Convert 309.28 to icd 10

DIAGNOSTIC AND STATISTICAL MANUAL OF

MENTAL DISORDERS FIFTH E D I T I O N

AMERICAN PSYCHIATRIC ASSOCIATION

DIAGNOSTIC AND STATISTICAL MANUAL OF

MENTAL DISORDERS F ! F T H E D I T ¡ O N

DSM-5

A División of American PsychiatricAssodation

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 tised 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)

ISBN 978-0-89042-555-8 (Paperback)

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) L American Psychiatric Association. II. American Psychiatric Association. DSM-5 Task Forcé. 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 616.89W5—dc23

2013011061

British Library Cataloguing in Publication Data A CIP record is available from the British Library.

Text Design—Tammy J. Cordova

Manufacturing—Edwards Brothers Malloy

Contents

DSM-5 C lassification...................... ............................................. xiii Preface........................................................... .................................. xli

Section 9 DSM-5 Basics

Introduction........................................................................................5

Use of the M an ua l...........................................................................19

Cautionary Statement for Forensic Use of DSM-5................ .25

Section 11 íiiagnostic 0rft@ri3 snd (#od©s

Neurodevelopmental Disorders.................... ................................ 31 Schizophrenia Spectrum and Other Psychotic D isorders.. . . . .87 Bipolar and Related Disorders.....................................................123 Depressive Disorders ................................................................... 155 Anxiety Disorders........................ .................................................. 189 Obsessive-Compulsive and Related D isorders........................ 235 Trauma- and Stressor-Related Disorders................................... 265 Dissociative D isorders................................................................ 291 Somatic Symptom and Related Disorders.................................309 Feeding and Eating Disorders.....................................................329 Elimination D isorders...................................................................355 Sleep-Wake Disorders........................................ ..........................361 Sexual D ysfunctions.....................................................................423 Gender D ysphoria ............................................ ............................451

Disruptive, Impulse-Control, and Conduct Disorders...............461 Substance-Related and Addictive D isorders.............................481 Neurocognitive Disorders............................................................. 591 Personality Disorders............................................................. .. 645 Paraphilic Disorders..................................................................... 685 Other Mental D isorders................................................ . ............707

Medication-lnduced Movement Disorders and Other Adverse Effects of M ed ica tion .............................. 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 D isorders.................761

Conditions for Further S tudy....................................................... 783

Highlights of Changes From DSM-IV to DSM-5.........................809 Glossary of Technical Term s....................................................... 817

Glossary of Cultural Concepts of D istress.............. ..................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 C ontributors...................................897

Index 917

DSM-5 Task Forcé David J. Kupfer, M.D.

Task Forcé Chair D a r r e l A» Regier, M.D., M.P.H.

Task Forcé Vice-Chair William E. Narrow, M.D., M.P.H.,

Research Director

Dan G. Blazer, M.D., Ph.D., M.P.H. Jack D. Burke Jr., M.D., M.P.H. William T. Carpenter Jr., M.D. F. Xavier Castellanos, M.D. Wilson M. Compton, M.D., M.P.E. Joel E. Dimsdale, M.D. Javier I. Escobar, M.D., M.Sc. . Jan A. Fawcett, M.D. Bridget F. Grant, Ph.D., Ph.D. (2009-) Steven E. Hyman, M.D. (2007-2012) Dilip V. Jeste, M.D. (2007-2011) Helena C. Kraemer, Ph.D. Daniel T. Mamah, M.D., M.P.E. James P. McNulty, A.B., Sc.B. Howard B. Moss, M.D. (2007-2009)

Susan K. Schultz, M.D., Text Editor Emily A. Kuhl, Ph.D., APA Text Editor

Charles P. O'Brien, M.D., Ph.D. Roger Peele, M.D. Katharine A. Phillips, M.D. Daniel S. Pine, M.D. Charles F. Reynolds III, M.D. Maritza Rubio-Stipec, Sc.D. David Shaffer, M.D. Andrew E. Skodol II, M.D. Susan E. Swedo, M.D. B. Timothy Walsh, M.D. Philip Wang, M.D., Dr.P.H. (2007-2012) William M. Womack, M.D. Kimberly A. Yonkers, M.D. Kenneth J. Zucker, Ph.D. Norman Sartorius, M.D., Ph.D., Consultant

APA División of Research Staff on DSM-5 Darrel A. Regier, M.D., M.P.H.,

Director, División o f Research William E. Narrow, M.D., M.P.H.,

Associate Director Emily A. Kuhl, Ph.D., Sénior Science

Writer; Staff Text Editor Diana E. Clarke, Ph.D., M.Sc., Research

Statistician

Lisa H. Greiner, M.S.S.A., DSM-5 Field Triáis Project M anager

Eve K. Moscicki, Sc.D., M.P.H., Director, Practice Research Network

S. Janet Kuramoto, Ph.D. M.H.S., Sénior Scientific Research Associate, Practice Research Network

Jennifer J. Shupirika, Assistant Director, DSM Operations

Seung-Hee Hong, DSM Sénior Research Associate

Anne R. Hiller, DSM Research Associate Alison S. Beale, DSM Research Associate Spencer R. Case, DSM Research Associate

Joyce C. West, Ph.D., M.P.P., Health Policy Research Director, Practice Research Network

Farifteh F. Duffy, Ph.D., Quality Care Research Director, Practice Research Network

Lisa M. Countis, Field Operations Manager, Practice Research Network

Amy Porfiri, M.B.A. Christopher M. Reynolds, Director ofFinance and Administration Executive Assistant

APA Office of the Medical Director James H. S c u lly Jr., M.D.

Medical Director and CEO

Editorial and Coding Consuitants Michael B. First, M.D. M aria N. Ward, M.Ed., RHIT, CCS-P

DSM-5 Work Groups ADHD and Disruptive Behavior Disorders

David Sh a ffer , M .D. Chair

R Xavier Ca stella n o s, M.D. Co-Chair

Paul J. Frick, Ph.D., Text Coordinator Glorísa Canino, Ph.D. Terrie E. Moffitt, Ph.D. Joel T. Nigg, Ph.D.

Luis Augusto Rohde, M.D., Sc.D. Rosemary Tannock, Ph.D. Eric A. Taylor, M.B. Richard Todd, Ph.D., M.D. (d. 2008)

Anxiety, Obsessive-Compulsive Spectrum, Posttraumatic, and DIssocíatíve Disorders

K atharine A. P h illip s , M.D. Chair

Michelle G. Craske, Ph.D., Text Coordinator

J. Gavin Andrews, M.D. Susan M. Bógels, Ph.D. Matthew J. Friedman, M.D., Ph.D. Eric Hollander, M.D. (2007-2009) Roberto Lewis-Fernández, M.D., M.T.S. Robert S. Pynoos, M.D., M.P.H.

Scott L. Rauch, M.D. H. Blair Simpson, M.D., Ph.D. David Spiegel, M.D. Dan J. Stein, M.D., Ph.D. M urray B. Stein, M.D. Robert J. Ursano, M.D. Hans-XJlrich Wittchen, Ph.D.

Childhood and Adolescent Disorders Daniel S. F in e , M .D. .

Chair Ronald E. Dahl, M.D. E. Jane Costello, Ph.D. (2007-2009) Regina Smith James, M.D. Rachel G. Klein, Ph.D.

Jam es F. Leckman, M.D. Ellen Leibenluft, M.D. Judith H. L. Rapoport, M.D. Charles H. Zeanah, M.D.

Eatíng Disorders B. Timothy W a ls h , M.D.

Chair Stephen A. Wonderlich, Ph.D.,

Text Coordinator Evelyn Attia, M.D. Anne E. Becker, M.D., Ph.D., Sc.M. Rachel Bryant-Waugh, M.D. Hans W. Hoek, M.D., Ph.D.

Richard E. Kreipe, M.D. Marsha D. Marcus, Ph.D. Jam es E. Mitchell, M.D. Ruth H. Striegel-Moore, Ph.D. G. Terence Wilson, Ph.D. Barbara E. Wolfe, Ph.D. A.P.R.N.

Mood Disorders Ja n A. F a w ce tt, M.D.

Chair Ellen Frank, Ph.D., Text Coordinator Jules Angst, M.D. (2007-2008) William H. Coryell, M.D. Lori L. Davis, M.D. Raymond J. DePaulo, M.D. Sir David Goldberg, M.D. James S. Jackson, Ph.D.

Kenneth S. Kendler, M.D., Ph.D. (2007-2010)

Mario Maj, M.D., Ph.D. Husseini K. Manji, M.D. (2007-2008) Michael R. Phillips, M.D. Trisha Suppes, M.D., Ph.D. Carlos A. Zarate, M.D.

Neurocognítive Disorders DILIP V. JESTE, M.D. (2007-2011)

Chair Emeritus D a n G. B lazer, M.D., Ph.D., M.P.H.

Chair R o n a ld C. Petersen , M.D., Ph.D.

Co-Chair Mary Ganguli, M.D., M.P.H.,

Text Coordinator Deborah Blacker, M.D., Sc.D. Waraehal Faison, M.D. (2007-2008)

Igor Grant, M.D. Eric J. Lenze, M.D. Jane S. Paulsen, Ph.D. Perminder S. Sachdev, M.D., PhD.

Neurodevelopmental Disorders Susan E. Sw edo , M.D.

Chair Gillian Baird, M.A., M.B., B.Chir.,

Text Coordinator Edwin H. Cook Jr., M.D. Francesca G. Happé, Ph.D. James C. Harris, M.D. Walter E. Kaufmann, M.D. Bryan H. King, M.D.

Catherine E. Lord, Ph.D. Joseph Piven, M.D. Sally J. Rogers, Ph.D. Sarah J. Spence, M.D., Ph.D. Fred Volkmar, M.D. (2007-2009) Amy M. Wetherby, Ph.D. Harry H. Wright, M.D.

Personality and Personality Disorders1 Andrew E. Skodol, M.D.

Chair John M. Oldham , M.D.

Co-Chair Robert F. Krueger, Ph.D., Text

Coordinator Renato D. Alarcon, M.D., M.P.H. Cari C. Bell, M.D. Donna S. Bender, Ph.D.

Lee Anna Clark, Ph.D. W. John Livesley, M.D., Ph.D. (2007-2012) Leslie C. Morey, Ph.D. Larry J. Siever, M.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 W illiam T. C arpenter Jr., M.D.

Chair Deartna M. Barch, Ph.D., Text

Coordinator Juan R. Bustillo, M.D. W olfgang Gaebel, M.D. Raquel E. Gur, M.D., Ph.D. Stephan H. Heckers, M.D.

Dolores Malaspina, M.D., M.S.P.H. Michael J. Owen, M.D., Ph.D. Susan K. Schultz, M.D. Rajiv Tandon, M.D. Ming T. Tsuang, M.D., Ph.D. Jim van Os, M.D.

Sexual and Gender Identity Disorders Kenneth J. Zucker, P h .D.

Chair Lori Brotto, Ph.D., Text Coordinator Irving M. Binik, Ph.D. Ray M. Blanchard, Ph.D. Peggy T. Cohen-Kettenis, Ph.D. Jack Drescher, M.D. Cynthia A. Graham, Ph.D.

Martin P. Kafka, M.D. Richard B. Krueger, M.D. Niklas Lángstróm, M.D., Ph.D. Heino F.L. Meyer-Bahlburg, Dr. rer. nat. Friedemann Pfáfflin, M.D. Robert Taylor Segraves, M.D., Ph.D.

SIeep-Wake Disorders C h a rle s F. Reynolds III, M.D.

Chair Ruth M. O'Hara, Ph.D., Text Coordinator Charles M. Morin, Ph.D. Alian I. Pack, Ph.D.

Kathy P. Parker, Ph.D., R.N. Susan Redline, M.D., M.P.Fí. Dieter Riemann, Ph.D.

Somatic Symptom Disorders Joel E. Dimsdale, M .D .

Chair James L. Levenson, M.D., Text

Coordinator Arthur J. Barsky III, M.D. Francis Creed, M.D. Nancy Frasure-Smith, Ph.D. (2007-2011)

Michael R. Irwin, M.D. Francis J. Keefe, Ph.D. (2007-2011) Sing Lee, M.D. Michael Sharpe, M.D. Lawson R. Wulsin, M.D.

Substance-Related Disorders C h a r le s P. CXBrien, M .D ., Ph.D .

Chair Thomas J. Crow ley, M .D.

Co-Chair W ilson M. Compton, M.D., M.P.E.,

Text Coordinator Marc Auriacombe, M.D. Guilherme L. G. Borges, M.D., Dr.Sc. Kathleen K. Bucholz, Ph.D. Alan J. Budney, Ph.D. Bridget F. Grant, Ph.D., Ph.D. Deborah S. Hasin, Ph.D.

Thomas R. Kosten, M.D. (2007-2008) Walter Ling, M.D. Spero M. Manson, Ph.D. (2007-2008) A. Thomas McLellan, Ph.D. (2007-2008) Nancy M. Petry, Ph.D. Marc A. Schuckit, M.D. Wim van den Brink, M.D., Ph.D.

(2007-2008)

DSM-5 Study Groups D iagnostic Spectra and DSM/ICD Harmonization

Steven E. H ym an , 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 K imberly A. Y onkers, M.D.

Chair R oberto 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. W ulsin , 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.DV 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 Ja c k 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., PhD. David Shaffer, M.D.

DSM-5 Research Group W illiam E. N arrow , M.D., M.P.H.

Chair Jack D. Burke Jr., M.D., M.P.H. David J. Kupfer, M.D. Diana E. Clarke, PhD., M.Sc. Darrel A. Regier, M.D., M.P.H. Helena C. Kraemer, PhD. David Shaffer, M.D.

Course Specifiers and Glossary WOLFGANG GAEBEL, M.D.

Chair Ellen Frank, PhD. Dan J. Stein, M.D., Ph.D. Charles P. O'Brien, M.D., Ph.D. Eric A. Taylor, M.B. Norman Sartorius, M.D., PhD ., 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 ñame, 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-XO-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 ñames, page numbers for the corresponding text or criteria are included in parentheses.

Note for all mental disorders due to another medical condition: Indícate the ñame of the other medical condition in the ñame of the mental disorder due to [the medical condi- tion]. The code and ñame 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) 319 (..........) Intellectual Disability (Intellectual Developmental Disorder) (33)

Specify current severity: |F70} Mild fP71) Moderate (FT2) Severe (F73) Profound

315.8 (F88) Global Developmental Delay (41)

319 (F79) Unspecified Intellectual Disability (Intellectual Developmental Disorder) (41)

Communication Disorders (41) 315.39 (f£v ' Language Disorder (42)

315.39 tíT'C Speech Sound Disorder (44)

315.35 fFé'̂ - Childhood-Onset Fluency Disorder (Stuttering) (45) Note: Later-onset cases are diagnosed as 307.0 (F98.5) adult-onset fluency

disorder. 315.39 {FEO ,89) Social (Pragmatic) Communication Disorder (47)

307.9 (FUt, ̂ Unspecified Communication Disorder (49)

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 catatonía (use additional code 293.89 [F06.1])

Attention-Deficit/Hyperactivity Disorder (59) __ «__ |...........) Attention-Deficit /Hyperactivity Disorder (59)

Specify whether: 314.01 '/ Combined presentation 314.00 ' Predominantly inattentive presentation 314.01 ' Predominantly hyperactive/impulsive presentation

Specify if: In partial remission Specify cmrevá. severity: Mild, Moderate, Severe

314.01 í *r' 'J;} Other Specified Attention-Deficit/Hyperactivity Disorder (65)

314.01 i-' *0 Unspecified Attention-Deficit/Hyperactivity Disorder (66)

Specific Learning Disorder (66) __.__ f,__ .__i Specific Learning Disorder (66)

Specify if: 315.00 ” With impairment in reading (specify if with word reading

accuracy, reading rate or fluency, reading comprehension) 315.2 ' , K ¿ With impairment in written expression (specify if with spelling

accuracy, grammar and punctuation accuracy, clarity or organization of written expression)

315.1 ' ' > ; 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 ‘ Developmental Coordination Disorder (74)

307.3 ,* 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 *' ^5.2) Tourette’s Disorder (81)

307.22 Persisten! (Chronic) Motor or Vocal Tic Disorder (81) Specify if: With motor tics only, With vocal tics only

DSM-5 Classification xv

307.21 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 *v'}Vv Unspecified Neurodevelopmental Disorder (86)

Schizophrenia Spectrum and Other Psychotic Disorders (87)

The following specifiers apply to Schizophrenia Spectrum and Other Psychotic Disorders where indicated: aSpecify 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; Múltiple episodes, currently in acute episode; Múl­ tiple episodes, currently in partial remission; Múltiple episodes, currently in full remission; Continuous; Unspecified

b Specify if: With catatonía (use additional code 293.89 [FOó.l]) cSpecify current severity of delusions, hallucinations, disorganized speech, abnormal psycho-

motor behavior, negative symptoms, impaired cognition, depression, and mania symptoms

301.22 Schizotypal (Personality) Disorder (90)

297.1 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 contení

298.8 Brief Psychotic Disorderb' c (94) Specify if: With marked stressor(s), Without marked stressor(s), With

postpartum onset 295*40 ; , Schizophreniform Disorderb/ c (96)

Specify if: With good prognostic features, Without good prognostic fea- tures

295.90 >, ■ . Schizophreniaa/ D/ c (99)

___? ; Schizoaffective Disorder3' b/ c (105) Specify whether:

295.70 ; > Bipolar type 295.70 Depressive type

___.__ í__ ....J Substance/Medication-Induced Psychotic Disorder0 (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 Condition0 (115) Specify whether:

293.81 With delusions 293.82 With hallucinations

xvi DSM-5 Classification

293.89 Catatonía Associated With Another Mental Disorder (Catatonía Specifier) (119)

293.89 (F06.1} Catatonic Disorder Due to Another Medical Condition (120)

293.89 *í Unspecified Catatonía (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 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, mpderate-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 catatonía (use additional code 293.89 [F06.1]); With peripartum onset; With seasonal pattem

__ ■__i___*__1 Bipolar I Disorder3 (123) ___( _ . _ J Current or most recent episode manic 296.41 i?.: Mild 296.42 r:l* Moderate 296.43 / Severe 296.44 With psychotic features 296.45 - , In partial remission 296.46 In full remission 296.40 ?r.V 7 Unspecified 296.40 {F31.0) Current or most recent episode hypomanic 296.45 f In partial remission 296.46 In full remission 296.40 'fr*;. Unspecified __ .__ ' _.. _ Current or most recent episode depressed 296.51 Mild 296.52 ^ Moderate 296.53 ff 31.4) Severe 296.54 With psychotic features 296.55 v ' 1* , In partial remission 296.56 ' In full remission 296.50 .''W ^ Unspecified 296.7 :* Current or most recent episode unspecified

296.89 ' í Bipolar II Disorder3 (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 not currently met:

Mild, Moderate, Severe

DSM-5 Olassiíication

301,13 Cyclothymic Disorder (139) Specify if: With anxious di stress

___.__ i . .. ? Substance/Medication-Induced Bipolar and Related Disorder (142) Note: See the criteria set and corresponding recording procedures for

substance-specific codes and 1CD-9-CM and ICD-10-CiVÍ coding. Specify if: With onset during intoxication, With onset during withdrawa!

293,83 i _ , I Bipolar and Related Disorder Due to Another Medical Condition (145)

Specify if: ' / , ' With manic features / :̂ ' With manic- or hypomanic-Tike episode

' -", * 7 With mixed features

296.89 T ̂/ Other Specified Bipolar and Related Disorder (148)

296.80 ' /' 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-incongment psychotic features; With catatonía (use additional code 293.89 [F06.1]); With peripartum onset; With seasonal parlera

296=99 (F34ÍÍ) Disruptive Mood Dysregulation Disorder (156) ,.a ,Major Depressive Disordera (160)

Single episode 296.21 ;V?/2áÍ¡ Mild 296.22 F32, i) Moderate 296.23 fF3P/

" . í Recurren! episode 296.31 Mild 296.32 Moderate 296.33 7 -37^ Severe 296.34 (P3&2Í With psychotic features 296.35 'F3SA1) ín partial remission 296,36 r33/42| ín full remission 296.30 Unspecified

300.4 < ̂*í * Persistent Depressive Disorder 'sthymia)a (168) Specify if: In partial remission, In full remission Specify if: Eariy onset, Late onset Specify i*: With puré dysthvmic syndrome; With persisten! major depres-

sive episode; With intermittent major depressive episode.s, with curren!

xviii DSM-5 Classification

625.4

293.83

311

311

309.21

312.23

300.29

300.23

300.01

300.22

300.02

episode; With intermiiíent major depiessive episodes, wirhoat curren; episode

Specify current severity: Mild, Moderate, Severe ÍN94.3j Premenstrual Dysphoric Disorder (171)

{___ J Substance/Medication-Induced Depressive Disorder (175) Note: See the criteria set and corresponding recording procedures for

substance-specifie codes and ICD-9-CM and ICD-10-CM coding. Specify if: With onset during intoxication, With onset during withdrawa i

Depressive Disorder Due to Another Medical Condition (18C) Specify if:

/ ' y' ‘ With depressive features '' 0C, Oo With major depressive-like episode Wz') ̂ , With mixed features

(F32.8) Other Specified Depressive Disorder (183)

l Unspecified Depressive Disorder (184)

Anxiety Disorders (189) (F9S,0) Separation Anxiety Disorder (190)

ÍF94,0) Selective Mutism (195)

(__■ j Specific Phobia (197) Specify if:

IF4C121 Sf Animal (F40.228) Natural environment I__ J Blood-injection-injury fF40.230| Fear of blood {F40,2r*, Fear of injections and transfusions (F4G.232? Fear of other medical care íf 40,233s Fear of injury

/ ' ' Situational Other

Social Anxiety Disorder (Social Phobia) (202) Specify if: Performance only

|F41 iJ| Panic Disorder (208)

' . _ i Panic Attack Specifier (214)

(P40*00f Agoraphobia (217)

lf4 íA ¡ Generalized Anxiety Disorder (222)

í ___ j 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 meciication use

DSM-5 Classification

293.84 i/- Anxiety Disorder Due to Another Medical Condition (230)

300.09 ,C; Other Specified Anxiety Disorder (233)

300,00 \V Unspecified Anxiety Disorder (233)

Obsessive-Compulsive and Related Disorders (235) The following specifier applies to Obsessive-Compulsive and Related Disorders where indicated: * Specify if: With good or fair insight, With poor insight, With absent ins igh l / d eiu s i ona i beHers

300.3 Obsessive-Compulsive Disordera (237) Specify if: Tic-related

300.7 ' ̂ — Body Dysmorphic Disordera (242) Specify if: With muscle dysmorphia

300.3 Hoarding Disorder3 (247) Specify if: With excessive acquisition

312.39 " * ¿ Trichotillomania (Hair-Pulling Disorder) (251)

698.4 , ^ ' Excoriation (Skin-Picking) Disorder (254)

___.__ i , f 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 ÍCD-10-CM coding.

Specify if: With onset during intoxication, With onset during wiíhdrawol, With onset after medication use

294.8 ÍF06.S) 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 Other Specified Obsessive-Compulsive and Related Disorder (263) ‘

300.3 ' ̂ ' Unspecified Obsessive-Compulsive and Related Disorder (264)

Trauma- and Stressor-Related Disorders (265) 313.89 ' V . ' Reactive Attachment Disorder (265)

Specify if: Persistent Specify current severity: Severe

313.89 ; , ' Disinhibited Social Engagement Disorder (268) Specify if: Persistent Specify current severity: Severe

309.81 ' , Posttraumatic Stress Disorder (irtcludes Posttraumatic Stress Disorder for Children 6 Years and Younger) (271)

Specify whether: With dissociative syinptoms Specify if: With delayed expression

308.3 ' Acute Stress Disorder (280)

XX DSM-5 Classification

__ .__ J Adjustment Disorders (286) Specify whether:

309.0 (F43.21) With depressed mood 309.24 fF43*22) With anxiety 309.28 ff43,23) With mixed anxiety and depressed mood 309.3 ÍF43.24) With disturbance of conduct 309.4 (F43,25) With mixed disturbance of emotions and conduct 309.9 ^43.20) Unspecified

309.89 'Vi V Other Specified Trauma- and Stressor-Related Disorder (289)

309.9 Unspecified Trauma- and Stressor-Related Disorder (290)

Dissociative Disorders (291) 300.14 Dissociative Identity Disorder (292)

300-12 !?44.Q} Dissociative Amnesia (298) Specify if:

300.13 ÍF44.1) With dissociative fugue

300-6 Depersonalization/Derealízation Disorder (302)

300.15 f f44.89) Other Specified Dissociative Disorder (306)

300.15

Somatic Symptom and Related Disorders (309) 300.82 ÍF45.1) Somatic Symptom Disorder (311)

Specify if: With predominant pain Specify if: Persistent Specify current severity: Mild, Moderate, Severe

300.7 íllness Anxiety Disorder (315) Specify whether: Care seeking type, Care avoidant type

300.11 i___i Conversión Disorder (Functional Neurological Symptom Disorder) (318)

Specify symptom type: if~44„4) With weakness or paralysis íb44,4) With abnormal movement s f44Á¡ With swallowing symptoms iF44.4) With speech symptom ^44.5) With attacks or seizures |F44.6) With anesthesia or sensory loss {r 44.6) With special sensory symptom -44.7* With mixed symptoms

Specify if: Acute episode, Persistent Specify if: With psychological stressor (specify stressor), Without psycho-

logicai stressor

DSM-5 Classification xxi

318 Psychologícal Factors Affecting Other Medical Conditions (322) Specify current severity: Mild, Moderate, Severe, Extreme

300.19 Factitious Disorder (includes Factitious Disorder ímposed on Self, Factitious Disorder Imposed on Another) (324)

Specify Single episode, Recurren! episodes 300.89 ' Other Specified Somatic Symptom and Related Disorder (327)

300.82 ' „ , Unspecified Somatic Symptom and Reía red Disorder (327)

Feeding and Eating Disorders (329) The following specifiers apply to Feed ing and Eating Disorders wh^re indicated: aSpecify if: In remission ^Specify if: In partial remission, In full remission cSpecify current severity: Mild, Moderate, Severe, Extreme . 307,52: , ; Picaa (329)

*'7 ' ; In children #í In adults

307.53 ?<''■£$,>. < ? Rumination Disordera (332)

307.59 ? Avoidant/Restrictive Food Intake Disordera (334)

307.1 í . „ „ . I Anorexia Nervosab/ c (338) Specify whether:

i f>C ,01 ) Restricting type ; F5C; Binge-eating/ purging type

307.51 v/; % Bulimia Nervosab' c (345)

307.51 ---• Binge-Eating Disorderb' c (350)

307.59 (F50.8) Other Specified Feeding or Eating Disorder (353)

307.50 Unspecified Feeding or Eating Disorder (354)

Elimination Disorders (355) 307.6 '.'Vo Enuresis (355) _

Specify whether: Nocturnal only, Diurna] only, Nocturnal and diurna! 307.7 * , Encopresis (357)

Specify whether: With constipa!ion and overHow incontinence, Without constipation and overflow incontinence

__ .__ : , ; Other Specified Elimination Disorder (359) 788.39 '' 7 ', K 'í; With urinary symptoms 787.60 (H15.9) With fecal symptoms

__ .__, ~ ? Unspecified Elimination Disorder (360) 788.30 ' With urinary symptoms 787.60 - í; 1 With fecal symptoms

xxii DSM-5 Classification

Sleep-Wake Disorders (361) The following specifiers apply to Sleep-Wake Disorders where indicated: aSpecify if: Episodic, Persistent, Recurrent bSpecify if: Acute, Subacute, Persistent €Specify current severity: Mild, Moderate, Severe

780.52 (G47.00) Insomnia Disorder3 (362) Specify if: With non-sleep disorder mental comorbidity, With other

medical comorbidity, With other sleep disorder 780.54 *' ~ Hypersomnolence Disorderb/ c (368)

Specify if: With mental disorder, With medical condition, With another sleep disorder

___ .__ .._»..J Narcolepsyc (372) Specify whether:

347.00 ' ' Narcolepsy without cataplexy but with hypocretin deficiency 347*01 Narcolepsy with cataplexy but without hypocretin deficiency 347.00 ' x / 7 Autosomal dominant cerebellar ataxia, deafness, and

narcolepsy 347.00 (G47.419} Autosomal dominant narcolepsy, obesity, and type 2 diabetes 347.10 1047*429} Narcolepsy secondary to another medical condition

Breathing~Related Sleep Disorders (378) 327.23 Obstructive Sleep Apnea Hypopneac (378)

__ .__ C__■... J Central Sleep Apnea (383) Specify whether:

327.21 (G47.31) Idiopathic central sleep apnea 786.04 * /) Cheyne-Stokes breathing 780.57 7) Central sleep apnea comorbid with opioid use

Note: First code opioid use disorder, if present. Specify current severity

___-__ í___.....) Sleep-Related Hypoventilation (387) Specify whether:

327.24 Idiopathic hypoventilation 327.25 (€547,35) Congenital central alveolar hypoventilation 327.26 C / V.; Comorbid sleep-related hypoventilation

Specify current severity

__ .__ {___.__) Circadian Rhythm Sleep-Wake Disorders3 (390) Specify whether:

307.45 # ^ 7 .2 Delayed sleep phase type (391) Specify if: Familial, Overlapping with non-24-hour sleep-wake type

307.45 (047,22) Advanced sleep phase type (393) Specify if: Familial

307.45 (G47.23) Irregular sleep-wake type (394) 307.45 (€547,24) Non-24-hour sleep-wake type (396)

DSM-5 Classification :tiüh

307.45 C ' Shift work type (397) 307.45 (€147*20) Unspecified type

Parasomnias (399) __ .__ _ ._ j Non-Rapid Eye Movement Sleep Arousal Disorders (399)

Specify whether: 307.46 ; r‘ ' V Sleepwalking type

Specify if: With sleep-related eating, With slesp-reMsd sexual behavior (sexsom r. ia)

307.46 Sleep terror type

307.47 ^ < ', Nightmare Disorderb/ c (404) Specify if: During sleep onset Specify if: With associated non-sleep disorder, W*'ch associatea oiie'

medical condition, With associated other s-eco dísorde,

327.42 í*y;y r V Rapid Eye Movement Sleep Behavior Disorder (407)

333.94 (yyyfJ/5' Restless Legs Syndrome (410)

,_ í , 1 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 / withd r a w a 1 780.52 ' / Other Specified Insomnia Disorder (420)

780.52 4, y y Unspecified Insomnia Disorder (420)

780.54 H' 'J ' - Other Specified Hypersomnolence Disorder (421)

780.54 (G4/.1Ü; Unspecified Hypersomnolence Disorder (421)

780.59 (G47.8) Other Specified Sleep-Wake Disorder (421)

780.59 (íy; Unspecified Sleep-Wake Disorder (422)

Sexual Dysfunctions (423) The following specifiers apply to Sexual Dysfunctions where indicated: JSpecify whether: Lifelong, Acquired b Specify whether: General ized, Sitúa ti onal 1 Specify current severity: Mild, Moderate, Severe

302.74 V ; y" Delayed Ejaculation3' b' c (424)

302.72 Cf52.yy Erectile Disordera/ b/ c (426)

302.73 (F52.31 j Female Orgasmic DisorderS/ b/ c (429) Specify if: Never experienced an orgasm under any sitúa tion

302.72 ̂ ' Female Sexual Interest/Arousal Disorder3' D/ c (433)

302.76 r Genito-Pelvic Pain/Penetration Disorder3 7 L (437)

xxiv DSM-5 Classification

302.71 V' Male Hypoactive Sexual Desíre Disordera/ b/ c (440)

302.75 (F52.4) Premature (Early) E)aculationa/ b/ c (443) -

__ ._, (___,__J Substance/Medication-Induced Sexual Dysfunction0 (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 withdrawa!,

With onset after medication use 302.79 Other Specified Sexual Dysfunction (450)

302.70 ..... Unspecified Sexual Dysfunction (450)

Gender Dysphoria (451) __ .__ f_*__I Gender Dysphoria (452) 302.6 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.

302.8 Other Specified Gender Dysphoria (459)

302.6 Unspecified Gender Dysphoria (459)

Disruptive, Impulse-Control and Conduct Disorders (461] 313.81

312.34

312.81 - , 312.32 ' 312.89

301.7 ' /

312.33 (F63.1)

312.32

312.89 - ' ‘

312.9

Oppositional Defiant Disorder (462) Specify current severity: Mild, Moderate, Severe Intermittent Explosive Disorder (466)

Conduct Disorder (469) Specify whether:

Childhood-onset type Adolescent-onset type Unspecified onset

Specify if: With limited prosocial emotions Specify current severity: Mild, Moderate, Severe Antisocial Personality Disorder (476)

Pyromania (476)

Kleptomania (478)

Other Specified Disruptive, Impulse-Control, and Conduct Disorder (479)

Unspecified Disruptive, Impulse-Control, and Conduct Disorder (480)

DSM-5 Classiíication XXV

Substance-Related and Addictive Disorders (481) The following specifiers and note apply to Substance-Related and Addictive Disorders where indicated: * Specify if: ín early remission, In sustained remission bSpecify if: In a controlled environment cSpecify if: With perceptual disturbances c]The 1CD-10-CM code indica tes the comorbid presence of a modera ir or se'-'?™? subŝ ancc- uss

disorder, which must be present in order to apply the code for subsiarxe v/ithársvvai.

Substance-Related Disorders (483)

Aícohol-Reíated Disorders (490)

___.__ í _» í Alcohol Use Disordera/ b (490) Specify current severity:

305.00 ; Mild 303.90 ' , ' Moderate 303.90 /' Severe

303.00 _ j Alcohol Intoxication (497) | Fi 0. i 29) With use disorder, mild ̂ '0 With use disorder, moderate or severe

' ̂0/. ' Without use disorder

291.81 í__ J Alcohol WithdrawalC/ d (499) fUi's 4 , Without perceptual disturbances

" ' ̂ With perceptual disturbances

___.__ . _j Other Alcohol-Induced Disorders (502)

291.9 (F1Q,99i Unspecified Alcohol-Related Disorder (503)

Caffeine-Related Disorders (503) 305.90 • ' Caffeine Intoxication (503)

292.0 / ' 1 ̂- Caffeine Withdrawal (506) ___.__ i__ . i Other Caffeine-Induced Disorders (508)

292.9 Unspecified Caffeine-Related Disorder (509)

Cannabis-Related Disorders (509)

___.__ I__i Cannabis Use Disordera/ b (509) Specify current severity:

305.20 (Fi2Aíh Mild 304.30 > Y, Moderate 304.30 S ^ Severe

292.89 { ._) Cannabis IntoxicationG (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 (F12a 122) With use disorder, mild (F With use disorder, moderate or severe fF ̂ : Without use disorder

292.0 Cannabis Withdrawald (517)

___.__ {..........) Other Canrtabis-Induced Disorders (519)

292.9 ̂ ̂ Unspecified Cannabis-Related Disorder (519)

Hallucinogen-Reiated Disorders (520)

___.__ f__ .__) Phencyclidine Use Disordera/ b (520) Specify current severity:

305.90 fF Mild 304.60 (F16.20) Moderate 304.60 ff 16*20) Severe

___.__ {__...__) Other Hallucinogen Use Disorder3' b (523) Specify the particular hallucinogen Specify current severity:

305.30 fF Mild 304.50 (F Moderate 304.50 (FI 6,20} Severe

292.89 í .__| Phencyclidine Intoxication (527) (F16.129) With use disorder, mild (FI 6,229) With use disorder, moderate or severe (F18.929} Without use disorder

292.89 i __.__} Other Hallucinogen Intoxication (529) Xs ̂ , With use disorder, mild fFH, With use disorder, moderate or severe (FI 6.929) Without use disorder

292.89 {F16,983) Hallucinogen Persisting Perception Disorder (531)

___.__ f__ .__)___ Other Phencyclidine-Induced Disorders (532)

___.__ ......J Other Hallucinogen-Induced Disorders (532)

292.9 f F U n s p e c i f i e d Phencyclidine-Related Disorder (533)

292.9 Unspecified Hallucinogen-Reiated Disorder (533)

Inhalant-Related Disorders (533)

___.__ (__..,__| Inhalant Use DisorderS/ b (533) Specify the particular inhalant Specify current severity:

305.90 (F18.10) Mild

xxvi DSM-5 Classiíication

DSM-5 Classification XXVÍ!

304.00 ;jKo,£C} Moderate 304.00 (F18.20) Severe ~

292.89 I__ .__J Inhalant Intoxication (538) 129} With use disorder, mild

With use disorder, moderate or severe ' í , / t Without use disorder

___Other Inhalant-Induced Disorders (540)

292.9 S Unspecified Inhalant-Related Disorder (540)

Opioid-Related Disorders (540)

___ .__ i__ ._i Opioid Use Disorder3 (541) Specify if: On maintenance therapy, In a controlled environment Specify current severity:

305.50 Mild - 304.00 ̂ Moderate 304.00 ' ^ Severe

292»89 !__ *_) Opioid Intoxication0 (546) Without perceptual disturbances

With use disorder, mild With use disorder, moderate or severe Without use disorder

With perceptual disturbances With use disorder, mild

'i 1Í 2^2; With use disorder, moderate or severe Without use disorder

292.0 |F11,231 Opioid Withdrawald (547)

___-__ f__ .__J Other Opioid-Induced Disorders (549)

292.9 - ; Unspecified Opioid-Related Disorder (550)

Sedative-, Hypnotic-, or AnxiolytioReíated Disorders (550)

___-__ (__ .__i Sedative, Hypnotic, or Anxiolytic Use Disorder3' b (550) Specify/ current severity:

305.40 Mild ~ 304.10 < Moderate 304.10 ' - Severe

292.89 i...Sedative, Hypnotic, or Anxiolytic Intoxication (556) ! 3,1 ̂ With use disorder, mild

22G; With use disorder, moderate or severe ' Without use disorder

292.0 Sedative, Hypnotic, or Anxiolytic WithdrawalC/ d (557) Without perceptual disturbances With perceptual disturbances

xxviii DSM-5 Classification

— ■■— Other Sedative-, Hypnotic-, or Anxioiytic-índuced Disorders (560)

292.9 (F13.99) Unspecified Sedative-, Hypnotic-, or Anxiolytic-Related Disorder (560)

Stimulant-Related Disorders (561)

I.._•_) Stimulant Use Disordera/ b (561) Specify current severity:

(_ ..■_.I Mild 305.70 (F15.10) Amphetamine-type substance 305.60 (F 14,10) Cocaine 305.70 . 0) Other or unspecified stimulant ___B ( _ ■ _ ) Moderate 304.40 0) Amphetamine-type substance 304.20 (F14.20) Cocaine 304.40 {f i 6.20} Other or unspecified stimulant

. í__ Severe 304.40 (FI 5.20) Amphetamine-type substance 304.20 {f 14.20) Cocaine 304.40 (h í o«2U) Other or unspecified stimulant

292.89 (_._J Stimulant Intoxication0 (567) Specify the specific intoxicant

292.89

(F15.129! 29)

{F15.929}

Amphetamine or other stimulant, Without perceptual disturbances

With use disorder, mild With use disorder, moderate or severe Without use disorder

292.89 f_-.J (F14.129) ÍF14.229)

Cocaine, Without perceptual disturbances With use disorder, mild With use disorder, moderate or severe Without use disorder

292.89

n 'í v , , (FI 5,222) (FI 5,922)

Amphetamine or other stimulant, With perceptual disturbances

With use disorder, mild With use disorder, moderate or severe Without use disorder

292.89 f__ ._ J (F14.122) {FI 4,222) * ^

Cocaine, With perceptual disturbances With use disorder, mild With use disorder, moderate or severe Without use disorder

292.0

{FI -5,23) (F14.23)

Stimulant Withdrawald (569) Specify the specific substance causing the withdrawal syndrome

Amphetamine or other stimulant Cocaine

Other Stimulant-Induced Disorders (570)

DSM-5 Classification

292.9 Unspecified Stimulant-Related Disorder (570) \f 'í2 , h9) Amphetamine or other stimul a nt (F14.99) Cocaine

Tobacco-Related Disorders (571)

__ .__ ; ; Tobacco Use Disordera (571) Specify if: On maintenance therapy, In a conírollcd efr/i ív/ri Specify cu rren t severity:

305.1 : , Mild Moderate

,200i Severe 305.1 305.1

292.0 t2tó) Tobacco WithdrawaP (575)

__ .__ í . .. ) Other Tobacco-Tnduced Disorders (576)

292.9 '' //.,/; Unspecified Tobacco-Related Disorder (577)

Other (or Unknown) Substance-Related Disorders (577)

__ I , J Other (or Unknown) Substance Use Disordera/ b (577) Specify current severity:

305.90 'P Mild 304.90 Moderate 304.90 ' ¿X, Severe

292.89 í _ _. . J Other (or Unknown) Substance Intoxication (581) ~'" -' With use disorder, mild

(ír19.229) With use disorder, moderate or severe I f 19,929) Without use disorder

292.0 fr 19.239) Other (or Unknown) Substance Withdrawald (583)

__ .__ (__*__) Other (or Unknown) Substance-Induced Disorders (584)

292.9 'r ' "X, Unspecified Other (or Unknown) Substance-Related Disorder (585)

Non-Substance-Related Disorders (585) 312.31 V ̂ ' Gambling Disorder5 (585)

Specify if: Episodic, Persistent Specify current severity: Mild, Moderate, Severe

Neurocognitive Disorders (591)

__ .__ i . j Delirium (596) aNote: See the criteria set and corresponding recording procedures for

substance-specific codes and ICD-9-CM and ICD-10-CM coding Specify whether:

__ a__" ’ Substance intoxication deiiriuma __ ._ ̂ Substance withdrawal deiiriuma 292.81 ' Medication-induced deliriuma 293.0 ;K X ' Delirium due to another medical condition

XXX DSM-5 Ciassification

293.0 (POS) Delirium due to múltiple 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 Neurocogniíive Disorders (602) Specify whether due to: Alzheimer's disease, Frontotemporal lobar degeneration, Lewy body

disease, Vascular disease, Trauma tic brain injury, Substance/medication use, HÍV infection, Prion disease, Parkinson's disease, Huntington's disease, Another medical condition, Múlti­ 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.

^Specify 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 Disease^

Note: Code first 331.0 (G30.9) Alzheimer's disease. 294.11 With behavioral disturbance 294JO , Without behavioral disturbance

331.9 {031 .9} Possible Major Neurocognitive Disorder Due to Alzheimer's Disease3' b

331.83 (G31 .84) Mild Neurocognitive Disorder Due to Alzheimer's Diseasea

Major or Mild Frontotemporal Neurocognitive Disorder (614)

___.__ i__ ,__) Probable Major Neurocognitive Disorder Due to Frontotemporal Lobar Degeneration^

Note: Code first 331.19 (G31.09) frontotemporal disease. With behavioral disturbance Without behavioral disturbance

Possible Major Neurocognitive Disorder Due to Frontotemporal Lobar Degenerationa/ b

Mild Neurocognitive Disorder Due to Frontotemporal Lobar Degeneration3

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 '>0* Without behavioral disturbance

294 .11 £1) 294,.10 (F02.

331,.9 (G31 ,91

331,.83 (G31 .84}

DSM-5 Classífication xxxi

331.9 ; . ,, Possible Major Neurocognitive Disorder With Lewy Bodiesa/

331.83 (G31 * Mild Neurocognitive Disorder With Lewy Bodiesa

Major or Mild Vascular Neurocognitive Disorder (621)

__ .__ {___*__; Probable Major Vascular Neurocognitive Disorder53 Note: No additional medical code for vascular disease.

290.40 ' r ' With behavioral disturbance 290.40 , , . Without behavioral disturbance

331.9 - ' Possible Major Vascular Neurocognitive Dísordera/b

331.83 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 With behavioral disturbance 294.10 > V Without behavioral disturbance

331.83 //%/ ' Mild Neurocognitive Disorder Due to Traumatic Brain Injurycl

Substance/Medication-Induced Major or Mild Neurocognitive Disorder3 (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 H!V Infection (632)

Major Neurocognitive Disorder Due to HIV Infectionb Note: Code first 042 (B20) HIV infection.

With behavioral disturbance Without behavioral disturbance

Mild Neurocognitive Disorder Due to HIV Infection3

Major or Mild Neurocognitive Disorder Due to Prion Disease (634)

__ .__ f......*....} Major Neurocognitive Disorder Due to Prion Disease^ Note: Code first 046.79 (A81.9) prion disease.

294.11 With behavioral disturbance 294.10 V' Without behavioral disturbance

331.83 '* ̂ Mild Neurocognitive Disorder Due to Prion Disease3

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 /: ', With behavioral disturbance 294.10 Without behavioral disturbance

— *___ í.......... J

294.11 294.10 |F02,80)

331.83 {G31.84)

xxxi i DSM-5 Classification

331.9 , ' 1 ' Major Neurocognitive Disorder Possíbly Due to Parkinson's Disease3' b

331.83 (G31.84) Mild Neurocognitive Disorder Due to Parkinson's Diseasea

Major or Mild Neurocognitive Disorder Due to Huntington’s Disease (838)

___._ ' , Major Neurocognitive Disorder Due to Huntington's Diseaseb Note: Code first 333.4 (G10) Huntington's disease.

294=11 - " " With behavioral disturbance 294.10 , / Without behavioral disturbance

331.83 : > , ' Mild Neurocognitive Disorder Due to Huntington's Disease3

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 r ' With behavioral disturbance 294.10 Without behavioral disturbance

331.83 Mild Neurocognitive Disorder Due to Another Medical Condition3

Major or Mild Neurocognitive Disorder Due to Múltiple Etiologies (642)

__ .__ Major Neurocognitive Disorder Due to Múltiple Etiologiesb Note: Code first all the etiological medical conditions (with the exception

of vascular disease). 294.11 ^ " ; With behavioral disturbance 294.10 (F02.80) Without behavioral disturbance

331.83 % s Mild Neurocognitive Disorder Due to Múltiple Etiologies3

Unspecified Neurocognitive Disorder (643) 799.59 7 ' Unspecified Neurocognitive Disorder3

Personality Disorders (645)

Cluster A Personality Disorders 301.0 w Paranoid Personality Disorder (649)

301.20 (F60.1) Schizoid Personality Disorder (652)

301.22 "r í ' Schizotypal Personality Disorder (655)

Cluster B Personality Disorders 301.7 (F60.2) Antisocial Personality Disorder (659)

301.83 Borderline Personality Disorder (663)

301.50 Histrionic Personality Disorder (667)

301.81 Narcissistic Personality Disorder (669)

DSM-5 Classifícation x x ii SI

Ciuster C Personality Disorders 301.82 (PSCIBI Avoidant Personality Disorder (672)

301.6 (F60.7) Dependent Personality Disorder (675)

301.4 (F60.5) Obsessive-Compulsive Personality Disorder (678)

Other PersonaSity Disorders 310.1 “

301,89 — ? ‘ 301.9

''' Personality Change Due to Another Medical Condition (682) Specify whether: Labile type, Disinhibited type, Aggressive type, Apathetic

type, Paranoid type, Other type, Combined Lype, Uiispecincd cype , Other Specified Personality Disorder (684)

¿i 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 ifH : , Voyeuristic Disorder3 (686)

302.4 Exhibitionistic Disorder3 (689) Specify whether: Sexually aroused by exposing geni tais to prepubertal

children, Sexually aroused by exposing genitals to physically mature individuáis, Sexually aroused by exposing genitals to prepubertal chil­ dren and to physically mature individuáis

302.89 t v ;;; Frotteuristic Disorder3 (691)

302.83 ( f i5 i Sexual Masochism Disorder3 (694) Specify if: With asphyxiophilia

302.84 Sexual Sadism Disorder3 (695) 302.2 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 ' - ;11 Fetishistic Disorder3 (700) Specify: Body part(s), Nonliving object(s), Other

302.3 ¡!} Transvestic Disorder3 (702) Specify if: With fetishism, With autogynephilia

302.89 ' Other Specified Paraphilic Disorder (705) 302.9 < Unspecified Paraphilic Disorder (705)

Other Mental Disorders (707) 294.8 (F06.fií) Other Specified Mental Disorder Due to Another Medical .

Condition (707) 294.9 Unspecified Mental Disorder Due to Another Medical Condition

(708) 300.9 '¿T ;̂ Other Specified Mental Disorder (708)

300.9 (F99) Unspecified Mental Disorder (708)

xxxiv DSM-5 Classification

Medication-lnduced Movement Disorders and Other Adverse Effects of Medication (709)

332.1 Neuroleptic-Induced Parkinsonism (709)

332.1 Other Medication-lnduced Parkinsonism (709)

333.92 Neuroleptic Malignant Syndrome (709)

333.72 - Medication-lnduced Acute Dystonia (711)

333.99 '• ' Medication-lnduced Acute Akathisia (711)

333.85 Tardive Dyskinesia (712)

333.72 Tardive Dystonia (712)

333.99 ' / 'V 4* Tardive Akathisia (712)

333.1 ', - Medication-lnduced Postural Tremor (712)

333.99 ‘ Other Medication-lnduced Movement Disorder (712)

__ Antidepressant Discontinuation Syndrome (712) 995.29 Initial encounter 995.29 Subsequent encounter 995.29 Sequelae

Other Adverse Effect of Medication (714) 995.20 Initial encounter 995.20 ' : ‘i Subsequent encounter 995.20 : X ' Sequelae

Other Conditions That May B e a F o c o s of Clinical Attention (715)

Relational Problems (715)

Problems Related to Family Upbringing (715) ¥61.20 ' >V Parent-Child Relational Problem (715) V61.8 - :Y ^ ,K r ,í Sibling Relational Problem (716)

V61.8 ’r// Upbringing Away From Parents (716)

V61.29 Child Affected by Parental Relationship Distress (716)

Other Problems Related to Primary Support Group (716) ¥61.10 (Z63.0) Relationship Distress With Spouse or Intimate Partner (716)

¥61.03 (263*5) Disruption of Family by Separation or Divorce (716)

¥61.8 (Z63.8) High Expressed Emotion Level Within Family (716)

¥62.82 Uncomplicated Bereavement (716)

DSM-5 Classification

Abuse and Negiecí (717) Child Maltreatment and Neglect Problems (717 )

Child Physical Abuse (717)

Child Physical Abuse, Confirmed (717) 995.54 (T74.12XA) Initial encounter 995.54 ' ^ / Y Subsequent encounter

Child Physical Abuse, Suspected (717) 995.54 Initial encounter 995.54 Subsequent encounter

Other Circumstances Related to Child Physical Abuse (718) ¥61.21 / ̂ - Encounter for mental health services for victim of child abuse

by parent ¥61.21 , '' ' Encounter for mental health services for victim of nonparental

child abuse ¥15.41 < - Personal history (past history) of physical abuse in childhood ¥61.22 * *' -, ̂ ' Encounter for mental health services for perpetrator of parental

child abuse ¥62.83 Y ̂ 0 Encounter for mental health services for perpetrator of

nonparental child abuse

Child Sexual Abuse (718) Child Sexual Abuse, Confirmed (718) 995.53 ̂ y4 Initial encounter 995.53 ' ̂ Subsequent encounter

Child Sexual Abuse, Suspected (718) •995.53 (¥78 Initial encounter 995.53 (T76,Yv^Y Subsequent encounter

Other Circumstances Related to Child Sexual Abuse (718) ¥61.21 Encounter for mental health services for victim of child sexual

abuse by parent ¥61.21 y ■" ■/ Encounter for mental health services for victim of nonparental

child sexual abuse ¥15.41 Y Y/ ' - Personal history (past history) of sexual abuse ín childhood ¥61.22 {Z69.011) Encounter for mental health services for perpetrator of parental

child sexual abuse ¥62.83 ¿'‘Y; ‘ Encounter for mental health services for perpetrator of

nonparental child sexual abuse

Child Neglect (718) Child Neglect, Confirmed (718) 995.52 Y74/YXA) Initial encounter 995.52 " ^ Y "Y Subsequent encounter

xxxvi DSM-5 Classification

Child Neglect, Suspected (719) 995.52 (176.02XA) Initial encounter 995.52 (T76.02XD) Subsequent encounter

Other Circumstances Related to Child Neglect (719) V61.21 (Z69 M10} Encounter for mental health services for victim of child neglect

by parent V61.21 (T76.02XD) Encounter for mental health services for victim of nonparental

child neglect V15.42 ̂ Personal history (past history) of neglect in childhood V61.22 (T69.011) Encounter for mental health services for perpetrator of parental

child neglect V62.83 Encounter for mental health services for perpetrator of

nonparental child neglect

Child Psychological Abuse (719)

Child Psychological Abuse, Confirmed (719) 995.51 (TV/ Initial encounter 995.51 í Í7/r /■x ^ Subsequent encounter

Child Psychological Abuse, Suspected (719) 995.51 (176.32XA) Initial encounter 995.51 (176,32XD) Subsequent encounter

Other Circumstances Related to Child Psychological Abuse (719) Encounter for mental health services for victim of child

psychological abuse by parent Encounter for mental health services for victim of nonparental

child psychological abuse Personal history (past history) of psychological abuse in

childhood Encounter for mental health services for perpetrator of parental

child psychological abuse 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 (T76.11XD Initial encounter 995.81 (T76.11XD) Subsequent encounter

Other Circumstances Related to Spouse or Partner Violence, Physical (720) ¥61.11 (z69.11) Encounter for mental health services for victim of spouse or

partner violence, physical

V61 21 (269 010)

V61 21 (Z69 020)

V15 42 (Z62 811)

V61 22 (Z69 011)

V62 83 (Z69 021)

DSM-5 Classification xxxvii

¥15,41 (Z91.410) Personal history (past history) of spouse or partner violence, physical

¥61.12 (269.12) 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 ' ^ A) Initial encounter 995.83 * Subsequent encounter

Spouse or Partner Violence, Sexual, Suspected (720) 995.83 '. 1 ; >14; Initial encounter 995.83 > Subsequent encounter

Other Circumstances Related to Spouse or Partner Violence, Sexual (720) ¥61.11 ' Encounter for mental health services for victim of spouse or

partner violence, sexual ¥15.41 ✓ ̂ Personal history (past history) of spouse or partner violence,

sexual ¥61.12 Y ' t 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 ' Y ' ¿i1 Initial encounter 995.85 MD'j Subsequent encounter

Spouse or Partner Neglect, Suspected (721) 995.85 /Y ' '' : « | Initial encounter 995.85 > Subsequent encounter

Other Circumstances Related to Spouse or Partner Neglect (721) ¥61J 1 ', ‘ ' Encounter for mental health services for victim of spouse or

partner neglect ¥15.42 ' ; Personal history (past history) of spouse or partner neglect ¥61.12 , Y 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 ' -T* 'ÁA) Initial encounter 995.82 ; Subsequent encounter

Spouse or Partner Abuse, Psychological, Suspected (721) 995.82 ''' r Y/

Other Circumstances Related to Spouse or Partner Abuse, Psychological (721) ¥61.11 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 {269.12) 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 { f74 1 Initial encounter 995.81 Subsequent encounter

Adult Physical Abuse by Nonspouse or Nonpartner, Suspected (722) 995.81 (176*1 i XA) 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 >7 74Y 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 *77431 XA) Initial encounter 995.82 ' í ^ S u b s e q u e n t encounter

Adult Psychological Abuse by Nonspouse or Nonpartner, Suspected (722) 995.82 (T7r* ̂* X ') Initial encounter 995.82 (T/o *,''/

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 ¥62.83 (Z69.82) Encounter for mental health services for perpetrator of

nonspousal adult abuse

Educational and Occupational Problems (723)

Educational Problems (723) ¥62.3 Academic or Educational Problem (723)

Occupational Problems (723) ¥62.21 (Z56.82) Problem Related to Current Military Deployment Status (723)

¥62.29 (Z56.9) Other Problem Related to Employment (723)

Housing and Economic Problems (723)

Housing Problems (723) ¥60.0 (259,0) Homelessness (723)

¥60.1 (259,1) Inadequate Housing (723)

DSM-5 Classificaíion xxxix

¥80.89 Discord With Neighbor, Lodger, or Landlord (723)

¥60.6 Problem Related to Living in a Residential Institution (724)

Economic Problems (724) ¥60.2 - ' Lack of Adequate Food or Safe Drinking Water (724)

¥60.2 Extreme Poverty (724)

¥60.2 Low Income (724)

¥60,2 **' Insufficient Social Insurance or Welfare Support (724)

¥60.9 > ' - ■' Unspecified Housing or Economic Problem (724)

Other Problems Related to the Sociai Environment (724) ¥62.89 Phase of Life Problem (724)

¥60.3 ' ✓.." Problem Related to Living Alone (724)

¥62.4 v „ Acculturation Difficulty (724)

¥62.4 ' c /„ ' Social Exclusión or Rejection (724)

¥62.4 , , Target of (Perceived) Adverse Discrimination or Persecution (724)

¥62.9 Unspecified Problem Related to Social Environment (725)

Problems Reiated to Crlme or Interaction With the Legal System (725) Victim of Crime (725)

Conviction in Civil or Criminal Proceedings Without Imprisonment (725)

Imprisonment or Other Incarceration (725)

Problems Related to Release From Prison (725)

Problems Related to Other Legal Circumstances (725)

Other Health Service Encounters for Counseüng and Medical Advice (725) ¥65.49 ' ' " Sex Counseling (725)

¥65.40 Other Counseling or Consultation (725)

Problems Related to Other Psychosociaf, Persona!, and Environmental Circumstances (725) ¥62.89 Religious or Spiritual Problem (725)

¥61.7 Problems Related to Unwanted Pregnancy (725)

¥61.5 , Problems Related to Multiparity (725)

¥62.89 Discord With Social Service Provider, Including Probation Officer, Case Manager, or Social Services Worker (725)

¥62.89 Victim of Terrorism or Torture (725)

¥62.22 Exposure to Disaster, War, or Other Hostilities (725)

¥62.89 Other Problem Related to Psychosocial Circumstances (725)

¥62.9 Unspecified Problem Related to Unspecified Psychosocial Circumstances (725)

¥62.89 (265*4)

¥62.5 (265*0)

¥62.5 „ ¿ ¿

¥62.5

¥62.5 Í265*3)

xS DSM-5 Classification

¥15,.49 (Z91 .49)

¥15 .59 (Z91 .6)

CM5 ,22 (Z91 ,82)

¥15,.89 (Z91, ¥69,.9 1272,.9) ¥71,,01 rr, t

¥71,,02

Other Circumstances of Personal History (726) Other Personal History of Psychological Trauma (726)

Personal History of Self-Harm (726)

Personal History of Military Deployment (726)

Other Personal Risk Factors (726)

Problem Related to Lifestyle (726)

Adult Antisocial Behavior (726)

Child or Adolescent Antisocial Behavior (726)

Problems Related to Access to Medical and Other Health Care (726) ¥63.9 / ' ,/ Unavailability or Inaccessibility of Health Care Facilities (726)

¥63=8 7 , Unavailability or Inaccessibility of Other Helping Agencies (726)

Nonadherence to Medical Treatment (726) ¥15.81 (Z91.19) Nonadherence to Medical Treatment (726) 278.00 (E66.9) Overweight or Obesity (726)

¥65.2 (Z76.5) Malingering (726) ¥40.31 (Z91.83) Wandering Associated With a Mental Disorder (727) ¥62.89 (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 facilítate more reliable diagnoses of these disorders. With successive editions over the past 60 years, it has become a standard reference for clinícal 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 Ianguage to communicate the essential characteristics of men­ tal disorders presented by their patients. The information is of valué 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, cónsul- tation-liaison, clinical, private practice, and primary care—as well in general cornmuriity epidemiological studies of mental disorders. DSM-5 is also a tool for coilecting and com- municating accurate public health statistics on mental disorder morbidity and mortalíty 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 considera tion in planning DSM-5. The classification of disorders is harmonized with the World Health Organization's Inter­ national Classification ofDiseases (ICD), the official coding system used in the United States, so that the DSM criteria define disorders identified by ICD diagnostic ñames 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 múltiple 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:

xls

xlii Preface

• Represeníation of developmental issues related to diagnosis. The change in chapter organization better reflects a iifespan approach, with disorders more frequently diag- nosed in childhood (e.g., neurodevelopmental dfsorders) 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 Iifespan. 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, Aspergeas 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 ponen! criteria within the respective criteria for each disorder. This approach will facil­ ítate 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 exclusión 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 elimina ted 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 sión 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 xlill

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 ín conceptualizing personality disorders. Although the benefits of a more dimensional approach to personality disorders have been identified in previous ecü- tions, the transition from a categorical diagnostic system of individual disorders to one based on the relatíve 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 Versión, 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 Forcé, in conjunction with other review bodies and, eventuaily, the APA Board of Trast­ 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 División of Re­ search; the ñames of everyone involved are too numerous to m en tion 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.