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Instructions to Clinicians
The DSM-5 Level 1 Cross-Cutting Symptom Measure is a self- or informant-rated measure that assesses mental health
domains that are important across psychiatric diagnoses. It is intended to help clinicians identify additional areas of inquiry
that may have significant impact on the individual’s treatment and prognosis. In addition, the measure may be used to track
changes in the individual’s symptom presentation over time.
This adult version of the measure consists of 23 questions that assess 13 psychiatric domains, including depression, anger,
mania, anxiety, somatic symptoms, suicidal ideation, psychosis, sleep problems, memory, repetitive thoughts and behaviors,
dissociation, personality functioning, and substance use. Each item inquires about how much (or how often) the individual has
been bothered by the specific symptom during the past 2 weeks. If the individual is of impaired capacity and unable to
complete the form (e.g., an individual with dementia), a knowledgeable adult informant may complete the measure. The
measure was found to be clinically useful and to have good test-retest reliability in the DSM-5 Field Trials that were conducted
in adult clinical samples across the United States and in Canada.
Scoring and Interpretation
Each item on the measure is rated on a 5-point scale (0=none or not at all; 1=slight or rare, less than a day or two; 2=mild or
several days; 3=moderate or more than half the days; and 4=severe or nearly every day). The score on each item within a
domain should be reviewed. Because additional inquiry is based on the highest score on any item within a domain, the
clinician is asked to indicate that score in the “Highest Domain Score” column. A rating of mild (i.e., 2) or greater on any item
within a domain (except for substance use, suicidal ideation, and psychosis) may serve as a guide for additional inquiry and
follow up to determine if a more detailed assessment for that domain is necessary. For substance use, suicidal ideation, and
psychosis, a rating of slight (i.e., 1) or greater on any item within the domain may serve as a guide for additional inquiry and
follow-up to determine if a more detailed assessment is needed. The DSM-5 Level 2 Cross-Cutting Symptom Measures may be
used to provide more detailed information on the symptoms associated with some of the Level 1 domains (see Table 1 below).
Frequency of Use
To track change in the individual’s symptom presentation over time, the measure may be completed at regular intervals as
clinically indicated, depending on the stability of the individual’s symptoms and treatment status. For individuals with
impaired capacity, it is preferable that the same knowledgeable informant completes the measures at follow-up
appointments. Consistently high scores on a particular domain may indicate significant and problematic symptoms for the
individual that might warrant further assessment, treatment, and follow-up. Clinical judgment should guide decision making.
Table 1: Adult DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure: domains, thresholds for further inquiry, and
associated Level 2 measures for adults ages 18 and over
Threshold to guide
further inquiry
DSM-5 Level 2 Cross-Cutting Symptom Measure available online
LEVEL 2—Depression—Adult (PROMIS Emotional Distress—Depression—Short
Form)
1
LEVEL 2—Anger—Adult (PROMIS Emotional Distress—Anger—Short Form)
1
LEVEL 2—Mania—Adult (Altman Self-Rating Mania Scale)
LEVEL 2—Anxiety—Adult (PROMIS Emotional Distress—Anxiety—Short Form)
1
LEVEL 2—Somatic Symptom—Adult (Patient Health Questionnaire 15 Somatic
Symptom Severity [PHQ-15])
LEVEL 2—Sleep Disturbance - Adult (PROMIS—Sleep Disturbance—Short Form)
1
Repetitive Thoughts
and Behaviors
LEVEL 2—Repetitive Thoughts and Behaviors—Adult (adapted from the Florida
Obsessive-Compulsive Inventory [FOCI] Severity Scale [Part B])
LEVEL 2—Substance Abuse—Adult (adapted from the NIDA-modified ASSIST)
1
The PROMIS Short Forms have not been validated as an informant report scale by the PROMIS group.