DSM-5-TR Self-Rated Level 1 Cross-Cutting Symptom Measure, Adult
The DSM-5-TR Self-Rated Level 1 Cross-Cutting Symptom Measure, Adult is a 23-item transdiagnostic screener developed by the American Psychiatric Association (APA) to identify clinically relevant symptoms across 13 mental health domains. It provides a rapid, whole-person view of symptom patterns that may require more targeted follow-up.
The measure does not yield a total score; each domain is interpreted individually. A rating of 2 or higher (Moderate/Severe) within any domain suggests the need for focused assessment. The measure is not diagnostic and is intended as a first-line screener for triage and monitoring.
Type: Transdiagnostic mental health symptom screener
Population: Adults (18+)
Length: 23 items across 13 domains
Format: Self-report
Completion Time: 5–10 minutes
- At intake, to identify broad symptom areas
- Every 4–12 weeks for treatment monitoring
- After major clinical changes (e.g., medication adjustments, acute symptom shifts)
- Can be repeated more frequently depending on clinical need
Foundational Context
The Level 1 Cross-Cutting Measure was created as part of the DSM-5-TR field trials to improve early identification of symptoms that span diagnostic boundaries. Traditional categorical diagnoses can obscure comorbidity or evolving symptom pictures; the Level 1 Measure brings those patterns into view through a brief, structured self-report. Its validation demonstrated strong usability and reliability across outpatient and inpatient settings, making it suitable for general mental health, primary care, and specialty clinics.
What the DSM-5-TR Level 1 measures
The Level 1 Measure screens symptoms across 13 mental health domains, including depression, anxiety, sleep problems, trauma-related symptoms, psychosis, dissociation, substance use, and more. Each item captures symptom severity over the past two weeks on a 0–4 scale (“None” → “Severe”).
**Instructions to Clinicians **
The DSM-5-TR 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-TR Field Trials that were conducted in adult clinical samples across the United States and in Canada.
How to administer the DSM-5-TR Level 1
The adult Level 1 measure is completed by the patient, usually before the clinical interview, in about 5–10 minutes. Each of the 23 items asks how much (or how often) the person has been bothered by a symptom during the past 2 weeks. If the individual is of impaired capacity and unable to complete the form, a knowledgeable adult informant may complete it instead, ideally the same informant at follow-up.
- Suitable for intake, triage, and monitoring
- Complements targeted assessment workflows
- Essential for identifying comorbidity early
- Works across mental health and primary care settings
- Requires follow-up assessment for elevated domains
The DSM-5-TR 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).
DSM-5-TR Level 1 scoring and interpretation
Scoring Structure
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.
- Items scored 0–4
- No total score
- Interpretation is domain-specific
Clinical Meaning
- Any nonzero suicidal ideation → Immediate clinical attention required
- Mild symptoms (score of 1) may still be clinically relevant when persistent or impairing
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.
Psychometric properties
Reliability
- Strong test–retest reliability in DSM-5-TR field trials
- High clinician agreement on item interpretation
Validity
- Excellent convergent validity with disorder-specific measures
- Sensitive to clinical change, supporting use in monitoring
- Validated across outpatient, inpatient, and primary care settings
Published evidence
- In the DSM-5 Field Trials (seven adult sites in the United States and Canada), test-retest reliabilities of the adult cross-cutting items were generally good to excellent; retest interviews were 4 hours to 2 weeks apart (Narrow et al., 2013).
- In routine clinical practice field trials (621 clinicians, 1,269 patients), 52% of adult patients reported the cross-cutting measures would help their clinicians better understand their symptoms (Mościcki et al., 2013).
- In a Japanese general-population sample, the total score showed high internal consistency, test-retest reliability and convergent validity, but several individual items had low test-retest reliability and the measure mainly captured internalizing symptoms (Soda et al., 2026).
Limitations
- Not diagnostic; only flags areas of concern
- Some domains (SI, psychosis) require immediate clinical assessment
- Limited depth per domain (1–3 items each)
- Relies on patient self-report, which may be influenced by insight, mood, or context
- Several individual items showed low test-retest reliability in a Japanese general-population sample (Soda et al., 2026)
This library is an academic and clinical reference. A scale described here is not necessarily offered in HiBoop; each page says whether it is.
Bill this assessment
In the US, the DSM-5-TR Self-Rated Level 1 Cross-Cutting Symptom Measure, Adult is usually billed under these CPT codes. Payer rules vary.
Using this assessment in practice
For clinicians
Send it as a gentle check-in before the session. The score is waiting when you open the chart, and the trend builds itself.
For individuals
This page is a clinical reference, not a diagnostic tool. If you have concerns about your own symptoms, bring this information to a qualified mental health professional.
Frequently Asked Questions
Does the DSM-5 Level 1 Cross-Cutting Symptom Measure produce a total score?
No. The measure does not yield a single total score. Each of the 13 domains is interpreted individually using the highest item score within that domain. Clinicians identify which domains exceed the threshold for further inquiry rather than summing across domains.
Is the DSM-5 Level 1 measure self-report or clinician-administered?
It is primarily a self-rated measure completed by the patient before the clinical interview. When a patient lacks the capacity to self-complete (for example, due to significant cognitive impairment), a knowledgeable adult informant may complete it instead.
References
- 1.Narrow WE, Clarke DE, Kuramoto SJ, Kraemer HC, Kupfer DJ, Greiner L, Regier DA. 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.View source
- 2.Mościcki EK, Clarke DE, Kuramoto SJ, Kraemer HC, Narrow WE, Kupfer DJ, Regier DA. Testing DSM-5 in routine clinical practice settings: feasibility and clinical utility. Psychiatr Serv. 2013;64(10):952-60.View source
- 3.Soda T, Toyama A, Takeda M, Kunisato Y, Yamashita Y. Reliability and Validity of the DSM-5 Level 1 Cross-Cutting Symptom Measure in Japan: Insights into General and Specific Psychiatric Symptom Assessment. J Pers Assess. 2026;108(1):31-43.View source
Last reviewed: Jun 3, 2026
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