The Diagnostic and Statistical Manual of Mental Disorders (DSM–5) is the product of more than 10 years of effort by hundreds of international experts in all aspects of mental health. Their dedication and hard work have yielded an authoritative volume that defines and classifies mental disorders in order to improve diagnoses, treatment, and research.
Changes to the ICD-10-CM
The 2019 release of ICD-10-CM includes new, updated or deleted codes for medical conditions, which have been approved within the past year. A handful of these changes pertain to mental disorders, and thus affect the coding of DSM-5 Disorders.
About the Changes
The National Center for Health Statistics (NCHS), a federal agency within the Centers for Disease Control and Prevention (CDC), oversees the International Statistical Classification of Diseases and Related Health Problems (ICD-10-CM) in the United States.
The Coordination and Maintenance Committee approves proposed changes to ICD-10-CM on a yearly basis, which are then disseminated to medical and mental health professionals.
Changes will be implemented for all health care practitioners and payers in the United States.
Online Assessment Measures
For further clinical evaluation and research, the APA is offering a number of “emerging measures” in Section III of DSM-5. These patient assessment measures were developed to be administered at the initial patient interview and to monitor treatment progress, thus serving to advance the use of initial symptomatic status and patient reported outcome (PRO) information, as well as the use of “anchored” severity assessment instruments. Instructions, scoring information, and interpretation guidelines are included. Clinicians and researchers may provide APA with feedback on the instruments’ usefulness in characterizing patient status and improving patient care.
Level 1 Cross-Cutting Symptom Measures
Level 2 Cross-Cutting Symptom Measures
Disorder-Specific Severity Measures
Disability Measures
Personality Inventories
Early Development and Home Background
Cultural Formulation Interviews
These measures should be used to enhance clinical decision-making and not as the sole basis for making a clinical diagnosis. Further information on these measures can be found in DSM-5. The measures can be broadly classified into four types:
- Cross-cutting symptom measures may aid in a comprehensive mental status assessment by drawing attention to symptoms that are important across diagnoses. They are intended to help identify additional areas of inquiry that may guide treatment and prognosis. The cross-cutting measures have two levels: Level 1 questions are a brief survey of 13 domains for adult patients and 12 domains for child and adolescent patients, and Level 2 questions provide a more in-depth assessment of certain domains.
- Severity measures are disorder-specific, corresponding closely to criteria that constitute the disorder definition. They may be administered to individuals who have received a diagnosis or who have a clinically significant syndrome that falls short of meeting full criteria. Some of the assessments are self-completed, whereas others require a clinician to complete.
- The World Health Organization Disability Assessment Schedule, Version 2.0 (WHODAS 2.0) assesses a patient’s ability to perform activities in six areas: understanding and communicating; getting around; self-care; getting along with people; life activities (e.g., household, work/school); and participation in society. The scale is self- or informant-administered and corresponds to concepts contained in the WHO International Classification of Functioning, Disability and Health.
- The Personality Inventories for DSM-5 measure maladaptive personality traits in five domains: negative affect, detachment, antagonism, disinhibition, and psychoticism. For adults and children ages 11 and older, there are brief forms with 25 items and full versions with 220 items. A full version for informants is also available.
Additional Assessment Measures
- The Early Development and Home Background (EDHB) form may assist in the assessment of the early development and past and current home background experiences of a child receiving care. Two versions are provided: one to be completed by the child’s parent or guardian, and the other to be completed by the clinician.
- The Cultural Formulation Interview (CFI) is a set of 16 questions that clinicians may use to obtain information during a mental health assessment about the impact of culture on key aspects of an individual’s clinical presentation and care.
- The Cultural Formulation Interview—Informant Version collects collateral information on the CFI domains from family members or caregivers.
- Supplementary Modules to the Cultural Formulation Interview can help clinicians conduct a more comprehensive cultural assessment. The first eight supplementary modules explore the domains of the core CFI in greater depth. The next three modules focus on populations with specific needs, such as children and adolescents, older adults, and immigrants and refugees. The last module explores the experiences and views of individuals who perform caregiving functions.