by Barbara McLaughlin, MDiv, LCSW

Charles D. Safford, LCSW

Barbara McLaughlin, MDIV, LCSW is the clinical supervisor at Advantage BHS in Athens, GA, and an experienced writer and trainer in the field of social work. She has almost 20 years of experience as a clinician and has served as the Director of Social Work at the Clark Center at Memorial Medical Center

Charlie Safford is the president and owner of  Mr. Safford has over thirty-five years of post-masters experience as a clinical therapist. In addition to his work as a therapist, he has been a trainer and training developer for over twenty years.

This course addresses diagnosis using the DSM-5 and the major changes to the Diagnostic and Statistical Manual from version IV-TR to version 5.  

This course is the copyrighted property of and may not be copied in part or in entirety without the express written permission of For information on how to secure permission to use this course or any part of this course, contact us at:


This course may not be utilized without first making proper payment. Entering this course in an unauthorized manner would represent an ethical violation. 

Course Objectives

Objectives for this Course

This course is designed to improve the capacity of health professionals to make accurate diagnoses utilizing the DSM-5. When the trainee completes this course, he or she will be able to:

- Comprehend the history, use, and structure of the DSM-5.

- Understand the organization of the DSM-5

- Know how to utilize the DSM-5 for diagnosis

- Grasp the most common diagnostic errors and how to get them right

- Comprehend the key changes from the DSM-IV-TR to the DSM-5



- to complete this course in its entirety

- to complete all exercises contained in this course

- to complete the course post-test

- to complete the evaluation form after taking this course

Your decision to continue at this time constitutes acceptance of this agreement.


Easy Navigation Instructions  

You may move through this course by simply scrolling down, using the scroll bar on the right side of the page. You may also move quickly to any specific page in the course by clicking on the Pages tab on the left side of the course. This will open thumbnail pages. Using the scroll bar on the left, simply scroll down to the thumbnail of the page you wish to move to, and click on that thumbnail. The page you have chosen will immediately open.

At the bottom of the page of each section, you will also find a navigation button that allows you to move easily to the next section. To move to the next section in the course, simply click on the Next Section button.

Section I: Introduction
Section II: Overview of the DSM-5
Section III: Comprehensive Assessment and Diagnosis
Section IV: Important Changes from the DSM-IV-TR to the DSM-5
Section V: Important Structural Changes to the DSM
Section VI: Diagnostic Terms and Categories No Longer to Be Used in the DSM-5
Section VII: Diagnostic Categories Removed/Replaced in the DSM-5
Section VIII: Significant New Diagnoses Introduced into the DSM-5
Section IX: Important Reformulations of Diagnostic Criteria
Section X: Diagnostic Criteria with More Subtle Reformulations
Section XI: Addressing Diagnostic Complexities – Bipolar and Related Disorders
Section XII: Addressing Diagnostic Complexities – Depressive Disorders
Section XIII: Addressing the Complexities - Anxiety Disorders
Section XIV: Addressing the Complexities – Schizophrenia Spectrum and Other Psychotic Disorders
Section XV: Addressing the Complexities - Substance Use Disorders
Section XVI: Addressing the Complexities – Personality Disorders
References and Test


Section I: Introduction 

As mental health practitioners, it is imperative to understand and apply mental health diagnoses appropriately and accurately. Diagnosis is made with the classification system found within the Diagnostic and Statistical Manual, a document that has been very carefully assembled, adapted and improved over the years by leading mental health professionals in a carefully supervised and ongoing process.

 A new version of the Diagnostic and Statistical Manual, the DSM-5, was released in March of 2013 with significant changes from the prior version, the DSM-IV-TR. For more experienced clinicians with a good working knowledge of the DSM-IV-TR, it will be important to transition to the DSM-5 and incorporate the changes into their diagnostic process. Sections IV-X of this course will address in some detail the key changes that mental health clinicians must understand in order to record accurate diagnoses under the new guidelines.

The Diagnostic and Statistical Manual is not a perfect mechanism for presenting an absolutely clear picture of a client's problems. After all, clients are human beings, with complex human problems. Neither they - nor their problems - can ever be fully encapsulated in a series of numbers without omitting as much information as is captured. 

Accurate diagnosis allows for consistency and standardization throughout all mental health disciplines and for important information about the general nature of a person's problems to be quickly disseminated to all professionals engaged in the client’s treatment.

Accurate diagnosis also allows for common ground to be established in terms of research concerning the effectiveness of various kinds of treatment for the cluster of problems that are defined by a specific diagnosis. Each clinician has certain ethical obligations to provide the most effective treatment approaches possible for each client. This research base has important implications for choosing the best treatment approach and diagnostic formulation for any particular client.

Furthermore, to some degree accurate diagnosis is also a valid part of the process of performing a thorough evaluation of the client, in preparation for shaping the client's treatment plan. The conscientious clinician does not allow the diagnosis to blind him or herself to the other aspects of the whole person who is seeking help, but neither does s/he ignore the information contained in the diagnosis. Diagnosis has its appropriate place in the process of understanding and working with the client's problems – over and above the implications of keeping accurate records for insurance companies and meeting ethical standards.

For these reasons and more, it is – we repeat – imperative for the clinician to understand and apply accurate diagnoses. Part of the problem, for most clinicians, is that clear and accurate diagnosis is not always easy, even for practitioners with a good deal of clinical experience. There are a great number of diagnostic categories to keep track of, many of which have similar or overlapping symptoms.

For example, anxiety and depression are key elements of a great number of diagnoses. However, the anxiety and depression can manifest themselves in markedly different – or even very subtle - ways within the context of different disorders. Depression that has resulted from the trauma of open heart surgery has a very different etiology than depression that comes from a bi-polar disorder, even though many of the key features that are presented by the client may appear very similar in nature. 

Simply identifying the presence of anxiety and depression, while important in terms of beginning to define some areas of focus in the treatment planning, is insufficient to make an accurate diagnosis. The etiology or origins of the presenting symptoms is important for making an accurate diagnosis. There are degrees of anxiety and depression that must be factored in, as well as investigation of the variety of other symptoms that help determine what the diagnosis might be. 

The purpose of this course is to help the trainee gain a deeper and more detailed understanding of the process of making an accurate diagnosis. We will attempt to focus on some of the areas that are most likely to create confusion for the clinician, areas where subtle differences between problem presentation will make the selection of a diagnosis difficult and confusing. We will attempt to clarify areas with which even more experienced clinicians are likely to struggle in choosing between diagnoses.

When the course is complete, the clinician will have a better understanding of some of the areas that are most likely to create inaccurate diagnoses in the course of her/his career. This improves the professionalism of the clinician who provides services, and improves the state of the mental health profession as a whole.