text
stringlengths 1
1.57k
| embedding
sequence | __index_level_0__
int64 0
13k
|
|---|---|---|
Note that in some cases a specifier or subtype is codable in but not in | [
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] | 600 |
Accordingly in some c ases the 4th or 5th character codes for the types or specifiers are provided only for the coding designations A diagnosis is usually applied to the current ous diagnoses from which the individual has recovered shoul d be clearly noted as such Specifiers indicating course g in partial remission in full may be listed after the diagnosis and are indicated in a numb er of criteria sets | [
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] | 602 |
Severity specifiers are indicated by the struction Specify current in the criteria se t and include tions | [
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Descriptive features specifiers have also been provided in the criteria set and convey additional information that can inform trea tment planning g disorder with poor | [
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] | 604 |
Not all disorders include course severity descriptive features specifiers Movement Disorders and Other Conditions That May Be a Fo cus of Clinical Attention In addition to important psychosocial and en vironmental factors Multiaxial in the elsewhere in this ma these chapters in Section II also tain other conditions that are not mental disorders but may be encountered by mental health clinicians | [
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] | 605 |
These conditions may be listed as a reason for clinical visit in addition to or in place of the mental disorders listed in Section II | [
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] | 606 |
A separate chapter is devoted to disorders and other adverse effects of medication that may be sessed and treated by clinicians in mental health practice such as akathisia tardive nesia and dystonia | [
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] | 607 |
The description of neurol eptic malignant syndrome is expanded from that provided in to highlight the em ergent and potentially ture of this condition and a new entry on an tidepressant discontinuation syndrome is vided | [
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] | 608 |
An additional chapter discusses other conditions that may be a focus of clinical attention | [
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These include relational problems problems related to abuse and neglect lems with adherence to treatment regimens obesity antisocial behavior and malingering Principal Diagnosis When more than one diagnosis for an individual is given in an inpatient setting the cipal diagnosis is the condition established after study to be chiefly responsible for sioning the admission of the individual | [
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] | 610 |
When more than one diagnosis is given for an individual in an outpatient setting the reason for visit is the condition that is chiefly sponsible for the ambulatory care medical servic es received during the visit | [
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] | 611 |
In most cases the principal diagnosis or the reason for visit is also the main focus of attention or ment | [
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] | 612 |
It is often difficult somewhat ar to determine which diagnosis is the principal diagnosis or the reason for visit especially when for example a related diagnosis such as alcohol use disorder is accompanied by a diagnosis such as schizophrenia | [
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For example it may be unclear which diagnosis shouldUse of the Manual 23 be considered for an individual hospitalized with both schizophrenia and cohol use disorder because each condition ma y have contributed equally to the need for admission and treatment | [
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The principal diagnosis is indicated by listing it first and the maining disorders are listed in order of focu s of attention and treatment | [
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] | 615 |
When the cipal diagnosis or reason for visit is a ment al disorder due to another medical condition g major neurocognitive disorder due to disease psychotic disorder due to malignant lung ICD coding rules re quire that the etiological medical condition be listed first | [
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] | 616 |
In that case the principal diagnosis or reason for visit would be the mental disorder due to the medical condition the seco nd listed diagnosis | [
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] | 617 |
In most cases the order listed as the principal diagnosis or the reason for visit is followed by the qualifying phrase or for Provisional Diagnosis The specifier can be used when there is a strong presumption that the full criteria will ultimately be met for a disord er but not enough information is available to make a firm diagnosis | [
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] | 618 |
The clinician can indi cate the diagnostic uncertainty by recording following the diagnosis | [
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] | 619 |
For example this diagnosis might be used when an individual who appears to ha ve a major depressive disorder is unable to give an quate history and thus it canno t be established that the full cr iteria are met | [
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] | 620 |
Another use of the term provisional is for those situations in which differential diagnosis depends sively on the duration of illness | [
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] | 621 |
For example a diagnosis of schizophreniform disorder quires a duration of less than 6 months bu t of at least 1 month and can only be given provisionally if assigned before remission has occurred Coding and Reporting Procedures Each disorder is accompanied by an identify ing diagnostic and statistical code which is typically used by institutions and agencies for data collection and billing purposes | [
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Centers fo r Medicare and Medicaid vices and the Centers for Disease Cont rol and National Center for Health Statistics to ensure co nsistent international recordin g of prevalence and mortality rates for identified health conditions | [
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For most clinicians the codes are used to identify the diagnosis or reason for visit for CMS and private insurance servic e claims | [
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The official coding system in use in the United States as of publication of this ma nual is | [
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] | 626 |
ficial adoption of is scheduled to take place on October 1 2014 and these codes which are shown parenthetically in this manual should not be used until the cial implementation occurs | [
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] | 627 |
Both and codes have been listed ceding the name of the disorder in the classification and accompanying the criteria set for each disorder | [
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] | 628 |
For some diagnoses g neurocognitive and induced the appropriate code depe nds on further specification and is listed within the criteria set for the disorder as coding notes and in some cases further clarified in a section on recording proc edures | [
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The names of some di sorders are followed by native terms enclosed in parentheses which in most cases were the names for the disorders Looking to the Assessment and Monitoring Tools The various components of are provided to facilitate patient assessment and to aid in developing a comprehensive case formulation | [
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] | 630 |
Whereas the diagnostic criteria in tion II are measures that have undergone extensive review the Use of the Manual ment tools a cultural formul ation interview and conditions for further study included in Section III are those for which we determined that the scientific evidence is not yet able to support widespread clinical use | [
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] | 631 |
These diagnostic aids and criteria are included to highlight the evolution and direction of scientif ic advances in these areas and to stimulate further research Each of the measures in Section III is provi ded to aid in a compre hensive assessment of individuals that will contribute to a diagnosi s and treatment plan tailored to the ual presentation and clinical context | [
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Where cultural dynamics are particularly important for diagnostic assessment the cultural formulation interview should be considered as a useful aid to communication with the individual | [
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] | 633 |
symptom and specific severity measures provide quantitative ratings of important clinical areas that are designed to be used at the initial evaluation to establish a baseline for comparison with ings on subsequent encounters to monito r changes and inform treatment planning The use of such measures will undoubtedly be facilitated by digital applications and the measures are included in Section III to provide for further evaluation and ment | [
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] | 634 |
As with each DSM edition the diagnostic criteria and the classification of mental disorders reflect the current consensu s on the evolving knowledge in our field 25Cautionary Statement for Forensic Use of Although the diagnostic criteria and text are primarily designed to assist clinicians in conducting clinical assessment case formulation an d treatment planning is also used as a reference for the cour ts and attorneys in assessing the forensic sequences of mental disorders | [
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] | 635 |
As a result it is important to note that the definition of mental disorder included in was developed to meet the needs of clinicians public health professionals and research investigators rather than all of the technical needs of the courts and legal professionals | [
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] | 636 |
It is also im portant to note that does not provide treatment guidelines for any given disorder When used appropriately diagnoses and di agnostic information can assist legal sion makers in their determinations | [
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] | 637 |
For exampl e when the presence of a mental disorder is the predicate for a su bsequent legal determination g involuntary civil the use of an established system of diagnosi s enhances the value and reliability of the termination | [
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] | 638 |
By providing a co mpendium based on a review of the pertinent clinical and research literature may facilitate legal decision understanding of the evant characteristics of mental disorders | [
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] | 639 |
The literature related to di agnoses also serves as a check on ungrounded speculation about ment al disorders and about the functioning of a particular individual | [
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] | 640 |
Finally diagnostic in formation about longitud inal course may prove decision making when the legal issue co ncerns an mental functioning at a past or future point in time However the use of should be inform ed by an awareness of the risks and itations of its use in forensic settings | [
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] | 641 |
When categories criteria and textual tions are employed for forensic purposes ther e is a risk that diagnostic information will be misused or misunderstood | [
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] | 642 |
These dangers aris e because of the imperfect fit between the questions of ultimate concern to the law and the information contained in a clinical sis | [
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] | 643 |
In most situations the clinical diagnosis of a mental disorder such as tual disability developmental di schizophrenia major neurocognitive disorder gambling disorder or pedophilic di sorder does not imply that an individual with such a condition meets legal criteria for the presence of a mental disorder or a fied legal standard g for co mpetence criminal responsibility or | [
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] | 645 |
It is precisely because ments abilities and disabilities vary widely wi thin each diagnostic category that ment of a particular diagnosis does not imply a specific level of im pairment or disability Use of to assess for th e presence of a mental diso rder by nonclinical ical or otherwise insufficiently trained indi viduals is not advised | [
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] | 646 |
Nonclinical decision makers should also be cautioned that a di agnosis does not carry any necessary tions regarding the etiology or causes of the mental di sorder or the degree of control over behaviors that may be associat ed with the disorder | [
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] | 647 |
Even when diminished control over behavior is a feature of the disorder having the nosis in itself does not demons trate that a particular individu al is unable to trol his or her behavior at a particular time This page intentionally left blank 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 and Related Disorders 235 and Disorders 265 Dissociative Disorders 291 Somatic Symptom and Related Disorders 309 Feeding and Eating Disorders 329 Elimination Disorders 355 Disorders 361 Sexual Dysfunctions 423 Gender Dysphoria 451 Disruptive and Conduct Disorders 461 and Addictive Disorders 481 Neurocognitive Disorders 591 Personality Disorders 645 Paraphilic Disorders 685 Other Mental Disorders 707 Movement Disorders and Other Adverse Effects of Medication 709 Other Conditions That May Be a Focus of Clinical Attention 715This page intentionally left blank This section contains the diagnostic criteria approved for routine clinical use along with the codes codes are shown For each mental disorder the diagnostic criteria are followed by descriptive text to assist in diagnostic decision making | [
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] | 648 |
Where needed specific recording procedures are presented with the diagnostic criteria to provide guidance in selecting the most appropriate code | [
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] | 650 |
Although not considered as official disorders medication movement disorders and other adverse effects of medication as well as other conditions that may be a focus of clinical attention additi onal V codes and forthcoming Z are provided to indicate other reasons for a clinical visit such as environmental factors and relational problems | [
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] | 651 |
These codes are adapted from and and we re neither reviewed nor approved as official diagnoses but can provide additional context for a clinical mulation and treatment plan | [
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] | 652 |
These three criteria and their descriptive text the nduced movement disorders and other verse effects of medication and the descriptions of other conditions that may be a focus of clinical the key elements of the clinical agnostic process and thus are presented together This page intentionally left blank 31Neurodevelopmental Disorders The neurodevelopmental disorders are a group of co nditions with onset in the developmental period | [
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] | 653 |
The diso rders typically manifest early in development often fore the child enters grade school and are characterized by developmental deficits that produce impairments of person al social academic or occupational functioning | [
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] | 654 |
The range of developmental deficits varies from very specific limitations of learning or control of executive functions to glob al impairments of social skills or intelligence | [
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The velopmental disorders frequent ly for example in dividuals with autism trum disorder often have intellectual disability developmental and many children with disorder also have a specific learning disorder | [
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] | 656 |
For some diso rders the clinical presentation includes symptoms of cess as well as deficits and delays in achiev ing expected milestones | [
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For example autism spectrum disorder is diagnose d only when the characteristic deficits of social cation are accompanied by excessively repetitive behaviors restricted interests and tence on sameness Intellectual disability lectual developmental is characterized by deficits in general mental abilities such as reasoning problem solving planning abstract thinking judgment academic learning and learning from experience | [
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The deficits result in ments of adaptive functioning such that the individual fails to meet standards of personal independence and social responsibility in one or more aspects of daily life including munication social participation academic or occupational functionin g and personal pendence at home or in community settings | [
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] | 659 |
Global developmental delay as its name implies is diagnosed when an individual fa ils to meet expected developmental milestones in several areas of intellectual functioning | [
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] | 660 |
The diagnosis is used for individuals who are unable to undergo systematic assessments of intellectual functioning including children who are too young to participate in standardiz ed testing | [
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] | 661 |
Intellectual disability may result from an acquired insult during the developm ental period from for example a severe head injury in which case a neurocognitive disorder also may be diagnosed The communication disorders include language disorder speech sound disorder cial communication disorder and fluency disorder | [
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Childhood fluency order is characterized by disturbances of the normal fluency an d motor production of speech including repetitive sounds or syllables prolongation of consonants or vowel sounds broken words blocking or words pr oduced with an exce ss of physical tension Like other neurodevelopmental disorders communication di sorders begin early in life and may produce lifelong functional impairments Autism spectrum disorder is characterized by persistent deficits in social tion and social interaction across multiple cont exts including deficits in social reciprocity nonverbal communicative behavior s used for social interaction and skills in developing maintaining and understandin g relationships | [
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] | 664 |
In addition to the social communication deficits the diagnosis of autism spectrum disorder requires th e presence of restricted petitive patterns of behavior interests or activities | [
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Because symptoms change with velopment and may be masked by compensator y mechanisms the diagnostic criteria may32 Neurodevelopmental Disorders be met based on historical information although the current presentation must cause nificant impairment Within the diagnosis of autism spectrum disorder individual clinical characteristics are noted through the use of specifiers or without accompanying intellectual with or without accompan ying structural language im associated with a known or associated with another neurodevelopmental mental or behavioral as well as specifiers that describe the autistic symptoms at first wi th or without loss of established | [
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These specifiers provide clinicians with an opportunity to individualize the diagnosis and communicate a richer clinical description of the affected individuals | [
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For example many individuals previously diagnosed with Asperg disorder would now receive a diagnosis of autism spectrum disorder without language or intellectual impairment ADHD is a neurodevelopmental disorder defined by impairing levels of inattention organization | [
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] | 668 |
Inattention and disorganization entail ity to stay on task seeming not to listen and lo sing materials at leve ls that are inconsistent with age or developmental level | [
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] | 669 |
entails overactivity fidgeting ability to stay seated intruding into other activities and inability to that are excessive for age or developmental level | [
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In childhood ADHD frequently overlaps with disorders that are often considered to be disorders such as oppositional defiant disorder and conduct di sorder | [
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] | 671 |
ADHD often persists in to adulthood with resultant impairments of social academic and occupational functioning The neurodevelopmental motor disorders in clude developmental coordination der stereotypic movement disorder and tic disorders | [
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] | 672 |
Developmen tal coordination order is characterized by deficits in the acquisition and execution of coordinated motor skills and is manifested by clumsiness and slow ness or inaccuracy of performance of tor skills that cause interference with activiti es of daily living | [
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] | 673 |
St ereotypic movement order is diagnosed when an individual has repetitive seemingly driven and apparently purposeless motor behaviors such as hand fl apping body rocking head banging biting or hitting | [
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] | 674 |
The movements interfere with social academic or other activities | [
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If the behaviors cause this should be specified as part of the diagnostic description Tic disorders are characterized by the presen ce of motor or vocal tics which are sudden rapid recurrent nonrhythmic sterotyped motor movements or vocalizations | [
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] | 676 |
The tion presumed etiology and clinical presentation define the specific tic disorder that is disorder persistent motor or vocal tic disorder provisional tic disorder other specified tic disorder and unspecified tic disorder | [
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] | 677 |
disorder is diagnosed when the individual has multiple motor and vocal tics that have been present for at least 1 year and that have a symptom course Specific learning disorder as the name implie s is diagnosed when there are specific cits in an ability to perceive or process information efficiently and accurately | [
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] | 678 |
This neurodevelopmental disorder first manifests during the years of formal schooling and is characterized by persistent and impairing diffi culties with learning foundational academic skills in reading writing or math | [
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] | 679 |
The perfor mance of the affected academic skills is well below average for age or acceptable performance levels are achieved only with extraordinary effort | [
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Specific learning disorder may occur in individuals identified as tually gifted and manifest only when the le arning demands or assessment procedures g timed pose barriers that cannot be overcome by their innate intelligence and c tory strategies | [
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] | 681 |
For all individuals specific le arning disorder can produce lifelong impairments in activities dependent on the skills including occupational performance The use of specifiers for the neurodevelopme ntal disorder diagnoses enriches the ical description of the clinical course and current symptomatology | [
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] | 682 |
In tion to specifiers that describe the clinical presentation such as age at onset or severity ratings the neurodevelopmental disorders ma y include the specifier with a known medical or genetic condition or environmental factor This specifier gives Disability Developmental 33 cians an opportunity to document factors that may have played a role in the etiology of the disorder as well as those that might affect the clinical course | [
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Examples include genetic disorders such as fragile X syndrome tuberous sclerosis and Rett medical ditions such as and environmental fa ctors including very low birth weight and fetal alcohol exposure in the absence of stigmata of fetal alcohol Intellectual Disabilities Intellectual Disability Developmental Diagnostic Criteria Intellectual disability development al is a disorder with onset during the developmental period that includes both intellectual and adaptive functioning deficits in conceptual social and practical domains | [
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] | 684 |
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] | 685 |
Deficits in intellectual functions such as reasoning problem solving planning abstract thinking judgment academic learning and learning from experience confirmed by both clinical assessment and individualized standardized intelligence testing B | [
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] | 686 |
Deficits in adaptive functioning that result in failure to meet developmental and cultural standards for personal independence and social responsibility | [
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] | 687 |
Without ing support the adaptive deficits limit functioning in one or more activities of daily life such as communication social participation and independent living across multiple environments such as home school work and community C | [
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Onset of intellectual and adaptive deficits during the developmental period The diagnostic term intellectual disability is the equivalent term for the nosis of intellectual developmental disorders | [
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] | 689 |
Although the term intellectual disability is used throughout this manual both terms are used in the title to clarify relationships with other classification systems | [
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] | 690 |
Moreover a federal statute in the United States Law replaces the term mental retardation with intellectual disability and research journals use the term intellectual disability | [
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Thus intellectual disability is the term in common use by medical educational and other professions and by the lay public and advocacy groups Specify current severity Table 317 Mild 318 0 Moderate 318 1 Severe 318 2 Profound Specifiers The various levels of severity are defined on the basis of adaptive functioning and not IQ scores because it is adaptive functioning that determines the level of supports required Moreover IQ measures ar e less valid in the lower end of the IQ range 34 Neurodevelopmental DisordersTABLE 1 Severity levels for intellectual disability developmental Severity level Conceptual domain Social domain Practical domain Mild For preschool children there may be no obvious conceptual differences | [
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] | 692 |
Fo r children and adults there are difficulties in learning demic skills involving reading writing arithmetic time or money with support needed in one or more areas to meet expectations | [
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] | 693 |
In adults abstract thinking utive function e planning strategizing priority setting and cognitive and memory as well as functional use of academic skills g reading money are impaired There is a somewhat concrete approach to problems and solutions compared with | [
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] | 694 |
Compared with typically developing mates the individual is immature in social interactions | [
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] | 695 |
For example there may be culty in accurately perceiving social cues | [
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] | 696 |
Communication conversation and guage are more concrete or immature than expected for age | [
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] | 697 |
There may be difficulties ulating emotion and behavior in ate these difficulties are noticed by peers in social situations | [
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There is limited understanding of risk in social social judgment is immature for age and the person is at risk of being manipulated by others The individual may functi on in personal care | [
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