DSM - Munta

Delusional Disorder

A mental disorder in which a person has one or more persistent, false beliefs that are not based in reality (delusions), but aside from these beliefs, their thinking and functioning are generally normal.

a. The presence of one (or more) delusions with a duration of 1 month or longer.

b. Criterion A for schizophrenia has never been met.

Note; Hallucinations, if present, are not prominent and are related to the delusional theme (e.g., the sensation of being infested with insects associated with delusions of infestation).

Brief Psychotic Disorder

A sudden onset of psychotic symptoms (like delusions, hallucinations, or disorganized speech/behavior) lasting at least 1 day but less than 1 month, with full return to baseline functioning.

1. Delusions

2. Hallucinations

3. Disorganized speech (e.g., frequent derailment or incoherence)

4. Grossly disorganized or catatonic behavior.

Schizophreniform disorder

a mental illness with schizophrenia-like symptoms. An episode of the disorder lasts at least 1 month but less than 6 months

Symptoms

1. Delusions

2. Hallucinations

3. Disorganized speech (e.g., frequent derailment or incoherence)

4. Grossly disorganized or catatonic behavior

5. Negative symptoms (i.e., diminished emotional expression or avolition)

Schizophrenia

a chronic mental disorder causing distorted thinking, perceptions, emotions, and behavior, such as hallucinations or delusions. symptoms persist for more than 6 months and often involve long-term functional impairment.

Symptoms; 

1. Delusions

2. Hallucinations

3. Disorganized speech (e.g., frequent derailment or incoherence)

4. Grossly disorganized or catatonic behavior

5. Negative symptoms (i.e., diminished emotional expression or avolition).

Schizoaffective disorder

A condition where symptoms of schizophrenia (like delusions or hallucinations) occur alongside major mood episodes (depression or mania), with some psychotic symptoms present even when mood symptoms are not.

1. An uninterrupted period of illness during which there is a major mood episode (major depressive or manic) concurrent with Criterion A of schizophrenia.

2. Delusions or hallucinations for 2 or more weeks in the absence of a major mood episode (depressive or manic) during the lifetime duration of the illness.

Catatonia

A specifier that is a state of abnormal movement and behavior, often associated with psychiatric or medical conditions

Symptoms; 

1. Stupor (i.e., no psychomotor activity

2. Catalepsy (i.e., passive induction of a posture held against gravity)

3. Waxy flexibility (i.e., slight, even resistance to positioning by examiner)

4.  Mutism (i.e., no, or very little, verbal response)

5. Negativism (i.e., opposition or no response to instructions or external stimuli).

6. Posturing (i.e., spontaneous and active maintenance of a posture against gravity)

7. Mannerism (i.e., odd, circumstantial caricature of normal actions)

8. Stereotypy (i.e., repetitive, abnormally frequent, non-goal-directed movements)

9. Agitation, not influenced by external stimuli

10. Grimacing

11. Echolalia (i.e., mimicking another’s speech)

12. Echopraxia (i.e., mimicking another’s movements)

Bipolar I Disorder

a mood disorder characterized by at least one full manic episode. Depression may also occur, but is not required.

Symptoms;

• Inflated self-esteem or grandiosity

• Decreased need for sleep

• Elevated energy

• Irritability

• More talkative than usual or pressure to keep talking.

• Flight of ideas or subjective experience that thoughts are racing

• Distractibility 

• Increase in goal-directed activity or psychomotor agitation 

• Excessive involvement in activities (high potential for painful consequences)

Bipolar II Disorder

characterized by recurrent depressive episodes and hypomanic episodes. But not severe enough to cause psychosis or major impairment.

Symptoms for MD & Hypomania; 

1. Inflated self-esteem/ grandiosity

2. Decreased need for sleep

3. More talkative than usual or pressure to keep talking

4. Flight of ideas or subjective experience that thoughts are racing

5. Distractibility

6. Increase in goal-directed activity or psychomotor agitation.

7. Excessive involvement in activities (high potential for painful consequences)

Cyclothymic Disorder

a mood disorder involving chronic, fluctuating mood swings that are less severe than those in bipolar I or II.

Symptoms;

1. At least 2 years (numerous episodes of hypomania & depression - don't meet criteria)

2. Symptom present 50% of time

Disruptive Mood Dysregulation Disorder

a childhood disorder marked by chronic irritability (most of days) and frequent, severe temper outbursts.

Symptoms; (present at least 12 months or more)

1. Recurrent temper outbursts manifested (verbally/behaviorally) out of proportion 

2. Outbursts are inconsistent with developmental level 

3. Temper outbursts ca. three or more times per week

4. Irritable or angry most of the day, nearly every day (observable by others)

Major Depressive Episode

a period of at least two weeks where a person experiences a persistently depressed mood or a loss of interest/pleasure in almost all activities.

1. Depressed mood (most of the day, nearly every day) 

2. Diminished interest or pleasure in all, or almost all, activities 

3. Significant weight loss (not dieting) or weight gain, or decrease or increase in appetite

4. Insomnia or hypersomnia

5. Psychomotor agitation or retardation

6. Fatigue or loss of energy

7. Feelings of worthlessness or guilt 

8. Diminished ability to think or concentrate, or indecisiveness

9. Recurrent thoughts of death/ suicidal ideation/ suicide attempt

Major Depressive Disorder

a mental health condition characterized by one or more Major Depressive Episodes that cause significant distress or impairment. (describes the overall disorder, not just the individual episodes)

1. Depressed mood (most of the day, nearly every day) 

2. Diminished interest or pleasure in all, or almost all, activities 

3. Significant weight loss (not dieting) or weight gain, or decrease or increase in appetite

4. Insomnia or hypersomnia

5. Psychomotor agitation or retardation

6. Fatigue or loss of energy

7. Feelings of worthlessness or guilt 

8. Diminished ability to think or concentrate, or indecisiveness

9. Recurrent thoughts of death/ suicidal ideation/ suicide attempt

Persistent Depressive Disorder

(Dysthymia) is a chronic form of depression where a person has a persistently low mood for at least 2 years. Can be combined with MDD.

Symptoms (present while depressed); 

1. Poor appetite or overeating

2. Insomnia or hypersomnia

3. Low energy or fatigue

4. Low self-esteem

5. Poor concentration or difficulty making decisions

6. Feelings of hopelessness.

Premenstrual Dysphoric Disorder

a severe form of premenstrual syndrome (PMS) that causes intense emotional and physical symptoms in the week before menstruation.

Symptoms; 

1. Marked affective lability (e.g., mood swings)

2. Marked irritability or anger or increased interpersonal conflicts

3. Marked depressed mood, feelings of hopelessness, or self-deprecating thoughts

4. Marked anxiety, tension, and/or  being keyed up/ on edge.

5. Decreased interest in usual activities

6. Subjective difficulty in concentration

7. Fatigue or lack of energy

8. Marked change in appetite

9. Hypersomnia or insomnia.

10. being overwhelmed or out of control

11. Physical symptoms (pain, bloating ect.)

Peripartum Onset

A Specifier is applied to major depressive episodes/ disorder if onset of mood symptoms occurs during pregnancy or in the 4 weeks following delivery.

Seasonal Pattern

A Specifier is applied to major depressive disorder with regular temporal relationship between the onset and a particular time of the year.

Separation Anxiety Disorder

a developmentally inappropriate and excessive fear of being apart from loved ones, causing distress and worry.

Symptoms; 

1. Recurrent excessive distress when separation from home/ major attachment figures

2. Persistent and excessive worry about losing major attachment figures 

3. Persistent/ excessive worry about an untoward event that causes separation 

4. Persistent reluctance or refusal to go out, because of fear of separation

5. Excessive fear of or reluctance about being alone/ without major attachment figures

6. Reluctance/ refusal to sleep away from home without/ major attachment figure

7. Repeated nightmares involving the theme of separation

8. Repeated complaints of physical symptoms when separation from attachment figures 

Selective Mutism

An anxiety disorder where a child consistently cannot speak in certain social situations, despite being able to speak normally in others.

1. Consistent failure to speak in specific social situations (expectation for speaking) despite speaking in other situations

2. Interferes with educational/ occupational achievement or with social communication

3. Not attributable to a lack of knowledge of, or comfort with, the spoken language

Specific Phobia

an intense, irrational fear of a particular object or situation that leads to avoidance or distress.

Symptom;

1. Fear or anxiety about a specific object or situation

2. Object or situation almost always provokes immediate fear or anxiety

3. Actively avoided or endured with intense fear or anxiety.

4. Out of proportion to the actual danger posed

Social Anxiety Disorder

(Social Phobia) an intense fear of social situations where one might be judged, leading to avoidance or extreme distress.

Symptoms;

1. Fear or anxiety about one or more social situations (individual is exposed to possible scrutiny by others)

2. Fears to act way or show anxiety symptoms that will be negatively evaluated

3. Social situations almost always provoke fear or anxiety.

4. Social situations are avoided or endured with intense fear or anxiety

5. Fear or anxiety is out of proportion to the actual threat

Panic Disorder

(Panic Attack Specifier) Recurrent unexpected panic attacks—intense episodes of fear with physical symptoms.

Symptoms;

1. Palpitations, pounding heart, or accelerated heart rate

2. Sweating, chills or heat sensations

3. Trembling or shaking/ numbness or tingling sensations

4. Sensations of shortness of breath or Feelings of choking

5. Chest pain or discomfort

6. Nausea/ abdominal distress

7. Feeling dizzy, unsteady, light-headed, or faint

8. feelings of unreality or being detached from oneself 

9. Fear of losing control/ “going crazy.”/ dying.

At least one of the attacks has been followed by 1 month (or more) of one or both:

1. Persistent concern or worry about additional panic attacks or their consequences

2. Maladaptive change in behavior related to the attacks (e.g., avoidance)

Agoraphobia

fear of being in places or situations where escape might be difficult, often leading to avoidance of public spaces.

Symptoms;

1. Fear/ anxiety in 2/more situations: Public transportation, being in open spaces or enclosed places, standing in line/ being in a crowd, being outside of the home alone.

2. Fears or avoids these situations (escape might be difficult or help might not be available) if panic symptoms appear. 

3. fear or anxiety is out of proportion to the actual danger 

4. Situations are actively avoided, require the presence of a companion, or are endured with intense fear or anxiety.

Generalized Anxiety Disorder

Excessive worry about everyday life events where the individual finds it difficult to control the worry

Symptoms;

1. Restlessness or feeling keyed up or on edge

2. Being easily fatigued

3. Difficulty concentrating or mind going blank

4.  Irritability

5. Muscle tension.

6. Sleep disturbance (falling or staying asleep/restless/unsatisfying sleep).

Obsessive-Compulsive Disorder

(OCD) a condition where a person has unwanted, repetitive thoughts (obsessions) and feels compelled to perform certain behaviors (compulsions) to reduce anxiety.

Symptoms; (Presence of obsessions, compulsions, or both)

1. Obsession; Recurrent and persistent thoughts, urges, or images that are experienced that cause anxiety/ distress or attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with other thought or action (i.e., by performing a compulsion).

Compulsions; Repetitive behaviors or mental acts that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly or behaviors or mental acts are aimed at preventing/ reducing anxiety or distress or preventing some dreaded event or situation (however not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive)

Body Dysmorphic Disorder

a mental health condition where a person is obsessed with perceived flaws in their appearance, often causing distress and repetitive behaviors (not observable or appear slight to others)

Symptoms;

1. Has performed repetitive behaviors (e.g., mirror checking or skin picking) or mental acts (e.g., comparing appearance) in response to the appearance concerns.

2. Cause significant distress or impairment

Hoarding Disorder

a condition where a person struggles to discard possessions, leading to clutter that disrupts living spaces and daily life (regardless of their actual value)

Symptom;

1.  Perceived need to save the items and to distress associated with discarding them

2. Possessions clutter active living areas and compromises their intended use

3. Hoarding causes significant distress or impairment

Trichotillomania

(Hair-Pulling Disorder) a disorder where a person feels compelled to pull out their hair, causing noticeable hair loss and distress.

Symptoms;

1. Recurrent pulling out of one’s hair, resulting in hair loss

2. Repeated attempts to decrease or stop hair pulling

3. The hair pulling causes significant distress or impairment

Excoriation (Skin-Picking) Disorder

a condition where a person repeatedly picks at their skin, causing damage and distress

Symptoms; 

1. Recurrent skin picking resulting in skin lesions

2. Repeated attempts to decrease or stop skin picking

3. The skin picking causes distress or impairment

Reactive Attachment Disorder

a condition in children where they have difficulty forming healthy emotional bonds due to neglect or inconsistent caregiving.

Symptoms; 

1. Consistent pattern of inhibited, emotionally withdrawn behavior toward caregivers (child rarely seeks comfort when distressed/ child rarely responds to comfort when distressed)

2. persistent social and emotional disturbance ( Minimal social and emotional responsiveness to others/ Limited positive affect/ Episodes of unexplained irritability, sadness, or fearfulness)

3. Child has experienced a pattern of extremes of insufficient care as evidenced by: Social neglect or deprivation (lack of having basic emotional needs for comfort, stimulation, and affection met by caregiving),  limit opportunities to form stable attachments or unusual settings that severely limit opportunities to form selective attachments .

Disinhibited Social Engagement Disorder

a childhood condition where a child shows overly familiar or inappropriate behavior with strangers, often due to neglect or lack of stable attachments.

Symptoms; (which a child actively approaches and interacts with unfamiliar adults)

1. Reduced reticence in approaching and interacting with unfamiliar adults

2. Overly familiar verbal or physical behavior

3. Absent checking back with adult caregiver after venturing away

4. Willingness to go off with an unfamiliar adult with minimal or no hesitation.

5. Child has experienced a pattern of extremes of insufficient care as evidenced by: Social neglect or deprivation (lack of having basic emotional needs for comfort, stimulation, and affection met by caregiving),  limit opportunities to form stable attachments or unusual settings that severely limit opportunities to form selective attachments .

Posttraumatic Stress Disorder

a condition where a person experiences distressing memories, flashbacks, or avoidance after a traumatic event.

Symptoms;

1. Exposure to actual or threatened death, serious injury, or sexual violence 

2. Recurrent, involuntary, and intrusive distressing memories of the traumatic event

3. Recurrent distressing dreams in which the content and/or affect related to the event

4. Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. 

5. Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).

6. Persistent avoidance of stimuli associated with the traumatic event

7. Negative alterations in cognitions and mood associated with the traumatic event

Acute Stress Disorder

a short-term reaction to a traumatic event, causing anxiety, flashbacks, or avoidance, lasting from 3 days to 4 weeks.

Symptoms; 

1. Exposure to actual or threatened death, serious injury, or sexual violence

2. Recurrent, involuntary, and intrusive distressing memories of the traumatic event

3. Recurrent distressing dreams in which the content and/or affect related to the event

4. Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. 

5. Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).

6. Persistent inability to experience positive emotions

7. Persistent avoidance of stimuli associated with the traumatic event

8. Negative alterations in cognitions and mood associated with the traumatic event

9. Arousal symptoms (sleep disturbance ect.) and Dissociative symptoms ( altered sense of the reality or inability to remember an important aspect of event)

Adjustment Disorders

a stress-related condition where a person has difficulty coping with a major life change, causing emotional or behavioral symptoms (occurring within 3 months of the onset of the stressor)

Symptoms; 

1. Emotional or behavioral symptoms in response to an identifiable stressor

2. Distress that is out of proportion to the severity or intensity of the stressor (compare to external context and cultural factors)

3. Significant impairment

Dissociative Identity Disorder

a condition where a person has two or more distinct identities or personality states that control their behavior at different times.

Symptoms;

1. Two or more distinct personality states

2. Marked discontinuity in sense of self and sense of agency

3. Related alterations in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning

4. Recurrent gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting

5. The symptoms cause distress or impairment

Dissociative Amnesia

a disorder where a person cannot recall important personal information, usually following trauma or stress.

Symptoms; 

1. inability to recall important autobiographical information (inconsistent with ordinary forgetting)

2. The symptoms cause distress or impairment

Depersonalization/Derealization Disorder

Persistent episodes of feeling detached from oneself (depersonalization) or feeling that the world around you is unreal or dreamlike (derealization), while knowing it’s not actually true.

1. Depersonalization; Experiences of unreality, detachment, or being an outside observer with respect to one’s thoughts, feelings, sensations, body, or actions (e.g., perceptual alterations, distorted sense of time, unreal or absent self, emotional and/or physical numbing).

2. Derealization; Experiences of unreality or detachment with respect to surroundings (e.g., individuals or objects are experienced as unreal, dreamlike, foggy, lifeless, or visually distorted).

Somatic symptom disorder

Distressing physical symptoms (like pain or fatigue) combined with excessive thoughts, feelings, or behaviors about those symptoms.

Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns as manifested by at least one of the following;

1. Disproportionate and persistent thoughts about the seriousness of one’s symptoms.

2. Persistently high level of anxiety about health or symptoms.

3. Excessive time and energy devoted to these symptoms or health concerns.

Illness anxiety disorder (formerly hypochondriasis)

Intense worry about having or developing a serious illness, often with minimal or no physical symptoms.

1. Preoccupation with having or acquiring a serious illness. 

2. Somatic symptoms are not present or, if present, are only mild in intensity. If another medical condition is present or there is a high risk for developing a medical condition (e.g., strong family history is present), the preoccupation is clearly excessive or disproportionate.

3. There is a high level of anxiety about health, and the individual is easily alarmed about personal health status.

4. The individual performs excessive health-related behaviors (e.g., repeatedly checks his or her body for signs of illness) or exhibits maladaptive avoidance (e.g., avoids doctor appointments and hospitals).

Conversion (or functional neurological symptom) disorder

Neurological symptoms (such as paralysis, blindness, or seizures) that appear without a medical explanation, often linked to psychological stress or conflict.

1. One or more symptoms of altered voluntary motor or sensory function.

   1. Motor symptoms include weakness or paralysis; abnormal movements, such as tremor, jerks, or dystonic movements; and gait abnormalities. 

   2. Sensory symptoms include altered, reduced, or absent skin sensation, vision, or hearing.

2. Clinical findings provide evidence of incompatibility between the symptom and recognized neurological or medical conditions.

Factitious disorder

A condition in which a person deliberately fakes, exaggerates, or causes physical or psychological symptoms to appear ill, injured, or in need of care — not for money or external rewards, but to gain attention, sympathy, or the “sick role.”

1. Falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception.

2. The individual presents himself or herself to others as ill, impaired, or injured.

3. The deceptive behavior is evident even in the absence of obvious external rewards.

4. The behavior is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder.

Pica

Repeated eating of non-food items (like dirt, paper, chalk) for at least a month, inappropriate for the person’s age.

1. Persistent eating of nonnutritive, nonfood substances over a period of at least 1 month.

2. The eating of nonnutritive, nonfood substances is inappropriate to the developmental level of the individual.

3. The eating behavior is not part of a culturally supported or socially normative practice.

Rumination Disorder

Repeated regurgitation of food after eating — the food may be re-chewed, re-swallowed, or spit out — not due to a medical issue.

1. Repeated regurgitation of food over a period of at least 1 month. Regurgitated food may be re-chewed, re-swallowed, or spit out.

2. The repeated regurgitation is not attributable to an associated gastrointestinal or other medical condition (e.g., gastroesophageal reflux, pyloric stenosis).

3. The eating disturbance does not occur exclusively during the course of anorexia nervosa, bulimia nervosa, binge-eating disorder, or avoidant/restrictive food intake disorder.

Avoidant/Restrictive Food Intake Disorder

Limited eating due to lack of interest in food, sensory sensitivity, or fear of choking/vomiting — not about body image or weight.

1. Significant weight loss (or failure to achieve expected weight gain or faltering growth in children).

2. Significant nutritional deficiency.

3. Dependence on enteral feeding or oral nutritional supplements.

4. Marked interference with psychosocial functioning.

Anorexia Nervosa

Severe restriction of food leading to significantly low body weight, intense fear of gaining weight, and a distorted body image.

1. Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected.

2. Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight.

3. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.

Bulimia Nervosa

Repeated episodes of binge eating followed by behaviors to prevent weight gain (vomiting, fasting, excessive exercise, or laxative use).

1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances. 

2. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).

3. Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise.

Binge-Eating Disorder

Episodes of eating large amounts of food with a feeling of loss of control, but without the purging behaviors seen in bulimia.

1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances. 

2. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating). 

B. The binge-eating episodes are associated with three (or more) of the following;

1.  Eating much more rapidly than normal.

2. Eating until feeling uncomfortably full.

3. Eating large amounts of food when not feeling physically hungry.

4. Eating alone because of feeling embarrassed by how much one is eating.

5. Feeling disgusted with oneself, depressed, or very guilty afterward.

Insomnia disorder

Difficulty falling asleep, staying asleep, or getting good-quality sleep, causing daytime tiredness or problems functioning.

1. Difficulty initiating sleep. (In children, this may manifest as difficulty initiating sleep without caregiver intervention.)

2. Difficulty maintaining sleep, characterized by frequent awakenings or problems returning to sleep after awakenings. (In children, this may manifest as difficulty returning to sleep without caregiver intervention.)

3. Early-morning awakening with inability to return to sleep.

Hypersomnolence disorder

Excessive daytime sleepiness despite getting enough (or more than enough) sleep at night.

1. Recurrent periods of sleep or lapses into sleep within the same day.

2. A prolonged main sleep episode of more than 9 hours per day that is nonrestorative (i.e., unrefreshing).

3. Difficulty being fully awake after abrupt awakening.

Restless legs syndrome

An uncomfortable urge to move the legs, usually in the evening or at night, making it hard to fall asleep.

1. The urge to move the legs begins or worsens during periods of rest or inactivity.

2. The urge to move the legs is partially or totally relieved by movement.

3. The urge to move the legs is worse in the evening or at night than during the day, or occurs only in the evening or at night.

Narcolepsy

A disorder involving sudden sleep attacks, excessive daytime sleepiness, and sometimes sudden loss of muscle tone (cataplexy).

1. Episodes of cataplexy, defined as either (a) or (b), occurring at least a few times per month;

   1. In individuals with long-standing disease, brief (seconds to minutes) episodes of sudden bilateral loss of muscle tone with maintained consciousness that are precipitated by laughter or joking.

   2. In children or in individuals within 6 months of onset, spontaneous grimaces or jaw-opening episodes with tongue thrusting or a global hypotonia, without any obvious emotional triggers.

2. Hypocretin deficiency, as measured using cerebrospinal fluid (CSF) hypocretin-1 immunoreactivity values (less than or equal to one-third of values obtained in healthy subjects tested using the same assay, or less than or equal to 110 pg/mL). Low CSF levels of hypocretin-1 must not be observed in the context of acute brain injury, inflammation, or infection.

3. Nocturnal sleep polysomnography showing rapid eye movement (REM) sleep latency less than or equal to 15 minutes, or a multiple sleep latency test showing a mean sleep latency less than or equal to 8 minutes and two or more sleep-onset REM periods.

Nightmare Disorder

Frequent, vivid nightmares that cause distress or disrupt sleep, often remembered clearly upon waking.

1. Repeated occurrences of extended, extremely dysphoric, and well-remembered dreams that usually involve efforts to avoid threats to survival, security, or physical integrity and that generally occur during the second half of the major sleep episode.

2. On awakening from the dysphoric dreams, the individual rapidly becomes oriented and alert.

3. The sleep disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Sleep-related hypoventilation

Breathing becomes too slow or shallow during sleep, leading to low oxygen and high carbon dioxide levels.

Polysomnograpy demonstrates episodes of decreased respiration associated with elevated CO2 levels. (Note: In the absence of objective measurement of CO2 , persistent low levels of hemoglobin oxygen saturation unassociated with apneic/hypopneic events may indicate hypoventilation.)

Obstructive sleep apnea hypopnea

Repeated episodes where the airway collapses or becomes blocked during sleep, causing breathing interruptions and snoring.

1. Evidence by polysomnography of at least five obstructive apneas or hypopneas per hour of sleep and either of the following sleep symptoms;

   1. Nocturnal breathing disturbances; snoring, snorting/gasping, or breathing pauses during sleep.

   2. Daytime sleepiness, fatigue, or unrefreshing sleep despite sufficient opportunities to sleep that is not better explained by another mental disorder (including a sleep disorder) and is not attributable to another medical condition. 

2. Evidence by polysomnography of 15 or more obstructive apneas and/or hypopneas per hour of sleep regardless of accompanying symptoms

Central sleep apnea

Breathing repeatedly stops during sleep because the brain doesn’t send proper signals to the breathing muscles.

1. Evidence by polysomnography of five or more central apneas per hour of sleep.

2. The disorder is not better explained by another current sleep disorder.

Gender Dysphoria in Children

A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months’ duration, as manifested by at least six of the following (one of which must be Criterion A1);

1. A strong desire to be of the other gender or an insistence that one is the other gender (or some alternative gender different from one’s assigned gender). 

2. In boys (assigned gender), a strong preference for cross-dressing or simulating female attire; or in girls (assigned gender), a strong preference for wearing only typical masculine clothing and a strong resistance to the wearing of typical feminine clothing.

3. A strong preference for cross-gender roles in make-believe play or fantasy play.

4. A strong preference for the toys, games, or activities stereotypically used or engaged in by the other gender.

5. A strong preference for playmates of the other gender.

6. In boys (assigned gender), a strong rejection of typically masculine toys, games, and activities and a strong avoidance of rough-and-tumble play; or in girls (assigned gender), a strong rejection of typically feminine toys, games, and activities.

7. A strong dislike of one’s sexual anatomy.

8. A strong desire for the primary and/or secondary sex characteristics that match one’s experienced gender.

Gender Dysphoria in Adolescents and Adults

A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months’ duration.

1. A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics (or in young adolescents, the anticipated secondary sex characteristics).

2. A strong desire to be rid of one’s primary and/or secondary sex characteristics because of a marked incongruence with one’s experienced/expressed gender (or in young adolescents, a desire to prevent the development of the anticipated secondary sex characteristics).

3. A strong desire for the primary and/or secondary sex characteristics of the other gender.

4. A strong desire to be of the other gender (or some alternative gender different from one’s assigned gender).

5. A strong desire to be treated as the other gender (or some alternative gender different from one’s assigned gender).

6. A strong conviction that one has the typical feelings and reactions of the other gender (or some alternative gender different from one’s assigned gender).

Exhibitionistic disorder

A strong urge to expose one’s genitals to an unsuspecting person, causing distress or impairment.

1. Over a period of at least 6 months, recurrent and intense sexual arousal from the exposure of one’s genitals to an unsuspecting person, as manifested by fantasies, urges, or behaviors.

2. The individual has acted on these sexual urges with a nonconsenting person, or the sexual urges or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Voyeuristic disorder

Intense urges to secretly watch unsuspecting people who are naked, undressing, or having sex.

1. Over a period of at least 6 months, recurrent and intense sexual arousal from observing an unsuspecting person who is naked, in the process of disrobing, or engaging in sexual activity, as manifested by fantasies, urges, or behaviors.

2. The individual has acted on these sexual urges with a nonconsenting person, or the sexual urges or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

3. The individual experiencing the arousal and/or acting on the urges is at least 18 years of age

Frotteurisitc disorder

Recurrent urges to touch or rub against a non-consenting person, typically in crowded places.

1. Over a period of at least 6 months, recurrent and intense sexual arousal from touching or rubbing against a nonconsenting person, as manifested by fantasies, urges, or behaviors. 

2. The individual has acted on these sexual urges with a nonconsenting person, or the sexual urges or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Sexual sadism

Sexual arousal from causing physical or psychological suffering to another person, when it causes distress or involves a non-consenting person.

1. Over a period of at least 6 months, recurrent and intense sexual arousal from the physical or psychological suffering of another person, as manifested by fantasies, urges, or behaviors.

2. The individual has acted on these sexual urges with a nonconsenting person, or the sexual urges or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Sexual masochism disorders

Sexual arousal from being humiliated, beaten, bound, or otherwise made to suffer, causing distress or impairment.

1. Over a period of at least 6 months, recurrent and intense sexual arousal from the act of being humiliated, beaten, bound, or otherwise made to suffer, as manifested by fantasies, urges, or behaviors.

2. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Fetishistic disorder

Sexual arousal focused on nonliving objects (like shoes, leather) or highly specific body parts, causing distress or impairment.

1. Over a period of at least 6 months, recurrent and intense sexual arousal from either the use of nonliving objects or a highly specific focus on nongenital body part(s), as manifested by fantasies, urges, or behaviors.

2. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

3. The fetish objects are not limited to articles of clothing used in cross-dressing (as in transvestic disorder) or devices specifically designed for the purpose of tactile genital stimulation (e.g., vibrator).

Transvestic disorder

Recurrent sexual arousal from cross-dressing, only considered a disorder when it causes significant distress or impairment.

1. Over a period of at least 6 months, recurrent and intense sexual arousal from cross-dressing, as manifested by fantasies, urges, or behaviors.

2. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Pedophilic disorder

Strong, recurrent sexual urges toward prepubescent children, and acting on these urges or experiencing distress because of them.

1. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child or children (generally age 13 years or younger).

2. The individual has acted on these sexual urges, or the sexual urges or fantasies cause marked distress or interpersonal difficulty.

3. The individual is at least age 16 years and at least 5 years older than the child or children in Criterion A

Oppositional Defiant Disorder

A pattern of angry, irritable mood, arguing, defiance, or refusal to follow rules, especially toward authority figures.

Angry/Irritable Mood

1. Often loses temper.

2. Is often touchy or easily annoyed.

3. Is often angry and resentful. 

Argumentative/Defiant Behavior

4. Often argues with authority figures or, for children and adolescents, with adults.

5. Often actively defies or refuses to comply with requests from authority figures or with rules.

6. Often deliberately annoys others.

7. Often blames others for his or her mistakes or misbehavior. 

Vindictiveness

8. Has been spiteful or vindictive at least twice within the past 6 months.

Intermittent Explosive Disorder

Recurrent, sudden outbursts of anger or aggression that are much more intense than the situation warrants.

1. Verbal aggression or physical aggression toward property, animals, or other individuals, occurring twice weekly, on average, for a period of 3 months. The physical aggression does not result in damage or destruction of property and does not result in physical injury to animals or other individuals.

2. Three behavioral outbursts involving damage or destruction of property and/or physical assault involving physical injury against animals or other individuals occurring within a 12-month period.

3. The magnitude of aggressiveness expressed during the recurrent outbursts is grossly out of proportion to the provocation or to any precipitating psychosocial stressors.

4. The recurrent aggressive outbursts are not premeditated (i.e., they are impulsive and/or anger-based) and are not committed to achieve some tangible objective (e.g., money, power, intimidation).

Conduct Disorder

A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated

Aggression to People and Animals 

1. Often bullies, threatens, or intimidates others.

2. Often initiates physical fights.

3. Has used a weapon that can cause serious physical harm to others

4. Has been physically cruel to people.

5. Has been physically cruel to animals.

6. Has stolen while confronting a victim 

7. Has forced someone into sexual activity. 

Destruction of Property 

8. Has deliberately engaged in fire setting with the intention of causing serious damage.

9. Has deliberately destroyed others’ property (other than by fire setting). 

Deceitfulness or Theft

10. Has broken into someone else’s house, building, or car.

11. Often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others).

12. Has stolen items of nontrivial value without confronting a victim

Serious Violations of Rules 

13. Often stays out at night despite parental prohibitions, beginning before age 13 years.

14. Has run away from home overnight at least twice while living in the parental or parental surrogate home, or once without returning for a lengthy period.

15. Is often truant from school, beginning before age 13 years.

Pyromania

A strong urge to set fires deliberately, along with fascination or pleasure related to fire-setting.

1. Deliberate and purposeful fire setting on more than one occasion.

2. Tension or affective arousal before the act.

3. Fascination with, interest in, curiosity about, or attraction to fire and its situational contexts (e.g., paraphernalia, uses, consequences).

4. Pleasure, gratification, or relief when setting fires or when witnessing or participating in their aftermath.

Kleptomania

Recurrent, irresistible urges to steal items that are not needed for personal use or value, often followed by relief or release of tension.

1. Recurrent failure to resist impulses to steal objects that are not needed for personal use or for their monetary value.

2. Increasing sense of tension immediately before committing the theft.

3. Pleasure, gratification, or relief at the time of committing the theft.

Paranoid personality disorder

Characterized by strong distrust and suspicion of others; people often believe others are out to harm, deceive, or exploit them. Beginning by early adulthood.

1. Aspects, without sufficient basis, that others are exploiting, harming,deceiving him.

2. Is preoccupied with unjustified doubts about the loyalty/trustworthiness of friends. 

3. Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her.

4. Reads hidden demeaning or threatening meanings into benign remarks or events

5. Persistently bears grudges.

6. Perceives attacks on his/her character or reputation that are not apparent to others and is quick to react angrily/counterattack 

7. Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner

Schizoid personality disorder

A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood

1. Neither desires nor enjoys close relationships, including being part of a family. 

2. Almost always chooses solitary activities. 

3. Has little, if any, interest in having sexual experiences with another person.

4. Takes pleasure in few, if any, activities.

5. Lacks close friends or confidants other than first-degree relatives.

6. Appears indifferent to the praise or criticism of others.

7. Shows emotional coldness, detachment, or flattened affectivity.

Schizotypal personality disorder

Involves odd beliefs, unusual behavior, and discomfort in close relationships; may include magical thinking or eccentric speech. Beginning by early adulthood.

1. Ideas of reference (excluding delusions of reference). 

2. Odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms 

3. Unusual perceptual experiences, including bodily illusions

4. Odd thinking and speech 

5. Suspiciousness or paranoid ideation

6. Inappropriate or constricted affect

7. Behavior or appearance that is odd, eccentric, or peculiar

8. Lack of close friends or confidants other than first-degree relatives

9. Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self

Antisocial personality disorder

Defined by disregard for others’ rights, deceitfulness, impulsivity, and lack of remorse; often associated with rule-breaking or criminal behavior. Occurring since age 15 years.

1. Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest. 

2. Deceitfulness, as indicated by repeated lying, use of aliases, or conning others

3. Impulsivity or failure to plan ahead.

4. Irritability and aggressiveness, indicated by repeated physical fights or assaults

5. Reckless disregard for safety of self or others.

6. Consistent irresponsibility

7. Lack of remorse

Borderline personality disorder

Pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood.

1. Frantic efforts to avoid real or imagined abandonment. 

2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.

3. Identity disturbance

4. Impulsivity in at least two areas that are potentially self-damaging 

5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.

6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).

7. Chronic feelings of emptiness.

8. Inappropriate, intense anger or difficulty controlling anger 

9. Transient, stress-related paranoid ideation or severe dissociative symptoms.

Histrionic personality disorder

Characterized by excessive emotionality and attention-seeking; individuals may be dramatic, flirtatious, and crave approval.

1. Is uncomfortable in situations in which he or she is not the center of attention.

2. Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior.

3. Displays rapidly shifting and shallow expression of emotions.

4. Consistently uses physical appearance to draw attention to self.

5. Has a style of speech that is excessively impressionistic and lacking in detail.

6. Shows self-dramatization, theatricality, and exaggerated expression of emotion.

7. Is suggestible (i.e., easily influenced by others or circumstances).

8. Considers relationships to be more intimate than they actually are.

Narcissistic personality disorder

Involves grandiosity, need for admiration, and lack of empathy; people often have an inflated sense of importance. Beginning by early adulthood.

1. Has a grandiose sense of self-importance 

2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.

3. Believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions).

4. Requires excessive admiration.

5. Has a sense of entitlement 

6. Is interpersonally exploitative 

7. Lacks empathy

8. Is often envious of others or believes that others are envious of him or her

9. Shows arrogant, haughty behaviors or attitudes

Avoidant personality disorder

Marked by social inhibition, feelings of inadequacy, and hypersensitivity to criticism; individuals want relationships but fear rejection. Beginning by early adulthood.

1. Avoids occupational activities that involve significant interpersonal contact because of fears of criticism, disapproval, or rejection.

2. Is unwilling to get involved with people unless certain of being liked.

3. Shows restraint within intimate relationships because of the fear of being shamed or ridiculed.

4. Is preoccupied with being criticized or rejected in social situations.

5. Is inhibited in new interpersonal situations because of feelings of inadequacy.

6. Views self as socially inept, personally unappealing, or inferior to others.

7. Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing.

Dependent personality disorder

A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood.

1. Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others.

2. Needs others to assume responsibility for most major areas of his or her life.

3. Has difficulty expressing disagreement with others because of fear of loss of support or approval.

4. Has difficulty initiating projects or doing things on his or her own (because of a lack of self-confidence in judgment or abilities rather than a lack of motivation or energy).

5. Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant.

6. Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself.

7. Urgently seeks another relationship as a source of care and support when a close relationship ends.

8. Is unrealistically preoccupied with fears of being left to take care of himself or herself.

Obsessive-Compulsive personality disorder

A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood.

1. Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost.

2. Shows perfectionism that interferes with task completion

3. Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships

4. Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values

5. Is unable to discard worn-out or worthless objects even when they have no sentimental value.

6. Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things.

7. Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes.

8. Shows rigidity and stubbornness.