ABNORMAL PSYCHOLOGY

ANXIETY DISORDERS

Disorder

Key Symptoms

Differential Diagnosis

Panic Attack (Specifier)

• Sudden onset of intense fear or discomfort that peaks within minutes.

• Physical symptoms like palpitations, pounding heart, or accelerated heart rate, shortness of breath or a feeling of being smothered etc.

• Psychological symptoms including fear of losing control or going crazy and dying

Two types: expected & unexpected (nocturnal panic attack)

Note: It is not a mental disorder and cannot be coded. Can be used as a specifier.

Panic Disorder has to be repeated unexpected panic attacks but full diagnostic criteria should be met

Panic Disorder

• Recurrent and unexpected panic attacks

• At least one panic attack is followed by persistent concern or worry about having more attacks or their consequences (e.g., fear of having a heart attack or "going crazy")

• Not attributable to other medical conditions, mental disorder or physiological effects of substance abuse

In contrast to generalized anxiety disorder, it is characterized by recurrent, unexpected panic attacks while GAD involves chronic, excessive worry across multiple life domains

In contrast to separation anxiety, it is marked by the fear of panic attacks occurring unexpectedly, regardless of the presence of attachment figures.

In contrast to social anxiety or social phobia, it focuses on the sudden onset of panic attacks that can occur unexpectedly in any context.

In contrast to agoraphobia, it centers on the occurrence of unexpected panic attacks regardless of location.

In contrast to selective mutism, it involves sudden and intense episodes of fear that may occur in any situation, not just speaking in social ones.

In contrast to specific phobia, it is defined by recurrent panic attacks that are not limited to a particular fear-inducing stimulus.

Generalized Anxiety Disorder

• Excessive worry and anxiety about various events or activities (e.g., work, school) that is difficult to control, occurring on more days than not for at least 6 months.

• Physical symptoms like restlessness, fatigue, concentration difficulties etc.(only needs 1 for children)

• Not attributable to physiological effects of substance abuse and is not better explained by another mental disorder.

In contrast to panic disorder, it involves chronic, excessive worry across various situations & not the sudden, unexpected panic attacks.

In contrast to separation anxiety, it involves pervasive worry about multiple life domains & not just fear of separation from attachment figures.

In contrast to social anxiety or social phobia, it involves generalized worry about various aspects of life instead of specifically on fear of social judgment and embarrassment.

In contrast to agoraphobia, it involves constant, nonspecific worry across different contexts & not concerned with fear of being in situations where escape might be difficult.

In contrast to selective mutism, it involves generalized anxiety and worry & not inability to speak in specific social situations due to underlying anxiety.

In contrast to specific phobia,it involves persistent worry across many aspects of life & not of fear of a single, specific object or situation.

Separation Anxiety Disorder

• Developmentally inappropriate and excessive fear or anxiety concerning separation from attachment figures

• Fear, anxiety, and avoidance lasts at least 4 weeks in children and adolescents and typically 6 months or more in adults

• Not better explained by other mental disorders

In contrast to panic disorder, the anxiety concerns the possibility of being away from attachment figures and worry about untoward events befalling them rather than being incapacitated by an unexpected panic attack.

In contrast to generalized anxiety disorder, the anxiety predominantly concerns separation from attachment figures.

In contrast to social phobia, they are worried about being separated from attachment figures.

In contrast to selective mutism,

In contrast to specific phobia,

In contrast to agoraphobia, they are not anxious about being trapped or incapacitated in situations from which escape is perceived as difficult in the event of panic-like symptoms.

Social Anxiety Disorder (Social Phobia)

• Intense fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others (e.g., public speaking, meeting new people).

• Fear of acting in a way that will be negatively evaluated (humiliation, embarrassment).

• Avoidance of social situations or enduring them with intense fear.

• The fear or anxiety is out of proportion to the actual threat posed by the social situation and lasts for 6 months or more.

Note: Performance anxiety is a specifier to which the fear is restricted to performing or speaking in public.

In contrast to panic disorder, the fear is about negative social evaluation & not the sudden onset of unexpected panic attacks in any situation.

In contrast to generalized anxiety disorder, it is specific to fear of social situations and judgment while GAD involves pervasive worry about various aspects of life.

In contrast to separation anxiety, it is driven by fear of negative evaluation in social settings rather than fear of separation from attachment figures.

In contrast to agoraphobia, it focuses on fear of being judged in social situations rather than fear of being trapped or unable to escape.

In contrast to selective mutism, it involves fear of negative judgment in social situations but individuals can still speak whereas selective mutism involves a consistent failure to speak in specific social settings.

In contrast to specific phobia, it centers on fear of social judgment & not fear of specific objects or situations unrelated to social evaluation.

Agoraphobia

• Marked fear or anxiety about two or more of the following situations: public transpo, being in open or enclosed spaces, standing in line or being in a crowd, and being outside of home alone.

• Fear or avoidance of these situations due to thoughts that escape might be difficult or help unavailable in case of panic-like symptoms or incapacitation.

• Avoidance of these situations or enduring them with intense fear.

In contrast to panic disorder, it involves avoidance of specific places due to fear of not escaping & not fear of panic attacks occurring unexpectedly in any context.

In contrast to generalized anxiety disorder, situation-specific (fear of places) & not pervasive, generalized anxiety across different life domains.

In contrast to separation anxiety, it is focused on fear of places or situations & not separation from attachment figures.

In contrast to social anxiety or social phobia, it is about the fear of places where one cannot escape & not inclined to fear social scrutiny or embarrassment.

In contrast to selective mutism, it is focused on the fear of public places & not the failure to speak in social situations.

In contrast to specific phobia, it involves fear across multiple settings related to escape difficulties & not centered on a particular object or scenario.

Selective Mutism

• Consistent failure to speak in specific social situations (e.g., at school) where there is an expectation to speak, despite speaking in other situations (e.g., at home).

• The disturbance interferes with educational or occupational achievement or social communication.

• The duration of the disturbance is at least 1 month (not limited to the first month of school).

• Not due to lack of knowledge of or comfort with the spoken language required in the social situation and is not explained by a communication disorder.

In contrast to panic disorder, it focuses on the failure to speak due to specific social situations and not about worries of another panic attack.

In contrast to generalized anxiety disorder, anxiety is situation-specific (related to speaking) not generalized.

In contrast to separation anxiety disorder, it is tied to verbal communication in social contexts not fear of separation from attachment figures.

In contrast to social phobia or social anxiety disorder, it can be associated with selective mutism and in such cases, both diagnoses may be given.

In contrast to agoraphobia, it is related to the fear of speaking in certain settings & not fear of being in specific places where escape is perceived as difficult.

In contrast to specific phobia, it involves anxiety tied to verbal communication in certain social contexts & not fear of a specific object or situation that triggers avoidance or distress.

Specific Phobia

• Marked fear or anxiety about a specific object or situation (e.g., flying, heights, animals, injections).

• The phobic object or situation almost always provokes immediate fear or anxiety.

• The phobic object or situation is actively avoided or endured with intense fear or anxiety.

• The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation.

Note: It is common for individuals to have multiple specific phobias.

In contrast to panic disorder, anxiety is triggered by a particular object or situation.

In contrast to generalized anxiety disorder, it is related to specific, isolated stimuli or situations.

In contrast to separation anxiety disorder, it is focused on fear of non-relational, isolated stimuli (e.g., animals, flying, heights).

In contrast to social anxiety disorder (social phobia), the fear is of a specific object or situation without social scrutiny.

In contrast to agoraphobia, it involves fear of a particular object or situation that may not relate to escape concerns.

In contrast to selective mutism, a broader fear of certain non-social stimuli (e.g., animals, heights).

TRAUMA- AND STRESSOR-RELATED DISORDERS

Disorder

Key Symptoms

Differential Diagnosis

Reactive Attachment Disorder

• Inhibited, emotionally withdrawn behavior towards caregivers by rarely seeking and responding to comfort when distressed.

• Social and emotional disturbance through minimal social and emotional responsiveness to others, limited positive affect, and episodes of unexplained irritability, sadness, or fearfulness, even in nonthreatening situations.

• Children experience insufficient care patterns through social neglect or deprivation, with basic emotional needs unmet, frequent changes in primary caregivers, limiting stable attachment formation, rearing in environments (e.g., institutions) that hinder selective attachments.

• Disturbances presumed to result from inadequate care. Symptoms must not meet criteria for autism spectrum disorder, persist more than 12 months and is severe if all symptoms are high levels.

• Evident before age 5, with a developmental age of at least 9 months.

In contrast to DSDE, it features indiscriminate sociability with strangers.

In contrast to PTSD, re-experiencing trauma and hyperarousal.

In contrast to ASD, temporary and occurs shortly after trauma.

In contrast to Adjustment disorder, response to specific life stressors.

Disinhibited Social Engagement Disorder

Social Interaction with Unfamiliar Adults:

• Actively approaches and interacts with unfamiliar adults, demonstrating at least two of the following behaviors:

  • Reduced Reticence: Lacks hesitation in approaching unfamiliar adults.

  • Overly Familiar Behavior: Exhibits inappropriate verbal or physical interactions.

  • Absence of Checking Back: Does not return to caregiver after exploring, even in unfamiliar environments.

  • Willingness to Leave: Easily goes off with an unfamiliar adult with minimal hesitation.

Not Just Impulsivity:

• Behaviors are characterized by socially disinhibited conduct rather than mere impulsivity, distinguishing it from attention-deficit/hyperactivity disorder (ADHD).

History of Insufficient Care:

• Child has experienced a pattern of extreme insufficient care, evidenced by:

  • Social Neglect: Lack of emotional needs (comfort, stimulation, affection) met.

  • Frequent Changes in Caregivers: Changes that hinder stable attachments (e.g., frequent foster care changes).

  • Unusual Rearing Conditions: Environments that limit opportunities for selective attachments (e.g., high child-to-caregiver ratios in institutions).

Connection Between Care and Behavior:

• The disturbed behaviors in Criterion A are presumed to be a result of the insufficient care experienced in Criterion C.

Developmental Age:

• The child must have a developmental age of at least 9 months.

In contrast to RAD, emotional withdrawal and limited positive affect toward caregivers.

In contrast to PTSD, features re-experiencing trauma, avoidance, and hyperarousal.

In contrast to ASD, short-term response to trauma, with dissociative symptoms and hypervigilance.

In contrast to Adjustment disorder, involves emotional or behavioral symptoms in response to a specific stressor.

Posttraumatic Stress Disorder

Trauma Exposure:

• Directly experiencing, witnessing, learning about, or being repeatedly exposed to traumatic events involving death, injury, or sexual violence.

Intrusion Symptoms (One or More):

• Recurrent, distressing memories or dreams.

• Flashbacks or dissociative reactions.

• Psychological distress or physiological reactions to reminders of the trauma.

Avoidance Symptoms:

• Avoiding distressing memories, thoughts, or reminders of the trauma.

Negative Alterations in Cognitions and Mood (Two or More):

• Inability to remember key aspects of the trauma.

• Persistent negative beliefs or expectations.

• Distorted cognitions leading to self-blame.

• Negative emotional states and diminished interest in activities.

• Feelings of detachment or inability to experience positive emotions.

Alterations in Arousal and Reactivity (Two or More):

• Irritable behavior or angry outbursts.

• Reckless or self-destructive behavior.

• Hypervigilance, exaggerated startle response, concentration issues, and sleep disturbances.

Duration:

• Symptoms last more than 1 month.

Distress and Impairment:

• Symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning.

Exclusions:

• Symptoms are not due to substance effects or another medical condition.

In contrast to RAD, involves disturbed attachment behaviors due to inadequate caregiving, without trauma-focused symptoms

In contrast to DSDE, it features indiscriminate social behaviors due to neglect rather than a traumatic event.

In contrast to ASD, it has PTSD-like symptoms but occurs within 3 days to 1 month of the trauma and does persist.

In contrast to Adjustment disorder, arises from non-traumatic stressors, with less severe symptoms

Acute Stress Disorder

Trauma Exposure:

• Directly experiencing, witnessing, or learning about a traumatic event involving death, serious injury, or sexual violation.

Symptoms (Nine or More Symptoms from any of the 5 categories):

• Intrusion: Distressing memories, dreams, flashbacks, or strong reactions to reminders of the trauma.

• Negative Mood: Inability to experience positive emotions.

• Dissociation: Altered sense of reality or inability to recall aspects of the trauma.

• Avoidance: Efforts to avoid distressing memories or external reminders related to the trauma.

• Arousal: Sleep disturbances, irritability, hypervigilance, concentration problems, and exaggerated startle response.

Duration:

• Symptoms last 3 days to 1 month after the trauma.

Distress and Impairment:

• Symptoms cause significant distress or impairment in functioning.

Exclusions:

• Symptoms are not due to substance effects or other medical conditions and do not fit brief psychotic disorder criteria.

In contrast to RAD, emotional withdrawal in young children due to early neglect.

In contrast to DSDE, features indiscriminate social behavior due to neglect.

In contrast to PTSD, persists beyond one month post-trauma.

In contrast to Adjustment disorder, arises from non-traumatic stressors and lacks reactions typically tied to a traumatic event,

Adjustment Disorder

Onset of Symptoms:

• Symptoms develop within 3 months of exposure to an identifiable stressor.

Types of Symptoms:

• Emotional or behavioral symptoms may include:

  • Anxiety

  • Depressed mood

  • Irritability

  • Difficulty in social or occupational functioning

Clinically Significant Distress:

• Symptoms are clinically significant if they result in:

  • Marked Distress: Distress is out of proportion to the severity of the stressor.

  • Significant Impairment: Notable difficulty in social, occupational, or other important areas of functioning.

Exclusions:

• Symptoms do not meet the criteria for another mental disorder and are not a simple exacerbation of a preexisting disorder.

• Symptoms should not represent normal bereavement.

Duration of Symptoms:

• Symptoms do not persist for more than an additional 6 months after the stressor or its consequences have ended.

In contrast to RAD, develops from severe neglect during early childhood, leading to emotional withdrawal and inability to form healthy attachments.

In contrast to DSDE, overly familiar behavior towards strangers due to a lack of appropriate caregiving

In contrast to PTSD, it requires exposure to severe trauma and presents with specific traumatic symptoms.

In contrast to ASD, it occurs within 3 days to 1 month of a traumatic event and includes dissociative symptoms.

OBSESSIVE-COMPULSIVE AND RELATED DISORDER (OCD)

Disorder

Key Symptoms

Differential Diagnosis

Obsessive Compulsive Disorder

• Obsessions are persistent, intrusive thoughts, urges, or images that cause anxiety. Suppressing or neutralizing thought through actions (Compulsion: Repetitive behavior or mental process performed. Reducing anxiety is often excessive and not realistically connected to the feared outcome.

• Time-consuming, causing distress or impairment in other important areas of functioning.

• Not due to substance or another mental disorder.

• Individuals may recognize that their thoughts and behaviors are unreasonable or excessive, though insight can vary from good ( beliefs are definitely or probably not true or that they may or may not be true), poor (Probably true), absent (beliefs are true).

• In some cases, OCD can co-occur with tic disorders.

In contrast to Body dysmorphic, more on perceived physical flaws and compulsions revolve on appearance checking, grooming, and seeking reassurance.

In contrast to hoarding, strong attachment to possessions and is not distressing; it often feels purposeful and focuses in common items.

In contrast to trichotillomania. compulsive hair pulling without obsessive thoughts.

In contrast to excoriation, repetitive skin picking leads to tissue damage without obsessive thought.

Body Dysmorphic

• Preoccupation with one or more perceived physical defects that are minor or unobservable to others.

• Repetitive behaviors–causes distress or impairment in functional areas of life (e.g. Mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (eg. constant comparisons of appearance to others) in response to appearance concern.

• Not explained by concerns with body fat or weight related to eating disorders.

• With Muscle dysmorphia: Preoccupation with the belief that one's body is too small or insufficiently muscular.

• Insight on body dysmorphic beliefs vary from good (beliefs are definitely or probably not true or that they may or may not be true), poor (Probably true), absent (beliefs are true).

In contrast to OCD, obsessions are typically broader (not limited to appearance).

In contrast to hoarding, centered on possessions and clutter, unrelated to body image.

In contrast to trichotillomania, Hair pulling is a response to anxiety or tension.

In contrast to excoriation, skin picking is a response to tension or habit.

Hoarding

• Difficulty discarding possessions regardless of their value due to perceived need to save items and distress when discarding.

• Cluttered living areas to the point they cannot be used as intended which causes distress and impairment in functioning areas (safe environment).

• Not due to another medical or mental disorder.

• With excessive acquisition: difficulty discarding accompanied by obtaining unnecessary items or no available space.

• With insight: Ranges from good (recognizes problem), poor (mostly convinced not problematic despite evidence), absent (completely denies any issue).

In contrast to OCD, it's driven by obsessions like contamination and harm as it is highly distressing and unwanted.

In contrast to body dysmorphic, focuses on appearance-related items used to conceal or enhance perceived physical defects.

In contrast to Trichotillomania, Involves repetitive pulling of hair, not accumulation of objects.

In contrast to excoriation, focused on repetitive skin picking, not hoarding behavior.

Trichotillomania

• Recurrent hair pulling leading to noticeable hair loss with repeated attempts to stop or reduce hair pulling causing distress or impairment in daily functioning.

• Behavior not explained by medical or other mental disorders.

In contrast to OCD, hair-pulling may be part of symmetry rituals, but main focus is on preventing harm or achieving exactness.

In contrast to body dysmorphic, hair removal occurs due to perceived flaws in appearance

In contrast, hoarding involves the collection of items, with discarding anxiety.

In contrast to excoriation, focus on skin-picking, often in response to skin imperfections.

Excoriation

• Recurrent skin picking leading to skin lesions with repeated attempts to stop or reduce skin picking causing distress or impairment in daily functioning.

• Not attributed to the physiological effect of substance, medical condition, and mental disorder.

In contrast to OCD, skin picking may occur as a compulsion due to contamination obsessions.

In contrast to body dysmorphic, individuals may pick at their skin due to concerns about their appearance.

In contrast to hoarding, it leads to poor self-care, causing skin lesions.

In contrast to trichotillomania, while both involve repetitive behaviors, this focused on hair pulling.

SOMATIC SYMPTOM

Disorder

Key Symptoms

Differential Diagnosis

Somatic Symptom Disorder

• Distressing Somatic Symptoms: One or more physical symptoms that significantly disrupt daily life.

• Excessive Thoughts/Behaviors: Persistent thoughts of the severity of symptoms, high anxiety towards health/symptoms, or excessive time spent focused on health concerns.

• Chronic Condition: The symptoms or preoccupation with health last for more than 6 months.

In contrast to illness anxiety disorder, this has extensive worries and severe somatic symptoms.

In contrast to conversion disorder, focus is on distress particular symptom causes, not a loss of function (i.e. of a limb).

In contrast to factitious disorder, there is presence of somatic symptoms, no evidence of falsification.

Illness Anxiety Disorder

• Preoccupation with having or acquiring a serious illness, despite mild or no somatic symptoms.

• Excessive health-related anxiety and easily alarmed about personal health.

• Repeated health checks or avoidance of medical care.

• The illness preoccupation persists for at least 6 months.

• The preoccupation is not better explained by other mental disorders.

In contrast to somatic symptom disorder, individuals have minimal somatic symptoms and are primarily concerned with the idea of being ill.

In contrast to conversion disorder, this has none to minimal somatic symptoms, and preoccupied with getting ill

In contrast to factitious disorder, none to minimal presence of somatic symptoms, with no evidence of falsification.

Conversion Disorder (Functional Neurological Symptom Disorder)

• Altered Function: Involves one or more symptoms affecting voluntary motor or sensory function (e.g., paralysis, tremors, loss of sensation).

• Incompatibility: Clinical findings show a mismatch between symptoms and established neurological or medical conditions.

• Exclusion of Other Disorders: Symptoms cannot be better explained by other medical or mental disorders.

• Significant Distress: Symptoms lead to clinically significant distress or impairment in social, occupational, or other important areas of functioning

In contrast to somatic symptom disorder, both can be diagnosed together, but this is incompatible to pathophysiology (i.e. pain, fatigue), no excessive thoughts, feelings, and behaviors.

In contrast to illness anxiety disorder, this entails the severe loss of function of motor or sensations

In contrast to factitious disorder, it does not require proof that symptoms are NOT intentionally produced.

Factitious Disorder

Factitious Disorder Imposed on Self:

• Falsification of Symptoms: Deliberately faking physical or psychological signs or inducing injury/disease.

• Presentation: The individual presents themselves as ill or impaired.

• Deception: Behavior is deceptive without clear external rewards.

• Exclusion of Other Disorders: Not better explained by another mental disorder.

Factitious Disorder Imposed on Another:

• Falsification of Symptoms in Another: Inducing or faking symptoms in another person (the victim).

• Presentation: The individual presents the victim as ill or impaired.

• Deception: Behavior is deceptive without clear external rewards.

• Exclusion of Other Disorders: Not better explained by another mental disorder.

Both forms of factitious disorder involve deception without tangible external incentives.

In contrast to somatic symptom disorder, this needs evidence that an individual is providing false information or behaving deceptively.

In contrast to illness anxiety disorder, this needs evidence of falsification or deception of somatic symptoms.

In contrast to conversion disorder, it requires evidence of deceptive falsification of symptoms with neurological symptoms.

DISSOCIATIVE

Disorder

Key Symptoms

Differential Diagnosis

Dissociative Identity Disorder

• Disruption of Identity: Presence of two or more distinct personality states, leading to changes in behavior, consciousness, memory, perception, and cognition.

• Memory Gaps: Inability to recall important personal information, everyday events, or traumatic experiences that go beyond normal forgetting.

• Distress or Impairment: Symptoms cause significant distress or impairment in social, occupational, or other areas of functioning.

• Not Culturally Normal: The disturbance is not part of culturally accepted practices (e.g., possession in certain cultures).

• Not Substance-Induced: Symptoms are not due to substance use or medical conditions.

In contrast to Dissociative Amnesia, this entails the presence of distinct personality states or alters that typically changes the entire individual.

In contrast to Depersonalization/Derealization disorder, it involves identity disruption and alters.

Dissociative Amnesia

• Inability to Recall Important Autobiographical Information: Memory loss, typically related to traumatic or stressful events, that goes beyond normal forgetting.

• Localized or Selective Amnesia: Often involves memory gaps for specific events or periods, or in rare cases, generalized amnesia for one’s entire identity and life history.

• Significant Distress or Impairment: The memory loss causes distress or impacts social, occupational, or other areas of functioning.

• Not Due to Substance Use or Medical Conditions: The amnesia cannot be attributed to substances, medical conditions, or neurological factors.

• Not Better Explained by Other Disorders: The memory disturbance isn't due to other dissociative, stress, or cognitive disorders.

In contrast to DID, it is centered on memory loss without identity alteration, its amnesia is relatively stable.

In contrast to Depersonalization/Derealization disorder, it is characterized by memory loss related to personal identity or trauma

Depersonalization/Derealization Disorder

• Depersonalization: Persistent feelings of detachment from oneself, as if observing one's thoughts, feelings, or body from the outside.

• Derealization: A sense of unreality or detachment from surroundings, where people or objects seem dreamlike or distorted.

• Intact Reality Testing: Despite these experiences, the individual knows what is real and unreal.

• Distress or Impairment: The symptoms cause significant distress or impairment in daily functioning.

• Not Substance-Induced: Symptoms are not caused by drugs, medical conditions, or another mental disorder.

In contrast to DID, it manifests as feeling disconnected from oneself or reality but without identity disruption.

In contrast to Dissociative Amnesia, it involves feelings of detachment from oneself or the external world, with intact memory.

MOOD (DEPRESSION)

Disorder

Key Symptoms

Differential Diagnosis

Disruptive Mood Dysregulation Disorder

• Severe, recurrent temper outbursts (verbal or behavioral) that are grossly out of proportion to the situation.

• Outbursts occur on average three or more times per week.

• Mood between outbursts is persistently irritable or angry most of the day, nearly every day.

• Symptoms persist for 12 months or more, present in at least two settings (e.g., home, school, and peer settings)

• Not attributable to the physiological effects of substance abuse or other medical or neurological conditions.

Note: This condition is usually diagnosed between the ages of 6 and 18.

In contrast to major depressive disorder, it is characterized by severe temper outbursts and chronic irritability rather than consistent depressive episodes.

In contrast to dysthymia, it is marked by chronic irritability and frequent temper outbursts and not a consistently chronic low mood.

In contrast to premenstrual dysphoric disorder, it features persistent irritability and outbursts that are present year-round and are not cyclically related.

Major Depressive Disorder

• Depressed mood most of the day, nearly every day.

• Markedly diminished interest or pleasure in most activities (anhedonia).

• Significant weight loss or gain, or changes in appetite.

• Insomnia or hypersomnia nearly every day.

• Fatigue or loss of energy.

• Feelings of worthlessness or excessive guilt.

• Difficulty concentrating or indecisiveness.

• Recurrent thoughts of death or suicidal ideation.

• The symptoms should not be caused by a physical health condition or substance use and not be better explained by another mental health disorder like schizophrenia and not have experienced episodes of mania or hypomania.

Note: At least 5 of these symptoms for 2 weeks or longer.

In contrast to disruptive mood dysregulation disorder, it is characterized by persistent episodes of depressed mood and loss of interest or pleasure in adults or adolescents without severe temper outbursts.

In contrast to dysthymia, it presents with more intense depressive episodes but can be shorter in duration.

In contrast to premenstrual dysphoric disorder, it involves consistent depressive episodes that are not cyclically related to menstruation.

Persistent Depressive Disorder (Dysthymia)

• Chronic depressed mood for most of the day, for at least 2 years (1 year for children/adolescents).

• Along with a depressed mood, at least two of the following: poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, low self-esteem, poor concentration, or feelings of hopelessness.

• Symptoms are less severe than in Major Depressive Disorder, but more persistent.

In contrast to disruptive mood dysregulation disorder, it is characterized by a chronic, persistent low mood lasting for at least two years, with symptoms that are less severe but more enduring.

In contrast to major depressive disorder, it presents as a continuous low mood without the episodic angry outbursts.

In contrast to premenstrual dysphoric disorder, it represents a chronic state of low mood that is not tied to specific time periods or physiological changes.

Premenstrual Dysphoric Disorder

• Severe mood symptoms (e.g., mood swings, irritability, or anger) in the week before menstruation, improving shortly after menstruation begins.

• At least one of the following: depressed mood, anxiety, marked irritability, or emotional sensitivity.

• Physical symptoms include breast tenderness, bloating, or fatigue.

• The symptoms must occur in most menstrual cycles for at least a year.

• Symptoms cause significant distress or impairment in social, occupational, or other areas of functioning.

In contrast to disruptive mood dysregulation disorder, is specifically tied to the menstrual cycle and does not typically involve temper outbursts.

In contrast to major depressive disorder, it is characterized by significant mood symptoms that specifically emerge in the luteal phase of the menstrual cycle and improve shortly after menstruation begins.

In contrast to dysthymia, it presents with severe mood disturbances that are temporally linked to the menstrual cycle.

MOOD (BIPOLAR)

Disorder

Key Symptoms

Differential Diagnosis

Bipolar I Disorder

Manic Episode:

• Duration: At least 1 week (or any duration if hospitalization is needed).

• Mood Changes: Elevated, expansive, or irritable mood.

• Increased Energy: Abnormally increased activity or energy.

• Symptoms: Three or more of the following:

  • Grandiosity or inflated self-esteem.

  • Decreased need for sleep.

  • Increased talkativeness.

  • Racing thoughts or flight of ideas.

  • Distractibility.

  • Increased goal-directed activities or psychomotor agitation.

  • Engagement in high-risk activities.

Hypomanic Episode (may occur):

• Duration: At least 4 consecutive days.

• Mood Changes: Similar to manic episode but less severe.

• Symptoms: Same as those in a manic episode but do not cause marked impairment.

Major Depressive Episode (may occur):

• Duration: Symptoms present for at least 2 weeks.

• Symptoms: Five or more, including:

  • Depressed mood or loss of interest/pleasure.

  • Significant weight change or appetite disturbance.

  • Sleep disturbances (insomnia/hypersomnia).

  • Fatigue or loss of energy.

  • Feelings of worthlessness or guilt.

  • Diminished ability to think or concentrate.

  • Suicidal thoughts or behaviors.

Diagnosis Requirements:

• At least one manic episode is required for a diagnosis of Bipolar I Disorder.

• Episodes cannot be better explained by other psychotic disorders.

In contrast to Bipolar 2, it involves the presence of past episodes of mania

In contrast to Cyclothymic Disorder, it requires at least one manic episode, with symptoms being severe that last at least seven days.

Bipolar II Disorder

Hypomanic Episodes:

• Duration: Lasting at least 4 consecutive days.

• Mood Changes: Abnormally elevated, expansive, or irritable mood.

• Increased Activity/Energy: Noticeable change from usual behavior.

• Symptoms: At least three of the following:

  • Inflated self-esteem or grandiosity

  • Decreased need for sleep

  • Increased talkativeness or pressure to keep talking

  • Racing thoughts or flight of ideas

  • Distractibility

  • Increased goal-directed activities or psychomotor agitation

  • Excessive involvement in risky activities

Major Depressive Episodes:

• Duration: Present during the same 2-week period.

• Symptoms: At least five of the following:

  • Depressed mood or loss of interest/pleasure

  • Significant weight change or appetite change

  • Sleep disturbances (insomnia or hypersomnia)

  • Psychomotor agitation or retardation

  • Fatigue or loss of energy

  • Feelings of worthlessness or excessive guilt

  • Diminished ability to think or concentrate

  • Recurrent thoughts of death or suicidal ideation

No Manic Episodes:

• Individuals with Bipolar II Disorder have never experienced a manic episode.

Significant Distress or Impairment:

• The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

In contrast to Bipolar 1, this involves NO past episodes of mania

In contrast to Cyclothymic Disorder, this requires at least one major depressive episode, and full hypomanic and depressive episodes.

Cyclothymic Disorder

• Chronic mood fluctuations lasting at least 2 years (1 year in children/adolescents) involving numerous periods of hypomanic and depressive symptoms.

• Hypomanic and depressive symptoms are present for at least half the time, without symptom-free periods longer than 2 months.

• Symptoms do not meet the full criteria for a hypomanic episode, major depressive episode, or manic episode.

• The mood instability causes clinically significant distress or impairment in social, occupational, or other areas of functioning.

• Symptoms are not better explained by other psychotic disorders, substance use, or medical conditions.

In contrast to Bipolar 1, it requires no manic episodes, and its hypomanic and depressive symptoms are less severe and do not meet the full criteria.

In contrast to Bipolar 2, this involves no major depressive episodes and has milder hypomanic and depressive symptoms that do not meet the full criteria for either a hypomanic or major depressive episode.