The fifth edition of the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5) is out this month. The National Institute of Mental Health hates it. (Sort of.) We at KISI were disappointed to find Non-Suicidal Self-Injury, a diagnosis we fully expected to be part of DSM-5, relegated to the back of the book, in a section on “Conditions for Further Study.” It isn’t available as a formal diagnosis.
We’ll discuss the criteria for NSSI, as described in the DSM-5′s Conditions for Further Study, in a separate post. For now, though, there actually is a diagnostic code that practitioners can use when self-injury is the focus of treatment.
And as it turns out, it’s in the perfect place.
“Personal history of self-harm” (V15.59) is a new diagnostic category listed in what are called the V-codes. These diagnoses are not considered mental illnesses in and of themselves, but rather are “other conditions or problems that may be a focus of clinical attention or that may otherwise affect the diagnosis, course, prognosis, or treatment of a patient’s mental disorder.” Importantly, while insurers will not pay for treatment of the DSM-5′s Conditions for Further Study (as these are not acceptable formal diagnoses at this time), many plans do pay for treatment related to V-codes, contrary to popular belief. Some of the conditions listed in the V-codes include Parent-Child Relational Problem (V61.20), Relationship Distress with Spouse or Intimate Partner (V61.10), Academic or Educational Problem (V62.3), and Homelessness (V60.0).
Again, the V-codes describe situations or circumstances that are not mental illnesses. That’s important to how we think about self-injury here at KISI: As a relational problem requiring relational solutions. The self-injurer is often not mentally ill, but rather is engaging in a coping strategy. With this new V-code diagnosis available to providers, many self-injurers will be able to get the benefits of treatment through their insurance company, without the stigma of being labelled mentally ill.
– Ben Caldwell is a Fellow at the Kahn Institute for Self-Injury.