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This chapter examines the diagnosis of personality disorder in general and narcissistic personality disorder (NPD) in particular. After reviewing the history of the construct of NPD, the reasons why it was targeted for elimination in the DSM-5 and the counter-arguments against its elimination are described. NPD was originally eliminated from the manual because it was not considered to be real, but was later reinserted. Opinions differ about whether it was reinserted because it had some clinical reality, or put back in for only political reasons. The chapter concludes by looking at why constructs for personality disorder such as NPD are included in the domain of psychiatry disorder. It is argued that competing versions of the essentialist bias interfered with the implementation in the DSM-5 of a competition between categories and dimensions that would have set up conditions in which progress would have had a better chance of occurring.

Approximately 10–20% of students experience a mental health problem during their school-age years. The Every Student Succeeds Act (ESSA) assumes school-based mental health providers will serve these students in schools. The DSM-5 made five significant changes from previous editions. Enabling students with mental disorders to be eligible for school-based services requires familiarity with the assessment requirements of the Individuals with Disabilities Education Act (IDEA) and Section 504 of the Rehabilitation Act. School counseling can be provided using a multitiered system of supports ranging from universal prevention to intensive intervention. The best way to serve students is to collaborate with teachers, parents, community providers, and even school administrators. Finally, students’ progress toward general education goals should be monitored regularly so that they can graduate on time, become employed, and be engaged citizens.

Students with specific learning disorder (SLD) account for 35% of all students receiving special education services. In the DSM-5, SLD combines four previous diagnoses into one. The Individuals with Disabilities Education Act (IDEA) and the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) agree that children should be excluded from being diagnosed if the disorder is primarily due to environmental, cultural, or economic disadvantage. They differ on the DSM-5’s exclusion for the lack of proficiency in the language of instruction. Schools can screen for SLD using the testing or the dual-discrepancy model of response to intervention (RTI). Assessment requires a comprehensive evaluation by the school. Students with SLD often suffer from poor social skills and low self-esteem. Intervention may be titrated according to the student’s level of need using multitiered systems of support. Collaborating with teachers, parents, and community providers is especially important for these students. A case example illustrates how an ecological approach can help students grow and learn.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) does not describe the typical symptoms noted by researchers of pediatric bipolar disorder under bipolar I or II because there is a great deal of controversy over whether bipolar disorder exists in children. Researchers who have gathered data on children who experience irritability, mood swings, elevated moods, inattention, hyperactivity, defiance, compulsive behaviors, sadness, and sleep problems have called the condition either pediatric bipolar disorder (PBD; for children 3–12) or early-onset bipolar disorder (EOBD; for children 13–18). Students with PBD or EOBD have little control over their mood swings and irritability, calling for a combination of pharmacological and environmental interventions along with close monitoring of any side effects and evaluation of the effectiveness of interventions. Bipolar disorder in children is considered a progressive condition that manifests differently as the child ages, moving from more irritability, restlessness, and rapid mood swings to less frequent mood swings but longer depressive moods.

This chapter reviews the literature on depression in youth. Prevalence rates, which increase in the middle and high school years, are discussed, as is the importance of addressing depression in youth. The school social worker’s role in assessment and prevention/intervention is explored given the current research status in the field. Targeted programs treating those who are at risk of depression are more effective than universal prevention, although these might be more difficult to deliver, given issues surrounding consent and potential stigma. Interventions shown to be effective for depressive disorders include cognitive-behavioral therapy and interpersonal therapy. A case study is provided.

Eating disorders among school-age children have become an increasingly serious mental health concern over the past decade. Children and adolescents from 5 to 18 years old are being diagnosed with eating disorders, and the latest edition of the Diagnostic and Statistical of Mental Disorders, Fifth Edition (DSM-5) has expanded the eating disorders section to allow for more precise diagnoses of these disorders. Children and adolescents with eating disorders can suffer from anxiety, depression, and other mental disorders underlying the eating disorder. Youth often hide their eating disorder from adults, making it difficult for school professionals to assist them. This chapter includes evidence-based information on the assessment and diagnosis of and interventions for school-age children with eating disorders.

Students who meet criteria for disruptive, impulse control, and conduct disorders generally present with a wide range of challenging behaviors that impede their ability to function appropriately at school and at home. Understanding the differential diagnosis and comorbid manifestations of these disorders—particularly the two most common disruptive disorders (i.e., oppositional defiant disorder and conduct disorder)—can assist school practitioners in addressing students’ behavior and socioemotional well-being in school. It is also important that school practitioners are knowledgeable about Individuals with Disabilities Education Act (IDEA) categories for which students exhibiting the symptoms of these disorders are most likely to qualify for school-based services. This chapter provides resources to assist schools and school-based practitioners in implementing universal screening, progress monitoring, and rapid assessment of students, as well as evidence-based psychosocial interventions to meet the needs of students with disruptive, impulse control, and conduct disorders.

This chapter moves toward a fundamental conceptual reorientation of disorder around risk by engaging directly the three major competing theories within the philosophy of medicine, those of Boorse, Wakefield, and Culver & Gert. The chapter argues that, in light of the development of biomarkers, each theory is inadequate, and proposes a reorientation of the concept of disorder around probability of harm associated with biological variation. The chapter defends this reoriented concept, and shows that, rather than being threatened and confused by the development of bioprediction, it is fortified; conventional diagnostic nosology is replaced by a actuarial risk assessment that brings to the fore debate on what types of risks matter and how much. As a practical consequence of this analysis, this chapter raises concern about the removal of the clause about risk of harm from the concept of mental disorder in the transition from DSM-IV-TR to DSM-5.

This chapter illustrates some of the benefits of conceiving of disorder in terms of probability of harm (a Probability Dysfunction), one of which is the possibility to recognize that specific disorder names (nosology) often act as heuristics for “risk bands”, that is, levels and types of risk of harm, that can be used to guide appropriate responses. Thinking carefully about the how well a new category name accurately captures the risk band of those within the category, for example, as estimated by biomarkers, the chapter argues, is sometimes sufficient to attenuate many of the practical concerns in debates about how to handle high-risk states. This chapter applies this strategy, informed by the Probability Dysfunction concept of disorder, to the debate on high risk states first psychosis and dementia, for example ‘prodromal’ or ‘preclinical’ Alzheimer Disease.

Mental illnesses are more common than cancer, diabetes, or heart disease. Ongoing research has advanced knowledge on the underlying biology, prevention, and treatments for mental illnesses. Unfortunately, most people who need treatment do not receive it. This chapter provides an introduction to serious mental health disorders in children and adolescents and addresses barriers to people receiving effective treatments. It addresses federal efforts focused on earlier identification of mental illness and improving access to effective treatments. While this book focuses on diagnosing mental illness in children and adolescence, Chapter 1 puts into context what children and adolescents need for good mental health; the importance of partnering with youth and caregivers, addressing issues from a strengths perspective, and engaging in culturally sensitive practice; and the importance of understanding that people are not their mental illness. Finally, an overview of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the overall structure of the book is provided.

This chapter lays the framework for the book by defining and discussing trauma as well as describing the many aspects of trauma. An overview on the research on trauma will be presented along with descriptions about the various types of trauma clients may experience. A brief overview of common evidence-based treatments currently used to help clients deal with their trauma and with their limitations is also presented. The chapter provides a review of the SFBT trauma research and discusses ways SFBT can provide an alternative approach to helping clients. The chapter concludes by discussing why and how the SFBT approach might be more beneficial for clients managing trauma.

This chapter describes how SFBT has been used in the treatment of substance use and relies on the clinical literature to illustrate interventions. Specific ways to engage clients with substance use will be covered, including the questions to ask in order to promote change. In addition, this chapter will describe a case where SFBT has been used with a client with alcohol use disorder and explain how SFBT may be used in groups to treat substance use. Finally, this chapter will discuss the emerging outcome literature on SFBT with clients who have substance use including studies that assess substance use and trauma.

In this chapter, the authors provide a broad overview of diagnosable psychiatric disorders, their symptoms, and examples of current theoretical and empirical thought underlying these conditions. In providing a primer concerning mental health, they first review the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), with respect to how psychopathology is defined and the nature of the diagnostic system. They then shift to definitions, key examples, and example theories for (i) clinical disorders (e.g., depressive and anxiety disorders), (ii) personality disorders (with an emphasis on borderline and antisocial personality disorders), and (iii) substance use disorders. While this chapter draws heavily from the DSM-5, such is done primarily for educational and illustrative purposes within the broader context of discussing key issues related to the behavioral science of firearms.

Philosophers of science have long argued that establishment of reliable classificatory schemes is a crucial first step in the beginning of measurement in any science. This survey of the emergence of diagnostic practices around schizophrenia in the 20th and 21st centuries supports the highly provisional nature of the diagnosis and its susceptibility to a variety of intellectual, social, and cultural forces in the profession of psychiatry and beyond. The field of psychiatry, although largely deemphasizing the role of classification over the first half of the 20th, has placed increased emphasis on the reliability of classificatory schemes over the past 60 years. Although the goal of enhanced reliability since DSM-III has clearly been successful, accompanying incremental validation of psychiatric classifications remains largely absent, with specific findings from neurobiology or psychological science largely unable to support these diagnostic distinctions.

There has been renewed interest in psychiatric classification, with the recent development of the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the 11th edition of the International Classification of Disease (ICD-11), and the Research Domain Criteria (RDoC) framework. This chapter will consider issues relevant to cognitive enhancement, particularly interventions for individuals with subthreshold symptoms, from the perspective of debates in psychiatric classification. DSM-5, ICD-11, and RDoC each take a somewhat different approach to delineation of the normal from the pathological, and so to the conceptualization of individuals with subthreshold symptoms. For the foreseeable future, an integrative approach to the assessment and treatment of patients with subthreshold symptoms will emphasize the fuzziness of the boundary between enhancement and treatment, will incorporate DSM, ICD, RDoC and a range of other constructs, and will weigh up a broad range of relevant facts and values in clinical decision-making.

This chapter discusses case studies where, in the name of treating a woman’s sexual disinterest/resistance, she is not etherized, overpowered, or pressured. Instead, she is taught how to become more attuned to her own feelings, to her own “authentic self.” In this chapter, we see how power in sex therapy sometimes operates more like a velvet glove than a mailed fist. We see how sex therapists sometimes operate with the understanding that a sexually disinterested woman may desire sex more if she feels she has the power to refuse. Thus conceived, sex therapy sometimes appears to support a woman’s autonomy and empowerment, yet, paradoxically, the normal conclusion of these cases is that the sexually disinterested/resistant woman becomes less resistant and more sexually compliant.

This chapter on schizophrenia genetics examines the experimental basis of searches for schizophrenia genes, new ways to think about them, and some preliminary results of the post-2005 genome-wide association studies (GWAS) results. A number of recent quotes from schizophrenia researchers are also provided. Schizophrenia is characterized as a dimensional disorder using the analyses from chapters 4 and 5 of prototypes. A backdrop of classical behavioral and psychiatric genetics, recent molecular genetics results, and some probable further developments of DSM-5 are discussed. Schizophrenia's etiology is presented using the Lewis model, including cognitive aspects of the disorder, genetic results, and multilevel components such as cells and circuits. This model illustrates how the partial reduction account from chapter 5 can be extended to cover human psychiatry. Also considered is how genes versus SNPs should be conceived, and the "endophenotypes" concept and some epigenetic approaches to schizophrenia genetics are discussed.