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DSM-5: From Pathological Gambling to Gambling Disorder. Heather A. Chapman, Ph.D , NCGCII, BACC Louis Stokes Cleveland VA Medical Center Case Western Reserve University School of Medicine. DSM-5. Mainly incremental changes from DSM-IV No more Roman numerals

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Dsm 5 from pathological gambling to gambling disorder

DSM-5: From Pathological Gambling to Gambling Disorder

Heather A. Chapman, Ph.D, NCGCII, BACC

Louis Stokes Cleveland VA Medical Center

Case Western Reserve University School of Medicine


Dsm 5
DSM-5

  • Mainly incremental changes from DSM-IV

  • No more Roman numerals

  • Considering online updates in the future (e.g. DSM-5.1) making it a “living document”


Dsm 51
DSM-5

  • DSM-5 is now in effect as of 12/31/13.

  • DSM-5 is fully compatible with ICD-9 system now in use by insurance companies and includes ICD-10 codes (to be implemented 10/1/14).


Problems with dsm iv addressed by dsm 5
Problems with DSM-IV Addressed by DSM-5

  • High rates of co-morbidity

  • High use of NOS category

  • Concerns about reliability and validity


Guiding principles for changes to dsm
Guiding Principles for Changes to DSM

  • Research evidence should support any addition or substantive modification.

  • Changes should be based on empirical research rather than clinical consensus.

    • Behavioral science

    • Neuroscience

  • Continuity with the current manual should be maintained when possible.

  • Routine clinical practices must be able to implement any changes.


Dsm 5 structure
DSM-5 Structure

  • Section I: Basics/Introduction

  • Section II: Diagnostic Criteria and Codes

  • Section III: Emerging Measures and Models

  • Appendix


Section i basics
Section I: Basics

  • Introduction

  • Use of the Manual

  • Cautionary Statement for Forensic Use


Section i basics introduction
Section I: Basics: Introduction

  • DSM-5 better reliability than DSM-IV.

    • Research to validate diagnoses continues.

    • The boundaries between many disorder categories are fluid over the life course.

    • DSM-5 accommodates dimensional approaches to mental disorders.


Nos cnec conditions not elsewhere classified
NOS/CNECconditions not elsewhere classified

  • Problem: widespread use of Not Otherwise Specified (NOS) diagnoses.

  • DSM-5 removes the NOS diagnosis. It adds

    • Other Specified Disorder (criteria vary by disorder)

    • Unspecified Disorder (for use when there is insufficient information to be more specific)

  • NOS  CNEC (conditions not elsewhere classified):

    • Only for 6 months.

    • Only for specific reasons:

      • Diagnosis unclear (e.g., psychotic disorder CNEC)

      • Clinician not trained to make the dx.

      • Clinician cannot get info (e.g., client uncooperative; records not available).

      • You do not have enough info.

      • Clinicians needs or is required to take more time of direct observation (e.g., 12 months).


22 chapters
22Chapters:


Two clusters of disorders
Two Clusters of Disorders

  • Internalizing group

    Disorders with prominent anxiety, depressive, and somatic symptoms

  • Externalizing group

    Disorders with prominent impulsive, disruptive conduct, and substance use symptoms

    Disorders within these clusters are adjacent in the DSM-5.


Organization of disorders
Organization of Disorders

  • Disorders are organized on developmental and lifespan considerations.

  • DSM-5 begins with diagnoses that manifest early in life, then adolescence and young adulthood, then adulthood and later life.


Cultural issues
Cultural Issues

  • Culture is considered as it shapes the experience and expression of the symptoms, signs, and behaviors that are criteria for diagnosis.

  • Section III contains a Cultural Formulation.

  • The Appendix contains a Glossary of Cultural Concepts of Distress.


Cultural issues cont
Cultural Issues, cont.

  • DSM-5 replaces the construct of the culture-bound syndrome in DSM-IV with 3 concepts:

    • Cultural syndrome: a cluster of invariant symptoms in a specific cultural group

    • Cultural idiom of distress: a way of talking about suffering among people in a cultural group

    • Cultural explanation or perceived cause for symptoms, illness, or distress


Dsm 5 is non axial
DSM-5 is Non-Axial

  • DSM-IV axes I, II, and III have been combined.

  • Continue to list relevant medical conditions.

  • The GAF in DSM-IV has been eliminated. Instead, use the World Health Organization Disability Assessment Schedule (WHODAS).

  • The WHODAS-2.0 is on page 747 of the DSM-5 and is also available online.


Chart entry example of a diagnosis
Chart Entry Example of a Diagnosis

  • Major depressive disorder, recurrent, severe; gambling disorder; COPD

  • Anxiety; Insomnia

  • Recent divorce; financial insecurity

  • Function seriously impaired


Section i basics use of the manual
Section I: Basics: Use of the Manual

  • Clinical Case Formulation

    • Making diagnoses requires clinical judgment, not just checking off the symptoms in the criteria.

    • The client’s cultural and social context must be considered.

    • The DSM-5 does not include all possible mental disorders.


Definition of a mental disorder
Definition of a Mental Disorder

  • A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning.

  • There is usually significant distress or disability in social or occupational activities.


Definition of a mental disorder1
Definition of a Mental Disorder

  • The diagnosis of a mental disorder should have clinical utility; it should help clinicians to determine prognosis and treatment plan.

  • The diagnosis of a mental disorder is not equivalent to a need for treatment.


Definition of a mental disorder2
Definition of a Mental Disorder

  • Diagnoses are made on the basis of

    • The clinical interview

    • DSM-5 text descriptions

    • DSM-5 criteria

    • Clinician judgment


Steps in making a diagnosis
Steps in Making a Diagnosis

  • Administer cross-cutting assessments

  • Administer WHODAS 2.0

  • Conduct clinical interview

  • Determine whether a diagnostic threshold is met

  • Consider subtypes and/or specifiers

  • Consider contextual information, disorder text, distress, clinician judgment

  • Apply codes and develop a treatment plan


Section i basics cautionary statement for forensic use of dsm 5
Section I: Basics: Cautionary Statement for Forensic Use of DSM-5

  • The diagnosis of a mental disorder does not imply that the person meets legal criteria for the presence of a mental disorder or a specific legal standard for competence, criminal responsibility, disability, etc.

  • Having a diagnosis does not imply that the person is (or was) unable to control his or her behavior at a particular time.


Section ii diagnostic criteria and codes
Section II: Diagnostic Criteria and Codes DSM-5

Highlights of Specific Disorder Revisions


Neurodevelopmental disorders
Neurodevelopmental Disorders DSM-5

  • Autism Spectrum Disorder (ASD) replaces DSM-IV’s Autistic Disorder, Asperger’s Disorder, Pervasive Developmental Disorder, etc.

  • Rationale: Clinicians had applied the criteria for these disorders inconsistently and incorrectly. There was not enough data to justify continuing to separate these disorders.


Intellectual disability
Intellectual Disability DSM-5

  • The term “Intellectual Disability” replaces “Mental Retardation.”

  • DSM-5 places greater emphasis on adaptive functioning deficits rather than IQ scores alone.


  • Attention-Deficit/Hyperactivity Disorder DSM-5

    • Age of onset was raised from 7 years to 12 years.

    • The symptom threshold for adults was reduced to five symptoms.

  • Specific Learning Disorder

    • Now presented as a single disorder, with specifiers for deficits in reading, writing, and mathematics.


Schizophrenia spectrum and other psychotic disorders
Schizophrenia Spectrum and Other Psychotic Disorders DSM-5

  • Schizophrenia

    • Elimination of special treatment of bizarre delusions and special hallucinations in Criterion A.

    • At least one of two required symptoms to meet Criterion A must be delusions, hallucinations, or disorganized speech.

    • Specific subtypes were deleted due to poor reliability and validity.

  • Schizoaffective Disorder

    • Now based on the lifetime (rather than the episodic) duration of the illness.

  • Catatonia

    • Now exists as a specifier for many mental disorders.


Bipolar and related disorders
Bipolar and Related Disorders DSM-5

  • Mania and Hypomania

    • Criterion A now includes increased energy/activity as a required symptom.

    • “Mixed episode” is replaced with a “with mixed features” specifier.

    • “With anxious distress” was added as a specifier for bipolar and depressive disorders.


Depressive disorders
Depressive Disorders DSM-5

  • The bereavement exclusion was eliminated from major depressive episode (MDE).

    • In some people, a major loss can lead to a MDE.

  • Disruptive Mood Dysregulation Disorder (DMDD) was added.

    • For children with extreme behavioral dyscontrol but persistent rather than episodic irritability.

    • This should decrease the number of children diagnosed with bipolar disorder.

  • Dysthymic Disorder was renamed Persistent Depressive Disorder.


Anxiety disorders
Anxiety Disorders DSM-5

  • DSM-5 has four chapters to cover the anxiety disorders covered by two chapters in DSM-IV.

    • Anxiety Disorders

    • Obsessive-Compulsive & Related Disorders

    • Trauma- & Stressor-Related Disorders

    • Dissociative Disorders

  • Anxiety Disorders

    • Panic attacks was added as a specifier for any mental disorder.

    • Panic attacks can occur in many mental disorders.


Obsessive compulsive related disorders
Obsessive-Compulsive & Related Disorders DSM-5

  • Hoarding Disorder was added.

  • Excoriation (Skin-Picking) Disorder was added.

  • Body Dysmorphic Disorder (BDD) was moved from the chapter on somatic disorders to the chapter on OCD & Related disorders.

    A “delusional” specifier was added for both OCD and BDD.


Trauma stressor related disorders
Trauma- & Stressor-Related Disorders DSM-5

  • Posttraumatic Stress Disorder

    • The stressor criterion (A) is now more explicit.

    • Criterion A2 (subjective reaction) is eliminated.

    • The symptom clusters were enlarged from 3 to 4.

    • Separate criteria were added for children age 6 and younger.

    • Reactive attachment disorder was separated into RAD and disinhibited social engagement disorder.


Feeding and eating disorders
Feeding and Eating Disorders DSM-5

  • Binge Eating Disorder (BED) is new.

  • The diagnosis of Anorexia Nervosa no longer requires amenorrhea as a diagnostic criterion.


Sleep wake disorders
Sleep- DSM-5Wake Disorders

  • Primary Insomnia renamed Insomnia Disorder.

  • Rapid Eye Movement Sleep Behavior Disorder and Restless Legs Syndrome elevated to the main body of the manual.

  • Subtypes expanded for Circadian Rhythm Sleep Disorders.


Disruptive impulse control and conduct disorders
Disruptive, Impulse-Control, and Conduct Disorders DSM-5

  • Conduct Disorder

    Added a specifier “with limited prosocial emotions.”

  • Intermittent Explosive Disorder

    Provides more specific criteria to define outbursts.

    Trichotillomania was moved from the Impulse-Control Disorder chapter in DSM-IV to the Obsessive-Compulsive and Related Disorders chapter in DSM-5.


Neurocognitive disorders
Neurocognitive Disorders DSM-5

  • The word dementia was eliminated; the new term is Major Neurocognitive Disorder.

    • The word “Dementia” was linked to old age diseases and clinicians tended to be pessimistic about its prognosis.

  • Mild Neurocognitive Disorder is new.

    • This condition exists and treatment can help.

    • Neurocognitive decline is not inevitable.


Adjustment disorders
Adjustment Disorders DSM-5

  • The chapter “Adjustment Disorders” in DSM-IV was incorporated into the chapter on Trauma- and Stressor-Related Disorders in DSM-5.

  • Criterion B-1 was rephrased as “marked distress that is out of proportion to the severity or intensity of the stressor.”

    • Symptoms are in response to an identifiable stressor.


Personality disorders
Personality Disorders DSM-5

  • All 10 PDs in DSM-IV remain intact in DSM-5.

  • Note that “Axis II” in DSM-IV no longer exists.

  • Section III of the DSM-5 contains an alternate, trait-based approach to assessing personality. It helps with the diagnosis of people who meet the core criteria for a PD but do not meet the criteria for a specific type of PD.


Alternate model for pds
Alternate Model for PDs DSM-5

  • PDs are characterized by impairments in personality functioning and pathological personality traits.

  • General Criteria for Personality Disorder

  • Specific Personality Disorders

    • Antisocial, Avoidant, Borderline, Narcissistic, Obsessive-Compulsive, and Schizotypal.


Alternate model for pds1
Alternate Model for PDs DSM-5

  • Proposed Diagnostic Criteria

    • Impairment in personality functioning.

      • Identity

      • Self-direction

      • Empathy

      • Intimacy

    • Pathological personality trait domains.

      • Negative affectivity; detachment; antagonism; disinhibition; psychoticism.


Paraphilic disorders
Paraphilic DSM-5 Disorders

  • Emphasizes paraphilicdisorders rather than paraphilias.

  • Paraphilias that do not involve non-consenting victims are not necessarily indicative of a mental disorder.

  • To have a paraphilic disorder requires distress, impairment, or abuse of a non-consenting victim.


Substance related and addictive disorders
Substance-Related and Addictive Disorders DSM-5

  • Substance Use Disorder (SUD)

    • Substance abuse and substance dependence are combined into a single disorder.

    • Severity can be rated as mild, moderate, or severe.

    • Craving was added as a new criterion for SUD.

    • Legal consequences was removed as a criterion.


Substance related addictive disorders
Substance-Related & DSM-5 Addictive Disorders

  • No “abuse” or “dependence”; now “use.”

  • Chapter reorganized by substance.

    • 10 classes of drugs:

      Alcohol; Caffeine; Cannabis; Hallucinogens; Inhalants; Opioids; Sedatives, hypnotics & anxiolytics; Stimulants; Tobacco; Other.

  • Two groups of disorders:

    • (a) Substance use disorders,

    • (b) Substance-induced disorders.

p. 481


Substance related addictive disorders1
Substance-Related & DSM-5 Addictive Disorders

  • Substance use disorder: continued use of substance despite significant substance-related problems. 4 sets of criteria:

    • Impaired control (4 criteria).

    • Social impairment (3 criteria).

    • Risky use (2 criteria).

    • Pharmacological criteria (2 criteria: tolerance & withdrawal).


Substance related and addictive disorders1
Substance DSM-5-Related and Addictive Disorders

  • Cannabis withdrawal is a new disorder.

  • Caffeine withdrawal is a new disorder.


Substance related addictive disorders2
Substance-Related & DSM-5 Addictive Disorders

  • Severity levels:

    • Mild (2-3 symptoms)

    • Moderate (4-5 symptoms)

    • Severe (> 6 symptoms)

  • Remission:

    • Early vs Sustained;

    • Maintenance therapy

    • Controlled environment

Example: Moderate Valium use disorder; Mild alcohol use disorder; Secobarbital withdrawal.


Substance related addictive disorders3
Substance-Related & DSM-5 Addictive Disorders

  • New language:

    “All drugs that are taken in excess have in common direct activation of the brain reward system…. Individuals with lower levels of self-control, which may reflect impairments of brain inhibitory mechanisms, may be particularly predisposed to develop substance use disorders, suggesting that the roots of substance use disorders for some persons can be seen in behaviors long before the onset of actual substance use itself.”(p. 481)


Substance related addictive disorders4
Substance-Related & DSM-5 Addictive Disorders

  • “This chapter also includes gambling disorder, reflecting evidence that gambling behaviors activate reward systems similar to those activated by drugs of abuse, and produce some behavioral symptoms that appear comparable to those produced by the substance use disorders.”

    (p. 481)


Non substance related and addictive disorders
Non-Substance DSM-5-Related and Addictive Disorders

  • “Pathological Gambling” in DSM-IV was renamed “Gambling Disorder” and moved from the Impulse Control Disorders chapter to the chapter in DSM-5 called Substance-Related and Addictive Disorders.

  • Internet Gaming Disorder is included in Chapter 3 as a “condition for further study.”

  • No other behavioral addictions are mentioned even hypersexuality


Pathological Gambling: DSM-IV DSM-5

  • is preoccupied with gambling

  • needs to gamble with increasing amounts of money for desired excitement

  • repeated unsuccessful efforts to control, cut back, or stop

  • restless or irritable when attempting to cut down or stop gambling

  • gambles as a way of escaping from problems or of relieving a dysphoricmood

  • "chasing"

  • lies to conceal the extent of involvement with gambling

  • has committed illegal acts, to finance gambling

  • has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling

  • relies on others to provide money to relieve a desperate financial situation caused by gambling

ODADAS Advanced Training 2013-4


Gambling Disorder: DSM- DSM-55

  • is preoccupied with gambling

  • needs to gamble with increasing amounts of money for desired excitement

  • repeated unsuccessful efforts to control, cut back, or stop

  • restless or irritable when attempting to cut down or stop gambling

  • gambles as a way of escaping from problems or of relieving a dysphoricmood

  • "chasing"

  • lies to conceal the extent of involvement with gambling

  • has committed illegal acts, to finance gambling

  • has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling

  • relies on others to provide money to relieve a desperate financial situation caused by gambling

ODADAS Advanced Training 2013-4


Dsm 5 gambling disorder
DSM-5 Gambling Disorder DSM-5

ODADAS Advanced Training 2013-4



Windsor items literature review and focus groups and testing
Windsor Items DSM-5 literature review and focus groups and testing

  • Have you frequently gambled with larger amounts of money than you intended to or for longer periods of time than you intended to?

  • Did you make excuses or think of reasons to justify your gambling, such as “I will win money, or I need to calm down”?

  • Did your gambling cause you to feel depressed, for example, sad, anxious, withdrawn, tearful?

  • Did your gambling cause you to disregard the worth or value of money?

  • Has your gambling caused you to have negative feelings about your self-worth or your outlook on life?

  • Has your gambling caused you to lose interest in things that used to be important to you, such as relationships, work, hobbies, family activities, friends, etc.?

  • Did you feel that you were in control when you gambled?

  • Have you gambled to fill a void or emptiness in your life?

  • Did you continue to gamble despite having lost your life savings or house due to gambling? (DSM-III-R)

  • Have you been secretive about your gambling and tried to hide the evidence of your gambling?

  • Did you believe it was possible to win more than you lose?

ODADAS Advanced Training 2013-4


Windsor items literature review and focus groups and testing1
Windsor Items DSM-5 literature review and focus groups and testing

  • How often have you spent a lot of time thinking about past gambling experiences, planning your next gambling activity, or thinking of ways to get money to gamble?  

  • How often have you needed to gamble with larger amounts of money or with larger bets in order to obtain the same feeling of excitement?  

  • How often have you tried to control, cut back, or stop gambling several times and were unsuccessful?  For example, setting a money or time limit for yourself and then going over it.  

  • How often have you felt restless or irritable when you tried to cut down or stop gambling?  

  • How often did you feel that your gambling was a way of avoiding or escaping from personal problems or a way of relieving uncomfortable emotions, such as feelings of nervousness, helplessness, guilt, anxiety or sadness?  

  • After you lost money gambling how often did you return another day to get even or try to win back your losses?  

  • How often have you lied to family members, therapists, or others to hide your gambling from them?  

  • How often have you committed any illegal acts such as forgery, fraud, theft, or embezzlement to get money to gamble or to pay gambling debts?  

  • How often have you risked or lost a relationship with someone important to you, or a job, or career opportunity because of gambling?

  • How often have you relied on others to pay your gambling debts or to pay your bills when you had financial problems caused by your gambling?  

    Not in the past 12 months once a few times many times

ODADAS Advanced Training 2013-4


Dsm 5 changes rationale
DSM-5 DSM-5Changes Rationale

  • The Criterion of “Illegal Acts”

    • It does not appear to be a decisive symptom for most people with gambling problems (American Psychiatric Association, 2010)

    • Individuals who commit illegal acts as a result of their gambling already reach the threshold of five or more symptoms and, therefore, this symptom does not improve the precision of the diagnostic code for identifying most individuals with pathological gambling/gambling disorder.

ODADAS Advanced Training 2013-4


Other conditions that may be a focus of clinical attention
Other Conditions That May Be A Focus of Clinical Attention DSM-5

  • The list of “V-Code” and other conditions was expanded to 134 separate conditions.

  • Examples

    • Relational Problems

    • Abuse and Neglect

    • Educational and Occupational Problems

    • Phase of Life Problem

    • Malingering


V codes
V codes DSM-5

  • CodeCondition

  • V15.41 Personal history (past history) of physical abuse in childhood

  • V15.41 Personal history (past history) of sexual abuse in childhood

  • V15.41 Personal history (past history) of spouse or partner violence, Physical

  • V15.41 Personal history (past history) of spouse or partner violence, Sexual

  • V15.42 Personal history (past history) of neglect in childhood

  • V15.42 Personal history (past history) of psychological abuse in childhood

  • V15.42 Personal history (past history) of spouse or partner psychological abuse

  • V15.42 Personal history (past history) of spouse or partner neglect

  • V15.49 Other personal history of psychological trauma

  • V15.59 Personal history of self-harm


V codes1
V codes DSM-5

  • CodeCondition

  • V15.81Nonadherenceto medical treatment

  • V15.89 Other personal risk factors

  • V40.31 Wandering associated with a mental disorder

  • V60.0 Homelessness

  • V60.1 Inadequate housing

  • V60.2 Extreme poverty

  • V60.2 Insufficient social insurance or welfare support

  • V60.2 Lack of adequate food or safe drinking water

  • V60.2 Low income

  • V60.3 Problem related to living alone


V codes2
V codes DSM-5

  • CodeCondition

  • V60.6 Problem related to living in a residential institution

  • V60.89 Discord with neighbor, lodger, or landlord

  • V60.9 Unspecified housing or economic problem

  • V61.03 Disruption of family by separation or divorce

  • V61.10 Relationship distress with spouse or intimate partner

  • V61.11 Encounter for mental health services for victim of spouse or partner psychological abuse

  • V61.11 Encounter for mental health services for victim of spouse or partner neglect

  • V61.11 Encounter for mental health services for victim of spouse or partner violence, Physical

  • V61.11 Encounter for mental health services for victim of spouse or partner violence, Sexual

  • V61.12 Encounter for mental health services for perpetrator of spouse or partner psychological abuse

  • V61.12 Encounter for mental health services for perpetrator of spouse or partner neglect


V codes3
V codes DSM-5

  • CodeCondition

  • V61.12 Encounter for mental health services for perpetrator of spouse or partner violence, Physical

  • V61.12 Encounter for mental health services for perpetrator of spouse or partner violence, Sexual

  • V61.20 Parent-child relational problem

  • V61.21 Encounter for mental health services for victim of child neglect by parent

  • V61.21 Encounter for mental health services for victim of nonparental child neglect

  • V61.21 Encounter for mental health services for victim of child abuse by parent

  • V61.21 Encounter for mental health services for victim of nonparental child abuse

  • V61.21 Encounter for mental health services for victim of child psychological abuse by parent

  • V61.21 Encounter for mental health services for victim of nonparental child psychological abuse

  • V61.21 Encounter for mental health services for victim of child sexual abuse by parent

  • V61.21 Encounter for mental health services for victim of nonparental child sexual abuse


V codes4
V codes DSM-5

  • CodeCondition

  • V61.22 Encounter for mental health services for perpetrator of parental child neglect

  • V61.22 Encounter for mental health services for perpetrator of parental child abuse

  • V61.22 Encounter for mental health services for perpetrator of parental child psychological abuse

  • V61.22 Encounter for mental health services for perpetrator of parental child sexual abuse

  • V61.29 Child affected by parental relationship distress

  • V61.5 Problems related to multiparity

  • V61.7 Problems related to unwanted pregnancy

  • V61.8 High expressed emotion level within family

  • V61.8 Sibling relational problem

  • V61.8 Upbringing away from parents

  • V62.21 Problem related to current military deployment status


V codes5
V codes DSM-5

  • CodeCondition

  • V62.22 Exposure to disaster, war, or other hostilities

  • V62.22 Personal history of military deployment

  • V62.29 Other problem related to employment

  • V62.3 Academic or educational problem

  • V62.4 Acculturation difficulty

  • V62.4 Social exclusion or rejection

  • V62.4 Target of (perceived) adverse discrimination or persecution

  • V62.5 Conviction in civil or criminal proceedings without imprisonment

  • V62.5 Imprisonment or other incarceration

  • V62.5 Problems related to other legal circumstances

  • V62.5 Problems related to release from prison

  • V62.82 Uncomplicated bereavement


V codes6
V codes DSM-5

  • CodeCondition

  • V62.83 Encounter for mental health services for perpetrator of nonspousal adult abuse

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

  • V62.83 Encounter for mental health services for perpetrator of nonparental child abuse

  • V62.83 Encounter for mental health services for perpetrator of nonparental child psychological abuse

  • V62.83 Encounter for mental health services for perpetrator of nonparental child sexual abuse

  • V62.89 Borderline intellectual functioning

  • V62.89 Discord with social service provider, including probation officer, case manager, or social services worker

  • V62.89 Other problem related to psychosocial circumstances

  • V62.89 Phase of life problem

  • V62.89 Religious or spiritual problem

  • V62.89 Victim of crime


V codes7
V codes DSM-5

  • CodeCondition

  • V62.89 Victim of terrorism or torture

  • V62.9 Unspecified problem related to social environment

  • V62.9 Unspecified problem related to unspecified psychosocial circumstances

  • V63.8 Unavailability or inaccessibility of other helping agencies

  • V63.9 Unavailability or inaccessibility of health care facilities

  • V65.2 Malingering

  • V65.40 Other counseling or consultation

  • V65.49 Encounter for mental health services for victim of nonspousal adult abuse

  • V65.49 Sex counseling

  • V69.9 Problem related to lifestyle

  • V71.01 Adult antisocial behavior

  • V71.02 Child or adolescent antisocial behavior


Section iii emerging measures and models
Section III: Emerging Measures and Models DSM-5

  • Optional Assessment Measures

    • Level 1 Cross-Cutting Symptom Measure

      • To measure depression, anger, mania, anxiety, etc.

      • To screen for important symptoms; self-administered by patient; brief (1-3 questions per symptom domain).

    • Level 2 Cross-Cutting Symptom Measure

      • To be done when a Level 1 item is endorsed at the level of “mild” or greater.


Emerging measures cont
Emerging Measures, cont. DSM-5

  • Diagnosis-Specific Severity Measures

    • To document the severity of a specific disorder.

    • Some are clinician-rated, some are patient-rated.


Emerging measures cont1
Emerging Measures, cont. DSM-5

  • WHO Disability Assessment Schedule 2.0

    • Replaces the GAF Scale in DSM-IV

    • Is recommended but not required.

    • Has 36 self-administered questions.

  • Cultural Formulation

    • Outline for Cultural Formulation

    • Cultural Formulation Interview


  • Conditions for further study
    Conditions for Further Study DSM-5

    • Attenuated Psychosis Syndrome

    • Persistent Complex Bereavement Disorder

    • Caffeine Use Disorder

    • Internet Gaming Disorder

    • Suicidal Behavior Disorder

    • Non-suicidal Self-Injury


    Suicidal behavior disorder
    Suicidal Behavior Disorder DSM-5

    • A suicide attempt within the past 24 months.

    • The act is not non-suicidal self-injury.

    • Suicidal ideation does not qualify.


    Nonsuicidal self injury
    Nonsuicidal DSM-5 Self-Injury

    • In the last year the person has, on 5 or more days, engaged in intentional self-inflicted damage to the surface of his or her body . . . with the expectation that the injury will lead to only minor or moderate physical harm (i.e. there is no suicidal intent).

    • Five additional criteria.


    For more information
    For More Information DSM-5

    • http://www.dsm5.org

    • http://www.psychiatry.org/practice/dsm/dsm5

    • http://www.psychiatry.org/dsm5


    References
    References DSM-5

    American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders, fifth edition. Arlington, VA: American Psychiatric Association.

    Jones, K. D. (2013, March). Understanding the DSM-5 and the ICD. Workshop sponsored by the American Psychological Association.

    Nock, M. K. (2013, October). Teaching about psychopathology: Implications of DSM-5. Workshop sponsored by Harvard University and Macmillan Higher Education.

    Thienhaus, O. J. (2013, October). DSM-5: What You Need To Know To Transition From DSM-IV. Workshop sponsored by the American Psychiatric Association and the Arizona Psychiatric Society. Flagstaff, AZ.


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