DSM-5 Diagnostic and Statistical Manual of Mental Disorders PDF
Document Details
Uploaded by WiseQuartz
2013
American Psychiatric Association
Tags
Summary
The DSM-5 is a manual for the classification and diagnosis of mental disorders, providing diagnostic criteria and codes. It's used by mental health professionals to properly categorize and diagnose mental health conditions. This is an important resource for understanding and treating mental health issues.
Full Transcript
DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS FIFTH EDITION DSM-5 ™ American Psychiatric Association Officers 2012–2013 PRESIDENT DILIP V. JESTE, M.D. PRESIDENT-ELECT JEFFREY A. LIEBERMAN, M.D. TREASURER...
DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS FIFTH EDITION DSM-5 ™ American Psychiatric Association Officers 2012–2013 PRESIDENT DILIP V. JESTE, M.D. PRESIDENT-ELECT JEFFREY A. LIEBERMAN, M.D. TREASURER DAVID FASSLER, M.D. SECRETARY ROGER PEELE, M.D. Assembly SPEAKER R. SCOTT BENSON, M.D. SPEAKER-ELECT MELINDA L. YOUNG, M.D. Board of Trustees JEFFREY AKAKA, M.D. CAROL A. BERNSTEIN, M.D. BRIAN CROWLEY, M.D. ANITA S. EVERETT, M.D. JEFFREY GELLER, M.D., M.P.H. MARC DAVID GRAFF, M.D. JAMES A. GREENE, M.D. JUDITH F. KASHTAN, M.D. MOLLY K. MCVOY, M.D. JAMES E. NININGER, M.D. JOHN M. OLDHAM, M.D. ALAN F. SCHATZBERG, M.D. ALIK S. WIDGE, M.D., PH.D. ERIK R. VANDERLIP, M.D., MEMBER-IN-TRAINING TRUSTEE-ELECT DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS FIFTH EDITION DSM-5 ™ Washington, DC London, England Copyright © 2013 American Psychiatric Association DSM and DSM-5 are trademarks of the American Psychiatric Association. Use of these terms is prohibited without permission of the American Psychiatric Association. ALL RIGHTS RESERVED. Unless authorized in writing by the APA, no part of this book may be reproduced or used in a manner inconsistent with the APA’s copyright. This prohibition applies to unauthorized uses or reproductions in any form, including electronic applications. Correspondence regarding copyright permissions should be directed to DSM Permissions, American Psychiatric Publishing, 1000 Wilson Boulevard, Suite 1825, Arlington, VA 22209- 3901. Manufactured in the United States of America on acid-free paper. ISBN 978-0-89042-554-1 (Hardcover) 2nd printing June 2013 ISBN 978-0-89042-555-8 (Paperback) 2nd printing June 2013 American Psychiatric Association 1000 Wilson Boulevard Arlington, VA 22209-3901 www.psych.org The correct citation for this book is American Psychiatric Association: Diagnostic and Statisti- cal Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Associa- tion, 2013. Library of Congress Cataloging-in-Publication Data Diagnostic and statistical manual of mental disorders : DSM-5. — 5th ed. p. ; cm. DSM-5 DSM-V Includes index. ISBN 978-0-89042-554-1 (hardcover : alk. paper) — ISBN 978-0-89042-555-8 (pbk. : alk. paper) I. American Psychiatric Association. II. American Psychiatric Association. DSM-5 Task Force. III. Title: DSM-5. IV. Title: DSM-V. [DNLM: 1. Diagnostic and statistical manual of mental disorders. 5th ed. 2. Mental Disorders— classification. 3. Mental Disorders—diagnosis. WM 15] RC455.2.C4 616.89'075—dc23 2013011061 British Library Cataloguing in Publication Data A CIP record is available from the British Library. Text Design—Tammy J. Cordova Manufacturing—R.R. Donnelley Contents DSM-5 Classification................................... xiii Preface............................................... xli Section I DSM-5 Basics Introduction............................................5 Use of the Manual......................................19 Cautionary Statement for Forensic Use of DSM-5............25 Section II Diagnostic Criteria and Codes Neurodevelopmental Disorders...........................31 Schizophrenia Spectrum and Other Psychotic Disorders......87 Bipolar and Related Disorders...........................123 Depressive Disorders..................................155 Anxiety Disorders......................................189 Obsessive-Compulsive and Related Disorders.............235 Trauma- and Stressor-Related Disorders..................265 Dissociative Disorders.................................291 Somatic Symptom and Related Disorders.................309 Feeding and Eating Disorders...........................329 Elimination Disorders..................................355 Sleep-Wake Disorders..................................361 Sexual Dysfunctions...................................423 Gender Dysphoria.....................................451 Disruptive, Impulse-Control, and Conduct Disorders........ 461 Substance-Related and Addictive Disorders............... 481 Neurocognitive Disorders............................... 591 Personality Disorders.................................. 645 Paraphilic Disorders................................... 685 Other Mental Disorders................................ 707 Medication-Induced Movement Disorders and Other Adverse Effects of Medication................ 709 Other Conditions That May Be a Focus of Clinical Attention.. 715 Section III Emerging Measures and Models Assessment Measures................................. 733 Cultural Formulation................................... 749 Alternative DSM-5 Model for Personality Disorders......... 761 Conditions for Further Study............................ 783 Appendix Highlights of Changes From DSM-IV to DSM-5............. 809 Glossary of Technical Terms............................ 817 Glossary of Cultural Concepts of Distress................. 833 Alphabetical Listing of DSM-5 Diagnoses and Codes (ICD-9-CM and ICD-10-CM)............................ 839 Numerical Listing of DSM-5 Diagnoses and Codes (ICD-9-CM)......................................... 863 Numerical Listing of DSM-5 Diagnoses and Codes (ICD-10-CM)........................................ 877 DSM-5 Advisors and Other Contributors.................. 897 Index................................................ 917 DSM-5 Task Force DAVID J. KUPFER, M.D. Task Force Chair DARREL A. REGIER, M.D., M.P.H. Task Force Vice-Chair William E. Narrow, M.D., M.P.H., Susan K. Schultz, M.D., Text Editor Research Director Emily A. Kuhl, Ph.D., APA Text Editor Dan G. Blazer, M.D., Ph.D., M.P.H. Charles P. O’Brien, M.D., Ph.D. Jack D. Burke Jr., M.D., M.P.H. Roger Peele, M.D. William T. Carpenter Jr., M.D. Katharine A. Phillips, M.D. F. Xavier Castellanos, M.D. Daniel S. Pine, M.D. Wilson M. Compton, M.D., M.P.E. Charles F. Reynolds III, M.D. Joel E. Dimsdale, M.D. Maritza Rubio-Stipec, Sc.D. Javier I. Escobar, M.D., M.Sc. David Shaffer, M.D. Jan A. Fawcett, M.D. Andrew E. Skodol II, M.D. Bridget F. Grant, Ph.D., Ph.D. (2009–) Susan E. Swedo, M.D. Steven E. Hyman, M.D. (2007–2012) B. Timothy Walsh, M.D. Dilip V. Jeste, M.D. (2007–2011) Philip Wang, M.D., Dr.P.H. (2007–2012) Helena C. Kraemer, Ph.D. William M. Womack, M.D. Daniel T. Mamah, M.D., M.P.E. Kimberly A. Yonkers, M.D. James P. McNulty, A.B., Sc.B. Kenneth J. Zucker, Ph.D. Howard B. Moss, M.D. (2007–2009) Norman Sartorius, M.D., Ph.D., Consultant APA Division of Research Staff on DSM-5 Darrel A. Regier, M.D., M.P.H., Jennifer J. Shupinka, Assistant Director, Director, Division of Research DSM Operations William E. Narrow, M.D., M.P.H., Seung-Hee Hong, DSM Senior Research Associate Director Associate Emily A. Kuhl, Ph.D., Senior Science Anne R. Hiller, DSM Research Associate Writer; Staff Text Editor Alison S. Beale, DSM Research Associate Diana E. Clarke, Ph.D., M.Sc., Research Spencer R. Case, DSM Research Associate Statistician Joyce C. West, Ph.D., M.P.P., Lisa H. Greiner, M.S.S.A., DSM-5 Field Health Policy Research Director, Practice Trials Project Manager Research Network Eve K. Moscicki, Sc.D., M.P.H., Farifteh F. Duffy, Ph.D., Director, Practice Research Network Quality Care Research Director, Practice S. Janet Kuramoto, Ph.D. M.H.S., Research Network Senior Scientific Research Associate, Lisa M. Countis, Field Operations Practice Research Network Manager, Practice Research Network Amy Porfiri, M.B.A. Christopher M. Reynolds, Director of Finance and Administration Executive Assistant APA Office of the Medical Director JAMES H. SCULLY JR., M.D. Medical Director and CEO Editorial and Coding Consultants Michael B. First, M.D. Maria N. Ward, M.Ed., RHIT, CCS-P DSM-5 Work Groups ADHD and Disruptive Behavior Disorders DAVID SHAFFER, M.D. Chair F. XAVIER CASTELLANOS, M.D. Co-Chair Paul J. Frick, Ph.D., Text Coordinator Luis Augusto Rohde, M.D., Sc.D. Glorisa Canino, Ph.D. Rosemary Tannock, Ph.D. Terrie E. Moffitt, Ph.D. Eric A. Taylor, M.B. Joel T. Nigg, Ph.D. Richard Todd, Ph.D., M.D. (d. 2008) Anxiety, Obsessive-Compulsive Spectrum, Posttraumatic, and Dissociative Disorders KATHARINE A. PHILLIPS, M.D. Chair Michelle G. Craske, Ph.D., Text Scott L. Rauch, M.D. Coordinator H. Blair Simpson, M.D., Ph.D. J. Gavin Andrews, M.D. David Spiegel, M.D. Susan M. Bögels, Ph.D. Dan J. Stein, M.D., Ph.D. Matthew J. Friedman, M.D., Ph.D. Murray B. Stein, M.D. Eric Hollander, M.D. (2007–2009) Robert J. Ursano, M.D. Roberto Lewis-Fernández, M.D., M.T.S. Hans-Ulrich Wittchen, Ph.D. Robert S. Pynoos, M.D., M.P.H. Childhood and Adolescent Disorders DANIEL S. PINE, M.D. Chair Ronald E. Dahl, M.D. James F. Leckman, M.D. E. Jane Costello, Ph.D. (2007–2009) Ellen Leibenluft, M.D. Regina Smith James, M.D. Judith H. L. Rapoport, M.D. Rachel G. Klein, Ph.D. Charles H. Zeanah, M.D. Eating Disorders B. TIMOTHY WALSH, M.D. Chair Stephen A. Wonderlich, Ph.D., Richard E. Kreipe, M.D. Text Coordinator Marsha D. Marcus, Ph.D. Evelyn Attia, M.D. James E. Mitchell, M.D. Anne E. Becker, M.D., Ph.D., Sc.M. Ruth H. Striegel-Moore, Ph.D. Rachel Bryant-Waugh, M.D. G. Terence Wilson, Ph.D. Hans W. Hoek, M.D., Ph.D. Barbara E. Wolfe, Ph.D. A.P.R.N. Mood Disorders JAN A. FAWCETT, M.D. Chair Ellen Frank, Ph.D., Text Coordinator Kenneth S. Kendler, M.D. Jules Angst, M.D. (2007–2008) (2007–2010) William H. Coryell, M.D. Mario Maj, M.D., Ph.D. Lori L. Davis, M.D. Husseini K. Manji, M.D. (2007–2008) Raymond J. DePaulo, M.D. Michael R. Phillips, M.D. Sir David Goldberg, M.D. Trisha Suppes, M.D., Ph.D. James S. Jackson, Ph.D. Carlos A. Zarate, M.D. Neurocognitive Disorders DILIP V. JESTE, M.D. (2007–2011) Chair Emeritus DAN G. BLAZER, M.D., PH.D., M.P.H. Chair RONALD C. PETERSEN, M.D., PH.D. Co-Chair Mary Ganguli, M.D., M.P.H., Igor Grant, M.D. Text Coordinator Eric J. Lenze, M.D. Deborah Blacker, M.D., Sc.D. Jane S. Paulsen, Ph.D. Warachal Faison, M.D. (2007–2008) Perminder S. Sachdev, M.D., Ph.D. Neurodevelopmental Disorders SUSAN E. SWEDO, M.D. Chair Gillian Baird, M.A., M.B., B.Chir., Joseph Piven, M.D. Text Coordinator Sally J. Rogers, Ph.D. Edwin H. Cook Jr., M.D. Sarah J. Spence, M.D., Ph.D. Francesca G. Happé, Ph.D. Rosemary Tannock, Ph.D. James C. Harris, M.D. Fred Volkmar, M.D. (2007–2009) Walter E. Kaufmann, M.D. Amy M. Wetherby, Ph.D. Bryan H. King, M.D. Harry H. Wright, M.D. Catherine E. Lord, Ph.D. Personality and Personality Disorders1 ANDREW E. SKODOL, M.D. Chair JOHN M. OLDHAM, M.D. Co-Chair Robert F. Krueger, Ph.D., Text Lee Anna Clark, Ph.D. Coordinator W. John Livesley, M.D., Ph.D. (2007–2012) Renato D. Alarcon, M.D., M.P.H. Leslie C. Morey, Ph.D. Carl C. Bell, M.D. Larry J. Siever, M.D. Donna S. Bender, Ph.D. Roel Verheul, Ph.D. (2008–2012) 1 The members of the Personality and Personality Disorders Work Group are responsible for the alternative DSM-5 model for personality disorders that is included in Section III. The Section II personality disorders criteria and text (with updating of the text) are retained from DSM-IV-TR. Psychotic Disorders WILLIAM T. CARPENTER JR., M.D. Chair Deanna M. Barch, Ph.D., Text Dolores Malaspina, M.D., M.S.P.H. Coordinator Michael J. Owen, M.D., Ph.D. Juan R. Bustillo, M.D. Susan K. Schultz, M.D. Wolfgang Gaebel, M.D. Rajiv Tandon, M.D. Raquel E. Gur, M.D., Ph.D. Ming T. Tsuang, M.D., Ph.D. Stephan H. Heckers, M.D. Jim van Os, M.D. Sexual and Gender Identity Disorders KENNETH J. ZUCKER, PH.D. Chair Lori Brotto, Ph.D., Text Coordinator Martin P. Kafka, M.D. Irving M. Binik, Ph.D. Richard B. Krueger, M.D. Ray M. Blanchard, Ph.D. Niklas Långström, M.D., Ph.D. Peggy T. Cohen-Kettenis, Ph.D. Heino F.L. Meyer-Bahlburg, Dr. rer. nat. Jack Drescher, M.D. Friedemann Pfäfflin, M.D. Cynthia A. Graham, Ph.D. Robert Taylor Segraves, M.D., Ph.D. Sleep-Wake Disorders CHARLES F. REYNOLDS III, M.D. Chair Ruth M. O’Hara, Ph.D., Text Coordinator Kathy P. Parker, Ph.D., R.N. Charles M. Morin, Ph.D. Susan Redline, M.D., M.P.H. Allan I. Pack, Ph.D. Dieter Riemann, Ph.D. Somatic Symptom Disorders JOEL E. DIMSDALE, M.D. Chair James L. Levenson, M.D., Text Michael R. Irwin, M.D. Coordinator Francis J. Keefe, Ph.D. (2007–2011) Arthur J. Barsky III, M.D. Sing Lee, M.D. Francis Creed, M.D. Michael Sharpe, M.D. Nancy Frasure-Smith, Ph.D. (2007–2011) Lawson R. Wulsin, M.D. Substance-Related Disorders CHARLES P. O’BRIEN, M.D., PH.D. Chair THOMAS J. CROWLEY, M.D. Co-Chair Wilson M. Compton, M.D., M.P.E., Thomas R. Kosten, M.D. (2007–2008) Text Coordinator Walter Ling, M.D. Marc Auriacombe, M.D. Spero M. Manson, Ph.D. (2007-2008) Guilherme L. G. Borges, M.D., Dr.Sc. A. Thomas McLellan, Ph.D. (2007–2008) Kathleen K. Bucholz, Ph.D. Nancy M. Petry, Ph.D. Alan J. Budney, Ph.D. Marc A. Schuckit, M.D. Bridget F. Grant, Ph.D., Ph.D. Wim van den Brink, M.D., Ph.D. Deborah S. Hasin, Ph.D. (2007–2008) DSM-5 Study Groups Diagnostic Spectra and DSM/ICD Harmonization STEVEN E. HYMAN, M.D. Chair (2007–2012) William T. Carpenter Jr., M.D. William E. Narrow, M.D., M.P.H. Wilson M. Compton, M.D., M.P.E. Charles P. O’Brien, M.D., Ph.D. Jan A. Fawcett, M.D. John M. Oldham, M.D. Helena C. Kraemer, Ph.D. Katharine A. Phillips, M.D. David J. Kupfer, M.D. Darrel A. Regier, M.D., M.P.H. Lifespan Developmental Approaches ERIC J. LENZE, M.D. Chair SUSAN K. SCHULTZ, M.D. Chair Emeritus DANIEL S. PINE, M.D. Chair Emeritus Dan G. Blazer, M.D., Ph.D., M.P.H. Daniel T. Mamah, M.D., M.P.E. F. Xavier Castellanos, M.D. Andrew E. Skodol II, M.D. Wilson M. Compton, M.D., M.P.E. Susan E. Swedo, M.D. Gender and Cross-Cultural Issues KIMBERLY A. YONKERS, M.D. Chair ROBERTO LEWIS-FERNÁNDEZ, M.D., M.T.S. Co-Chair, Cross-Cultural Issues Renato D. Alarcon, M.D., M.P.H. Leslie C. Morey, Ph.D. Diana E. Clarke, Ph.D., M.Sc. William E. Narrow, M.D., M.P.H. Javier I. Escobar, M.D., M.Sc. Roger Peele, M.D. Ellen Frank, Ph.D. Philip Wang, M.D., Dr.P.H. (2007–2012) James S. Jackson, Ph.D. William M. Womack, M.D. Spiro M. Manson, Ph.D. (2007–2008) Kenneth J. Zucker, Ph.D. James P. McNulty, A.B., Sc.B. Psychiatric/General Medical Interface LAWSON R. WULSIN, M.D. Chair Ronald E. Dahl, M.D. Richard E. Kreipe, M.D. Joel E. Dimsdale, M.D. Ronald C. Petersen, Ph.D., M.D. Javier I. Escobar, M.D., M.Sc. Charles F. Reynolds III, M.D. Dilip V. Jeste, M.D. (2007–2011) Robert Taylor Segraves, M.D., Ph.D. Walter E. Kaufmann, M.D. B. Timothy Walsh, M.D. Impairment and Disability JANE S. PAULSEN, PH.D. Chair J. Gavin Andrews, M.D. Hans W. Hoek, M.D., Ph.D. Glorisa Canino, Ph.D. Helena C. Kraemer, Ph.D. Lee Anna Clark, Ph.D. William E. Narrow, M.D., M.P.H. Diana E. Clarke, Ph.D., M.Sc. David Shaffer, M.D. Michelle G. Craske, Ph.D. Diagnostic Assessment Instruments JACK D. BURKE JR., M.D., M.P.H. Chair Lee Anna Clark, Ph.D. Helena C. Kraemer, Ph.D. Diana E. Clarke, Ph.D., M.Sc. William E. Narrow, M.D., M.P.H. Bridget F. Grant, Ph.D., Ph.D. David Shaffer, M.D. DSM-5 Research Group WILLIAM E. NARROW, M.D., M.P.H. Chair Jack D. Burke Jr., M.D., M.P.H. David J. Kupfer, M.D. Diana E. Clarke, Ph.D., M.Sc. Darrel A. Regier, M.D., M.P.H. Helena C. Kraemer, Ph.D. David Shaffer, M.D. Course Specifiers and Glossary WOLFGANG GAEBEL, M.D. Chair Ellen Frank, Ph.D. Dan J. Stein, M.D., Ph.D. Charles P. O’Brien, M.D., Ph.D. Eric A. Taylor, M.B. Norman Sartorius, M.D., Ph.D., David J. Kupfer, M.D. Consultant Darrel A. Regier, M.D., M.P.H. Susan K. Schultz, M.D. DSM-5 Classification Before each disorder name, ICD-9-CM codes are provided, followed by ICD-10-CM codes in parentheses. Blank lines indicate that either the ICD-9-CM or the ICD-10-CM code is not applicable. For some disorders, the code can be indicated only according to the subtype or specifier. ICD-9-CM codes are to be used for coding purposes in the United States through Sep- tember 30, 2014. ICD-10-CM codes are to be used starting October 1, 2014. Following chapter titles and disorder names, page numbers for the corresponding text or criteria are included in parentheses. Note for all mental disorders due to another medical condition: Indicate the name of the other medical condition in the name of the mental disorder due to [the medical condi- tion]. The code and name for the other medical condition should be listed first immedi- ately before the mental disorder due to the medical condition. Neurodevelopmental Disorders (31) Intellectual Disabilities (33) ___.__ (___.__) Intellectual Disability (Intellectual Developmental Disorder) (33) Specify current severity: 317 (F70) Mild 318.0 (F71) Moderate 318.1 (F72) Severe 318.2 (F73) Profound 315.8 (F88) Global Developmental Delay (41) 319 (F79) Unspecified Intellectual Disability (Intellectual Developmental Disorder) (41) Communication Disorders (41) 315.32 (F80.2) Language Disorder (42) 315.39 (F80.0) Speech Sound Disorder (44) 315.35 (F80.81) Childhood-Onset Fluency Disorder (Stuttering) (45) Note: Later-onset cases are diagnosed as 307.0 (F98.5) adult-onset fluency disorder. 315.39 (F80.89) Social (Pragmatic) Communication Disorder (47) 307.9 (F80.9) Unspecified Communication Disorder (49) xiii xiv DSM-5 Classification Autism Spectrum Disorder (50) 299.00 (F84.0) Autism Spectrum Disorder (50) Specify if: Associated with a known medical or genetic condition or envi- ronmental factor; Associated with another neurodevelopmental, men- tal, or behavioral disorder Specify current severity for Criterion A and Criterion B: Requiring very substantial support, Requiring substantial support, Requiring support Specify if: With or without accompanying intellectual impairment, With or without accompanying language impairment, With catatonia (use additional code 293.89 [F06.1]) Attention-Deficit/Hyperactivity Disorder (59) ___.__ (___.__) Attention-Deficit/Hyperactivity Disorder (59) Specify whether: 314.01 (F90.2) Combined presentation 314.00 (F90.0) Predominantly inattentive presentation 314.01 (F90.1) Predominantly hyperactive/impulsive presentation Specify if: In partial remission Specify current severity: Mild, Moderate, Severe 314.01 (F90.8) Other Specified Attention-Deficit/Hyperactivity Disorder (65) 314.01 (F90.9) Unspecified Attention-Deficit/Hyperactivity Disorder (66) Specific Learning Disorder (66) ___.__ (___.__) Specific Learning Disorder (66) Specify if: 315.00 (F81.0) With impairment in reading (specify if with word reading accuracy, reading rate or fluency, reading comprehension) 315.2 (F81.81) With impairment in written expression (specify if with spelling accuracy, grammar and punctuation accuracy, clarity or organization of written expression) 315.1 (F81.2) With impairment in mathematics (specify if with number sense, memorization of arithmetic facts, accurate or fluent calculation, accurate math reasoning) Specify current severity: Mild, Moderate, Severe Motor Disorders (74) 315.4 (F82) Developmental Coordination Disorder (74) 307.3 (F98.4) Stereotypic Movement Disorder (77) Specify if: With self-injurious behavior, Without self-injurious behavior Specify if: Associated with a known medical or genetic condition, neuro- developmental disorder, or environmental factor Specify current severity: Mild, Moderate, Severe Tic Disorders 307.23 (F95.2) Tourette's Disorder (81) 307.22 (F95.1) Persistent (Chronic) Motor or Vocal Tic Disorder (81) Specify if: With motor tics only, With vocal tics only DSM-5 Classification xv 307.21 (F95.0) Provisional Tic Disorder (81) 307.20 (F95.8) Other Specified Tic Disorder (85) 307.20 (F95.9) Unspecified Tic Disorder (85) Other Neurodevelopmental Disorders (86) 315.8 (F88) Other Specified Neurodevelopmental Disorder (86) 315.9 (F89) Unspecified Neurodevelopmental Disorder (86) Schizophrenia Spectrum and Other Psychotic Disorders (87) The following specifiers apply to Schizophrenia Spectrum and Other Psychotic Disorders where indicated: a Specify if: The following course specifiers are only to be used after a 1-year duration of the dis- order: First episode, currently in acute episode; First episode, currently in partial remission; First episode, currently in full remission; Multiple episodes, currently in acute episode; Mul- tiple episodes, currently in partial remission; Multiple episodes, currently in full remission; Continuous; Unspecified bSpecify if: With catatonia (use additional code 293.89 [F06.1]) cSpecify current severity of delusions, hallucinations, disorganized speech, abnormal psycho- motor behavior, negative symptoms, impaired cognition, depression, and mania symptoms 301.22 (F21) Schizotypal (Personality) Disorder (90) 297.1 (F22) Delusional Disordera, c (90) Specify whether: Erotomanic type, Grandiose type, Jealous type, Persecu- tory type, Somatic type, Mixed type, Unspecified type Specify if: With bizarre content 298.8 (F23) Brief Psychotic Disorderb, c (94) Specify if: With marked stressor(s), Without marked stressor(s), With postpartum onset 295.40 (F20.81) Schizophreniform Disorderb, c (96) Specify if: With good prognostic features, Without good prognostic fea- tures 295.90 (F20.9) Schizophreniaa, b, c (99) ___.__ (___.__) Schizoaffective Disordera, b, c (105) Specify whether: 295.70 (F25.0) Bipolar type 295.70 (F25.1) Depressive type ___.__ (___.__) Substance/Medication-Induced Psychotic Disorderc (110) Note: See the criteria set and corresponding recording procedures for substance-specific codes and ICD-9-CM and ICD-10-CM coding. Specify if: With onset during intoxication, With onset during withdrawal ___.__ (___.__) Psychotic Disorder Due to Another Medical Conditionc (115) Specify whether: 293.81 (F06.2) With delusions 293.82 (F06.0) With hallucinations xvi DSM-5 Classification 293.89 (F06.1) Catatonia Associated With Another Mental Disorder (Catatonia Specifier) (119) 293.89 (F06.1) Catatonic Disorder Due to Another Medical Condition (120) 293.89 (F06.1) Unspecified Catatonia (121) Note: Code first 781.99 (R29.818) other symptoms involving nervous and musculoskeletal systems. 298.8 (F28) Other Specified Schizophrenia Spectrum and Other Psychotic Disorder (122) 298.9 (F29) Unspecified Schizophrenia Spectrum and Other Psychotic Disorder (122) Bipolar and Related Disorders (123) The following specifiers apply to Bipolar and Related Disorders where indicated: aSpecify: With anxious distress (specify current severity: mild, moderate, moderate-severe, severe); With mixed features; With rapid cycling; With melancholic features; With atypical features; With mood-congruent psychotic features; With mood-incongruent psychotic features; With catatonia (use additional code 293.89 [F06.1]); With peripartum onset; With seasonal pattern ___.__ (___.__) Bipolar I Disordera (123) ___.__ (___.__) Current or most recent episode manic 296.41 (F31.11) Mild 296.42 (F31.12) Moderate 296.43 (F31.13) Severe 296.44 (F31.2) With psychotic features 296.45 (F31.73) In partial remission 296.46 (F31.74) In full remission 296.40 (F31.9) Unspecified 296.40 (F31.0) Current or most recent episode hypomanic 296.45 (F31.71) In partial remission 296.46 (F31.72) In full remission 296.40 (F31.9) Unspecified ___.__ (___.__) Current or most recent episode depressed 296.51 (F31.31) Mild 296.52 (F31.32) Moderate 296.53 (F31.4) Severe 296.54 (F31.5) With psychotic features 296.55 (F31.75) In partial remission 296.56 (F31.76) In full remission 296.50 (F31.9) Unspecified 296.7 (F31.9) Current or most recent episode unspecified 296.89 (F31.81) Bipolar II Disordera (132) Specify current or most recent episode: Hypomanic, Depressed Specify course if full criteria for a mood episode are not currently met: In partial remission, In full remission Specify severity if full criteria for a mood episode are currently met: Mild, Moderate, Severe DSM-5 Classification xvii 301.13 (F34.0) Cyclothymic Disorder (139) Specify if: With anxious distress ___.__ (___.__) Substance/Medication-Induced Bipolar and Related Disorder (142) Note: See the criteria set and corresponding recording procedures for substance-specific codes and ICD-9-CM and ICD-10-CM coding. Specify if: With onset during intoxication, With onset during withdrawal 293.83 (___.__) Bipolar and Related Disorder Due to Another Medical Condition (145) Specify if: (F06.33) With manic features (F06.33) With manic- or hypomanic-like episode (F06.34) With mixed features 296.89 (F31.89) Other Specified Bipolar and Related Disorder (148) 296.80 (F31.9) Unspecified Bipolar and Related Disorder (149) Depressive Disorders (155) The following specifiers apply to Depressive Disorders where indicated: aSpecify: With anxious distress (specify current severity: mild, moderate, moderate-severe, severe); With mixed features; With melancholic features; With atypical features; With mood- congruent psychotic features; With mood-incongruent psychotic features; With catatonia (use additional code 293.89 [F06.1]); With peripartum onset; With seasonal pattern 296.99 (F34.8) Disruptive Mood Dysregulation Disorder (156) ___.__ (___.__) Major Depressive Disordera (160) ___.__ (___.__) Single episode 296.21 (F32.0) Mild 296.22 (F32.1) Moderate 296.23 (F32.2) Severe 296.24 (F32.3) With psychotic features 296.25 (F32.4) In partial remission 296.26 (F32.5) In full remission 296.20 (F32.9) Unspecified ___.__ (___.__) Recurrent episode 296.31 (F33.0) Mild 296.32 (F33.1) Moderate 296.33 (F33.2) Severe 296.34 (F33.3) With psychotic features 296.35 (F33.41) In partial remission 296.36 (F33.42) In full remission 296.30 (F33.9) Unspecified 300.4 (F34.1) Persistent Depressive Disorder (Dysthymia)a (168) Specify if: In partial remission, In full remission Specify if: Early onset, Late onset Specify if: With pure dysthymic syndrome; With persistent major depres- sive episode; With intermittent major depressive episodes, with current xviii DSM-5 Classification episode; With intermittent major depressive episodes, without current episode Specify current severity: Mild, Moderate, Severe 625.4 (N94.3) Premenstrual Dysphoric Disorder (171) ___.__ (___.__) Substance/Medication-Induced Depressive Disorder (175) Note: See the criteria set and corresponding recording procedures for substance-specific codes and ICD-9-CM and ICD-10-CM coding. Specify if: With onset during intoxication, With onset during withdrawal 293.83 (___.__) Depressive Disorder Due to Another Medical Condition (180) Specify if: (F06.31) With depressive features (F06.32) With major depressive-like episode (F06.34) With mixed features 311 (F32.8) Other Specified Depressive Disorder (183) 311 (F32.9) Unspecified Depressive Disorder (184) Anxiety Disorders (189) 309.21 (F93.0) Separation Anxiety Disorder (190) 313.23 (F94.0) Selective Mutism (195) 300.29 (___.__) Specific Phobia (197) Specify if: (F40.218) Animal (F40.228) Natural environment (___.__) Blood-injection-injury (F40.230) Fear of blood (F40.231) Fear of injections and transfusions (F40.232) Fear of other medical care (F40.233) Fear of injury (F40.248) Situational (F40.298) Other 300.23 (F40.10) Social Anxiety Disorder (Social Phobia) (202) Specify if: Performance only 300.01 (F41.0) Panic Disorder (208) ___.__ (___.__) Panic Attack Specifier (214) 300.22 (F40.00) Agoraphobia (217) 300.02 (F41.1) Generalized Anxiety Disorder (222) ___.__ (___.__) Substance/Medication-Induced Anxiety Disorder (226) Note: See the criteria set and corresponding recording procedures for substance-specific codes and ICD-9-CM and ICD-10-CM coding. Specify if: With onset during intoxication, With onset during withdrawal, With onset after medication use DSM-5 Classification xix 293.84 (F06.4) Anxiety Disorder Due to Another Medical Condition (230) 300.09 (F41.8) Other Specified Anxiety Disorder (233) 300.00 (F41.9) Unspecified Anxiety Disorder (233) Obsessive-Compulsive and Related Disorders (235) The following specifier applies to Obsessive-Compulsive and Related Disorders where indicated: a Specify if: With good or fair insight, With poor insight, With absent insight/delusional beliefs 300.3 (F42) Obsessive-Compulsive Disordera (237) Specify if: Tic-related 300.7 (F45.22) Body Dysmorphic Disordera (242) Specify if: With muscle dysmorphia 300.3 (F42) Hoarding Disordera (247) Specify if: With excessive acquisition 312.39 (F63.3) Trichotillomania (Hair-Pulling Disorder) (251) 698.4 (L98.1) Excoriation (Skin-Picking) Disorder (254) ___.__ (___.__) Substance/Medication-Induced Obsessive-Compulsive and Related Disorder (257) Note: See the criteria set and corresponding recording procedures for substance-specific codes and ICD-9-CM and ICD-10-CM coding. Specify if: With onset during intoxication, With onset during withdrawal, With onset after medication use 294.8 (F06.8) Obsessive-Compulsive and Related Disorder Due to Another Medical Condition (260) Specify if: With obsessive-compulsive disorder–like symptoms, With appearance preoccupations, With hoarding symptoms, With hair- pulling symptoms, With skin-picking symptoms 300.3 (F42) Other Specified Obsessive-Compulsive and Related Disorder (263) 300.3 (F42) Unspecified Obsessive-Compulsive and Related Disorder (264) Trauma- and Stressor-Related Disorders (265) 313.89 (F94.1) Reactive Attachment Disorder (265) Specify if: Persistent Specify current severity: Severe 313.89 (F94.2) Disinhibited Social Engagement Disorder (268) Specify if: Persistent Specify current severity: Severe 309.81 (F43.10) Posttraumatic Stress Disorder (includes Posttraumatic Stress Disorder for Children 6 Years and Younger) (271) Specify whether: With dissociative symptoms Specify if: With delayed expression 308.3 (F43.0) Acute Stress Disorder (280) xx DSM-5 Classification ___.__ (___.__) Adjustment Disorders (286) Specify whether: 309.0 (F43.21) With depressed mood 309.24 (F43.22) With anxiety 309.28 (F43.23) With mixed anxiety and depressed mood 309.3 (F43.24) With disturbance of conduct 309.4 (F43.25) With mixed disturbance of emotions and conduct 309.9 (F43.20) Unspecified 309.89 (F43.8) Other Specified Trauma- and Stressor-Related Disorder (289) 309.9 (F43.9) Unspecified Trauma- and Stressor-Related Disorder (290) Dissociative Disorders (291) 300.14 (F44.81) Dissociative Identity Disorder (292) 300.12 (F44.0) Dissociative Amnesia (298) Specify if: 300.13 (F44.1) With dissociative fugue 300.6 (F48.1) Depersonalization/Derealization Disorder (302) 300.15 (F44.89) Other Specified Dissociative Disorder (306) 300.15 (F44.9) Unspecified Dissociative Disorder (307) Somatic Symptom and Related Disorders (309) 300.82 (F45.1) Somatic Symptom Disorder (311) Specify if: With predominant pain Specify if: Persistent Specify current severity: Mild, Moderate, Severe 300.7 (F45.21) Illness Anxiety Disorder (315) Specify whether: Care seeking type, Care avoidant type 300.11 (___.__) Conversion Disorder (Functional Neurological Symptom Disorder) (318) Specify symptom type: (F44.4) With weakness or paralysis (F44.4) With abnormal movement (F44.4) With swallowing symptoms (F44.4) With speech symptom (F44.5) With attacks or seizures (F44.6) With anesthesia or sensory loss (F44.6) With special sensory symptom (F44.7) With mixed symptoms Specify if: Acute episode, Persistent Specify if: With psychological stressor (specify stressor), Without psycho- logical stressor DSM-5 Classification xxi 316 (F54) Psychological Factors Affecting Other Medical Conditions (322) Specify current severity: Mild, Moderate, Severe, Extreme 300.19 (F68.10) Factitious Disorder (includes Factitious Disorder Imposed on Self, Factitious Disorder Imposed on Another) (324) Specify Single episode, Recurrent episodes 300.89 (F45.8) Other Specified Somatic Symptom and Related Disorder (327) 300.82 (F45.9) Unspecified Somatic Symptom and Related Disorder (327) Feeding and Eating Disorders (329) The following specifiers apply to Feeding and Eating Disorders where indicated: a Specify if: In remission b Specify if: In partial remission, In full remission cSpecify current severity: Mild, Moderate, Severe, Extreme 307.52 (___.__) Picaa (329) (F98.3) In children (F50.8) In adults 307.53 (F98.21) Rumination Disordera (332) 307.59 (F50.8) Avoidant/Restrictive Food Intake Disordera (334) 307.1 (___.__) Anorexia Nervosab, c (338) Specify whether: (F50.01) Restricting type (F50.02) Binge-eating/purging type 307.51 (F50.2) Bulimia Nervosab, c (345) 307.51 (F50.8) Binge-Eating Disorderb, c (350) 307.59 (F50.8) Other Specified Feeding or Eating Disorder (353) 307.50 (F50.9) Unspecified Feeding or Eating Disorder (354) Elimination Disorders (355) 307.6 (F98.0) Enuresis (355) Specify whether: Nocturnal only, Diurnal only, Nocturnal and diurnal 307.7 (F98.1) Encopresis (357) Specify whether: With constipation and overflow incontinence, Without constipation and overflow incontinence ___.__ (___.__) Other Specified Elimination Disorder (359) 788.39 (N39.498) With urinary symptoms 787.60 (R15.9) With fecal symptoms ___.__ (___.__) Unspecified Elimination Disorder (360) 788.30 (R32) With urinary symptoms 787.60 (R15.9) With fecal symptoms xxii DSM-5 Classification Sleep-Wake Disorders (361) The following specifiers apply to Sleep-Wake Disorders where indicated: a Specify if: Episodic, Persistent, Recurrent b Specify if: Acute, Subacute, Persistent c Specify current severity: Mild, Moderate, Severe 307.42 (F51.01) Insomnia Disordera (362) Specify if: With non–sleep disorder mental comorbidity, With other medical comorbidity, With other sleep disorder 307.44 (F51.11) Hypersomnolence Disorderb, c (368) Specify if: With mental disorder, With medical condition, With another sleep disorder ___.__ (___.__) Narcolepsyc (372) Specify whether: 347.00 (G47.419) Narcolepsy without cataplexy but with hypocretin deficiency 347.01 (G47.411) Narcolepsy with cataplexy but without hypocretin deficiency 347.00 (G47.419) Autosomal dominant cerebellar ataxia, deafness, and narcolepsy 347.00 (G47.419) Autosomal dominant narcolepsy, obesity, and type 2 diabetes 347.10 (G47.429) Narcolepsy secondary to another medical condition Breathing-Related Sleep Disorders (378) 327.23 (G47.33) Obstructive Sleep Apnea Hypopneac (378) ___.__ (___.__) Central Sleep Apnea (383) Specify whether: 327.21 (G47.31) Idiopathic central sleep apnea 786.04 (R06.3) Cheyne-Stokes breathing 780.57 (G47.37) Central sleep apnea comorbid with opioid use Note: First code opioid use disorder, if present. Specify current severity ___.__ (___.__) Sleep-Related Hypoventilation (387) Specify whether: 327.24 (G47.34) Idiopathic hypoventilation 327.25 (G47.35) Congenital central alveolar hypoventilation 327.26 (G47.36) Comorbid sleep-related hypoventilation Specify current severity ___.__ (___.__) Circadian Rhythm Sleep-Wake Disordersa (390) Specify whether: 307.45 (G47.21) Delayed sleep phase type (391) Specify if: Familial, Overlapping with non-24-hour sleep-wake type 307.45 (G47.22) Advanced sleep phase type (393) Specify if: Familial 307.45 (G47.23) Irregular sleep-wake type (394) 307.45 (G47.24) Non-24-hour sleep-wake type (396) DSM-5 Classification xxiii 307.45 (G47.26) Shift work type (397) 307.45 (G47.20) Unspecified type Parasomnias (399) ___.__ (__.__) Non–Rapid Eye Movement Sleep Arousal Disorders (399) Specify whether: 307.46 (F51.3) Sleepwalking type Specify if: With sleep-related eating, With sleep-related sexual behavior (sexsomnia) 307.46 (F51.4) Sleep terror type 307.47 (F51.5) Nightmare Disorderb, c (404) Specify if: During sleep onset Specify if: With associated non–sleep disorder, With associated other medical condition, With associated other sleep disorder 327.42 (G47.52) Rapid Eye Movement Sleep Behavior Disorder (407) 333.94 (G25.81) Restless Legs Syndrome (410) ___.__ (___.__) Substance/Medication-Induced Sleep Disorder (413) Note: See the criteria set and corresponding recording procedures for substance-specific codes and ICD-9-CM and ICD-10-CM coding. Specify whether: Insomnia type, Daytime sleepiness type, Parasomnia type, Mixed type Specify if: With onset during intoxication, With onset during discontinua- tion/withdrawal 780.52 (G47.09) Other Specified Insomnia Disorder (420) 780.52 (G47.00) Unspecified Insomnia Disorder (420) 780.54 (G47.19) Other Specified Hypersomnolence Disorder (421) 780.54 (G47.10) Unspecified Hypersomnolence Disorder (421) 780.59 (G47.8) Other Specified Sleep-Wake Disorder (421) 780.59 (G47.9) Unspecified Sleep-Wake Disorder (422) Sexual Dysfunctions (423) The following specifiers apply to Sexual Dysfunctions where indicated: a Specify whether: Lifelong, Acquired b Specify whether: Generalized, Situational c Specify current severity: Mild, Moderate, Severe 302.74 (F52.32) Delayed Ejaculationa, b, c (424) 302.72 (F52.21) Erectile Disordera, b, c (426) 302.73 (F52.31) Female Orgasmic Disordera, b, c (429) Specify if: Never experienced an orgasm under any situation 302.72 (F52.22) Female Sexual Interest/Arousal Disordera, b, c (433) 302.76 (F52.6) Genito-Pelvic Pain/Penetration Disordera, c (437) xxiv DSM-5 Classification 302.71 (F52.0) Male Hypoactive Sexual Desire Disordera, b, c (440) 302.75 (F52.4) Premature (Early) Ejaculationa, b, c (443) ___.__ (___.__) Substance/Medication-Induced Sexual Dysfunctionc (446) Note: See the criteria set and corresponding recording procedures for substance-specific codes and ICD-9-CM and ICD-10-CM coding. Specify if: With onset during intoxication, With onset during withdrawal, With onset after medication use 302.79 (F52.8) Other Specified Sexual Dysfunction (450) 302.70 (F52.9) Unspecified Sexual Dysfunction (450) Gender Dysphoria (451) ___.__ (__.__) Gender Dysphoria (452) 302.6 (F64.2) Gender Dysphoria in Children Specify if: With a disorder of sex development 302.85 (F64.1) Gender Dysphoria in Adolescents and Adults Specify if: With a disorder of sex development Specify if: Posttransition Note: Code the disorder of sex development if present, in addition to gender dysphoria. 302.6 (F64.8) Other Specified Gender Dysphoria (459) 302.6 (F64.9) Unspecified Gender Dysphoria (459) Disruptive, Impulse-Control, and Conduct Disorders (461) 313.81 (F91.3) Oppositional Defiant Disorder (462) Specify current severity: Mild, Moderate, Severe 312.34 (F63.81) Intermittent Explosive Disorder (466) ___.__ (__.__) Conduct Disorder (469) Specify whether: 312.81 (F91.1) Childhood-onset type 312.82 (F91.2) Adolescent-onset type 312.89 (F91.9) Unspecified onset Specify if: With limited prosocial emotions Specify current severity: Mild, Moderate, Severe 301.7 (F60.2) Antisocial Personality Disorder (476) 312.33 (F63.1) Pyromania (476) 312.32 (F63.2) Kleptomania (478) 312.89 (F91.8) Other Specified Disruptive, Impulse-Control, and Conduct Disorder (479) 312.9 (F91.9) Unspecified Disruptive, Impulse-Control, and Conduct Disorder (480) DSM-5 Classification xxv Substance-Related and Addictive Disorders (481) The following specifiers and note apply to Substance-Related and Addictive Disorders where indicated: a Specify if: In early remission, In sustained remission b Specify if: In a controlled environment c Specify if: With perceptual disturbances d The ICD-10-CM code indicates the comorbid presence of a moderate or severe substance use disorder, which must be present in order to apply the code for substance withdrawal. Substance-Related Disorders (483) Alcohol-Related Disorders (490) ___.__ (___.__) Alcohol Use Disordera, b (490) Specify current severity: 305.00 (F10.10) Mild 303.90 (F10.20) Moderate 303.90 (F10.20) Severe 303.00 (___.__) Alcohol Intoxication (497) (F10.129) With use disorder, mild (F10.229) With use disorder, moderate or severe (F10.929) Without use disorder 291.81 (___.__) Alcohol Withdrawalc, d (499) (F10.239) Without perceptual disturbances (F10.232) With perceptual disturbances ___.__ (___.__) Other Alcohol-Induced Disorders (502) 291.9 (F10.99) Unspecified Alcohol-Related Disorder (503) Caffeine-Related Disorders (503) 305.90 (F15.929) Caffeine Intoxication (503) 292.0 (F15.93) Caffeine Withdrawal (506) ___.__ (___.__) Other Caffeine-Induced Disorders (508) 292.9 (F15.99) Unspecified Caffeine-Related Disorder (509) Cannabis-Related Disorders (509) ___.__ (___.__) Cannabis Use Disordera, b (509) Specify current severity: 305.20 (F12.10) Mild 304.30 (F12.20) Moderate 304.30 (F12.20) Severe xxvi DSM-5 Classification 292.89 (___.__) Cannabis Intoxicationc (516) Without perceptual disturbances (F12.129) With use disorder, mild (F12.229) With use disorder, moderate or severe (F12.929) Without use disorder With perceptual disturbances (F12.122) With use disorder, mild (F12.222) With use disorder, moderate or severe (F12.922) Without use disorder 292.0 (F12.288) Cannabis Withdrawald (517) ___.__ (___.__) Other Cannabis-Induced Disorders (519) 292.9 (F12.99) Unspecified Cannabis-Related Disorder (519) Hallucinogen-Related Disorders (520) ___.__ (___.__) Phencyclidine Use Disordera, b (520) Specify current severity: 305.90 (F16.10) Mild 304.60 (F16.20) Moderate 304.60 (F16.20) Severe ___.__ (___.__) Other Hallucinogen Use Disordera, b (523) Specify the particular hallucinogen Specify current severity: 305.30 (F16.10) Mild 304.50 (F16.20) Moderate 304.50 (F16.20) Severe 292.89 (___.__) Phencyclidine Intoxication (527) (F16.129) With use disorder, mild (F16.229) With use disorder, moderate or severe (F16.929) Without use disorder 292.89 (___.__) Other Hallucinogen Intoxication (529) (F16.129) With use disorder, mild (F16.229) With use disorder, moderate or severe (F16.929) Without use disorder 292.89 (F16.983) Hallucinogen Persisting Perception Disorder (531) ___.__ (___.__) Other Phencyclidine-Induced Disorders (532) ___.__ (___.__) Other Hallucinogen-Induced Disorders (532) 292.9 (F16.99) Unspecified Phencyclidine-Related Disorder (533) 292.9 (F16.99) Unspecified Hallucinogen-Related Disorder (533) Inhalant-Related Disorders (533) ___.__ (___.__) Inhalant Use Disordera, b (533) Specify the particular inhalant Specify current severity: 305.90 (F18.10) Mild DSM-5 Classification xxvii 304.60 (F18.20) Moderate 304.60 (F18.20) Severe 292.89 (___.__) Inhalant Intoxication (538) (F18.129) With use disorder, mild (F18.229) With use disorder, moderate or severe (F18.929) Without use disorder ___.__ (___.__) Other Inhalant-Induced Disorders (540) 292.9 (F18.99) Unspecified Inhalant-Related Disorder (540) Opioid-Related Disorders (540) ___.__ (___.__) Opioid Use Disordera (541) Specify if: On maintenance therapy, In a controlled environment Specify current severity: 305.50 (F11.10) Mild 304.00 (F11.20) Moderate 304.00 (F11.20) Severe 292.89 (___.__) Opioid Intoxicationc (546) Without perceptual disturbances (F11.129) With use disorder, mild (F11.229) With use disorder, moderate or severe (F11.929) Without use disorder With perceptual disturbances (F11.122) With use disorder, mild (F11.222) With use disorder, moderate or severe (F11.922) Without use disorder 292.0 (F11.23) Opioid Withdrawald (547) ___.__ (___.__) Other Opioid-Induced Disorders (549) 292.9 (F11.99) Unspecified Opioid-Related Disorder (550) Sedative-, Hypnotic-, or Anxiolytic-Related Disorders (550) ___.__ (___.__) Sedative, Hypnotic, or Anxiolytic Use Disordera, b (550) Specify current severity: 305.40 (F13.10) Mild 304.10 (F13.20) Moderate 304.10 (F13.20) Severe 292.89 (___.__) Sedative, Hypnotic, or Anxiolytic Intoxication (556) (F13.129) With use disorder, mild (F13.229) With use disorder, moderate or severe (F13.929) Without use disorder 292.0 (___.__) Sedative, Hypnotic, or Anxiolytic Withdrawalc, d (557) (F13.239) Without perceptual disturbances (F13.232) With perceptual disturbances xxviii DSM-5 Classification ___.__ (___.__) Other Sedative-, Hypnotic-, or Anxiolytic-Induced Disorders (560) 292.9 (F13.99) Unspecified Sedative-, Hypnotic-, or Anxiolytic-Related Disorder (560) Stimulant-Related Disorders (561) ___.__ (___.__) Stimulant Use Disordera, b (561) Specify current severity: ___.__ (___.__) Mild 305.70 (F15.10) Amphetamine-type substance 305.60 (F14.10) Cocaine 305.70 (F15.10) Other or unspecified stimulant ___.__ (___.__) Moderate 304.40 (F15.20) Amphetamine-type substance 304.20 (F14.20) Cocaine 304.40 (F15.20) Other or unspecified stimulant ___.__ (___.__) Severe 304.40 (F15.20) Amphetamine-type substance 304.20 (F14.20) Cocaine 304.40 (F15.20) Other or unspecified stimulant 292.89 (___.__) Stimulant Intoxicationc (567) Specify the specific intoxicant 292.89 (___.__) Amphetamine or other stimulant, Without perceptual disturbances (F15.129) With use disorder, mild (F15.229) With use disorder, moderate or severe (F15.929) Without use disorder 292.89 (___.__) Cocaine, Without perceptual disturbances (F14.129) With use disorder, mild (F14.229) With use disorder, moderate or severe (F14.929) Without use disorder 292.89 (___.__) Amphetamine or other stimulant, With perceptual disturbances (F15.122) With use disorder, mild (F15.222) With use disorder, moderate or severe (F15.922) Without use disorder 292.89 (___.__) Cocaine, With perceptual disturbances (F14.122) With use disorder, mild (F14.222) With use disorder, moderate or severe (F14.922) Without use disorder 292.0 (___.__) Stimulant Withdrawald (569) Specify the specific substance causing the withdrawal syndrome (F15.23) Amphetamine or other stimulant (F14.23) Cocaine ___.__ (___.__) Other Stimulant-Induced Disorders (570) DSM-5 Classification xxix 292.9 (___.__) Unspecified Stimulant-Related Disorder (570) (F15.99) Amphetamine or other stimulant (F14.99) Cocaine Tobacco-Related Disorders (571) ___.__ (___.__) Tobacco Use Disordera (571) Specify if: On maintenance therapy, In a controlled environment Specify current severity: 305.1 (Z72.0) Mild 305.1 (F17.200) Moderate 305.1 (F17.200) Severe 292.0 (F17.203) Tobacco Withdrawald (575) ___.__ (___.__) Other Tobacco-Induced Disorders (576) 292.9 (F17.209) Unspecified Tobacco-Related Disorder (577) Other (or Unknown) Substance–Related Disorders (577) ___._ (___.__) Other (or Unknown) Substance Use Disordera, b (577) Specify current severity: 305.90 (F19.10) Mild 304.90 (F19.20) Moderate 304.90 (F19.20) Severe 292.89 (___.__) Other (or Unknown) Substance Intoxication (581) (F19.129) With use disorder, mild (F19.229) With use disorder, moderate or severe (F19.929) Without use disorder 292.0 (F19.239) Other (or Unknown) Substance Withdrawald (583) ___.__ (___.__) Other (or Unknown) Substance–Induced Disorders (584) 292.9 (F19.99) Unspecified Other (or Unknown) Substance–Related Disorder (585) Non-Substance-Related Disorders (585) 312.31 (F63.0) Gambling Disordera (585) Specify if: Episodic, Persistent Specify current severity: Mild, Moderate, Severe Neurocognitive Disorders (591) ___.__ (___.__) Delirium (596) a Note: See the criteria set and corresponding recording procedures for substance-specific codes and ICD-9-CM and ICD-10-CM coding. Specify whether: ___.__ (___.__) Substance intoxication deliriuma ___.__ (___.__) Substance withdrawal deliriuma 292.81 (___.__) Medication-induced deliriuma 293.0 (F05) Delirium due to another medical condition xxx DSM-5 Classification 293.0 (F05) Delirium due to multiple etiologies Specify if: Acute, Persistent Specify if: Hyperactive, Hypoactive, Mixed level of activity 780.09 (R41.0) Other Specified Delirium (602) 780.09 (R41.0) Unspecified Delirium (602) Major and Mild Neurocognitive Disorders (602) Specify whether due to: Alzheimer’s disease, Frontotemporal lobar degeneration, Lewy body disease, Vascular disease, Traumatic brain injury, Substance/medication use, HIV infection, Prion disease, Parkinson’s disease, Huntington’s disease, Another medical condition, Multi- ple etiologies, Unspecified a Specify Without behavioral disturbance, With behavioral disturbance. For possible major neuro- cognitive disorder and for mild neurocognitive disorder, behavioral disturbance cannot be coded but should still be indicated in writing. bSpecify current severity: Mild, Moderate, Severe. This specifier applies only to major neurocogni- tive disorders (including probable and possible). Note: As indicated for each subtype, an additional medical code is needed for probable major neurocognitive disorder or major neurocognitive disorder. An additional medical code should not be used for possible major neurocognitive disorder or mild neurocognitive disorder. Major or Mild Neurocognitive Disorder Due to Alzheimer’s Disease (611) ___.__ (___.__) Probable Major Neurocognitive Disorder Due to Alzheimer’s Diseaseb Note: Code first 331.0 (G30.9) Alzheimer’s disease. 294.11 (F02.81) With behavioral disturbance 294.10 (F02.80) Without behavioral disturbance 331.9 (G31.9) Possible Major Neurocognitive Disorder Due to Alzheimer’s Diseasea, b 331.83 (G31.84) Mild Neurocognitive Disorder Due to Alzheimer’s Diseasea Major or Mild Frontotemporal Neurocognitive Disorder (614) ___.__ (___.__) Probable Major Neurocognitive Disorder Due to Frontotemporal Lobar Degenerationb Note: Code first 331.19 (G31.09) frontotemporal disease. 294.11 (F02.81) With behavioral disturbance 294.10 (F02.80) Without behavioral disturbance 331.9 (G31.9) Possible Major Neurocognitive Disorder Due to Frontotemporal Lobar Degenerationa, b 331.83 (G31.84) Mild Neurocognitive Disorder Due to Frontotemporal Lobar Degenerationa Major or Mild Neurocognitive Disorder With Lewy Bodies (618) ___.__ (___.__) Probable Major Neurocognitive Disorder With Lewy Bodiesb Note: Code first 331.82 (G31.83) Lewy body disease. 294.11 (F02.81) With behavioral disturbance 294.10 (F02.80) Without behavioral disturbance DSM-5 Classification xxxi 331.9 (G31.9) Possible Major Neurocognitive Disorder With Lewy Bodiesa, b 331.83 (G31.84) Mild Neurocognitive Disorder With Lewy Bodiesa Major or Mild Vascular Neurocognitive Disorder (621) ___.__ (___.__) Probable Major Vascular Neurocognitive Disorderb Note: No additional medical code for vascular disease. 290.40 (F01.51) With behavioral disturbance 290.40 (F01.50) Without behavioral disturbance 331.9 (G31.9) Possible Major Vascular Neurocognitive Disordera, b 331.83 (G31.84) Mild Vascular Neurocognitive Disordera Major or Mild Neurocognitive Disorder Due to Traumatic Brain Injury (624) ___.__ (___.__) Major Neurocognitive Disorder Due to Traumatic Brain Injuryb Note: For ICD-9-CM, code first 907.0 late effect of intracranial injury without skull fracture. For ICD-10-CM, code first S06.2X9S diffuse traumatic brain injury with loss of consciousness of unspecified duration, sequela. 294.11 (F02.81) With behavioral disturbance 294.10 (F02.80) Without behavioral disturbance 331.83 (G31.84) Mild Neurocognitive Disorder Due to Traumatic Brain Injurya Substance/Medication-Induced Major or Mild Neurocognitive Disordera (627) Note: No additional medical code. See the criteria set and corresponding recording procedures for substance-specific codes and ICD-9-CM and ICD-10-CM coding. Specify if: Persistent Major or Mild Neurocognitive Disorder Due to HIV Infection (632) ___.__ (___.__) Major Neurocognitive Disorder Due to HIV Infectionb Note: Code first 042 (B20) HIV infection. 294.11 (F02.81) With behavioral disturbance 294.10 (F02.80) Without behavioral disturbance 331.83 (G31.84) Mild Neurocognitive Disorder Due to HIV Infectiona Major or Mild Neurocognitive Disorder Due to Prion Disease (634) ___.__ (___.__) Major Neurocognitive Disorder Due to Prion Diseaseb Note: Code first 046.79 (A81.9) prion disease. 294.11 (F02.81) With behavioral disturbance 294.10 (F02.80) Without behavioral disturbance 331.83 (G31.84) Mild Neurocognitive Disorder Due to Prion Diseasea Major or Mild Neurocognitive Disorder Due to Parkinson’s Disease (636) ___.__ (___.__) Major Neurocognitive Disorder Probably Due to Parkinson’s Diseaseb Note: Code first 332.0 (G20) Parkinson’s disease. 294.11 (F02.81) With behavioral disturbance 294.10 (F02.80) Without behavioral disturbance xxxii DSM-5 Classification 331.9 (G31.9) Major Neurocognitive Disorder Possibly Due to Parkinson’s Diseasea, b 331.83 (G31.84) Mild Neurocognitive Disorder Due to Parkinson’s Diseasea Major or Mild Neurocognitive Disorder Due to Huntington’s Disease (638) ___.__ (___.__) Major Neurocognitive Disorder Due to Huntington’s Diseaseb Note: Code first 333.4 (G10) Huntington’s disease. 294.11 (F02.81) With behavioral disturbance 294.10 (F02.80) Without behavioral disturbance 331.83 (G31.84) Mild Neurocognitive Disorder Due to Huntington’s Diseasea Major or Mild Neurocognitive Disorder Due to Another Medical Condition (641) ___.__ (___.__) Major Neurocognitive Disorder Due to Another Medical Conditionb Note: Code first the other medical condition. 294.11 (F02.81) With behavioral disturbance 294.10 (F02.80) Without behavioral disturbance 331.83 (G31.84) Mild Neurocognitive Disorder Due to Another Medical Conditiona Major or Mild Neurocognitive Disorder Due to Multiple Etiologies (642) ___.__ (___.__) Major Neurocognitive Disorder Due to Multiple Etiologiesb Note: Code first all the etiological medical conditions (with the exception of vascular disease). 294.11 (F02.81) With behavioral disturbance 294.10 (F02.80) Without behavioral disturbance 331.83 (G31.84) Mild Neurocognitive Disorder Due to Multiple Etiologiesa Unspecified Neurocognitive Disorder (643) 799.59 (R41.9) Unspecified Neurocognitive Disordera Personality Disorders (645) Cluster A Personality Disorders 301.0 (F60.0) Paranoid Personality Disorder (649) 301.20 (F60.1) Schizoid Personality Disorder (652) 301.22 (F21) Schizotypal Personality Disorder (655) Cluster B Personality Disorders 301.7 (F60.2) Antisocial Personality Disorder (659) 301.83 (F60.3) Borderline Personality Disorder (663) 301.50 (F60.4) Histrionic Personality Disorder (667) 301.81 (F60.81) Narcissistic Personality Disorder (669) DSM-5 Classification xxxiii Cluster C Personality Disorders 301.82 (F60.6) Avoidant Personality Disorder (672) 301.6 (F60.7) Dependent Personality Disorder (675) 301.4 (F60.5) Obsessive-Compulsive Personality Disorder (678) Other Personality Disorders 310.1 (F07.0) Personality Change Due to Another Medical Condition (682) Specify whether: Labile type, Disinhibited type, Aggressive type, Apathetic type, Paranoid type, Other type, Combined type, Unspecified type 301.89 (F60.89) Other Specified Personality Disorder (684) 301.9 (F60.9) Unspecified Personality Disorder (684) Paraphilic Disorders (685) The following specifier applies to Paraphilic Disorders where indicated: aSpecify if: In a controlled environment, In full remission 302.82 (F65.3) Voyeuristic Disordera (686) 302.4 (F65.2) Exhibitionistic Disordera (689) Specify whether: Sexually aroused by exposing genitals to prepubertal children, Sexually aroused by exposing genitals to physically mature individuals, Sexually aroused by exposing genitals to prepubertal chil- dren and to physically mature individuals 302.89 (F65.81) Frotteuristic Disordera (691) 302.83 (F65.51) Sexual Masochism Disordera (694) Specify if: With asphyxiophilia 302.84 (F65.52) Sexual Sadism Disordera (695) 302.2 (F65.4) Pedophilic Disorder (697) Specify whether: Exclusive type, Nonexclusive type Specify if: Sexually attracted to males, Sexually attracted to females, Sexu- ally attracted to both Specify if: Limited to incest 302.81 (F65.0) Fetishistic Disordera (700) Specify: Body part(s), Nonliving object(s), Other 302.3 (F65.1) Transvestic Disordera (702) Specify if: With fetishism, With autogynephilia 302.89 (F65.89) Other Specified Paraphilic Disorder (705) 302.9 (F65.9) Unspecified Paraphilic Disorder (705) Other Mental Disorders (707) 294.8 (F06.8) Other Specified Mental Disorder Due to Another Medical Condition (707) 294.9 (F09) Unspecified Mental Disorder Due to Another Medical Condition (708) 300.9 (F99) Other Specified Mental Disorder (708) 300.9 (F99) Unspecified Mental Disorder (708) xxxiv DSM-5 Classification Medication-Induced Movement Disorders and Other Adverse Effects of Medication (709) 332.1 (G21.11) Neuroleptic-Induced Parkinsonism (709) 332.1 (G21.19) Other Medication-Induced Parkinsonism (709) 333.92 (G21.0) Neuroleptic Malignant Syndrome (709) 333.72 (G24.02) Medication-Induced Acute Dystonia (711) 333.99 (G25.71) Medication-Induced Acute Akathisia (711) 333.85 (G24.01) Tardive Dyskinesia (712) 333.72 (G24.09) Tardive Dystonia (712) 333.99 (G25.71) Tardive Akathisia (712) 333.1 (G25.1) Medication-Induced Postural Tremor (712) 333.99 (G25.79) Other Medication-Induced Movement Disorder (712) ___.__ (___.__) Antidepressant Discontinuation Syndrome (712) 995.29 (T43.205A) Initial encounter 995.29 (T43.205D) Subsequent encounter 995.29 (T43.205S) Sequelae ___.__ (___.__) Other Adverse Effect of Medication (714) 995.20 (T50.905A) Initial encounter 995.20 (T50.905D) Subsequent encounter 995.20 (T50.905S) Sequelae Other Conditions That May Be a Focus of Clinical Attention (715) Relational Problems (715) Problems Related to Family Upbringing (715) V61.20 (Z62.820) Parent-Child Relational Problem (715) V61.8 (Z62.891) Sibling Relational Problem (716) V61.8 (Z62.29) Upbringing Away From Parents (716) V61.29 (Z62.898) Child Affected by Parental Relationship Distress (716) Other Problems Related to Primary Support Group (716) V61.10 (Z63.0) Relationship Distress With Spouse or Intimate Partner (716) V61.03 (Z63.5) Disruption of Family by Separation or Divorce (716) V61.8 (Z63.8) High Expressed Emotion Level Within Family (716) V62.82 (Z63.4) Uncomplicated Bereavement (716) DSM-5 Classification xxxv Abuse and Neglect (717) Child Maltreatment and Neglect Problems (717) Child Physical Abuse (717) Child Physical Abuse, Confirmed (717) 995.54 (T74.12XA) Initial encounter 995.54 (T74.12XD) Subsequent encounter Child Physical Abuse, Suspected (717) 995.54 (T76.12XA) Initial encounter 995.54 (T76.12XD) Subsequent encounter Other Circumstances Related to Child Physical Abuse (718) V61.21 (Z69.010) Encounter for mental health services for victim of child abuse by parent V61.21 (Z69.020) Encounter for mental health services for victim of nonparental child abuse V15.41 (Z62.810) Personal history (past history) of physical abuse in childhood V61.22 (Z69.011) Encounter for mental health services for perpetrator of parental child abuse V62.83 (Z69.021) Encounter for mental health services for perpetrator of nonparental child abuse Child Sexual Abuse (718) Child Sexual Abuse, Confirmed (718) 995.53 (T74.22XA) Initial encounter 995.53 (T74.22XD) Subsequent encounter Child Sexual Abuse, Suspected (718) 995.53 (T76.22XA) Initial encounter 995.53 (T76.22XD) Subsequent encounter Other Circumstances Related to Child Sexual Abuse (718) V61.21 (Z69.010) Encounter for mental health services for victim of child sexual abuse by parent V61.21 (Z69.020) Encounter for mental health services for victim of nonparental child sexual abuse V15.41 (Z62.810) Personal history (past history) of sexual abuse in childhood V61.22 (Z69.011) Encounter for mental health services for perpetrator of parental child sexual abuse V62.83 (Z69.021) Encounter for mental health services for perpetrator of nonparental child sexual abuse Child Neglect (718) Child Neglect, Confirmed (718) 995.52 (T74.02XA) Initial encounter 995.52 (T74.02XD) Subsequent encounter xxxvi DSM-5 Classification Child Neglect, Suspected (719) 995.52 (T76.02XA) Initial encounter 995.52 (T76.02XD) Subsequent encounter Other Circumstances Related to Child Neglect (719) V61.21 (Z69.010) Encounter for mental health services for victim of child neglect by parent V61.21 (Z69.020) Encounter for mental health services for victim of nonparental child neglect V15.42 (Z62.812) Personal history (past history) of neglect in childhood V61.22 (Z69.011) Encounter for mental health services for perpetrator of parental child neglect V62.83 (Z69.021) Encounter for mental health services for perpetrator of nonparental child neglect Child Psychological Abuse (719) Child Psychological Abuse, Confirmed (719) 995.51 (T74.32XA) Initial encounter 995.51 (T74.32XD) Subsequent encounter Child Psychological Abuse, Suspected (719) 995.51 (T76.32XA) Initial encounter 995.51 (T76.32XD) Subsequent encounter Other Circumstances Related to Child Psychological Abuse (719) V61.21 (Z69.010) Encounter for mental health services for victim of child psychological abuse by parent V61.21 (Z69.020) Encounter for mental health services for victim of nonparental child psychological abuse V15.42 (Z62.811) Personal history (past history) of psychological abuse in childhood V61.22 (Z69.011) Encounter for mental health services for perpetrator of parental child psychological abuse V62.83 (Z69.021) Encounter for mental health services for perpetrator of nonparental child psychological abuse Adult Maltreatment and Neglect Problems (720) Spouse or Partner Violence, Physical (720) Spouse or Partner Violence, Physical, Confirmed (720) 995.81 (T74.11XA) Initial encounter 995.81 (T74.11XD) Subsequent encounter Spouse or Partner Violence, Physical, Suspected (720) 995.81 (T76.11XA) Initial encounter 995.81 (T76.11XD) Subsequent encounter Other Circumstances Related to Spouse or Partner Violence, Physical (720) V61.11 (Z69.11) Encounter for mental health services for victim of spouse or partner violence, physical DSM-5 Classification xxxvii V15.41 (Z91.410) Personal history (past history) of spouse or partner violence, physical V61.12 (Z69.12) Encounter for mental health services for perpetrator of spouse or partner violence, physical Spouse or Partner Violence, Sexual (720) Spouse or Partner Violence, Sexual, Confirmed (720) 995.83 (T74.21XA) Initial encounter 995.83 (T74.21XD) Subsequent encounter Spouse or Partner Violence, Sexual, Suspected (720) 995.83 (T76.21XA) Initial encounter 995.83 (T76.21XD) Subsequent encounter Other Circumstances Related to Spouse or Partner Violence, Sexual (720) V61.11 (Z69.81) Encounter for mental health services for victim of spouse or partner violence, sexual V15.41 (Z91.410) Personal history (past history) of spouse or partner violence, sexual V61.12 (Z69.12) Encounter for mental health services for perpetrator of spouse or partner violence, sexual Spouse or Partner, Neglect (721) Spouse or Partner Neglect, Confirmed (721) 995.85 (T74.01XA) Initial encounter 995.85 (T74.01XD) Subsequent encounter Spouse or Partner Neglect, Suspected (721) 995.85 (T76.01XA) Initial encounter 995.85 (T76.01XD) Subsequent encounter Other Circumstances Related to Spouse or Partner Neglect (721) V61.11 (Z69.11) Encounter for mental health services for victim of spouse or partner neglect V15.42 (Z91.412) Personal history (past history) of spouse or partner neglect V61.12 (Z69.12) Encounter for mental health services for perpetrator of spouse or partner neglect Spouse or Partner Abuse, Psychological (721) Spouse or Partner Abuse, Psychological, Confirmed (721) 995.82 (T74.31XA) Initial encounter 995.82 (T74.31XD) Subsequent encounter Spouse or Partner Abuse, Psychological, Suspected (721) 995.82 (T76.31XA) Initial encounter 995.82 (T76.31XD) Subsequent encounter Other Circumstances Related to Spouse or Partner Abuse, Psychological (721) V61.11 (Z69.11) Encounter for mental health services for victim of spouse or partner psychological abuse xxxviii DSM-5 Classification V15.42 (Z91.411) Personal history (past history) of spouse or partner psychological abuse V61.12 (Z69.12) Encounter for mental health services for perpetrator of spouse or partner psychological abuse Adult Abuse by Nonspouse or Nonpartner (722) Adult Physical Abuse by Nonspouse or Nonpartner, Confirmed (722) 995.81 (T74.11XA) Initial encounter 995.81 (T74.11XD) Subsequent encounter Adult Physical Abuse by Nonspouse or Nonpartner, Suspected (722) 995.81 (T76.11XA) Initial encounter 995.81 (T76.11XD) Subsequent encounter Adult Sexual Abuse by Nonspouse or Nonpartner, Confirmed (722) 995.83 (T74.21XA) Initial encounter 995.83 (T74.21XD) Subsequent encounter Adult Sexual Abuse by Nonspouse or Nonpartner, Suspected (722) 995.83 (T76.21XA) Initial encounter 995.83 (T76.21XD) Subsequent encounter Adult Psychological Abuse by Nonspouse or Nonpartner, Confirmed (722) 995.82 (T74.31XA) Initial encounter 995.82 (T74.31XD) Subsequent encounter Adult Psychological Abuse by Nonspouse or Nonpartner, Suspected (722) 995.82 (T76.31XA) Initial encounter 995.82 (T76.31XD) Subsequent encounter Other Circumstances Related to Adult Abuse by Nonspouse or Nonpartner (722) V65.49 (Z69.81) Encounter for mental health services for victim of nonspousal adult abuse V62.83 (Z69.82) Encounter for mental health services for perpetrator of nonspousal adult abuse Educational and Occupational Problems (723) Educational Problems (723) V62.3 (Z55.9) Academic or Educational Problem (723) Occupational Problems (723) V62.21 (Z56.82) Problem Related to Current Military Deployment Status (723) V62.29 (Z56.9) Other Problem Related to Employment (723) Housing and Economic Problems (723) Housing Problems (723) V60.0 (Z59.0) Homelessness (723) V60.1 (Z59.1) Inadequate Housing (723) DSM-5 Classification xxxix V60.89 (Z59.2) Discord With Neighbor, Lodger, or Landlord (723) V60.6 (Z59.3) Problem Related to Living in a Residential Institution (724) Economic Problems (724) V60.2 (Z59.4) Lack of Adequate Food or Safe Drinking Water (724) V60.2 (Z59.5) Extreme Poverty (724) V60.2 (Z59.6) Low Income (724) V60.2 (Z59.7) Insufficient Social Insurance or Welfare Support (724) V60.9 (Z59.9) Unspecified Housing or Economic Problem (724) Other Problems Related to the Social Environment (724) V62.89 (Z60.0) Phase of Life Problem (724) V60.3 (Z60.2) Problem Related to Living Alone (724) V62.4 (Z60.3) Acculturation Difficulty (724) V62.4 (Z60.4) Social Exclusion or Rejection (724) V62.4 (Z60.5) Target of (Perceived) Adverse Discrimination or Persecution (724) V62.9 (Z60.9) Unspecified Problem Related to Social Environment (725) Problems Related to Crime or Interaction With the Legal System (725) V62.89 (Z65.4) Victim of Crime (725) V62.5 (Z65.0) Conviction in Civil or Criminal Proceedings Without Imprisonment (725) V62.5 (Z65.1) Imprisonment or Other Incarceration (725) V62.5 (Z65.2) Problems Related to Release From Prison (725) V62.5 (Z65.3) Problems Related to Other Legal Circumstances (725) Other Health Service Encounters for Counseling and Medical Advice (725) V65.49 (Z70.9) Sex Counseling (725) V65.40 (Z71.9) Other Counseling or Consultation (725) Problems Related to Other Psychosocial, Personal, and Environmental Circumstances (725) V62.89 (Z65.8) Religious or Spiritual Problem (725) V61.7 (Z64.0) Problems Related to Unwanted Pregnancy (725) V61.5 (Z64.1) Problems Related to Multiparity (725) V62.89 (Z64.4) Discord With Social Service Provider, Including Probation Officer, Case Manager, or Social Services Worker (725) V62.89 (Z65.4) Victim of Terrorism or Torture (725) V62.22 (Z65.5) Exposure to Disaster, War, or Other Hostilities (725) V62.89 (Z65.8) Other Problem Related to Psychosocial Circumstances (725) V62.9 (Z65.9) Unspecified Problem Related to Unspecified Psychosocial Circumstances (725) xl DSM-5 Classification Other Circumstances of Personal History (726) V15.49 (Z91.49) Other Personal History of Psychological Trauma (726) V15.59 (Z91.5) Personal History of Self-Harm (726) V62.22 (Z91.82) Personal History of Military Deployment (726) V15.89 (Z91.89) Other Personal Risk Factors (726) V69.9 (Z72.9) Problem Related to Lifestyle (726) V71.01 (Z72.811) Adult Antisocial Behavior (726) V71.02 (Z72.810) Child or Adolescent Antisocial Behavior (726) Problems Related to Access to Medical and Other Health Care (726) V63.9 (Z75.3) Unavailability or Inaccessibility of Health Care Facilities (726) V63.8 (Z75.4) Unavailability or Inaccessibility of Other Helping Agencies (726) Nonadherence to Medical Treatment (726) V15.81 (Z91.19) Nonadherence to Medical Treatment (726) 278.00 (E66.9) Overweight or Obesity (726) V65.2 (Z76.5) Malingering (726) V40.31 (Z91.83) Wandering Associated With a Mental Disorder (727) V62.89 (R41.83) Borderline Intellectual Functioning (727) Preface The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) is a classification of mental disorders with associated criteria de- signed to facilitate more reliable diagnoses of these disorders. With successive editions over the past 60 years, it has become a standard reference for clinical practice in the mental health field. Since a complete description of the underlying pathological processes is not possible for most mental disorders, it is important to emphasize that the current diagnos- tic criteria are the best available description of how mental disorders are expressed and can be recognized by trained clinicians. DSM is intended to serve as a practical, functional, and flexible guide for organizing information that can aid in the accurate diagnosis and treatment of mental disorders. It is a tool for clinicians, an essential educational resource for students and practitioners, and a reference for researchers in the field. Although this edition of DSM was designed first and foremost to be a useful guide to clinical practice, as an official nomenclature it must be applicable in a wide diversity of contexts. DSM has been used by clinicians and researchers from different orientations (bi- ological, psychodynamic, cognitive, behavioral, interpersonal, family/systems), all of whom strive for a common language to communicate the essential characteristics of men- tal disorders presented by their patients. The information is of value to all professionals associated with various aspects of mental health care, including psychiatrists, other physicians, psychologists, social workers, nurses, counselors, forensic and legal special- ists, occupational and rehabilitation therapists, and other health professionals. The criteria are concise and explicit and intended to facilitate an objective assessment of symptom pre- sentations in a variety of clinical settings—inpatient, outpatient, partial hospital, consul- tation-liaison, clinical, private practice, and primary care—as well in general community epidemiological studies of mental disorders. DSM-5 is also a tool for collecting and com- municating accurate public health statistics on mental disorder morbidity and mortality rates. Finally, the criteria and corresponding text serve as a textbook for students early in their profession who need a structured way to understand and diagnose mental disorders as well as for seasoned professionals encountering rare disorders for the first time. Fortu- nately, all of these uses are mutually compatible. These diverse needs and interests were taken into consideration in planning DSM-5. The classification of disorders is harmonized with the World Health Organization’s Inter- national Classification of Diseases (ICD), the official coding system used in the United States, so that the DSM criteria define disorders identified by ICD diagnostic names and code numbers. In DSM-5, both ICD-9-CM and ICD-10-CM codes (the latter scheduled for adop- tion in October 2014) are attached to the relevant disorders in the classification. Although DSM-5 remains a categorical classification of separate disorders, we recog- nize that mental disorders do not always fit completely within the boundaries of a single disorder. Some symptom domains, such as depression and anxiety, involve multiple di- agnostic categories and may reflect common underlying vulnerabilities for a larger group of disorders. In recognition of this reality, the disorders included in DSM-5 were reordered into a revised organizational structure meant to stimulate new clinical perspectives. This new structure corresponds with the organizational arrangement of disorders planned for ICD-11 scheduled for release in 2015. Other enhancements have been introduced to pro- mote ease of use across all settings: xli xlii Preface Representation of developmental issues related to diagnosis. The change in chapter organization better reflects a lifespan approach, with disorders more frequently diag- nosed in childhood (e.g., neurodevelopmental disorders) at the beginning of the man- ual and disorders more applicable to older adulthood (e.g., neurocognitive disorders) at the end of the manual. Also, within the text, subheadings on development and course provide descriptions of how disorder presentations may change across the lifespan. Age-related factors specific to diagnosis (e.g., symptom presentation and prevalence differences in certain age groups) are also included in the text. For added emphasis, these age-related factors have been added to the criteria themselves where applicable (e.g., in the criteria sets for insomnia disorder and posttraumatic stress disorder, spe- cific criteria describe how symptoms might be expressed in children). Likewise, gender and cultural issues have been integrated into the disorders where applicable. Integration of scientific findings from the latest research in genetics and neuroimag- ing. The revised chapter structure was informed by recent research in neuroscience and by emerging genetic linkages between diagnostic groups. Genetic and physiological risk factors, prognostic indicators, and some putative diagnostic markers are high- lighted in the text. This new structure should improve clinicians’ ability to identify di- agnoses in a disorder spectrum based on common neurocircuitry, genetic vulnerability, and environmental exposures. Consolidation of autistic disorder, Asperger’s disorder, and pervasive developmen- tal disorder into autism spectrum disorder. Symptoms of these disorders represent a single continuum of mild to severe impairments in the two domains of social commu- nication and restrictive repetitive behaviors/interests rather than being distinct disor- ders. This change is designed to improve the sensitivity and specificity of the criteria for the diagnosis of autism spectrum disorder and to identify more focused treatment tar- gets for the specific impairments identified. Streamlined classification of bipolar and depressive disorders. Bipolar and depres- sive disorders are the most commonly diagnosed conditions in psychiatry. It was there- fore important to streamline the presentation of these disorders to enhance both clinical and educational use. Rather than separating the definition of manic, hypomanic, and major depressive episodes from the definition of bipolar I disorder, bipolar II disorder, and major depressive disorder as in the previous edition, we included all of the com- ponent criteria within the respective criteria for each disorder. This approach will facil- itate bedside diagnosis and treatment of these important disorders. Likewise, the explanatory notes for differentiating bereavement and major depressive disorders will provide far greater clinical guidance than was previously provided in the simple be- reavement exclusion criterion. The new specifiers of anxious distress and mixed fea- tures are now fully described in the narrative on specifier variations that accompanies the criteria for these disorders. Restructuring of substance use disorders for consistency and clarity. The categories of substance abuse and substance dependence have been eliminated and replaced with an overarching new category of substance use disorders—with the specific substance used defining the specific disorders. “Dependence” has been easily confused with the term “addiction” when, in fact, the tolerance and withdrawal that previously defined dependence are actually very normal responses to prescribed medications that affect the central nervous system and do not necessarily indicate the presence of an addiction. By revising and clarifying these criteria in DSM-5, we hope to alleviate some of the widespread misunderstanding about these issues. Enhanced specificity for major and mild neurocognitive disorders. Given the explo- sion in neuroscience, neuropsychology, and brain imaging over the past 20 years, it was critical to convey the current state-of-the-art in the diagnosis of specific types of disor- ders that were previously referred to as the “dementias” or organic brain diseases. Bi- ological markers identified by imaging for vascular and traumatic brain disorders and Preface xliii specific molecular genetic findings for rare variants of Alzheimer’s disease and Hun- tington’s disease have greatly advanced clinical diagnoses, and these disorders and others have now been separated into specific subtypes. Transition in conceptualizing personality disorders. Although the benefits of a more dimensional approach to personality disorders have been identified in previous edi- tions, the transition from a categorical diagnostic system of individual disorders to one based on the relative distribution of personality traits has not been widely accepted. In DSM-5, the categorical personality disorders are virtually unchanged from the previous edition. However, an alternative “hybrid” model has been proposed in Section III to guide future research that separates interpersonal functioning assessments and the ex- pression of pathological personality traits for six specific disorders. A more dimensional profile of personality trait expression is also proposed for a trait-specified approach. Section III: new disorders and features. A new section (Section III) has been added to highlight disorders that require further study but are not sufficiently well established to be a part of the official classification of mental disorders for routine clinical use. Dimen- sional measures of symptom severity in 13 symptom domains have also been incorpo- rated to allow for the measurement of symptom levels of varying severity across all diagnostic groups. Likewise, the WHO Disability Assessment Schedule (WHODAS), a standard method for assessing global disability levels for mental disorders that is based on the International Classification of Functioning, Disability and Health (ICF) and is ap- plicable in all of medicine, has been provided to replace the more limited Global As- sessment of Functioning scale. It is our hope that as these measures are implemented over time, they will provide greater accuracy and flexibility in the clinical description of individual symptomatic presentations and associated disability during diagnostic as- sessments. Online enhancements. DSM-5 features online supplemental information. Additional cross-cutting and diagnostic severity measures are available online (www.psychiatry.org/dsm5), linked to the relevant disorders. In addition, the Cul- tural Formulation Interview, Cultural Formulation Interview—Informant Version, and supplementary modules to the core Cultural Formulation Interview are also included online at www.psychiatry.org/dsm5. These innovations were designed by the leading authorities on mental disorders in the world and were implemented on the basis of their expert review, public commentary, and independent peer review. The 13 work groups, under the direction of the DSM-5 Task Force, in conjunction with other review bodies and, eventually, the APA Board of Trust- ees, collectively represent the global expertise of the specialty. This effort was supported by an extensive base of advisors and by the professional staff of the APA Division of Re- search; the names of everyone involved are too numerous to mention here but are listed in the Appendix. We owe tremendous thanks to those who devoted countless hours and in- valuable expertise to this effort to improve the diagnosis of mental disorders. We would especially like to acknowledge the chairs, text coordinators, and members of the 13 work groups, listed in the front of the manual, who spent many hours in this vol- unteer effort to improve the scientific basis of clinical practice over a sustained 6-year pe- riod. Susan K. Schultz, M.D., who served as text editor, worked tirelessly with Emily A. Kuhl, Ph.D., senior science writer and DSM-5 staff text editor, to coordinate the efforts of the work groups into a cohesive whole. William E. Narrow, M.D., M.P.H., led the research group that developed the overall research strategy for DSM-5, including the field trials, that greatly enhanced the evidence base for this revision. In addition, we are grateful to those who contributed so much time to the independent review of the revision proposals, including Kenneth S. Kendler, M.D., and Robert Freedman, M.D., co-chairs of the Scien- tific Review Committee; John S. McIntyre, M.D., and Joel Yager, M.D., co-chairs of the Clinical and Public Health Committee; and Glenn Martin, M.D., chair of the APA Assem- xliv Preface bly review process. Special thanks go to Helena C. Kraemer, Ph.D., for her expert statistical consultation; Michael B. First, M.D., for his valuable input on the coding and review of cri- teria; and Paul S. Appelbaum, M.D., for feedback on forensic issues. Maria N. Ward, M.Ed., RHIT, C
