Bulimia Nervosa 3/12/15. Avoidant/Restrictive Food Intake Disorder. Anorexia Nervosa

Transcription

1 Avoidant/Restrictive Food Intake Disorder Renamed from Feeding Disorder of infancy or early childhood Renamed to better capture and diagnose what was previously diagnosed as eating disorder NOS Anorexia Nervosa No longer requires amenorrhea Restriction of energy intake leading to a significantly low body weight Intense fear of becoming fat/gaining weight or persistent behavior that interferes with weight gain Disturbance of body weight or shape experience, selfevaluation, or seriousness Restricting type or Binge Eating/Purging Type Bulimia Nervosa Recurrent episodes of binge eating Reduction in the average frequency and inappropriate compensatory behavior frequency Eating within a 2 hour period amounts that are larger than most would eat in a similar circumstance. A sense of lack of control Compensatory behaviors (self induced vomiting, laxative misuse, diuretics, fasting, excessive exercise At lease once episode per week for 3 months 1

2 Binge Eating Disorder (BED) 3 or more of the following: Eating much more rapidly than normal Eating until uncomfortably full Eating large amounts when not physically hungry Eating alone because embarrasses about amount Feeling disgusted, depressed, or guilty afterwards Elimination Disorders Elimination Disorders No new changes Enuresis (nocturnal and diurnal) Encopresis (with/without constipation and overflow incontinence) Other Specified Elimination Disorder Unspecified Elimination Disorder 2

3 Sleep Wake Disorders Sleep Wake Disorders Insomnia Disorder (formerly Primary Insomnia to reflect the bidirectional relationship between insomnia and concurrent medical disorders) Hypersomnolence Disorder Narcolepsy-now distinguished as known to be associated with hypocretin deficiency Adapted from Southern Regional AHEC and Dr. Sy Atezaz Saeed, MD, DFAPA Breathing-Related Sleep Disorders Obstructive Sleep Apnea Hypopnea Syndrome Central Sleep Apnea Sleep-Related Hypoventilation Circadian Rhythm Sleep-Wake Disorders expanded subtypes: Delayed sleep phase (familial, overlapping 24 hour) Advanced sleep phase (familial) Irregular sleep wake type Non 24 hour sleep wake type Shift work type 3

4 Parasomnias Non-Rapid Eye Movement Sleep Arousal Disorders Sleepwalking Sleep Terrors Nightmare Disorder Rapid Eye Movement Sleep Behavior Disorder (research now demonstrates that the disorder) Restless Legs Syndrome (research now demonstrates that the disorder) Substance/Medication-Induced Sleep Disorder Other Specified Insomnia Disorder Other Specified Hypersomnolence Disorder Unspecified Hypersomnolence Disorder Other Specified Sleep-Wake Disorder Unspecified Sleep-Wake Disorder Sexual Dysfunctions Sexual Dysfunctions Previously in DSM IV, this was referred to as sexual pain or disturbance in the sexual response cycle. DSMV has added gender specific and consolidated some former sexual dysfunction dxs. All sexual dysfunction diagnoses require a minimal duration of 6 months. 4

5 Sexual Dysfunctions cont. Genito-Pelvic Pain Penetration Disorder, new Dx merging former vaginismus and dyspareunia. Former sexual aversion disorder has been removed. Subtypes include: lifelong and generalized. Associated features/factors include: partner, relationship, individual vulnerability, cultural, religious, and/or medical. Gender Dysphoria Gender Dysphoria A new DX class in the DSM 5 Emphasizes gender incongruence vs. gender identity disorder. Considered a multi category with wide variations. Child criteria vs. adolescent/adult criteria Sub-typing based on sexual orientation has been removed due to clinical insignificance. Post transition specifier has been added 5

6 Disruptive, Impulse- Control, and Conduct Disorders Includes: Oppositional Defiant Disorder, Intermittent Explosive Disorder, Conduct Disorder, Antisocial Personality Disorder, Pyromania, Kleptomania, other Specified and Unspecified Disruptive, Impulse-Control, and Conduct disorders Oppositional Defiant Disorder Changes DSM IV Criteria for Conduct Disorder must not be met. DSM5 First, symptoms are now grouped into three types: angry/irritable mood, argumentative/ defiant behavior, and vindictiveness the exclusion criterion for conduct disorder has been removed. given that many behaviors associated with symptoms of oppositional defiant disorder occur commonly in normally developing children and adolescents, a note has been added to the criteria to provide guidance on the frequency typically needed for a behavior to be considered symptomatic of the disorder. a severity rating has been added to the criteria to reflect research showing that the degree of pervasiveness of symptoms across settings is an important indicator of severity (F91.3)Oppositional Defiant Disorder Criteria A. Four of the following Often loses temper Is often touchy or easily annoyed Is often angry or resentful Often argues with authority figures Often actively defies or refuses to comply with requests from authority figures Often deliberatively annoys others Often blames others for his or her mistakes or behavior Has been spiteful or vindictive at least twice within the past 6 months B. The disturbance in behavior is associated with distress in the individual or others in his or her immediate social context. C. The behaviors do not occur exclusively during the course of psychotic, substance use, depressive, or bipolar disorder. Specifiers: mild; moderate; severe 6

7 Conduct Disorder Changes DSM5 A descriptive features specifier has been added for individuals who meet full criteria for the disorder but also present with limited prosocial emotions Conduct Disorder Criteria Presence of at least 3 of the following 15 criteria in past 12 months with at least one present in past 6 months. Often bullies, threatens, or intimidates others Often initiates fights Has used weapon that can cause serious harm to others Has been physically cruel to animals Has been physically cruel to people Has stolen while confronting an individual Has forced someone into sexual activity. Has deliberatively engaged in fire setting with intent to cause damage Has deliberatively destroyed property Has broken into someone else's property Often lies to obtain goods or favors or to avoid obligations Has stolen items of nontrivial value without confronting an individual Often stays out late past parental prohibitions before age 13 Has run away from home at least twice or once without returning for lengthy period of time Often truant from school, beginning before age 13 Specifiers: (F91.1) childhood onset (shows symptoms prior to age 10); (F91.2) Adolescent Onset (no symptomology before age 10); (F91.9) unspecified onset; with limited prosocial emotions; mild; moderate; severe Intermittent Explosive Disorder Changes DSM-IV requires physical aggression DSM5 Verbal aggression and nondestructive / noninjurious physical aggression also meet criteria a minimum age of 6 years (or equivalent developmental level) is now required. 7

8 Intermittent Explosive Disorder Criteria A. Verbal or physical aggression occurring twice weekly over 3 months; or Three behavioral outbursts resulting in damage to property or person in past 12 month period. B. Magnitude of Aggression is disproportionate to the precipitating factor C. Outbursts are not premeditated or planned to achieve another purpose D. Outbursts cause marked stress and cause impairment in day to day function E. Chronological age is at least 6 years old. F. Outbursts not better explained by another disorder. Changes to Antisocial Personality Disorder DSM5 Dually listed in Disruptive, Impulse-control, and Conduct Disorder and in Personality Disorders (F60.2) Antisocial Personality Disorder Criteria (Cluster B) A. A Pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 years, as indicated by 3 or more of the following: Failure to conform to social norms with respect to lawful behaviors Deceitfulness, as indicated by repeated lying Impulsivity or failure to plan ahead Irritability and aggressiveness Reckless disregard for safety of self or others Consistent irresponsibility Lack of remorse B. The individual is at least age 18 C. there is evidence of conduct disorder with onset before age 15 years old. D. The occurrence of antisocial behavior is not exclusively during the course of schizophrenia or bipolar disorder 8

9 Pyromania and Kleptomania Changes/Criteria (F63.1) Pyromania No changes noted A. Deliberate and purposeful fire setting on more than one occasion B. Tension or affective arousal before the act C. Fascination or attraction to fire and its situational contexts D. Pleasure or gratification when setting fires and witnessing their aftermath E. Fire setting not done for gain, expression of ideology, to conceal a crime, to express anger, or in response to delusion/hallucination or cognitive impairment F. Fire setting not better explained by conduct disorder, mania, or antisocial personality disorder (F63.3) Kleptomania No changes noted from DSM IV A. Recurrent failure to resist stealing objects that are needed for personal use or monetary value B. Increasing sense of tension before committing the theft C. Pleasure, gratification, or relief upon committing theft. D. Stealing is not committed to express anger or vengeance or because of hallucination or delusion E. Stealing is not better explained by conduct disorder, mania, or antisocial personality disorder. Substance-Related and Addictive Disorders Includes: Substance use disorders, Substance-induced disorders, Non substance related Disorder, Gambling Disorder Changes in Substance related diagnosis DSM-IV Separates substance abuse and dependence Does not have non substance related addictive disorders with this category.. Recurrent legal problems is a criterion for substance abuse Threshold of one or more criteria for a diagnosis of substance abuse and three or more for substance dependence. Cannabis and Caffeine withdrawal are in DSM-IV Appendix B, Criteria Sets and Axes Provided for Further Study ). No category for tobacco abuse The DSM-IV has specifier for a physiological subtype DSM-IV has diagnosis of polysubstance dependence. DSM V Does not separate the diagnoses of substance abuse and dependence Criteria are provided for substance use disorder, accompanied by criteria for intoxication, withdrawal, substance/medication-induced disorders, and unspecified substance-induced disorders, where relevant Recurrent legal problems criterion for substance abuse has been deleted from DSM-5, and a new criterion, craving or a strong desire or urge to use a substance, has been added In addition, the threshold for substance use disorder diagnosis in DSM-5 is set at two or more criteria, Cannabis withdrawal is new for DSM-5, as is caffeine withdrawal the criteria for DSM-5 tobacco use disorder are the same as those for other substance use disorders. Severity of the DSM-5 substance use disorders is based on the number of criteria endorsed: 2 3 criteria indicate a mild disorder; 4 5 criteria, a moderate disorder; and 6 or more, a severe disorder. The DSM-IV specifier for a physiological subtype has been eliminated in DSM-5, as has the DSM-IV diagnosis of polysubstance dependence. Early remission from a DSM-5 substance use disorder is defined as at least 3 but less than 12 months without substance use disorder criteria (except craving), and sustained remission is defined as at least 12 months without criteria (except craving). Additional new DSM-5 specifiers include in a controlled environment and on maintenance therapy as the situation warrants. 9

10 New Recording Procedures for Substance Use and Substance Induced Disorders Use the code that applies to the class of substance but record the name of the specific substance. Ex: (F13.20) Moderate Alprazolam disorder instead of Moderate Sedative, hypnotic or anxiolytic disorder Ex: (F15.129) Methamphetamine withdrawal instead of stimulant withdrawal For ICD10 the substance use aspect of the clinical picture is combined with the substance-induced aspect into a single code. Ex: If both heroin use disorder and heroin withdrawal disorder are both present they are represented in the single code of F For substance/medication induced disorders ICD 10 combines the substance induced mental disorder and the substance use disorder into one code Alcohol Related Disorders Alcohol use disorder: (F10.10) mild; (F10.20) moderate; (F10.20) severe; in early remission; in sustained remission; in a controlled environment Alcohol intoxication: (F mild alcohol use, F moderate/severe, F no co morbid alcohol use) Alcohol withdrawal: (F without perceptual disturbances); (F with perceptual disturbances Unspecified Alcohol related disorder (F10.99) Caffeine and Cannabis Related Disorders Caffeine Intoxication (F15.929) Caffeine withdrawal (F15.93) Unspecified caffeine related disorder (F15.99) Cannabis Use Disorder: (F12.10) mild; (F12.20) moderate/ severe; in early remission; in sustained remission; in a controlled environment Cannabis Intoxicity: Without perceptual disturbances (F mild use disorder; F moderate/ severe use disorder; F no co morbid use disorder With perceptual disturbances (F mild use disorder; F mod/severe use disorder; F2.922 no co morbid use disorder Cannabis Withdrawal (F12.288) ICD 10 code indicates a moderate or severe use disorder. It is not permissible to code a mild co morbid Cannabis use disorder with Cannabis withdrawal Unspecified Cannabis Use Disorder (F12.99) 10

11 Hallucinogen Related Disorders Phencyclidine Use Disorder: (F16.10) mild; (F16.20) mild/severe; in early remission, in sustained remission, in controlled environment Other Hallucinogen use Disorder: (F16.10) mild; (F16.20) moderate/severe; in early remission; in sustained remission, in controlled environment Phencyclidine Intoxication: (F mild use disorder; F mod/severe use disorder; F no co morbid use disorder Other Hallucinogen Intoxication: same as Phencyclidine Hallucinogen Persistent Perception disorder (F16.983) Unspecified Phencyclidine and other Hallucinogen Disorders (F16.99) Inhalant Related Disorders Inhalant Use disorder: (F18.10) mild; (F18.20) moderate/severe; in early remission, in sustained remission, in a controlled environment Inhalant Intoxication: (F mild use disorder; F moderate/severe use disorder; F no co morbid use disorder Unspecified inhalant related disorder (F18.99) Opioid Related Disorders Opioid Use Disorder: (F11.10) mild; (F11.20) moderate/severe; in early remission, in sustained remission, on maintenance therapy, in controlled environment Opioid Intoxication: Without perceptual disturbances (F with mild use disorder; F with moderate/severe use disorder; F with no co morbid use disorder) With perceptual disturbances (F with mild use disorder; F with moderate use disorder; F with no co morbid use disorder Opioid Withdrawal (F11.23) Unspecified Opioid Related Disorder (F11.99) 11

12 Sedative-, Hypnotic-, or Anxiolytic- Related Disorders Sedative-, Hypnotic-, or Anxiolytic use Disorder: (F13.10) mild; (F13.20) moderate/severe; in early remission, in sustained remission, in controlled environment Sedative, hypnotic, or Anxiolytic Intoxication: (F mild use disorder, F moderate/severe use disorder, F no co morbid use disorder Sedative, Hypnotic, or Anxiolytic withdrawal Without perceptual disturbances (F13.239) With perceptual disturbances (F13.232) It is not permissible to code a co morbid mild sedative, hypnotic, or anxiolytic disorder with a withdrawal disorder. Unspecified Sedative, Hypnotic, or Anxiolytic Disorder (F13.99) Stimulant-Related Disorder Stimulant Use Disorder: Mild: (F15.10) Amphetamine-type substance/other or unspecified stimulant; (F14.10) Cocaine; Moderate/Severe: (F15.20) Amphetamine-type substance/ other or unspecified stimulant; (F14.20) Cocaine In early remission; in sustained remission; in controlled environment Stimulant Intoxication: Amphetamine or other stimulant use disorder without perceptual disturbances (F with mild use disorder; F with mod/severe use disorder; F with no co morbid use disorder) Cocaine use disorder without perceptual disturbances (F with mild use disorder; F with moderate/severe use disorder; F with no co morbid use disorder) Amphetamine or other stimulant use disorder with perceptual disturbances (F with mild use disorder; F with mod/severe use disorder; F with no co morbid use disorder) Cocaine use disorder (F with mild use disorder; F with mod/severe use disorder; F with no co morbid use disorder Stimulant Withdrawal: (F15.23 Amphetamine or other stimulant disorder; F14.23 Cocaine use disorder) Unspecified Stimulant-Related Disorder: (Unspecified Amphetamine or other stimulant use disorder F15.99; Unspecified cocaine use disorder F14.99) Tobacco-Related Disorders Tobacco Use Disorder: 305.1(Z72.0 mild; F mod/severe); in early remission, in sustained remission, on maintenance therapy, in controlled environment Tobacco Withdrawal: (F17.203) Unspecified Tobacco-Related Disorder: (F17.209) 12

13 Other (or Unknown) Substance- Related Disorders Other (or Unknown) substance use disorder: (F19.10) mild; (F19.20) moderate/ severe ; in early remission, in sustained remission; in controlled environment Other (or Unknown) substance withdrawal: (F19.239) Unspecified Other (or unknown) Substancerelated Disorder: (F19.99) Non-substance-Related Disorders Gambling Disorder (F63.0) A. 4 or more of the following in a 12 month period Needs to gamble with increasing amounts of money in order to achieve the desired excitement Is restless or irritable when attempting to cut down or stop gambling Has made repeated unsuccessful efforts to control, cut back or stop gambling Is often preoccupied with gambling Often gambles when feeling distressed After losing money gambling, often returns another day to get even Lies to conceal the extent of involvement with gambling Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling Relies on others to provide money to relieve desperate financial situations caused by gambling B. Gambling behavior is not better explained by a manic episode Specifiers episodic; persistent; in early remission; in sustained remission; mild; moderate; severe Neuro-cognitive Disorders 13

14 Neurocognitive Disorders Delirium the criteria have been updated. Prior to securing this diagnosis refer to the updated criteria. Major and Mild Neurocognitive Disorder Dementia and Amnesic Disorders are now ensumed under Major NCD Mild NCD new diagnosis for less severe NCD. Less disabling syndromes. NCD Etiogical Subtypes, cont. Vascular Alzheimer s Frontotemporal Lewy bodies Traumatic brain injury Parkinson s HIV Huntington s Pick s prion Another medical condition Substance medication induced NOS Personality Disorders 14

15 Personality Disorders As the Axes have been eliminated, Personality Disorders are simply listed with other diagnoses Diagnoses should be listed in order of acuity Personality Disorders Cluster A (odd and eccentric) -Paranoid -Schizoid -Schizotypal Cluster B (dramatic, emotional, erratic) -Antisocial -Borderline -Histrionic -Narcissistic Cluster C (anxious and fearful) -Avoidant -Dependent -Obsessive-compulsive (personality disorder, not OCD) Paraphilic Disorders 15

16 Paraphilic Disorders Specifies in a controlled environment and in remission have been added. No change in diagnostic structure Differentiation between Paraphilic Disorder and Paraphilias Paraphilic Disorders - A paraphilic disorder is a paraphilia that is currently causing distress or impairment to the individual or a paraphilia whose satisfaction has entailed personal harm, or risk of harm, to others. Paraphilia - a necessary but not a sufficient condition for having a paraphilic disorder, and a paraphilia by itself does not automatically justify or require clinical intervention. Other Mental Conditions Changes to Other Mental Disorders Psychological Factors affecting Physical Condition (316) now categorized under Somatic Symptoms and Related Disorders Less complex subtypes of psychological factors: (mental disorder, psychological factors, personality traits, maladaptive health behaviors, etc. give way to simply mild, moderate, severe, extreme) Based on recognition that these relationships are complex and increased awareness that physical symptoms are found to be only partially psychosomatic 16

17 Changes to Other Mental Disorders As well, new categories of Other Mental Disorders to allow for more vaguely diagnosed mind-body related distress Other Specified Mental Disorder Secondary to Another Medical Condition (294.8) Specific symptom complexes can be designated, but do not reach the threshold of a specific mental disorder diagnosis, and can be directly related to a medical condition Medical Condition is specified with an ICD code, and the symptom complex (i.e., dissociative symptoms) is described Changes to Other Mental Disorders Unspecified Mental Disorder Secondary to Another Medical Condition (294.9) Specific symptom complexes are not designated, but there is significant psychological distress that can be directly related to a medical condition Medical Condition is specified with an ICD code, but the symptom complex (i.e., dissociative symptoms) is not described Changes to Other Mental Disorders Other Specified Mental Disorder and Unspecified Mental Disorder (300.9) Similar categorization when there is evidence of significant psychological distress that does not reach the threshold of a specific diagnosis, and is not related to a medical condition As before, the former is used when clinician specifies a symptom complex (i.e., depressive symptoms), and the latter is used when a symptom complex is not specified 17

18 Medication Induced Disorders Changes to Medication-Induced Movement Disorders and Other Adverse Effects of Medication Separate section for this category (previously lumped with Other Conditions That May Be a Focus of Clinical Attention) reflect greater awareness and levity of these issues Main change reflected in the name of the sub-section: neuroleptic-induced changed to medication-induced Reflects an increased awareness that multiple medication categories (atypical antipsychotics, antidepressants, certain non-psychopharmacologic medications) can induce these movement disorders Changes to Medication-Induced Movement Disorders and Other Adverse Effects of Medication With the exception of maintaining the Neuroleptic-Induced Parkinsonism, all disorder categories reflect global potential for medication source. Neuroleptic-Induced Parkinsonism Other Medication-Induced Parkinsonism Neuroleptic Malignant Syndrome Medication-Induced Acute Dystonia Medication-Induced Acute Akathesia Tardive Dyskinesia Tardive Dystonia Tardive Akathesia Medication-Induced Postural Tremor Medication-Induced Movement Disorder Other Adverse Effect of Medication 18

19 Changes to Medication-Induced Movement Disorders and Other Adverse Effects of Medication Antidepressant Discontinuation Syndrome New disorder designation Reflects frequent report of a collection of adverse reactions to the abrupt discontinuation of antidepressant medications Can be any sub-category of serotenergic antidepressant Complaints include: electric shock sensations, nausea, non-specific anxiety and dread Variable presentation, typically related at least in part to dose, receptor affinities, half-life Other Conditions of Clinical Attention Changes to Other Conditions That May Be a Focus of Clinical Attention These are not considered mental disorders, simply areas of that might impact mental well-being DSM 5 has separate sections for PFAPC and Medication-Induced Disorders (reflecting an increased awareness of their impact) and groups the other conditions into categories reflecting their source Identity Problem, Age-Related Cognitive Decline eliminated (redundant, better defined elsewhere) No more waste basket sections 19

20 Changes to Other Conditions That May Be a Focus of Clinical Attention DSM 5 Other Conditions categories include: Relational Problems Abuse and Neglect Educational and Occupational Problems Housing and Economic Problems Other Problems Related to Social Environment Problems Related to Crime Other Health Service Encounters for Counseling and Medical Advice Problems Related to Other Psychosocial, Personal, and Environmental Circumstances Other Circumstances of Personal History Problems Related to Access to Medical and Other Health Care Nonadherence to Medical Treatment Relational Problems Parent-Child sub-category expansion Upbringing away from parent Child affected by parent relationship distress Partner-Partner sub-category expanded Disruption of Family by Separation or Divorce Uncomplicated Bereavement place-marked here High Expressed Emotion Level within Family Increased recent awareness of global impact Abuse and Neglect Global alterations and expansions to address varying aspects of abuse/neglect Each category of Abuse (Child, Adult Spouse/ Partner, Adult Non-partner) has new specifiers These include a specification of whether or not the incident relates to an initial event or subsequent event Includes specification of abuse type within each category (physical, psychological, sexual, or neglect) 20

21 Abuse and Neglect Psychological specifier Reflection of increased awareness of impact Non-Partner specifier Reflection of increased awareness of variety of perpetrator/victim situations In particular, reflects elder abuse/neglect Abuse and Neglect Global alterations and expansions to address varying aspects of abuse/neglect Each category of Abuse (Child, Adult Spouse/ Partner, Adult Non-partner) has new specifiers These include a specification of whether or not the incident relates to an initial event or subsequent event Includes specification of abuse type within each category (physical, psychological, sexual, or neglect) Educational and Occupational Problems DSM IV Academic Problem comes under this category, newly referred to as Academic or Educational Problem (V62.3) DSM 5 splits Occupational Problem into: Problems Related to Current Military Deployment Status (V62.21) Problems related to civilian employment (Other Problems Related to Employment) (V62.29) Emphasizes the higher risk for emotional stress with military service 21

22 Housing Problems New category in DSM 5 Subcategories include: Homelessness (V60.0) Inadequate Housing (V60.1) Discord with Neighbor, Lodger, or Landlord (V60.89) Problems Related to Living in an Residential Institution (V60.6) Economic Problems New category in DSM 5 Subcategories include: Lack of Adequate Food or Safe Drinking Water (V60.2) Extreme Poverty (V60.2) Low Income (V60.2) Insufficient Social Insurance or Welfare Support (V60.2) Unspecified Housing or Economic Problem (V60.9) Other Problems Related to Social Environment New category in DSM 5 Acculturation Problem, Phase of Life Problem incorporated into this category Subcategories include: Phase of Life Problem (V62.89) Problem Related to Living Alone (V60.3) Acculturation Difficulty (V62.4) Social Exclusion or Rejection (V62.4) Target of (Perceived) Adverse Discrimination or Persecution (V62.4) Unspecified Problem Related to Social Environment (V62.4) 22

23 Problems Related to Crime or Interaction with the Legal System Entirely new category in DSM 5 Subcategories include: Victim of Crime (V62.89) Conviction in Civil or Criminal Proceedings without Imprisonment (V62.5) Imprisonment or Other Incarceration (V62.5) Problems Related to Release from Prison (V62.5) Problems Related to Other Legal (V62.5) Circumstances (V62.5) Other Health Service Encounters for Counseling and Medical Advice New Category in DSM 5 Subcategories Include: Sex Counseling (V65.49) Other Counseling or Consultation (V65.40) Problems Related to Other Psychosocial, Personal and Environmental Circumstances New Category in DSM 5 DSM IV Religious or Spiritual Problem incorporated into this category Subcategories Include: Religious or Spiritual Problem (V62.89) Problems Related to Unwanted Pregnancy (V61.7) Problems Related to Multiparity (V61.5) Discord with Social Service Provider, Including Probation Officer, Case Manager, or Social Services Worker (V62.89) 23

24 Problems Related to Other Psychosocial, Personal and Environmental Circumstances Subcategories Include: Victim of Terrorism or Torture (V62.89) Exposure to Disaster, War, or Other Hostilities (V62.22) Other Problem Related to Psychosocial Circumstances (V62.89) Unspecified Problem Related to Unspecified Psychosocial Circumstances (V62.9) Other Circumstances of Personal History New Category in DSM 5 DSM IV Identity Problem better defined by this category DSM IV Adult Antisocial Behavior and Child or Adolescent Antisocial Behavior incorporated into this category Subcategories Include: Other Personal History of Psychological Trauma (V15.69) Personal History of Self-Harm (V15.59) Personal History of Military Deployment (V62.22) Other Personal Risk Factors (V15.89) Problem Related to Lifestyle (V69.9) Adult Antisocial Behavior (V71.01) Child or Adolescent Antisocial Behavior (V71.02) Problems Related to Access to Medical and Other Health Care New Category in DSM 5 Subcategories Include: Unavailability or Inaccessibility of Health Care Facilities (V63.9) Unavailability or Inaccessibility of Other Helping Agencies (V63.8) 24

25 Nonadherence to Medical Treatment New Category in DSM 5 DSM IV Malingering, Non-Adherence to Medical Treatment, Borderline Intellectual Functioning incorporated into this category Subcategories Include: Non-Adherence to Medical Treatment (V15.81) Overweight or Obesity (278.00) Malingering (V65.2) Wandering Associated with a Mental Disorder (V40.31) Borderline Intellectual Functioning (V62.89) 25