Essentials of Psychiatric Diagnosis Responding to the Challenge of DSM 5® Digital DOCX Download
Uploaded by
gh.ynhpuynhcoongtachEssentials of Psychiatric Diagnosis Responding to the Challenge of DSM 5® Digital DOCX Download
Uploaded by
gh.ynhpuynhcoongtachEssentials of Psychiatric Diagnosis Responding to the
Challenge of DSM 5®
Visit the link below to download the full version of this book:
https://medipdf.com/product/essentials-of-psychiatric-diagnosis-responding-to-th
e-challenge-of-dsm-5/
Click Download Now
To my patients,
who taught me almost everything I know
about psychiatric diagnosis
and much of what I know about life
About the Author
Allen Frances, MD, is a clinician, educator, researcher, and leading
authority on psychiatric diagnosis. He chaired the DSM-IV Task Force,
was a member of the Task Force that prepared DSM-III-R, and wrote the
final version of the Personality Disorders section in DSM-III. The author of
several hundred papers and more than a dozen books, most recently Sav-
ing Normal: An Insider's Revolt against Out-of-Control Psychiatric Diagnosis,
DSM-5, Big Pharma, and the Medicalization of Ordinary Life, Dr. Frances is
Professor Emeritus and former Chair of the Department of Psychiatry and
Behavioral Sciences at Duke University.
v
Acknowledgments
Profound gratitude goes to Marie Sprayberry and Barbara Watkins of
The Guilford Press, who have done a simply wonderful job of editing this
book. Any writing or coding errors are mine, but my expectation is that
there will be few because of the diligence and skill of these two stalwarts
of accuracy and clarity.
vi
Contents
Chapter 1
How to Use This Book 1
Audience 1
Organization of the Book 2
Containing Diagnostic Inflation and Avoiding Fads 5
Problems with DSM‑5 5
Caution Boxes 6
The Diagnostic Interview 7
Stepped Diagnosis 13
A Dozen General Tips 14
References 16
Chapter 2
Disorders Usually First Diagnosed 17
in Childhood and Adolescence
Attention‑Deficit/Hyperactivity Disorder 18
314.01/ F90.1 Attention‑Deficit/Hyperactivity Disorder, Predominantly
Hyperactive–Impulsive 18
314.00/ F90.0 Attention‑Deficit/Hyperactivity Disorder,
Predominantly Inattentive 18
314.01/ F90.2 Attention‑Deficit/Hyperactivity Disorder, Combined 18
314.9/ F90.9 Unspecified Attention‑Deficit/Hyperactivity Disorder 18
Caution: ADHD and Age 19
vii
viii Contents
Conduct Disorder and Oppositional Defiant Disorder 21
312.81/ F91.1 Conduct Disorder, Childhood‑Onset Type 21
312.82/ F91.2 Conduct Disorder, Adolescent‑Onset Type 21
312.89/ F91.9 Conduct Disorder, Unspecified Onset 21
313.81/ F91.3 Oppositional Defiant Disorder 23
312.9/ F90.9 Unspecified Disruptive Behavior Disorder 25
299.00/ F84.0 Autism Spectrum Disorder 25
309.21/ F93.0 Separation Anxiety Disorder 28
Intellectual Developmental Disorder 29
317/ F70 Mild 29
318.0/ F71 Moderate 29
318.1/ F72 Severe 29
318.2/ F73 Profound 29
Specific Learning Disorder 31
315.00/ F81.0 Reading (special problems in reading comprehension,
speed, or accuracy) 31
315.1/ F81.2 Mathematics (special problems in arithmetic, copying
numbers or signs, or recognizing them) 31
314.2/ F81.81 Written Expression (special problems with grammar,
sentence structure, or organization) 32
315.9/ F81.9 Unspecified 32
Feeding Disorders 33
307.52/ F98.3 Pica (in children) 33
307.53/ F98.21 Rumination Disorder 33
Elimination Disorders 34
307.7/ F98.1 Encopresis 34
307.6/ F98.0 Enuresis 35
Chapter 3
Depressive Disorders 36
Major Depressive Disorder 36
296.21/ F32.0 Major Depressive Disorder, Single Episode, Mild 36
296.22/ F32.1 Major Depressive Disorder, Single Episode,
Moderate 36
296.23/ F32.2 Major Depressive Disorder, Single Episode, Severe
Without Psychotic Features 37
Contents ix
296.24/ F32.3 Major Depressive Disorder, Single Episode, Severe
With Psychotic Features 37
296.20/ F32.9 Major Depressive Disorder, Single Episode,
Unspecified 37
296.31/ F33.0 Major Depressive Disorder, Recurrent, Mild 37
296.32/ F33.1 Major Depressive Disorder, Recurrent, Moderate 37
296.33/ F33.2 Major Depressive Disorder, Recurrent, Severe Without
Psychotic Features 37
296.34/ F33.3 Major Depressive Disorder, Recurrent, Severe With
Psychotic Features 37
296.30/ F33.9 Major Depressive Disorder, Recurrent, Unspecified 37
Caution: Grief versus Major Depressive Disorder 41
300.4/ F34.1 Persistent Depressive Disorder (Dysthymia) 41
625.4/ N94.3 Premenstrual Dysphoric Disorder 43
Substance‑Induced Depressive Disorder 44
[For ICD-10-CM codes, see the Appendix: Crosswalk to ICD-10-CM Codes.]
291.89 If Alcohol‑Induced 44
292.84 If Induced by Any Other Substance (Indicate Substance) 44
Depressive Disorder Due to Another Medical Condition
(Indicate the Medical Condition) 45
293.83/ F06.31 With Depressive Features 45
293.83/ F06.32 With Major Depressive-Like Episode 45
293.83/ F06.34 With Mixed Features 45
311/ F32.9 Unspecified Depressive Disorder 47
296.90/ F39 Unspecified Mood Disorder 47
Caution: Disruptive Mood Dysregulation Disorder 47
Chapter 4
Bipolar Disorders 49
296.xx Bipolar I Disorder 49
[For ICD-10-CM codes, see the Appendix: Crosswalk to ICD-10-CM Codes.]
Fourth-Digit Codes:
.0x Bipolar I Disorder, Single Manic Episode 49
.40 Bipolar I Disorder, Most Recent Episode Hypomanic 49
.4x Bipolar I Disorder, Most Recent Episode Manic 49
.5x Bipolar I Disorder, Most Recent Episode Depressed 49
x Contents
.6x Bipolar I Disorder, Most Recent Episode Mixed 49
.7 Bipolar I Disorder, Most Recent Episode Unspecified 49
Fifth-Digit Codes:
.x1 Mild 50
.x2 Moderate 50
.x3 Severe 50
.x4 Severe With Psychotic Features 50
.x5 In Partial Remission 50
.x6 In Full Remission 50
.x0 Unspecified 50
Caution: The Fad of Childhood Bipolar Disorders 53
296.89/ F31.81 Bipolar II Disorder 54
301.13/ F34.0 Cyclothymic Disorder 57
Substance‑Induced Bipolar Disorder 58
[For ICD-10-CM codes, see the Appendix: Crosswalk to ICD-10-CM Codes.]
291.89 If Alcohol‑Induced 58
292.84 If Induced by Any Other Substance (Indicate Substance) 58
Bipolar Disorder Due to Another Medical Condition
(Indicate the Medical Condition) 59
293.83/ F06.33 With Manic Features 59
293.83/ F06.33 With Manic or Hypomanic-Like Episodes 59
293.83/ F06.34 With Mixed Features 59
296.80/ F31.9 Unspecified Bipolar Disorder 60
296.90/ F39 Unspecified Mood Disorder 60
Chapter 5
Anxiety Disorders 61
Panic Disorder 61
300.21/ F40.01 Panic Disorder With Agoraphobia 61
300.01/ F41.0 Panic Disorder Without Agoraphobia 61
300.22/ F40.0 Agoraphobia 64
300.23/ F40.10 Social Anxiety Disorder (Social Phobia) 67
Specific Phobia 69
300.29/ F40.218 Animal 69
300.29/ F40.230 Blood–Injection–Injury, Fear of Blood 69
Contents xi
300.29/ F40.231 Blood–Injection–Injury, Fear of Injections
and Transfusions 69
300.29/ F40.233 Blood–Injection–Injury, Fear of Injury 69
300.29/ F40.232 Blood–Injection–Injury, Fear of Other
Medical Care 69
300.29/ F40.228 Natural Environment 69
300.29/ F40.248 Situational 69
300.29/ F40.298 Other 69
300.02/ F41.1 Generalized Anxiety Disorder 70
Caution: Overdiagnosis of Generalized Anxiety Disorder 71
293.84/ F06.4 Anxiety Disorder Due to Another
Medical Condition (Indicate the Medical
Condition) 73
Substance‑Induced Anxiety Disorder 74
[For ICD-10-CM codes, see the Appendix: Crosswalk to ICD-10-CM Codes.]
291.89 If Alcohol‑Induced 74
292.89 If Induced by Any Other Substance (Indicate Substance) 74
300.00/ F41.9 Unspecified Anxiety Disorder 75
Chapter 6
Obsessive–Compulsive and Related Disorders 76
300.3/ F42 Obsessive–Compulsive Disorder 76
300.7/ F45.22 Body Dysmorphic Disorder 81
300.3/ F42 Hoarding Disorder 83
Tic Disorders 84
307.23/ F95.2 Tourette’s Disorder 84
307.22/ F95.1 Chronic Motor or Vocal Tic Disorder 84
307.21/ F95.0 Provisional Tic Disorder 84
333.3/ G25.61 Substance‑Induced Tic Disorder
(Indicate Substance) 84
333.3/ G25.69 Tic Disorder Due to Another Medical Condition
(Indicate the Medical Condition) 84
307.20/ F95.9 Unspecified Tic Disorder 84
312.39/ F63.3 Hair‑Pulling Disorder (Trichotillomania) 86
xii Contents
292.89 Substance‑Induced Obsessive–Compulsive
and Related Disorder 86
[For ICD-10-CM codes, see the Appendix: Crosswalk to ICD-10-CM Codes.]
294.8/ F06.8 Obsessive–Compulsive and Related Disorder Due
to Another Medical Condition (Indicate the
Medical Condition) 87
300.00/ F42 Unspecified Obsessive–Compulsive and Related
Disorder 87
Chapter 7
Trauma‑ and Stressor‑Related Disorders 88
309.81/ F43.10 Posttraumatic Stress Disorder 88
Caution: The Stressor Gatekeeper 89
308.3/ F43.0 Acute Stress Disorder 91
Adjustment Disorder 91
309.0/ F43.21 Adjustment Disorder With Depressed Mood 91
309.24/ F43.22 Adjustment Disorder With Anxiety 91
309.28/ F43.23 Adjustment Disorder With Mixed Anxiety/
Depressed Mood 91
309.3/ F43.24 Adjustment Disorder With Conduct Disturbance 91
309.4/ F43.25 Adjustment Disorder With Mixed Disturbance of
Emotions and Conduct 91
309.9/ F43.20 Unspecified Adjustment Disorder 91
309.89/ F43.8 Unspecified Trauma‑ and Stressor‑Related
Disorder 93
Chapter 8
Schizophrenia Spectrum 94
and Other Psychotic Disorders
295.9/ F20.9 Schizophrenia 94
295.40/ F20.81 Schizophreniform Disorder 99
Schizoaffective Disorder 100
295.70/ F25.0 Bipolar Type 100
295.70/ F25.1 Depressive Type 100
Contents xiii
297.1/ F22 Delusional Disorder 101
297.3/ F24 Shared Psychotic Disorder (Folie à Deux) 104
298.8/ F23 Brief Psychotic Disorder 105
Substance‑Induced Psychotic Disorder 106
[For ICD-10-CM codes, see the Appendix: Crosswalk to ICD-10-CM Codes.]
291.9 If Alcohol‑Induced 106
292.9 If Induced by Any Other Substance (Indicate Substance) 106
Psychotic Disorder Due to Another Medical Condition
(Indicate the Medical Condition) 107
293.81/ F06.2 With Delusions 107
293.82/ F06.0 With Hallucinations 107
293.89/ F06.1 Catatonic Disorder Due to Another
Medical Condition (Indicate
the Medical Condition) 108
298.9/ F29 Unspecified Psychotic Disorder 109
Caution: Attenuated Psychosis Syndrome 109
Chapter 9
Substance‑Related Disorders 110
and Behavioral Addictions
Caution: Substance Abuse and Substance Dependence 110
Substance Dependence 112
303.90/ F10.20 Alcohol Dependence 112
304.40/ F15.20 Amphetamine Dependence 112
304.30/ F12.20 Cannabis Dependence 112
304.20/ F14.20 Cocaine Dependence 112
304.30/ F16.20 Hallucinogen Dependence 112
304.60/ F18.20 Inhalant Dependence 112
304.00/ F11.20 Opioid Dependence 112
304.60/ F16.20 Phencyclidine Dependence 112
304.10/ F13.20 Sedative, Hypnotic, or Anxiolytic Dependence 112
305.1/ F17.200 Tobacco Dependence 112
304.80/ F19.20 Polysubstance Dependence 112
304.90/ F19.20 Other (or Unknown) Substance Dependence
(Indicate Substance If Known) 112
xiv Contents
Substance Abuse 114
305.00/ F10.10 Alcohol Abuse 114
305.70/ F15.10 Amphetamine Abuse 114
305.20/ F12.10 Cannabis Abuse 114
305.60/ F14.10 Cocaine Abuse 114
305.30/ F16.10 Hallucinogen Abuse 114
305.90/ F18.10 Inhalant Abuse 114
305.50/ F11.10 Opioid Abuse 114
305.90/ F16.10 Phencyclidine Abuse 114
305.40/ F13.10 Sedative, Hypnotic, or Anxiolytic Abuse 114
305.90/ F19.10 Other (or Unknown) Substance Abuse
(Indicate Substance If Known) 114
Substance Intoxication 115
[For ICD-10-CM codes, see the Appendix: Crosswalk to ICD-10-CM Codes.]
303.00 Alcohol Intoxication 115
305.90 Caffeine Intoxication 115
292.89 Intoxication With Any Other Substance
(Indicate Substance) 116
292.89 Other (or Unknown) Substance Intoxication
(Indicate Substance If Known) 116
Substance Withdrawal 116
[For ICD-10-CM codes, see the Appendix: Crosswalk to ICD-10-CM Codes.]
291.81 Alcohol Withdrawal 116
292.0 Withdrawal from Any Other Substance (Indicate Substance) 116
292.0 Other (or Unknown) Substance Withdrawal
(Indicate Substance If Known) 116
Substance‑Induced Mental Disorders 117
Caution: Pathological Gambling and Other Behavioral Addictions 119
Chapter 10
Neurocognitive Disorders 120
Delirium 121
293.0/ F05 Delirium Due to Another Medical Condition
(Indicate the Medical Condition) 121
[For ICD-10-CM codes for Substance-Induced Delirium, see the Appendix:
Crosswalk to ICD-10-CM Codes.]
291.0 If Alcohol-Induced 121
Contents xv
292.81 If Induced by Any Other Substance
(Indicate Substance) 121
780.09/ R41.0 Unspecified Delirium 121
Major Neurocognitive Disorder (Dementia) 124
290.xx/ F01.xx Vascular Dementia 124
.40/ .51 With Behavioral Disturbance 124
.40/ .50 Without Behavioral Disturbance 124
294.xx/ F02.xx Dementia Due to Any Other Medical Condition
(Indicate the Medical Condition) 124
.11/ .81 With Behavioral Disturbance 124
.10/ .80 Without Behavioral Disturbance 124
[For ICD-10-CM codes for Substance-Induced Persisting Dementia,
see the Appendix: Crosswalk to ICD-10-CM Codes.]
291.2 If Alcohol-Induced 124
292.82 If Induced by Any Other Substance
(Indicate Substance) 124
Mild Neurocognitive Disorder 128
Caution: Mild Neurocognitive Disorder 128
294.8/ R41.9 Unspecified Neurocognitive Disorder 129
Chapter 11
Personality Disorders 130
301.83 / F60.3 Borderline Personality Disorder 131
301.7 / F60.2 Antisocial Personality Disorder 131
301.81 / F60.81 Narcissistic Personality Disorder 132
301.50 / F60.4 Histrionic Personality Disorder 132
301.4 / F60.5 Obsessive–Compulsive Personality Disorder 132
301.82 / F60.6 Avoidant Personality Disorder 133
301.6 / F60.7 Dependent Personality Disorder 133
301.0 / F60.0 Paranoid Personality Disorder 133
301.20 / F60.1 Schizoid Personality Disorder 133
301.22 / F21 Schizotypal Personality Disorder 134
310.1 / F07.0 Personality Change Due to Another Medical Condition
(Indicate the Medical Condition) 134
301.9 / F60.9 Unspecified Personality Disorder 134
Caution: Avoiding Forensic Use of Unspecified Personality Disorder 134
Caution: Personality Dimensions in DSM‑5’s Section 3 137
xvi Contents
Chapter 12
Impulse Control Disorders 138
312.31/ F63.0 Pathological Gambling 138
Caution: The Concept of Behavioral Addictions 139
312.34/ F63.81 Intermittent Explosive Disorder 140
CAUTION: Intermittent Explosive Disorder Diagnosis 141
312.33/ F63.1 Pyromania 141
312.32/ F63.2 Kleptomania 142
312.30/ F63.9 Unspecified Impulse Control Disorder 143
Caution: Avoiding Forensic Misuse of Unspecified Impulse
Control Disorder 143
Chapter 13
Eating Disorders 144
307.1/ F50.00 Anorexia Nervosa 144
307.51/ F50.2 Bulimia Nervosa 146
307.51/ F50.8 Binge‑Eating Disorder 147
Caution: Binge‑Eating Disorder 147
307.50/ F50.9 Unspecified Eating Disorder 148
Caution: Avoidant/Restrictive Food Intake Disorder 148
Chapter 14
Sleep–Wake Disorders 149
780.52/ G47.00 Insomnia Disorder 149
Circadian Rhythm Sleep–Wake Disorder 152
307.45/ G47.21 Delayed Sleep Phase Type 152
307.45/ G47.22 Advanced Sleep Phase Type 152
307.45/ G47.23 Irregular Sleep–Wake Type 152
307.45/ G47.24 Non-24-Hour Sleep–Wake Type 152
307.45/ G47.26 Shift Work Type 152
307.45/ G47.20 Unspecified Type 152
Contents xvii
780.54/ G47.10 Hypersomnolence Disorder 153
780.57/ G47.30 Unspecified Sleep Apnea 154
Non-Rapid Eye Movement Sleep Arousal Disorder 155
307.46/ F51.3 Sleepwalking Type 155
307.46/ F51.4 Sleep Terror Type 155
307.47/ F51.5 Nightmare Disorder 155
327.42/ G47.52 Rapid Eye Movement Sleep
Behavior Disorder 156
Substance‑Induced Sleep–Wake Disorder 157
[For ICD-10-CM codes, see the Appendix: Crosswalk to ICD-10-CM Codes.]
291.82 If Alcohol‑Induced 157
292.85 If Induced by Any Other Substance (Indicate Substance) 157
327.01/ G47.01 Insomnia Due to Another Medical Condition
(Indicate the Medical Condition) 158
327.14/ G47.14 Hypersomnia Due to Another Medical
Condition (Indicate the Medical
Condition) 158
780.52/ G47.00 Unspecified Insomnia 158
780.54/ G47.10 Unspecified Hypersomnia 158
780.59/ G47.9 Unspecified Sleep–Wake Disorder 158
Chapter 15
Sexual and Gender Issues 159
Gender Dysphoria 160
302.6/ F64.2 Gender Dysphoria in Children 160
302.85 / F64.1 Gender Dysphoria in Adolescents or Adults 160
Caution: Gender Dysphoria 160
Sexual Dysfunctions 161
302.71 / F52.0 Male Hypoactive Sexual Desire Disorder 161
302.72 / F52.21 Erectile Disorder 161
302.75 / F52.4 Early Ejaculation 162
302.74 / F52.32 Delayed Ejaculation 163
302.72 / F52.22 Female Sexual Interest/Arousal Disorder 164
