Published September 5, 2026
DSM-5-TR Quick Reference for the NCMHCE: Durations, Counts, and Specifiers
By David Zimmerman · 9 min read · Clinical content
The NCMHCE does not ask you to recite DSM-5-TR criteria; it presents a client and expects you to recognize the diagnosis, the duration rule that separates it from its neighbor, and the specifier that changes the plan. This reference is the exam-facing subset: durations, counts, and the distinctions that show up in Domain 2B stems. Every entry is from DSM-5-TR[1]; use it with the differential-diagnosis post, which covers the confusable pairs in depth.
Durations and counts the exam tests
| Disorder | Duration / count rule | Neighbor to rule out |
|---|---|---|
| Major depressive episode | ≥2 weeks; 5 of 9 symptoms incl. depressed mood or anhedonia | Persistent depressive disorder; adjustment disorder; bereavement |
| Persistent depressive disorder | ≥2 years adults (1 year youth), most days; 2+ associated symptoms | MDD (episodic, more severe) |
| Prolonged grief disorder (new in TR) | ≥12 months after the death adults (6 months youth); daily yearning/preoccupation | MDD; normal grief |
| Adjustment disorder | Onset within 3 months of a stressor; resolves within 6 months after the stressor ends | MDD, GAD, PTSD (if criteria met, those win) |
| Generalized anxiety disorder | ≥6 months, more days than not, multiple domains; 3+ associated symptoms (1 in children) | Panic disorder; adjustment disorder with anxiety |
| Panic disorder | Recurrent unexpected attacks + ≥1 month of concern or behavior change | Attacks secondary to another disorder (panic attack specifier) |
| Social anxiety / specific phobia | ≥6 months | Agoraphobia; panic disorder |
| Separation anxiety | ≥4 weeks children; ≥6 months adults | GAD |
| OCD | No duration; obsessions/compulsions time-consuming (e.g., >1 hour/day) or impairing | OCPD (no obsessions/compulsions); GAD |
| Acute stress disorder | 3 days to 1 month after trauma | PTSD (>1 month) |
| PTSD | >1 month; four clusters (intrusion, avoidance, negative cognition/mood, arousal) | Acute stress disorder; adjustment disorder |
| Brief psychotic → schizophreniform → schizophrenia | 1 day–1 month → 1–6 months → ≥6 months (≥1 month active) | Substance/medical causes; mood disorder with psychotic features |
| Delusional disorder | ≥1 month of delusions; functioning otherwise not markedly impaired | Schizophrenia |
| Manic episode (bipolar I) | ≥1 week (any duration if hospitalized); 3+ symptoms (4 if irritable only) | Hypomania; substance-induced |
| Hypomanic episode (bipolar II) | ≥4 consecutive days; no marked impairment, no psychosis, no hospitalization | Mania |
| Cyclothymic disorder | ≥2 years (1 year youth) of subthreshold hypomanic and depressive symptoms | Bipolar II; borderline PD |
| ADHD | Several symptoms before age 12; ≥6 months; 6+ symptoms (5+ at 17 and older) in ≥2 settings | Anxiety, trauma, sleep disorders |
| Oppositional defiant disorder | ≥6 months; 4+ symptoms | Conduct disorder; DMDD |
| Conduct disorder | 3+ of 15 criteria in 12 months (1 in past 6 months) | ODD; antisocial PD (18+) |
| Anorexia nervosa | Restriction → significantly low weight; fear of gain; disturbed body experience (no duration) | Bulimia (normal weight); ARFID (no body-image disturbance) |
| Bulimia nervosa / binge-eating disorder | ≥1×/week for 3 months; BED has no compensatory behavior | Anorexia, binge-purge type (low weight) |
| Substance use disorder | 2+ of 11 criteria in 12 months: mild 2–3, moderate 4–5, severe 6+ | Intoxication/withdrawal alone; substance-induced disorders |
| Remission specifiers (SUD) | Early: 3–12 months without criteria (craving allowed); sustained: ≥12 months | |
| Insomnia disorder | ≥3 nights/week for ≥3 months | Sleep disturbance from another disorder |
| Somatic symptom / illness anxiety | Persistent, typically ≥6 months | Each other (SSD has somatic symptoms; IAD minimal symptoms) |
Specifiers that change the plan
- MDD: with anxious distress, with mixed features, with psychotic features (level of care), with peripartum onset, with seasonal pattern.
- Bipolar: with rapid cycling (4+ episodes/year), with mixed features, current episode type and severity.
- PTSD: with dissociative symptoms (depersonalization/derealization), with delayed expression (full criteria not met until ≥6 months post-trauma).
- SUD: severity, remission, in a controlled environment, on maintenance therapy.
- Eating disorders: anorexia subtype (restricting vs. binge-eating/purging) and severity by BMI; bulimia severity by episodes per week.
The rule the exam uses most
Diagnosis is tested inside cases
Every CaseSavvy case is written to DSM-5-TR criteria with the differential in the rationale. 5 free full cases, no card.
Quick check
Interactive
Durations, counts, and neighbors
A client has had depressed mood most of the day, more days than not, for three years, with low energy and poor self-esteem, but never a two-week period severe enough to meet full MDD criteria. Which diagnosis fits?
How to study DSM-5-TR for the NCMHCE
- Learn durations as pairs of neighbors (ASD/PTSD, brief psychotic/schizophreniform/schizophrenia, MDD/PDD), because that is how the exam asks.
- For each disorder, know the one specifier that changes level of care or treatment.
- Do not memorize full criteria lists; memorize the count rule and the one exclusion that gets tested.
- Pair with the screening instruments cheat sheet and the Domain 2B practice questions.
Sources
Frequently asked questions
What is the difference between acute stress disorder and PTSD?
Timing. Acute stress disorder covers three days to one month after the trauma; PTSD requires symptoms lasting more than one month.
How is substance use disorder severity determined in DSM-5-TR?
By criteria count in the past 12 months: two or three is mild, four or five moderate, six or more severe. Early remission is 3–12 months without meeting criteria (craving excepted); sustained is 12 months or more.
What changed for grief in DSM-5-TR?
DSM-5-TR added prolonged grief disorder: intense yearning or preoccupation persisting at least 12 months after the death in adults (6 months in children) with impairment, replacing the DSM-5 "persistent complex bereavement" proposal.
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