DSM-5-TR Guide

A person has lower general thinking ability, such as reasoning, problem solving, and learning from experience. These limits make everyday life harder, like handling money, communicating, or living on one's own. Severity is based on how much daily support the person needs, not on an IQ score alone.

• Lower reasoning, planning, and learning ability confirmed by testing and clinical judgment
• Trouble with everyday life skills in thinking, social, and practical areas
• Needs support at school, work, or home to function
• Severity rated by adaptive functioning, not IQ alone

Note DSM-5-TR renamed it from 'intellectual disability' to 'intellectual developmental disorder' to match ICD-11. The older term is still shown in parentheses.

Used for children under age 5 who are behind in several areas of development, but who are too young to be tested reliably. It is a temporary label. The child should be reassessed later.

• Behind in several developmental milestones at once
• Child is too young for standard testing
• Calls for reassessment after some time passes

Note It is not a permanent diagnosis. Many children later receive a more specific diagnosis or catch up.

A child has ongoing trouble learning and using language, whether spoken, written, or signed. They may have a small vocabulary, build short or simple sentences, or struggle to tell a story. The problem is not explained by hearing loss or another condition.

• Smaller vocabulary than peers
• Simpler or shorter sentences
• Trouble explaining ideas or following a conversation
• Language skills clearly below age level

Note Includes problems with understanding (receptive) and with speaking (expressive) language.

A child has trouble making speech sounds clearly, which makes their speech hard to understand. This goes beyond the normal mistakes toddlers make. It can affect school and social life.

• Speech sounds are left out, swapped, or distorted
• Speech is harder to understand than expected for age
• Not caused by hearing loss or a physical problem like cleft palate

Note Formerly called phonological disorder.

This is stuttering that begins in childhood. The normal flow of speech is broken up by repeated sounds, stretched sounds, or blocks where no sound comes out. It can cause worry about speaking.

• Repeating sounds or syllables
• Stretching out sounds
• Pauses or blocks within words
• Speaking anxiety or avoiding speaking situations

Note Stuttering that starts in adulthood is coded differently (adult-onset fluency disorder, F98.5).

A person struggles with the social use of language. They may not know how to take turns in a conversation, change their tone for different listeners, or understand hints and jokes. Unlike autism, there are no restricted or repetitive behaviors.

• Trouble using language for greeting and sharing information
• Hard to adjust speech to the listener or setting
• Difficulty with jokes, sarcasm, or implied meaning
• No repetitive behaviors or narrow interests

Note Autism must be ruled out first. This diagnosis was new in DSM-5.

Autism affects how a person communicates and relates to others. It also involves repetitive behaviors, strong focused interests, or unusual reactions to senses like sound or touch. It is a spectrum, so support needs range from low to very high.

• Differences in social back-and-forth and nonverbal communication
• Trouble developing or keeping relationships
• Repetitive movements, speech, or insistence on routines
• Very intense or narrow interests
• Over- or under-reaction to sensory input

Note DSM-5 merged autistic disorder, Asperger's disorder, and PDD-NOS into this one diagnosis. DSM-5-TR clarified wording so all social criteria must be met. Specifiers include with or without intellectual or language impairment and severity levels 1 to 3.

ADHD is an ongoing pattern of trouble paying attention, being overly active, acting without thinking, or a mix of these. It shows up in more than one setting, like home and school. It gets in the way of learning, work, or relationships.

• Easily distracted, loses things, and has trouble finishing tasks
• Fidgeting, restlessness, or trouble staying seated
• Interrupting or acting before thinking
• Problems appear in two or more settings

Note It is not caused by laziness or bad parenting. Presentation can change over time, so the code may change too.

A person has lasting trouble learning a key school skill, such as reading, writing, or math, even with help. Their skills are well below what is expected for their age. It is not explained by intellectual disability, vision or hearing problems, or poor teaching.

• Slow or inaccurate reading, or poor reading comprehension
• Problems with spelling, grammar, or organizing writing
• Trouble with number sense, math facts, or math reasoning
• Skills stay low despite targeted help

Note Dyslexia and dyscalculia are covered here as types. Each area of impairment is coded separately.

A child's motor skills, like catching a ball, handwriting, or using scissors, are well below age level. They may seem clumsy or slow. This makes daily tasks and school harder.

• Clumsiness, such as dropping or bumping into things
• Slow or inaccurate motor skills
• Trouble with handwriting, sports, or self-care tasks
• Not due to a neurological condition like cerebral palsy

Note Sometimes informally called dyspraxia.

A person repeats movements that seem driven and have no clear purpose, like hand flapping, body rocking, or head banging. These can interfere with daily life or cause self-injury.

• Repetitive, purposeless-seeming movements
• May cause injury in some cases
• Interferes with social, school, or other activities

Note Specifiers note whether self-injury is present and whether a known medical, genetic, or environmental factor is involved.

A person has both multiple motor tics and at least one vocal tic. Tics are sudden, fast, repeated movements or sounds. They may come and go and change over time.

• Multiple motor tics, like blinking or shoulder shrugging
• At least one vocal tic, like throat clearing or sniffing
• Tics wax and wane in frequency

Note Only a small number of people with Tourette's shout offensive words (coprolalia).

A person has motor tics or vocal tics, but not both. The tics have lasted a long time.

• Only motor tics or only vocal tics
• Tics may come and go

Note Specify whether motor tics only or vocal tics only.

A person has one or more tics that have been present for less than a year. Many childhood tics fade on their own.

• Motor tics, vocal tics, or both
• Short history of tics

Note If tics last past a year, the diagnosis may change to persistent tic disorder or Tourette's.

These labels are used when a person has real symptoms and problems that fit the chapter but do not meet the full criteria for a specific disorder. 'Other specified' lets the clinician record the reason. 'Unspecified' is used when there is not enough information.

• Symptoms cause distress or impairment
• Full criteria for a named disorder are not met

Note DSM-5-TR also lists neurodevelopmental disorder associated with prenatal alcohol exposure as an example of other specified.

A long-standing pattern of odd beliefs, unusual perceptions, and eccentric behavior, along with discomfort in close relationships. It is milder than schizophrenia and does not involve lasting psychosis.

• Odd or magical thinking
• Unusual perceptual experiences
• Few close friends and strong social anxiety
• Eccentric speech or appearance

Note It is listed in this chapter because it is on the schizophrenia spectrum, but its full description is in the personality disorders chapter.

A person holds one or more firm false beliefs (delusions) for a long time. Aside from the delusion, their behavior and thinking are often fairly normal. They usually do not have the broad symptoms of schizophrenia.

• Fixed false beliefs that do not change with evidence
• Daily functioning often mostly intact
• Common types: persecutory, jealous, grandiose, somatic, erotomanic

Note DSM-5-TR subtypes describe the delusion's theme. A 'with bizarre content' specifier exists.

A sudden episode of psychosis that lasts a short time, and then the person fully returns to how they were before. It can follow a major stressor or childbirth, but it can also happen without one.

• Sudden onset of delusions, hallucinations, or disorganized speech
• Full return to prior functioning
• May follow a major stressor or occur around childbirth

Note Specifiers note marked stressors, no stressors, or postpartum onset.

It has the same kind of symptoms as schizophrenia, but it has lasted a shorter time. Some people recover, and some later receive a schizophrenia diagnosis.

• Two or more core psychotic symptoms
• Same symptom picture as schizophrenia
• Decline in functioning is not required

Note About two-thirds of people first given this diagnosis later go on to receive a schizophrenia or schizoaffective diagnosis.

Schizophrenia is a serious, long-term disorder that affects how a person thinks, feels, and acts. People may hear or see things others do not, hold false beliefs, or speak in confusing ways. Motivation, emotion, and self-care often decline.

• Delusions and hallucinations
• Disorganized speech or behavior
• Negative symptoms, like low motivation or reduced emotion
• Clear drop in work, social, or self-care functioning

Note Schizophrenia is not 'split personality.' DSM-5 removed the old subtypes (paranoid, disorganized, etc.).

A person has symptoms of schizophrenia plus major mood episodes (depression or mania). Psychotic symptoms also happen for a stretch of time without mood symptoms.

• Psychotic symptoms together with a major mood episode
• At least 2 weeks of psychosis without mood symptoms
• Mood episodes present for most of the illness

Note Type depends on whether manic episodes have occurred (bipolar type) or only depressive ones.

Catatonia is a group of movement and behavior changes. A person may not move or speak, hold odd postures, resist being moved, or copy others' words or actions. It can happen with psychotic, mood, or medical conditions.

• Not moving or responding (stupor)
• Not speaking (mutism)
• Holding strange postures
• Repeating others' speech or movements

Note Catatonia is a specifier for many disorders, not a separate illness. It can be life-threatening and often responds to treatment.

Psychotic symptoms can be caused by drugs, alcohol, medicines, or withdrawal. They can also be caused by a medical illness, like a brain tumor or epilepsy. In these cases the cause is the substance or illness, not a primary psychotic disorder.

• Delusions or hallucinations linked in time to a substance or illness
• Evidence from history, exam, or lab tests
• Not better explained by another psychotic disorder

Used when there are psychotic symptoms that cause problems but do not fit a named disorder. Examples include attenuated psychosis syndrome or persistent auditory hallucinations alone.

• Psychotic symptoms with distress or impairment
• Does not meet full criteria for a specific disorder

Note Attenuated psychosis syndrome appears as an example here and in the conditions for further study.

Bipolar I is defined by at least one manic episode. Mania is a period of very high or irritable mood with a lot of energy that seriously disrupts life. Many people also have episodes of major depression, but depression is not required for the diagnosis.

• Very high, expansive, or irritable mood with increased energy
• Needing much less sleep, racing thoughts, fast talking
• Risky choices, like overspending
• Can include psychosis or need for hospital care

Note DSM-5 requires increased energy or activity, not only mood change, to count as mania.

Bipolar II involves at least one hypomanic episode and at least one major depressive episode, but never a full manic episode. Hypomania is a milder high that others notice but that does not cause major impairment.

• Hypomanic periods of raised mood and energy
• Major depressive episodes that are often long and disabling
• No history of full mania

Note Bipolar II is not a 'milder' form of bipolar I. The depression can be severe and long-lasting.

A person has many ups and downs in mood over a long time. The highs are not strong enough to be hypomania, and the lows are not strong enough to be major depression. Stable periods are short.

• Frequent periods of mild highs and mild lows
• Stable mood never lasts longer than 2 months
• Never meets full criteria for a mania, hypomania, or major depression

Manic-like or hypomanic symptoms can be caused by drugs, medicines such as steroids, or by medical conditions such as thyroid disease. The mood changes are a direct result of that cause.

• Raised or irritable mood tied to a substance or illness
• Evidence the cause can produce these symptoms

Used when bipolar-type symptoms cause problems but do not meet full criteria. An example is short hypomanic episodes of 2 to 3 days along with major depression.

• Bipolar-type symptoms with distress or impairment
• Does not meet full criteria

Note DSM-5-TR added unspecified mood disorder (F39) for cases where it is not yet clear whether the pattern is bipolar or depressive.

Children with DMDD have frequent, severe temper outbursts that are far out of proportion to the situation. Between outbursts they are irritable or angry most of the day, nearly every day.

• Severe temper outbursts about three or more times a week
• Constant irritable or angry mood between outbursts
• Happens in at least two settings, like home and school

Note Added in DSM-5 partly to reduce over-diagnosis of bipolar disorder in children.

Major depression is a period of low mood or loss of interest in most things, along with other changes like sleep, appetite, energy, and focus. It causes real problems at home, school, or work. It is more than normal sadness.

• Depressed mood or loss of interest or pleasure
• Changes in sleep, appetite, or weight
• Tiredness, trouble focusing, feelings of worthlessness or guilt
• Thoughts of death or suicide

Note Specifiers include anxious distress, mixed features, melancholic, psychotic features, peripartum onset, and seasonal pattern.

This is a long-lasting depression. The mood may be less intense than major depression, but it lasts for years and can include full major depressive episodes along the way.

• Low mood most days for a long time
• Poor appetite or overeating, sleep changes, low energy
• Low self-esteem and hopelessness
• Symptom-free periods last no more than 2 months

Note Combines what DSM-IV called dysthymia and chronic major depression.

PMDD causes strong mood symptoms, like irritability, sadness, or anxiety, in the week before a menstrual period. Symptoms improve soon after the period starts and are mostly gone the week after.

• Mood swings, irritability, or anger
• Depressed mood or anxiety
• Physical symptoms like breast tenderness or bloating
• Pattern tied to the menstrual cycle

Note Much more severe than typical PMS. Moved from the appendix to a full diagnosis in DSM-5.

Depression can be caused by alcohol, drugs, some medicines, or withdrawal. It can also be caused by medical illness like stroke, Parkinson's disease, or hypothyroidism.

• Depressive symptoms linked to a substance or illness
• Evidence the cause can produce depression

Used when depressive symptoms cause problems but do not meet full criteria. Examples include short-duration depression or recurrent brief depression.

• Depressive symptoms with distress or impairment
• Does not meet full criteria

Note DSM-5-TR updated unspecified depressive disorder from F32.9 to F32.A.

A person has intense fear about being apart from people they are close to. They may worry that harm will come to a loved one or refuse to be away from them. It can happen in adults as well as children.

• Distress when separated or expecting separation
• Worry that something bad will happen to loved ones
• Refusing to go to school, work, or sleep away from home
• Nightmares or physical complaints about separation

Note DSM-5 moved it to this chapter and allowed diagnosis in adults.

A child consistently does not speak in certain social places, like school, even though they can and do speak in other places, like at home. It is not caused by a language problem.

• Speaks at home but not in certain settings
• Interferes with school or social life
• Not due to lack of language knowledge

Note It is usually linked to social anxiety, not defiance.

A person has strong fear of a certain object or situation, such as heights, spiders, flying, or needles. The fear is much stronger than the real danger. They avoid it or face it with intense distress.

• Immediate fear when facing the trigger
• Avoiding the object or situation
• Fear is out of proportion to the actual danger

Note Blood-injection-injury phobia can cause fainting, unlike most phobias.

A person has strong fear of social situations where they might be judged or embarrassed. They worry about showing anxiety or doing something humiliating. They avoid these situations or endure them with great distress.

• Fear of being judged or watched
• Worry about embarrassment or rejection
• Avoiding social or performance situations

Note Specifier: performance only, for fear limited to speaking or performing in public. Formerly called social phobia.

A person has repeated, unexpected panic attacks. These are sudden waves of intense fear with physical symptoms. Afterward, they worry about more attacks or change their behavior to avoid them.

• Sudden panic attacks with racing heart, shaking, or shortness of breath
• Fear of dying, losing control, or 'going crazy' during attacks
• Ongoing worry about future attacks

Note Panic attacks can occur in many disorders and can be recorded as a specifier. Panic disorder requires repeated unexpected attacks.

A person fears and avoids places where escape might be hard or help might not be available if they panic. Examples include public transportation, crowds, open spaces, or being outside the home alone.

• Fear of public transportation, open or closed spaces, crowds, or being out alone
• Avoiding these places or needing a companion
• Fear is out of proportion to the actual danger

Note DSM-5 separated agoraphobia from panic disorder. They can be diagnosed together.

A person worries too much about many everyday things, like work, health, or money. The worry is hard to control and comes with physical symptoms like muscle tension or trouble sleeping.

• Excessive worry about many topics
• Hard to stop or control the worry
• Restlessness, fatigue, poor focus, irritability, tense muscles, or poor sleep

Anxiety or panic can be caused by substances like caffeine, stimulants, or withdrawal from alcohol, or by medical problems like an overactive thyroid or heart conditions.

• Anxiety or panic tied to a substance or illness
• Evidence the cause can produce anxiety

Note Opioid-induced anxiety codes changed in October 2022 (e.g., F11.188, F11.288, F11.988).

Used when anxiety causes problems but does not meet criteria for a named anxiety disorder. Examples include limited-symptom attacks or cultural syndromes like khyâl cap or ataque de nervios.

• Anxiety with distress or impairment
• Does not meet full criteria

OCD involves obsessions, which are unwanted thoughts, images, or urges that cause anxiety, and compulsions, which are actions a person feels driven to do to reduce that anxiety. The cycle takes up a lot of time or causes real distress.

• Unwanted, intrusive thoughts (like fear of germs or harm)
• Repetitive behaviors or mental acts (like washing, checking, counting)
• Takes more than about 1 hour a day or causes distress

Note Insight specifier: good or fair, poor, or absent/delusional. A tic-related specifier also exists. Being neat or organized is not OCD.

A person is preoccupied with flaws in their appearance that others cannot see or think are minor. They spend a lot of time checking, fixing, or hiding these perceived flaws.

• Preoccupation with perceived appearance flaws
• Mirror checking, grooming, seeking reassurance, or comparing
• Significant distress or impairment

Note Muscle dysmorphia (believing one's body is too small) is a specifier.

A person has ongoing difficulty throwing away or parting with things, no matter their value. Items build up and clutter living spaces so they cannot be used normally.

• Strong need to save items and distress when discarding
• Clutter blocks normal use of living areas
• Often includes excessive acquiring

Note Added as its own disorder in DSM-5. It is different from collecting.

A person repeatedly pulls out their own hair, leading to hair loss. They try to stop but cannot.

• Repeated hair pulling causing hair loss
• Repeated attempts to stop
• Distress or impairment

A person repeatedly picks at their skin, causing sores or wounds. They try to stop but cannot.

• Repeated picking causing skin lesions
• Repeated attempts to stop
• Distress or impairment

Note New as a full diagnosis in DSM-5.

Obsessions, compulsions, or related behaviors can be caused by a substance or by a medical condition, such as strep-related neuropsychiatric conditions (PANDAS) in some children.

• OC-type symptoms tied to a substance or illness

Used when OC-type symptoms cause problems but do not meet full criteria. Examples include body-focused repetitive behaviors like nail biting or lip chewing, and obsessional jealousy.

• OC-type symptoms with distress or impairment
• Does not meet full criteria

A young child who has had severe neglect rarely seeks or accepts comfort from caregivers. They seem withdrawn and emotionally shut down.

• Rarely seeks or responds to comfort when upset
• Limited positive emotion and social response
• History of severe neglect or frequent caregiver changes

A child with a history of neglect acts overly friendly with strangers. They may go off with an unfamiliar adult without checking with their caregiver.

• Approaches and interacts with strangers without hesitation
• Overly familiar talk or physical behavior
• Little checking back with caregiver
• History of neglect or disrupted care

Note Split from reactive attachment disorder in DSM-5.

PTSD can develop after a person experiences or witnesses a traumatic event, such as violence, a serious accident, or sexual assault. They relive the event, avoid reminders, feel more negative, and stay on high alert.

• Intrusive memories, nightmares, or flashbacks
• Avoiding reminders of the trauma
• Negative changes in mood and beliefs
• Being easily startled, irritable, or on guard

Note A separate set of criteria exists for children age 6 and younger. Dissociative subtype is a specifier. ICD-10-CM also has F43.11 acute and F43.12 chronic, but DSM-5-TR uses F43.10.

Acute stress disorder is a strong stress reaction in the first month after a trauma. Symptoms are similar to PTSD but are short-term.

• Intrusive memories or bad dreams
• Feeling numb, detached, or in a daze
• Avoidance and high alertness

Note If symptoms last past 1 month, the diagnosis may change to PTSD.

An adjustment disorder is a stronger-than-expected emotional or behavior reaction to a stressful life change, such as a breakup, job loss, or move. It causes distress or trouble functioning.

• Emotional or behavior symptoms after an identifiable stressor
• Distress out of proportion to the stressor, or real impairment
• Not normal grief and not another mental disorder

Prolonged grief disorder is intense, long-lasting grief after the death of someone close. The person keeps longing for or being preoccupied with the one who died, and this keeps them from getting on with life.

• Intense yearning for or preoccupation with the deceased
• Emotional pain, numbness, or feeling life is meaningless
• Trouble re-engaging with friends or activities
• Grief goes beyond cultural and social norms

Note New in DSM-5-TR. It was first coded F43.8 in the 2022 manual; ICD-10-CM changed it to F43.81 starting October 1, 2022.

Used when trauma or stress-linked symptoms cause problems but do not meet criteria for a named disorder. Examples include adjustment-like reactions that start late or last longer than 6 months.

• Stress-related symptoms with distress or impairment
• Does not meet full criteria

Note Other specified changed from F43.8 to F43.89 on October 1, 2022.

A person has two or more distinct identities or personality states. Each may have its own sense of self and way of acting. The person also has gaps in memory for everyday events or important personal information.

• Two or more distinct identity states
• Memory gaps not explained by ordinary forgetting
• Distress or impairment
• Not part of accepted cultural or religious practice

Note Formerly called multiple personality disorder. In some cultures it can appear as possession-form identity.

A person cannot remember important personal information, usually about a stressful or traumatic event. The memory loss is more than normal forgetting and is not caused by a brain injury or substance.

• Inability to recall important personal information
• Often linked to trauma or stress
• Not due to substances or a medical condition

Note Dissociative fugue (unexpected travel or wandering with memory loss) is now a specifier, not its own disorder.

A person has repeated experiences of feeling detached from their own body or mind (depersonalization), or feeling that the world is unreal or dreamlike (derealization). They know these feelings are not real.

• Feeling outside one's body or like watching oneself
• Surroundings seem unreal, foggy, or distant
• Reality testing stays intact

Note Brief episodes are common and not a disorder. This diagnosis requires ongoing distress or impairment.

Used for dissociative symptoms that cause problems but do not fit a named disorder. Examples include identity disturbance after brainwashing or dissociative trance.

• Dissociative symptoms with distress or impairment
• Does not meet full criteria

A person has one or more physical symptoms, like pain or fatigue, and spends too much thought, worry, time, or energy on them. The symptoms may or may not have a medical cause.

• Distressing physical symptoms
• Excessive thoughts about how serious symptoms are
• High health anxiety
• Lots of time and energy spent on symptoms

Note It replaced somatization disorder and part of hypochondriasis from DSM-IV. Specifier: with predominant pain.

A person worries a lot about having or getting a serious illness, even though they have few or no symptoms. They may check their body often or avoid doctors out of fear.

• Preoccupation with having a serious illness
• Few or mild physical symptoms
• Checking or reassurance seeking, or avoiding care

Note Specify care-seeking type or care-avoidant type.

A person has nervous-system symptoms, like weakness, shaking, seizures, or vision loss, that do not match known neurological disease. Exam findings show the symptoms are not caused by a standard neurological condition.

• Changes in movement or sensation
• Clinical findings do not fit known neurological disease
• Real, not faked
• Distress or impairment

Note DSM-5-TR put 'functional neurological symptom disorder' first in the name. A psychological stressor is no longer required.

A person has a medical condition, and psychological or behavioral factors make it worse. Examples include stress that triggers asthma or skipping medicine due to denial.

• A known medical condition
• Psychological or behavior factors worsen it or its treatment

Note The mental factor is not a separate mental disorder here; it is influencing a medical one.

A person fakes, exaggerates, or causes illness or injury in themselves or in someone else, like a child. They do this even without obvious outside rewards like money.

• Falsifying signs or symptoms of illness
• Presents self or another as sick or injured
• Deception without obvious external reward

Note When imposed on another, the perpetrator receives the diagnosis, not the victim. This was once called Munchausen by proxy. It is not the same as malingering, which is faking for a clear external gain.

Used when somatic symptoms cause problems but do not meet full criteria. Examples include brief somatic symptom disorder and pseudocyesis (false belief of pregnancy with body signs).

• Somatic symptoms with distress or impairment
• Does not meet full criteria

A person regularly eats things that are not food, like dirt, chalk, paper, or ice. This is not part of normal development or a cultural practice.

• Eating non-nutritive, non-food substances
• Not age-appropriate or culturally supported
• Can cause medical problems like poisoning or blockage

Note Adult pica code changed from F50.89 to F50.83 in October 2024.

A person repeatedly brings up food after eating. They may re-chew, re-swallow, or spit it out. It is not caused by a medical problem like reflux.

• Repeated regurgitation of food
• Not caused by a gastrointestinal condition
• Not only during another eating disorder

Note Before October 2024, F98.21 was used at all ages.

A person eats too little or too narrow a range of foods, leading to weight loss, poor nutrition, or dependence on supplements. It is driven by low interest in eating, sensitivity to food texture or smell, or fear of choking or vomiting, not by body image.

• Very limited food variety or amount
• Weight loss, nutrition deficits, or reliance on supplements
• Not driven by concern about weight or shape

Note Expanded in DSM-5 from the DSM-IV feeding disorder of infancy or early childhood. It is more than picky eating.

A person restricts how much they eat, leading to a very low body weight. They have an intense fear of gaining weight and a distorted view of their body shape or size.

• Significantly low body weight from restricted intake
• Intense fear of weight gain or behavior that blocks gain
• Distorted body image or not recognizing how serious low weight is

Note Severity is based on BMI in adults (or BMI percentile in youth). Loss of menstrual periods is no longer required. Anorexia has one of the highest death rates of any mental disorder.

A person has repeated episodes of binge eating followed by actions to prevent weight gain, like vomiting, laxatives, fasting, or heavy exercise. Self-worth is tied closely to body shape and weight.

• Binge eating with a sense of loss of control
• Compensating behaviors like vomiting or fasting
• Self-image overly based on weight and shape

Note Most people with bulimia are in the normal weight range. Severity is based on the number of compensatory episodes per week.

A person has repeated episodes of eating a very large amount of food in a short time and feeling unable to stop. Unlike bulimia, they do not regularly vomit or use other behaviors to make up for it.

• Eating much more than most people would in a similar time
• Feeling a loss of control while eating
• Eating fast, eating alone, or eating until uncomfortably full
• Strong distress about bingeing

Note Became a full diagnosis in DSM-5. It is not the same as occasional overeating.

Used when eating problems cause distress or impairment but do not meet full criteria. Examples include atypical anorexia (all features but weight in normal range), purging disorder, and night eating syndrome.

• Eating-related symptoms with distress or impairment
• Does not meet full criteria

Note Atypical anorexia can be just as medically serious as anorexia nervosa.

Enuresis means repeatedly wetting the bed or clothes, whether on purpose or by accident. It can happen only at night, only during the day, or both. It is only diagnosed once a child is old enough that dry nights and days would normally be expected.

• Repeated wetting of bed or clothing
• Child is at least 5 years old in developmental terms
• Specifiers: nocturnal only, diurnal only, or both
• Not caused by a medical condition or a substance such as a diuretic
• Often causes embarrassment or limits activities like sleepovers

Note Most children outgrow it. Bedwetting alarms and some medications are common treatments.

Encopresis means repeatedly passing stool in places such as clothing or the floor. Most cases are linked to long-term constipation, where hard stool builds up and softer stool leaks around it. The child often does not do it on purpose.

• Repeated passing of stool in inappropriate places
• Child is at least 4 years old in developmental terms
• Specifiers: with or without constipation and overflow incontinence
• Not caused by a medical condition other than one involving constipation
• Often linked with shame and avoiding school or social events

This label is used when a person has elimination symptoms that cause distress or problems but do not fully meet the criteria for enuresis or encopresis. The clinician writes down the specific reason, such as wetting that happens less often than required.

• Symptoms of a wetting or soiling problem
• Full criteria are not met
• Clinician states the reason

This label is used when there are clear elimination symptoms but the clinician does not specify why full criteria are not met. It is common in emergency or short-visit settings.

• Elimination symptoms cause distress or impairment
• Reason for not meeting full criteria is not stated

Insomnia disorder means being unhappy with how much or how well you sleep, even when you have enough chance to sleep. People may struggle to fall asleep, wake up often, or wake too early and not get back to sleep. It leads to daytime problems like fatigue, low mood, or poor focus.

• Trouble starting sleep, staying asleep, or waking too early
• Happens despite enough opportunity to sleep
• Causes daytime distress or impairment
• Specifiers: episodic, persistent, or recurrent
• Can occur with another mental, medical, or sleep disorder

Note Cognitive behavioral therapy for insomnia (CBT-I) is the recommended first treatment.

Hypersomnolence disorder means feeling too sleepy during the day even after a main sleep of 7 hours or more. People may nap repeatedly, sleep very long hours without feeling rested, or have a hard time fully waking up.

• Excessive sleepiness despite at least 7 hours of main sleep
• Repeated naps or lapses into sleep during the day
• Long sleep that does not feel refreshing
• Severe grogginess after waking (sleep inertia)
• Not better explained by another sleep disorder or a substance

Narcolepsy causes repeated, sudden urges to sleep or falling asleep during the day. Many people also have cataplexy, which is a brief loss of muscle tone often triggered by laughing or strong emotion. It is linked to a loss of the brain chemical hypocretin (orexin).

• Irresistible sleep attacks or naps during the day
• Cataplexy episodes in many cases
• Low hypocretin in spinal fluid, or fast entry into REM sleep on a sleep test
• Vivid dream-like images when falling asleep or waking, and sleep paralysis are common
• Specifiers for type and severity

In obstructive sleep apnea, the airway repeatedly narrows or closes during sleep, which briefly stops or reduces breathing. This causes snoring, gasping, and broken sleep, and leads to daytime sleepiness. It is confirmed with a sleep study.

• Loud snoring, snorting, gasping, or pauses in breathing during sleep
• Daytime sleepiness or unrefreshing sleep
• Sleep study shows at least 5 breathing events per hour with symptoms, or 15 or more per hour even without symptoms
• Severity based on number of events per hour
• Linked to obesity, high blood pressure, and heart disease

In central sleep apnea, breathing pauses happen because the brain does not send the usual signal to breathe, not because the airway is blocked. It is often seen in people with heart failure, stroke, or long-term opioid use.

• Sleep study shows 5 or more central breathing pauses per hour
• Not better explained by another sleep disorder
• Subtypes: idiopathic, Cheyne-Stokes breathing, comorbid with opioid use
• Can cause broken sleep and daytime sleepiness

Sleep-related hypoventilation means breathing is too shallow or slow during sleep, so carbon dioxide levels in the blood rise. It often occurs with severe obesity, lung disease, or nerve and muscle disorders.

• Sleep study shows periods of shallow breathing with high carbon dioxide
• Subtypes: idiopathic, congenital, or comorbid with another condition
• Can cause morning headaches, fatigue, and sleepiness

These disorders happen when a person's internal body clock does not match the sleep schedule their life requires. For example, a teen may not feel sleepy until 3 a.m. but must wake for school at 6 a.m. The mismatch causes insomnia, daytime sleepiness, or both.

• Ongoing mismatch between body clock and required schedule
• Causes insomnia, sleepiness, or both
• Types: delayed phase, advanced phase, irregular, non-24-hour, shift work
• Specifiers: episodic, persistent, or recurrent

These disorders involve partial waking from deep sleep, usually in the first third of the night. The person may walk around (sleepwalking) or wake suddenly screaming in fear (sleep terrors). They are hard to wake during the episode and usually remember little or nothing.

• Repeated episodes of incomplete waking from deep sleep
• Sleepwalking or sleep terror episodes
• Little or no memory of the episode
• Hard to comfort or wake during an episode
• Causes distress, injury risk, or impairment

Nightmare disorder means having repeated, very upsetting dreams that the person remembers clearly. The dreams usually involve threats to safety or survival. The person becomes alert quickly after waking, and the nightmares cause distress or daytime problems.

• Repeated long, frightening dreams that are well remembered
• Quickly alert and oriented after waking
• Causes distress or impairment
• Specifiers for duration (acute, subacute, persistent) and severity

Note Common after trauma. Imagery rehearsal therapy is an evidence-based treatment.

In REM sleep behavior disorder, the body does not stay still during dreaming as it normally does. People act out their dreams by talking, shouting, punching, or kicking. It can cause injury and may be an early sign of Parkinson's disease or Lewy body disease.

• Repeated vocal or physical acting out of dreams during REM sleep
• Person is alert and oriented on waking
• Sleep study shows REM sleep without normal muscle relaxation
• Risk of injury to self or bed partner

Restless legs syndrome is a strong urge to move the legs, usually with uncomfortable feelings in them. The urge gets worse when resting and in the evening or at night, and moving the legs brings relief. It often disrupts sleep.

• Urge to move the legs with unpleasant sensations
• Worse at rest and in the evening or night
• Relieved by moving
• Causes distress, sleep loss, or impairment
• Linked to low iron, pregnancy, and kidney disease

This diagnosis is used when a serious sleep problem is caused by using, or stopping, a substance or medication. Examples include insomnia during alcohol withdrawal or sleepiness from sedatives.

• Prominent sleep disturbance
• Starts during or soon after intoxication, withdrawal, or medication exposure
• Types: insomnia, daytime sleepiness, parasomnia, or mixed
• Not better explained by an independent sleep disorder

These labels cover sleep problems that cause distress but do not fully match a specific sleep diagnosis. With the other specified label, the clinician writes down the reason, such as brief insomnia.

• Clinically significant sleep symptoms
• Full criteria for a specific disorder not met
• Reason is stated (other specified) or not stated (unspecified)

Note The APA's September 2025 update changed the example wording from short-term insomnia disorder to short-term insomnia.

Delayed ejaculation means a marked delay in, or absence of, ejaculation during partnered sexual activity, even when the person wants to ejaculate. It causes significant distress.

• Marked delay or absence of ejaculation
• Present on almost all occasions of partnered sex
• Specifiers: lifelong or acquired; generalized or situational; severity
• Not better explained by a medical condition, medication, or relationship distress

Erectile disorder means repeated difficulty getting or keeping an erection during sexual activity, or a noticeable drop in firmness. It causes the person distress.

• Trouble getting or keeping an erection, or reduced rigidity
• Present on almost all occasions
• Specifiers: lifelong or acquired; generalized or situational; severity
• Rises with age and with heart disease and diabetes

Female orgasmic disorder means a marked delay in, much lower frequency of, or absence of orgasm, or much weaker orgasms, during sexual activity. It causes the person distress.

• Delayed, rare, absent, or much less intense orgasms
• Present on almost all occasions
• Specifiers: lifelong or acquired; generalized or situational; severity; whether she has ever had an orgasm

This disorder means a lasting lack of, or big drop in, sexual interest or arousal. It may show up as few sexual thoughts, not starting sex, or little pleasure or physical response during sex. It causes the person distress.

• Reduced sexual interest, thoughts, or fantasies
• Less starting of or responding to sexual activity
• Reduced excitement, pleasure, or physical arousal
• Diagnosis needs at least 3 such changes

This disorder involves ongoing difficulty with vaginal penetration during intercourse. It can include pain, fear of pain, or tightening of the pelvic floor muscles when penetration is attempted.

• Difficulty with vaginal penetration
• Pain in the vulva, vagina, or pelvis during penetration attempts
• Fear or anxiety about pain
• Tensing of pelvic floor muscles

This disorder means a lasting lack of, or very low, sexual thoughts and desire for sexual activity. The clinician judges this against the person's age and life situation. It causes the person distress.

• Persistently low or absent sexual thoughts, fantasies, and desire
• Judged in light of age and context
• Specifiers: lifelong or acquired; generalized or situational; severity

Premature ejaculation means ejaculating very soon after penetration, usually within about 1 minute, and before the person wishes. It happens on most occasions and causes distress.

• Ejaculation within about 1 minute of penetration
• Happens before the person wants it to
• Present on almost all occasions
• Severity based on timing (mild, moderate, severe)

This diagnosis is used when a sexual problem is caused by a substance or a medication. Antidepressants, blood pressure medications, and alcohol are common causes.

• Clear sexual dysfunction
• Began during or soon after use, withdrawal, or medication start
• Not better explained by an independent sexual dysfunction

These labels are used for distressing sexual problems that do not meet criteria for one of the specific disorders.

• Clinically significant sexual symptoms
• Full criteria not met
• Reason stated (other specified) or not stated (unspecified)

This diagnosis applies to children who have a strong, lasting sense that they are a gender different from the one assigned at birth, along with significant distress or problems functioning. It is based on a pattern of behaviors and statements, not a single preference for certain toys or clothes.

• Strong desire to be, or insistence that one is, another gender (required)
• Preference for clothing, play, roles, or playmates typical of the experienced gender
• Dislike of one's sexual anatomy
• At least 6 of 8 indicators must be present
• Specifier: with a difference of sex development

This diagnosis applies to teens and adults who feel a clear mismatch between their experienced gender and their assigned gender, which causes distress or impairment. People may want to change their body or be treated as their experienced gender.

• Marked mismatch between experienced gender and sex characteristics
• Strong wish to be rid of or to have certain sex characteristics
• Strong wish to be, and be treated as, another gender
• At least 2 of 6 indicators must be present
• Specifiers: with a difference of sex development; posttransition

These labels are used when gender-related distress is significant but does not meet the full criteria, for example if it has lasted less than 6 months.

• Clinically significant gender-related distress
• Full criteria not met
• Reason stated or not stated

Oppositional defiant disorder is a lasting pattern of angry or irritable mood, arguing and defiance, or spitefulness. The behavior goes beyond what is typical for the child's age and shows up with at least one person who is not a sibling.

• Frequent loss of temper, touchiness, or resentment
• Arguing with adults and refusing rules
• Deliberately annoying others or blaming others
• Spiteful behavior
• Severity based on number of settings affected

Intermittent explosive disorder involves repeated outbursts of aggression that are far out of proportion to what set them off. The outbursts are impulsive or angry, not planned, and the person often feels regret afterward.

• Sudden verbal or physical outbursts out of proportion to the trigger
• Outbursts are not planned or for a goal
• Causes distress, legal trouble, or damaged relationships
• Person is at least 6 years old in developmental terms

Conduct disorder is a repeated pattern of behavior that violates other people's basic rights or major age-appropriate rules. It can include aggression toward people or animals, destroying property, lying or stealing, and serious rule-breaking like running away.

• Aggression toward people or animals
• Destruction of property
• Deceitfulness or theft
• Serious violations of rules
• Specifier: with limited prosocial emotions (for example, lack of remorse or empathy)

Antisocial personality disorder is listed in this chapter and in the Personality Disorders chapter. It is a long-term pattern of disregarding and violating the rights of others that starts in childhood or teen years as conduct disorder.

• Pattern of disregard for others' rights
• Person is at least 18
• Signs of conduct disorder before age 15

Note See the separate Personality Disorders page for full coverage.

Pyromania means setting fires on purpose more than once because of a fascination with fire and a sense of tension before and relief or pleasure after. It is not done for money, revenge, or a political cause.

• Deliberate fire setting on more than one occasion
• Tension or arousal before, pleasure or relief after
• Strong interest in fire and related things
• Not done for gain, anger, or because of another disorder

Kleptomania means repeatedly failing to resist urges to steal things that the person does not need for personal use or for their money value. The person feels growing tension before the theft and relief or pleasure during it.

• Repeated urges to steal unneeded items
• Tension before and relief during the theft
• Not done out of anger or revenge
• Often causes guilt and shame afterward

These labels are used when disruptive or impulse-control symptoms cause significant problems but do not meet criteria for a specific disorder in this chapter.

• Clinically significant behavior problems
• Full criteria not met
• Reason stated or not stated

A substance use disorder is a problematic pattern of using a substance that leads to real harm or distress. DSM-5-TR lists 11 possible signs, and at least 2 in the same 12-month period are needed. The signs fall into four groups: losing control over use, social problems, risky use, and body changes such as tolerance and withdrawal.

• Impaired control: using more or longer than planned, failed attempts to cut down, lots of time spent, strong cravings
• Social impairment: failing at work, school, or home; continued use despite relationship problems; giving up activities
• Risky use: using in physically dangerous situations, or despite knowing it causes health or mental problems
• Pharmacological signs: tolerance and withdrawal (not counted when a medication is taken as prescribed)
• Severity: mild 2 to 3 signs, moderate 4 to 5, severe 6 or more

Note Specifiers also include in a controlled environment and, for opioids and tobacco, on maintenance therapy.

Alcohol use disorder is a harmful pattern of drinking marked by loss of control, cravings, and continued use despite problems. Intoxication causes slurred speech, poor coordination, and poor judgment. Withdrawal after heavy use can cause shaking, sweating, anxiety, and in severe cases seizures or delirium, so it can be dangerous.

• Use disorder uses the 11 general signs
• Intoxication: slurred speech, unsteady walking, memory gaps, poor judgment
• Withdrawal: tremor, sweating, fast pulse, nausea, insomnia, anxiety, possible seizures
• Withdrawal can progress to delirium tremens, a medical emergency

DSM-5-TR includes caffeine intoxication and caffeine withdrawal. Caffeine use disorder is not an official diagnosis; it is listed only as a condition for further study. Intoxication usually follows a large dose, and withdrawal happens when a daily user suddenly stops.

• Intoxication usually follows more than about 250 mg (about 2 to 3 cups of brewed coffee)
• Intoxication: restlessness, nervousness, insomnia, flushed face, stomach upset, rapid heartbeat
• Withdrawal: headache, marked fatigue, low mood, trouble concentrating, flu-like symptoms
• No official caffeine use disorder diagnosis

Cannabis use disorder is a problematic pattern of marijuana or other cannabis use that causes distress or impairment. Intoxication causes red eyes, increased appetite, dry mouth, and changes in mood and judgment. Withdrawal after heavy daily use causes irritability, sleep problems, and low appetite.

• Use disorder uses the 11 general signs
• Intoxication: red eyes, increased appetite, dry mouth, fast heart rate, slowed reaction time
• Withdrawal: irritability, anxiety, trouble sleeping, strange dreams, reduced appetite, restlessness
• Higher-potency products are linked with higher risk

This group covers phencyclidine (PCP) and other hallucinogens such as LSD, psilocybin, and MDMA. Intoxication changes perception, mood, and thinking and can cause panic or dangerous behavior. There is no official withdrawal diagnosis, but some people have lasting flashbacks called hallucinogen persisting perception disorder.

• Use disorder uses most of the general signs (withdrawal is not a criterion)
• PCP intoxication: agitation, aggression, numbness, jerky eye movements, loss of coordination
• Other hallucinogen intoxication: intensified perceptions, illusions, dilated pupils, fast heart rate
• Persisting perception disorder: re-experiencing visual changes after stopping use

Inhalant use disorder involves problematic use of chemical vapors from things like glue, paint thinner, gasoline, or aerosol sprays. Intoxication looks like being drunk and can cause sudden death from heart rhythm problems. DSM-5-TR does not include an inhalant withdrawal diagnosis.

• Use disorder uses the general signs except withdrawal
• Intoxication: dizziness, slurred speech, unsteady walking, lethargy, euphoria
• Risk of sudden death, brain damage, and organ damage
• Most common in younger adolescents

Opioid use disorder is a problematic pattern of using heroin, fentanyl, or prescription pain relievers. Intoxication causes drowsiness, pinpoint pupils, and slowed breathing, which can lead to fatal overdose. Withdrawal is very uncomfortable, with flu-like symptoms, but is rarely life-threatening in itself.

• Use disorder uses the 11 general signs
• Specifiers include on maintenance therapy (for example, methadone or buprenorphine)
• Intoxication: drowsiness, pinpoint pupils, slurred speech, slowed breathing
• Withdrawal: low mood, nausea, muscle aches, runny nose, dilated pupils, diarrhea, yawning, insomnia

Note Medications for opioid use disorder (methadone, buprenorphine, naltrexone) reduce overdose deaths.

This group covers benzodiazepines, sleep medications, and barbiturates. A use disorder is a problematic pattern of use beyond medical need. Intoxication looks like alcohol intoxication, and withdrawal can be dangerous and cause seizures.

• Use disorder uses the 11 general signs, but tolerance and withdrawal alone do not count when taken as prescribed
• Intoxication: slurred speech, poor coordination, memory and attention problems, stupor
• Withdrawal: sweating, tremor, insomnia, anxiety, nausea, possible seizures
• Mixing with opioids or alcohol raises overdose risk

This group covers methamphetamine, cocaine, and prescription stimulants. The clinician specifies which stimulant is involved. Intoxication causes energy, alertness, and a racing heart, while withdrawal often brings a crash of tiredness, low mood, and increased appetite.

• Use disorder uses the 11 general signs
• Intoxication: euphoria or anxiety, fast heart rate, dilated pupils, high blood pressure, agitation
• Withdrawal: fatigue, vivid unpleasant dreams, sleep changes, increased appetite, low mood
• Can cause heart attack, stroke, and stimulant-induced psychosis

Tobacco use disorder is a problematic pattern of using cigarettes, vapes, or other nicotine products. People often want to quit but find it hard. DSM-5-TR includes tobacco withdrawal but not tobacco intoxication.

• Use disorder uses the 11 general signs
• Common signs include cravings and using more than intended
• Withdrawal: irritability, anxiety, trouble concentrating, increased appetite, restlessness, low mood, insomnia
• Specifiers include on maintenance therapy (such as nicotine replacement) and in a controlled environment

Note Mild tobacco use disorder is coded Z72.0 (tobacco use) because ICD-10-CM has no mild nicotine dependence code.

This category covers substances not in the other classes, such as anabolic steroids, kava, nitrous oxide, or unknown pills. The same signs of a use disorder, intoxication, and withdrawal apply.

• Use disorder uses the 11 general signs
• Used when the substance is known but not in another class, or is unknown
• Intoxication and withdrawal symptoms depend on the substance

Gambling disorder is the only non-substance addiction in DSM-5-TR. It is a lasting pattern of problem gambling that causes serious distress or harm to finances, relationships, or work. People often chase losses and lie to hide how much they gamble.

• Needing to gamble with larger amounts to get the same excitement
• Restless or irritable when trying to cut down
• Chasing losses and relying on others for money
• Lying about gambling or risking jobs and relationships
• Needs 4 of 9 signs; severity mild 4 to 5, moderate 6 to 7, severe 8 to 9

Delirium is a sudden change in attention and awareness, often with confusion that comes and goes during the day. It is caused by a medical problem, a substance, withdrawal, or a medication. It is a medical emergency, especially in older adults.

• Trouble focusing and shifting attention
• Reduced awareness of surroundings
• Develops quickly and fluctuates during the day
• Other thinking changes such as memory, language, or perception
• Specifiers: acute or persistent; hyperactive, hypoactive, or mixed

Note Since October 2022, other specified and unspecified delirium use F05 instead of R41.0 (APA, 2022 coding update).

Major neurocognitive disorder is a significant decline in one or more thinking areas that makes a person need help with everyday tasks like paying bills or managing medicines. It is the DSM term for what most people call dementia.

• Significant decline from a prior level in one or more cognitive areas
• Decline shown by concern from someone and by testing
• Interferes with independence in daily activities
• Not only during delirium
• Specifiers: severity (mild, moderate, severe) and behavioral disturbance (agitation, psychotic disturbance, mood symptoms, anxiety, or other disturbance such as apathy, sleep problems, or wandering)

Note Before October 2022, major NCD used F02.80 / F02.81 without severity. The new F02.A-, F02.B-, F02.C- (and F01, F03) codes capture severity and behavior. For example, F02.A0 is mild with no behavioral disturbance, F02.A11 is mild with agitation, and F02.A18 is mild with other behavioral disturbance.

Mild neurocognitive disorder is a modest decline in thinking abilities that a person or others notice and that testing confirms, but the person can still live independently. They may need more effort or tricks, like lists, to manage.

• Modest decline from a prior level in one or more cognitive areas
• Independence in daily activities is kept, though with more effort
• Not only during delirium
• Not better explained by another mental disorder

Note Before October 2022, mild NCD was coded G31.84 for all etiologies; now F06.70 / F06.71 are used for probable medical causes.

This is the most common cause of major NCD. It usually begins with trouble learning and remembering new information, then slowly affects language, planning, and other skills. Probable means genetic or clear clinical evidence supports it; possible means evidence is less certain.

• Slow, gradual onset and steady decline
• Memory and learning are usually affected first
• Probable versus possible depends on genetic testing, family history, and clinical course
• The APA's 2024 update allows mixed causes to be recorded

Frontotemporal NCD comes from damage to the front and side areas of the brain. It often changes personality and behavior, such as loss of manners or empathy, or affects language. Memory may be fairly well preserved early on.

• Behavioral variant: disinhibition, apathy, loss of empathy, compulsive behavior, food changes
• Language variant: trouble speaking, naming, or understanding words
• Often starts before age 65
• Relative sparing of memory and visual skills early

This type of NCD is caused by abnormal protein deposits called Lewy bodies. Thinking and alertness can go up and down from day to day. People often see detailed visual hallucinations and develop Parkinson-like movement symptoms.

• Fluctuating attention and alertness
• Repeated, detailed visual hallucinations
• Parkinson-like stiffness and slowness that begin after thinking problems
• Often has REM sleep behavior disorder
• Very sensitive to antipsychotic medications

Vascular NCD is caused by reduced blood flow to the brain from strokes or small blood vessel disease. Symptoms may appear suddenly after a stroke or build up in steps. Slowed thinking and trouble with planning are common.

• Decline linked in time to strokes or evidence of blood vessel disease
• Complex attention and planning are often most affected
• May worsen in steps
• Brain imaging shows vascular damage
• For mild NCD probably due to vascular disease, the code I67.9 is listed first

This NCD results from a head injury, such as a fall, car crash, or blast, that caused loss of consciousness, memory loss, confusion, or other signs of brain injury. The thinking problems appear right after the injury, or once the person regains consciousness, and last past the acute recovery period.

• Evidence of a brain injury with loss of consciousness, amnesia, confusion, or neurological signs
• Cognitive problems begin right after the injury
• Symptoms last beyond the early recovery period
• Can include headaches, irritability, and mood changes

This NCD is caused by long-term use of a substance such as alcohol, sedatives, or inhalants, or by a medication. The thinking problems last beyond the usual time of intoxication and withdrawal.

• Cognitive decline linked to substance or medication exposure
• Lasts beyond intoxication and acute withdrawal
• Alcohol can cause an amnestic-confabulatory type (Korsakoff syndrome)
• Some improvement may occur after long abstinence

This NCD is caused by HIV affecting the brain. It often causes slowed thinking, trouble with attention, and slowed movement.

• Documented HIV infection
• Cognitive decline not better explained by other brain conditions
• Often slowed thinking and processing
• Effective HIV treatment has made major NCD much less common

Prion diseases, such as Creutzfeldt-Jakob disease, are caused by abnormal proteins that damage the brain. They progress very quickly and are fatal.

• Sudden onset and very rapid decline
• Muscle jerks (myoclonus) and loss of coordination
• Biomarker or brain imaging evidence
• Fatal, usually within about a year

This NCD develops in people with established Parkinson's disease. Thinking problems come on gradually after the movement symptoms are already present.

• Diagnosed Parkinson's disease
• Cognitive decline starts gradually after movement symptoms
• Slowed thinking and problems with planning are common
• Not due to another condition

Note Parkinson's disease code changed from G20 to G20.C on October 1, 2023 (APA coding update).

Huntington's disease is an inherited brain disease that causes uncontrolled movements, mood changes, and thinking decline. Problems with planning and processing speed often appear early.

• Genetic diagnosis or clear family history
• Gradual decline in thinking
• Involuntary jerky movements (chorea)
• Mood changes, irritability, apathy

This NCD is caused by a medical condition not listed above, such as a brain tumor, multiple sclerosis, low thyroid, or vitamin B12 deficiency. The condition has to be shown to explain the thinking decline.

• Evidence of a medical condition that can affect the brain
• Cognitive decline best explained by that condition
• Some causes, like thyroid or B12 problems, may be partly reversible

Note The APA's September 2025 update changed the multiple sclerosis code from G35 to G35.D.

This diagnosis is used when more than one cause is contributing, such as Alzheimer's disease plus vascular disease. It is common in older adults.

• Evidence that two or more causes are involved
• Each cause is recorded
• Common in very old adults

This label is used when a person has clear thinking decline but the type or cause cannot be determined.

• Cognitive symptoms cause distress or impairment
• Cause or type cannot be determined

A lasting pattern of distrust and suspicion, where others' motives are read as harmful.

• Cluster A

A lasting pattern of detachment from relationships and a limited range of emotional expression.

• Cluster A

A lasting pattern of discomfort in close relationships, odd beliefs or perceptions, and eccentric behavior.

• Cluster A
• Also listed in the schizophrenia spectrum chapter

A lasting pattern of disregarding and violating the rights of others, starting with conduct problems before age 15.

• Cluster B
• Also listed in the disruptive and conduct chapter
• Must be at least 18

A lasting pattern of unstable relationships, self-image, and emotions, with marked impulsivity.

• Cluster B

A lasting pattern of strong emotionality and attention-seeking.

• Cluster B

A lasting pattern of grandiosity, need for admiration, and lack of empathy.

• Cluster B

A lasting pattern of social inhibition, feeling inadequate, and being very sensitive to criticism.

• Cluster C

A lasting pattern of needing to be taken care of, leading to clinging behavior and fear of separation.

• Cluster C

A lasting pattern of preoccupation with order, perfection, and control at the cost of flexibility.

• Cluster C
• Different from obsessive-compulsive disorder

This disorder involves recurring sexual arousal from watching people who do not know they are being observed in private situations. It is diagnosed when the person has acted on these urges with someone who did not consent, or when the urges cause distress or impairment.

• Arousal centered on observing unaware people
• Acted on with a nonconsenting person, or causes distress
• Person must be at least 18

This disorder involves recurring sexual arousal from exposing one's genitals to an unsuspecting person. It is diagnosed when the person has acted on this with a nonconsenting person or it causes distress or impairment.

• Arousal centered on exposing oneself to unsuspecting people
• Acted on with a nonconsenting person, or causes distress
• Specifiers for the age or physical maturity of the people exposed to

This disorder involves recurring sexual arousal from touching or rubbing against a person who has not consented, often in crowded places. It is diagnosed when it has been acted on or it causes distress or impairment.

• Arousal centered on nonconsensual touching
• Acted on with a nonconsenting person, or causes distress

This disorder involves recurring sexual arousal from being humiliated, bound, or made to suffer, which causes the person significant distress or impairment. Consensual activity without distress is not a disorder.

• Arousal centered on being humiliated or made to suffer
• Causes distress or impairment
• Specifier: with asphyxiophilia (a high-risk practice)

This disorder involves recurring sexual arousal from the physical or psychological suffering of another person. It is diagnosed when acted on with a nonconsenting person or when it causes distress or impairment.

• Arousal centered on another person's suffering
• Acted on with a nonconsenting person, or causes distress

This disorder involves recurring sexual interest in prepubescent children (generally 13 or younger). It is diagnosed when the person has acted on it, or when it causes marked distress or relationship problems. Acting on it is child sexual abuse and a serious crime.

• Sexual interest focused on prepubescent children
• Acted on, or causes marked distress or difficulty
• Person is at least 16 and at least 5 years older than the child
• Specifiers: exclusive or nonexclusive type; sex of children; limited to incest

This disorder involves recurring sexual arousal focused on nonliving objects or on a nongenital body part, which causes significant distress or impairment.

• Arousal focused on objects or specific nongenital body parts
• Causes distress or impairment
• Not limited to clothing used in cross-dressing or devices made for genital stimulation

This disorder involves recurring sexual arousal from cross-dressing that causes significant distress or impairment. Cross-dressing by itself, and gender identity, are not disorders.

• Arousal linked to cross-dressing
• Causes distress or impairment
• Specifiers: with fetishism; with autogynephilia

These labels are used for other unusual sexual interests that cause distress, impairment, or harm to others but do not match one of the named disorders.

• Clinically significant paraphilic symptoms
• Full criteria for a named disorder not met
• Reason stated or not stated

Note A paraphilia (an unusual sexual interest) is not itself a disorder. It becomes a paraphilic disorder only when it causes the person distress or impairment, or when acting on it has harmed or risked harming others, including anyone who did not consent.

This label is used when a medical condition directly causes mental symptoms that do not fit a specific disorder. An example is dissociative symptoms caused by complex partial seizures.

• Mental symptoms directly caused by a medical condition
• Does not fit a specific disorder
• Clinician states the reason

This label is used when a medical condition causes mental symptoms, but the clinician does not specify the type or reason.

• Mental symptoms caused by a medical condition
• Type or reason not stated

This label is used for mental symptoms that cause distress or impairment but do not fit any specific diagnosis in any chapter. The clinician writes down the reason.

• Clinically significant mental symptoms
• Does not fit any other DSM category
• Reason stated

This label is used when mental symptoms are clearly present and impairing, but there is not enough information to make a more specific diagnosis.

• Clinically significant mental symptoms
• Not enough information to be specific
• Often used in emergency settings

This code is new in DSM-5-TR. It is used when a person is evaluated and no mental disorder or other condition is found.

• Evaluation completed
• No mental disorder found
• No other condition that is a focus of attention found

This is a Parkinson-like set of symptoms caused by medications that block dopamine, such as antipsychotics or some anti-nausea drugs. It usually appears within a few weeks of starting or raising the dose.

• Tremor, muscle stiffness, or slowed movement
• Begins after starting or raising a dopamine-blocking medication
• Often improves when the dose is lowered or the drug is changed

This is parkinsonism caused by a medication other than a dopamine blocker, such as lithium or valproate.

• Parkinson-like symptoms
• Linked to a medication that is not a dopamine blocker

Neuroleptic malignant syndrome is a rare but life-threatening reaction to dopamine-blocking medications. It causes very high fever, severe muscle stiffness, confusion, and unstable blood pressure and heart rate. It is a medical emergency.

• High fever and severe muscle rigidity
• Confusion or reduced consciousness
• Unstable blood pressure, sweating, fast heart rate
• Raised creatine kinase on blood tests

Acute dystonia is sudden, involuntary muscle spasms, often in the neck, jaw, eyes, or tongue, caused by a dopamine-blocking medication. It can be frightening and painful but responds quickly to treatment.

• Sudden muscle spasms or abnormal postures
• Can affect neck, eyes (upward gaze), jaw, or tongue
• More common in young males and with high-potency drugs

Akathisia is an intense inner restlessness with an urge to keep moving, caused by a medication. People may pace, shift their weight, or be unable to sit still. It is distressing and can raise the risk of stopping treatment.

• Subjective restlessness
• Pacing, rocking, or constant leg movements
• Linked to antipsychotics or sometimes antidepressants

Tardive dyskinesia is involuntary, repetitive movements, most often of the mouth, tongue, face, or limbs, that develop after long-term use of dopamine-blocking medication. It can be long-lasting even after the medication is stopped.

• Involuntary movements of the face, tongue, lips, or limbs
• Develops after at least a few months of use (shorter in older adults)
• May persist after stopping the medication

These are late-appearing forms of dystonia or akathisia that develop after long-term medication use and may last even after the medication is stopped.

• Muscle spasms or restlessness that appear late in treatment
• May persist after stopping

This is a fine shaking of the hands or other body parts when holding a position, caused by medications such as lithium, valproate, or some antidepressants.

• Fine tremor when holding a posture
• Linked to a specific medication
• Not better explained by another tremor disorder

This label covers medication-caused movement problems that do not fit the specific categories above.

• Movement problem caused by a medication
• Does not fit another listed type

This is a set of symptoms that can occur when someone suddenly stops or sharply lowers an antidepressant after taking it for at least a month. Symptoms can include dizziness, flu-like feelings, sleep problems, and brief electric shock sensations.

• Follows abrupt stop or large dose reduction
• Dizziness, nausea, flu-like symptoms, insomnia, irritability
• Brief electric shock sensations are common
• Usually improves with restarting and slow tapering

This label is used for other medication side effects that become a focus of care, such as serious weight gain, low blood pressure, or sexual side effects not covered elsewhere.

• Side effect of a medication taken as prescribed
• Becomes a focus of clinical attention

These codes, new in DSM-5-TR, record that a person has engaged in a potentially self-harming act with at least some intent to die. They can be used with or without another mental disorder.

• Current episode or personal history can be coded
• Includes attempts that did not cause injury
• Helps track risk, since past attempts are a strong predictor of future suicide
• The first printing of DSM-5-TR showed T14.91A and T14.91D. The APA corrected these to T14.91XA and T14.91XD in October 2022.

Note If you or someone you know is in crisis in the US, call or text 988.

These codes, new in DSM-5-TR, record deliberate self-harm, such as cutting or burning, done without intent to die. Nonsuicidal self-injury disorder itself remains a condition for further study.

• Deliberate self-harm without suicidal intent
• Current or personal history can be coded
• Often used to relieve distress

These codes record problems in close relationships that affect a person's health or treatment. Examples are ongoing conflict with a partner, strained parent-child relationships, or the effects of divorce on the family.

• Problems with a partner, parent, child, or sibling
• Can be the main reason for a visit
• Includes normal grief after a death (uncomplicated bereavement)

These codes record child maltreatment, intimate partner violence, and abuse of adults by others. There are separate codes for confirmed versus suspected cases, first versus later visits, and for a person's past history of abuse.

• Types: physical, sexual, psychological, and neglect
• Confirmed (T74) versus suspected (T76) codes
• Other Z codes record visits for victim or perpetrator services
• Past history codes (Z62.81x) used for adults abused as children

This code records school or learning problems that are a focus of care but are not due to a learning disorder or other mental disorder, such as failing grades, poor attendance, or conflict with teachers.

• Academic difficulties or school conflict
• Not better explained by a mental disorder
• Can apply to students of any age

These codes record work-related problems that affect mental health or care, such as job loss, stress at work, unemployment, or the stress of military deployment.

• Unemployment, job threat, or workplace conflict
• Stress related to military deployment
• Affects treatment or functioning

These codes record housing problems that affect health or care, including homelessness, unsafe or crowded housing, and conflict with landlords or neighbors.

• Sheltered or unsheltered homelessness
• Unsafe, crowded, or inadequate housing
• Housing conflict or institutional living

Note Inadequate housing changed from Z59.1 to Z59.10 on October 1, 2023 (APA coding update).

These codes record money-related hardships that affect health or treatment, such as not having enough food, living in poverty, or lacking health insurance.

• Food insecurity or lack of safe water
• Extreme poverty or low income
• Insufficient insurance or welfare support

Note Insufficient social insurance or welfare support (Z59.7) was split into Z59.71 and Z59.72 on October 1, 2024 (APA coding update).

These codes record social stresses such as major life transitions, loneliness, trouble adjusting to a new culture, or being the target of discrimination.

• Life transitions such as retirement or leaving home
• Living alone or social exclusion
• Acculturation stress and discrimination

These codes record contact with crime or the legal system that affects a person's care, whether as a victim or someone involved with the courts or prison.

• Being a crime victim
• Arrest, conviction, incarceration, or release
• Other legal stressors

This group covers other issues that can shape care, such as spiritual struggles, not following a treatment plan, faking symptoms for outside gain, and problems getting health care.

• Spiritual or moral distress
• Not following treatment recommendations
• Deliberately faking or exaggerating symptoms for external gain (malingering)
• Barriers to getting health care

Note Nonadherence changed from Z91.19 to Z91.199 in October 2022. In September 2025 the APA renamed Z65.8 Moral, Religious, or Spiritual Problem. Newer obesity class codes (E66.811 to E66.813) exist in ICD-10-CM since October 2024, but DSM-5-TR still lists E66.9.