Facts About DSM-5-TR Psychiatric News.

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Facts About DSM-5-TR

Published Online: 24 Feb 2022

https://doi.org/10.1176/appi.pn.2022.03.3.28

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Q. How was DSM-5-TR developed?
A. DSM-5-TR is a text revision of DSM-5 and includes revised
text and new references, clarifications to diagnostic criteria, and
updates to ICD-10-CM codes since DSM-5 was published in
2013. It features a new disorder, prolonged grief disorder, as
well as ICD-10-CM codes for suicidal behavior and nonsuicidal
self-injury. DSM-5-TR is based on updates to the scientific
literature since the publication of DSM-5 in 2013 and involved
the help of over 200 subject matter experts. More information
about its development is provided in the DSM-5-TR
“Introduction” in Section I.

Q. What is the difference between a text revision of DSM and a

new edition?
A. A text revision of DSM is released when a number of changes
to the text that accompanies the description of disorders and
their criteria are warranted by new evidence or the need for
more clarity. Although the text of DSM-5 had occasional
corrections since its release in 2013, DSM-5-TR was a
systematic text revision based on the literature in the 10 years
since the development of DSM-5. In contrast, a new edition of
DSM is released when there are enough advances in the field to
support the creation, substantive revisions, and elimination of
multiple diagnostic criteria sets or disorders.

Q. What important changes to DSM-5-TR appear in the new

edition?
A. These are the major changes from DSM-5 to DSM-5-TR:

Revised text for almost all disorders with updated

 sections on associated features, prevalence, development
and course, risk and prognostic factors, culture,
diagnostic markers, suicide, and differential diagnosis

Addition of the new diagnosis of prolonged grief disorder

to Section II

Over 70 modified criteria sets with helpful clarifications

since publication of DSM-5

Fully updated “Introduction” and “Use of the Manual” to

guide usage and provide context for important
terminology

Considerations of the impact of racism and

discrimination on mental disorders integrated into the
text

New ICD-10-CM codes to flag and monitor suicidal

behavior and nonsuicidal self-injury that can be used
without the requirement of another diagnosis

Updated ICD-10-CM codes implemented since 2013,

including over 50 coding updates new to DSM-5-TR for
substance intoxication and withdrawal and other
disorders

Q. Are there changes in the manual that might affect a

patient’s diagnosis or insurance coverage?
A. The text revisions in DSM-5-TR should not affect insurance
coverage or result in changing diagnoses that have already been
made. The manual, however, includes a new disorder—
prolonged grief disorder—with billable ICD-10-CM code, F43.8.

Q. How are the roles of racism, cultural considerations, and

the social determinants of mental health in determining
diagnoses and their impact on mental health addressed in
DSM-5-TR?
A. See Impact of Culture, Race, Social Determinants Reflected
Throughout New DSM-5-TR.

Q. How can the new ICD-10-CM codes for suicidal behavior

and nonsuicidal self-injury be used?
A. Because suicidal behavior may be helpful to track or flag for
clinical attention and care of individuals, ICD-10-CM codes are
now available for use by any clinician and do not require a
mental disorder diagnosis. The suicidal behavior ICD-10-CM
codes can be used for individuals who have engaged in
potentially self-injurious behavior with at least some intent to
die as a result of the act. Evidence of intent to end their life can
be explicit or inferred from the behavior or circumstances. A
suicide attempt may or may not result in self-injury.

The nonsuicidal self-injury ICD-10-CM codes can be used for

individuals who have engaged in intentional self-inflicted
damage to their body that is likely to induce bleeding, bruising,
or pain (for instance, by cutting, burning, stabbing, hitting, or
excessive rubbing) in the absence of suicidal intent.

These codes appear in the Section II chapter “Other Conditions

That May Be a Focus of Clinical Attention”; conditions,
behaviors, circumstances, and problems in this chapter do not
represent mental disorders but can affect the diagnosis, course,
prognosis, or care of a disorder.

Q. What is the process for making changes to DSM?

A. Anyone can initiate the process for consideration of a
proposal for changes to DSM; see here for more information.
Proposals must provide all information requested for
consideration; see the DSM-5 Proposals Submission Guidance
Document posted here. Changes can be made when warranted
by evidence from new research without waiting for a new edition
of DSM.

Q. What is prolonged grief disorder, and why is it being

recognized as a diagnosis?
A. Years of research and clinical experience indicate that some
people experience a persistent inability to overcome their grief
for the loss of a loved one for at least one year or more, with
intense yearning or preoccupation with thoughts or memories of
the deceased person almost every day since the death. These
symptoms are severe enough to impair day-to-day functioning.
In addition, the duration and severity of the bereavement
reaction must clearly exceed what is expected based on
standards related to the individual’s social, cultural, or religious
background. This does not mean that people feeling grief
periodically one year or more after the loss of a loved one have
the disorder. However, those with intense and impairing grief
after one year may be considered for the diagnosis.

Q. Does creating the diagnosis of prolonged grief disorder

have the effect of pathologizing grief?
A. The diagnosis of prolonged grief disorder is not intended to
pathologize grief. Individuals who meet the criteria for
prolonged grief disorder experience something dramatically
different from the grief normally experienced by anyone who
loses a loved one. The grief is intractable and disabling in a way
that typical grieving is not. People whose symptoms meet the
criteria for prolonged grief disorder need and deserve to get
appropriate care.

Q. What changes were made to DSM-5-TR related to gender

identity and sexual orientation?
A. There have been updates to the terminology to describe
gender dysphoria based on updated culturally sensitive
language. The term “desired gender” is now “experienced
gender,” the term “cross-sex medical procedure” is now “gender-
affirming medical procedure,” and the term “natal male”/“natal
female” is now “individual assigned male/female at birth.” The
entire text of the Gender Dysphoria chapter has also been
updated based on the literature.

Q. Why have DSM codes been dropped from DSM-5-TR and

only ICD-10-CM codes are used?
A. There are no DSM codes. The codes that appear in DSM are
the ICD codes that are equivalent to the DSM diagnoses given
the version of the manual. For DSM-5-TR, only ICD-10-CM
codes are used because this is the version of ICD that is in effect
in the United States. ICD-10-CM stands for the International
Classification of Diseases, 10th Edition, Clinical Modification.
Although based on the World Health Organization’s ICD-10
codes, ICD-10-CM codes in DSM-5 (and thus DSM-5-TR) have
been modified from ICD-10 for clinical use by the U.S. Centers
for Disease Control and Prevention’s National Center for Health
Statistics (NCHS) and provide the only permissible diagnostic
Statistics (NCHS) and provide the only permissible diagnostic
codes for mental disorders for clinical use in the United States.
In the United States, the use of ICD-10-CM codes for disorders
in DSM-5-TR has been mandated by the Health Care Financing
Administration for purposes of reimbursement under the
Medicare system. The use of these diagnostic codes is
fundamental to medical record keeping and facilitates data
collection, retrieval, and compilation of statistical information.

Q. Why are there some changes to criteria sets for mental

disorders in DSM-5-TR?
A. As discussed in more detail in the DSM-5-TR “Introduction”
section, changes to criteria sets occurred through different
formal mechanisms that were separate from the DSM-5-TR text
revision process. A formal proposal and review process, across
several stages, conducted by the DSM Steering Committee, is
necessary for changes to criteria sets. All proposed changes to
criteria sets are also reviewed and approved by the APA
Assembly and APA Board of Trustees. For some criteria sets,
such as the addition of the new prolonged grief disorder, the
review process for the criteria had begun before the
development of DSM-5-TR started, and formal approval of the
criteria set changes coincided with the publication of DSM-5-
TR. ■

APA members may purchase DSM-5-TR and

related titles at a discount.

Also, see related articles about the additions

and changes in DSM-5-TR related to the impact
of culture, race, and racism on diagnosis and
an overview of how DSM-5-TR differs from
DSM-5 .
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