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

Posts made in October, 2013

What Mental Health Professionals Need to Know About the DSM 5 Part 2

Posted by on Oct 9, 2013 in DSM IV-TR, DSM5, Psychotherapy | 4 comments


dsm5-2 Welcome back! I’m so glad you returned to learn about even more changes that have been implemented in the DSM 5. I got a lot of feedback and made a few clarifications in part 1. But there is more to come. I know that this is a lot of new material to digest, especially if like me, you have been using the Axis system your entire career. Alas, the only thing that is constant is change, so we might as well go with the flow. Now on to the changes

1. In case you missed it, the Mood Disorder category has now been split into Bipolar and Related Disorders and Depressive Disorders

2. Disruptive Mood Dysregulation Disorder – think Bipolar for children. This diagnosis cannot coexist with Bipolar or ODD. DMDD can coexist with ADHD.

3. Persistent Depressive Disorder now covers MDD and Dysthymia. Criteria states symptoms must be present over a 2 year span. Bereavement is no longer considered an exclusion for depression.

4. For the first time, there is now a gender specific mental health diagnosis – Premenstrual Dysphoric Disorder. The diagnosis was previously being assessed in the DSM-IV.

5. Separation Anxiety can be diagnosed in adults now. Social Anxiety DO replaces Social Phobia. Panic Disorder and Agoraphobia have been separated. Panic Attack is now a disorder. Children only have to meet 1 out of 6 criteria to be diagnosed with GAD

6. There is no age exclusion for personality disorders. A 12 year old can be diagnosed with Borderline as long as the symptoms have been present for 1 year

7. In order to have a diagnosis of PTSD, must be explicit about traumatic event and Criterion B has been eliminated (patient may not respond with horror). There are now 4 symptom clusters: Re-experiencing, Avoidance, Numbing, and Arousal/Reactivity

8. For Anorexia Nervosa, Amenorrhea has been removed as criterion. Instead of 85% of expected weight, the new criteria is significantly low body weight. Binge Eating Disorder has been added. For Bulimia, the threshold has been lowered to 1x per week for binging and purging

9. The terms abuse and dependence have been replaced by “Use” in the Substance-Related and Addictive Disorders Category. There are criteria for: Intoxication, Withdrawal, Substance-Induced Disorders, and Other/Unspecified substance related disorders. Two or more criteria must be met to give a diagnosis, raised from one. Legal issues is no longer a criteria for Substance Use. Severity is determined by number of criteria met.

10. Delirium is now a separate disorder. Dementia and Amnestic Disorders are now under Major and Mild Neurocognitive Disorder (NCD). If the NCD is caused by a medical condition, you list the disorder as Major/Mild NCD due to Medical Condition i.e Major NCD due to Alzheimers/HIV/Another Medical Condition.

Ok folks. That’s all for now. And as a friendly reminder, ICD codes will be in full effect October 2014. But not all of the new diagnoses listed in DSM5 have a code yet. We’ll discuss that in a later post. As always questions and comments are appreciated so drop those below. If you want articles delivered directly to your inbox, sign up on the right.

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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

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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