DIAGNOSTIC AND STATISTICAL
MANUAL OF
MENTAL DISORDERS
FIFTH EDITION
DSM-5™


American Psychiatric Association
Officers 2012–2013
PRESIDENT  DILIP V. J ESTE , M.D.
PRESIDENT -ELECT  JEFFREY  A. L IEBERMAN , M.D.
TREASURER  DAVID  FASSLER , M.D.
SECRETARY  ROGER  PEELE , M.D.
Assembly
SPEAKER  R. S COTT  BENSON , M.D.
SPEAKER -ELECT  MELINDA  L. Y OUNG , M.D.
Board of Trustees
JEFFREY  AKAKA , M.D.
CAROL  A. B ERNSTEIN , M.D.
BRIAN  CROWLEY , M.D.
ANITA  S. E VERETT , M.D.
JEFFREY  GELLER , M.D., M.P.H.
MARC DAVID  GRAFF , M.D.
JAMES  A. G REENE , M.D.
JUDITH  F. K ASHTAN , M.D.
MOLLY  K. M CVOY, M.D.
JAMES  E. N ININGER , M.D.
JOHN  M. O LDHAM , M.D.
ALAN F. S CHATZBERG , M.D.
ALIK S. W IDGE , M.D., P H.D.
ERIK R. V ANDERLIP , M.D.,
MEMBER -IN-TRAINING  TRUSTEE -ELECT


Washington, DC
London, EnglandDIAGNOSTIC AND STATISTICAL
MANUAL OF
MENTAL DISORDERS
FIFTH EDITION
DSM-5™


Copyright © 2013 American Psychiatric Association
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is prohibited without perm ission of the American Psychiatric Association.
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The correct citation for this book is American Psychiatric Association: Diagnostic and Statisti-
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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 Us e 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 Re lated 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 Con duct Disorders . . . . . . . . 461
Substance-Related and Addictive Disord ers . . . . . . . . . . . . . . . 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 Fo cus of Clinical Attention . . 715
 Section III
Emerging Measures and Models
Assessment Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 733
Cultural Formulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 749
Alternative DSM-5 Model for Personality Disorder s . . . . . . . . . 761


Conditions for Further Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . 783
 Appendix
Highlights of Ch anges From DSM-IV to DSM-5 . . . . . . . . . . . . . 809
Glossary of Technical Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . 817
Glossary of Cultural Concepts of Dist ress . . . . . . . . . . . . . . . . . 833
Alphabetical Listing of DSM-5 Diagno ses and Codes
(ICD-9-CM and ICD-10-CM). . . . . . . . . . . . . . . . . . . . . . . . . . . . 839
Numerical Listing of DS M-5 Diagnoses and Codes
 (ICD-9-CM) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 863
Numerical Listing of DS M-5 Diagnoses and Codes
 (ICD-10-CM) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 877
DSM-5 Advisors and Other Contributors  . . . . . . . . . . . . . . . . . . 897


Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 917


DSM-5 Task Force
DAVID  J. K UPFER , M.D.
Task Force Chair
DARREL  A. R EGIER , M.D., M.P.H.
Task Force Vice-Chair
William E. Narrow, M.D., M.P.H.,
Research DirectorSusan K. Schultz, M.D., Text Editor
Emily A. Kuhl, Ph.D., APA Text Editor
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)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.


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 Division of Research Staff on DSM-5
Darrel A. Regier, M.D., M.P.H.,
Director, Division of Research
William E. Narrow, M.D., M.P.H.,
Associate Director
Emily A. Kuhl, Ph.D., Senior Science
Writer; Staff Text Editor
Diana E. Clarke, Ph.D., M.Sc., Research
Statistician
Lisa H. Greiner, M.S.S.A., DSM-5 Field
Trials Project Manager
Eve K. Moscicki, Sc.D., M.P.H.,
Director, Practice Research Network
S. Janet Kuramoto, Ph.D. M.H.S.,
Senior Scientific Research Associate,
Practice Research Network
Amy Porfiri, M.B.A.
Director of Finance and AdministrationJennifer J. Shupinka, Assistant Director,
DSM Operations
Seung-Hee Hong, DSM Senior 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
Christopher M. Reynolds,
Executive Assistant


Manager, Practice Research Network
Christopher M. Reynolds,
Executive Assistant
APA Office of the Medical Director
JAMES  H. S CULLY  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. X AVIER  CASTELLANOS , M.D.
Co-Chair
Paul J. Frick, Ph.D., Text Coordinator
Glorisa 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 Dissociative Disorders
KATHARINE  A. P HILLIPS , M.D.
Chair
Michelle G. Craske, Ph.D., Text
Coordinator
J. Gavin Andrews, M.D.
Susan M. Bögels, 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.
Murray B. Stein, M.D.
Robert J. Ursano, M.D.
Hans-Ulrich Wittchen, Ph.D.
Childhood and Adolescent Disorders
DANIEL  S. P INE, M.D.
Chair


DANIEL  S. P INE, 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.James F. Leckman, M.D.
Ellen Leibenluft, M.D.
Judith H. L. Rapoport, M.D.
Charles H. Zeanah, M.D.
Eating Disorders
B. T IMOTHY  WALSH , 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.
James 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
JAN A. F AWCETT , 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.
(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.
Neurocognitive Disorders
DILIP V. J ESTE , M.D. (2007–2011)
Chair Emeritus
DAN G. B LAZER , M.D., P H.D., M.P.H.
Chair
RONALD  C. P ETERSEN , M.D., P H.D.
Co-Chair
Mary Ganguli, M.D., M.P.H.,
Text Coordinator
Deborah Blacker, M.D., Sc.D.
Warachal Faison, M.D. (2007–2008)Igor Grant, M.D.
Eric J. Lenze, M.D.
Jane S. Paulsen, Ph.D.
Perminder S. Sachdev, M.D., Ph.D.
Neurodevelopmental Disorders
SUSAN  E. S WEDO , M.D.
Chair
Gillian Baird, M.A., M.B., B.Chir.,
Text Coordinator
Edwin H. Cook Jr., M.D.


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.
Rosemary Tannock, Ph.D.
Fred Volkmar, M.D. (2007–2009)
Amy M. Wetherby, Ph.D.
Harry H. Wright, M.D.
Personality and Personality Disorders1
ANDREW  E. S KODOL , M.D.
Chair
JOHN  M. O LDHAM , M.D.
Co-Chair
Robert F. Krueger, Ph.D., Text
Coordinator
Renato D. Alarcon, M.D., M.P.H.
Carl 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)
1The 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 upda ting of the text) are retained from DSM-IV-TR.


Psychotic Disorders
WILLIAM  T. C ARPENTER  JR., M.D.
Chair
Deanna M. Barch, Ph.D., Text
Coordinator
Juan R. Bustillo, M.D.
Wolfgang 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. Z UCKER , PH.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 Långström, M.D., Ph.D.
Heino F.L. Meyer-Bahlburg, Dr. rer. nat.
Friedemann Pfäfflin, M.D.
Robert Taylor Segraves, M.D., Ph.D.
Sleep-Wake Disorders
CHARLES  F. R EYNOLDS  III, M.D.
Chair
Ruth M. O’Hara, Ph.D., Text Coordinator
Charles M. Morin, Ph.D.
Allan I. Pack, Ph.D.Kathy P. Parker, Ph.D., R.N.
Susan Redline, M.D., M.P.H.


Susan Redline, M.D., M.P.H.
Dieter Riemann, Ph.D.
Somatic Symptom Disorders
JOEL E. D IMSDALE , 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
CHARLES  P. O’B RIEN , M.D., P H.D.
Chair
THOMAS  J. C ROWLEY , M.D.
Co-Chair
Wilson 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
Diagnostic Spect ra and DSM/ICD Harmonization
STEVEN  E. H YMAN , M.D.
Chair (2007–2012)
William T. Carpenter Jr., M.D.
Wilson M. Compton, M.D., M.P.E.
Jan A. Fawcett, M.D.
Helena C. Kraemer, Ph.D.
David J. Kupfer, M.D.William E. Narrow, M.D., M.P.H.
Charles P. O’Brien, M.D., Ph.D.
John M. Oldham, M.D.
Katharine A. Phillips, M.D.
Darrel A. Regier, M.D., M.P.H.
Lifespan Developmental Approaches
ERIC J. L ENZE , M.D.
Chair
SUSAN  K. S CHULTZ , M.D.
Chair Emeritus
DANIEL  S. P INE, M.D.
Chair Emeritus
Dan G. Blazer, M.D., Ph.D., M.P.H.
F. Xavier Castellanos, M.D.
Wilson M. Compton, M.D., M.P.E.Daniel T. Mamah, M.D., M.P.E.
Andrew E. Skodol II, M.D.
Susan E. Swedo, M.D.
Gender and Cross-Cultural Issues
KIMBERLY  A. Y ONKERS , M.D.
Chair
ROBERTO  LEWIS -FERNÁNDEZ , M.D., M.T.S.
Co-Chair, Cross-Cultural Issues
Renato D. Alarcon, M.D., M.P.H.
Diana E. Clarke, Ph.D., M.Sc.
Javier I. Escobar, M.D., M.Sc.


Javier I. Escobar, M.D., M.Sc.
Ellen Frank, Ph.D.
James S. Jackson, Ph.D.
Spiro M. Manson, Ph.D. (2007–2008)
James P. McNulty, A.B., Sc.B.Leslie C. Morey, Ph.D.
William E. Narrow, M.D., M.P.H.
Roger Peele, M.D.
Philip Wang, M.D., Dr.P.H. (2007–2012)
William M. Womack, M.D.
Kenneth J. Zucker, Ph.D.
Psychiatric/General Medical Interface
LAWSON  R. W ULSIN , M.D.
Chair
Ronald E. Dahl, M.D.
Joel E. Dimsdale, M.D.
Javier I. Escobar, M.D., M.Sc.
Dilip V. Jeste, M.D. (2007–2011)
Walter E. Kaufmann, M.D.Richard E. Kreipe, M.D.
Ronald C. Petersen, Ph.D., M.D.
Charles F. Reynolds III, M.D.
Robert Taylor Segraves, M.D., Ph.D.
B. Timothy Walsh, M.D.


Impairment and Disability
 JANE S. P AULSEN , PH.D.
Chair
J. Gavin Andrews, M.D.
Glorisa Canino, Ph.D.
Lee Anna Clark, Ph.D.
Diana E. Clarke, Ph.D., M.Sc.
Michelle G. Craske, Ph.D.Hans W. Hoek, M.D., Ph.D.
Helena C. Kraemer, Ph.D.
William E. Narrow, M.D., M.P.H.
David Shaffer, M.D.
Diagnostic Assessm ent Instruments
JACK D. B URKE  JR., M.D., M.P.H.
Chair
Lee Anna Clark, Ph.D.
Diana E. Clarke, Ph.D., M.Sc.
Bridget F. Grant, Ph.D., Ph.D.Helena C. Kraemer, Ph.D.
William E. Narrow, M.D., M.P.H.
David Shaffer, M.D.
DSM-5 Research Group
WILLIAM  E. N ARROW , M.D., M.P.H.
Chair
Jack D. Burke Jr., M.D., M.P.H.
Diana E. Clarke, Ph.D., M.Sc.
Helena C. Kraemer, Ph.D.David J. Kupfer, M.D.
Darrel A. Regier, M.D., M.P.H.
David Shaffer, M.D.
Course Specifiers and Glossary
WOLFGANG  GAEBEL , M.D.
Chair
Ellen Frank, Ph.D.
Charles P. O’Brien, M.D., Ph.D.
Norman Sartorius, M.D., Ph.D.,
Consultant
Susan K. Schultz, M.D.Dan J. Stein, M.D., Ph.D.
Eric A. Taylor, M.B.


Eric A. Taylor, M.B.
David J. Kupfer, M.D.
Darrel A. Regier, M.D., M.P.H.


xiiiDSM-5
 Classification
Before each disorder name, ICD-9-CM code s are provided, followe d by ICD-10-CM codes
in parentheses. Blank lines indicate that eith er 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 name s, page numbers for the corresponding text
or criteria are incl uded in parentheses.
Note for all mental disorders due to another medical condition:  Indicate the name of
the other medical condition in the name of th e mental disorder due to [the medical condi-
tion]. The code and name for the other medica l condition should be listed first immedi-
ately before the mental disorder  due to the medical condition.
Neurodevelopmental Disorders  (31)
Intellectual Disabilities (33)
___.__ (___.__) Intellectual Disability (Intelle ctual 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)


315.39 (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)


xiv DSM-5 Classification
Autism Spectrum Disorder (50)
299.00 (F84.0) Autism Spectrum Disorder (50)
Specify  if: Associated with a known medic al or genetic condition or envi-
ronmental factor; Associ ated 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 accompanyi ng 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 punctu ation accuracy, clarity or
organization of written expression)


accuracy, grammar and punctu ation 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 Schizophre nia Spectrum and Othe r 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; 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, Mi xed type, Unspecified type
Specify  if: With bizarre content


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 featur es, 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-Ind uced 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 intoxicatio n, 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 Anothe r 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, modera te, 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


296.46  (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 ep isode: 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 Bipo lar 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 intoxicatio n, 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 psych otic features; Wi th catatonia
(use additional code 293.89 [F06.1]); With peripartum on set; 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


296.22  (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 ma jor depressive epis odes, 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 IC D-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


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 IC D-9-CM and ICD-10-CM coding.
Specify  if: With onset during intoxicatio n, With onset during withdrawal,
With onset after medication use


DSM-5 Classification xix
293.84  (F06.4) Anxiety Disorder Due to Anot her 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 Rela ted Disorders where indicated:
aSpecify  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 intoxicatio n, 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


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 Enga gement 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 Stress or-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 Dissocia tive 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


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 (s pecify 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 Fact itious 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 Feedin g and Eating Disorders where indicated:
aSpecify  if: In remission
bSpecify  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, Diur nal only, Nocturnal and diurnal
307.7  (F98.1) Encopresis (357)
Specify  whether: With constipation an d 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 Sl eep-Wake Disorders where indicated:
aSpecify  if: Episodic, Persistent, Recurrent
bSpecify  if: Acute, Subacute, Persistent
cSpecify  current severity: Mi ld, 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 bu t 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


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 alve olar 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-Induc ed 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, Dayt ime sleepiness type, Parasomnia
type, Mixed type
Specify  if: With onset during intoxicatio n, 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:
aSpecify  whether: Lifelong, Acquired
bSpecify  whether: Generalized, Situational
cSpecify  current severity: Mi ld, 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-Induc ed Sexual Dysfunctionc (446)
Note:  See the criteria set and corresponding recording procedures for
substance-specific codes and IC D-9-CM and ICD-10-CM coding.
Specify  if: With onset during intoxicatio n, 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 develo pment 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-Contro l, and Conduct Disorders  (461)
313.81  (F91.3) Oppositional Defi ant Disorder (462)
Specify  current severity: Mild, Moderate, Severe


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:
aSpecify  if: In early remission, In sustained remission
bSpecify  if: In a controlled environment
cSpecify  if: With perceptual disturbances
dThe ICD-10-CM code indicates the comorbid pres ence 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 Intoxi cation (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-Induc ed Disorders (508)


___.__  (___.__) Other Caffeine-Induc ed 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


(F16.229) With use disorder, moderate or severe
(F16.929) Without use disorder
292.89  (F16.983) Hallucinogen Persisting Pe rception 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-R elated 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-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 Anxi olytic 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


(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) Su bstance–Related Disorder (585)
Non-Substance-Related Disorders (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)
aNote:  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, Hypoacti ve, 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
aSpecify  Without behavioral disturbance,  With behavioral disturbance. For possible major neuro-
cognitive disorder and for mild ne urocognitive disorder, behavioral disturbanc e 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 (i ncluding probable and possible).
Note:  As indicated for each subtype, an additional  medical code is needed for probable major
neurocognitive disorder or majo r neurocognitive disorder. An additional medical code should
not be used for possible major neurocognitive disorder or mild neur ocognitive 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


294.11  (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 Di sorder 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 Neur ocognitive 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 IC D-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 criter ia set and corresponding recording procedures
for substance-specific codes and ICD-9-CM and ICD-10-CM coding.
Specify  if: Persistent


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 Disord er 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 Disord er 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 Neurocognit ive Disorder (643)


Unspecified Neurocognit ive 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 Personalit y 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 Pa raphilic 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 exposi ng 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)


302.2  (F65.4) Pedophilic Disorder (697)
Specify  whether: Exclusive type, Nonexclusive type
Specify  if: Sexually attracted to males, Se xually 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 Disconti nuation 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)


of Clinical Attention  (715)
Relational Problems (715)
Problems Related to Fa mily 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 Se paration 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 serv ices 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


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 histor y) 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 se rvices 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


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 serv ices 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 serv ices 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 serv ices 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 serv ices 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)


Other Circumstances Related to Spouse or Partner Neglect (721)
V61.11  (Z69.11) Encounter for mental health serv ices 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 serv ices 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 serv ices 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 Nonspous e 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 Nonspo use 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 Ab use 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 Disc rimination 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 So cial 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 Psyc hosocial 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 Mili tary 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)


xliPreface
The American Psychiatric  Association’s Diagnostic and Statistical Manual of
Mental Disorders (DSM) is a classification of mental di sorders with associ ated 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 diso rders, it is important to emph asize that the current diagnos-
tic criteria are the best available descriptio n of how mental disord ers 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 fi rst 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 diff erent orientations (bi-
ological, psychodynamic, cognitive, behavior al, interpersonal, family/systems), all of
whom strive for a common language to commu nicate the essential ch aracteristics 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, nu rses, counselors, forensic and legal special-
ists, occupational and rehabilitation therapists , and other health professionals. The criteria
are concise and explicit and intended to fac ilitate an objective asse ssment of symptom pre-


sentations in a variety of clinical settings—inpatient, outpatient, partial hospital, consul-
tation-liaison, clinical, private practice, an d 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 encounteri ng rare disorders for the first time. Fortu-
nately, all of these uses are mutually compatible.
These diverse needs and interests were take n into consideration in planning DSM-5.
The classification of disorders is harmoniz ed 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 catego rical classification of sepa rate disorders, we recog-
nize that mental disorders do not always fit completely within the boundaries of a single
disorder. Some symptom domains, such as de pression 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 in cluded 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


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:


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 olde r 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 pr esentations 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 di sorder and posttraumati c stress disorder, spe-
cific criteria describe how symptoms might be expressed in children). Likewise, gender
and cultural issues have been integrat ed into the disorders where applicable.
•Integration of scientific findings from th e latest research in genetics and neuroimag-
ing. The revised chapter structure was informed by recent research in neuroscience and
by emerging genetic linkages between diag nostic groups. Genetic and physiological
risk factors, prognostic indicators, and so me putative diagnostic markers are high-
lighted in the text. This new structure shoul d improve clinicians’ ability to identify di-
agnoses in a disorder spectrum based on common neurocircuitry, genetic vulnerability,
and environmental exposures.
•Consolidation of autistic disorder, Asperg er’s disorder, and pervasive developmen-
tal disorder into autism spectrum disorder.  Symptoms of these disorders represent a
single continuum of mild to severe impair ments in the two domains of social commu-
nication and restrictive repetitive behaviors/ interests rather than being distinct disor-


nication and restrictive repetitive behaviors/ interests rather than being distinct disor-
ders. This change is designed to improve the se nsitivity 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 bi polar and depressive disorders.  Bipolar and depres-
sive disorders are the most co mmonly diagnosed conditions in psychiatry. It was there-
fore important to streamline th e presentation of these disorders to enhance both clinical
and educational use. Rather than separating  the definition of ma nic, hypomanic, and
major depressive episodes from the definition of bipolar I disorder, bipolar II disorder,
and major depressive disorder as in the prev ious 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 bereav ement and major depres sive 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 narrativ e on specifier variations that accompanies
the criteria for these disorders.
•Restructuring of substance use diso rders 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. “Depen dence” has been easily confused with the
term “addiction” when, in fa ct, the tolerance and withdrawal that previously defined
dependence are actually very  normal responses to prescr ibed medications that affect
the central nervous system and do not necessar ily indicate the presence of an addiction.


the central nervous system and do not necessar ily 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.


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 br ain imaging over the pa st 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 fi ndings for rare variants of  Alzheimer’s disease and Hun-
tington’s disease have greatly advanced cl inical 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 disorder s have been identified in previous edi-
tions, the transition from a ca tegorical diagnostic system of individual disorders to one
based on the relative distribution of personality traits ha s not been widely accepted. In
DSM-5, the categorical personality disorder s are virtually unchan ged from the previous
edition. However, an alternative “hybrid” model has been proposed in Section III to
guide future research that separates interp ersonal 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 requir e further study but are not sufficiently well established to
be a part of the official classification of me ntal 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 symp tom levels of varying severity across all
diagnostic groups. Likewise, the WHO Di sability Assessment Schedule (WHODAS), a
standard method for assessing global disabilit y levels for mental disorders that is based
on the International Classification of Functi oning, Disability and Health (ICF) and is ap-
plicable in all of medicine, has been provid ed to replace the more limited Global As-
sessment of Functioning scale. It is our hope that as these measures are implemented


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 presen tations 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 re levant 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 leadin g 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 group s, under the direction of the DSM-5 Task
Force, in conjunction with other review bodi es and, eventually, the APA Board of Trust-
ees, collectively represent the gl obal 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 to o 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 diagno sis of mental disorders.
We would especially like to acknowledge th e chairs, text coordinators, and members of
the 13 work groups, listed in the front of th e manual, who spent many hours in this vol-
unteer effort to improve the scientific basis of  clinical practice over a sustained 6-year pe-


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 st aff text editor, to coordinate the efforts of
the work groups into a cohesive whole. Willia m E. Narrow, M.D., M. P.H., led the research
group that developed the overall research stra tegy for DSM-5, including the field trials,


the work groups into a cohesive whole. Willia m E. Narrow, M.D., M. P.H., led the research
group that developed the overall research stra tegy for DSM-5, including the field trials,
that greatly enhanced the eviden ce base for this revision. In addition, we are grateful to
those who contributed so much time to the in dependent review of the revision proposals,
including Kenneth S. Ke ndler, M.D., and Robert Freedman , M.D., co-chairs of the Scien-
tific Review Committee; John S. McIntyre, M.D., and Joel Ya ger, 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., fo r her expert statistical
consultation; Michael B. First, M.D., for his valuable input on the coding and review of cri-
teria; and Paul S. Appelbau m, M.D., for feedback on forensic issues. Maria N. Ward,
M.Ed., RHIT, CCS-P, also helped in verifying all ICD coding. The Summit Group, which
included these consultants, the chairs of all review groups, the task force chairs, and the
APA executive officers, chaired by Dilip V. Jeste, M.D., provided le adership and vision in
helping to achieve compromise and consensus.  This level of commitment has contributed
to the balance and objectivity that  we feel are hallmarks of DSM-5.
We especially wish to recognize the outst anding APA Division of Research staff—
identified in the Task Force and Work Grou p listing at the front of this manual—who
worked tirelessly to interact with the task force, work groups, advisors, and reviewers to
resolve issues, serve as liaison s between the groups, direct and manage the academic and
routine clinical practice field trials, and record  decisions in this important process. In par-
ticular, we appreciate the support and guidan ce provided by James H. Scully Jr., M.D.,
Medical Director and CEO of the APA, throug h the years and travails of the development
process. Finally, we thank the editorial and pr oduction staff of American Psychiatric Pub-
lishing—specifically, Rebecca Rinehart, Publish er; John McDuffie, Edit orial Director; Ann
Eng, Senior Editor; Greg Kuny, Managing Editor; and Tammy Cordova, Graphics Design


Manager—for their guidance in bringing this all together and creating the final product. It
is the culmination of efforts of  many talented individuals who dedicated their time, exper-
tise, and passion that  made DSM-5 possible.
David J. Kupfer, M.D.
 DSM-5 Task Force Chair
Darrel A. Regi er, M.D., M.P.H.
 DSM-5 Task Force Vice-Chair
December 19, 2012


SECTION I
DSM-5 Basics
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
Use of the Manual  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19
Cautionary Statement for Forensic Use of DSM-5 . . . . . . . . . . . . . . . . . .25


This page intentionally left blank


This section  is a basic orientation to the purpose, structure, content, and
use of DSM-5. It is not intended to provide an exhaustive account of the evo-
lution of DSM-5, but rather to give readers a succinct overview of its key ele-
ments. The introductory section descr ibes the public, professional, and expert
review process that was used to extensively evaluate the diagnostic criteria
presented in Section II. A summary of t he DSM-5 structure, harmonization with
ICD-11, and the transition to a non-axial system with a new approach to as-
sessing disability is also presented. “Use of the Manual” includes “Definition of
a Mental Disorder,” forensic considerations, and a brief overview of the diag-
nostic process and use of coding and recording procedures.


5Introduction
The creation  of the fifth edition of Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) was a massive undertaking that involv ed hundreds of peop le working toward a
common goal over a 12-year process. Much thought and deliberation were involved in
evaluating the diagnostic criter ia, considering the organization of every aspect of the man-
ual, and creating new features believed to be mo st useful to clinicians. All of these efforts
were directed toward the goal of enhancing th e clinical usefulness of DSM-5 as a guide in
the diagnosis of mental disorders.
Reliable diagnoses are essential for guidin g treatment recommendations, identifying
prevalence rates for mental health service pl anning, identifying patient groups for clinical
and basic research, and documenting importan t public health information such as mor-
bidity and mortality rates. As the understand ing of mental disorders and their treatments
has evolved, medical, scientific, and clinical professionals have focused on the character-
istics of specific disorders and their im plications for treatment and research.
While DSM has been the cornerstone of substant ial progress in reliability, it has been well
recognized by both the American Psychiatric Association (APA) and the broad scientific com-
munity working on mental diso rders that past science was no t mature enough to yield fully
validated diagnoses—that is, to provide consistent, strong, and objective scientific validators
of individual DSM disorders. The science of mental disorders continues to evolve. However,
the last two decades since DSM-IV was released  have seen real and durable progress in such
areas as cognitive neuroscience , brain imaging, epidemiology, and genetics. The DSM-5 Task
Force overseeing the new edition recognized that research advances will require careful, iter-
ative changes if DSM is to maintain its place as  the touchstone classifi cation of mental disor-


ders. Finding the right balance is critical. Speculative results do not belong in an official
nosology, but at the same time, DSM must evolve in the context of other clinical research ini-
tiatives in the field. One important aspect of this transition derives from the broad recognition
that a too-rigid categorical system does not capt ure clinical experience or important scientific
observations. The results of nu merous studies of comorbidity and disease transmission in fam-
ilies, including twin studies and molecular genetic studies, make strong arguments for what
many astute clinicians have long observed: the boundaries between many disorder “catego-
ries” are more fluid over the li fe course than DSM-IV recognized, and many symptoms as-
signed to a single disorder may occur, at vary ing levels of severity, in many other disorders.
These findings mean that DSM, like other medi cal disease classifications, should accommo-
date ways to introduce dimens ional approaches to mental di sorders, including dimensions
that cut across current categories. Such an appr oach should permit a more accurate description
of patient presentations and increase the validity of a diagnosis (i.e., the degree to which diag-
nostic criteria reflect the comprehensive mani festation of an underlying psychopathological
disorder). DSM-5 is designed to better fill the need of clinicians, patients, families, and re-
searchers for a clear and concise description of ea ch mental disorder organized by explicit di-
agnostic criteria, supplemented, when approp riate, by dimensional measures that cross
diagnostic boundaries, and a brie f digest of information about th e diagnosis, risk factors, as-
sociated features, research advances, and various expressions  of the disorder.
Clinical training and experience are needed to use DSM for determining a diagnosis. The
diagnostic criteria identify symptoms, behavior s, cognitive functions, personality traits, phys-


Clinical training and experience are needed to use DSM for determining a diagnosis. The
diagnostic criteria identify symptoms, behavior s, cognitive functions, personality traits, phys-
ical signs, syndrome combinations, and durations that require clinical expertise to differenti-
ate from normal life variation and transient responses to stress. To facilitate a thorough


6 Introduction
examination of the range of symptoms present, DSM can serve clinicians as a guide to identify
the most prominent symptoms that should be assessed when diagnosing a disorder. Although
some mental disorders may have well-defined  boundaries around symptom clusters, scien-
tific evidence now places many, if not most, disorders on a spectrum with closely related dis-
orders that have shared symptoms, shared genetic and environmental risk factors, and
possibly shared neural substrates (perhaps most  strongly established for a subset of anxiety
disorders by neuroimaging and animal models). In short, we have come to recognize that the
boundaries between disorders are more  porous than originally perceived.
Many health profession and educational groups have been  involved in the development
and testing of DSM-5, including physicians, psychologists, social workers, nurses, counselors,
epidemiologists, statisticians, neuroscientists, and neuropsychologists. Finally, patients, fam-
ilies, lawyers, consumer organizations, and advoca cy groups have all participated in revising
DSM-5 by providing feedback on the mental di sorders described in this volume. Their moni-
toring of the descriptions and explanatory text  is essential to improve  understanding, reduce
stigma, and advance the treatment and eventual cures for these conditions.
A Brief History
The APA first published a predecessor of DSM in 1844, as a statistical classification of in-
stitutionalized mental patients. It was designed to improve co mmunication about the
types of patients cared for in these hospitals.  This forerunner to DSM also was used as a
component of the full U.S. census. After World War II, DSM evolved through four major
editions into a diagnostic classification system for psychiatrists, other physicians, and
other mental health professionals that descri bed the essential features of the full range of


other mental health professionals that descri bed the essential features of the full range of
mental disorders. The current ed ition, DSM-5, builds on the go al of its predecessors (most
recently, DSM-IV-TR, or Text Revision, published in 2000) of providing guidelines for di-
agnoses that can inform treatment and management decisions.
DSM-5 Revision Process
In 1999, the APA launched an evaluation of the strengths and weaknesses of DSM based on
emerging research that did not support the bo undaries established for some mental disor-
ders. This effort was coordinated with the World Health Organization (WHO) Division of
Mental Health, the World Psychiatric Associat ion, and the National Institute of Mental
Health (NIMH) in the form of several conferen ces, the proceedings of which were published
in 2002 in a monograph entitled A Research Agenda for DSM-V.  Thereafter, from 2003 to 2008,
a cooperative agreement with the APA and th e WHO was supported by the NIMH, the Na-
tional Institute on Drug Abuse (NIDA), and the National Institute on Alcoholism and Alco-
hol Abuse (NIAAA) to convene 13 internatio nal DSM-5 research planning conferences,
involving 400 participants from 39 countries, to  review the world litera ture in specific diag-
nostic areas to prepare for revision s in developing both DSM-5 and the International Classi-
fication of Diseases,  11th Revision (ICD-11). Reports from  these conferences formed the basis
for future DSM-5 Task Force reviews and set the stage for the new edition of DSM.


for future DSM-5 Task Force reviews and set the stage for the new edition of DSM.
In 2006, the APA named David J. Kupfer, M.D., as Chair and Darrel A. Regier, M.D.,
M.P.H., as Vice-Chair of the DSM-5 Task Fo rce. They were char ged with recommending
chairs for the 13 diagnostic work groups and additional task force members with a multi-
disciplinary range of expertise who would oversee the development of DSM-5. An addi-
tional vetting process was init iated by the APA Board of Trus tees to disclose sources of
income and thus avoid conflicts of interest by task force and work group members. The full
disclosure of all income and research grants  from commercial sources, including the phar-


income and thus avoid conflicts of interest by task force and work group members. The full
disclosure of all income and research grants  from commercial sources, including the phar-
maceutical industry, in the previous 3 years, the imposition of an income cap from all com-
mercial sources, and the publication of disclosu res on a Web site set a new standard for the


Introduction 7
field. Thereafter, the task force of 28 memb ers was approved in 2007, and appointments of
more than 130 work group members were approved in 2008. More than 400 additional
work group advisors with no voting authority were also approved to participate in the pro-
cess. A clear concept of the next evolutionary stage for the classification of mental disorders
was central to the efforts of the task force an d the work groups. This vision emerged as the
task force and work groups recounted the history of DSM-IV’s classification, its current
strengths and limitations, and strategic directio ns for its revision. An intensive 6-year pro-
cess involved conducting liter ature reviews and secondary an alyses, publishing research
reports in scientific journals, developing dr aft diagnostic criteria, posting preliminary
drafts on the DSM-5 Web site for public comme nt, presenting preliminary findings at pro-
fessional meetings, performing field tr ials, and revising criteria and text.
Proposals for Revisions
Proposals for the revision of DSM-5 diagnostic criteria were develo ped by members of the
work groups on the basis of ra tionale, scope of change, expected impact on clinical man-
agement and public health, strength of the su pporting research evidence, overall clarity,
and clinical utility. Proposals encompassed chan ges to diagnostic criteria; the addition of
new disorders, subtypes, an d specifiers; and the deleti on of existing disorders.
In the proposals for revisions, strengths and weaknesses in the current criteria and no-
sology were first identified. Novel scientific findings over the previous two decades were
considered, leading to the creation of a resear ch plan to assess potential changes through
literature reviews and se condary data analyses. Four princi ples guided the draft revisions: