Because longitudinal studies are lacking, little is known about the clinical course of

antidepressant discontinuation syndrome. Symptoms appear to abate over time with very gradual
dosage reductions. Symptoms are usually short-lived, lasting no more than 2 weeks, and are
seldom present more than 3 weeks after discontinuation.

Differential Diagnosis
The differential diagnosis of antidepressant discontinuation syndrome includes a relapse of the
disorder for which the medication was prescribed (e.g., depression or panic disorder), somatic
symptom disorder, bipolar I or bipolar II disorder with mixed features, substance use disorders,
migraine, or cerebrovascular accident. Discontinuation symptoms often resemble symptoms of a
persistent anxiety disorder or a return of somatic symptoms of depression for which the
medication was initially given. It is important not to confuse discontinuation syndrome with a
relapse of the original depressive or anxiety disorder for which the medication was being
prescribed. Antidepressant discontinuation syndrome differs from substance withdrawal in that
antidepressants themselves have no reinforcing or euphoric effects. Individuals typically do not
escalate the dose of medications on their own, and they generally do not engage in drug-seeking
behavior to obtain additional medication. Criteria for a substance use disorder are not met.

Other Adverse Effect of Medication

T50.905A Initial encounter
T50.905D Subsequent encounter
T50.905S Sequelae
This category is available for optional use by clinicians to code side effects of medication (other
than movement symptoms) when these adverse effects become a main focus of clinical attention.
Examples include severe hypotension, cardiac arrhythmias, and priapism.

820
821
 Other Conditions That May Be a Focus of
Clinical Attention

This chapter includes conditions and psychosocial or environmental problems that may be
a focus of clinical attention or otherwise affect the diagnosis, course, prognosis, or treatment of
an individual’s mental disorder. These conditions are presented with their corresponding codes
from ICD-10-CM (usually Z codes). A condition or problem in this chapter may be coded 1) if it
is a reason for the current visit; 2) if it helps to explain the need for a test, procedure, or
treatment; 3) if it plays a role in the initiation or exacerbation of a mental disorder; or 4) if it
constitutes a problem that should be considered in the overall management plan.
The conditions and problems listed in this chapter are not mental disorders. Their inclusion in
DSM-5-TR is meant to draw attention to the scope of additional issues that may be encountered
in routine clinical practice and to provide a systematic listing that may be useful to clinicians in
documenting these issues.
For quick reference to all codes in this section, see the DSM-5-TR Classification. Conditions
and problems that may be a focus of clinical attention are listed in the subsequent text as follows:
1. Suicidal behavior (potentially self-injurious behavior with at least some intent to die) and
nonsuicidal self-injury (intentional self-inflicted damage to the body in the absence of
suicidal intent).
2. Abuse and neglect (e.g., child and adult maltreatment and neglect problems, including
physical abuse, sexual abuse, neglect, and psychological abuse).
3. Relational problems (e.g., parent-child relational problem, sibling relational problem,
relationship distress with spouse or intimate partner, disruption by separation or divorce).
4. Educational problems (e.g., illiteracy or low-level literacy, schooling unavailable or
unattainable, failed school examinations, underachievement in school).
5. Occupational problems (e.g., unemployment, change of job, threat of job loss, stressful
work schedule, discord with boss and workmates).
6. Housing problems (e.g., homelessness; inadequate housing; discord with neighbor, lodger,
or landlord).
7. Economic problems (e.g., lack of adequate food or safe drinking water, extreme poverty,
low income).
8. Problems related to the social environment (e.g., problem related to living alone,
acculturation difficulty, social exclusion or rejection).
9. Problems related to interaction with the legal system (e.g., conviction in criminal
proceedings, imprisonment or other incarceration, problems related to release from prison,
problems related to other legal circumstances).
10. Problems related to other psychosocial, personal, and environmental circumstances
(e.g., problems related to unwanted pregnancy, victim of crime, victim of terrorism).
11. Problems related to access to medical and other health care (e.g., unavailability or
inaccessibility of health care facilities).
12. Circumstances of personal history (e.g., personal history of psychological trauma, military
deployment).

822

13. Other health service encounters for counseling and medical advice (e.g., sex counseling,
other counseling or consultation).
14. Additional conditions or problems that may be a focus of clinical attention (e.g.,
wandering associated with a mental disorder, uncomplicated bereavement, phase of life
problem).

Suicidal Behavior and Nonsuicidal Self-Injury

Coding Note for ICD-10-CM Suicidal Behavior
For T codes only, the 6th character should be coded as follows:
A (initial encounter)—Use while the individual is receiving active treatment for the
condition (e.g., emergency department encounter, evaluation and treatment by a new
clinician); or
D (subsequent encounter)—Use for encounters after the individual has received active
treatment for the condition and when he or she is receiving routine care for the condition
during the healing or recovery phase (e.g., medication adjustment, other aftercare and
follow-up visits).

Suicidal Behavior
This category may be used for individuals who have engaged in potentially self-injurious
behavior with at least some intent to die as a result of the act. Evidence of intent to end one’s life
can be explicit or inferred from the behavior or circumstances. A suicide attempt may or may not
result in actual self-injury. If the individual is dissuaded by another person or changes his or her
mind before initiating the behavior, this category does not apply.

Current Suicidal Behavior

T14.91A Initial encounter: If suicidal behavior is part of the initial encounter with the clinical
presentation
T14.91D Subsequent encounter: If suicidal behavior is part of subsequent encounters with the
clinical presentation
Z91.51 History of Suicidal Behavior
If suicidal behavior has occurred during the individual’s lifetime

Nonsuicidal Self-Injury
This category may be used for individuals who have engaged in intentional self-inflicted damage
to their body of a sort likely to induce bleeding, bruising, or pain (e.g., cutting, burning, stabbing,
hitting, excessive rubbing) in the absence of suicidal intent.
R45.88 Current Nonsuicidal Self-Injury
If nonsuicidal self-injurious behavior is part of the clinical presentation
Z91.52 History of Nonsuicidal Self-Injury
If nonsuicidal self-injurious behavior has occurred during the individual’s lifetime

Abuse and Neglect

Maltreatment by a family member (e.g., caregiver, intimate adult partner) or by a nonrelative can
be the area of current clinical focus, or such maltreatment can be an important factor in the
assessment and treatment of individuals with mental disorders or other medical conditions.
Because of the legal implications of abuse and neglect, care should be used in assessing these
conditions and assigning these codes. Having a past history of abuse or

823

neglect can influence diagnosis and treatment response in a number of mental disorders, and may
also be noted along with the diagnosis.
For the following categories, in addition to listings of the confirmed or suspected event of
abuse or neglect, other codes are provided for use if the current clinical encounter is to provide
mental health services to either the victim or the perpetrator of the abuse or neglect. A separate
code is also provided for designating a past history of abuse or neglect.
Coding Note for ICD-10-CM Abuse and Neglect Conditions
For T codes only, the 7th character should be coded as follows:
A (initial encounter)—Use while the individual is receiving active treatment for the
condition (e.g., surgical treatment, emergency department encounter, evaluation and
treatment by a new clinician); or
D (subsequent encounter)—Use for encounters after the individual has received active
treatment for the condition and when he or she is receiving routine care for the condition
during the healing or recovery phase (e.g., cast change or removal, removal of external or
internal fixation device, medication adjustment, other aftercare and follow-up visits).

Child Maltreatment and Neglect Problems

Child Physical Abuse
This category may be used when physical abuse of a child is a focus of clinical attention. Child
physical abuse is nonaccidental physical injury to a child—ranging from minor bruises to severe
fractures or death—occurring as a result of punching, beating, kicking, biting, shaking, throwing,
stabbing, choking, hitting (with a hand, stick, strap, or other object), burning, or any other
method that is inflicted by a parent, caregiver, or other individual who has responsibility for the
child. Such injury is considered abuse regardless of whether the caregiver intended to hurt the
child. Physical discipline, such as spanking or paddling, is not considered abuse as long as it is
reasonable and causes no bodily injury to the child.

Child Physical Abuse, Confirmed

T74.12XA Initial encounter
T74.12XD Subsequent encounter

Child Physical Abuse, Suspected

T76.12XA Initial encounter
T76.12XD Subsequent encounter

Other Circumstances Related to Child Physical Abuse

Z69.010 Encounter for mental health services for victim of child physical abuse by parent
Z69.020 Encounter for mental health services for victim of nonparental child physical abuse
Z62.810 Personal history (past history) of physical abuse in childhood
Z69.011 Encounter for mental health services for perpetrator of parental child physical abuse
Z69.021 Encounter for mental health services for perpetrator of nonparental child physical
abuse

Child Sexual Abuse

This category may be used when sexual abuse of a child is a focus of clinical attention. Child
sexual abuse encompasses any sexual act involving a child that is intended to provide sexual
gratification to a parent, caregiver, or other individual who has responsibility

824

for the child. Sexual abuse includes activities such as fondling a child’s genitals, penetration,
incest, rape, sodomy, and indecent exposure. Sexual abuse also includes noncontact exploitation
of a child by a parent or caregiver—for example, forcing, tricking, enticing, threatening, or
pressuring a child to participate in acts for the sexual gratification of others, without direct
physical contact between child and abuser.

Child Sexual Abuse, Confirmed

T74.22XA Initial encounter
T74.22XD Subsequent encounter

Child Sexual Abuse, Suspected

T76.22XA Initial encounter
T76.22XD Subsequent encounter

Other Circumstances Related to Child Sexual Abuse

Z69.010 Encounter for mental health services for victim of child sexual abuse by parent
Z69.020 Encounter for mental health services for victim of nonparental child sexual abuse
Z62.810 Personal history (past history) of sexual abuse in childhood
Z69.011 Encounter for mental health services for perpetrator of parental child sexual abuse
Z69.021 Encounter for mental health services for perpetrator of nonparental child sexual abuse

Child Neglect
This category may be used when child neglect is a focus of clinical attention. Child neglect is
defined as any confirmed or suspected egregious act or omission by a child’s parent or other
caregiver that deprives the child of basic age-appropriate needs and thereby results, or has
reasonable potential to result, in physical or psychological harm to the child. Child neglect
encompasses abandonment; lack of appropriate supervision; failure to attend to necessary
emotional or psychological needs; and failure to provide necessary education, medical care,
nourishment, shelter, and/or clothing.

Child Neglect, Confirmed

T74.02XA Initial encounter
T74.02XD Subsequent encounter

Child Neglect, Suspected

T76.02XA Initial encounter
T76.02XD Subsequent encounter

Other Circumstances Related to Child Neglect

Z69.010 Encounter for mental health services for victim of child neglect by parent
Z69.020 Encounter for mental health services for victim of nonparental child neglect
Z62.812 Personal history (past history) of neglect in childhood
Z69.011 Encounter for mental health services for perpetrator of parental child neglect
Z69.021 Encounter for mental health services for perpetrator of nonparental child neglect

825

Child Psychological Abuse

This category may be used when psychological abuse of a child is a focus of clinical attention.
Child psychological abuse is nonaccidental verbal or symbolic acts by a child’s parent or
caregiver that result, or have reasonable potential to result, in significant psychological harm to
the child. (Physical and sexual abusive acts are not included in this category.) Examples of
psychological abuse of a child include berating, disparaging, or humiliating the child; threatening
the child; harming/abandoning—or indicating that the alleged offender will harm/abandon—
people or things that the child cares about; confining the child (as by tying a child’s arms or legs
together or binding a child to furniture or another object, or confining a child to a small enclosed
area [e.g., a closet]); egregious scapegoating of the child; coercing the child to inflict pain on
himself or herself; and disciplining the child excessively (i.e., at an extremely high frequency or
duration, even if not at a level of physical abuse) through physical or nonphysical means.

Child Psychological Abuse, Confirmed

T74.32XA Initial encounter
T74.32XD Subsequent encounter

Child Psychological Abuse, Suspected

T76.32XA Initial encounter
T76.32XD Subsequent encounter

Other Circumstances Related to Child Psychological Abuse

Z69.010 Encounter for mental health services for victim of child psychological abuse by parent
Z69.020 Encounter for mental health services for victim of nonparental child psychological
abuse
Z62.811 Personal history (past history) of psychological abuse in childhood
Z69.011 Encounter for mental health services for perpetrator of parental child psychological
abuse
Z69.021 Encounter for mental health services for perpetrator of nonparental child
psychological abuse

Adult Maltreatment and Neglect Problems

826

Spouse or Partner Violence, Physical

This category may be used when spouse or partner physical violence is a focus of clinical
attention. Spouse or partner physical violence is nonaccidental acts of physical force that result,
or have reasonable potential to result, in physical harm to an intimate partner or that evoke
significant fear in the partner. Nonaccidental acts of physical force include shoving, slapping,
hair pulling, pinching, restraining, shaking, throwing, biting, kicking, hitting with the fist or an
object, burning, poisoning, applying force to the throat, cutting off the air supply, holding the
head under water, and using a weapon. Acts for the purpose of physically protecting oneself or
one’s partner are excluded.

Spouse or Partner Violence, Physical, Confirmed

T74.11XA Initial encounter
T74.11XD Subsequent encounter
Spouse or Partner Violence, Physical, Suspected
T76.11XA Initial encounter
T76.11XD Subsequent encounter

Other Circumstances Related to Spouse or Partner Violence, Physical

Z69.11 Encounter for mental health services for victim of spouse or partner violence, physical
Z91.410 Personal history (past history) of spouse or partner violence, physical
Z69.12 Encounter for mental health services for perpetrator of spouse or partner violence,
physical

Spouse or Partner Violence, Sexual

This category may be used when spouse or partner sexual violence is a focus of clinical
attention. Spouse or partner sexual violence involves the use of physical force or psychological
coercion to compel the partner to engage in a sexual act against his or her will, whether or not the
act is completed. Also included in this category are sexual acts with an intimate partner who is
unable to consent.

Spouse or Partner Violence, Sexual, Confirmed

T74.21XA Initial encounter
T74.21XD Subsequent encounter

Spouse or Partner Violence, Sexual, Suspected

T76.21XA Initial encounter
T76.21XD Subsequent encounter

Other Circumstances Related to Spouse or Partner Violence, Sexual

Z69.81 Encounter for mental health services for victim of spouse or partner violence, sexual
Z91.410 Personal history (past history) of spouse or partner violence, sexual
Z69.12 Encounter for mental health services for perpetrator of spouse or partner violence,
sexual

Spouse or Partner Neglect

This category may be used when spouse or partner neglect is a focus of clinical attention. Spouse
or partner neglect is any egregious act or omission by one partner that deprives a dependent
partner of basic needs and thereby results, or has reasonable potential to result, in physical or
psychological harm to the dependent partner. This category may be used in the context of
relationships in which one partner is extremely dependent on the other partner for care or for
assistance in navigating ordinary daily activities—for example, a partner who is incapable of
self-care because of substantial physical, psychological/intellectual, or cultural limitations (e.g.,
inability to communicate with others and manage everyday activities as a result of living in a
foreign culture).
Spouse or Partner Neglect, Confirmed
T74.01XA Initial encounter
T74.01XD Subsequent encounter

827

Spouse or Partner Neglect, Suspected

T76.01XA Initial encounter
T76.01XD Subsequent encounter

Other Circumstances Related to Spouse or Partner Neglect

Z69.11 Encounter for mental health services for victim of spouse or partner neglect
Z91.412 Personal history (past history) of spouse or partner neglect
Z69.12 Encounter for mental health services for perpetrator of spouse or partner neglect

Spouse or Partner Abuse, Psychological

This category may be used when spouse or partner psychological abuse is a focus of clinical
attention. Spouse or partner psychological abuse encompasses nonaccidental verbal or symbolic
acts by one partner that result, or have reasonable potential to result, in significant harm to the
other partner. Acts of psychological abuse include berating or humiliating the victim;
interrogating the victim; restricting the victim’s ability to come and go freely; obstructing the
victim’s access to assistance (e.g., law enforcement; legal, protective, or medical resources);
threatening the victim with physical harm or sexual assault; harming, or threatening to harm,
people or things that the victim cares about; unwarranted restriction of the victim’s access to or
use of economic resources; isolating the victim from family, friends, or social support resources;
stalking the victim; and trying to make the victim question his or her sanity (“gaslighting”).

Spouse or Partner Abuse, Psychological, Confirmed

T74.31XA Initial encounter
T74.31XD Subsequent encounter

Spouse or Partner Abuse, Psychological, Suspected

T76.31XA Initial encounter
T76.31XD Subsequent encounter

Other Circumstances Related to Spouse or Partner Abuse, Psychological

Z69.11 Encounter for mental health services for victim of spouse or partner psychological
abuse
Z91.411 Personal history (past history) of spouse or partner psychological abuse
Z69.12 Encounter for mental health services for perpetrator of spouse or partner
psychological abuse

Adult Abuse by Nonspouse or Nonpartner

This category may be used when the abuse of an adult by another adult who is not an intimate
partner is a focus of clinical attention. Such maltreatment may involve acts of physical, sexual, or
emotional abuse. Examples of adult abuse include nonaccidental acts of physical force (e.g.,
pushing/shoving, scratching, slapping, throwing something that could hurt, punching, biting) that
have resulted—or have reasonable potential to result—in physical harm or have caused
significant fear; forced or coerced sexual acts; and verbal or symbolic acts with the potential to
cause psychological harm (e.g., berating or humiliating the person; interrogating the person;
restricting the person’s ability to come and go freely; obstructing the person’s access to
assistance; threatening the person; harming or threatening to harm people or things that the
person cares about; restricting the person’s

828

access to or use of economic resources; isolating the person from family, friends, or social
support resources; stalking the person; trying to make the person think that he or she is crazy).
Acts for the purpose of physically protecting oneself or the other person are excluded.

Adult Physical Abuse by Nonspouse or Nonpartner, Confirmed

T74.11XA Initial encounter
T74.11XD Subsequent encounter

Adult Physical Abuse by Nonspouse or Nonpartner, Suspected

T76.11XA Initial encounter
T76.11XD Subsequent encounter

Adult Sexual Abuse by Nonspouse or Nonpartner, Confirmed

T74.21XA Initial encounter
T74.21XD Subsequent encounter

Adult Sexual Abuse by Nonspouse or Nonpartner, Suspected

T76.21XA Initial encounter
T76.21XD Subsequent encounter

Adult Psychological Abuse by Nonspouse or Nonpartner, Confirmed

T74.31XA Initial encounter
T74.31XD Subsequent encounter

Adult Psychological Abuse by Nonspouse or Nonpartner, Suspected

T76.31XA Initial encounter
T76.31XD Subsequent encounter

Other Circumstances Related to Adult Abuse by Nonspouse or Nonpartner

Z69.81 Encounter for mental health services for victim of nonspousal or nonpartner adult
abuse
Z69.82 Encounter for mental health services for perpetrator of nonspousal or nonpartner adult
abuse

Relational Problems
Key relationships, especially intimate adult partner relationships and parent/caregiver-child
relationships, have a significant impact on the health of the individuals in these relationships.
These relationships can be health promoting and protective, neutral, or detrimental to health
outcomes. In the extreme, these close relationships can be associated with maltreatment or
neglect, which has significant medical and psychological consequences for the affected
individual. A relational problem may come to clinical attention either as the reason that the
individual seeks health care or as a problem that affects the course, prognosis, or treatment of the
individual’s mental disorder or other medical condition.

829

Parent-Child Relational Problem

Z62.820 Parent–Biological Child
Z62.821 Parent–Adopted Child
Z62.822 Parent–Foster Child
Z62.898 Other Caregiver–Child
For this category, the term parent is used to refer to one of the child’s primary caregivers, who
may be a biological, adoptive, or foster parent or may be another relative (such as a grandparent)
who fulfills a parental role for the child. This category may be used when the main focus of
clinical attention is to address the quality of the parent-child relationship or when the quality of
the parent-child relationship is affecting the course, prognosis, or treatment of a mental disorder
or other medical condition. Typically, the parent-child relational problem is associated with
impaired functioning in behavioral, cognitive, or affective domains. Examples of behavioral
problems include inadequate parental control, supervision, and involvement with the child;
parental overprotection; excessive parental pressure; arguments that escalate to threats of
physical violence; and avoidance without resolution of problems. Cognitive problems may
include negative attributions of the other’s intentions, hostility toward or scapegoating of the
other, and unwarranted feelings of estrangement. Affective problems may include feelings of
sadness, apathy, or anger about the other individual in the relationship. Clinicians should take
into account the developmental needs of the child and the cultural context.
Z62.891 Sibling Relational Problem
This category may be used when the focus of clinical attention is a pattern of interaction among
siblings that is associated with significant impairment in individual or family functioning or with
development of symptoms in one or more of the siblings, or when a sibling relational problem is
affecting the course, prognosis, or treatment of a sibling’s mental disorder or other medical
condition. This category may be used for either children or adults if the focus is on the sibling
relationship. Siblings in this context include full, half-, step-, foster, and adopted siblings.
Z63.0 Relationship Distress With Spouse or Intimate Partner
This category may be used when the major focus of the clinical contact is to address the quality
of the intimate (spouse or partner) relationship or when the quality of that relationship is
affecting the course, prognosis, or treatment of a mental disorder or other medical condition.
Partners can be of the same or different genders. Typically, the relationship distress is associated
with impaired functioning in behavioral, cognitive, or affective domains. Examples of behavioral
problems include conflict resolution difficulty, withdrawal, and overinvolvement. Cognitive
problems can manifest as chronic negative attributions of the other’s intentions or dismissals of
the partner’s positive behaviors. Affective problems would include chronic sadness, apathy,
and/or anger about the other partner.

Problems Related to the Family Environment

Z62.29 Upbringing Away From Parents
This category may be used when the main focus of clinical attention pertains to issues regarding
a child being raised away from the parents or when this separate upbringing affects the course,
prognosis, or treatment of a mental disorder or other medical condition. The child could be one
who is under state custody and placed in kin care or foster care. The child could also be one who
is living in a nonparental relative’s home, or with friends, but whose out-of-home placement is
not mandated or sanctioned by the courts. Problems related to a child living in a group home or
orphanage are also included. This category excludes issues related to Z59.3 Problem Related to
Living in a Residential Institution.

830

Z62.898 Child Affected by Parental Relationship Distress

This category may be used when the focus of clinical attention is the negative effects of parental
relationship discord (e.g., high levels of conflict, distress, or disparagement) on a child in the
family, including effects on the child’s mental disorder or other medical condition.
Z63.5 Disruption of Family by Separation or Divorce
This category may be used when partners in an intimate adult couple are living apart because of
relationship problems or are in the process of divorce.
Z63.8 High Expressed Emotion Level Within Family
Expressed emotion is a construct used as a qualitative measure of the “amount” of emotion—in
particular, hostility, emotional overinvolvement, and criticism directed toward a family member
who is an identified patient—displayed in the family environment. This category may be used
when a family’s high level of expressed emotion is the focus of clinical attention or is affecting
the course, prognosis, or treatment of a family member’s mental disorder or other medical
condition.

Educational Problems
These categories may be used when an academic or educational problem is the focus of clinical
attention or has an impact on the individual’s diagnosis, treatment, or prognosis. Problems to be
considered include illiteracy or low-level literacy; lack of access to schooling owing to
unavailability or unattainability; problems with academic performance (e.g., failing school
examinations, receiving failing marks or grades) or underachievement (below what would be
expected given the individual’s intellectual capacity); discord with teachers, school staff, or other
students; problems related to inadequate teaching; and any other problems related to education
and/or literacy.
Z55.0 Illiteracy and Low-Level Literacy
Z55.1 Schooling Unavailable and Unattainable
Z55.2 Failed School Examinations
Z55.3 Underachievement in School
Z55.4 Educational Maladjustment and Discord With Teachers and Classmates
Z55.8 Problems Related to Inadequate Teaching
Z55.9 Other Problems Related to Education and Literacy

Occupational Problems
These categories may be used when an occupational problem is the focus of clinical attention or
has an impact on the individual’s treatment or prognosis. Areas to be considered include
problems with employment or in the work environment, including problems related to current
military deployment status; unemployment; recent change of job; threat of job loss; stressful
work schedule; uncertainty about career choices; sexual harassment on the job; other discord
with boss, supervisor, co-workers, or others in the work environment; uncongenial or hostile
work environments; other physical or mental strain related to work; sexual harassment on the
job; and any other problems related to employment and/or occupation.
Z56.82 Problem Related to Current Military Deployment Status
This category may be used when an occupational problem directly related to an individual’s
military deployment status is the focus of clinical attention or has an impact on the individual’s
diagnosis, treatment, or prognosis. Psychological reactions to deployment are not included in this
category; such reactions would be better captured as an adjustment disorder or another mental
disorder.

831

Z56.0 Unemployment
Z56.1 Change of Job
Z56.2 Threat of Job Loss
Z56.3 Stressful Work Schedule
Z56.4 Discord With Boss and Workmates
Z56.5 Uncongenial Work Environment
Z56.6 Other Physical and Mental Strain Related to Work
Z56.81 Sexual Harassment on the Job
Z56.9 Other Problem Related to Employment

Housing Problems
Z59.01 Sheltered Homelessness
This category may be used when sheltered homelessness has an impact on an individual’s
treatment or prognosis. An individual is considered to be experiencing sheltered homelessness if
the primary nighttime residence is a homeless shelter, a warming shelter, a domestic violence
shelter, a motel, or in a temporary or transitional living situation.
Z59.02 Unsheltered Homelessness
This category may be used when unsheltered homelessness has an impact on an individual’s
treatment or prognosis. An individual is considered to be experiencing unsheltered homelessness
if residing in a place not meant for human habitation, such as a public space (e.g., tunnel,
transportation station, mall), a building not intended for residential use (e.g., abandoned
structure, unused factory), a car, a cave, a cardboard box, or some other ad hoc housing situation.
Z59.1 Inadequate Housing
This category may be used when lack of adequate housing has an impact on an individual’s
treatment or prognosis. Examples of inadequate housing conditions include lack of heat (in cold
temperatures) or electricity, infestation by insects or rodents, inadequate plumbing and toilet
facilities, overcrowding, lack of adequate sleeping space, and excessive noise. It is important to
consider cultural norms before assigning this category.
Z59.2 Discord With Neighbor, Lodger, or Landlord
This category may be used when discord with neighbors, lodgers, or a landlord is a focus of
clinical attention or has an impact on the individual’s treatment or prognosis.
Z59.3 Problem Related to Living in a Residential Institution
This category may be used when a problem (or problems) related to living in a residential
institution is a focus of clinical attention or has an impact on the individual’s treatment or
prognosis. Psychological reactions to a change in living situation are not included in this
category; such reactions would be better captured as an adjustment disorder.
Z59.9 Other Housing Problem
This category may be used when there is a problem related to housing circumstances other than
as specified above.
Economic Problems
These categories may be used when an economic problem is the focus of clinical attention or has
an impact on the individual’s treatment or prognosis. Areas to be considered include lack of
adequate food (food insecurity) or safe drinking water, extreme poverty, low income, insufficient
social or health insurance or welfare support, or any other economic problems.

832

Z59.41 Food Insecurity

Z58.6 Lack of Safe Drinking Water
Z59.5 Extreme Poverty
Z59.6 Low Income
Z59.7 Insufficient Social or Health Insurance or Welfare Support
This category may be used for individuals who meet eligibility criteria for social or welfare
support but are not receiving such support, who receive support that is insufficient to address
their needs, or who otherwise lack access to needed insurance or support programs. Examples
include inability to qualify for welfare support because of lack of proper documentation or
evidence of address, inability to obtain adequate health insurance because of age or a preexisting
condition, and denial of support owing to excessively stringent income or other requirements.
Z59.9 Other Economic Problem
This category may be used when there is a problem related to economic circumstances other than
as specified above.

Problems Related to the Social Environment

Z60.2 Problem Related to Living Alone
This category may be used when a problem associated with living alone is the focus of clinical
attention or has an impact on the individual’s treatment or prognosis. Examples of such problems
include chronic feelings of loneliness, isolation, and lack of structure in carrying out activities of
daily living (e.g., irregular meal and sleep schedules, inconsistent performance of home
maintenance chores).
Z60.3 Acculturation Difficulty
This category may be used when difficulty in adjusting to a new culture (e.g., following
migration) is the focus of clinical attention or has an impact on the individual’s treatment or
prognosis.
Z60.4 Social Exclusion or Rejection
This category may be used when there is an imbalance of social power such that there is
recurrent social exclusion or rejection by others. Examples of social rejection include bullying,
teasing, and intimidation by others; being targeted by others for verbal abuse and humiliation;
and being purposefully excluded from the activities of peers, workmates, or others in one’s social
environment.
Z60.5 Target of (Perceived) Adverse Discrimination or Persecution
This category may be used when there is perceived or experienced discrimination against or
persecution of the individual based on his or her membership (or perceived membership) in a
specific category. Typically, such categories include gender or gender identity, race, ethnicity,
religion, sexual orientation, country of origin, political beliefs, disability status, caste, social
status, weight, and physical appearance.
Z60.9 Other Problem Related to Social Environment
This category may be used when there is a problem related to the individual’s social environment
other than as specified above.

Problems Related to Interaction With the Legal System

These categories may be used when a problem related to interaction with the legal system is the
focus of clinical attention or has an impact on the individual’s treatment or prognosis. Areas to
be considered include conviction in criminal proceedings, imprisonment or other incarceration,
problems related to release from prison, and problems related to other legal circumstances (e.g.,
civil litigation, child custody or support proceedings).

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Z65.0 Conviction in Criminal Proceedings Without Imprisonment

Z65.1 Imprisonment or Other Incarceration
Z65.2 Problems Related to Release From Prison
Z65.3 Problems Related to Other Legal Circumstances (e.g., civil litigation, child
custody or support proceedings)

Problems Related to Other Psychosocial, Personal, and

Environmental Circumstances
Z72.9 Problem Related to Lifestyle
This category may be used when a lifestyle problem is a specific focus of treatment or directly
affects the course, prognosis, or treatment of a mental disorder or other medical condition.
Examples of lifestyle problems include lack of physical exercise, inappropriate diet, high-risk
sexual behavior, and poor sleep hygiene. A problem that is attributable to a symptom of a mental
disorder should not be coded unless that problem is a specific focus of treatment or directly
affects the course, prognosis, or treatment of the individual. In such cases, both the mental
disorder and the lifestyle problem should be coded.
Z64.0 Problems Related to Unwanted Pregnancy
Z64.1 Problems Related to Multiparity
Z64.4 Discord With Social Service Provider, Including Probation Officer, Case
Manager, or Social Services Worker
Z65.4 Victim of Crime
Z65.4 Victim of Terrorism or Torture
Z65.5 Exposure to Disaster, War, or Other Hostilities

Problems Related to Access to Medical and Other Health Care

These categories may be used when a problem related to access to medical or other health care is
the focus of clinical attention or has an impact on the individual’s treatment or prognosis.
Z75.3 Unavailability or Inaccessibility of Health Care Facilities
Z75.4 Unavailability or Inaccessibility of Other Helping Agencies

Circumstances of Personal History

Z91.49 Personal History of Psychological Trauma
Z91.82 Personal History of Military Deployment

Other Health Service Encounters for Counseling and Medical

Advice
Z31.5 Genetic Counseling
This category may be used for individuals seeking genetic counseling to understand the risks of
developing a mental disorder with a significant genetic component (e.g., bipolar disorder) for
themselves and other family members, including their existing children, as well as the risks for
their future children.

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Z70.9 Sex Counseling

This category may be used when the individual seeks counseling related to sex education, sexual
behavior, sexual orientation, sexual attitudes (embarrassment, timidity), others’ sexual behavior
or orientation (e.g., spouse, partner, child), sexual enjoyment, or any other sex-related issue.
Z71.3 Dietary Counseling
This category may be used when the individual seeks counseling related to dietary issues like
weight management.
Z71.9 Other Counseling or Consultation
This category may be used when counseling is provided or advice/consultation is sought for a
problem that is not specified above or elsewhere in this chapter (e.g., counseling regarding drug
abuse prevention in an adolescent).

Additional Conditions or Problems That May Be a Focus of

Clinical Attention
Z91.83 Wandering Associated With a Mental Disorder
This category may be used for individuals with a mental disorder whose desire to walk about
leads to significant clinical management or safety concerns. For example, individuals with major
neurocognitive or neurodevelopmental disorders may experience a restless urge to wander that
places them at risk for falls and causes them to leave supervised settings without needed
accompaniment. This category excludes individuals whose intent is to escape an unwanted
housing situation (e.g., children who are running away from home, individuals who no longer
wish to remain in the hospital) or those who walk or pace as a result of medication-induced
akathisia.
Coding note: First code associated mental disorder (e.g., major neurocognitive disorder,
autism spectrum disorder), then code Z91.83 wandering associated with [specific mental
disorder].
Z63.4 Uncomplicated Bereavement
This category may be used when the focus of clinical attention is a normal reaction to the death
of a loved one. As part of their reaction to such a loss, some grieving individuals present with
symptoms characteristic of a major depressive episode—for example, feelings of sadness and
associated symptoms such as insomnia, poor appetite, and weight loss. The bereaved individual
typically regards the depressed mood as “normal,” although the individual may seek professional
help for relief of associated symptoms such as insomnia or anorexia. The duration and
expression of “normal” bereavement vary considerably among different cultural groups. Further
guidance in distinguishing grief from a major depressive episode and from prolonged grief
disorder is provided in their respective texts.
Z60.0 Phase of Life Problem
This category may be used when a problem adjusting to a life-cycle transition (a particular
developmental phase) is the focus of clinical attention or has an impact on the individual’s
treatment or prognosis. Examples of such transitions include entering or completing school,
leaving parental control, getting married, starting a new career, becoming a parent, adjusting to
an “empty nest” after children leave home, and retiring.
Z65.8 Religious or Spiritual Problem
This category may be used when the focus of clinical attention is a religious or spiritual problem.
Examples include distressing experiences that involve loss or questioning of faith, problems
associated with conversion to a new faith, or questioning of spiritual values that may not
necessarily be related to an organized church or religious institution.

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Z72.811 Adult Antisocial Behavior

This category may be used when the focus of clinical attention is adult antisocial behavior that is
not attributable to a mental disorder (e.g., conduct disorder, antisocial personality disorder).
Examples include the behavior of some professional thieves, racketeers, or dealers in illegal
substances.
 Z72.810 Child or Adolescent Antisocial Behavior
This category may be used when the focus of clinical attention is antisocial behavior in a child or
adolescent that is not attributable to a mental disorder (e.g., intermittent explosive disorder,
conduct disorder). Examples include isolated antisocial acts by children or adolescents (not a
pattern of antisocial behavior).
Z91.19 Nonadherence to Medical Treatment
This category may be used when the focus of clinical attention is nonadherence to an important
aspect of treatment for a mental disorder or another medical condition. Reasons for such
nonadherence may include discomfort resulting from treatment (e.g., medication side effects),
expense of treatment, personal value judgments or religious or cultural beliefs about the
proposed treatment, age-related debility, and the presence of a mental disorder (e.g.,
schizophrenia, personality disorder). This category may be used only when the problem is
sufficiently severe to warrant independent clinical attention and does not meet diagnostic criteria
for psychological factors affecting other medical conditions.
E66.9 Overweight or Obesity
This category may be used when overweight or obesity is a focus of clinical attention.
Z76.5 Malingering
The essential feature of malingering is the intentional production of false or grossly exaggerated
physical or psychological symptoms, motivated by external incentives such as avoiding military
duty, avoiding work, obtaining financial compensation, evading criminal prosecution, or
obtaining drugs. Under some circumstances, malingering may represent adaptive behavior—for
example, feigning illness while a captive of the enemy during wartime. Malingering should be
strongly considered if any combination of the following is noted:
1. Medicolegal context of presentation (e.g., the individual is referred by an attorney to the
clinician for examination, or the individual self-refers while litigation or criminal charges are
pending).
2. Marked discrepancy between the individual’s claimed stress or disability and the objective
findings and observations.
3. Lack of cooperation during the diagnostic evaluation and in complying with the prescribed
treatment regimen.
4. The presence of antisocial personality disorder.
Malingering differs from factitious disorder in that the motivation for the symptom
production in malingering is an external incentive, whereas in factitious disorder external
incentives are absent. Malingering is differentiated from functional neurological symptom
disorder (conversion disorder) and other somatic symptom–related mental disorders by the
intentional production of symptoms and by the obvious external incentives associated with it.
Definite evidence of feigning (such as clear evidence that loss of function is present during the
examination but not at home) would suggest a diagnosis of factitious disorder if the individual’s
apparent aim is to assume the sick role, or malingering if it is to obtain an incentive, such as
money.
R41.81 Age-Related Cognitive Decline
This category may be used when the focus of clinical attention is an objectively identified
decline in cognitive functioning consequent to the aging process that is within normal limits

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given the individual’s age. Individuals with this condition may report problems remembering
names or appointments or may experience difficulty in solving complex problems. This category
should be considered only after it has been determined that the cognitive impairment is not better
explained by a specific mental disorder or attributable to a neurological condition.
R41.83 Borderline Intellectual Functioning
This category may be used when an individual’s borderline intellectual functioning is the focus
of clinical attention or has an impact on the individual’s treatment or prognosis. Differentiating
borderline intellectual functioning and mild intellectual developmental disorder (intellectual
disability) requires careful assessment of intellectual and adaptive functions and their
discrepancies, particularly in the presence of co-occurring mental disorders that may affect
patient compliance with standardized testing procedures (e.g., schizophrenia or attention-
deficit/hyperactivity disorder, with severe impulsivity).