Relationship Distress With Spouse or Intimate Partner

This category should be used when the major focus of the clinical contact is to address the quality of the intimate (spouse or partner) relationship or when the quality of that relationship is affecting the course, prognosis, or treatment of a mental or other medical disorder. Partners can be of the same of different genders. Typically, the relationship distress is associated with impaired functioning in behavioral, cognitive, or affective domains. Examples of behavioral problems include conflict resolution difficulty, withdrawal, and overinvolvement. Cognitive problems can manifest as chronic negative attributions of the other's intentions or dismissals of the partner's positive behaviors. Affective problems would include chronic sadness, apathy, and/or anger about the other partner.

Note: This category excludes clinical encounters for mental health services for spousal or partner abuse problems and sex counseling.

Disruption of Family by Separation or Divorce

This category should be used when partners in an intimate adult couple are living apart due to relationship problems or are in the process of divorce.

High Expressed Emotion Level Within Family

Expressed emotion is a construct used as a qualitative measure of the "amount" of emotion - in particular, hostility, emotional overinvolvement, and criticism directed toward a family member who is an identified patient - displayed in the family environment. This category should be used when a family's high level of expressed emotion is the focus of clinical attention or is affecting the course, prognosis, or treatment of a family member's mental or other medical disorder.

Uncomplicated Bereavement

This category can be used when the focus of clinical attention is a normal reaction to the death of a loved one. As part of their reaction to such a loss, some grieving individuals present with symptoms characteristic of a major depressive episode - for example, feelings of sadness and associated symptoms such as insomnia, poor appetite, and weight loss. The bereaved individual typically regards the depressed mood as "normal," although the individual may seek professional help for relief of associated symptoms such as insomnia or anorexia. The duration and expression of "normal" bereavement vary considerably among different cultural groups. Further guidance in distinguishing grief from a major depressive episode is provided in the criteria for major depressive episode.

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