eNewsletter - April 2015

Behavioral Health Partners

The DSM-5: More than 900 Changes in Fewer than 900 Words
By Nadjeh Awadallah, EdD, LCPC

“When the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was released at the American Psychiatric Association’s Annual Meeting in May 2013, it marked the end of more than a decade’s journey in revising the criteria for the diagnosis and classification of mental disorders.”
-David Kupfer, MD, Chair, DSM-5 Task Force

Dissecting all of the changes to the most recent iteration of the DSM would take up far more space than what is allotted in a one-page article for a monthly newsletter. So, the objective of this article is to highlight some of the major changes to the manual.

The first notable change is right on the cover of the manual: de-Romanized numerals. DSM uses 5 rather than V. The reason for the shift from the Roman numerals we’ve all grown accustomed to Arabic numerals is the intent to move away from revisionary editions that take years to publish. In other words, there are no more “TR” designations. This change is designed to make the manual more organic, opening the door for micro-revisions, particularly with regard to neuro-scientific discovery/advancement. This paves the way for versions 5.1, 5.2, 5.3, etc, with more rapid reaction to developments within the industry.

The elimination of multi-axial designation of disorders has been one of the most publicly noted changes to the manual. The intent of this change was to structure the DSM as a medical or nosological system, in order to harmonize with the International Classification of Diseases (ICD), a diagnostic tool utilized by the World Health Organization (WHO).

The ICD is a standardized diagnostic tool that was developed to track medical health and diseases throughout the world for epidemiological, health management and clinical purposes. The ICD has been translated into over 43 languages and is used globally in the provision of medical treatment. This coding system allows for the tabulation of the incidence and prevalence of various diseases shedding light on the general health of different populations in different environments. Therefore, the DSM-5 denotes psychological disorders to be general medical disorders with a biomedical orientation.

Specifically, Axis I and II essentially are now combined. Axis III and IV and psychosocial stressors, are no longer differentiated either. Psychosocial context, while important, is not regarded within the DSM-5 to be essential to diagnosis. Auxiliary contextual information is helpful, but if these disorders are to be truly regarded as epiphenomenal, the disorder is not defined by the cause.

In other words, a broken arm is still a broken arm whether it is the result of a bicycle accident or a plane crash. The goal of normalizing the perception of psychological disorders follows this logic. In fact, the actual Global Assessment of Functioning (GAF) scores have been eliminated altogether due to their subjective nature and considerable lack of validity and reliability.

Furthermore, neuroscience is at the forefront of the revision. For example, the first chapter of DSM-5 is entitled “Neurodevelopmental Disorders” which illustrates this change. The recurring theme is that psychological distress and disorders are founded in underlying brain pathology. The DSM-5 is ideologically themed in biological reductionism.

Again, it is impossible to layout all major changes to the DSM in this short article, but here are some other notable innovations to the manual:

  • Numerical coding has become alphanumeric coding
  • Contextual factors (Axis IV) are conveyed via V Codes and Z Codes. In the DSM-5, there is an expanded list of codes used to document pertinent contextual information to be included alongside mental disorders and medical conditions in a non-axial diagnosis.
  • “Not Otherwise Specified” has been replaced with “Other Specified” and “Unspecified”
  • Principle or Provisional diagnoses established
  • Conceptual/Philosophical Changes include establishment of Autism Spectrum Disorder; OCD and PTSD are no longer Anxiety Disorders.
  • Schizophrenia has become extrapolated into a spectrum of disorders.
  • Somatoform disorders are gone, because intra-psychic distress precipitating psychological disorder does not match the biological reductionism model; relaying back to the theme that there must be a biological foundation of the disorder. Somatic symptoms disorders have been redistributed in classifications throughout the DSM 5.
  • Bipolar disorder now emphasizes symptoms being a disorder of energy and level of activity in addition to the feature of mood-variability. The emotional presentation use to be the predominant focus in diagnosis, and now consequential behavior/motivation/level of functioning is primarily noted.
  • Substance-Related and Addicted Disorders have been radically re-conceptualized. Categorically, DSM-5 identifies “Substance Use Disorders,” “Substance-Induced Disorders (i.e. intoxication and withdrawal)” and “Non-Substance Related Disorders (addiction that specifies behavioral addictions like gambling and internet use).” The distinction between abuse and dependence no longer exists.

As you can see, this article doesn’t even begin to scratch the surface with regard to the fundamental changes to the DSM. The implications of all the changes will impact diagnosis, treatment, insurance payment/authorization, and likely the view of the interrelatedness of behavioral disorders and physiological ailments within the healthcare industry.

The DSM-5 has restructured the classification of behavioral disorders to the extent that clinicians will need to change the way they conceptualize comorbidity and how certain behavioral disorders relate to other disorders.

If you are looking for another reference for these changes, readers are advised to consult the American Psychological Association’s 20-page comparison of the DSM-IV TR and the DSM 5 entitled, Highlights of Changes from DSM-IV-TR to DSM-5 which can be found at: http://www.dsm5.org/Documents/changes.

Additionally, Linden Oaks is hosting a Webinar entitled, DSM-5: What’s Different, on Wednesday, June 7, 2015 from 12:00 pm – 1:00 pm. The Webinar is free of charge and 1.0 continuing education credits will be offered for IAODAPCA (CADC), LCPC/LPC, LCSW/MSW, LMFT, and Psychologists. Attendees will take a deeper dive into some of these changes and the Webinar will include a question and answer session.

Register online for DSM-5 Webinar

Nadjeh Awadallah, EdD, LCPC
Nadjeh is a Licensed Clinical Professional Counselor and Community Liaison for Linden Oaks Behavioral Health/Northwest Community Healthcare. Nadjeh holds advanced degrees in clinical psychology as well as education, and has worked in the mental health field since 2008 as both a clinician and an educator. A graduate of the University of Wisconsin- Milwaukee and the Illinois School of Professional Psychology, Nadjeh earned a Master’s Degree in Clinical Psychology and completed his practicum internship at Catholic Charities-Diocese of Joliet. Nadjeh also earned a Doctorate in Education from Argosy University. He is a member of the faculty at Argosy and Rockford University; teaching upper-division courses in Psychology and Human Development since 2012. Nadjeh previously worked as a therapist and program developer for Swedish American Hospital, and in the Intake and Assessment Department at Rogers Memorial Hospital.

Free CE Webinar: DSM-5: What's Different?

The next Webinar in the Linden Oaks Wednesday Webinar Series is DSM-5: What’s Different? The online presentation will examine recent DSM-5 changes and how they will affect the behavioral health industry.

Our Webinar speaker Nadjeh Awadallah, EdD, LCPC, is a licensed clinical professional counselor who has worked in a variety of different behavioral health settings including behavioral health program development.

This educational activity, which can be done from your office or home, is scheduled for Wednesday, June 17, 2015 from 12:00-1:00pm. Continuing education credit will be available for CADC/IAODAPCA, LCPC/LPC, LCSW/ MSW, LMFT, and Psychologist (note what you need at registration).

Registration is required as spots are limited. Access to the Webinar will be granted upon registration.

Register online

Questions? Contact us at: Linden Oaks.

The Elephant in the Room: The talks that every parent should have
Family-Focused Substance Abuse Prevention

Family Focused Subastance Abuse Prevention is the next topic in the Linden Oaks Parenting Series. This presentation will be held on Tuesday May 12 from 6:30 pm-8:30 pm at the Meiley-Swallow Hall Theatre (31 South Ellsworth Street, Naperville, IL), on the campus of North Central College. This informative program is free and open to all ages.

The event will include two short presentations by members of the Linden Oaks Addiction Treatment Programs followed by a question and answer discussion panel with experts in the field and community service providers.

Drug abuse is a preventable behavior, and drug dependence is a treatable disease. But neither prevention nor treatment can occur without focus on the family as a whole. Educating families about substance use and abuse is a complex topic.

Growing up, many parents received “the talk” from their parents which often never seemed to have the depth or breadth to really capture the complexity of the issue. Research tells us that the days of having “the talk” have come to an end. Good prevention requires an ongoing conversation and begins with many talksstarting at an early age and continuing into the adult years. Many parents have questions regarding how to talk to their kids, especially when it comes to explaining their own past experiences, portrayals in the media, and the impact of social media. The program seeks to give parents the tools and tips to equip them to talk to their children.

Experimenting with drugs is not a rite of passage for adolescents and parents shouldn’t assume that there’s no way to stop their children from using drugs. Research indicates that early substance use, abuse, and experimentation can have significantly detrimental effects on the individual over the life course. Experience does tells us of the difference between experimentation and abuse, but parental messages and family involvement remain critical to helping children to make good decisions.

Research in the neurosciences has brought to light new understanding of the adolescent and young adult brain, and the importance of harnessing its vast potential to make healthy choices and decisions. Intervention and prevention programs that involve parents and teach them how to improve parenting skills and develop family-strengthening strategies have proven effective in reducing predictors of substance abuse, even in “high-risk” families.

Addiction is a family disease. The program will also touch on the consequences of addiction and the importance of understanding that it touches the lives of everyone surrounding the individual. Good treatment requires that the conversation change from “their” issue (individual-focused only) to “our” issue (family-focused). The family needs and benefits from an understanding of the addiction, education on addictive behaviors and family communication skills, and building a strong support network for the entire family. It is as important to understand what the addict is experiencing as it is to explore the experience of the family. Involving family and loved ones in treatment can often be the deciding factor in successful and sustained recovery.

As described above, the program appeals to a broad spectrum of parents and students, including middle and high school-age, college-age, and beyond. Prevention is the primary focus of this presentation and the critical importance of addressing substance use and abuse as a family system issue, not just a problem that is confined to the individual. There will be significant attention paid to suggestions for how to take a positive parenting approach to prevention, while also identifying appropriate strategies for intervention with those who may be impacted by substance use disorders.


  • David C. Lott, MD, FASAM, FAPA,Medical Director of Addiction Services, Linden Oaks
  • Justin Wolfe, LCPC, CADC, CRC, Clinical Therapist in Addiction Services, Linden Oaks

Discussion Panel:

  • David C. Lott, MD, FASAM, FAPA,Medical Director of Addiction Services, Linden Oaks
  • Justin Wolfe LCPC, CADC, CRC, Clinical Therapist in Addiction Services, Linden Oaks
  • Pam Witt, LCSW, CADC, Social Worker, Neuqua Valley High School
  • Mark Piccoli, Director, DuPage Metropolitan Enforcement Group
  • Deb Lewin, Co-founder, P.A.T.H. Parent Support Group
  • IdaLynn Wenhold, Executive Director, KidsMatter


Additional 2015 Live Professional Seminar Series Dates Announced

Linden Oaks has announced the rest of the live professional seminar presentation dates for 2015. The professional seminar series includes six additional topics and extends through December 2015. The series includes fresh topical information on school refusal, generation gaps and marijuana legislation.

The seminars take place at the Linden Oaks Naperville Outpatient Center (1335 N. Mill Street, Naperville) from 9:00 a.m. - 12:15 p.m. The cost is $30.

The additional 2015 topic/dates are:

  • FRIDAY, JUNE 12, 2015
    • Pain Management in Psychiatric Patients
    • Keynote Speaker: Michael Martin, MD
  • FRIDAY, JULY 10, 2015
    • TMS and ECT Treatment for Chronic Depression: What is the Difference?
    • Keynote Speaker:Philip Janicak, MD
  • FRIDAY, AUGUST 14, 2015
    • Ethics and Diversity in Behavioral Health
    • Keynote Speaker: Brenda J. Barnwell, LCSW, CADC
  • FRIDAY, SEPTEMBER 18, 2015
    • Impact of Marijuana Legalization
    • Keynote Speaker: Kevin Sabet, Ph.D.
  • FRIDAY, OCTOBER 9, 2015
    • Curbing School Refusal: Tips for the Behavioral Health Professional
    • Keynote Speaker: Laura Koehler, Psy.D.
  • FRIDAY, NOVEMBER 13, 2015
    • Bridging Generation Gaps in the Counseling of Seniors and Older Adults
    • Keynote Speaker: Chuck Ritli, LCPC
  • FRIDAY, DECEMBER 11, 2015
    • DBT: Using Dialectical Behavior Therapy in Everyday Life
    • Keynote Speaker: Matthew D. Lauer Psy.D.

Continuing education units are available for these three hour live seminars including: IAODAPCA (CADC), LCPC/LPC, LCSW/MSW, LMFT, and Psychologist.

Registration is required for all presentations as space is limited. To register visit: www.edward.org/loh-seminars. Questions? Contact us at: lindenoaks@edward.org.

The Big SERVE: Community volunteers to sew stress relief blankets to benefit behavioral health patients

The Big SERVE is a community-wide volunteer event to help those in need. It takes place over the course of a weekend on May 2 and 3. Throughout the weekend, participants volunteer to complete various service projects for organizations and people in the community.

The Big SERVE event is a collaboration between Community Christian Church, Hope United Methodist Church, Plainfield United Methodist Church, and the Village of Plainfield. Volunteers from these organizations and the surrounding communities work on 5-10 service projects that will serve their community. Volunteers can choose which projects and the dates/times they would like to serve. Benefiting organizations include: The Green Harvest Food Pantry, The Forgotten Initiative, Ready Set Ride, Yard Brigades, DuPage River Sweep, and this year, Linden OaksBehavioral Health.

This year, Linden Oaks will be the receipents of the volunteer efforts of the BigSERVE. As one of the chosen service projects, volunteers will help make stress relief blankets for adolescent patients with anxiety and depression. These blankets are essential tools for patients in programming and serve as an appropriate outlet for stress relief.

The Stress Relief Blanket Project for Linden Oaks will kick off on Sunday, May 3 at 1:00 pm. Participants will form an assembly line to cut, pin, sew, and tie the blankets. Volunteers are needed for all areas. Sewing experience is a plus but not necessary.

The Stress Relief Blanket Project will take place at the Edward Plainfield Emergency Room Outpatient Center & Medical Group in the lower level conference room (24600 W. 127th, Plainfield, IL).

Volunteers are needed. To volunteer, visit: https://www.eventbrite.com/e/linden-oaks-stress-blankets-tickets-16456892007.

Don't have the time to participate? Donations are appreciated as well. Items needed include: Rotary Cutters, 6X24 inch rulers, sewing scissors, threads of any color, tailor's chalk, long straight pins, one yard of fleece or cash donations.

If you have questions or would like to donate to the cause, contact project leader Christine Hanley at chanley@edward.org or 630-646-5150.

For information on The Big SERVE or other service projects, www.thebigserve.info.

Addiction Treatment Program Leadership to Present at Prestigious National Conference

Linden Oaks Behavioral Health is proud to announce that David Lott, MD, FASAM, FAPA, Medical Director of Addiction Treatment Programs, and Beth Sack, LCPC, CADC, MHS, Manager of Addiction Treatment Programs, will be presenting at the prestigious 2015 National Conference on Addiction Disorders (NCAD) in St. Louis, Missouri on August 3, 2015.

Their workshop is entitled, “Implementing Contingency Management Techniques in a Community Treatment Program”, and will provide information and interactive experience to explore the barriers to Contingency Management (CM) use and encourage implementation of these practical, low-cost techniques. Participants will experience a live demonstration of the CM process in use in the Linden Oaks Adolescent Program, including an interactive hands-on experience with this technique. This workshop will provide an important training opportunity by helping participants find ways to take advantage of a powerful but underutilized treatment approach, and assist them in learn to identifying and addressing the challenges typically faced in the successful implementation of a CM program.

The National Conference on Addiction Disorders (NCAD) is a premier, respected and trusted national conference that provides a diverse educational curriculum on the prevention, intervention, treatment, and recovery management of addictions that affect various genders, generations and cultures. It features nationally recognized treatment providers, authors and educators discussing a wide range of topics in a compelling array of keynote sessions and in-depth workshops. More information about this event and the presentation can be found at: http://www.addictionpro.com/ncad-conference/national-conference-addiction-disorders

For more information regarding Linden Oaks Addiction treatment programs, visit: addiction services.

12th Annual ANAD Candlelight Vigil

The National Association for Anorexia Nervosa and Associated Eating Disorders (ANAD) and Linden Oaks will host the 12th Annual Candlelight Vigil for those affected by eating disorders on Monday, May 18 from 6 - 7:30 p.m.

The event, open to the public, will be held in the Healing Garden at Linden Oaks Behavioral Health on the campus of Edward Hospital, 801 S. Washington St. in Naperville. The theme of this year’s Vigil is “Unlock Your Freedom.”

The Vigil is held each year to motivate and encourage recovery, provide support for families, to commemorate those who have lost their lives and recognize those who have recovered and survived.

Stacey Prussman, a stand-up comedian, will be the keynote speaker for the event. Prussman’s earliest memories of disordered eating patterns and negative self-image were around age 10. After an audition for the title role in the musical “Annie” on Broadway, an agent told her, “You need to lose weight.” For more information, visit www.staceyprussman.com.

ANAD, founded in 1976, is a non-profit organization dedicated to the prevention and alleviation of eating disorders. For more information, visit www.anad.org or call (630) 577-1333.

The Linden Oaks Eating Disorders Program, designated a Center of Excellence by The Joint Commission, offers four levels of care with the latest techniques designed to help adults and adolescents recover from anorexia, bulimia and other eating disorders. For more information, visit eating disorders. For a free assessment, call the Linden Oaks Help Line at (630) 305-5027.

2nd Annual Brandon Marshall Mental Health Awareness Ride

Project 360 (formerly the Brandon Marshall Foundation), Starved Rock Harley-Davidson and Linden Oaks Behavioral Health are teaming for mental health awareness again this May.

On Saturday, May 16, 2015, the 2nd Annual Brandon Marshall Mental Health Awareness Ride will take place. The motorcycle ride will start at the Linden Oaks Behavioral Health Outpatient Center (1335 N. Mill St., Naperville) and end at the Starved Rock Harley-Davidson dealership (750 Centennial Dr., Ottawa).

The motorcycle ride will kick off at Linden Oaks at 10:00 am with public speeches by Brandon Marshall, NFL wide receiver and mental health advocate, and his wife, Michi Marshall. This kick off is open to the public and all ages are welcome.

After the speeches, bikers will hit the road at approximately 10:30am.The motorcycle ride route is 50 miles through suburbs including Aurora, Oswego and Yorkville. At the finish, Starved Rock-Harly Davidson will host a mental health awareness celebration which will include a cookout, raffles, and prizes.

This year, Brandon and Michi will host a private meet and greet session with select VIP guests prior to the motorcycle ride from 8:30-9:30am at Linden Oaks. VIP tickets are $50 and include a continental breakfast, photos, and event lanyard. Motorcycle ride and ride passenger tickets are $25/$15 and include lunch in Ottawa and a ride bracelet.

If you are interested in more information or how to register for the ride, visit http://www.eventbrite.com/e/2nd-annual-brandon-marshall-mental-health-awareness-ride-tickets-16660579241.