May 14, 2024

10 Reasons to Start Using the DSM-5-TR Level 1 Cross-Cutting Measure

Written by

Carlene MacMillan, M.D.

Developed by the American Psychiatric Association and now integrated in Osmind's EHR, the DSM-5-TR Level 1 Cross-Cutting Measure (DSM-XC) is an essential tool for modern psychiatric practices. Designed to address the limitations of traditional categorical diagnoses, this tool provides a comprehensive overview of a patient's mental health symptoms. It’s the psychiatric equivalent of a stethoscope and can lead to further more targeted assessments for areas of concern.

Before you learn how to use the DSM-XC, read on to understand why it will transform your practice.

Here are ten compelling reasons to integrate the DSM-XC into your clinical practice with all your patients.

1. Holistic Review of Systems

The DSM-XC consists of 23 questions that cover 13 symptom domains, including depression, anger anxiety, mania, somatic symptoms, suicidal ideation, psychosis, sleep problems, memory, repetitive thoughts and behaviors, dissociation, personality functioning, and substance use.

This broad scope ensures that clinicians capture the full spectrum of a patient's symptoms, leading to a more comprehensive understanding of their mental health. Think of it as a Psychiatric ROS completed by the patient ahead of an initial session and then periodically every 3-6 months.

2. Less Biased Diagnoses

Many clinicians use the PHQ-9, a depression scale, as their major screening scale for new patients. However, several of the symptoms on these scales, such as sleep disturbances and anxiety are common across many different diagnoses. If all you have is hammer, everything looks like a nail so depression diagnoses are rampant if only using it.  

By evaluating symptoms across multiple domains, the DSM-XC helps identify disorders that would be missed with a single-diagnosis approach. This can lead to more accurate, comprehensive diagnoses and better-targeted treatments.

3. Patient-Centered Care

The DSM-XC engages patients in their own care. By self-reporting their symptoms, patients become more involved in the diagnostic process, which can improve treatment adherence and outcomes.

4. Research-Backed Reliability

DSM-5 field trials have shown that the DSM-XC has good-to-excellent test-retest reliability and strong clinical utility from both patient and clinician perspectives. This ensures that the tool is both reliable and valid in clinical settings. Followup studies conducted by others in the field across different patient populations have similarly supported the broad use of the DSM-XC.

5. Cost-Effective Screening

The Level 1 Cross-Cutting Measure is free to use clinically, making it a cost-effective tool for routine screening. Its accessibility encourages widespread use without adding financial burden to practices or fears around copyright infringement.

6. Alignment with Modern Research Initiatives

The DSM-XC dovetails with the National Institute of Mental Health’s Research Domain Criteria (RDoC) conceptualization, which aims to integrate basic science and neurobiology into psychiatric assessment and diagnosis. The NIMH has even been requesting it be included in many of their supported research. Using the DSM-XC keeps your practice aligned with cutting-edge research.

7. Supports Transdiagnostic Psychiatry

The DSM-XC supports a transdiagnostic, dimensional approach to psychiatric diagnosis, recognizing that many mental health symptoms overlap across different disorders. This perspective can lead to more nuanced and effective treatment plans. This measure represents a significant step by the APA towards an entirely new way of conceptualizing psychiatric disorders while at the same time keeping concepts around major domains of concern intact.

8. Improved Screening for Research

In research settings, the DSM-XC has proven effective in screening healthy volunteers. When combined with clinical history, its sensitivity and specificity improve, making it a valuable tool for selecting study participants and disqualifying others. Combining the DSM-XC responses, which cover the past 2 weeks, with a review of the patient's current psychiatric medications significantly increases the ability to assess their eligibility for studies.

9. Addresses Co-Occurring Symptoms

The DSM-XC's comprehensive symptom review identifies mixed presentations, such as major depressive disorder with anxiety symptoms, leading to more targeted treatment plans and improved prognostic outcomes.

10. Future-Proof Your Practice

As psychiatric care evolves towards multi-dimensional and patient-centered approaches, integrating the DSM-XC into your practice ensures you stay ahead of the curve. This tool represents the future of psychiatric assessment, blending patient-reported experiences with clinical judgment to deliver high-quality care.

Osmind is collaborating with the APA to include this measure, alongside 40+ rating scales inside our all-in-one psychiatry EHR. You'll have peace of mind knowing you're using evidence-based measures that improve diagnostic accuracy and patient care.

Ready to future-proof your practice? Schedule a demo of Osmind to see how.

Selected References:

1. Clarke DE, Kuhl EA. DSM-5 cross-cutting symptom measures: a step towards the future of psychiatric care? World Psychiatry. 2014;13(3):314-316. doi:10.1002/wps.20154

2. Narrow WE, Clarke DE, Kuramoto SJ, et al. DSM-5 Field Trials in the United States and Canada, Part III: Development and Reliability Testing of a Cross-Cutting Symptom Assessment for DSM-5. Am J Psychiatry. 2013;170(1):71-82. doi:10.1176/appi.ajp.2012.12071000

3. Gibbons A, Farmer C, Shaw JS, Chung JY. Examining the Factor Structure of the DSM-5 Level 1 Cross-Cutting Symptom Measure. medRxiv. Published online November 16, 2021:2021.04.28.21256253. doi:10.1101/2021.04.28.21256253

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