Teaching mental health providers how to navigate the managed care industry and increase cash flow

What Mental Health Professionals Need to Know About the DSM 5 Part 1

Posted by on Oct 7, 2013 in DSM IV-TR, DSM5, Mental Health, Psychotherapy | 1 comment

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dsm5-2 Many changes are coming down the pipe for the mental health community, not the least of which is the massive changes that were implemented in the DSM 5 released earlier this year. It is expected that the DSM IV-TR will be completely phased out as of 1/1/14. And just to add more confusion to the mix, starting October 2014 the codes used for the diagnoses for billing purposes will be the ICD codes. But enough shop talk. There are many facets to the DSM 5 that need to be discussed. And it all won’t be covered in 1 post. So here goes


1. The new DSM is organized more along developmentally homogeneous categories. (I.E. no more mood disorder category as was seen in  DSM IV-TR). The changes are meant to assist in making more specific diagnoses.

2. The Chapters are Neurodevelopmental Disorders, Schizophrenia Spectrum and Other Psychotic Disorders, Bipolar and Related Disorders, Anxiety Disorders, Obsessive-Compulsive and Related Disorders, Trauma and Stressor Related Disorders, Dissociative Disorders, Somatic Symptom and Related Disorders, Feeding and Eating Disorders, Sleep Wake Disorders, Sexual Dysfunctions, Disruptive/Impulse Control Disorders/Conduct Disorders, Substance Related and Addictive Disorders, Neurocognitive Disorders, and Personality Disorders

3. Axis is no more and the GAF has gone the way of the dinosaur. Now you list the diagnoses in order of primacy

4. Old and busted: Mental Retardation. New and Hot: Intellectual Disability. ID is no longer determined merely by an IQ score. According to the new criteria, both cognitive ability and adaptive functioning need to be assessed.

5. Pervasive Developmental Disorder NOS, Asperger’s, Childhood Disintegrative DO, and Autistic DO are now under the umbrella term of Autism Spectrum Disorders.

6. To meet criteria for ADHD, six symptoms in either the inattentive or hyperactivity/impulsivity domain must exist for children and five symptoms present for adults. Symptoms must be present by age 12 instead of age 7.

7. Schizotypal Personality Disorder is now listed in the  Schizophrenia Spectrum and Other Psychotic Disorders chapter.

8. Subtypes for Schizophrenia (i.e. disorganized, paranoid, catatonic) are eliminated.

9. The Mixed Episode specifier for Bipolar DO has been eliminated. In it’s place is the “mixed features” specifier. As long as the features of a depressive episode coincide with a manic or hypomanic episode and vice versa, the specifier applies. There is also the new anxious distress specifier

10. The NOS (i.e. Depressive DO NOS, Bipolar DO NOS) is now meant to be used in emergency situations when there may not be enough time to make a differential diagnosis (i.e. pt is brought in to the ER during a manic episode). It is expected that if a mental health professional gives an initial NOS diagnosis, a more definitive diagnosis be established by the second or third session.

Ok, folks, thats all for part I. Come back later for part 2. Or if you want it and other articles delivered directly to your mailbox sign up on the right.

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