On another page, we discussed many advanced points and details about the clinical features of restless legs syndrome (RLS). Those details of the Clinical features are necessary in order to correctly diagnose RLS. If you haven’t already, please make sure to read that page.
That understanding also makes it easy for us to understand the DSM-5 diagnostic criteria for RLS (American Psychiatric Association, 2013), which are discussed below. The DSM-5 criteria largely reflect what we have already discussed on that other page, though they don’t give many of the important details of the clinical features that we had discussed.
Note: In DSM-5, Restless Legs Syndrome is one of the ten diagnoses included in the chapter on Sleep-Wake Disorders.
Note: The ICD-10 diagnostic code for restless legs syndrome is G25.81. In ICD-10, “G” is the category of diagnostic codes for Diseases of the Nervous System.
Key diagnostic criterion in DSM-5
“An urge to move the legs” is the key diagnostic feature.
Along with this urge to move, “usually,” “uncomfortable and unpleasant sensations in the legs” are either present or may even be the reason for the urge to move.
What else in addition to this key criterion? A mnemonic I suggest is my rule of three’s:
– THREE characteristics of the symptoms (explained below) that should be present
– THREE severity criteria should all be met
– The symptoms should occur at least THREE times a week, and
– The symptoms should have lasted for at least THREE months.
More on each of these below.
THREE characteristics of the urge to move the legs
In addition to the key diagnostic criterion mentioned above, ALL of the following diagnostic criteria must be met with regard to the urge to move the legs:
1. It begins or worsens during rest or inactivity.
2. It is partially or totally relieved by moving.
3. It only occurs or is worse in the evening or at night
THREE severity criteria
As you know, DSM-5 diagnostic criteria typically include some types of severity criteria so that we don’t diagnose the disorders in people who might have similar symptoms in a very mild form, rarely, or without distress or impairment.
What about for restless legs syndrome? What does DSM-5 consider to be enough severity to warrant a diagnosis of RLS? ALL THREE of the following severity criteria should be met in order to diagnose RLS according to DSM-5. The symptoms:
1. Occur at least THREE times per week
2. Have persisted for at least THREE months.
3. Lead to EITHER “significant distress” OR impairment one or more important areas of functioning.
Exclusion of other causes of the symptoms
Other potential causes of the symptoms (the urge to move the legs) should be excluded. These could include another mental disorder, a “medical” condition, or a substance (one that is abused or a medication).
Allen RP, Picchietti DL, Garcia-Borreguero D, Ondo WG, Walters AS, Winkelman JW, Zucconi M, Ferri R, Trenkwalder C, Lee HB; International Restless Legs Syndrome Study Group. Restless legs syndrome/Willis-Ekbom disease diagnostic criteria: updated International Restless Legs Syndrome Study Group (IRLSSG) consensus criteria–history, rationale, description, and significance. Sleep Med. 2014 Aug;15(8):860-73. PubMed PMID: 25023924.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Association, 2013.
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