By definition, counseling is a “professional relationship that empowers diverse individuals, families, and groups to accomplish mental health, wellness, education, and career goals” (ACA, 2013, para. 2). To accomplish this role, practitioners often incorporate diagnosis as one component of the counseling process. Therefore, it is not surprising that ethical guidelines for the profession and accreditation standards for counselor education programs encourage counselors to have an understanding of diagnostic nomenclature. For example, the ACA Code of Ethics (ACA, 2014) Section E.5.a., Proper Diagnosis, requires counselors to “take special care to provide proper diagnosis of mental disorders” (p. 11). The Council for Accreditation of Counseling and Related Educational Programs (CACREP; 2009) requires that counselors learn strategies for collaborating and communicating with other human service providers as part of their common core curricular experiences. Thus, learning outcomes for clinical mental health counselors require demonstrated knowledge regarding the most recent edition of the DSM. Ask any professional counselor and he or she is likely to agree that a thorough understanding of the DSM is an essential aspect of interdisciplinary communication.

Despite widespread guidance encouraging counselors to be familiar with the DSM, utilization of the manual is not without challenges and controversy. Many professional counselors feel unprepared or uncomfortable when faced with the task of assigning clients a diagnosis (Mannarino, Loughran, & Hamilton, 2007). Other professionals are conflicted about the DSM‘s focus on psychopathology and feel the mechanistic approach reduces “complex information about people into a few words . . . describing a person’s parts (symptoms) as static” (Mannarino et al., 2007). As counselors are only too aware, clients cannot be encapsulated into fixed categories. Each client comes to counseling with numerous sociocultural issues that the counselor must consider prior to making a diagnosis and putting together an approach for treatment. This is also particularly important given a large body of research that provides support for the far-reaching impact of poverty and social class on psychological and emotional well-being (e.g., American Psychological Association, 2007; Belle & Doucet, 2003; Groh, 2006). For example, studies of children and adolescents from lower socioeconomic families report higher instances of emotional and conduct problems, including chronic delinquency and early onset of antisocial behavior (McLoyd, 1998). Low income has also been correlated to higher levels of family distress and discord as well as higher rates of parental mental illness.

We wrote this Learning Companion to make the DSM-5 accessible to professional counselors by breaking down the complexity of the changes and additions found within the revised manual. Because the CACREP 2009 Standards require that programs “provide an understanding of the nature and needs of persons at all developmental levels and in multicultural contexts, . . . including an understanding of psychopathology and situational and environmental factors that affect both normal and abnormal behavior” (p. 9), we believe it essential that new and seasoned professional counselors, counselor educators, and counseling students have easily accessible and accurate information regarding the DSM-5 and implications of changes for current counseling practice.

The DSM-5, after 14 years of debate and deliberation, was intended to be the most radical revision to date (Frances & First, 2011; Jones, 2012b; Miller & Levy, 2011). Beginning in 1999, a year before the DSM-IV-TR was published, APA began collaboration with the National Institute of Mental Health (NIMH) on a new edition. The intent of these meetings was to develop a more scientifically based manual that would increase clinical utility while maintaining continuity with previous editions (APA, 2012a). The process began with an initial DSM-5 Research Planning Committee Conference, held in 1999, in which APA and NIMH deliberated on a research agenda and priorities for the new manual. Additional conferences, sponsored by APA, NIMH, and WHO, took place in 2000 and resulted in the formation of six work groups. These initial work groups focused on nomenclature, neuroscience and genetics, developmental issues and diagnosis, personality and relational disorders, mental disorders and disability, and cross-cultural issues. In 2002, a series of six white papers was published with the intent of “providing direction and potential incentives for research that could improve the scientific basis of future classifications” (Kupfer, First, & Regier, 2002, p. xv). Two final manuscripts were published in 2007. One focused on mental disorders in infants, young children, and older persons and the other on gender, cultural, and spiritual issues.

After the release of the initial research agenda for the DSM-5, it became clear that further deliberation was needed with regard to nomenclature, neuroscience, developmental science, personality disorders, and the relationship between culture and psychiatric diagnoses (APA, 2000; Kupfer et al., 2002). Steered by APA, NIMH, and WHO, 13 conferences were held between 2004 and 2008 in which participants discussed relevant diagnostic questions and solicited feedback from colleagues and other professionals regarding potential changes. Findings from these conferences facilitated the research base for proposed revisions for the DSM-5 and fueled the agenda of the DSM-5 work groups (see Kupfer et al., 2002, for the full DSM-5 research agenda).

In 2007, APA officially commissioned the DSM-5 Task Force, made up of 29 members, including David J. Kupfer, MD, chair, and Darrel A. Regier, MD, MPH, vice-chair (APA, 2012a). The DSM-5 Task Force expanded the work groups from six to 13. These included attention-deficit/hyperactivity disorder (ADHD) and disruptive behavior disorders; anxiety, obsessive-compulsive spectrum, posttraumatic, and dissociative disorders; childhood and adolescent disorders; eating disorders; mood disorders; neurocognitive disorders; neurodevelopmental disorders; personality disorders; psychotic disorders; sexual and gender identity disorders; sleep-wake disorders; somatic symptoms disorders; and substance-related disorders. Although each of these work groups investigated specific disorders, cross-collaboration was common. Kupfer and Regier provided clear direction to the work groups to, among other things, eradicate the use of not otherwise specified (NOS) diagnoses within categories, do away with functional impairments as necessary components of diagnostic criteria, and use empirically based evidence to justify diagnostic classes and specifiers (Gever, 2012; Regier, Narrow, Kuhl, & Kupfer, 2009). With these marching orders, each work group proposed draft criteria and changes for the new manual.

Three rounds of public comment regarding proposed changes took place between April 2010 and June 2012. An estimated 13,000 mental health professionals commented on the proposed criteria (APA, 2012c, 2012d). Additionally, mental health professionals conducted field trials to “assess the feasibility, clinical utility, reliability, and (where possible) the validity of the draft criteria and the diagnostic-specific and cross-cutting dimensional measures being suggested for DSM-5