The specifier ”provisional" can be used when there is a strong presumption that the full criteria will ultimately be met for a disorder but not enough information is available to make a firm diagnosis. The clinician can indicate the diagnostic uncertainty by recording "(provisional)” following the diagnosis. For example, this diagnosis might be used when an individual who appears to have a major depressive disorder is unable to give an ade- quate history, and thus it cannot be established that the full criteria are met. Another use of the term provisional is for those situations in which differential diagnosis depends exclu- sively on the duration of illness. For example, a diagnosis of schizophreniform disorder re- quires a duration of less than 6 months but of at least 1 month and can only be given provisionally if assigned before remission has occurred.
Each disorder is accompanied by an identifying diagnostic and statistical code, which is typically used by institutions and agencies for data collection and billing purposes. There are specific recording protocols for these diagnostic codes (identified as coding notes in the text) that were established by WHO, the US. Centers for Medicare and Medicaid Ser— vices (CMS), and the Centers for Disease Control and Prevention’s National Center for
Health Statistics to ensure consistent international recording of prevalence and mortality rates for identified health conditions. For most clinicians, the codes are used to identify the diagnosis or reason for visit for CMS and private insurance service claims. The official coding system in use in the United States as of publication of this manual is ICD-9-CM. Of- ficial adoption of ICD-lO-CM 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 offi- cial implementation occurs. Both ICD-9-CM and ICD-IO—CM codes have been listed 1) pre- ceding the name of the disorder in the classification and 2) accompanying the criteria set for each disorder. For some diagnoses (e.g., neurocognitive and substance/medication- induced disorders), the appropriate code depends 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 procedures. The names of some disorders are followed by alter- native terms enclosed in parentheses, which, in most cases, were the DSM-IV names for the disorders.
Looking to the Future:
The various components of DSM-S are provided to facilitate patient assessment and to aid in developing a comprehensive case formulation. Whereas the diagnostic criteria in Sec- tion II are well-established measures that have undergone extensive review, the assess- 24 Use of the Manual ment tools, a cultural formulation interview, and conditions for further study included in
Section III are those for which we determined that the scientific evidence is not yet avail- able to support widespread clinical use. These diagnostic aids and criteria are included to highlight the evolution and direction of scientific advances in these areas and to stimulate further research.
Each of the measures in Section III is provided to aid in a comprehensive assessment of individuals that will contribute to a diagnosis and treatment plan tailored to the individ- ual presentation and clinical context. 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. Cross-cutting symptom and diagnosis- 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 rat- ings on subsequent encounters to monitor 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 develop- ment. As with each DSM edition, the diagnostic criteria and the DSM-5 classification of mental disorders reﬂect the current consensus on the evolving knowledge in our field.
Forensic Use of DSM-5
Although the DSM-5 diagnostic criteria and text are primarily designed to assist clinicians in conducting clinical assessment, case formulation, and treatment planning,