DSM 5

Schizophrenia Spectrum & Psychotic Other Disorders

Characterized by abnormalities of one or more: delusions,hallucinations, disorganized thinking (speech), disorganized or abnormal motor (including catatonia) & negative symptoms. Severity is rated by assessing the primary symptoms of psychosis on a 5point scale for each so based on presence & strength of the screen from 0 (not present) to 4 (present & severe). Disorders presented in order of severity.

Delusions (thinking)

Fixed, false beliefs that are unchangeable. Content varies and can be bizarre or non-bizarre. Non-bizarre are situations that are possible and bizarre are those that are clearly implausible

Hallucinations (perception)

Vivid & clear perceptions that occur w/out external stimuli. May occur in any sensory modality. Auditory experiences are the most common and tend to be experienced as voices that are distinct from one's own thoughts

Disorganized Thinking

Usually inferred from speech - person switches from topic to topic (derailment or loose associations) or provides answers that diverge from questions asked (tangentiality)

Grossly Disorganized or Abnormal Motor Behavior (including catatonia)

May range from childlike silliness to unexpected agitation, typically interfering with goal-directed behaviors and activities of daily living. Catatonia is a marked decrease in reactivity that ranges from resistance to instructions (negativism), to maintaining odd posture,to lack of verbal or motor response (mutism and stupor). Can also involve excessive motor activity (catatonic excitement) repeated stereotype movement, grimacing, and echoing of speech.

Negative Symptoms

Include diminished emotional expression and avolition (decrease in self-initiated purposeful activities), alogia (reduced speech output), anhedonia (diminished pleasure) & asociality (lack of interest in social interactions)

Specifier w/catatonia

Can be coded for any of the disorders. Criteria involve a clinical picture that is dominated by 3 or more: stupor (no psychomotor activity), catalepsy (posture is held passively, against gravity), waxy flexibility (resistance to positioning by another), mutism (no verbal response), negativism (no response instructions or external stimuli), posturing (actively maintaining a posture against gravity), mannerism (caricature of normal actions), stereo to be repetitive non-goal directed movements, agitation, grimacing, echolalia (mimicking another's speech) or echopraxia (imitating another's movement)

Schizotypal Personality Disorder

Is considered part of the schizophrenia spectrum and is also in the personality disorders.

Delusional Disorder

One or more delusions for at least one month with no additional symptoms found in schizophrenia. The person's behavior is relatively unimpaired and is not obviously. If manic or major depressive episodes occur concur with the delusions, the duration of the moon episode is brief relative to the duration of the delusion. Specifiers include erotomanic type, grandiose type, jealous type, persecutory type, somatic type, mixed type, and unspecified type. Specifier with bizarre content if bizarre. Onset is typically in middle to late adulthood & the most common subtype is persecutory

Erotomanic type

Involves delusions and which another person, usually of higher status, is in love with the individual

Grandiose type

Characterized by delusions of inflated self-worth, power, knowledge, or a special relationship to a deity or famous person

Jealous type

Involves delusions in which the person believes that a sexual partner is being unfaithful

Persecutory type

Characterized by delusions in which the person is being persecuted or ill treated, which may trigger violent behavior

Somatic type

Involved illusion relating to body functions and sensations

Mixed type

Involves characteristics of more than one of the types of without any single theme predominating

Unspecified type

Delusions who's themes are not characteristic of any of the types

Brief Psychotic Disorder

Characterized by one or more: delusions, hallucinations, disorganized speech, or grossly disorganized or catatonic behavior. The episode lasts from one day to one month with eventual return to premorbid level of functioning. Specifiers: with Mark stressor, without marked stressor, or with postpartum onset. With catatonia is also used.

Schizophreniform Disorder

Symptoms are identical to schizophrenia and distinguished only by duration. Diagnosis is made when the duration of the illness is at least one month but less than six. If person has not recovered after onset "provisional" is added to the dx and will be changed to schizophrenia after 6 months. Specifiers include with good prognostic features & without good prognostic features. catatonia is also used if present

Good prognostic features

Include two or more: onset of prominent psychotic symptoms within four weeks of the first noticeable change in behavior (acute onset), confusion or perplexity, good premorbid social and occupational functioning, and absence of flat or blunted affect.

Schizophrenia

Diagnostic criteria require the presence of two or more sx of psychosis each for a significant time during a 1 month period. At least one sx must be hallucinations, disorganized speech, or delusions. Since onset the person must be functioning at a level markedly below previous functioning for a significant portion of time in areas such as work, personal relations or self-care. Signs must persist for at least 6 months with at least 1 month of active sx. During prodromal or residual periods, the signs of disturbance May include only negative symptoms or two or more symptoms in attenuated (weakened) forms.

Schizophrenia onset & course

Typically occurs between late teens and early 30s with onset prior to adolescence rarely occurring. Median age is early to mid 20s for men and late 20s for women. It may be abrupt or gradual and in most cases involve a prodromal phase which is characterized by deterioration in overall functioning in the beginning. The course is variable but full remission is rather uncommon, some individuals have a course characterized by exacerbations and remissions while other show progressive deterioration

Schizophrenia prognosis

Prognosis is best with good prior functioning, abrupt onset, fewer negative symptoms, minimal cognitive impairment & female gender (females tend to have fewer negative symptoms). Later on that has been associated with better prognosis however the effect of age on onset on prognosis is likely related to gender as females have a later age of onset. Suicide risk is high.

Schizophrenia & genes

First-degree relatives have a concordance rate of 10% and have a greater risk of developing schizophrenia than the general population. Identical twins have a 50% concordance rate, the risk of developing schizophrenia when both parents have the disorder is about 45%. Relatives of individuals with schizophrenia havoc increased risk of developing other schizophrenia spectrum disorders including schizotypal and paranoid personality disorders and delusional disorder

Schizophrenia & brain

MRI of the brain the persons with schizophrenia showing enlargement of the lateral and third ventricles, a smaller cerebral cortex, and a smaller thalamus (the filter for sensory input). PET scans indicate decreased frontal lobe activity which have been associated with the negative symptoms

Treatment for Schizophrenia

Medication management is a key component and typically life long. Most common are antipsychotics. Psychosocial interventions such as CBT and family psychoeducation. Expressed emotion by family members has been shown to predict relapse many family approaches work to decrease expressed emotion and focus on strength and resiliency. Social skills training teach skills related to communication, service, disease management and independent living.

Schizoaffective Disorder

Uninterrupted period of illness during which there has been a major mood episode concurrent with the sxs of schizophrenia and delusions or hallucinations for at least 2 weeks w/out prominent mood sxs. Mood symptoms are present for the majority of the course of the disorder but the schizophrenia symptoms are prominent. With Catatonia is used if sxs are present

Schizoaffective Dis Bipolar type

Used if a manic episode is part of the presentation, whether or not a major depressive episode occurs

Schizoaffective Dis Depressive type

Used only if major depressive episodes are part of the presentation

Substance/medication induced psychotic disorder

Substances that can induce a psychotic disorder include alcohol, cannabis, hallucinogens (including PCP), inhalants, sedatives, hypnotics, anxiolytics and stimulants including (cocaine)

Psychotic disorder due to another medical condition

Medical conditions that are known to manifest with delusions or hallucinations include neurological conditions, in the kindest orders, and metabolic condition. Specifiers include with delusions or with hallucinations

Catatonic disorder due to another medical condition

Medical conditions that are known to manifest with catatonia including neurological conditions and metabolic conditions

Other specified/unspecified schizophrenia spectrum and other psychotic disorder

Psychotic like symptoms below threshold for full psychosis

Bipolar and related disorders

Three types of mood episodes: manic, depressive, hypomanic. episodes should be specified as mild moderate or severe. Full criteria not met it should be specified as in partial remission or in full remission. Other specifiers include: with anxious distress, with mixed features, with rapid cycling, with mood congruent or mood incongruent psychotic features, with catatonia, with peripartum onset, and with seasonal pattern.

Manic episode

An abnormally elevated, expansive, or irritable mood with increased goal directed activity or energy that lasts at least one week and is present most of the day nearly every day. Three or more symptoms: inflated self-esteem or grandiosity, decreased need for sleep, pressured speech, flight of ideas or racing thoughts, distractibility, increased goal directed activity, psychomotor agitation and excessive involvement in activities that have a high likelihood of adverse consequences. Either causes significant impairment in functioning or necessitates hospitalization (no minimum duration of symptoms required when hospitalization is necessary)

Hypomanic episode

A period of elevated, expensive, or irritable mood as well as increased activity or energy that lasts at least four days and is present most days nearly every day. Three or more of the following symptoms: inflated self-esteem or grandiosity, decreased need for sleep, pressured speech, flight of ideas or racing thoughts, distractibility, increased go directed activity or psycho motor agitation and involvement in activities that have a high likelihood of adverse consequences. Distinct from a manic episode in that it is not severe enough to impaired functioning or require hospitalization

Major depressive episode

Requires at least 5 sxs during a 2 week period represented change from previous functioning. At least one symptom must be either depressed mood or loss of interest or pleasure (anhedonia). Other sxs: unintentional weight loss or gain or change in appetite; disturbed sleep; psychomotor agitation or retardation; fatigue or loss of energy; feelings of worthlessness or guilt; poor concentration or indecisiveness; and recurrent thoughts of death or suicidal ideation, intent or plan.

With anxious distress specifier

Two or more symptoms present most days; during the mood episode: feeling keyed up or tense, feeling unusually restless, difficulty concentrating because of worry, fear that something awful may happen, or feeling like one may lose self-control.

With mixed features specifier

Manic or hypomanic includes at least three: dysphoria or depressed mood, loss of interest or pleasure, psychomotor retardation, fatigue or loss of energy, feelings of worthlessness or guilt, or recurrent bouts of death or suicidality

Depressive includes at least three: elevated or expansive mood, inflated self-esteem or grandiosity, pressured speech, flight of ideas or racing thoughts, increased energy or goal directed activity, involvement in activities that have a high likelihood of adverse consequences, or decreased need for sleep.

With rapid cycling

Presence of at least 4 mood episodes in the previous 12 months that are demarcated by a partial or full remission of at least two months or a switch to an episode of the opposite pole.

With mood congruent or mood incongruent psychotic features

Involve the presence of delusions or hallucinations at any time in the episode. Mood congruent features delusions and hallucinations consistent with the mood. Mood incongruent features delusions and hallucinations that are not consistent with the mood.

With peripartum onset

When the onset of the current or most recent mood episode is during pregnancy or within four weeks of delivery

With seasonal pattern

When there is a regular temporal relationship between the onset of a mood episode and a particular time of the year and full remissions also occur at a characteristic time of the year

Bipolar I disorder

Essential features that occurrence of it one manic episode, other episodes may proceed or follow that are not necessary for the diagnosis. The current or most recent episode should specified as manic, hypomanic, depressed, or unspecified. Equally common in males & females, more common in high-income than low-income countries. Has the highest concordance (heredity) rates of all the major mental disorders. Risk of suicide is at least 15 times that of the general population. Mean age of onset for first mood episode is 18. Typically recurrent, those who have one manic episode have future mood episodes. Research a shown the stressors play more of a role in precipitating the first and/or second episode of the disorder then subsequent episodes. Medication management is typically lifelong and commonly prescribed meds include lithium, Tegretol, or Depakene. Psychoeducation about the disorder with the goal of improving adherence to medication has strong research support.

Bipolar II disorder

Diagnosed when there has been at least one major depressive episode and at least one hypomanic episode and there has never been a manic episode. The average age of onset is in mid 20s and appears to be more common in women. The risk of the disorder is highest among relatives of people with the disorder

Cyclothymic disorder

Diagnosed when the presence of numerous periods of hypomanic symptoms and numerous periods of depressive symptoms have occurred for at least two years (one year in children adolescents). During the 2 year period, symptoms have been present at least half the time and have never been absent for more than two months at a time. Criteria for mood episodes have never been met. Symptoms must cause significant distress or impairment. The specifier with anxious distress is available for use

Substance/medication induced bipolar and related disorder

Substances that can induce a bipolar related disorder include stimulants, phencyclidine (PCP), and steroids

Bipolar and related disorder due to another medical condition

Medical conditions that may cause a bipolar manic or hypomanic condition include Cushing's disease, multiple sclerosis, stroke, TBI

Other specified/unspecified related disorder

When the full criteria is not met but symptoms are present

Depressive Disorders

All involve sad, empty, or irritable mood plus somatic & cognitive changes that significantly affect functioning

Disruptive Mood Dysregulation Disorder

Involves recurrent temper outbursts (verbal or physical) three or more times a week for over one year in at least two settings. Between outbursts the mood is persistently irritable or angry most of the day nearly every day. Diagnosis must be made between ages 6-18 but sxs must have been present before age 10. There has never been a period of more than one day in which the symptoms of a manic or hypomanic episode have been present.

Major Depressive Disorder

Presence of a major depressive episode characterized by five in two weeks. One of the symptoms must be either depressed mood or loss of interest or pleasure. Other symptoms include: weight loss or gain, change in appetite: insomnia or hypersomnia; psychomotor agitation or retardation; fatigue or loss of energy; feelings of worthlessness or guilt; poor concentration or indecisiveness; our current thoughts of death or suicidal ideation, intent, or plan. There has never been a manic or hypomanic episode present.

MDE vs grief

The distinction between the two is that in grief, feeling of emptiness and loss dominate, with MDE there is a persistent depressive mood and inability to experience pleasure. The dysphoria in grief tends to occur in waves, associated with thoughts of the loss rather than being persistent. Themes in MDE include feelings of self loathing, worthlessness, and wanting to end ones life due to inadequacy. These themes are not commonly seen in grief and loss. The presence of an MDE in addition to grief can be considered & be diagnosed with appropriate.

MDD & treatment/course

Onset can be at any age, although peaks in the 20s. The course is variable some rarely experience full remission, others experience isolated episodes with full return to premorbid functioning. Recovery typically begins within three months of onset for others may take up to a year. Factors associated with lower recovery rates: current episode duration, psychotic features, anxiety, personality disorders, and symptom severity. Risk of recurrence is higher when the preceding episode was severe, in younger individuals, and for persons who have had multiple episodes. Rate is Eagle and prepubertal girls and boys but one .5 to 3 times higher and females than males beginning in early adolescence. Risk factors include neuroticism (negative affectivity), adverse childhood experiences, and stressful life events. Possibility for suicide exist at all times.

Treatment for MDD

Cognitive therapy, interpersonal therapy, behavior therapy/behavior activation, self-management/self-control therapy. Behavior activation shown to be just as effective as medication and more effective than cognitive therapy when treating severe depression.

Suicide & MDD

Women make more attempts but men follow through more. Older people commit suicide more often. Whites and Native Americans have the highest rates. Most who commit suicide have a mental disorder, most often mood, schizophrenia, personality, or substance use. Hopelessness is a stronger predictor than the presence and severity of depression. Single best predictor of completed suicide is history of serious suicide attempts. Most frequently cited risk factors include being male, single/living alone, family history of suicide, and chronic pain or illness.

Persistent Depressive Disorder (Dysthymia)

Depressed mood for most of the day, for more days than not, for at least two years (one year for children adolescents). While depressed two or more of the following: change in appetite, sleep difficulties, low energy or fatigue, low self esteem, poor concentration or indecisiveness, & hopelessness. Functioning is impaired or significant distress. During the two-year timeframe the person has not been without symptoms for more than two months at a time. Criteria for major depressive episode may be continuously present for two years. There's never been a manic or hypomanic episode in criteria for cyclothymia have not been met. Specifiers: early-onset (before age 21) or late onset (age 21 or older). For the most recent 2 years of of the disorder must specify: with pure dysthymia (no MDE), with persistent major depressive episode (full criteria for MDE met during preceding two years), with intermittent major depressive episode, with current episode (current MDE with periods or eight weeks or more with symptoms below threshold for MDE), and with intermittent major depressive episodes, without current episode (no current MDE but one or more in the in the preceding two years). Early and insidious onset & chronic. early onset is associated with higher likelihood of comorbid personality & substance use disorders

Premenstrual dysphoric disorder

That in the majority of menstrual cycles there are at least five symptoms present in the week before the onset of menses, symptoms start to improve within a few days after the onset of menses, and are minimal or absent in the week postmenses. At least one must be present: marked affective lability, marked irritability or increased interpersonal conflict, marked depressed mode or marked anxiety. Additionally, at least one let's be present. Decreased interest in usual activities, difficulty concentrating, lethargy or fatigue, change in appetite, sleep difficulties, feeling overwhelmed, and physical sxs. Symptoms must be present for most menstrual cycles in the preceding year.

Substance/medication induced depressive disorder

Substances that can induce a depressive disorder include alcohol, hallucinogens (including PCP), inhalants, opioids, sedatives, hypnotics and anxiolytics, and stimulants (including cocaine)

Depressive disorder due to another medical condition

Medical conditions that are known to manifest with symptoms of depression include stroke, Huntington's disease, Parkinson's disease, & TBI. The neuroendocrine conditions of hypothyroidism and Cushing's disease are also associated with depression

Other specific/unspecified depressive disorder

Symptoms are present but do not meet full criteria

Anxiety disorders

Typically include both fear (response to a real or perceived emotional threat) or anxiety (response to a future threat). Fear is often associated with increased autonomic arousal, escape behaviors, and panic attacks. Many develop in childhood and tend to persist, more frequent in females. The disorders in this section are arranged developmentally and sequenced based on typical age of onset.

Panic attacks

A discrete period of intense fear or discomfort that come on abruptly and reach a peak within 10 minutes accompanied by four or more physical and/or cognitive symptoms. May be expected or unexpected. Limited-symptom panic attacks have fewer than four symptoms. Can be used as a specifier for anything Zaidi disorder as well as other mental disorders. Those that are co occur with another mental disorder are associated with increased symptom severity, higher rates of suicide, and poorer treatment response.

Separation Anxiety Disorder

Characterized by a developmentally inappropriate and excessive anxiety concerning being away from home or away from the person(s) to whom the individual is attached. Need three or more: distress when separation occurs/anticipated, worry about harm befalling the major attachment figure, worry about getting lost or kidnapped, reluctance to go out because of fear of separation, reluctance/fear of being alone without the major attachment figure, reluctant/refusal to go to sleep without being near the major attachment figure, repeated nightmares about separation, repeated physical complaints when separation occurs/anticipated. duration must be at least 4 weeks in children and adolescents & 6 months+ in adults. Frequently develops after life stress, especially after a significant loss, the most common evidence-based treatment is CBT and family therapy is also used.

Selective mutism

Involves a consistent failure to speak in specific social situations when speaking is expected, in spite of speaking in other situations. A minimum of one month duration is required for the diagnosis. Onset is usually before age 5. In children it is related to fear and anxiety not disobedience. Treatment includes combination of behavioral therapy and cognitive therapy- desensitization, relaxation protocols to include guided imagery.

Specific Phobia

Involves a marked fear or anxiety caused by the presence or anticipation of a specific object or situation. Exposure provokes an immediate anxiety response and the phobic situation is either avoided or endured with intense distress. Fear and anxiety is out of the proportion to the actual danger and typically last for six months or more. Specifiers: animal, natural environment (heights, storms, etc.), blood injection injury, situational (planes, elevators, etc) or other (loud sounds, costumed characters, etc.). Common to have multiple specific phobias in which case multiple diagnoses are given. Expose your-based therapies are the treatment of choice. In vivo exposure usually yields the strongest results; massed exposure May result in more robust clinical improvement. Therapist assisted exposure based procedures are highly effective. Virtual-reality exposure is useful for phobias that may be difficult to treat in vivo. Systematic desensitization, which involves pairing exposure with relaxation maybe preferred by patients. However it is effective but requires more time and is less successful at decreasing avoidance. Many exposure therapies include a cognitive component which can be particularly helpful for certain phobias.

Social Anxiety Disorder (Social Phobia)

Involves fear of one or more social situations in which the person is exposed to potential scrutiny by others, for example social interactions, being observed, and performing. Person fears their behavior will be embarrassing, humiliating, or lead to rejection. Fear, anxiety, or avoidance is persistent, typically lasts six months or more. If the fear is restricted to speaking or performing in public the specifier performance only should be used. Strong support for treating with cognitive therapy and with behavioral approaches (including exposure & relaxation). Combining cognitive and behavioral therapy seems to yield the best results.

Panic Disorder

Characterized by recurrent unexpected panic attacks. At least one of the attacks has been followed by one month or more of a one or both of the following: persistent concern about having additional panic attacks or the consequences of the attacks or a significant change in behavior related to the attacks. Panic attacks and a diagnosis of panic disorder are related to higher rates of suicide. Prevalence is higher in individuals with other anxiety disorders especially Agoura phobia, major depression, bipolar disorder, and possible alcohol use disorder. Comorbid with a number of medical symptoms and conditions. Cognitive behavioral therapy is considered the evidence-based treatment of choice - includes psychoeducation, cognitive restructuring, in vivo exposure, and interoceptive exposure to aversive psychological sensations. Relaxation training or breathing retraining is sometimes included as well.

Agoraphobia

Intense fear or anxiety about two or more situations: using public transportation, being in open spaces, being in enclosed spaces, standing in line or being in a crowd, or being outside the home. Situations are avoided because of thoughts that escape might be difficult or that help might not be available when incapacitating or embarrassing symptoms occur. The fear, anxiety, or avoidance is persistent and typically last six months or more. Individuals also have comorbid mental disorders most common co occurring diagnoses include other anxiety disorders, depressive disorders,PTSD, and alcohol use disorder. Usually treated with CBT very similar to the treatment of panic disorder

Generalized Anxiety Disorder

Diagnosed when there is excessive anxiety and worry about a number of events or activities, occurring more days than not for at least six months. Requires three or more: restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbance. Only one symptom is required in children. The median age of onset is 30 years, which is later then for all the other anxiety disorders. Disorders usually chronic, with the fluctuating course during which symptoms wax and wane. CBT or anxiety management training may be best treatment approaches. Anxiety management training is a combination of relaxation and cognitive restructuring.

Substance/Medication-Induced Anxiety Disorder

Substances that can induce an anxiety disorder: alcohol, caffeine, cannabis, hallucinogens (including PCP), inhalants, opioids, sedatives, hypnotics and anxiolytics, and stimulants (including cocaine)

Anxiety disorder due to another medical condition

Medical conditions that are known to manifest with symptoms of anxiety include endocrine disorders, cardiovascular disorders, respiratory illness, metabolic disturbances, and neurological illness

Other specified/unspecified anxiety disorder

Symptoms of anxiety that do not fit in any category

Obsessive-Compulsive and Related Disorders

This section begins with OCD - characterized by obsessions and/or compulsions, then related disorders of body dysmorphic disorder and hoarding disorder - characterized by cognitive symptoms(perceived defects in appearance, perceived need to save possessions), trichotillomania and excoriation -characterized by recurrent body focused repetitive behaviors.

Obsessive-Compulsive Disorder

Involves either obsessions and/or compulsions. Obsessions are recurrent thoughts, urges, or images that are experienced as intrusive and cause distress or anxiety. The person attempts to either ignore or suppress the thoughts or to neutralize them with some other thought or action. Compulsions are repetitive behaviors or mental acts the person feels driven to perform as an attempt to prevent or reduce distress or prevent some dreaded situation. Obsessions or compulsions take more than one hour per day or cause significant distress or impairment. Specifiers: with good or fair insight, with poor insight, and with absent insight/delusional beliefs. Tic-related it's coded if the individual has a current or past history of a tic disorder.

OCD course & treatment

Males have an earlier age of onset than females, usually before age 10 as a result males are more commonly affected in childhood and also more likely to have a comorbid tic disorder. In adulthood females are slightly more commonly Fectig. Suicide risk is high. Evidenced based treatments include exposure with response prevention and cognitive therapy. The two approaches are often combined.

Body Dysmorphic Disorder

Preoccupation with one or more perceived defects in appearance. The perceived flaws are either not observable or slight. Excessive repetitive behaviors or mental acts are performed. Usually begins in adolescence and occurs slightly more frequently in women. Suicidal ideation and attempts are high. Major depressive disorder is the most common comorbid disorder also social anxiety disorder and substance related disorders are common. Treatment typically includes CBT and medication. Specifiers: with good or fair insight, with poor insight, and with absent insight/delusional beliefs. With muscle dysmorphia is coded if the individual is preoccupied with the idea that their body build is too small or not muscular enough.

Hoarding Disorder

Involves persistent difficulty throwing out or giving up possessions, regardless of actual value. There is a perceived need to save items and distress associated with discarding items, which results in a cluttered living space. Specifiers: with good or fair insight, with poor insight, and with absent insight/delusional beliefs. With excessive accusation is coded if in addition to difficultly discarding there is an excessive acquisition of items that are not needed or for which there is no space.

Trichotillomania

Recurrent pulling out of one's own hairs, resulting in noticeable hair loss with repeated attempts to decrease or stop hair pulling.

Excoriation (Skin-Picking) Disorder

Recurrent picking at one and resulting in skin lesions, with repeated attempts to decrease or stop picking.

Substance/Medication-Induced Obsessive-Compulsive and Related Disorder

Substances that can induce an obsessive-compulsive and related disorder include amphetamines (or other stimulants) and cocaine.

Obsessive-Compulsive and Related Disorder due to Another Medical Condition

Medical conditions that are known to manifest with symptoms include Sydenham's chorea and pediatric acute-onset neuropsychiatric syndrome (PANS)

Other Specified/Unspecified Obsessive-Compulsive and Related Disorder

Examples include body dysmorphic like disorder without repetitive behaviors, obsessional jealousy, and koro (intense anxiety that the penis or vulva/nipples will recede into the body, possibly leading to death)

Trauma and Stressor Related Disorders

All include the diagnostic criteria of exposure to a traumatic or stressful event. Symptoms of psychological distress following exposure vary and many manifest as anxiety or fear-based symptoms, anhedonic and dysphoric symptoms, externalizing and aggressive symptoms or dissociative symptoms

Reactive attachment disorder

Consistent pattern of inhibited, emotionally withdrawn behavior toward the caregiver, as manifested by the child rarely seeking nor responding to comfort when distressed. Exhibits at least two: minimally responsive to others, limited positive affect, or episodes of unexplained sadness, fear or irritation. Child has also experienced grossly insufficient care. Present before five and the child has a developmental age of at least nine months. Specifier of persistent is to be given when the disorder is present for more than 12 months and severe when all symptoms are present, with each symptom at a high-level.

Disinhibited social engagement disorder

Behavior in which a child actively approaches and interacts with adult strangers and exhibits at least two: lack of hesitation in approaching unfamiliar adults, overly familiar behavior with strangers that violate cultural social boundaries, lack of checking back with caregiver after venturing away, and willingness to go off with an unfamiliar adult without hesitation. Mikell has also experienced extremely insufficient care and has a developmental age of at least nine months. Specifier of persistent is to be given when the disorder is present for more than 12 months and severe when all symptoms are present, with each symptom at a high-level.

Posttraumatic stress disorder

An individual has been exposed to a traumatic event (actual or threatened death, serious injury, or sexual violence) in one or more ways: directly experiencing the event, witnessing the event, learning that the event has occurred to a close family member, or experiencing repeated exposure to aversive details of traumatic events. Four characteristic symptoms include: intrusive symptoms, avoidance of stimuli associated with the trauma, negative alterations in cognitions and mood, and increased arousal. Children six years and younger, the three characteristic symptoms include: intrusive symptoms, avoidance and/or negative alterations in cognitions and mood, and increased arousal. Symptoms must last for more than one month. Specifiers: with dissociative symptoms and with delayed expression if the onset of symptoms was at least six months after the event

PTSD course & treatment

Duration of symptoms varies widely with complete recovery within three months to longer than 12 months. Risk factors for development includes severity of the trauma, perceived life threat, interpersonal violence, prior mental disorders, dissociation during and after the trauma, lack of support, female gender, younger age, lower SES, lower education, lower intelligence, & minority racial/ethnic status. more prevalent among females and is associated with suicidal ideation and attempts. Interventions include CPT, PE, seeking safety (when comorbid with SUD) and EMDR (controversial as the mechanism of change may simply be exposure). Also SIT. Psychological debriefing wasn't at first thought to prevent the development of PTSD and other trauma related symptoms but the method has been found to be ineffective and some research has indicated that it makes recovery more difficult as compared to having no treatment at all.

Acute stress disorder

Similar exposure to trauma as with PTSD and evidences nine or more symptoms from any five categories of intrusion, negative mood, dissociation, avoidance, and arousal. Symptoms typically begin immediately after the trauma and must persist for at least three days but no longer than one month.

Adjustment disorders

Involve the presence of emotional or behavioral symptoms in response to an identifiable psychosocial stressor. The disorder develops within three months of the onset of the stressor and remits within six months of the stressors termination. Person experiences marked distress in excess of what would be expected or there is significant impairment in functioning. Only diagnosed if the stress related disturbance does not qualify for another mental disorder nor is it an exacerbation of a pre-existing mental disorder. Specifiers: with depressed mood, with anxiety, with mixed anxiety and depressed mood, with disturbance of conduct, with mixed disturbance of emotions and conduct, and unspecified

Other specified/unspecified trauma and stressor related disorder

Include adjustment-like disorders with late onset of symptoms that occur more than three months after the stressor, persistent complex bereavement disorder, or ataque de nervios

Dissociative Disorders

Involve a disturbance or alteration in the normally integrative functions of consciousness, identity, memory, perception, emotion, body representation, motor control, and behavior. May be experienced as intrusions into awareness and behavior (positive sxs such as derealization) and/or as an inability to access information (negative sxs such as amnesia). Frequently occur following a trauma

Dissociative identity disorder

The presence of two or more distinct identities or personalities. Involves discontinuity in sense of self, frequently with accompanying alterations in affect, bx, consciousness, memory, perception, cognition, and/or sensory motor functioning. Also an inability to recall every day events, important personal information, and/or traumatic events that are too extensive to be explained by forgetfulness

Dissociative amnesia

And inability to recall important personal information, usually of a traumatic or stressful nature, that cannot be explained by ordinary forgetfulness. Most commonly selective for a specific event or events, rather than generalized amnesia. Specifier with dissociative fugue is used when it includes purposeful travel or bewildered wandering with an inability to recall one's past.

Depersonalization/Derealization disorder

Persistent or recurrent episodes of depersonalization (a sense of unreality or detachment from one's thoughts, feelings, body, or actions) or derealization (a sense of unreality or detachment from one's surroundings). Reality testing remains intact.

Other specified/unspecified dissociative disorder

Examples include identity disturbance due to prolonged and intense coercive persuasion, or acute dissociative reactions to stressful events (sometimes lasting only a few hours or days)

Somatic Symptoms and Related Disorders

Common feature is the prominence of somatic symptoms associated with significant distress and impairment. These individuals are more commonly encountered in primary care and other medical settings. Highlights distressing somatic symptoms plus abnormal thoughts, feelings, and behaviors in response to symptoms.

Somatic Symptom Disorders

Characterized by one or more somatic symptoms that are distressing or result in significant disruption of daily life. Evidences excessive thoughts, feelings, or behaviors related to the somatic symptoms as manifest by at least one: persistent thoughts about the seriousness of one's symptoms, persistent high levels of anxiety about health or symptoms, or excessive time and energy devoted to symptoms or health concerns. (Nutshell: somatic sxs & significant attention the sxs). Somatic sxs may not be present continuously but the worries are persistent (typically more than 6 months). Specifiers: with predominant pain (when the somatic sxs predominantly involve pain), and persistent (severe sxs, marked impairment, & long duration). Also severity is coded mild, moderate, or severe. More prevalent in females. Comorbid anxiety & depression is common. When chronic pain is prominent, evidenced-based treatments include CBT & ACT

Illness Anxiety Disorder

Involves a preoccupation with having or developing a serious illness. Somatic sxs or mild or not present and there is significant anxiety about health. Either performs excessive health-related behaviors or demonstrates maladaptive avoidance. Illness preoccupation lasts at least 6 months.prevalence is similar in both men and women (nutshell: anxiety about developing an illness)

Conversion Disorder (functional neurological symptom disorder)

Involves one or more symptoms or deficits affecting voluntary motor or sensory function. Symptoms are not intentionally produced but are incompatible with recognized neurological or medical conditions (nutshell: have sxs but don't match any known neuro or med condition). Specifiers: with weakness or paralysis, with abnormal movement, with swallowing symptoms, with speech symptoms, with attacks of seizures, and with anesthesia or sensory loss, with special sensory symptom, or with mixed symptoms. Must also specify if: acute episode (sxs present less than 6 months), or persistent (sxs present more than six months), and with psychological stressor (stressor needs to be specified) or without psychological stressor. Occurs 2 to 3 times more frequently in women.

Psychological factors affecting other medical conditions

Essential feature is a medical symptom or condition is present, and psychological or behavior factors adversely affect the medical condition in one or more ways: factors have influenced the course or pathophysiology of the medical condition (exacerbation or delayed recovery), the factors interfere with treatment (poor adherence), or the factors create an additional health risk. Specify: mild moderate severe or extreme.