i

DIAGNOSTIC AND STATISTICAL

MANUAL OF
MENTAL DISORDERS
FIFTH EDITION
TEXT REVISION

DSM-5-TR™
ii

American Psychiatric Association

DSM-5-TR
Officers 2021–2022
PRESIDENT
VIVIAN B. PENDER, M.D.
PRESIDENT-ELECT
REBECCA W. BRENDEL, M.D., J.D.
TREASURER RICHARD F. SUMMERS, M.D.
SECRETARY SANDRA DEJONG, M.D., M.SC.

Assembly
SPEAKER
MARY JO FITZ-GERALD, M.D., M.B.A.
SPEAKER-ELECT
ADAM P. NELSON, M.D.

Board of Trustees
ELIE G. AOUN, M.D., M.R.O.
JENNY L. BOYER, M.D., PH.D., J.D.
KENNETH CERTA, M.D.
C. FREEMAN, M.D., M.B.A.
MARY HASBAH ROESSEL, M.D.
GLENN A. MARTIN, M.D.
ERIC M. PLAKUN, M.D.
MICHELE REID, M.D.
FELIX TORRES, M.D., M.B.A.
SANYA VIRANI, M.D., M.P.H.
CHERYL D. WILLS, M.D.
MELINDA YOUNG, M.D.
UROOJ YAZDANI, M.D.,
RESIDENT-FELLOW MEMBER TRUSTEE-ELECT
DSM-5
Officers 2012–2013
PRESIDENT
DILIP V. JESTE, M.D.
PRESIDENT-ELECT
JEFFREY A. LIEBERMAN, M.D.
TREASURER DAVID FASSLER, M.D.
SECRETARY ROGER PEELE, M.D.

Assembly
SPEAKER
R. SCOTT BENSON, M.D.
SPEAKER-ELECT
MELINDA L. YOUNG, M.D.

Board of Trustees
JEFFREY AKAKA, M.D.
CAROL A. BERNSTEIN, M.D.
BRIAN CROWLEY, M.D.
ANITA S. EVERETT, M.D.
JEFFREY GELLER, M.D.,
M.P.H. MARC DAVID GRAFF,
M.D.
JAMES A. GREENE, M.D.
JUDITH F. KASHTAN, M.D.
MOLLY K. MCVOY, M.D.
JAMES E. NININGER, M.D.
JOHN M. OLDHAM, M.D.
ALAN F. SCHATZBERG, M.D.
ALIK S. WIDGE, M.D., PH.D.
ERIK R. VANDERLIP, M.D.,
MEMBER-IN-TRAINING TRUSTEE-ELECT
iii

DIAGNOSTIC AND STATISTICAL

MANUAL OF
MENTAL DISORDERS
FIFTH EDITION
TEXT REVISION
DSM-5-TR™

iv

Copyright © 2022 American Psychiatric Association

DSM, DSM-5, and DSM-5-TR are registered trademarks of the American Psychiatric Association. Use of these terms
is prohibited without permission of the American Psychiatric Association.
ALL RIGHTS RESERVED. Unless authorized in writing by the APA, no part of this book may be reproduced or used
in a manner inconsistent with the APA’s copyright. This prohibition applies to unauthorized uses or reproductions in
any form, including electronic applications.
Correspondence regarding copyright permissions should be directed to DSM Permissions, American Psychiatric
Association Publishing, 800 Maine Avenue SW, Suite 900, Washington, DC 20024-2812.
Manufactured in the United States of America on acid-free paper.
ISBN 978-0-89042-575-6 (Hardcover) 1st printing February 2022
ISBN 978-0-89042-576-3 (Paperback) 1st printing February 2022
American Psychiatric Association
800 Maine Avenue SW
Suite 900
Washington, DC 20024-2812
www.psychiatry.org
The correct citation for this book is American Psychiatric Association: Diagnostic and Statistical Manual of Mental
Disorders, Fifth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2022.
Library of Congress Cataloging-in-Publication Data
Names: American Psychiatric Association, issuing body.
Title: Diagnostic and statistical manual of mental disorders : DSM-5-TR / American Psychiatric
Association. Other titles: DSM-5-TR
Description: Fifth edition, text revision. | Washington, DC : American Psychiatric Association Publishing, [2022] |
Includes index.
Identifiers: LCCN 2021051781 (print) | LCCN 2021051782 (ebook) | ISBN 9780890425756 (hardcover ; alk. paper) |
ISBN 9780890425763 (paperback ; alk. paper) | ISBN 9780890425770 (ebook)
Subjects: MESH: Diagnostic and statistical manual of mental disorders. 5th ed | Mental Disorders—classification |
Mental Disorders—diagnosis
Classification: LCC RC455.2.C4 (print) | LCC RC455.2.C4 (ebook) | NLM WM 15 | DDC 616.89/
075—dc23/eng/20211209 LC record available at https://lccn.loc.gov/2021051781
LC ebook record available at https://lccn.loc.gov/2021051782.
British Library Cataloguing in Publication Data
A CIP record is available from the British Library.
Text Design—Tammy J. Cordova
Manufacturing—Sheridan Books, Inc.
v
Contents
DSM-5-TR Chairs and Review Groups
DSM-5 Task Force and Work Groups
Preface to DSM-5-TR
Preface to DSM-5

DSM-5-TR Classification

Section I
DSM-5 Basics

Introduction
Use of the Manual
Cautionary Statement for Forensic Use of DSM-5

Section II
Diagnostic Criteria and Codes

Neurodevelopmental Disorders
Schizophrenia Spectrum and Other Psychotic Disorders
Bipolar and Related Disorders
Depressive Disorders
Anxiety Disorders
Obsessive-Compulsive and Related Disorders
Trauma- and Stressor-Related Disorders
Dissociative Disorders
Somatic Symptom and Related Disorders
Feeding and Eating Disorders
Elimination Disorders
Sleep-Wake Disorders

vi

Sexual Dysfunctions
Gender Dysphoria
Disruptive, Impulse-Control, and Conduct Disorders
Substance-Related and Addictive Disorders
Neurocognitive Disorders
Personality Disorders
Paraphilic Disorders
Other Mental Disorders and Additional Codes
Medication-Induced Movement Disorders and Other Adverse Effects of
Medication
Other Conditions That May Be a Focus of Clinical Attention

Section III
Emerging Measures and Models

Assessment Measures
Culture and Psychiatric Diagnosis
Alternative DSM-5 Model for Personality Disorders
Conditions for Further Study

Appendix
Alphabetical Listing of DSM-5-TR Diagnoses and ICD-10-CM Codes
Numerical Listing of DSM-5-TR Diagnoses and ICD-10-CM Codes
DSM-5 Advisors and Other Contributors

Index
vii

DSM-5-TR Chairs
MICHAEL B. FIRST, M.D.
Revision Subcommittee Co-Chair and DSM-5-TR Editor
PHILIP WANG, M.D., DR.P.H.
Revision Subcommittee Co-Chair
WILSON M. COMPTON, M.D., M.P.E.
Revision Subcommittee Vice Chair
DANIEL S. PINE, M.D.
Revision Subcommittee Vice Chair
SUSAN K. SCHULTZ, M.D.
Text Consultant
PHILIP R. MUSKIN, M.D., M.A.
Conflict of Interest Review Editor
ANN M. ENG
DSM Managing Editor

APA Division of Research Staff on DSM-5-TR

NITIN GOGTAY, M.D.
Chief, Division of Research, and Deputy Medical Director
PHILIP WANG, M.D., DR.P.H.
former Deputy Medical Director and Director of Research
Diana E. Clarke, Ph.D., Managing Director of Research and Senior Research
Statistician/Epidemiologist
Lamyaa H. Yousif, M.D., Ph.D., M.Sc., Senior DSM Operations Manager and Research
Associate
Sejal Patel, M.P.H., Senior Research Associate
Laura Thompson, M.S., Research Associate and Program Manager
Stephanie Smith, Ph.D., former Senior DSM Operations Manager and Science Writer

APA Office of the Medical Director

SAUL LEVIN, M.D., M.P.A.
CEO and Medical Director
COLLEEN M. COYLE, J.D.
General Counsel
DSM Steering Committee
PAUL S. APPELBAUM, M.D.
Chairperson
ELLEN LEIBENLUFT, M.D.
Vice Chairperson
KENNETH S. KENDLER, M.D.
Vice Chairperson
Members
Renato D. Alarcón, M.D., M.P.H
Pamela Y. Collins, M.D., M.P.H.
Michelle G. Craske, Ph.D.
Michael B. First, M.D.
Dolores Malaspina, M.D., M.S., M.S.P.H.
Glenn Martin, M.D.
Susan K. Schultz, M.D.
Andrew E. Skodol, M.D.
Kimberly A. Yonkers, M.D.

viii

Liaisons
Wilson M. Compton, M.D., M.P.E., National Institute on Drug Abuse George F.
Koob, Ph.D. (2019–2020), National Institute on Alcohol Abuse and Alcoholism
Lorenzo Leggio, M.D., Ph.D. (2020– ), National Institute on Alcohol Abuse and
Alcoholism Sarah Morris, Ph.D., National Institute of Mental Health
Cross-Cutting Review Groups
Cross-Cutting Culture Review Group
ROBERTO LEWIS-FERNÁNDEZ, M.D.
Chair
Renato D. Alarcón, M.D., M.P.H.
Anne E. Becker, M.D., Ph.D.
Kamaldeep Bhui, C.B.E., M.D.
Guilherme Borges, Ph.D.
Suparna Choudhury, Ph.D.
Jack Drescher, M.D.
Ana Gómez-Carrillo, M.D.
Brian J. Hall, Ph.D.
Felicia Heidenreich-Dutray, M.D.
Eva Heim, Ph.D.
Stefan G. Hofmann, Ph.D.
G. Eric Jarvis, M.D.
Christian Kieling, M.D., Ph.D.
Laurence J. Kirmayer, M.D.
Brandon Kohrt, M.D., Ph.D.
Rishav Koirala, M.D., Ph.D. candidate
Andrian Liem, Ph.D.
Francis G. Lu, M.D.
Kwame McKenzie, M.D.
Fahimeh Mianji, Ph.D.
Byamah Brian Mutamba, M.B.Ch.B., M.Med. (Psych), M.P.H.,
Ph.D. Claudia Rafful, Ph.D.
Cécile Rousseau, M.D.
Andrew G. Ryder, Ph.D.
Vedat Şar, M.D.
Soraya Seedat, M.D., Ph.D.
Gwen Yeo, Ph.D.
Ricardo Orozco Zavala, Ph.D.

Cross-Cutting Forensic Review Group

DEBRA A. PINALS, M.D.
Chair
Carl E. Fisher, M.D.
Steven K. Hoge, M.D.
Reena Kapoor, M.D.
Jeffrey L. Metzner, M.D.
Howard Zonana, M.D.

Cross-Cutting Sex and Gender Review Group

KIMBERLY A. YONKERS, M.D.
Chair
Margaret Altemus, M.D.
Lucy C. Barker, M.D.
Ariadna Forray, M.D.
Constance Guille, M.D.
Susan G. Kornstein, M.D.
Melissa A. Nishawala, M.D.
Jennifer L. Payne, M.D.
Walter A. Rocca M.D., M.P.H.
Manpreet K. Singh, M.D., M.S.
Simone Vigod, M.D., M.Sc.
Kristine Yaffe, M.D.
Anahita Bassir Nia, M.D., Consultant

ix

Cross-Cutting Suicide Review Group

MICHAEL F. GRUNEBAUM, M.D.
Lead Reviser
David A. Brent, M.D., Reviewer
Katalin Szanto, M.D., Reviewer

Ethnoracial Equity and Inclusion Work Group

ROBERTO LEWIS-FERNÁNDEZ, M.D.
Co-Chair
DANIELLE HAIRSTON, M.D.
Co-Chair
Renato D. Alarcón, M.D., M.P.H.
Paul S. Appelbaum, M.D., ex officio
Diana E. Clarke, Ph.D., M.Sc.
Constance E. Dunlap, M.D.
Nitin Gogtay, M.D.
Joseph P. Gone, Ph.D.
Jessica E. Isom, M.D., M.P.H.
Laurence J. Kirmayer, M.D.
Francis G. Lu, M.D.
Dolores Malaspina, M.D., M.S., M.S.P.H.
Altha J. Stewart, M.D.
Lamyaa H. Yousif, M.D., Ph.D., M.Sc.

Review Groups by Section II Chapter

Neurodevelopmental Disorders
GILLIAN BAIRD, M.B., B.CHIR.
Section Editor
Michael H. Bloch, M.D., M.S.
Jane E. Clark, Ph.D.
James C. Harris, M.D.†
Bryan H. King, M.D., M.B.A.
James F. Leckman, M.D., Ph.D.
Amy E. Margolis, Ph.D.
Diane Paul, Ph.D.
Steven R. Pliszka, M.D.
Mabel L. Rice, Ph.D.
Amy M. Wetherby, Ph.D.
Juliann Woods, Ph.D.

Schizophrenia Spectrum and Other Psychotic

Disorders STEPHAN HECKERS, M.D.
Section Editor
Somya Abubucker, M.D.
Oliver Freudenreich, M.D.
Paolo Fusar-Poli, M.D., Ph.D.
Dr. med. Stefan Gutwinski
Andreas Heinz, M.D., Ph.D.
Frank Pillmann, M.D., Ph.D.
James B. Potash, M.D., M.P.H.
Marc A. Schuckit, M.D.
Paul Summergrad, M.D.
Rajiv Tandon, M.D.
Sebastian Walther, M.D.

Bipolar and Related Disorders

MICHAEL J. OSTACHER, M.D., M.P.H., M.M.SC.
Section Editor
Benjamin I. Goldstein, M.D., Ph.D.
Greg Murray, Ph.D.
Martha Sajatovic, M.D.
Marc A. Schuckit, M.D.
Paul Summergrad, M.D.
Trisha Suppes, M.D., Ph.D.
Holly A. Swartz, M.D.
Bryan K. Tolliver, M.D., Ph.D.

Depressive Disorders
WILLIAM H. CORYELL, M.D.
Section Editor
Scott R. Beach, M.D.
Ellen Leibenluft, M.D.
Robert M. McCarron, D.O.
Marc A. Schuckit, M.D.
Kimberly A. Yonkers, M.D.
Sidney Zisook, M.D.

Anxiety Disorders
MICHELLE G. CRASKE, PH.D.
Section Editor
Katja Beesdo-Baum, Ph.D.
Susan Bogels, Ph.D.
Lily A. Brown, Ph.D.
Richard LeBeau, Ph.D.
Vijaya Manicavasagar, Ph.D.
Bita Mesri, Ph.D.
Peter Muris, Ph.D.
Thomas H. Ollendick, Ph.D.
Kate Wolitzky-Taylor, Ph.D.
Tomislav D. Zbozinek, Ph.D.

Susan K. Schultz, M.D., Text Consultant

Obsessive-Compulsive and Related Disorders

KATHARINE A. PHILLIPS, M.D.
Section Editor
Randy O. Frost, Ph.D.
Jon E. Grant, M.D., M.P.H., J.D.
Christopher Pittenger, M.D., Ph.D.
Helen Blair Simpson, M.D., Ph.D.
Dan J. Stein, M.D., Ph.D.
Gail Steketee, Ph.D.

Susan K. Schultz, M.D., Text Consultant

Trauma- and Stressor-Related Disorders

MATTHEW J. FRIEDMAN, M.D., PH.D.
Section Editor
David A. Brent, M.D.
Richard Bryant, Ph.D.
Julianna M. Finelli, M.D.
Dean G. Kilpatrick, Ph.D.
Roberto Lewis-Fernández, M.D.
Holly G. Prigerson, Ph.D.
Robert S. Pynoos, M.D., M.P.H.
Paula P. Schnurr, Ph.D.
James J. Strain, M.D.
Robert J. Ursano, M.D.
Frank W. Weathers, Ph.D.
Charles H. Zeanah Jr., M.D.

Susan K. Schultz, M.D., Text Consultant

Dissociative Disorders
RICHARD J. LOEWENSTEIN, M.D.
Section Editor
Frank W. Putnam Jr., M.D.
Daphne Simeon, M.D.
Susan K. Schultz, M.D., Text Consultant

Somatic Symptom and Related Disorders

JAMES L. LEVENSON, M.D.
Section Editor
Marc D. Feldman, M.D.
Bernd Löwe, Prof. Dr. med. Dipl.-Psych.
Jill M. Newby, Ph.D.
Jon Stone, M.B.Ch.B., Ph.D.
Gregory Yates, M.A.

xi

Feeding and Eating Disorders

B. TIMOTHY WALSH, M.D.
Section Editor
MICHAEL J. DEVLIN, M.D.
Reviewer

Elimination Disorders
DANIEL S. PINE, M.D.
Section Editor
Israel Franco, M.D.
Patricio C. Gargollo, M.D.
Peter L. Lu, M.D., M.S.
Stephen A. Zderic, M.D.

Sleep-Wake Disorders
MICHAEL J. SATEIA, M.D.
Section Editor
R. Robert Auger, M.D.
Jack D. Edinger, Ph.D.
Kiran Maski, M.D., M.P.H.
Stuart F. Quan, M.D.
Thomas E. Scammell, M.D.
Marc A. Schuckit, M.D.
Erik K. St. Louis, M.D., M.S.
John W. Winkelman, M.D., Ph.D.

Sexual Dysfunctions
LORI A. BROTTO, PH.D.
Section Editor
Stanley E. Althof, Ph.D.
Cynthia A. Graham, Ph.D.
Dennis Kalogeropoulos, Ph.D.
Julie Larouche, M.Ps.
Pedro Nobre, Ph.D.
Michael A. Perelman, Ph.D.
Natalie O. Rosen, Ph.D.
Marc A. Schuckit, M.D.

Sharon J. Parish, M.D., Medical Reviewer

Susan K. Schultz, M.D., Text Consultant

Gender Dysphoria
JACK DRESCHER, M.D.
Section Editor
Stewart L. Adelson, M.D.
Walter O. Bockting, Ph.D.
William Byne, M.D., Ph.D.
Annelou L.C. de Vries, M.D., Ph.D.
Cecilia Dhejne, M.D., Ph.D.
Thomas D. Steensma, Ph.D.

Disruptive, Impulse-Control, and Conduct Disorders

PAUL J. FRICK, PH.D.
Section Editor
Jeffrey D. Burke, Ph.D.
S. Alexandra Burt, Ph.D.
Emil F. Coccaro, M.D.
Jon E. Grant, M.D., M.P.H., J.D.

xii

Substance-Related and Addictive Disorders

DEBORAH S. HASIN, PH.D.
Section Editor
Carlos Blanco, M.D., Ph.D.
David Bochner, Ph.D.
Alan J. Budney, Ph.D.
Wilson M. Compton, M.D., M.P.E.
John R. Hughes, M.D.
Laura M. Juliano, Ph.D.
Bradley T. Kerridge, Ph.D.
Marc N. Potenza, M.D., Ph.D.
Marc A. Schuckit, M.D.

Neurocognitive Disorders
SUSAN K. SCHULTZ, M.D.
Section Editor
Brian S. Appleby, M.D.
David B. Arciniegas, M.D.
Karl Goodkin, M.D., Ph.D.
Sharon K. Inouye, M.D., M.P.H.
Constantine Lyketsos, M.D., M.H.S.
Ian G. McKeith, M.D.
Bruce L. Miller, M.D.
David J. Moser, Ph.D.
Peggy C. Nopoulos, M.D.
Howard J. Rosen, M.D.
Perminder S. Sachdev, M.D., Ph.D.
Marc A. Schuckit, M.D.
Paul Summergrad, M.D.
Daniel Weintraub, M.D.

Personality Disorders
MARK ZIMMERMAN, M.D.
Section Editor
Donald W. Black, M.D.
Robert F. Bornstein, Ph.D.
Erin A. Hazlett, Ph.D.
Lisa Lampe, M.B.,B.S., Ph.D.
Royce Lee, M.D.
Joshua D. Miller, Ph.D.
Anthony Pinto, Ph.D.
Elsa F. Ronningstam, Ph.D.
Douglas B. Samuel, Ph.D.
Susan K. Schultz, M.D.
Glen L. Xiong, M.D.
Mary C. Zanarini, Ed.D.

Paraphilic Disorders
RICHARD B. KRUEGER, M.D.
Section Editor
Peer Briken, M.D.
Luk Gijs, Ph.D.
Andreas Mokros, Ph.D.
Pekka Santtila, Ph.D.
Michael C. Seto, Ph.D.

Medication-Induced Movement Disorders and Other Adverse Effects of

Medication ALAN F. SCHATZBERG, M.D.
Section Editor
Jacob S. Ballon, M.D., M.P.H.
Kevin J. Black, M.D.
Peter F. Buckley, M.D.
Leslie Citrome, M.D., M.P.H.
Ira D. Glick, M.D.
Rona Hu, M.D.
Paul E. Keck Jr., M.D.
Stephen R. Marder, M.D.
Laura Marsh, M.D.
Richard C. Shelton, M.D.
Nolan Williams, M.D.

xiii

Other Conditions That May Be a Focus of Clinical

Attention Michael B. First, M.D.
Nitin Gogtay, M.D.
Diana E. Clarke, Ph.D.
Lamyaa H. Yousif, M.D., Ph.D., M.Sc.

Reviewers for Section III Texts

Assessment Measures
Nitin Gogtay, M.D.
Philip Wang, M.D., Dr.P.H.
Diana E. Clarke, Ph.D.
Lamyaa H. Yousif, M.D., Ph.D., M.Sc.
Stephanie Smith, Ph.D.

Culture and Psychiatric Diagnosis

ROBERTO LEWIS-FERNÁNDEZ, M.D.
Section Editor
Neil Krishan Aggarwal, M.D., M.B.A., M.A.
Ana Gómez-Carrillo, M.D.
G. Eric Jarvis, M.D.
Bonnie N. Kaiser, Ph.D., M.P.H.
Laurence J. Kirmayer, M.D.
Brandon Kohrt, M.D., Ph.D.
Conditions for Further Study
Attenuated Psychosis Syndrome
Paolo Fusar-Poli, M.D., Ph.D.
Stephan Heckers, M.D.
Depressive Episodes With Short-Duration Hypomania
Benjamin I. Goldstein, M.D., Ph.D.
Greg Murray, Ph.D.
Michael J. Ostacher, M.D., M.P.H., M.M.Sc.
Caffeine Use Disorder
Laura M. Juliano, Ph.D.
Alan J. Budney, Ph.D.
Deborah S. Hasin, Ph.D.
Wilson M. Compton, M.D., M.P.E.
Internet Gaming Disorder
Charles O’Brien, M.D., Ph.D.
Jon E. Grant, M.D., M.P.H., J.D.
Wilson M. Compton, M.D., M.P.E.
Deborah S. Hasin, Ph.D.
Neurobehavioral Disorder Associated With Prenatal Alcohol
Exposure Bridget F. Grant, Ph.D., Ph.D.
Deborah S. Hasin, Ph.D.
Suicidal Behavior Disorder
Michael F. Grunebaum, M.D.
David A. Brent, M.D.
Katalin Szanto, M.D.
Nonsuicidal Self-Injury
E. David Klonsky, Ph.D.
Jennifer J. Muehlenkamp, Ph.D.
Jason J. Washburn, Ph.D.

Review Committees of the DSM Steering Committee

Note: These groups reviewed formal proposals for changes vetted by the DSM
Steering Committee since the publication of DSM-5.

Neurodevelopmental Disorders
DANIEL S. PINE, M.D.
Chairperson
Catherine E. Lord, Ph.D.
Sally Ozonoff, Ph.D.
Joseph Piven, M.D.
Moira A. Rynn, M.D.
Anita Thapar, M.D.

xiv
Serious Mental Disorders
CARRIE E. BEARDEN, PH.D.
Chairperson
William T. Carpenter, M.D.
Benoit H. Mulsant, M.D., M.S.
Peter V. Rabins, M.D., M.P.H.
Mark Zimmerman, M.D.

Internalizing Disorders
ROBERTO LEWIS-FERNÁNDEZ, M.D.
Chairperson
William H. Coryell, M.D.
Constance Hammen, Ph.D.
James L. Levenson, M.D.
Katharine A. Phillips, M.D.
Dan J. Stein, M.D., Ph.D.

Additional Reviewers for Prolonged Grief Disorder

David A. Brent, M.D.
Michael B. First, M.D.
Matthew J. Friedman, M.D., Ph.D.
Christopher M. Layne, Ph.D.
Roberto Lewis-Fernández, M.D.
Paul K. Maciejewski, Ph.D.
Katharine A. Phillips, M.D.
Holly G. Prigerson, Ph.D.
Robert S. Pynoos, M.D.
Charles F. Reynolds III, M.D.
M. Katherine Shear, M.D.
Thomas A. Widiger, Ph.D.
Kimberly A. Yonkers, M.D.
Helena Chmura Kraemer, Ph.D., Consultant

Externalizing Disorders and Personality Disorders

CARLOS BLANCO, M.D., PH.D.
Chairperson
Lee Anna Clark, Ph.D.
Richard B. Krueger, M.D.
Christopher J. Patrick, Ph.D.
Marc A. Schuckit, M.D.

Body Systems Disorders

PETER DANIOLOS, M.D.
Chairperson
Cynthia A. Graham,
Ph.D. Debra K.
Katzman, M.D. B.
Timothy Walsh, M.D.
Joel Yager, M.D.

†
Died April 5, 2021.
xv

DSM-5 Task Force and Work Groups

DAVID J. KUPFER, M.D.
Task Force Chair
DARREL A. REGIER, M.D., M.P.H.
Task Force Vice-Chair
William E. Narrow, M.D., M.P.H., Research Director
Susan K. Schultz, M.D., Text Editor
Emily A. Kuhl, Ph.D., APA Text Editor
Dan G. Blazer, M.D., Ph.D., M.P.H.
Jack D. Burke Jr., M.D., M.P.H.
William T. Carpenter Jr., M.D.
F. Xavier Castellanos, M.D.
Wilson M. Compton, M.D., M.P.E.
Joel E. Dimsdale, M.D.
Javier I. Escobar, M.D., M.Sc.
Jan A. Fawcett, M.D.
Bridget F. Grant, Ph.D., Ph.D. (2009–)
Steven E. Hyman, M.D. (2007–2012)
Dilip V. Jeste, M.D. (2007–2011)
Helena C. Kraemer, Ph.D.
Daniel T. Mamah, M.D., M.P.E.
James P. McNulty, A.B., Sc.B.
Howard B. Moss, M.D. (2007–2009)
Charles P. O’Brien, M.D., Ph.D.
Roger Peele, M.D.
Katharine A. Phillips, M.D.
Daniel S. Pine, M.D.
Charles F. Reynolds III, M.D.
Maritza Rubio-Stipec, Sc.D.
David Shaffer, M.D.
Andrew E. Skodol II, M.D.
Susan E. Swedo, M.D.
B. Timothy Walsh, M.D.
Philip Wang, M.D., Dr.P.H. (2007–2012)
William M. Womack, M.D.
Kimberly A. Yonkers, M.D.
Kenneth J. Zucker, Ph.D.
Norman Sartorius, M.D., Ph.D., Consultant

APA Division of Research Staff on DSM-5

Darrel A. Regier, M.D., M.P.H., Director, Division of Research
William E. Narrow, M.D., M.P.H., Associate Director
Emily A. Kuhl, Ph.D., Senior Science Writer; Staff Text Editor
Diana E. Clarke, Ph.D., M.Sc., Research Statistician

Lisa H. Greiner, M.S.S.A., DSM-5 Field Trials Project Manager

Eve K. Moscicki, Sc.D., M.P.H., Director, Practice Research Network
S. Janet Kuramoto, Ph.D., M.H.S., Senior Scientific Research Associate, Practice
Research Network

Amy Porfiri, M.B.A. Director of Finance and Administration

Jennifer J. Shupinka, Assistant Director, DSM Operations
Seung-Hee Hong, DSM Senior Research Associate
Anne R. Hiller, DSM Research Associate
Alison S. Beale, DSM Research Associate
Spencer R. Case, DSM Research Associate

Joyce C. West, Ph.D., M.P.P., Health Policy Research Director, Practice Research
Network Farifteh F. Duffy, Ph.D., Quality Care Research Director, Practice
Research Network Lisa M. Countis, Field Operations Manager, Practice Research
Network

Christopher M. Reynolds, Executive Assistant

APA Office of the Medical Director

JAMES H. SCULLY JR., M.D.
Medical Director and CEO

xvi

Editorial and Coding Consultants

Michael B. First, M.D.
Maria N. Ward, M.Ed., RHIT, CCS-P

DSM-5 Work Groups

ADHD and Disruptive Behavior Disorders
DAVID SHAFFER, M.D.
Chair
F. XAVIER CASTELLANOS, M.D.
Co-Chair
Paul J. Frick, Ph.D., Text Coordinator
Glorisa Canino, Ph.D.
Terrie E. Moffitt, Ph.D.
Joel T. Nigg, Ph.D.
Luis Augusto Rohde, M.D., Sc.D.
Rosemary Tannock, Ph.D.
Eric A. Taylor, M.B.
Richard Todd, Ph.D., M.D. (d. 2008)

Anxiety, Obsessive-Compulsive Spectrum, Posttraumatic, and Dissociative

Disorders KATHARINE A. PHILLIPS, M.D.
Chair
Michelle G. Craske, Ph.D., Text Coordinator
J. Gavin Andrews, M.D.
Susan M. Bögels, Ph.D.
Matthew J. Friedman, M.D., Ph.D.
Eric Hollander, M.D. (2007–2009)
Roberto Lewis-Fernández, M.D., M.T.S.
Robert S. Pynoos, M.D., M.P.H.
Scott L. Rauch, M.D.
H. Blair Simpson, M.D., Ph.D.
David Spiegel, M.D.
Dan J. Stein, M.D., Ph.D.
Murray B. Stein, M.D.
Robert J. Ursano, M.D.
Hans-Ulrich Wittchen, Ph.D.

Childhood and Adolescent Disorders

DANIEL S. PINE, M.D.
Chair
Ronald E. Dahl, M.D.
E. Jane Costello, Ph.D. (2007–2009)
Regina Smith James, M.D.
Rachel G. Klein, Ph.D.
James F. Leckman, M.D.
Ellen Leibenluft, M.D.
Judith H. L. Rapoport, M.D.
Charles H. Zeanah, M.D.

Eating Disorders
B. TIMOTHY WALSH, M.D.
Chair
Stephen A. Wonderlich, Ph.D., Text
Coordinator Evelyn Attia, M.D.
Anne E. Becker, M.D., Ph.D., Sc.M.
Rachel Bryant-Waugh, M.D.
Hans W. Hoek, M.D., Ph.D.
Richard E. Kreipe, M.D.
Marsha D. Marcus, Ph.D.
James E. Mitchell, M.D.
Ruth H. Striegel-Moore, Ph.D.
G. Terence Wilson, Ph.D.
Barbara E. Wolfe, Ph.D., A.P.R.N.

xvii

Mood Disorders
JAN A. FAWCETT, M.D.
Chair
Ellen Frank, Ph.D., Text Coordinator
Jules Angst, M.D. (2007–2008)
William H. Coryell, M.D.
Lori L. Davis, M.D.
Raymond J. DePaulo, M.D.
Sir David Goldberg, M.D.
James S. Jackson, Ph.D.
Kenneth S. Kendler, M.D. (2007–2010)
Mario Maj, M.D., Ph.D.
Husseini K. Manji, M.D. (2007–2008)
Michael R. Phillips, M.D.
Trisha Suppes, M.D., Ph.D.
Carlos A. Zarate, M.D.

Neurocognitive Disorders
DILIP V. JESTE, M.D. (2007–2011)
Chair Emeritus
DAN G. BLAZER, M.D., PH.D., M.P.H.
Chair
RONALD C. PETERSEN, M.D., PH.D.
Co-Chair
Mary Ganguli, M.D., M.P.H., Text Coordinator
Deborah Blacker, M.D., Sc.D.
Warachal Faison, M.D. (2007–2008)
Igor Grant, M.D.
Eric J. Lenze, M.D.
Jane S. Paulsen, Ph.D.
Perminder S. Sachdev, M.D., Ph.D.

Neurodevelopmental Disorders
SUSAN E. SWEDO, M.D.
Chair
Gillian Baird, M.A., M.B., B.Chir., Text
Coordinator Edwin H. Cook Jr., M.D.
Francesca G. Happé, Ph.D.
James C. Harris, M.D.
Walter E. Kaufmann, M.D.
Bryan H. King, M.D.
Catherine E. Lord, Ph.D.
Joseph Piven, M.D.
Sally J. Rogers, Ph.D.
Sarah J. Spence, M.D., Ph.D.
Rosemary Tannock, Ph.D.
Fred Volkmar, M.D. (2007–2009)
Amy M. Wetherby, Ph.D.
Harry H. Wright, M.D.

Personality and Personality Disorders1

ANDREW E. SKODOL, M.D.
Chair
JOHN M. OLDHAM, M.D.
Co-Chair
Robert F. Krueger, Ph.D., Text Coordinator
Renato D. Alarcón, M.D., M.P.H.
Carl C. Bell, M.D.
Donna S. Bender, Ph.D.
Lee Anna Clark, Ph.D.
W. John Livesley, M.D., Ph.D. (2007–2012)
Leslie C. Morey, Ph.D.
Larry J. Siever, M.D.
Roel Verheul, Ph.D. (2008–2012)

xviii

Psychotic Disorders
WILLIAM T. CARPENTER JR., M.D.
Chair
Deanna M. Barch, Ph.D., Text Coordinator
Juan R. Bustillo, M.D.
Wolfgang Gaebel, M.D.
Raquel E. Gur, M.D., Ph.D.
Stephan H. Heckers, M.D.
Dolores Malaspina, M.D., M.S.P.H.
Michael J. Owen, M.D., Ph.D.
Susan K. Schultz, M.D.
Rajiv Tandon, M.D.
Ming T. Tsuang, M.D., Ph.D.
Jim van Os, M.D.

Sexual and Gender Identity Disorders

KENNETH J. ZUCKER, PH.D.
Chair
Lori Brotto, Ph.D., Text Coordinator
Irving M. Binik, Ph.D.
Ray M. Blanchard, Ph.D.
Peggy T. Cohen-Kettenis, Ph.D.
Jack Drescher, M.D.
Cynthia A. Graham, Ph.D.
Martin P. Kafka, M.D.
Richard B. Krueger, M.D.
Niklas Långström, M.D., Ph.D.
Heino F.L. Meyer-Bahlburg, Dr. rer. nat.
Friedemann Pfäfflin, M.D.
Robert Taylor Segraves, M.D., Ph.D.
Sleep-Wake Disorders
CHARLES F. REYNOLDS III, M.D.
Chair
Ruth M. O’Hara, Ph.D., Text Coordinator
Charles M. Morin, Ph.D.
Allan I. Pack, Ph.D.
Kathy P. Parker, Ph.D., R.N.
Susan Redline, M.D., M.P.H.
Dieter Riemann, Ph.D.

Somatic Symptom Disorders

JOEL E. DIMSDALE, M.D.
Chair
James L. Levenson, M.D., Text Coordinator
Arthur J. Barsky III, M.D.
Francis Creed, M.D.
Nancy Frasure-Smith, Ph.D. (2007–2011)
Michael R. Irwin, M.D.
Francis J. Keefe, Ph.D. (2007–2011)
Sing Lee, M.D.
Michael Sharpe, M.D.
Lawson R. Wulsin, M.D.

Substance-Related Disorders
CHARLES P. O’BRIEN, M.D., PH.D.
Chair
THOMAS J. CROWLEY, M.D.
Co-Chair
Wilson M. Compton, M.D., M.P.E., Text
Coordinator Marc Auriacombe, M.D.
Guilherme L. G. Borges, M.D., Dr.Sc.
Kathleen K. Bucholz, Ph.D.
Alan J. Budney, Ph.D.
Bridget F. Grant, Ph.D., Ph.D.
Deborah S. Hasin, Ph.D.
Thomas R. Kosten, M.D. (2007–2008)
Walter Ling, M.D.
Spero M. Manson, Ph.D. (2007-2008)
A. Thomas McLellan, Ph.D. (2007–2008)
Nancy M. Petry, Ph.D.
Marc A. Schuckit, M.D.
Wim van den Brink, M.D., Ph.D. (2007–2008)

xix

DSM-5 Study Groups

Diagnostic Spectra and DSM/ICD Harmonization
STEVEN E. HYMAN, M.D.
Chair (2007–2012)
William T. Carpenter Jr., M.D.
Wilson M. Compton, M.D., M.P.E.
Jan A. Fawcett, M.D.
Helena C. Kraemer, Ph.D.
David J. Kupfer, M.D.
William E. Narrow, M.D., M.P.H.
Charles P. O’Brien, M.D., Ph.D.
John M. Oldham, M.D.
Katharine A. Phillips, M.D.
Darrel A. Regier, M.D., M.P.H.

Lifespan Developmental Approaches

ERIC J. LENZE, M.D.
Chair
SUSAN K. SCHULTZ, M.D.
Chair Emeritus
DANIEL S. PINE, M.D.
Chair Emeritus
Dan G. Blazer, M.D., Ph.D., M.P.H.
F. Xavier Castellanos, M.D.
Wilson M. Compton, M.D., M.P.E.
Daniel T. Mamah, M.D., M.P.E.
Andrew E. Skodol II, M.D.
Susan E. Swedo, M.D.

Gender and Cross-Cultural Issues

KIMBERLY A. YONKERS, M.D.
Chair
ROBERTO LEWIS-FERNÁNDEZ, M.D., M.T.S.
Co-Chair, Cross-Cultural Issues
Renato D. Alarcón, M.D., M.P.H.
Diana E. Clarke, Ph.D., M.Sc.
Javier I. Escobar, M.D., M.Sc.
Ellen Frank, Ph.D.
James S. Jackson, Ph.D.
Spero M. Manson, Ph.D. (2007–2008)
James P. McNulty, A.B., Sc.B.
Leslie C. Morey, Ph.D.
William E. Narrow, M.D., M.P.H.
Roger Peele, M.D.
Philip Wang, M.D., Dr.P.H. (2007–2012)
William M. Womack, M.D.
Kenneth J. Zucker, Ph.D.

Psychiatric/General Medical Interface

LAWSON R. WULSIN, M.D.
Chair
Ronald E. Dahl, M.D.
Joel E. Dimsdale, M.D.
Javier I. Escobar, M.D., M.Sc.
Dilip V. Jeste, M.D. (2007–2011)
Walter E. Kaufmann, M.D.
Richard E. Kreipe, M.D.
Ronald C. Petersen, M.D., Ph.D.
Charles F. Reynolds III, M.D.
Robert Taylor Segraves, M.D., Ph.D.
B. Timothy Walsh, M.D.

xx

Impairment and Disability

JANE S. PAULSEN, PH.D.
Chair
J. Gavin Andrews, M.D.
Glorisa Canino, Ph.D.
Lee Anna Clark, Ph.D.
Diana E. Clarke, Ph.D., M.Sc.
Michelle G. Craske, Ph.D.
Hans W. Hoek, M.D., Ph.D.
Helena C. Kraemer, Ph.D.
William E. Narrow, M.D., M.P.H.
David Shaffer, M.D.

Diagnostic Assessment Instruments

JACK D. BURKE JR., M.D., M.P.H.
Chair
Lee Anna Clark, Ph.D.
Diana E. Clarke, Ph.D., M.Sc.
Bridget F. Grant, Ph.D., Ph.D.
Helena C. Kraemer, Ph.D.
William E. Narrow, M.D., M.P.H.
David Shaffer, M.D.

DSM-5 Research Group

WILLIAM E. NARROW, M.D., M.P.H.
Chair
Jack D. Burke Jr., M.D., M.P.H.
Diana E. Clarke, Ph.D., M.Sc.
Helena C. Kraemer, Ph.D.
David J. Kupfer, M.D.
Darrel A. Regier, M.D., M.P.H.
David Shaffer, M.D.

Course Specifiers and Glossary

WOLFGANG GAEBEL, M.D.
Chair
Ellen Frank, Ph.D.
Charles P. O’Brien, M.D., Ph.D.
Norman Sartorius, M.D., Ph.D., Consultant
Susan K. Schultz, M.D.
Dan J. Stein, M.D., Ph.D.
Eric A. Taylor, M.B.
David J. Kupfer, M.D.
Darrel A. Regier, M.D., M.P.H.
1
The members of the Personality and Personality Disorders Work Group are responsible for the alternative DSM-5
model for personality disorders that is included in Section III. The Section II personality disorders criteria and text (with
updating of the text) are retained from DSM-IV-TR.
xxi

Preface to DSM-5-TR
The American Psychiatric Association’s Diagnostic and Statistical Manual of
Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), is the first published revision
to DSM-5. This revised manual integrates the original published DSM-5 diagnostic
criteria with modifications (mostly for clarity) for over 70 disorders, comprehensively
updated descriptive text accompanying each of the DSM disorders based on reviews of
the literature since the publication of DSM-5, and the addition of a new diagnosis,
prolonged grief disorder, and symptom codes for reporting suicidal and nonsuicidal self-
injurious behavior. These changes differ from the scope of the prior text revision, DSM-
IV-TR, in which the updates were confined almost exclusively to the text, leaving the
diagnostic criteria virtually unchanged. This edition also integrates all prior online
updates made to DSM-5 after its publication in 2013, in response to usage, specific
scientific advances, and ICD-10-CM coding adjustments through an iterative revision
process. Consequently, DSM-5-TR is the product of three separate revision processes,
each one overseen by separate (but overlapping) groups of experts: the development of
the original DSM-5 diagnostic criteria and text by the DSM-5 Task Force, published in
2013; updates to the DSM-5 diagnostic criteria and text by the DSM Steering Committee,
which has overseen the iterative revision process; and fully updated text overseen by the
Revision Subcommittee.
The clinical and research understanding of mental disorders continues to advance.
As a result, most of the DSM-5-TR disorder texts have had at least some revision since
the 9 years from original publication in DSM-5, with the overwhelming majority having
had significant revisions. Sections of the text that were most extensively updated were
Prevalence, Risk and Prognostic Factors, Culture-Related Diagnostic Issues, Sex- and
Gender-Related Diagnostic Issues, Association With Suicidal Thoughts or Behavior, and
Comorbidity. Also, for the first time ever, the entire DSM text has been reviewed and
revised by a Work Group on Ethnoracial Equity and Inclusion to ensure appropriate
attention to risk factors such as the experience of racism and discrimination, as well as
to the use of non-stigmatizing language. For future periodic DSM-5-TR coding and other
updates, see www.dsm5.org.
For benefit of reference in this manual, “DSM” refers generally to DSM as an entity,
not specifying a particular edition (e.g., “Clinical training and experience are needed to
use DSM for determining a clinical diagnosis.”). “DSM-5” refers to the entire set of
currently approved criteria sets, disorders, other conditions, and content officially
published in May 2013. “DSM-5- TR” refers to approved text in this current volume.
Although the scope of the text revision did not include conceptual changes to the criteria
sets or to other DSM-5 constructs, the need to make changes in certain diagnostic
criteria sets for the purpose of clarification became apparent in conjunction with the text
updates made across the book. Because the conceptual construct of criteria is
unchanged, the criteria sets in DSM-5-TR that had their origins in DSM-5 are still
referred to as “DSM-5-criteria.” The new diagnostic entity prolonged grief disorder is
referred to
as a DSM-5-TR disorder, because of its addition in this volume.
The development of DSM-5-TR was a tremendous team effort. We are especially
indebted to the tireless efforts of Wilson M. Compton, M.D., M.P.E., and Daniel S. Pine,
M.D., as DSM-5 Text Revision Subcommittee Vice Chairs, as well as the more than 200
experts from across our field who did the lion’s share of the work in the preparation of
the text revision. We would also like to thank Paul Appelbaum, M.D., Chair of the DSM
Steering

xxii

Committee, along with the entire DSM Steering Committee, for their careful review of the
text and criteria clarifications, and for making other helpful suggestions. Special gratitude
goes to Ann M. Eng, DSM Managing Editor, for her timely shepherding of the DSM-5-TR
development process from planning to completion and for her meticulous attention to
detail, all critical to the success of this revision. We are grateful for the valuable
contributions and help of Nitin Gogtay, M.D., Chief of the American Psychiatric
Association Division of Research and Deputy Medical Director; Diana E. Clarke, Ph.D.,
Managing Director of Research and Senior Research Statistician/Epidemiologist; and
Lamyaa H. Yousif, M.D., Ph.D., M.Sc., Senior DSM Operations Manager and Research
Associate. We are thankful for the leadership of John McDuffie, Publisher, American
Psychiatric Association Publishing, and the work of the following editorial and production
staff at American Psychiatric Association Publishing in bringing this important work to
fruition: Greg Kuny, Managing Editor, Books; Tammy Cordova, Graphic Design
Manager; Andrew Wilson, Director of Production; Judy Castagna, Assistant Director of
Production Services; Erika Parker, Acquisitions Editor; Alisa Riccardi, Senior Editor,
Books; and Carrie Y. Farnham, Senior Editor, Books. Finally, we also recognize with
appreciation Saul Levin, M.D., M.P.A., CEO and Medical Director of the American
Psychiatric Association, for his advocacy and support of this comprehensive text
revision.

Michael B. First, M.D.

Revision Subcommittee Co-Chair and DSM-5-TR Editor
Philip Wang, M.D., Dr.P.H.
Revision Subcommittee Co-Chair
November 5, 2021
xxiii

Preface to DSM-5

The American Psychiatric Association’s Diagnostic and Statistical Manual of

Mental Disorders (DSM) is a classification of mental disorders with associated criteria
designed to facilitate more reliable diagnoses of these disorders. With successive
editions over the past 60 years, it has become a standard reference for clinical practice
in the mental health field. Since a complete description of the underlying pathological
processes is not possible for most mental disorders, it is important to emphasize that the
current diagnostic criteria are the best available description of how mental disorders are
expressed and can be recognized by trained clinicians. DSM is intended to serve as a
practical, functional, and flexible guide for organizing information that can aid in the
accurate diagnosis and treatment of mental disorders. It is a tool for clinicians, an
essential educational resource for students and practitioners, and a reference for
researchers in the field.
Although this edition of DSM was designed first and foremost to be a useful guide to
clinical practice, as an official nomenclature it must be applicable in a wide diversity of
contexts. DSM has been used by clinicians and researchers from different orientations
(biological, psychodynamic, cognitive, behavioral, interpersonal, family/systems), all of
whom strive for a common language to communicate the essential characteristics of
mental disorders presented by their patients. The information is of value to all
professionals associated with various aspects of mental health care, including
psychiatrists, other physicians, psychologists, social workers, nurses, counselors,
forensic and legal specialists, occupational and rehabilitation therapists, and other health
professionals. The criteria are concise and explicit and intended to facilitate an objective
assessment of symptom presentations in a variety of clinical settings—inpatient,
outpatient, partial hospital, consultation-liaison, clinical, private practice, and primary care
—as well in general community epidemiological studies of mental disorders. DSM-5 is
also a tool for collecting and communicating accurate public health statistics on mental
disorder morbidity and mortality rates. Finally, the criteria and corresponding text serve
as a textbook for students early in their profession who need a structured way to
understand and diagnose mental disorders as well as for seasoned professionals
encountering rare disorders for the first time. Fortunately, all of these uses are mutually
compatible.
These diverse needs and interests were taken into consideration in planning DSM-5.
The classification of disorders is harmonized with the World Health Organization’s
International Classification of Diseases (ICD), the official coding system used in the
United States, so that the DSM criteria define disorders identified by ICD diagnostic
names and code numbers. In DSM-5, both ICD-9-CM and ICD-10-CM codes (the latter
scheduled for adoption in October 2015) are attached to the relevant disorders in the
classification.
Although DSM-5 remains a categorical classification of separate disorders, we
recognize that mental disorders do not always fit completely within the boundaries of a
single disorder. Some symptom domains, such as depression and anxiety, involve
multiple diagnostic categories and
may reflect common underlying vulnerabilities for a larger group of disorders. In
recognition of this reality, the disorders included in DSM-5 were reordered into a revised
organizational structure meant to stimulate new clinical perspectives. This new structure
corresponds with the organizational arrangement of disorders planned for ICD-11
scheduled for release in 2015. Other enhancements have been introduced to promote
ease of use across all settings:

xxiv

Representation of developmental issues related to diagnosis. The change in chapter organization better
reflects a lifespan approach, with disorders more frequently diagnosed in childhood (e.g., neurodevelopmental
disorders) at the beginning of the manual and disorders more applicable to older adulthood (e.g., neurocognitive
disorders) at the end of the manual. Also, within the text, subheadings on development and course provide
descriptions of how disorder presentations may change across the lifespan. Age-related factors specific to
diagnosis (e.g., symptom presentation and prevalence differences in certain age groups) are also included in the
text. For added emphasis, these age-related factors have been added to the criteria themselves where applicable
(e.g., in the criteria sets for insomnia disorder and posttraumatic stress disorder, specific criteria describe how
symptoms might be expressed in children). Likewise, gender and cultural issues have been integrated into the
disorders where applicable.
Integration of scientific findings from the latest research in genetics and neuroimaging. The revised
chapter structure was informed by recent research in neuroscience and by emerging genetic linkages between
diagnostic groups. Genetic and physiological risk factors, prognostic indicators, and some putative diagnostic
markers are highlighted in the text. This new structure should improve clinicians’ ability to identify diagnoses in a
disorder spectrum based on common neurocircuitry,
genetic vulnerability, and environmental exposures.
Consolidation of autistic disorder, Asperger’s disorder, and pervasive developmental disorder into autism
spectrum disorder. Symptoms of these disorders represent a single continuum of mild to severe impairments in
the two domains of social communication and restrictive repetitive behaviors/interests rather than being distinct
disorders. This change is designed to improve the sensitivity and specificity of the criteria for the diagnosis of
autism spectrum disorder and to identify more focused treatment targets for the specific impairments identified.
Streamlined classification of bipolar and depressive disorders. Bipolar and depressive disorders are the
most commonly diagnosed conditions in psychiatry. It was therefore important to streamline the presentation of
these disorders to enhance both clinical and educational use. Rather than separating the definition of manic,
hypomanic, and major depressive episodes from the definition of bipolar I disorder, bipolar II disorder, and major
depressive disorder as in the previous edition, we included all of the component criteria within the respective
criteria for each disorder. This approach will facilitate bedside diagnosis and treatment of these important
disorders. Likewise, the explanatory notes for differentiating bereavement and major depressive disorder will
provide far greater clinical guidance than was previously provided in the simple bereavement exclusion criterion.
The new specifiers of anxious distress and mixed features are now fully described in the narrative on specifier
variations that accompanies the criteria for these disorders.
Restructuring of substance use disorders for consistency and clarity. The categories of substance abuse
and substance dependence have been eliminated and replaced with an overarching new category of substance
use disorders—with the specific substance used defining the specific disorders. “Dependence” has been easily
confused with the term “addiction” when, in fact, the tolerance and withdrawal that previously defined dependence
are actually very normal responses to prescribed medications that affect the central nervous system and do not
necessarily indicate the presence of an addiction. By revising and clarifying these criteria in DSM-5, we hope to
alleviate some of the widespread misunderstanding about these issues.
Enhanced specificity for major and mild neurocognitive disorders. Given the explosion in neuroscience,
neuropsychology, and brain imaging over the past 20 years, it was critical to convey the current state-of-the-art in
the diagnosis of specific types of disorders that were previously referred to as the “dementias” or organic brain
diseases. Biological markers identified by imaging for vascular and traumatic brain disorders and

xxv

specific molecular genetic findings for rare variants of Alzheimer’s disease and Huntington’s disease have greatly
advanced clinical diagnoses, and these disorders and others have now been separated into specific subtypes.
Transition in conceptualizing personality disorders. Although the benefits of a more dimensional approach to
personality disorders have been identified in previous editions, the transition from a categorical diagnostic system
of individual disorders to one based on the relative distribution of personality traits has not been widely accepted.
In DSM-5, the categorical personality disorders are virtually unchanged from the previous edition. However, an
alternative “hybrid” model has been proposed in Section III to guide future research that separates interpersonal
functioning assessments and the expression of pathological personality traits for six specific disorders. A more
dimensional profile of personality trait expression is also proposed for a trait-specified approach.
Section III: new disorders and features. A new section (Section III) has been added to highlight disorders that
require further study but are not sufficiently well established to be a part of the official classification of mental
disorders for routine clinical use. Dimensional measures of symptom severity in 13 symptom domains have also
been incorporated to allow for the measurement of symptom levels of varying severity across all diagnostic
groups. Likewise, the WHO Disability Assessment Schedule (WHODAS), a standard method for assessing global
disability levels for mental disorders that is based on the International Classification of Functioning, Disability and
Health (ICF) and is applicable in all of medicine, has been provided to replace the more limited Global
Assessment of Functioning scale. It is our hope that as these measures are implemented over time, they will
provide greater accuracy and flexibility in the clinical description of individual symptomatic presentations and
associated disability during diagnostic assessments.
Online enhancements. DSM-5 features online supplemental information. Additional cross-cutting and diagnostic
severity measures are available online (www.psychiatry.org/dsm5), linked to the relevant disorders. In addition,
the Cultural Formulation Interview, Cultural Formulation Interview—Informant Version, and supplementary
modules to the core Cultural Formulation Interview are also included online at www.psychiatry.org/dsm5.

These innovations were designed by the leading authorities on mental disorders in

the world and were implemented on the basis of their expert review, public commentary,
and independent peer review. The 13 work groups, under the direction of the DSM-5
Task Force, in conjunction with other review bodies and, eventually, the APA Board of
Trustees, collectively represent the global expertise of the specialty. This effort was
supported by an extensive base of advisors and by the professional staff of the APA
Division of Research; the names of everyone involved are too numerous to mention here
but are listed in the Appendix. We owe tremendous thanks to those who devoted
countless hours and invaluable expertise to this effort to improve the diagnosis of mental
disorders.
We would especially like to acknowledge the chairs, text coordinators, and members
of the 13 work groups, listed in the front of the manual, who spent many hours in this
volunteer effort to improve the scientific basis of clinical practice over a sustained 6-year
period. Susan K. Schultz, M.D., who served as text editor, worked tirelessly with Emily A.
Kuhl, Ph.D., senior science writer and DSM-5 staff text editor, to coordinate the efforts of
the work groups into a
cohesive whole. William E. Narrow, M.D., M.P.H., led the research group that developed
the overall research strategy for DSM-5, including the field trials, that greatly enhanced
the evidence base for this revision. In addition, we are grateful to those who contributed
so much time to the independent review of the revision proposals, including Kenneth S.
Kendler, M.D., and Robert Freedman, M.D., co-chairs of the Scientific Review
Committee; John S. McIntyre, M.D., and Joel Yager, M.D., co-chairs of the Clinical and
Public Health Committee; and Glenn Martin, M.D., chair of the APA Assembly

xxvi

review process. Special thanks go to Helena C. Kraemer, Ph.D., for her expert statistical
consultation; Michael B. First, M.D., for his valuable input on the coding and review of
criteria; and Paul S. Appelbaum, M.D., for feedback on forensic issues. Maria N. Ward,
M.Ed., RHIT, CCS-P, also helped in verifying all ICD coding. The Summit Group, which
included these consultants, the chairs of all review groups, the task force chairs, and the
APA executive officers, chaired by Dilip V. Jeste, M.D., provided leadership and vision in
helping to achieve compromise and consensus. This level of commitment has
contributed to the balance and objectivity that we feel are hallmarks of DSM-5.
We especially wish to recognize the outstanding APA Division of Research staff—
identified in the Task Force and Work Group listing at the front of this manual—who
worked tirelessly to interact with the task force, work groups, advisors, and reviewers to
resolve issues, serve as liaisons between the groups, direct and manage the academic
and routine clinical practice field trials, and record decisions in this important process. In
particular, we appreciate the support and guidance provided by James H. Scully Jr.,
M.D., Medical Director and CEO of the APA, through the years and travails of the
development process. Finally, we thank the editorial and production staff of American
Psychiatric Publishing—specifically, Rebecca Rinehart, Publisher; John McDuffie,
Editorial Director; Ann Eng, Senior Editor; Greg Kuny, Managing Editor; and Tammy
Cordova, Graphics Design Manager—for their guidance in bringing this all together and
creating the final product. It is the culmination of efforts of many talented individuals who
dedicated their time, expertise, and passion that made DSM-5 possible.

David J. Kupfer, M.D.

DSM-5 Task Force Chair
Darrel A. Regier, M.D., M.P.H.
DSM-5 Task Force Vice-Chair
December 19, 2012
xxvii
DSM-5-TR Classification

Before each disorder name, ICD-10-CM codes are provided. Blank lines indicate that the
ICD 10-CM code depends on the applicable subtype, specifier, or class of substance.
For periodic DSM-5-TR coding and other updates, see www.dsm5.org.
Following chapter titles and disorder names, page numbers for the corresponding
text or criteria are included in parentheses.
Note for all mental disorders due to another medical condition: Insert the name
of the etiological medical condition within the name of the mental disorder due to [the
medical condition]. The code and name for the etiological medical condition should be
listed first immediately before the mental disorder due to the medical condition.

Neurodevelopmental Disorders (35)

Intellectual Developmental Disorders (37)
___.__ Intellectual Developmental Disorder (Intellectual Disability) (37)
Specify current severity:
F70 Mild
F71 Moderate
F72 Severe
F73 Profound
F88 Global Developmental Delay (46)
F79 Unspecified Intellectual Developmental Disorder (Intellectual Disability) (46)
Communication Disorders (46)
F80.2 Language Disorder (47)
F80.0 Speech Sound Disorder (50)
F80.81 Childhood-Onset Fluency Disorder (Stuttering) (51)
Note: Later-onset cases are diagnosed as F98.5 adult-onset fluency disorder.
F80.82 Social (Pragmatic) Communication Disorder (54)
F80.9 Unspecified Communication Disorder (56)

xxviii

Autism Spectrum Disorder (56)

F84.0 Autism Spectrum Disorder (56)
Specify current severity: Requiring very substantial support, Requiring substantial support,
Requiring support
Specify if: With or without accompanying intellectual impairment, With or without
accompanying language impairment
Specify if: Associated with a known genetic or other medical condition or environmental factor
(Coding note: Use additional code to identify the associated genetic or other medical
condition); Associated with a neurodevelopmental, mental, or behavioral problem
Specify if: With catatonia (use additional code F06.1)
Attention-Deficit/Hyperactivity Disorder (68)
___.__ Attention-Deficit/Hyperactivity Disorder (68)
Specify if: In partial remission
Specify current severity: Mild, Moderate, Severe
Specify whether:
F90.2 Combined presentation
F90.0 Predominantly inattentive presentation
F90.1 Predominantly hyperactive/impulsive presentation F90.8
Other Specified Attention-Deficit/Hyperactivity Disorder (76)
F90.9 Unspecified Attention-Deficit/Hyperactivity Disorder (76)
Specific Learning Disorder (76)
___.__ Specific Learning Disorder (76)
Specify current severity: Mild, Moderate, Severe
Specify if:
F81.0 With impairment in reading (specify if with word reading accuracy, reading
rate or fluency, reading comprehension)
F81.81 With impairment in written expression (specify if with spelling accuracy,
grammar and punctuation accuracy, clarity or organization of
written
expression)
F81.2 With impairment in mathematics (specify if with number sense,
memorization of arithmetic facts, accurate or fluent
calculation,
accurate math reasoning)
Motor Disorders (85)
F82 Developmental Coordination Disorder (85)
F98.4 Stereotypic Movement Disorder (89)
Specify if: With self-injurious behavior, Without self-injurious behavior
Specify if: Associated with a known genetic or other medical condition, neurodevelopmental
disorder, or environmental factor
Specify current severity: Mild, Moderate, Severe
Tic Disorders
F95.2 Tourette's Disorder (93)
F95.1 Persistent (Chronic) Motor or Vocal Tic Disorder (93)
Specify if: With motor tics only, With vocal tics only
xxix

F95.0 Provisional Tic Disorder (93)

F95.8 Other Specified Tic Disorder (98)
F95.9 Unspecified Tic Disorder (98)
Other Neurodevelopmental Disorders (99)
F88 Other Specified Neurodevelopmental Disorder (99)
F89 Unspecified Neurodevelopmental Disorder (99)

Schizophrenia Spectrum and Other Psychotic Disorders (101)

a
The following specifiers apply to Schizophrenia Spectrum and Other Psychotic Disorders where indicated: Specify
if: The following course specifiers are only to be used after a 1-year duration of the disorder: First episode, currently
in acute episode; First episode, currently in partial remission; First episode, currently in full remission; Multiple
episodes, currently in acute episode; Multiple episodes, currently in partial remission; Multiple episodes, currently in
full remission; Continuous; Unspecified
b
Specify if: With catatonia (use additional code F06.1)
c
Specify current severity of delusions, hallucinations, disorganized speech, abnormal psychomotor behavior,
negative symptoms, impaired cognition, depression, and mania symptoms
F21 Schizotypal (Personality) Disorder (104)
F22 Delusional Disordera,c(104)
Specify whether: Erotomanic type, Grandiose type, Jealous type, Persecutory type,
Somatic type, Mixed type, Unspecified type
Specify if: With bizarre content
F23 Brief Psychotic Disorderb,c(108)
Specify if: With marked stressor(s), Without marked stressor(s), With peripartum onset
F20.81 Schizophreniform Disorderb,c(111)
Specify if: With good prognostic features, Without good prognostic features
F20.9 Schizophreniaa,b,c(113)
a,b,c
___.__ Schizoaffective Disorder (121)
Specify whether:
F25.0 Bipolar type
F25.1 Depressive type
c
___.__ Substance/Medication-Induced Psychotic Disorder (126)
Note: For applicable ICD-10-CM codes, refer to the substance classes under Substance-
Related and Addictive Disorders for the specific substance/medication-induced psychotic
disorder. See also the criteria set and corresponding recording procedures in the manual
for more information.
Coding note: The ICD-10-CM code depends on whether or not there is a comorbid
substance use disorder present for the same class of substance. In any case, an
additional separate diagnosis of a substance use disorder is not given.
Specify if: With onset during intoxication, With onset during withdrawal, With onset after
medication use

xxx
c
___.__ Psychotic Disorder Due to Another Medical Condition (131)
Specify whether:
F06.2 With delusions
F06.0 With hallucinations
F06.1 Catatonia Associated With Another Mental Disorder (Catatonia Specifier) (135) F06.1
Catatonic Disorder Due to Another Medical Condition (136)
F06.1 Unspecified Catatonia (137)
Note: Code first R29.818 other symptoms involving nervous and musculoskeletal systems.
F28 Other Specified Schizophrenia Spectrum and Other Psychotic Disorder (138) F29
Unspecified Schizophrenia Spectrum and Other Psychotic Disorder (138)

Bipolar and Related Disorders (139)

The following specifiers apply to Bipolar and Related Disorders where indicated:
a
Specify: With anxious distress (specify current severity: mild, moderate, moderate-severe, severe); With mixed
features; With rapid cycling; With melancholic features; With atypical features; With mood-congruent psychotic
features; With mood incongruent psychotic features; With catatonia (use additional code F06.1); With peripartum
onset; With seasonal pattern
b
Specify: With anxious distress (specify current severity: mild, moderate, moderate-severe, severe); With mixed
features; With rapid cycling; With peripartum onset; With seasonal pattern
a
___.__ Bipolar I Disorder (139)
___.__ Current or most recent episode manic
F31.11 Mild
F31.12 Moderate
F31.13 Severe
F31.2 With psychotic features
F31.73 In partial remission
F31.74 In full remission
F31.9 Unspecified
F31.0 Current or most recent episode hypomanic
F31.71 In partial remission
F31.72 In full remission
F31.9 Unspecified
___.__ Current or most recent episode depressed
F31.31 Mild
F31.32 Moderate
F31.4 Severe
F31.5 With psychotic features
F31.75 In partial remission
F31.76 In full remission
F31.9 Unspecified
F31.9 Current or most recent episode unspecified

xxxi

F31.81 Bipolar II Disorder (150)

b a
Specify current or most recent episode: Hypomanic , Depressed
Specify course if full criteria for a mood episode are not currently met: In partial
remission, In full remission
Specify severity if full criteria for a major depressive episode are currently met: Mild, Moderate,
Severe
F34.0 Cyclothymic Disorder (159)
Specify if: With anxious distress (specify current severity: mild, moderate, moderate-
severe, severe) ___.__ Substance/Medication-Induced Bipolar and Related Disorder (162)
Note: For applicable ICD-10-CM codes, refer to the substance classes under Substance-
Related and Addictive Disorders for the specific substance/medication-induced bipolar and
related disorder. See also the criteria set and corresponding recording procedures in the
manual for more information.
Coding note: The ICD-10-CM code depends on whether or not there is a comorbid
substance use disorder present for the same class of substance. In any case, an
additional separate diagnosis of a substance use disorder is not given.
Specify if: With onset during intoxication, With onset during withdrawal, With onset after
medication use
___.__ Bipolar and Related Disorder Due to Another Medical Condition (166) Specify if:
F06.33 With manic features
F06.33 With manic- or hypomanic-like episode
F06.34 With mixed features
F31.89 Other Specified Bipolar and Related Disorder (168)
F31.9 Unspecified Bipolar and Related Disorder (169)
F39 Unspecified Mood Disorder (169)

Depressive Disorders (177)

F34.81 Disruptive Mood Dysregulation Disorder (178)
___.__ Major Depressive Disorder (183)
Specify: With anxious distress (specify current severity: mild, moderate, moderate-
severe, severe); With mixed features; With melancholic features; With atypical
features; With mood-congruent
psychotic features; With mood-incongruent psychotic features; With catatonia (use
additional code F06.1); With peripartum onset; With seasonal pattern
___.__ Single episode
F32.0 Mild
F32.1 Moderate
F32.2 Severe
F32.3 With psychotic features
F32.4 In partial remission
F32.5 In full remission
F32.9 Unspecified

xxxii

___.__ Recurrent episode

F33.0 Mild
F33.1 Moderate
F33.2 Severe
F33.3 With psychotic features
F33.41 In partial remission
F33.42 In full remission
F33.9 Unspecified
F34.1 Persistent Depressive Disorder (193)
Specify: With anxious distress (specify current severity: mild, moderate, moderate-
severe, severe); With atypical features
Specify if: In partial remission, In full remission
Specify if: Early onset, Late onset
Specify if: With pure dysthymic syndrome; With persistent major depressive episode; With
intermittent major depressive episodes, with current episode; With intermittent major
depressive episodes,
without current episode
Specify current severity: Mild, Moderate, Severe
F32.81 Premenstrual Dysphoric Disorder (197)
___.__ Substance/Medication-Induced Depressive Disorder (201)
Note: For applicable ICD-10-CM codes, refer to the substance classes under Substance-
Related and Addictive Disorders for the specific substance/medication-induced depressive
disorder. See also the criteria set and corresponding recording procedures in the manual
for more information.
Coding note: The ICD-10-CM code depends on whether or not there is a comorbid
substance use disorder present for the same class of substance. In any case, an
additional separate diagnosis of a substance use disorder is not given.
Specify if: With onset during intoxication, With onset during withdrawal, With onset after
medication use
___.__ Depressive Disorder Due to Another Medical Condition (206)
Specify if:
F06.31 With depressive features
F06.32 With major depressive–like episode
F06.34 With mixed features
F32.89 Other Specified Depressive Disorder (209)
F32.A Unspecified Depressive Disorder (210)
F39 Unspecified Mood Disorder (210)

Anxiety Disorders (215)

F93.0 Separation Anxiety Disorder (217)
F94.0 Selective Mutism (222)
___.__ Specific Phobia (224)
Specify if:
F40.218 Animal
F40.228 Natural environment
___.__ Blood-injection-injury

xxxiii

F40.230 Fear of blood

F40.231 Fear of injections and transfusions
F40.232 Fear of other medical care
F40.233 Fear of injury
F40.248 Situational
F40.298 Other
F40.10 Social Anxiety Disorder (229)
Specify if: Performance only
F41.0 Panic Disorder (235)
___.__ Panic Attack Specifier (242)
F40.00 Agoraphobia (246)
F41.1 Generalized Anxiety Disorder (250)
___.__ Substance/Medication-Induced Anxiety Disorder (255)
Note: For applicable ICD-10-CM codes, refer to the substance classes under Substance-
Related and Addictive Disorders for the specific substance/medication-induced anxiety
disorder. See also the criteria set and corresponding recording procedures in the manual
for more information.
Coding note: The ICD-10-CM code depends on whether or not there is a comorbid
substance use disorder present for the same class of substance. In any case, an
additional separate diagnosis of a substance use disorder is not given.
Specify if: With onset during intoxication, With onset during withdrawal, With onset after
medication use
F06.4 Anxiety Disorder Due to Another Medical Condition (258)
F41.8 Other Specified Anxiety Disorder (261)
F41.9Unspecified Anxiety Disorder (261)

Obsessive-Compulsive and Related Disorders (263)

The following specifier applies to Obsessive-Compulsive and Related Disorders where
a
indicated: Specify if: With good or fair insight, With poor insight, With absent
insight/delusional beliefs
F42.2 Obsessive-Compulsive Disordera(265)
Specify if: Tic-related
F45.22 Body Dysmorphic Disordera(271)
Specify if: With muscle dysmorphia
F42.3 Hoarding Disordera(277)
Specify if: With excessive acquisition
F63.3 Trichotillomania (Hair-Pulling Disorder) (281)
F42.4 Excoriation (Skin-Picking) Disorder (284)
___.__ Substance/Medication-Induced Obsessive-Compulsive and Related Disorder (287) Note: For applicable
ICD-10-CM codes, refer to the substance classes under Substance-Related and Addictive Disorders for the
specific substance/medication-induced obsessive-compulsive and
related disorder. See also the criteria set and corresponding recording procedures in the
manual for more information.

xxxiv
Coding note: The ICD-10-CM code depends on whether or not there is a comorbid
substance use disorder present for the same class of substance. In any case, an
additional separate diagnosis of a substance use disorder is not given.
Specify if: With onset during intoxication, With onset during withdrawal, With onset after
medication use
F06.8 Obsessive-Compulsive and Related Disorder Due to Another Medical Condition (291)
Specify if: With obsessive-compulsive disorder–like symptoms, With appearance
preoccupations, With hoarding symptoms, With hair-pulling symptoms, With skin-picking
symptoms
F42.8 Other Specified Obsessive-Compulsive and Related Disorder (293)
F42.9 Unspecified Obsessive-Compulsive and Related Disorder (294)

Trauma- and Stressor-Related Disorders (295)

F94.1 Reactive Attachment Disorder (295)
Specify if: Persistent
Specify current severity: Severe
F94.2 Disinhibited Social Engagement Disorder (298)
Specify if: Persistent
Specify current severity: Severe
F43.10 Posttraumatic Stress Disorder (301)
Specify whether: With dissociative symptoms
Specify if: With delayed expression
___.__ Posttraumatic Stress Disorder in Individuals Older Than 6 Years (301) ___.__
Posttraumatic Stress Disorder in Children 6 Years and Younger (303) F43.0 Acute
Stress Disorder (313)
___.__ Adjustment Disorders (319)
Specify if: Acute, Persistent (chronic)
Specify whether:
F43.21 With depressed mood
F43.22 With anxiety
F43.23 With mixed anxiety and depressed mood
F43.24 With disturbance of conduct
F43.25 With mixed disturbance of emotions and conduct F43.20
Unspecified
F43.8 Prolonged Grief Disorder (322)
F43.8 Other Specified Trauma- and Stressor-Related Disorder (327)
F43.9 Unspecified Trauma- and Stressor-Related Disorder (328)

Dissociative Disorders (329)

F44.81 Dissociative Identity Disorder (330)
F44.0 Dissociative Amnesia (337)

xxxv

Specify if:
F44.1 With dissociative fugue
F48.1 Depersonalization/Derealization Disorder (343)
F44.89 Other Specified Dissociative Disorder (347)
F44.9 Unspecified Dissociative Disorder (348)

Somatic Symptom and Related Disorders (349)

F45.1 Somatic Symptom Disorder (351)
Specify if: With predominant pain
Specify if: Persistent
Specify current severity: Mild, Moderate, Severe
F45.21 Illness Anxiety Disorder (357)
Specify whether: Care-seeking type, Care-avoidant type
___.__ Functional Neurological Symptom Disorder (Conversion Disorder) (360) Specify
if: Acute episode, Persistent
Specify if: With psychological stressor (specify stressor), Without psychological
stressor Specify symptom type:
F44.4 With weakness or paralysis
F44.4 With abnormal movement
F44.4 With swallowing symptoms
F44.4 With speech symptom
F44.5 With attacks or seizures
F44.6 With anesthesia or sensory loss
F44.6 With special sensory symptom
F44.7 With mixed symptoms
F54 Psychological Factors Affecting Other Medical Conditions (364) Specify
current severity: Mild, Moderate, Severe, Extreme
___.__ Factitious Disorder (367)
Specify: Single episode, Recurrent episodes
F68.10 Factitious Disorder Imposed on Self
F68.A Factitious Disorder Imposed on Another
F45.8 Other Specified Somatic Symptom and Related Disorder (370) F45.9
Unspecified Somatic Symptom and Related Disorder (370)

Feeding and Eating Disorders (371)

The following specifiers apply to Feeding and Eating Disorders where indicated:
a
Specify if: In remission
b
Specify if: In partial remission, In full remission
c
Specify current severity: Mild, Moderate, Severe, Extreme
___.__ Picaa(371)
F98.3 In children
F50.89 In adults

xxxvi

F98.21 Rumination Disordera(374)

F50.82 Avoidant/Restrictive Food Intake Disordera(376)
___.__ Anorexia Nervosab,c(381)
Specify whether:
F50.01 Restricting type
F50.02 Binge-eating/purging type
F50.2 Bulimia Nervosab,c(387)
F50.81 Binge-Eating Disorderb,c(392)
F50.89 Other Specified Feeding or Eating Disorder (396)
F50.9 Unspecified Feeding or Eating Disorder (397)

Elimination Disorders (399)

F98.0 Enuresis (399)
Specify whether: Nocturnal only, Diurnal only, Nocturnal and diurnal
F98.1 Encopresis (402)
Specify whether: With constipation and overflow incontinence, Without constipation and
overflow incontinence
___.__ Other Specified Elimination Disorder (405)
N39.498 With urinary symptoms
R15.9 With fecal symptoms
___.__ Unspecified Elimination Disorder (405)
R32 With urinary symptoms
R15.9 With fecal symptoms

Sleep-Wake Disorders (407)

The following specifiers apply to Sleep-Wake Disorders where indicated:
a
Specify if: Episodic, Persistent, Recurrent
b
Specify if: Acute, Subacute, Persistent
c
Specify current severity: Mild, Moderate, Severe
F51.01 Insomnia Disordera(409)
Specify if: With mental disorder, With medical condition, With another sleep disorder
F51.11 Hypersomnolence Disorderb,c(417)
Specify if: With mental disorder, With medical condition, With another sleep disorder
___.__ Narcolepsyc(422)
Specify whether:
G47.411 Narcolepsy with cataplexy or hypocretin deficiency (type 1)
G47.419 Narcolepsy without cataplexy and either without hypocretin deficiency or
hypocretin unmeasured (type 2)

xxxvii

G47.421 Narcolepsy with cataplexy or hypocretin deficiency due to a medical

condition
G47.429 Narcolepsy without cataplexy and without hypocretin deficiency due to a
medical condition
Breathing-Related Sleep Disorders (429)
G47.33 Obstructive Sleep Apnea Hypopneac(429)
___.__ Central Sleep Apnea (435)
Specify current severity
Specify whether:
G47.31 Idiopathic central sleep apnea
R06.3 Cheyne-Stokes breathing
G47.37 Central sleep apnea comorbid with opioid use
Note: First code opioid use disorder, if present.
___.__ Sleep-Related Hypoventilation (439)
Specify current severity
Specify whether:
G47.34 Idiopathic hypoventilation
G47.35 Congenital central alveolar hypoventilation
G47.36 Comorbid sleep-related hypoventilation

___.__ Circadian Rhythm Sleep-Wake Disordersa(443)

Specify whether:
G47.21 Delayed sleep phase type (444)
Specify if: Familial, Overlapping with non-24-hour sleep-wake type
G47.22 Advanced sleep phase type (446)
Specify if: Familial
G47.23 Irregular sleep-wake type (447)
G47.24 Non-24-hour sleep-wake type (448)
G47.26 Shift work type (450)
G47.20 Unspecified type

Parasomnias (451)
__.__ Non–Rapid Eye Movement Sleep Arousal Disorders (452)
Specify whether:
F51.3 Sleepwalking type
Specify if: With sleep-related eating, With sleep-related sexual
behavior (sexsomnia)
F51.4 Sleep terror type
F51.5 Nightmare Disorderb,c(457)
Specify if: During sleep onset
Specify if: With mental disorder, With medical condition, With another sleep disorder
G47.52 Rapid Eye Movement Sleep Behavior Disorder (461)

G25.81 Restless Legs Syndrome (464)

xxxviii

___.__ Substance/Medication-Induced Sleep Disorder (468)

Note: For applicable ICD-10-CM codes, refer to the substance classes under Substance-
Related and Addictive Disorders for the specific substance/medication-induced sleep
disorder. See also the
criteria set and corresponding recording procedures in the manual for more information.
Coding note: The ICD-10-CM code depends on whether or not there is a comorbid
substance use disorder present for the same class of substance. In any case, an
additional separate diagnosis of a substance use disorder is not given.
Specify whether: Insomnia type, Daytime sleepiness type, Parasomnia type, Mixed type
Specify if: With onset during intoxication, With onset during withdrawal, With onset after
medication use
G47.09 Other Specified Insomnia Disorder (475)
G47.00 Unspecified Insomnia Disorder (475)
G47.19 Other Specified Hypersomnolence Disorder (475)
G47.10 Unspecified Hypersomnolence Disorder (476)
G47.8 Other Specified Sleep-Wake Disorder (476)
G47.9 Unspecified Sleep-Wake Disorder (476)
Sexual Dysfunctions (477)
The following specifiers apply to Sexual Dysfunctions where indicated:
a
Specify whether: Lifelong, Acquired
b
Specify whether: Generalized, Situational
c
Specify current severity: Mild, Moderate, Severe
F52.32 Delayed Ejaculationa,b,c(478)
F52.21 Erectile Disordera,b,c(481)
F52.31 Female Orgasmic Disordera,b,c(485)
Specify if: Never experienced an orgasm under any situation
F52.22 Female Sexual Interest/Arousal Disordera,b,c(489)
F52.6 Genito-Pelvic Pain/Penetration Disordera,c(493)
F52.0 Male Hypoactive Sexual Desire Disordera,b,c(498)
F52.4 Premature (Early) Ejaculationa,b,c(501)
c
___.__ Substance/Medication-Induced Sexual Dysfunction (504)
Note: For applicable ICD-10-CM codes, refer to the substance classes under Substance-
Related and Addictive Disorders for the specific substance/medication-induced sexual
dysfunction. See also the criteria set and corresponding recording procedures in the
manual for more information.
Coding note: The ICD-10-CM code depends on whether or not there is a comorbid
substance use disorder present for the same class of substance. In any case, an
additional separate diagnosis of a substance use disorder is not given.
Specify if: With onset during intoxication, With onset during withdrawal, With onset after
medication use
F52.8 Other Specified Sexual Dysfunction (509)
F52.9 Unspecified Sexual Dysfunction (509)

xxxix

Gender Dysphoria (511)

The following specifier and note apply to Gender Dysphoria where indicated:
a
Specify if: With a disorder/difference of sex development
b
Note: Code the disorder/difference of sex development if present, in addition to gender
dysphoria. __.__ Gender Dysphoria (512)

F64.2 Gender Dysphoria in Childrena,b

F64.0 Gender Dysphoria in Adolescents and Adultsa,b
Specify if: Posttransition
F64.8 Other Specified Gender Dysphoria (520)
F64.9 Unspecified Gender Dysphoria (520)

Disruptive, Impulse-Control, and Conduct Disorders (521)

F91.3 Oppositional Defiant Disorder (522)
Specify current severity: Mild, Moderate, Severe
F63.81 Intermittent Explosive Disorder (527)
__.__ Conduct Disorder (530)
Specify if: With limited prosocial emotions
Specify current severity: Mild, Moderate, Severe
Specify whether:
F91.1 Childhood-onset type
F91.2 Adolescent-onset type
F91.9 Unspecified onset
F60.2 Antisocial Personality Disorder (537)
F63.1 Pyromania (537)
F63.2 Kleptomania (539)
F91.8 Other Specified Disruptive, Impulse-Control, and Conduct Disorder (541) F91.9
Unspecified Disruptive, Impulse-Control, and Conduct Disorder (541)

Substance-Related and Addictive Disorders (543)

Substance-Related Disorders (544)
Alcohol-Related Disorders (553)
___.__ Alcohol Use Disorder (553)
Specify if: In a controlled environment
Specify current severity/remission:
F10.10 Mild
F10.11 In early remission
F10.11 In sustained remission

xl

F10.20 Moderate
F10.21 In early remission
F10.21 In sustained remission
F10.20 Severe
F10.21 In early remission
F10.21 In sustained remission
___.__ Alcohol Intoxication (561)
F10.120 With mild use disorder
F10.220 With moderate or severe use disorder F10.920
Without use disorder
___.__ Alcohol Withdrawal (564)
Without perceptual disturbances
F10.130 With mild use disorder
F10.230 With moderate or severe use disorder F10.930
Without use disorder
With perceptual disturbances
F10.132 With mild use disorder
F10.232 With moderate or severe use disorder F10.932
Without use disorder
___.__ Alcohol-Induced Mental Disorders (567)
Note: Disorders are listed in their order of appearance in the manual.
a
Specify With onset during intoxication, With onset during withdrawal
b
Specify if: Acute, Persistent
c
Specify if: Hyperactive, Hypoactive, Mixed level of activity

___.__ Alcohol-Induced Psychotic Disordera(126) F10.159

With mild use disorder
F10.259 With moderate or severe use disorder F10.959
Without use disorder
___.__ Alcohol-Induced Bipolar and Related Disordera(162) F10.14
With mild use disorder
F10.24 With moderate or severe use disorder F10.94
Without use disorder
___.__ Alcohol-Induced Depressive Disordera(201) F10.14
With mild use disorder
F10.24 With moderate or severe use disorder F10.94
Without use disorder
___.__ Alcohol-Induced Anxiety Disordera(255) F10.180
With mild use disorder
F10.280 With moderate or severe use disorder F10.980
Without use disorder
___.__ Alcohol-Induced Sleep Disordera(468) Specify
whether Insomnia type
F10.182 With mild use disorder

xli

F10.282 With moderate or severe use disorder F10.982

Without use disorder
___.__ Alcohol-Induced Sexual Dysfunctiona(504) Specify if:
Mild, Moderate, Severe
F10.181 With mild use disorder
F10.281 With moderate or severe use disorder F10.981
Without use disorder
___.__ Alcohol Intoxication Deliriumb,c(672) F10.121
With mild use disorder
F10.221 With moderate or severe use disorder
F10.921 Without use disorder
___.__ Alcohol Withdrawal Deliriumb,c(673)
F10.131 With mild use disorder
F10.231 With moderate or severe use disorder
F10.931 Without use disorder
___.__ Alcohol-Induced Major Neurocognitive Disorder (712) Specify if:
Persistent
___.__ Amnestic-confabulatory type
F10.26 With moderate or severe use disorder
F10.96 Without use disorder
___.__ Nonamnestic-confabulatory type
F10.27 With moderate or severe use disorder
F10.97 Without use disorder
___.__ Alcohol-Induced Mild Neurocognitive Disorder (712) Specify if:
Persistent
F10.188 With mild use disorder
F10.288 With moderate or severe use disorder
F10.988 Without use disorder
F10.99 Unspecified Alcohol-Related Disorder (568)
Caffeine-Related Disorders (569)
F15.920 Caffeine Intoxication (569)
F15.93 Caffeine Withdrawal (571)
___.__ Caffeine-Induced Mental Disorders (574)
Note: Disorders are listed in their order of appearance in the manual.
Specify With onset during intoxication, With onset during withdrawal, With onset after
medication use. Note: When taken over the counter, substances in this class can also
induce the relevant substance induced mental disorder.
F15.980 Caffeine-Induced Anxiety Disorder (255)
F15.982 Caffeine-Induced Sleep Disorder (468)
Specify whether Insomnia type, Daytime sleepiness type, Mixed type
F15.99 Unspecified Caffeine-Related Disorder (574)

xlii

Cannabis-Related Disorders (575)

___.__ Cannabis Use Disorder (575)
Specify if: In a controlled environment
Specify current severity/remission:
F12.10 Mild

F12.11 In early remission

F12.11 In sustained remission
F12.20 Moderate
F12.21 In early remission
F12.21 In sustained remission
F12.20 Severe
F12.21 In early remission
F12.21 In sustained remission
___.__ Cannabis Intoxication (582)
Without perceptual disturbances
F12.120 With mild use disorder
F12.220 With moderate or severe use disorder
F12.920 Without use disorder
With perceptual disturbances
F12.122 With mild use disorder
F12.222 With moderate or severe use disorder
F12.922 Without use disorder
___.__ Cannabis Withdrawal (584)
F12.13 With mild use disorder
F12.23 With moderate or severe use disorder
F12.93 Without use disorder
___.__ Cannabis-Induced Mental Disorders (586)
Note: Disorders are listed in their order of appearance in the manual.
a
Specify With onset during intoxication, With onset during withdrawal, With onset after
medication use. Note: When prescribed as medication, substances in this class can
also induce the relevant substance-induced mental disorder.
b
Specify if: Acute, Persistent
c
Specify if: Hyperactive, Hypoactive, Mixed level of activity

___.__ Cannabis-Induced Psychotic Disordera(126)

F12.159 With mild use disorder
F12.259 With moderate or severe use disorder
F12.959 Without use disorder
___.__ Cannabis-Induced Anxiety Disordera(255)
F12.180 With mild use disorder
F12.280 With moderate or severe use disorder
F12.980 Without use disorder
___.__ Cannabis-Induced Sleep Disordera(468)

Specify whether Insomnia type, Daytime sleepiness type, Mixed type

F12.188 With mild use disorder
F12.288 With moderate or severe use disorder

xliii

F12.988 Without use disorder

___.__ Cannabis Intoxication Deliriumb,c(672)
F12.121 With mild use disorder
F12.221 With moderate or severe use disorder
F12.921 Without use disorder
F12.921 Pharmaceutical Cannabis Receptor Agonist–Induced Deliriumb,c(674)
Note: When pharmaceutical cannabis receptor agonist
medication taken as prescribed. The designation “taken as
prescribed” is used to
differentiate medication-induced delirium from substance intoxication
delirium.
F12.99 Unspecified Cannabis-Related Disorder (586)
Hallucinogen-Related Disorders (587)
___.__ Phencyclidine Use Disorder (587)
Specify if: In a controlled environment
Specify current severity/remission:
F16.10 Mild
F16.11 In early remission
F16.11 In sustained remission
F16.20 Moderate
F16.21 In early remission
F16.21 In sustained remission
F16.20 Severe
F16.21 In early remission
F16.21 In sustained remission
___.__ Other Hallucinogen Use Disorder (590)
Specify the particular hallucinogen
Specify if: In a controlled environment
Specify current severity/remission:
F16.10 Mild
F16.11 In early remission

F16.11 In sustained remission

F16.20 Moderate
F16.21 In early remission
F16.21 In sustained remission
F16.20 Severe
F16.21 In early remission
F16.21 In sustained remission
___.__ Phencyclidine Intoxication (594)
F16.120 With mild use disorder
F16.220 With moderate or severe use disorder
F16.920 Without use disorder
___.__ Other Hallucinogen Intoxication (596)
F16.120 With mild use disorder
F16.220 With moderate or severe use disorder
F16.920 Without use disorder

xliv

F16.983 Hallucinogen Persisting Perception Disorder (598)

___.__ Phencyclidine-Induced Mental Disorders (600)
Note: Disorders are listed in their order of appearance in the manual.
a
Specify With onset during intoxication, With onset after medication use. Note: When
prescribed as medication, substances in this class can also induce the relevant substance-induced mental disorder.
a
___.__ Phencyclidine-Induced Psychotic Disorder (126) F16.159 With mild use
disorder
F16.259 With moderate or severe use disorder
F16.959 Without use disorder
___.__ Phencyclidine-Induced Bipolar and Related Disordera(162) F16.14
With mild use disorder
F16.24 With moderate or severe use disorder
F16.94 Without use disorder
___.__ Phencyclidine-Induced Depressive Disordera(201) F16.14
With mild use disorder
F16.24 With moderate or severe use disorder
F16.94 Without use disorder
Phencyclidine-Induced Anxiety Disordera(255)
___.__
F16.180 With mild use disorder
F16.280 With moderate or severe use disorder
F16.980 Without use disorder
___.__ Phencyclidine Intoxication Delirium (672)
Specify if: Acute, Persistent
Specify if: Hyperactive, Hypoactive, Mixed level of activity
F16.121 With mild use disorder
F16.221 With moderate or severe use disorder
F16.921 Without use disorder
___.__ Hallucinogen-Induced Mental Disorders (600)
Note: Disorders are listed in their order of appearance in the manual.
a
Specify With onset during intoxication, With onset after medication use. Note: When
prescribed as medication, substances in this class can also induce the relevant substance-
b
induced mental disorder. Specify if: Acute, Persistent
c
Specify if: Hyperactive, Hypoactive, Mixed level of activity

___.__ Other Hallucinogen–Induced Psychotic Disordera(126) F16.159

With mild use disorder
F16.259 With moderate or severe use disorder
F16.959 Without use disorder
___.__ Other Hallucinogen–Induced Bipolar and Related Disordera(162) F16.14
With mild use disorder
F16.24 With moderate or severe use disorder
F16.94 Without use disorder
___.__ Other Hallucinogen–Induced Depressive Disordera(201) F16.14
With mild use disorder
F16.24 With moderate or severe use disorder
F16.94 Without use disorder

xlv

___.__ Other Hallucinogen-Induced Anxiety Disordera(255) F16.180

With mild use disorder
F16.280 With moderate or severe use disorder
F16.980 Without use disorder
___.__ Other Hallucinogen Intoxication Deliriumb,c(672) F16.121
With mild use disorder

F16.221 With moderate or severe use disorder

F16.921 Without use disorder
F16.921 Ketamine or Other Hallucinogen–Induced Deliriumb,c(674) Note:
When ketamine or other hallucinogen medication taken as
prescribed. The designation “taken as prescribed” is used to
differentiate medication-induced delirium from substance intoxication
delirium.
F16.99 Unspecified Phencyclidine-Related Disorder (600)
F16.99 Unspecified Hallucinogen-Related Disorder (601)

Inhalant-Related Disorders (601)

___.__ Inhalant Use Disorder (601)
Specify the particular inhalant
Specify if: In a controlled environment
Specify current severity/remission:
F18.10 Mild
F18.11 In early remission
F18.11 In sustained remission
F18.20 Moderate
F18.21 In early remission
F18.21 In sustained remission
F18.20 Severe
F18.21 In early remission
F18.21 In sustained remission
___.__ Inhalant Intoxication (605)
F18.120 With mild use disorder
F18.220 With moderate or severe use disorder
F18.920 Without use disorder
___.__ Inhalant-Induced Mental Disorders (607)
Note: Disorders are listed in their order of appearance in the manual.
a
Specify With onset during intoxication

___.__ Inhalant-Induced Psychotic Disordera(126)

F18.159 With mild use disorder
F18.259 With moderate or severe use disorder F18.959
Without use disorder
___.__ Inhalant-Induced Depressive Disordera(201) F18.14
With mild use disorder
F18.24 With moderate or severe use disorder F18.94
Without use disorder

xlvi

___.__ Inhalant-Induced Anxiety Disordera(255) F18.180

With mild use disorder
F18.280 With moderate or severe use disorder F18.980
Without use disorder
___.__ Inhalant Intoxication Delirium (672)
Specify if: Acute, Persistent
Specify if: Hyperactive, Hypoactive, Mixed level of activity
F18.121 With mild use disorder
F18.221 With moderate or severe use disorder F18.921
Without use disorder
___.__ Inhalant-Induced Major Neurocognitive Disorder (712) Specify
if: Persistent
F18.17 With mild use disorder
F18.27 With moderate or severe use disorder F18.97
Without use disorder
___.__ Inhalant-Induced Mild Neurocognitive Disorder (712) Specify
if: Persistent
F18.188 With mild use disorder
F18.288 With moderate or severe use disorder F18.988
Without use disorder
F18.99 Unspecified Inhalant-Related Disorder (608)
Opioid-Related Disorders (608)
___.__ Opioid Use Disorder (608)
Specify if: On maintenance therapy, In a controlled environment
Specify current severity/remission:
F11.10 Mild
F11.11 In early remission
F11.11 In sustained remission
F11.20 Moderate
F11.21 In early remission
F11.21 In sustained remission
F11.20 Severe
F11.21 In early remission
F11.21 In sustained remission
___.__ Opioid Intoxication (615)
Without perceptual disturbances
F11.120 With mild use disorder
F11.220 With moderate or severe use disorder
F11.920 Without use disorder
With perceptual disturbances
F11.122 With mild use disorder
F11.222 With moderate or severe use disorder
F11.922 Without use disorder

xlvii

___.__ Opioid Withdrawal (617)

F11.13 With mild use disorder
F11.23 With moderate or severe use disorder
F11.93 Without use disorder
___.__ Opioid-Induced Mental Disorders (619)
Note: Disorders are listed in their order of appearance in the manual.
a
Specify With onset during intoxication, With onset during withdrawal, With onset after
medication use. Note: When prescribed as medication, substances in this class can
also induce the relevant substance-induced mental disorder.
b
Specify if: Acute, Persistent
c
Specify if: Hyperactive, Hypoactive, Mixed level of activity

___.__ Opioid-Induced Depressive Disordera(201)

F11.14 With mild use disorder
F11.24 With moderate or severe use disorder
F11.94 Without use disorder
___.__ Opioid-Induced Anxiety Disordera(255)
F11.180 With mild use disorder
F11.280 With moderate or severe use disorder
F11.980
Without use disorder
___.__ Opioid-Induced Sleep Disordera(468)
Specify whether Insomnia type, Daytime sleepiness type, Mixed type
F11.182 With mild use disorder
F11.282 With moderate or severe use disorder
F11.982 Without use disorder
___.__ Opioid-Induced Sexual Dysfunctiona(504)
Specify if: Mild, Moderate, Severe
F11.181 With mild use disorder
F11.281 With moderate or severe use disorder
F11.981 Without use disorder
___.__ Opioid Intoxication Deliriumb,c(672)
F11.121 With mild use disorder
F11.221 With moderate or severe use disorder
F11.921 Without use disorder
___.__ Opioid Withdrawal Deliriumb,c(673)
F11.188 With mild use disorder
F11.288 With moderate or severe use disorder
F11.988 Without use disorder
___.__ Opioid-Induced Deliriumb,c(674)
Note: The designation “taken as prescribed” is used to differentiate
medication-induced delirium from substance intoxication delirium and
substance withdrawal delirium.
F11.921 When opioid medication taken as prescribed (674) F11.988 During
withdrawal from opioid medication taken as prescribed (674) F11.99 Unspecified Opioid-
Related Disorder (619)

xlviii

Sedative-, Hypnotic-, or Anxiolytic-Related Disorders (620)

___.__ Sedative, Hypnotic, or Anxiolytic Use Disorder (620)
Specify if: In a controlled environment
Specify current severity/remission:
F13.10 Mild
F13.11 In early remission
F13.11 In sustained remission
F13.20 Moderate
F13.21 In early remission
F13.21 In sustained remission
F13.20 Severe
F13.21 In early remission
F13.21 In sustained remission
___.__ Sedative, Hypnotic, or Anxiolytic Intoxication (626)
F13.120 With mild use disorder
F13.220 With moderate or severe use disorder
F13.920 Without use disorder
___.__ Sedative, Hypnotic, or Anxiolytic Withdrawal (628)
Without perceptual disturbances
F13.130 With mild use disorder
F13.230 With moderate or severe use disorder
F13.930 Without use disorder
With perceptual disturbances
F13.132 With mild use disorder
F13.232 With moderate or severe use disorder
F13.932 Without use disorder
___.__ Sedative-, Hypnotic-, or Anxiolytic-Induced Mental Disorders (631) Note:
Disorders are listed in their order of appearance in the
manual.
a
Specify With onset during intoxication, With onset during withdrawal, With onset after
medication use. Note: When prescribed as medication, substances in this class can
also induce the relevant substance-induced mental disorder.
b
Specify if: Acute, Persistent
c
Specify if: Hyperactive, Hypoactive, Mixed level of activity

___.__ Sedative-, Hypnotic-, or Anxiolytic-Induced Psychotic Disordera(126) F13.159

With mild use disorder
F13.259 With moderate or severe use disorder
F13.959 Without use disorder
___.__ Sedative-, Hypnotic-, or Anxiolytic-Induced Bipolar and Related
Disordera(162)
F13.14 With mild use disorder

xlix

F13.24
With moderate or severe use disorder
F13.94 Without use disorder
___.__ Sedative-, Hypnotic-, or Anxiolytic-Induced Depressive Disordera(201) F13.14
With mild use disorder
F13.24 With moderate or severe use disorder
F13.94 Without use disorder
___.__ Sedative-, Hypnotic-, or Anxiolytic-Induced Anxiety Disordera(255) F13.180
With mild use disorder
F13.280 With moderate or severe use disorder
F13.980 Without use disorder
___.__ Sedative-, Hypnotic-, or Anxiolytic-Induced Sleep Disordera(468)
Specify whether Insomnia type, Daytime sleepiness type, Parasomnia
type, Mixed type
F13.182 With mild use disorder
F13.282 With moderate or severe use disorder
F13.982 Without use disorder
___.__ Sedative-, Hypnotic-, or Anxiolytic-Induced Sexual Dysfunctiona(504) Specify
if: Mild, Moderate, Severe
F13.181 With mild use disorder
F13.281 With moderate or severe use disorder
F13.981 Without use disorder
___.__ Sedative-, Hypnotic-, or Anxiolytic Intoxication Deliriumb,c(672) F13.121
With mild use disorder
F13.221 With moderate or severe use disorder
F13.921 Without use disorder
___.__ Sedative-, Hypnotic-, or Anxiolytic Withdrawal Deliriumb,c(673) F13.131
With mild use disorder
F13.231 With moderate or severe use disorder
F13.931 Without use disorder
___.__ Sedative-, Hypnotic-, or Anxiolytic-Induced Deliriumb,c(674) Note: The
designation “taken as prescribed” is used to differentiate
medication-induced delirium from substance intoxication delirium and
substance withdrawal delirium.
F13.921 When sedative, hypnotic, or anxiolytic medication taken as prescribed
(674)
F13.931 During withdrawal from sedative, hypnotic, or anxiolytic medication taken as
prescribed (674)
___.__ Sedative-, Hypnotic-, or Anxiolytic-Induced Major Neurocognitive Disorder
(712)
Specify if: Persistent
F13.27 With moderate or severe use disorder
F13.97 Without use disorder
___.__ Sedative-, Hypnotic-, or Anxiolytic-Induced Mild Neurocognitive Disorder
(712)
Specify if: Persistent
F13.188 With mild use disorder
F13.288 With moderate or severe use disorder
F13.988 Without use disorder
F13.99 Unspecified Sedative-, Hypnotic-, or Anxiolytic-Related Disorder (632) l

Stimulant-Related Disorders (632)

___.__ Stimulant Use Disorder (632)
Specify if: In a controlled environment
Specify current severity/remission:
___.__ Mild
F15.10 Amphetamine-type substance
F14.10 Cocaine
F15.10 Other or unspecified stimulant
___.__ Mild, In early remission
F15.11 Amphetamine-type substance
F14.11 Cocaine
F15.11 Other or unspecified stimulant
___.__ Mild, In sustained remission
F15.11 Amphetamine-type substance
F14.11 Cocaine
F15.11 Other or unspecified stimulant
___.__ Moderate
F15.20 Amphetamine-type substance
F14.20 Cocaine
F15.20 Other or unspecified stimulant
___.__ Moderate, In early remission
F15.21 Amphetamine-type substance
F14.21 Cocaine
F15.21 Other or unspecified stimulant
___.__ Moderate, In sustained remission
F15.21 Amphetamine-type substance
F14.21 Cocaine
F15.21 Other or unspecified stimulant
___.__ Severe
F15.20 Amphetamine-type substance
F14.20 Cocaine
F15.20 Other or unspecified stimulant
___.__ Severe, In early remission
F15.21 Amphetamine-type substance
F14.21 Cocaine
F15.21 Other or unspecified stimulant
___.__ Severe, In sustained remission
F15.21 Amphetamine-type substance
F14.21 Cocaine
F15.21 Other or unspecified stimulant
___.__ Stimulant Intoxication (640)
Specify the particular intoxicant
Without perceptual disturbances

li

___.__ Amphetamine-type substance or other stimulant intoxication

F15.120 With mild use disorder
F15.220 With moderate or severe use disorder F15.920
Without use disorder
___.__ Cocaine intoxication
F14.120 With mild use disorder
F14.220 With moderate or severe use disorder
F14.920 Without use disorder
With perceptual disturbances
___.__ Amphetamine-type substance or other stimulant intoxication
F15.122 With mild use disorder
F15.222 With moderate or severe use disorder
F15.922 Without use disorder
___.__ Cocaine intoxication
F14.122 With mild use disorder
F14.222 With moderate or severe use disorder
F14.922 Without use disorder

___.__ Stimulant Withdrawal (643)

Specify the particular substance that causes the withdrawal syndrome
___.__ Amphetamine-type substance or other stimulant withdrawal F15.13
With mild use disorder
F15.23 With moderate or severe use disorder
F15.93 Without use disorder
___.__ Cocaine withdrawal
F14.13 With mild use disorder
F14.23 With moderate or severe use disorder
F14.93 Without use disorder
___.__ Stimulant-Induced Mental Disorders (644)
Note: Disorders are listed in their order of appearance in the manual.
a
Specify With onset during intoxication, With onset during withdrawal, With onset after
medication use. Note: When prescribed as medication, amphetamine-type substances
and other stimulants can also induce the relevant substance-induced mental disorder.
b
Specify if: Acute, Persistent
c
Specify if: Hyperactive, Hypoactive, Mixed level of activity
___.__ Amphetamine-Type Substance (or Other Stimulant)–Induced Psychotic
Disordera(126)
F15.159 With mild use disorder
F15.259 With moderate or severe use disorder
F15.959 Without use disorder
___.__ Cocaine-Induced Psychotic Disordera(126)
F14.159 With mild use disorder
F14.259 With moderate or severe use disorder
F14.959 Without use disorder

lii

___.__ Amphetamine-Type Substance (or Other Stimulant)–Induced Bipolar and

Related Disordera(162)
F15.14 With mild use disorder
F15.24 With moderate or severe use disorder
F15.94 Without use disorder
___.__ Cocaine-Induced Bipolar and Related Disordera(162) F14.14
With mild use disorder
F14.24 With moderate or severe use disorder
F14.94 Without use disorder
___.__ Amphetamine-Type Substance (or Other Stimulant)–Induced Depressive
Disordera(201)
F15.14 With mild use disorder
F15.24 With moderate or severe use disorder
F15.94 Without use disorder
___.__ Cocaine-Induced Depressive Disordera(201)
F14.14 With mild use disorder
F14.24 With moderate or severe use disorder
F14.94 Without use disorder
___.__ Amphetamine-Type Substance (or Other Stimulant)–Induced Anxiety
Disordera(255)
F15.180 With mild use disorder
F15.280 With moderate or severe use disorder
F15.980 Without use disorder
___.__ Cocaine-Induced Anxiety Disordera(255)
F14.180 With mild use disorder
F14.280 With moderate or severe use disorder
F14.980 Without use disorder
___.__ Amphetamine-Type Substance (or Other Stimulant)–Induced Obsessive
Compulsive and Related Disordera(287)
F15.188 With mild use disorder
F15.288 With moderate or severe use disorder
F15.988 Without use disorder
___.__ Cocaine-Induced Obsessive-Compulsive and Related Disordera(287)

F14.188 With mild use disorder

F14.288 With moderate or severe use disorder
F14.988 Without use disorder
___.__ Amphetamine-Type Substance (or Other Stimulant)–Induced Sleep
Disordera(468)
Specify whether Insomnia type, Daytime sleepiness type, Mixed type
F15.182 With mild use disorder
F15.282 With moderate or severe use disorder
F15.982 Without use disorder
___.__ Cocaine-Induced Sleep Disordera(468)
Specify whether Insomnia type, Daytime sleepiness type, Mixed type
F14.182 With mild use disorder
F14.282 With moderate or severe use disorder

liii

F14.982 Without use disorder

___.__ Amphetamine-Type Substance (or Other Stimulant)–Induced Sexual
Dysfunctiona(504)
Specify if: Mild, Moderate, Severe
F15.181 With mild use disorder
F15.281 With moderate or severe use disorder
F15.981 Without use disorder
___.__ Cocaine-Induced Sexual Dysfunctiona(504)
Specify if: Mild, Moderate, Severe
F14.181 With mild use disorder
F14.281 With moderate or severe use disorder
F14.981 Without use disorder
___.__ Amphetamine-Type Substance (or Other Stimulant) Intoxication
Deliriumb,c(672)
F15.121 With mild use disorder
F15.221 With moderate or severe use disorder
F15.921 Without use disorder
___.__ Cocaine Intoxication Deliriumb,c(672)
F14.121 With mild use disorder
F14.221 With moderate or severe use disorder
F14.921 Without use disorder
F15.921 Amphetamine-Type (or Other Stimulant) Medication–Induced
Deliriumb,c(674)
Note: When amphetamine-type or other stimulant medication taken as
prescribed. The designation “taken as prescribed” is used to
differentiate medication-induced delirium from substance intoxication
delirium.
___.__ Amphetamine-Type Substance (or Other Stimulant)–Induced Mild
Neurocognitive Disorder (712)
Specify if: Persistent
F15.188 With mild use disorder
F15.288 With moderate or severe use disorder
F15.988 Without use disorder
___.__ Cocaine-Induced Mild Neurocognitive Disorder (712) Specify
if: Persistent
F14.188 With mild use disorder
F14.288 With moderate or severe use disorder
F14.988 Without use disorder
___.__ Unspecified Stimulant-Related Disorder (644)
F15.99 Amphetamine-type substance or other stimulant
F14.99 Cocaine
Tobacco-Related Disorders (645)
___.__ Tobacco Use Disorder (645)
Specify if: On maintenance therapy, In a controlled environment
Specify current severity/remission:
Z72.0 Mild

liv

F17.200 Moderate
F17.201 In early remission
F17.201 In sustained remission
F17.200 Severe
In early remission
F17.201
F17.201 In sustained remission
F17.203 Tobacco Withdrawal (649)
Note: The ICD-10-CM code indicates the comorbid presence of a moderate or severe
tobacco use disorder, which must be present in order to apply the code for tobacco
withdrawal.
___.__ Tobacco-Induced Mental Disorders (651)
F17.208 Tobacco-Induced Sleep Disorder, With moderate or severe use disorder
(468)
Specify whether Insomnia type, Daytime sleepiness type, Mixed type
Specify With onset during withdrawal, With onset after
medication use F17.209 Unspecified Tobacco-Related Disorder (651)
Other (or Unknown) Substance–Related Disorders (652)
___.__ Other (or Unknown) Substance Use Disorder (652)
Specify if: In a controlled environment
Specify current severity/remission:
F19.10 Mild
F19.11 In early remission
F19.11 In sustained remission
F19.20 Moderate
F19.21 In early remission
F19.21 In sustained remission
F19.20 Severe
F19.21 In early remission
F19.21 In sustained remission
___.__ Other (or Unknown) Substance Intoxication (656)
Without perceptual disturbances
F19.120 With mild use disorder
F19.220 With moderate or severe use disorder
F19.920 Without use disorder
With perceptual disturbances
F19.122 With mild use disorder
F19.222 With moderate or severe use disorder
F19.922 Without use disorder

___.__ Other (or Unknown) Substance Withdrawal (658)

Without perceptual disturbances
F19.130 With mild use disorder
F19.230 With moderate or severe use disorder
F19.930 Without use disorder

lv
With perceptual disturbances
F19.132 With mild use disorder
F19.232 With moderate or severe use disorder
F19.932 Without use disorder
___.__ Other (or Unknown) Substance–Induced Mental Disorders (660)
Note: Disorders are listed in their order of appearance in the manual.
a
Specify With onset during intoxication, With onset during withdrawal, With onset after
medication use. Note: When prescribed as medication or taken over the counter,
substances in this class can also induce the relevant substance-induced mental
disorder.
b
Specify if: Acute, Persistent
c
Specify if: Hyperactive, Hypoactive, Mixed level of activity

___.__ Other (or Unknown) Substance–Induced Psychotic Disordera(126)

F19.159 With mild use disorder
F19.259 With moderate or severe use disorder
F19.959 Without use disorder
___.__ Other (or Unknown) Substance–Induced Bipolar and Related Disordera (162)
F19.14 With mild use disorder
F19.24 With moderate or severe use disorder
F19.94 Without use disorder
___.__ Other (or Unknown) Substance–Induced Depressive Disordera(201) F19.14
With mild use disorder
F19.24 With moderate or severe use disorder
F19.94 Without use disorder
___.__ Other (or Unknown) Substance–Induced Anxiety Disordera(255) F19.180
With mild use disorder
F19.280 With moderate or severe use disorder
F19.980 Without use disorder
___.__ Other (or Unknown) Substance–Induced Obsessive-Compulsive and
Related Disordera(287)
F19.188 With mild use disorder
F19.288 With moderate or severe use disorder
F19.988 Without use disorder
___.__ Other (or Unknown) Substance–Induced Sleep Disordera(468)
Specify whether Insomnia type, Daytime sleepiness type, Parasomnia
type, Mixed type
F19.182 With mild use disorder
F19.282 With moderate or severe use disorder
F19.982 Without use disorder
___.__ Other (or Unknown) Substance–Induced Sexual Dysfunctiona(504) Specify
if: Mild, Moderate, Severe
F19.181 With mild use disorder
F19.281 With moderate or severe use disorder
F19.981 Without use disorder

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___.__ Other (or Unknown) Substance Intoxication Deliriumb,c(672) F19.121

With mild use disorder
F19.221 With moderate or severe use disorder
F19.921 Without use disorder
___.__ Other (or Unknown) Substance Withdrawal Deliriumb,c(673) F19.131
With mild use disorder
F19.231 With moderate or severe use disorder
F19.931 Without use disorder
___.__ Other (or Unknown) Medication–Induced Deliriumb,c(674) Note: The
designation “taken as prescribed” is used to differentiate
medication-induced delirium from substance intoxication delirium and
substance withdrawal delirium.
F19.921 When other (or unknown) medication taken as prescribed (674)
F19.931 During withdrawal from other (or unknown) medication taken as
prescribed (674)
___.__ Other (or Unknown) Substance–Induced Major Neurocognitive Disorder (712)
Specify if: Persistent
F19.17 With mild use disorder
F19.27 With moderate or severe use disorder
F19.97 Without use disorder
___.__ Other (or Unknown) Substance–Induced Mild Neurocognitive Disorder (712)
Specify if: Persistent
F19.188 With mild use disorder
F19.288 With moderate or severe use disorder
F19.988 Without use disorder
F19.99 Unspecified Other (or Unknown) Substance–Related Disorder (660)
Non-Substance-Related Disorders (661)
F63.0 Gambling Disorder (661)
Specify if: Episodic, Persistent
Specify if: In early remission, In sustained remission
Specify current severity: Mild, Moderate, Severe

Neurocognitive Disorders (667)

___.__ Delirium (672)
Specify if: Acute, Persistent
Specify if: Hyperactive, Hypoactive, Mixed level of activity
a
Note: For applicable ICD-10-CM codes, refer to the substance classes under Substance-
Related and Addictive Disorders for the specific substance/medication-induced delirium.
See also the criteria set and corresponding recording procedures in the manual for more
information.
Specify whether:

___.__ Substance intoxication deliriuma

___.__ Substance withdrawal deliriuma

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___.__ Medication-induced deliriuma

F05 Delirium due to another medical condition
F05 Delirium due to multiple etiologies
R41.0 Other Specified Delirium (678)
R41.0 Unspecified Delirium (678)
Major and Mild Neurocognitive Disorders (679)
Specify whether due to [any of the following medical etiologies]: Alzheimer’s disease, Frontotemporal degeneration,
Lewy body disease, Vascular disease, Traumatic brain injury, Substance/medication use, HIV infection, Prion
disease, Parkinson’s disease, Huntington’s disease, Another medical condition, Multiple etiologies, Unspecified
etiology
a
Specify current severity: Mild, Moderate, Severe. This specifier applies only to major neurocognitive disorders
(including probable and possible).
b
Specify: Without behavioral disturbance, With behavioral disturbance. For all mild neurocognitive
disorders, substance/medication-induced major neurocognitive disorder, and unspecified neurocognitive
disorder, behavioral disturbance cannot be coded but should still be recorded.
Note: As indicated for each subtype, an additional medical code is needed for most major neurocognitive disorders,
including those due to probable and possible medical etiologies. The medical etiology should be coded first, before
the code for the major neurocognitive disorder. An additional medical code should not be used for any mild
neurocognitive disorder and is not used for major or mild vascular neurocognitive disorder, substance/medication-
induced major or mild neurocognitive disorder, and unspecified neurocognitive disorder.
Coding note: For major and mild neurocognitive disorders: Use additional code(s) to indicate clinically significant
psychiatric symptoms due to the same medical condition causing the major NCD (e.g., F06.2 psychotic disorder
due to Alzheimer’s disease with delusions; F06.32 depressive disorder due to Parkinson’s disease, with major
depressive-like episode.) Note: The additional codes for mental disorders due to another medical condition are
included with disorders with which they share phenomenology (e.g., for depressive disorders due to another
medical condition, see “Depressive Disorders”).

Major or Mild Neurocognitive Disorder Due to Alzheimer’s Disease (690)

___.__ Major Neurocognitive Disorder Due to Probable Alzheimer’s Diseasea Note:
Code first G30.9 Alzheimer’s disease.
F02.81 With behavioral disturbance
F02.80 Without behavioral disturbance
___.__ Major Neurocognitive Disorder Due to Possible Alzheimer’s Diseasea
Note: Code first G30.9 Alzheimer’s disease.
F02.81 With behavioral disturbance
F02.80 Without behavioral disturbance
G31.84 Mild Neurocognitive Disorder Due to Alzheimer’s Diseaseb
Major or Mild Frontotemporal Neurocognitive Disorder (695)
___.__ Major Neurocognitive Disorder Due to Probable Frontotemporal Degenerationa Note:
Code first G31.09 frontotemporal degeneration.
F02.81 With behavioral disturbance
F02.80 Without behavioral disturbance

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___.__ Major Neurocognitive Disorder Due to Possible Frontotemporal Degenerationa Note:

Code first G31.09 frontotemporal degeneration.
F02.81 With behavioral disturbance
F02.80 Without behavioral disturbance
G31.84 Mild Neurocognitive Disorder Due to Frontotemporal Degenerationb
Major or Mild Neurocognitive Disorder With Lewy Bodies (699)
___.__ Major Neurocognitive Disorder With Probable Lewy Bodiesa
Note: Code first G31.83 Lewy body disease.
F02.81 With behavioral disturbance
F02.80 Without behavioral disturbance
___.__ Major Neurocognitive Disorder With Possible Lewy Bodiesa
Note: Code first G31.83 Lewy body disease.
F02.81 With behavioral disturbance
F02.80 Without behavioral disturbance
G31.84 Mild Neurocognitive Disorder With Lewy Bodiesb
Major or Mild Vascular Neurocognitive Disorder (702)
___.__ Major Neurocognitive Disorder Probably Due to Vascular Diseasea
Note: No additional medical code for vascular disease.
F01.51 With behavioral disturbance
F01.50 Without behavioral disturbance
___.__ Major Neurocognitive Disorder Possibly Due to Vascular Diseasea
Note: No additional medical code for vascular disease.
F01.51 With behavioral disturbance
F01.50 Without behavioral disturbance
G31.84 Mild Neurocognitive Disorder Due to Vascular Diseaseb
Major or Mild Neurocognitive Disorder Due to Traumatic Brain Injury (706)
___.__ Major Neurocognitive Disorder Due to Traumatic Brain Injurya
Note: For ICD-10-CM, code first S06.2X9S diffuse traumatic brain injury with loss of
consciousness of unspecified duration, sequela.
F02.81 With behavioral disturbance
F02.80 Without behavioral disturbance
G31.84 Mild Neurocognitive Disorder Due to Traumatic Brain Injuryb
Substance/Medication-Induced Major or Mild Neurocognitive Disorder (712)
Note: No additional medical code. For applicable ICD-10-CM codes, refer to the substance classes under
Substance-Related and Addictive Disorders for the specific substance/medication-induced major or mild
neurocognitive disorder. See also the criteria set and corresponding recording procedures in the manual for more
information.
Coding note: The ICD-10-CM code depends on whether or not there is a comorbid substance use disorder present
for the same class of substance. In any case, an additional separate diagnosis of a substance use disorder is not
given.
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Specify if: Persistent

___.__ Substance/Medication-Induced Major Neurocognitive Disordera,b
Note: If a substance use disorder is present, record mild substance use disorder (ICD-10-CM
code not available if mild substance use disorder does not cause a major neurocognitive
disorder) or moderate or severe substance use disorder; if no substance use disorder is
present, record only [specific
substance]-induced major neurocognitive disorder.
___.___ Substance/Medication-Induced Mild Neurocognitive Disorderb
Note: If a substance use disorder is present, record mild substance use disorder or
moderate or severe substance use disorder; if no substance use disorder is present, record
only [specific substance]-
induced mild neurocognitive disorder.
Major or Mild Neurocognitive Disorder Due to HIV Infection (717)
___.__ Major Neurocognitive Disorder Due to HIV Infectiona
Note: Code first B20 HIV infection.
F02.81 With behavioral disturbance
F02.80 Without behavioral disturbance
G31.84 Mild Neurocognitive Disorder Due to HIV Infectionb
Major or Mild Neurocognitive Disorder Due to Prion Disease (721)
___.__ Major Neurocognitive Disorder Due to Prion Diseasea
Note: Code first A81.9 prion disease.
F02.81 With behavioral disturbance
F02.80 Without behavioral disturbance
G31.84 Mild Neurocognitive Disorder Due to Prion Diseaseb
Major or Mild Neurocognitive Disorder Due to Parkinson’s Disease (723)
___.__ Major Neurocognitive Disorder Probably Due to Parkinson’s Diseasea
Note: Code first G20 Parkinson’s disease.
F02.81 With behavioral disturbance
F02.80 Without behavioral disturbance
___.__ Major Neurocognitive Disorder Possibly Due to Parkinson’s Diseasea
Note: Code first G20 Parkinson’s disease.
F02.81 With behavioral disturbance
F02.80 Without behavioral disturbance
G31.84 Mild Neurocognitive Disorder Due to Parkinson’s Diseaseb
Major or Mild Neurocognitive Disorder Due to Huntington’s Disease (726)
___.__ Major Neurocognitive Disorder Due to Huntington’s Diseasea
Note: Code first G10 Huntington’s disease.
F02.81 With behavioral disturbance
F02.80 Without behavioral disturbance
G31.84 Mild Neurocognitive Disorder Due to Huntington’s Diseaseb

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Major or Mild Neurocognitive Disorder Due to Another Medical Condition (729)

___.__ Major Neurocognitive Disorder Due to Another Medical Conditiona
Note: Code first the other medical condition.
F02.81 With behavioral disturbance
F02.80 Without behavioral disturbance
G31.84 Mild Neurocognitive Disorder Due to Another Medical Conditionb
Major or Mild Neurocognitive Disorder Due to Multiple Etiologies (731)
___.__ Major Neurocognitive Disorder Due to Multiple Etiologiesa
Note: Code first all the etiological medical conditions (with the exception of vascular disease,
which is not coded).