May 23, 2024

How to Use the DSM-5-TR Level 1 Cross-Cutting Symptom Measure (DSM-XC)

Written by

Carlene MacMillan, M.D.

“What gets measured gets managed.” Accurate diagnosis is crucial for effective treatment in the field of psychiatry. However, traditional screening tools often focus on a limited set of symptoms focused on a single disorder like depression, leading to potential bias and missed diagnoses.

In our last article, we gave you 10 reasons why you should use the DSM-5-TR Level Cross-Cutting Symptom measure aka the DSM-XC.

This article is your go-to guide for how to use the DSM-XC in your practice.

If you're using Osmind's psychiatry EHR, the DSM-XC comes included, alongside 40+ mood surveys, with progress you can see graphed over time.

What is the DSM-XC?

The DSM-XC is a tool that helps you assess mental health symptoms across various psychiatric diagnoses. It is a self-report measure consisting of 23 items rated on a 5-point likert scale (0=none, 4=severe) across various domains like depression, anger, mania, anxiety, somatic symptoms, suicidal ideation, psychosis, sleep problems, memory, and repetitive thoughts/behaviors.

The American Psychiatric Association (APA) developed the DSM-5-TR Level 1 Cross-Cutting Symptom Measure to help clinicians take a bird’s eye view during initial assessments and then periodically during the course of treatment. This tool acts as a review of systems, screening across a wide range of mental health domains. By asking one or two questions about each domain, the cross-cutting measure helps providers identify areas that require further investigation, ensuring a more accurate and holistic diagnostic approach.

Now integrated into Osmind's Psychiatry EHR, alongside 40+ scales!

DSM-XC Administration, Scoring, and Interpretation


An adult patient typically completes the DSM-XC as part of the initial assessment process. The measure asks about symptoms experienced in the past two weeks, providing a valuable up-to-date window into current concerns. The APA recommends administering the DSM-XC measure every 3-6 months as a check-in to monitor changes in symptom presentation over time. The measure can be used to track changes in an individual's symptom presentation by administering it at regular intervals as clinically indicated.


Scoring can be done at three levels:

  • Item Level: Review individual item scores.
  • Domain Level: Sum item scores within each domain.
  • Full Survey Level: Sum all item scores.

However, it is important to note that the factor structure and guidance on interpreting total scores are still being researched. Recent studies have examined the factor structure, with one proposing a two-factor solution and another suggesting a six-factor solution capturing mood, worry, activation, somatic, confusion, and substance use factors.

  • General Domains: For most domains (except substance use, suicidal ideation, and psychosis), a rating of mild (2) or greater on any item within that domain may serve as a guide for additional clinical inquiry and follow-up assessment.
  • Substance Use, Suicidal Ideation, and Psychosis: For these specific domains, a rating of slight (1) or greater on any item may warrant further assessment.

In summary, the DSM-XC provides a dimensional assessment of cross-cutting psychiatric symptoms, with scoring thresholds to guide further clinical evaluation within specific domains.

While its overall factor structure is still being investigated to provide guidance on interpreting total scores, the measure serves as a valuable tool for initial assessment and tracking changes in symptom presentation over time.

The measure asks about the past two weeks, providing a valuable up-to-date review of systems. The measure can be used to track changes in an individual's symptom presentation over time by administering it at regular intervals as clinically indicated.

Level 2 Measures and Clinical Assessment

In the event that a patient indicates concerns in a certain domain, the next steps are to send any more comprehensive relevant measures regarding that domain and to inquiry during a visit about this particular domain.

For example, if someone indicated possible difficulties with mania, the Altman Self-Rating Mania Scale would be appropriate. For areas around self-harm, psychosis and cognitive difficulties the next step is a clinical assessment focused on these areas.

Streamline Clinical Use with Osmind

While the DSM-5-TR Level 1 Cross-Cutting Symptom Measure can simplify psychiatric screening, practices historically have encountered barriers in administering it unless it is a seamless part of their workflow. That's why we've teamed up with the APA to build this tool right into our psychiatry-focused EHR.

Clinicians can easily access and utilize the cross-cutting measure alongside our library of over 40 other critical assessment tools, such as the PHQ-9 for depression, and the GAD-7 for anxiety.

By combining these measures in one easy-to-use dashboard, you get access to clear, measurable, and evidence-based graphs of your patient's progress in one place.

Ready to future-proof your psychiatry practice?

Schedule a demo with Osmind today to explore how our platform can help you save time and advance evidence-generating medicine.

By working together, we can shape the future of mental healthcare to be more data-driven, personalized, and effective for every patient.

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