ABNORMAL

PSYCHOLOGY
PERSONAL
REVIEWER

Aquino, Hannah Mae E.

BS Psychology 3-B
I. NEURODEVELOPMEN-  Maternal disease
(including placental
TAL DISORDERS disease)
 The disorders typically manifest  Environmental
early in development, often before influences (e.g.,
the child enters school, and are alcohol, other drugs,
characterized by developmental toxins, teratogens)
deficits or differences in brain  PERINATAL
processes that produce impairments  Labor and delivery-
of personal, social, academic, or related events-
occupational functioning neonatal
 The range of developmental deficits encephalopathy (lack
or differences varies from very of oxygen to the
specific limitations of learning or baby)
control of executive functions to  POSTNATAL
global impairments of social skills or  Hypoxic ischemic
intellectual ability. The injury (the brain
neurodevelopmental disorders experiences a
frequently co-occur with one another decrease in oxygen or
(e.g., communication disorders and blood flow)
autism spectrum disorder may be  Traumatic brain
associated with anxiety disorders; injury Infections
ADHD with oppositional defiant Demyelinating
disorder; tics with obsessive disorders
compulsive disorder)  Seizure disorders
Intellectual Developmental Disorders (e.g., infantile
 People with ID experience spasms)
difficulties with day-to- day  Severe and chronic
activities to an extent that reflects social deprivation
both the severity of their cognitive  Toxic metabolic
deficits and the type and amount of syndromes
assistance they receive. DSM-5  Intoxications (e.g.,
identifies difficulties in three lead,mercury)
domains: conceptual (e.g., skill o Biological
deficits in areas such as language,  Genetic influences
reasoning, knowledge, and memory), - portion of the people with
social (e.g., problems with social more severe ID have
judgment and the ability to make and identifiable single-gene
retain friendships), and practical disorders, involving a
(e.g., difficulties managing personal dominant gene (which
care or job responsibilities) expresses itself when
(American Psychiatric Association, paired with a normal
2013). formerly termed " mental gene), a recessive gene
retardation (which expresses itself
 Etiology of Intellectual Disability only when paired with
 PRENATAL another copy of itself), or
 Genetic syndromes an X-linked gene (present
(e.g., sequence on the X or sex
variations or copy chromosome)
number variants - mutations in genetic
involving one or more material can occur at
genes; chromosomal various points in
disorders) development, and this
 Inborn errors of helps explain the causes
metabolism of previously puzzling
 Brain malformations cases of ID
 - passing/carrying a abstract thinking, judgment, academic
dominant gene that results
in ID
 Chromosomal Influences
- number of chromosomes
(e.g., trichromosome 21)
 Fragile X Syndrome
- caused by an abnormality
on the X chromosome, a
mutation that makes the
tip of the chromosome
look as though it was
hanging from a thread,
giving it the appearance
of fragility
o Psychosocial
 Cultural influences that may
contribute to ID can include
abuse, neglect, and social
deprivation. Cultural-familial
Intellectual Disability-
cognitive impairments that
result from a combination of
psychosocial and biological
influences, although the
specific mechanisms that lead
to this type of intellectual
disability are not yet
understood
DSM-V TR
 characterized by deficits in general
mental abilities, such as reasoning,
problem-solving, planning, abstract
thinking, judgment, academic
learning, and learning from
experience
 result in impairments of adaptive
functioning, such that the individual
fails to meet standards of personal
independence and social
responsibility in one or more aspects
of daily life, including
communication, social participation,
academic or occupational
functioning, and personal
independence at home or in
community settings
Diagnostic Criteria
Intellectual developmental disorder
(intellectual disability) is a disorder with
onset during the developmental period that
includes both intellectual and adaptive
functioning deficits in conceptual, social,
and practical domains. The following three
criteria must be met:
A. Deficits in intellectual functions, such
as reasoning, problem-solving, planning,
learning, and learning from experience,
confirmed by both clinical assessment and
individualized, standardized intelligence
testing.
B. Deficits in adaptive functioning that
result in failure to meet developmental and
sociocultural standards for personal
independence and social responsibility.
Without ongoing support, the adaptive
deficits limit functioning in one or more
activities of daily life, such as
communication, social participation, and
independent living, across multiple
environments, such as home, school, work,
and community.
C. Onset of intellectual and adaptive
deficits during the developmental period.
TREATMENTS
Once a diagnosis is made, help for
individuals with intellectual disability is
focused on looking at the individual’s
strengths and needs, and the supports he or
she needs to function at home, in
school/work and in the community
 Early intervention (infants and
toddlers).
 Special education. Family support
(for example, respite care support
groups for families).
 Transition services from childhood
to adulthood.
 Vocational programs.
 Day programs for adults.
 Housing and residential options.
 Case management.
  SPEECSPEECHH - the
expressive production of sounds
and includes an individual’s
articulation, fluency, voice, and
resonance quality.
 LANGUAGE- includes the form,
function, and use of a
conventional system of symbols
(i.e., spoken words, sign language,
written words, pictures) in a rule-
governed manner for
communication.
 COMMUNICATION- includes any
verbal or nonverbal behavior
(whether intentional or
unintentional) that has the
potential to influence the behavior,
ideas, or attitudes of another
individual.
 Etiology
 Communication disorders
may be developmental or
acquired. The cause may be
related to biological problems
such as abnormalities of brain
development, or possibly by
exposure to toxins during
pregnancy, such as abused
substances or environmental
toxins such as lead. A genetic
factor is sometimes
considered a contributing
cause in some cases.
 BIOLOGICAL
 Hereditary/Family history
 Exposure to toxins during
pregnancy Brain injury
 Autism
 Intellectual/Learning
disability- difficulty with
receptive or expressive
language
 Hearing impairment –
assessment of hearing is one
of the first steps in the
COMMUNICATION DISORDERS investigation of speech and
An impairment in the ability to language problems
receive, send, process, and comprehend  Physical disability – cleft lip
concepts or verbal, nonverbal and graphic and palate; malformations of
symbol systems. the mouth or nose may cause
 A communication disorder may be communication disorders
evident in the processes of hearing,  Developmental disorder –
language, and/or speech. some children with a
developmental
 A communication disorder may
range in severity from mild to disability/disorder (i.e., Down
profound. It Syndrome) maybe slower to
learn and talk
 PSYCHOLOGICAL Treatment
 Behavior/Emotional Problems-  Speech Therapy
children with significant behavior or  identifying the specific
emotional problems may also have a grammar targets and
communication disorder. In some practicing their appropriate
cases the behavior problems are use first in drills and then in
extreme and the focus on the safety conversation, and also
and security of the child is the teaching strategies to help
priority with word retrieval
 understanding the meanings
 SOCIAL of the words ―vague‖ and
 Bilingualism /Multilingual ―specific‖ by practicing
environment Residential Mobility identifying utterances as
 Lack of proper social interaction either ―vague‖ or ―specific‖
and then using specific
utterances to describe
pictures and real-life
occurrences
 Rett syndrome, fragile X
syndrome, and
MECP2 duplication
syndrome
 NON-SYNDROMIC ASD
- etiology of non-
syndromic ASD is still
relatively undefined due
to its genetic
heterogeneity
- a collaboration of de novo
mutations and prenatal
plus postnatal
COMMON TREATMENT FOR environmental factors are
COMMUNICATION DISORDERS likely to play a role
o BIOLOGICAL
 Working with a Speech-language  ASD is considered a complex
pathologist genetic disorder with high
 Speech-language pathologist will heritability. Families that
work with the rehabilitation team, have one child with ASD
including a physical and have about a 20% chance of
occupational therapist, to address having another child with the
other relevant skills before or in disorder (Ozonoff et al.,
parallel with speech therapy sessions 2011).
 Depending on the goal, a speech- o PSYCHOSOCIAL
language pathologist may remediate  More sophisticated research
and promote skills or teach using larger samples of
alternative forms of communication, children and families
such as augmentative and alternative suggests that the parents of
communication (AAC) or sign individuals with autism may
language not differ substantially from
parents of children without
disabilities (Bhasin &
Schendel, 2007).
AUTISM SPECTRUMDISORDER
 Autism spectrum disorder (ASD) is a Diagnostic Criteria
neurodevelopmental disorder that, at A. Persistent deficits in social
its core, affects how one perceives communication and social interaction
and socializes with others (Durand, across multiple contexts, as manifested by
2014). all of the following, currently or by history
 DSM-5 combined most of the (examples are illustrative, not exhaustive;
disorders previously included under see text):
the umbrella term ―pervasive 1. Deficits in social-emotional reciprocity,
developmental disorders‖ (e.g., ranging, for example, from abnormal social
autistic disorder, Asperger’s approach and failure of normal back-and-
disorder, and childhood forth conversation; to reduced sharing of
disintegrative disorder) and included interests, emotions, or affect; to failure to
them into this one category initiate or respond to social interactions.
(American Psychiatric Association, 2. Deficits in nonverbal communicative
2013). behaviors used for social interaction,
 Etiology of ASD ranging, for example, from poorly integrated
 SYNDROMIC ASD verbal and nonverbal communication; to
- often associated with abnormalities in eye contact and body
chromosomal language or deficits in understanding and
abnormalities or use of gestures; to a total lack of facial
monogenic alterations expressions and nonverbal communication.
such examples include 3. Deficits in developing, maintaining, and
understanding relationships, ranging, for Asperger’s disorder, or pervasive
example, from difficulties adjusting developmental disorder not otherwise
behavior to suit various social contexts; to specified should be given the diagnosis of
difficulties in sharing imaginative play or in autism spectrum disorder. Individuals who
making friends; to absence of interest in have marked deficits in social
peers. communication, but whose symptoms do not
B. Restricted, repetitive patterns of otherwise meet criteria for autism spectrum
behavior, interests, or activities, as disorder, should be evaluated for social
manifested by at least two of the (pragmatic) communication disorder.
following, currently or by history Specify current severity based on social
(examples are illustrative, not exhaustive; communication impairments and restricted,
see text): repetitive patterns of behavior (see Table 2):
1. Stereotyped or repetitive motor Requiring very substantial support
movements, use of objects, or speech (e.g., Requiring substantial support
simple motor stereotypies, lining up toys or Requiring support
flipping objects, echolalia, idiosyncratic Specify if:
phrases) With or without accompanying
2. Insistence on sameness, inflexible intellectual impairment
adherence to routines, or ritualized patterns With or without accompanying
of verbal or nonverbal behavior (e.g., language impairment
extreme distress at small changes, Specify if:
difficulties with transitions, rigid thinking Associated with a known genetic or
patterns, greeting rituals, need to take same other medical condition or
route or eat same food every day). environmental factor
3. Highly restricted, fixated interests that are (Coding note: Use additional code
abnormal in intensity or focus (e.g., strong to identify the associated genetic or
attachment to or preoccupation with unusual other medical condition.)
objects, excessively circumscribed or Associated with a
perseverative interests). neurodevelopmental, mental, or
4. Hyper- or hyporeactivity to sensory input behavioral problem
or unusual interest in sensory aspects of the Specify if:
environment (e.g., apparent indifference to With catatonia (refer to the criteria
pain/temperature, adverse response to for catatonia associated with another
specific sounds or textures, excessive mental disorder, p. 135, for
smelling or touching of objects, visual definition) (Coding note: Use
fascination with lights or movement) additional code F06.1 catatonia
C. Symptoms must be present in the early associated with autism spectrum
developmental period (but may not become disorder to indicate the presence of
fully manifest until social demands exceed the comorbid catatonia.)
limited capacities, or may be masked by
learned strategies in later life). Severi Social Restricted,
D. Symptoms cause clinically significant ty Communicati repetitive
impairment in social, occupational, or other level on behaviors
important areas of current functioning. Level Severe Inflexibility
E. These disturbances are not better 3 deficits in of behavior,
explained by intellectual developmental ―Requi verbal and extreme
disorder (intellectual disability) or global ring nonverbal difficulty
developmental delay. Intellectual very social coping with
developmental disorder and autism spectrum substa communicatio change, or
disorder frequently co-occur; to make ntial n skills cause other
comorbid diagnoses of autism spectrum suppor severe restricted/re
disorder and intellectual developmental t‖ impairments petitive
disorder, social communication should be in behaviors
below that expected for general functioning, markedly
developmental level. very limited interfere
Note: Individuals with a well-established initiation of with
DSM-IV diagnosis of autistic disorder, social functioning
 interactions, in all nonverbal
and minimal spheres. communicatio
response to Great n.
social distress/diffi Level Without Inflexibility
overtures culty 1 supports in of behavior
from others. changing ―Requi place, deficits causes
For example, focus or ring in social significant
a person with action. suppor communicatio interference
few words of t‖ n cause with
intelligible noticeable functioning
speech who impairments. in one or
rarely initiates Difficulty more
interaction initiating contexts.
and, when he social Difficulty
or she does, interactions, switching
makes and clear between
unusual examples of activities.
approaches to atypical or Problems of
meet needs unsuccessful organization
only and responses to and
responds to social planning
only very overtures of hamper
direct social others. May independenc
approaches. appear to have e.
Level Marked Inflexibility decreased
2 deficits in of behavior, interest in
―Requi verbal and difficulty social
ring nonverbal coping with interactions.
substa social change, or For example,
ntial communicatio other a person who
suppor n skills; social restricted/re is able to
t‖ impairments petitive speak in full
apparent even behaviors sentences and
with supports appear engages in
in place; frequently communicatio
limited enough to n but whose
initiation of be obvious to-and-fro
social to the casual conversation
interactions; observer with others
and reduced and interfere fails, and
or abnormal with whose
responses to functioning attempts to
social in a variety make friends
overtures of contexts. are odd and
from others. Distress typically
For example, and/or unsuccessful.
a person who difficulty
speaks simple changing
sentences, focus or
whose action.
interaction is
limited to
narrow
special
interests, and
who has
markedly odd
TREATMENTS disorder, but specific medications can help
 Behavior and communication control symptoms. For example, certain
therapies. medications may be prescribed if your child
- Many programs address is hyperactive; antipsychotic drugs are
the range of social, sometimes used to treat severe behavioral
language and behavioral problems; and antidepressants may be
difficulties associated prescribed for anxiety. Keep all health care
with autism spectrum providers updated on any medications or
disorder. Some programs supplements your child is taking. Some
focus on reducing medications and supplements can interact,
problem behaviors and causing dangerous side effects.
teaching new skills. Other
programs focus on ATTENTION-DEFICIT/
teaching children how to HYPERACTIVITY DISORDER
act in social situations or (ADHD)
communicate better with
 one of the most common
others. Applied behavior
neurodevelopmental disorders of
analysis (ABA) can help
childhood. It is usually first
children learn new skills
diagnosed in childhood and often
and generalize these skills
lasts into adulthood. Children with
to multiple situations
ADHD may have trouble paying
through a reward-based
attention, controlling impulsive
motivation system.
behaviors (may act without thinking
 Educational therapies. about what the result will be), or be
- Children with autism
overly active.
spectrum disorder often
 a persistent pattern of inattention
respond well to highly
and/or hyperactivity- impulsivity
structured educational
that interferes with functioning or
programs. Successful
development
programs typically
include a team of  Etiology of Attention-Deficit/
Hyperactivity Disorder
specialists and a variety
o BIOLOGICAL
of activities to improve
 Genetic Influence
social skills,
- Genes
communication and
- gene mutations
behavior. Preschool
- Heredity
children who receive
- Research shows that
intensive, individualized
parents and siblings of
behavioral interventions
someone with ADHD are
often show good
more likely to have
progress.
ADHD themselves.
Family therapies. Parents and other family
- Too much exposed of
members can learn how to play and interact
alcohols, cigarettes in
with their children in ways that promote
utero, and incorrect diet
social interaction skills, manage problem
o PSYCHOSOCIAL
behaviors, and teach daily living skills and
 Cultural Influence
communication.
 Bad Parenting
Other therapies. Depending on your child's
 Negative response of teachers
needs, speech therapy to improve
or parents
communication skills, occupational therapy
- May contribute to
to teach activities of daily living, and
feelings of low self-
physical therapy to improve movement and
esteem, especially in
balance may be beneficial. A psychologist
children who are also
can recommend ways to address problem
depressed (Anastopoulos,
behavior.
Sommer, & Schatz, 2009)
Medications. No medication can improve
the core signs of autism spectrum
  Always telling to behave in school or
at house sit quietly, and pay
attention.
- May create a negative
self-image in these
children, which, in turn,
can negatively affect their
ability to make friends,
and these effects can last
into adulthood
 History of child abuse, neglect
Diagnostic Criteria
A. A persistent pattern of inattention and/or
hyperactivity-impulsivity that interferes with
functioning or development, as characterized
by (1) and/or (2):
1. Inattentive Type Diagnosis Criteria
 Displays poor listening skills
 Loses and/or misplaces items
needed to complete activities or
tasks
 Sidetracked by external or
unimportant stimuli
 Forgets daily activities Diminished
attention span
 Lacks ability to complete
schoolwork and other assignments
or to follow instructions Avoids or is
disinclined to begin homework or
activities requiring concentration
 Fails to focus on details and/or
makes thoughtless mistakes in
schoolwork or assignments
2. Hyperactive/ Impulsive Type
Diagnosis Criteria
Hyperactive Symptoms:
 Squirms when seated or fidgets with
feet/hands
 Marked restlessness that is difficult
to control Appears to be driven by ―a
motor‖ or is often ―on the go‖
 Lacks ability to play and engage in
leisure activities in a quiet manner
 Incapable of staying seated in class
 Overly talkative
Impulsive Symptoms:
 Difficulty waiting turn
 Interrupts or intrudes into
conversations and activities of others
 Impulsively blurts out answers
before questions completed
Additional Requirements for Diagnosis
 Symptoms present prior to age 12
years
 Symptoms not better accounted for
by a different psychiatric disorder
(e.g., mood disorder, anxiety
disorder) and do not
occur exclusively during
a psychotic disorder (e.g.,
schizophrenia)
 Symptoms not exclusively a
manifestation of oppositional
behavior
Classification
Combined Type:
 Patient meets both inattentive and
hyperactive/impulsive criteria for the
past 6 months
Predominantly Inattentive Type:
 Patient meets inattentive criterion,
but not hyperactive/impulse
criterion, for the past 6 months
Predominantly Hyperactive/Impulsive
Type:
 Patient meets hyperactive/impulse
criterion, but not inattentive
criterion, for the past 6 months
Specify current severity:
Mild: Few, if any, symptoms in excess of
those required to make the diagnosis are
present, and symptoms result in no more
than minor impairments in social or
occupational functioning.
Moderate: Symptoms or functional
impairment between ―mild‖ and ―severe‖ are
present.
Severe: Many symptoms in excess of those
required to make the diagnosis, or several
symptoms that are particularly severe, are
present, or the symptoms result in marked
impairment in social or occupational
functioning.
Note: For children below 17 years old, the
DSM-5 diagnosis of ADHD requires 6
symptoms of hyperactivity and impulsivity
or 6 symptoms of inattention.
For adolescents 17 years old and adults, 5
symptoms of hyperactivity and impulsivity
or 5 symptoms of inattention are required.
Autism spectrum disorder
-Individuals with ADHD and those with
autism spectrum disorder exhibit inattention,
social dysfunction, and difficult-to-manage
behavior.
Note: Children with autism spectrum
disorder
may display tantrums because of an inability
to tolerate a change from their expected
course of events. In contrast, children with
ADHD may misbehave or have a tantrum physiological problems,
during a major transition because of alcohol or drug exposure
impulsivity or poor self- control. during pregnancy, low birth
weight, oxygen deprivation,
Reactive attachment disorder or early or prolonged
-Children with reactive attachment disorder labor. Environmental
may show social disinhibition, but not the factors, such as skipping
full ADHD symptom cluster, and display school, a lack of social or
other features such as a lack of enduring parental interaction, or poor
relationships that are not characteristic of reading comprehension,
ADHD. can have a significant
impact in certain situations.
Treatment - Specific learning disorders
 Treating ADHD often requires can be inherited or develop
medical, educational, behavioral over time. The cause could
therapy and psychological be biological issues, such
intervention. This comprehensive as a premature baby, a low
approach to treatment is birth rate, prenatal poor
sometimes called ―multimodal‖ and, nutrition, or exposure to
depending on the age of the toxins such as lead or
individual with ADHD, may include: nicotine or lack of
- parent training environmental issues, lack
- medication of family interactions,
- skills training poor reading habits in
- counseling school/house, poor
- behavioral therapy reading comprehension,
- educational supports failure to attend school. In
- education regarding some cases, a genetic factor
ADHD is regarded as a contributing
Working closely with health care providers factor.
and other professionals, treatment should be  Biological
tailored to the unique needs of each Genetic Influence
individual and family to help the patient - Learning Disorders have a
control symptoms, cope with the disorder, strong genetic component. If
improve overall psychological well-being a child has a parent with a
and manage social relationships. learning disability, the child’s
risk for having a specific
Specific Learning Disorder learning disorder is much
 Specific learning disorders are higher.
neurodevelopmental disorders that - Exposure to toxins like lead
are typically diagnosed in early or nicotine
school-aged children, although may  Psychosocial
not be recognized until adulthood. Cultural Influence
They are characterized by a - Cultural influences that may
persistent impairment in at least one contribute to Specific
of three major areas: reading, written Learning Disorders can
expression, and/or math. include;
 Characterized by performance that is - Neglected, Bullied, Abused
substantially below what would be - Get Embarrassed at school
expected given the person’s age, Bad Parenting
intelligence quotient (IQ) score, and - Poor conversation at school
education or house
 Etiology of Specific Learning Criteria for Specific Learning Disorder
Disorder To be diagnosed with a
- A specific learning disorder specific learning disorder, a person
may be inherited or develop must meet four criteria
gradually. The cause could be
 1. Have difficulties in at least one of
the following areas for at least six
months despite targeted
- Difficulty reading (e.g.,
inaccurate, slow and only
with much effort). Difficulty
understanding the meaning of
what is read.
- Difficulty with spelling.
- Difficulty with written
expression (e.g., problems
with grammar, punctuation or
organization). Difficulty
understanding number
concepts, number facts or
calculation.
- Difficulty with
mathematical reasoning
(e.g., applying math
concepts or solving
math problems).
2. The affected academic skills that
are substantially below what is
expected for the child’s age and
cause problems in school, work or
everyday activities. (For individuals
age 17 years and older, a
documented history of impairing
learning difficulties may be
substituted for the standardized
assessment.)
3. The difficulties start during school-
age even if some people don’t
experience significant problems
until adulthood (when academic,
work and day-to-day demands are
greater).
4. Learning difficulties are not due to
other conditions, such as
intellectual disability, vision or
hearing problems, a neurological
condition (e.g., pediatric stroke),
adverse conditions such as economic
or environmental disadvantage, lack
of instruction, or difficulties
speaking/understanding the
language.
Additional Requirements for Diagnosis
 With impairment in reading:
- Word reading accuracy
- Reading rate or fluency
- Reading comprehension
Dyslexia is a term that refers to
difficulty in acquiring and processing
language that is typically manifested
by the lack or proficiency in reading,
spelling and writing. People with
dyslexia have difficulty connecting
letters they see on a page with the
sounds they make. As a result,
reading becomes slow and effortful
and is not a fluent process for them.
 With impairment in written
expression:
- Spelling accuracy
- Grammar and punctuation
accuracy
- Clarity or organization of
written expression
Dysgraphia is a term used to
describe difficulties with putting
one’s thoughts on to paper. Problems
with writing can include difficulties
with spelling, grammar, punctuation,
and handwriting.
 With impairment in mathematics:
- Number sense
- Memorization of arithmetic
facts
- Accurate or fluent calculation
- Accurate math reasoning
Dyscalculia is a term used to
describe difficulties learning number
related concepts or using the symbols
and functions to perform math
calculations. Problems with math can
include difficulties with number
sense, memorizing math facts, math
calculations, math reasoning and
math problem solving.
Severity Levels
Learning disorder can vary in severity;
 Mild: Some difficulties with
learning in one or two academic
areas, but may be able to compensate
 Moderate: Significant difficulties
with learning, requiring some
specialized teaching and some
accommodations or supportive
services
 Severe: Severe difficulties with
learning, affecting several academic
areas and requiring ongoing
intensive specialized teaching
Treatment
 Special education services can help
children with learning disabilities
improve reading, writing and math.
Effective interventions involve
systematic, intensive, individualized
 instruction that may improve the
learning difficulties and/or help the
individual use strategies to
compensate for their disorder.
 Education for a person with
learning disabilities often involves
multimodal teaching – using multiple
senses.
 Under federal law, the Individuals
with Disabilities Education Act
(IDEA), students with learning
disorders are eligible for special
education services. (Republic Act
(RA) 11650 or the "Instituting a
Policy of Inclusion and Services for
Learners with Disabilities in Support
of Inclusive Education Act.")
 Students with specific learning
disorder often benefit from
accommodations, such as additional
time on tests and written
assignments, using computers for
typing rather than writing by hand,
and smaller class size. Successful
interventions, strategies and
accommodations for a child may
change over time as the child
develops and academic expectations
change.
 There are no FDA approved
medications for specific learning
disorders. However, medications
may be indicated for comorbid
disorders such as ADHD and
anxiety.
 Research has shown that the most
effective treatments for reading
disorder are structured, targeted
strategies that address phonological
awareness, decoding skills,
comprehension and fluency.
 Treatments for writing problems are
in two general areas: the process of
writing and the process of composing
written expression.
 Treatment for dyscalculia often
includes multisensory instruction to
help kids understand math concepts.
Accommodations, like using
manipulative and assistive
technology, can also help kids with
dyscalculia.
Motor Disorder
 Motor disorders are malfunctions of
the nervous system that cause
involuntary or uncontrollable
movements or actions of the body.
These disorders can cause lack of
intended movement or an excess of
involuntary movement. Symptoms of
motor disorders include tremors,
jerks, twitches, spasms, contractions,
or gait problems.
 The DSM-5 motor disorders include
developmental coordination
disorder; stereotypic movement
disorder; and the tic disorders of
Tourette’s Disorder, persistent
(chronic) motor or vocal tic disorder,
and provisional tic disorder.
Developmental Coordination Disorder
 Developmental coordination disorder
(DCD), also known as
developmental motor coordination
disorder, developmental dyspraxia,
or simply dyspraxia, is a chronic
neurological disorder beginning in
childhood.
 It is also known to affect planning of
movements and coordination as a
result of brain messages not being
accurately transmitted to the body.
 Impairments in skilled motor
movements per a child’s
chronological age interfere with
activities of daily living.
 Etiology of Developmental
coordination disorder (DCD)
 DCD (developmental coordination
disorder) can be inherited or develop
over time. The cause could be
biological issues, like exposure to
toxins like drugs or alcohol, or lack
environmental engagement. In
some circumstances, a genetic factor
is regarded as a contributing factor.
  Biological
- cerebral palsy
- Heredity/Family History
- Being born prematurely,
before the 37th week of
pregnancy
- Being born with a low birth
weight
- Being exposed in
illegal drugs, alcohol or
cigarettes during prenatal
- Threatened abortion
- Fetal distress during labor
 Psychological
- Lower cognitive functioning
Developmental coordination
disorder is more likely to
occur in people with lower
cognitive functioning.
- Injuries/Painful medical
condition
Developmental coordination
disorder is most likely to
affect someone who
experiences repetitive
injuries.
 Social
- Social Isolation
- Environmental Stress
- Lack of Social Interactions
Diagnostic Criteria
 Acquisition and execution of
coordinated motor skills are below
what would be expected at a given
chronologic age and opportunity for
skill learning and use; difficulties are
manifested as clumsiness (eg,
dropping or bumping into objects)
and as slowness and inaccuracy of
performance of motor skills (eg,
catching an object, using scissors,
handwriting, riding a bike, or
participating in sports)
 The motor skills deficit significantly
or persistently interferes with
activities of daily living
appropriate to the chronologic
age (eg, self-care and self-
maintenance) and impacts
academic/school productivity,
prevocational and vocational
activities, leisure, and play
 The onset of symptoms is in the early
developmental period
 The motor skills deficits cannot be
better explained by intellectual
disability or visual impairment and
are not attributable to a neurologic
condition affecting movement (eg,
cerebral palsy, muscular dystrophy,
or a degenerative disorder)
Treatment
 Occupational therapy It helps kids
gain motor skills and learn to do
basic tasks that are needed for school
and everyday living. These tasks
include things like writing, typing,
tying shoes and getting dressed.
 Physical therapy is an ideal remedy
for a child with DCD. A physical
therapist usually carries out an
evaluation that entails history of a
child, motor tests and examination
on physical traits. After doing an
examination, a physical therapist will
work with a child to improve body
balance and coordination, muscle
strength and motor skills to make it
easy for them to go about daily
activities without struggling too
much.
STEREOTYPIC MOVEMENT
DISORDER
 Stereotypic movement disorder is a
condition in which a person makes
repetitive, purposeless movements.
These can be hand waving, body
rocking, or head banging. The
movements interfere with normal
activity or may cause bodily harm.
 Etiology
- Genetic factors, biological
problems, exposure to toxins
like alcohol or drugs, or
environmental factors may all
contribute to stereotypic
movement disorder.
o Biological
 Genetic factors: Stereotypic
movement disorder may be genetic,
as some children who develop it
have family members who had the
condition when they were young.
 Developmental conditions:
Developmental conditions like
autism can cause a child to develop
secondary motor stereotypies.
 Gender: Boys may be more likely to
develop stereotypic movement
disorder than girls.
o Psychological
  Brain conditions or
injuries: The condition may
be caused by brain injuries or
neurological problems in
childhood
o Social
 Exposed in abusive
environment
- People who are exposed to an
abusive environment or who
watch abusive media,
particularly children, will
engage in that behavior
Diagnostic Criteria
A. Repetitive, seemingly driven, and
apparently purposeless motor
behavior (e.g., hand shaking or
waving, body rocking, head banging,
self-biting, hitting own body).
B. The repetitive motor behavior
interferes with social, academic, or
other activities and may result in
self-injury.
C. Onset is in the early developmental
period.
D. The repetitive motor behavior is not
attributable to the physiological
effects of a substance or neurological
condition and is not better explained
by another neurodevelopmental or
mental disorder (e.g.,trichotillomania
[hair-pulling disorder],
obsessivecompulsive disorder).
Specify if:
 With self-injurious behavior (or
behavior that would result in an
injury if preventive measures
were not used)
 Without self-injurious behavior
Specify if:
 Associated with a known genetic
or other medical condition,
neurodevelopmental disorder, or
environmental factor (e.g.,
LeschNyhan syndrome,
intellectual developmental
disorder [intellectual disability],
intrauterine alcohol exposure)
Coding note: Use additional
code to identify the associated
genetic or other medical
condition, neurodevelopmental
disorder, or environmental factor.
Specify current severity:
Mild: Symptoms are easily suppressed
by sensory stimulus or distraction.
Moderate: Symptoms require explicit
protective measures and behavioural
modification.
Severe: Continuous monitoring and
protective measures are required to
prevent serious injury.
Treatment
 Behavior therapy: Behavior therapy
can help the person recognize the
patterns in their movements and offer
positive reinforcement to help the
person reduce or stop the
movements.
 Cognitive behavioral therapy
(CBT): CBT can help the person
change unhelpful patterns of
thinking; however, it may not be
helpful in very young children.
Tic Disorder
Tics are fast, repetitive muscle movements
that result in sudden and difficult to control
body jolts or sounds.
 They're fairly common in childhood
and typically first appear at around 5
years of age. Very occasionally they
can start in adulthood.
 Tics are not usually serious and
normally improve over time. But
they can be frustrating and interfere
with everyday activities.
Examples of tics include:
- blinking, wrinkling the nose
or grimacing
- jerking or banging the head
- clicking the fingers
- touching other people or
things
- coughing, grunting or
sniffing
- repeating a sound or phrase –
in a small number of cases,
this maybe something
obscene or offensive
 Tics can happen randomly and they
may be associated with something
such as stress, anxiety, tiredness,
excitement or happiness. They tend
to get worse if they're talked about or
focused on.
 They often start with an unpleasant
sensation that builds up in the body
until relieved by the tic – known as
an urge – although they can
sometimes be partly suppressed.
  Etiology
- Changes in the parts of the
brain that control movement
are thought to be the cause.
They can run in families, and
in many cases, there is a
genetic cause. They also
frequently occur in
conjunction with other
conditions, such as attention
deficit hyperactivity disorder
(ADHD) and Obsessive
Compulsive Disorder
(OCD). Tics can be triggered
by illegal drugs like cocaine
or amphetamines, and they
can also be caused by more
serious health conditions like
cerebral palsy or
Huntington's disease.
o Biological
- Heredity/ Family History
- Presence of ADHD/OCD
- Caused by more serious
health conditions
o Psychosocial
- Presence of illegal drugs
- Social factors
Diagnostic Criteria
Diagnostic Criteria Note:
A tic is a sudden, rapid, recurrent,
nonrhythmic motor movement or
vocalization.
Tourette’s Disorder
A. Both multiple motor and one or more
vocal tics have been present at some
time during the illness, although not
necessarily concurrently.
B. The tics may wax and wane in
frequency but have persisted for
more than 1 year since first tic onset.
C. Onset is before age 18 years.
D. The disturbance is not attributable to
the physiological effects of a
substance (e.g., cocaine) or another
medical condition (e.g., Huntington’s
disease, postviral encephalitis).
Persistent (Chronic) Motor or Vocal Tic
Disorder
A. Single or multiple motor or vocal tics
have been present during the illness,
but not both motor and vocal.
B. The tics may wax and wane in
frequency but have persisted for
more than 1 year since first tic onset.
C. Onset is before age 18 years.
D. The disturbance is not attributable to
the physiological effects of a
substance (e.g., cocaine) or another
medical condition (e.g., Huntington’s
disease, postviral encephalitis).
E. Criteria have never been met for
Tourette’s disorder.
Specify if:
With motor tics only
With vocal tics only
Provisional Tic Disorder
A. Single or multiple motor and/or
vocal tics.
B. The tics have been present for less
than 1 year since first tic onset.
C. Onset is before age 18 years.
D. The disturbance is not attributable to
the physiological effects of a
substance (e.g., cocaine) or another
medical condition (e.g., Huntington’s
disease, postviral encephalitis).
E. Criteria have never been met for
Tourette’s disorder or persistent
(chronic) motor or vocal tic disorder.
Note:
Specifiers: The ―motor tics only‖ or ―vocal
tics only‖ specifier is only required for
persistent (chronic) motor or vocal tic
disorder.
Three Types of Tic Disorder
1. Tourette’s Disorder
 Tics are the main symptom of
Tourette's syndrome. They
usually appear in childhood
between the ages of 2 and 14
(around 6 years is the
average).
 People with Tourette's
syndrome have a combination
of physical and vocal tics
Examples of physical tics
include: blinking, eye rolling,
grimacing, shoulder shrugging,
jerking of the head or limbs,
jumping, twirling, touching
objects and other people
Examples of vocal tics include:
grunting, throat clearing,
whistling, coughing, tongue
clicking, animal sound, saying
random words and phrases
repeating a sound, word or
phrase
 2. Persistent (Chronic) Motor or
vocal Tic Disorder
II. Schizophrenia
 Have one or more motor tics Spectrum and Other
or vocal tics, but not both.
Examples of physical tics Psychotic Disorders
include: blinking, eye rolling,  A spectrum as it applies to mental
grimacing, shoulder shrugging, disorder is a range of linked
jerking of the head or limbs, conditions, sometimes also extending
jumping, twirling, touching to include singular symptoms and
objects and other people traits
Examples of vocal tics include: SCHIZOPHRENIA
grunting, throat clearing,  Eugen Bleuler (1857–1939) A Swiss
whistling, coughing, tongue psychiatrist who introduced the term
clicking, animal sounds, saying schizophrenia, meaning ―splitting of
random words and phrases, the mind.‖
repeating a sound, word or  a serious mental disorder in which
phrase people interpret reality abnormally
3. Provisional Tic Disorder The Symptoms Associated with
 Criteria have never been met Schizophrenia falls into 3 Categories
for Tourette’s disorder or 1. Positive Symptoms
persistent (chronic) motor or 2. Cognitive Symptoms
vocal tic disorder. 3. Negative Symptoms
 Mild form of TS Such symptoms include:
 Avolition
Treatment  Asociality
 Therapy  Flat Affect
a. Behavior therapy – Cognitive  Anhedonia
Behavioral Interventions for Tics,  Alogia (or poverty of speech)
including habit- reversal training,
can help you monitor tics, identify
premonitory urges and learn to Active
voluntarily move in a way that's Prodromal
Phase
incompatible with the tic.
b. Psychotherapy – In addition to
helping you cope with Tourette
syndrome, psychotherapy can help
with accompanying problems, Residual
such as ADHD, obsessions, phase
depression or anxiety.
c. Deep brain stimulation (DBS) –
For severe tics that don't CYCLE THROUGH 3 PHASES
respond to other treatment, DBS ETIOLOGY
might help. DBS involves implanting  The exact cause of Schizophrenia is
a battery-operated medical device in unknown.
the brain to deliver electrical  To uncover the cause of this
stimulation to targeted areas that disorder, researchers look in several
control movement. However, this areas:
treatment is still in the early research a) the possible genes
stages and needs more research to b) chemical action of the drugs
determine if it's a safe and effective that help people with this
treatment for Tourette syndrome. disorder
c) Abnormalities in the working
of the brains
d) Environmental risk factors
Biological Factors
GENES
 Researchers have found that closer
blood relatives of individuals
diagnosed with schizophrenia run a
greater risk of developing the
disorder
ENDOPHENOTYPES
 The strategy in genetic research has
moved from demonstrating that
heredity is involved in schizophrenia
to attempting to identify the genes
that are responsible for the specific
characteristics or traits that are
evident in this disorder. This
approach involves the identification
and study of endophenotypes—
measurable, heritable traits (Braff,
Freedman, Schork, & Gottesman,
2007).
NEUROSTRUCTURE
 Individuals with schizophrenia have
decreased volume in the cortex
another areas of the brain (Haijma et
al., 2013), as well as ventricular
enlargement (enlarged spaces in the
brain; Ettinger et al., 2012).
BIOCHEMICAL INFLUENCES
 Abnormalities in certain
neurotransmitters (chemicals that
allow brain cells to communicate
with one another) including
dopamine, serotonin, GABA, and
glutamate have also been linked to
schizophrenia (Benes, 2009; de la
Fuente-Sandoval et al., 2013).
Particular attention is given to the
neurotransmitter dopamine (Howes,
Kambeitz, et al., 2012).
 The use of cocaine, amphetamines,
alcohol, and especially cannabis
appears to increase the chances of
developing a psychotic disorder
(Callaghan et al., 2012; Zammit,
Owen, Evans, Heron, & Lewis,
2012)
PSYCHOLOGICAL FACTOR
 Early cognitive deficits are also
associated with schizophrenia.
 Early behavioral disturbances and
cognitive and language deficits were
evident in some individuals
diagnosed with schizophrenia.
 Such a communication pattern may
interfere with the development of
interpersonal rapport and emotional
connection.
communication problems and the lack of
insight that frequently occurs with
schizophrenia may result, in part, from
deficits in the theory of mind.
Social Factors
 Relationships within the home can
also influence the development of
schizophrenia.
 Maltreatment during childhood or
other significant social stressors may
alter neurodevelopment in a manner
that increases susceptibility to
schizophrenia. Certain social events
appear to influence the appearance of
psychotic symptoms.
 Expressed emotion (EE), a negative
communication pattern found among
some relatives of individuals with
schizophrenia, has been associated
with higher relapse rates in
individuals diagnosed with
schizophrenia (Breitborde, Lopez, &
Nuechterlein, 2009).
Major Symptoms (DSM-5)
Diagnostic Criteria for Schizophrenia
A. Two (or more) of the following, each
present for a significant portion of
time during a 1-month period (or less
if successfully treated). At least one
of these must be (1), (2), or (3):
1. Delusions
2. Hallucinations
3. Disorganized speech (e.g.,
frequent derailment or
incoherence)
4. Grossly disorganized or
catatonic behavior
5. Negative symptoms (i.e.,
diminished emotional
expression or avolition)
B. For a significant portion of the time
since the onset of the disturbance,
level of functioning in one or more
major areas, such as work,
interpersonal relations, or self-care,
is markedly below the level achieved
prior to the onset (or when the onset
is in childhood or adolescence, there
is failure to achieve expected level of
 interpersonal, academic,
occupational functioning).
C. Continuous signs of the disturbance
persist for at least 6 months. This 6-
month period must include at least 1
month of symptoms (or less if
successfully treated) that meet
Criterion A (i.e., active-phase
symptoms) and may include periods
of prodromal or residual symptoms.
During these prodromal or residual
periods, the signs of the disturbance
may be manifested by only negative
symptoms or by two or more
symptoms listed in Criterion A
present in an attenuated form (e.g.,
odd beliefs, unusual perceptual
experiences).
D. Schizoaffective disorder and
depressive or bipolar disorder with
psychotic features have been ruled
out because either
1) no major depressive or
manic episodes have
occurred concurrently
with the active-phase
symptoms; or
2) if mood episodes have occurred during
active-phase symptoms, they have been
present for a minority of the total duration of
the active and residual periods of the illness.
E. The disturbance is not attributable to
the physiological effects of a
substance (e.g., a drug of abuse, a
medication) or another medical
condition.
F. If there is a history of autistic
spectrum disorder or a neglect. Having a parental figure who is cold
communication disorder of
childhood onset, the additional
diagnosis of schizophrenia is made
only if prominent delusions or
hallucinations, in addition to the
other required symptoms of
schizophrenia, are also present for at
least 1 month (or less if successfully
treated)
Treatment
 Through the years, schizophrenia has
been treated by a variety of means,
or including performing a prefrontal
lobotomy.
 Medication
The use of antipsychotic
medication
The Thorazine, the first
antipsychotic drug, to be the
beginning of a new era in treating
schizophrenia
Long-acting injectable antipsychotics
SCHIZOTYPAL (PERSONALITY)
DISORDER
Schizotypal personality disorder is
an ingrained pattern of thinking and
behavior marked by unusual beliefs and
fears, and difficulty with forming and
maintaining relationships.
Clinical Description
 These individuals are often
considered odd or bizarre because of
how they relate to other people, how
they think and behave, and even how
they dress. They have ideas of
reference;
 usually not able to ―test reality‖ or
see the illogic of their ideas.
Individuals with schizotypal
personality disorder also have odd
beliefs or engage in ―magical
thinking, ‖
Etiology
There are genetic and environmental
links to SCHIZOTYPAL (PERSONALITY)
DISORDER
Biopsychosocial Factors (Causes)
A family history of schizophrenia
disorders or other mental health conditions.
Brain malfunction, including brain trauma.
Childhood experiences including abuse or
or detached from you.
Major Symptoms (DSM-5)
Diagnostic Criteria for Schizotypal
Personality Disorder Major Symptoms
(DSM-5)
A. The presence of one (or more) delusion
with 1 a duration of 1 month or longer.
B. Criterion A for Schizophrenia has never
been met.
Note: Hallucinations, if present, are not
prominent and are related to the delusion
theme (e.g., the sensation of being infested
with insects associated with delusion of
infestation)
C. Apart from the impact of the delusion(s)
or its ramification, functioning is not
markedly impaired, and behaavior is not
obviously bizarre or odd.
D. If manic or major depressive episodes
have occurred; these have been brief relative
to the duration of delusional periods.
E. The disturbance is not attributable to the
physiological effects of a substance or other
medical condition and is not better explained
by another mental disorder, such as body
dysmorphic disorder or ebsessive-
compulsive disorder
Treatment
Involves a combination of psychotherapy
and medication.
 Psychotherapy can include psycho-
education about social skills as well
as cognitive-behavioral techniques
that help patients identify and
challenge negative or distorted
patterns of thinking.
 Family therapy may also help
educate family members about the
disorder, improve communication,
and address patterns which increase
anxiety for the individual.
No medications have currently been
approved by the Food and Drug
Administration for the treatment of
schizotypal personality disorder.
 However, doctors may prescribe
antipsychotic medications,
antidepressants, mood stabilizers, or
anti-anxiety medications to help with
symptoms.
BRIEF PSYCHOTIC DISORDER
 BPD is a short-term disturbance that
involves the sudden onset of at least
1 positive psychotic symptom.
 It is similar to schizophrenia, but
rather than being a chronic illness, it
lasts for less than 1 month.
Three Basic Forms of BPD
1. Brief psychotic disorder with
obvious stressor (also called brief
reactive psychosis).
2. Brief psychotic disorder without
obvious stressor.
3. Brief psychotic disorder with
postpartum onset.
Etiology
 The exact cause of Brief Psychotic
Disorder is not known. But one
theory suggests a genetic link and the
disorder is triggered by a major
stress or traumatic event.
Biopsychosocial Factors (causes)
 It is possible there is a genetic link
 Poor coping skills could trigger the
disorder as a defense against or
escape from a very frightening or
stressful situation.
 The disorder is triggered by a major
stress or traumatic event.
Diagnostic Criteria
A. Presence of one (or more) of the
following symptoms. At least one of
these must be (1), (2), or (3):
1. Delusions.
2. Hallucinations.
3. Disorganized speech (e.g.,
frequent derailment or
incoherence).
4. Grossly disorganized or
catatonic behavior.
Note: Do not include a symptom if it is a
culturally sanctioned response.
B. Duration of an episode of the
disturbance is at least 1 day but less
than 1 month, with eventual full
return to premorbid level of
functioning.
C. The disturbance is not better
explained by major depressive or
bipolar disorder with psychotic
features or another psychotic
disorder such as schizophrenia or
catatonia, and is not attributable to
the physiological effects of a
substance (e.g., a drug of abuse, a
medication) or another medical
condition.
Specify if:
With marked stressor(s) (brief reactive
psychosis): If symptoms occur in response
to events that, singly or together, would be
markedly stressful to almost anyone in
similar circumstances in the individual’s
culture.
Without marked stressor(s): If symptoms
do not occur in response to events that,
singly or together, would be markedly
stressful to almost anyone in similar
circumstances in the individual’s culture.
With peripartum onset: If onset is during
pregnancy or within 4 weeks postpartum.
Specify if:
With catatonia (refer to the criteria for
catatonia associated with another mental
disorder, p. 135, for definition).
Coding note: Use additional code F06.1
catatonia associated with brief psychotic
disorder to indicate the presence of the
comorbid catatonia.
Specify current severity:
Severity is rated by a quantitative
assessment of the primary symptoms of
psychosis, including delusions,
hallucinations, disorganized speech,
abnormal psychomotor behavior, and
negative symptoms. Each of these symptoms
may be rated for its current severity (most
severe in the last 7 days) on a 5-point scale
ranging from 0 (not present) to 4 (present
and severe). (See Clinician-Rated
Dimensions of Psychosis Symptom Severity
in the chapter ―Assessment Measures.‖)
Note: Diagnosis of brief psychotic disorder
can be made without using this severity
specifier.
Treatment
Medication:
The doctor might prescribe antipsychotic
medications to ease or eliminate the
symptoms and end the brief psychotic
disorder.
Psychotherapy
Through counseling, or ―talk therapy.
SCHIZOPHRENIFORM DISORDER
Schizophreniform disorder is a short-
term type of psychotic disorder, a serious
mental condition that can distort the way
you:
 Think.
 Act.
 Expresses emotions.
 Perceive reality.
 Relate to others.
ETIOLOGY
The exact causes of schizophrenia are
unknown. Research suggests a combination
of physical, genetic, psychological and
environmental factors can make a person
more likely to develop the condition. Some
people may be prone to schizophrenia, and a
stressful or emotional life event might
trigger a psychotic episode.
Biopsychosocial Factors (Causes)
 Genetics (heredity): A tendency to
develop schizophreniform disorder
might be passed on from parents to
their children. This increases your
risk of developing the disorder
compared to the general population.
However, this does not guarantee
that the disorder will be passed on.
 Brain chemistry: If you have
schizophrenia or schizophreniform
disorder, you might have an
imbalance of certain chemicals in the
brain. These chemicals, called
neurotransmitters, are substances that
help nerve cells in the brain send
messages to each other. An
imbalance in these chemicals can
interfere with the transmission of
messages, leading to symptoms.
 Environmental factors: Evidence
suggests that certain factors in the
environment might trigger
schizophreniform disorder in people
who have inherited a tendency to
develop the disorder. These factors
can be poor social interactions or a
highly stressful event.
Diagnostic Criteria
A. Two (or more) of the following, each
present for a significant portion of
time during a 1- month period (or
less if successfully treated). At least
one of these must be (1), (2), or (3):
1. Delusions.
2. Hallucinations.
3. Disorganized speech (e.g., frequent
derailment or incoherence).
4. Grossly disorganized or catatonic
behavior.
5. Negative symptoms (i.e., diminished
emotional expression or avolition).
B. An episode of the disorder lasts at
least 1 month but less than 6 months.
When the diagnosis must be made
without waiting for recovery, it
should be qualified as ―provisional.‖
C. Schizoaffective disorder and
depressive or bipolar disorder with
psychotic features have been ruled
out because either
1) no major depressive or manic episodes
have occurred concurrently with the active
phase symptoms, or
2) if mood episodes have occurred during
active-phase symptoms, they have been
present for a minority of the total duration of
the active and residual periods of the illness.
D. The disturbance is not attributable to
the physiological effects of a
substance (e.g., a drug of abuse, a
medication) or another medical
condition.
Specify if:
With good prognostic features: This
specifier requires the presence of at least two
of the following features: onset of prominent
psychotic symptoms within 4 weeks of the
first noticeable change in usual behavior or
functioning; confusion or perplexity; good
premorbid social and occupational
functioning; and absence of blunted or flat
affect.
Without good prognostic features: This
specifier is applied if two or more of the
above features have not been present.
Specify if:
With catatonia (refer to the criteria for
catatonia associated with another mental
disorder, p. 135, for definition).
Coding note: Use additional code F06.1
catatonia associated with schizophreniform
disorder to indicate the presence of the
comorbid catatonia.
Specify current severity:
Severity is rated by a quantitative
assessment of the primary symptoms of
psychosis, including delusions,
hallucinations, disorganized speech,
abnormal psychomotor behavior, and
negative symptoms. Each of these symptoms
may be rated for its current severity (most
severe in the last 7 days) on a 5-point scale
ranging from 0 (not present) to 4 (present
and severe). (See Clinician-Rated
Dimensions of Psychosis Symptom Severity
in the chapter ―Assessment Measures.‖)
Note: Diagnosis of schizophreniform
disorder can be made without using this
severity specifier.
TREATMENT
Medication — The primary medications
used to treat the psychotic symptoms of
schizophreniform disorder — such as
delusions, hallucinations and disordered
thinking — are called anti-psychotics. A
group of newer medicines, called atypical
antipsychotics, are most commonly used.
 Psychotherapy — Family therapy
can help families deal more
effectively with a loved one who has
schizophreniform disorder, enabling
them to contribute to a better
outcome.
Schizoaffective Disorder
Schizoaffective disorder is a condition
where symptoms of both psychotic and
mood disorders are present together during
one episode (or within a two-week period of
each other).
The word schizoaffective has two parts: '
schizo–' refers to psychotic symptoms. '–
affective ' refers to mood symptoms
ETIOLOGY
The exact causes of schizoaffective disorder
are still being investigated, but genetics are
likely a factor.
Biopsychosocial Factors (Causes)
Factors that increase the risk of developing
schizoaffective disorder include:
 GENETIC AND PSYSIOLOGICAL
 CULTURAL AND
SOCIOECONOMIC FACTORS
o Having a close blood relative
— such as a parent or sibling
— who has schizoaffective
disorder, schizophrenia or
bipolar disorder
o Stressful events that may
trigger symptoms
o Taking mind-altering drugs,
which may worsen symptoms
when an underlying disorder
is present
Diagnostic Criteria
A. An uninterrupted period of illness
during which there is a major mood
episode (major depressive or manic)
concurrent with Criterion A of
schizophrenia.
Note: The major depressive episode must
include Criterion A1: Depressed mood.
B. Delusions or hallucinations for 2 or
more weeks in the absence of a
major mood episode (depressive or
manic) during the lifetime duration
of the illness.
C. Symptoms that meet criteria for a
major mood episode are present for
 the majority of the total duration of
the active and residual portions of
the illness.
D. The disturbance is not attributable to
the effects of a substance (e.g., a
drug of abuse, a medication) or
another medical condition.
Specify whether:
F25.0 Bipolar type: This subtype applies if
a manic episode is part of the presentation.
Major depressive episodes may also occur.
F25.1 Depressive type: This subtype
applies if only major depressive episodes are
part of the presentation.
Specify if:
With catatonia (refer to the criteria for
catatonia associated with another mental
disorder, p. 135, for definition).
Coding note: Use additional code F06.1
catatonia associated with schizoaffective
disorder to indicate the presence of the
comorbid catatonia.
Specify if:
The following course specifiers are only to
be used after a 1-year duration of the
disorder and if they are not in contradiction
to the diagnostic course criteria.
First episode, currently in acute episode:
First manifestation of the disorder meeting
the defining diagnostic symptom and time
criteria. An acute episode is a time period in
which the symptom criteria are fulfilled.
First episode, currently in partial
remission: Partial remission is a time period
during which an improvement after a
previous episode is maintained and in which
the defining criteria of the disorder are only
partially fulfilled.
First episode, currently in full remission:
Full remission is a period of time after a
previous episode during which no disorder-
specific symptoms are present.
Multiple episodes, currently in acute
episode: Multiple episodes may be
determined after a minimum of two episodes
(i.e., after a first episode, a remission and a
minimum of one relapse).
Multiple episodes, currently in partial
remission
Multiple episodes, currently in full
remission Continuous: Symptoms fulfilling
the diagnostic symptom criteria of the
disorder are remaining for the majority of
the illness course, with subthreshold
symptom periods being very brief relative to
the overall course.
Unspecified
Specify current severity:
Severity is rated by a quantitative
assessment of the primary symptoms of
psychosis, including delusions,
hallucinations, disorganized speech,
abnormal psychomotor behavior, and
negative symptoms. Each of these symptoms
may be rated for its current severity (most
severe in the last 7 days) on a 5-point scale
ranging from 0 (not present) to 4 (present
and severe). (See Clinician-Rated
Dimensions of Psychosis Symptom Severity
in the chapter ―Assessment Measures.‖)
Note: Diagnosis of schizoaffective disorder
can be made without using this severity
specifier.
TREATMENT
 Antipsychotics. The only medication
approved by the Food and Drug
Administration specifically for the
treatment of schizoaffective disorder
is the antipsychotic drug
paliperidone (Invega). However,
doctors may prescribe other
antipsychotic drugs to help manage
psychotic symptoms such as
delusions and hallucinations.
 Mood-stabilizing medications. When
the schizoaffective disorder is
bipolar type, mood stabilizers can
help level out the mania highs and
depression lows.
 Antidepressants. When depression is
the underlying mood disorder,
antidepressants can help manage
feelings of sadness, hopelessness, or
difficulty with sleep and
concentration.
Substance / Medication Iduced Psychotic
Disorder
It is a mental health condition in
which the onset of your psychotic episodes
or psychotic disorder symptoms can be
traced to starting or stopping using alcohol
or a drug (onset during intoxication or onset
during withdrawal).
Etiology
 Typically caused by the misuse of
alcohol or drugs.
BIOPSYCHOSOCIAL FACTOR
(CAUSES)
 traumatic brain injury or stroke
 A family or personal history of
schizophrenia, mood disorders, or
psychotic disorders
 Side effects of certain prescription
medications
 Dementia, such as Alzheimer ' s
disease
 Brain tumors, lesions, or cysts
 Genetic abnormalities
Diagnostic Criteria
A. Presence of one or both of the
following symptoms:
1. Delusions.
2. Hallucinations.
B. There is evidence from the history,
physical examination, or laboratory
findings of both (1) and (2):
1. The symptoms in
Criterion A developed
during or soon after
substance intoxication or
withdrawal or after
exposure to or withdrawal
from a medication.
2. The involved
substance/medication is
capable of producing the
symptoms in Criterion A.
C. The disturbance is not better
explained by a psychotic disorder
that is not substance/medication-
induced. Such evidence of an
independent psychotic disorder could
include the following:
The symptoms preceded the onset of the
substance/medication use; the symptoms
persist for a substantial period of time (e.g.,
about 1 month) after the cessation of acute
withdrawal or severe intoxication; or there is
other evidence of an independent non-
substance/medication-induced psychotic
disorder (e.g., a history of recurrent
nonsubstance/medication-related episodes).
D. The disturbance does not occur
exclusively during the course of a
delirium.
E. The disturbance causes clinically
significant distress or impairment in
social, occupational, or other
important areas of functioning.
Note: This diagnosis should be made instead
of a diagnosis of substance intoxication or
substance withdrawal only when the
symptoms in Criterion A predominate in the
clinical picture and when they are
sufficiently severe to warrant clinical
attention.
Coding note: The ICD-10-CM codes for the
[specific substance/medication]-induced
psychotic disorders are indicated in the table
below. Note that the ICD-10-CM code
depends on whether or not there is a
comorbid substance use disorder present for
the same class of substance. In any case, an
additional separate diagnosis of a substance
use disorder is not given. If a mild substance
use disorder is comorbid with the
substanceinduced psychotic disorder, the 4th
position character is ―1,‖ and the clinician
should record ―mild [substance] use
disorder‖ before the substance-induced
psychotic disorder (e.g., ―mild cocaine use
disorder with cocaineinduced psychotic
disorder‖). If a moderate or severe substance
use disorder is comorbid with the
substanceinduced psychotic disorder, the 4th
position character is ―2,‖ and the clinician
should record ―moderate [substance] use
disorder‖ or ―severe [substance] use
disorder,‖ depending on the severity of the
comorbid substance use disorder. If there is
no comorbid substance use disorder (e.g.,
after a one-time heavy use of the substance),
then the 4th position character is ―9,‖ and
the clinician should record only the
substance-induced psychotic disorder.
 With Mild Use
Disorder With Moderate or
Without Use Disorder
Severe Use Disorder
Alcohol F10.159 F10.259 F10.259
Cannabis F12.159 F12.259 F12.259
Phencyclidine F16.159 F16.259 F16.259
Other hallucinogen F16.159 F16.259 F16.259
Inhalant F18.159 F18.259 F18.259
Sedative, hypnotic, or
anxiolytic F13.159 F13.259 F13.259

Amphetamine-type
substance (or other
stimulant) F15.159 F15.259 F15.259

Cocaine F14.159 F14.259 F14.259

Other (or unknown)
substance F19.159 F19.259 F19.259

Specify (see Table 1 in the chapter Dimensions of Psychosis Symptom Severity

―Substance-Related and Addictive
Disorders,‖ which indicates whether ―with
onset during intoxication‖ and/or ―with
onset during withdrawal‖ applies to a given
substance class; or specify ―with onset after
medication use‖):
With onset during intoxication: If criteria
are met for intoxication with the substance
and the symptoms develop during
intoxication.
With onset during withdrawal: If criteria
are met for withdrawal from the substance
and the symptoms develop during, or shortly
after, withdrawal.
With onset after medication use: If
symptoms developed at initiation of
medication, with a change in use of
medication, or during withdrawal of
medication.
Specify current severity:
Severity is rated by a quantitative
assessment of the primary symptoms of
psychosis, including delusions,
hallucinations, abnormal psychomotor
behavior, and negative symptoms. Each of
these symptoms may be rated for its current
severity (most severe in the last 7 days) on a
5-point scale ranging from 0 (not present) to
4 (present and severe). (See Clinician-Rated
in the chapter ―Assessment Measures.‖)
Note: Diagnosis of substance/medication-
induced psychotic disorder can be made
without using this severity specifier.
Treatment
Your doctor may prescribe antipsychotic
drugs and other types of medication to help
control your symptoms and treat other
conditions that may be affecting you like
anxiety, depression, or PTSD.
Delusion Disorder
ETIOLOGY OF DELUSIONAL
DISORDER
Delusional disorder is relatively rare, has a
later age of onset as compared to
schizophrenia, and does not show a gender
predominance. The patients are also
relatively stable. The exact cause of the
delusional disorder is unknown.
 Many biological conditions like
substance use, medical conditions,
neurological conditions can cause
delusions.
 The delusional disorder involves the
limbic system and basal ganglia in
those with intact cortical functioning
Hypersensitive persons and ego defense
mechanisms like reaction formation,
projection, and denial are some
psychodynamic theories for delusional
disorder. Social isolation, envy, distrust,
suspicion, and low self-esteem are some of
the factors which when becoming intolerable
leads to a person seeking an explanation and
thus forming a delusion as a solution.
BIOPSYCHOSOCIAL FACTORS
(CAUSES)
 Genetic factors: The fact that
delusional disorder is more common
in people who have family members
with delusional disorder or
schizophrenia suggests there might
be a genetic factor involved.
 Biological factors: Researchers are
studying how abnormalities of
certain areas of your brain might be
involved in the development of
delusional disorder. An imbalance of
certain chemicals in your brain,
called neurotransmitters, has been
linked to the formation of delusional
symptoms.
 Environmental and psychological
factors: Evidence suggests that
delusional disorder can be triggered
by stress. Alcohol use disorder and
substance use disorder might
contribute to the condition.
Hypersensitivity and ego defense
mechanisms like reaction formation,
projection and denial are some
psychodynamic theories for the
development of delusional disorder.
TREATMENT
Treatment for delusional disorder most often
includes psychotherapy (talk therapy) and
medication, but delusional disorder is highly
resistant to treatment with medication alone.
III. Bipolar Disorder
 Bipolar Disorder is a mental illness
that causes unusual shifts in mood,
energy, activity levels, concentration,
and the ability to carry out day-today
tasks
Mania or Hypomania
 Mania and hypomania are
periods where a person feels
elated, very active, and full of
energy. Hypomania is a milder
form of mania. Mania and
hypomania both involve periods
when the individual feels excited
or experiences an energized
mood.
 Causes: Childhood trauma, brain
chemistry, family links, medication,
drugs, and alcohol
 MANIC & HYPOMANIC
EPISODE
1. Inflated self-esteem of grandiosity.
2. Decreased need for sleep.
3. More talkative than usual or
pressure to keep talking.
4. Flight of ideas or subjective
experience that thoughts are racing.
5. Distractibility, as reported or
observed.
6. Increase in goal-directed activity
(either socially, at work or school, or
sexually) or psychomotor agitation.
7. Excessive involvement in
activities that have a high potential
for painful consequences
 MAJOR DEPRESSIVE EPISODE
1. Depressed mood most of the day,
nearly every day, as indicated by
either subjective report or
observation made by others.
2. Marked diminished interest or
pleasure in all, or almost all,
activities most of the day, nearly
every day (as indicated by either
subjective account or observation).
3. Significant weight loss when not
dieting or weight gain, or decrease or
increase in appetite nearly every day.
4. Insomnia or hypersomnia nearly
every day
5. Psychomotor agitation or
retardation to nearly every day
(observable by others; not merely
subjective feelings of restlessness or
being slowed down).
6. Fatigue or loss of energy nearly
every day.
7. Feelings of worthlessness or
excessive or inappropriate guilt
(which may be delusional) nearly
every day (not merely self-reproach
or guilt being sick).
8. Diminished ability to think or
concentrate, or indecisiveness, nearly
every day.
9. Recurrent thoughts of death (not
just fear of dying), recurrent suicidal
ideation without a specific plan, or
 suicide attempt or a specific plan for
committing suicide.
Types of Bipolar Disorder
1) BIPOLAR I
 The Bipolar I disorder criteria
represents the modern understanding
of the classic manicdepressive
disorder or affective psychosis
described in the 19th century,
differing from the classic description
only to the extent that neither
psychosis nor the lifetime experience
of a major depressive episode is a
requirement
 More severe
 Major Symptoms: Manic episode,
Hypomanic
2) BIPOLAR II
 At least one episode of hypomania
and one episode of major depression
3) CYCLOTHYMIA
 Cyclothymic Disorder
 At least two years (one year for
children and adolescents)
 Numerous periods with hypomanic
symptoms that do not meet criteria
for a hypomanic episode
 Numerous periods with depressive
symptoms that do not meet criteria
for a major depressive episode.
DIAGNOSTIC CRITERIA
A. For at least 2 years (at least 1 year in
children and adolescents) there have been
numerous periods with hypomanic
symptoms that do not meet criteria for a
hypomanic episode and numerous periods
with depressive symptoms that do not meet
criteria for a major depressive episode.
B. During the above 2-year period (1 year in
children and adolescents), the hypomanic
and depressive periods have been present for
at least half the time and the individual has
not been without the symptoms for more
than 2 months at a time.
C. Criteria for major depressive, manic, or
hypomanic episodes have never been met.
D. The symptoms in Criterion A are not
better explained by schizoaffective disorder,
schizophrenia, schizophreniform disorder,
delusional disorder, or other specified or
unspecified schizophrenia spectrum and
other psychotic disorders.
E. The symptoms are not attributable to the
psychological effects of a substance abuse
(e.g., a drug of abuse, a medication) or
another medical condition (e.g.,
hyperthyroidism).
F. The symptoms cause clinically significant
distress or impairment in social,
occupational, or other important areas of
functioning.
SUBSTANCE/MEDICATIONINDUCED
BIPOLAR AND RELATED DISORDER
 Substance/Medication-Induced
Bipolar and Related Disorder is
diagnosed when a substance
(alcohol, illicit drugs, or prescribed
medication) causes
manic/hypomanic and/or depressive
symptoms while an individual is
using the substance or during a
withdrawal syndrome associated
with the substance
 Causes: alcohol, phencyclidine,
hallucinogens, and amphetamines
DIAGNOSTIC CRITERIA
A.A prominent and persistent disturbance in
mood that predominates in the clinical
picture and is characterized by elevated,
expansive, or irritable mood, with or without
depressed mood, or markedly diminished
interest or pleasure in all, or almost all,
activities.
B. There is evidence from the history,
physical examination, or laboratory findings
of both (1) and (2):
i) The symptoms in Criterion A
developed during or soon after
substance intoxication or withdrawal
or after exposure to a medication.
ii) The involved
substance/medication is capable of
producing the symptoms in Criterion
A.
C. The disturbance is not better explained by
a bipolar or related disorder that is not
substance/medication induced. Such
evidence of an independent bipolar or
related disorder could include the following:
-The symptoms precede the onset of the
substance/medication use
-The symptoms persist for a substantial
period of time (e.g. - about 1 month) after
the cessation of acute withdrawal or severe
intoxication
-There is other evidence suggesting the
existence of an independent non-
substance/medication-induced bipolar and
related disorder (e.g. - a history of recurrent
non-substance/medication-related episodes).
D. The disturbance does not occur
exclusively during the course of a delirium.
E. The disturbance causes clinically
significant distress or impairment in social,
occupational, or other important areas of
functioning
ONSET SPECIFIER
Specify if:
 With onset during intoxication: If the
criteria are met for intoxication with
the substance and the symptoms
develop during intoxication.
 With onset during withdrawal: If
criteria are met for withdrawal from
the substance and the symptoms
develop during, or shortly after,
withdrawal.
BIPOLAR AND RELATED DISORDER
DUE TO ANOTHER MEDICAL
CONDITION
A. A prominent and persistent period of
abnormally elevated, expansive, or irritable
mood and abnormally increased activity or
energy that predominates in the clinical
picture. B. There are evidences from the
history, physical examination, or laboratory
findings that the disturbance is the direct
pathophysiological consequence of another
medical condition.
C. The disturbance is not better explained by
another mental disorder.
D. The disturbance does not occur
exclusively during the course of a delirium.
E. The disturbance causes clinically
significant distress or impairment in social,
occupational, or other important areas of
functioning, or necessitates hospitalization
to prevent harm to self or others, or there are
psychotic features
Coding note: The ICD-9-CM code for
bipolar and related disorder due to another
medical condition is 293.83, which is
assigned regardless of the specifier.
Specify if:
(F06.33) With manic features: Full criteria
are not met for a manic or hypomanic
episode. (F06.33) With manic- or
hypomanic- like episode: Full criteria are
met except Criterion D for a manic episode
or except Criterion F for a hypomanic
episode.
(F06.34) With mixed features: Symptoms of
depression are also present but do not
prodominate in the clinical picture
TREATMENTS
 Medications
 Psychotherapy
IV. Depressive Disorder
1. Disruptive Mood Dysregulation
Disorder
 childhood condition that is
characterized by severe anger,
irritability, and frequent temper
outbursts

DIAGNOSTIC CRITERIA
A. Severe recurrent temper outbursts
manifested verbally (e.g., verbal rages)
and/or behaviorally (e.g., physical
aggression toward people or property) that
are grossly out of proportion in intensity or
duration to the situation or provocation.
B. The temper outbursts are inconsistent
with developmental level.
C. The temper outbursts occur, on average,
three or more times per week.
D. The mood between temper outbursts is
persistently irritable or angry most of the
day, nearly every day, and is observable by
others (e.g., parents, teachers, peers).
E. Criteria A-D have been present for12 or
more months. Throughout that time, the
individual has not had a period lasting 3 or
more consecutive months without all of the
symptoms in Criteria A-D.
F.
Criteria A and D are present in at least two
of three settings (i.e., at home, at school,
with peers) and are severe in at least one of
these.
G. The diagnosis should not be made for the
first time before age 6 years or after age 18
years.
H. By history or observation, the age at
onset of Criteria A-E is before 10 years.
I. There has never been a distinct period
lasting more than 1 day during which the
full symptom criteria, except duration, for a
manic or hypomanic episode have been met.
Note: Developmentally appropriate mood
elevation, such as occurs in the context of a
highly positive event or its anticipation,
should not be considered as a symptom of
mania or hypomania.
J. The behaviors do not occur exclusively
during an episode of major depressive
disorder and are not better explained by
another mental disorder (e.g., autism
spectrum disorder, posttraumatic stress
disorder, separation anxiety disorder,
persistent depressive disorder [dysthymia]).
K. The symptoms are not attributable to the
physiological effects of a substance or to
another medical or neurological condition
2. Major Depressive Disorder
 Major depressive disorder,
commonly known as depression or
clinical depression, is a medical
condition caused by a chemical
imbalance in the brain. It is a mood
disorder that can cause you to feel
low for weeks or months and lose
interest in things you once enjoyed.
DIAGNOSTIC CRITERIA
A. Five (or more) of the following
symptoms have been present during the
same 2-week period and represent a change
from previous functioning: at least one of
the symptoms is either (1) depressed mood
or (2) loss of interest or pleasure.
Note: Do not include symptoms that
are clearly attributable to another
medical condition.
1. Depressed mood most of the day, nearly
every day, as indicated by either subjective
report (e.g., feels sad, empty, hopeless) or
observation made by others (e.g., appears
tearful). (Note: In children and adolescents,
can be irritable mood.)
2. Markedly diminished interest or pleasure
in all, or almost all, activities most of the
day, nearly every day (as indicated by either
subjective account or observation).
3. Significant weight loss when not dieting
or weight gain (e.g., a change of more than
5% of body weight in a month), or decrease
or increase in appetite nearly every day.
(Note: In children, consider failure to make
expected weight gain.)
4. Insomnia or hypersomnia nearly every
day.
5. Psychomotor agitation or retardation
nearly every day (observable by others, not
merely subjective feelings of restlessness or
being slowed down).
6. Fatigue or loss of energy nearly every
day.
7. Feelings of worthlessness or excessive or
inappropriate guilt (which may be
delusional) nearly every day (not merely
self-reproach or guilt about being sick).
8. Diminished ability to think or concentrate,
or indecisiveness, nearly every day (either
by subjective account or as observed by
others).
9. Recurrent thoughts of death (not just fear
of dying), recurrent suicidal ideation without
a specific plan, or a suicide attempt or a
specific plan for committing suicide
B. The symptoms cause clinically significant
distress or impairment in social,
occupational, or other important areas of
functioning.
C. The episode is not attributable to the
physiological effects of a substance or to
another medical condition. Note: Criteria A-
C represent a major depressive episode.
D. The occurrence of the major depressive
episode is not better explained by
schizoaffective disorder, schizophrenia,
schizophreniform disorder, delusional
disorder, or other specified and unspecified
schizophrenia spectrum and other psychotic
disorders.
E. There has never been a manic episode or
a hypomanic episode.
Note: This exclusion does not apply
if all of the manic-like or
hypomanic-like episodes are
substance-induced or are attributable
to the physiological effects of
another medical condition
3. Persistent Depressive Disorder
(Dysthymia)
 Depressed mood for most of the day
more than half of the time for 2 years
(or 1 year for children and adolescents).
 characterized by chronic depression on
a spectrum from mild to severe
DIAGNOSTIC CRITERIA
A. Depressed mood for most of the day, for
more days than not, as indicated by either
subjective account or observation by others,
for at least 2 years.
Note: In children and adolescents,
mood can be irritable and duration
must be at least 1 year. B. Presence,
while depressed, of two(or more)of
the following:
1. Poor appetite or overeating.
2. Insomnia or hypersomnia.
3. Low energy or fatigue.
4. Low self-esteem.
5. Poor concentration or difficulty
making decisions. 6. Feelings of
hopelessness
C. During the 2-year period (1year for
children or adolescents) of the disturbance,
the individual has never been without the an exacerbation of the symptoms of another
symptoms in Criteria A and B for more than disorder.
2 months at a time. F. Criterion A should be confirmed by
A. Criteria for a major depressive prospective daily ratings during at least two
disorder may be continuously present symptomatic cycles.
for 2 years. G. The symptoms are not attributable to the
B. There has never been a manic physiological effects of substance or another
episode or a hypomanic episode, and medical condition
criteria have never been met for
cyclothymic disorder.
C. The disturbance is not better
explained by a persistent
schizoaffective disorder,
schizophrenia, delusional disorder, or
V. Anxiety Disorders
 Anxiety – A fundamental human
other specified or unspecified emotion that produces bodily
schizophrenia spectrum and other reactions that prepare us for ―fight or
psychotic disorder. flight‖
D. The symptoms are not attributable
 Fear – An intense emotion
to the physiological effects of a
experienced in response to a
substance (e.g., a drug of abuse, a
threatening situation
medication) or another medical
 Panic – sudden, overwhelming fright
condition (e.g. hypothyroidism).
or terror
E. The symptoms cause clinically
significant distress or impairment in  Panic Attack – abrupt experience of
social, occupational, or other intense fear or discomfort
important areas of functioning. accompanied by a number of
physical symptoms, such as dizziness
or heart palpitations
4. Premenstrual Dysphoric Disorder
Two types of panic attack
 a condition in which a woman has
1. Expected (cued)
severe depression symptoms,
2. Unexpected (uncued)
irritability, and tension before
menstruation  Fear or anxiety symptoms that
DIAGNOSTIC CRITERIA interfere with an individual’s day-
A. In the majority of menstrual cycles, at today functioning.
least five symptoms must be present in the  Often accompanied by depression or
final week before the onset of menses, start substance abuse
to improve within a few days after the onset  Etiology
of, and become minimal or absent in the  Biological Dimension
week postmenses. * Overactive fear circuitry in
B. One (or more) of the following symptoms brain
must be present: *5-HTTLPR genotype
• Mood swings variations
• Marked irritability or anger or increased *Abnormalities in
interpersonal conflicts. neurotransmitters
• Marked depressed mood *Reduced serotonin activity
• Marked anxiety  Psychological Dimension
C. One (or more) of the following symptoms *Negative appraisal –
must additionally be present: interpreting evens as
*Decreased interest in usual activities threatening
*Difficulty in concentration * Easy *Anxiety sensitivity – trait
fatigability involving fear of
*Change in appetite * Sleep Disturbance physiological changes within
*Overwhelmed or out of control the body
*Physical symptoms *Conditioning experiences
D. Clinically significant distress or *Limited sense of control
interference E. The disturbance is not merely  Social Dimension
*Daily environmental stress
 *Lack of social support
*Stressful relationships
*Severe childhood
maltreatment
 Sociocultural Dimension
* Gender differences
*Cultural factors
*Acculturation conflicts
1. Specific Anxiety Disorders
 Phobias
Phobia – A strong, persistent,
and unwarranted fear of a
specific object or situation
Three Categories of Phobias
A. Social Anxiety Disorder (Social
Phobia)
 An intense fear of being scrutinized
in social or performance situations
 Performance only type – only in
situations in which they must speak
or perform in public
 Often comorbid with major
depressive disorders, substanceuse
disorders, and suicidal thoughts or
attempts
 Tend to believe that others are
evaluating them or viewing them
negatively
 Remain alert for ―threat‖ cues such
as signs of disapproval or criticism.
 Engaging in ―safety behaviors‖
 Tend to be socially submissive ○
Often report stressful interpersonal
relationship
 Marked and disproportionate fear
consistently triggered by exposure to
potential social scrutiny
 Exposure to the trigger leads to
intense anxiety about being
evaluated negatively
 Trigger situations are avoided or else
endured with intense anxiety
 Symptoms persist for at least 6
months
 The fear, anxiety, or avoidance
causes clinically significant distress
or impairment in social,
occupational, or other important
areas of functioning.
 Not better explained by the
symptoms of another mental disorder
 If another medical condition is
present, the fear, anxiety, or
avoidance is clearly unrelated or is
excessive.
B. Specific Phobia
 An extreme fear of a specific object
or situation.
 Three primary types of specific
phobias:
 Living creatures
 Environmental conditions
 Blood/injections or injury
 Situational factors
 Often begin during childhood
 Onset of some specific phobias:
Animal phobias – age 7
Blood phobias – age 9
Dental phobia – age 12
Claustrophobia – age 20
 Early fears are common and most
remit without treatment. 21
 Blood phobias are associated with a
unique physiological response:
fainting in the phobic situation.
 Marked and disproportionate fear
consistently triggered by specific
objects or situations
 The object or situation is avoided or
else endured with intense anxiety
 Symptoms persist for at least 6
months
 The fear, anxiety, or avoidance
causes clinically significant distress
or impairment in social,
occupational, or other important
areas of functioning.
 Not better explained by the
symptoms of another mental disorder
C. Agoraphobia
 An intense fear of being in public
places where escape or help may not
be readily available.
 Intense fear of at least two of the
following situations:
a. Being outside of the home alone
b. Traveling via public transportation
c. Being in open spaces. Being in
stores or theaters
e. Standing in line or being in a
crowd
 Fear that they might be incapacitated
or severely embarrassed by fainting,
losing control over bodily functions,
 or displaying excessive fear in public
25
 Possibility of a panic attack – an
episode of intense fear accompanied
by symptoms such as pounding
heart, trembling, shortness of breath,
and fear of losing control or dying.
2. Panic Disorders
 A condition involving recurrent,
unexpected panic attacks with
apprehension over future attacks
or behavioral changes to avoid
attacks.
 Etiology of Panic Disorder
 Biological Dimension
*Modest heritability
*Decreased availability of
serotonin GABA
*Amygdala and fear
circuitry reactivity
 Psychological Dimension
*Anxiety sensitivity or
physiological vigilance
*Catastrophic thoughts
(Cognitive Behavioral
Perspective
*Examples of
catastrophic thoughts in
panic disorder
 Social Dimension
*Anxiety-filled social
environment
*Separation or loss
*Peer victimization
 Sociocultural Dimension
*Fewer panic attacks
among Asian adolescents
*Gender differences
(more common in
women)
*Cultural differences in
expression
DIAGNOSTIC CRITERIA
A. Recurrent unexpected panic attacks are
present.
B. At least one of the attacks has been
followed by 1 month or more of one or both
of the following: (a) Persistent concern or
worry about additional panic attacks or their
consequences (e.g., losing control, having a
heart attack, ―going crazy‖), or (b) A
significant maladaptive change in behavior
related to the attacks (e.g., behaviors
designed to avoid having panic attacks, such
as avoidance of exercise or unfamiliar
situations).
C. The disturbance is not attributable to the
physiological effects of a substance (e.g., a
drug of abuse, a medication) or another
medical condition (e.g., hyperthyroidism,
cardiopulmonary disorders).
D. The disturbance is not better explained by
another mental disorder (e.g., the panic
attacks do not occur only in response to
feared social situations, as in social anxiety
disorder).
3. Generalized Anxiety Disorder
 Excessive anxiety and worry at least
50 % of days about a number of
events or activities
 The person finds it hard to control
the worry
 The worry is sustained for at least 6
months
 The anxiety and worry are associated
with at least three (or one in
children) of the following:
restlessness or feeling keyed up or on
edge; easily fatigued; difficulty
concentrating or mind going blank;
irritability; muscle tension; sleep
disturbance
 A condition characterized by
persistent, high levels of anxiety and
excessive worry over many life
circumstances
 Etiology of GAD
 Biological Dimension
- Some genetic
influence
- Overactive fear
network
- Abnormalities
with GABA
receptors
 Psychological Dimension
- Lower threshold
for uncertainty
- Anxiety-evoking
schemas (mental
frameworks for
organizing and
interpreting
information)
 - Use of worry as
coping
- Worry about
worrying
 Social Dimension
- Lack of social
network
- Separation or loss
- Anxious
nonresponsive
parents
- Peer conflicts and
victimization
 Sociocultural Dimension
- Stressful or poor
living conditions
- Prejudice and
discrimination
- Low
socioeconomic
status
DIAGNOSTIC CRITERIA
A. Excessive anxiety and worry
(apprehensive expectation), occurring more
days than not for at least 6 months about a
number of events or activities (such as work
or school performance). B. The individual
finds it difficult to control the worry.
C. The anxiety and worry are associated
with at least three (or more) of the following
six symptoms (with at least some symptoms
present for more days than not for the past 6
months) [Note: Only one item is required in
children]:
1. Restlessness or feeling keyed up
or on edge
2. Being easily fatigued
3. Difficulty concentrating or mind
going blank
4. Irritability
5. Muscle tension
6. Sleep disturbance (difficulty
falling or staying asleep or restless,
unsatisfying sleep)
D. The anxiety, worry or physical symptoms
cause clinically significant distress or
impairment in social, occupational, or other
important areas of functioning.
E. The disturbance is not due to the direct
physiological effects of a substance (e.g., a
drug of abuse, a medication) or a general
medical condition (e.g., hyperthyroidism).
F. The disturbance is not better explained by
another mental disorder (e.g., anxiety or
worry about having panic attacks in panic
disorder, negative evaluation in social
anxiety disorder).
4. Separation Anxiety Disorder
 Characterized by children’s
unrealistic and persistent worry that
something will happen to their
parents or other important people in
their life or that something will
happen to the children themselves
or that will separate them from their
parents.
 Developmentally inappropriate and
excessive fear or anxiety concerning
separation from those to whom the
individual is attached
 The fear, anxiety, or avoidance is
persistent, lasting at least 4 weeks in
children and adolescents and
typically 6 months or more in adults.
 The disturbance causes clinically
significant distress or impairment in
social, academic, occupational, or
other important areas of functioning.
 The disturbance is not better
explained by another mental disorder
5. Selective Mutism (SM)
 A rare childhood disorder
characterized by a lack of speech in
one or more settings in which
speaking is socially expected.
 Characterized by a consistent failure
to speak in social situations in which
there is an expectation to speak (e.g.,
school) even though the individual
speaks in other situations.
 This interferes with normal social
communication.
 The duration of the disturbance is at
least 1 month
VI. Obsessive
Compulsive & Related
Disorders
1. Obsessive compulsive disorder (OCD)
is a common mental health condition where
a person has obsessive thoughts and
compulsive behaviours.
 Obsessions - are recurrent and
persistent thoughts, urges, or images
that are experienced as intrusive and
unwanted.
  Compulsions - are repetitive
behaviours or mental acts that an
individual feels driven to perform in
response to an obsession or
according to rules that must be
applied rigidly
 Pursuing cleanliness and
orderliness, sometimes
through elaborate rituals
 Performing repetitive,
magically protective acts,
such as counting or
touching a body part
 Repetitive checking to
ensure that certain acts are
carried out
 The obsessions and compulsions are
time consuming and cause
significant distress and impairment
 Not attributable to direct
physiological effects of substances or
any medical condition
 Not better explained by other mental
disorder
DIAGNOSTIC CRITERIA
1. Presence of obsessions, compulsions, or
both:
 Recurrent and persistent thoughts,
urges, or images
 The individual attempts to ignore or
suppress such thoughts, urges, or
images to neutralize them.
Compulsions are defined by
 Repetitive behaviors (eg., hand
washing, ordering checking) or
mental acts (e.g., praying, counting,
repeating words silently) that the
individual feels driven to perform in
response to an obsession or
according to rules that must be
applied rigidly.
 The behaviors or mental acts are
aimed at preventing or reducing
anxiety or distress, or preventing
some dreaded event or situation
2. The obsessions or compulsions are time-
consuming (e.g., take more than 1 hour per
day) or cause clinically significant distress
or impairment in social, occupational, or
other important areas of functioning.
3. The obsessive-compulsive symptoms are
not attributable to the physiological effects
of a substance (e.g., a drug of abuse, a
medication) or another medical condition.
4. The disturbance is not better explained by
the symptoms of another mental disorder
(e.g., excessive worries, as in generalized
anxiety disorder; preoccupation with
appearance, as in body dysmorphic disorder;
difficulty discarding or parting with
possessions, as in hoarding disorder; hair
pulling, as in trichotillomania [hair-pulling
disorder]; skin picking, as in excoriation
[skin-picking] disorder; stereotypies, as in
stereotypic movement disorder; ritualized
eating behavior, as in eating disorders;
preoccupation with substances or gambling,
as in substance-related and addictive
disorders)
Specify if:
With good or fair insight: The individual
recognizes that obsessive-compulsive
disorder beliefs are definitely or probably
not true or that they may or may not be true.
With poor insight: The individual thinks
obsessive-compulsive disorder beliefs are
probably true.
With absent insight/delusional beliefs: The
individual is completely convinced that
obsessive compulsive disorder beliefs are
true.
Specify if:
Tic-related: The individual has a current or
past history of a tic disorder.
2. Body Dysmorphic Disorder
 Preoccupation with one or more
perceived defects in appearance
 The person has performed repetitive
behaviors or mental acts (e.g., mirror
checking, seeking reassurance, or
excessive grooming) in response
 The preoccupation with appearance
can interfere with many aspects of
occupational and social functioning.
 Preoccupation is not restricted to
concerns about weight or body fat
DIAGNOSTIC CRITERIA
A. Preoccupation with one or more
perceived defects or flaws in physical
appearance that are not observable or appear
slight to others.
B. At some point during the course of the
disorder, the individual has performed
repetitive behaviors (e.g., mirror checking,
excessive grooming, skin picking,
reassurance seeking) or mental acts (e.g.,
comparing his or her appearance with that of
others) in response to the appearance
concerns.
C. The preoccupation causes clinically
significant distress or impairment in social,
occupational, or other important areas of
functioning.
D. The appearance preoccupation is not
better explained by concerns with body fat
or weight in an individual whose symptoms
meet diagnostic criteria for an eating
disorder.
Specify if:
With muscle dysmorphia: The individual is
preoccupied with the idea that his or her
body build is too small or insufficiently
muscular. This specifier is used even if the
individual is preoccupied with other body
areas, which is often the case.
Specify if:
Indicate degree of insight regarding body
dysmorphic disorder beliefs (e.g., ―I look
ugly‖ or ―I look deformed‖).
With good or fair insight: The
individual recognizes that the body
dysmorphic disorder beliefs are
definitely or probably not true or that
they may or may not be true.
With poor insight: The individual
thinks that the body dysmorphic
disorder beliefs are probably true.
With absent insight/delusional
beliefs: The individual is completely
convinced that the body dysmorphic
disorder beliefs are true.
3. Hoarding Disorder
 Persistent difficulty discarding or
parting with possessions, regardless
of their actual value
 Perceived need to save items and
Distress associated with discarding
 The symptoms result in the
accumulation of a large number of
possessions that clutter active living
spaces to the extent that their
intended use is compromised unless
others intervene.
 Not attributable to any medical
condition
 Not better explained by another
mental disorder
DIAGNOSTIC CRITERIA
 Hoarding appears to begin early in
life and spans well into the late
stages. Hoarding symptoms may first
emerge around ages 15–19 years,
start interfering with the individual’s
everyday functioning by the mid-20s,
and cause clinically significant
Impairment by the mid-30s.
Participants in clinical research
studies are usually in their 50s.
 Pathological hoarding in children
appears to be easily distinguished
from developmentally adaptive
saving and collecting behaviors
A. Persistent difficulty discarding or parting
with possessions, regardless of their actual
value.
B. This difficulty is due to a perceived need
to save the items and to distress associated
with discarding them.
C. The difficulty discarding possessions
results in the accumulation of possessions
that congest and clutter active living areas
and substantially compromises their
intended use. If living areas are uncluttered,
it is only because of the interventions of
third parties (e.g., family members, cleaners,
authorities).
D. The hoarding causes clinically significant
distress or impairment in social,
occupational, or other important areas of
functioning (including maintaining a safe
environment for self and others).
E. The hoarding is not attributable to another
medical condition (e.g., brain injury,
cerebrovascular disease, Prader-Willi
syndrome).
F. The hoarding is not better explained by
the symptoms of another mental disorder
(e.g., obsessions in obsessive-compulsive
disorder, decreased energy in major
depressive disorder, delusions in
schizophrenia or another psychotic disorder,
cognitive deficits in major neurocognitive
disorder, restricted interests in autism
spectrum disorder).
Specify if:
With excessive acquisition: If difficulty
discarding possessions is accompanied by
excessive acquisition of items that are not
needed or for which there is no available
space. Specify if:
With good or fair insight: The individual
recognizes that hoarding-related beliefs and
behaviors (pertaining to difficulty discarding
items, clutter, or excessive acquisition) are
problematic.
With poor insight: The individual is mostly
convinced that hoarding-related beliefs and
behaviors (pertaining to difficulty discarding
items, clutter, or excessive acquisition) are
not problematic despite evidence to the
contrary.
With absent insight/delusional beliefs:
The individual is completely convinced that
hoardingrelated beliefs and behaviors
(pertaining to difficulty discarding items,
clutter, or excessive acquisition) are not
problematic despite evidence to the contrary
4. Trichotillomania (Hair-Pulling
Disorder)
 recurrent pulling out of one's hair
resulting in hair loss, and repeated
attempts to decrease or stop hair
pulling
 Functional impairment and
significant distress
 Not attributable to any medical
condition
 Not better explained by the
symptoms of another mental disorder
DIAGNOSTIC CRITERIA
A. Recurrent pulling out of one’s hair,
resulting in hair loss.
B. Repeated attempts to decrease or stop
hair pulling.
C. The hair pulling causes clinically
significant distress or impairment in social,
occupational, or other important areas of
functioning.
D. The hair pulling or hair loss is not
attributable to another medical condition
(e.g., a dermatological condition).
E. The hair pulling is not better explained by
the symptoms of another mental disorder
(e.g., attempts to improve a perceived defect
or flaw in appearance in body dysmorphic
disorder).
5. Excoriation (Skin-Picking) Disorder
 Also called dermatillomania, skin
picking disorder is where you cannot
stop picking at your skin. There are
things you can try to help yourself,
but some people may need
professional treatment
DIAGNOSTIC CRITERIA
A. Recurrent skin picking resulting in skin
lesions.
B. Repeated attempts to decrease or stop
skin picking
C. The skin picking causes clinically
significant distress or impairment in social,
occupational or other important areas of
functioning.
D. The skin picking is not attributable to the
physiological effects of a substance or
another medical condition
E. The skin picking is not better explained
by symptoms of another mental disorder
(delusions or tactile hallucinations in a
psychotic disorder, attempts to improve a
perceived defect or flaw in appearance in
body dysmorphic disorder, stereotypies in
stereotypic movement disorder, or intention
to harm oneself in non-suicidal self-injury)
VII. Trauma & Stressor
Related Disorders
 Disorders in which exposure to a
traumatic or stressful event is listed
explicitly as a diagnostic criterion.
 These include:
 Reactive Attachment
Disorder
 Disinhibited Social
Engagement Disorder
 Posttraumatic Stress Disorder
(PTSD)
 Acute Stress Disorder
 Adjustment Disorder
 Psychological distress following
exposure to a traumatic or stressful
event is quite variable. In some
cases, symptoms can be well
understood within an anxiety- or
fear-based.
 However, many individuals who
have been exposed to a traumatic or
stressful event exhibit a phenotype in
which, rather than anxiety- or fear-
based symptoms, the most prominent
clinical characteristics are anhedonic
and dysphoric symptoms,
externalizing angry and aggressive
symptoms, or dissociative symptoms
 TRAUMA
A condition that results from
circumstances experienced by
an individual as harmful or
life threatening and that has
lasting adverse effects on the
individual’s functioning and
mental health. Could be
caused by natural or man
related disasters (e.g.
accidents, deaths or rape,,,).
1. REACTIVE ATTACHMENT
DISORDER (RAD)
 RAD of infancy or early childhood is
characterized by a pattern of
markedly disturbed and
developmentally inappropriate
attachment behaviors, in which a
child rarely or minimally turns
preferentially to an attachment figure
for comfort, support, protection, and
nurturance.
 The essential feature is absent or
grossly underdeveloped attachment
between the child and putative
caregiving adults.
 It is unclear whether reactive
attachment disorder occurs in older
children and, if so, how it differs
from its presentation in young
children. Because of this, the
diagnosis should be made with
caution in children older than 5 years
 Absence or grossly underdeveloped
attachment between the child and
putative caregiving adults.
 A persistent social and emotional
disturbance characterized
 The child has experienced a pattern
of extremes of insufficient care
 The disturbance is evident before age
5 years.
 The child has a developmental age of
at least 9 months
DIAGNOSTIC CRITERIA
A. A consistent pattern of inhibited,
emotionally withdrawn behavior toward
adult caregivers, manifested by both of the
following:
1. The child rarely or minimally
seeks comfort when distressed.
2. The child rarely or minimally
responds to comfort when distressed.
B. A persistent social and emotional
disturbance characterized by at least two of
the following:
1. Minimal social and emotional
responsiveness to others.
2. Limited positive affect.
3. Episodes of unexplained
irritability, sadness, or fearfulness
that are evident even during
nonthreatening interactions with
adult caregivers.
C. The child has experienced a pattern of
extremes of insufficient care as evidenced
by at least one of the following:
1. Social neglect or deprivation in the
form of persistent lack of having
basic emotional needs for comfort,
stimulation, and affection met by
caregiving adults.
2. Repeated changes of primary
caregivers that limit opportunities to
form stable attachments (e.g.,
frequent changes in foster care).
3. Rearing in unusual settings that
severely limit opportunities to form
selective attachments (e.g.,
institutions with high child-to-
caregiver ratios).
D. The care in Criterion C is presumed to be
responsible for the disturbed behavior in
Criterion A (e.g., the disturbances in
Criterion A began following the lack of
adequate care in Criterion C).
E. The criteria are not met for autism
spectrum disorder.
F. The disturbance is evident before age 5
years. G. The child has a developmental age
of at least 9 months.
Specify if:
Persistent: The disorder has been present
for more than 12 months.
Specify current severity:
Reactive attachment disorder is specified as
severe when a child exhibits all symptoms
of the disorder, with each symptom
manifesting at relatively high levels.
2. DISINHIBITED SOCIAL
ENGAGEMENT DISORDER
 The essential feature of disinhibited
social engagement disorder is a
pattern of behavior that involves
culturally inappropriate, overly
familiar behavior with relative
strangers.
 This overly familiar behavior
violates the social boundaries of the
culture
 A pattern of behavior in which a
child actively approaches and
interacts with unfamiliar adults
 The behaviors are not limited to
impulsivity
 The child has experienced a pattern
of extremes of insufficient care
DIAGNOSTIC CRITERIA
A. A pattern of behavior in which a child
actively approaches and interacts with
unfamiliar adults and exhibits at least two of
the following:
1. Reduced or absent reticence in
approaching and interacting with
unfamiliar adults.
2. Overly familiar verbal or physical
behavior (that is not consistent with
culturally sanctioned and with age-
appropriate social boundaries).
3. Diminished or absent checking
back with adult caregiver after
venturing away, even in unfamiliar
settings.
4. Willingness to go off with an
unfamiliar adult with minimal or no
hesitation.
B. The behaviors in Criterion A are not
limited to impulsivity (as in attention-
deficit/hyperactivity disorder) but include
socially disinhibited behavior.
C. The child has experienced a pattern of
extremes of insufficient care as evidenced
by at least one of the following:
1. Social neglect or deprivation in the
form of persistent lack of having
basic emotional needs for comfort,
stimulation, and affection met by
caregiving adults.
2. Repeated changes of primary
caregivers that limit opportunities to
form stable attachments (e.g.,
frequent changes in foster care).
3. Rearing in unusual settings that
severely limit opportunities to form
selective attachments (e.g.,
institutions with high child-to-
caregiver ratios).
D. The care in Criterion C is presumed to be
responsible for the disturbed behavior in
Criterion A (e.g., the disturbances in
Criterion A began following the pathogenic
care in Criterion C).
E. The child has a developmental age of at
least 9 months.
Specify if:
Persistent: The disorder has been present for
more than 12 months.
Specify current severity:
Disinhibited social engagement disorder is
specified as severe when the child exhibits
all symptoms of the disorder, with each
symptom manifesting at relatively high
levels
3. POSTTRAUMATIC STRESS
DISORDER (PTSD)
 An anxiety disorder in which the
individual experiences several
distressing symptoms for more than a
month following a traumatic event,
such as a reexperiencing of the
traumatic event, an avoidance of
reminders of the trauma, a numbing
of general responsiveness, and
increased arousal.
 Exposure to actual or threatened
death, serious injury, or sexual
violence
 Presence of intrusion symptoms (1)
 Persistent avoidance of stimuli
associated with the traumatic event/s
(1)
 Negative alterations in cognitions
and mood associated with the
traumatic event/s (2)
 Marked alterations in arousal and
reactivity associated with the
traumatic event/s (2)
 Duration is more than one month
 Functional Impairment
 Not attributable to physiological
effects of substance or any medical
condition
DIAGNOSTIC CRITERIA
Posttraumatic Stress Disorder in
Individuals Older Than 6 Years
Note: The following criteria apply to
adults, adolescents, and children
older than 6 years. For children 6
years and younger, see
corresponding criteria below
A. Exposure to actual or threatened death,
serious injury, or sexual violence in one (or
more) of the following ways:
1. Directly experiencing the
traumatic event(s).
2. Witnessing, in person, the event(s)
as it occurred to others.
3. Learning that the traumatic
event(s) occurred to a close family
member or close friend. In cases of
actual or threatened death of a family
member or friend, the event(s) must
have been violent or accidental
4. Experiencing repeated or extreme
exposure to aversive details of the
 traumatic event(s) (e.g., first
responders collecting human
remains; police officers repeatedly
exposed to details of child abuse).
Note: Criterion A4 does not apply to
exposure through electronic media,
television, movies, or pictures, unless
this exposure is work related.
B. Presence of one (or more) of the
following intrusion symptoms associated
with the traumatic event(s), beginning after
the traumatic event(s) occurred:
1. Recurrent, involuntary, and
intrusive distressing memories of the
traumatic event(s). Note: In children
older than 6 years, repetitive play
may occur in which themes or
aspects of the traumatic event(s) are
expressed.
2. Recurrent distressing dreams in
which the content and/or affect of the
dream are related to the traumatic
event(s).
Note: In children, there may be
frightening dreams without
recognizable content.
3. Dissociative reactions (e.g.,
flashbacks) in which the individual
feels or acts as if the traumatic
event(s) were recurring. (Such
reactions may occur on a continuum,
with the most extreme expression
being a complete loss of awareness
of present surroundings.) Note: In
children, trauma-specific
reenactment may occur in play.
4. Intense or prolonged
psychological distress at exposure to
internal or external cues that
symbolize or resemble an aspect of
the traumatic event(s).
5. Marked physiological reactions to
internal or external cues that
symbolize or resemble an aspect of
the traumatic event(s).
C. Persistent avoidance of stimuli associated
with the traumatic event(s), beginning after
the traumatic event(s) occurred, as
evidenced by one or both of the following:
1. Avoidance of or efforts to avoid
distressing memories, thoughts, or
feelings about or closely associated
with the traumatic event(s).
2. Avoidance of or efforts to avoid
external reminders (people, places,
conversations, activities, objects,
situations) that arouse distressing
memories, thoughts, or feelings
about or closely associated with the
traumatic event(s).
D. Negative alterations in cognitions and
mood associated with the traumatic event(s),
beginning or worsening after the traumatic
event(s) occurred, as evidenced by two (or
more) of the following:
1. Inability to remember an
important aspect of the traumatic
event(s) (typically due to dissociative
amnesia and not to other factors such
as head injury, alcohol, or drugs).
2. Persistent and exaggerated
negative beliefs or expectations
about oneself, others, or the world
(e.g., ―I am bad,‖ ―No one can be
trusted,‖ ―The world is completely
dangerous,‖ ―My whole nervous
system is permanently ruined‖).
3. Persistent, distorted cognitions
about the cause or consequences of
the traumatic event(s) that lead the
individual to blame himself/herself
or others.
4. Persistent negative emotional state
(e.g., fear, horror, anger, guilt, or
shame).
5. Markedly diminished interest or
participation in significant activities.
6. Feelings of detachment or
estrangement from others.
7. Persistent inability to experience
positive emotions (e.g., inability to
experience happiness, satisfaction, or
loving feelings).
E. Marked alterations in arousal and
reactivity associated with the traumatic
event(s), beginning or worsening after the
traumatic event(s) occurred, as evidenced by
two (or more) of the following:
1. Irritable behavior and angry
outbursts (with little or no
provocation) typically expressed as
verbal or physical aggression toward
people or objects.
2. Reckless or self-destructive
behavior.
3. Hypervigilance.
4. Exaggerated startle response.
5. Problems with concentration.
6. Sleep disturbance (e.g., difficulty
falling or staying asleep or restless
sleep).
F. Duration of the disturbance (Criteria B, C,
D, and E) is more than 1 month.
G. The disturbance causes clinically
significant distress or impairment in social,
occupational, or other important areas of
functioning.
H. The disturbance is not attributable to the
physiological effects of a substance (e.g.,
medication, alcohol) or another medical
condition.
Specify whether:
With dissociative symptoms: The
individual’s symptoms meet the criteria for
posttraumatic stress disorder, and in
addition, in response to the stressor, the
individual experiences persistent or
recurrent symptoms of either of the
following:
1. Depersonalization: Persistent or
recurrent experiences of feeling
detached from, and as if one were an
outside observer of, one’s mental
processes or body (e.g., feeling as
though one were in a dream; feeling
a sense of unreality of self or body or
of time moving slowly).
2. Derealization: Persistent or
recurrent experiences of unreality of
surroundings (e.g., the world around
the individual is experienced as
unreal, dreamlike, distant, or
distorted).
Note: To use this subtype, the
dissociative symptoms must
not be attributable to the
physiological effects of a
substance (e.g., blackouts,
behavior during alcohol
intoxication) or another
medical condition (e.g.,
complex partial seizures).
Specify if:
With delayed expression: If the full
diagnostic criteria are not met until at
least 6 months after the event
(although the onset and expression of
some symptoms may be immediate).
Posttraumatic Stress Disorder in
Children 6 Years and Younger
A. In children 6 years and younger, exposure
to actual or threatened death, serious injury,
or sexual violence in one (or more) of the
following ways:
1. Directly experiencing the
traumatic event(s).
2. Witnessing, in person, the event(s)
as it occurred to others, especially
primary caregivers.
3. Learning that the traumatic
event(s) occurred to a parent or
caregiving figure.
B. Presence of one (or more) of the
following intrusion symptoms associated
with the traumatic event(s), beginning after
the traumatic event(s) occurred:
1. Recurrent, involuntary, and
intrusive distressing memories of the
traumatic event(s).
Note: Spontaneous and intrusive
memories may not necessarily
appear distressing and may be
expressed as play reenactment.
2. Recurrent distressing dreams in
which the content and/or affect of the
dream are related to the traumatic
event(s).
Note: It may not be possible to
ascertain that the frightening content
is related to the traumatic event.
3. Dissociative reactions (e.g.,
flashbacks) in which the child feels
or acts as if the traumatic event(s)
were recurring. (Such reactions may
occur on a continuum, with the most
extreme expression being a complete
loss of awareness of present
surroundings.) Such trauma-specific
reenactment may occur in play.
4. Intense or prolonged
psychological distress at exposure to
internal or external cues that
symbolize or resemble an aspect of
the traumatic event(s).
5. Marked physiological reactions to
reminders of the traumatic event(s).
C. One (or more) of the following
symptoms, representing either persistent
avoidance of stimuli associated with the
traumatic event(s) or negative alterations in
cognitions and mood associated with the
traumatic event(s), must be present,
beginning after the event(s) or worsening
after the event(s):
Persistent Avoidance of Stimuli
1. Avoidance of or efforts to avoid
activities, places, or physical
reminders that arouse recollections
of the traumatic event(s).
2. Avoidance of or efforts to avoid
people, conversations, or
interpersonal situations that arouse
recollections of the traumatic
event(s).
Negative Alterations in Cognitions
 3. Substantially increased frequency
of negative emotional states (e.g.,
fear, guilt, sadness, shame,
confusion).
4. Markedly diminished interest or
participation in significant activities,
including constriction of play.
5. Socially withdrawn behavior.
6. Persistent reduction in expression
of positive emotions.
D. Alterations in arousal and reactivity
associated with the traumatic event(s),
beginning or worsening after the traumatic
event(s) occurred, as evidenced by two (or
more) of the following:
1. Irritable behavior and angry
outbursts (with little or no
provocation) typically expressed as
verbal or physical aggression toward
people or objects (including extreme
temper tantrums).
2. Hypervigilance.
3. Exaggerated startle response.
4. Problems with concentration.
5. Sleep disturbance (e.g., difficulty
falling or staying asleep or restless
sleep).
E. The duration of the disturbance is more
than 1 month.
F. The disturbance causes clinically
significant distress or impairment in
relationships with parents, siblings, peers, or
other caregivers or with school behavior.
G. The disturbance is not attributable to the
physiological effects of a substance (e.g.,
medication or alcohol) or another medical
condition.
Specify whether:
With dissociative symptoms: The
individual’s symptoms meet the criteria for
posttraumatic stress disorder, and the
individual experiences persistent or
recurrent symptoms of either of the
following:
1. Depersonalization: Persistent or
recurrent experiences of feeling
detached from, and as if one were an
outside observer of, one’s mental
processes or body (e.g., feeling as
though one were in a dream; feeling
a sense of unreality of self or body or
of time moving slowly).
2. Derealization: Persistent or
recurrent experiences of unreality of
surroundings (e.g., the world around
the individual is experienced as
unreal, dreamlike, distant, or
distorted).
Note: To use this subtype, the
dissociative symptoms must not be
attributable to the physiological
effects of a substance (e.g.,
blackouts) or another medical
condition (e.g., complex partial
seizures).
Specify if:
With delayed expression: If the full
diagnostic criteria are not met until at least 6
months after the event (although the onset
and expression of some symptoms may be
immediate).
4. ACUTE STRESS DISORDER
 The essential feature of acute stress
disorder is the development of
characteristic symptoms lasting from
3 days to 1 month following
exposure to one or more traumatic
events
 Fairly similar to those of PTSD, but
the duration is shorter.
 Symptoms occur between 3 days and
1 month after a trauma.
DIAGNOSTIC CRITERIA
A. Exposure to actual or threatened death,
serious injury, or sexual violence in one (or
more) of the following ways:
1. Directly experiencing the
traumatic event(s). 2. Witnessing, in
person, the event(s) as it occurred to
others.
3. Learning that the event(s)
occurred to a close family member or
close friend. Note: In cases of actual
or threatened death of a family
member or friend, the event(s) must
have been violent or accidental.
4. Experiencing repeated or extreme
exposure to aversive details of the
traumatic event(s) (e.g., first
responders collecting human
remains, police officers repeatedly
exposed to details of child abuse).
Note: This does not apply to
exposure through electronic media,
television, movies, or pictures, unless
this exposure is work related.
B. Presence of nine (or more) of the
following symptoms from any of the five
categories of intrusion, negative mood,
dissociation, avoidance, and arousal,
beginning or worsening after the traumatic
event(s) occurred:
Intrusion Symptoms
1. Recurrent, involuntary, and
intrusive distressing memories of the
traumatic event(s).
Note: In children, repetitive play
may occur in which themes or
aspects of the traumatic event(s) are
expressed.
2. Recurrent distressing dreams in
which the content and/or affect of the
dream are related to the event(s).
Note: In children, there may be
frightening dreams without
recognizable content.
3. Dissociative reactions (e.g.,
flashbacks) in which the individual
feels or acts as if the traumatic
event(s) were recurring. (Such
reactions may occur on a continuum,
with the most extreme expression
being a complete loss of awareness
of present surroundings.)
Note: In children, trauma-specific
reenactment may occur in play.
4. Intense or prolonged
psychological distress or marked
physiological reactions in response
to internal or external cues that
symbolize or resemble an aspect of
the traumatic event(s).
Negative Mood
5. Persistent inability to experience
positive emotions (e.g., inability to
experience happiness, satisfaction, or
loving feelings).
Dissociative Symptoms
6. An altered sense of the reality of
one’s surroundings or oneself (e.g.,
seeing oneself from another’s
perspective, being in a daze, time
slowing).
7. Inability to remember an
important aspect of the traumatic
event(s) (typically due to dissociative
amnesia and not to other factors such
as head injury, alcohol, or drugs).
Avoidance Symptoms
8. Efforts to avoid distressing
memories, thoughts, or feelings
about or closely associated with the
traumatic event(s).
9. Efforts to avoid external reminders
(people, places, conversations,
activities, objects, situations) that
arouse distressing memories,
thoughts, or feelings about or closely
associated with the traumatic
event(s).
Arousal Symptoms
10. Sleep disturbance (e.g., difficulty
falling or staying asleep, restless
sleep).
11. Irritable behavior and angry
outbursts (with little or no
provocation), typically expressed as
verbal or physical aggression toward
people or objects.
12. Hypervigilance.
13. Problems with concentration.
14. Exaggerated startle response.
C. Duration of the disturbance (symptoms in
Criterion B) is 3 days to 1 month after
trauma exposure.
Note: Symptoms typically begin
immediately after the trauma, but
persistence for at least 3 days and up
to a month is needed to meet disorder
criteria.
D. The disturbance causes clinically
significant distress or impairment in social,
occupational, or other important areas of
functioning.
E. The disturbance is not attributable to the
physiological effects of a substance (e.g.,
medication or alcohol) or another medical
condition (e.g., mild traumatic brain injury)
and is not better explained by brief psychotic
disorder.
5. ADJUSTMENT DISORDER
 The presence of emotional or
behavioral symptoms in response to
an identifiable stressor is the
essential feature of adjustment
disorders
 The development of emotional or
behavioral symptoms in response to
an identifiable stressor(s) occurring
within 3 months of the onset of the
stressor(s).
 These symptoms or behaviors are
clinically significant, as evidenced
by one or both of the following:
 Marked distress that is out of
proportion to the severity or intensity
of the stressor
 Significant impairment in social,
occupational, or other important
areas of functioning.
 The stress-related disturbance does
not meet the criteria for another
 mental disorder and is not merely an
exacerbation of a preexisting mental
disorder.
 The symptoms do not represent
normal bereavement.
 Once the stressor or its consequences
have terminated, the symptoms do
not persist for more than an
additional 6 months.
DIAGNOSTIC CRITERIA
A. The development of emotional or
behavioral symptoms in response to an
identifiable stressor(s) occurring within 3
months of the onset of the stressor(s).
B. These symptoms or behaviors are
clinically significant, as evidenced by one or
both of the following:
1. Marked distress that is out of
proportion to the severity or intensity
of the stressor, taking into account
the external context and the cultural
factors that might influence symptom
severity and presentation.
2. Significant impairment in social,
occupational, or other important
areas of functioning.
C. The stress-related disturbance does not
meet the criteria for another mental disorder
and is not merely an exacerbation of a
preexisting mental disorder.
D. The symptoms do not represent normal
bereavement and are not better explained by
prolonged grief disorder.
E. Once the stressor or its consequences
have terminated, the symptoms do not
persist for more than an additional 6 months.
Specify whether:
F43.21 With depressed mood: Low
mood, tearfulness, or feelings of
hopelessness are predominant.
F43.22 With anxiety: Nervousness,
worry, jitteriness, or separation
anxiety is predominant.
F43.23 With mixed anxiety and
depressed mood: A combination of
depression and anxiety is
predominant.
F43.24 With disturbance of
conduct: Disturbance of conduct is
predominant.
F43.25 With mixed disturbance of
emotions and conduct: Both
emotional symptoms (e.g.,
depression, anxiety) and a presence of two or more people
disturbance of conduct are
predominant.
F43.20 Unspecified: For
maladaptive reactions that are not
classifiable as one of the specific
subtypes of adjustment disorder.
Specify if:
Acute: This specifier can be used to
indicate persistence of symptoms for
less than 6 months.
Persistent (chronic): This specifier
can be used to indicate persistence of
symptoms for 6 months or longer. By
definition, symptoms cannot persist
for more than 6 months after the
termination of the stressor or its
consequences. The persistent
specifier therefore applies when the
duration of the disturbance is longer
than 6 months in response to a
chronic stressor or to a stressor that
has enduring consequences.
VIII. Dissociative
Disorders
 Dissociative disorders are mental
disorders that involve experiencing a
disconnection and lack of continuity
between thoughts, memories,
surroundings, actions and identity.
 Major Symptoms (DSM-5)
Significant memory loss of
specific times, people and
events
Out-of-body experiences,
such as feeling as though you
are watching a movie of
yourself
Mental health problems such
as depression, anxiety and
thoughts of suicide
A sense of detachment from
your emotions, or emotional
numbness
A lack of a sense of self-
identity
1. DISSOCIATIVE IDENTITY
DISORDER
 Formerly known as multiple
personality disorder, this disorder is
characterized by "switching" to
alternate identities. You may feel the
 talking or living inside your head,
and you may feel as though you ' re
possessed by other identities.
Major Symptoms:
 Memory loss (amnesia) of certain
time periods, events, people and
personal information.
 A sense of being detached from
yourself and your emotions
 A perception of the people and
things around you as distorted and
unreal.
 A blurred sense of identity.
 Significant stress or problems in your
relationships, work or other
important areas of your life.
 Inability to cope well with emotional
or professional stress
 Mental health problems, such as
depression, anxiety, and suicidal
thoughts and behaviors.
2. DISSOCIATIVE AMNESIA
 Dissociative amnesia is memory loss
that cannot be explained by a
neurological abnormality or typical
forgetfulness. It belongs to the rare
class of psychiatric ailments known
as dissociative disorders. As the
name fugue implies, the condition
involves psychological flight from an
overwhelming situation.
Major Symptoms:
 Localized
A person's memory loss
affects specific areas of
knowledge or aspects of their
life, such as a period of
childhood or information
about a friend or co-worker.
Frequently, the memory loss
is linked to a specific
traumatic event. A crime
victim, for example, may
have no recollection of being
robbed at gunpoint, but can
recall details about the rest of
the day.
 Generalized
Memory loss has a significant
impact on a person's life
and/or identity being unable
to recall your name,
occupation, family,
friends.
 Fugue
A new persona. One middle
manager, for example, was
passed over for promotion.
His family reported him
missing after he failed to
return home from work. He
was found a week later, 600
miles away, working as a
short-order cook under a
different name. No family
member, friend, or co-worker
could be identified when he
was apprehended by the
police, and he couldn't
remember any of them, he
didn't say who he was or
explain why he couldn't be
identified.
3. DEPERSONALIZATION/
DERIALIZATION DISORDER
 Depersonalization
Experiences of unreality,
detachment, or being an
outside observer with respect
to one ' s thoughts, feelings,
sensations, body, or actions
(e.g., perceptual alterations,
distorted sense of time, unreal
or absent self, emotional or
physical numbing).
 Derealization
Experiences of unreality or
detachment with respect to
surroundings (e.g.,
individuals or objects are
experienced as unreal,
dreamlike, foggy, lifeless or
visually distorted).
Major Symptoms (DSM-5)
1. Depersonalization symptoms
 Patients feel as if their lives are being
watched from afar. Many patients
also describe themselves as "unreal"
Or "like a machine " or "automaton"
(having no control over what they do
or say). They may be emotionally
and physically numb, or they may be
emotionless and disconnected, out of
body experience. Some patients are
unable to express or identify their
feelings (alexithymia). They are
frequently unable to recall their
recollections clearly since they are
or
separated from them
2. Derealization Symptoms
  Patients may feel as if they are in a
dream or a fog, or as if they are
surrounded by a veil or a glass wall.
They are separated from their
environment. The world appears to
be devoid of color, vitality, or
lifelessness. It' s usual to see the
world distorted in a subjective way.
The appearance of objects that are
hazy or extraordinarily clear, flat,
smaller or larger than they are
(macropasia or micropsia) It' s
possible that sounds are louder or
softer than they are, and that time is
moving too slowly or too quickly
IX. Somatic Symptom
and Related Disorders
 The major diagnosis in this
diagnostic class, somatic symptom
disorder, emphasizes diagnosis made
on the basis of positive symptoms
and signs (distressing somatic
symptoms plus abnormal thoughts,
feelings, and behaviors in response
to these symptoms) rather than the
absence of a medical explanation for
somatic symptoms.
 A distinctive characteristic of many
individuals with somatic symptom
disorder is not the somatic symptoms
per se, but instead the way they
present and interpret them.
Incorporating affective, cognitive,
and behavioral components into the
criteria for somatic symptom
disorder provides a more
comprehensive and accurate
reflection of the true clinical picture
than can be achieved by assessing
the somatic complaints alone
1. SOMATIC SYMPTOM
DISORDER
 Somatic symptom disorder is
characterized by an extreme
focus on physical symptoms —
such as pain or fatigue — that
causes major emotional distress
and problems functioning.
 The physical symptoms may or
may not be associated with a
diagnosed medical condition, but
the person is experiencing
symptoms and believes they are
sick (that is, not faking the
illness).
 A person is not diagnosed with
somatic symptom disorder solely
because a medical cause can’t be
identified for a physical
symptom. The emphasis is on the
extent to which the thoughts,
feelings and behaviors related to
the illness are excessive or out of
proportion
DIAGNOSTIC CRITERIA
A. One or more somatic symptoms that are
distressing or result in significant disruption
of daily life.
B. Excessive thoughts, feelings, or behaviors
related to the somatic symptoms or
associated health concerns as manifested by
at least one of the following:
1. Disproportionate and persistent
thoughts about the seriousness of
one’s symptoms.
2. Persistently high level of anxiety
about health or symptoms.
3. Excessive time and energy
devoted to these symptoms or health
concerns.
C. Although any one somatic symptom may
not be continuously present, the state of
being symptomatic is persistent (typically
more than 6 months).
Specify if:
With predominant pain (previously
pain disorder): This specifier is for
individuals whose somatic symptoms
predominantly involve pain.
Specify if:
Persistent: A persistent course is
characterized by severe symptoms,
marked impairment, and long
duration (more than 6 months).
Specify current severity:
Mild: Only one of the symptoms
specified in Criterion B is fulfilled.
Moderate: Two or more of the
symptoms specified in Criterion B
are fulfilled.
Severe: Two or more of the
symptoms specified in Criterion B
are fulfilled, plus there are multiple
somatic complaints (or one very
severe somatic symptom).
2. ILLNESS ANXIETY DISORDER
 Illness anxiety disorder, sometimes
called hypochondriasis or health
anxiety, is worrying excessively that
 you are or may become seriously ill.
You may have no physical
symptoms.
 May believe that normal body
sensations or minor symptoms are
signs of severe illness, even though a
thorough medical exam doesn't
reveal a serious medical condition.
 May experience extreme anxiety that
body sensations, such as muscle
twitching or fatigue, are associated
with a specific, serious illness. This
excessive anxiety — rather than the
physical symptom itself — results in
severe distress that can disrupt your
life.
 Illness anxiety disorder is a long-
term condition that can fluctuate in
severity. It may increase with age or
during times of stress
 focus of the fear and worry is on
uncomfortable or unusual physical
sensations being an indication of a
serious medical condition
DIAGNOSTIC CRITERIA
A. Preoccupation with having or acquiring a
serious illness.
B. Somatic symptoms are not present or, if
present, are only mild in intensity. If another
medical condition is present or there is a
high risk for developing a medical condition
(e.g., strong family history is present), the
preoccupation is clearly excessive or
disproportionate.
C. There is a high level of anxiety about
health, and the individual is easily alarmed
about personal health status.
D. The individual performs excessive
health-related behaviors (e.g., repeatedly
checks his or her body for signs of illness) or
exhibits maladaptive avoidance (e.g., avoids
doctor appointments and hospitals)
E. Illness preoccupation has been present for
at least 6 months, but the specific illness that
is feared may change over that period of
time.
F. The illness-related preoccupation is not
better explained by another mental disorder,
such as somatic symptom disorder, panic
disorder, generalized anxiety disorder, body
dysmorphic disorder, obsessive-compulsive
disorder, or delusional disorder, somatic
type. Specify whether:
Care-seeking type: Medical care, including
physician visits or undergoing tests and
procedures, is frequently used.
Care-avoidant type: Medical care is rarely
used.
3. CONVERSION DISORDER
(Functional
Neurological Symptom Disorder)
 Conversion disorder is a condition in
which you have physical symptoms
of a health problem but no injury or
illness to explain them. The
symptoms happen because your
brain ―converts‖ the effects of a
mental health issue into disruptions
of your brain or nervous system.
 The symptoms are real but don’t
match up with recognized brain-
related conditions.
 It’s not faking or attention-seeking. It
isn't just something in a person’s
head or that they’ve imagined. While
it’s a mental health condition, the
physical symptoms are still real. A
person with conversion disorder
can’t control the symptoms just by
trying or thinking about it
 Motor Symptoms
 weakness or paralysis;
 abnormal movements, such
as tremor ordystonic
movements;
 gait abnormalities;
 abnormal limb posturing.
 Sensory Symptoms
 Altered, reduced, or absent
skin sensation, vision, or
hearing.
 Episodes of abnormal
generalized limb shaking
with apparent impaired or
loss of consciousness may
resemble epileptic seizures
(also called psychogenic or
non-epileptic seizures).
 Episodes of unresponsiveness
resembling syncope or coma.
 Other Symptoms
 reduced or absent speech
volume (dysphonia/aphonia),
 altered articulation
(dysarthria), sensation of a
lump in the throat (globus),
 diplopia
DIAGNOSTIC CRITERIA
A. One or more symptoms of altered to produce more symptoms, resulting
voluntary motor or sensory function. in getting themselves unnecessary
B. Clinical findings provide evidence of procedures and surgeries
incompatibility between the symptom and  People with this disorder fake or
recognized neurological or medical manufacture physical or
conditions. C. The symptom or deficit is not psychological symptoms, but without
better explained by another medical or any apparent motive.
mental disorder.  The person presents himself to others
D. The symptom or deficit causes clinically as ill or injured
significant distress or impairment in social,  Deceptive behavior is evident
occupational, or other important areas of  Not better explained by another
functioning or warrants medical evaluation. mental disorder
Coding note: The ICD-9-CM code Factitious Disorder Subtypes
for conversion disorder is 300.11,  Factitious disorder on
which is assigned regardless of the self (Münchausen
symptom type. The ICD-10-CM Syndrome)
code depends on the symptom type - the person
Specify symptom type: presents himself
(F44.4) With weakness or paralysis or herself to others
(F44.4) With abnormal movement as ill, impaired, or
(e.g., tremor, dystonic movement, injured
myoclonus, gait disorder)  Factitious disorder
(F44.4) With swallowing symptoms imposed on another
(F44.4) With speech symptom (e.g., - The person
dysphonia, slurred speech) fabricates
(F44.5) With attacks or seizures symptoms in
(F44.6) With anesthesia or sensory another person
loss and then presents
(F44.6) With special sensory that person to
symptom (e.g., visual, olfactory, or others as ill,
hearing disturbance) impaired, or
(F44.7) With mixed symptoms injured
Specify if:  NOTE: Factitious disorder is not the
Acute episode: Symptoms present for less same as malingering. Because
than 6 months. malingering is motivated by external
Persistent: Symptoms occurring for 6 rewards or incentives, it is not
months or more. considered a mental disorder within
Specify if: the DSM framework.
With psychological stressor (specify
stressor)
Without psychological stressor
4. FACTITIOUS DISORDER (Munchausen X. Feeding and Eating
Syndrome)
 Factitious disorder is a serious
Disorders
mental health disorder in which a  Feeding and eating disorders are
person appears sick or produces characterized by a persistent
physical or mental illness. People disturbance of eating or eating-
with factitious disorder deliberately related behavior that results in the
produce symptoms of an illness for altered consumption or absorption of
the purpose of receiving care and food and that significantly impairs
attention in a medical setting. The physical health or psychosocial
symptoms aren’t intended to get functioning
them practical benefits — the gain is  Feeding Disorder
believed to be mainly psychological.  commonly in infancy or early
 It’s associated with severe emotional childhood, a child’ s refusal to
difficulties and patients’ likelihood eat certain food groups, textures,
of harming themselves by continuing solids or liquids for at least one
 month causes them to not gain
enough weight or grow naturally.
 Eating Disorder
 Group of conditions by abnormal
eating habits to detriment of an
individual’s physical and mental
health.
1. PICA Disorder
 Is an eating disorder involving items
that are not typically thought of as
food and do not contain significant
nutritional value.
 Typical substances ingested tend to
vary with age and availability. They
may include paper, soap, cloth, hair,
string, wool, soil, chalk, talcum
powder, paint, gum, etc.
 Pica gets its name from a bird
species, the Eurasian magpie (the
formal Latin name for that species is
Pica pica). This bird has a reputation
for eating unusual objects.
DIAGNOSTIC CRITERIA
A. Persistent eating of nonnutritive, nonfood
substances over a period of at least 1 month.
B. The eating of nonnutritive, nonfood
substances is inappropriate to the
developmental level of the individual.
C. The eating behavior is not part of a
culturally supported or socially normative
practice.
D. If the eating behavior occurs in the
context of another mental disorder (e.g.,
intellectual developmental disorder
[intellectual disability], autism spectrum
disorder, schizophrenia) or medical
condition (including pregnancy), it is
sufficiently severe to warrant additional
clinical attention.
Coding note: The ICD-10-CM codes for
pica are F98.3 in children and F50.89 in
adults. Specify if: In remission: After full
criteria for pica were previously met, the
criteria have not been met for a sustained
period of time
2. Rumination Disorder
 Rumination disorder is a condition in
which people repeatedly and
unintentionally spit up (regurgitate)
undigested or partially digested food
from the stomach, rechew it, and
then either swallow it or spit it out.
Because the food hasn 't yet been
digested, it reportedly tastes normal
and isn 't acidic, as vomit is.
Rumination typically happens at
every meal, soon after eating.
DIAGNOSTIC CRITERIA
A. Repeated regurgitation of food over a
period of at least 1 month. Regurgitated food
may be re-chewed, re-swallowed, or spit out.
B. The repeated regurgitation is not
attributable to an associated gastrointestinal
or other medical condition (e.g.,
gastroesophageal reflux, or pyloric stenosis).
C. The eating disturbance does not occur
exclusively during the course of anorexia
nervosa, bulimia nervosa, binge-eating
disorder, or avoidant/restrictive food intake
disorder.
D. If the symptoms occur in the context of
another mental disorder (e.g., intellectual
developmental disorder [intellectual
disability] or another neurodevelopmental
disorder), they are sufficiently severe to
warrant additional clinical attention
3. Avoidant/Restrictive Food Intake
Disorder (ARFID)
 Is a new diagnosis in the DSM-5,
and was previously referred to as
―Selective Eating Disorder. ‖ ARFID
is similar to anorexia in that both
disorders involve limitations in the
amount and/or types of food
consumed, but unlike anorexia,
ARFID does not involve any distress
about body shape or size or fears of
fatness.
 It is also commonly mistaken as
picky eating but it is important to
note that they are not the same
 ARFID is mainly seen in children
and adolescents but can occur in all
ages. There are three primary
subtypes of ARFID described by the
Eating Recovery
Center:
Avoidant: Avoiding food
because of sensory features
like smells or textures
Aversive: Avoiding food
because of fear, like fear of
choking or vomiting.
Restrictive: Low appetite,
little interest in food, and
extreme pickiness are
characteristic of the
restrictive subtype of ARFID
DIAGNOSTIC CRITERIA
A. An eating or feeding disturbance (e.g.,
apparent lack of interest in eating or food;
avoidance based on the sensory
characteristics of food; concern about
aversive consequences of eating) associated
with one (or more) of the following:
1. Significant weight loss (or failure
to achieve expected weight gain or
faltering growth in children).
2. Significant nutritional deficiency.
3. Dependence on enteral feeding or
oral nutritional supplements.
4. Marked interference with
psychosocial functioning.
B. The disturbance is not better explained by
lack of available food or by an associated
culturally sanctioned practice
C. The eating disturbance does not occur
exclusively during the course of anorexia
nervosa or bulimia nervosa, and there is no
evidence of a disturbance in the way in
which one ’ s body weight or shape is
experienced.
D. The eating disturbance is not attributable
to a concurrent medical condition or not
better explained by another mental disorder.
When the eating disturbance occurs in the
context of another condition or disorder, the
severity of the eating disturbance exceeds
that routinely associated with the condition
or disorder and warrants additional clinical
attention
Specify if:
In remission: After full criteria for
avoidant/restrictive food intake
disorder were previously met, the
criteria have not been met for a
sustained period of time
4. Anorexia Nervosa
 Anorexia nervosa is an eating
disorder that can result in severe
weight loss. A person with anorexia
is preoccupied with calorie intake
and weight. People with anorexia
nervosa eat an extremely low-calorie
diet and have an excessive fear of
gaining weight.
 Anorexia is most commonly
diagnosed in adolescent women, but
it’s been diagnosed in older and
younger women and in men.
DIAGNOSTIC CRITERIA
A. Restriction of energy intake relative to
requirements, leading to a significantly low
body weight in the context of age, sex,
developmental trajectory, and physical
health. Significantly low weight is defined
as a weight that is less than minimally
normal or, for children and adolescents, less
than that minimally expected.
B. Intense fear of gaining weight or of
becoming fat, or persistent behavior that
interferes with weight gain, even though at a
significantly low weight.
C. Disturbance in the way in which one ’ s
body weight or shape is experienced, undue
influence of body weight or shape on self-
evaluation, or persistent lack of recognition
of the seriousness of the current low body
weight
5. Bulimia Nervosa
 Bulimia nervosa, commonly called
bulimia, is a serious, potentially life-
threatening eating disorder. People
with bulimia may secretly binge —
eating large amounts of food with a
loss of control over the eating and
then purge, trying to get rid of the
extra calories in an unhealthy way.
 People with bulimia are usually at a
normal, healthy weight. But they
judge themselves harshly based on
their view of their body shape and/or
weight. They usually have self-
esteem issues closely linked to their
body image
DIAGNOSTIC CRITERIA
A. Recurrent episodes of binge eating. An
episode of binge eating is characterized by
both of the following:
1. Eating, in a discrete period of time
(e.g., within any 2-hour period), an
amount of food that is definitely
larger than what most individuals
would eat in a similar period of time
under similar circumstances.
2. A sense of lack of control over
eating during the episode (e.g., a
feeling that one cannot stop eating or
control what or how much one is
eating).
B. Recurrent inappropriate compensatory
behaviors in order to prevent weight gain,
such as self-induced vomiting; misuse of
laxatives, diuretics, or other medications;
fasting; or excessive exercise.
C. The binge eating and inappropriate
compensatory behaviors both occur, on
average, at least once a week for 3 months.
D. Self-evaluation is unduly influenced by
body shape and weight.
E. The disturbance does not occur
exclusively during episodes of anorexia
nervosa.
Specify if:
In partial remission: After full
criteria for bulimia nervosa were
previously met, some, but not all, of
the criteria have been met for a
sustained period of time.
In full remission: After full criteria
for bulimia nervosa were previously
met, none of the criteria have been
met for a sustained period of time.
Specify current severity:
The minimum level of severity is based on
the frequency of inappropriate compensatory
behaviors (see below). The level of severity
may be increased to reflect other symptoms
and the degree of functional disability.
Mild: An average of 1–3 episodes of
inappropriate compensatory
behaviors per week.
Moderate: An average of 4–7
episodes of inappropriate
compensatory behaviors per week.
Severe: An average of 8–13 episodes
of inappropriate compensatory
behaviors per week.
Extreme: An average of 14 or more
episodes of inappropriate
compensatory behaviors per week.
6. Binge-Eating Disorder
 Binge eating disorder (BED) is a
severe, life-threatening, and treatable
eating disorder characterized by
recurrent episodes of eating large
quantities of food (often very quickly
and to the point of discomfort); a
feeling of a loss of control during the
binge; experiencing shame, distress
or guilt afterwards; and not regularly
using unhealthy compensatory
measures (e.g., purging) to counter
the binge eating
DIAGNOSTIC CRITERIA
A. Recurrent episodes of binge eating. An
episode of binge eating is characterized by
both of the following:
1. Eating, in a discrete period of time
(e.g., within any 2-hour period), an
amount of food that is definitely
larger than what most people would
eat in a similar period of time under
similar circumstances.
2. A sense of lack of control over
eating during the episode (e.g., a
feeling that one cannot stop eating or
control what or how much one is
eating).
B. The binge-eating episodes are associated
with three (or more) of the following:
1. Eating much more rapidly than
normal.
2. Eating until feeling uncomfortably
full.
3. Eating large amounts of food
when not feeling physically hungry.
4. Eating alone because of feeling
embarrassed by how much one is
eating.
5. Feeling disgusted with oneself,
depressed, or very guilty afterward.
C. Marked distress regarding binge eating is
present.
D. The binge eating occurs, on average, at
least once a week for 3 months.
E. The binge eating is not associated with
the recurrent use of inappropriate
compensatory behavior as in bulimia
nervosa and does not occur exclusively
during the course of bulimia nervosa or
anorexia nervosa. Specify if:
In partial remission: After full
criteria for bingeeating disorder were
previously met, binge eating occurs
at an average frequency of less than
one episode per week for a sustained
period of time.
In full remission: After full criteria
for binge-eating disorder were
previously met, none of the criteria
have been met for a sustained period
of time.
Specify current severity:
The minimum level of severity is based on
the frequency of episodes of binge eating
(see below). The level of severity may be
increased to reflect other symptoms and the
degree of functional disability.
Mild: 1–3 binge-eating episodes per
week.
Moderate: 4–7 binge-eating
episodes per week.
Severe: 8–13 binge-eating episodes
per week.
Extreme: 14 or more binge-eating
episodes per week.

XI. Sleep-Wake
Disorders
 Sleep-wake disorders encompass
10 disorders or disorder groups:
insomnia disorder,
hypersomnolence disorder,
narcolepsy, breathing-related
sleep disorders, circadian rhythm
sleep-wake disorders, non–rapid
eye movement (NREM) sleep
arousal disorders, nightmare
disorder, rapid eye movement
(REM) sleep behavior disorder,
restless legs syndrome, and
substance/medication-induced
sleep disorder.
 Four distinct sleep stages can be
measured by polysomnography:
REM sleep and three stages of
NREM sleep (N1, N2, and N3).
 REM sleep, during which the
majority of typical story-like
dreams occur, occupies about
20%–25% of total sleep.
 NREM sleep stage 1 (N1) is
a transition from wakefulness
to sleep and occupies about
5% of time spent asleep in
healthy adults.
 NREM sleep stage 2 (N2),
which is characterized by
specific
electroencephalographic
waveforms (sleep spindles
and K complexes), occupies
about 50% of time spent
asleep.
 NREM sleep stage 3 (N3)
(also known as slow-wave
sleep) is the deepest level of
sleep and occupies about
20% of sleep time in healthy,
younger adults.
1. INSOMNIA DISORDER
 It is the dissatisfaction with sleep
quantity or quality, associated with
one (or more) of the following
symptoms:
Difficulty initiating sleep
Difficulty maintaining sleep,
characterized by frequent
awakenings or problems returning to
sleep after awakenings
DIAGNOSTIC CRITERIA
A. A predominant complaint of
dissatisfaction with sleep quantity or quality,
associated with one (or more) of the
following symptoms:
1. Difficulty initiating sleep. (In
children, this may manifest as
difficulty initiating sleep without
caregiver intervention.)
2. Difficulty maintaining sleep,
characterized by frequent
awakenings or problems returning to
sleep after awakenings. (In children,
this may manifest as difficulty
returning to sleep without caregiver
intervention.)
3. Early-morning awakening with
inability to return to sleep.
B. The sleep disturbance causes clinically
significant distress or impairment in social,
occupational, educational, academic,
behavioral, or other important areas of
functioning.
C. The sleep difficulty occurs at least 3
nights per week.
D. The sleep difficulty is present for at least
3 months.
E. The sleep difficulty occurs despite
adequate opportunity for sleep.
F. The insomnia is not better explained by
and does not occur exclusively during the
course of another sleepwake disorder (e.g.,
narcolepsy, a breathing-related sleep
disorder, a circadian rhythm sleep-wake
disorder, a parasomnia).
G. The insomnia is not attributable to the
physiological effects of a substance (e.g., a
drug of abuse, a medication).
H. Coexisting mental disorders and medical
conditions do not adequately explain the
predominant complaint of insomnia.
Specify if:
With mental disorder, including
substance use disorders
With medical condition
With another sleep disorder
Coding note: The code F51.01
applies to all three specifiers. Code
also the relevant associated mental
disorder, medical condition, or other
sleep disorder immediately after the
code for insomnia disorder in order
to indicate the association.
Specify if:
Episodic: Symptoms last at least 1
month but less than 3 months.
Persistent: Symptoms last 3 months
or longer.
Recurrent: Two (or more) episodes
within the space of 1 year.
Note: Acute and short-term insomnia (i.e., Subacute: Duration of 1–3 months.
symptoms lasting less than 3 months but Persistent: Duration of more than 3 months.
otherwise meeting all criteria with regard to Specify current severity:
frequency, intensity, distress, and/or Specify severity based on degree of
impairment) should be coded as another difficulty maintaining daytime alertness as
specified insomnia disorder. manifested by the occurrence of multiple
attacks of irresistible sleepiness within any
2. HYPERSOMNOLENCE DISORDER given day occurring, for example, while
 It is a condition where a person sedentary, driving, visiting with friends, or
experiences significant episodes of working
sleepiness, even after having 7 hours Mild: Difficulty maintaining
or more of quality sleep. daytime alertness 1–2 days/week.
DIAGNOSTIC CRITERIA Moderate: Difficulty maintaining
A. Self-reported excessive sleepiness daytime alertness 3–4 days/week.
(hypersomnolence) despite a main sleep Severe: Difficulty maintaining
period lasting at least 7 hours, with at least daytime alertness 5–7 days/week.
one of the following symptoms:
1. Recurrent periods of sleep or 3. NARCOLEPSY
lapses into sleep within the same  It is a sleep disorder that makes
day. people very drowsy during the day.
2. A prolonged main sleep episode of People with narcolepsy find it hard
more than 9 hours per day that is to stay awake for long periods of
nonrestorative (i.e., unrefreshing). time. They fall asleep suddenly
3. Difficulty being fully awake after DIAGNOSTIC CRITERIA
abrupt awakening. A. Recurrent periods of an irrepressible need
B. The hypersomnolence occurs at least to sleep, lapsing into sleep, or napping
three times per week, for at least 3 months. occurring within the same day. These must
C. The hypersomnolence is accompanied by have been occurring at least three times per
significant distress or impairment in week over the past 3 months.
cognitive, social, occupational, or other B. The presence of at least one of the
important areas of functioning. following:
D. The hypersomnolence is not better 1. Episodes of cataplexy, defined as
explained by and does not occur exclusively either (a) or (b), occurring at least a
during the course of another sleep disorder few times per month:
(e.g., narcolepsy, breathingrelated sleep a. In individuals with long-
disorder, circadian rhythm sleep-wake standing disease, brief
disorder, or a parasomnia). (seconds to minutes) episodes
E. The hypersomnolence is not attributable of sudden bilateral loss of
to the physiological effects of a substance muscle tone with maintained
(e.g., a drug of abuse, a medication). consciousness that are
F. Coexisting mental and medical disorders precipitated by laughter or
do not adequately explain the predominant joking.
complaint of hypersomnolence. b. In children or in
Specify if: individuals within 6 months
With mental disorder, including of onset, spontaneous
substance use disorders grimaces or jaw-opening
With medical condition episodes with tongue
With another sleep disorder thrusting or a global
Coding note: The code F51.11 hypotonia, without any
applies to all three specifiers. Code obvious emotional triggers.
also the relevant associated mental 2. Hypocretin deficiency, as
disorder, medical condition, or other measured using cerebrospinal fluid
sleep disorder immediately after the (CSF) hypocretin-1
code for hypersomnolence disorder immunoreactivity values (less than
in order to indicate the association. or equal to onethird of values
Specify if: obtained in healthy subjects tested
Acute: Duration of less than 1 month. using the same assay, or less than or
 equal to 110 pg/mL). Low CSF
levels of hypocretin-1 must not be
observed in the context of acute
brain injury, inflammation, or
infection.
3. Nocturnal sleep polysomnography
showing rapid eye movement (REM)
sleep latency less than or equal to 15
minutes, or a multiple sleep latency
test showing a mean sleep latency
less than or equal to 8 minutes and
two or more sleep-onset REM
periods.
4. BREATHING-RELATED SLEEP
DISORDER
 Obstructive sleep apnea hypopnea
 Central sleep apnea
 Sleep-related hypoventilation
 Obstructive sleep apnea occurs when
your breathing is interrupted during
sleep, for longer than 10 seconds at
least 5 times per hour (on average)
throughout your sleep period. These
periods are called hypopneas when
your breathing is reduced and you're
not taking in enough oxygen.
DIAGNOSTIC CRITERIA
A. Either (1) or (2):
1. Evidence by polysomnography of
at least five obstructive apneas or
hypopneas per hour of sleep and
either of the following sleep
symptoms:
a. Nocturnal breathing
disturbances: snoring,
snorting/gasping, or breathing
pauses during sleep.
b. Daytime sleepiness,
fatigue, or unrefreshing sleep
despite sufficient
opportunities to sleep that is
not better explained by
another mental disorder
(including a sleep disorder)
and is not attributable to
another medical condition.
2. Evidence by polysomnography of
15 or more obstructive apneas and/or
hypopneas per hour of sleep
regardless of accompanying
symptoms.
Specify current severity:
Mild: Apnea hypopnea index is less
than 15.
Moderate: Apnea hypopnea index is
15–30.
Severe: Apnea hypopnea index is
greater than 30.
5. CENTRAL SLEEP APNEA
 Central sleep apnea is a disorder in
which your breathing repeatedly
stops and starts during sleep.
 Central sleep apnea causes:
Cheyne-Stokes breathing
Narcotic-induced central sleep apnea
High-altitude periodic breathing
Treatment-emergent apnea
Medical condition-induced apnea
Idiopathic (primary) central sleep apnea
DIAGNOSTIC CRITERIA
A. Evidence by polysomnography of five or
more central apneas per hour of sleep.
B. The disorder is not better explained by
another current sleep disorder.
6. SLEEP-RELATED
HYPOVENTILATION
 Sleep-related hypoventilation
disorders are characterized by
insufficient ventilation, which leads
to an increase of carbon dioxide
levels in the arteries
 Use of medications and other
substances that suppress the central
nervous system, such as
benzodiazepines, opiates, and
alcohol
 Neuromuscular and chest wall
disorders
 Asthma or another pulmonary
disorder
 Hypothyroidism
 Obesity
DIAGNOSTIC CRITERIA
A. Polysomnograpy demonstrates episodes
of decreased respiration associated with
elevated CO2 levels. (Note: In the absence
of objective measurement of CO2, persistent
low levels of hemoglobin oxygen saturation
unassociated with apneic/hypopneic events
may indicate hypoventilation.)
B. The disturbance is not better explained by
another current sleep disorder.
7. CIRCADIAN RHYTHM SLEEP-
WAKE DISORDERS
 Circadian rhythm disorders, also
known as sleep-wake cycle
disorders, are problems that occur
when your body's internal clock,
which tells you when it's time to
 sleep or wake, is out of sync with 8. NON-RAPID EYE MOVEMENT
your environment. (NREM) SLEEP AROUSAL DISORDER
DIAGNOSTIC CRITERIA  Non-rapid eye movement (NREM)
A. A persistent or recurrent pattern of sleep sleep arousal disorders involve
disruption that is primarily due to an episodes of incomplete awakening
from sleep, usually occurring during
alteration of the circadian system or to a
the first third of a major sleep
misalignment between the endogenous episode, and are accompanied by
circadian rhythm and the sleep-wake either sleepwalking or sleep terrors.
schedule required by an individual’s The episodes cause significant
physical environment or social or distress or problems functioning.
professional schedule. NREM sleep arousal disorders are
B. The sleep disruption leads to excessive most common among children and
become less common with increasing
sleepiness or insomnia, or both.
age.
C. The sleep disturbance causes clinically  Sleepwalking - involves repeated
significant distress or impairment in social, episodes of rising from bed and
occupational, and other important areas of walking around during sleep. While
functioning. sleepwalking, the individual has a
Specify whether: blank, staring face; is relatively
G47.21 Delayed sleep phase type: A pattern of delayed unresponsive to others; and is
sleep onset and awakening times, with an inability to fall difficult to wake up.
asleep and awaken at a desired or conventionally
 Sleep terrors - (also called night
acceptable earlier time.
Specify if:
terrors) are episodes of waking
Familial: A family history of delayed abruptly from sleep, usually
sleep phase is present. beginning with a panicky scream.
Specify if: During each episode, the person
Overlapping with non-24-hour experiences intense fear and
sleepwake type: Delayed sleep phase
associated physical signs such as
type may overlap with another
circadian rhythm sleepwake disorder,
rapid breathing, accelerated heart
non-24-hour sleep-wake type rate and sweating
G47.22 Advanced sleep phase type: A pattern of DIAGNOSTIC CRITERIA
advanced sleep onset and awakening times, with an A. Recurrent episodes of incomplete
inability to remain awake or asleep until the desired or awakening from sleep, usually occurring
conventionally acceptable later sleep or wake times.
Specify if:
during the first third of the major sleep
Familial: A family history of advanced episode, accompanied by either one of the
sleep phase is present. following:
G47.23 Irregular sleep-wake type: A temporally 1. Sleepwalking
disorganized sleep-wake pattern, such that the timing of 2. Sleep terrors
sleep and wake periods is variable throughout the 24-hour B. No or little (e.g., only a single visual
period.
scene) dream imagery is recalled.
G47.24 Non-24-hour sleep-wake type: A pattern of sleep-
wake cycles that is not synchronized to the 24-hour C. Amnesia for the episodes is present.
environment, with a consistent daily drift (usually to later D. The episodes cause clinically significant
and later times) of sleep onset and wake times. distress or impairment in social,
G47.26 Shift work type: Insomnia during the major sleep occupational, or other important areas of
period and/or excessive sleepiness (including inadvertent functioning.
sleep) during the major awake period associated with a shift
E. The disturbance is not attributable to the
work schedule (i.e., requiring unconventional work hours).
G47.20 Unspecified type
physiological effects of a substance (e.g., a
Specify if: drug of abuse, a medication).
Episodic: Symptoms last at least 1 month but less than 3 F. Coexisting mental disorders and medical
months. conditions do not explain the episodes of
Persistent: Symptoms last 3 months or longer. sleepwalking or sleep terrors.
Recurrent: Two or more episodes occur within the space
Specify whether:
of 1 year.
F51.3 Sleepwalking type
Specify if:
With sleep-related eating
 With sleep-related sexual behavior
(sexsomnia)
F51.4 Sleep terror type
9. NIGHTMARE DISORDER
 Nightmare disorder is defined by the
repeated occurrence of nightmares
that cause clinically significant
distress or impairment in social,
occupational or other important areas
of functioning.
 Nightmares may begin in children
between 3 and 6 years old and tend
to decrease after the age of 10.
During the teen and young adult
years, girls appear to have
nightmares more often than boys do.
Some people have them as adults or
throughout their lives.
DIAGNOSTIC CRITERIA
A. Repeated occurrences of extended,
extremely dysphoric, and well-remembered
dreams that usually involve efforts to avoid
threats to survival, security, or physical
integrity and that generally occur during the
second half of the major sleep episode.
B. On awakening from the dysphoric
dreams, the individual rapidly becomes
oriented and alert.
C. The sleep disturbance causes clinically
significant distress or impairment in social,
occupational, or other important areas of
functioning.
D. The nightmare symptoms are not
attributable to the physiological effects of a
substance (e.g., a drug of abuse, a
medication).
E. Coexisting mental disorders and medical
conditions do not adequately explain the
predominant complaint of dysphoric dreams.
Specify if:
During sleep onset
Specify if:
With mental disorder, including
substance use disorders
With medical condition
With another sleep disorder
Coding note: The code F51.5 applies
to all three specifiers. Code also the
relevant associated mental disorder,
medical condition, or other sleep
disorder immediately after the code
for nightmare disorder in order to
indicate the association.
Specify if:
Acute: Duration of period of nightmares is 1
month or less.
Subacute: Duration of period of nightmares
is greater than 1 month but less than 6
months.
Persistent: Duration of period of nightmares
is 6 months or greater.
Specify current severity:
Severity can be rated by the
frequency with which the nightmares
occur:
Mild: Less than one episode per
week on average.
Moderate: One or more episodes per
week but less than nightly.
Severe: Episodes nightly.
10. RAPID EYE MOVEMENT (REM)
SLEEP BEHAVIOR DISORDER
 Rapid eye movement (REM) sleep
behavior disorder (RBD) is a
parasomnia characterized by dream-
enactment behaviors that emerge
during a loss of REM sleep atonia.
RBD dream enactment ranges in
severity from benign hand gestures
to violent thrashing, punching, and
kicking. Patients typically present to
medical attention with a concern
related to injurious or potentially
injurious actions to themselves
and/or their bed partner
DIAGNOSTIC CRITERIA
A. Repeated episodes of arousal during sleep
associated with vocalization and/or complex
motor behaviors.
B. These behaviors arise during rapid eye
movement (REM) sleep and therefore
usually occur more than 90 minutes after
sleep onset, are more frequent during the
later portions of the sleep period, and
uncommonly occur during daytime naps.
C. Upon awakening from these episodes, the
individual is completely awake, alert, and
not confused or disoriented.
D. Either of the following:
1. REM sleep without atonia on
polysomnographic recording.
2. A history suggestive of REM sleep
behavior disorder and an established
synucleinopathy diagnosis (e.g.,
Parkinson’s disease, multiple system
atrophy).
E. The behaviors cause clinically significant
distress or impairment in social,
occupational, or other important areas of
functioning (which may include injury to
self or the bed partner).
F. The disturbance is not attributable to the
physiological effects of a substance (e.g., a
drug of abuse, a medication) or another
medical condition.
G. Coexisting mental disorders and medical
conditions do not explain the episodes.
11. RESTLESS LEGS SYNDROME
 Restless legs syndrome (RLS), also
called Willis-Ekbom Disease, causes
unpleasant or uncomfortable
sensations in the legs and an
irresistible urge to move them.
Symptoms commonly occur in the
late afternoon or evening hours, and
are often most severe at night when a
person is resting, such as sitting or
lying in bed. They also may occur
when someone is inactive and sitting
for extended periods (for example,
when taking a trip by plane or
watching a movie). Since symptoms
can increase in severity during the
night, it could become difficult to fall
asleep or return to sleep after waking
up. Moving the legs or walking
typically relieves the discomfort but
the sensations often recur once the
movement stops. RLS is classified as
a sleep disorder since the symptoms
are triggered by resting and
attempting to sleep, and as a
movement disorder, since people are
forced to move their legs in order to
relieve symptoms. It is, however,
best characterized as a neurological
sensory disorder with symptoms that
are produced from within the brain
itself
DIAGNOSTIC CRITERIA
A. An urge to move the legs, usually
accompanied by or in response to
uncomfortable and unpleasant sensations
in the legs, characterized by all of the
following:
1. The urge to move the legs begins
or worsens during periods of rest or
inactivity.
2. The urge to move the legs is
partially or totally relieved by
movement.
3. The urge to move the legs is worse
in the evening or at night than during
the day, or occurs only in the
evening or at night.
B. The symptoms in Criterion A occur at
least three times per week and have persisted
for at least 3 months.
C. The symptoms in Criterion A are
accompanied by significant distress or
impairment in social, occupational,
educational, academic, behavioral, or other
important areas of functioning.
D. The symptoms in Criterion A are not
attributable to another mental disorder or
medical condition (e.g., arthritis, leg edema,
peripheral ischemia, leg cramps) and are not
better explained by a behavioral condition
(e.g., positional discomfort, habitual foot
tapping).
E. The symptoms are not attributable to the
physiological effects of a drug of abuse or
medication (e.g., akathisia).
12. Substance/Medication-Induced Sleep
Disorder
 Substance or medication-induced
sleep disorder is the official
diagnostic name for insomnia and
other sleep problems which are
caused by the use of alcohol, drugs,
or taking certain medications.
Roughly translated, that means that
one of the effects of drinking
alcohol, using a drug, or taking a
medication, is having a problem with
getting to sleep at the time you want
to sleep, staying asleep at the time
you want to sleep, excessive
sleepiness during the day, or unusual
behaviors when you do sleep.
DIAGNOSTIC CRITERIA
A. A prominent and severe disturbance in
sleep.
B. There is evidence from the history,
physical examination, or laboratory findings
of both (1) and (2):
1. The symptoms in Criterion A
developed during or soon after
substance intoxication or withdrawal
or after exposure to or withdrawal
from a medication.
2. The involved
substance/medication is capable of
producing the symptoms in Criterion
A.
C. The disturbance is not better explained by
a sleep disorder that is not
substance/medication-induced. Such
evidence of an independent sleep disorder
could include the following: The symptoms
precede the onset of the
substance/medication use; the symptoms
persist for a substantial period of time (e.g.,
about 1 month) after the cessation of acute
withdrawal or severe intoxication; or there is
other evidence suggesting the existence of
an independent nonsubstance/medication-
induced sleep disorder (e.g., a history of
recurrent non-substance/medicationrelated
episodes).
D. The disturbance does not occur
exclusively during the course of a delirium.
E. The disturbance causes clinically
significant distress or impairment in social,
occupational, or other important areas of
functioning.
Note: This diagnosis should be made instead
of a diagnosis of substance intoxication or
substance withdrawal only when the
symptoms in Criterion A predominate in the
clinical picture and when they are
sufficiently severe to warrant clinical
attention.
XII. Sexual Dysfunctions
 Sexual dysfunctions are a distress or othet significant stressors and is
heterogeneous group of disorders
that are typically characterized by a
clinically significant disturbance in a
person’s ability to respond sexually
or to experience sexual pleasure.
 Sexual dysfunctions can be either
lifelong or acquired. Lifelong refers
to a chronic condition that is present
during a person’s entire sexual life;
acquired refers to a disorder that
begins after sexual activity has been
relatively normal. In addition,
disorders can either be generalized,
occurring every time the individual
attempts sex, or they can be
situational, occurring with some
partners or at certain times but not
with other partners or at other times.
Specific Sexual Dysfunctions
1. Delayed Ejaculation
 Delayed ejaculation, also called
delayed orgasm, happens when
you take a long time and need a
lot of stimulation to reach sexual
climax and ejaculate. In some
cases, you might not ejaculate at
all.
DIAGNOSTIC CRITERIA
A. Either of the following symptoms must
be experienced on almost all or all occasions
(approximately 75%-100%) of partnered
sexual activity (in identified situational
contexts or, if generalized, in all contexts),
and without the individual desiring delay:
1. Mared delay in ejacultion.
2. Marked infrequency or absence of
ejaculation.
B. The symptoms in Criterion A have
persisted for a minimum duration of
approximately 6 months.
C. The symptoms in Criterion A cause
clinically significant distress in the
individual.
D. The sexual dysfunction is not better
explained by a nonsexual mental disorder or
as a consequence of severe relationship
not attributable to the effects of a
substance/medication or another medical
condition.
2. Erectile Disorder
 It is defined in the DSM-5 as the
recurrent inability to achieve an
erection, the inability to maintain
an adequate erection, and/or a
noticeable decrease in erectile
rigidity during partnered sexual
activity
DIAGNOSTIC CRITERIA
A. At least one of the three following
symptoms must be experienced on almost all
or all (approximately 75% -100%) occasion
of sexual activity (in identified situational
context or, if generalized, in all contexts):
1. Marked difficulty in obtaining an
erection during sexual activity
2. Marked difficulty in maintaining
an erection until the completion of
sexual activity
3. Marked decreased in erectile
rigidity
B. The symptoms in Criterion A have
persisted for a minimum duration of
approximately 6 months
C. The symptoms in Criterion A cause
clinically significant distress in the
individual
D. The sexual dysfunction is not better
explained by a non-sexual mental disorder
or as a consequence of severe relationship
distress or other significant stressors and is
not attributable to the effects of a
substance/medication or another medical
condition
3. Female Orgasmic Disorder
 Female orgasmic disorder
involves orgasm that is absent,
infrequent, markedly diminished
in intensity, or markedly delayed
in response to stimulation despite
normal levels of subjective
arousal.
 Female orgasmic disorder can be
primary or secondary:
 Primary: Women have never
been able to have an orgasm.
 Secondary: Women were
previously able to have an
orgasm but are now no longer
able to do so.
 Symptoms and Signs:
Women with orgasmic disorder
often have other types of sexual
dysfunction (eg, dyspareunia,
pelvic floor dysfunction).
Anxiety disorders and depression
are also more common among
women with this disorder.
Major Symptoms
1. Delayed, infrequent, or absent orgasm or
markedly decreased intensity of orgasm after
a normal sexual arousal phase on all or
almost all occasions of sexual activity.
2. Distress or interpersonal problems due to
orgasmic dysfunction.
3. No other disorder or substance that
exclusively accounts for the orgasmic
dysfunction.
4. Symptoms must have been present for ≥ 6
months.
Because the type of stimulation that triggers
orgasm varies widely, clinicians must use
clinical judgment to determine whether the
woman's response is deficient, based on her
age, sexual experience, and adequacy of the
sexual stimulation she receives.
DIAGNOSTIC CRITERIA
A. Presence of either of the following
symptoms and experienced on almost all or
all (approximately 75%-100%) occassions
of sexual activity (in identified situational
sexual context or, if generalized, in all
contexts):
1. Marked delay in, marked
infrequency of, or absence of
orgasm.
2. Markedly reduced intensity of
orgasmic sensations.
B. The symptoms in Criterion A have
persisted for a minimum duration of
approximately 6 months.
C. The symptoms in Criterion A cause
clinically significant distress in the
individual.
D. The sexual dysfunction is not better
explained by a nonsexual mental disorder or
as a consequence of severe relationship
distress (e.g., partner violence) or other
significant stressors and is not attributable to
the effects of a substance/medication or
another medical condition.
4. Female Sexual Interest/Arousal
Disorder
 characterized by absence of or a
decrease in sexual interest, initiation
of sexual activity, pleasure, thoughts,
and fantasies; absence of responsive
desire; and/or lack of subjective
arousal or of physical genital
response to sexual stimulation—
nongenital, genital, or both
DIAGNOSTIC CRITERIA
A. Lack of, or significantly reduced, sexual
interest/arousal, as manifested by at least
three of the following:
1. Absent/reduced interest in sexual
activity.
 2. Absent/reduced sexual/erotic
thoughts or fantasies. 5. Genito-pelvic pain/penetration
3. No/reduced initiation of sexual disorder (GPPPD)
activity, and typically unreceptive to  Genito-pelvic pain/penetration
a partner’s attempts to initiate. disorder (GPPPD) refers to
4. Absent/reduced sexual significant pain and difficulty with
excitement/pleasure during sexual
penetrative vaginal sex that lasts for
activity in almost all or all
(approximately 75%–100%) sexual at least six months.
encounters (in identified situational  GPPPD is actually an umbrella term
contexts or, if generalized, in all for two sexual pain disorders:
contexts). dyspareunia (painful intercourse) and
5. Absent/reduced sexual vaginismus (a situation in which the
interest/arousal in response to any muscles in the vagina contract to the
internal or external sexual/erotic cues
point that penetration is difficult, and
(e.g., written, verbal, visual)
6. Absent/reduced genital or sometimes impossible).
nongenital sensations during sexual
DIAGNOSTIC CRITERIA
activity in almost all or all
A. Persistent or recurrent difficulties with
(approximately 75%–100%) sexual
one (or more) of the following:
encounters (in identified situational
1. Vaginal penetration during
contexts or, if generalized, in all
intercourse.
contexts).
2. Marked vulvovaginal or pelvic
B. The symptoms in Criterion A have
pain during vaginal intercourse or
persisted for a minimum duration of
penetration attempts.
approximately 6 months.
3. Marked fear or anxiety about
C. The symptoms in Criterion A cause
vulvovaginal or pelvic pain in
clinically significant distress in the
anticipation of, during, or as a result
individual.
of vaginal penetration.
D. The sexual dysfunction is not better
4. Marked tensing or tightening of
explained by a nonsexual mental disorder or
the pelvic floor muscles during
as a consequence of severe relationship
attempted vaginal penetration.
distress (e.g., partner violence) or other
B. The symptoms in Criterion A have
significant stressors and is not attributable to
persisted for a minimum duration of
the effects of a substance/medication or
approximately 6 months.
another medical condition.
C. The symptoms in Criterion A cause
Specify whether:
clinically significant distress in the
Lifelong: The disturbance has been
individual.
present since the individual became
D. The sexual dysfunction is not better
sexually active.
explained by a nonsexual mental disorder or
Acquired: The disturbance began
as a consequence of a severe relationship
after a period of relatively normal
distress (e.g., partner violence) or other
sexual function.
significant stressors and is not attributable to
Specify whether:
the effects of a substance/medication or
Generalized: Not limited to certain
another medical condition.
types of stimulation, situations, or
Specify whether:
partners.
Lifelong: The disturbance has been
Situational: Only occurs with
present since the individual became
certain types of stimulation,
sexually active.
situations, or partners.
Acquired: The disturbance began
Specify current severity:
after a period of relatively normal
Mild: Evidence of mild distress over the
sexual function.
symptoms in Criterion A.
Specify current severity:
Moderate: Evidence of moderate distress
Mild: Evidence of mild distress over
over the symptoms in Criterion A.
the symptoms in Criterion A.
Severe: Evidence of severe or extreme
distress over the symptoms in Criterion A
 Moderate: Evidence of moderate
distress over the symptoms in
Criterion A.
Severe: Evidence of severe or
extreme distress over the symptoms
in Criterion A.
6. Male Hypoactive Sexual Desire
Disorder
 (MHSDD) is defined in the DSM-5
as persistent or recurrently deficient
sexual or erotic thoughts, fantasies,
and desire for sexual activity. These
symptoms must have persisted for a
minimum of six months, and they
must cause clinically significant
distress
DIAGNOSTIC CRITERIA
A. Persistently or recurrently deficient (or
absent) sexual/erotic thoughts or fantasies
and desire for sexual activity. The judgment
of deficiency is made by the clinician, taking
into account factors that affect sexual
functioning, such as age and general and
sociocultural contexts of the individual’s
life.
B. The symptoms in Criterion A have
persisted for a minimum duration of
approximately 6 months.
C. The symptoms in Criterion A cause
clinically significant distress in the
individual.
D. The sexual dysfunction is not better
explained by a nonsexual mental disorder or
as a consequence of severe relationship
distress or other significant stressors and is
not attributable to the effects of a
substance/medication or another medical
condition.
Specify whether:
Lifelong: The disturbance has been present
since the individual became sexually active.
Acquired: The disturbance began after a
period of relatively normal sexual function
Specify whether:
Generalized: Not limited to certain
types of stimulation, situations, or
partners.
Situational: Only occurs with
certain types of stimulation,
situations, or partners.
Specify current severity:
Mild: Evidence of mild distress over
the symptoms in Criterion A.
Moderate: Evidence of moderate
distress over the symptoms in
Criterion A.
Severe: Evidence of severe or
extreme distress over the symptoms
in Criterion A.
7. Premature (early) Ejaculation
 A far more common male orgasmic
disorder is premature ejaculation,
ejaculation that occurs well before
the man and his partner wish it to
(Althof, 2006; Polonsky, 2000;
Wincze, 2009; Wincze & Weisberg,
2015), defined as approximately 1
minute after penetration in DSM-5.
 Although DSM-5 specifies a
duration of less than approximately 1
minute, it is difficult to define
―premature.‖ An adequate length of
time before ejaculation varies from
individual to individual.
DIAGNOSTIC CRITERIA
A. A persistent or recurrent pattern of
ejaculation occurring during partnered
sexual activity within approximately 1
minute following vaginal penetration and
before the individual wishes it.
Note: Although the diagnosis of
premature (early) ejaculation may be
applied to individuals engaged in
nonvaginal sexual activities, specific
duration criteria have not been
established for these activities.
B. The symptom in Criterion A must have
been present for at least 6 months and must
be experienced on almost all or all
(approximately 75%–100%) occasions of
sexual activity (in identified situational
contexts or, if generalized, in all contexts).
C. The symptom in Criterion A causes  Order of presentation of the listed
clinically significant distress in the paraphilic disorders:
individual. Anomalous activity
D. The sexual dysfunction is not better preferences (first group)
explained by a nonsexual mental disorder or  COURTSHIP DISORDER
as a consequence of severe relationship (Resemble distorted
distress or other significant stressors and is components of human
not attributable to the effects of a courtship behavior)
substance/medication or another medical - Voyeuristic
condition. Disorder
Specify whether: - Exhibitionistic
Lifelong: The disturbance has been present Disorder
since the individual became sexually active. - Frotteuristic
Acquired: The disturbance began after a Disorder
period of relatively normal sexual function.  ALGOLAGNIC DISORDER
Specify whether: (involve pain and suffering)
Generalized: Not limited to certain types of - Sexual
stimulation, situations, or partners. Masochism
Situational: Only occurs with certain types Disorder
of stimulation, situations, or partners. - Sexual Sadism
Specify current severity: Disorder
Mild: Ejaculation occurring within Anomalous target preferences
approximately 30 seconds to 1 minute of (second group)
vaginal penetration.  One directed at other humans
Moderate: Ejaculation occurring within - Pedophilic
approximately 15–30 seconds of vaginal Disorder
penetration.  Two directed elsewhere
Severe: Ejaculation occurring prior to sexual - Fetishistic
activity, at the start of sexual activity, or Disorder
within approximately 15 seconds of vaginal - Transvestic
penetration. Disorder
1. VOYEURISTC DISORDER
 Recurrent and intense sexual arousal
XII. Paraphilic from observing an unsuspecting
Disorders person who is naked, in the process
 PARAPHILIA is any intense and of disrobing, or engaging in sexual
persistent sexual interest in genital activity, as manifested by fantasies,
stimulation or preparatory fondling urges, or behaviors
with phenotypically normal,  Voyeurs are also known as ―Peeping
physically mature, consenting human Toms, ‖ who use binoculars, mirrors,
partners and recording cameras while peering
 A paraphilia that is currently causing through peepholes and windows
distress or impairment to the DIAGNOSTIC CRITERIA
individual or paraphilia whose A. Over a period of at least 6 months,
satisfaction has entailed personal recurrent and intense sexual arousal from
harm or risk of harm to others. observing an unsuspecting person who is
 Involves: Inanimate objects; naked, in the process of disrobing, or
Children; Non-consenting adults; engaging in sexual activity, as manifested by
Suffering or humiliation fantasies, urges, or behaviors.
B. The individual has acted on these sexual
urges with a non-consenting person, or the
sexual urges or fantasies cause clinically
significant distress or impairment in social,
occupational, or other important areas of
functioning.
C. The individual experiencing the arousal
and/or acting on the urges is at least 18 years
of age.
Specify if:
In a controlled environment: This specifier
is primarily applicable to individuals living
in institutional or other settings where
opportunities to engage in voyeuristic
behavior are restricted.
In full remission: The individual has not
acted on the urges with a non-consenting
person, and there has been no distress or
impairment in social, occupational, or other
areas of functioning, for at least 5 years
while in an uncontrolled environment
2. EXHIBISTIONISTIC DISORDER
 Achieving sexual arousal and
gratification by exposing genitals
to unsuspecting strangers.
(Långström, 2010)
 It involves acting on these urges with
a non-consenting person or
experiencing significant distress or
functional impairment because of
such urges and impulses
DIAGNOSTIC CRITERIA
A. Over a period of at least 6 months,
recurrent and intense sexual arousal from the
exposure of one’s genitals to an
unsuspecting person, as manifested by
fantasies, urges, or behaviors.
B. The individual has acted on these sexual
urges with a non-consenting person, or the
sexual urges or fantasies cause clinically
significant distress or impairment in social,
occupational, or other important areas of
functioning.
Specify whether:
Sexually aroused by exposing
genitals to prepubertal children
Sexually aroused by exposing
genitals to physically mature
individuals
Sexually aroused by exposing
genitals to prepubertal children and
to physically mature individuals
Specify if:
In a controlled environment: This
specifier is primarily applicable to
individuals living in institutional or
other settings where opportunities to
expose one’s genitals are restricted.
In full remission: The individual has
not acted on the urges with a non-
consenting person, and there has
been no distress or impairment in
social, occupational, or other areas of
functioning, for at least 5 years while
in an uncontrolled environment.
3. FROTTEURISTIC DISORDER
 Recurrent and intense sexual arousal
from touching or rubbing against a
non-consenting person
DIAGNOSTIC CRITERIA
A. Over a period of at least 6 months,
recurrent and intense sexual arousal from
touching or rubbing against a non-
consenting person, as manifested by
fantasies, urges, or behaviors.
. The individual has acted on these sexual
urges with a non-consenting person, or the
sexual urges or fantasies cause clinically
significant distress or impairment in social,
occupational, or other important areas of
functioning.
Specify if:
In a controlled environment: This
specifier is primarily applicable to
individuals living in institutional or
other settings where opportunities to
touch or rub against a non-
consenting person are restricted.
In full remission: The individual has
not acted on the urges with a non-
consenting person, and there has
been no distress or impairment in
social, occupational, or other areas of
functioning, for at least 5 years while
in an uncontrolled environment.
4. SEXUAL MASOCHISM DISORDER
  there is sexual arousal from the act of
being humiliated, beaten, bound, or
otherwise made to suffer
DIAGNOSTIC CRITERIA
A. Over a period of at least 6 months,
recurrent and intense sexual arousal from the
act of being humiliated, beaten, bound, or
otherwise made to suffer, as manifested by
fantasies, urges, or behaviors.
B. The fantasies, sexual urges, or behaviors
cause clinically significant distress or
impairment in social, occupational, or other
important areas of functioning.
Specify if:
With asphyxiophilia: If the
individual engages in the practice of
achieving sexual arousal related to
restriction of breathing.
Specify if:
In a controlled environment: This
specifier is primarily applicable to
individuals living in institutional or
other settings where opportunities to
engage in masochistic sexual
behaviors are restricted.
In full remission: There has been no
distress or impairment in social,
occupational, or other areas of
functioning for at least 5 years while
in an uncontrolled environment.
5. SEXUAL SADISM DISORDER
 The individual is sexually aroused by
the physical or psychological
suffering of another person
DIAGNOSTIC CRITERIA
A. Over a period of at least 6 months,
recurrent and intense sexual arousal from the
physical or psychological suffering of
another person, as manifested by fantasies,
urges, or behaviors.
B. The individual has acted on these sexual
urges with a non-consenting person, or the
sexual urges or fantasies cause clinically
significant distress or impairment in social,
occupational, or other important areas of
functioning.
Specify if:
In a controlled environment: This
specifier is primarily applicable to
individuals living in institutional or
other settings where opportunities to
engage in sadistic sexual behaviors
are restricted.
In full remission: The individual has
not acted on the urges with a non-
consenting person, and there has
been no distress or impairment in
social, occupational, or other areas of
functioning, for at least 5 years while
in an uncontrolled environment.
6. PEDOPHILIC DISORDER
 recurrent intense sexually arousing
fantasies, urges, or behaviors
involving prepubescent or young
adolescents, usually under the age of
thirteen
 identified by an individual who is
five years older or more than the
child who is the victim of the
fantasies or behavior patterns
DIAGNOSTIC CRITERIA
A. Over a period of at least 6 months,
recurrent, intense sexually arousing
fantasies, sexual urges, or behaviors
involving sexual activity with a
prepubescent child or children (generally
age 13 years or younger).
B. The individual has acted on these sexual
urges, or the sexual urges or fantasies cause
marked distress or interpersonal difficulty.
C. The individual is at least age 16 years and
at least 5 years older than the child or
children in Criterion A.
Note: Do not include an individual in
late adolescence involved in an
ongoing sexual relationship with a
12- or 13-year-old.
Specify whether:
Exclusive type (attracted only to
children)
Nonexclusive type
Specify if:
Sexually attracted to males
Sexually attracted to females
Sexually attracted to both
Specify if:
Limited to incest
7. FETISHISTIC DISORDER
 is characterized by a distressing and
persistent pattern of sexual arousal
involving the use of nonliving
objects or specific, nongenital body
parts
DIAGNOSTIC CRITERIA
A. Over a period of at least 6 months,
recurrent and intense sexual arousal from
either the use of nonliving objects or a
highly specific focus on nongenital body
part(s), as manifested by fantasies, urges, or
behaviors.
B. The fantasies, sexual urges, or behaviors
cause clinically significant distress or
impairment in social, occupational, or other
important areas of functioning.
C. The fetish objects are not limited to
articles of clothing used in cross-dressing (as
in transvestic disorder) or devices
specifically designed for the purpose of
tactile genital stimulation (e.g., vibrator).
Specify:
Body part(s)
Nonliving object(s)
Other Specify if:
In a controlled environment: This
specifier is primarily applicable to
individuals living in institutional or
other settings where opportunities to
engage in fetishistic behaviors are
restricted.
In full remission: There has been no
distress or impairment in social,
occupational, or other areas of
functioning for at least 5 years while
in an uncontrolled environment.
8. TRANSVESTIC DISORDER
 is sexually aroused by the act of
cross-dressing as the opposite
gender, and yet finds the act of
dressing and the resulting arousal
distressing
 TRANSVESTISM - simply a clinical
term for cross-dressing
 T RANSVESTIC DISORDER - If a
person’s urges are experienced with
a sense of intense anxiety and shame,
emotional pressure, sometimes to the
point of compulsion, and are
accompanied by sexual satisfaction
can transvestic disorder be diagnosed
DIAGNOSTIC CRITERIA
A. Over a period of at least 6 months,
recurrent and intense sexual arousal from
cross-dressing, as manifested by fantasies,
urges, or behaviors.
B. The fantasies, sexual urges, or behaviors
cause clinically significant distress or
impairment in social, occupational, or other
important areas of functioning.
Specify if:
With fetishism: If sexually aroused
by fabrics, materials, or garments.
With autogynephilia: If sexually
aroused by thoughts or images of self
as a woman.
Specify if:
In a controlled environment: This
specifier is primarily applicable to
individuals living in institutional or
other settings where opportunities to
cross-dress are restricted.
In full remission: There has been no
distress or impairment in social,
occupational, or other areas of
functioning for at least 5 years while
in an uncontrolled environment.
OTHER SPECIFIED PARAPHILIC
DISORDER
1. Telephone Scatologia
2. Necrophilia
3. Zoophilia
4. Coprophilia
5. Klismaphilia
6. Urophilia

XIII. Gender Dysphoria
 A marked incongruence between
one’s experienced/expressed gender
and assigned gender, of at least 6
months’ duration
 Strong desire to be a member of the
other gender or strongly expressing
the belief that one is a member of the
other gender
 Strong preferences for playing with
members of the other gender and for
toys, games, and activities associated
with the other gender
 Strong feelings of disgust and
personal distress about one’s sexual
anatomy
 Strong desires to have physical
characteristics associated with one’s
experienced gender
 Strong preferences for assuming
roles of the other gender in make
believe or fantasy play
 Strong preferences for wearing
clothing typically associated with the
other gender and rejection of
clothing associated with one’s own
gender
XIV. Disruptive, Impulse
Control and Conduct
Disorders
 involving problems in the self-
control of emotions and behaviors
1. Oppositional Defiant Disorder
 A pattern of angry/irritable mood,
argumentative/defiant behavior, or
vindictiveness lasting at least 6
months
 The disturbance in behavior is
associated with distress
 The behaviors do not occur
exclusively during the course of a
psychotic, substance use, depressive,
or bipolar disorder. Also, the criteria
are not met for disruptive mood
dysregulation disorder.
2. Intermittent Explosive Disorder
 Recurrent behavioral outbursts
representing a failure to control
aggressive impulses
 The magnitude of aggressiveness
expressed during the recurrent
outbursts is grossly out of
proportion to the provocation
 The recurrent aggressive
outbursts are not premeditated
and are not committed to achieve
some tangible objective
3. Conduct Disorder
 A repetitive and persistent pattern of
behavior in which the basic rights of
others or major ageappropriate
societal norms or rules are violated,
as manifested by the presence of the
following criteria in the past 12
months; 6 months duration
– Aggression to People and Animals
– Destruction of Property
– Deceitful ness or Theft
– Serious Violations of Rules
 Functional impairment
 If the individual is age 18 years or
older, criteria are not met for
antisocial personality disorder
4. Pyromania
 Deliberate and purposeful fire setting
on more than one occasion
 Tension or affective arousal before
the act
 Fascination with, interest in,
curiosity about, or attraction to fire
and its situational contexts
 Pleasure, gratification, or relief when
setting fires or when witnessing or
participating in their aftermath.
5. Kleptomania
 Recurrent failure to resist impulses to
steal objects that are not needed for
personal use or for their monetary
value.
 Increasing sense of tension
immediately before committing the
theft.
 Pleasure, gratification, or relief at the
time of committing the theft.
 The stealing is not committed to
express anger or vengeance and is
not in response to a delusion or a
hallucination.
 The stealing is not better explained
by conduct disorder, a manic
episode, or antisocial personality
disorder
XV. Substance-Related
and Addictive Disorders
1. Substance Use Disorder
 A maladaptive pattern of substance
use leading to clinically significant
impairment or distress
 Recurrent substance use in situations
in which it is physically hazardous
(e.g., driving an automobile or
operating a machine when impaired
by substance use)
 Continued use leading to impairment
in school or work
 Development of tolerance
 Characteristic withdrawal syndrome
depending on substance
 Persistent desire to cut down or
decrease substance use
 Drug-seeking behavior
2. Gambling Disorder
 Persistent and recurrent problematic
gambling behavior leading to
clinically significant impairment or
distress, as indicated by the
individual exhibiting four (or more)
of the symptoms
 The gambling behavior is not better
explained by a manic episode.
XV. Personality
Disorders
 Personality – The way of thinking,
feeling and behaving that makes a
person different from other people.
An individual’ s personality is
influenced by experiences,
environment and inherited
characteristics
GENERAL PERSONALITY DISORDER
DIAGNOSTIC CRITERIA
A. An enduring pattern of inner experience
and behavior that deviates markedly from
the expectations of the individual’ s culture.
This pattern is manifested in two (or more)
of the following areas:
1. Cognition (i.e., ways of perceiving
and interpreting self, other people,
and events).
2. Affectivity (i.e., the range,
intensity, lability, and
appropriateness of emotional
response).
3. Interpersonal functioning.
4. Impulse control
B. The enduring pattern is inflexible and
pervasive across a broad range of personal
and social situations.
C. The enduring pattern leads to clinically
significant distress or impairment in social,
occupational, or other important areas of
functioning.
D. The pattern is stable and cf long duration,
and its onset can be traced back at least to
adolescence or early adulthood
E. The enduring pattern is not better
explained as a manifestation or consequence
of another mental disorder.
F. The enduring pattern is not attributable to
the physiological effects of a substance
(e.g., a drug of abuse, a medication)
or,another medical condition (e.g.,
head,trauma)
Cluster A Personality Disorder
 Consist of odd and eccentric
personality disorder:
 1. PARANOID PERSONALITY
DISORDER
 Paranoid Personality Disorder is a
personality disorder that consists of a
pervasive distrust or suspiciousness
of others the point that their motives
are interpreted as malevolent.
 It is characterized by a pattern of
distrust and suspiciousness of others.
Individuals with this disorder tend to
negatively interpret the actions,
words, and intentions of others.
 They suspect that others intend to
harm or deceive them, though there
may be little supporting evidence for
such concerns.
 Individuals can also hold grudges for
long periods of time and are reluctant
to confide in others
DIAGNOSTIC CRITERIA
A. A pervasive distrust and suspiciousness
of others such that their motives are
interpreted as malevolent, beginning by
early adulthood and present in a variety of
contexts, as indicated by four (or more) of
the following:
1. Suspects, without sufficient basis,
that others are exploiting, harming,
or deceiving him or her.
2. Is preoccupied with unjustified
doubts about the loyalty or
trustworthiness of friends or
associates.
3. Is reluctant to confide in others
because of unwarranted fear that the
information will be used maliciously
against him or her.
4. Reads hidden demeaning or
threatening meanings into benign
remarks or events.
5. Persistently bears grudges (i.e., is
unforgiving of insults, injuries, or
slights).
6. Perceives attacks on his or her
character reputation that are not
apparent to others and is quick to
react angrily or to counterattack.
7. Has recurrent suspicions, without
justification, regarding fidelity of
spouse or sexual partner.
B. Does not occur exclusively during the
course of schizophrenia, a bipolar disorder
or depressive disorder with psychotic
features, or another psychotic disorder and is
not attributable to the physiological effects
of another medical condition.
Note: If criteria are met prior to the onset of
schizophrenia, add ―premorbid,‖ i.e.,
―paranoid personality disorder (premorbid).‖
2. SCHIZOID PERSONALITY
DISORDER
 Schizoid Personality Disorder is a
personality disorder characterized by
a pervasive pattern of detachment
from social relationships and a
restricted range of expression of
emotions in interpersonal settings
that begins by early adulthood. These
individuals often appear to be
socially isolated or ―loners,‖ and do
not desire intimacy.
DIAGNOSTIC CRITERIA
A. A pervasive pattern of detachment from
social relationships and a restricted range of
expression of emotions in interpersonal
settings, beginning by early adulthood and
present in a variety of contexts, as indicated
by four (or more) of the following:
1. Neither desires nor enjoys close
relationships, including being part of
a family.
2. Almost always chooses solitary
activities.
3. Has little, if any, interest in having
sexual experiences with another
person.
4. Takes pleasure in few, if any,
activities.
5. Lacks close friends or confidants
other than firstdegree relatives.
6. Appears indifferent to the praise or
criticism of others.
7. Shows emotional coldness,
detachment, or flattened affectivity.
B. Does not occur exclusively during the
course of schizophrenia, a bipolar disorder
or depressive disorder with psychotic
features, another psychotic disorder, or
autism spectrum disorder and is not
attributable to the physiological effects of
another medical condition.
Note: If criteria are met prior to the onset
of schizophrenia, add ―premorbid,‖ i.e.,
―schizoid personality disorder (premorbid).‖
3. SCHIZOTYPAL PERSONALITY
DISORDER
 Schizotypal Personality Disorder is a
personality disorder characterized by
pervasive patterns of ―strange ‖ or ―
odd‖ behavior, appearance, or
thinking.
 These peculiarities are not so severe
that they can be diagnosed as
schizophrenia, and there is no history
of actual psychotic episodes.
 Individuals will often have ideas of
reference, but not to a delusional
quality.
 Symptoms may be first apparent in
childhood, when the individual has
peculiar thoughts, unusual language,
and/or bizarre fantasies.
DIAGNOSTIC CRITERIA
A. A pervasive pattern of social and
interpersonal deficits marked by acute
discomfort with, and reduced capacity for,
close relationships as well as by cognitive or
perceptual distortions and eccentricities of
behavior, beginning by early adulthood and
present in a variety of contexts, as indicated
by five (or more) of the following:
1. Ideas of reference (excluding
delusions of reference).
2. Odd beliefs or magical thinking
that influences behavior and is
inconsistent with subcultural norms
(e.g., superstitiousness, belief in
clairvoyance, telepathy, or ―sixth
sense‖; in children and adolescents,
bizarre fantasies or preoccupations).
3. Unusual perceptual experiences,
including bodily illusions.
4. Odd thinking and speech (e.g.,
vague, circumstantial, metaphorical,
overelaborate, or stereotyped).
5. Suspiciousness or paranoid
ideation.
6. Inappropriate or constricted affect.
7. Behavior or appearance that is
odd, eccentric, or peculiar.
8. Lack of close friends or confidants
other than firstdegree relatives.
9. Excessive social anxiety that does
not diminish with familiarity and
tends to be associated with paranoid
fears rather than negative judgments
about self.
B. Does not occur exclusively during the
course of schizophrenia, a bipolar disorder
or depressive disorder with psychotic
features, another psychotic disorder, or
autism spectrum disorder.
Note: If criteria are met prior to the onset of
schizophrenia, add ―premorbid,‖ e.g.,
―schizotypal personality disorder
(premorbid).‖
Cluster B Personality Disorder
 Consist of dramatic or erratic
personality disorder:
1. ANTISOCIAL PERSONALITY
DISORDER
 Antisocial Personality Disorder
(ASPD) is a personality disorder
characterized by a history of
continuous and chronic behaviour
where there is disregard for and
violation of the rights of others.
Individuals repeatedly engage in
unlawful activities (e.g. drug use,
assault, or theft), endanger the well-
being of others, and frequently lie.
They tend to be aggressive and
impulsive and may find it difficult to
maintain employment for long.
Contrary to the name, having
antisocial personality does not mean
the individual does not have friends;
on the contrary, they may have a
superficial charm and be very
deceptive.
DIAGNOSTIC CRITERIA
A. A pervasive pattern of disregard for and
violation of the rights of others, occurring
since age 15 years, as indicated by three (or
more) of the following:
1. Failure to conform to social norms
with respect to lawful behaviors, as
 indicated by repeatedly performing
acts that are grounds for arrest.
2. Deceitfulness, as indicated by
repeated lying, use of aliases, or
conning others for personal profit or
pleasure.
3. Impulsivity or failure to plan
ahead.
4. Irritability and aggressiveness, as
indicated by repeated physical fights
or assaults.
5. Reckless disregard for safety of
self or others.
6. Consistent irresponsibility, as
indicated by repeated failure to
sustain consistent work behavior or
honor financial obligations.
7. Lack of remorse, as indicated by
being indifferent to or rationalizing
having hurt, mistreated, or stolen
from another.
B. The individual is at least age 18 years.
C. There is evidence of conduct disorder
with onset before age 15 years.
D. The occurrence of antisocial behavior is
not exclusively during the course of
schizophrenia or bipolar disorder
2. BORDERLINE PERSONALITY
DISORDER
 Borderline Personality Disorder
(BPD) is a personality disorder
characterized by emotional
dysregulation, a pattern of unstable
interpersonal relationships and high
impulsivity/recklessness. Patients
can oscillate quickly between
devaluing and idealizing
relationships (commonly known as
―splitting‖). Other features include
difficulty controlling anger, recurrent
suicidal or self-harm behaviours,
identity disturbance, and chronic
feelings of emptiness.
DIAGNOSTIC CRITERIA
A pervasive pattern of instability of
interpersonal relationships, self-image, and
affects, and marked impulsivity, beginning
by early adulthood and present in a variety
of contexts, as indicated by five (or more) of
the following:
1. Frantic efforts to avoid real or imagined
abandonment. (Note: Do not include suicidal
or self-mutilating behavior covered in
Criterion 5.)
2. A pattern of unstable and intense
interpersonal relationships characterized by
alternating between extremes of idealization
and devaluation.
3. Identity disturbance: markedly and
persistently unstable self-image or sense of
self.
4. Impulsivity in at least two areas that are
potentially self-damaging (e.g., spending,
sex, substance abuse, reckless driving, binge
eating). (Note: Do not include suicidal or
self-mutilating behavior covered in Criterion
5.)
5. Recurrent suicidal behavior, gestures, or
threats, or self-mutilating behavior.
6. Affective instability due to a marked
reactivity of mood (e.g., intense episodic
dysphoria, irritability, or anxiety usually
lasting a few hours and only rarely more
than a few days).
7. Chronic feelings of emptiness.
8. Inappropriate, intense anger or difficulty
controlling anger (e.g., frequent displays of
temper, constant anger, recurrent physical
fights).
9. Transient, stress-related paranoid ideation
or severe dissociative symptoms.
3. HISTRIONIC PERSONALITY
DISORDER (Dramatic Personality
Disorder)
 Histrionic personality disorder
(HPD) is a mental health condition
marked by intense, unstable
emotions and a distorted self-image.
The word ―histrionic‖ means
―dramatic or theatrical.‖
 Excessively emotional
 Tend to be overly dramatic and often
appear almost to be acting
DIAGNOSTIC CRITERIA
A pervasive pattern of excessive
emotionality and attention seeking,
beginning by early adulthood and present in
a variety of contexts, as indicated by five (or
more) of the following:
1. Is uncomfortable in situations in which he
or she is not the center of attention.
2. Interaction with others is often
characterized by inappropriate sexually
seductive or provocative behavior.
3. Displays rapidly shifting and shallow
expression of emotions.
4. Consistently uses physical appearance to
draw attention to self.
5. Has a style of speech that is excessively
impressionistic and lacking in detail.
6. Shows self-dramatization, theatricality,
and exaggerated expression of emotion.
7. Is suggestible (i.e., easily influenced by
others or circumstances).
8. Considers relationships to be more
intimate than they actually are.
4. NARCISSISTIC PERSONALITY
DISORDER
 Narcissistic personality disorder is a
mental health condition in which
people have an unreasonably high
sense of their own importance.
 They need and seek too much
attention and want people to admire
them.
 People with this disorder may lack
the ability to understand or care
about the feelings of others. But
behind this mask of extreme
confidence, they are not sure of their
self-worth and are easily upset by the
slightest criticism.
DIAGNOSTIC CRITERIA
A pervasive pattern of grandiosity (in
fantasy or behavior), need for admiration,
and lack of empathy, beginning by early
adulthood and present in a variety of
contexts, as indicated by five (or more) of
the following:
1. Has a grandiose sense of self-importance
(e.g., exaggerates achievements and talents,
expects to be recognized as superior without
commensurate achievements).
2. Is preoccupied with fantasies of unlimited
success, power, brilliance, beauty, or ideal
love.
3. Believes that he or she is ―special‖ and
unique and can only be understood by, or
should associate with, other special or high-
status people (or institutions).
4. Requires excessive admiration.
5. Has a sense of entitlement (i.e.,
unreasonable expectations of especially
favorable treatment or automatic compliance
with his or her expectations).
6. Is interpersonally exploitative (i.e., takes
advantage of others to achieve his or her
own ends).
7. Lacks empathy: is unwilling to recognize
or identify with the feelings and needs of
others.
8. Is often envious of others or believes that
others are envious of him or her.
9. Shows arrogant, haughty behaviors or
attitudes.
Cluster C Personality Disorder
 Consist of anxious or fearful
personality disorder
1. AVOIDANT PERSONALITY
DISORDER
 People with avoidant personality
disorder are extremely sensitive to
the opinions of others and therefore
avoid social relationships.
 Their extremely low self-esteem,
coupled with a fear of rejection,
causes them to reject the attention of
others
DIAGNOSTIC CRITERIA
A pervasive pattern of social inhibition,
feelings of inadequacy, and hypersensitivity
to negative evaluation, beginning by early
adulthood and present in a variety of
contexts, as indicated by four (or more) of
the following:
1. Avoids occupational activities that
involve significant interpersonal contact
because of fears of criticism, disapproval, or
rejection.
2. Is unwilling to get involved with people
unless certain of being liked.
3. Shows restraint within intimate
relationships because of the fear of being
shamed or ridiculed.
4. Is preoccupied with being criticized or
rejected in social situations.
5. Is inhibited in new interpersonal situations
because of feelings of inadequacy.
6. Views self as socially inept, personally
unappealing, or inferior to others.
7. Is unusually reluctant to take personal
risks or to engage in any new activities
because they may prove embarrassing.
2. DEPENDENT PERSONALITY
DISORDER
 They rely on others in making
decisions for themselves which
results in an unreasonable fear of
abandonment
DIAGNOSTIC CRITERIA
A pervasive and excessive need to be taken
care of that leads to submissive and clinging
behavior and fears of separation, beginning
by early adulthood and present in a variety
of contexts, as indicated by five (or more) of
the following:
1. Has difficulty making everyday decisions
without an excessive amount of advice and
reassurance from others.
2. Needs others to assume responsibility for
most major areas of his or her life.
3. Has difficulty expressing disagreement
with others because of fear of loss of support
or approval. (Note: Do not include realistic
fears of retribution.)
4. Has difficulty initiating projects or doing
things on his or her own (because of a lack
of self-confidence in judgment or abilities
rather than a lack of motivation or energy).
5. Goes to excessive lengths to obtain
nurturance and support from others, to the
point of volunteering to do things that are
unpleasant.
6. Feels uncomfortable or helpless when
alone because of exaggerated fears of being
unable to care for himself or herself.
7. Urgently seeks another relationship as a
source of care and support when a close
relationship ends.
8. Is unrealistically preoccupied with fears
of being left to take care of himself or
herself.
3. ObsessiveCompulsive Personality
Disorder
 OCPD is a mental health condition
that causes an extensive
preoccupation with perfectionism,
organization, and control.
 Fixation on details
 People with OCPD have rigid beliefs
and need to have control of
themselves, others, and situations.
DIAGNOSTIC CRITERIA
A pervasive pattern of preoccupation with
orderliness, perfectionism, and mental and
interpersonal control, at the expense of
flexibility, openness, and efficiency,
beginning by early adulthood and present in
a variety of contexts, as indicated by four (or
more) of the following:
1. Is preoccupied with details, rules, lists,
order, organization, or schedules to the
extent that the major point of the activity is
lost.
2. Shows perfectionism that interferes with
task completion (e.g., is unable to complete
a project because his or her own overly strict
standards are not met).
3. Is excessively devoted to work and
productivity to the exclusion of leisure
activities and friendships (not accounted for
by obvious economic necessity).
4. Is overconscientious, scrupulous, and
inflexible about matters of morality, ethics,
or values (not accounted for by cultural or
religious identification).
5. Is unable to discard worn-out or worthless
objects even when they have no sentimental
value.
6. Is reluctant to delegate tasks or to work
with others unless they submit to exactly his
or her way of doing things.
7. Adopts a miserly spending style toward
both self and others; money is viewed as
something to be hoarded for future
catastrophes.
8. Shows rigidity and stubbornness.

Clinical Assessment,
Diagnosis, and
Treatment
ASSESSMENT
 Collecting of relevant information in
an effort to reach a conclusion
CLINICAL ASSESSMENT
 Gathering information and drawing
conclusions about the traits, skills,
abilities, emotional functioning, and
psychological problems of an
individual
 Systematic evaluation and
measurement of psychological,
biological, and social factors in an
individual presenting with a possible
psychological disorder
PSYCHODIAGNOSIS
 Process of determining whether the
particular problem afflicting the
individual meets all criteria for a
psychological disorder
 Assessment and description of an
individual’s psychological
symptoms, including inferences
about what might be causing the
psychological distress
Characteristics of Assessment
Tools
RELIABILITY
 Degree to which a procedure or test
yields consistent results
Types of Reliability
 Test-retest reliability – systematically evaluate the
assessment tool yields similar
results every time it is given to
the same people
 Internal consistency reliability
– various parts of a test yield
similar or consistent results
 Interrater (or interjudge)
reliability – different judges
independently agree on how to
score and interpret an assessment
tool
VALIDITY
 Extent to which a test or procedure
actually measures what it was
designed to measure
Types of Validity
 Predictive validity – how well a
test or measure predicts or
forecasts a person’s behavior,
response, or performance
 Concurrent or descriptive
validity – degree to which the
measures gathered from one tool
agree with the measures gathered
from other assessment technique
 Construct validity – how well a
test or measure relates to the
characteristics of disorder in
question
 Content validity – how well a
test measures what it is intended
to measure
STANDARDIZATION
 Process by which a certain set of
standards or norms is determined for
a technique to make its use
consistent across different situations
 Standards apply to the procedures of
testing, scoring, and evaluating of
data
1. ASSESSMENT TOOLS
A. Clinical Interview
a. Mental Status Exam (MSE)
 A set of questions and
observations that
client’s awareness,
orientation with regard to
time and place, attention
span, memory, judgment and
insight, thought content and
processes, mood, and
appearance.
b. Semistructured Clinical Interviews
 Made up of questions that
have been carefully phrased
 and tested to elicit useful
information in a consistent
manner so that clinicians can
be sure they have inquired
about the most important
aspects of particular disorders
 Clinicians may also depart
from set questions to follow
up on specific issues
c. Structured Clinical Interviews
 Standardized questions that
are worded the same way for
all clients
B. Physical Examination
C. Behavioral Assessment
 Using direct observation to
formally assess an
individual’s thoughts,
feelings, and behavior in
specific situations or contexts
 The ABCs of Observation
 Antecedent – before
 Behavior – during
 Consequence – after
 Self-Monitoring
 Self-observation
 Observation of own
behavior to find patterns
D. Psychological Testing
a. Projective Testing
 Variety of methods in which
ambiguous stimuli are
presented to people who are
asked to describe what they
see
b. Personality Inventories
 Self-report questionnaires
that assess personal traits
c Intelligence Tests
 It assesses individual’s
intellectual strengths and
weaknesses, particularly
when mental retardation or
brain damage is suspected.
E. Neuropsychological Testing
 Neuropsychological Tests
 Measure abilities in areas
such as receptive and
expressive language,
attention and concentration,
memory, motor skills,
perceptual abilities, and
learning and abstraction in
such a way that the clinician
can make educated guesses
about the person’s
performance and the possible
existence of brain impairment
F. Neuroimaging
Two Categories of Neuroimaging
 Images of brain structure
 Computerized axial
tomography (CAT)
 Magnetic resonance imaging
(MRI)
 Images of brain functioning
 Positron emission
tomography (PET)
 Single photon emission
computed tomography
(SPECT)
 Functional MRI (fMRI) –
BOLD-fMRI (Blood-
Oxygen-Level-Dependent
fMRI)
G. Psychophysiological Assessment
 Assessing measurable changes in
the nervous system that reflect
emotional or psychological
events
 Measurement may be taken
directly from the brain or
peripherally from other parts of
the body
 Electroencephalogram
(EEG)
 Electrodermal responding
(formerly galvanic skin
response or GSR)
2. CLASSIFICATION SYSTEMS
 When certain symptoms occur
together regularly – a cluster of
symptoms is called a syndrome – and
follow a particular course, clinicians
agree that those symptoms make up a
particular mental disorder.
 A list of disorders, along with
descriptions of symptoms and
 guideline for making appropriate
diagnoses
 Emil Kraepelin developed the first
modern classification system
 A classification system for abnormal
behaviors aims to provide distinct
categories and indicators for atypical
behaviors, thought processes, and
emotional disturbances
Five purposes of classification
1. As a nomenclature
2. As a basis of information retrieval
3. As a descriptive system
4. As a predictive system
5. As a basis for a theory of
psychopathology
A. Classical (or pure) categorical approach
 Assumes that every diagnosis has a
clear underlying pathophysiological
cause and that each disorder is
unique
 It is useful in medicine but is
inappropriate to the complexity of
psychological disorders
B. Dimensional Approach
 The variety of cognitions, moods,
and behaviors with which the patient
presents is noted and quantified on a
scale
 Describes the objects of
classification in terms of continuous
dimensions
 Based on an ordered sequence or on
quantitative measurements
C. Prototypical approach
 Identifies certain essential
characteristics of an entity so that
others can classify it but it also
allows certain nonessential variations
that do not necessarily change the
classification
Diagnostic and Statistical Manual of Mental
Disorders
 A widely used classification system
for psychiatric disorders
 Lists all officially designated mental
disorders and the characteristics or
symptoms needed to confirm a
diagnosis
 Diagnostic criteria include physical,
behavioral, and emotional
characteristics associated with a
disorder
 Symptoms must cause significant
distress or impairment in social,
occupational, or other important
areas of functioning
 All DSMs are based on the
classification system developed by
Emil Kraepelin in around 1850 42
 DSM, 1952 – 106 mental disorders
 DSM-II, 1968 – 182 mental
disorders
 DSM-III, 1980 – 265 mental
disorders
 DSM-III-R – 292 mental disorders
 DSM-IV, 1994 – 297 mental
disorders
 DSM-5, 2013 – 500+ mental
disorders
Exceptions to the categorical nature of
DSM-5:
1. Autism categories are replaced with one
disorder called ―autism spectrum disorder,‖
and an alternative dimensional model for the
diagnosis of personality disorders is added
2. ―Risk syndromes‖ are added that
represent milder forms of well-established
disorders
3. Assessment procedures are enhanced to
permit more than a simple ―yes-or-no‖
option
  Subtypes – mutually exclusive
subgrouping within a diagnosis
 Specifiers – specific features
associated with a diagnostic category
 Remission – a diminution in
the seriousness of an illness
 Prognosis – prediction of the
probable outcome of a
disorder, including the
chances of full recovery
 Cross-cutting measure – assesses
common symptoms that are not
specific to one disorder
 Comorbid – the presence of
two or more disorders in the
same person
 Comorbidity – co-occurrence
of different disorders
 Course – usual pattern that a disorder
follows
3. ISSUES IN ASSESSMENT OF
MENTAL DISORDERS
Challenges in Assessment
 Resistance to providing information
 Evaluating children
 Evaluating individuals across
cultures
Ethical Issues in Assessment
1. Potential cultural bias of the instrument of
the clinician
2. Theoretical orientation of the clinician
3. Underemphasis on the external situation
4. Insufficient validation
5. Inaccurate data or premature evaluation
Culture and the Development of Mental
Disorders
1. Culture may cause stress and
psychological problems.
2. Culture may influence a person’s reaction
to stress.
3. Culture may influence which symptoms
of a disorder are expressed and the content
of the symptoms.
4. Culture may reinforce certain forms of
mental disorder.
Four Main Areas to be Considered
1. Clinicians must overcome a language
barrier if one exists.
2. Clinicians must obtain information about
the cultural background of a client.
3. Clinicians must be culturally sensitive.
4. Clinicians must be knowledgeable about
cultural variations in psychological
problems.
Social and Cultural Considerations in DSM-
5
 Includes a plan for integrating
important social and cultural
influences on diagnosis
 Culture – values, knowledge, and
practices that individuals derive from
membership in different ethnic
groups, religious groups, or other
social groups, as well as how
membership in these groups may
affect the individual’s perspective on
their experience with psychological
disorders
 Cultural formulation – description of
a disorder from the perspective of the
patient’s personal experience and in
terms of his or her primary social and
cultural group
Five domains of the CFI
 Cultural identity of the client
 Cultural ideas of distress
 Cultural factors related to the social
environment
 Cultural influences on the
relationship between the client and
the mental health professional
 Overall cultural assessment
Disadvantages of Classification
 Labeling a person as having mental
disorder can result in
overgeneralization, stigma, and
stereotypes
 A label may lead those who are
labeled to believe that they do indeed
possess characteristics associated
with the label or may cause them to
behave in accordance with the label
  Although social systems often
require labels, mental health labels
do not provide the precise, functional
information required by health care
organizations

4. TREATMENT OPTIONS AND

DECISIONS

Factors that influence treatment decisions:

 Assessment information
 Diagnosis
 Clinician’s theoretical orientation
and familiarity with research
 State of knowledge in the field

General conclusions in therapy outcome

studies:
1. People in therapy are usually better off
than people with similar problems who
receive no treatment.
2. The various therapies do not appear to
differ dramatically in their general
effectiveness.
3. Certain therapies or combinations of
therapies do appear to be more effective than
others for certain disorders.

Empirically supported treatment

 The active identification, promotion,
and teaching of those interventions
that have received clear research
support.
Reference:
American Psychiatric Association (2013).
Diagnostic and statistical manual of mental
disorders. (5th ed.). Washington, DC:
American Psychiatric Association