MODULE 4-9 (AbPsych)

Anxiety

is a negative mood state characterized by bodily symptoms of physical tension and by apprehension about the future

Panic

the alarm response of fear when there is nothing to be afraid of—that is, if you have a false alarm

Fear

is an immediate alarm reaction to danger

Diagnostic Criteria for Panic Attack

An abrupt surge of intense fear or intense discomfort that reaches a peak within minutes (4 or more should be present):
1. Palpitations, pounding heart, or accelerate heart rate
2. Sweating
3. Trembling or shaking
4. Sensations of shortness of breath or smothering
5. Feeling of choking
6. Chest pain or discomfort
7. Nausea or abdominal distress
8. Feeling dizzy, unsteady, lightheaded, or faint
9. Chills or heat sensations
10. Parethesias
11. Derealization or depersonalization
12. Fear of losing control or going crazy
13. Fear of dying

Causes of Anxiety

Biological, Psychological, and Social Contributions

Diagnostic Criteria for Generalized Anxiety Disorder

A. Excessive anxiety and worry occurring more days than not for at least 6 months about a number of events or activities.
B. The individual finds it difficult to control the worry.
C. The anxiety and worry are present for more days than not for at least 6 months (3 or more)
1. Restlessness or feeling keyed up or on edge
2. Being easily fatigue
3. Difficulty concentrating or mind going blank
4. Irritability
5. Muscle Tension
6. Sleep disturbance
D. Cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
E. Is not due to the direct physiological effects of a substance
F. Is not better explained by another mental disorder

Panic Disorder

in which individuals experience severe, unexpected panic attacks; they may think they’re dying or otherwise losing control.

Agoraphobia

which is fear and avoidance of situations in which a person feels unsafe or unable to escape to get home or to a hospital in the event of a developing panic symptoms or other physical symptoms, such as loss of bladder control.

Diagnostic Criteria for Panic Disorder

A. Recurrent unexpected attacks are present.
B. At least one of the attacks has been followed by one month or more of one or both of the following:
a. persistent concern or worry about additional panic attacks or their consequences
b. a significant maladaptive change in behavior related to the attacks
C. Is not attributable to the physiological effects of a substance
D. Is not better explained by another mental disorders

Diagnostic Criteria for Agoraphobia

A. Marked fear or anxiety about 2 or more of the following situations: Public transportation, open spaces, enclosed places, standing in line, or being in a crowd outside the home alone.
B. the individual fears or avoids these situations due to thoughts that escape might be difficult or help might not be available in the event of developing panic-like symptoms or other incapacitating or embarrassing symptoms
C. the agoraphobic situations almost always provoke fear or anxiety.
D. Situations are actively avoided, required the presence of a companion, or are endured with intense fear or anxiety.
E. the fear or anxiety is out of proportion to the actual danger posed by the situations, and to the sociocultural context.
F. Avoidance is persistent, typically lasting for 6 months or more
G. Causes clinically significant distress or impairment in social, occupational or other important areas of functioning.
H. If another or medical conditioned is persistent is present, the fear, anxiety or avoidance is clearly excessive.
I. Is not better explained by the symptoms of another mental disorder.

Panic Control Treatment

developed at one of our clinics concentrates on exposing patients with panic disorder to the cluster of interoceptive (physical) sensations that remind them of their panic attacks.

Specific Phobia

is an irrational fear of a specific object or situation that markedly interferes with an individual’s ability to function.

Diagnostic Criteria for Specific Phobia

A. Marked fear or anxiety about a specific object or situation.
B. Always provokes immediate fear or anxiety.
C. Is actively avoided or endured with intense fear or anxiety.
D. The fear or anxiety is out of proportion to the actual danger posed by a specific object or situation, and to the sociocultural context.
E. Is persistent, typically lasting for 6 months or more.
F. Causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
G. Is not better explained by the symptoms of another mental disorder (agoraphobia, OCD, PTSD, separation anxiety disorder, social anxiety disorder)
Specify if:
1. Animal
2. Natural environment
3. Blood-injection-injury
4. Situational
5. Other

Diagnostic Criteria for Social Anxiety Disorder (Social Phobia)

A. Marked fear or anxiety about one or more social situations in which the person is exposed to possible scrutiny by others. (Social interactions, being observed, or performing in front of others.)
B. The individual fears that he or she will act in a way, or show anxiety symptoms, that will be negatively evaluated.
C. The social situations almost always provoke fear or anxiety.
D. The social situations are avoided or endured with intense fear or anxiety.
E. Is out of proportion to the actual threat posed by the social situation, and to the sociocultural context.
F. Is persistent, typically lasting for 6 months or more.
G. Causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
H. Is not attributable to the effects of a substance or other medical condition.
I. Is not better explained by the symptoms of another mental disorder. (Panic disorder and separation anxiety disorder)
J. If another medical condition is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.
Specify if:
Performance only: If the fear is restricted to speaking or performing in public.

Posttraumatic Stress Disorder

is the one disorder for which we know the cause at least in terms of the precipitating event: someone personally experiences a trauma and develops a disorder.

Diagnostic Criteria for Posttraumatic Stress Disorder

A. Exposure to actual threatened death, serious injury, or sexual violence in one (or more) of the following ways:
1. Directly experience the traumatic event(s)
2. Witnessing, in person, the event(s) occurred to a close friend
3. Learning that the event(s) occurred to a close relative or close friend. (must be violent or accidental)
4. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s).
B. Presence of 1 (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred:
1. Recurrent, involuntary and intrusive distressing memories of the traumatic event(s)
2. Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s).
3. Dissociative reactions in which the individual feels or acts as if the traumatic event(s) were recurring.
4. Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
5. Marked psychological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
C. Persistent avoidance of the stimuli associated with the traumatic event(s), beginning after the TE occurred (one or both of the following);
1. Avoidance of or efforts to avoid distressing memories, thoughts, feelings or conversation about or closely associated with the TE.
2. Avoidance of or efforts to avoid external reminders that arouse distressing memories, thoughts, feelings or conversation about or closely associated with the TE.
3. Inability to recall an important aspect of the trauma.
4. Markedly diminished interest or participation in significant activities.
5. Feeling of detachment or estrangement from others.
6. Restricted range of affect
7. Sense of a foreshortened future
D. Negative alterations in cognitions and mood associated with the TE, beginning or worsening after the TE occurred (2 or more of the following);
1. Inability to remember an important aspect of the TE.
2. Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world.
3. Persistent distorted cognitions about the cause or consequences of the TE that lead the individuals to blame themselves or others.
4. Persistent negative emotional state
5. Markedly diminished interest or participation in significant activity
6. Feelings of detachment or estrangement from others
7. Persistent inability to experience positive emotions
E. Duration of the disturbance (Criterion B, C, D, and E) is more than 1 month
F. Causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Specify if:
With delayed expression
With Dissociative Symptoms

Adjustment Disorders

anxious or depressive reactions to life stress that are generally milder than one would see in acute stress disorder or PTSD but are nevertheless impairing in terms of interfering with work or school performance, interpersonal relationships, or other areas of living.

Diagnostic Criteria for Adjustment Disorders

A. The development of emotional or behavioral symptoms in response to an identifiable stressor(s) occurring within 3 months of the onset of the stressor(s)
B. These symptoms or behaviors are clinically significant (one or both of the following);
1. distress is out of proportion to the severity or intense of the stressor
2. significant impairment in social, occupational, or other important areas of functioning
C. The stress-related disturbance does not meet the criteria for another mental disorder and is not merely an exacerbation of a preexisting mental disorder.
D. Do not represent normal bereavement
E. Once the stressor or its consequences have terminated, the symptoms do not persists for more than an additional 6 months
Specify whether:
With depressed mood
With anxiety
With mixed anxiety and depressed mood
With disturbance of conduct
With mix disturbance of emotions and conduct
Unspecified

Attachment Disorders

refers to disturbed and developmentally inappropriate behaviors in children, emerging before five years of age, in which the child is unable or unwilling to form normal attachment relationships with caregiving adults.

Diagnostic Criteria for Separation Anxiety Disorder

A. Developmentally inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached (at least 3 of the following);
1. Recurrent excessive distress when anticipating or experiencing separation from home or from major attachment figures.
2. Persistent and excessive worry about losing major attachment figures or about possible harm to them, such as illness, injury, disasters, or death.
3. Persistent and excessive worry about experiencing an untoward event that causes separation from major attachment figure.
4. Persistent reluctance or refusal to go out, away from home, to school, to work, or elsewhere because of fear of separation.
5. Persistent and excessive fear of or reluctance about being alone or without major attachment figures at home or in other settings.
6. Persistent reluctance or refusal to sleep away from home or to go to sleep without being near a major attachment figure.
7. Repeated nightmares involving the theme or separation.
8. Repeated complaints of physical symptoms when separation from major attachment figures occurs or is anticipated.
B. Is persistent, lasting at least 4 weeks in children and adolescents and typically, 6 months or more in adults.
C. Causes clinically significant distress or impairment in social, academic, occupational, or other important areas of functioning.
D. Is not better explained by another mental disorder (psychotic disorders, agoraphobia, generalized anxiety disorder, illness anxiety disorder)

Reactive Attachment Disorder

the child will very seldom seek out a caregiver for protection, support, and nurturance and will seldom respond to offers from caregivers to provide this kind of care.

Diagnostic Criteria for Reactive Attachment Disorder

A. A consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers, manifested by both of the following:
1. The child rarely or minimally seeks comfort when distress.
2. The child rarely or minimally responds to comfort when distressed.
B. A persistent social and emotional disturbance characterized by at least two of the following;
1. Minimal social and emotional responsiveness to others
2. Limited positive affect
3. Episodes of unexplained irritability, sadness, or fearfulness that re evident even during nonthreatening interactions with adult caregivers
C. The child experienced a pattern of extremes of insufficient care as evidenced by at least 1 of the following:
1. Social neglected or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation, and affection met by caregiving adults.
2. Repeated changes of primary caregivers that limit opportunities to form stable attachments
3. Rearing in unusual settings that severely limit opportunities to form selective attachments
D. The care in Criterion C is presumed to be responsible for the disturbed behavior in Criterion A.
E. The criteria are not met for autism spectrum disorder.
F. The disturbance is evident before age 5 years.
G. The child has a developmental age at least 9 months.

Disinhibited Social Engagement Disorder

a similar set of child rearing circumstances— perhaps including early persistent harsh punishment—would result in a pattern of behavior in which the child shows no inhibitions whatsoever to approaching adults.

Diagnostic Criteria for Disinhibited Social Engagement Disorder

A. A pattern of behavior in which a child actively approaches and interacts with unfamiliar adults and exhibits at least 2 of the following:
1. Reduced or absent reticence in approaching and interacting with unfamiliar adults.
2. Overly familiar verbal or physical behavior
3. Diminished or absent checking back with adult caregiver after venturing away, even in unfamiliar settings.
4. Willingness to go off with an unfamiliar adult with minimal or no hesitation.
B. The behaviors in Criterion A are not limited to impulsivity but include socially disinhibited behavior.
C. The child has experienced a pattern of extremes of insufficient care as evidenced by at least one of the following:
1. Social neglected or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation, and affection met by caregiving adults.
2. Repeated changed of primary caregivers that limit opportunities to form stable attachments
3. Rearing in unusual settings that severely limit opportunities to form selective attachments
D. The care in Criterion C is presumed to be responsible for the disturbed behavior in Criterion A.
E. The child has a developmental age for at least 9 months.

Obsessions

are intrusive and mostly nonsensical thoughts, images, or urges that the individual tries to resist or eliminate.

Compulsions

are the thoughts or actions used to suppress the obsessions and provide relief.

Diagnostic Criteria for Obsessive Compulsive Disorder

A. Presence of both obsessions, compulsions, or both;
B. The obsessions or compulsions are time-consuming or causes clinically distress or impairment in social, occupational or other important areas of functioning.
C. Is not due to the direct physiological effects of a substance or another medical condition
D. Is not better explained by the symptoms of another mental disorder (excessive worries, generalized anxiety disorder, dysmorphic disorder)

Body Dysmorphic Disorder

is a preoccupation with some imagined defect in appearance by someone who actually looks reasonably normal. The disorder has been referred to as “imagined ugliness”

Diagnostic Criteria for Body Dysmorphic Disorder

A. Preoccupation with one or more defects or flaws in physical appearance that are not observable or appear slight to others.
B. At some point during the course of the disorder, the individual has performed repetitive behaviors or mental acts in response to the appearance concerns.
C. Causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
D. Is not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnostic criteria for an eating disorder.
Specify if:
With good or fair insight
With poor insight
With muscle dysmorphia

Diagnostic Criteria for Hoarding Disorder

A. Persistent difficulty discarding or parting with possessions, regardless of their actual value.
B. This difficulty is due to a perceived need to save the items and to distress associated with discarding them.
C. Results in the accumulation of possessions that congest and clutter active living areas and substantially compromises their intended use.
D. Causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
E. Is not attributable to another medical condition.
F. Is not better explained by the symptoms of another mental disorder.
Specify if:
With excessive acquisition
With good or fair insight
With poor insight
With absent insight/delusional beliefs

Trichotillomania (Hair Pulling Disorder)

The urge to pull out one’s own hair from anywhere on the body, including the scalp, eyebrows, and arms.

Diagnostic Criteria for Trichotillomania (Hair Pulling Disorder)

A. Recurrent pulling out of one’s hair, resulting to hair loss.
B. Repeated attempts to decrease or stop hair pulling.
C. Causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
D. Is not attributable to another medical condition.
E. Is not better explained by the symptoms of another mental disorder.

Excoriation (Skin Picking Disorder)

is characterized, as the label implies, by repetitive and compulsive picking of the skin, leading to tissue damage.

Diagnostic Criteria for Excoriation (Skin Picking Disorder)

A. Recurrent skin picking resulting in skin lesions.
B. Repeated attempts to decrease or stop skin picking.
C. Causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
D. Is not attributable to the physiological effects.
E. Is not better explained by the symptoms of another mental disorder.

Diagnostic Criteria for Somatic Symptom Disorder

A. One or more somatic symptoms that are distressing and/or result in significant disruption of daily life.
B. Excessive thoughts, feelings, and behaviors related to the somatic symptoms or associated health concerns as manifested by at least one of the following:
1. Disproportionate and persistent thoughts about the seriousness of one’s symptoms
2. High Level of health-related anxiety
3. Excessive time and energy devoted to these symptoms or health concerns
C. Although any one symptoms may bot be continuously present, the state of being symptomatic is persistent (typically more than 6 months).

Illness Anxiety Disorder

was formerly known as “hypochondriasis,” which is still the term widely used among the public.

Diagnostic Criteria for Illness Anxiety Disorder

A. Preoccupation with fears of having or acquiring a serious illness.
B. Somatic symptoms are not present or, if present, are only mild in intensity. If another medical condition is present or there is a high risk for developing a medical condition, the preoccupation is clearly excessive or disproportionate.
C. There is a high level of anxiety about health, and the individual is easily alarmed about personal health status.
D. The individual performs excessive health-related behaviors or exhibits maladaptive avoidance.
E. Illness preoccupation has been present for at least 6 months, but the specific illness that is feared may change over that period of time.
F. Is not better explained by another mental disorder (somatic symptom disorder, generalized anxiety disorder, or OCD)

Conversion Disorder

generally have to do with physical malfunctioning, such as paralysis, blindness, or difficulty speaking (aphonia), without any physical or organic pathology to account for the malfunction.

Diagnostic Criteria for Conversion Disorder (Functional Neurological Symptom Disorder)

A. One or more symptoms of altered voluntary motor or sensory function.
B. Clinical findings provide evidence of incompatibility between the symptom and recognized neurological or medical conditions.
C. Is not better explained by another medical or mental disorder.
D. Causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation.

Malingering

It involves pretending to have a physical or psychological condition in order to gain a reward or avoid something.

Factitious Disorders

The symptoms are under voluntary control, as with malingering, but there is no obvious reason for voluntarily producing the symptoms except, possibly, to assume the sick role and receive increased attention.

Factitious Disorder Imposed on Another

When an individual deliberately makes someone else sick, the condition. It was also known previously as Munchausen syndrome by proxy.

Diagnostic Criteria for Factitious Disorders

A. Falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception.
B. The individual presents him/herself to others as ill, impaired, or injured.
C. Is evident even in the absence of obvious external rewards.
D. Is not better accounted for by another mental disorder (delusional belief system or acute psychosis).

Depersonalization

your perception alters so that you temporarily lose the sense of your own reality, as if you were in a dream and you were watching yourself.

Depersonalization-Derealization Disorder

When feelings of unreality are so severe and frightening that they dominate an individual’s life and prevent normal functioning.

Diagnostic Criteria for Depersonalization-Derealization Disorder

A. The presence of persistent or recurrent experiences of depersonalization, derealization, or both.
B. Reality testing remains intact.
C. Cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
D. Is not attributable to the physiological effects of a substance or another medical condition.
E. Is not better explained by another mental disorder (schizophrenia or panic disorder)

Generalized Amnesia

People who are unable to remember anything, including who they are. May be lifelong or may extend from a period in the more recent past.

Localized or Selective Amnesia

a failure to recall specific events, usually traumatic, that occur during a specific period.

Dissociative Fugue

memory loss revolves around a specific incident—an unexpected trip (or trips). Mostly, individuals just take off and later find themselves in a new place, unable to remember why or how they got there.

Diagnostic Criteria for Dissociative Amnesia

A. An inability to recall important autobiographical information, usually a traumatic or stressful nature, that is inconsistent with ordinary forgetting.
B. Causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
C. Is not attributable to the physiological effects of a substance or a neurological or other medical condition.
D. Is not better explained by DID, PTSD, acute stress disorder, somatic system disorder, or major neurocognitive disorder.

Dissociative Identity Disorder

may adopt as many as 100 new identities, all simultaneously coexisting, although the average number is closer to 15.

Alters

is the shorthand term for the different identities or personalities in DID.

Switch

The transition from one personality to another.

Diagnostic Criteria for Dissociative Identity Disorder

A. Disruption of identity characterized by two or more distinct personality states, which may be described in some cultures as an experience of possession. The disruption of marked discontinuity in sense of self and sense of agency, accompanied by related alterations in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning. These signs and symptoms may be observed by others or reported by the individual.
B. Recurrent gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting.
C. Cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
D. Is not a normal part of a broadly accepted cultural or religious practice.
E. Are not attributable to the physiological effects of a substance or another medical condition.

Diagnostic Criteria for Major Depressive Episode

A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
1. Depressed mood most of the day, nearly every day, as indicated by either subjective report or observation made by others
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
3. Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.
4. Insomnia or hypersomnia nearly every day.
5. Psychomotor agitation or retardation nearly every day
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
B. Cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
C. Are not due to the direct physiological effects of a substance or a general medical condition.

Mania

is abnormally exaggerated elation, joy, or euphoria. Individuals find extreme pleasure in every activity.

Criteria for Manic Episode

A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, at least lasting 1 week and present most of the day, nearly every day.
B. 3 or more of the following symptoms are present to a significant degree and represent a noticeable change from usual behavior:
1. Inflated self-esteem or grandiosity
2. Decreased need for sleep
3. More talkative than usual or pressure to keep talking
4. Flight or ideas or subjective experiences that thoughts are racing
5. Distractibility, as reported or observed
6. Increase in goal-oriented activity or psychomotor agitation
7. Excessive involvement in activities that have a high potential for painful consequences
C. Is sufficiently severe to cause marked impairment in social occupational functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features
D. Is not attributable to the physiological effects of a substance or to another general medical condition

Hypomanic Episode

a less severe version of a manic episode that does not cause marked impairment in social or occupational

functioning and need last only 4 days rather than a

full week.

Major Depressive Disorder

defined by the absence of manic, or hypomanic episodes before or during the disorder

Diagnostic Criteria for Major Depressive Disorder

A. At least one major depressive episode
B. Is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders
C. There has never been a manic episode or hypomanic episode

Persistent Depressive Disorder

is defined as depressed mood that continues at least 2 years, during which the patient cannot be symptom free for more than 2 months at a time even though they may not experience all of the symptoms of a major depressive episode.

Diagnostic Criteria for Persistent Depressive Disorder (Dysthymia)

A. Depressive mood for most of the day, for more days than not, as indicated by wither subjective account or observation by others, for at least 2 years.
B. Presence, while depressed, of two (or more) of the following:
1. Poor appetite or overeating
2. Insomnia or hypersomnia
3. Low energy or fatigue
4. Low self-esteem
5. Poor concentration or difficulty making decisions
6. Feelings of hopelessness
C. During the 2 year period of the disturbance, the person has never been without the symptoms in criteria A and B for more than 2 months at a time.
D. Criteria for major depressive disorder may be continuously present for 2 years
E. There has never been a manic episode or a hypomanic, and criteria have never been met for cyclothymic disorder
F. Is not better explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.
G. Are not attributable to the physiological effects of a substance or another medical condition
H. Cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

Diagnostic Criteria for Bipolar I Disorder

A. Criteria have been met for at least one manic episode.
B. At least one manic episode is not better explained by schizoaffective disorder and is not superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder

Diagnostic Criteria for Hypomanic Episode

A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly everyday.
B. During the period of mood disturbances and increase energy and activity (3 or more) symptoms are persistent, represent a noticeable change from usual behavior, and have been present to a significant degree:
1. Inflated self-esteem or grandiosity
2. Decreased need for sleep
3. More talkative than usual or pressure to keep talking
4. Flight of ideas or subjective experience that thoughts are racing
5. Distractibility, as reported or observed
6. Increase in goal-directed activity or psychomotor agitation
7. Excessive involvement in activities that have a high potential for painful consequences
C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic
D. The disturbance in mood and the change in functioning are observable by others
E. Is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization.
F. Is not attributable to the physiological effects of a substance

Diagnostic Criteria for Bipolar II Disorder

A. Criteria have been met for at least 1 hypomanic episode and at least 1 major depressive episode. Minimum duration is 4 days; and it is not severe enough to marked social or occupational impairment or hospitalization.
B. There has never been a manic episode.
C. Is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.
D. Causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Antidepressants

are used to treat depressive disorders: selective-serotonin reuptake inhibitorrs (SSRIs), mixed reuptake inhibitors, tricyclic antidepressants, and monoamine oxidase (MAO) inhibitors.

Cognitive-Behavioral Therapy

Treatment involves correcting cognitive errors and substituting less depressing and (perhaps) more realistic thoughts and appraisals.

Sexual Dysfunction

find it difficult to function adequately while having sex;

Philia

refers to a strong attraction or liking, and para indicates the attraction is abnormal.

Lifelong

refers to a chronic condition that is present during a person’s entire sexual life.

Acquired

refers to a disorder that begins after sexual activity has been relatively normal.

Generalized

occurring every time the individual attempts sex

Situational

occurring with some partners or at certain times but not with other partners or at other times.

Erectile Disorder

is a specific disorder of arousal. The problem here is not desire.

Criteria for Male Hypoactive Sexual Desire Disorder

A. Persistently or recurrently deficient (or absent) sexual/erotic thoughts or fantasies and desire for sexual activity.
B. Persisted for a minimum duration of approximately 6 months.
C. Causes clinically significant distress in the individual.
D. Is not better explained by a non-sexual mental disorder or as a consequence of severe relationship distress or other significant stressors and is not attributable to the effects of a substance/medication or another medical condition.

Criteria for Female Sexual Interest/Arousal Disorder

A. Lack of, or significantly reduced, sexual interest/arousal, as manifested by at least 3 of the following:
1. Absent/reduced interest in sexual activity
2. Absent/reduced sexual/erotic thoughts or fantasies.
3. No/reduced initiation of sexual activity, and typically unreceptive to a partner’s attempts to initiate.
4. Absent/reduced sexual excitement/pleasure during sexual activity in almost all or all sexual encounters.
5. Absent/reduced sexual interest/arousal in response to any internal or external sexual/erotic cues.
6. Absent/reduced genital or nongenital sensations during sexual activity in almost all or all sexual encounters.
B. Have persisted for a minimum duration of approximately 6 months.
C. Causes clinically significant distress in the individual.
D. Is not better explained by a non-sexual mental disorder or as a consequence of severe relationship distress or other significant stressors and is not attributable to the effects of a substance/medication or another medical condition.

Orgasm Disorder

An inability to achieve an orgasm despite adequate sexual desire and arousal is commonly seen in women and less commonly seen in men.

Delayed Ejaculation

Males who achieve orgasm only with great difficulty or not at all meet criteria

Criteria for Female Orgasmic Disorder

A. Presence of either of the following symptoms and experienced on almost all or all occasions of sexual activity.
1. Marked delayed in, marked infrequency of, or absence of orgasm.
2. Markedly reduced intensity of orgasmic sensations.
B. Have persisted for a minimum duration of approximately 6 months.
C. Causes clinically significant distress in the individual.
D. Is not better explained by a non-sexual mental disorder or as a consequence of severe relationship distress or other significant stressors and is not attributable to the effects of a substance/medication or another medical condition

Criteria for Premature Ejaculation

A. A persistent or recurrent pattern f ejaculation occurring during partnered sexual activity within approximately 1 minute following vaginal penetration and before the person wishes is.
B. Have persisted for a minimum duration of approximately 6 months (must be experienced almost all or all occasions).
C. Causes clinically significant distress in the individual.
D. Is not better explained by a non-sexual mental disorder or as a consequence of severe relationship distress or other significant stressors and is not attributable to the effects of a substance/medication or another medical condition

Genito-Pelvic Pain/Penetration Disorder

A sexual dysfunction specific to women refers to difficulties with penetration during attempted intercourse or significant pain during intercourse.

Interviews

usually supported by numerous questionnaires because patients may provide more information on paper than in a verbal interview

Medical Evaluation

to rule out the variety of medical conditions that can contribute to sexual problems

Psychophysiological Assessment

to directly measure the physiological aspects of sexual arousal

Fetishistic Disorder

a person is sexually attracted to nonliving objects.

Fetishistic Arousal

is associated with two classes of objects or activities: (1) an inanimate object or (2) a source of specific tactile stimulation, such as rubber, particularly clothing made out of rubber.

Criteria for Fetishistic Disorder

A. Over a period of at least 6 months, recurrent and intense sexual arousal from the use of nonliving objects or a highly specific focus on nongenital body part(s), as manifested by fantasies, urges, or behaviors.
B. Causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
C. The fetish objects are not limited to articles of clothing used in cross-dressing or devices specifically designed for the purpose of tactile genital stimulation.

Criteria for Frotteuristic Disorder

A. Over a period of at least 6 months, recurrent and intense sexual arousal from touching or rubbing against a non-consenting person, manifested by fantasies, urges, or behaviors.
B. Causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Voyeuristic Disorder

is the practice of observing, to become aroused, an unsuspecting individual undressing or naked.

Exhibitionistic Disorder

is achieving sexual arousal and gratification by exposing genitals to unsuspecting strangers

Criteria for Voyeuristic Disorder

A. Over a period of at least 6 months, recurrent and intense sexual arousal from observing an unsuspecting person who is naked, in the process of disrobing, or engaging in sexual activity, as manifested by fantasies, urges, or behaviors.
B. Causes clinically significant distress or impairment in social, occupational, or other areas of functioning.
C. The individual experiencing the urges is at least 18 years of age.

Criteria for Exhibitionistic Disorders

A. Over a period of at least 6 months, recurrent and intense sexual arousal from the exposure of one’s genitals to an unsuspecting person, as manifested by fantasies, urges, or behaviors.
B. Causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Criteria for Transvestic Disorder

A. Over a period of at least 6 months, recurrent and intense sexual arousal from cross-dressing, as manifested by fantasies, urges, or behaviors.
B. Causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Specify if:
With fetishism
With autogynephilia

Sexual Sadism

inflicting pain or humiliation and becoming sexually aroused is specifically associated with violence and injury in these conditions

Sexual Masochism

suffering pain or humiliation and becoming sexually aroused is specifically associated with violence and injury in these conditions

Criteria for Sexual Sadism Disorder

A. Over a period of at least 6 months, recurrent and intense sexual arousal from the psychological or physical suffering of another person, as manifested by fantasies, urges, or behaviors.
B. Causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Criteria for Sexual Masochism Disorder

A. Over a period of at least 6 months, recurrent and intense sexual arousal from the act of being humiliated, beaten, bound, or otherwise made to suffer, as manifested by fantasies, urges, or behaviors.
B. Causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Pedophilic Disorder

Perhaps the most tragic sexual deviance is sexual attraction to children (or young adolescents generally aged 13 years or younger)

Criteria for Pedophilic Disorder

A. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child or children.
B. Cause marked distress or interpersonal difficulty.
C. The individual is at least age 16 years and at least 5 years older than the child or children in Criterion A.
Specify type:
Exclusive type (attracted only to children)
Nonexclusive type
Specify if:
Sexually attracted to males, females, or both
Limited to incest