This document provides an overview and agenda for a presentation on the transition to the DSM-5 diagnostic manual. The presentation includes discussing the changes between the DSM-IV and DSM-5, an overview of the new DSM-5 structure and criteria, and implications for billing. Major changes highlighted include separating mood disorders, adding new diagnoses like disruptive mood dysregulation disorder in children, and removing the multiaxial system in favor of a dimensional assessment.

1. +
DSM-5 Making the Transition to the
New Manual

2. +
DSM-5: Making the Transition to
the New Manual
Dr. Christine Chasek LIMHP, LADC
University of Nebraska at Kearney
Burke and Associates, PC

3. + Introduction

4. +
Agenda for the Day
n DSM 5 Overview and Basics
n Disorders and Criteria Changes by Category
n Lunch! On-site
n Continue Disorders and Criteria
n Implications and Billing
n Questions/Wrap up/Evaluations

5. + DSM-5: The How To Manual
n Purpose of the DSM-5 – Stimulate new clinical perspectives;
align closer to the ICD system
n What to do when you get your new DSM-5
1. Cry – because of the money you had to spend and the hours
youwill spend learning it and re-learning what has
become second nature to you!
2. Read the manual (Yes I did say read it!)
In this order:
Section I: DSM 5 Basics
Highlights of Changes from DSM-IV-TR to DSM-5
Section II: Diagnostic Criteria and Codes

6. + DSM- The “Evolution of our
Profession” Manual

7. + Basic Changes in the DSM-5
n Moved from a categorical model to scientifically-
validated measures, rating scales, and the impact of
culture
n Chapters are restructured based on the disorders’
relatedness to one another as well as symptom
characteristics
n 15 new Diagnoses were added; some diagnoses were
reclassified or removed; some diagnostic criteria were
clarified
n Axial system was removed!
n The way the diagnosis is recorded has changed
significantly

8. + DSM-5 Basics
n New definition of “mental disorder” focused on clinically significant
disturbances, developmental processes, culturally approved responses, and
social deviant behavior (pg 20).
A mental disorder is a syndrome characterized by clinically significant
disturbance in an individual’s cognition, emotional regulation, or behavior
that reflects a dysfunction in the psychological, biological, or developmental
processes underlying mental functioning. Mental disorders are usually
associated with significant distress or disability in social, occupational, or
other important activities. An expectable or culturally approved response to a
common stressor or loss, such as the death of a loved one, is not a mental
disorder. Socially deviant behavior (e.g. political, religious, or sexual) and
conflicts that are primarily between the individual and society are not mental
disorders unless the deviance or conflict results from a dysfunction in the
individual, as described above. DSM-5

9. + DSM-5 Basics
n A Dimensional Approach to Diagnosis: The DSM-5 is intended to encourage
client conceptualization from a physical, psychological, cognitive, and
cultural viewpoint
n Move away from limited categorical diagnosis to a more holistic view of
clients that takes into consideration developmental and lifestyle issues,
cultural issues, and gender differences
n The disorders are organized into a framework beginning with those that
occur in early life, followed by disorders that occur in adolescence and
young adulthood, and ends with diagnosis more relevant to adulthood and
later life
n Clustering of disorders in a framework of “internalizing” and
“externalizing”
n Internalizing- disorders with prominent anxiety, depressive and somatic
symptoms
n Externalizing-disorders with prominent impulsive, disruptive conduct, and
substance use symptoms

10. +
DSM-5 Basics þ
n Not meant to merely be a “check off” of clinical criteria; must
complete a full clinical history taking into account the “new”
definition of mental disorders. The diagnosis should also should
have clinical utility determining prognosis, treatment planning, and
treatment outcomes.
n Expanded elements of a diagnosis:
n Diagnostic criteria are the guidelines for making a diagnosis
n Subtypes and specifiers are used for increased specificity when
the full criteria are met when applicable
n Specific criteria for defining disorder severity (mild, moderate,
severe etc.), descriptive features (in a controlled environment,
etc.), and course (remission, partial remission, etc. ) are used
when applicable

11. +
DSM-5 Basics
n Dimensional Assessment versus a Multiaxial Assessment
n The multiaxial system is gone in the DSM-5. It is replaced by a nonaxial
documentation of diagnosis (formerly Axis I, II, and III) with separate
notations for important psychosocial and contextual factors (formerly Axis
IV) and disability (formerly Axis V). This is the dimensional assessment
in action!
n Axis I,II, and III are combined
n Axis IV is now replaced with ICD 9 V codes (Z codes-in the ICD-10).
n Many of the previous Axis IV issues are listed in Other Conditions That
May Be a Focus of Clinical Attention (pgs 715-727)
n Axis V will be replaced with the WHODAS scales; currently it is optional
and not required to be recorded in the diagnosis (pg 745) however this will
likely change soon.

12. + DSM-5 Diagnosis Vs. Billing Codes
n The DSM-5 is a set of diagnostic criteria that is used to select the appropriate
ICD-9 / ICD-10 codes for billing.
n The DSM-5 was written to crosswalk with both the ICD-9 and 10 codes.
Ex: 296.21 (F32.0) Major Depressive Disorder, Single Episode, Mild
ICD-9 Code ICD-10 Code
The current DSM 5 codes are compatible with the ICD-9; the ICD-10 codes are
added in parenthesis
n Sometimes different disorders / subtypes share the same diagnostic code.
This is not an error! It is because the DSM-5 is designed to match the ICD-9
(10) codes and sometimes there isn’t a separate code for diagnoses.
EX: 300.3 (F42) Obsessive-Compulsive Disorder
300.3 (F42) Hoarding Disorder

13. +
Example “NEW” DSM-5 Diagnosis
n V62.21 Problem Related to Current Military Deployment Status, 300.4
Persistent Depression Disorder (Dysthymia), With anxious distress, In
partial remission, early onset, With pure dysthymic syndrome, Moderate,
278.00 Overweight or Obesity, WHODAS: 63
n 312.39 Trichotillomania (Hair-Pulling Disorder), 305.70 Mild
Methamphetamine Disorder, V62.4 Social Exclusion or Rejection,
WHODAS: 70
n What are your first reactions?
n What makes this so different and why?

14. + DSM-5 Basics
n Principal Diagnosis
n When more than one diagnosis is given, the principal diagnosis should be
identified; the principal diagnosis should be the primary focus of treatment.
n The Principal diagnosis is listed first followed by the others in order of
focus of attention and treatment.
n Provisional Diagnosis
n The specifier “provisional” can be used when there is a strong presumption
that the full criteria for the disorder will be met but not enough information
is available to make a firm diagnosis, also used when the duration of the
illness is an issue (criteria met for 5 months when 6 months is the criteria
for duration);
n Write “Provisional” following the wording of the diagnosis when this is
used

15. +
DSM-5 Basics
n To enhance diagnostic specificity, the previous NOS designation in DSM IV-
TR has been replaced with:
n Other Specified Disorder- used to record the specific reasons the client
does not meet the criteria for any specific category within the diagnosis
class; can use the DSM wording or you own after the Other Specified
Ex: 311 Other Specified Depressive Disorder, depressive episode with
insufficient symptoms
n Unspecified Disorder – used to record a diagnosis that doesn’t meet the
specific criteria for the diagnosis but the clinician does not choose to
specify the specific reason
Ex: 311 Unspecified Depressive Disorder
n These two choices take into account client presentations that do not fit
exactly into the diagnosis boundaries of each of the disorders.

16. + DSM-5 Chapters and Sequence
n 1. Neurodevelopmental Disorders
n 2. Schizophrenia Spectrum and
Other Psychotic Disorders
n 3. Bipolar and Related Disorders
n 4. Depressive Disorders
n 5. Anxiety Disorders
n 6. Obsessive-Compulsive and
Related Disorders
n 7. Trauma- and Stessor-Related
Disorders
n 8. Dissociative Disorders
n 9. Somatic Symptom Disorders
n 10. Feeding and Eating Disorders
n 11. Elimination Disorders
n 12. Sleep-Wake Disorders
n 13. Sexual Dysfunction
n 14. Gender Dysphoria
n 15. Disruptive, Impulse Control
and Conduct Disorder
n 16. Substance-Related and
Addictive Disorders
n 17. Neurocognitive Disorders
n 18. Personality Disorders
n 19. Paraphilic Disorders
n 20. Other Disorders

17. + Highlights of Major Changes in Diagnostic
Criteria
n Mood Disorders are separated into Depressive Disorders and Bipolar
Disorders
n Anxiety Disorders are broke out into Anxiety, OCD, Trauma
n Neurocognitive Disorder replaces Dementia
n Gender Identity Disorder is out of the Sexual Dysfunctions chapter and is now
Gender Dsyphoria
n Mental Retardation is gone- Intellectual Disability added
n Autism Spectrum Disorder –combines all previous disorders
n Several changes in Diagnostic Criteria for ADHD have been made
n Obsessive-Compulsive and Related Disorders (New) contains Hoarding
Disorder
n Depressive Disorders:
n Disruptive Mood Dysregulation disorder for children up to 18 years
n Dysthymia changed to Persistent Depressive Disorder

18. +
Good Websites to Keep your
Eye on for DSM-5 Information
n DSM 5 Home Page
n Magellan DSM 5 Information