DSM-5-TR Assessment Measures Overview

Limitations of Categorical Approach

• Failure to find zones of rarity between diagnoses
• Need for intermediate categories
• High rates of comorbidity
• Frequent use of other or unspecified diagnoses
• Relative lack of utility in furthering identification of unique antecedent validators for most mental disorders
• Lack of treatment specificity for various diagnostic categories

Need for Dimensional Approach

• Combining dimensional approach with DSM's categorical diagnoses to capture heterogeneity in presentation of mental and substance use disorders
• Allowing clinicians to communicate particular variations of features that apply to presentations that meet criteria for a disorder
• Features include:
  • Differential severity of individual symptoms
  • Symptoms that are part of diagnostic features and those associated with the disorder
  • Measured by intensity, duration, and impact on functioning

Benefits of Dimensional Approach

• Identifying conditions that do not meet criteria for a disorder but are severe and disabling and in need of treatment
• Incorporating basic disease mechanisms into diagnostic criteria sets to enhance accuracy
• Enhancing diagnostic practice through dimensional approach in psychiatric evaluation guidelines

Cross-Cutting Symptom Measures

• Modeled on general medicine's review of systems
• Reviewing critical psychopathological domains across age groups and diagnoses
• Aiding in comprehensive mental status assessment of individuals at initial evaluation
• Systematically drawing attention to signs and symptoms of other domains of mental health and functioning
• Two levels of inquiry:
  • Level 1 uses brief, efficient, and easy-to-administer assessments to identify symptoms and domains of psychopathology
  • Level 2 uses more in-depth, detailed assessments to clarify severity and impact of symptoms on functioning

Symptom Domains for Adults and Youth

• 1-3 questions assess each of 13 symptom domains for adults (self-rated) to identify emerging signs and symptoms.
• 12 symptom domains are assessed in children (ages 6-17, parent-rated) and adolescents (child-rated, ages 11-17).
• Level 2 questions provide a more in-depth assessment of specific domains, including:
  • Depression
  • Anxiety
  • Mania
  • Anger
  • Irritability
  • Somatic symptoms

Measurement-Based Care

• The measures are designed to be administered at both initial interviews and follow-up visits.
• Standardized assessment tools are used to inform measurement-based care, a key aspect of patient care.

Severity Measures in Psychiatric Diagnostic Assessment

• Severity measures are disorder-specific and used to track individuals' progress over time, informing a precise plan of care.
• Their purpose is to identify emerging symptoms and concerns, support ongoing symptom monitoring and treatment adjustment, and provide quality care for individuals with mental and substance use disorders.
• These measures are crucial components of psychiatric diagnostic assessment, corresponding closely to the criteria that constitute the disorder definition.
• They can be administered to individuals who have received a diagnosis or who have a clinically significant syndrome that falls short of meeting full criteria for a diagnosis.
• Examples of severity measures include the Clinician-Rated Dimensions of Psychosis Symptom Severity for individuals with schizophrenia.
• Severity measures can be self-rated by the individual, rated by the clinician based on observation, or administered both at initial interview and over time.
• The purpose of administration is to track the severity of the individual's disorder and measure response to treatment.
• Severity measures help operationalize symptom frequency, intensity, duration, overall severity, type, and DSM-5 diagnoses.

World Health Organization Disability Assessment Schedule, Version 2.0 (WHODAS 2.0)

• The WHODAS 2.0 is a self-administered assessment that evaluates an individual's ability to perform activities in six areas.
• The six areas include understanding and communicating, getting around, self-care, getting along with people, life activities, and participation in society.
• It is designed for individuals with any medical condition, not just mental disorders, and can be used over time to track changes in an individual's level of functioning.
• The WHODAS 2.0 corresponds to concepts contained in the WHO International Classification of Functioning, Disability and Health.
• Assessment of functioning is a key aspect of psychiatric diagnostic assessment, as most DSM-5 criteria sets include a requirement that the disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Mental Disorders and Functional Impairment

• Individuals with mental disorders are more likely to experience severe impairment in functioning, including:
  • Impaired communication or understanding
  • Difficulty getting along with others
  • Inability to carry out activities at work, home, or school
  • Limited participation in social activities

Comparing Mental Disorders and Chronic Medical Conditions

• Mental disorders have a more direct impact on functional impairment compared to chronic medical conditions
• Functional impairment can affect prognosis across diagnoses

Functional Impairment and Relapse

• Residual functional impairment after symptoms subside can lead to recurrence or relapse of conditions such as major depressive disorder and anxiety disorders

DSM-5 Level 1 Cross-Cutting Symptom Measure

• Includes:
  • Clinician-Rated Dimensions of Psychosis Symptom Severity
  • WHODAS 2.0
  • Clinician instructions, scoring information, and interpretation guidelines

Online Resources

• The child-rated version of the DSM-5 measure, additional dimensional assessments, and other resources are available online at www.psychiatry.org/dsm5