Recent Advances in

Classificatory Systems- ICD

11 & DSM 5 TR
BASIC OVERVIEW AND THE NEED FOR IT

ICD- 11
 ICD-11

 The 11th version of the ICD was released on June 18, 2018, as a
preliminary version.
 It was officially presented at the World Health Assembly in May 2019 and
began to be used as the official reporting system on January 1, 2022.
 This version is the result of work completed over the course of a decade
involving 300 specialists divided into 30 workgroups across 55 countries
who provided input.
 The ICD-11 catalogs known human diseases, medical conditions, and
mental health disorders and is used for insurance coding purposes, for
statistical tracking of illnesses, and as a global health categorization tool
that can be used across countries and in different languages.
 The aim of WHO and the American Psychiatric Association is to harmonize
the structure of DSM-5 and ICD-11 which influenced the chapter structure
of ICD-11.
 26 CHAPTERS
 2 SUPPLEMENTARY SECTIONS
Chapter V: Supplementary
section for functional assessment
Chapter X: Extension codes-
Severity, course, timeline, onset,
etc
 Changes from ICD-10
to ICD-11
Changes in the chapter structure
New diagnostic categories & changes in diagnostic criteria.
 Chapter Structure

 The ICD-11 MBND chapter contains 21 disorder groupings compared

with 11 disorder groupings in ICD-10 (Table in the next slide)
 Sleep-wake disorders and conditions related to sexual health were
separated from the ICD-11 MBND chapter and cross-listed from the new
sleep-wake disorders and conditions related to sexual health chapters.
 A central difference between ICD-11 and ICD-10 regarding chapter
structure is the omission of a separate disorder grouping for mental and
behavioral disorders with onset during childhood and adolescence. The
disorders previously pooled in this grouping were moved to other
disorder groupings in the ICD-11 MBND chapter, highlighting
developmental continuity across the lifespan.
DISORDER GROUPINGS IN ICD 10
• F00-F09 Organic, including symptomatic, mental disorders
• F10-F19 Mental and behavioural disorders due to psychoactive substance use
• F20-F29 Schizophrenia, schizotypal and delusional disorders
• F30-F39 Mood [affective] disorders
• F40-F48 Neurotic, stress-related and somatoform disorders
• F50-F59 Behavioural syndromes associated with physiological disturbances and
physical factors
• F60-F69 Disorders of adult personality and behaviour
• F70-F79 Mental retardation
• F80-F89 Disorders of psychological development
• F90-F98 Behavioural and emotional disorders with onset usually occurring in childhood
and adolescence
• F99-F99 Unspecified mental disorder
DISORDER GROUPINGS IN ICD 11
 Neurodevelopmental disorders
 Schizophrenia or other primary psychotic disorders
 Catatonia
 Mood disorders
 Anxiety or fear-related disorders
 Obsessive-compulsive or related disorders
 Disorders specifically associated with stress
 Dissociative disorders
 Feeding or eating disorders
 Elimination disorders
 Disorders of bodily distress or bodily experience
Continued…
 Disorders due to substance use or addictive behaviours
 Impulse control disorders
 Disruptive behaviour or dissocial disorders
 Personality disorders and related traits
 Paraphilic disorders
 Factitious disorders
 Neurocognitive disorders
 NEW DIAGNOSTIC SUBGROUP IN
NEW ICD 11
SUBGROUP DESCRIPTION
Catatonia A syndrome of primarily psychomotor
disturbances (no longer regarded as a
subtype of Schizophrenia) characterized
by the occurrence of several different
symptoms including stupor,
catalepsy,waxy flexibility, mutism,
negativism, posturing, mannerisms,
stereotypies, psychomotor agitation,
grimacing, ecolalia and echopraxia

Bipolar type II disorder Defined by the occurrence of at least

one hypomanic episode and one
depressive episode
Body dysmorphic disorder Characterised by persistent
preoccupation with at least one defect
or flaw in one’s appearance,
unnoticeable or only slightly noticeable
to others.
 Olfactory reference disorder Olfactory Reference Disorder is
characterized by persistent
preoccupation with the belief that
one is emitting a perceived foul or
offensive body odour or breath that is
either unnoticeable or only slightly
noticeable to others.
Hoarding disorder Hoarding disorder is characterised by
accumulation of possessions due to
excessive acquisition of or difficulty
discarding possessions, regardless of their
actual value.
Excoriation disorder Excoriation disorder is characterized by
recurrent picking of one’s own skin leading
to skin lesions, accompanied by
unsuccessful attempts to decrease or stop
the behaviour.
Complex post-traumatic stress disorder Complex post-traumatic stress disorder
(Complex PTSD) is a disorder that may
develop following exposure to an event or
series of events of an extremely
threatening or horrific nature, most
commonly prolonged or repetitive events
from which escape is difficult or
 Prolonged grief disorder Prolonged grief disorder is a disturbance in
which, following the death of a partner,
parent, child, or other person close to the
bereaved, there is persistent and pervasive
grief response characterized by longing for
the deceased or persistent preoccupation
with the deceased accompanied by intense
emotional pain
Binge eating disorder Binge eating disorder is characterized by
frequent, recurrent episodes of binge eating
Avoidant-restrictive food intake disorder Avoidant-restrictive food intake disorder
(ARFID) is characterized by abnormal eating
or feeding behaviours that result in the
intake of an insufficient quantity or variety
of food to meet adequate energy or
nutritional requirements.
Body integrity dysphoria Body integrity dysphoria is characterized by
an intense and persistent desire to become
 Gaming disorder Gaming disorder is characterized by a
pattern of persistent or recurrent gaming
behaviour (‘digital gaming’ or ‘video-
gaming’), which may be online (i.e., over
the internet) or offline
Compulsive sexual behaviour disorder Compulsive sexual behaviour disorder is
characterized by a persistent pattern of
failure to control intense, repetitive sexual
impulses or urges resulting in repetitive
sexual behaviour.
Intermittent explosive disorder Intermittent explosive disorder is
characterized by repeated brief episodes of
verbal or physical aggression or destruction
of property that represent a failure to
control aggressive impulses
 6A00-6A06.Z: Neuro-developmental Disorders
 Neurodevelopmental Disorders are behavioral and cognitive disorders arising during the developmental
period that involve significant difficulties in the acquisition and execution of specific intellectual, motor,
language, or social functions. In this context, arising during the developmental period is typically considered
to mean that these disorders have their onset prior to the age of 18, regardless of the age at which the
individual first comes to clinical attention. Although behavioral and cognitive deficits are present in many
mental and behavioral disorders that can arise during the developmental period (e.g., Schizophrenia, Bipolar
Disorder), only disorders whose core features are neurodevelopmental are included in this grouping. The
presumptive etiology for Neurodevelopmental Disorders is complex, and in many individual cases is
unknown, but they are presumed to be primarily due to genetic or other factors that are present from birth.
However, lack of appropriate environmental stimulation or adequate learning opportunities and experiences
may also be contributory factors in Neurodevelopmental Disorders and should be routinely considered in
their assessment. Certain Neurodevelopmental Disorders may also arise from injury, disease, or another
insult to the central nervous system when this occurs during the developmental period.
Neurodevelopmental Disorders include the
following:
6A20-6A2Z: Schizophrenia or other primary psychotic disorders

 Schizophrenia or Other Primary Psychotic Disorders is a grouping of disorders characterized by significant

impairments in reality testing and alterations in behavior as manifested by symptoms such as delusions,
hallucinations, formal thought disorder (typically manifested as disorganized speech), and disorganized
behavior. They may be accompanied by psychomotor disturbances and negative symptoms such as blunted
or flat affect. These symptoms do not occur primarily as a result of substance use (e.g., Hallucinogen
Intoxication) or another medical condition not classified under Mental, Behavioural or Neurodevelopmental
Disorders (e.g., Huntington’s Disease). The disorders in this grouping are referred to as primary psychotic
disorders because psychotic symptoms are their defining feature. Psychotic symptoms may also occur in the
context of other mental disorders (e.g., in Mood Disorders or Dementia), but in these cases, the symptoms
occur alongside other characteristic features of those disorders. Whereas experiences of reality
loss/distortion occur on a continuum and can be found throughout the population, disorders in this group
represent patterns of symptoms and behaviors that occur with sufficient frequency and intensity to deviate
from expected cultural or subcultural expectations.
Schizophrenia or Other Primary Psychotic
Disorders include the following:
 6A20 Schizophrenia
 6A21 Schizoaffective Disorder
 6A22 Schizotypal Disorder
 6A23 Acute and Transient Psychotic Disorder
 6A24 Delusional Disorder
 6A2Y Other Specified Schizophrenia or Primary Psychotic Disorders
Schizophrenia or other primary psychotic disorders

 All the subtypes have been discarded

 Symptom specifier- +ve, -ve symptoms, depressive, manic, psychomotor
&cognitive symptoms
 Course specifier:
Longitudinal- first episode, episodic, and continuous
Cross-Sectional- symptomatic, partial remission, and in remission.
 Catatonia
 Catatonia is a syndrome of primarily psychomotor disturbances, characterized by the co-occurrence of
several symptoms of decreased, increased, or abnormal psychomotor activity. The assessment of Catatonia
is complex and requires observation, interview and physical examination. Catatonia can occur in the context
of another mental disorder, such as Schizophrenia or Other Primary Psychotic Disorders, Mood Disorders,
and Neurodevelopmental Disorders, especially Autism Spectrum Disorder. Catatonia can also develop
during or soon after intoxication or withdrawal from certain psychoactive substances, including
phencyclidine (PCP), cannabis, hallucinogens such as mescaline or LSD, cocaine and MDMA or related
drugs, or during the use of certain psychoactive and non-psychoactive medications (e.g., antipsychotic
medications, benzodiazepines, steroids, disulfiram, ciprofloxacin). Finally, Catatonia can occur as a direct
pathophysiological consequence of a medical condition not classified under Mental, Behavioural or
Neurodevelopmental Disorders. Examples of medical conditions that may be associated with Catatonia
include diabetic ketoacidosis, hypercalcemia, hepatic encephalopathy, homocystinuria, neoplasms, head
trauma, cerebrovascular disease, and encephalitis.
Catatonia includes the following:
 6A60-6A8Z: Mood Disorders

 Mood Disorders refers to a superordinate grouping of Depressive Disorders and Bipolar

Disorders. Mood disorders are defined according to particular types of Mood Episodes and
their pattern over time. The primary types of Mood Episodes are:
 Depressive Episode
 Manic Episode
 Mixed Episode
 Hypomanic Episode
 Mood Episodes are not independently diagnosable entities, and therefore do not have their
own diagnostic codes. Rather, Mood Episodes are the components of Bipolar or Related
Disorders and Depressive Disorders.
Mood Disorders include the following:

Bipolar or Related Disorders include the following:

 6A60 Bipolar Type | Disorder
 6A61 Bipolar Type Il Disorder
 6A62 Cyclothymic Disorder
 6A6Y Other Specified Bipolar or Related Disorders
Depressive Disorders include the following:*
 6A70 Single Episode Depressive Disorder*
 6A71 Recurrent Depressive Disorder*
 6A72 Dysthymic Disorder*
 6ATY Other Specified Depressive Disorders
 Depression
 Symptom specifier: Melancholic, anxiety,
panic attacks, psychotic symptoms, and the
seasonal pattern qualifier.
 Severity specifier: Mild, moderate, severe.
 Longitudinal: first episode, episodic,
chronic
 Cross-sectional: symptomatic, partial remission,
and in remission.
Anxiety or fear-related disorders
 Anxiety or Fear-Related Disorders are characterized by excessive fear and anxiety and
related behavioural disturbances, with symptoms severe enough to result in
significant distress or impairment in functioning. Fear and anxiety are closely related
phenomena; fear represents a reaction to perceived imminent threat in the present,
whereas anxiety is more future-oriented, referring to perceived anticipated threat. One
of the major ways in which different Anxiety or Fear-Related Disorders are
distinguished from one another is the focus of apprehension, that is, the stimuli or
situations that trigger the fear or anxiety. The focus of apprehension may be highly
specific as in Specific Phobia or relate to a broader class of situations as in Generalized
Anxiety Disorder. The clinical presentation of Anxiety or Fear-Related Disorders
typically includes specific associated cognitions that can assist in differentiating
among the disorders by clarifying the focus of apprehension.
6B00-6B0Z: Anxiety or Fear-Related
Disorders include the following:
Obsessive-compulsive or related
disorders
 Obsessive-Compulsive or Related Disorders comprise a group of disorders
characterized by repetitive thoughts and behaviours. Although these disorders also
have some features in common with disorders in other groupings (e.g., Anxiety or
Fear-Related Disorders), the disorders included in the grouping of Obsessive-
Compulsive or Related Disorders have commonalities on key diagnostic validators
and frequently co-occur, which may be partly related to shared genetic factors.
 Cognitive phenomena such as obsessions, intrusive thoughts, and preoccupations
are central to a subset of these conditions (i.e., Obsessive-Compulsive Disorder,
Body Dysmorphic Disorder, Hypochondriasis, and Olfactory Reference Disorder) and
are accompanied by related repetitive behaviours. Hoarding Disorder is not
associated with intrusive unwanted thoughts but rather is characterized by a
compulsive need to accumulate possessions and distress related to discarding them.
Also included in the grouping are Body-Focused Repetitive Behaviour Disorders,
which are primarily characterized by recurrent and habitual actions directed at the
integument (e.g., hair pulling, skin picking) and lack a prominent cognitive aspect.
Obsessive-Compulsive or Related
Disorders include the following:
Disorders specifically associated with stress

 Disorders Specifically Associated with Stress are directly related to

exposure to a stressful or traumatic event, or a series of such events or
adverse experiences. For each of the disorders in this grouping, an
identifiable stressor is a necessary, though not sufficient, causal factor.
Most people who experience stressors do not develop a disorder.
Stressful events for some disorders in this grouping are within the
normal range of life experiences (e.g., divorce, socio-economic
problems, bereavement). Other disorders require exposure to a stressor
that is extremely threatening or horrific in nature (i.e., potentially
traumatic events). With all disorders in this grouping, it is the nature,
pattern, and duration of the symptoms that arise in response to the
stressful events—together with associated functional impairment—that
distinguishes the disorders.
Disorders Specifically Associated with
Stress include the following:
 Dissociative disorders

 Dissociative disorders are characterised by involuntary disruption or

discontinuity in the normal integration of one or more of the following:
identity, sensations, perceptions, affects, thoughts, memories, control
over bodily movements, or behaviour. Disruption or discontinuity may be
complete, but is more commonly partial, and can vary from day to day or
even from hour to hour. The symptoms of dissociative disorders are not
due the direct effects of a medication or substance, including withdrawal
effects, are not better explained by another Mental, behavioural, or
neurodevelopmental disorder, a Sleep-wake disorder, a Disease of the
nervous system or other health condition, and are not part of an accepted
cultural, religious, or spiritual practice. Dissociative symptoms in
dissociative disorders are sufficiently severe to result in significant
impairment in personal, family, social, educational, occupational or other
important areas of functioning
Dissociative Disorders include
the following:
 Feeding or eating disorders

 Feeding or Eating Disorders involve abnormal eating or feeding

behaviours that are not better accounted for by another medical
condition and are not developmentally appropriate or culturally
sanctioned. Feeding disorders involve behavioural disturbances that are
not related to body weight or shape concerns, such as eating of non-
edible substances or voluntary regurgitation of foods. Eating disorders
involve abnormal eating behaviour and preoccupation with food
accompanied in most instances by prominent body weight or shape
concerns.
Feeding or Eating Disorders include the
following:
 Elimination disorders

 Elimination disorders include the repeated voiding of urine into clothes

or bed (enuresis) and the repeated passage of faeces in inappropriate
places (encopresis). Elimination disorders should only be diagnosed after
the individual has reached a developmental age when continence is
ordinarily expected (5 years for enuresis and 4 years for encopresis).
The urinary or faecal incontinence may have been present from birth
(i.e., an atypical extension of normal infantile incontinence), or may
have arisen following a period of acquired bladder or bowel control. An
Elimination disorder should not be diagnosed if the behaviour is fully
attributable to another health condition that causes incontinence,
congenital or acquired abnormalities of the urinary tract or bowel, or
excessive use of laxatives or diuretics.
 Elimination Disorders include the following:
 6C00 Enuresis
 6C01 Encopresis
Disorders of bodily distress or
bodily experience
 Disorders of Bodily Distress and Bodily Experience are characterized by
disturbances in the person’s experience of their body. Bodily Distress
Disorder involves bodily symptoms that the individual finds distressing
and to which excessive attention is directed. Body Integrity Dysphoria
involves a disturbance in the person’s experience of the body
manifested by the persistent desire to have a specific physical disability
accompanied by persistent discomfort or intense feelings of
inappropriateness concerning current non-disabled body configuration.
Disorders of Bodily Distress and Bodily
Experience include the following:
 Disorders due to substance use

 Disorders due to substance use include single episodes of harmful

substance use, substance use disorders (harmful substance use and
substance dependence), and substance-induced disorders such as
substance intoxication, substance withdrawal and substance-induced
mental disorders, sexual dysfunctions and sleep-wake disorders.
Disorders due to substance use
 6C40 Disorders due to use of alcohol
 6C41 Disorders due to use of cannabis
 6C42 Disorders due to use of synthetic cannabinoids
 6C43 Disorders due to use of opioids
 6C44 Disorders due to use of sedatives, hypnotics or anxiolytics
 6C45 Disorders due to use of cocaine
 6C46 Disorders due to use of stimulants including amphetamines, methamphetamine or
methcathinone
 6C47 Disorders due to use of synthetic cathinones
 6C48 Disorders due to use of caffeine
 6C49 Disorders due to use of hallucinogens
 6C4A Disorders due to use of nicotine
 6C4B Disorders due to use of volatile inhalants
 6C4C Disorders due to use of MDMA or related drugs, including MDA
 6C4D Disorders due to use of dissociative drugs including ketamine and phencyclidine
[PCP]
 6C4E Disorders due to use of other specified psychoactive substances, including
medications
Disorders due to substance use

 6C4F Disorders due to use of multiple specified psychoactive substances,

including medications
 6C4G Disorders due use of unknown or unspecified psychoactive substances
 6C4H Disorders due to use of non-psychoactive substances
 6C50 Gambling disorder
 6C51 Gaming disorder
 6C5Y Other specified disorders due to addictive behaviours
 6C5Z Disorders due to addictive behaviours, unspecified
 Impulse control disorders

 Impulse Control Disorders are characterized by the repeated failure to resist a strong impulse,
drive, or urge to perform an act that is rewarding to the person, at least in the short-term,
despite longer-term harm either to the individual or to others, marked distress about the
behaviour pattern, or significant impairment in personal, family, social, educational,
occupational, or other important areas of functioning. Impulse Control Disorders involve a
range of specific behaviours, including fire-setting, stealing, sexual behaviour, and explosive
aggressive outbursts.
 The episodes of the behaviour involved in Impulse Control Disorders are often preceded by a
rise in tension or affective arousal, which can also occur when attempting to resist the
behaviour. The episodes of the behaviour are typically followed by pleasure, gratification, or
relief of tension following the behaviour. However, over the course of the disorder, individuals
may report less awareness of building tension or arousal prior to the behaviour or a reduction
in pleasure or gratification following the behaviour. They may also experience feelings of guilt
or shame following the behaviour. The behaviours involved in Impulse Control Disorders are
not fully attributable to another mental disorder, the direct central nervous system effects of a
medication or substance, including substance intoxication and withdrawal, or another medical
condition not classified under Mental, Behavioural or Neurodevelopmental Disorders.
Impulse Control Disorders include the
following
 Disruptive behaviour or dissocial
disorders
 Disruptive behaviour and dissocial disorders are characterised by
persistent behaviour problems that range from markedly and
persistently defiant, disobedient, provocative or spiteful (i.e., disruptive)
behaviours to those that persistently violate the basic rights of others or
major age-appropriate societal norms, rules, or laws (i.e., dissocial).
Onset of Disruptive and dissocial disorders is commonly, though not
always, during childhood.
Disruptive Behaviour or Dissocial
Disorders include the following:
Personality disorders and related
traits
 Personality refers to an individual’s characteristic way of behaving,
experiencing life, and of perceiving and interpreting themselves, other
people, events, and situations. Personality Disorder is a marked
disturbance in personality functioning, which is nearly always associated
with considerable personal and social disruption. The central
manifestations of Personality Disorder are impairments in functioning of
aspects of the self (e.g., identity, self-worth, capacity for self-direction)
and/or problems in interpersonal functioning (e.g., developing and
maintaining close and mutually satisfying relationships, understanding
others’ perspectives, managing conflict in relationships). Impairments in
self-functioning and/or interpersonal functioning are manifested in
maladaptive (e.g., inflexible or poorly regulated) patterns of cognition,
emotional experience, emotional expression, and behaviour.
 Personality disorders and related
traits
 6D10 Personality disorder
 6D10.0 Mild Personality Disorder
 6D10.1 Moderate Personality Disorder
 6D10.2 Severe Personality Disorder
 Trait domain specifiers that may be recorded include the following:
 6D11.0 Negative Affectivity
 6D11.1 Detachment
 6D11.2 Dissociality
 6D11.3 Disinhibition
 6D11.4 Anankastia
 6D11.5 Borderline pattern
 Paraphilic disorders

 Paraphilic disorders are characterised by persistent and intense patterns

of atypical sexual arousal, manifested by sexual thoughts, fantasies,
urges, or behaviours, the focus of which involves others whose age or
status renders them unwilling or unable to consent and on which the
person has acted or by which he or she is markedly distressed.
Paraphilic disorders may include arousal patterns involving solitary
behaviours or consenting individuals only when these are associated
with marked distress that is not simply a result of rejection or feared
rejection of the arousal pattern by others or with significant risk of injury
or death.
 Paraphilic Disorders include the
following:
 6D30 Exhibitionistic Disorder
 6D31 Voyeuristic Disorder
 6D32 Pedophilic Disorder
 6D33 Coercive Sexual Sadism Disorder
 6D34 Frotteuristic Disorder
 6D35 Other Paraphilic Disorder Involving Non-Consenting
Individuals
 6D36 Other Paraphilic Disorder Involving Solitary Behaviour or
Consenting Individual
 Factitious disorders

 Factitious Disorders are characterized by feigning, falsifying, or

intentionally inducing or aggravating medical, psychological, or
behavioural signs and symptoms or injury in oneself or in another
person associated with identified deception. A pre-existing disorder or
disease may be present, but the individual intentionally aggravates
existing symptoms or falsifies or induces additional symptoms.
Individuals with Factitious Disorders seek treatment or otherwise present
themselves or another person as ill, injured, or impaired based on the
feigned, falsified, or self-induced signs, symptoms, or injuries. The
deceptive behaviour is not solely motivated by obvious external rewards
or incentives (e.g., obtaining disability payments or evading criminal
prosecution). This is in contrast to Malingering, in which clear external
rewards or incentives motivate the behaviour
Factitious Disorders include:
 6D50 Factitious Disorder Imposed on Self
 6D51 Factitious Disorder Imposed on Another
 Neurocognitive disorders

 Neurocognitive disorders are characterised by primary clinical deficits in

cognitive functioning that are acquired rather than developmental. That
is, neurocognitive disorders do not include disorders characterised by
deficits in cognitive function that are present from birth or that typically
arise during the developmental period, which are classified in the
grouping neurodevelopmental disorders. Rather, neurocognitive
disorders represent a decline from a previously attained level of
functioning. Although cognitive deficits are present in many mental
disorders (e.g., schizophrenia, bipolar disorders), only disorders whose
core features are cognitive are included in the neurocognitive Disorders
grouping. In cases where the underlying pathology and etiology for
neurocognitive disorders can be determined, the identified etiology
should be classified separately.
Neurocognitive disorders
Neurocognitive disorders
Neurocognitive disorders
DSM 5 TR
 The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the
handbook used by healthcare professionals in the United States and
much of the world as the authoritative guide to the diagnosis of mental
disorders. DSM contains descriptions, symptoms and other criteria for
diagnosing mental disorders. It provides a common language for
clinicians to communicate about their patients and establishes
consistent and reliable diagnoses that can be used in research on
mental disorders. It also provides a common language for researchers to
study the criteria for potential future revisions and to aid in the
development of medications and other interventions.
 The DSM‐5 Text Revision (DSM‐5‐TR)is the first published revision of DSM‐5 since its
original publication in 2013. Like the previous text revision (DSM‐IV‐TR), the main goal of
DSM‐5‐TR is to comprehensively update the descriptive text that is provided for each
DSM disorder based on reviews of the literature since the release of the prior version.
However, in contrast to DSM‐IV‐TR, in which updates were confined almost exclusively to
the text, there are a number of significant changes and improvements in DSM‐5‐TR that
are of interest to practicing clinicians and researchers. These changes include the
addition of diagnostic entities, and modifications and updated terminology in diagnostic
criteria and specifier definitions.
 The updates to the diagnostic criteria and text in DSM‐5‐TR are the product of two
separate but concurrent processes: the iterative revision process that allows the addition
or deletion of disorders and specifiers as well as changes in diagnostic criteria to be
made on an ongoing basis, which commenced soon after the publication of DSM‐5, and a
complementary text revision process which began in 2019.
 While most of the changes instituted since publication of DSM‐5 and included in this text
revision involve relatively minor changes and serve to correct errors, clarify ambiguities,
or resolve inconsistencies between the diagnostic criteria and text, some are significant
enough to have an impact on clinical practice
UPDATES
 Discrete words changes to more Neutral
As part of the changes implemented in DSM-5-TR is the use of language that challenges
the view that races are discrete and natural entities:
• The term “racialized” is used instead of “race/racial” to highlight the socially
constructed nature of race.
• The term “ethnoracial” is used in the text to denote the U.S. Census categories, such
as Hispanic, White, or African American, that combine ethnic and racialized identifiers.
• The terms “minority” and “non-White” are avoided because they describe social groups
in relation to a racialized “majority,” a practice that tends to perpetuate social
hierarchies.
• The emerging term “Latinx” is used in place of Latino/Latina to promote gender-
inclusive terminology.
• The term Caucasian is not used because it is based on obsolete and erroneous views
about the geographic origin of a prototypical pan-European ethnicity.
• Prevalence data on specific ethnoracial groups were included when existing research
documented reliable estimates based on representative samples.
 Changes in Diagnostic Criteria
 More Precise Criteria Existing criteria have been updated in DSM-5-TR to provide more precise
descriptions and reflect the scientific advances and clinical experience of the last decade. Below
are brief summaries of changes to select disorders.
 Autism Spectrum Disorder: Criterion A phrase “as manifested by the following” was revised to
read “as manifested by all of the following” to improve its clarity. The revision by the workgroup
was made to maintain a high diagnostic threshold by requiring “all of the following,” and not “any
of the following” criteria, as could be mistakenly implied by the previous wording of the criterion.
 Disruptive Mood Dysregulation Disorder: The text in the “Development and Course” section
describing the age range at which disruptive mood dysregulation disorder can be diagnosed and
for which validity is established was updated to “6–18 years,” as noted in criterion G.
 Posttraumatic Stress Disorder: For children 6 years and younger, the note that “witnessing
does not include events that are witnessed only in electronic media, television, movies, or
pictures” in Criterion A.2 was removed for its redundancy, given that criterion A.2 already
indicates that the events occurring to others must be witnessed in person.
 Prolonged Grief Disorder: Prolonged Grief Disorder is a new disorder in DSM-5-TR. Specific
language was added to the criteria to define the difference between children and adolescents
versus adults. The intent of that is to reflect current scientific evidence and highlight the different
reactions children or adolescents might have in such situations.
 Changes in Coding System
 -Since October 1, 2015, the official coding system in the United States has been the
International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-
CM). ICD-10-CM is a version of the World Health Organization’s ICD-10 that has been
modified for clinical use by the Centers for Disease Control and Prevention’s National
Center for Health Statistics (NCHS) and provides the only permissible diagnostic codes
for mental disorders for clinical use in the United States. The codes that appear in
DSM are the ICD codes that are equivalent to the DSM diagnoses. In DSM-5 both ICD-9
and ICD-10 codes were included, given that at the time of DSM-5 release the ICD-9-CM
system was still in use in the United States. DSM-5-TR will, however, include only ICD-
10-CM codes since they are the only official coding system in the United States at this
time. Most disorders in DSM-5-TR have an alphanumeric ICD-10-CM code that appears
preceding the name of the disorder (or coded subtype or specifier). The text sections
“recording procedures” or “coding notes” describe the appropriate coding procedure
for the DSM diagnoses. The use of diagnostic codes is fundamental to medical record
keeping. It facilitates data collection and retrieval and compilation of statistical
information.
 Assessment Measures
 Some of the changes regarding the Assessment Measures:
A. Sex “Male/Female” checkboxes: In DSM-5-TR, all Sex “Male/Female” checkboxes at
beginning of each measure were deleted to eliminate the use of binary classification.
B. Clinician-Rated Dimensions of Psychosis Symptom Severity measure: The
instructions for use of the measure were edited in keeping with criteria (severity
specifiers) for schizophrenia spectrum and other psychotic disorders.
C. World Health Organization Disability Assessment Schedule 2.0: Clarifications
were added to the instructions on how to calculate the summary scores for the WHODAS
2.0 36-item full version.
 Changes for specific disorder
 Persistent complex bereavement disorder, originally located in the Third section, has
been moved to the chapter “trauma- and stressor-related disorders” in Section II as an
official diagnosis. Based on thorough reviews finding sufficient evidence of validity,
reliability, and clinical utility to justify its recognition as an official DSM diagnosis, it is
now named “prolonged grief disorder” and the criteria have been appropriately
reformulated.
 The stimulant-induced mild neurocognitive disorder has been added to the existing
types of substance-induced mild neurocognitive disorders such as alcohol, inhalants,
and sedative, hypnotics or anxiolytic substances.
Changes in severity specifiers for manic episodes:

 The severity specifiers from DSM-IV have been readopted in DSM-5-TR: “mild” if only
minimum symptom criteria are met; “moderate” if there is a significant increase in
activity or impairment in judgment, and “severe” if almost continual supervision is
required. The decision to use them stemmed from the fact that the “mild” severity
specifier for manic episodes (few, if any, symptoms in excess of required threshold;
distressing but manageable symptoms; and the symptoms result in minor impairment
in social or occupational functioning) was inconsistent with manic episode criterion C
which requires that the mood disturbance be sufficiently severe to cause marked
impairment in social or occupational functioning; necessitate hospitalization; or
include psychotic features.
Addition of course specifiers to adjustment disorder

 Duration of symptom specifiers were inadvertently left out of DSM-5 and

have been reinstated in DSM-5-TR:
 “acute” if symptoms have persisted for less than 6 months, and
 “persistent” if symptoms have persisted for 6 months or longer after
the termination of the stressors or its consequences.
 Changes to delirium criterion A

Delirium criterion A has been reformulated to avoid using “orientation,” the

reason for the change is that the previous characterization of the
awareness component as “reduced orientation to the environment” was
confusing given that “disorientation” already appears as one of the
“additional disturbances in cognition” listed in criterion C.
 Sequenced Recognition
 The chapters in DSM-5 and DSM-5-TR are sequenced in recognition of the advances in
our understanding of the underlying vulnerabilities and symptom characteristics of
disorders. This sequence reflects what has been learned during the past few decades
about how the brain functions and how genes and the environment influence a
person’s health and behavior. The chapters are also grouped by broad categories that
—in some cases—indicate the common features within larger disorder groups. The
new framework is intended to encourage research within and across diagnostic
groupings with the hope of advancing our understanding of the relationships between
disorders. The more researchers and clinicians know about these connections, the
more they will be able to identify patterns or even causes of mental health disorders,
which in turn may inform the development of better treatments. DSM-5 and DSM-5-TR
are organized in sequence with the developmental lifespan. This organization is
evident in every chapter and within individual diagnostic categories, with disorders
typically diagnosed in childhood detailed first, followed by those in adolescence,
adulthood, and later life. Disorders previously addressed in a single “infancy,
childhood and adolescence” chapter are now integrated throughout the manual.
 Extensive Revision
Subcommittee
 Work on DSM-5-TR began with the creation of a Revision Subcommittee
to oversee the entire process. Section editors selected revisers brought
their specific expertise in the various subspecialties of mental health.
Each Work Group member has contributed hundreds of hours to the task
of updating and improving the DSM through conducting literature
reviews covering the past 10 years and reviewing and updating the text.
Approximately 21% of the participants in DSM-5-TR are international
experts, 60% are psychiatrists, 25% psychologists, and 15% other
health professionals, as compared to about 30% international experts in
DSM-5, 64% psychiatrists, 30% psychologists, and 6% other health
professionals.
 REFERENCES
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