This gap in information is particularly problematic in clinical situations in which the pa- tient’s symptom presentation by itself (particularly in mild forms) is not inherently path- ological and may be encountered in individuals for whom a diagnosis of ”mental disorder" would be inappropriate. Therefore, a generic diagnostic criterion requiring dis- tress or disability has been used to establish disorder thresholds, usually worded ”the dis- turbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.” The text following the revised definition of a mental tient’s need for treatment. Use of information from family members and other third parties (in addition to the individual) regarding the individual’s performance is recommended when necessary.
Elements of a Diagnosis
Diagnostic criteria are offered as guidelines for making diagnoses, and their use should be informed by clinical judgment. Text descriptions, including introductory sections of each diagnostic chapter, can help support diagnosis (e.g., providing differential diagnoses; de- scribing the criteria more fully under ”Diagnostic Features”).
Following the assessment of diagnostic criteria, clinicians should consider the applica- tion of disorder subtypes and / or specifiers as appropriate. Severity and course specifiers should be applied to denote the individual’s current presentation, but only when the full criteria are met. When full criteria are not met, clinicians should consider whether the tion. Where applicable, specific criteria for defining disorder severity (e.g., mild, moder— ate, severe, extreme), descriptive features (e.g., with good to fair insight; in a controlled environment), and course (e.g., in partial remission, in full remission, recurrent) are pro- vided with each diagnosis. On the basis of the clinical interview, text descriptions, criteria, and clinician judgment, a final diagnosis is made.
The general convention in DSM-5 is to allow multiple diagnoses to be assigned for those presentations that meet criteria for more than one DSM-S disorder.
Subtypes and specifiers (some of which are coded in the fourth, fifth, or sixth digit) are provided for increased specificity. Subtypes define mutually exclusive and jointly exhaus- tive phenomenological subgroupings within a diagnosis and are indicated by the instruc- tion ”Specify whether” in the criteria set. In contrast, specifiers are not intended to be mutually exclusive or jointly exhaustive, and as a consequence, more than one specifier may be given. Specifiers are indicated by the instruction "Specify" or ”Specify if" in the cri- teria set. Specifiers provide an opportunity to define a more homogeneous subgrouping of 22 Use of the Manual individuals with the disorder who share certain features (e.g., major depressive disorder, with mixed features) and to convey information that is relevant to the management of the individual’s disorder, such as the “with other medical comorbidity” specifier in sleep- wake disorders. Although a fifth digit is sometimes assigned to code a subtype or specifier (e.g., 294.11 [F0281] major neurocognitive disorder due to Alzheimer’s disease, with be- havioral disturbance) or severity (296.21 [F320] major depressive disorder, single episode, mild), the majority of subtypes and specifiers included in DSM-5 cannot be coded within the ICD-9—CM and ICD-lO-CM systems and are indicated only by including the subtype or specifier after the name of the disorder (e.g., social anxiety disorder [social phobia], per- formance type). Note that in some cases, a specifier or subtype is codable in ICD-10-CM but not in ICD-9-CM. Accordingly, in some cases the 4th or 5th character codes for the sub- types or specifiers are provided only for the ICD-lO-CM coding designations.
A DSM-5 diagnosis is usually applied to the individual’s current presentation; previ- ous diagnoses from which the individual has recovered should be clearly noted as such.