Professional Documents
Culture Documents
Diagnostic and Statistical Manual of Mental Disorders: Fourth Edition
Diagnostic and Statistical Manual of Mental Disorders: Fourth Edition
Diagnostic and Statistical Manual of Mental Disorders: Fourth Edition
TEXT REVISION
- -
•
,
•
Published by the
American Psychiatric Association
Washington, DC
·
•
Copyright © 2000 American Psychiatric Association
DSM, DSM-JV, and DSM-IV-TR are 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 AP A's copyright. This prohibition ap-
plies to unauthorized uses or reprod\lctions in any form, including electronic .1 pplications.
Correspondence regarding copyright permissions should be directed to the DSM Permissions,
Office of Publishing Operations, American Psychiatric Association, 1400 K Street, N.W., Wash-
ing ton, DC 20005.
Manufactured in the United States of America on acid-free paper.
American Psychiatric Association
}.l{lO K Street, N W., Washington, DC 20005
www.psych.org
The correct citation for this book is American Psychiatric Association: Diagnostic and Statistical
MaJlJlal of Mf'Jl ta/ Disorders, Fourth Edition, Text Re,rision . Washington, DC, American Psychi-
atric Association, 2()()() .
library of Congress Cataloging-in-Pub lication Data
Diagnostic .md sta tis tical manual of mental d isorders: OS},,·I-IV . -Ith ed . , text revision .
p. ; cm.
Prepared by the Task Force on DSM-IV and othercommittecs and workgroups of the Amer-
ican PsychiatriCAssociation .
Includes index .
ISBN Q...S9O-U.-024-6 (casebound: alk . paper)-ISBN 0-890-12-025-4 (pbk..: alk . paper)
1. t-,'Ienlal illness Classification-Handbooks, manuals, etc . 2. Mental ilIness-Diagnosis-
Handbooks, man uals, etc. I.. Tille: OSM-IV. II.. American Psychiatric Association . Ill. American
Psychiatric Association . Task Force on OSM-IV .
[DNLM: 1. Mental Oisorders--classification . 2. Mental Disorders--diagnosis.
WM 15 0536 2000J
RC455 . 2. CI. 0536 2000
616. S9'075-d.c21
00-02-1852
British library Cataloguing in Pu b li cation Data
A crr record is available from the British Library .
Text Design- Anne Barnes
Manufacturing-R.. R.. Donnelley & Sons Comp.m y
Contents
-
Appendix A
Decision Trees for Differential Diagnosis . ................. . 745
Appendix B
Criteria Sets and Axes Provided for Further Study ......•.... . 759
Appendix C
Glossary of Techni ca l Terms .....•.•. • .•.................. 819
Appendix D
Highlights of Changes in
DSM-IV Text Revision ..............•. •.•. •.•.•.• ........ 829
Appendix E
Alphabetical Listing of
DSM-IV-TR Diagnoses and Codes ......•.•.•.•............ 845
Appendix F
Numerical Listing of
DSM-IV-TR Diagnoses and Codes ........•...•.•.• . • . . . ... 857
Appendix G
ICD-9-CM Codes for Selected General Medical
- Conditions and Medication-Induced Disorders . ..... . . . .... . 867
Appendix H
DSM-IV Classification
(W ith ICD-1O Codes) ..... • .•.•. • .•.•.•.•.•.•. • ... .. ..... 883
-
Appendix I
Outline for Cultural Fo rmul ati o n and
Glossary of Culture-Bound Syndromes ........ •.• .•. . . ... .. 897
Appendix J
DSM -IV Co nt rib ut o rs .... ... . . ...•.•.• . • . • . • . ........... 905
Appendix K
DSM-I V Text Revisio n Advi sers . . .. .... . ................... 929
The DSM-JV Text Revision Work Groups are listed on pp. xv-)':v ii .
•
XI
••
XII DSM-IV Wo rk Groups
xv
,
•
-
Psychiatric System Interface Disorders (Adjustment, Dissociat ive,
Factiti ous, Impulse-Co ntrol, and Somatof orm Disorders and
Psychological Factors Affecting Medical Conditions)
Text Revision Work Group
Mitchell Cohen, M.D. Russell Noyes, Jr., M.D.
Marc Feldman, M.D. Katharine Anne Phillips. M.D.
Eric Hollander, M.D. Eyal Shemesh, M.D.
Steven A. King, M. D. David A. Spiegel, M.D.
James Leven son, M.D. James J. Strain, M.D.
Ronald L Mar tin, M.D. (deceased) Sean H. Yutzy, M.D.
Jeffrey Newcom, M.D.
D SM-TV was a team effort. More than 1,000 people (and numerou s professional
organiza tions) have helped us in the preparation of this docum ent. Members of the
Task Force on DSM-IV and DSM -IV Staff are listed on p. xi, members of the DSM-IV
Work Groups are lis ted on pp. xii-xiv, and a lis t of other participants is included in
App endix J.
The major responsibility for the content of DSM-I V rests with the Task Force on
DSM-IV and members of the DSM-lV Work Groups. They have worked (often much
harder than they bargained for) with a dedication and good cheer that has been inspi-
rational to us. Bob Spitzer has our special thanks for his untiring efforts and unique per-
spective. Norman Sartorius, Darrel Regier, Lewis Ju dd, Fred Goodwin, and Chuck
Kaelber were instrumental in facilitating a m utually productive interchange between
the American Psychiatric Association and the World Health O rganization that has
improved both DSM-IV and ICD-lO, and increased their compatibility. We are grate-
ful to Robert Israel, Sue Meads, and Amy Blum at the National Center for Health
Statistics and Andrea Albawn-Feinstein at the American Health Information Man-
agement Association for suggestions on the DSM-IV coding system . Denis Prager,
Peter Na than, and David Kupfer helped us to develop a novel data reanal ysis strate-
gy that has been supported with fundin g from the John D. and Ca therine T. Mac-
A rthur Fowldation.
Many individuals w ithin the American Psychiatric Association deserve recogni-
tion. Mel Sabshin's special wisdom and grace made even the most tedious tasks seem
worth doing. The American Psychiatric Association Committee on Psychiatric Diag-
nosis and Assessment (chaired by Layton McCurdy) provided valuable direction and
counsel . We would also like to thank the American Psychiatric Association Presidents
(Drs. Fink, Pa rdes, Benedek, Hartmatm, Eng lish, and Mcintyre) and Assembly Speak-
ers (Drs. Cohen, FlatIUTI, Hanin, Pfaehler, and Shellow}.\vho helped wi th the planning
of our work. Carolyn Ra binowitz and Jack White, and their respective staffs in the
American Psychiatric Associa tion Medica l Director's Offi ce and the Bus iness Admi.n-
istration Office, have provided valua ble assis tatlCe in the organization of the project.
Several other individu als have our special gra ti tude. Wendy Davis, Nancy Vet-
torello, and Nancy Sydnor-Greenberg developed an d implemented an organizational
struchlre that has kept this com plex project from spuming out of control. We ha ve
also been b lessed w ith an wlUs lially a ble administrative s taff, which has included
Elisabeth Fitzhugh, Willa I-fall, Kelly McKinney, Gloria Helen Stayna, Sarah
Tilly, lina Rosenthal, Susan Mann, Joanne Mas, and, esp ecially, Cind y Jones. Ruth
Ross, our tireless Science Editor, has been responsible for imp roving the clarity of ex-
pression and o rganization of DSM-IV. Myriam Kline (Research Coordinator for the
NIH-funded DSM-IV Focu sed Field Tria ls), Jim Thompson {Research Coordinator for
•
XIX
Ixx Acknowledgm ent s for DSM· IV
the MacArthur Founda tion-funded Videotape Field Trial), and Sandy Ferris (Assis-
tant Director for the Office of Research) have made many val uable contributions. We
would also like to acknowledge all the other staff persons at the American PsychialTic
Association who have helped w ith th is project. Ron McMiUen, Claire Reinburg, Pam
Harley, and Jane D.1Venport of American Psychiatric Press have provided expert pro-
duction assis tance.
Acknowledgments for
DSM-IV Text Revision
T he effort to revise the DSM-IV text WilS also a team effort. We are especially in-
debted to the tireless efforts of the DSM-IY Text Revision Work Groups (listed on
pp. xv- xvii), w ho did the lion's share of the work in the preparation of this revision.
' Ne would also llke to acknowledge the contribution of the various .1dvisers to the
Work Groups (see Appendix K, p . 929), w ho provided their p erspccti\!C on whether
the proposed dlanges were jus tified . Fina lly, we would like to tha nk the American
Psychiatric Association's Committee on Psychiatric Diagnosis and Assessment (listed
on p. xvii), w ho provided helpful guidance and oversigh t during the p rocess as well
as approv,, ! of the final d ocument. Special g ratitude goes to committee members
Katharine A. Phillips and Janet B. W. \o\' i11ial11s, for their meticulous ly careful review
of the text revision. O f course, none of this could have happened without the invalu-
able organizational and administrative assistance provided by the DSM-IV s taff,
Laurie tvlcQueen and Yoshie Satake, and production assis tance provided by Anne
Barnes, Pam Harley, Greg Kuny, Claire Rcinburg, and Ron McMillen at American
Psychiatric Press.
First, MD.