Diagnosing Relational Problems

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(1) How would you incorporate the DSM-5 into the assessment phase with a couple or family? (Include the relational V codes and Z codes in your discussion).

"Relational problems are clinically significant behavioral or psychological syndromes or patterns that occur between or among individuals and that are associated with present distress or disability or with a significant increased risk of suffering death, pain, disability, or an important loss of freedom. Relational problems (e.g., partner relational problems, partner abuse, child maltreatment) are included as Axis I disorders in the DSM-IV as V-codes [i.e., "Other conditions that may be a focus of clinical attention"]. (DSM-IV-TR online For example, the V61.9 code describes "Relational Problems related to a mental disorder, or General Medicine condition. Lawrence et al (2009) suggest that once it is recognized that some form of clinical intervention is necessary, the DSM V can be incorporated (using the relational codes) into the therapeutic process to address the role of relationships. The family and relation processes based on the Diagnostic and Statistical Manual of Mental Disorders ((DSM-IV-TR [APA], 2000) criteria allow for the inclusion of diagnoses within specific contexts on Axis I; and on the Global Assessment of Relational Functioning (GARF) scale. Primarily, the DSMs' three primary goals are to provide a structure for understanding the cases of mental disorders, (b) provide a common language in which to describe the disorder, and (c) to provide clinical treatment for the disorder (Lawrence, Beach & Doss, 2009).

Based on DSM criteria, relation problems are included in the diagnoses when the problems become the focus of clinical attention. When the relation problems are clinically significant, they are presented on Axis I; however, when they are not the focus of clinically importance, the symptoms are placed on Axis IV (psychosocial and environmental conditions). Lawrence et al (2009) describe situations in which it may be appropriate to assign V (relational) codes into a diagnosis. First, there are relational syndromes described as "well-defined, identified patterns of interaction between relationship members"(p. 171). Relational syndromes are associated with clinically significant impairment in functioning among one or more members within the relationship unit.

Secondly, the category of "Central relational processes is an expansion of V61.0 [Relational Problems related to a medical disorder or General medical condition]. It must be a number of illnesses not associated with functional impairment. Finally. There are relational specifies applies to the individual current presentation (e.g., mild, moderated, partial ...