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Clinical Intervention (Psychology)

Clinical Intervention II

Psychosocial Case Study

Assignment

Overview

You will review the case study provided to develop a biopsychosocial, determine the mental status examination, and apply a diagnosis using the DSM V. You must use the following outline to write-out the biopsychosocial:

I. Presenting Problem

II. Background Information/History

III. Medical History

IV. Education

V. Employment History

VI. Substance Abuse History

VII. Mental Status Examination

Diagnostic Impression

You will use the DSM V to diagnose the identified client. You write put your diagnosis in bold with the proper ICD code. What is the primary, secondary, and tertiary diagnosis you would give this client? Why? You need to use DSM V citation(s) to justify the reason for your diagnosis. What is your diagnostic impression of this client? You will need to use three literature (journals or books) to justify your clinical impressions.

You must use APA 7th edition writing style to correctly highlight the subtitle of the biopsychosocial and diagnostic impression. This paper will be 6-7 pages double space in 12 size fonts.

Clinical Intervention (Psychology)

DIAGNOSTIC AND STATISTICAL
MANUAL OF

MENTAL DISORDERS
F I F T H E D I T I O N

DSM-5™

American Psychiatric Association

Officers 2012–2013
PRESIDENT DILIP V. JESTE, M.D.

PRESIDENT-ELECT JEFFREY A. LIEBERMAN, M.D.
TREASURER DAVID FASSLER, M.D.
SECRETARY ROGER PEELE, M.D.

Assembly
SPEAKER R. SCOTT BENSON, M.D.

SPEAKER-ELECT MELINDA L. YOUNG, M.D.

Board of Trustees
JEFFREY AKAKA, M.D.

CAROL A. BERNSTEIN, M.D.
BRIAN CROWLEY, M.D.

ANITA S. EVERETT, M.D.
JEFFREY GELLER, M.D., M.P.H.

MARC DAVID GRAFF, M.D.
JAMES A. GREENE, M.D.

JUDITH F. KASHTAN, M.D.
MOLLY K. MCVOY, M.D.
JAMES E. NININGER, M.D.
JOHN M. OLDHAM, M.D.

ALAN F. SCHATZBERG, M.D.
ALIK S. WIDGE, M.D., PH.D.

ERIK R. VANDERLIP, M.D.,
MEMBER-IN-TRAINING TRUSTEE-ELECT

Washington, DC
London, England

DIAGNOSTIC AND STATISTICAL
MANUAL OF

MENTAL DISORDERS
F I F T H E D I T I O N

DSM-5™

Copyright © 2013 American Psychiatric Association

DSM and DSM-5 are trademarks of the American Psychiatric Association. Use of these terms
is prohibited without permission of the American Psychiatric Association.

ALL RIGHTS RESERVED. Unless authorized in writing by the APA, no part of this book may
be reproduced or used in a manner inconsistent with the APA’s copyright. This prohibition
applies to unauthorized uses or reproductions in any form, including electronic applications.

Correspondence regarding copyright permissions should be directed to DSM Permissions,
American Psychiatric Publishing, 1000 Wilson Boulevard, Suite 1825, Arlington, VA 22209-
3901.

Manufactured in the United States of America on acid-free paper.

ISBN 978-0-89042-554-1 (Hardcover) 2nd printing June 2013

ISBN 978-0-89042-555-8 (Paperback) 2nd printing June 2013

American Psychiatric Association
1000 Wilson Boulevard
Arlington, VA 22209-3901
www.psych.org

The correct citation for this book is American Psychiatric Association: Diagnostic and Statisti-
cal Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Associa-
tion, 2013.

Library of Congress Cataloging-in-Publication Data
Diagnostic and statistical manual of mental disorders : DSM-5. — 5th ed.

p. ; cm.
DSM-5
DSM-V
Includes index.
ISBN 978-0-89042-554-1 (hardcover : alk. paper) — ISBN 978-0-89042-555-8 (pbk. : alk. paper)
I. American Psychiatric Association. II. American Psychiatric Association. DSM-5 Task Force.
III. Title: DSM-5. IV. Title: DSM-V.
[DNLM: 1. Diagnostic and statistical manual of mental disorders. 5th ed. 2. Mental Disorders—
classification. 3. Mental Disorders—diagnosis. WM 15]
RC455.2.C4
616.89’075—dc23

2013011061

British Library Cataloguing in Publication Data
A CIP record is available from the British Library.

Text Design—Tammy J. Cordova

Manufacturing—R. R. Donnelley

Contents

DSM-5 Classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii

Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xli

Section I
DSM-5 Basics

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5

Use of the Manual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19

Cautionary Statement for Forensic Use of DSM-5 . . . . . . . . . . . .25

Section II
Diagnostic Criteria and Codes

Neurodevelopmental Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . .31

Schizophrenia Spectrum and Other Psychotic Disorders . . . . . .87

Bipolar and Related Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . .123

Depressive Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .155

Anxiety Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .189

Obsessive-Compulsive and Related Disorders . . . . . . . . . . . . .235

Trauma- and Stressor-Related Disorders . . . . . . . . . . . . . . . . . .265

Dissociative Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .291

Somatic Symptom and Related Disorders . . . . . . . . . . . . . . . . .309

Feeding and Eating Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . .329

Elimination Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .355

Sleep-Wake Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .361

Sexual Dysfunctions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .423

Gender Dysphoria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .451

Disruptive, Impulse-Control, and Conduct Disorders . . . . . . . . 461

Substance-Related and Addictive Disorders . . . . . . . . . . . . . . . 481

Neurocognitive Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 591

Personality Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 645

Paraphilic Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 685

Other Mental Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 707

Medication-Induced Movement Disorders
and Other Adverse Effects of Medication . . . . . . . . . . . . . . . . 709

Other Conditions That May Be a Focus of Clinical Attention . . 715

Section III
Emerging Measures and Models

Assessment Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 733

Cultural Formulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 749

Alternative DSM-5 Model for Personality Disorders . . . . . . . . . 761

Conditions for Further Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . 783

Appendix
Highlights of Changes From DSM-IV to DSM-5 . . . . . . . . . . . . . 809

Glossary of Technical Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . 817

Glossary of Cultural Concepts of Distress . . . . . . . . . . . . . . . . . 833

Alphabetical Listing of DSM-5 Diagnoses and Codes
(ICD-9-CM and ICD-10-CM) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 839

Numerical Listing of DSM-5 Diagnoses and Codes
(ICD-9-CM) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 863

Numerical Listing of DSM-5 Diagnoses and Codes
(ICD-10-CM) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 877

DSM-5 Advisors and Other Contributors . . . . . . . . . . . . . . . . . . 897

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 917

DSM-5 Task Force
DAVID J. KUPFER, M.D.

Task Force Chair
DARREL A. REGIER, M.D., M.P.H.

Task Force Vice-Chair
William E. Narrow, M.D., M.P.H.,

Research Director
Susan K. Schultz, M.D., Text Editor
Emily A. Kuhl, Ph.D., APA Text Editor

Dan G. Blazer, M.D., Ph.D., M.P.H.
Jack D. Burke Jr., M.D., M.P.H.
William T. Carpenter Jr., M.D.
F. Xavier Castellanos, M.D.
Wilson M. Compton, M.D., M.P.E.
Joel E. Dimsdale, M.D.
Javier I. Escobar, M.D., M.Sc.
Jan A. Fawcett, M.D.
Bridget F. Grant, Ph.D., Ph.D. (2009–)
Steven E. Hyman, M.D. (2007–2012)
Dilip V. Jeste, M.D. (2007–2011)
Helena C. Kraemer, Ph.D.
Daniel T. Mamah, M.D., M.P.E.
James P. McNulty, A.B., Sc.B.
Howard B. Moss, M.D. (2007–2009)

Charles P. O’Brien, M.D., Ph.D.
Roger Peele, M.D.
Katharine A. Phillips, M.D.
Daniel S. Pine, M.D.
Charles F. Reynolds III, M.D.
Maritza Rubio-Stipec, Sc.D.
David Shaffer, M.D.
Andrew E. Skodol II, M.D.
Susan E. Swedo, M.D.
B. Timothy Walsh, M.D.
Philip Wang, M.D., Dr.P.H. (2007–2012)
William M. Womack, M.D.
Kimberly A. Yonkers, M.D.
Kenneth J. Zucker, Ph.D.
Norman Sartorius, M.D., Ph.D., Consultant

APA Division of Research Staff on DSM-5
Darrel A. Regier, M.D., M.P.H.,

Director, Division of Research
William E. Narrow, M.D., M.P.H.,

Associate Director
Emily A. Kuhl, Ph.D., Senior Science

Writer; Staff Text Editor
Diana E. Clarke, Ph.D., M.Sc., Research

Statistician

Lisa H. Greiner, M.S.S.A., DSM-5 Field
Trials Project Manager

Eve K. Moscicki, Sc.D., M.P.H.,
Director, Practice Research Network

S. Janet Kuramoto, Ph.D. M.H.S.,
Senior Scientific Research Associate,
Practice Research Network

Amy Porfiri, M.B.A.
Director of Finance and Administration

Jennifer J. Shupinka, Assistant Director,
DSM Operations

Seung-Hee Hong, DSM Senior Research
Associate

Anne R. Hiller, DSM Research Associate
Alison S. Beale, DSM Research Associate
Spencer R. Case, DSM Research Associate

Joyce C. West, Ph.D., M.P.P.,
Health Policy Research Director, Practice
Research Network

Farifteh F. Duffy, Ph.D.,
Quality Care Research Director, Practice
Research Network

Lisa M. Countis, Field Operations
Manager, Practice Research Network

Christopher M. Reynolds,
Executive Assistant

APA Office of the Medical Director
JAMES H. SCULLY JR., M.D.

Medical Director and CEO

Editorial and Coding Consultants
Michael B. First, M.D. Maria N. Ward, M.Ed., RHIT, CCS-P

DSM-5 Work Groups

ADHD and Disruptive Behavior Disorders
DAVID SHAFFER, M.D.

Chair

F. XAVIER CASTELLANOS, M.D.
Co-Chair

Paul J. Frick, Ph.D., Text Coordinator
Glorisa Canino, Ph.D.
Terrie E. Moffitt, Ph.D.
Joel T. Nigg, Ph.D.

Luis Augusto Rohde, M.D., Sc.D.
Rosemary Tannock, Ph.D.
Eric A. Taylor, M.B.
Richard Todd, Ph.D., M.D. (d. 2008)

Anxiety, Obsessive-Compulsive Spectrum, Posttraumatic,
and Dissociative Disorders

KATHARINE A. PHILLIPS, M.D.
Chair

Michelle G. Craske, Ph.D., Text
Coordinator

J. Gavin Andrews, M.D.
Susan M. Bögels, Ph.D.
Matthew J. Friedman, M.D., Ph.D.
Eric Hollander, M.D. (2007–2009)
Roberto Lewis-Fernández, M.D., M.T.S.
Robert S. Pynoos, M.D., M.P.H.

Scott L. Rauch, M.D.
H. Blair Simpson, M.D., Ph.D.
David Spiegel, M.D.
Dan J. Stein, M.D., Ph.D.
Murray B. Stein, M.D.
Robert J. Ursano, M.D.
Hans-Ulrich Wittchen, Ph.D.

Childhood and Adolescent Disorders
DANIEL S. PINE, M.D.

Chair

Ronald E. Dahl, M.D.
E. Jane Costello, Ph.D. (2007–2009)
Regina Smith James, M.D.
Rachel G. Klein, Ph.D.

James F. Leckman, M.D.
Ellen Leibenluft, M.D.
Judith H. L. Rapoport, M.D.
Charles H. Zeanah, M.D.

Eating Disorders
B. TIMOTHY WALSH, M.D.

Chair

Stephen A. Wonderlich, Ph.D.,
Text Coordinator

Evelyn Attia, M.D.
Anne E. Becker, M.D., Ph.D., Sc.M.
Rachel Bryant-Waugh, M.D.
Hans W. Hoek, M.D., Ph.D.

Richard E. Kreipe, M.D.
Marsha D. Marcus, Ph.D.
James E. Mitchell, M.D.
Ruth H. Striegel-Moore, Ph.D.
G. Terence Wilson, Ph.D.
Barbara E. Wolfe, Ph.D. A.P.R.N.

Mood Disorders
JAN A. FAWCETT, M.D.

Chair

Ellen Frank, Ph.D., Text Coordinator
Jules Angst, M.D. (2007–2008)
William H. Coryell, M.D.
Lori L. Davis, M.D.
Raymond J. DePaulo, M.D.
Sir David Goldberg, M.D.
James S. Jackson, Ph.D.

Kenneth S. Kendler, M.D.
(2007–2010)

Mario Maj, M.D., Ph.D.
Husseini K. Manji, M.D. (2007–2008)
Michael R. Phillips, M.D.
Trisha Suppes, M.D., Ph.D.
Carlos A. Zarate, M.D.

Neurocognitive Disorders
DILIP V. JESTE, M.D. (2007–2011)

Chair Emeritus

DAN G. BLAZER, M.D., PH.D., M.P.H.
Chair

RONALD C. PETERSEN, M.D., PH.D.
Co-Chair

Mary Ganguli, M.D., M.P.H.,
Text Coordinator

Deborah Blacker, M.D., Sc.D.
Warachal Faison, M.D. (2007–2008)

Igor Grant, M.D.
Eric J. Lenze, M.D.
Jane S. Paulsen, Ph.D.
Perminder S. Sachdev, M.D., Ph.D.

Neurodevelopmental Disorders
SUSAN E. SWEDO, M.D.

Chair

Gillian Baird, M.A., M.B., B.Chir.,
Text Coordinator

Edwin H. Cook Jr., M.D.
Francesca G. Happé, Ph.D.
James C. Harris, M.D.
Walter E. Kaufmann, M.D.
Bryan H. King, M.D.
Catherine E. Lord, Ph.D.

Joseph Piven, M.D.
Sally J. Rogers, Ph.D.
Sarah J. Spence, M.D., Ph.D.
Rosemary Tannock, Ph.D.
Fred Volkmar, M.D. (2007–2009)
Amy M. Wetherby, Ph.D.
Harry H. Wright, M.D.

Personality and Personality Disorders1

ANDREW E. SKODOL, M.D.
Chair

JOHN M. OLDHAM, M.D.
Co-Chair

Robert F. Krueger, Ph.D., Text
Coordinator

Renato D. Alarcon, M.D., M.P.H.
Carl C. Bell, M.D.
Donna S. Bender, Ph.D.

Lee Anna Clark, Ph.D.
W. John Livesley, M.D., Ph.D. (2007–2012)
Leslie C. Morey, Ph.D.
Larry J. Siever, M.D.
Roel Verheul, Ph.D. (2008–2012)

1 The members of the Personality and Personality Disorders Work Group are responsible for the
alternative DSM-5 model for personality disorders that is included in Section III. The Section II
personality disorders criteria and text (with updating of the text) are retained from DSM-IV-TR.

Psychotic Disorders
WILLIAM T. CARPENTER JR., M.D.

Chair

Deanna M. Barch, Ph.D., Text
Coordinator

Juan R. Bustillo, M.D.
Wolfgang Gaebel, M.D.
Raquel E. Gur, M.D., Ph.D.
Stephan H. Heckers, M.D.

Dolores Malaspina, M.D., M.S.P.H.
Michael J. Owen, M.D., Ph.D.
Susan K. Schultz, M.D.
Rajiv Tandon, M.D.
Ming T. Tsuang, M.D., Ph.D.
Jim van Os, M.D.

Sexual and Gender Identity Disorders
KENNETH J. ZUCKER, PH.D.

Chair

Lori Brotto, Ph.D., Text Coordinator
Irving M. Binik, Ph.D.
Ray M. Blanchard, Ph.D.
Peggy T. Cohen-Kettenis, Ph.D.
Jack Drescher, M.D.
Cynthia A. Graham, Ph.D.

Martin P. Kafka, M.D.
Richard B. Krueger, M.D.
Niklas Långström, M.D., Ph.D.
Heino F.L. Meyer-Bahlburg, Dr. rer. nat.
Friedemann Pfäfflin, M.D.
Robert Taylor Segraves, M.D., Ph.D.

Sleep-Wake Disorders
CHARLES F. REYNOLDS III, M.D.

Chair

Ruth M. O’Hara, Ph.D., Text Coordinator
Charles M. Morin, Ph.D.
Allan I. Pack, Ph.D.

Kathy P. Parker, Ph.D., R.N.
Susan Redline, M.D., M.P.H.
Dieter Riemann, Ph.D.

Somatic Symptom Disorders
JOEL E. DIMSDALE, M.D.

Chair

James L. Levenson, M.D., Text
Coordinator

Arthur J. Barsky III, M.D.
Francis Creed, M.D.
Nancy Frasure-Smith, Ph.D. (2007–2011)

Michael R. Irwin, M.D.
Francis J. Keefe, Ph.D. (2007–2011)
Sing Lee, M.D.
Michael Sharpe, M.D.
Lawson R. Wulsin, M.D.

Substance-Related Disorders
CHARLES P. O’BRIEN, M.D., PH.D.

Chair

THOMAS J. CROWLEY, M.D.
Co-Chair

Wilson M. Compton, M.D., M.P.E.,
Text Coordinator

Marc Auriacombe, M.D.
Guilherme L. G. Borges, M.D., Dr.Sc.
Kathleen K. Bucholz, Ph.D.
Alan J. Budney, Ph.D.
Bridget F. Grant, Ph.D., Ph.D.
Deborah S. Hasin, Ph.D.

Thomas R. Kosten, M.D. (2007–2008)
Walter Ling, M.D.
Spero M. Manson, Ph.D. (2007-2008)
A. Thomas McLellan, Ph.D. (2007–2008)
Nancy M. Petry, Ph.D.
Marc A. Schuckit, M.D.
Wim van den Brink, M.D., Ph.D.

(2007–2008)

DSM-5 Study Groups

Diagnostic Spectra and DSM/ICD Harmonization
STEVEN E. HYMAN, M.D.

Chair (2007–2012)

William T. Carpenter Jr., M.D.
Wilson M. Compton, M.D., M.P.E.
Jan A. Fawcett, M.D.
Helena C. Kraemer, Ph.D.
David J. Kupfer, M.D.

William E. Narrow, M.D., M.P.H.
Charles P. O’Brien, M.D., Ph.D.
John M. Oldham, M.D.
Katharine A. Phillips, M.D.
Darrel A. Regier, M.D., M.P.H.

Lifespan Developmental Approaches
ERIC J. LENZE, M.D.

Chair

SUSAN K. SCHULTZ, M.D.
Chair Emeritus

DANIEL S. PINE, M.D.
Chair Emeritus

Dan G. Blazer, M.D., Ph.D., M.P.H.
F. Xavier Castellanos, M.D.
Wilson M. Compton, M.D., M.P.E.

Daniel T. Mamah, M.D., M.P.E.
Andrew E. Skodol II, M.D.
Susan E. Swedo, M.D.

Gender and Cross-Cultural Issues
KIMBERLY A. YONKERS, M.D.

Chair

ROBERTO LEWIS-FERNÁNDEZ, M.D., M.T.S.
Co-Chair, Cross-Cultural Issues

Renato D. Alarcon, M.D., M.P.H.
Diana E. Clarke, Ph.D., M.Sc.
Javier I. Escobar, M.D., M.Sc.
Ellen Frank, Ph.D.
James S. Jackson, Ph.D.
Spiro M. Manson, Ph.D. (2007–2008)
James P. McNulty, A.B., Sc.B.

Leslie C. Morey, Ph.D.
William E. Narrow, M.D., M.P.H.
Roger Peele, M.D.
Philip Wang, M.D., Dr.P.H. (2007–2012)
William M. Womack, M.D.
Kenneth J. Zucker, Ph.D.

Psychiatric/General Medical Interface
LAWSON R. WULSIN, M.D.

Chair

Ronald E. Dahl, M.D.
Joel E. Dimsdale, M.D.
Javier I. Escobar, M.D., M.Sc.
Dilip V. Jeste, M.D. (2007–2011)
Walter E. Kaufmann, M.D.

Richard E. Kreipe, M.D.
Ronald C. Petersen, Ph.D., M.D.
Charles F. Reynolds III, M.D.
Robert Taylor Segraves, M.D., Ph.D.
B. Timothy Walsh, M.D.

Impairment and Disability
JANE S. PAULSEN, PH.D.

Chair

J. Gavin Andrews, M.D.
Glorisa Canino, Ph.D.
Lee Anna Clark, Ph.D.
Diana E. Clarke, Ph.D., M.Sc.
Michelle G. Craske, Ph.D.

Hans W. Hoek, M.D., Ph.D.
Helena C. Kraemer, Ph.D.
William E. Narrow, M.D., M.P.H.
David Shaffer, M.D.

Diagnostic Assessment Instruments
JACK D. BURKE JR., M.D., M.P.H.

Chair

Lee Anna Clark, Ph.D.
Diana E. Clarke, Ph.D., M.Sc.
Bridget F. Grant, Ph.D., Ph.D.

Helena C. Kraemer, Ph.D.
William E. Narrow, M.D., M.P.H.
David Shaffer, M.D.

DSM-5 Research Group
WILLIAM E. NARROW, M.D., M.P.H.

Chair

Jack D. Burke Jr., M.D., M.P.H.
Diana E. Clarke, Ph.D., M.Sc.
Helena C. Kraemer, Ph.D.

David J. Kupfer, M.D.
Darrel A. Regier, M.D., M.P.H.
David Shaffer, M.D.

Course Specifiers and Glossary
WOLFGANG GAEBEL, M.D.

Chair

Ellen Frank, Ph.D.
Charles P. O’Brien, M.D., Ph.D.
Norman Sartorius, M.D., Ph.D.,

Consultant
Susan K. Schultz, M.D.

Dan J. Stein, M.D., Ph.D.
Eric A. Taylor, M.B.
David J. Kupfer, M.D.
Darrel A. Regier, M.D., M.P.H.

xiii

DSM-5
Classification

Before each disorder name, ICD-9-CM codes are provided, followed by ICD-10-CM codes
in parentheses. Blank lines indicate that either the ICD-9-CM or the ICD-10-CM code is not
applicable. For some disorders, the code can be indicated only according to the subtype or
specifier.

ICD-9-CM codes are to be used for coding purposes in the United States through Sep-
tember 30, 2014. ICD-10-CM codes are to be used starting October 1, 2014.

Following chapter titles and disorder names, page numbers for the corresponding text
or criteria are included in parentheses.

Note for all mental disorders due to another medical condition: Indicate the name of
the other medical condition in the name of the mental disorder due to [the medical condi-
tion]. The code and name for the other medical condition should be listed first immedi-
ately before the mental disorder due to the medical condition.

Neurodevelopmental Disorders (31)

Intellectual Disabilities (33)

___.__ (___.__) Intellectual Disability (Intellectual Developmental Disorder) (33)
Specify current severity:

317 (F70) Mild
318.0 (F71) Moderate
318.1 (F72) Severe
318.2 (F73) Profound

315.8 (F88) Global Developmental Delay (41)

319 (F79) Unspecified Intellectual Disability (Intellectual Developmental
Disorder) (41)

Communication Disorders (41)
315.32 (F80.2) Language Disorder (42)

315.39 (F80.0) Speech Sound Disorder (44)

315.35 (F80.81) Childhood-Onset Fluency Disorder (Stuttering) (45)
Note: Later-onset cases are diagnosed as 307.0 (F98.5) adult-onset fluency

disorder.

315.39 (F80.89) Social (Pragmatic) Communication Disorder (47)

307.9 (F80.9) Unspecified Communication Disorder (49)

xiv DSM-5 Classification

Autism Spectrum Disorder (50)
299.00 (F84.0) Autism Spectrum Disorder (50)

Specify if: Associated with a known medical or genetic condition or envi-
ronmental factor; Associated with another neurodevelopmental, men-
tal, or behavioral disorder

Specify current severity for Criterion A and Criterion B: Requiring very
substantial support, Requiring substantial support, Requiring support

Specify if: With or without accompanying intellectual impairment, With
or without accompanying language impairment, With catatonia (use
additional code 293.89 [F06.1])

Attention-Deficit/Hyperactivity Disorder (59)

___.__ (___.__) Attention-Deficit/Hyperactivity Disorder (59)
Specify whether:

314.01 (F90.2) Combined presentation
314.00 (F90.0) Predominantly inattentive presentation
314.01 (F90.1) Predominantly hyperactive/impulsive presentation

Specify if: In partial remission
Specify current severity: Mild, Moderate, Severe

314.01 (F90.8) Other Specified Attention-Deficit/Hyperactivity Disorder (65)

314.01 (F90.9) Unspecified Attention-Deficit/Hyperactivity Disorder (66)

Specific Learning Disorder (66)

___.__ (___.__) Specific Learning Disorder (66)
Specify if:

315.00 (F81.0) With impairment in reading (specify if with word reading
accuracy, reading rate or fluency, reading comprehension)

315.2 (F81.81) With impairment in written expression (specify if with spelling
accuracy, grammar and punctuation accuracy, clarity or
organization of written expression)

315.1 (F81.2) With impairment in mathematics (specify if with number sense,
memorization of arithmetic facts, accurate or fluent
calculation, accurate math reasoning)

Specify current severity: Mild, Moderate, Severe

Motor Disorders (74)
315.4 (F82) Developmental Coordination Disorder (74)

307.3 (F98.4) Stereotypic Movement Disorder (77)
Specify if: With self-injurious behavior, Without self-injurious behavior
Specify if: Associated with a known medical or genetic condition, neuro-

developmental disorder, or environmental factor
Specify current severity: Mild, Moderate, Severe

Tic Disorders

307.23 (F95.2) Tourette’s Disorder (81)

307.22 (F95.1) Persistent (Chronic) Motor or Vocal Tic Disorder (81)
Specify if: With motor tics only, With vocal tics only

DSM-5 Classification xv

307.21 (F95.0) Provisional Tic Disorder (81)

307.20 (F95.8) Other Specified Tic Disorder (85)

307.20 (F95.9) Unspecified Tic Disorder (85)

Other Neurodevelopmental Disorders (86)
315.8 (F88) Other Specified Neurodevelopmental Disorder (86)

315.9 (F89) Unspecified Neurodevelopmental Disorder (86)

Schizophrenia Spectrum
and Other Psychotic Disorders (87)

The following specifiers apply to Schizophrenia Spectrum and Other Psychotic Disorders
where indicated:
aSpecify if: The following course specifiers are only to be used after a 1-year duration of the dis-

order: First episode, currently in acute episode; First episode, currently in partial remission;
First episode, currently in full remission; Multiple episodes, currently in acute episode; Mul-
tiple episodes, currently in partial remission; Multiple episodes, currently in full remission;
Continuous; Unspecified

bSpecify if: With catatonia (use additional code 293.89 [F06.1])
cSpecify current severity of delusions, hallucinations, disorganized speech, abnormal psycho-

motor behavior, negative symptoms, impaired cognition, depression, and mania symptoms

301.22 (F21) Schizotypal (Personality) Disorder (90)

297.1 (F22) Delusional Disordera, c (90)
Specify whether: Erotomanic type, Grandiose type, Jealous type, Persecu-

tory type, Somatic type, Mixed type, Unspecified type
Specify if: With bizarre content

298.8 (F23) Brief Psychotic Disorderb, c (94)
Specify if: With marked stressor(s), Without marked stressor(s), With

postpartum onset

295.40 (F20.81) Schizophreniform Disorderb, c (96)
Specify if: With good prognostic features, Without good prognostic fea-

tures

295.90 (F20.9) Schizophreniaa, b, c (99)

___.__ (___.__) Schizoaffective Disordera, b, c (105)
Specify whether:

295.70 (F25.0) Bipolar type
295.70 (F25.1) Depressive type

___.__ (___.__) Substance/Medication-Induced Psychotic Disorderc (110)
Note: See the criteria set and corresponding recording procedures for

substance-specific codes and ICD-9-CM and ICD-10-CM coding.
Specify if: With onset during intoxication, With onset during withdrawal

___.__ (___.__) Psychotic Disorder Due to Another Medical Conditionc (115)
Specify whether:

293.81 (F06.2) With delusions
293.82 (F06.0) With hallucinations

xvi DSM-5 Classification

293.89 (F06.1) Catatonia Associated With Another Mental Disorder (Catatonia
Specifier) (119)

293.89 (F06.1) Catatonic Disorder Due to Another Medical Condition (120)

293.89 (F06.1) Unspecified Catatonia (121)
Note: Code first 781.99 (R29.818) other symptoms involving nervous and

musculoskeletal systems.

298.8 (F28) Other Specified Schizophrenia Spectrum and Other Psychotic
Disorder (122)

298.9 (F29) Unspecified Schizophrenia Spectrum and Other Psychotic
Disorder (122)

Bipolar and Related Disorders (123)
The following specifiers apply to Bipolar and Related Disorders where indicated:
aSpecify: With anxious distress (specify current severity: mild, moderate, moderate-severe, severe);

With mixed features; With rapid cycling; With melancholic features; With atypical features;
With mood-congruent psychotic features; With mood-incongruent psychotic features; With
catatonia (use additional code 293.89 [F06.1]); With peripartum onset; With seasonal pattern

___.__ (___.__) Bipolar I Disordera (123)
___.__ (___.__) Current or most recent episode manic
296.41 (F31.11) Mild
296.42 (F31.12) Moderate
296.43 (F31.13) Severe
296.44 (F31.2) With psychotic features
296.45 (F31.73) In partial remission
296.46 (F31.74) In full remission
296.40 (F31.9) Unspecified
296.40 (F31.0) Current or most recent episode hypomanic
296.45 (F31.71) In partial remission
296.46 (F31.72) In full remission
296.40 (F31.9) Unspecified
___.__ (___.__) Current or most recent episode depressed
296.51 (F31.31) Mild
296.52 (F31.32) Moderate
296.53 (F31.4) Severe
296.54 (F31.5) With psychotic features
296.55 (F31.75) In partial remission
296.56 (F31.76) In full remission
296.50 (F31.9) Unspecified
296.7 (F31.9) Current or most recent episode unspecified

296.89 (F31.81) Bipolar II Disordera (132)
Specify current or most recent episode: Hypomanic, Depressed
Specify course if full criteria for a mood episode are not currently met: In

partial remission, In full remission
Specify severity if full criteria for a mood episode are currently met:

Mild, Moderate, Severe

DSM-5 Classification xvii

301.13 (F34.0) Cyclothymic Disorder (139)
Specify if: With anxious distress

___.__ (___.__) Substance/Medication-Induced Bipolar and Related Disorder (142)
Note: See the criteria set and corresponding recording procedures for

substance-specific codes and ICD-9-CM and ICD-10-CM coding.
Specify if: With onset during intoxication, With onset during withdrawal

293.83 (___.__) Bipolar and Related Disorder Due to Another Medical Condition
(145)

Specify if:
(F06.33) With manic features
(F06.33) With manic- or hypomanic-like episode
(F06.34) With mixed features

296.89 (F31.89) Other Specified Bipolar and Related Disorder (148)

296.80 (F31.9) Unspecified Bipolar and Related Disorder (149)

Depressive Disorders (155)
The following specifiers apply to Depressive Disorders where indicated:
aSpecify: With anxious distress (specify current severity: mild, moderate, moderate-severe,

severe); With mixed features; With melancholic features; With atypical features; With mood-
congruent psychotic features; With mood-incongruent psychotic features; With catatonia
(use additional code 293.89 [F06.1]); With peripartum onset; With seasonal pattern

296.99 (F34.8) Disruptive Mood Dysregulation Disorder (156)

___.__ (___.__) Major Depressive Disordera (160)
___.__ (___.__) Single episode
296.21 (F32.0) Mild
296.22 (F32.1) Moderate
296.23 (F32.2) Severe
296.24 (F32.3) With psychotic features
296.25 (F32.4) In partial remission
296.26 (F32.5) In full remission
296.20 (F32.9) Unspecified
___.__ (___.__) Recurrent episode
296.31 (F33.0) Mild
296.32 (F33.1) Moderate
296.33 (F33.2) Severe
296.34 (F33.3) With psychotic features
296.35 (F33.41) In partial remission
296.36 (F33.42) In full remission
296.30 (F33.9) Unspecified

300.4 (F34.1) Persistent Depressive Disorder (Dysthymia)a (168)
Specify if: In partial remission, In full remission
Specify if: Early onset, Late onset
Specify if: With pure dysthymic syndrome; With persistent major depres-

sive episode; With intermittent major depressive episodes, with current

xviii DSM-5 Classification

episode; With intermittent major depressive episodes, without current
episode

Specify current severity: Mild, Moderate, Severe

625.4 (N94.3) Premenstrual Dysphoric Disorder (171)

___.__ (___.__) Substance/Medication-Induced Depressive Disorder (175)
Note: See the criteria set and corresponding recording procedures for

substance-specific codes and ICD-9-CM and ICD-10-CM coding.
Specify if: With onset during intoxication, With onset during withdrawal

293.83 (___.__) Depressive Disorder Due to Another Medical Condition (180)
Specify if:

(F06.31) With depressive features
(F06.32) With major depressive-like episode
(F06.34) With mixed features

311 (F32.8) Other Specified Depressive Disorder (183)

311 (F32.9) Unspecified Depressive Disorder (184)

Anxiety Disorders (189)

309.21 (F93.0) Separation Anxiety Disorder (190)

313.23 (F94.0) Selective Mutism (195)

300.29 (___.__) Specific Phobia (197)
Specify if:

(F40.218) Animal
(F40.228) Natural environment
(___.__) Blood-injection-injury
(F40.230) Fear of blood
(F40.231) Fear of injections and transfusions
(F40.232) Fear of other medical care
(F40.233) Fear of injury
(F40.248) Situational
(F40.298) Other

300.23 (F40.10) Social Anxiety Disorder (Social Phobia) (202)
Specify if: Performance only

300.01 (F41.0) Panic Disorder (208)

___.__ (___.__) Panic Attack Specifier (214)

300.22 (F40.00) Agoraphobia (217)

300.02 (F41.1) Generalized Anxiety Disorder (222)

___.__ (___.__) Substance/Medication-Induced Anxiety Disorder (226)
Note: See the criteria set and corresponding recording procedures for

substance-specific codes and ICD-9-CM and ICD-10-CM coding.
Specify if: With onset during intoxication, With onset during withdrawal,

With onset after medication use

DSM-5 Classification xix

293.84 (F06.4) Anxiety Disorder Due to Another Medical Condition (230)

300.09 (F41.8) Other Specified Anxiety Disorder (233)

300.00 (F41.9) Unspecified Anxiety Disorder (233)

Obsessive-Compulsive and Related Disorders (235)
The following specifier applies to Obsessive-Compulsive and Related Disorders where indicated:
aSpecify if: With good or fair insight, With poor insight, With absent insight/delusional beliefs

300.3 (F42) Obsessive-Compulsive Disordera (237)
Specify if: Tic-related

300.7 (F45.22) Body Dysmorphic Disordera (242)
Specify if: With muscle dysmorphia

300.3 (F42) Hoarding Disordera (247)
Specify if: With excessive acquisition

312.39 (F63.3) Trichotillomania (Hair-Pulling Disorder) (251)

698.4 (L98.1) Excoriation (Skin-Picking) Disorder (254)

___.__ (___.__) Substance/Medication-Induced Obsessive-Compulsive and
Related Disorder (257)

Note: See the criteria set and corresponding recording pro

Clinical Intervention (Psychology)

1

(Note: This case study is based on many actual cases. All the names used are made up, and

any relation to actual people or events is purely accidental and coincidental.)

PSYCHOSOCIAL CASE STUDY

Marci has smoked cigarettes since age 16 and currently smokes one pack daily. Marci

stopped smoking cigarettes for six months one year ago, but she presently does not plan to cut

down or quit.

She has five prescription pills (Xanax) for depression and anxiety that were given to

her by a college classmate (for whom they were prescribed). Marci shared that she had been

struggling with feelings of sadness and worrying too much about two months ago. She hasn’t

taken them yet but has considered trying them.

Marci first experimented with marijuana during her senior year of high school (age 17),

with her use becoming more regular after she entered college. Marci was first introduced to

marijuana by her high school boyfriend, who used it every day along with alcohol on the

weekends. Marci has never been in an in-patient nor an out-patient program. When her parents

first discovered her marijuana use, they insisted that she seek professional help for what they

perceived to be a drug problem. Although they even threatened to call her college academic

dean because of her dropping grades, Marci refused help and began to discuss quitting school.

While she started drinking wine with her family when she was 13, she started to

“seriously” drink starting around 18-years-old. She currently drinks four or more alcoholic

beverages (usually wine or wine coolers; sometimes beer) three to four times a week and had

been smoking marijuana two to three times a week for one year. Her usual pattern was to go

on weekend binges, starting to drink and smoke on Friday evenings until 2:00 a.m. She

would then have a glass or two of wine around lunchtime on Saturday, smoking a joint or two

2

with a couple of friends during Saturday afternoons prior to attending college sporting or

social events. She would then go to parties with friends on Saturday evenings, typically

consuming six to seven cans/bottles/cups of beer and sharing several joints of marijuana with

others. She had also started to consume energy drinks (Red Bull, Monster, etc.) when she

drank beer at these parties to get an added “boost” to her high.

During the past two months, she has sometimes had one to two glasses of wine (she

also used to smoke half a joint of marijuana with it) when alone on school nights. On the

mornings after she used alcohol, Marci tended to sleep in and cut class, but not every week.

Her recreational and social interests had increasingly involved the use of alcohol and

marijuana, now since her arrest, it is mainly alcohol (although she still desires to smoke

cannabis). Recently, Marci has begun to express concern to her friends about “feeling

depressed and anxious,” but she reports no suicidal ideation or panic attacks. She is also

concerned since she has missed her period.

Marci does not admit to any physical problems. She says she was not hurt in her

accidents other than a few bumps and bruises. She says she did not hit her head or lose

consciousness from the accidents. She says she has been sexually active for the past two

years with her “semi-permanent” boyfriend of two years. She thought she was pregnant about

one year ago, but it turned out to be a “false alarm.” She says every now and then, especially

during allergy season, she tends to get a “dry, hacky cough.”

Marci is the oldest of three children (one brother, Jacob, 17-years-old; and one sister,

Sarah, 14-years-old) and continues to live at home while attending college. Her mother, Joan,

is a successful attorney, and her father, John, is a school administrator. Her family has always

3

attended weekly services at their church and have, on a couple of occasions, gone as a family on

church-sponsored humanitarian missions to Latin America. Marci and her siblings were always

very active in the youth groups, and helping with various church ministries, such as the nursery

and pre-school child-care Sunday schools. From taking these trips, the family started

incorporating drinking wine with their evening dinners, similar to some of the local customs

observed in these countries. This started when Marci was around 13-years-old. Marci’s parents

found out about her use of marijuana six months prior to her arrest. Marci’s parents found out

about her use of marijuana six months prior to her arrest. After her DUI, her parents sat her down

and expressed their concern about the amount she was drinking and want her to stop.

Since their confrontation and her arrest, she did cut down somewhat on her use of both alcohol

and marijuana, and (when pressed by her parents) she would abstain for several weeks at a time.

As one consequence, her parents stopped giving her permission to drive a family car and were

concerned about her influence on her younger siblings.

Neither her brother nor her sister currently drink or use substances. Her brother Jacob

admits to “drinking a beer with his friends” when he was 16-years-old, but did not like it. He

also admitted to trying his mother’s (Joan) cigarettes several times (about 10 of them) when he

15-years-old, but since he wanted to play sports, he stopped. Her sister Sarah says she has never

used and does not want to try any of it because she “hates the smell of all of it, and sees from

Marci’s example how much trouble it causes.”

Her father (45-years-old) drank alcohol to the point of inebriation many times when he

was younger (being arrested once for Public Intoxication when he was 19), but stopped when he

met and married Joan 25 years ago when they were both 20-years-old. He has not drank alcohol

regularly since then (other than the glass of wine at dinner). He has not had any particular

4

problem with mood disorders, although he says he “worries from time-to-time about problems at

work and providing for his family.” He says both his parents struggled with depression and

anxiety, but never (to his knowledge) used any prescription or illegal drugs. He says his dad

drank occasionally, and John got his first taste of liquor from the stash his dad kept in the

workshop when he was around 12-years-old. John’s mother never drank, but she told John her

father (John’s grandfather) was an alcoholic most of John’s life until his death 42 years ago.

John is an only child.

Marci’s mother (45-years-old) says she used marijuana growing up (“like everyone my

age at the time”) and has struggled off-and-on with depression and anxiety since she was quite

young. She never drank when she was younger but has enjoyed the practice of drinking a glass

of wine with dinner. She says she occasionally will have another glass or two “to help her

sleep.” Joan says she was addicted to tobacco, and smoked cigarettes for over 30 years before

beginning to quit about three years ago using nicotine gum and patches. She has now cut the

gum and patch use down considerably and has not had a cigarette for two weeks. Joan says her

father drank excessively all her life and was quite violent when he was drunk. She says that her

father would beat up her mother frequently, and put her in the hospital at least once that she

remembers for two days. Her father could also be verbally abusive to her two brothers and two

sisters (Joan is the youngest). Joan’s father died from a car accident 10 years ago, and alcohol is

thought to have been a factor. Joan’s mother also drank, but not to the excess of her father, and

could get “acid-tongued” to the father and all the children. Joan reports that she and the two

sisters do not have a good relationship with their mother, but the two brothers seem to have an

okay relationship. At this time, Joan’s oldest brother drinks excessively, and seems to be

following in her father’s footsteps. The other brother has never touched alcohol as far as Joan

5

knows. (Interestingly, both brothers blame the use and non-use of alcohol on the example of

their father.) Joan says she is very close to the younger brother, but she has a “love-hate”

relationship with the older brother, since he reminds her so much of her dad and his abuse. Both

of Joan’s sisters drank and smoked a little when they were younger but stopped once they

married and had children (though the oldest sister’s first-born son displays some symptoms of

Fetal Alcohol Syndrome). She does not know anything about her grandparents since they died

(on both sides) before she was born, although there were “family rumors” that there was a lot of

drinking that took place on both maternal and paternal sides.

Marci is currently unemployed. In the past she has worked as a waitress, and when she

turned 21, as a part-time bartender for the extra money. Her longest place of employment was

waitressing for six months. Over the past four years, she has been fired or left three other places

of employment due to excessive absenteeism and once for destruction of property.

Marci was arrested five months ago for Driving While Impaired (DWI) with a blood

alcohol level of 0.13. She was also charged with possession of 1 gram of marijuana. Her license

was suspended, but she has driving privileges to get to school/work and back. Over the past

three years she has had two accidents that occurred while she was intoxicated with alcohol and

marijuana, but no other people or vehicles were involved, and no charges were filed against her.

In the first one (30 months ago), she backed into a light pole in the mall parking lot. In the other

(13 months ago), she slid into a ditch when making a moderate curve on a road under normal

road conditions, suffering some cuts to her face and bruises to her chest, sides, and knees, and

needing to call a friend to pull her car out of the ditch. She also had one “destruction of

property” count two years ago, where she was placed on six months of probation and ordered to

pay reparations to the owner, which she did.

6

Marci is a 22-year-old female college student who was arrested five months ago for

driving while impaired with a blood alcohol level of 0.13. She was also charged with possession

of a small amount (about 1 gram) of marijuana. Her license was suspended, but she has driving

privileges to get to school/work and back.

Marci admits that, since she began smoking marijuana, her previously good and trusting

relationship with her parents has soured. She had begun to hide and lied to them about using, and

had felt increasingly negative about herself, especially as her grades have suffered and her general

interests have narrowed. On several occasions she tried cocaine, and on another, LSD, but she

found the experiences unpleasant. It was not until her arrest that she began to feel some guilt and

remorse over the fact that her drinking and especially her marijuana use was negatively impacting

her relationship with her parents, and interfering with her desire to be an attorney. She had also

become gradually aware that marijuana had been affecting her motivation, her schoolwork, and her

spiritual life, but she has not expressed concerns about her use of alcohol.

Marci achieved normal milestones and performed well in high school, generally

achieving A’s and B’s. She is in her junior year of college. She wanted to live away from home

during college, but her parents resisted the idea because of financial pressures and their tendency

to be overprotective. Although she has always been a good student, her grades have begun to go

down and she is not meeting her academic potential.

Marci is neatly dressed, and displays a compliant manner. Her grooming was

appropriate. She was cooperative in the interview answering all questions politely. Her mood

seemed somewhat anxious and depressed.

Her affect was appropriate, and she was not overly emotional but appears torn between

embarrassment and anger at being forced to attend counseling. Her rate of speech was somewhat

rapid when addressing her substance using history and seemed pressured at times, but otherwise

appeared normal. Her tone modulated from high when discussing subjects that made her anxious

7

(such as failing school, getting arrested), and low when discussing subjects that were depressing

to her (problems with her parents trusting her). Her thought processes were logical, and she

Page 8 of 9

demonstrated proper insight to her own actions, how they contributed to her situation, and her

continued lack of feeling the need to stop marijuana and alcohol consumption. She was oriented

x 4 (to person, place, time, reason why she is being assessed). She had no problem answering

the mental status questions or doing “serial sevens.”

She states that, although she has not used marijuana since she was arrested, she still has

doubts about its harmfulness. Her use of alcohol has not changed. She says that she finds

marijuana pleasurable and relaxing and that, if she could find a way to not get caught, she would

like to continue using it. She believes that both alcohol and marijuana have helped her feel better

about not achieving the high goals she had set for herself and not fulfilling the expectations her

parents have for her.

Marci shows no evidence of a thought disorder, and her content of thought appeared

normal. She did not demonstrate any psychotic symptoms, and denied any past or current

hallucinations or delusions. She admitted to feeling paranoid at times when she was using

marijuana. She denied any obsessions or compulsions. She reports that she has been depressed

and anxious at times but that these feelings have never been lasting (although they have been

more frequent over the past month). Her memory did not seem impaired, and her intelligence

appeared above average. She has only a few problems regarding sleeping (trouble sleeping

soundly, getting up too late), but no eating problems, history of panic attacks or agoraphobia,

cognitive deficits, or learning disability. She denies any suicidal and homicidal ideations.

Page 9 of 9