dsm4.txt

1. Repetitive physical or mental actions that an individual feels compelled to perform in response to an obsession or according to rigid rules.

2. The mental actions or physical behaviors are intended to prevent or limit distress, or to avoid a feared event or situation. However, the chosen acts are not appropriately connected with the expected event or situation.

1. Repeated and persistent thoughts, impulses, or images that cause marked anxiety or distress and are both intrusive and inappropriate.

2. Not simply excessive worries about real-life problems.

3. The individual tries to ignore, suppress, or replace the thoughts, impulses, or images.

4. The individual realizes that the thoughts, impulses, or images come strictly from within their own mind.

• Delirium: consciousness disturbances and cognitive changes that develop in a brief period.
• Dementia: a set of cognitive deficiencies that include memory impairment.
• Amnestic disorder: memory impairment without other cognitive impairment.
• Cognitive Disorder Not Otherwise Specified.

• A. Conspicuous hallucinations or delusions.

• B. Either of these:

• -- 1. Criterion A symptoms developed during or within a month of Substance Intoxication or Withdrawal.
• -- 2. Medication use directly relates to the disturbance.

C. Not better described by a Psychotic Disorder that is not substance induced.

D. Not solely during delirium.

• At least three or more of the following:
• - 1. Efforts to avoid associated thoughts, feelings, or conversations.
• - 2. Efforts to avoid people, places, or activities that stimulate recollections of the trauma.
• - 3. Failure to recollect some important aspect of the trauma.
• - 4. Markedly reduced interest or participation in important activities.
• - 5. A sense of detachment or alienation from others.
• - 6. Restricted affective range.
• - 7. Sense of future life constrictions.

• Recurrence of at least one of the following:
• - 1. Images.
• - 2. Thoughts.
• - 3. Dreams.
• - 4. Illusions.
• - 5. Flashbacks.
• - 6. A sense of reliving the experience.
• - 7. Distress when reminded of the event.

• At least one of the following:
• - 1. Distressing recollections of the event that both recur and intrude.
• - 2. Distressing and recurring dreams of the event.
• - 3. Acting or feeling as if the event were recurring.
• - 4. Intense distress when exposed to cues that symbolize or are similar to the event.
• - 5. Physiological reactivity when exposed to cues that symbolize or are similar to the event.

• Frequent appearance of at least six of the relevant symptoms for at least 6 months:
• Hyperactivity
• -- Fidgets or squirms.
• -- Leaves seat against expectations.
• -- Runs or climbs when inappropriate.
• -- Inability to play quietly.
• -- "On the go".
• -- Talks excessively

• Impulsivity
• -- Gives answers before questions are complete.
• -- Problems waiting for their turn.
• -- Interrupts others.

• Frequent appearance of at least six of the following symptoms for at least 6 months:
• -- 1. Failure to pay attention to details, or makes careless mistakes.
• -- 2. Failure to sustain attention in tasks or play activities.
• -- 3. Failure to seemingly listen when directly addressed.
• -- 4. Failure to follow through on instructions or finish assignments.
• -- 5. Problems with task organization.
• -- 6. Failure to sustain required mental effort.
• -- 7. Frequently loses task-related items.
• -- 8. Easily distracted.
• -- 9. Consistently forgetful.

• At least two of the following:
• -- 1. Getting to sleep or staying asleep is difficult.
• -- 2. Testiness or outbursts of anger.
• -- 3. Concentration becomes difficult.
• -- 4. Excessive vigilance.
• -- 5. Startle response is exaggerated.

• Schizoaffective Disorder and Mood Disorder With Psychotic Features are ruled out because of either:
• 1. No Major Depressive, Manic, or Mixed Episodes have occurred in tandem with active-phase symptoms.
• 2. Total duration of any mood episodes occurring during active-phase symptoms is brief relative to active and residual periods

• A. The individual experiences a traumatic event that includes both:
• -- 1. Participating, witnessing, or confronting an event that involves actual or threatened death or serious injury.
• -- 2. Intense fear, helplessness, or horror.

• B. During or afterwards, the person has at least three dissociative symptoms.

• -- 1. Numbing, detachment, or absence of emotional responsiveness
• -- 2. Reduction in awareness of surroundings ("in a daze")
• -- 3. Derealization
• -- 4. Depersonalization
• -- 5. Dissociative amnesia

C. Persistent reexperiencing of the event in at least one way.

D. Avoiding stimuli that recall the trauma.

E. Marked symptoms of anxiety or increased arousal.

F. Distress or impairment in social, occupational, or other important functioning.

G. Occurs within 4 weeks of the trauma. Lasts at least 2 days and at most 4 weeks.

H. Not caused by a substance or a general medical condition. Not simply a worsening of a preexisting Axis I or Axis II disorder.

• A. Since age 15, a disregard for and violation of others' rights as indicated by at least three of the following:
• -- 1. Illegal behavior.
• -- 2. Deceitfulness.
• -- 3. Impulsiveness.
• -- 4. Irritable and aggressive conduct.
• -- 5. Disregard for safety of others and self.
• -- 6. Irresponsible behavior.
• -- 7. Lack of remorse.

B. The person is at least age 18 years.

C. Conduct Disorder with onset prior to age 15.

D. Not solely during the course of Schizophrenia or a Manic Episode.

A. Obsessions or compulsions, prominent anxiety, or Panic Attacks.

B. A general medical condition directly causes the disturbance.

C. Not exclusively during delirium.

D. Distress or impairment in social, occupational, or other important functioning.

• A. Either Inattention or Hyperactivity-impulsivity

• B. Some impairment from item A symptoms appeared before age 7.

• C. Some symptomatic impairment appears in at least two settings.

• D. Obvious impairment in social, occupational, or academic functioning.

• E. Not solely during Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder.

Note: Attention-Deficit/Hyperactivity Disorder alone is not a diagnosis (need specifier - Combined / Predominantly Inattentive / Predominantly Hyperactive-Impulsive / NOS type).

• A. A total of six or more of the following items:
• -- 1. At least two symptoms of qualitative impairment in social interaction.
• -- 2. At least one symptom of qualitative impairment in communication.
• -- 3. At least one symptom of restricted repetitive and stereotyped patterns of behavior, interests, and activities.

• B. Delays or abnormalities in at least one of the following areas with onset prior to age 3:

• -- 1. Social interaction.
• -- 2. Social language communication.
• -- 3. Symbolic or imaginative play.

C. Not better accounted for by Rett's Disorder or Childhood Disintegrative Disorder.

• Marked impairment of multiple nonverbal behaviours
• Failure to develop peer relationships appropriate to developmental level
• Lack of spontaneous seeking to share enjoyment or achievements
• Lack of social/emotional reciprocity

• Delay or lack of development of spoken language without compensation through alternative modes
• Impaired ability to initiate or sustain conversation despite adequate speech
• Stereotyped/repetitive use of language or idiosyncratic language
• Lack of make-believe or social imitative play (for developmental level)

• Preoccupation of one or more stereotyped patterns that is abnormal in intensity
• Inflexible adherence to specific nonfunctional routines/rituals
• Stereotyped motor mannerisms
• Preoccupation with parts of objects

• A pervasive pattern of inadequacy, sensitivity, and inhibition, indicated by at least four of the following:
• -- 1. Avoids occupational activities involving interpersonal contact.
• -- 2. Shuns involvement with people unless sure of being liked.
• -- 3. Restrained in intimate relationships.
• -- 4. Preoccupied by criticism or social rejection.
• -- 5. Inhibition and feelings of inadequacy in new situations.
• -- 6. Feels inept, unappealing, or inferior.
• -- 7. Avoids personal risks or potentially embarrassing activities.

• Pervasive pattern of unstable interpersonal relationships, self-image, affects, and impulsivity as indicated by at least five of the following:
• -- 1. Frenzied efforts to avoid abandonment.
• -- 2. Vacillating, intense interpersonal relationships.
• -- 3. Identity disturbance.
• -- 4. Impulsiveness in two self-damaging areas.
• -- 5. Repeated suicidal behavior.
• -- 6. Affective instability.
• -- 7. Chronic feelings of emptiness
• -- 8. Inappropriate and intense anger.
• -- 9. Paranoid ideation or dissociation.

• A. At least one of these symptoms:
• -- 1. Delusions
• -- 2. Hallucinations
• -- 3. Disorganized speech
• -- 4. Behavior that is grossly disorganized or catatonic

B. Disturbance lasts from 1 day to less than 1 month with return to premorbid levels.

C. Not better described by Mood Disorder With Psychotic Features, Schizoaffective Disorder, or Schizophrenia.

• At least two of the following symptoms appear for a significant portion of a one month period:
• 1. Delusions.
• 2. Hallucinations.
• 3. Disorganized speech.
• 4. Grossly disorganized or catatonic behavior.
• 5. Negative symptoms.

• 
  less than 1 month required if successfully treated
• 
  only 1 symptom required if bizarre delusion, or Ah of running commentary or 2+ voices conversing

• If there is any history of Autistic Disorder (or some other Pervasive Developmental Disorder), make the additional diagnosis of Schizophrenia only if:
• 1. Conspicuous delusions or hallucinations are present.
• 2. Duration is at least one month.
• 3. Duration is less than one month if successfully treated.

• A. A repetitive and persistent pattern of violating major age-appropriate societal norms or the rights of others. Requires at least three symptoms in the past 12 months (at least one in the past 6 months):
• -- 1. Aggression to people and animals.
• -- 2. Destruction of property.
• -- 3. Deceitfulness or theft.
• -- 4. Serious violations of rules.

B. Impairment in social, academic, or occupational functioning.

C. For individuals 18 years or older, criteria not met for Antisocial Personality Disorder.

• A. Nonbizarre delusions lasting at least 1 month.

• B. Item "A" for Schizophrenia never met.

C. Functioning not impaired and behavior not odd or bizarre.

D. If mood episodes occur concurrent with delusions, they have been brief relative to the delusional periods.

E. Not caused by a substance or a general medical condition.'

• Extreme need to be taken care of as indicated by at least five of the following:
• -- 1. Difficulty in decision-making.
• -- 2. Requires others to bear responsibility in major areas of his or her life.
• -- 3. Has difficulty disagreeing with others.
• -- 4. Difficulties in initiating projects.
• -- 5. Goes to lengths to obtain support of others.
• -- 6. Uncomfortable or helpless when alone.
• -- 7. Urgently needs care and support from a new relationship when a close bond ends.
• -- 8. Unrealistic fears about taking care of himself or herself.

• Continuous signs for at least 6 months.
• At least 1 month meets item "A" active-phase symptoms.
• May include periods of prodromal or residual symptoms
• During prodromal or residual periods, signs may include only negative symptoms or at least two item "A" active-phase symptoms (in attenuated form).

A. Depressed mood for most of day, for more days than not for at least 2 years.

• B. At least two symptoms:

• -- 1. appetite change
• -- 2. sleep change
• -- 3. low energy
• -- 4. low self-esteem
• -- 5. poor concentration or decision making
• -- 6. hopelessness

C. Symptoms in Items A and B never disappear for more than 2 months at a time.

D. No Major Depressive Episode has been present during the first 2 years (or prev. full remission).

E. Has never been a Manic, Mixed or Hypomanic Episode, or a Cyclothymic Disorder.

F. Not solely during a chronic Psychotic Disorder.

G. Not due to a substance or a general medical condition.

H. Distress or impairment in social, occupational, or other important functioning.

A. Repeated release of feces into inappropriate places. Can be involuntary or intentional.

B. Once a month or more, for at least 3 months.

C. At least 4 years old (chronological age or equivalent developmental level).

D. Not due exclusively to a substance or a general medical condition, excepting a mechanism involving constipation.

• A. Repeated urination in bed or clothes. Can be involuntary or intentional.

• B. Twice a week for at least 3 consecutive months. Or causes distress or impairment in social, occupational, or other important functioning.

• C. At least 5 years old (chronologically, or equivalent developmental level).

• D. Not due solely to a substance or a general medical condition.

• A. Excess anxiety and worry about a number of events for more days than not for at least 6 months.

• B. Difficulty in controlling the worry.

• C. Three or more specific symptoms.

• -- 1. restlessness, keyed up, on edge
• -- 2. easily fatigued
• -- 3. difficulty concentrating or mind blank
• -- 4. irritability
• -- 5. muscle tension
• -- 6. sleep disturbance

• D. Anxiety and worry not confined to aspects of an Axis I disorder and not limited to PTS

  D.

• E. Impairment in social, occupational, or other important functioning.

• F. Not due to a substance or a general medical condition. Not limited to Mood, Psychotic, or Pervasive Developmental Disorders.

• Pattern of seeking attention and extreme emotionality as indicated by at least five of the following:
• 1. Uncomfortable if not the center of attention.
• 2. Acts provocatively or sexually seductively.
• 3. Shifting and shallow expression of emotions.
• 4. Attracts attention with physical appearance.
• 5. Uses impressionistic, undetailed speaking style.
• 6. Uses theatrical expressions of emotion.
• 7. Is unduly suggestible.
• 8. Perceives more intimacy in relationships than actually exists.

• A. Presence of at least two Major Depressive Episodes.

• B. The episode is not better accounted for by Schizoaffective Disorder, and is not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

• C. No Manic Episode, Mixed Episode, or Hypomanic Episode has ever occurred.

• A. Presence of one Major Depressive Episode.

• B. The episode is not better accounted for by Schizoaffective Disorder, and is not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

• C. No Manic Episode, Mixed Episode, or Hypomanic Episode has ever occurred.

• A. A significantly below average IQ (70 and below).

• B. Simultaneous deficits in present adaptive functioning in at least two key areas.

• C. Onset before 18 years of age.

Note: Mental Retardation alone is not a diagnosis.

• Pervasive pattern of admiration seeking, grandiosity, and lack of empathy, that includes at least five of the following:
• 1. Grandiose feeling of self-importance.
• 2. Fantasizes success, power, brilliance, beauty, or love.
• 3. Sees self as special and unique.
• 4. Demands inordinate admiration.
• 5. Believes in self entitlement.
• 6. Exploits others.
• 7. Not empathetic.
• 8. Envies others or thinks they envy him or her.
• 9. Is arrogant or haughty.

• Pervasive pattern of perfectionism, control and orderliness as indicated by four or more of the following:
• 1. Preoccupation with details and order.
• 2. Perfectionism interferes with getting work done.
• 3. Work supercedes leisure activities.
• 4. Inflexible in moral and ethical matters.
• 5. Difficulty in discarding worthless objects.
• 6. Hesitates to delegate tasks or work with others.
• 7. Stingy spending habits.
• 8. Stubborn and rigid.

• A. Pattern of hostile and defiant behavior for at least 6 months, during which at least four symptoms are present (often...).
• -- 1. loses temper
• -- 2. argues with adults
• -- 3. actively defies or refuses to comply rules/requests
• -- 4. deliberately annoys people
• -- 5. blames others for own mistakes
• -- 6. touchy, easily annoyed
• -- 7. angry, resentful
• -- 8. spiteful, vindictive

• B. Impairment in social, academic, or occupational functioning.

• C. Not exclusively during Psychotic or Mood Disorders.

• D. Criteria not met for Conduct Disorder, and, if age 18 years or older, criteria not met for Antisocial Personality Disorder.

• A. Manifest hallucinations or delusions.

• B. Direct result of a general medical condition.

• C. Not solely during delirium.

• A. Uninterrupted period of illness that concurrently includes both:
• 1. Symptoms meeting Item "A" for Schizophrenia
• 2. Either a Major Depressive Episode, a Manic Episode, or a Mixed Episode.

B. Delusions or hallucinations for at least 2 weeks with no prominent mood symptoms.

C. Mood episode symptoms present for a large portion of the entire duration of the disorder's active and residual periods.

D. Not caused by a substance or general medical condition.'

• A. Detachment from relationships, and a limited range of emotional expression as indicated by at least four of the following:
• 1. Doesn't desire or enjoy close relationships.
• 2. Often selects solitary activities.
• 3. Little interest in sex with others
• 4. Few activities give pleasure.
• 5. Doesn't have close friends or confidants.
• 6. Apathetic to praise or criticism.
• 7. Demonstrates coolness or flattened affectivity.

B. Not solely during Schizophrenia, a Mood Disorder With Psychotic Features, another Psychotic Disorder, or a Pervasive Developmental Disorder. Also not due to a general medical condition.

• At least two of the following:
• 1. Motoric immobility.
• 2. Purposeless and excessive motor activity.
• 3. Extreme negativism or mutism.
• 4. Odd voluntary movements or mannerisms.
• 5. Echolalia or echopraxia.

• A. All of the following are prominent:
• 1. Disorganized speech.
• 2. Disorganized behavior.
• 3. Flat or inappropriate affect.

B. Not Catatonic Type.

A. One or more prominent delusions or repeated auditory hallucinations.

B. None of these is prominent: disorganized speech or behavior, catatonic behavior or flat or inappropriate affect.

A. No prominent delusions, hallucinations, disorganized speech, or catatonic or grossly disorganized behavior.

B. A continuing disturbance, indicated by either negative symptoms or at least two item "A" active-phase symptoms (in attenuated form).

• Item "A" symptoms are present.
• Not Paranoid, Disorganized, or Catatonic Type.

A. Items A, D, and E of Schizophrenia are met (symptoms, mood/sczaff/GMC exclusion)

B. An episode (including prodromal, active, and residual phases) lasts at least one month but less than six months.

• A. Excessive and developmentally inappropriate anxiety concerning separation from home or those to whom the person is attached, as evidenced by at least three symptoms (all persistent & excessive).
• -- 1. distress when separation occurs/anticipated
• -- 2. worry a/b losing or harm to attachment figures
• -- 3. worry that untoward event will cause separation
• -- 4. school reluctance/refusal (or elsewhere) due to this fear
• -- 5. fear/reluctance of being alone
• -- 6. reluctance/refusal to sleep w/o attachment figure
• -- 7. nightmares a/b separation
• -- 8. c/o physical symptoms when separation occurs/anticipated

• B. At least 4 weeks in duration.

• C. Onset precedes age 18.

• D. Distress or impairment in social, occupational, or other important functioning.

• E. Not solely during Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder. In adolescents and adults, is not better described by Panic Disorder With Agoraphobia.

• A. Delusion develops in a person who is in a relationship with another person who already has a delusion.

• B. Delusion is similar to the pre-established delusion of the other person.

• C. Not better described by another Psychotic Disorder or a Mood Disorder with Psychotic Features. Neither is it caused by a substance or a general medical condition.

• For a significant portion of time since disturbance onset, at least one of the following major functioning areas is(are) markedly below pre-onset level:
• 1. Work.
• 2. Interpersonal relations.
• 3. Self-care.

• A. Substance abuse with at least one of the following within a 12-month period:
• 1. Failure in work, school, home, or other major obligations.
• 2. Use of substance in physically dangerous situations.
• 3. Legal problems related to substance use.
• 4. Continued use despite consequent social or interpersonal problems.

B. Symptoms never met for Substance Dependence for given substance class.

Note: Substance Abuse alone is not a diagnosis. See each substance.

• Substance abuse with at least three of the following within a 12-month period:
• 1. Tolerance.
• 2. Withdrawal.
• 3. Increased substance consumption.
• 4. Wish to reduce or limit substance use.
• 5. Obtaining, using, or recovering from the substance consumes considerable time.
• 6. Elimination or reduction of social, occupational, or recreational activities.
• 7. Substance use continues despite awareness of consequent problems.

Note: Substance Dependence alone is not a diagnosis. See each substance.

• A. A reversible substance-specific syndrome develops due to ingestion of or exposure to a substance.

• B. Maladaptive psychological or behavioral changes caused by the substance during or shortly after use.

• C. Symptoms not due to a general medical condition.

Note: Substance Intoxication alone is not a diagnosis. See each substance.

Disturbance not due to a substance or a general medical condition.

• A. Substance-specific syndrome development caused by reducing or ceasing substance use.

• B. The substance-specific syndrome causes distress or impairment in social, occupational, or other important functioning.

• C. A general medical condition does not cause the symptoms.

Note: Substance Withdrawal alone is not a diagnosis. See each substance.

• At least three of the following:
• 1. Numbing, detachment, or lack of emotional responsiveness.
• 2. Reduced awareness of the individual's surroundings.
• 3. Derealization.
• 4. Depersonalization.
• 5. Dissociative amnesia.

• 1. Bullies, threatens, or intimidates.
• 2. Starts physical fights.
• 3. Has used a dangerous weapon.
• 4. Has been physically cruel to people.
• 5. Has been physically cruel to animals.
• 6. Has stolen from a victim.
• 7. Has forced sex on others.

• Destruction of Property:
• 8. Deliberate fire setting.
• 9. Deliberate destruction of others' property.

• Deceitfulness or Theft:
• 10. Breaking into someone else's house, building, or car.
• 11. Lying to obtain goods or favors, or to avoid obligations.
• 12. Has stolen nontrivial but valuable items without confronting the victim.

• 1. Excessive distress at separation from home or from major attachment figures.
• 2. Excessive concern for major attachment figures.
• 3. Excessive worry that an unfavorable event will cause separation from a major attachment figure.
• 4. Fear of separation accounts for reluctance or refusal to go somewhere.
• 5. Extreme fear of being alone.
• 6. Reluctance or refusal to go to sleep when not near a major attachment figure.
• 7. Nightmares about separation. 8. Actual or anticipated separation from major attachment figures causes complaints of physical ailments.

• 1. Loses temper.
• 2. Argues with adults.
• 3. Does not comply with adults' requests or rules.
• 4. Purposefully annoys people.
• 5. Blames others for their mistakes or misbehavior.
• 6. Readily annoyed by others.
• 7. Angry and resentful.
• 8. Spiteful or vindictive.

• At least one of the following:
• 1. Delayed or lacking spoken language development, without compensation.
• 2. Marked impairment in the ability of individuals with adequate speech to start or maintain a conversation with others.
• 3. Stereotyped and repetitive use of language.
• 4. Lack of varied and spontaneous make-believe or social imitative play that is appropriate to developmental level.

• At least two of the following:
• 1. Marked impairment when using multiple nonverbal behaviors to control social interaction.
• 2. Inability to develop appropriate developmental-level peer relationships.
• 3. Failure to spontaneously seek to share enjoyment, interests, or achievements with others.
• 4. Deficient social or emotional reciprocity.

• At least one of the following:
• 1. Abnormal (in intensity or focus) preoccupation with stereotyped and restricted interest patterns.
• 2. Obstinate adherence to nonfunctional routines or rituals.
• 3. Stereotyped and repetitive motor mannerisms.
• 4. Persistent preoccupation with parts of objects.

• 1. Beginning before age 13, ignores parental prohibitions regarding staying out at night..
• 2. Has run away from home, overnight at least twice or for a long duration once.
• 3. Beginning before age 13, skips school.

• Sexual Dysfunctions Disturbance in the sexual response cycle.
• Paraphilias For at least 6 months, arousing urges, fantasies, or behaviors involving children, nonhuman objects, suffering or humiliation.
• Gender Identity Disorders Cross-gender identification and discomfort with one's actual sex.
• Gender Disorder Not Otherwise Specified
• Sexual Disorder Not Otherwise Specified

• Primary Sleep Disorders or Dyssomnias: Disturbance in amount, quality, or timing of sleep.
• Parasomnias: Abnormal event during sleep.
• Sleep Disorder Related to Another Mental Disorder
• Sleep Disorder Due to a General Medical Condition
• Substance-Induced Sleep Disorder

• Schizophrenia
• Schizophreniform Disorder
• Schizoaffective Disorder
• Delusional Disorder
• Brief Psychotic Disorder
• Shared Psychotic Disorder
• Psychotic Disorder Due to a General Medical Condition
• Substance-Induced Psychotic Disorder
• Psychotic Disorder Not Otherwise Specified

• A. Characteristic (Active-Phase)Symptoms

• B. Social and/or Occupational Dysfunction

• C. Duration Requirement

• D. Schizoaffective & Mood Disorder Exclusion

• E. Substance or General Medical Condition Exclusion

• F. Conditions Regarding Relationship to a Pervasive Developmental Disorder

Note: Schizophrenia alone is not a diagnosis.

• Unspecified Mental Disorder (nonpsychotic)
• No Diagnosis or Condition on Axis I
• Diagnosis or Condition Deferred on Axis I
• No Diagnosis on Axis II
• Diagnosis Deferred on Axis II

• Adjustment Disorder With Depressed Mood
• Adjustment Disorder With Anxiety
• Adjustment Disorder With Mixed Anxiety and Depressed Mood
• Adjustment Disorder With Disturbance of Conduct
• Adjustment Disorder With Mixed Disturbance of Emotions and Conduct
• Adjustment Disorder Unspecified

• Amnestic Disorder Due to a General Medical Condition.
• Substance-Induced Persisting Amnestic Disorder.
• Amnestic Disorder Not Otherwise Specified.

• 1. Panic Disorder Without Agoraphobia
• 2. Panic Disorder With Agoraphobia
• 3. Agoraphobia Without History of Panic Disorder
• 4. Specific Phobia
• 5. Social Phobia
• 6. Obsessive-Compulsive Disorder
• 7. Posttraumatic Stress Disorder
• 8. Acute Stress Disorder
• 9. Generalized Anxiety Disorder
• 10. Anxiety Disorder Due to a General Medical Condition
• 11. Substance-Induced Anxiety Disorder
• 12. Anxiety Disorder Not Otherwise Specified

• Attention-Deficit/Hyperactivity Disorder
• -- Combined Type o Predominantly Inattentive Type
• -- Predominantly Hyperactive-Impulsive Type
• -- Not Otherwise Specified
• Conduct Disorder
• Oppositional Defiant Disorder
• Disruptive Behavior Disorder Not Otherwise Specified

Bipolar I Disorder
Single Manic Episode
Most Recent Episode Hypomanic
Most Recent Episode Manic
Most Recent Episode Mixed
Most Recent Episode Depressed
Most Recent Episode Unspecified
Bipolar II Disorder
Cyclothymia
Bipolar Disorder Not Otherwise Specified

Mental Retardation
Learning Disorders
Motor Skills Disorders
Communication Disorders
Pervasive Developmental Disorders
Attention-Deficit and Disruptive Behavior Disorders
Feeding and Eating Disorders of Infancy and Early Childhood
Tic Disorders
Elimination Disorders
Other Disorders of Infancy, Childhood, or Adolescence

Psychological Factors Affecting Medical Condition
Medication-Induced Movement Disorders
Other Medication-Induced Disorders
Relational Problems
Problems Related to Abuse or Neglect
Additional Conditions that May Be a Focus of Clinical Attention

Paranoid Personality Disorder
Schizoid Personality Disorder
Schizotypal Personality Disorder These individuals often appear odd or eccentric.

# Antisocial Personality Disorder # Borderline Personality Disorder # Histrionic Personality Disorder # Narcissistic Personality Disorder These individuals often appear dramatic, emotional, or erratic.

Avoidant Personality Disorder
Dependent Personality Disorder
Obsessive-Compulsive Personality Disorder
Personality Disorder Not Otherwise Specified These individuals often appear anxious or fearful.

Mild: IQ level 50-55 to approximately 70.
Moderate: IQ level 35-40 to 50-55.
Severe: IQ level 20-25 to 35-40.
Profound: IQ level below 20 or 25.
Severity Unspecified: strong presumption of retardation but person's intelligence is untestable by standard tests.

Expressive Language Disorder
Mixed Receptive-Expressive Language Disorder
Phonological Disorder
Stuttering
Communication Disorder Not Otherwise Specified

Delirium Due to a General Medical Condition
Substance-Induced Delirium
Delirium Due to Multiple Etiologies
Delirium Not Otherwise Specified

Erotomanic
Grandiose
Jealous
Persecutory
Somatic
Mixed
Unspecified

Dementia of the Alzheimer's Type
Vascular Dementia
Dementia Due to: o HIV Disease o Head Trauma o Parkinson's Disease o Huntington's Disease o Pick's Disease o Creutzfeldt-Jakob Disease
Dementia Due to Other General Medical Conditions
Substance-Induced Persisting Dementia
Dementia Due to Multiple Etiologies
Dementia Not Otherwise Specified

Major Depressive Disorder, Single Episode
Major Depressive Disorder, Recurrent
Dysthymic Disorder
Depressive Disorder Not Otherwise Specified

A. Purposeful creation or feigning of signs or symptoms (physical or psychological).

B. Assuming the sick role is the motivation.

C. External incentives are not present.

A. Severe pain is paramount and calls for clinical attention.

B. Distress or impairment in social, occupational, or other important functioning.

C. Psychological factors play a key role in all aspects of the pain.

D. Symptom or deficit not faked or purposefully produced.

E. Neither Dyspareunia, nor any Mood, Anxiety, or Psychotic Disorder can explain the pain. Note: Pain Disorder alone is not a diagnosis.

Period of intense fear or discomfort with at least four of the following symptoms developed abruptly and peaked within 10 minutes: 1. Palpitations or accelerated heart rate 2. Sweating 3. Trembling 4. Shortness of breath 5. Sensation of choking 6. Chest pain 7. Nausea or abdominal upset 8. Feeling dizzy, lightheaded, or faint 9. Depersonalization or feelings of unreality 10. Fear of losing control 11. Fear of dying 12. Numbness or tingling (Paresthesias)1 13. Chills or hot flushes Note: Panic Attack alone is not a diagnosis.

Emotional or behavioral symptoms caused by identifiable stressor(s) within 3 months of the stressor onset.
Either of the following: 1. Marked distress beyond expectations. 2. Significant impairment in social, occupational, or academic functioning.
Not an exacerbation of preexisting Axis I or Axis II disorder.
Not Bereavement.Symptoms disappear within 6 months of the end of the stressor. Note: Adjustment Disorder alone is not a diagnosis.

A. Anxiety about being in a location or situation: 1. from which it would be difficult or embarrassing to escape, or 2. where help may not be available in the event of unexpected Panic Attack or panic-like symptoms.

B. The person avoids the places or situations, or endures them with marked distress or anxiety, or the person requires a companion. Note: Agoraphobia alone is not a diagnosis.

A. Agoraphobia connected to fear of developing panic-like symptoms.

B. Criteria not met for Panic Disorder.

C. Not caused by a substance or a general medical condition.

D. If a general medical condition is present, the fear noted in Item A clearly exceeds expectations for the condition.

A. Refusal to maintain age- and height-appropriate body weight.

B. Although underweight, fear of putting on weight or becoming fat.

C. Disturbed by body weight or shape, allowing them to unduly affect self evaluation. Also denying seriousness of being underweight.

D. Amenorrhea, in post-menarcheal females.

A. Major Depressive Episode is current or most recent.

B. At least one previous Manic Episode or Mixed Episode.

C. Episodes in A and B are not better accounted for by Schizoaffective Disorder, and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

A. Hypomanic Episode is current or most recent.

B. A previous Manic or Mixed Episode.

C. Distress or impairment in social, occupational, or other important functioning.

D. Neither A nor B above are better accounted for by Schizoaffective Disorder. Neither are they not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

A. Manic Episode is current or most recent.

B. At least one previous Major Depressive Episode, Manic Episode, or Mixed Episode.

C. Episodes in A and B are not better accounted for by Schizoaffective Disorder. Neither are they not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

A. Mixed Episode is current or most recent.

B. At least one previous Major Depressive Episode, Manic Episode, or Mixed Episode.

C. Episodes in A and B are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

A. Other than duration, a Manic, Hypomanic, Mixed, or Major Depressive Episode is current or most recent.

B. At least one previous Manic Episode or Mixed Episode.

C. Distress or impairment in social, occupational, or other important functioning.

D. Symptoms in A and B above are not better accounted for by Schizoaffective Disorder. Neither are they superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

E. Symptoms in A and B are not due to a substance or a general medical condition.

A. One Manic Episode and no previous Major Depressive Episodes.

B. The episode is not better accounted for by Schizoaffective Disorder, and is not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

A. One or more Major Depressive Episodes.

B. At least one Hypomanic Episode.

C. Never a Manic or Mixed Episode.

D. Items A and B are not better accounted for by Schizoaffective Disorder, and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

E. Distress or impairment in social, occupational, or other important functioning.

A. Excessive concern for imaginary appearance defects or minor anomalies.

B. Distress or impairment in social, occupational, or other important functioning.

A. Extraordinary sleepiness or insomnia caused by a sleep-related breathing condition.

B. Not caused by another mental disorder, or a substance, or a general non-breathing-related medical condition.

A. Repeated binge eating involving excess food and lack of control.

B. Inappropriate compensatory behavior to prevent weight gain.

C. Episodes in Items A and B average at least twice a week for 3 months.

D. Excess bias of body weight or shape on self evaluation.

E. Not exclusively during Anorexia Nervosa.

A. Motoric immobility, excess motor activity, extreme negativism, voluntary movement peculiarities, echolalia or echopraxia.

B. The disturbance is the direct consequence of a general medical condition.

C. Not exclusively during delirium.

A. Extreme sleepiness or insomnia caused by a mismatch between a person's sleep-wake schedule and circadian sleep-wake pattern.

B. Distress or impairment in social, occupational, or other important functioning.

C. Not solely during another Sleep Disorder or mental disorder.

D. Not caused by a substance or general medical condition.

A. At least one voluntary motor or sensory function deficit.

B. Psychological factors are associated.

C. Symptom or deficit is not purposely faked or produced.

D. Symptom or deficit is not due to a general medical condition, a substance, or a culturally-approved behavior or experience.

E. Distress or impairment in social, occupational, or other important functioning, or calls for medical evaluation.

F. Symptom or deficit not restricted to pain or sexual dysfunction. Not occurring solely during Somatization Disorder.

A. Many periods over 2+ years with hypomanic symptoms as well as depressive symptoms (but not a Major Depressive Episode).

B. During the 2 year period, symptoms do not disappear for more than 2 months at a time.

C. No Major Depressive Episode, Manic Episode, or Mixed Episode appears during the first 2 years of the disturbance.

D. Symptoms not better accounted for by Schizoaffective Disorder, and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

E. Not due to a substance or a general medical condition.

F. Distress or impairment in social, occupational, or other important functioning.

A. Persistent or repeated feelings of being detached from one's self.

B. Reality testing is intact.

C. Distress or impairment in social, occupational, or other important functioning.

D. Not solely during another mental disorder. Also not due to a substance or a general medical condition.

A. At least one instance, going beyond ordinary forgetfulness, of not recalling important personal information.

B. Not solely occurring during Dissociative Identity Disorder, Dissociative Fugue, Posttraumatic Stress Disorder, Acute Stress Disorder, or Somatization Disorder. Also not due to a substance or a neurological or a general medical condition.

C. Distress or impairment in social, occupational, or other important functioning.

A. Unexpected travel from home or work with inability to recall personal history.

B. Confused about his or her identity or assumption of a new identity.

C. Not solely during Dissociative Identity Disorder. Also not due to a substance or a general medical condition.

D. Distress or impairment in social, occupational, or other important functioning.

A. At least two distinct identities or personalities.

B. At least two of these identities or personalities repeatedly assume control of the person's behavior.

C. Can not remember, to an extent beyond ordinary forgetfulness, important personal information.

D. Not due to a substance or a general medical condition

A. Genital pain related to sexual intercourse in a male or a female.

B. Marked distress or interpersonal difficulty.

C. Not solely due to Vaginismus or lack of lubrication. Also not due to a substance or a general medical condition.

A. For at least 6 months: sexual fantasies, urges, or behaviors that involve exposing one's genitals to a stranger.

B. Distress or impairment in social, occupational, or other important functioning

A. Meets criteria for (General) Factitious Disorder (see flash card Factitious 2).

B. Psychological and physical symptoms and signs are present but neither predominates.

A. Meets criteria for (General) Factitious Disorder (see flash card Factitious 2).

B. Physical signs and symptoms predominate.

A. Meets criteria for (General) Factitious Disorder (see flash card Factitious 2).

B. Psychological signs and symptoms predominate.

A. Missing or delayed orgasm after normal sexual excitement.

B. Marked distress or interpersonal difficulty.

C. Not due to a substance or a general medical condition.

A. Difficulties in attaining or maintaining sufficient lubrication-swelling sexual response.

B. Marked distress or interpersonal difficulty.

C. Not due to a substance or a general medical condition.

A. For at least 6 months: sexual fantasies, urges, or behaviors that involve inanimate objects.

B. Distress or impairment in social, occupational, or other important functioning.

C. The inanimate objects used are not limited to female cross-dress clothing or genital stimulation equipment.

A. For at least 6 months: sexual fantasies, urges, or behaviors that involve touching or rubbing a nonconsenting person.

B. Distress or impairment in social, occupational, or other important functioning.

A. Cross-gender identification.

B. Uncomfortable with his or her sex (or associated gender role).

C. No simultaneous physical intersex condition.

D. Distress or impairment in social, occupational, or other important functioning.

A. For at least 1 month, excessive sleepiness manifested by either daytime sleep or long sleep episodes.

B. Distress or impairment in social, occupational, or other important functioning.

C. The hypersomnia relates to another Axis I or Axis II disorder yet requires independent clinical attention for its severity.

D. Not due to insufficient sleep.

E. Not caused by a substance or a general medical condition.

A. Limited or no sexual fantasies or desire.

B. Marked distress or interpersonal difficulty.

C. Not due to a substance or a general medical condition.

A. Misinterpreting physical symptoms as being caused by a serious disease.

B. Medical reassurances do not allay the preoccupation.

C. Neither delusional nor simply concern about appearance.

D. Distress or impairment in social, occupational, or other important functioning.

E. Lasts at least 6 months.

F. Not better explained by Generalized Anxiety Disorder, Obsessive-Compulsive Disorder, Panic Disorder, a Major Depressive Episode, Separation Anxiety, or any other Somatoform Disorder.

At least four days of persistently expansive or irritable mood.

B. At least three (four if only irritable) symptoms persist.

C. Uncharacteristic change in functioning.

D. Disturbance in mood and the change in functioning are observable by others.

E. No marked impairment in social or occupational functioning. Does not require hospitalization. No psychotic features.

F. Not due to a substance or a general medical condition.

A. Difficulty getting to or staying asleep, or non-restorative sleep, for at least one month.

B. Distress or impairment in social, occupational, or other important functioning.

C. The severity of the insomnia calls for independent clinical attention, yet is related to another Axis I or Axis II disorder.

D. Not caused by a substance or a general medical condition.

A. Failure (several episodes) to resist aggressive impulses resulting in assaults or property destruction.

B. The aggressive behavior is disproportionate to precipitating psychosocial stressors.

C. Not due to a substance or a general medical condition.

A. Repeated failure to resist impulses to steal objects that are not really needed for personal use or for monetary value.

B. Increasing tension just before stealing.

C. Pleasure or relief while stealing.

D. Not done to express anger or to get even, and not due to a delusion or a hallucination.

A. At least five symptoms, differing from previous functioning, present during a two week period. One of the symptoms must be either depressed mood or loss of interest or pleasure.

B. Not a Mixed Episode.

C. The symptoms cause distress or impairment in social, occupational, or other important functioning.

D. Not due to a substance or a general medical condition.

E. Not Bereavement.

A. Difficulties in attaining or maintaining erection while having sex.

B. Marked distress or interpersonal difficulty.

C. Not due to a substance or a general medical condition.

A. Missing or delayed orgasm after normal sexual excitement.

B. Marked distress or interpersonal difficulty.

C. Not due to a substance or a general medical condition.

A. At least one week of unusually and persistently expansive or irritable mood.

B. At least three symptoms (4 if only irritable) have persisted during the disturbance,

C. Not a Mixed Episode.

D. Impairs occupational functioning, social activities or relationships. May require hospitalization to prevent injury to self or others. May include psychotic features.

E. Not due to a substance or a general medical condition.

A. Qualifies as both a Manic Episode and a Major Depressive Episode (excepting duration) nearly every day for a week or more.

B. Impairs occupational functioning, social activities or relationships. May require hospitalization to prevent injury to self or others. May include psychotic features.

C. Not due to a substance or a general medical condition.

A. Prominent and persistent mood disturbance that includes either or both: 1. Depressed mood or decreased interest or pleasure in activities. 2. Elevated, expansive, or irritable mood.

B. Physiological result of a general medical condition.

C. Not solely during delirium.

D. Distress or impairment in social, occupational, or other important functioning.

A. Overpowering daily attacks of sleep for three or more months.

B. One or both of the following: 1. Cataplexy. 2. Repeated elements of rapid eye movement sleep.

C. Not caused by a substance or a general medical condition.

A. Frequent awakenings with explicit recall of notably frightening dreams.

B. Quick orientation and alertness upon awakening.

C. Distress or impairment in social, occupational, or other important functioning.

D. Not solely during another mental disorder and not caused by a substance or a general medical condition.

A. Either obsessions or compulsions.

B. The individual realizes that the obsessions or compulsions are extreme.

C. Obsessions or compulsions cause marked distress, consume more than one hour per day, or interfere considerably with normal functioning, activities and relationships.

D. The obsessions or compulsions are not limited to any other Axis I disorder that may be present.

E. Not due to a substance or general medical condition.

A. Meets the criteria for (General) Pain Disorder (see flash card Somatoform 5).

B. Both psychological factors and a general medical condition contribute prominently to all aspects of the pain.

A. Meets the criteria for (General) Pain Disorder (see flash card Somatoform 5).

B. Psychological factors account for pain.

C. Any general medical condition that exists is secondary.

D. Do not diagnose if Somatization Disorder is present.

A. Both of the following: 1. Recurrent and unexpected Panic Attacks. 2. One or more of these symptoms follows the attacks for at least 1 month: 1. persistent concern about more attacks 2. worry about implications or consequences of the attack 3. significant change in behavior resulting from the attacks

B. Agoraphobia is present.

C. Neither a substance nor a general medical condition accounts for the Panic Attacks.

A. Both of the following: 1. Recurrent and unexpected Panic Attacks. 2. One or more of these symptoms follows the attacks for at least 1 month: 1. persistent concern about more attacks 2. worry about implications or consequences of the attack 3. significant change in behavior resulting from the attacks

B. No Agoraphobia is present.

C. Neither a substance nor a general medical condition accounts for the Panic Attacks.

A. Pervasive distrust of others indicated by four or more of the following: 1. Suspects others of exploition or deception. 2. Doubts trustworthiness of friends. 3. Hesitant to confide in others. 4. Sees hidden negative meanings. 5. Constantly bears grudges. 6. Sees character attacks and reacts angrily. 7. Suspects sex partner of infidelity.

B. Not solely during Schizophrenia, a Mood Disorder With Psychotic Features, or another Psychotic Disorder. Not due to a general medical condition.

A. Involves at least five of the following: 1. Preoccupation with gambling. 2. Using larger amounts of money. 3. Repeated attempts to cut back or stop. 4. Irritable when trying to cut back or stop. 5. Gambles to escape problems or to relieve a dysphoric mood. 6. Keeps gambling even after losing. 7. Lies to conceal the gambling. 8. Commits illegal acts to obtain funds. 9. A significant relationship, job, or career opportunity is lost or jeopardized. 10. Turns to others for relief money.

B. A Manic Episode doesn't better account for the gambling.

A. For at least 6 months: sexual fantasies, urges, or behaviors involving sex with prepubescent children.

B. Distress or impairment in social, occupational, or other important functioning.

C. The prepubescent child is at least 5 years younger than the pedophilic person, who is at least 16 years old.

A. Persistent personality disturbance that differs from a previous personality.

B. Results from a general medical condition.

C. Not solely during delirium.

D. Distress or impairment in social, occupational, or other important functioning.

A. The individual experiences a traumatic event that includes both: 1. Participating, witnessing, or confronting an event that involves actual or threatened death or serious injury. 2. Intense fear, helplessness, or horror.

B. The individual persistently reexperiences the traumatic event in at least one way.

C. The individual persistently avoids stimuli associated with the trauma and experiences numbing of general responsiveness in at least three ways.

D. The person experiences persistent symptoms of increased arousal in at least two ways.

E. The symptoms in Items B, C, and D last more than 1 month.

F. Impairment in important functioning.

A. Ejaculation before, on, or shortly after entry and before desired.

B. Marked distress or interpersonal difficulty.

C. Not due to a substance.

A. For at least 1 month, excessive sleepiness manifested by either daytime sleep or long sleep episodes.

B. Distress or impairment in social, occupational, or other important functioning.

C. Not insomnia, or insufficient sleep, or solely during another Sleep Disorder.

D. Not solely during another mental disorder.

E. Not caused by a substance or a general medical condition.

A. Problems for at least 1 month getting to or staying asleep, or not feeling rested after sleep.

B. Distress or impairment in social, occupational, or other important functioning.

C. Not solely during Narcolepsy, Breathing-Related Sleep Disorder, Circadian Rhythm Sleep Disorder, or a Parasomnia.

D. Not solely during another mental disorder.

E. Not caused by a substance or a general medical condition.

A. Deliberate setting of fires on multiple occasions.

B. Experiences tension or affective arousal prior to fire setting.

C. Fire stimulates fascination, interest, curiosity, or attraction.

D. Fires bring pleasure or relief.

E. Fires are not set to make money, express sociopolitical ideas, hide crimes, express anger, get even, or improve living conditions. Also not due to delusions, hallucinations, or impaired judgment.

A. Pattern of interpersonal and social deficiencies indicated by at least five of the following: 1. Ideas (excluding delusions) of reference. 2. Odd beliefs or magical thinking. 3. Unusual perceptions. 4. Odd speech or thought patterns. 5. Suspiciousness. 6. Inappropriate or limited affect. 7. Peculiar behavior or appearance. 8. No close friends 9. Extreme social anxiety.

B. Not solely during Schizophrenia, a Mood Disorder With Psychotic Features, another Psychotic Disorder, or a Pervasive Developmental Disorder.

A. Extreme aversion to and avoidance of genital sexual contact.

B. Marked distress or interpersonal difficulty.

A. Sexual dysfunction with marked distress or interpersonal difficulty.

B. Sexual dysfunction is explained by a general medical condition.

A. For at least 6 months: sexual fantasies, urges, or behaviors that involve suffering or being humiliated, beaten, or bound.

B. Distress or impairment in social, occupational, or other important functioning.

A. For at least 6 months: sexual fantasies, urges, or behaviors that involve acts of psychological or physical suffering.

B. Distress or impairment in social, occupational, or other important functioning.

A. A severe sleep disturbance that calls for independent clinical attention.

B. Caused by a general medical condition.

C. Not solely during delirium.

D. Not Breathing-Related Sleep Disorder or Narcolepsy.

E. Distress or impairment in social, occupational, or other important functioning.

A. Recurrent sudden awakenings with a scream.

B. Both extreme fear and autonomic arousal.

C. Not responsive to comforting efforts by others.

D. Episodic amnesia and no detailed dream recall.

E. Distress or impairment in social, occupational, or other important functioning.

F. Not caused by a substance or a general medical condition.

A. Recurring episodes of getting out of bed and walking around during sleep.

B. Blank face and stare, does not respond to the communications of others, and is difficult to wake up.

C. Episodic amnesia on awakening.

D. Behavior and mental activity are unimpaired within a few minutes of awakening.

E. Distress or impairment in social, occupational, or other important functioning.

F. Not caused by a substance or a general medical condition.

A. Marked and persistent fear of situations involving unfamiliar people or scrutiny by others, with a fear of humiliation or embarrassment.

B. The feared social situation causes anxiety.

C. The individual realizes that the fear is extreme.

D. The feared social or performance situations are either endured with intense anxiety, or avoided.

E. Phobic response interferes with the person's normal routine, activities, functioning, or relationships, or there is distress.

F. If the person is under age 18 years, the disorder last 6 months or more.

G. Not due to a general medical condition or a substance.

H. The fear in Item A is not related to a general medical condition or other mental disorder.

A. Frequent physical complaints before age 30 that either lead to treatment being sought or notable impairment in functioning.

B. History of each of the following: 1. Four pain symptoms. 2. Two gastrointestinal symptoms. 3. One sexual symptom. 4. One pseudo-neurological symptom.

C. Either of the following: 1. Symptoms in "B" are not explained by a general medical condition or a substance. 2. When a general medical condition does exist, the complaints or impairment are beyond expectations.

D. Symptoms are not faked or purposefully produce'

A. Existence or anticipation of specific objects or situations triggers excessive fear that is both marked and persistent.

B. Exposure to the object or situation causes an anxiety response.

C. The individual realizes that the fear is unreasonable.

D. The object or situation is either endured with intense anxiety or distress or avoided.

E. The phobic response significantly interferes with the person's normal routine, activities, functioning, or relationships.

F. If the person is under age 18 years, the disorder lasts 6 months or more.

A. Obsessions or compulsions, prominent anxiety, or panic attacks.

B. Either: 1. Symptoms in Item A developed during or within 1 month of substance intoxication/withdrawal, or 2. 3. Medication use relates to the disturbance.

C. The disturbance cannot be better accounted for by an Anxiety Disorder that is not substance induced.

D. Not exclusively during delirium.

E. Distress or impairment in social, occupational, or other important functioning.

A. Prominent and persistent mood disturbance that includes either or both: 1. Depressed mood or markedly diminished interest or pleasure in activities. 2. Elevated, expansive, or irritable mood.

B. Either: 1. Symptoms in A above develop during or within one month of Substance Intoxication or Withdrawal. 2. Medication use relates etiologically to the disturbance.

C. The disturbance cannot be better accounted for by a Mood Disorder not substance induced.

D. Not solely during delirium.

E. Distress or impairment in social, occupational, or other important functioning.

A. Sexual dysfunction with marked distress or interpersonal difficulty.

B. The dysfunction is explained by substance use by either of the following: 1. The symptoms in Item A developed during or within a month of Substance Intoxication. 2. Medication use relates to the disturbance.

C. Not explained by a Sexual Dysfunction that is not substance induced.

A. A severe sleep disturbance that calls for independent clinical attention.

B. Evidence of either: 1. Development of symptoms during or within a month of Substance Intoxication or Withdrawal, or 2. Medication relates to the sleep disturbance.

C. Not a non-substance-induced Sleep Disorder.

D. Not solely during delirium.

E. Distress or impairment in social, occupational, or other important functioning.

A. For at least 6 months: sexual fantasies, urges, or behaviors by a heterosexual male that involve cross-dressing.

B. Distress or impairment in social, occupational, or other important functioning.

A. Noticeable hair loss from repeated pulling out of one's hair.

B. Becoming more tense just prior to pulling out hair or trying to resist the behavior.

C. Pleasure or relief at pulling out hair.

D. Not due to a general medical condition or to another mental disorder.

E. Distress or impairment in social, occupational, or other important functioning.

'A. At least one physical complaint.

B. Either of the following: 1. Symptoms in "A" are not explained by a general medical condition or a substance. 2. When a general medical condition does exist, the complaints or impairment are beyond expectations.

C. Distress or impairment in social, occupational, or other important functioning.

D. The disturbance lasts at least 6 months.

E. Symptoms are not faked or purposefully produced'

A. Spasms in the outer third of the vagina that interferes with sexual intercourse.

B. Marked distress or interpersonal difficulty.

C. Not due to a medical condition.

A. For at least 6 months: sexual fantasies, urges, or behaviors that involve observing a person who is unclothed, disrobing, or having sex.

B. Distress or impairment in social, occupational, or other important functioning.

Dissociative Amnesia
Dissociative Fugue
Dissociative Identity Disorder
Depersonalization Disorder
Dissociative Disorder Not Otherwise Specified

Primary Insomnia
Primary Hypersomnia
Narcolepsy
Breathing-Related Sleep Disorder
Circadian Rhythm Sleep Disorder
Dyssomnia Not Otherwise Specified

Anorexia Nervosa
Bulimia Nervosa
Eating Disorder Not Otherwise Specified

Encopresis
Enuresis

Factitious Disorder With Predominately Psychological Signs and Symptoms
Factitious Disorder With Predominately Physical Signs and Symptoms
Factitious Disorder With Combined Psychological and Physical Signs and Symptoms
Factitious Disorder Not Otherwise Specified Note: Factitious Disorder alone is not a diagnosis.

Pica
Rumination Disorder
Feeding Disorder of Infancy or Early Childhood

A. Pattern of inner behavior and experience that distinctly deviates from cultural expectations in at least two of the following ways: 1. Cognition. 2. Affectivity. 3. Interpersonal functioning. 4. Impulse control.

B. The pattern is inflexible and pervasive.

C. Distress or impairment in social, occupational, or other important functioning.

D. The pattern began in adolescence or early adulthood and is both stable and enduring.

E. Not better accounted for as a result of another mental disorder.

F. Not caused by a substance or a general medical condition.

Intermittent Explosive Disorder
Kleptomania
Pyromania
Pathological Gambling
Trichotillomania
Impulse-Control Disorder Not Otherwise Specified

1. Depressed mood. 2. Decreased interest or pleasure in activities. 3. Significant variations in weight or appetite. 4. Insomnia or hypersomnia. 5. Psychomotor agitation or retardation. 6. Daily fatigue or energy loss. 7. Feelings of worthlessness or guilt. 8. Difficulties in concentration or decisiveness. 9. Recurrent thoughts of death or suicidal ideation, plan, or attempt.

1. Overeating or poor appetite. 2. Hypersomnia or insomnia. 3. Fatigue or low energy. 4. Low self-esteem. 5. Difficulties with concentration or making decisions. 6. Feelings of hopelessness.

1. Inflated self-esteem. 2. Reduced need for sleep. 3. Unusually talkative. 4. Racing thoughts or flight of ideas. 5. Distractibility. 6. Psychomotor agitation or increase in goal-oriented activities. 7. Involvement in activities that give pleasure but are also likely to bring pain.

1. Inflated self-esteem. 2. Reduced need for sleep. 3. Unusually talkative. 4. Racing thoughts or flight of ideas. 5. Distractibility. 6. Psychomotor agitation or increase in goal-oriented activities. 7. Involvement in activities that give pleasure but are also likely to bring pain.

Learning Disorders:
Reading
Mathematics
Written Expression
Not Otherwise Specified Motor Skills:
Developmental Coordination Disorder

Medication-Induced Movement Disorders: 1. Neuroleptic-Induced Parkinsonism 2. Neuroleptic Malignant Syndrome 3. Neuroleptic-Induced Acute Dystonia 4. Neuroleptic-Induced Acute Akathisia 5. Neuroleptic-Induced Tardive Dyskinesia 6. Medication-Induced Postural Tremor 7. Medication-Induced Movement Disorder Not Otherwise Specified Other Medication-Induced Disorder: 1. Adverse Effects of Medication Not Otherwise Specified

'
Delirium
Dementia
Amnestic Disorder
Psychotic Disorder
Mood Disorder
Anxiety Disorder
Sexual Dysfunction
Sleep Disorder
Catatonic Disorder
Personality Change
Mental Disorder Not Otherwise Specified Note: All of the above "due to a general medical condition".'

Major Depressive Episode
Manic Episode
Mixed Episode
Hypomanic Episode Note: Mood Episodes are not codable. See specific Mood Disorders.

Separation Anxiety Disorder
Selective Mutism
Reactive Attachment Disorder of Infancy or Early Childhood
Stereotypic Movement Disorder
Disorder of Infancy, Childhood, or Adolescence Not Otherwise Specified

Mood Disorder Due to a General Medical Condition
Substance-Induced Mood Disorder
Mood Disorder Not Otherwise Specified

Sleep Disorder Due to a General Medical Condition
Substance-Induced Sleep Disorder

1. Exhibitionism 2. Voyeurism 3. Sexual Sadism 4. Sexual Masochism 5. Fetishism 6. Transvestic Fetishism 7. Frotteurism 8. Pedophilia 9. Paraphilias Not Otherwise Specified

Nightmare Disorder
Sleep Terror Disorder
Sleepwalking Disorder
Parasomnia Not Otherwise Specified

Autistic Disorder
Rett's Disorder
Childhood Disintegrative Disorder
Asperger's Disorder
Pervasive Developmental Disorder Not Otherwise Specified

Physical Abuse of Child
Sexual Abuse of Child
Neglect of Child
Physical Abuse of Adult
Sexual Abuse of Adult

Mental Disorder
Psychological Symptoms
Personality Traits or Coping Style
Maladaptive Health Behaviors
Stress-Related Physiological Response
Other or unspecified psychological or behavioral factors

Relational Problem Related to a Mental Disorder or General Medical Condition
Parent-Child Relational Problem
Partner Relational Problem
Sibling Relational Problem
Relational Problem Not Otherwise Specified

Paranoid Type
Disorganized Type
Catatonic Type
Undifferentiated Type
Residual Type

Sexual Desire Disorders Hypoactive Sexual Desire Disorder Sexual Aversion Disorder
Sexual Arousal Disorders Female Sexual Arousal Disorder Male Erectile Disorder
Orgasmic Disorders Female Orgasmic Disorder Male Orgasmic Disorder Premature Ejaculation
Sexual Pain Disorders Dyspareunia Vaginismus
Sexual Dysfunction Due to a General Medical Condition
Substance-Induced Sexual Dysfunction
Sexual Dysfunction Not Otherwise Specified

Insomnia Related to Another Mental Disorder
Hypersomnia Related to Another Mental Disorder

Somatization Disorder
Undifferentiated Somatoform Disorder
Conversion Disorder
Pain Disorder
Hypochondriasis
Body Dysmorphic Disorder
Somatoform Disorder Not Otherwise Specified

Alcohol
Amphetamine
Caffeine
Cannabis
Cocaine
Hallucinogen
Inhalants
Nicotine
Opioid
Phencyclidine
Sedatives, Hypnotics, or Anxiolytics
Polysubstance
Other Substance

At least three of the following symptoms, experienced for more days than not during the preceding 6 months: 1. Restlessness. 2. Fatigue. 3. Problems with concentration. 4. Irritability. 5. Muscle tension. 6. Sleep disturbance.

Tourette's Disorder
Chronic Motor or Vocal Tic Disorder
Transient Tic Disorder
Tic Disorder Not Otherwise Specified

• Labile Type: Affective lability.
• Disinhibited Type: Poor impulse control.
• Aggressive Type: Aggressive behavior.
• Apathetic Type: Apathy and indifference.
• Paranoid Type: Suspiciousness
• Other Type.
• Combined Type.
• Unspecified Type.