Diagnosis & Maladaptive Development

how the DSM-5 defines mental illness

a client must experience symptoms to an extent that impairment or distress in academic, occupational, social, or some other important area of functioning is evident.

Neurodevelopmental Disorders

Intellectual Developmental Disorder (formerly known as Mental Retardation), specific learning disorder, motor disorders/coordination disorders. stereotypic movement disorder, Tourettesis diagnosed when a client’s academic achievement (as measured using standardized tests) is below expected levels given the client’s age and intellectual ability, and is usually related to reading, math and written expression problems., chronic motor or vocal dis., provisional tic dis, ADD, ADHD

specific learning disorder

is diagnosed when a client’s academic achievement (as measured using standardized tests) is below expected levels given the client’s age and intellectual ability, and is usually related to reading, math and written expression problems.

motor disorders/dev. coordination disorder:

involves significant impairment in gross or fine motor coordination skills

Stereotypic Movement/tic Disorder

involve sudden, recurrent, stereotyped vocalizations or motor movements

Tourette’s dis

s a combination of at least one vocal tic and multiple motor tics occurring a number of times per day over at least a year. Tourette’s also onsets prior to age 18 years.

Chronic motor or vocal tic disorder

the presence of vocal or motor tics, but not both, differentiating it from Tourette’s Disorder, occurring a number of times per day over at least a year.

Provisional Tic Disorder

the presence of vocal and/or motor tics occurring a number of times per day for at least a month but for less than a year. Thus, Provisional Tic Disorder is often diagnosed in individuals prior to the other more chronic and severe tic disorders.

ADHD/ADD

involves a significant pattern of inattention and/or hyperactivity/impulsivity that begins prior to age 5 years. Prevalence is 3% to 7% of a school-age population and is two to nine times more likely to be diagnosed in males.

ASD

pervasive, severe impairment in more than one area of development, including: abnormal communication, social interactions, and restricted (repetitive, stereotyped) range of interests and behaviors.

Schizophrenia

involves two or more of the psychotic symptoms (hallucinations, delusions) listed above occurring for most of the time during an active phase period of at least 1 month out of at least a 6-month disturbance period during which social or occupational functioning is significantly impaired. Schizophrenia usually exhibits onset in late adolescence through young adulthood.

Schizophreniform

symptoms are similar to those of Schizophrenia, except that the duration is less than 6 months (with a 1-month active phase) and social or occupational functioning may not occur. At times, the diagnosis of Schizophreniform Disorder is given provisionally until the 6-month time period has been reached when a diagnosis of Schizophrenia can be made.

Schizoaffective Disorder

an uninterrupted period during which concurrent symptoms of active-phase Schizophrenia (2 or more weeks of hallucinations and delusions) and a Mood Disorder (e.g., depression, mania) occur.

Delusional disorder

involves non-bizarre delusions (e.g., being followed, deceived by a spouse) occurring for at least 1 month without concurrent prominent Schizophrenia or mood symptoms.

Brief psychotic dis.

a psychotic symptom (e.g., hallucinations, delusions, disorganized speech, catatonic/disorganized behavior) present for at least 1 day but less than 1 month.

Bipolar I

one or more Manic or Mixed Episodes, with no history of a Major Depressive Episode. Bipolar I Disorder is genetically transmitted and occurs equally in males and females. (has to have a full manic episode)

Bipolar 2

g the presence of at least one Major Depressive Episode and Hypomanic Episode and is more commonly diagnosed in females than males.

cyclothymic disorder

characterized by numerous periods of depression interspersed with periods of hypomania lasting for at least 2 years in adults (1 year in children or adolescents).

major depressive disorder

involving one or more major depressive episodes in the absence of a Manic, Hypomanic, or Mixed Episode. This disorder is diagnosed in females twice as frequently as in males.

Dysthymic dis

involving a chronically depressed mood occurring most days for a minimum of 2 years (1 year in children and adolescents). Many of the symptoms resemble those of major depressive episode, but the individual does not experience the classic 2-week acute marked impairment; rather the symptom display is less severe and more chronic. This disorder is often diagnosed prior to adulthood.

Agoraphobia

a (loosely translated as meaning “fear of the marketplace”) criteria include intense anxiety over being in situations in which escape may be difficult and embarrassment may occur should a panic attack ensue. Agoraphobia may occur with or without the occurrence of a panic attack.

Panic dis

involves recurrent panic attacks either with or without Agoraphobia.

specific phobia

a marked, persistent fear of a specific situation or object (e.g., flying, animals, insects, enclosed spaces).

social anxiety disorder

a marked, persistent fear of performance or social situations in which humiliation or embarrassment may occur as a result of scrutiny by others (athletic performance, bullying, making a speech in public).

GAD

involves excessive anxiety occurring most days over at least a 6-month period, accompanied by at least three of the following symptoms: restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and difficulties sleeping. The symptoms of anxiety cannot be due to some other disorder.

separation anixety dis.

involves excessive anxiety when separated from an attachment figure (e.g., mother), lasting at least 4 weeks, beginning before 18 years of age, and causing significant impairment in academic or social functioning.

OCD

involves recurrent obsessions (i.e., thoughts, impulses, images) that cause marked distress, that are not simply excessive worries about life situations, that the person has great difficulty suppressing, and that are recognized as the product of one’s own mind. Likewise, compulsions are recurrent behaviors or mental acts (e.g., counting, praying) aimed at reducing distress but not connected to what they are designed to prevent.

Body dysmorphic dis.

involves a preoccupation with an imagined appearance defect, or an exaggeration of a slight defect, that is not better accounted for by another mental disorder (e.g., Anorexia Nervosa).

Trichotillomania

involves repeated hair pulling resulting in noticeable hair loss, accompanied by feelings of tension preceding the hair pulling and pleasure or satisfaction at the time the hair is pulled.

PTSD

involves development of symptoms following exposure to a traumatic stressor or event involving actual or threatened death or serious injury and during which the person responded in horror or helplessness. The individual must persistently re-experience the event, persistently avoid associated stimuli, and experience persistent symptoms of arousal/ stress not present prior to the trauma. Importantly, PTSD is not diagnosed until 1 month has elapsed after the trauma.

acute stress disorder

characteristics similar to PTSD but is only diagnosed within 1 month after the traumatic event. Thus, at times an individual may be diagnosed with Acute Stress Disorder immediately after a traumatic event, then that diagnosis may change to PTSD should the symptoms not ameliorate within a 1-month period.

Adjustment dis

psychological responses to identifiable stressors. Symptoms must begin within 3 months after the stressful event, and a more significant impairment than would ordinarily be expected must result. Ordinarily, adjustment to the stressor is expected within 6 months after the precipitating event, unless the stressor is chronic.

dissociative disorders

involve a disruption in normal integrated functions of consciousness, memory, identity, or perception. Onset of these disorders may be sudden or gradual; the duration may be transient or chronic; and they are not due to another mental disorder, substance, or general medical condition.

dissociative amnesia

an inability to recall important (and usually traumatic) information that is beyond ordinary forgetfulness.

Dissociative identity disorder

(formerly Multiple Personality Disorder) is the presence of two or more distinct identities or personalities recurrently taking control of the person’s behavior, along with an inability to recall important personal information.

depersonalization/derealization dis.

encompasses feelings of detachment from one’s mental processes or body (e.g., dreamlike state), without loss of contact with reality.

somatic symptom disorders

involves a history of physical complaints occurring over several years, and causing significant impairment. Importantly, the complaints are not the result of a general medical condition or are far in excess of such a condition.

conversion dis.

involves symptoms/deficits in voluntary motor or sensory functions, preceded by stressors or psychological conflicts, which are not the result of a general medical condition or substance use. Importantly, the symptoms are judged not to be intentionally produced.

factitious disorder

involves the intentional feigning of physical or psychological symptoms in order to assume the “sick role.” Importantly, no external reward is sought (e.g., economic gain, avoiding legal responsibilities), which differentiates this disorder from malingering. (used to be called muchhousen’s disorder)

Anorexia nervosa

involves a refusal to maintain a normal body weight for age and height, usually defined as less than 85% of normal expected weight. Furthermore, clients display an intense fear of gaining weight, disturbance in body image, and (in postmenarchal females) the absence of at least three consecutive menstrual cycles.

bulimia nervosa

involves recurrent binge eating episodes in which an individual ingests a significantly large amount of food over a 2-hour or shorter time period, perceives a lack of control to stop eating during this period, then engages in some compensatory action to prevent weight gain (e.g., laxatives, vomiting, excessive exercise). The binging–compensation cycle occurs at least three times per week for at least 3 months, and clients experience a disturbed body image.

Elimination disorders

• Encopresis is the (usually involuntary) depositing of feces in inappropriate places (e.g., floor, clothing, furniture).

• Enuresis is (usually involuntary) urination in inappropriate places (e.g., bedding, clothing), either during nighttime sleep (nocturnal) or during the day (diurnal).

Sleep-Wake dis.

ordinarily categorized as primary or due to another mental disorder or a general medical condition and include Insomnia Disorder, Hypersomnolence Disorders, Narcolepsy/Hypocretin Deficiency, Obstructive and Central Sleep Apneas, Circadian Rhythm Sleep-Wake Disorder, Nightmare Disorder, Rapid Eye Movement Sleep Behavior Disorder, and Restless Legs Disorder. Sleep Disorders can also be caused by another mental disorder or a general medical condition or substance use, and they should be coded accordingly.

Gender Dysphoria

replaced that of Gender Identity Disorder and is now differentiated according to whether it occurs in children, adolescents, or adults. It involves a persistent cross-gender identification and discomfort with one’s sex or sex role.

intermittent explosive disorder

involves distinct episodes of aggressive impulses, significantly disproportional to the social context, resulting in serious assault or destruction of property.

conduct dis.

a persistent pattern of behaviors that violate the rights of others or social rules (e.g., cruelty, stealing, bullying, fighting, rape) in an individual under the age of 18 years.

oppositional defiant dis.

involves a recurrent pattern of defiant, disobedient, hostile, and negative behaviors toward authority figures. Individuals with Conduct Disorder cannot be simultaneously diagnosed with Oppositional Defiant Disorder.

substance abuse

involves a pattern of maladaptive substance use that interferes with major role obligations, is physically hazardous, results in legal problems, or causes persistent interpersonal problems.

substance dependence

involves continued use of a substance in spite of noticeable impairment (e.g., tolerance, withdrawal, desire to “cut down” on the substance, reduction in other activities because of substance use). s

substance intoxication

after ingesting a substance that leads to maladaptive behavior (e.g., mood lability, impaired judgment, impaired social or occupational functioning).

delirium

involves a disturbance in consciousness (e.g., awareness of environment) and cognition (e.g., disorientation, memory problems), due to either a general medical condition or substance use. Ordinarily, Delirium develops over the course of several hours and fluctuates in severity throughout the day.

neurocognitive disorder

involves memory impairment and at least one other cognitive deficiency (e.g., language, motor, executive functioning), due to either a general medical condition (e.g., Alzheimer’s type, Parkinson’s Disease, HIV) or substance use.

schizotypal personality dis.

Pattern of relational discomfort, perceptual distortion, and behavioral eccentricities.

antisocial personality

Pattern of violations and disregard of others’ rights. (impulsive)

borderline personality dis.

Pattern of unstable relationships, self-image, and affect, and impulsive behaviors.

narcissistic personality

Pattern of grandiose behaviors, need for admiration, and reduced empathy for others.

avoidant personality disorder

Pattern of social avoidance, inadequacy, oversensitivity to negative evaluations.

OCPD

Pattern of perfectionism, control, and orderliness.

paraphillic dis.

involve intense sexually arousing fantasies, urges, or behaviors usually involving nonhuman objects, humiliation of one’s partner, or children. Examples include Exhibitionistic, Fetishistic, Frotteuristic, Pedophilic, Sexual Masochism, Sexual Sadism, and Voyeuristic Disorders.