DSM+II+1968

SPECIAL INSTRUCTIONS
It is recommended that, in addition to recording multiple disorders in
conformity with these principles, the diagnostician underscore the disorder
on the patient's record that he considers the underlying one. Because
these principles will not always be applied or used consistently,
statistical systems should account for all significant diagnoses recorded
in every case.
Qualifying Phrases and Adjectives
The ICD is based on a classification scheme which allots three digits
for the designation of major disease categories and a fourth digit for
the specification of additional detail within each category. DSM-II
has introduced a fifth digit for coding certain qualifying phrases that
may be used to specify additional characteristics of mental disorders.
This digit does not disturb the content of either the three- or four-digit
categories in the ICD section on mental disorders.
These terms are as follows:
(1.) In the brain syndromes a differentiation of acute and chronic
conditions may be provided by .xl acute and .x2 chronic. This will
help maintain continuity with DSM-I. These qualifying adjectives are
recommended only for mental disorders specified as associated with
physical conditions and are, of course, unnecessary in disorders seen
only in an acute or chronic form.
Those who wish to continue the distinction made in DSM-I between
"acute" and "chronic" organic brain syndromes must now add these
as qualifying terms. Note also that a recorded diagnosis which merely
indicates an organic brain syndrome and does not specify whether or
not it is psychotic will now be classified under Non-psychotic organic
brain syndromes.
(2.) The qualifying phrase, .x5 in remission, may also be used to
indicate a period of remission in any disorder. This is not synonymous
with No mental disorder.
(3.) With a few exceptions, all disorders listed in parts IV through
IX may be classified as .x6 mild, .x7 moderate, and .x8 severe. But
exceptions must be made in coding Passive-aggressive personality,
Inadequate personality, and the two sub-types of Hysterical neurosis
because their basic code numbers have five digits. Antisocial personality
should always be specified as mild, moderate, or severe.
(4.) As explained on page 23, the qualifying phrase not psychotic
(.x6) may be used for the psychoses listed in section III when the
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