnostic assessment.

Question 39

DSM-5: Ethnicity is a culturally…?

Answer 39

Ethnicity is a culturally-constructed group identity used to define peoples and communities. It may be rooted in a common history, geography, language, religion, or other shared characteristics of a group, which distinguish that group from others. Ethnicity may be self-assigned or attributed by outsiders.

note: The water polo team, every year they have a practice that they swim naked. That would be culture?

Question 40

DSM-5 replaced previous cultural formulation with the Cultural Formulation Interview which is?

Answer 40

A brief semi-structured clinical interview with 16 questions that assess the client’s subjective view (person-centered approach) of cultural factors re: the presentation of symptoms (effort is to help diminish the clinician’s own cultural biases and to help the clinician avoid stereotyping the patient).

Question 41

DSM-5: Hedges notes that the Cultural Formulation Interview (CFI) will be very helpful given that?

Answer 41

“Experiences of racism and discrimination in the larger society may impede establishing trust and safety in the clinical diagnostic encounter ….. Effects may include: problems eliciting symptoms, misunderstanding of the cultural and clinical significance of symptoms and behaviors, and difficulty establishing or maintaining the rapport needed for an effective clinical alliance.”

Question 42

DSM-5; What are the three general perspectives guiding ethics?

Answer 42

(1) divergent ethics
(2) convergent ethics
(3) dynamic ethics

note: Ethics are guided by one of three general perspectives

Question 43

DSM-5: What are divergent ethics?

Answer 43

Relativism (avoids imposing value judgments and allows each cultural context to be understood in its own terms)

Question 44

DSM-5: What are convergent ethics?

Answer 44

Absolutism (disregards problems of ethnocentrism and applies the same evaluative criteria across cultures in the same fixed and unchanging perspective)

Question 45

DSM-5: What are dynamic ethics?

Answer 45

Universalism (assumes that while psychological processes, such as pleasure and pain, might be the same in all cultures, the way they are manifested is significantly different in each culture)

Question 46

DSM-5: What is the key issue with ethics and culture from Hedges?

Answer 46

“Ethical principles generated in one cultural context cannot be applied to other substantially different cultural contexts without modification ….”

Question 47

DSM-5: What are the four ethical principals for multicultural practice?

Answer 47

(1) acknowledgement and valuation of diversity
(2) the importance of each clinician’s cultural self-assessment
(3) acquisition of cultural awareness
(4) adaptation of skills

Question 48

DSM-5: What is acknowledgement and valuation of diversity?

Answer 48

Ethical principal for Multicultural Practice:

In terms of understanding how race, culture, and ethnicity contribute to the uniqueness of each individual, family, and community, as well as how diversity exists within each ethnic, cultural, and racial group.

Question 49

DSM-5: What is the importance of each clinician’s cultural self-assessment?

Answer 49

Ethical principal for Multicultural Practice:

In regard to his or her own culture and its impact on personal and professional beliefs and behaviors.

Question 50

DSM-5: What is acquisition of cultural awareness?

Answer 50

Ethical principal for Multicultural Practice:

The systematic acquisition of cultural awareness of each client’s background; and

Question 51

DSM-5: What is the adaptation of skills?

Answer 51

Ethical principal for Multicultural Practice:

The adaptation of skills to the needs and styles of each client’s culture.