list of assessment measures, accompanied by scoring and interpretation guidelines, are available from the American Psychiatric Association and the World Health Organization. A limited number of dimensional and cross-cutting assessments are published in the print edition of DSM-5. A larger number of assessments were made available after the DSM-5 was published and are available for download free of charge at www.psychiatry.org/practice/dsm/dsm5/online-assessment-measures
Specific measures and their availability are listed below:
- Level 1 Cross-Cutting Measures
DSM-5 includes two cross-cutting questionnaires that help clinicians determine other potential areas of concern that could impact the client’s diagnosis. Using a 5-point Likert scale ranging from None or not at all (0) to Severe (nearly every day), adults are asked to endorse 13 symptom domains (e.g., depression, anger, repetitive thoughts) and children and adolescents are assessed on 12 domains (e.g., somatic symptoms, inattention, irritability). The goal is to identify additional areas that may have an impact on the person’s assessment, treatment, and prognosis. The results of these symptom measures can also be used to track changes in symptoms over time and document any improvement and progress.
The following two cross-cutting symptom measures are available in the print version of DSM-5—one is a self-rated assessment of symptoms for adults, and the other is for children between the ages of 6 and 17, which is intended to be completed by parents or guardians.
1. Self-Rated Level 1 Cross-Cutting Symptom Measure—Adult (available in print version, DSM-5, p. 738)
2. Parent/Guardian-Rated DSM-5 Level 1 Cross-Cutting Symptom Measure—Child Age 6–17 (see DSM-5, p. 740)
- Level 2 Cross-Cutting Symptom Measures (available for download online)
Sometimes the results of Level 1 assessments indicate more in-depth (Level 2) symptom measures are needed. Level 2 cross-cutting measures are available for most of the symptom domains covered in Level 1. Online versions are available for download for the following Level 2 Measures:
For Adults
LEVEL 2—Depression—Adult (PROMIS Emotional Distress—Depression—Short Form)
LEVEL 2—Anger—Adult (PROMIS Emotional Distress—Anger—Short Form)
LEVEL 2—Mania—Adult (Altman Self-Rating Mania Scale [ASRM])
LEVEL 2—Anxiety—Adult (PROMIS Emotional Distress—Anxiety—Short Form)
LEVEL 2—Somatic Symptom—Adult (Patient Health Questionnaire 15 Somatic Symptom Severity Scale [PHQ-15])
LEVEL 2—Sleep Disturbance—Adult (PROMIS—Sleep Disturbance— Short Form)
LEVEL 2—Repetitive Thoughts and Behaviors—Adult (Adapted from the Florida Obsessive-Compulsive Inventory [FOCI] Severity Scale [Part B])
LEVEL 2—Substance Use—Adult (Adapted from the NIDA-Modified ASSIST)
For Parents of Children Ages 6–17
LEVEL 2—Somatic Symptom—Parent/Guardian of Child Age 6–17 (Patient Health Questionnaire 15 Somatic Symptom Severity Scale [PHQ-15])
LEVEL 2—Sleep Disturbance—Parent/Guardian of Child Age 6–17 (PROMIS—Sleep Disturbance—Short Form)
LEVEL 2—Inattention—Parent/Guardian of Child Age 6–17 (Swanson, Nolan, and Pelham, version IV [SNAP-IV])
LEVEL 2—Depression—Parent/Guardian of Child Age 6–17 (PROMIS Emotional Distress—Depression—Parent Item Bank)
LEVEL 2—Anger—Parent/Guardian of Child Age 6–17 (PROMIS Emotional Distress—Calibrated Anger Measure—Parent)
LEVEL 2—Irritability—Parent/Guardian of Child Age 6–17 (Affective Reactivity Index [ARI])
LEVEL 2—Mania—Parent/Guardian of Child Age 6–17 (Adapted from the Altman Self-Rating Mania Scale [ASRM])
LEVEL 2—Anxiety—Parent/Guardian of Child Age 6–17 (Adapted from PROMIS Emotional Distress—Anxiety—Parent Item Bank)
LEVEL 2—Substance Use—Parent/Guardian of Child Age 6–17 (Adapted from the NIDA-Modified ASSIST)
For Children Ages 11–17
LEVEL 2—Somatic Symptom—Child Age 11–17 (Patient Health Questionnaire 15 Somatic Symptom Severity Scale [PHQ-15])
LEVEL 2—Sleep Disturbance—Child Age 11–17 (PROMIS—Sleep Disturbance—Short Form)
LEVEL 2—Depression—Child Age 11–17 (PROMIS Emotional Distress—Depression—Pediatric Item Bank)
LEVEL 2—Anger—Child Age 11–17 (PROMIS Emotional Distress—Calibrated Anger Measure—Pediatric)
LEVEL 2—Irritability—Child Age 11–17 (Affective Reactivity Index [ARI])
LEVEL 2—Mania—Child Age 11–17 (Altman Self-Rating Mania Scale [ASRM])
LEVEL 2—Anxiety—Child Age 11–17 (PROMIS Emotional Distress—Anxiety—Pediatric Item Bank)
LEVEL 2—Repetitive Thoughts and Behaviors—Child Age 11–17 (Adapted from the Children’s Florida Obsessive Compulsive Inventory [C-FOCI] Severity Scale)
LEVEL 2—Substance Use—Child Age 11–17 (Adapted from the NIDA-Modified ASSIST)
- Disorder-Specific Severity Measures for Adults
Clinician-Rated Dimensions of Psychosis Symptom Severity (available in print version, p. 743)
Severity Measure for Depression—Adult (Patient Health Questionnaire [PHQ-9])
Severity Measure for Separation Anxiety Disorder—Adult
Severity Measure for Specific Phobia—Adult
Severity Measure for Social Anxiety Disorder (Social Phobia)—Adult
Severity Measure for Panic Disorder—Adult
Severity Measure for Agoraphobia—Adult
Severity Measure for Generalized Anxiety Disorder—Adult
Severity of Posttraumatic Stress Symptoms—Adult (National Stressful Events Survey PTSD Short Scale [NSESS])
Severity of Acute Stress Symptoms—Adult (National Stressful Events Survey Acute Stress Disorder Short Scale
- World Health Organization Disability Assessment Schedule 2.0
A hand-scored simple version of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) is included in DSM-5 (see pages 745–748). WHODAS 2.0 provides a useful assessment scale that may also be used to track treatment progress at regular intervals. The APA recommends that clinicians link in to the eHRS (electronic health record system) for more complex assessments of symptoms (APA, 2013a, p. 745).
CULTURAL FORMULATION
A Cultural Formulation section is included in DSM-5 to help clinicians recognize and consider the richness of cultural concepts, rules, and practices in the lives of their clients. Cultural formulation interviews can help increase awareness of how cultural context can influence presentation of mental illness and subsequently influence diagnosis. DSM-5 expands on the Outline for Cultural Formulation that was included in DSM-IV, and provides a suggested Cultural Formulation Interview (CFI) with suggestions for follow-up questions. An informant version (CFI-Informant) is also included and can be used to supplement information obtained by the CFI or, if the individual is unable to provide information (e.g., due to cognitive dysfunction or florid psychosis), may actually replace the CFI.
An outline for cultural formulation, based on DSM-IV material, provides a framework for assessing and understanding cultural features of a client’s mental health problem. The outline calls for assessment of the client in the following areas:
- Cultural identity
- Cultural conceptualizations of distress
- Psychosocial stressors and cultural features of vulnerability and resilience
- Cultural features of the clinical relationship between client and clinician
- Overall cultural assessment
The Cultural Formulation Interview is a set of 16 questions that can be used by clinicians to conduct a culturally competent mental health assessment. Two types of interviews are included in the print version of DSM-5:
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