DSM-V-TR

Includes main criterion for most if not all of DSM-V-TR diagnoses. Some condensing of language, so not all parts are word-for-word. Generally excludes universal dx criteria (e.g., "causes significant impairment," "Not better explained by another disorder"). Work in progress

Intellectual Developmental Disorder

A) Intellectual functioning deficits (confirmed by clinical and standardized assessment)

B) Adaptive functioning deficits. Fails to have personal independence and social responsibility. Functioning limited in 1+ life domains across multiple environments without ongoing support

C) Onset of deficits occurred during developmental periods

(Mild, Moderate, Severe, Profound)

Language Disorder

A) Difficulties in acquisition and use of language. Includes the following:

1. Reduced vocabulary

2. Limited sentence structure capabilities

3. Impairments in discourse and conversation

B) Language abilities below those expected for age and result in functional limitations

C) Onset of symptoms occurred in early developmental period

Speech Sound Disorder

A) Persistent difficulty with speech sound production that interferes with intelligibility or communication

B) Limitations in communication as a result

C) Onset of symptoms occurred in early developmental period

Childhood-Onset Fluency Disordering

“Stuttering”

A) Disturbances in normal fluency and time patterning of speech, are inappropriate for individual’s age + language ability, persist over time and include 1+ of following:

1. Sound and syllable repetitions

2. Sound prolongations of consonants as well as vowels

3. Broken words (e.g., pauses w/in a word)

4. Audible or silent blocking (filled or unfilled pauses)

5. Circumlocutions (word substitutions to avoid problematic word)

6. Words produced with excess of physical tension

7. Monosyllabic whole-word repetitions (e.g., “I-I-I-I see him”)

B) Disturbances cause anxiety about speaking or limits communication

C) Onset of symptoms occurred in early developmental period

Social (Pragmatic) Communication Disorder

A) Persistent difficulties in social use of verbal & nonverbal communication as manifested by ALL of following:

1. Deficits in social communication (e.g., greeting, discoursing)

2. Impaired ability to change communication to match context or listener needs (e.g., speak differently to child than adult)

3. Difficulties following conversation/story-telling rules (e.g., taking turns in conversations, use of nonverbal cues)

4. Difficulties understanding implicitly stated, ambiguous, or nonliteral language (e.g., metaphors, making inferences)

B) Deficits produce functional limitations

C) Onset of symptoms occurred in early developmental period (deficits may not be apparent until social communication demands exceed limited capabilities)

Autism Spectrum Disorder

A) Persistent communication and interaction deficits as manifested by ALL of following (currently or in history)

1. Deficits in social-emotional reciprocity (e.g., fail to do back-and-forth conversations, reduced social responsiveness, reduced affect)

2. Deficits in nonverbal behaviors used for social interaction (e.g., poor eye contact, lack of facial expressions, reduced use of gestures)

3. Deficits in developing, maintaining, and understanding relationships (e.g., difficulties adjusting behaviors based on context, reduced interest in peers, impaired play skills)

B) Restricted, repetitive patterns of behavior, interests, or activities. Manifested by 2+ of following:

1. Stereotyped or repetitive motor movements, object-use, or speech

2. Insistence on sameness, inflexible routine adherence, or ritualized patterns of behavior (e.g., difficulties with change, wanting the same food everyday)

3. Highly restricted, fixated interests that are abnormal in intensity of focus

4. Hyper- or hyporeactivity to sensory input or unusual interest in sensory cues

C) Onset of symptoms occurred in early developmental period

Attention-Deficit/Hyperactivity Disorder

A) Persistent pattern of inattention and/or hyperactivity-impuslivity that interferes with functioning, as characterized by 1 or 2:

1) Inattention. 6+ symptoms for 6 months, negatively impact social/academic functioning

1. Poor detail-oriented; makes careless mistakes

2. Difficulties sustaining attention

3. Doesn’t seem to be listening when spoken to

4. Fails to follow through on or finish instructions or tasks

5. Difficulties organizing tasks and activities (e.g., poor time management, disorganized, fails to meet deadlines)

6. Avoids or dislikes sustained mental effort tasks (e.g., homework, writing reports, completing forms)

7. Often loses things (e.g., keys, books, wallets)

8. Easily distracted by extraneous stimuli or thoughts

9. Forgetful (e.g., to do chores, pay bills, return calls)

2) Hyperactivity and impulsivity. 6+ symptoms for 6 month, negatively impact social/academic functioning

1. Fidgets, squirms

2. Fails to remain in place (e.g., stay in seat or room)

3. Runs around, climbs (restlessness in teens+adults)

4. Fails to be quiet during leisure time

5. “On the go” (e.g., restless, driven, energetic)

6. Talks excessively

7. Blurts out answer for Q is completed (e.g., can’t wait their turn in conversations)

8. Difficulty waiting turn in (e.g., in line)

9. Interrupts or intrudes on others (e.g., use others’ things without permission, butts into conversations or activities, take over what others are doing)

B) Symptoms present before 12 years old

C) Symptoms present in 2+ settings

D) Symptoms clearly interfere with functioning

Specific Learning Disorder

A) Difficulties learning and using academic skills. 1+ symptoms for 6 months DESPITE interventions targeting difficulties.

1. Inaccurate, slow, effortful word reading (e.g., difficulty sounding out words)

2. Difficulty understanding meaning of what is read (e.g., understand syntax but not deeper meaning)

3. Difficulties with spelling

4. Difficulties with written expression (e.g., grammar mistakes, poor organization or clarity of content)

5. Difficulties with numbers or calculations

6. Difficulties with mathematical reasoning

B) Affected academic skills substantially below age expectations confirmed by assessment

C) Learning difficulties began during school age years but may not be fully manifest until demands outweigh capabilities

Coding:

a) Impaired reading; “dyslexia” (i.e., word reading accuracy, reading rate or fluency, reading comprehension)

b) Impaired written expression (i.e., spelling accuracy, gramary & punctuation accuracy, clarity & organization of written expression)

c) Impaired mathematics; “dyscalculia” (i.e., number sense, memorize arithmetic facts, accurate or fluent calculations, accurate math reasoning)

Stereotypic Movement Disorder

A) Repetitive, driven, apparently purposefully motor behavior (e.g., hand-shaking, head-banging, self-biting)

B) Repetitive motor behavior interferes with activities and may result in self-injury

C) Onset of symptoms occurred in early developmental period

D) Not attributable to substances, OCD, other mental disorder

Tourette’s Disorder

A) Both multiple motor AND 1+ vocal tics have been present

B) Tics wax and wane in frequency but persisted for 1yr+ since first tic onset

C) Onset before 18 years

Persistent (Chronic) Motor or Vocal Tic Disorder

A) Single or multiple motor or vocal tics present during illness, but not both at same time

B) Tics wax and wane in frequency but have persisted for 1yr+ since first tic onset

C) Onset before 18 years

E) Criteria NEVER met for Tourettes

Provisional Tic Disorder

A) Single or multiple motor and/or vocal tics

B) Tics present for less than one year since first tic onset

C) Onset before 18 years

E) Never met criteria Tourette’s or persistent tic disorder

Delusional Disorder

A) Presence of 1+ delusion for 1+ month

B) Criterion A for schizophrenia never met

C) Besides delusions and their ramifications, functioning is not markedly impaired nor is behavior odd

D) Any manic or depressive episodes brief relative to duration of delusion periods

Specifiers

1. Erotomanic (That person is in love with me)

2. Grandiose (I have great but unrecognized talent)

3. Jealous (My spouse is cheating on me)

4. Persecutory (Someone is after me)

5. Somatic (Something is wrong with my body)

6. Mixed

7. Unspecified

Brief Psychotic Disorder

A) Presence of 1+ of following (one MUST be 1, 2, or 3)

1. Delusions

2. Hallucinations

3. Disorganized speech

4. Grossly disorganized or catatonic behavior

B) Duration at least 1 day but less than 1 month

Schizophreniform Disorder

A) 2+ following for at least 1 month (must incl. 1, 2, or 3)

1. Delusions

2. Hallucinations

3. Disorganized speech

4. Grossly disorganized or catatonic behavior

5. Negative symptoms (e.g., diminished emot. expression, avolition)

B) At least 1 month but less than 6 months

C) Schizoaffective and depressive/bipolar with psychotic features have been ruled out; dep/manic episodes are NOT concurrent with psychotic episodes

Schizophrenia

A) 2+ following for at least 1 month (must incl. 1, 2, or 3)

1. Delusions

2. Hallucinations

3. Disorganized speech

4. Grossly disorganized or catatonic behavior

5. Negative symptoms (e.g., diminished emot. expression, avolition)

B) Functioning in 1+ life domains significantly diminished relative to original functioning

C) Continuous signs of disturbance for at least 6 months

D) Schizoaffective and depressive/bipolar with psychotic features have been ruled out; dep/manic episodes are NOT concurrent with psychotic episodes

F) If history of autism or communication disorder, schizophrenia only added if prominent delusions and hallucinations (and other criteria) present for at least 1 month

Schizoaffective disorder

A) Uninterrupted period with concurrent mood (depressive or manic) and psychotic episodes. Major depressive MUST includes depressed mood.

B) Delusions or hallucinations for 2+ weeks in absence of mood episode during illness lifetime

C) Major mood symptoms present for majority of illness effects

Specify if bipolar or depressive type

Substance/Medication-Induced Psychotic Disorder

A) Presence of delusions and/or hallucinations

B) Evidence that both

1. Symptoms of Criterion A developed during or soon after substance or medication intoxication or withdrawal

2. Involved substance/medication is capable of producing Criterion A symptoms

C) Disturbances not better explained by psychotic disorder NOT substance/medication-induced (i.e., psychotic disorder present outside of subs/meds)

D) Disturbance does not occur exclusively during course of delirium

Catatonia

A) Clinical picture dominated by 3+ of following:

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

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

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

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

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

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

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

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

9. Agitation, not influenced by external stimuli

10. Grimacing

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

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

Bipolar I Disorder

Manic episode required; depressive episode common but NOT required

Manic Episode

A) Distinct period of elevated, expansive, or irritable mood and increased activity/energy; lasts at least a week and present for most days.

B) During mood disturbance, 3+ following (four if mood only irritable) present and represent notable change from usual behavior

1. Inflated self esteem; grandiosity

2. Decreased need for sleep (e.g., feel rested after only 3 hours)

3. More talkative than usual; pressured speech

4. Flight of ideas or “racing” thoughts

5. Distractible

6. Increase in goal-directed activity (either socially, occupationally/academically, sexually)

7. Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

C) Mood disturbances severe enough to cause marked functional impairments OR require hospitalizations to prevent harm to self or others

D) Episode not due to substances or medical condition

Major Depressive Disorder/Episode

A) 5+ of following symptoms have been present during same 2-week period, represent change in previous functioning. At least one symptom MUST be criterion 1 (depressed mood) or 2 (loss of interest or pleasure)

1. Depressed mood (can be irritable mood in youth)

2. Loss of interest or pleasure in most/all activities nearly everyday

3. Significant weight gain/loss or increased/decreased in appetite

4. Insomnia or hypersomnia

5. Psychomotor agitation or retardation (observable by others, NOT merely self-report)

6. Fatigue or loss of energy

7. Feelings of worthless or excessive/inappropriate guilt

8. Diminished concentration, focus, thinking, decisiveness

9. Recurrent thoughts of death, SI, suicide attempt, specific plan

Bipolar II Disorder

Hypomanic episode AND depressive episode required

Hypomanic episode

A) Distinct period of elevated, expansive, or irritable mood and increased activity/energy; lasts at least 4 consecutive days

B) During mood disturbance, 3+ following (four if mood only irritable) present and represent notable change from usual behavior

1. Inflated self esteem; grandiosity

2. Decreased need for sleep (e.g., feel rested after only 3 hours)

3. More talkative than usual; pressured speech

4. Flight of ideas or “racing” thoughts

5. Distractible

6. Increase in goal-directed activity (either socially, occupationally/academically, sexually)

7. Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

C+E) Mood disturbances NOT severe enough to cause marked functional impairments NOR require hospitalizations to prevent harm to self or others BUT represent marked change from typical functioning

F) Episode not due to substances or medical condition

Cyclothymic Disorder

A) At least 2 years (1 in youth) of multiple hypomanic-symptomatic periods that do not meet criteria for hypomanic episode AND multiple depressive-symptomatic periods that do not meet criteria for depressive episode

B) During same time frame as criterion A, symptoms have been present for at least half the time and individual has not been without symptoms for more than 2 months at a time

C) Criteria for major depressive, manic, or hypomanic episodes have never been met

D) Symptoms in criterion A not better explained by psychotic disorder

Disruptive Mood Dysregulation Disorder

A) Severe recurrent temper outbursts manifested verbally (e.g., verbal rages) and/or behaviorally (e.g., physical aggression towards people or property) that are grossly out of proportion in intensity or duration to situation or provocation

B) Temper outbursts inconsistent with developmental level

C) Temper outbursts occur, on average, 3+ times a week

D) Mood between outbursts is persistently irritable or angry MOD/NED, and is observable by others

E) Criterion A-D present for 12+ months with no period greater than 3 months where all of A-D criteria were not met

F) Criterion A and D present in at least 2 of 3 settings (i.e., home, school, w/ peers), and are severe in at least one of these

G) Dx should not be made for first time before 6 or after 18 years

H) Age of onset of A-E before 10 years

I) No distinct period lasting more than 1 day during which manic/hypomanic episode criterion met

J) Behaviors do NOT occur exclusively during major depressive episode and are not better explained by another disorder. NOTE: DMDD cannot be coexist with ODD, Intermittent Explosive Disorder, or Bipolar Disorder.

K) Not due to meds, substances, or neurological condition

Persistent Depressive Disorder

A) Depressed mood MOD, more days than not, for at least 2 years (1 year youth)

B) Presence, while depressed, of 2+ following

1. Poor appetite or overeating

2. Insomnia/hypersomnia

3. Low energy or fatigue

4. Low self-esteem

5. Poor concentration or difficulty making decisions

6. Feelings of hopelessness

C) During criterion A period, individual has never been without symptoms of A&B for more than 2 months at a time

D) Criteria for major depressive disorder may be continuously present for 2 years

E) NEVER been a manic or hypomanic

F) Not better explained by psychotic disorder

Separation Anxiety Disorder

A) Fear or anxiety concerning separation from attached figure; 3+ of following

1. Recurrent excessive distress when anticipating or experiencing separation from home or major attachment figures

2. Persistent excessive worry about losing major attachment figure or about possible harm to them (e.g., illness, injury, disasters, death)

3. Persistent excessive worry about experiencing untoward event that causes separation from attachment figure (e.g., getting lost, being kidnapped, becoming ill)

4. Persistent reluctance or refusal to go out (e.g., of home, to school) due to fear of separation

5. Persistent excessive fear of or reluctance about being alone or without attachment figure 

6. Persistent reluctance or refusal to sleep away from home or without being nearby attachment figure

7. Repeated nightmares involving theme of separation

8. Repeated complaints of physical symptoms (e.g., headaches, nausea) when separation from attached figure occurs or is anticipated

B) Lasts at least 4 weeks in youth or 6+ months in adults

D) Disturbance not better explained by another disorder (e.g., autism, agoraphobia)

Selective Mutism

A) Consistent failure to speak in specific social situations in which there is an expectation to for speaking (e.g., school) despite speaking in other situations

B) Disturbance interferes with educational or occupational achievement or other social communications

C) Duration at least 1 month (NOT limited to first month of school)

D) Failure to speak not attributable to lack of knowledge of or comfort with spoken language required in situation

E) Not better explained by communication disorder nor occurs exclusively during autism, schizophrenia, or other psychotic disorder

Specific Phobia

A) Marked fear or anxiety about a specific object or situation. NOTE: in children, fear/anxiety may show up as crying, tantrums, clinging, or freezing

B) Phobic object/situation almost always provokes immediate fear/anx

C) Phobic object/situation actively avoided or endured with intense fear/anx

D) Fear/anx out of proportion to actual danger posed by object/situation or relative to sociocultural context

E) Fear, anx, or avoidance lasts at least 6+ months

Specifiers:

1. Animal

2. Natural environment (e.g., heights, water)

3. Blood-injection-injury

4. Situational (e.g., airplanes, elevators)

5. Other

Social Anxiety Disorder

A) Marked fear or anxiety about 1+ social situations in which individual is exposed to possible scrutiny by others (e.g., social interactions, being observed, performances)

B) Indiv fears they will act in a way or show anx symptoms that will be negatively evaluated (e.g., humiliating, embarrassing, lead to rejection, offend others)

C) Social situations almost always provoke fear or anxiety

D) Social situations avoided or endured with intense fear or anxiety

E) Fear/anx out of proportion to actual threat posed by social situation or relative to sociocultural context

F) Persistent, lasts 6+ months

Panic Disorder

A) Recurrent unexpected panic attacks, which constitutes an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes and includes 4+ of following:

1. Palpitations, pounding heart, or accelerated heart rate

2. Sweating

3. Trembling or shaking

4. Sensations of shortness of breath

5. Feelings of choking

6. Chest pain or discomfort

7. Nausea or abdominal distress

8. Dizzy, unsteady, light-hearted, or faint

9. Chills or heat sensations

10. Paresthesias (numbness or tingling)

11. Derealization or depersonalization

12. Fear of losing control or going crazy

13. Fear of dying

B) At least one attack followed by 1+ month of 1+ of following:

1. Persistent concern or worry about additional panic attacks or their consequences (e.g., heart attack, losing control)

2. Significant maladaptive change in behavior related to the attack (e.g., avoidance)

Agoraphobia

A) Marked fear/anx about 2+ of following

1. Using public transportation

2. Being in open spaces (e.g., parking lots, bridges)

3. Being in enclosed spaces

4. Standing in line or being in a crowd

5. Being outside of the home alone

B) Individual fears or avoids situations b/c worries escape might be difficult or help might not be available in event of panic-like symptoms or other incapacitating or embarrassing symptoms (e.g., falling down, incontinence)

C) Agoraphobic situations almost always provoke fear/anx

D) Agoraphobic situations actively avoided, require presence of companion, or are endured with intense fear or anxiety

E) Fear/anx out of proportion to actual danger or context

F) Fear/anx/avoidance lasts 6+ months

Note: Agoraphobia is dxed irrespective of panic disorder! They can be co-diagnosed if individual meets criteria for both. 

Generalized Anxiety Disorder

A) Anxiety/worry occurring more often than not for 6+ months about a number of events/activities

B) Individual finds it difficult to control the worry

C) Anx/worry associated with 3+ of following symptoms (only 1 symp required for children)

1. Restlessness or feeling on edge

2. Being easily fatigued

3. Difficulty concentrating or mind going blank

4. Irritability

5. Muscle tension

6. Sleep disturbances

Obsessive-Compulsive Disorder

A) Presence of obsessions, compulsions, or both.

Obsessions include:

1. Recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted, and that in most individuals causes marked anxiety or distress

2. Individual attempts to ignore or suppress such thoughts, urges, or images or to neutralize them with some other thought or action (i.e., compulsion)

Compulsions include:

1. Repetitive behaviors or mental acts that an individual feels driven to perform in response to an obsession or according to rigid rules

2. Behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or prevent a dreaded situation; however, they are not connected in realistic way to what they’re designed to neutralize/prevent OR are excessive

B) Obsessions/compulsions are time consuming (e.g., >1hr per day) or cause significantly clinical distress or impairment

Body Dysmorphic Disorder

A) Preoccupation with 1+ perceived defects or flaws in one’s appearance that are slight or not observable

B) Individual has performed or is performing repetitive behaviors (e.g., excessive grooming, reassurance seeking, mirror checking) or mental acts (e.g., self-other comparisons) in response to concerns

D) Preoccupation NOT better explained by body fat or weight in someone who meets criteria for an eating disorder

Specifier:

• With muscle dysmorphia

• Insight

Hoarding Disorder

A) Persistent difficulty discarding or parting with possessions, regardless of their actual value

B) Perceived need to save items and distress associated with discarding them

C) Difficulty tossing items results in accumulation of items that clutters and congests active living areas; if a space is uncluttered, it is due to 3rd party intervention (e.g., fam member)

Trichotillomania

Hair-pulling disorder

A) Recurrent pulling out of one’s hair, resulting in hair loss

B) Repeated attempts to decrease or stop hair pulling

Excoriation Disorder

“Skin-Picking”

A) Recurrent skin picking resulting in skin lesions

B) Repeated attempts to decrease or stop skin picking

Reactive Attachment Disorder

A) Consistent pattern of inhibited, emotionally withdrawn bx towards adult caregivers; must include both of following:

1. Rarely or minimally seeking comfort when distressed

2. Rarely or minimally responds to comfort when distressed

B) Persistent social and emotional disturbances characterized by 2+ of following:

1. Minimal social and emotional responsiveness to others

2. Limited positive affect

3. Episodes of unexplained irritability, sadness, or fearfulness even in nonthreatening interactions

C) Experienced a pattern of extremes of insufficient care; 1+ of following:

1. Social neglect or deprivation; caregiving adults failed to meet their basic emotional needs (i.e., comfort, stimulation, affection)

2. Repeated changes in primary caregivers that limit opportunities to form stable attachments

3. Rearing in unusual settings that severely limit opportunities for forming stable attachments (e.g., institutions with high child-to-caregiver ratios)

D) Care in criterion C presumed responsible for criterion A

E) Autism disorder NOT met

F) Evident before 5 years old

G) At least 9 months of developmental age

Disinhibited Social Engagement Disorder

A) Pattern of behavior in which a child actively approaches and interacts with unfamiliar adults and exhibits at least 2+ of following:

1. Reduced or absent hesitance in engaging with unfamiliar adults

2. Overly familiar verbal or physical behavior (not culturally or age appropriate)

3. Diminished or absent checking-in with caregivers after venturing away, even in unfamiliar settings

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

B) Criterion A behaviors not limited to impulsivity (e.g., ADHD) but include socially disinhibited bx

C) Experienced a pattern of extremes of insufficient care; 1+ of following:

1. Social neglect or deprivation; caregiving adults failed to meet their basic emotional needs (i.e., comfort, stimulation, affection)

2. Repeated changes in primary caregivers that limit opportunities to form stable attachments

3. Rearing in unusual settings that severely limit opportunities for forming stable attachments (e.g., institutions with high child-to-caregiver ratios)

D) Care in criterion C presumed responsible for criterion A

E) At least 9 months of developmental age

Posttraumatic Stress Disorder (older than 6)

A) Exposure to actual or threatened death, serious injury, or sexual violence in 1+ of following:

1. Directly witness event

2. Witness event occur to others

3. Learning event occurred to close family member or friend; if actual or threatened death, MUST have been violent or accidental

4. Experiencing repeated or extreme exposure to aversive details of events (e.g., first responders collecting human remains). NOTE: Media consumption doesn’t apply unless it’s work related.

B) Presence of 1+ INTRUSION symptoms

1. Recurrent, involuntary, intrusive distressing memories of event (or repetitive play in children)

2. Recurrent distressing dreams wherein content/affect is related to event (or distressing but unrecognizable content for kids)

3. Dissociative reactions (e.g., flashbacks) in which person feels or acts like they’re re-experiencing the event

4. Intense or prolonged psychological distress at exposure to cues that symbolize or resemble event (i.e., triggers)

5. Marked physiological reactions to cues that symbolize or resemble event (i.e., triggers)

C) Persistent AVOIDANCE of event-associated stimuli as evidenced by either/both:

1. Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or associated with the event

2. Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or associated with the event

D) Negative alterations in COGNITION AND MOOD associated with events, evidenced by 2+ of following:

1. Inability to remember important aspect of event (typically due to dissociative amnesia, NOT due to other factors like TBI or drugs)

2. Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., “I am bad,” “No one can be trusted,” “The world is dangerous”)

3. Persistent, distorted cognitions about the cause of consequence of event that lead individual to blame self or others

4. Persistent negative emotional state (e.g., anger, fear, guilt)

5. Markedly diminished interest or participation in significant activities

6. Feelings of detachment or estrangement from others

7. Persistent inability to experience positive emotions (e.g., happiness, satisfaction, love)

E) Marked alterations in AROUSAL AND REACTIVITY associated with events, evidenced by 2+ of following: 

1. Irritability or angry outbursts (with little/no provocation) typically expressed as verbal or physical aggression towards people or objects

2. Reckless or self-destructive behavior

3. Hypervigilance

4. Exaggerated startle response

5. Problems with concentration

6. Sleep disturbances

F) Duration of disturbance (criterion B-E) 1+ month

Acute Stress Disorder

A) Exposure to actual or threatened death, serious injury, or sexual violence in 1+ of following:

1. Directly witness event

2. Witness event occur to others

3. Learning event occurred to close family member or friend; if actual or threatened death, MUST have been violent or accidental

4. Experiencing repeated or extreme exposure to aversive details of events (e.g., first responders collecting human remains). NOTE: Media consumption doesn’t apply unless it’s work related.

B) Presence of 9+ of following symptoms from any of 4 categories, beginning or worsening after event occurred

1. INTRUSION

   1. Recurrent, involuntary, intrusive distressing memories of event (or repetitive play in children)

   2. Recurrent distressing dreams wherein content/affect is related to event (or distressing but unrecognizable content for kids)

   3. Dissociative reactions (e.g., flashbacks) in which person feels or acts like they’re re-experiencing the event

   4. Intense or prolonged psychological distress or marked physiological reaction at exposure to cues that symbolize or resemble event (i.e., triggers)

2. NEGATIVE MOOD

   1. Persistent inability to experience positive emotions (e.g., happiness, satisfaction, love)

3. DISSOCIATION

   1. An altered sense of reality of one’s surroundings or oneself (e.g., in a daze, time slowing, body dissociation)

   2. Inability to remember important aspect of event (typically due to dissociative amnesia, NOT due to other factors like TBI or drugs)

4. AVOIDANCE

   1. Efforts to avoid distressing memories, thoughts, or feelings about or associated with the event

   2. Efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or associated with the event

5. AROUSAL

   1. Sleep disturbances

   2. Irritability or angry outbursts (with little/no provocation) typically expressed as verbal or physical aggression towards people or objects

   3. Hypervigilance

   4. Exaggerated startle response

   5. Problems with concentration

C) Disturbance duration (criterion B symptoms) lasting between 3 days to 1 month after event

Adjustment Disorder

A) Development of emotional or behavioral symptoms in response to an identifiable stressor(s) occurring within 3 months of onset of stressors

B) Symptoms or behaviors clinically significant; either/both of following:

1. Marked distress out of proportion to severity or intensity of stressor (taking into account sociocultural/contextual factors)

2. Significant impairment in social, occupational, or other important areas of functioning

C) Stress-related disturbance does not meet criteria for another mental disorder and is not merely an exacerbation of a pre-existing mental disorder

D) Does not represent normal bereavement or is not better explained by prolonged grief

E) Once stressor or consequences terminated, symptoms do not persist for more than 6 additional months

Prolonged Grief Disorder

A) Death, of at least 12 months ago, of a person who was close to bereaved individuals (6 months in youth)

B) Since death, grief response characterized by either/both of following, which have been present MOD/NED to clinically significant degree:

1. Intense yearning/longing for deceased person

2. Preoccupation with thoughts or memories of deceased person (for youth, preoccupation may be circumstances of death)

C) Since death, 3+ of following present MOD/NED:

1. Identity disruption (e.g., feeling part of oneself has died) since death

2. Marked sense of disbelief about death

3. Avoidance of reminders that person is dead (in youth, may be efforts to avoid reminders)

4. Intense emotional pain (e.g., anger, bitter, sorrow) related to death

5. Difficulty reintegrating into one’s relationships and activities after death

6. Emotional numbness (e.g., absent/reduced emotional experience) due to death

7. Feeling life is meaningless due to the death

8. Intense loneliness as result of death

Dissociative Identity Disorder

A) Disruption of identity characterized by 2+ distinct personality states (in some cultures, “possession”) . Identity disruption involved marked discontinuity in sense of self and sense of agency, accompanied by related alterations in A/B/Cs, consciousness, memory, and/or sensory-motor functioning. Signs & symptoms may be self or other reported.

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

D) Disturbance not part of religiously or culturally accepted practice

Dissociative Amnesia

A) Inability to recall important autobiographical information, usually of a traumatic or stressful nature, inconsistent with ordinary forgetting (usually consisting of localized or selective amnesia for specific life event(s); or generalized amnesia for identity and life history)

Depersonalization/Derealization Disorder

A) Presence of persistent or recurrent experiences of either/both:

1. Depersonalization: Experiences of unreality, detachment, or being an outside observer with respect to one’s thoughts, feelings, sensations, body, or actions (e.g., perceptual alterations, distorted sense of time, numbness)

2. Derealization: Experiences of unreality or detachment with respect to surroundings (e.g., unrealness, foggy, lifeless, visually distorted, dreamlike)

B) During dep/der experiences, reality testing remains intact

Somatic Symptom Disorder

A) 1+ somatic symptoms that are distressing or disrupt daily life

B) Excessive thoughts, feelings, or behaviors related to somatic symptoms or associated health concerns as manifested by 1+ of following:

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

2. Persistently high level of anxiety about health or symptoms

3. Excessive time & energy devoted to symptoms or health concerns

C) Although any one somatic symptom may not be continuously present, the state of being symptomatic persists (6+ months)

Illness Anxiety Disorder

A) Preoccupation with 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 of developing a medical condition (e.g., genetic predisposition), the preoccupation is clearly excessive or disproportionate

C) High level of anxiety about health; individual easily alarmed by health status

D) Individual performs excessive health-related behaviors (e.g., repeatedly check body for signs of illness) or exhibits maladaptive avoidance (e.g., avoids hospitals)

E) Preoccupation present for 6+ (but specific feared illness may change)

Conversion Disorder

A) 1+ symptoms of altered voluntary motor or sensory function

B) Clinical findings produce evidence of incompatibility between symptom and recognized neurological or medical conditions

C) Symptom/deficit not better explained by another mental/medical condition

Factitious Disorder

Imposed on SELF or OTHER. Regardless, factitious disorder is given to the perpetrator, not victim.

A) Falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception

B) Individual presents self or other to others as ill, impaired, or injured

C) Deceptive behavior evident even in absence of obvious external rewards

D) Behavior not better explained by delusional disorder or other disorder

Pica

A) Persistent eating of non-nutritive, nonfood substances over a period of at least 1 month

B) Eating behavior inappropriate to developmental level of individual

C) Eating behavior not part of culturally, religiously, socially supported practice

D) If behavior co-occurs with another mental disorder or condition, it is severe to warrant additional clinical attention

Rumination Disorder

A) Repeated regurgitation of food over 1+ month period. Regurgitated food may be re-chewed, re-swallowed, or spit out.

B) Repeated regurgitation not attributable to gastrointestinal or other medical condition

C) Eating disturbance does not occur exclusively during course of anorexia, bulimia, binge-eating disorder, or avoidant/restrictive food intake disorder

D) If behavior co-occurs with another mental disorder or condition, it is severe to warrant additional clinical attention

Avoidant/Restrictive Food Intake Disorder

A) Eating/feeding disturbance (e.g., lack of interest in food; sensory issues; concern about aversive consequences of eating) associated with 1+ of following:

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

2. Significant nutritional deficiency

3. Dependence of enteral feeding or oral nutritional supplements

4. Marked interference with psychosocial functioning

B) Disturbance not better explained by lack of available food or culturally sanctioned practice

C) Disturbance does not occur exclusively in anorexia or bulimia, and there is NO evidence of disturbance in body weight/shape experiencing

D) If behavior co-occurs with another mental disorder or condition, it exceeds routine severity associated with that condition and thus warrants additional clinical attention

Anorexia Nervosa

A) Restriction of energy intake relative to requirements, leading to sign. low body weight (i.e., less than minimally normal or expected) in context of age, sex, developmental trajectory, and physical health

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

C) Disturbance in way one’s body weight or shape is experienced, undue influence of body weight/shape on self-eval, or persistent lack of recognition of seriousness of current low body weight

Specifiers:

1. Restricting

2. Binge-eating/Purging

Severity based on BMI

Bulimia Nervosa

A) Recurrent episodes of binge eating, which is characterized by both of following:

1. Eating, in discrete time period (e.g., within 2 hours) a definitely larger amount of food relative to typical eating of similar folks/time/circumstances

2. A sense of lack of control over eating during episodes (e.g., “I can’t stop”)

B) Recurrent inappropriate compensatory behaviors in order to prevent weight gain (e.g., vomiting, laxatives, fasting, excessive exercise)

C) Binge eating & compensatory bxs occur, on average, 1x week for 3+ months

D) Self evaluation unduly influenced by body shape and weight

E) Disturbance does not occur exclusively during anorexia episodes

Severity based on # of episodes of compensatory behaviors per week

Mild: 1-3

Moderate: 4-7

Severe: 8-13

Extreme: 14+

Binge-eating disorder

A) Recurrent episodes of binge eating, which is characterized by both of following:

1. Eating, in discrete time period (e.g., within 2 hours) a definitely larger amount of food relative to typical eating of similar folks/times/circumstances

2. A sense of lack of control over eating during episodes (e.g., “I can’t stop”)

B) Binge eating episodes associated with 3+ of following:

1. Eating much more rapidly than normal

2. Eating until feeling uncomfortably full

3. Eating large amounts of food when not physically hungry

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

5. Feeling disgusted with oneself, depressed, or guilty afterwards

C) Marked distress regarding binge eating is present

D) Binge eating occurs, on average, 1x a week for 3+ months

Severity based on # of binge eating episodes per week

Mild: 1-3

Moderate: 4-7

Severe: 8-13

Extreme: 14+

Enuresis

A) Repeated voiding of urine into bed or clothes (involuntary or intentional)

B) Bx either 2x a week for 3+ consecutive months or causes sign. distress or impairment

C) Chronological age or equivalent developmental level at least 5 years old

Encopresis

A) Repeated passage of feces into inappropriate places (e.g., clothes, floor; involuntary or intentional)

B) At least one such event occurs each month for at least 3+ months

C) Chronological age or equivalent developmental level at least 4 years old

Insomnia Disorder

A) Dissatisfaction with sleep quantity/quality; 1+ of following symptoms:

1. Difficultly initiating sleep

2. Difficulty maintaining sleep (e.g., frequent awakenings or problems returning to sleep after awakenings)

3. Early morning awakening with inability to return to sleep

B) Sleep disturbance causes distress or impairment

C) Occurs at least 3 nights a week

D) Present for at least 3 months

E) Sleep difficulty occurs despite adequate opportunity for sleep

F) Not attributable to another sleep disorder or issue