Diagnostic Criteria (DSM5)

Other Specified Vs. Unspecified

Other Specified: When there are presentations in which symptoms characteristic of the category of diagnosis are present and the clinician explains.

Unspecified: When characteristics of the category are present but a client does not fit full criteria of a specific diagnosis, but the clinician chooses NOT to specify the reason that the criteria was not met.

Substance/medication Induced...

Many diagnosis also have this as a diagnostic option

- When symptoms precede the onset of the substance/medication use and the symptoms continue a short while (about a month) after cessation of med/substance.

Due to Medical...

Many diagnosis have this diagnosis option: When there is evidence from history, physical examination, or laboratory findings that the disturbance is the direct physiological consequence of another medical condition.

(proof the medical condition caused the diagnostic features)

Intellectual Disability

Intellectual and Adaptive functioning deficits in conceptual, social, and practical domains.

All requirements must be met
> deficits in intellectual functions (reasoning, problem solving, abstract thinking, judgement, academic learning, learning by experience) confirmed by testing/assessments
> deficits in adaptive functioning causing failure in developmental and sociocultural standards. limiting functioning in daily life, communication, social participation, independent living.
> onset of deficits during developmental period.

Know difference between mild, moderate, severe, profound specifiers (pg. 34)

Global Developmental Delay

- Individuals Under 5 y/o
- Individual fails to meet developmental milestones in several areas.
- too young to be confirmed by standardized testing
- requires reassessment after a period of time.

Language Disorder

Difficulties using language across modalities (spoken, written, sign language)
> Reduced vocabulary
> Limited sentence structure.
> Impairment to discourse
-Language ability significantly below expected for age.
-limits communication, social participation, academics, occupation
- onset is early developmental period

Speech Sound Disorder

- difficulty producing speech at appropriate level
- limits communication, social, academic, occupational
- early developmental period
- not due to medical reasons

Childhood-Onset Fluency Disorder

(stuttering)
Disturbances in fluency of speech pattern inappropriate for age and persistent.
1+
> Sound and syllable repetitions
> Sound prolongations of consonants as well as vowels
> Broken words
> audible or sound blocking
> substituting words for less difficult ones
> words produced with excess tension
> whole word repetitions
- causes difficulty in communicating in multiple areas
- in early developmental period
- not due to medical

Adult-onset diagnostic code also available.

Social (Pragmatic) Communication Disorder

Difficulties in verbal + nonverbal
manifested by all...
> deficits using communication for social purposes
> impairment in changing communication pattern to match the situation
> difficulty for following communication standards (taking turns, verbal and non verbal signs)
> Difficulty understanding inferences or ambiguous meaning language.

Autism Spectrum Disorder

- Difficulty in communication
- restricted repetitive behaviors: 2+
> repetitive movement of self, objects, or speech
> inflexibility in routines, ritualized patterns of behavior
> Fixated interests with abnormal intensity of focus
> hyper/hypoactivity to sensory input
- Early developmental period
- Clinically significant impairment
- Not better explained by another diagnosis

Attention-Deficit/Hyperactivity Disorder (ADHD)

Pattern of inattention and hyperactivity-impulsivity that interferes with functioning for 6+ months

- Inattention 6+ (5+ for adults)
> careless mistakes/ lacks attention to detail
> difficulty sustaining attention
> difficulty listening
> fails to finish tasks
> reluctant to engage in tasks requiring focus
> loses items
> easily distracted by stimuli
> forgetful of daily activities

- Hyperactivity 6+ (5+ for adults)
> often fidgets
> leaves seat when expected to sit
> runs and climbs when inappropriate
> unable to engage in leisure activities quietly
> often "on the go"
> talks excessively
> Blurts out answer before question is done
> difficulty waiting turn
> interrupts or intrudes others

- symptoms present prior to age 12
- two or more settings

Specific Learning Disorder

Difficulty learning and using academic skills
persisted 6+ months
1 of the following difficulties
> word reading
> understanding what is read
> spelling
> written expression
> number sense
> mathematical reasoning
- substantial and quantifiable below those expected with individuals age
- begin in school age years but may fully manifest later
- not better explained by other diagnosis

Specifiers
- impairment in reading
- impairment with written expression
- impairment in mathematics
- Mild: improve with mild accommodations
- Moderate: needs intensive specialized teaching
- Severe: even with help ct. may not be able to complete effectively.

Developmental Coordination Disorder

coordinated motor skills substantially below expected for age. (viewed as clumsiness or being slow)
- significantly impairs daily living tasks and other life domains.
- not better explained by...

Stereotypic Movement Disorder

- repetitive, seemily driven, and apparently purposeless motor behavior
- interferes with life domains and may result in self-injury
- early developmental period
- not attributed to other diagnosis

Specify:
- W/ self-injurious behavior
- W/o self-injurious behavior
- Associated with known medical or genetic condition, neurodevelopmental disorder, or environmental factor.
- Mild, Moderate, or severe

Tourette's Disorder

Tic Disorder
- Both motor and one of more vocal tics present at some time during illness, although not necessarily concurrently
- 1 year duration (may wax and wane in frequency)
- before age 18
- not due to substance or medical condition

Persistent (Chronic) Motor or Vocal Tic Disorder

Tic Disorder
- Single or multiple motor or vocal tics present during illness
- NOT both motor and vocal
- Over 1 year
- before age 18
- Criteria never met for tourettes
- not attributed to psychological, substance, or medical condition.
- Specify: with motor tics only or vocal tics only.

Provisional Tic Disorder

Tic Disorder
- Single or multiple motor and/or vocal tics
- present less than 1 year
- before 18
- criteria never met for Tourettes or Persistent Motor or Vocal Tic Disorder

Delusional Disorder

- One or more delusion for 1+ months
- Criterion A for schizophrenia (hallucinations) has never been met
- Overall functioning is not impaired
- If manic or depressive episodes occurred they were brief in comparison to the delusion.
- Not due to psychological, substance, or medical diagnosis

Types of Delusions:
> Erotamanic: delusion someone else is in love with them
> Grandiose: Very important
> Jealous: spouse or lover is unfaithful
> Persecutory: Being conspired against
> Somatic: body functions or sensations
> mixed: no one theme dominates
> unspecified: cannot be clearly determined

Other specifiers pg. 91

Brief Psychotic Disorder

1 day - 1 month (not longer)
- 1+ of the following symptoms
> delusions
> hallucinations
> disorganized speech
> disorganized or catatonic behavior

See other specifiers pg. 94

Schizophreniform Disorder

1 month - 6 months (not longer)
- 2+ of the following symptoms ( one symptom must be the first 3)
> delusions
> hallucinations
> disorganized speech
> disorganized or catatonic behavior
> Negative Symptoms
- Schizoaffective and depressive or bipolar ruled out
- not due to substance or medical

Schizophrenia

Over 6 months
- 2+ of the following symptoms ( one symptom must be the first 3)
> delusions
> hallucinations
> disorganized speech
> disorganized or catatonic behavior
> Negative Symptoms
- Level of functioning impaired in one or more domain
- One month of active symptoms, less if treated
- Schizoaffective and depressive or bipolar ruled out
- not due to substance or medical
- if history off autism or communication disorder only add schizophrenia if delusions or hallucinations are prominent

Schizoaffective Disorder

Major mood episode and criterion A of schizophrenia
- Delusion and Hallucination occur for 2+ weeks in absence of major mood episode.
- Symptoms of Major Mood Episode are present for majority of total duration
- not due to substance or mediacal

Specify:
Bipolar Type (includes manic)
Depressive Type
With Catatonia

See episode specifiers on page 106

Catatonia Associated with Another Mental Disorder (Catatonia Specifier)

3+ of the folliwng symptoms
> stupor (no activity)
> Catalepsy (rigidity of body)
> Waxy Flexibility
> Mutism
> Negativism (no response to stimuli)
> Posturing
> Mannerism
> Stereotypy (repetative non goal directed movement)
> Agitation
> Echolalia (mocking speech)
> Echopraxia (mocking movement)

Bipolar 1

Bipolar I requires 1 type of episode
-MUST have a manic episode
Mania- A distinct period of abnormally and persistently
elevated, expansive, or irritable mood and
abnormally and persistently increased goal-directed
activity or energy.
During this period, three or more of the following
symptoms are present (four if mood is only irritable)
>Inflated Self Esteem (grandiosity)
>Need less sleep or decreased need for sleep
>Racing thoughts or flight of ideas
>Distractability
>Increase in goal directed activity or psychomotor agitation
>More talkative than usual
>Involvement in activities that could have painful
consequences
>Very severe impairment in functioning
>Symptoms for at least 1 week (present most of the
day,nearly everyday) or less if hospitalized
-CAN have Hypomanic episode
-CAN have Depressive episode

Bipolar 2

-Can NEVER have a manic episode
Bipolar II requires 2 types of episodes
-MUST have a Hypomanic episode
Hypomania
>Inflated self-esteem (grandiosity)
>Need less sleep or decreased need for sleep
>Racing thoughts or flight of ideas
>Distractability
>Increase in goal directed activity or psychomotor
agitation
>More talkative than usual
>Involvement in activities that could have painful
consequences

-MUST have Major Depressive episode
>Depressed mood or loss of interest
>Weight loss or weight gain
>Insomnia or hypersomnia
>Loss of energy
>Feelings of worthlessness
>Difficulty concentrating
>Recurrent thoughts of death
-A change in functioning is OBSERVABLE but not SEVERE
and does NOT require hospitalization
-Symptoms for at least 4 days

Cyclothymic Disorder

-Symptoms for 2 years (At least one year in children and
adolescents)
-Depressive symptoms (that never meet criteria for a major
depressive episode
AND
-Hypomanic symptoms (that never meet criteria for hypomanic episode)

>During 2 year period (1 year in children and adolescents)
the hypomanic and depressive periods have been
present for at least halt the time and not without
symptoms for more than 2 months at a time

>Symptoms cause significant distress or impairment in significant or important areas of functioning

Specifiers for Bipolar & Related Disorders

Severity
>Mild (two symptoms)
>Moderate (three symptoms)
>Moderate-Severe (four or five symptoms)
>Severe (four or five symptoms with motor agitation)

Course
>With psychotic features
>In partial remission
>In full remission
>Unspecified

Specify: (most recent episode)
-With anxious distress:
The presence of at least two of the following symptoms
>Feeling keyed up or tense
>Feeling unusually restless
>Difficulty concentrating because of worry
>Fear that something awful may happen
>Feelings of loss of control

-With mixed features:
At least 3 of the following symptoms:
A) >Prominent depressed mood, Feels sad or empty or
appears tearful
>Diminished interest or pleasure in all activities
>Psychomotor retardation nearly everyday (observable)
>Fatigue or loss of energy
>Feelings of worthlessness, or excessive or inappropriate
guilt
>Recurrent thoughts of death, recurrent suicidal ideation
without a plan, or suicide attempt, or specific plan for
committing suicide
B) Mixed symptoms are observable by others, change from usual behavior
C)When symptoms meet full episode for both mania and depression simultaneously, diagnosis should be Manic episode with mixed features (due to full mania)
D)Mixed symptoms are otherwise drug abuse, medication or other treatment


With rapid cycling
-With melancholic features
-With atypical features
-With mood-congruent psychotic features
-With mood-incongruent psychotic features
-With catatonia
-With peripartum onset
-With seasonal pattern

Disruptive Mood Dysregulation Disorder (DMDD)

-The core feature of disruptive mood dysregulation disorder is chronic, severe, persistent irritability.
-This severe irritability manifests itself in 2 ways:
>Severe recurrent temper outbursts manifested verbally (e.g., verbal rages) and/or behaviorally (e.g., physical aggression toward people or property that are grossly out of proportion to the situation)
>The mood between temper outbursts is persistently irritable or angry most of the day, nearly every day, and is observable by others (in between temper outbursts)
-Symptoms must be present before age 10
-Symptoms must be present for 12 months

Major Depressive Disorder (MDD)

5+ symptoms for 2 or more weeks. Must have either depressed mood or loss of interest or pleasure.
> depressed mood, diminished interest or pleasure in activities, weight loss or gain when not dieting, change in sleep, psychomotor changes, fatigue, feeling worthless or guilty, lack concentration, thoughts of death/suicidality
- Never has had a manic or hypomanic episode

Persistent Depressive Disorder (Dysthymia)

Depressed mood most of the day, for more days than not for 2 years. (children 1+ years)
- 2+ present while depresses
> Poor appetite/overeating, insomnia/hypersomnia, low energy, low self-esteem, poor concentration, feeling hopeless.
- criteria for MDD may have been present for 2 years.
- Never had manic or hypomanic episode or met criteria for cyclothymic disorder

Premenstrual Dysphoric Disorder

3 necessary conditions must be met for diagnosis to apply:
1)Symptoms must be present during the majority of menstrual cycles
-At least 5 of these symptoms must manifest during final week before onset of menses, improvement should be noticeable within a few days after beginning menses
-Symptoms should be minimal or abate the week after menses

2)At least one of the following symptoms must manifest:
-Severe mood swings and increased emotional sensitivity
-irritability and interpersonal friction
-Significantly depressed mood
-Considerable anxiety and emotional agitation

3)At least one of the following symptoms must be present for a cumulative total of at least 5 when combined with symptoms in #2 above:
-Decreased interest in daily activities
-Difficulty in focusing and concentration
-Significant lethargy
-Marked changes in eating habits (over eating or fixation on certain foods)
-Insomnia or hypersomnia
-Feelings of being overwhelmed
-Noticeable physical changes such as bloating, weight gain, swelling of joints, or muscle pain.

Specifiers for Depressive Disorders

All are possible specifiers:
- Anxious Distress: about 2 symptoms of anxiety
- Mixed features: meet some diagnostic criteria for manic/hypomanic but not enough for BP1 or BP2
- Melancholic Features
- Atypical: Mood reactivity
- With psychotic features
- With Catatonia
- Peripartum onset: during pregnancy or 4 weeks after delivery
- With Seasonal Pattern

- In partial remission
- In full remission

- Mild: meets minimum req.
- Moderate: between mild and severe.
- Severe: seriously distressing and interferes with occupational and social functioning.

Separation Anxiety Disorder

4+ weeks in children
6+ months in Adults
Developmentally inappropriate fear or anxiety when separated from attachment figure.
- 3+ of the follow.
>excessive distress when separate from figure or home
>Worry about injury or loss of figure
>persistent worry about being physically taken from figure
>reluctance to go out away from home due to fear of separation
>fear about being home or somewhere else with out figure
>cannot sleep away from home or go to sleep without being near figure
>nightmares with attachment theme
>complaints of physical pain when separation is anticipated.

Selective Mutism

-at least one month
-consistent failure to speak in certain settings despite being able to speak in others
-interferes with social, educational, or occupational areas.
-not due to lack of comfort with the spoken language
-Not better explained by communication disorder

Specific Phobia

6+ months
- actively avoid condition or object
- object or situation provoke immediate fear
- Fear out of proportion to the actual danger
- Causes impairment to in social, occupational, or other areas.
- Not better described by other mental disorder
(No age requirement)

Social Anxiety Disorder

6 months
Marked fear or anxiety where indv. is exposed to possible scrutiny by others.
(in children must occur in peer settings not only with adults)
-individual fears they will act in a way that will show anxiety symptoms that will be negatively evaluated.
-social situations almost always provoke fear or anxiety
-social situations are avoided or endured with intense anxiety
-out of proportion with actual threat
-not better explained by substance, another diagnosis, or medical.

Panic Disorder

Recurrent unexpected panic attacks

4 or more of the following:
• Palpitations, pounding heart rate
• Sweating
• Trembling or Shaking
• Shortness of Breath
• feeling of choking
• chest pain or discomfort
• nausea or abnormal distress
• dizzy, light-headed
• Chills or heat
• Parathesias
• Derealization or depersonalization
• fear if going crazy
• fear of dying

followed by at least one month of:
• persistent concern of additional attacks
• maladaptive changes in behavior to avoid having a panic attack.

(No age requirement, typical onset 20-24)
(if both agoraphobia and panic disorder are both met, assign both)

Agoraphobia

6+ months
-Fear/Anxiety of 2+ of the following
>public transportation
>open spaces
>enclosed spaces
>standing in line or crowd
>Being Outside of home alone
-Fears or avoids these situations due to thoughts that escape may be difficult in even of panic-like or other embarassing symptoms.
(No age requirement, childhood onset is rare)
(if both agoraphobia and panic disorder are both met, assign both)

Panic Attack Specifier

alone a diagnosis, but should be used when a panic attack is present along with any other anxiety disorder or other mental disorders.

Palpitations, sweating, trembling, shortness of breath, feeling of choking, chest pain, nausea, dizzy/faint, chills, numbness, depersonalization/derealization, fear of losing control, fear of dying.

Generalized Anxiety Disorder

6+ months
- 3 of 6
>Restlessness or feeling keyed up
>Easily fatigued
>Difficulty Concentrating
>Irritability
>Muscle Tension
>Sleep Disturbance
- Impairment in social, occupational, or other important areas
- Not due to substance

Obsessive-Compulsive Disorder

Indicated by the presence of obsessions and/or compulsions:
>Obsessions: Unwanted, intrusive thoughts or images that are experienced repeatedly and bring about distress; person tries to ignore or counteract and alleviate these thoughts and images with other thoughts or actions.

>Compulsions: Repetitive, ritualized actions that the individual feels compelled to perform in order to alleviate the distress caused by obsessions. The repetitive rituals are causally unconnected to the obsessions they are attempting to counteract and/or excessive in their application (for instance, repeatedly checking and rechecking that a door is indeed locked when one confirmation would suffice). Aimed at preventing or reducing anxiety or distress.
>Obsessions and/or compulsions are time consuming, lasting at least one hour a day.

>Specify if:
-With good or fair insight: Individual recognizes beliefs are definitely or probably not true or that they may or may not be true
-With poor insight: Individual thinks beliefs are probably true
-With absent insight/delusional beliefs: Individual is completely convinced beliefs are true

>Specify if:
Tic related: Individual has a current or past history of a tic disorder

Body Dysmorphic Disorder

Indicated by inordinate attention to at least one perceived flaw in physical appearance that is unnoticeable or appears slight to other observers. Individual engages in repetitive behaviors as a means of obtaining reassurance about appearance concerns (e.g., mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (e.g., comparing his/her appearance to others) in response to the appearance concerns.

>Specify if: With muscle dysmorphia: Individual is preoccupied with the idea that his/her body build is too small or insufficiently muscular. This specifier is used even if individual is preoccupied with other body areas, which is often the case.

>Specify if: Indicate degree of insight regarding body dysmorphic disorder beliefs (e.g., "I look ugly" or "I look deformed")
-With good or fair insight: Individual recognizes beliefs are definitely or probably not true or that they may or may not be true.
-With poor insight: Individual thinks beliefs are probably true.
-With absent insight/delusional beliefs: Individual is completely convinced beliefs are true.

Hoarding Disorder

Indicated by chronic difficulty in getting rid of possessions regardless of their value. This behavior stems from a need to save items and the associated distress of being without them. The accumulation of hoarded items is so excessive so as to make living areas difficult to inhabit.

>Specify if:
-With excessive acquisition: If difficulty discarding possessions is accompanied by excessive acquisition of items that are not needed or for which there is no available space

>Specify if:
-With good or fair insight: Individual recognizes beliefs and behaviors are problematic
-With poor insight: Individual is mostly convinced beliefs behaviors are not problematic despite evidence to contrary
-With absent insight/delusional beliefs-Individual is completely convinced beliefs and behaviors are not problematic despite evidence to contrary

Trichotillomania (Hair-Pulling Disorder)

Repetitive pulling of one's own hair resulting in hair loss, accompanied by repeated attempts to stop the behavior

Excoriation (Skin-Picking) Disorder

Repeated skin-picking behaviors resulting in skin lesions, accompanied by repeated attempts to cease this behavior.
>Skin picking not caused by physiological effects of a substance (e.g., cocaine) or another medical condition (e.g., scabies)

Reactive Attachment Disorder

A) Emotionally withdrawn behavior toward adult caregiver manifested by both
- child rarely seeks comfort when distressed
- rarely responds to comfort when distressed

B) Social and emotional disturbance characterized by 2+
- minimal social and emotional responsiveness to others
- limited positive affect
- unexplained irritability, sadness, or fearfulness that are evident even during nonthreatening interactions

C) Child has experienced patters of insufficient care by 1+
- social neglect: lack of basic emotional needs for comfort, stimulation, and affection
- repeated changes of primary caregivers. limit opportunities to form stable attachments.
- rearing in unusual settings that severely limit opportunities to form selective attachments.

> disturbance evident between age 9 months and 5 y/o

> Specifiers
- Persistent: over 12 months
- Severe: every symptom is met

Disinhibited Social Engagement Disorder

A) Child approaches and interacts with unfamiliar adults. 2+ of the following
- lack of reserve when engaging with unfamiliar adults
- overly familiar physical and verbal behavior
- doesnt check back at caregiver when walking away
- willingness to go off with an unfamiliar adult even in unfamiliar settings.

> Child has experienced insufficient care by 1+ the following:
- social neglect
- repeated change in caregiver not allowing for stable attachment
- rearing in unusual setting not allowing for selective attachments

> at least 9 months old

> Specifiers
- Persistent : more than 12 months
- Severe: meets all symptoms

Posttraumatic Stress Disorder (Children)

A) Exposure to actual or threatened death, injury, or sexual violence
- or learning traumatic event happened to parent or caregiver

B) 1+ of the following intrusion symptoms
- distressing memories
- distressing dreams
- dissociative reactions
- psychological distress to cues of event
- physiological reactions to reminders

C) One or Both
- Persistent avoidance of stimuli
- Negative Alterations in Cognition

D) Alterations in arousal or reactivity 2+ of the following
- Irritable or angry outbursts
- Hypervigilance
- exaggerated startle response
- problems with concentration
- sleep disturbance

> Duration over one month

> Specifiers: Dissociative symptoms, depersonalization, derealization,
- With delayed expression: full criteria not met till 6 months after.

Posttraumatic Stress Disorder (6+)

A) Exposure to actual or threatened death, serious injury, sexual violence

B) Presence of 1+ of the following after
- involuntary distressing memories of event
- distressing dreams related to event
- dissociative reactions where it feels as if the event is happening.
- psychological distress from exposure to cues of event
- physiological reactions to cues of event

C) Persistence Avoidance of stimuli associated with the event

D) Negative alterations in cognition or mood by 2+ of the following
- inability to remember importance aspects of the event
- exaggerated negative beliefs about self
- distorted cognitions about the cause of the event.
- persistent negative emotional state
- diminished interest in activities
- feeling detached from others
- inability to experience positive emotions

E) Alterations in arousal and reactivity by 2+ of the following
- irritable behavior and angry outbursts
- reckless or self-destructive behavior
- hypervigilance
- exaggerated startle response
- problems concentrating
- sleep disturbance

> Duration over 1 month

> Specifiers: Dissociative symptoms, depersonalization, derealization,
- With delayed expression: full criteria not met till 6 months after.

Acute Stress Disorder

> Between 3 days and 1 month after experiencing a traumatic event

> Presence of 9 of the following
(Intrusion)
- Distressing Memories
- Distressing Dreams
- Dissociative Reactions
- Psychological Distress
(Negative Mood)
- inability to experience positive emotions
(Dissociative symptoms)
- Altered sense of reality of oneself or surroundings
- Inability to remember important aspects of event
(Avoidance Symptoms)
- efforts to avoid distressing memories/thoughts/feelings about event
- Avoid external reminders
(Arousal Symptoms)
- Sleep disturbance
- irritability/ angry outbursts
- hypervigilance
- problems concentrating
- exaggerated startle response

Adjustment Disorders

Identifiable emotional or behavioral symptoms that occur within 3 moths of stressors.
> Clinically significant by one or both
- distress out of proportion to severity or intensity of stressor
- impairment in social, occupational, etc.
> Does not meet criteria for another disorder
> NOT normal bereavement
> Symptoms do not persist over 6 months after stressor

Specifiers
> With depressed mood
> With anxiety
> With anxiety and depressed mood
> Disturbance of Conduct
> Mixed emotion and conduct
> unspecified

Dissociative Identity Disorder

A) Two or more distinct personalities. Involves discontinuity in sense of self and sense of agency, alterations in affect, behavior, consciousness, memory, perception, cognition, and/or sensory motor functioning.
B) gaps in recall of every day events, personal information, and traumatic events.
C) Clinically significant distress
D) Not culturally explained

Pica

-Persistent eating of nonnutritive, non food substances over a period oft least 1 month
-Inappropriate to the developmental level of individual
-Not part of a culturally supported or socially normative practice

>Specify if:
-In Remission: After full criteria for pica were previously met, the criteria have not been met for a sustained period of time

Rumination Disorder

-Repeated regurgitation of food over a period of at least 1 month. Regurgitated food may be re-chewed, re-swallowed, or spit out.
-The repeated regurgitation is not attributable to an associated gastrointestinal or other medical condiditon (e.g., gastroesophageal reflux, pyloric stenosis.
-Does not occur exclusively during the course of anorexia, bulimia, binge-eating, or avoidant/restrictive food intake disorder.

>Specify if:
-In Remission: After full criteria for rumination disorder were previously met, the criteria have not been met for a sustained period of time

Avoidant/Restrictive Food Intake Disorder

Characterized by a chronic avoidance of, or lack of interest in, eating ( due to sensory attributes of food; concernabout aversive consequences of eating) to a degree constituting significant weight loss or nutritional deficiency. Condition may require enteral feeding.

>One (or more) of the following:
-significant weight loss (or failure to achieve expected weight gain or faltering growth in children
-Significant nutritional deficiency
-Dependence on enteral feeding or oral nutritional supplements
-Marked interference with psychosocial functioning
-Not better explained by lack of available food or by an associated culturally sanctioned practice
-Does not occur exclusively during the course of anorexia or bulimia, and there is no evidence of a disturbance in the way in which one's body weight or shape is experienced.

>Specify if:
-In Remission: After full criteria for avoidant/restrictive food intake disorder were previously met, the criteria have not been met for a sustained period of time

Anorexia Nervosa

Characterized by the individual's refusal to maintain a minimally normal body weight, intense fear of gaining weight, and significantly distorted perception of the shape and size of one's body.
-Significantly low body weight

>Specify whether:
-Restricting type: During last 3 months, the individual has not engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, duretics, or enemas). This subtype is accomplished primarily through dieting, fasting, and/or excessive exercise.

-Binge-eating/purging type: During last 3 months, the individual has engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas).

Specify if:
-In partial remission: After full criteria for anorexia were previously met, low body weight, has NOT been met for sustained period of time BUT intense fear of gaining weight or becoming fat, behavior that interferes with weight gain, or disturbances in self perception of weight and shape IS still met.
-In full remission- After full criteria for anorexia were previously met, note of the criteria have been met for sustained period of time

>Specify current severity: (Based on BMI, ranges of BMI are from World Health Organization)
Mild: BMI (greater than or equal to) 17kg/m(squared)
Moderate: BMI 16-16.99 kg/m(squared)
Severe: BMI 15-15.99 kg/m(squared)
Extreme: BMI (less than) 15kg/m(squared)

Bulimia Nervosa

Characterized by binge eating and inappropriate compensatory methods to prevent weight gain (e.g., induced vomiting, misuse of laxatives and diuretics, excessive exercise). Furthermore, self-evaluation is excessively influenced by body shape and weight.
-Normal body weight

>Specify if:
In partial remission: After full criteria for bulimia were previously met, some, but not all, of the criteria have been met for a sustained period of time.
In full remission: After full criteria for bulimia were previously met, none of the criteria have been met for sustained period of time.

>Specify current severity:
Mild: An average of 1-3 episodes per week
Moderate: An average of 4-7 episodes per week
Severe: An average of 8-13 episodes per week
Extreme: An average of 14 or more episodes per week

Binge-Eating Disorder

Characterized by periods of binge eating averaging once a week for at least 3 months. Binges are characterized by the rapid consumption of abnormally large quantities of food while apparently unable to control this behavior.

An episode of binge eating is characterized by both of the following:
-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
-A sense of lack of control over eating during the episode

Binge-eating episodes are associated with 3 (or more) of the following:
-Eating much more rapidly than normal
-Eating until feeling uncomfortably full
-Eating large amounts of food when not feeling physically hungry
-Eating alone because of feeling embarrassed by how much one is eating
-Feeling disgusted with oneself, depressed, or very guilty afterward
>Marked distress regarding binge eating
>binge eating occurs, on average, once a week for at least 3 months
>Binge eating not associated with recurrent use of inappropriate compensatory behavior (bulimia) and does not occur exclusively during course of bulimia or anorexia.

>Specify if:
In partial remission: After full criteria were previously met, binge eating occurs on an average frequency of less than one episode per week for a sustained period of time
>In full remission: After full criteria were previously met, non of the criteria have been met for a sustained period of time.

Specify current severity:
-Mild: 1-3 episodes per week
-Moderate: 4-7 episodes per week
-Severe: 8-13 episodes per week
-Extreme: 14 or more episodes per week

Enuresis

The condition is usually involuntary (but can be intentional), and primary physiological causes should be ruled out. To qualify for diagnosis, the condition needs to be present for prolonged period with frequent repeated incidents ( at least twice a week for 3 consecutive months or presence of clinically significant distress or impairment in important areas of functioning.

>Enuresis: Involves repeated urination in inappropriate places or occasions (e.g., bed, clothes)

>Chronological age is at least 5 years (or equivalent developmental level).

>Specify whether:
-Nocturnal only: Passage of urine only during nighttime sleep
-Diurnal only: Passage of urine during waking hours
-Nocturnal and diurnal: A combination of the two subtypes

Encopresis

The condition is usually involuntary (but can be intentional), and primary physiological causes should be ruled out. To qualify for diagnosis, the condition needs to be present for prolonged period with frequent repeated incidents. ( at least one such event occurs each month for at least 3 months)

>Encopresis: Repeated defacation in inappropriate places (e.g., clothing, floor), whether involuntary or intentional.
-At least one such event occurs each month for at least 3 months
-Chronological age is at least 4 years (or equivalent developmental level).

>Specify whether:
-With constipation and overflow incontinence: There is evidence of constipation on physical examination or by history.
-Without constipation and overflow incontinence: There is no evidence of constipation on physical examination or by history

Insomnia

Characterized by the inability to fall asleep or stay asleep, occurring at least 3 nights a week and lasting at least 3 months (In children, this may manifest as difficulty initiating and returning to sleep without caregiver intervention).
-Early-morning awakening without ability to return to sleep.
-Sleep difficulty occurs despite adequate opportunity for sleep.

>Specify if:
-With non-sleep disorder mental comorbidity, including substance use disorders
-With other medical comorbidity
-With other sleep disorder

>Specify if:
-Episodic: Symptoms last at least 1 month but less than 3 months.
-Persistent: Symptoms last 3 months or longer
-Recurrent: 2 (or more) episodes within the space of 1 year

Hypersomnolence Disorder

Characterized by excessive sleep lasting more than 9 hours that is unsatisfying, accompanied by episodes of lapsing into sleep during the day, and difficulty staying awake after awakening fully.
>Self reported excessive sleepiness (hypersomnolence) despite main sleep period of at least 7 hours with at least one of the following symptoms:
-Recurrent periods of sleep or lapses into sleep within the same day
-Prolonged main sleep episode of more than 9 hours per day that is nonrestorative (unrefreshing)
-Difficulty being fully awake after abrupt awakening
-Occurs at least 3 times per week for at least 3 months
-Accompanied by significant distress or impairment

Specify if:
-With mental disorder-including substance abuse disorders
-With medical condition
-With another sleep disorder

Specify if:
-Acute: Duration of less than 1 month
-Subacute: Duration of 1-3 months
-Persistent: Duration of more than 3 months

Specify current severity: Difficulty maintaining daytime alertness (sedentary, driving, working, visiting friends)
Mild: 1-2 days/week
Moderate: 3-4 days/week
Severe: 5-7 days/week

Narcolepsy

Characterized by episodes of an irresistible need to sleep or napping occurring during the same day. Condition occurs at least 3 times per week and last at least 3 months. Additionally, this condition is indicated by the presence of at least one of the following: episodes of cataplexy, hypocretin deficiency, rapid eye movement (REM) latency during sleep.

The presence of at least one of the following:

1) Episodes of cataplexy, defined as either (a) or (b), occurring at least a few times per month:
(a) 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.
(b) In children or individuals within 6 months of onset, spontaneous grimaces or jaw-opening episodes with tongue thrusting or 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 testing 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 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.

Specify whether:
>Narcolepsy without cataplexy but with hypocretin deficiency.
>Narcolepsy with cataplexy but without hypocretin deficiency.
>Autosomal dominant cerebeller ataxia, deafness, and narcolepsy
>Autosomal dominant narcolepsy, obesity, and type 2 diabetes
>Narcolepsy secondary to another medical condition

Specify current severity:
>Mild: Infrequent cataplexy (less than once per week), need for naps only once or twice per day, and less disturbed nocturnal sleep
>Moderate: Cataplexy once daily or every every few days, disturbed noctural sleep, and need for multiple naps daily
>Severe: Drug resistant cataplexy with multiple attacks daily, nearly constant sleepiness, and disturbed nocturnal sleep (i.e., movements, insomnia, and vivid dreaming)

Obstructive Sleep Apnea Hypopnea

Breathing-Related Sleep Disorder
Either (1) or (2):
1. Evidence of polysomnography of at least five obstructive appneas or hypopneas per hour of sleep and either of the following sleep symptoms:
>Nocturnal breathing disturbances: snoring, snorting, gasping, or breathing pauses during sleep
>Daytime sleepiness, fatigue or unrefreshing sleep despite sufficient opportunities to sleep that in not better explained by another mental disorder (including sleep disorder) and not attributable to another medical condition.

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

Specify current severity:
-Mild: Apnea hypopnea index is less than 15
-Moderate: Apnea hypopnea index is 15-30
-Severe: Apnea hyponea index is greater than 30

Central Sleep Apnea

Breathing-Related Sleep Disorder
A. Evidence by polysomnography of five or more central apneas per hour of sleep
B. The disorder is not better explained by another current sleep disorder

Specify whether:
-Idiopathic central sleep apnea:
Repeated episodes of apneas and hypopneas during sleep caused by variability in respiratory effort but without evidence of airway obstruction.

-Cheyne-Stokes breathing: A pattern of periodic crescendo-decrescendo variation in tidal volume that results in central apneas and hypopneas at a frequency of at least five events per hour , accompanied by frequent arousal.

-Central sleep apnea comorbid with opioid use: The pathogenesis of this subtype is attributed to the effects of opioids on the respiratory rhythm generators in teh medulla as well as the differential effects on hypoxic versus hypercapnic respiratory drive

Specify current severity:
Severity of central sleep apnea is graded according to the frequency of the breathing disturbances as well as the extent of associated oxygen desaturation and sleep fragmentation that occur as a consequence of repetitive respiratory disturbances.

Sleep Related Hypoventilation

Breathing-Related Sleep Disorder
-Polysomnography demonstrates episodes of decreased respiration associated with elevated CO2 levels.
-The disturbance is not better explained by another current sleep disorder

Specify whether:
>Idiopathic hypoventilation: His subtype is not attributable to any readily identified condition
>Congenital central alveolar hypoventilation: This subtype is a rare congenital disorder in which the individual typically presents in the perinatal period with shallow breathing, or cyanosis and apnea during sleep.
>Comorbid sleep-related hypoventilation: This subtype occurs as a consequence of a medical condition such as pulmonary disorder (interstitial lung disease, chronic obstruction pulmonary disease) or a neuromuscular or chest wall disorder (muscular dytrophies, postpolio syndrome, cervical spinal cord injury, kyphoscoliosis), or medications (benzodiazepines, opiates). It also occurs with obesity (obesity hypoventilation disorder), where it reflects a combination of increased work of breathing due to reduced chest wall compliance and ventilation -perfusion mismatch and variably reduced ventilatory drive. Such individuals are usually characterized by body mass index of greater than 30 and hypercapnia during wakefulness (with a pCO2 of greather than 45), without other evidence of hypoventilation

Specify current severity: Severity is graded according to the degree of hypoxemia and hypercarbia present during sleep and evidence of end organ impairment due to these abnormalities (i.e., right-sided heart failure). The presence of blood gas abnormalities during wakefulness is an indicator of greater severity.

Circadian Rhythm Sleep-wake

Breathing-Related Sleep Disorder
-Persistent pattern of sleep disruption that is primarily due to an alteration of the circadian system or to a misalignment between the endogenous circadian rhythm and the sleep-wake schedules required by an individual's physical environment or social or professional schedule.
-The sleep disruption leads to excessive sleepiness or insomnia, or both
-The sleep disturbance causes clinically significant distress or impairment in important areas of functioning.

Specify whether:
-Delayed sleep phase type: A pattern of delayed sleep onset and awakening times, with an inability to fall asleep and awaken at a desired or conventionally acceptable earlier time.

Specify if:
Familial: family history of of delayed sleep phase is present

Specify if:
-Overlapping with non-24 hour sleep-wake type: Delayed sleep phase type may overlap with another circadian rhythm sleep-wake disorder, non-24-hour sleep-wake type
-Advanced sleep phase type: Pattern of advanced sleep onset and awakening times, with an inability to remain awake or asleep until the desired or conventionally acceptable later sleep or wake times

Specify if:
Familial: Family history of advanced sleep phase is present
-Irregular sleep-wake type: A temporally disorganized sleep-wake pattern, such that the timing of sleep and wake periods is variable throughout the 24-hour period.
-Non-24-hour sleep-wake type: A pattern of sleep-wake cycles that is not synchronized to the 24-hour environment, with a consistent daily drift (usually to later and later times)
of sleep onset and wake times.
-Shift work type: Insomnia during the major sleep period and/or excessive sleepiness (including inadvertent sleep) during the major awake period associated with a shift work schedule (i.e., requiring unconventional work hours)
-Unspecified type

Specify if:
Episodic: Symptoms last at least 1 mo. but less than 3 mo.
Persistent: Symptoms last 3 months or longer
Recurrent: 2 or more episodes occur within space of 1 year

Oppositional Defiant Disorder

Irritable/Defiant/Vindictive behavior exhibited during interaction with individuals other than sibling.
6+ months
-4+ Symptoms (is often...)
> Often loses temper
>touchy or easily annoyed
>angry or resentful
>argues with authority figures or adults
>actively defies or refuses to follow rules
>deliberately annoys others
>blames others for their behavior
>has been spiteful or vindictive at least twice in the last 6 months
- More days than not for children 5-
- 2+ days a week for children 5+
- distress for those around them and/or impairment to social, occupational, educational, etc.
- Not during other mental health episode + does not meet criteria for Disruptive Mood Dysregulation.

Intermittent Explosive Disorder

6 y/o +

Either...
A) Verbal or Physical aggression toward property, animals, or individuals 2+ x weekly for 3+ months. Does not result in destruction or injury.
B) Outbursts involving damage or destruction or physical assault involving injury within 12-month period.
-Aggressiveness out of proportion to psychosocial stressors
- outbursts not premeditated or to achieve a tangible object.
- outbursts cause distress in individual or impairment to occupational or interpersonal functioning, or financial or legal consequences
- 6-18 y/o behavior that occurs part of adjustment disorder should not be considered for this diagnosis.
- not better explained by mental disorder, medical, or substance.

Conduct Disorder

Repetitive and persistent behavior that violates rights of others or other age-appropriate norms or rules are violated.
-3/15 in last year & 1 in last 6 months
>Bullies, threatens or intimidates others.
>Initiates Physical Fights
>Has used weapon that can cause serious harm
>physically cruel to people
>Physically cruel to animals
>stolen while threatening victim
>forced someone to sexual activity
>setting fire to harm
>destroy others property
>broken into house/car/building
>Cons others
>stolen without confronting victim
>stays out without parent permission -13 y/o
>run away from home 2+x over night 1x long period
>truant from school -13 y/o

-Specify
>onset of child, adolescent or unspecified
>Lack or remorse or guilt
>lack of empathy
>unconcerned about performance
>shallow deceitful

Pyromania

- Deliberate and purposeful set fire 1+x
- Tension or affective arousal before act
- fascination with, interest in, fire and its situational contexts.
- pleasure in fire setting
- not done for monetary gain, an expression, to conceal criminal activity, express anger, or improve living circumstances.

Kleptomania

- Failure to resist urge to steal objects not needed for personal use or monetary value
- increase tension immediately before theft
- pleasure and relief after theft
- Not committed to express anger or vengeance
- not explained by response to or another MHD.

Substance Use Disorders

a) Leading to a significant impairment or distress 2+ of the following
- taken in larger amounts and longer periods than intended
- unsuccessful efforts to cut down
- a lot of time spent to obtain or use
- cravings
- failure to fulfill major obligations at work, school, or home
- continued use despite persistent problems caused by use
- important social, occupational, or recreational activities given up due to use
- use in dangerous situations
- continued use despite physical or psychological problems caused or exacerbated by use.
- Tolerance: either needs more to have the same effect, or the same amount does not cause the same level of intoxication
- Withdrawal: see withdrawal syndromes section, or a closely related substance needed to relieve or avoid withdrawal symptoms

>Early Remission: 3-12 months
>Sustained Remission: 12+ months
>Controlled environment: if they are in recovery in an environment without access to problem substance.

Severity Levels:
Mild: 2-3 symptoms
Moderate: 4-5 symptoms
Severe: 6+ symptoms

DSM Use Disorders:
Alcohol
Caffeine
Cannabis
Hallucinogen
Phencyclidine
Inhalant (no withdrawal symptom)
Opioid
Sedative, Hypnotic, Anxiolytic
Stimulant
Tobacco
Unknown substance/other

* Take into consideration if the client is taking it under med. supervision.

Alcohol Intoxication

A) Recent Ingestion of Alcohol
B) Problematic Behavior or phsychological changes
C) 1+ during/shortly after use
- Slurred speech
- Incoordination
- Unsteady gait
- Nystagmus
- Impaired attention or memory
- Stupor or Coma
D) not better described by another medical condition or mental disorder

Alcohol Withdrawal

A) Cessation or reduction of alcohol use that has been heavy and prolonged
B) 2+ hours or day after cessation
- Autonomic hyperactivity (sweating/pulse)
- Hand Tremor
- Insomnia
- Nausea or vomiting
- Hallucinations or illusions
- Psycho-motor agitation
- Anxiety
- tonic-clonic seizures
C) Cause significant distress in social, occupational, or other important areas
D) Not due to another reason

Caffeine Intoxication

A) Recent Caffeine intake (usually 250mg+)
B) 5+
- Restlessness
- Nervousness
- Excitement
- Insomnia
- Flushed Face
- Diuresis
- Gastrointestinal disturbance
- Muscle twitching
- Rambling thought/speech
- Tachycardia or Cardiac Arrhythmia
- Inexhaustibility
- Psychomotor Agitation
C) Causes significant distress

Caffeine Withdrawal

A) Prolonged daily use
B) Abrupt cessation or reduction of caffeine followed by 24 hrs with 3+
- Headache
- Marked Fatigue or Drowsiness
- Dysphoric mood, depressed, irritable
- Difficulty concentrating
- flu-like symptoms
C) Significant distress/impairment

Cannabis Intoxication

A) Recent use of cannabis
B) Problematic Behavior or Psychological changes (impaired judgement, anxiety, etc)
C) 2+ of the following
- Conjunctival injection
- Increased Appetite
- Dry Mouth
- Tachycardia
D) Not due to another condition

Specify
With Perceptual Disturbances: Hallucinations with intact reality testing or auditory, visual, or tactile illusions occur in absence of delirium.

Cannabis Withdrawal

A) Cessation of cannabis use that has been heavy and prolonged (i.e., usually daily or almost daily use over a period of at least a few months).
B) 3+ within 1 week
- Irritability, anger, or aggression.
- Nervousness or anxiety.
- Sleep difficulty (e.g., insomnia, disturbing dreams).
- Decreased appetite or weight loss.
- Restlessness.
- Depressed mood.
- At least one of the following physical symptoms causing significant discomfort: abdominal pain, shakiness/tremors, sweating, fever, chills, or headache.
C) Clinically significant distress
D) The signs or symptoms are not attributable to another condition

Phencyclidine Intoxication

A) Recent use of Phencyclidine (or similar substance)
B) Problematic Behavior Changes
C) 2+ within 1 hour
- Vertical or horizontal nystagmus
- hypertension or tachycardia
- numbness
- ataxia
- dysarthria
- muscle rigidity
- seizures or coma
- hyperacusis
D) not another condition

Other Hallicinogen Intoxication

A) Use of hallucinogen (other than phencyclindine)
B) Problematic behavior or psychological changes
C) Perception changes in a state of full wakefulness and alertness
D) 2+ shortly after use
- Pupillary dilation
- Tachycardia
- Sweating
- Palpitations
- Blurring of vision
- Tremors
- Incorrdination
E) not another condition

Hallucinogen Persisting Perception Disorder

involves re-experiencing perceptual symptoms that were experienced while intoxicated. May persist for weeks, months, or years.
- Cause clinically significant distress.

Inhalant Intoxication

A) recent intended or unintended short-term high-dose exposure to inhalant substances.
B) Problematic behavioral or psychological changes
C) 2+ shortly after exposure
- Dizziness
- Nystagmus
- Incoordination
- Slurred Speech
- Unsteady Gait
- Lethargy
- Depressed reflexes
- psychomotor retardation
- Tremor
- General Muscle Weakness
- Blurred Vision or diplopia
- Stupor or coma
- Euphoria
D) Not another condition

Opioid Intoxication

A) Recent Use of opiod
B) Problematic behavior or psychological changes
C) Pupillary construction AND 1+ of the following shortly after
- Drowsiness or coma
- slurred speech
- Impairment in attention or memory
D) not another condition/disorder

Specify
With perceptual disturbances: hallucinations with intact reality testing or auditory, visual, or tactile illusions occur in absence of delirium.

Opioid Withdrawal

A) One of following
- Cessation of opioid use
- Administration off opioid antagonist after period of opioid use.
B) 3+ within minutes or days
- Dysphoric mood
- Nausea or vomiting
- muscle aches
- lacrimation or rhinorrhea
- Pupillary dilation, piloerection or sweating
- Diarrhea
- Yawning
- Fever
- Insomnia
C) Cause a clinically significant distress
D) Not another condition/disorder

Sadative, Hypnotic, or Anxiolytic Intoxication

A) Recent use
B) Maladaptive behavior or psychological changes
C) 1+ shortly after use
- Slurred speech
- Incoordination
- Unsteady gait
- Nystagmus
- Impairment in cognition
- Stupor or coma
D) not due to another condition

Sadative, Hypnotic, or Anxiolytic Withdrawal

A) Cessation of use
B) 2+ within hours or days
- Autonomic Hyperactivity
- Hand Tremor
- Insomnia
- Nausea or Vomiting
- Hallucinations or illusions
- Psychomotor agitation
- Anxiety
- Grand Mal Seizures
C) significant distress
D) Not another condition

Stimulant Intoxication

A) Recent use of stimulant
B) Problematic behavior/psychological changes
C) 2+ after use
- Tachycardia or bradycardia
- Pupillary dilation
- Elevated or Lowered BP
- Perspiration or chills
- Nausea or Vomiting
- Evidence of weight loss
- Psychomotor agitation or retardation
- Muscle weakness, respiratory depression, chest pain, cardiac arrhythmias
- Confusion, seizures, dyskinesias, dystonias or coma
D) not another condition or disorder

Specify Type of Intoxicant

Specify if:
With Perceptual Disturbances: Hallucinations with intact reality testing or auditory, visual, or tactile illusions occur in absence of delirium.

Stimulant Withdrawal

A) Cessation
B) Dysphoric mood and 2+ within hours or days
- Fatigue
- Vivid, unpleasant dreams
- Insomnia or hypersomnia
- Increased Appetite
- Psychomotor retardation or agitation
C) cause significant distress
D) Not another condition or disorder

Tabacco Withdrawal

A) Previous use of at least a few weeks
B) Abrupt cessation of use, or reduction. 4+ within 24 hours
- Irritability, frustration, or anger
- Anxiety
- Difficulty Concentrating
- Increased appitite
- Restlessness
- Depressed Mood
- Insomnia
C) Clinical Distress

Gambling Disorder

12 month period

A)4+ the following
- Gambles increased amount of money to achieve desired excitement
- Restless or irritable when trying to cut down or stop
- repeated unsuccessful efforts to cut down or stop
- preoccupied by gambling (thoughts)
- gambles when feeling distress
- after losing money, returns to get even
- lies to conceal extent of gambling
- negatively impacts work, relationships, or education
- relies on others to provide money to relieve financial situations caused by gambling
B) not better explained by manic episode

Speficy:
Episodic or Persistent

Early Remission: 3-12 months
Sustained Remission: 12+ months

Mild: 4-5 criteria
Moderate: 6-7 criteria
Severe: 8-9 criteria

General Personality Disorder

A) General pattern of inner experience and behavior that deviates from expected within ones culture. 2+ the following areas
- Cognition
- Affectivity
- Interpersonal Functioning
- Impulse Control
B) active across range of personal and social situations
C) Clinically distressing
D) Stable and long term, can be traced back to adolescence or early adulthood

Paranoid Personality Disorder

A) Distrust and suspicious of others. Begins in early adulthood. 4+ symptoms
- Suspects others are exploiting, harming, or deceiving them
- preoccupied with doubts about loyalty and trustworthiness of others
- reluctant to confide in others due to thinking info will be used against them.
- reads demeaning or threatening meanings into benign events.
- Persistently bears grudges
- perceives attacks on character that are not apparent to others and quick to react.
- suspicions of spouse without justification
B) Does not occur exclusively during course of schizophrenia, bipolar, or depression with psychotic features

Schizoid Personality Disorder

A) Detachment from social relationships and restricted range of expression of emotions in interpersonal settings. Begins in EARLY ADULTHOOD. various contexts. 4+ symptoms.
- Does not enjoy close relationships/ being part of a family.
- Chooses Solitary activities almost always
- Little, if any, interest in sexual experiences with another person
- Takes pleasure in few, if any, activities
- Lacks close relationships outside first-degree relatives
- Appears indifferent to praise or criticism from others
- Shows emotional coldness, detachment, or flattened affect.
B) not exclusively during schizophrenia, BP, Depress w/ psychotic, psychotic disorder, autism.

Schizotypal Personality Disorder

A) Social/interpersonal deficits marked by acute discomfort with relationships AND cognitive or perceptual distortions/eccentricities. Begins EARLY ADULTHOOD. 5+ following:
-Ideas of reference (excluding delusions)
-Odd beliefs/magical thinking (superstitious, clairvoyant, telepathy)
-Unusual perceptual experiences (body illusions)
-Odd thinking/speech (vague, over-elaborate, metaphorical)
-Suspicious/paranoid ideation
-Excessive social anxiety
-Inappropriate constriction of affect
-Odd/eccentric behavior
-Lacks close friends.
B) not during schizophrenia, DP, Depress W/ psychotic, other psychotic, or ASD.

Antisocial Personality Disorder

A) Violation of rights of others, disregard for others. SINCE AGE 15. 3+ Symptoms
- Failure to conform to social norms (participating in acts that are grounds for arrest)
- Deceitfulness (lying, conning, aliases)
- Impulsive/ failure to plan ahead
- Irritability and aggressiveness (fights/assaults)
- Disregard for safety of self and others
- Irrisponsible (failure to sustain work behavior or honor financial obligations)
- Lack of remorse
B) AT LEAST 18 to diagnose
C) Evidence of conduct disorder before age 15.
D) not Schizophrenia or Bipolar.

Borderline Personality Disorder

A) Instability of personal relationships, self-image, and affects, and marked impulsivity. beginning EARLY ADULTHOOD. 5+ Symptoms
- frantic efforts to avoid real of imagined abandonment
- unstable and intense interpersonal relationships.
- identity disturbance: unstable self-image or self of self.
- impulsivity in 2+ areas that are self-damaging (spending, sex, SU, reckless driving, eating, etc.)
- Suicidal gestures, behaviors, threats, or self-harm
- instablity due to reactivity of mood
- Chronic feelings of emptiness
- Inappropriate, intense anger or difficulty controlling anger
- Transient, stress-related paranoid ideation or severe dissociative symptoms.

Histrionic Personality Disorder

Excessive emotionality and attention seeking. beginning EARLY ADULTHOOD. 5+ symptoms
- Uncomfortable when not center of attention
- Sexually seductive and provocative behaviors towards others
- Rapidly shifting and shallow expression of emotions
- Uses physical appearance to draw attention to self.
- Speech that is excessively impressionistic and lacking in detail.
- exaggerated expression of emotion
- Suggestible (easily influenced)
- Considers relationships more intimate than they are

Narcissistic Personality Disorder

A) Grandiosity, need for admiration, lack of empathy. EARLY ADULTHOOD beginning. Various contexts. 5+ symptoms
- grandiose sense of self-importance (exaggerated achievements, expects praise)
- preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
- Believes they are "special" and can only associate with certain people
- Sense of entitlement.
- Interpersonally exploitive (takes advantage of others for own gain)
- Lacks empathy
- Envious of others or believes others are envious of them
- Arrogant, haughty behaviors

Avoidant Personality Disorder

A) Social inhibition, feeling inadequate, hypersensitivity to negative evaluation. begin EARLY ADULTHOOD. 4+ Symptoms
- Avoids occupational activities that involve interpersonal contact due to fears of criticism, disapproval, or rejection.
- Unwilling to get involved with people unless certain they will be liked
- Resistent within intimate relationships due to fear of being shamed or ridiculed
- preoccupied with being criticized or rejected
- inhibited in new interpersonal situations because of feelings of inadequacy
- views self as socially inept, personally unapealing, or inferior to others
- reluctant to risk and new activities due to it being embarsassing.