DSM-5 codes

This article gives an overview of diagnostic codes from DSM-5, the fifth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders.

Chapters

The DSM-5 lists the following chapters:

• Neurodevelopmental disorders
• Schizophrenia spectrum and other psychotic disorders
• Bipolar and related disorders
• Depressive disorders
• Anxiety disorders
• Obsessive-compulsive and related disorders
• Trauma- and stressor-related disorders
• Dissociative disorders
• Somatic symptom disorders
• Feeding and eating disorders
• Elimination disorders
• Sleep-wake disorders
• Sexual dysfunctions
• Gender dysphoria
• Disruptive, impulse control and conduct disorders
• Substance use and addictive disorders
• Neurocognitive disorders
• Personality disorders
• Paraphilic disorders
• Other disorders

Neurodevelopmental disorders

Neurodevelopmental disorders are disorders with onset in the developmental period, often before starting school, and that are characterized by a range of developmental deficits that impair normal functioning.

Intellectual disabilities

• 319 Intellectual disability (intellectual developmental disorder)

Deficits in intellectual functioning and every day adaptive functioning with onset during the developmental period.

Specify current severity:

Mild

Moderate

Severe

Profound

• 315.8 Global developmental delay

Pertains to those under 5 years old whose intellectual functioning can not be systematically assessed.

• 319 Unspecified intellectual disability (Intellectual developmental disorder)

Used in exceptional circumstances for individuals over 5 years old whose intellectual disability cannot be assessed because of sensory or physical impairments.

there are updated codes for this disorder.

Communication disorders

Main article: Communication disorder

Deficits in language, speech, or in any behaviors affecting verbal and nonverbal communications

• 315.39 Language disorder

Persistent deficits in comprehension or production of language (e.g. spoken, written, sign language) substantially below age level, beginning in the early developmental period, and not due to other disorders or conditions

• 315.39 Speech sound disorder

Persistent deficits in speech sound production, below that expected of age and developmental level, not due to other impairments such a physical, neurological or hearing disorders or conditions

• 315.35 Childhood-onset fluency disorder (stuttering)

Disturbance in normal speech patterns and fluency that interferes with normal achievement

• 315.39 Social (pragmatic) communication disorder

Primary deficits in understanding and following social practices of verbal and nonverbal communication in normal settings that functionally impair the individual; not better explained by other deficits

• 307.9 Unspecified communication disorder

Clinically significant symptoms of a communication disorder, but fails to meet the full criteria for any of the communication or neurodeveopmental disorders and the clinician does not specify the reason

Autism spectrum disorder

• 299.00 Autism spectrum disorder

Persistent communication and social interaction deficits in multiple situations; restricted, repetitive behavior and interests, originally manifested in the early developmental period and causing significant impairment

Specify if:

With or without accompanying intellectual impairment

With or without accompanying language impairment

Associated with a known medical or genetic condition or environmental factor

Associated with another neurodevelopmental, mental, or behavioral disorder

293.89 With catatonia

Specify current severity:

Level 1 Requiring support

Level 2 Requiring substantial support

Level 3 Requiring very substantial support

Attention deficit hyperactivity disorder

• Attention deficit hyperactivity disorder (ADHD)

"Persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development" beginning in childhood, and present across more than one setting

Specify whether:

• 314.01 Combined presentation
• 314.00 Predominantly inattentive presentation
• 314.01 Predominantly hyperactive/impulsive presentation

Specify if:

In partial remission

Specify current severity:

Mild

Moderate

Severe

• 314.01 Other specified attention-deficit/Hyperactivity disorder

Symptoms of ADHD are present and cause significant impairment in important functional areas, but do not meet the full criteria, and where the reason for failing the criteria is specified.

• 314.01 Unspecified attention-deficit/Hyperactivity disorder

Same as 314.01 above but with no reason specified or insufficient information is available to provide one

Specific learning disorder

• Specific learning disorder

A neurodevelopmental disorder of biological origin manifested in learning difficulty and problems in acquiring academic skills markedly below age level and manifested in the early school years, lasting for at least 6 months; not attributed to intellectual disabilities, developmental disorders, or neurological or motor disorders

Specify if:

• 315.00 With impairment in reading
• 315.2 With impairment in written expression
• 315.1 With impairment in mathematics

Specify current severity:

Mild

Moderate

Severe

Motor disorders

• 315.4 Developmental coordination disorder

Motor skill development substantially below age group, interfere with normal activities, and begin in "early developmental period". Not better accounted for by intellectual disabilities, visual problems, or a neurological condition such as cerebral palsy, or a degenerative disorder.

• 307.3 Stereotypic movement disorder

Repetitive, seemingly purposeless, often rhythmical motor behavior that interferes with normal activities, with onset in the "early developmental period".

Specify if:

With self-injurious behavior

Without self-injurious behavior

Specify if:

Associated with a known medical or genetic condition, neurodevelopmental disorder, or environmental factor

Specify current severity:

Mild

Moderate

Severe

Tic disorders

Main article: Tic disorders

"A tic is a sudden, rapid, recurrent, nonrhythmic motor movement or vocalization". Tic disorders are not due to use of a substance or to another medical condition; the diagnosis depends on the lack of any known cause.

• 307.23 Tourette's disorder

Multiple motor tics and at least one vocal tic present for more than one year, though not necessarily at the same time, with onset before age 18.

• 307.22 Persistent (Chronic) motor or vocal tic disorder

At least one motor or vocal tic, but not both; must be present for more than one year with onset before age 18.

Specify if:

With motor tics only

With vocal tics only

• 307.21 Provisional tic disorder

One or more motor and/or vocal tics, present for less than one year; onset before age 18.

• 307.20 Other specified tic disorder

Characteristic tic disorder symptoms causing distress or impairment but not meeting the "criteria for a tic disorder or any specific neurodevelopmental disorder"; the specific reason given e.g. onset over the age of 18

• 307.20 Unspecified tic disorder

Same as "307.20 Other specified tic disorder", but the reason is not specified

Other neurodevelopmental disorders

• 315.8 Other specified neurodevelopmental disorder

A category that pertains to characteristic symptoms of a neurodevelopmental disorder causing significant impairment but does not fulfill the criteria of a specific diagnostic class.

Specify: Specific reason, such as "associated with prenatal alcohol exposure"

• 315.9 Unspecified neurodevelopmental disorder

A category similar to 315.8, but without a specified reason.

Schizophrenia spectrum and other psychotic disorders

Key features that define the psychotic disorders in DSM-5 are:

Delusions - fixed beliefs not open to change even when evidence contradicts them; termed bizarre if implausible and not derived from ordinary experience

Hallucinations - involuntary sensory experiences not related to external stimuli

Disorganized thinking (speech) - derailment of focal topic or loose associations, incoherence

Grossly disorganized or abnormal motor behavior (including catatonia)

Negative symptoms - reduced emotional expression, avolition, alogia, anhedonia, asociality

• 297.1 Delusional disorder - presence of one or more fixed delusions, but otherwise functioning usually is not noticeably impaired.

Specify whether:

Erotomanic type

Grandiose type

Jealous type

Persecutory type

Somatic type

Mixed type

Unspecified type

Specify if:

With bizarre content

Specify if:

First episode, currently in acute episode

First episode, currently in partial remission

First episode, currently in full remission

Multiple episodes, currently in acute episode

Multiple episodes, currently in partial remission

Multiple episodes, currently in full remission

Unspecified

Specify current severity:

• 298.8 Brief psychotic disorder - sudden onset of at least one positive psychotic symptom, such as delusions, hallucinations, disorganized speech, lasting at least one day but less than one month

Specify if:

With marked stressor(s)

Without marked stressor(s)

With postpartum onset

Specify if:

With catatonia

Specify currenty severity:

• 295.40 Schizophreniform disorder

Symptoms identical to schizophrenia but lasting less that 6 months

Specify if:

With good prognostic features

Without good prognostic features

Specify if:

With catatonia

Specify current severity:

• 295.90 Schizophrenia

At least two of the following: (one of which must be delusions, hallucinations or disorganized speech), grossly disorganized or catatonic behavior, negative symptoms

Specify if:

First episode, currently in acute episode

First episode, currently in partial remission

First episode, currently in full remission

Multiple episodes, currently in acute episode

Multiple episodes, currently in partial remission

Multiple episodes, currently in full remission

Unspecified

Specify if:

With catatonia

Specify current severity

• 295.70 Schizoaffective disorder

Major depressive or manic mood disorder concurrent with primary symptoms of schizophrenia

Specify whether:

Bipolar type

Depressive type

Specify if:

With catatonia

Specify if:

First episode, currently in acute episode

First episode, currently in partial remission

First episode, currently in full remission

Multiple episodes, currently in acute episode

Multiple episodes, currently in partial remission

Multiple episodes, currently in full remission

Continuous

Unspecified

Specify current severity

• 291.9 Substance/Medication-induced psychotic disorder

Specify name of substance

Alcohol

Cannabis

Phencyclidine

Other hallucinogen

Inhalant

Sedative, hypnotic or anxioltic

Amphetamine (or other stimulant)

Cocaine

Other (or unknown) substance

then specify if:

With onset during intoxication

With onset during withdrawal

Specify current severity (optional)

0 (not present) to 4 (present and severe)

rated by primary symptoms of psychosis in the last 7 days, including delusions, hallucinations, abnormal psychomotor behavior, and negative symptoms.

• Psychotic disorder due to another medical condition

293.81 With delusion as the predominant symptom

293.82 With hallucinations as the predominant symptom

• 293.89 Catatonia

Marked psychomotor disturbance including decreased motor activity, or excessive and peculiar motor activity, ranging from unresponsiveness to agitation. Can include stupor, catalepsy and waxy flexibility, mutism and other puzzling behaviors. Rather than being a separate diagnosis, catatonia is associated with other mental disorders, other medical conditions, or can be unspecified.

Catatonia associated with another mental disorder (Catatonia specifier)

Specifier is defined by three or more of 12 listed symptoms

Catatonic disorder due to another medical condition

Criteria include three or more of 12 listed symptoms

Unspecified catatonia

Characteristic symptoms of catatonia are present but the underlying disorder is unclear, the full criteria are not met, or the information available is insufficient

Coding note: Code first 781.99 "Other symptoms involving nervous and musculoskeletal systems", followed by 293.89

• 298.8 Other specified schizophrenia spectrum and other psychotic disorder

Characteristic symptoms of schizophrenia spectrum and other psychotic disorder are present but full criteria for a diagnostic class are not met. The other specified is used to describe the presentation.

• 298.9 Unspecified schizophrenia spectrum and other psychotic disorder

Characteristic symptoms of schizophrenia spectrum and other psychotic disorder are present but full criteria for a diagnostic class are not met, but the clinician does not specify the reason.

Trauma- and stressor-related disorders

A new category has been created for those disorders that explicitly list in their criteria exposure to a traumatic or catastrophic event, emphasizing the close connection between disorders listed in this category and those in the categories of anxiety disorders, obsessive-compulsive disorders, and dissociative disorders. However, in this category's disorders the dominating characteristics are symptoms of anhedonia and dysphoria, anger and aggression, or symptoms of dissociation, or some combination of these, and vary considerably with heterogeneous presentations.

• 313.89 Reactive attachment disorder

A disorder of infancy or early childhood in which the child, though thought to be capable of forming selective attachments, does not seek comfort, protection or other nurturance associated with attachment to caregiving adults, and does not respond adequately to nurturing behaviors from caregivers when it is offered.

Specify if:

Persistent (more than 12 months)

Specify current severity:

• 313.89 Disinhibited social engagement disorder

A behavioral pattern in children of overly familiar and culturally inappropriate interations with relative strangers that violated social boundaries.

Specify if:

Persistent (over 12 months)

Specify current severity:

• 309.81 Posttraumatic stress disorder

There is a separate section for Posttraumatic stress disorder for children 6 years and younger

Specify whether:

With dissociative symptoms

1. Depersonalization
2. Derealization

Specify if:

With delayed expression (full criteria not expressed at least 6 months after traumatic event)

• 308.3 Acute stress disorder
• Adjustment disorder

Specify whether:

309.0 With depressed mood

309.24 With anxiety

309.28 With mixed anxiety and depressed mood

309.3 With disturbance of conduct

309.4 With mixed disturbance of emotions and conduct

309.9 Unspecified

• 309.89 Other specified Trauma- and stressor-related disorder
• 309.9 Unspecified trauma- and stressor-related disorder

Dissociative disorders in DSM-5.

Common to these disorders are disruptions or gaps in the normal integration of subjective experience resulting in discontinuities in affect, identity, memory, behavior, and motor control.

• 300.14 Dissociative identity disorder

The primary feature is the presence of two or more distinct personality states, self-reported or observed by others, resulting in failure to recall everyday events and/or important autobiographical information, and impairing continuity in the sense of self. The "experience of possession" is included as a cultural description of a fragmented identity.

• 300.12 Dissociative amnesia

The primary feature is the inability to remember important life history information, usually traumatic, that has been successfully stored but is inaccessible to the individual, causing significant distress or impairment in life functioning.

Specify if:

300.13 With dissociative fugue: Travel or wandering associated with amnesia for identity or important autobiographical information

• 300.6 Depersonalization/Derealization disorder

The primary feature is recurrent episodes of depersonalization and/or derealization that have functional consequences.

• 300.15 Other specified dissociative disorder

Symptoms of a dissociative disorder are present but do not meet the full criteria for a specific disorder. The clinician specifies the reason.

• 300.15 Unspecified dissociative disorder

As 300.15 above, but the clinician does not specify the reason

Elimination disorders

• The elimination disorders, included in the chapter on early diagnosis in DSM-IV, is an independent class in DSM-5.
• 307.6 Enuresis

Specify if:

Nocturnal only

Diurnal only

Nocturnal and diurnal

• 307.7 Encopresis

Specify if:

With constipation and overflow incontinence

Without constipation and overflow incontinence

• Other specified elimination disorder

Gender dysphoria in DSM-5

• 302.6 Gender dysphoria in children

Specify if:

With a disorder of sex development (e.g. such as congenital adrenogenital disorder)

• 302.85 Gender dysphoria in adolescents and adults

Specify if:

With a disorder of sex development (e.g. congenital medial conditions such as congenital adrenogenital disorder)

Posttransitional (the specifics of the person's degree of transition, medical procedures undergone or planned etc. to attain the desired gender)

Comment on subtypes and specifiers

The sexual orientation subtyping has been removed as unrelated to gender dysphoria and therefore not useful clinically.

The posttransition specifier has been added because after gender transition, although many people no longer meet criteria for gender dysphoria they still remain in need of treatments to improve life in the desired gender and this specifier recognizes that need.

Disruptive, impulse-control, and conduct disorders in DSM-5

DSM-5 has a new chapter on disruptive, impulse-control, and conduct disorders to bring under one unique category those behavioral conditions that violate the rights of others and/or cause significant conflict with society or draw the attention of authority figures. This DSM-5 category contains the following:

• 313.81 Oppositional defiant disorder

Frequent, persistent pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness exhibited over the course of at least six months, and with at least one non-sibling, and should exceed normal behavior for the individual's age, gender and culture.

Specify current severity:

Mild - symptoms occur in one setting only, such as home or school or work

Moderate - some symptoms present in at least two settings

Severe - some symptoms present in three or more settings

• 312.34 Intermittent explosive disorder

Rapid onset of recurrent impulsive, verbally or physically aggressive outbursts typically lasting less than 30 minutes, usually in response to minimal provocation by an intimate or associate, and causing marked impairment in functioning or legal consequences.

• Conduct disorder

Repetitive pattern of behavior that violates the basic rights of others, falling in to four categories:

Aggressive behavior causing or threatening harm to people or animals

Non-aggressive behavior causing property damage or loss

Deceitfulness or theft

Serious violations of rules, such as running away from home

Specify whether:

312.81 Childhood-onset type - before age 10

312.82 Adolescent-onset type - no symptoms before age 10

312.89 Unspecified onset - not enough information available

Specify if:

With limited prosocial emotions:

Lack of remorse or guilt

Callous - lack of empathy

Unconcerned about performance

Shallow or deficient affect

Specify current severity:

Mild - causes relatively minor harm to others, such as lying, staying out late, etc.

Moderate - intermediate harm such as stealing without confrontation, vandalism

Severe - cause considerable harm to others (e.g. forced sex, physical cruelty, use of a weapon, breaking and entering, stealing while confronting victim)

• 301.7 Antisocial personality disorder

Coded here as well as in "Personality disorders" because of this disorder's close connected with the "externalizing" conduct disorders in this chapter.

• 312.33 Pyromania

• 312.32 Kleptomania

• 312.89 Other specified disruptive, impulse-control, and conduct disorder

• 312.9 Unspecified disruptive, impulse-control, and conduct disorder

Substance-Related and Addictive Disorders

Substance-Related Disorders

• Alcohol-Related Disorders

Alcohol Use Disorders

Specify current severity:

305.00 Mild

303.90 Moderate

303.90 Severe

303.00 Alcohol Intoxication

With use disorder, mild

With use disorder, moderate or severe

Without use disorder

291.81 Alcohol Withdrawal

Without perceptual disturbances

With perceptual disturbances

291.81Other Alcohol-Induced Disorders

291.9 Unspecified Alcohol-Related Disorder

• Caffeine-Related Disorders

305.90 Caffeine Intoxication

292.0 Caffeine Withdrawal

292.0 Other Caffeine-Induced Disorders

292.9 Unspecified Caffeine-Related Disorder

• Cannabis-Related Disorders

Cannabis Use Disorder

Specify current severity:

305.20 Mild

304.30 Moderate

304.30 Severe

• Non-Substance-Related Disorders
• 312.31 Gambling Disorder

Specify if

Episodic, Persistent

Specify current severity

Mild

Moderate

Severe

Personality disorders

Criteria for a general personality disorder are provided with an emphasis on personality traits and the relationship of the specific personality disorder criteria to other mental disorders in which those behaviors also occur.

• Cluster A personality disorders
  • 301.0 Paranoid personality disorder
  • 301.2 Schizoid personality disorder
  • 301.22 Schizotypal personality disorder
• Cluster B personality disorders
  • 301.7 Antisocial personality disorder
  • 301.83 Borderline personality disorder
  • 301.50 Histrionic personality disorder
  • 301.81 Narcissistic personality disorder
• Cluster C personality disorders
  • 301.82 Avoidant personality disorder
  • 301.6 Dependent personality disorder
  • 301.4 Obsessive-compulsive personality disorder

The multiaxial system has been dropped in favor of a system evaluating psychosocial and contextual factors, although the category classification remains. Under consideration is a new trait-specific diagnostic method that views personality traits on a continuum. The relationship of personality traits to general personality dysfunction is under active investigation in another section of DSM-5, entitled "Alternative DSM-5 Model for Personality Disorders".

Paraphilic disorders in DSM-5

Eight disorders were chosen for listing in DSM-5 because of their frequency and because some of them are listed are criminal offenses due to their potential for public harm. It is recognized that many more paraphilias than those listed have been identified and described, and could be considered as paraphilic disorders because of their negative impact on the individual and others. The eight paraphilic disorders described in DSM-5 are the following:

• 302.82 Voyeuristic disorder
• 302.4 Exhibitionistic disorder
• 302.89 Frotteuristic disorder
• 302.83 Sexual masochism disorder
• 302.84 Sexual sadism disorder
• 302.2 Pedophilic disorder
• 302.81 Fetishistic disorder
• 302.3 Transvestic disorder

Specify if:

With fetishism

With autogynephilia

Specify if:

In a controlled environment

In full remission

• 302.89 Other specified paraphilic disorder
• 302.9 Unspecified paraphilic disorder