A Clinician’s Guide to the DSM-5-TR _ ___________________________________________________________
UPDATED TERMINOLOGY The DSM-5-TR incorporated updated terminology throughout the manual in its comprehensive revision process. This update in terminology serves several important purposes: • Reflecting current scientific understanding : The updated terminology aligns with the latest research and clinical understanding of mental disorders, ensuring that the language used is consistent with contemporary knowledge in the field. • Reducing stigma : Some terms were updated to use less stigmatizing language, crucial in promoting a more compassionate and understanding approach to mental health. • Improving clarity and precision : The revised terminology aims to provide more accurate and specific descriptions of symptoms and disorders, facilitating better communication among clinicians and researchers. • Enhancing cultural sensitivity : The updates include more culturally sensitive language to describe various aspects of mental health, including sexual orientation, gender identity, and cultural experiences. The DSM-5-TR incorporates several important terminology updates to reflect current scientific understanding and promote more sensitive, accurate language. Throughout the text, “neu- roleptic medications” have been replaced with “antipsychotic medications or other dopamine receptor blocking agents,” pro- viding a more precise description of these drugs’ mechanisms. In sections on gender dysphoria, “desired gender” has been updated to “experienced gender,” acknowledging individuals’ lived experiences better. The language surrounding substance use disorders has been revised to reduce stigma and align with the understanding of addiction as a medical condition. Terminology related to neurodevelopmental disorders has been updated to reflect current research and clinical practice. Additionally, the manual refines language used to describe cultural factors in mental health, emphasizing the importance of cultural competence in diagnosis and treatment. These changes demonstrate the ongoing effort to keep the DSM-5-TR relevant, accurate, and sensitive. The manual aims to improve communication among professionals, enhance diagnostic accuracy, and foster a more nuanced understanding of mental health conditions by adopting more precise, less stigmatizing, and culturally appropriate language. ICD-10-CM CODE UPDATES The DSM-5-TR incorporated several updates to ICD-10-CM codes to align with the latest changes in diagnostic classifica- tions [1]. Critical updates to the ICD-10-CM codes in the DSM-5-TR include the following.
New Codes Added • Prolonged grief disorder was added with the code F43.8. • New symptom codes were introduced for: ‒ Suicidal behavior (R45.851) ‒ Nonsuicidal self-injury (R45.88) • Codes for homelessness were expanded:
‒ Sheltered homelessness (Z59.01) ‒ Unsheltered homelessness (Z59.02)
Code Modifications • Unspecified depressive disorder was changed from F32.9 to F32.A. • Food insecurity now has a specific code, Z59.41, previously part of a broader category. • Lack of safe drinking water received its code Z58.6. • Personal history of self-harm was split into: ‒ Personal history of suicidal behavior (Z91.51) ‒ Personal history of nonsuicidal self-injury (Z91.52) Ongoing Updates The APA updates ICD-10-CM codes in response to broader medical coding system changes [22]. For example, in September 2023, Parkinson disease received an updated code G20.C and inadequate housing changed from Z59.1 to Z59.10. It is important to note that these coding updates are part of an ongoing process. The DSM-5-TR aims to maintain alignment with the ICD-10-CM, the official coding system used in the United States for diagnostic and billing purposes. Clinicians should regularly check for the most current coding updates, as they can affect diagnosis documentation and insur- ance reimbursement. The APA provides resources for staying informed about these changes, including periodic updates on their website. FOCUS ON CULTURE, RACISM, AND DISCRIMINATION The DSM-5-TR addressed culture, racism, and discrimination, representing a notable shift from the DSM-5 [1; 2]. Work Group on Ethnoracial Equity and Inclusion A dedicated Work Group on Ethnoracial Equity and Inclu- sion was established to review the entire manual for the first time in DSM history. This group, composed of ten diverse mental health practitioners, ensured appropriate attention was given to risk factors such as racism and discrimination and that non-stigmatizing language was used throughout the text. This was a significant departure from the DSM-5, which had no comprehensive review process focused on these issues.
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