DSM-5-TR

GAD (> 6 months)

Excessive anxiety & worry, more days than not for 6 months or longer, about a number of events or activities. Difficult to control the worry. 3 out of 6 sx.

1) restlessness or feeling keyed up or on edge

2) easily fatigued

3) difficulty concentrating or mind going blank

4) irritability

5) muscle tension

6) sleep disturbance (insomnia, restless, non-restorative)

*only 1 sx required for children

Social Anxiety Disorder

A) Fear or anxiety about 1 or more social situations in which exposed to possible scrutiny, being observed, & performing in front of others

B) Fears that they will act in a way or show anxiety sx that will be negatively evaluated

C) Social situations almost always provoke fear or anxiety

D) Social situations are avoided or endured w/ intense fear or anxiety

E) Fear or anxiety out of proportion

F) Fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more

PTSD (> 1 month)

A) Exposure to actual or threatened death, serious injury, or sexual violence, 1 (or more):

1. directly experiencing the event

2. witnessing, in person, the event

3. learning the event occurred to close family/friend. In actual/threatened death must be accidental or violent

4. experiencing repeated or extreme exposure to aversive details of the event (i.e. 1st responders)

B) 1 (or more) intrusive sx associated with event:

1. recurrent, involuntary, & intrusive memories

2. recurrent distressing dreams related to the event

3. dissociative reactions (i.e. flashbacks) which they feel or act as if the event is recurring

4. intense or prolonged distress at exposure to cues of event

5. marked physiological reactions to cues

C) Persistent avoidance of stimuli associated with the event, by one or both of the following:

1. avoidance of or efforts to avoid distressing memories, thoughts, or feelings about the event

2. avoidance of or efforts to avoid external reminders

D) Negative alterations in cognitions and mood associated with the event, by 2 (or more):

1. inability to remember an important aspect of the event

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 event that leads to blaming self or others

4. persistent negative emotional state (i.e. anger, fear, guilt)

5. markedly diminished interest or participation in activities

6. feelings of detachment from others

7. persistent inability to experience positive emotions

E) Marked alterations in arousal & reactivity, by 2 (or more):

1. irritable bx & angry outbursts

2. reckless bx

3. hypervigilance

4. exaggerated startle response

5. problems with concentration

6. sleep disturbance (i.e. insomnia or restless)

*Acute Stress Disorder 3 days to 1 month

Somatic Sx Disorder

A) 1 or more somatic sx that are distressing or result in life disruption

B) Excessive thoughts, feelings, or bx related to the somatic sx or associated health concerns by at least 1 of:

1. disproportionate & persistent thoughts about the seriousness of one's sx

2. persistently high level of anxiety about health/sx

3. excessive time & energy devoted to these sx or concerns

Illness Anxiety Disorder

A) Preoccupation with having or acquiring serious illness

B) Somatic sx not present or, if present, are mild

C) High level of anxiety about health

D) Performs excessive health-related bx (i.e. checks for illness)

E) Illness preoccupation present for at least 6 months

Functional Neurological Sx Disorder (Conversion Dx)

A) 1 or more sx of altered voluntary motor or sensory function

B) Clinical findings don't collaborate sx's

OCD (Obsessions or Compulsions or Both)

A) Obsessions:

1. recurrent & persistent thoughts, urges, or images that are experienced & are intrusive & unwanted

2. attempts to ignore or suppress thoughts, urges, images

Compulsions:

1. repetitive bx (i.e. hand washing, ordering, checking) or mental acts (i.e. praying, counting, repeating words) that they feel driven to perform in response to obsessions

2. bx's aimed at preventing or reducing anxiety/distress, or preventing some dreaded event

B) obsessions or compulsions are time-consuming (i.e. take more than 1 hr per day) or cause significant distress/impairment

Agoraphobia

A) Marked fear or anxiety about 2 (or more):

1. using public transportation

2. being in open spaces

3. being in enclosed places (i.e. shops, theaters)

4. standing in line or being in a crowd

5. being outside of the home alone

B) Fears or avoids these situations because of thoughts that escape might be difficult or help not available

C) Situations almost always provoke fear or anxiety

D) Situations are actively avoided, require companion, or endured with intense fear or anxiety

E) Fear or anxiety out of proportion to situation

F) Fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more

Panic Dx

A) Recurrent unexpected panic attacks. An abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, during which time 4 (or more):

1. palpitations, pounding heart, increased HR

2. sweating

3. trembling or shaking

4. sensations of smothering or SOB

5. feelings of choking

6. chest pain or discomfort

7. nausea or abdominal distress

8. feeling dizzy, unsteady, light-headed, 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 1 attack followed by 1 month (or more) of 1 or both:

1. persistent concern or worry about additional panic attacks or their consequences (i.e. losing control, heart attach, etc)

2. significant maladaptive change in bx related to the attacks (i.e. changes made to avoid attacks)

Anorexia Nervosa

A) Restriction of energy intake relative to requirements, leading to significantly low body weight

B) Intense fear of gaining weight or becoming fat, or persistent bx that interferes w/ weight gain, even though low weight

C) disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-eval, or persistent lack of recognition of the seriousness of current low body weight

-Restricting type: last 3 months has not engaged in binge eating or purging bx

-Binge-eating/purging type: last 3 months has engaged in recurrent episodes of binge-eating or purging bx

Bulimia Nervosa

A) Recurrent episodes of binge eating by both:

1. eating, in a discrete period of time (i.e. within any 2 hr period), an amount of food that is definitely larger than what most people would eat

2. sense of lack of control over eating during the episode (i.e. feeling that one cannot stop eating or control what or how much)

B) recurrent inappropriate compensatory bx in order to prevent weight gain (i.e. vomiting, laxatives, diuretics, fasting, excessive exercise)

C) binge eating & inappropriate compensatory bx both occur, on average, at least once a week for 3 months

D) self- eval is unduly influenced by body shape & weight

E) disturbance does not occur exclusively during episodes of anorexia nervosa

Major Neurocognitive Disorder

A) Evidence of significant cognitive decline from a previous level of performance in one more cognitive domains (complex attention, executive function, learning or memory, language, perceptual-motor, or social cognition) based on:

1. concern of the individual, knowledgeable informant, or the clinician that there has been a significant decline in function

2. substantial impairment in cognitive performance, preferably documented by standardized neuropsych testing or, in its absence, another qualified clinical assessment

B) Cognitive deficits interfere w/ independence in everyday activities (i.e. paying bills or managing meds)

C) Cognitive deficits do not occur exclusively in delirium

D) Cognitive deficits are not better explained by another mental disorder

Minor Neurocognitive Disorder

Same as Major Neurocognitive Disorder, except does not interfere w/ everyday activities

Oppositional Defiant Disorder (ODD)

A) Pattern of angry/irritable mood, argumentative/defiant bx, or vindictiveness lasting at least 6 months, 4 (or more) of 8:

1. loses temper (angry/irritable mood)

2. touchy or easily annoyed (angry/irritable mood)

3. angry & resentful (angry/irritable mood)

4. argues w/ authority figures or, for children & adolescents, w/ adults (argumentative/defiant bx)

5. actively defies or refuses to comply w/ requests from authority figures or w/ rules (argumentative/defiant bx)

6. deliberately annoys others (argumentative/defiant bx)

7. blames others for their mistakes or misbehaviors (argumentative/defiant bx)

8. has been spiteful or indictive at least twice with the past 6 months (vindictiveness)

B) Associated w/ distress in the individual or others (i.e. family, peer group, work colleagues), or impacts negatively on social, educational, occupational, or other important areas

C) Bx's do not occur exclusively during mental/substance

Intermittent Explosive Disorder

A) Recurrent behavioral outbursts representing a failure to control aggressive impulses as manifested by either:

1. verbal aggression (i.e. temper tantrums, tirades, arguments) or physical aggression toward property, animals, or others, occurring twice weekly, on avg, for 3 months. Physical aggression does not result in damage or injury

2. Three behavioral outbursts involving damage or assault w/ injury against animal/others within 12 month period

B) Magnitude of aggressiveness expressed during outbursts grossly out of proportion

C) Recurrent aggressive outbursts are not premeditated or to achieve tangible objective (i.e. money, power, intimidation)

D) Marked distress in individual or impairment in function

E) At least 6 years of age

F) Not better explained by other mental dx

Conduct Disorder

A) Repetitive & persistent pattern of bx in which the basic rights of others or major age-appropriate societal norms or rules are violated, 3 (or more) of 15 in past 12 months, w/ at least 1 in past 6 months:

1. bullies, threatens, or intimidates (aggression)

2. initiates physical fights (aggression)

3. used a weapon that can cause serious harm (aggression)

4. physically cruel to people (aggression)

5. physically cruel to animals (aggression)

6. stolen while confronting victim (aggression)

7. forced someone into sexual act (aggression)

8. deliberately engaged in fire setting w/ intent to cause serious damage (destruction)

9. deliberately destroyed others' property, other than fire (destruction)

10. broken into someone's building or car (deceitfulness)

11. lies to obtain goods or favors or avoid obligations (deceitfulness)

12. stolen items of nontrivial value w/o confronting (deceitfulness)

13. stays out at night despite parental prohibitions, beginning age 13 (serious violation of rules)

14. run away from home overnight at least twice or once for a lengthy period (serious violation of rules)

15. truant from school, before age 13 (serious violation of rules)

B) Clinically significant impairment in social, academic, or occupational function

C) If 18 or older, criteria for Antisocial Personality not met

Gender Dysphoria

A) Marked incongruence between one's experienced/expressed gender & assigned gender, at least 6 months, 6 (or more) of 8:

1. desire to be of the other gender or insistence that they are

2. in boys, preference for cross-dressing or simulating female attire; in girls, preference for wearing only masculine clothing & resistance to wearing female clothing

3. preference from cross-gender roles in play

4. preference for toys, games, or activities stereotypically of other gender

5. preference for playmates of other gender

6. in boys, rejection of masculine toys/games & avoidance of rough-&-tumble play; in girls, rejection of feminine toys/games

7. strong dislike of one's sexual anatomy

8. desire for primary &/or secondary sex characteristics of preferred gender

B) Clinically significant distress or impairment in social, school, or other areas

Disruptive Mood Dysregulation Disorder (Depressive Dx)

A) Severe recurrent temper outbursts manifested verbally &/or behaviorally (i.e. physical aggression) that are out of proportion

B) Temper outbursts inconsistent w/ developmental level

C) Outbursts occur, on avg, 3 or more times per week

D) Mood between outbursts is persistently irritable or angry and observable by others

E) Criteria A-D present for 12 or more months. No period lasting 3 or more consecutive months w/t all sx A-D

F) Criteria A-D present in at least 2 of 3 settings (home, school, w/ peers)

G) Dx between 6-18 yrs of age

H) By observation age of onset before 10 yrs of age

I) Never a period lasting more than 1 day during which full criteria for manic/hypomanic met

J) Bx don't occur exclusively during episode of MDD & not better explained by other mental dx

Major Depressive Disorder

A) 5 (or more) of 9 present during 2-wk period & change from previous function; at least 1 sx (1) depressed or (2) anhedonia;

1. depressed most of day, nearly every day, either subjective (i.e. feels sad, empty, hopeless) or observation (i.e. tearful)

2. diminished interest or pleasure in almost all activities most of the day, nearly every day (subjective or objective)

3. significant weight loss or gain (i.e. 5% body weight change in month) or decrease in appetite

4. insomnia or hypersomnia

5. psychomotor agitation or retardation (observable by others)

6. fatigue or loss of energy

7. feelings of worthlessness or excessive/inappropriate guilt (which may be delusional) (not merely self-reproach or guilt about being sick)

8. diminished ability to think or concentrate, or indecisiveness (subjective or observed)

9. recurrent thoughts of death, recurrent SI, or suicide attempt

Mild: few, if any, sx in excess of those required to make dx present, intensity if distressing but manageable, sx result in minor impairment

Moderate: number of sx, intensity of sx, &/or impairment between mild & severe

Severe: number of sx substantially in excess of that required to make dx, intensity of sx seriously distressing & unmanageable, markedly interfere w/ function

Persistent Depressive Disorder (Dysthymic Disorder)

A) Depressed most of the day, for more days than not, by either subjective or observation, for at least 2 yrs

B) Presence, while depressed, of 2 (or more) of 6;

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 2 yr period never w/o sx for more than 2 months at a time

D) Criteria for MDD may by continuously present for 2 yrs

E) Never a manic or hypomanic episode

Bipolar 1 Disorder

At least 1 lifetime manic episode criteria met w/ or w/o hypomanic or major depressive episode.

Note: manic episode that emerges during antidepressant tx, but persists at a fully syndromal level beyond the physiological effect of tx is sufficient evidence for manic episode & BP1 dx

Manic Episode

A) Abnormally & persistently elevated, expansive, or irritable mood & increased activity or energy, lasting at least 1 wk & present most of the day, nearly everyday (or hospitalization)

B) During period 3 (or more) of 7;

1. inflated self-esteem or grandiosity

2. decreased need for sleep (i.e. rested after only 3 hr)

3. more talkative or pressure to keep talking

4. flight of ideas or subjective experience that thoughts are racing

5. distractibility, reported or observed

6. increase in goal-directed activity or psychomotor agitation (i.e. purposeless non-goal-directed activity)

7. excessive involvement in activities that have high potential for painful consequences (i.e. buying sprees, sexual inhibition, foolish business investments)

Bipolar 2 Disorder

Must meet criteria for current or past hypomanic episode & current or past major depressive episode.

Note: hypomanic episode that emerges during antidepressant tx, but persists at a fully syndromal level beyond the physiological effect of tx is sufficient evidence for hypomanic episode. Caution that 1 or 2 sx (particularly increased irritability, edginess, or agitation following antidepressant use) not sufficient for hypomanic dx

Hypomanic Episode

A) Abnormally & persistently elevated, expansive, or irritable mood & increased activity or energy, lasting at least 4 days & present most of the day, nearly everyday

B) During period 3 (or more), 4 (or more) if mood only irritable;

1. inflated self-esteem or grandiosity

2. decreased need for sleep (i.e. rested after only 3 hr)

3. more talkative or pressure to keep talking

4. flight of ideas or subjective experience that thoughts are racing

5. distractibility, reported or observed

6. increase in goal-directed activity or psychomotor agitation (i.e. purposeless non-goal-directed activity)

7. excessive involvement in activities that have high potential for painful consequences (i.e. buying sprees, sexual inhibition, foolish business investments)

C) Unequivocal change in function & uncharacteristic

D) disturbance in mood & change in function observable

E) not severe enough to cause marked impairment or hospital

Catatonia

3 (or more) or 12;

1. stupor (no psychomotor activity)

2. catalepsy (passive induction of posture against gravity)

3. waxy flexibility (slight, even resistance to positioning)

4. mutism (no, or very little, verbal response, not aphasia)

5. negativism (opposition or no response to instructions or external stimuli)

6. posturing (spontaneous & active maintenance of posture against gravity)

7. mannerism (odd, circumstantial caricature or normal actions)

8. stereotypy (repetitive, abnormally frequent, non-goal directed movements)

9. agitation, not influenced by external stimuli

10. grimacing

11. echolalia (mimicking another's speech)

12. echopraxia (mimicking another's movements)