Neurodevelopmental Disorders

Intellectual Disabilities
Intellectual Disability (Intellectual Developmental Disorder)
317 (F70) Mild
318.0 (F71) Moderate
318.1 (F72) Severe
318.2 (F73) Profound
315.8 (F88) Global Developmental Delay
319 (F79) Unspecified Intellectual Disability (Intellectual Developmental Disorder)
Communication Disorders
315.32 (F80.2) Language Disorder
315.39 (F80.0) Speech Sound Disorder
315.35 (F80.81) Childhood-Onset Fluency Disorder (Stuttering)
315.39 (F80.89) Social (Pragmatic) Communication Disorder 307.9 (F80.9) Unspecified
Communication Disorder
Autism Spectrum Disorder
299.00 (F84.0) Autism Spectrum Disorder
Attention-Deficit/Hyperactivity Disorder
Attention-Deficit/Hyperactivity Disorder 314.01 (F90.2) Combined Presenta-
tion
314.00 (F90.0) Predominantly Inattentive Presentation
314.01 (F90.1) Predominantly Hyperactive/Impulsive Presentation
314.01 (F90.8) Other Specified Attention-Deficit/Hyperactivity Disorder
314.01 (F90.9) Unspecified Attention-Deficit/Hyperactivity Disorder
Specific Learning Disorder
Specific Learning Disorder
315.00 (F81.0) With Impairment in Reading
315.2 (F81.81) With Impairment in Written Expression 315.1 (F81.2) With Impairment in
Mathematics

Motor Disorders
315.4 (F82) Developmental Coordination Disorder
307.3 (F98.4) Stereotypic Movement Disorder
Tic Disorders
307.23 (F95.2) Tourette’s Disorder
307.22 (F95.1) Persistent (Chronic) Motor or Vocal Tic Disorder
307.21 (F95.0) Provisional Tic Disorder
307.20 (F95.8) Other Specified Tic Disorder
307.20 (F95.9) Unspecified Tic Disorder
Other Neurodevelopmental Disorders
315.8 (F88) Other Specified Neurodevelopmental Disorder
315.9 (F89) Unspecified Neurodevelopmental Disorder

‫أحمد[ تعليق عليه‬1]: Critical components include verbal
comprehension, working memory, perceptual
reasoning, quantitative reasoning, abstract thought, and
cognitive efficacy.
‫أحمد[ تعليق عليه‬2]: psychometrically valid, comprehen-
sive, and culturally appropriate tests of intelligence. Individ-
uals with intellectual developmental disorder have scores of
approximately two standard deviations or more below the
population mean, including a margin for measurement error
(generally ± 5 points). On tests with a standard deviation of
15 and a mean of 100, this involves a score of 65–75 (70 ±
5).
‫أحمد[ تعليق عليه‬3]: involves adaptive reasoning in three
domains: conceptual, social, and practical.
INTELLECTUAL DEVELOPMENTAL DISORDER (Intellectual Disability)
onset during the developmental period that includes both intellectual and adaptive functioning deficits in con-
ceptual, social, and practical domains. 3/3:
A. Deficits in intellectual functions, such as 1 reasoning, 2 problem solving, 3 planning, 4 abstract thinking, 5
judgment, 6 academic learning, and 7 learning from experience, confirmed by both 1 clinical assessment and 2
individualized, standardized intelligence testing.
B. Deficits in adaptive functioning that result in failure to meet developmental and sociocultural standards for per-
sonal independence and social responsibility. Without ongoing support, the adaptive deficits limit functioning in
one or more activities of daily life, such as 1 communication, 2 social participation, and 3 independent living,
across multiple environments, such as home, school, work, and community.
C. Onset of intellectual and adaptive deficits during the developmental period.
Note:
Specify current severity: Mild Moderate Severe Profound
Global Developmental Delay
individual fails to meet expected developmental milestones in several areas of intellectual functioning,
individuals are unable to undergo systematic assessments of intellectual functioning, as they are too young to partici-
pate in standardized testing (under 5 years). This category requires reassessment after a period of time.
Unspecified Intellectual Disability (Intellectual Disability Disorder)
individuals over the age of 5 years when assessment of the degree of intellectual disability (intellectual developmental
disorder) by means of locally available procedures is rendered difficult or impossible because of associated sensory
or physical impairments, as in blindness or prelingual deafness; locomotor disability; or presence of severe problem
behaviors or co-occurring mental disorder. This category should only be used in exceptional circumstances and re-
quires reassessment after a period of time.
 COMMUNICATION DISORDERS
Language Disorder
(i.e., spoken, written, sign language, :]4‫عليه تعليق [أحمد‬ Persistent difficulties in the acquisition and use of language across modalities due to deficits in comprehension
or other) or production 3/3:
(word knowledge and use) :]5‫عليه تعليق [أحمد‬ 1. Reduced vocabulary.
2. Limited sentence structure.
(ability to put words and word :]6‫عليه تعليق [أحمد‬ 3. Impairments in discourse
endings together to form sentences based on the rules of
grammar and morphology) B. Language abilities are substantially and quantifiably below those expected for age, resulting in functional
‫أحمد[ تعليق عليه‬7]: 1.(ability to use vocabulary and limitations.
connect sentences to explain or describe a topic or series C. Onset of symptoms is in the early developmental period.
of events or have a conversation).
D. DD: hearing or other sensory impairment, motor dysfunction, or another medical or neurological condition, intellec-
in effective communication, social :]8‫عليه تعليق [أحمد‬ tual disability (intellectual developmental disorder) or global developmental delay.
participation, academic achievement, or occupational
performance, individually or in any combination Speech Sound Disorder
A. Persistent difficulty with speech sound production that interferes with speech intelligibility or prevents verbal
communication of messages.
‫أحمد[ تعليق عليه‬9]: A.social participation, academic B. The disturbance causes limitations in effective communication that interfere with
achievement, or occupational performance, individually or C. Onset of symptoms is in the early developmental period.
in any combination.
D. DD: congenital or acquired conditions, such as cerebral palsy, cleft palate, deafness or hearing loss, traumatic
brain injury, or other medical or neurological conditions.
Childhood-Onset Fluency Disorder (Stuttering)
A. Disturbances in the normal fluency and time patterning of speech that are inappropriate for the individual’s
age and language skills, persist over time, and are characterized by frequent 1/7:
(e.g., pauses within a word) :]10‫عليه تعليق [أحمد‬ 1. Sound and syllable repetitions.
2. Sound prolongations of consonants as well as vowels.
(filled or unfilled pauses in speech) :]11‫عليه تعليق [أحمد‬
3. Broken words.
(word substitutions to avoid :]12‫عليه تعليق [أحمد‬ 4. Audible or silent blocking.
problematic words).
5. Circumlocutions
‫أحمد[ تعليق عليه‬13]: 1. (e.g., “I-I-I-I see him”). 6. Words produced with an excess of physical tension.
effective communication, social :]14‫عليه تعليق [أحمد‬ 7. Monosyllabic whole-word repetitions
participation, or academic or occupational performance B. The disturbance causes anxiety about speaking or limitations in, individually or in any combination.
‫أحمد[ تعليق عليه‬15]: (Note: Later-onset cases are C. The onset of symptoms is in the early developmental period.
diagnosed as adult-onset fluency disorder.)
D. DD:
‫أحمد[ تعليق عليه‬16]: such as greeting and sharing in- 1. a speech-motor or sensory deficit,
formation, in a manner that is appropriate for the social con-
text.
2. dysfluency associated with neurological insult (e.g., stroke, tumor, trauma),
3. Another medical condition 4. another mental disorder.
‫أحمد[ تعليق عليه‬17]: such as speaking differently in a
classroom than on a playground, talking differently to a child Social (Pragmatic) Communication Disorder
than to an adult, and avoiding use of overly formal language.
A. Persistent difficulties in the social use of verbal and nonverbal communication 4/4:
‫أحمد[ تعليق عليه‬18]: such as taking turns in conversa-
1. Deficits in using communication for social purposes
tion, rephrasing when misunderstood, and knowing how to
use verbal and nonverbal signals to regulate interaction. 2. Impairment of the ability to change communication to match context or the needs of the listener,
3. Difficulties following rules for conversation and storytelling,
(e.g., making inferences) :]19‫عليه تعليق [أحمد‬
4. Difficulties understanding what is not explicitly stated and nonliteral or ambiguous meanings of language
‫أحمد[ تعليق عليه‬20]: (e.g., idioms, humor, metaphors,
multiple meanings that depend on the context for interpreta-
B. The deficits result in functional limitations
tion). C. The onset of the symptoms is in the early developmental period
‫أحمد[ تعليق عليه‬21]: n effective communication, social D. DD exclude:
participation, social relationships, academic achievement, or 1. another medical or neurological condition 4. intellectual disability (intellectual developmental
occupational performance, individually or in combination. 2. low abilities in the domains of word structure and disorder),
‫أحمد[ تعليق عليه‬22]: A.(but deficits may not become grammar 5. global developmental delay,
fully manifest until social communication demands exceed 3. autism spectrum disorder, 6. another mental disorder.
limited capacities).
‫أحمد[ تعليق عليه‬23]: Ranging, for example, from
-1. abnormal social approach and failure of normal back-
and-forth conversation ;
2. to reduced sharing of interests, emotions, or affect ;
3. to failure to initiate or respond to social interactions.
Ranging, for example, from :]24‫عليه تعليق [أحمد‬
.1poorly integrated verbal and nonverbal communication ;
.2to abnormalities in eye contact and body language or defi-
cits in understanding and use of gestures ;
.3to a total lack of facial expressions and nonverbal com-
munication.
,Ranging, for example :]25‫عليه تعليق [أحمد‬
from difficulties adjusting behavior to suit various social 1
;contexts
.2to difficulties in sharing imaginative play or in making
friends
3. ;to absence of interest in peers.
‫أحمد[ تعليق عليه‬26]: E g
1. simple motor stereotypies,
2. lining up toys or flipping objects,
3. echolalia
4. Idiosyncratic phrases).
‫أحمد[ تعليق عليه‬27]: e.g.,
1. extreme distress at small changes,
2 difficulties with transitions, ...
‫أحمد[ تعليق عليه‬28]: e.g.,
‫أحمد[ تعليق عليه‬29]: (e.g.,
‫أحمد[ تعليق عليه‬30]: A.(but may not be-come fully ...
Symptoms cause clinically :]31‫عليه تعليق [أحمد‬
...
‫[ تعليق عليه‬aaA32]: A.Intellectual disability and au- ...
‫[ تعليق عليه‬aaA33]: Individuals who have marked defi-...
to a degree that is inconsistent with :]aaA34[ ‫عليه تعليق‬
...
‫[ تعليق عليه‬aaA35]: a.(e.g., overlooks or misses de- ...
‫[ تعليق عليه‬aaA36]: a.(e.g., has difficulty remaining ...
‫[ تعليق عليه‬aaA37]: (e.g., mind seems elsewhere, even ...
‫[ تعليق عليه‬aaA38]: e.g., starts tasks but quickly loses ...
‫[ تعليق عليه‬aaA39]: e.g., difficulty managing sequential...
‫[ تعليق عليه‬aaA40]: e.g., schoolwork or homework; for...
‫[ تعليق عليه‬aaA41]: a.(for older adolescents and
(e.g., doing chores, running errands; :]aaA42[ ‫عليه تعليق‬
...
‫[ تعليق عليه‬aaA43]: to a degree that is inconsistent with...
with or taps hands or feet or :]aaA44[ ‫عليه تعليق‬
...
‫[ تعليق عليه‬aaA45]: (e.g., leaves his or her place in the ...
‫[ تعليق عليه‬aaA46]: In adolescents or adults, may be ...
‫[ تعليق عليه‬aaA47]: e.g., is unable to be or uncomforta-...
‫[ تعليق عليه‬aaA48]: e.g., completes people’s sentences;...
‫[ تعليق عليه‬aaA49]: e.g., butts into conversations,
symptoms interfere with, or reduce :]50‫عليه تعليق [أحمد‬
...
‫[ تعليق عليه‬aaA51]: When full criteria were previously...
‫[ تعليق عليه‬aaA52]: : Few, if any, symptoms in excess ...
‫[ تعليق عليه‬aaA53]: : Symptoms or functional impair- ...
‫[ تعليق عليه‬aaA54]: : Many symptoms in excess of
‫[ تعليق عليه‬aaA55]: symptoms characteristic of ADHD...
As other specified but reason is not :]aaA56[ ‫عليه تعليق‬
...
AUTISM SPECTRUM DISORDER
A. Persistent deficits in social communication and social interaction across multiple contexts 3/3:
1. Deficits in social-emotional reciprocity,
2. Deficits in nonverbal communicative behaviors used for social interaction,
3. Deficits in developing, maintaining, and understanding relationships,
B. Restricted, repetitive patterns of behavior, interests, or activities, 2/4:
1. Stereotyped or repetitive motor movements, use of objects, or speech
2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior
3. Highly restricted, fixated interests that are abnormal in intensity or focus
4. Hyper- or hypo-reactivity to sensory input or unusual interest in sensory aspects of the environment
C. Onset: in the early developmental period
D. Impaired functioning
E. DD:
1. intellectual disability or global developmental delay. 2. social (pragmatic) communication disorder.
Specify if:
With or without accompanying intellectual impairment, language impairment
Associated with a known medical or genetic condition or environmental factor
Associated with another neurodevelopmental, mental, or behavioral disorder
With catatonia
ATTENTION-DEFICIT/HYPERACTIVITY DISORDER
A. A persistent pattern of inattention and/or hyperactivity-impulsivity + interferes with functioning or development; (1)
... and/or (2):
... 1. Inattention: 6/9 have (5/9 for 17 years and older) persisted for at least 6 months.
1. Often fails to give close attention to details or makes careless mistakes in school work, at work, or during other activities
2. Often has difficulty sustaining attention in tasks or play activities
3. Often does not seem to listen when spoken to directly
4. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace
5. Often has difficulty organizing tasks and activities
6. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort
7. Often loses things necessary for tasks or activities.
8. Is often easily distracted by extraneous stimuli
9. Is often forgetful in daily activities.
2. Hyperactivity and impulsivity: 6/8 (5/8 for age 17 years and older) persisted for at least 6 months
(5/7 in age 17 and older),
a. Often fidgets in seat.
b. Often leaves seat in situations when remaining seated is expected.
c. Often runs about or climbs in situations where it is inappropriate.
... d. Often unable to play or engage in leisure activities quietly.
e. Is often “on the go,” acting as if “driven by a motor”
f. Often talks excessively.
g. Often blurts out an answer before a question has been completed
h. Often has difficulty waiting his or her turn (e.g., while waiting in line).
i. Often interrupts or intrudes on others
B. Onset: age < 12 years.
C. Setting: ≥ 2 settings
D. Impaired functioning.
... E. DD schizophrenia or another psychotic disorder , mood disorder, anxiety disorder, dissociative disorder, personality disorder,
substance intoxication or withdrawal).
Specify whether: Combined presentation, Predominantly inattentive presentation, Predominantly hyperactive/impulsive presentation.
Specify if: In partial remission Specify current severity: Mild, Moderate, Severe
Other Specified & unspecified Attention-Deficit/ Hyperactivity Disorder
...
 (e.g., reads single words aloud :]aaA57[ ‫عليه تعليق‬
incorrectly or slowly and hesitantly, frequently guesses
SPECIFIC LEARNING DISORDER
words, has difficulty sounding out words). A. Difficulties learning and using academic skills, 1/6 for at least 6 months, despite the provision of interventions that target
those difficulties:
‫[ تعليق عليه‬aaA58]: e.g., may read text accurately but
not understand the sequence, relationships, inferences, or 1. Inaccurate or slow and effortful word reading
deeper meanings of what is read). 2. Difficulty understanding the meaning of what is read
3. Difficulties with spelling
‫[ تعليق عليه‬aaA59]: e.g., may add, omit, or substitute
vowels or consonants). 4. Difficulties with written expression
5. Difficulties mastering number sense, number facts, or calculation
‫[ تعليق عليه‬aaA60]: makes multiple grammatical or
punctuation errors within sentences; employs poor paragraph 6. Difficulties with mathematical reasoning
organization; written expression of ideas lacks clarity). B. The affected academic skills are substantially and quantifiably below those expected for the individual’s chronological
age, and cause significant interference with functioning . how to confirm?
‫[ تعليق عليه‬aaA61]: has poor understanding of numbers,
their magnitude, and relationships; counts on fingers to add C. The learning difficulties begin during school-age years
single-digit numbers instead of recalling the math fact as D. DD: 1. intellectual disabilities, 2. uncorrected visual or auditory acuity, 3. mental or neurological disorders, 4. psychosocial
peers do; gets lost in the midst of arithmetic computation and adversity, 5. lack of proficiency in the language of academic instruction, 6. inadequate educational instruction.
may switch procedures).
Specify if: With impairment in reading: Dyslexia / written expression / mathematics dyscalculia
‫[ تعليق عليه‬aaA62]: has severe difficulty applying Specify current severity:
mathematical concepts, facts, or procedures to solve quantita- Mild: Some difficulties in 1 or 2 academic domains, mild, the individual can compensate with assistance
tive problems).
Moderate: Marked difficulties 1 one or more academic domains, the individual needs interval intensive and specialized
academic or occupational :]aaA63[ ‫عليه تعليق‬
teaching during the school years. Daily supportive service
performance, or with activities of daily living,
Severe: Severe difficulties in several academic domains, so that the individual needs ongoing intensive individualized and
(confirmed by individually :]aaA64[ ‫عليه تعليق‬
administered standardized achievement measures and
specialized teaching for most of the school years. Daily support not sufficient
comprehensive clinical assessment. For individuals age 17
years and older, a documented history of impairing learning
MOTOR DISORDERS
difficulties ).
Developmental Coordination Disorder
but may not become fully manifest :]aaA65[ ‫عليه تعليق‬
... A. The acquisition and execution of coordinated motor skills is substantially below that expected.
alternative term used to refer to a :]aaA66[ ‫عليه تعليق‬
... 1. clumsiness
‫أحمد[ تعليق عليه‬67]: Spelling accuracy ...
2. slowness and inaccuracy
‫أحمد[ تعليق عليه‬68]: Number sense B. Impact on daily living activities, academic, others.
...
C. Onset of symptoms is in the early developmental period.
‫أحمد[ تعليق عليه‬69]: when provided with appropriate ...
D. DD: intellectual disability, visual impairment neurological condition
‫أحمد[ تعليق عليه‬70]: Some accommodations or support-
...
‫أحمد[ تعليق عليه‬71]: Even with an array of appropriate...
Stereotypic Movement Disorder
A. Repetitive, seemingly driven, and apparently purposeless motor behavior
given the individual’s :]72‫عليه تعليق [أحمد‬
...
B. interferes with activities and may result in self-injury.
(e.g., dropping or bumping into :]73‫عليه تعليق [أحمد‬
... C. Onset is in the early developmental period.
(e.g., catching an object, using :]74‫عليه تعليق [أحمد‬
... D. DD: the physiological effects of a substance or neurological, another neurodevelopmental or mental disorder Specify if:
‫أحمد[ تعليق عليه‬75]: A.The motor skills deficit in ... With/ without self-injurious behavior
‫أحمد[ تعليق عليه‬76]: A.(e.g., cerebral palsy, muscular
...
Specify if: Associated with a known medical or genetic condition, neurodevelopmental, or environmental
Specify current severity: Mild / Moderate / Severe
‫أحمد[ تعليق عليه‬77]: A.(e.g., hand shaking or waving,
...
social, academic, or other :]78‫عليه تعليق [أحمد‬ Tic Disorders :A tic is a sudden, rapid, recurrent, nonrhythmic motor movement or vocalization.
‫أحمد[ تعليق عليه‬79]: A.(e.g., trichotillomania [hair- ... Tourette’s Disorder
‫أحمد[ تعليق عليه‬80]: (or behavior that would result in ... A. multiple motor + one or more vocal tics have been present at some time during the illness
Lesch-Nyhan syndrome :]81‫عليه تعليق [أحمد‬ B. persisted for more than 1 year since first tic onset.
C. Onset is before age 18 years.
intellectual disability :]82‫عليه تعليق [أحمد‬
D. DD: substance, medical condition
e.g., , , intrauterine alcohol :]83‫عليه تعليق [أحمد‬
...
‫أحمد[ تعليق عليه‬84]: : Symptoms are easily suppressed...
Persistent (Chronic) Motor or Vocal Tic Disorder
‫أحمد[ تعليق عليه‬85]: : Symptoms require explicit pro- ...
as Tourette’s but criteria A: Single or multiple motor or vocal tics (not both motor and vocal).
Add criteria E: Criteria have never been met for Tourette’s disorder.
‫أحمد[ تعليق عليه‬86]: : Continuous monitoring and pro-...
Specify if: With motor tics only /With vocal tics only
‫أحمد[ تعليق عليه‬87]: A.(not necessarily concurrent- ...
Provisional Tic Disorder
The tics may wax and wane in :]88‫عليه تعليق [أحمد‬
... As Tourette’s but criterion A: Single or multiple motor and/or vocal tics.
(e.g., cocaine) :]89‫عليه تعليق [أحمد‬ Add criterion E: Criteria have never been met for Tourette’s disorder or persistent (chronic) motor or vocal tic disorder.
‫أحمد[ تعليق عليه‬90]: A.(e.g., Huntington’s disease, ...
Other Specified Tic Disorder and Unspecified Tic Disorder
‫أحمد[ تعليق عليه‬91]: symptoms characteristic of a tic ...
symptoms characteristic of a tic :]92‫عليه تعليق [أحمد‬
...
OTHER NEURODEVELOPMENTAL DISORDERS
 Other Specified Neurodevelopmental Disorder
neurodevelopmental disorder symptoms + impairment + do not meet the full criteria for any of the disorders in the neurodevel-
opmental disorders diagnostic class+ specific reason
An example:
Neurodevelopmental disorder associated with prenatal alcohol exposure: Neurodevelopmental disorder associated
with prenatal alcohol exposure is characterized by a range of developmental disabilities following exposure to alcohol in
utero.
Unspecified Neurodevelopmental Disorder
neurodevelopmental disorder symptoms + impairment + do not meet the full criteria for any of the disorders in the neurodevel-
opmental disorders diagnostic class+ no specific reason

‫أحمد[ تعليق عليه‬93]: =(no other psychotiv features

other than delusions Note :Hallucinations, if present, are not
prominent and are related to the delusional theme (e.g., the
sensation of being infested with insects associated with delu-
sions of infestation).
).A
Apart from the impact of the :]94‫عليه تعليق [أحمد‬
delusion(s) or its ramifications,
‫أحمد[ تعليق عليه‬95]: A.relative to the duration of the
delusional periods.
‫أحمد[ تعليق عليه‬96]: A., such as body dysmorphic
disorder or obsessive-compulsive disorder.
‫أحمد[ تعليق عليه‬97]: delusion that another person is in
love with the individual.
‫أحمد[ تعليق عليه‬98]: conviction of having some great
(but unrecognized) talent or insight or having made some
important discovery.
‫أحمد[ تعليق عليه‬99]: delusion that his or her spouse or
lover is unfaithful.
the individual’s belief that he or :]100‫عليه تعليق [أحمد‬
she is being conspired against, cheated, spied on, followed,
poisoned or drugged, maliciously maligned, harassed, or
obstructed in the pursuit of long-term goals.
‫أحمد[ تعليق عليه‬101]: delusion involves bodily func-
tions or sensations. Schizophrenia Spectrum and Other
‫أحمد[ تعليق عليه‬102]: no one delusional theme predom-
inates. Psychotic Disorders
‫أحمد[ تعليق عليه‬103]: the dominant delusional belief Delusional Disorder
cannot be clearly determined or is not described in the specif-
ic types (e.g., referential delusions without a prominent per- A. 1 or more delusion, duration = 1 month or longer.
secutory or grandiose component). B. Criterion A for schizophrenia has never been met.
C. functioning is not markedly impaired, and behavior is not obviously bizarre or odd.
‫أحمد[ تعليق عليه‬104]: Delusions are deemed bizarre if
they are clearly implausible, not understandable, and not D. If manic or major depressive episodes have occurred, these have been brief
derived from ordinary life experiences (e.g., an individual’s E. DD: substance related / another medical / another mental disorder
belief that a stranger has removed his or her internal organs Specify whether: Erotomanic / Grandiose type / TV Jealous type / Persecutory type / Somatic type / Mixed type
and replaced them with someone else’s organs without leav-
Unspecified type bizarre content
ing any wounds or scars).

First manifestation of the :]105‫عليه تعليق [أحمد‬
disorder meeting the defining diagnostic symptom and time
criteria.
‫أحمد[ تعليق عليه‬106]: a time period in which the symp-
tom criteria are fulfilled.
‫أحمد[ تعليق عليه‬107]: 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.
‫أحمد[ تعليق عليه‬108]: a period of time after a previous
episode during which no disorder-specific symptoms are
present.
‫أحمد[ تعليق عليه‬109]: Symptoms fulfilling the diagnos-
tic 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.
‫أحمد[ تعليق عليه‬110]: A.(e.g., frequent derailment or
incoherence).
If symptoms occur in response to :]111‫عليه تعليق [أحمد‬
events that, singly or together, would be markedly stressful to
almost anyone in similar circumstances in the individual’s
culture.
‫أحمد[ تعليق عليه‬112]: If onset is during pregnancy or
within 4 weeks postpartum.
‫أحمد[ تعليق عليه‬113]: B.(e.g., frequent derailment or
incoherence).
‫أحمد[ تعليق عليه‬114]: 1.diminished emotional ex-
pression
2.Avolition
3.Alogia
4.Anhedonia
5.Asociability
6.Self neglect
‫أحمد[ تعليق عليه‬115]: 2/4
‫أحمد[ تعليق عليه‬116]: A.For a significant portion of
the time since in one or more major areas, such as work, ...
symptoms that meet Criterion A :]117‫عليه تعليق [أحمد‬
My be less if successfully :]118R117‫عليه تعليق [أحمد‬
treated
During these prodromal or :]119‫عليه تعليق [أحمد‬
...
residual periods, the signs of the disturbance may be
communication disorder of :]120‫عليه تعليق [أحمد‬
childhood onset
major depressive episode must :]121‫عليه تعليق [أحمد‬
include Criterion A1
Including active and residual :]122‫عليه تعليق [أحمد‬
portions
‫أحمد[ تعليق عليه‬123]: a manic episode is part of the
presentation. Major depressive episodes may also occur.
‫أحمد[ تعليق عليه‬124]: only major depressive episodes
are part of the presentation.
from the history, physical :]125‫عليه تعليق [أحمد‬
examination, or laboratory findings
‫أحمد[ تعليق عليه‬126]: The disturbance causes clinically
significant distress or impairment in social, occupational, or...
‫أحمد[ تعليق عليه‬127]: If the criteria are met for intoxi-
cation with the substance and the symptoms develop during ...
‫أحمد[ تعليق عليه‬128]: If the criteria are met for with-
...
drawal from the substance and the symptoms develop during,
course specifiers (used after a 1-year duration of the disorder):
Episodic: (First episode/ Multiple episodes), currently in: (acute episode /partial remission / full remission )
Continuous
Unspecified
Specify severity: Last 7 days primary symptoms of psychosis (0-4)
Brief Psychotic Disorder
A. Symptoms: Episode of 1/4: (1/3:1 Delusions and/or 2 Hallucinations and/or 3 Disorganized speech) +/- (4 disor-
ganized/catatonic behavior)
B. Duration (1 day – <1 month) followed by complete remission.
C. DD: MDD/BAD with psychotic features ; schizophrenia or catatonia; substance ; another medical condition.
Specify precipitation: Without/ With marked stressor(s) (brief reactive psychosis)/ With postpartum onset
Specify if: With catatonia Specify severity: As delusional disorder
Schizophreniform Disorder
A. Symptoms: Episode of 2/5: (1/3:1 Delusions and/or 2 Hallucinations and/or 3 Disorganized speech) +/- 4 disor-
ganized/catatonic behavior +/- 5. Negative symptoms
Duration of each symptom: a significant portion of time during a 1-month period (or less if successfully treated)
B. Duration of the Episode: (1- >)6 months)
C. DD if mood symptoms present: Schizoaffective disorder , MDD , BAD with psychotic features excluded by
1) no mood episodes during the active-phase symptoms, or
2) mood episodes during active-phase symptoms, but for a minority of the total duration of the active and residual periods of
the illness.
D. DD substance related, another medical condition.
Specify With good prognostic features / /Without , Specify With catatonia Specify severity: As delusional
Schizophrenia
A. Symptoms: As Schizophreniform
B. Impaired function
C. Duration: at least 6 months (1 month active phase must be included +/- prodromal period,+/- residual period).
D. DD if mood symptoms present: As schizophreniform
E. DD substance related, another medical condition.
...
F. On top of ASD or CDC,: Duration required is 1 month active phase
course specifiers as delusional disorder Specify if: With catatonia Specify current severity: as delusional disorder
Schizoaffective Disorder
Diagnostic Criteria for Schizoaffective Disorder
A. major mood episode (major depressive or manic) + Criterion A of schizophrenia for uninterrupted period
B.: At least 2 weeks with delusions or hallucinations without major mood symptoms through total duration
C. Symptoms that meet criteria for a major mood episode are present for the majority of the total duration
D. DD: substance or medical condition.
Specify whether: Bipolar type / Depressive type
Specify if: With catatonia
Course Specifier: As delusional disorder
Specify current severity: As delusional disorder
Substance/Medication-Induced Psychotic Disorder
A. Either hallucination or/and delusons
B. By evidence: 1. developed during or soon after intoxication or withdrawal or after exposure to a medication/substance that is
2. capable of producing the +ve symptoms.
C. DD: independent psychotic, evidence: 1. The symptoms preceded the onset use; 2. persist for 1 month after the cessation
of acute withdrawal or severe intoxication; 3. a history of recurrent non-substance/medication-related episodes.
D. DD delirium.
E. Impaired functioning
Specify if With onset during intoxication / during withdrawal
Specify current severity: as delusional disorder
 Psychotic Disorder Due to Another Medical Condition
A. Prominent hallucinations or delusions.
from the history, physical :]129‫عليه تعليق [أحمد‬ B. There is evidence that the disturbance is the direct pathophysiological consequence of another medical condition.
examination, or laboratory findings C. DD: another mental disorder.
D. DD: delirium.
The disturbance causes clinically :]130‫عليه تعليق [أحمد‬ E. Impairment functioning
significant distress or impairment in social, occupational, or Specify whether: With delusions / With hallucinations
other important areas of functioning. Specify current severity: As delusional disorder
hallucinations are the :]131‫عليه تعليق [أحمد‬
predominant symptom Catatonia Associated With Another Mental Disorder (Catatonia Specifier)
A. 3/12:
‫أحمد[ تعليق عليه‬132]: 1.(i.e., no psychomotor ac- 1. Stupor 7. Mannerism
tivity; not actively relating to environment). 2. Catalepsy 8. Stereotypy
‫أحمد[ تعليق عليه‬138]: (i.e., odd, circumstantial carica- 3. Waxy flexibility 9. Agitation,
ture of normal actions). 4. Mutism 10. Grimacing.
‫أحمد[ تعليق عليه‬133]: 1.(i.e., passive induction of a 5. Negativism 11. Echolalia
posture held against gravity). 6. Posturing 12. Echopraxia
(i.e., repetitive, abnormally :]139‫عليه تعليق [أحمد‬
frequent, non-goal-directed movements).
Catatonic Disorder Due to Another Medical Condition
A. Same as catatonia due to another mental disorder
‫أحمد[ تعليق عليه‬134]: 1.(i.e., slight, even resistance
to positioning by examiner). B. evidence that the disturbance is the direct pathophysiological consequence of another medical condition.
C. DD: Exclude another mental disorder (e.g., a manic episode).
not influenced by external :]140‫عليه تعليق [أحمد‬
D. DD: delirium.
stimuli.
E. Distress & impaired functioning.
‫أحمد[ تعليق عليه‬135]: 1.(i.e., no, or very little,
verbal response [exclude if known aphasia]). Unspecified Catatonia
(i.e., mimicking another’s :]141‫عليه تعليق [أحمد‬
speech).
Other Specified Schizophrenia Spectrum and Other Psychotic Disorder
Predominance of symptoms characteristic of a schizophrenia spectrum and other psychotic disorder + clinically significant dis-
(i.e., opposition or no response :]136‫عليه تعليق [أحمد‬ tress or impaired functioning + not meet the full criteria for any disorder + specific reason (e.g., “persistent auditory hallucina-
to instructions or external stimuli).
tions”). Examples
(i.e., mimicking another’s :]142‫عليه تعليق [أحمد‬ 1. Persistent auditory hallucinations
movements).
2. Delusions with significant overlapping mood episodes
‫أحمد[ تعليق عليه‬137]: 1.(i.e., spontaneous and ac- 3. Attenuated psychosis syndrome
tive maintenance of a posture against gravity).
4. Delusional symptoms in partner of individual with delusional disorder
from the history, physical :]143‫عليه تعليق [أحمد‬
examination, or laboratory findings
Unspecified Schizophrenia Spectrum and Other Psychotic Disorder
clinically significant distress or :]144‫عليه تعليق [أحمد‬
Predominance of symptoms characteristic of a schizophrenia spectrum and other psychotic disorder + clinically significant dis-
impairment in social, occupational, or other important areas
of functioning tress or impaired functioning + not meet the full criteria for any disorder + choose not to specify the reason that the criteria are
not met ( presentations in which there is insufficient information to make a more specific diagnosis (e.g., in emergency room
‫أحمد[ تعليق عليه‬145]: symptoms characteristic of cata-
tonia cause clinically significant distress or impairment in
settings).
social, occupational, or other important areas of functioning
but either
1.the nature of the underlying mental disorder or other
medical condition is unclear,
2.full criteria for catatonia are not met,
3.there is insufficient information to make a more specific
diagnosis (e.g., in emergency room settings).
occurring in the absence of any :]146‫عليه تعليق [أحمد‬
other features.
This includes persistent delusions :]147‫عليه تعليق [أحمد‬
with periods of overlapping mood episodes that are present
for a substantial portion of the delusional disturbance (such
that the criterion stipulating only brief mood disturbance in
delusional disorder is not met).
This syndrome is characterized :]148‫عليه تعليق [أحمد‬
by psychotic like symptoms that are below a threshold for
full psychosis (e.g., the symptoms are less severe and more
transient, and insight is relatively maintained).
In the context of a relationship, :]149‫عليه تعليق [أحمد‬
the delusional material from the dominant partner provides
content for delusional belief by the individual who may not
otherwise entirely meet criteria for delusional disorder.
 abnormally and persistently :]150‫عليه تعليق [أحمد‬
elevated, expansive, or irritable
abnormally and persistently :]151‫عليه تعليق [أحمد‬
increased
most of the day, nearly every day :]152‫عليه تعليق [أحمد‬
‫أحمد[ تعليق عليه‬163]: most of the day, nearly every day
(subjective :feels sad, empty, hopeless) or objective). (irrita-
ble mood for children and adolescents.)
‫أحمد[ تعليق عليه‬153]: are present to a significant degree
...
‫أحمد[ تعليق عليه‬164]: in all, or almost all, activities
...
that is uncharacteristic of the :]162‫عليه تعليق [أحمد‬
...
(e.g., feels rested after only 3 :]154‫عليه تعليق [أحمد‬
...
nearly every day. (In children, :]165‫عليه تعليق [أحمد‬
...
‫أحمد[ تعليق عليه‬166]: nearly every day (objective, sub-...
(i.e., attention too easily drawn :]155‫عليه تعليق [أحمد‬
...
either socially, at work or school, :]156‫عليه تعليق [أحمد‬
...
(i.e., purposeless non-goal- :]157‫عليه تعليق [أحمد‬
...
‫أحمد[ تعليق عليه‬158]: e.g., engaging in unrestrained ...
‫أحمد[ تعليق عليه‬167]: (which may be delusional) nearly
...
in social or occupational :]159‫عليه تعليق [أحمد‬
to prevent harm to self or others :]160‫عليه تعليق [أحمد‬
‫أحمد[ تعليق عليه‬168]: In social, occupational, or other ...
persists at a fully syndromal level :]161‫عليه تعليق [أحمد‬
...
‫أحمد[ تعليق عليه‬169]: not better explained by schizoaf-...
‫أحمد[ تعليق عليه‬170]: A.schizoaffective disorder, ...
in social, occupational, or other :]171‫عليه تعليق [أحمد‬
...
if full criteria for a mood episode :]172‫عليه تعليق [أحمد‬
...
schizoaffective disorder, :]174‫عليه تعليق [أحمد‬
...
(e.g., a drug of abuse, a :]175‫عليه تعليق [أحمد‬
...
(e.g., hyperthyroidism) :]176‫عليه تعليق [أحمد‬
if full criteria for a mood episode :]173‫عليه تعليق [أحمد‬
...
in social, occupational, or other :]177‫عليه تعليق [أحمد‬
...
BIPOLER DISORDERS
Manic Episode Hypomanic Episode Depressive Episode
A. ↑/irritable mood + ↑activity or energy + duration either: 1 A. As mania but 4 consecutive days A. 5/9 through 2 weeks either (1) or (2) must included
week or/ any duration if hospitalization is necessary) instead of 1 week. 1. Depressed mood
B. 3/7 (4/7 if mood irritable) B. As mania 2. ↓↓ interest or pleasure
1. Inflated self-esteem or grandiosity. C. unequivocal change in functioning. 3. ↓or ↑weight (more than 5% in a month), or ↓ or ↑ in ap-
2. ↓ need for sleep D. changes in mood and functioning petite
3. ↑ talkatively / pressure to keep talking. are observable 4. ↑ or ↓sleep nearly every day.
4. Flight of ideas / subjective experience that thoughts E. No impairment/ No hospitalization/ 5. Psychomotor agitation or retardation
are racing. No psychosis 6. Physical: Fatigue or loss of energy nearly every day.
5. Distractibility F. DD: Exclude Substance related / an- 7. Cognition: ↓ ability to think or concentrate, or indeci-
6. ↑ goal-directed activity or psychomotor agitation other medical condition siveness, nearly every day.
7. ↑ involvement in activities that have a high potential for Antidepressant induced hypomanic 8. Depressive Thoughts: Feelings of worthlessness or
painful consequences episodes diagnosed hypomania if: excessive or inappropriate guilt
C. The mood disturbance is sufficiently severe to cause persists at a fully syndromal level be-
9. Death & suicide: Recurrent thoughts of death, suicidal
marked impairment functioning or /necessitate hospitaliza- yond the physiological effect of that ideation, or a suicide attempt or a specific plan for com-
tion, or /psychotic features. treatment mitting suicide.
D. DD: Exclude: 1. substance (e.g., a drug of abuse, a medi- B. significant distress or impairment
cation, other treatment) 2. another medical condition. C. DD: substance or another medical condition.
Antidepressant induced manic episodes diagnosed ma-
nia & bipolar one if:
Bipolar 1 Bipolar II Cyclothymic Disorder
A. at least one manic episode. A. at least one hypomanic episode + A. 1. Numerous periods with hypomanic symptoms + numerous
B. Exclude schizophrenia spectrum and other psychotic dis- at least one major depressive episode periods with depressive symptoms
orders B. never a manic episode. 2. Duration: at least 2 years (at least 1 year in children and ad-
• With anxious dis- • With mood-congruent psychotic C. Exclude schizophrenia spectrum olescents)
tress features and other psychotic disorders B. During the 2 (1) years:
1. The hypomanic and depressive periods have been
• With mixed features • With mood-incongruent psy- D. significant distress or impairment
• With rapid cycling chotic features present for at least half the time
Specify current or most recent epi-
• With melancholic • With catatonia 2. maximal asymptomatic period ≤ 2 months at a time.
sode: Hypomanic / Depressed
features With seasonal pattern C. Criteria for a major depressive, manic, or hypomanic epi-
Specify course: In partial remission /
With atypical fea- sode have never been met.
In full remission
tures D. Exclude schizophrenia and other psychotic disorders
Specify severity: Mild/ Moderate / Se-
E. DD: substance or another medical condition.
vere
Subtype specifiers: As bipolar I but F. significant distress or impairment
– melancholic, Atypical features ; + Specify if: With anxious distress
peripartum
 Bipolar continued
Substance/Medication-Induced Bipolar Bipolar and Related Other Specified Bipolar and Related Dis- Unspecified Bi-
and Related Disorder Disorder Due to Anoth- order and polar and Relat-
er Medical Condition ed Disorder

A. A prominent and persistent mood disturbance : A. A prominent and persis- symptoms characteristic of a bipolar and related disor- bipolar symptoms +
(elevated/ expansive/ irritable mood) ± (depressed tent period of abnormal- der + significant distress or impairment + do not meet clinically significant
‫أحمد[ تعليق عليه‬188]: (e.g., “short-duration cyclothy- mood / markedly diminished interest or pleasure in ly elevated / expansive/ the full criteria + specific reason distress or impairment
mia”). all, or almost all, activities). or irritable mood + ab- Examples of presentations that can be specified us- + not meet the full cri-
B. There is evidence of both (1) and (2): normally increased ac- ing the “other specified” designation include the follow- teria + no reason +
from the history, physical :]178‫عليه تعليق [أحمد‬
examination, or laboratory findings 1. The symptoms in developed during or soon tivity or energy ing: insufficient information
after substance intoxication / withdrawal / ex- B. There is evidence that the to make a more specif-
from the history, physical :]182‫عليه تعليق [أحمد‬ 1. Short-duration hypomanic episodes (2–3 days)
posure to a medication. disturbance is the direct ic diagnosis (e.g., in
examination, or laboratory findings and major depressive episodes: ≥ 1 lifetime MDE
2. The involved substance/medication is capa- pathophysiological con- emergency room set-
ble of producing the symptoms sequence of another + ≥ 2 full criteria short-duration (2-3 days) hypo-
tings).
medical condition. manic episodes that do not overlap in time with the
C. No any of the following evidence that indi-
C. Exclude another mental MDE, so the disturbance does not meet criteria for
‫أحمد[ تعليق عليه‬189]: (i.e., at least 4 consecutive days cate independent bipolar or related disorder:
disorder. major depressive episode, with mixed features.
of elevated mood and one or two of the other symptoms of a 1. The symptoms precede the onset of the
D. Exclude delirium. 2. Hypomanic episodes with insufficient symp-
hypomanic episode, or irritable mood and two or three of the substance/medication use;
other symptoms of a hypomanic episode.) E. The disturbance toms and major depressive episodes:
2. the symptoms persist for a substantial peri- ≥ 1 lifetime MDE + ≥ 2 not full criteria short-duration
in social, occupational, or other :]183‫عليه تعليق [أحمد‬ od of time (e.g., about 1 month) after the 1.causes clinically signifi-
important areas of functioning, cant distress or impairment (2-3 days) hypomanic episodes that do not overlap
cessation of acute withdrawal or severe in- in time with the MDE, so the disturbance does not
to prevent harm to self or others :]184‫عليه تعليق [أحمد‬ toxication or
meet criteria for major depressive episode, with
in social, occupational, or other :]179‫عليه تعليق [أحمد‬ 3. a history of recurrent non-substance/ medi- 2. necessitates hospitaliza- mixed features.
important areas of functioning. cation-related episodes. tion, or
3. Hypomanic episode without prior major depres-
‫أحمد[ تعليق عليه‬185]: Full criteria are not met for a D. DD: delirium. 3. there are psychotic fea- sive episode: ≥ 1 hypomanic episode + never full
manic or hypomanic episode. E. The disturbance causes clinically significant tures. criteria for a major depressive episode or a manic
‫أحمد[ تعليق عليه‬180]: If the criteria are met for intoxi- distress or impairment Specify if: episode ± persistent depressive disorder (dysthy-
cation with the substance and the symptoms develop during Specify if With manic features /With mia).
intoxication. With onset during intoxication / With onset dur- manic- or hypomanic-like 4. Short-duration cyclothymia (less than 24
‫أحمد[ تعليق عليه‬181]: If criteria are met for withdrawal ing withdrawal episode/ With mixed fea- months)
from the substance and the symptoms develop during, or tures
shortly after, withdrawal.
Full criteria are met except :]186‫عليه تعليق [أحمد‬
Criterion D for a manic episode or except Criterion F for a
hypomanic episode.
‫أحمد[ تعليق عليه‬187]: Symptoms of depression are also
present but do not predominate in the clinical picture.
 (e.g., verbal rages) :]190‫عليه تعليق [أحمد‬
Disruptive Mood Dys.
(e.g., physical aggression toward :]191‫عليه تعليق [أحمد‬
A. Severe recurrent temper
people or property)
outbursts verbally and/or
‫أحمد[ تعليق عليه‬194]: most of the day, nearly every day
behaviorally that are grossly
(subjective :feels sad, empty, hopeless) or objective). (irrita-
out of proportion in intensity
ble mood for children and adolescents.)
or duration to the situation
‫أحمد[ تعليق عليه‬195]: in all, or almost all, activities
most of the day, nearly every day (subjective or observation).
or provocation.
B. inconsistent with devel-
nearly every day. (In children, :]196‫عليه تعليق [أحمد‬
opmental level.
failure to make expected weight gain.)
C. Rate: ≥3 times per
‫أحمد[ تعليق عليه‬206]: 1.(e.g., mood swings; feeling week.
suddenly sad or tearful, or increased sensitivity to rejec-
D. between temper out-
tion).
bursts
‫أحمد[ تعليق عليه‬197]: nearly every day (objective, sub-
1. irritable or angry
jective is not sufficient).
mood
or increased interpersonal :]207‫عليه تعليق [أحمد‬2. Persistently
conflicts.
3. observable by oth-
‫أحمد[ تعليق عليه‬208]: 1.feelings of hopelessness, or ers
self-deprecating thoughts.
E. Duration: ≥12 months +
tension, and/or feelings of being :]209‫عليه تعليق [أحمد‬no ≥ 3 months free
keyed up or on edge.
F. settings 2/3: (at home,
‫أحمد[ تعليق عليه‬198]: (which may be delusional) nearlyat school, with peers) +
every day. severe in one of these.
(e.g., work, school, friends, :]210‫عليه تعليق [أحمد‬ G. Age of the diagnosis for
...
the first time (6-18)
most of the day, nearly every day, :]192‫عليه تعليق [أحمد‬
H. age at onset before 10
Not just fear of dying :]199‫عليه تعليق [أحمد‬years.
(e.g., parents, teachers, peers). :]193‫عليه تعليق [أحمد‬ I. Presence of manic or
hypomanic episode:
‫أحمد[ تعليق عليه‬200]: In social, occupational, or other ...
may, but not more than
‫أحمد[ تعليق عليه‬201]: Responses to a significant loss ...one day.
schizoaffective disorder, :]202‫عليه تعليق [أحمد‬ J. ...DD MDD, another men-
tal disorder (e.g., ASD,
: Full criteria for a major :]203‫عليه تعليق [أحمد‬ ...
PTSD, separation anxie-
‫أحمد[ تعليق عليه‬211]: A.in work, school, usual social ...ty disorder, [dysthymia]).
‫أحمد[ تعليق عليه‬204]: Full criteria for a major depres- K....DD: substance ,medical
‫أحمد[ تعليق عليه‬212]: A.such as major depressive ...or neurological condi-
tion.
‫أحمد[ تعليق عليه‬205]: Full criteria for a major depres- ...
Depressive Disorders
Major Depressive Episode
A. 5/9 through 2 weeks either (1) or (2) must includ-
ed
1. Depressed mood
↓↓ interest or pleasure
2.
3. ↓or ↑weight (more than 5% in a month), or ↓ or ↑
in appetite
4. ↑ or ↓sleep nearly every day.
5. Psychomotor agitation or retardation
6. Physical: Fatigue or loss of energy nearly every
day.
7. Cognition: ↓ ability to think or concentrate, or
indecisiveness, nearly every day.
8. Depressive Thoughts: Feelings of worthless-
ness or excessive or inappropriate guilt
9. Death & suicide: Recurrent thoughts of death,
suicidal ideation, or a suicide attempt or a specific
plan for committing suicide.
B. significant distress or impairment
C. DD: substance or another medical condition.
DD: significant loss
D. Exclude: schizophrenia spectrum and other psy-
chotic disorders.
E. Never manic or hypomanic episode. (substance-
induced or medical induced not excluded).
Single/ recurrent
Severity: Mild /Moderate/ Severe
With psychotic features
Remission: In partial/ full remission
Type specifiers:
With anxious distress With mixed features
With melancholic features With atypical features
With mood-congruent psychotic features
With mood-incongruent psychotic features
With catatonia With peripartum onset
With seasonal pattern
Persistent Depressive Disorder (Dysthymia)
A. Depressed mood (irritable in child & adoles-
cent) (subjective or objective)
Rate: most of the day, for more days than not,
Duration: ≥ 2 years (one year for children &
adolescents).
B. Presence, while depressed, 2/6
1. Poor appetite or overeating.
2. Insomnia or hypersomnia.
3. Physical: Low energy or fatigue.
4. Thoughts: Low self-esteem.
5. Thoughts: Feelings of hopelessness.
6. Cognition: Poor concentration or difficulty
making decisions.
C. asymptomatic duration ≤ 2 months/2years
D. Criteria for a major depressive disorder may be
continuously present for 2 years.
E. No manic or hypomanic episode, no cyclo-
thymic disorder.
F. Exclude schizophrenia spectrum and other
psychotic disorder.
G. DD: substance/ another medical condition
(e.g., hypothyroidism).
H. significant distress or impairment
subtype Specify if:
as MDD but – catatonic/ seasonal
remission: partial /full
Specify if: Early onset: < 21./Late onset: ≥ 21
Specify if (for most recent 2 years of persistent
depressive disorder):
With pure dysthymic syndrome.
With persistent major depressive episode
With intermittent major depressive epi-
sodes, with current episode/ without cur-
rent episode
Specify current severity: Mild / Moderate /Severe
Premenstrual Dysphoric Disorder
A. 5/9 criteria in the week before the on-
set of menses, start to improve within a
few days after the onset of menses, and
become minimal or absent in the week
post-menses.
B. ≥ 1/4:
1. Marked affective lability
2. Marked irritability or anger
3. Marked depressed mood,
4. Marked anxiety,
C. ≥ 1/7 (total 5 must present from B +
C).
1. Decreased interest in usual activi-
ties
2. Cognitive: Subjective difficulty in
concentration.
3. Physical: Lethargy, easy fatigabil-
ity, or marked lack of energy.
4. Marked change in appetite; over-
eating; or specific food cravings.
5. Sleep: Hypersomnia or insomnia.
6. Thoughts: A sense of being over-
whelmed or out of control.
7. Physical symptoms such as
breast tenderness or swelling, joint
or muscle pain, a sensation of
“bloating,” or weight gain.
Note: The symptoms in Criteria A–C must
have been met for most menstrual cycles
that occurred in the preceding year.
D. significant distress or impairment
E. DD: an exacerbation of the symptoms
of another disorder,
F. DD substance / another medical con-
dition (e.g., hyperthyroidism).
 Depressive disorders continued
Substance/Medication-Induced Depressive Disor- Depressive Disorder Due to Other Specified and unspecified Depressive Disorder
ders Another Medical Condition
A. A prominent and persistent disturbance in mood: A. A prominent and persistent Other Specified Depressive Disorder
period of depressive symptoms + clinically significant distress or impairment + not
1. depressed mood /or
(E.G., “SHORT-DURATION :]222‫عليه تعليق [أحمد‬ 1. depressed mood or meet the full criteria + specific reason
DEPRESSIVE EPISODE”).2. markedly diminished interest or pleasure in all, or 2. markedly diminished in- Examples:
almost all, activities. terest or pleasure in all,
1. Recurrent brief depression:
from the history, physical :]213‫عليه تعليق [أحمد‬ B. There is evidence of both (1) and (2): or almost all, activities
examination, or laboratory findings that predominates in the 1. depressed mood + ≥ 4/8 depressive symptoms
2 The symptoms in developed during or soon after
clinical picture. 2. Episode duration: 2–13 days
substance intoxication / withdrawal / exposure to a B. There is evidence that the 3. Rate: ≥ once per month (not associated with the menstrual cycle)
from the history, physical :]217‫عليه تعليق [أحمد‬
examination, or laboratory findings medication. disturbance is the direct path- 4. Disorder duration: ≥ 12 consecutive months
3 The involved substance/medication is capable of ophysiological consequence 5. never met criteria for any other depressive or bipolar disorder
producing the symptoms of another medical condition. 6. Exclude active or residual criteria for any psychotic disorder.
C. Exclude another mental dis-
C. No any of the following evidence that indicate in- order (e.g., adjustment disorder, 2. Short-duration depressive episode (4–13 days):
dependent bipolar or related disorder: with depressed mood, in which 1. Depressed affect + ≥ 4/8 major depressive episode symptoms +
the stressor is a serious medical significant distress or impairment
4. The symptoms precede the onset of the sub- 2. Episode duration: (4 - 14 days)
condition).
stance/medication use; 3. never met criteria for any other depressive or bipolar disorder
D. Exclude delirium.
5. the symptoms persist for a substantial period of time E. significant distress or impair- 4. Exclude active or residual criteria for any psychotic disorder.
‫أحمد[ تعليق عليه‬218]: in social, occupational, or other (e.g., about 1 month) after the cessation of acute ment 5. exclude criteria for recurrent brief depression.
important areas of functioning. withdrawal or severe intoxication Specify if: 3. Depressive episode with insufficient symptoms:
Full criteria are not met for a :]219‫عليه تعليق [أحمد‬ 6. a history of recurrent non-substance/ medication- With depressive features: 1. Depressed affect + ≥ 4/8 major depressive episode symptoms +
major depressive episode. With major depressive–like
related episodes. significant distress or impairment
Full criteria are met (except :]220‫عليه تعليق [أحمد‬ episode 2. persist for at least 2 weeks
D.
Criterion C) for a major depressive episode. DD: delirium. With mixed feature. 3. never met criteria for any other depressive or bipolar disorder,
Symptoms of mania or :]221‫عليه تعليق [أحمد‬ E. The disturbance causes clinically significant dis- 4. Exclude active or residual criteria for any psychotic disorder
hypomania are also present but do not predominate intress
the or impairment 5. Exclude criteria for mixed anxiety and depressive disorder symp-
clinical picture
Specify if toms.
in social, occupational, or other :]214‫عليه تعليق [أحمد‬
With
onset during intoxication / With onset during
important areas of functioning.
Unspecified Depressive Disorder
Depressive symptoms + clinically significant distress or impairment + not
withdrawal
‫أحمد[ تعليق عليه‬215]: If the criteria are met for intoxi- meet the full criteria + no reason + insufficient information to make a more
cation with the substance and the symptoms develop during
intoxication.
specific diagnosis (e.g., in emergency room settings).

‫أحمد[ تعليق عليه‬216]: If criteria are met for withdrawal

from the substance and the symptoms develop during, or
shortly after, withdrawal.
 anxiety
Separation Anxiety Disorder Selective Mutism Specific Phobia Social Anxiety Disorder (Social Phobia)
(e.g., flying, heights, animals, :]235‫عليه تعليق [أحمد‬
A. fear or anxiety concerning separation from A. Consistent failureA. Marked fear or anxiety about a A. Marked fear or anxiety about one or more
receiving an injection, seeing blood).
attachment figure: 1. Developmentally inap- to speak in specif- specific object or situation social situations in which the individual is
(e.g., having a conversation, :]247‫عليه تعليق [أحمد‬ propriate 2. Excessive 3. ≥ (3/8 symptoms): ic social situa- exposed to possible scrutiny by others.
meeting unfamiliar people), The phobic object or situation al-
1. Recurrent excessive distress when tions in which there most always Examples
(e.g., at school) :]231‫عليه تعليق [أحمد‬ is an expectationB.
anticipating or experiencing separation provokes immediate fear or anxiety. 1. social interactions
(e.g., eating or drinking), :]248‫عليه تعليق [أحمد‬ from home or major attachment figures. for speaking de-C. actively avoided or endured with
spite speaking in 2. being observed
(e.g., giving a speech). :]249‫عليه تعليق [أحمد‬ Persistent and excessive worry about intense fear or anxiety.
3. performing in front of others
2. Losing of / harm to major attachment fig- other situations. The fear or anxiety or avoidance is
(i.e., will be humiliating or :]250‫عليه تعليق [أحمد‬ B. The disturbanceD. B. fears being negatively evaluated (his acts or
embarrassing; will lead to rejection or offend others) ures out of proportion to the actual danger
3. Experiencing an untoward event that interferes with ed- posed by the specific object or situa- anxiety symptoms).
(e.g., getting lost, being :]223‫عليه تعليق [أحمد‬ ucational or occu- The social situations
kidnapped, having an accident, becoming ill) causes separation from a major attachment tion and to the sociocultural context.
pational achieve- C. almost always provoke fear or anxiety.
figure. E. persistent, typically lasting for 6
in social, occupational, or other :]236‫عليه تعليق [أحمد‬ ment or with social
Persistent reluctance or refusal to months or more. D. are avoided or endured with intense fear or anx-
important areas of functioning communication.
4. go out, away from home because of fear of F. causes clinically significant distress iety.
‫أحمد[ تعليق عليه‬232]: A.(not limited to the first ... C. duration : ≥ 1
separation. or impairment. The fear, anxiety or avoidance is
month
: fear, anxiety, and avoidance of :]237‫عليه تعليق [أحمد‬
... 5. being alone or without major attachment G. DD E. out of proportion to the actual threat posed by the
D. not attributable to
‫أحمد[ تعليق عليه‬233]: A.a lack of knowledge of, or ... figures at home or in other settings. Agoraphobia social situation and to the sociocultural context.
language barrier 1.
6. sleep away from home or to go to sleep F. persistent, typically lasting for 6 months or more.
: fear, anxiety, and avoidance of :]238‫عليه تعليق [أحمد‬
... E. DD 2. OCD
without being near a major attachment fig- G. causes clinically significant distress or impair-
: fear, anxiety, and avoidance of :]239‫عليه تعليق [أحمد‬ 1. communication dis-3. PTSD
... ure. ment.
order
‫أحمد[ تعليق عليه‬234]: e.g., childhood-onset fluency 7. Repeated nightmares involving the theme 4. separation anxiety disorder DD
... 2. autism spectrum
of separation. social anxiety disorder. H.
: fear, anxiety, and avoidance of :]240‫عليه تعليق [أحمد‬
... disorder, 5.
8. Repeated complaints of physical symp- 1. Substance related
: fear, anxiety, and avoidance of :]241‫عليه تعليق [أحمد‬
...
3. schizophrenia, or Specify if:
toms when separation from major attach- 2. another medical condition.
another psychotic Animal / Natural environment /
(e.g., headaches, stomachaches, :]224‫عليه تعليق [أحمد‬
... ment figures occurs or is anticipated. I. DD:
disorder. Blood-injection-injury / Situa-
(e.g., spiders, insects, dogs). :]242‫عليه تعليق [أحمد‬ B. Duration: lasting at least 4 weeks in children tional / Other 1. panic disorder,
and adolescents and typically 6 months or 2. body dysmorphic disorder,
(e.g., heights, storms, water). :]243‫عليه تعليق [أحمد‬
more in adults. 3. autism spectrum disorder.
(e.g., needles, invasive medical :]244‫عليه تعليق [أحمد‬
... C. Significant distress or impairment. J. If another medical condition (e.g., Parkinson’s
(e.g., airplanes, elevators, :]245‫عليه تعليق [أحمد‬
... D. DD: disease, obesity, disfigurement from burns or in-
(e.g., situations that may lead to :]246‫عليه تعليق [أحمد‬ 1. autism spectrum disorder jury) is present, the fear, anxiety, or avoidance is
...
2. psychotic disorders clearly unrelated or is excessive.
in social, academic, occupational, :]225‫عليه تعليق [أحمد‬
... 3. agoraphobia Specify if:
Refusing to leave home because :]226‫عليه تعليق [أحمد‬
... 4. GAD Performance only: If the fear is restricted to
: delusions or hallucinations :]227‫عليه تعليق [أحمد‬ 5. illness anxiety disorder speaking or performing in public.
...
refusal to go outside without a :]228‫عليه تعليق [أحمد‬
...
: worries about ill health or other :]229‫عليه تعليق [أحمد‬
...
: concerns about having an :]230‫عليه تعليق [أحمد‬
...
(e.g., automobiles, buses, trains, :]257‫عليه تعليق [أحمد‬
ships, planes). Panic Disorder
(e.g., parking lots, marketplaces, :]258‫عليه تعليق [أحمد‬
bridges).
(such as work or school :]267‫عليه تعليق [أحمد‬
performance)
(e.g., shops, theaters, cinemas). :]259‫عليه تعليق [أحمد‬
(e.g., fear of falling in the :]260‫عليه تعليق [أحمد‬
elderly; fear of incontinence).
anxiety or worry about having :]268‫عليه تعليق [أحمد‬
panic attacks
anxiety or worry about negative :]269‫عليه تعليق [أحمد‬
evaluation in social anxiety disorder
anxiety or worry about :]270‫عليه تعليق [أحمد‬
...
situational type :]261‫عليه تعليق [أحمد‬
anxiety or worry about separation :]271‫عليه تعليق [أحمد‬
...
‫أحمد[ تعليق عليه‬262]: 1 involve only social situations
anxiety or worry about reminders :]272‫عليه تعليق [أحمد‬
...
related exclusively to obsessions :]263‫عليه تعليق [أحمد‬
anxiety or worry about gaining :]273‫عليه تعليق [أحمد‬
...
Can be differentiated by : :]251‫عليه تعليق [أحمد‬
...
related exclusively to perceived :]264‫عليه تعليق [أحمد‬
...
anxiety or worry about physical :]274‫عليه تعليق [أحمد‬
...
related exclusively to reminders :]265‫عليه تعليق [أحمد‬
...
anxiety or worry about perceived :]275‫عليه تعليق [أحمد‬
...
related exclusively to fear of :]266‫عليه تعليق [أحمد‬
...
panic attacks occur only in :]252‫عليه تعليق [أحمد‬
...
panic attacks occur only in :]253‫عليه تعليق [أحمد‬
...
panic attacks occur only in :]254‫عليه تعليق [أحمد‬
...
anxiety or worry about having a :]276‫عليه تعليق [أحمد‬
...
anxiety or worry about the :]277‫عليه تعليق [أحمد‬
...
panic attacks occur only in :]255‫عليه تعليق [أحمد‬
...
panic attacks occur only in :]256‫عليه تعليق [أحمد‬
...
Anxiety cont.
Agoraphobia Generalized Anxiety Disorder
A. Recurrent unexpected panic attacks. surge of intense fear or intense dis- A. Marked fear or anxiety about ≥ 2/5: A. Excessive anxiety and worry (apprehen-
comfort that reaches a peak within minutes 4/13: 1. Using public transportation sive expectation), about a number of
AUTONOMIC /AROUSAL COMPONENT 2. Being in open spaces events or activities
Cardiovascular & Chest 3. Being in enclosed places Rate: occurring more days than not
1. Palpitations, pounding heart, or accelerated heart rate. 4. Standing in line or being in a crowd. Duration: at least 6 months,
2. Chest pain or discomfort. 5. Being outside of the home alone. B. difficulty to control the worry.
Autonomic: B. Cause of fears or avoidance: thoughts C. ≥ 3/6 (1/6 in children)
3. Sweating. that 1. escape might be difficult or 2. help Psychological
4. Trembling or shaking. might not be available in the event of 1. 1. Restlessness or feeling keyed up or on
Breath developing panic-like symptoms or 2. oth- edge.
5. Sensations of shortness of breath or smothering. er incapacitating or embarrassing symp- 2. Irritability
6. Feelings of choking. toms Physical
GIT: The agoraphobic situations 3. Being easily fatigued.
7. Nausea or abdominal distress. C. almost always provoke fear or anxiety. 4. Muscle tension.
Neurological: D. are actively avoided, require the presence Cognitive:
8. Feeling dizzy, unsteady, light-headed, or faint. of a companion, or are endured with in- 5. Difficulty concentrating or mind going
9. Chills or heat sensations. tense fear or anxiety. blank.
10. Paresthesias (numbness or tingling sensations). The fear or anxiety or avoidance is Behavioral: sleep
COGNITIVE COMPONENT E. out of proportion to the actual danger 6. Sleep disturbance (difficulty falling or
Psychological: posed by the agoraphobic situations and staying asleep, or restless, unsatisfying
11. Derealization (feelings of unreality) or depersonalization (being detached to the sociocultural context. sleep).
from oneself). F. persistent, typically lasting for 6 months or D. Cause clinically significant distress or im-
12. Fear of losing control or “going crazy.” more. pairment in functioning.
13. Fear of dying. G. causes clinically significant distress or E. DD: substance (e.g., a drug of abuse, a med-
Culture-specific symptoms (e.g., tinnitus, neck soreness, headache, uncon- impairment. ication) or another medical condition (e.g.,
trollable screaming or crying) H. If another medical condition (e.g., inflam- hyperthyroidism).
B. ≥ 1 attack followed by ≥1 month of ≥1 of the following: matory bowel disease, Parkinson’s dis- F. DD: another mental disorder
1. Persistent concern or worry about additional panic attacks or their ease) is present, the fear, anxiety, or 1. panic disorder
consequences (e.g., losing control, having a heart attack, “going crazy”). avoidance is clearly excessive. 2. social phobia
2. A significant maladaptive change in behavior related to the attacks DD: another mental disorder— 3. obsessive-compulsive disorder
(e.g., behaviors designed to avoid having panic attacks, such as avoidance 1- specific phobia; 4. separation anxiety disorder
of exercise or unfamiliar situations). 2- social anxiety disorder 5. posttraumatic stress disorder
C. DD 3- obsessive-compulsive disorder: 6. anorexia nervosa
1. substance 2. medical condition (hyperthyroidism, cardiopulmonary disorders). 4- body dysmorphic disorder 7. somatic symptom disorder
D. DD another mental disorder 5- posttraumatic stress disorder 8. body dysmorphic disorder
1. social anxiety disorder . specific phobia obsessive-compulsive disorder 6- separation anxiety disorder 9. illness anxiety disorder
2. posttraumatic stress disorder; 10. schizophrenia or delusional disorder
3. separation anxiety disorder.
 Anxiety cont.
Substance/Medication-Induced Anxiety Disorder Anxiety Disorder Due to An- Other Specified Anxiety Disorder & Unspecified Anxiety Disorder
other Medical Condition
A. Panic attacks or anxiety is predominant in the clinical picture. A. Panic attacks or anxiety is Other Specified Anxiety Disorder
from the history, physical :]278‫عليه تعليق [أحمد‬ B. There is evidence of both (1) and (2): predominant in the clinical anxiety disorder symptoms + clinically significant distress or
examination, or laboratory findings 1. The symptoms in developed during or soon after substance intox- picture. impairment + do not meet the full criteria for any of the anxiety
from the history, physical :]283‫عليه تعليق [أحمد‬ ication / withdrawal / exposure to a medication. B. There is evidence that the disorders + specific reason
examination, or laboratory findings 2. The involved substance/medication is capable of producing the disturbance is the direct Examples:
symptoms pathophysiological conse- 1. Limited-symptom attacks.
C. No any of the following evidence that indicate independent quence of another medical 2. Generalized anxiety not occurring more days than not.
anxiety or related disorder: condition. 3. Khyâl cap (wind attacks).
C. Exclude another mental 4. Ataque de nervios (attack of nerves)
7. The symptoms precede the onset of the substance/medication use;
disorder
8. the symptoms persist for a substantial period of time (e.g., about 1
D. Exclude delirium.
month) after the cessation of acute withdrawal or severe intoxica- Unspecified Anxiety Disorder
E. significant distress or im-
tion anxiety disorder symptoms + clinically significant distress or
‫أحمد[ تعليق عليه‬284]: in social, occupational, or other pairment
9. a history of recurrent non-substance/ medication-related episodes. impairment + do not meet the full criteria for any of the anxiety
important areas of functioning.
D. DD: delirium. disorders + no specific reason
E. The disturbance causes clinically significant distress or impair-
in social, occupational, or other :]279‫عليه تعليق [أحمد‬ ment
important areas of functioning. Specify if
‫أحمد[ تعليق عليه‬280]: If the criteria are met for intoxi- With onset during intoxication / With onset during withdrawal /
cation with the substance and the symptoms develop during With onset after medication use
intoxication.
Note: This diagnosis should be made instead of a diagnosis of sub-
‫أحمد[ تعليق عليه‬281]: If criteria are met for withdrawal stance intoxication or substance withdrawal only when the symptoms in
from the substance and the symptoms develop during, or
shortly after, withdrawal.
Criterion A predominate in the clinical picture and they are sufficiently
severe to warrant clinical attention.
‫أحمد[ تعليق عليه‬282]: Symptoms may appear either at
initiation of medication or after a modification or change in
use.
 , at some time during the :]285‫عليه تعليق [أحمد‬
OCD and related disorders
...
Obsessive-Compulsive Disorder Body Dysmorphic Disorder Hoarding Disorder
(e.g., mirror checking, excessive :]304‫عليه تعليق [أحمد‬
...
A. Presence of obsessions, compulsions, or both: A. Preoccupation with ≥ 1 A. Definition: Persistent difficulty discarding or
(e.g., comparing his or her :]305‫عليه تعليق [أحمد‬
... perceived defects or flaws in parting with possessions, regardless of their
Obsessions are defined by (1) and (2):
(e.g., hand washing, ordering, :]286‫عليه تعليق [أحمد‬
... physical appearance + that actual value.
1. i. Recurrent and persistent thoughts, urges, or images +
are not observable or appear B. due to
(e.g., praying, counting, :]287‫عليه تعليق [أحمد‬
... ii. experienced as intrusive and unwanted, + slight to others. a a perceived need to save the items
: The individual is preoccupied :]306‫عليه تعليق [أحمد‬
... iii. mostly cause marked anxiety or distress. B. repetitive behaviors or /and
2. The individual attempts to
(e.g., family members, cleaners, :]310‫عليه تعليق [أحمد‬
... mental acts in response to b distress associated with discarding
i ignore or suppress such thoughts, urges, or images, /or/ the appearance concerns. them.
‫أحمد[ تعليق عليه‬307]: The individual recognizes that ...
ii neutralize them with some other thought or action (compulsion). C. significant distress or im- C. results in accumulation of possessions that
(including maintaining a safe :]311‫عليه تعليق [أحمد‬
... pairment in functioning.
Compulsions are defined by (1) and (2): a congest and clutter active living are-
The individual thinks that the :]308‫عليه تعليق [أحمد‬
... D. DD: Eating disorder: con- as
1. Repetitive behaviors or mental acts that the individual feels driven to perform in response cerns with body fat or
The individual is completely :]309‫عليه تعليق [أحمد‬
... b substantially compromises their in-
to an obsession or according to rules that must be applied rigidly. weight. tended use.
excessive worries :]288‫عليه تعليق [أحمد‬ 2. The behaviors or mental acts are aimed at
Specify if: c If living areas are uncluttered, it is
preoccupation with appearance :]289‫عليه تعليق [أحمد‬ i preventing or reducing anxiety or distress, or only because of the interventions of
With muscle dysmorphia.
difficulty discarding or parting :]290‫عليه تعليق [أحمد‬
ii preventing some dreaded event or situation; third parties.
... Specify if:
however, these behaviors or mental acts are D. causes clinically significant distress or im-
‫أحمد[ تعليق عليه‬291]: 1 [hair-pulling disorder]; With good or fair insight
1- not connected in a realistic way with what they are designed to neutralize or prevent or pairment in functioning
skin-picking] disorder :]292‫عليه تعليق [أحمد‬ 2- are clearly excessive. With poor insight.
E. DD: another medical condition (e.g., brain
Note: Young children may not be able to articulate the aims of these behaviors or mental With absent in-
ritualized eating behavior :]293‫عليه تعليق [أحمد‬ injury, cerebrovascular disease, Prader-Willi
acts. sight/delusional beliefs.
preoccupation with substances or :]294‫عليه تعليق [أحمد‬ syndrome).
...
B. time-consuming (> 1 hour per day) or cause clinically significant distress or impairment. F. DD mental disorder
preoccupation with having an :]295‫عليه تعليق [أحمد‬
...
C. DD: 1. a substance 2. another medical condition.
1. obsessions in OCD,
sexual urges or fantasies :]296‫عليه تعليق [أحمد‬
D. DD another mental disorder
2. decreased energy in MDD,
impulses :]297‫عليه تعليق [أحمد‬
1- generalized anxiety disorder; 2. body dysmorphic disorder;
3.hoarding disorder; 4. trichotillomania 3. delusions in schizophrenia or another psy-
guilty ruminations :]298‫عليه تعليق [أحمد‬
5. excoriation 6. stereotypic movement disorder; chotic disorder,
thought insertion or delusional :]299‫عليه تعليق [أحمد‬...7. eating disorders; 8. substance-related and addictive disorders; 4. cognitive deficits in major neurocognitive dis-
‫أحمد[ تعليق عليه‬312]: If difficulty discarding posses- ...9. illness anxiety disorder; 10 paraphilic disorders;
order,
11 disruptive, impulse control, and conduct disorders;
‫أحمد[ تعليق عليه‬313]: The individual recognizes that ... 12. major depressive disorder; 13. schizophrenia spectrum and other psychotic dis- 5. restricted interests in ASD).
orders;
‫أحمد[ تعليق عليه‬300]: The individual recognizes that ... Specify if: With excessive acquisition
14. repetitive patterns of behavior, as in autism spectrum disorder). Specify if:
The individual thinks obsessive- :]301‫عليه تعليق [أحمد‬...
Specify if:
With good or fair insight
‫أحمد[ تعليق عليه‬302]: The individual is completely ... With good or fair insigh / With poor insight / With absent insight/delusional beliefs
With poor insight.
The individual is mostly :]314‫ عليه تعليق [أحمد‬Tic-related
... With absent insight/delusional beliefs
The individual has a current or :]303‫عليه تعليق [أحمد‬
...
‫أحمد[ تعليق عليه‬315]: The individual is completely ...
 from the history, physical :]316‫عليه تعليق [أحمد‬
examination, or laboratory findings OC and related continued
This is similar to body :]328‫عليه تعليق [أحمد‬ Trichotillomania / Excoriation Substance/Medication-Induced Obsessive- Obsessive-Compulsive and Other Specified and Un-
dysmorphic disorder except that the defects or flaws in
Compulsive and Related Disorder Related Disorder Due to specified OC
...
physical appearance are clearly observable by others (i.e.,
Another Medical Condition
from the history, physical :]321‫عليه تعليق [أحمد‬
Trichotillomania (Hair-Pulling Disorder) A. Obsessions, compulsions, skin picking, hair pull- Other Specified OCD
examination, or laboratory findings
A. Recurrent pulling out of one’s hair + resulting in ing, other body-focused repetitive behaviors, or A. Obsessions, compulsions, obsessive-compulsive and re-
Presentations that meet body :]329‫عليه تعليق [أحمد‬ hair loss. other symptoms characteristic of the obsessive- preoccupations with appear- lated disorder symptoms + clin-
...
dysmorphic disorder except that the individual has not
B. Repeated attempts to decrease or stop hair pull- compulsive and related disorders predominate in ance, hoarding, skin picking, ically significant distress or im-
‫أحمد[ تعليق عليه‬330]: 1.This is characterized by re- ing. the clinical picture. hair pulling, other body- pairment + do not meet the full
...
current body-focused repetitive behaviors (e.g., nail biting,
C. clinically significant distress or impairment in func- B. There is evidence of both (1) and (2): focused repetitive behaviors, criteria for any of the OCD dis-
This is characterized by non- :]331‫عليه تعليق [أحمد‬ tioning. 3. The symptoms in developed during or soon af- or other symptoms character- orders + specific reason
delusional preoccupation with a partner’s perceived
... D. DD: exclude another medical condition (e.g., a ter substance intoxication / withdrawal / expo- istic of obsessive-compulsive Examples:
A variant of taijin kyofusho that :]332‫عليه تعليق [أحمد‬ dermatological condition). sure to a medication. and related disorder predom- 1. Body dysmorphic–like dis-
...
is similar to body dysmorphic disorder and is characterized E. DD another mental disorder(e.g., attempts to 4. The involved substance/medication is capable inate in the clinical picture. order with actual flaws
Related to dhat syndrome, an :]333‫عليه تعليق [أحمد‬ improve a perceived defect or flaw in appearance of producing the criterion A symptoms C. There is evidence that the 2. Body dysmorphic–like dis-
...
episode of sudden and intense anxiety that the penis (or the in body dysmorphic disorder). C. No any of the following evidence that in- disturbance is the direct order without repetitive
Excoriation (Skin-Picking) Disorder pathophysiological conse- behaviors.
fear ‫۔‬A variant of taijin kyofusho :]334‫عليه تعليق [أحمد‬
... dicate independent obsessive compulsive and
A. Recurrent skin picking resulting in skin lesions. related disorder: quence of another medical 3. Body-focused repetitive
‫أحمد[ تعليق عليه‬322]: in social, occupational, or other condition.
important areas of functioning. B. Repeated attempts to decrease or stop skin pick- 10. The symptoms precede the onset of the sub- D. Exclude another mental behavior disorder
ing. stance/medication use; 4. Obsessional jealousy
If obsessive-compulsive :]323‫عليه تعليق [أحمد‬ disorder
C. The skin picking causes clinically significant dis- 11. the symptoms persist for a substantial period of 5. Shubo-kyofu
...
disorder–like symptoms predominate in the clinical E. Exclude delirium.
tress or impairment in social, occupational, or time (e.g., about 1 month) after the cessation of 6. Koro
in social, occupational, or other :]317‫عليه تعليق [أحمد‬ other important areas of functioning. F. significant distress or impair-
acute withdrawal or severe intoxication 7. Jikoshu-kyofu
important areas of functioning. ment
D. DD exclude: 1. substance (e.g., cocaine) 2. an- 12. a history of recurrent non-substance/ medica-
If preoccupation with perceived :]324‫عليه تعليق [أحمد‬ other medical condition (e.g., scabies). Specify if:
tion-related episodes. Unspecified Obsessive-
...
appearance defects or flaws predominates in the clinical
E. DD: another mental disorder With obsessive-
D. DD: delirium. compulsive disorder–like Compulsive and Related
‫أحمد[ تعليق عليه‬325]: If hoarding predominates in the 1. delusions or tactile hallucinations in a psychotic
clinical presentation. E. The disturbance causes clinically significant symptoms Disorder
disorder,
distress or impairment With appearance preoccu- obsessive-compulsive and re-
‫أحمد[ تعليق عليه‬318]: If the criteria are met for intoxi- 2. attempts to improve a perceived defect or flaw in
cation with the substance and the symptoms develop during ... appearance in body dysmorphic disorder, Specify if pations lated disorder symptoms + clin-
With onset during intoxication / With onset during With hoarding symptoms ically significant distress or im-
‫أحمد[ تعليق عليه‬319]: If criteria are met for withdrawal 3. stereotypies in stereotypic movement disorder,
from the substance and the symptoms develop during, or ... 4. intention to harm oneself in non-suicidal self inju- withdrawal / With onset after medication use With hair-pulling symp- pairment + do not meet the full
ry). toms criteria for any of the OCD dis-
‫أحمد[ تعليق عليه‬320]: Symptoms may appear either at Note: This diagnosis should be made in addition to a
initiation of medication or after a modification or change in ... diagnosis of substance intoxication or substance With skin-picking symp- orders + no specific reason
withdrawal only when the symptoms in Criterion A toms
If hair pulling predominates in :]326‫عليه تعليق [أحمد‬
the clinical presentation. predominate in the clinical picture and are sufficiently
severe to warrant clinical attention.
If skin picking predominates in :]327‫عليه تعليق [أحمد‬
the clinical presentation.
 (that is not consistent with :]338‫عليه تعليق [أحمد‬ Stress related
culturally sanctioned and with age-appropriate social
boundaries). Reactive Attachment Disorder Disinhibited Social Engagement Dis- Adjustment Disorders Other Specified and
order
‫أحمد[ تعليق عليه‬345]: 1.taking into account the ex-
ternal context and the cultural factors that might influence A. A consistent pattern of inhibited, emotionally A. a child actively approaches and in- A. The development of emotional Other Specified Trauma- and
symptom severity and presentation.
withdrawn behavior toward adult caregivers: teracts with unfamiliar adults 2/4: or behavioral symptoms in Stressor-Related Disorder
even in unfamiliar settings. :]339‫عليه تعليق [أحمد‬ The child- when distressed- rarely or mini- response to an identifiable trauma and stressor-related disorder
1. Reduced or absent reticence in ap-
with minimal or no hesitation :]340‫عليه تعليق [أحمد‬ mally: proaching and interacting with unfa- stressor(s) occurring within 3 symptoms + significant distress or
1. seeks comfort. miliar adults. months of the onset of the impairment in functioning + do not
: in ADHD, above behaviors :]341‫عليه تعليق [أحمد‬
limited to impulsivity, do not include socially disinhibited 2. responds to comfort. 2. Overly familiar verbal or physical be- stressor(s). meet the full criteria of that class+
behavior B. A persistent social and emotional disturb- havior B. clinically significant 1/2: specific reason
1. Marked distress that is out of Examples:
in the form of persistent lack of :]342‫عليه تعليق [أحمد‬ ance 2/3: 3. Diminished or absent checking back
having basic emotional needs for comfort, stimulation, and with adult caregiver after venturing proportion to the severity or
1. Minimal social and emotional responsiveness 1. Adjustment-like disorders with
affection met by caregiving adults. away intensity of the stressor,
to others. delayed onset of symptoms
that limit opportunities to form :]343‫عليه تعليق [أحمد‬ 4. Willingness to go off with an unfamil- 2. Significant impairment in func-
2. Limited positive affect. that occur more than 3 months
stable attachments (e.g., frequent changes in foster care). iar adult. tioning.
after the stressor.
3. Episodes of unexplained irritability, sadness, C. DD: do not meet the criteria
in the form of persistent lack of :]335‫عليه تعليق [أحمد‬ B. DD: exclude ADHD. 2. Adjustment-like disorders with
or fearfulness that are evident even during for another mental disorder
having basic emotional needs for comfort, stimulation, and C. The child has experienced a pattern prolonged duration of more
affection met by caregiving adults. nonthreatening interactions with adult care- and is not merely an exacerba-
givers. of extremes of insufficient care 2/3: than 6 months without pro-
that limit opportunities to form :]336‫عليه تعليق [أحمد‬ tion of a preexisting mental dis- longed duration of stressor.
stable attachments (e.g., frequent changes in foster care). C. The child has experienced a pattern of ex- 1. Social neglect or deprivation order. 3. Ataque de nervios.
tremes of insufficient care 1/3: 2. Repeated changes of primary care- D. DD: Exclude normal be-
This disorder is characterized by :]352‫عليه تعليق [أحمد‬ givers 4. Other cultural syndromes
severe and persistent grief and mourning reactions 1. Social neglect or deprivation reavement. 5. Persistent complex be-
2. Repeated changes of primary caregivers 3. Rearing in unusual settings that se- E. duration: not more than 6
(e.g., institutions with high child- :]344‫عليه تعليق [أحمد‬ reavement disorder:
to-caregiver ratios). verely limit opportunities to form se- months after termination of
3. Rearing in unusual settings that severely limit
lective attachments stressor.
(e.g., institutions with high child- :]337‫عليه تعليق [أحمد‬ opportunities to form selective attachments Unspecified Trauma- and
to-caregiver ratios). D. Causative relation between C and A Specify whether:
D. Causative relation between C and A Stressor-Related Disorder
E. The child has a developmental age of With depressed mood.
: Low mood, tearfulness, or :]346‫عليه تعليق [أحمد‬ E. DD: autism spectrum disorder. trauma and stressor-related disorder
feelings of hopelessness are predominant at least 9 months. With anxiety
F. Age of onset: before age 5 years. symptoms + significant distress or
Specify if: With mixed anxiety and de-
Nervousness, worry, jitteriness, :]347‫عليه تعليق [أحمد‬ G. developmental age at onset: of at least 9 impairment in functioning + do not
or separation anxiety is predominant Persistent: The disorder has been pre- pressed mood
months. meet the full criteria of that class+
sent for more than 12 months. With disturbance of conduct no specific reason
A combination of depression and :]348‫عليه تعليق [أحمد‬ Specify if:
anxiety is predominant Specify current severity: With mixed disturbance of
Persistent: The disorder has been present for emotions and conduct.
Disturbance of conduct is :]349‫عليه تعليق [أحمد‬
severe all symptoms of the disorder +
more than 12 months. Unspecified
predominant each symptom manifesting at relatively
Specify current severity: high levels.
Both emotional symptoms (e.g., :]350‫عليه تعليق [أحمد‬ severe all symptoms of the disorder + each
...
depression, anxiety) and a disturbance of conduct are symptom manifesting at relatively high levels.
For maladaptive reactions that :]351‫عليه تعليق [أحمد‬
are not classifiable as one of the specific subtypes ...
of

the traumatic event(s). :]353‫عليه تعليق [أحمد‬
A. Exposure to
, in person, the event(s) as it :]354‫عليه تعليق [أحمد‬
occurred to others way:
that the traumatic event(s) :]355‫ عليه تعليق [أحمد‬1. Directly experiencing 2. Witnessing. 3. Learning.
... 4. Experiencing repeated or extreme exposure
occurred to a close family member or close friend. In cases
‫أحمد[ تعليق عليه‬356]: to aversive details of the traumat-
...
‫أحمد[ تعليق عليه‬357]: associated with ...
Recurrent involuntary intrusive :]358‫عليه تعليق [أحمد‬
...
in > 6 child :]359‫عليه تعليق [أحمد‬
‫أحمد[ تعليق عليه‬380]: (e.g., fear,
...
‫أحمد[ تعليق عليه‬360]: Recurrent distressing dreams in ...
‫أحمد[ تعليق عليه‬361]: in which the individual feels or ...
‫أحمد[ تعليق عليه‬381]: An altered sense of the reality of...
‫أحمد[ تعليق عليه‬362]: Intense or prolonged psychologi-
...
‫أحمد[ تعليق عليه‬363]: Marked physiological reactions ...
Persistent avoidance of stimuli :]364‫عليه تعليق [أحمد‬
...
‫أحمد[ تعليق عليه‬365]: about or closely associated with...
(people, places, conversations, :]366‫عليه تعليق [أحمد‬
...
about or closely associated with :]367‫عليه تعليق [أحمد‬
...
Inability to remember an :]368‫عليه تعليق [أحمد‬
...
Persistent and exaggerated :]369‫عليه تعليق [أحمد‬
...
of the traumatic event(s) that lead :]370‫عليه تعليق [أحمد‬
...
(e.g., fear, horror, anger, guilt, or :]371‫عليه تعليق [أحمد‬
...
(e.g., inability to experience :]372‫عليه تعليق [أحمد‬
...
associated with the :]373‫عليه تعليق [أحمد‬
...
‫أحمد[ تعليق عليه‬374]: (with little or no provocation) ...
‫أحمد[ تعليق عليه‬375]: e.g., difficulty falling or staying...
‫أحمد[ تعليق عليه‬376]: Note: To use this subtype, the ...
‫أحمد[ تعليق عليه‬377]: Persistent or recurrent experienc-
...
‫أحمد[ تعليق عليه‬378]: Persistent or recurrent experienc-
...
If the full diagnostic criteria are :]379‫عليه تعليق [أحمد‬
...
PTSD PTSD CHILDREN < 6 years ATSD
A and B similar to > 6 years A. EXPOSURE: As PTSD
1. actual / threatened death 2. serious injury 3. sexual violence ≥ 1/4 B. ≥9 / 14 from any of the five categories:
C: 1 required from (2 avoidance items (criterion C
in >6) and 4 negative alteration in cognition “Cri- Intrusion Symptoms (items 1-4)
terion D in >6) As PTSD minus item 5 (physiological reaction)
Negative Mood
B. Intrusion symptoms of traumatic event (≥ 1/5) Negative Alterations in Cognitions 5. Only Item No 5 in PTSD (inability to experience +ve
1. memories/ repetitive play 1.Substantially increased frequency of negative emotions)
2. Dreams emotional states Dissociative Symptoms
3. Dissociative reactions (e.g., flashbacks/ play) 2. Markedly diminished interest or participation 6. Derealization & depersonalization: more simple defi-
4. Psychological Distress with exposure to cues in significant activities, including constriction of nition
5. Marked physiological reactions with exposure to cues play. 7. Dissociative amnesia
3. Socially withdrawn behavior. Avoidance Symptoms
C. Avoidance/ efforts of avoidance symptoms≥ 1/2: 8,9: As avoidance in PTSD
4. Persistent reduction in expression of positive
1. Of distressing memories, thoughts, or feelings Arousal Symptoms
emotions. 10 -14: As PTSD minus: Reckless or self-destructive
2. external reminders that arouse distressing memories, thoughts, or
D: As E in > 6 except : behavior.
feelings
D. Negative alterations in cognitions and mood associated with the
traumatic event(s), beginning or worsening after the traumatic event(s) 2. Reckless or self-destructive behavior. C. Duration: (3 days - 1 month) after trauma exposure.
E, F, G: as F, G, H in > 6
occurred, ≥ 2/7: Note: Symptoms typically begin immediately after the
1. dissociative amnesia trauma, but persistence for at least 3 days and up to a
2. negative beliefs & expectations month is needed to meet disorder criteria.
3. Persistent, distorted cognitions about the cause or consequences D. distress or impairment
4. Persistent negative emotional state E. DD: substance, another medical condition (e.g., mild
5. Markedly diminished interest or participation in significant activities. traumatic brain injury) ,brief psychotic disorder.
6. Feelings of detachment or estrangement from others.
7. Persistent inability to experience positive emotions.
E. Marked alterations in arousal and reactivity, ≥ 2/6:
1. Irritable behavior and angry outbursts
2. Reckless or self-destructive behavior.
3. Hypervigilance.
4. Exaggerated startle response.
5. Problems with concentration.
6. Sleep disturbance
F. Duration > 1 month.
G. distress or impairment
H. DD: substance or another medical condition.
Specify whether:
With dissociative symptoms:
1. Depersonalization
2. Derealization
Specify if: With delayed expression

for a specific event or events :]384‫عليه تعليق [أحمد‬
for identity and life history :]385‫عليه تعليق [أحمد‬
‫أحمد[ تعليق عليه‬382]: Marked discontinuity in sense of D. Not culturally or religiously accepted..
self and sense of agency, accompanied by related alterations
in affect, behavior, consciousness, memory, perception, cog-
nition, and/or sensory-motor functioning. These signs and
symptoms may be observed by others or reported by the
individual .
‫أحمد[ تعليق عليه‬383]: everyday events, important per-
sonal information, and/or traumatic events that are incon-
sistent with ordinary forgetting
‫أحمد[ تعليق عليه‬386]: Apparently purposeful travel or
bewildered wandering that is associated with amnesia for
identity or for other important autobiographical information.
‫أحمد[ تعليق عليه‬387]: (e.g., brainwashing, thought
reform, indoctrination while captive, torture, long-term polit-
ical imprisonment, recruitment by sects/cults or by terror
organizations)
Dissociative
Dissociative Identity Disorder Dissociative Amnesia
A. Disruption of identity: two or more distinct person- A. An inability to recall important autobiographical information, usually of a traumatic or stressful nature, that is
ality states, (an experience of possession). Click here inconsistent with ordinary forgetting.
for Description 1.localized or selective amnesia; 2. generalized amnesia.
B. Recurrent gaps in the recall of. B. clinically significant distress or impairment in functioning.
C. significant distress or impairment in functioning. C. DD: exclude 1. substance 2. neurological 3. other medical condition (e.g., partial complex seizures, transient
global amnesia, sequelae of a closed head injury/traumatic brain injury, other neurological condition).
Note: In children, the symptoms are not better ex- D. DD: exclude other mental: dissociative identity disorder, posttraumatic stress disorder, acute stress disorder, so-
plained by imaginary playmates or other fantasy play. matic symptom disorder, or major or mild neurocognitive disorder.
E. DD: a substance (e.g., blackouts or chaotic behavior Specify if: With dissociative fugue
during alcohol intoxication) or another medical condi-
tion (e.g., complex partial seizures).
Depersonalization/Derealization Disorder Other Specified, Unspecified Dissociative Disorder
A. The presence of persistent or recurrent experienc- Other Specified Dissociative Disorder
es of depersonalization, derealization, or both: Dissociative symptoms + significant distress or impairment in functioning + do not meet the full criteria of that class+
1. Depersonalization: Experiences of unreality, de- specific reason
tachment, or being an outside observer with re- 1. Chronic and recurrent syndromes of mixed dissociative symptoms: identity disturbance: less-than-marked
spect to one’s thoughts, feelings, sensations, body, discontinuities in sense of self and agency, or alterations of identity or episodes of possession + no dissociative
or actions (e.g., perceptual alterations, distorted amnesia.
sense of time, unreal or absent self, emotional 2. Identity disturbance due to prolonged and intense coercive persuasion: Individuals who have been subjected
and/or physical numbing). to intense coercive persuasion may present with prolonged changes in, or conscious questioning of, their identity.
2. Derealization: Experiences of unreality or detach- 3. Acute dissociative reactions to stressful events: acute, transient conditions ( duration < 1 month, and some-
ment with respect to surroundings (e.g., individuals times only a few hours or days.
or objects are experienced as unreal, dreamlike, constriction of consciousness; depersonalization;
foggy, lifeless, or visually distorted). derealization; perceptual disturbances (e.g., time slowing, macropsia);
B. reality testing remains intact. micro-amnesias; transients stupor; alterations in sensory motor functioning (e.g., analgesia, paralysis).
4. Dissociative trance:
C. significant distress or impairment in functioning.
• acute narrowing or complete loss of awareness of immediate surroundings that manifests as profound unre-
D. DD: 1. substance (e.g., a drug of abuse, medication) 2.
sponsiveness or insensitivity to environmental stimuli.
another medical condition (e.g., seizures).
• The unresponsiveness may be accompanied by
E. DD: another mental disorder, such as schizophrenia,
▪ minor stereotyped behaviors (e.g., finger movements) of which the individual is unaware and/or that he
panic disorder, major depressive disorder, acute stress
or she cannot control,
disorder, posttraumatic stress disorder, or another dis-
▪ transient paralysis or loss of consciousness.
sociative disorder.
• The dissociative trance is not a normal part of a broadly accepted collective cultural or religious practice.
Unspecified Dissociative Disorder
dissociative disorder symptoms + significant distress or impairment in functioning + do not meet the full criteria of that
class+ no specific reason
 Somatic Symptom and Related Disorders
Somatic Symptom Disorder Illness Anxiety Disorder Conversion Disorder (Functional Psychological Factors Affecting
Neurological Symptom Disorder) Other Medical Conditions
‫أحمد[ تعليق عليه‬389]: If another medical condition is
A. One or more somatic symp-
present or there is a high risk for developing a medical condi- A. Preoccupation A. One or more symptoms of A. A medical symptom or Factitious Disorder
tion (e.g., strong family history is present), the preoccupation toms that are distressing or with having or ac- altered voluntary motor or condition (other than a Factitious Disorder Imposed on Self
is clearly excessive or disproportionate. result in significant disrup- quiring a serious sensory function. mental disorder) is pre-
A. Falsification of physical or psychological
‫أحمد[ تعليق عليه‬390]: and the individual is easily tion of daily life. illness. B. Clinical findings provide evi- sent.
signs or symptoms, or induction of injury or
alarmed about personal health status. B. Excessive thoughts, feelings, B. Somatic symp- dence of incompatibility B. Psychological or behav- disease, associated with identified deception.
‫أحمد[ تعليق عليه‬397]: As shown by a close temporal or behaviors related to the toms are not pre- between the symptom and ioral factors adversely af-
B. The individual presents himself or herself to
association between the psychological factors and the devel- somatic symptoms or associ- sent or, if present, recognized neurological or fect the medical condition
others as ill, impaired, or injured.
opment or exacerbation of, or delayed recovery from, the ated health concerns ≥1/3: are only mild in in- medical conditions. 1/4:
medical condition. C. The deceptive behavior is evident even in the
1. Disproportionate and per- tensity. C. DD: exclude another medi- 1. The factors have influ-
absence of obvious external rewards.
(e.g., poor adherence). :]398‫عليه تعليق [أحمد‬ sistent thoughts about the C. high level of anxi- cal or mental disorder. enced the course of the
D. DD: exclude another mental disorder, such as
seriousness of one’s symp- ety about health, medical condition
‫أحمد[ تعليق عليه‬391]: (e.g., repeatedly checks or mala- D. significant distress or im- delusional disorder or another psychotic disor-
daptive avoidance of doctor appointments and hospitals). toms. D. The individual per- 2. The factors interfere
pairment in functioning or der.
2. Persistently high level of forms excessive with the treatment of the
(Previously Factitious Disorder :]402‫عليه تعليق [أحمد‬ warrants medical evalua- Specify:
anxiety about health or health-related be- medical condition
by Proxy) tion. Single episode Recurrent episodes
symptoms. haviors 3. The factors constitute
‫أحمد[ تعليق عليه‬394]: (e.g., tremor, dystonic move- 3. Excessive time and energy Specify symptom type: Factitious Disorder Imposed on Another
E. Duration: 6 additional well-
ment, myoclonus, gait disorder) With weakness or paralysis
devoted to these symptoms months, but the established health risks Same criteria but in another person (victim)
(e.g., dysphonia, slurred speech) :]395‫عليه تعليق [أحمد‬ or health concerns. specific illness that With abnormal movement for the individual. Note: The perpetrator, not the victim, receives this
(two or more events of :]403‫عليه تعليق [أحمد‬ C. Duration: persistently sympto- is feared may With swallowing symptoms 4. The factors influence diagnosis.
falsification of illness and/or induction of injury) matic for 6 months (symptoms change over that With speech symptom the underlying patho-
With attacks or seizures Specify: Single episode Recurrent episodes
precipitating or exacerbating :]399‫ عليه تعليق [أحمد‬can change from one to anoth- period of time. physiology,
symptoms or necessitating medical attention. er). F. DD: another men- With anesthesia or sensory Other Specified Somatic Symptom and Re-
C. DD: Exclude another men- lated Disorder
Specify if: tal disorder, such loss
somatic symptoms :]388‫عليه تعليق [أحمد‬ tal disorder as the psycho-
predominantly involve pain With predominant pain (previ- as somatic symp- With special sensory somatic symptom and related disorder + significant
logical factor (e.g., panic
ously pain disorder). tom disorder, panic symptom distress or impairment in functioning +do not meet
‫أحمد[ تعليق عليه‬396]: (e.g., visual, olfactory, or hearing disorder, MDD, PTSD).
Specify if: disorder, general- With mixed symptoms the full criteria somatic symptom and related disor-
disturbance) Specify current severity:
Persistent: severe symptoms, ized anxiety disor- Specify if: ders + specific reason
Duration of symptoms is less :]404‫ عليه تعليق [أحمد‬marked impairment, and long Mild: Increases medical 1. Brief somatic symptom disorder.
der, body dys- Acute episode:
than 6 months risk
duration (more than 6 months). morphic disorder, duration < 6 2. Brief illness anxiety disorder.
(e.g., inconsistent adherence with :]400‫عليه تعليق [أحمد‬ Specify current severity: obsessive- Moderate: Aggravates un-
months. 3. Illness anxiety disorder without excessive
antihypertension treatment). Mild: 1/3 symptoms of Criterion derlying medical condition
compulsive disor- Persistent: dura- health-related behaviors
Duration of symptoms is less :]405‫ عليه تعليق [أحمد‬B . der, or delusional Severe: Results in medical
tion ≥ 6 months or 4. Pseudocyesis
than 6 months Moderate: ≥ 2/3 symptoms of disorder, somatic hospitalization or emergen-
more. cy room visit. Unspecified Somatic Symptom and Related
(e.g., anxiety aggravating :]401‫عليه تعليق [أحمد‬ Criterion B. type.
... Specify if: Disorder
Severe: ≥ 2/3 symptoms in Cri- Extreme: Results in se-
Criterion D for illness anxiety :]406‫عليه تعليق [أحمد‬ ... terion B + multiple somatic Specify whether: With psychological stress- somatic symptom and related disorder + significant
vere, life-threatening risk
A false belief of being pregnant :]407‫عليه تعليق [أحمد‬ Care-seeking type or distress or impairment in functioning +do not meet
... complaints (or one very severe (e.g., ignoring heart attack
Care-avoidant Without psychological symptoms). the full criteria somatic symptom and related disor-
‫أحمد[ تعليق عليه‬392]: Medical care, including physi- ... somatic symptom).
type. stressor ders + no specific reason
Medical care is rarely used :]393‫عليه تعليق [أحمد‬
‫أحمد[ تعليق عليه‬415]: (e.g., apparent lack of interest in
eating or food; avoidance based on the sensory characteris-
tics of food; concern about aversive consequences of eating)
‫أحمد[ تعليق عليه‬419]: is defined as a weight that is less
than minimally normal or, for children and adolescents, less
than that minimally expected.
(or failure to achieve expected :]416‫عليه تعليق [أحمد‬
weight gain or faltering growth in children).
‫أحمد[ تعليق عليه‬420]: Intense fear of gaining weight
or of becoming fat
‫أحمد[ تعليق عليه‬421]: persistent behavior that inter-
feres with weight gain
‫أحمد[ تعليق عليه‬427]: 1. (e.g., a feeling that one can-
not stop eating or control what or how much one is eating).
such as self-induced vomiting; :]428‫عليه تعليق [أحمد‬
misuse of laxatives, diuretics, or other medications; fasting;
or excessive exercise.
(e.g., intellectual disability :]408‫عليه تعليق [أحمد‬
[intellectual developmental disorder], autism spectrum
disorder, schizophrenia)
(including pregnancy), :]409‫عليه تعليق [أحمد‬
This subtype describes :]422‫عليه تعليق [أحمد‬
...
presentations in which weight loss is accomplished primarily
After full criteria for bulimia :]429‫عليه تعليق [أحمد‬
...
(i.e., self-induced vomiting or the :]423‫عليه تعليق [أحمد‬
...
After full criteria for bulimia :]430‫عليه تعليق [أحمد‬
...
‫أحمد[ تعليق عليه‬417]: When the eating disturbance
(i.e., self-induced vomiting or the :]424‫عليه تعليق [أحمد‬
...
‫أحمد[ تعليق عليه‬410]: A.Regurgitated food may be ...
‫أحمد[ تعليق عليه‬418]: After full criteria for
‫أحمد[ تعليق عليه‬425]: After full criteria for anorexia ...
After full criteria for anorexia :]426‫عليه تعليق [أحمد‬
...
‫أحمد[ تعليق عليه‬411]: A.(e.g., gastroesophageal re- ...
anorexia nervosa, bulimia :]412‫عليه تعليق [أحمد‬
...
(e.g., intellectual disability :]413‫عليه تعليق [أحمد‬
...
‫أحمد[ تعليق عليه‬414]: After full criteria for rumination...
Pica
A. 1.Persistent eating of nonnutri-
tive, nonfood substances
2. duration; over a period of at
least 1month.
B. inappropriate to the develop-
mental level of the individual.
C. not part of a culturally supported
or socially normative practice.
D. If the eating behavior occurs in the
context of another mental disorder
or medical condition it is sufficient-
ly severe to warrant additional
clinical attention.
Specify if:
In remission: After full criteria for
pica were previously met, the crite-
ria have not been met for a sus-
tained period of time.
Rumination Disorder
A. Repeated regurgitation of food
B. over a period of at least 1 month.
C. not attributable to an associated
gastrointestinal or other medical
condition
...
D. does not occur exclusively dur-
ing the course of other eating dis-
orders
... E. If the symptoms occur in the con-
text of another mental disorder
they are sufficiently severe to war-
rant additional clinical attention.
Specify if:
In remission
EATING DISORDERS
Avoidant/Restrictive Food Intake Disorder
A. An eating or feeding disturbance:
persistent failure to meet appropri-
ate nutritional and/or energy needs
associated with 1/4:
1. Significant weight loss
2. Significant nutritional deficiency.
3. Dependence on enteral feeding or
oral nutritional supplements.
4. Marked interference with psycho-
social functioning.
B. The disturbance is not better ex-
plained by lack of available food or
by an associated culturally sanc-
tioned practice.
C. DD: exclude anorexia nervosa or
bulimia nervosa: no evidence of a dis-
turbance in the way in which one’s
body weight or shape is experienced.
D. DD: a concurrent medical condition /
another mental disorder.
Specify if:
In remission
Anorexia Nervosa
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.
B. Emotions (intense fear) or behavior (per-
sistent interfere) concerning weight gain
even though at a significantly low weight.
C. Cognition (Body image):
1. Disturbance in the way in which one’s
body weight or shape is experienced,
2.undue influence of body weight or shape
on self-evaluation,
3. persistent lack of recognition of the seri-
ousness of the current low body weight.
Specify whether:
Restricting type: no recurrent episodes of
binge / purge behavior during the last 3 months
Binge-eating/purging type: recurrent epi-
sodes of binge / purge behavior during the last
3 months
Specify if:
In partial remission / In full remission
Specify current severity:
Mild: BMI ≥ 17 kg/m2
Moderate: BMI 16–16.99 kg/m2
Severe: BMI 15–15.99 kg/m2
Extreme: BMI < 15 kg/m2
Bulimia Nervosa
A. Recurrent episodes of binge
eating that characterized by:
1. ↑amount of food /discrete peri-
od of time (e.g., within any 2-
hour period),
2. A sense of lack of control over
eating
B. Recurrent inappropriate com-
pensatory behaviors in order to
prevent weight gain,
C. Rate & duration: at least once a
week for 3 months.
D. Self-evaluation is unduly influ-
enced by body shape and
weight.
E. DD: Exclude anorexia nervosa.
Specify if:
In partial remission /
In full remission
Specify current severity:
The minimum level of severity is
based on the frequency of inappro-
priate compensatory behaviors
Mild: 1–3 / week.
Moderate: 4–7 episodes / week.
Severe: 8–13 episodes / week.
Extreme: 14 or more / week.

whether involuntary or :]437‫عليه تعليق [أحمد‬
intentional.
‫أحمد[ تعليق عليه‬431]: 2. (e.g., a feeling that one can-
not stop eating or control what or how much one is eating).
( chronological or equivalent :]438‫عليه تعليق [أحمد‬
developmental level).
Passage of urine only during :]439‫عليه تعليق [أحمد‬
nighttime sleep
Passage of urine during waking :]440‫عليه تعليق [أحمد‬
hours
A combination of the two :]441‫عليه تعليق [أحمد‬
subtypes above
(e.g., clothing, floor), whether :]442‫عليه تعليق [أحمد‬
involuntary or intentional.
(e.g., self-induced vomiting; :]434‫عليه تعليق [أحمد‬
misuse of laxatives, diuretics, or other medications)
‫أحمد[ تعليق عليه‬435]: To influence weight or shape
(Chronological or equivalent :]443‫عليه تعليق [أحمد‬
developmental level).
except through a mechanism :]444‫عليه تعليق [أحمد‬
involving constipation
‫أحمد[ تعليق عليه‬445]: There is evidence of constipation
on physical examination or by history.
‫أحمد[ تعليق عليه‬446]: There is no evidence of constipa-
tion on physical examination or by history.
such as changes in the :]436‫عليه تعليق [أحمد‬
individual’s sleep-wake cycle or by local social norms.
After full criteria for binge-eating :]432‫عليه تعليق [أحمد‬
disorder were previously met, binge eating occurs at an
average frequency of less than one episode per week for a
sustained period of time.
‫أحمد[ تعليق عليه‬433]: After full criteria for binge-
eating disorder were previously met, none of the criteria have
been met for a sustained period of time.
EATING DISORDERS contin.
Binge-Eating Disorder
A. Recurrent episodes of binge eating, each
is characterized by 2/2:
1. ↑amount of food /discrete period of time
(e.g., within any 2-hour period),
2. A sense of lack of control over eating
B. The binge-eating episodes are associated
with 3/5:
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 embar-
rassed by how much one is eating.
5. Feeling disgusted with oneself, de-
pressed, or very guilty afterward.
C. Marked distress regarding binge eating.
D. Rate: at least once a week
duration: for 3 months.
E. DD:
Exclude bulimia nervosa: (no recurrent use
of inappropriate compensatory behavior)
Exclude anorexia nervosa (no restrictive,
purging, underweight)
Specify if:
In partial remission
In full remission
Specify current severity:
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.
Other Specified Feeding or Eating Disorder
feeding and eating disorder symptoms + clinically signifi-
cant distress or impairment + not meet the full criteria for
feeding and eating disorders diagnostic class+ specific
reason
Examples:
1. Atypical anorexia nervosa: significant weight loss but
the individual’s weight is within or above the normal
range.
2. Bulimia nervosa (of low frequency and/or limited
duration): Rate of the binge eating / compensatory:
less than once a week and/or for less than 3 months.
3. Binge-eating disorder (of low frequency and/or lim-
ited duration): Rate: less than once a week and/or
duration: for less than 3 months.
4. Purging disorder: Recurrent purging behavior with-
out binge eating.
5. Night eating syndrome:
1. Recurrent episodes of night eating, ( after
awakening from sleep or by excessive food
consumption after the evening meal).
2. There is awareness and recall of the eating.
3. no explained by external influences
4. significant distress and/or impairment in func-
tioning.
5. DD: Exclude 1. binge-eating disorder 2. an-
other mental disorder (SUD) 3. another medi-
cal disorder 4. medication.
Unspecified Feeding or Eating Disorder
feeding and eating disorder symptoms + clinically signifi-
cant distress or impairment + not meet the full criteria for
feeding and eating disorders diagnostic class+ no specific
reason
ELIMINATION DISORDERS
Enuresis
A. Repeated voiding of urine into bed or clothes,
B. Either: 1. frequency: ≥ twice a week for ≥ 3 consecutive
months or 2. significant distress or impairment.
C. age ≥ 5 years
D. DD: substance (e.g., a diuretic, an antipsychotic medication)
or another medical condition (e.g., diabetes, spina bifida, a
seizure disorder).
Specify whether:
Nocturnal only.
Diurnal only.
Nocturnal and diurnal
Encopresis
A. Repeated passage of feces into inappropriate places
B. frequency: ≥ 1 month for at least 3 months.
C. age ≥ 4 years
D. DD: substance (e.g., laxatives) or another medical condition.
Specify whether:
With constipation and overflow incontinence:
Without constipation and overflow incontinence:
Other Specified Elimination Disorder
elimination disorder Symptoms + significant distress or impair-
ment + do not meet the full criteria for elimination disorders di-
agnostic class + specific reason (e.g., “low-frequency enuresis”).
Unspecified Elimination Disorder
elimination disorder Symptoms + significant distress or impair-
ment + do not meet the full criteria for elimination disorders di-
agnostic class + specific reason (e.g., “low-frequency enuresis”).
 . (In children: without caregiver :]447‫عليه تعليق [أحمد‬ Insomnia Disorder
intervention.)
A. A predominant complaint of dissatisfaction
‫أحمد[ تعليق عليه‬448]: characterized by frequent awak- with sleep quantity or quality, + ≥ 1/3:
enings or problems returning to sleep after awakenings. (In
children, this may manifest as difficulty returning to sleep 1. Difficulty initiating sleep
without caregiver intervention.)
2. Difficulty maintaining sleep,
with inability to return to sleep :]449‫عليه تعليق [أحمد‬ 3. Early-morning awakening.
(seconds to minutes) :]456‫عليه تعليق [أحمد‬ B. significant distress or impairment
C. Rate: ≥ 3 nights per week.
In individuals with long-standing :]457‫عليه تعليق [أحمد‬
disease D. Duration: ≥ 3 months.
E. adequate opportunity for sleep.
In children or in individuals :]458‫عليه تعليق [أحمد‬
F. DD: exclude another sleep-wake disorder
within 6 months of onset
G. DD: substance
(e.g., narcolepsy, a breathing- :]450‫عليه تعليق [أحمد‬
H. DD: mental disorders and medical conditions that
related sleep disorder, a circadian rhythm sleep-wake
disorder, a parasomnia). adequately explain the predominant complaint of
insomnia.
in cognitive, social, :]453‫عليه تعليق [أحمد‬
occupational, or other important areas of functioning. Specify if:
‫أحمد[ تعليق عليه‬459]: 1.(CSF) hypocretin-1 immu- With non–sleep disorder mental comorbidity,
noreactivity values (less than or equal to one-third of val- With other medical comorbidity
ues obtained in healthy subjects tested using the same as- With other sleep disorder
say, or less than or equal to 110 pg/mL). Low CSF levels
of hypocretin-1 must not be observed in the context of Specify if:
acute brain injury, inflammation, or infection. Episodic: symptoms last 1 - 3 months.
Nocturnal sleep :]460‫عليه تعليق [أحمد‬
Persistent: ≥ 3 months.
polysomnography Recurrent: ≥2 episodes /1 year.
other specified insomnia disorder:
By multiple sleep latency test :]461‫عليه تعليق [أحمد‬
Acute and short-term insomnia
including substance use disorders :]451‫عليه تعليق [أحمد‬
Criterion B requirements of low :]462‫عليه تعليق [أحمد‬
...
CSF hypocretin-1 levels and positive
Criterion B requirements of :]463‫عليه تعليق [أحمد‬
...
, including substance use :]454‫عليه تعليق [أحمد‬
...
This subtype is caused by exon :]464‫عليه تعليق [أحمد‬
...
‫أحمد[ تعليق عليه‬465]: Narcolepsy, obesity, and type 2 ...
‫أحمد[ تعليق عليه‬466]: infectious (e.g., Whipple’s dis- ...
‫أحمد[ تعليق عليه‬452]: (i.e., symptoms lasting less than...
‫أحمد[ تعليق عليه‬455]: Specify severity based on degree...
‫أحمد[ تعليق عليه‬467]: (i.e., movements, insomnia, and...
Hypersomnolence Disorder Narcolepsy
A. Self-reported excessive sleepiness (hypersomno- A. 1. Recurrent periods of an irrepressible need to sleep, laps-
lence) despite a main sleep period lasting at least ing into sleep, or napping occurring within the same day.
7 hours + ≥ 1/3: 2. rate: ≥ 3 times per week & duration: 3 months.
1. Recurrent periods of sleep or lapses into B. ≥ 1/3:
sleep within the same day. 1. Episodes of cataplexy, ≥ a few times per month, that is a
2. A prolonged main sleep episode of more than or b:
9 hours per day that is nonrestorative (i.e., un-
a. brief episodes of sudden bilateral loss of muscle
refreshing).
3. Difficulty being fully awake after abrupt awak- tone + maintained consciousness + precipitated by
ening. laughter or joking.
b. spontaneous grimaces or jaw-opening episodes +
B. Rate: ≥ 3 times / week, duration: ≥ 3 months.
tongue thrusting / a global hypotonia + no any obvi-
C. distress or impairment.
ous emotional triggers.
D. DD: exclude another sleep disorder (e.g., narco-
lepsy, breathing-related sleep disorder, circadian 2. Hypocretin deficiency (CSF)
3. REM: 1.(REM) sleep latency ≤ 15 minutes /or 2. (mean
rhythm sleep-wake disorder, or a parasomnia).
E. DD: exclude substance. sleep latency ≤ 8 minutes + ≥ 2 sleep-onset REM peri-
F. DD: mental and medical disorders that ade- ods).
quately explain the predominant complaint of hy- Specify whether:
persomnolence. (- cataplexy, + hypocretin deficiency)
Specify if: (+ cataplexy, - hypocretin deficiency) (rare 5%)
With mental disorder Autosomal dominant cerebellar ataxia, deafness, and
With medical condition narcolepsy
With another sleep disorder Autosomal dominant narcolepsy, obesity, and type 2 di-
Specify if: abetes
Acute: Duration < 1 month. Narcolepsy secondary to another medical condition
Subacute: Duration of 1–3 months.
Persistent: Duration > 3 months. Specify current severity:
Mild: cataplexy < 1/week, + need for naps 1-2 / day, + less
Specify current severity:
disturbed nocturnal sleep.
Mild: Difficulty maintaining daytime alertness 1–2
Moderate: Cataplexy 1/ day or every few days + need for
days/week.
multiple naps daily + disturbed nocturnal sleep.
Moderate: Difficulty maintaining daytime
Severe: Drug-resistant cataplexy with multiple attacks daily,
alertness 3–4 days/week.
+ nearly constant sleepiness + disturbed nocturnal sleep
Severe: Difficulty maintaining daytime
alertness 5–7 days/week.

snoring, snorting/gasping, or :]468‫عليه تعليق [أحمد‬
breathing pauses during sleep
‫أحمد[ تعليق عليه‬469]: a.Daytime sleepiness, fatigue,
or unrefreshing sleep despite sufficient opportunities to
sleep that is not better explained by another mental disor-
der (including a sleep disorder) and is not attributable to
another medical condition.
regardless of accompanying :]470‫عليه تعليق [أحمد‬
symptoms
Characterized by repeated :]471‫عليه تعليق [أحمد‬
episodes of apneas and hypopneas during sleep caused by
variability in respiratory effort but without evidence of
airway obstruction.
A pattern of periodic crescendo :]472‫عليه تعليق [أحمد‬
decrescendo variation in tidal volume that results in central
apneas and hypopneas at a frequency of at least five events
per hour, accompanied by frequent arousal.
‫أحمد[ تعليق عليه‬473]: The pathogenesis of this subtype
is attributed to the effects of opioids on the respiratory
rhythm generators in the medulla as well as the differential
effects on hypoxic versus hypercapnic respiratory drive.
This subtype is not attributable to :]474‫عليه تعليق [أحمد‬
any readily identified condition
‫أحمد[ تعليق عليه‬475]: This subtype is a rare congenital
disorder in which the individual typically presents in the
perinatal period with shallow breathing, or cyanosis and ap-
nea during sleep
‫أحمد[ تعليق عليه‬476]: This subtype occurs as a conse-
quence of a medical condition, such as a pulmonary disorder
(e.g., interstitial lung disease, chronic obstructive pulmonary
disease) or a neuromuscular or chest wall disorder (e.g.,
muscular dystrophies, postpolio syndrome, cervical spinal
cord injury, kyphoscoliosis), or medications (e.g., benzodiaz-
epines, opiates). It also occurs with obesity (obesity
hypoventilation disorder), where it reflects a combination of
increased work of breathing due to reduced chest wall com-
pliance and ventilation-perfusion mismatch and variably
reduced ventilatory drive. Such individuals usually are char-
acterized by body mass index of greater than 30 and hyper-
capnia during wakefulness (with a pCO2 of greater than 45),
without other evidence of hypoventilation.
‫أحمد[ تعليق عليه‬477]: delayed sleep onset and awak-
ening times, with an inability to fall asleep and awaken at a
desired or conventionally acceptable earlier time.
BREATHING-RELATED SLEEP DISORDERS
Obstructive Sleep Apnea Hypopnea
A. Either (1) or (2):
1. PSG ≥ 5 obstructive apneas or hypopneas / hour + Nocturnal breathing disturbances /or unrefreshing sleep
2. PSG ≥ 15 obstructive apneas and/or hypopneas / hour.
Specify current severity:
Mild: Apnea hypopnea index < 15.
Moderate: Apnea hypopnea index = 15–30.
Severe: Apnea hypopnea index > 30.
Central Sleep Apnea
A. PSG ≥ 5 central apneas per hour of sleep + B. exclude another current sleep disorder.
Specify whether:
Idiopathic central sleep apnea
Cheyne-Stokes breathing
Central sleep apnea comorbid with opioid use
Sleep-Related Hypoventilation
A. PSG: episodes of ↓ respiration + (↑ CO2 levels /or persistent ↓Hb O2 SAT whithout apneic/hypopneic events)
B. exclude current sleep disorder.
Specify whether:
Idiopathic hypoventilation.
Congenital central alveolar hypoventilation.
Comorbid sleep-related hypoventilation
Circadian Rhythm Sleep-Wake Disorders
A. A persistent or recurrent sleep disruption due to an alteration of the circadian system or to a misalignment between
the endogenous circadian rhythm and the sleep–wake schedule required by an individual’s physical environment
or social or professional schedule.
B. excessive sleepiness or insomnia, or both.
C. distress or impairment.
Specify whether:
Delayed sleep phase type: may be familial , may overlap with non-24-hour sleep-wake type
Advanced sleep phase type. may be familial
Irregular sleep-wake type
Non-24-hour sleep-wake type sleep-wake cycles not synchronized to the 24-hour environment, with a consistent
daily drift of sleep onset and wake times.
Shift work type
Unspecified type

advanced sleep onset and :]478‫عليه تعليق [أحمد‬ Specify if:

awakening times, with an inability to remain awake or asleep Episodic: Symptoms 1-3 months.
until the desired or conventionally acceptable later sleep or Persistent: Symptoms ≥ 3 ms.
wake times
Recurrent: ≥ 2 episodes / 1 year.
‫أحمد[ تعليق عليه‬479]: A temporally disorganized sleep
wake pattern, such that the timing of sleep and wake periods
is variable throughout the 24-hour period.
(usually to later and later times) :]480‫عليه تعليق [أحمد‬
‫أحمد[ تعليق عليه‬481]: : Insomnia during the major
sleep period and/or excessive sleepiness (including inadvert-
ent sleep) during the major awake period associated with a
shift work schedule (i.e., requiring unconventional work
hours).
 PARASOMNIAS
Parasomnias are disorders characterized by abnormal behavioral, experiential, or physiological events occurring in asso-
ciation with sleep, specific sleep stages, or sleep-wake transitions.

Non–Rapid Eye Movement Sleep Arousal Disorders

A. Recurrent episodes of incomplete awakening from sleep, usually occurring during the first third of the major sleep
episode (in deep sleep NREM 3,4), accompanied by either one of the following:
1. Sleepwalking: Repeated episodes of rising from bed during sleep and walking about. While sleepwalking:
1.the individual has a blank, staring face;
2. relatively unresponsive to the efforts of others to communicate with him or her
3.can be awakened only with great difficulty.
2. Sleep terrors: Recurrent episodes of abrupt terror arousals from sleep,
1.usually beginning with a panicky scream.
such as mydriasis, tachycardia, :]482‫عليه تعليق [أحمد‬ 2.There is intense fear and signs of autonomic arousal .
rapid breathing, and sweating, 3.There is relative unresponsiveness to efforts of others to comfort the individual during the episodes.
B. No or little dream imagery is recalled (e.g., only a single visual scene).
C. Amnesia for the episodes is present.
D. distress or impairment.
E. DD: exclude substance.
F. DD: exclude other causative mental and medical disorders.
specify:
Sleepwalking type
Specify if:
With sleep-related eating
With sleep-related sexual behavior (sexsomnia)
Sleep terror type

Nightmare Disorder
A. Repeated occurrences of 1.extended, 2.extremely dysphoric, 3. well-remembered dreams 4. Unpleasant Con-
usually involve efforts to avoid :]483‫عليه تعليق [أحمد‬ tent, 5. Timing: the second half of the major sleep episode.
threats to survival, security, or physical integrity B. After awakening state: rapidly becomes oriented and alert.
C. distress or impairment.
D. DD: exclude substance.
E. DD: exclude causative mental or medical condition.
Specify if:
During sleep onset
Specify if:
With associated non–sleep disorder, including substance use disorders
With associated other medical condition
With associated other sleep disorder
Specify if:
Acute: Duration ≤1 month.
Subacute: 1- 6 months.
Persistent: ≥ 6 months.
Specify current severity (frequency):
Mild: < 1 /week.
Moderate: ≥ 1 /week
Severe: Episodes nightly.

(e.g., Parkinson’s disease, :]484‫عليه تعليق [أحمد‬
multiple system atrophy).
(e.g., arthritis, leg edema, :]485‫عليه تعليق [أحمد‬
peripheral ischemia, leg cramps)
(e.g., positional discomfort, :]486‫عليه تعليق [أحمد‬
habitual foot tapping)
from the history, physical :]487‫عليه تعليق [أحمد‬
examination, or laboratory findings
in social, occupational, or other :]488‫عليه تعليق [أحمد‬
important areas of functioning.
‫أحمد[ تعليق عليه‬489]: Characterized by difficulty fall-
ing asleep or maintaining sleep, frequent nocturnal awaken-
ings, or nonrestorative sleep.
Characterized by predominant :]490‫عليه تعليق [أحمد‬
complaint of excessive sleepiness/fatigue during waking
hours or, less commonly, a long sleep period
Characterized by abnormal :]491‫عليه تعليق [أحمد‬
behavioral events during sleep
Rapid Eye Movement Sleep Behavior Disorder
A. Description: Repeated episodes of arousal during sleep associated with vocalization and/or complex motor be-
haviors.
B. Timing: during (REM) → occur >90 minutes after sleep onset, ↑ during the later portions of the sleep period, and
uncommonly occur during daytime naps.
C. Post awakening state: completely awake, alert, and not confused or disoriented.
D. Either of the following:
1. PSG: REM sleep without atonia.
2. A history suggestive of REM sleep behavior disorder + established synucleinopathy diagnosis
E. distress or impairment (include injury).
F. DD: exclude substance or another medical condition.
G. Coexisting mental and medical disorders do not explain the episodes.
Restless Legs Syndrome
A. An urge to move the legs + uncomfortable and unpleasant sensations in the legs:
1. begins or worsens during periods of rest or inactivity.
2. partially or totally relieved by movement.
3. is worse in the evening or at night than during the day, or occurs only in the evening or at night.
B. Rate: ≥ 3 times / week , duration: ≥ 3 months.
C. distress or impairment.
D. DD: exclude another mental disorder or medical condition or behavioral condition.
E. DD: exclude substance (e.g., akathisia).
Substance/Medication-Induced Sleep Disorder
A. A prominent and severe disturbance in sleep.
C. There is evidence of both (1) and (2):
5. The symptoms in developed during or soon after substance intoxication / withdrawal / exposure to a medication.
6. The involved substance/medication is capable of producing the symptoms
F. No any of the following evidence that indicate independent sleep disorder:
13. The symptoms precede the onset of the substance/medication use;
14. the symptoms persist for a substantial period of time (e.g., about 1 month) after the cessation of acute withdrawal
or severe intoxication
15. a history of recurrent non-substance/ medication-related episodes.
G. DD: delirium.
H. The disturbance causes clinically significant distress or impairment
Specify whether:
Insomnia type
Daytime sleepiness type.
Parasomnia type.
Mixed type.
Specify if
With onset during intoxication
With onset during discontinuation/withdrawal
Other Specified Insomnia Disorder
insomnia disorder symptoms + distress or impairment + do not meet the full criteria for insomnia disorder + specific
reason
Examples:
1. Brief insomnia disorder: Duration is less than 3 months.
2. Restricted to nonrestorative sleep: Predominant complaint is nonrestorative sleep unaccompanied by other
sleep symptoms such as difficulty falling asleep or remaining asleep.
Unspecified Insomnia Disorder
insomnia disorder symptoms + distress or impairment + do not meet the full criteria for insomnia disorder + no specific
reason
Other Specified Hypersomnolence Disorder
Hypersomnolence disorder symptoms + distress or impairment + do not meet the full criteria for insomnia disorder +
specific reason
(e.g., “brief-duration hypersomnolence,” as in Kleine-Levin syndrome).
Unspecified Hypersomnolence Disorder
Hypersomnolence disorder symptoms + distress or impairment + do not meet the full criteria for insomnia disorder +
no specific reason

Other Specified Sleep-Wake Disorder

Specified Sleep-Wake Disorder symptoms + distress or impairment + do not meet the full criteria for Sleep-Wake Dis-
order symptoms disorder + do not qualify for a diagnosis of unspecified insomnia disorder or unspecified hypersomno-
lence disorder + specific reason
(e.g., “repeated arousals during rapid eye movement sleep without polysomnography or history of Parkinson’s dis-
ease or other synucleinopathy”).
Unspecified Sleep-Wake Disorder
Specified Sleep-Wake Disorder symptoms + distress or impairment + do not meet the full criteria for Sleep-Wake Dis-
order symptoms disorder + do not qualify for a diagnosis of unspecified insomnia disorder or unspecified hypersomno-
lence disorder.
+ specific reason
Sexual Dysfunction
Delayed Ejaculation
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. Marked delay in ejaculation.
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 rela-
tionship 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.

Erectile Disorder
At least one of the three following symptoms must be experienced on almost all or all (approximately 75%–100%) oc-
casions of sexual activity (in identified situational contexts 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 decrease 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 nonsexual mental disorder or as a consequence of severe rela-
tionship distress or other significant stressors and is not attributable to the effects of a substance/medication or anoth-
er 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.

Female Orgasmic Disorder

Female orgasmic disorder involves recurrent delay in, marked infrequency of, or absence of orgasm, or markedly reduced intensi-
ty of orgasmic sensations. Women demonstrate wide variability in the type and intensity of stimulation needed for orgasm. For
this reason, the diagnosis requires that the symptoms are experienced on almost all occasions of sexual activity.
DSM-5 includes three important changes to female orgasmic disorder. “Marked infrequency” of orgasms and “reduced inten-
sity of orgasmic sensations” have been added as symptoms, either of which can fulfill the diagnosis. The addition of “markedly
reduced intensity of orgasmic sensations” reflects the fact that orgasm is not an “all or nothing” phenomenon and that diminished
intensity of orgasm may be a problem for some women. In addition, in DSM-5, the phrase “following a normal sexual excitement
phase” has been deleted because a woman’s experience of sexual excitement is not uniform, there is good evidence of substantial
variability, and none of the prevalence studies have assessed what constitutes a “normal sexual excitement phase.”

Female Sexual Interest/Arousal Disorder

In DSM-5, aspects of both hypoactive sexual desire disorder and female sexual arousal disorder have been combined to create
female sexual interest/arousal disorder. The diagnosis applies when a woman has either a lack of interest in sexual activity or an
inability to attain or maintain arousal.
The name change reflects the common experience that desire and (at least subjective) arousal highly overlap. In some women,
desire precedes arousal; in other women, desire follows arousal. There are inconsistencies in how desire is defined, with some
definitions focusing on sexual behavior as an indicator of desire, others focusing on spontaneous sexual thoughts and fantasies,
and still others emphasizing the responsive nature of women’s desire. The word desire in DSM-IV hypoactive sexual desire dis-
order has been changed to interest because desire connotes a deficiency and often implies a biological urge. The phrase “an ade-
quate lubrication-swelling response of sexual excitement” in DSM-IV female sexual arousal disorder has been eliminated because
evidence suggests that increases in vaginal blood flow during exposure to sexual stimuli may be a relatively “automatic re-
sponse,” and one that women may or may not be aware of. Furthermore, there is little evidence that women with a sexual arousal
disorder have impaired genital response; lubrication may or may not co-occur with subjective arousal. Finally, there is evidence
that women report a wide range of nongenital and genital changes, and it is unclear how common the “lubrication-swelling re-
sponse” is.

Genito-Pelvic Pain/Penetration Disorder

Genito-pelvic pain/penetration disorder applies when a person has pain or discomfort, muscular tightening, or fear or anxiety
about pain when having sexual intercourse. This disorder reflects a change from DSM-IV, in which two distinct disorders—
dyspareunia and vaginismus—were used to diagnose sexual pain disorders, both now subsumed within this new category.
Dyspareunia and vaginismus were unreliable diagnoses, and it was difficult for clinicians to distinguish between them. The new
category will correct that situation, yet allow for the diagnosis of pain and penetration disorders. This will also provide a frame-
work to facilitate clinician evaluation, diagnosis, and referral.

Male Hypoactive Sexual Desire Disorder

Male hypoactive sexual desire disorder applies when a man has diminished desire for sexual activity and few if any sexual
thoughts or fantasies (Brotto 2010). Because DSM5 has a new diagnosis for low sexual desire and arousal problems in women
(i.e., female sexual interest/arousal disorder), male hypoactive sexual desire disorder was created to enable a clinician to diagnose
a man’s diminished sexual desire. Other than the general changes to the category of sexual dysfunction in DSM-5, as stated earli-
er in this chapter, the criteria for male hypoactive sexual desire disorder are essentially unchanged from DSM-IV.

Premature (Early) Ejaculation

Early ejaculation is a condition in which a man ejaculates “during partnered sexual activity within approximately 1 minute fol-
lowing vaginal penetration and before the individual wishes it.” Early ejaculation is more common in novel sexual situations and
in men who have had a substantial interval since last orgasm.
The definition of early ejaculation has been operationalized by the use of “approximately 1 minute” as the amount of time af-
ter initiation of sexual activity that ejaculation occurs.
DSM-5 notes that premature (early) ejaculation can occur during nonvaginal sexual activities, but that specific duration crite-
ria have not been established and thus are not included.

Substance/Medication-Induced Sexual Dysfunction

Substance/medication-induced sexual dysfunction applies when a clinically significant sexual dysfunction develops during or
soon after substance intoxication or withdrawal or exposure to a medication, and the substance/medication is capable of produc-
ing the symptoms. Acute intoxication with or chronic abuse of various substances (e.g., alcohol, nicotine, opiates, sedatives) may
result in sexual dysfunction. In addition, many medications (e.g., antihypertensives, antidepressants, antipsychotics) may cause a
decrease in sexual interest and result in sexual performance difficulties.
Diagnostic Criteria for Substance/Medication-Induced Sexual Dysfunction

A. A clinically significant disturbance in sexual function is predominant in the clinical pic-ture.

B. There is evidence from the history, physical examination, or laboratory findings ofboth (1) and (2):
1. The symptoms in Criterion A developed during or soon after substance intoxication or withdrawal or after expo-
sure to a medication.
2. The involved substance/medication is capable of producing the symptoms inCriterion A.
C. The disturbance is not better explained by a sexual dysfunction that is not sub-stance/medication-induced. Such
evidence of an independent sexual dysfunction could include the following:
The symptoms precede the onset of the substance/medication use; the symptoms persist for a substantial peri-
od 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 non-substance/medication-induced sexual dysfunction
(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 in the individual.
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 are sufficiently severe to warrant clinical at-
tention.
Specify if (see Table 16–1 in the chapter “Substance-Related and Addictive Disorders” for diagnoses associated with
substance class):
With onset during intoxication: If the criteria are met for intoxication with the substance and the symptoms de-
velop 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: Symptoms may appear either at initiation of medication or after a modification
or change in use.
Specify current severity:
Mild: Occurs on 25%–50% of occasions of sexual activity.
Moderate: Occurs on 50%–75% of occasions of sexual activity. Severe: Occurs on 75% or more of oc-
casions of sexual activity.

Other Specified Sexual Dysfunction and Unspecified Sexual Dys-

function
Sexual dysfunctions that do not meet criteria for any specific sexual dysfunction are classified as other specified or unspecified
sexual dysfunction. The “other specified” diagnosis is appropriate when the clinician has concluded that a sexual dysfunction is
present but does not meet the full criteria for any of the disorders. In this instance the clinician chooses to communicate the spe-
cific reason the presentation does not meet the criteria (e.g., by specifying “sexual aversion”). The category unspecified sexual
dysfunction applies when symptoms of sexual dysfunction are present but the clinician chooses not to specify why the criteria are
not met for a specific disorder. It may also be used when there is insufficient information to make a more specific diagnosis of a
sexual dysfunction.
GENDER DYSPHORIA

Gender Dysphoria in Children

A. A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6
months’ duration, 6/8(1st must be present):
1. A strong desire to be of the other gender or an insistence that one is the other gender (or some alternative gen-
der different from one’s assigned gender).
2. In boys (assigned gender), a strong preference for cross-dressing or simulating female attire; or in girls (as-
signed gender), a strong preference for wearing only typical masculine clothing and a strong resistance to the
wearing of typical feminine clothing.
3. A strong preference for cross-gender roles in make-believe play or fantasy play.
4. A strong preference for the toys, games, or activities stereotypically used or engaged in by the other gender.
5. A strong preference for playmates of the other gender.
6. In boys (assigned gender), a strong rejection of typically masculine toys, games, and activities and a strong
avoidance of rough-and-tumble play; or in girls (assigned gender), a strong rejection of typically feminine toys,
games, and activities.
7. A strong dislike of one’s sexual anatomy.
8. A strong desire for the primary and/or secondary sex characteristics that match one’s experienced gender.
B. The condition is associated with clinically significant distress or impairment in social, school, or other im-
portant areas of functioning.
Specify if:
With a disorder of sex development (e.g., a congenital adrenogenital disorder such as congenital adrenal hy-
perplasia or androgen insensitivity syndrome).

Gender Dysphoria in Adolescents and Adults

A. A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6
months’ duration, as manifested by at least two of the following:
1. A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex
characteristics (or in young adolescents, the anticipated secondary sex characteristics).
2. A strong desire to be rid of one’s primary and/or secondary sex characteristics because of a marked incongru-
ence with one’s experienced/expressed gender (or in young adolescents, a desire to prevent the development
of the anticipated secondary sex characteristics).
3. A strong desire for the primary and/or secondary sex characteristics of the other gender.
4. A strong desire to be of the other gender (or some alternative gender different from one’s assigned gender).
5. A strong desire to be treated as the other gender (or some alternative gender different from one’s assigned
gender).
6. A strong conviction that one has the typical feelings and reactions of the other gender (or some alternative gen-
der different from one’s assigned gender).
B. The condition is associated with clinically significant distress or impairment in so-cial, occupational, or other im-
portant areas of functioning.
Specify if:
With a disorder of sex development (e.g., a congenital adrenogenital disorder such as congenital adrenal hy-
perplasia or androgen insensitivity syndrome)
Specify if:
Posttransition: The individual has transitioned to full-time living in the desired gender (with or without legalization
of gender change) and has undergone (or is preparing to have) at least one cross-sex medical procedure or treat-
ment regimen—namely, regular cross-sex hormone treatment or gender reassignment surgery confirming the de-
sired gender (e.g., penectomy, vaginoplasty in a natal male; mastectomy or phalloplasty in a natal female).

.

‫أحمد[ تعليق عليه‬492]: This specifier is primarily appli-
cable to individuals living in institutional or other settings
where opportunities to engage in voyeuristic behavior are
restricted.
in the process of disrobing, or :]493‫عليه تعليق [أحمد‬
engaging in sexual activity
‫أحمد[ تعليق عليه‬494]: Note: Do not include an individ-
ual in late adolescence involved in an ongoing sexual rela-
tionship with a 12- or 13-year-old.
PARAPHILIC DISORDERS
A. Duration: ≥ 6 months, recurrent and intense sexual arousal (fantasies, urges, or behaviors) from abnormal per-
ceived sexual stimuli
B. sexual urges or fantasies cause either 1. sexual act with a nonconsenting person 2. distress or impairment.
For all except pedophilic Specify if:
In a controlled environment
In full remission: criterion B (act or destress/impairment due to urges) not present ≥ 5 years while in an uncontrolled
environment
Disorders according abnormal perceived sexual stimuli
Voyeuristic Disorder
observing an unsuspecting person who is naked criterion c: ≥18 years of age
Exhibitionistic Disorder
exposure of one’s genitals to an unsuspecting person specifier: prepubertal children /physically mature individu-
als/ both
Frotteuristic Disorder
touching or rubbing against a nonconsenting person
Sexual Masochism Disorder
act of being humiliated, beaten, bound, or otherwise made to suffer
Specify if: With asphyxiophilia: If the individual engages in the practice of achieving sexual arousal related to re-
striction of breathing.
Sexual Sadism Disorder
physical or psychological suffering of another person
Pedophilic Disorder
Involving sexual activity with a prepubescent child or children (generally age 13 years or younger).
Criterion c: The individual is at least age 16 years and at least 5 years older than the child or children.
Specify whether: Exclusive type (attracted only to children) /Nonexclusive type
Specify if: Sexually attracted to males / females/ both
Specify if: Limited to incest
Fetishistic Disorder
either the use of nonliving objects or a highly specific focus on nongenital body part(s),
criterion 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
Transvestic Disorder
cross-dressing
Specify if:
With fetishism: If sexually aroused by fabrics, materials, or garments.
With autogynephilia: If sexually aroused by thoughts or images of self as female.
Other Specified Paraphilic Disorder
recurrent and intense sexual arousal involving
telephone scatologia (obscene phone calls),
necrophilia (corpses‫)جثة‬,
zoophilia (animals),
coprophilia (feces),
klismaphilia (enemas),
urophilia (urine)

the frequency and intensity of the :]495‫عليه تعليق [أحمد‬
behaviors are outside a range that is normative for the
individual’s developmental level, gender, and culture
(e.g., at home, at school, at work, :]496‫عليه تعليق [أحمد‬
with peers).
(e.g., temper tantrums, tirades, :]497‫عليه تعليق [أحمد‬
verbal arguments or fights)
The physical aggression does not :]498‫عليه تعليق [أحمد‬
result in damage or destruction of property and does not
result in physical injury to animals or other individuals.
toward property, animals, or :]499‫عليه تعليق [أحمد‬
other individuals, occurring
‫أحمد[ تعليق عليه‬500]: A.The magnitude of aggres-
siveness expressed during the recurrent outbursts is
grossly out of proportion to the provocation or to any
precipitating psychosocial stressors.
Disruptive, Impulse-Control, and
Conduct Disorders
Oppositional Defiant Disorder
A. angry/irritable mood, argumentative/defiant behavior, or vindictiveness exhibited during inter-
action with at least one individual who is not a sibling.
Duration: ≥ 6 months
4/8
Angry/Irritable Mood
1. Often loses temper.
2. Is often touchy or easily annoyed.
3. Is often angry and resentful.
Argumentative/Defiant Behavior
4. Often argues with authority figures or, for children and adolescents, with adults.
5. Often actively defies or refuses to comply with requests from authority figures or with rules.
6. Often deliberately annoys others.
7. Often blames others for his or her mistakes or misbehavior.
Vindictiveness
8. Has been spiteful or vindictive at least twice within the past 6 months.
RATE: For age < 5 years : most days , For age ≥ 5 years: ≥ once / week
B. Distress / impaired functioning.
C. DD: exclude: psychotic, substance use, depressive, or bipolar disorder, disruptive mood dysregu-
lation disorder.
Specify current severity:
Mild: one setting , Moderate: at least two settings., Severe: three or more settings.
Intermittent Explosive Disorder
A. Recurrent behavioral outbursts representing a failure to control aggressive impulses as
manifested by 1/2:
1. Verbal aggression or non-destructive physical aggression
Rate: twice weekly, duration: for 3 months.
2. Three behavioral outbursts involving damage or destruction of property and/or physical
assault involving physical injury against animals or other individuals occurring within a 12-
month period.
B. out of proportion magnitude
C. The recurrent aggressive outbursts are not premeditated (i.e., they are impulsive and/or anger-
based) and are not committed to achieve some tangible objective (e.g., money, power, intimi-
dation).
D. distress or impairment in functioning, or financial or legal consequences.
E. Chronological age is at least 6 years (or equivalent developmental level).
F. DD
1. another mental disorder (e.g., major depressive disorder, bipolar disorder, disruptive mood
dysregulation disorder, a psychotic disorder, antisocial personality disorder, borderline personality
disorder)
2. medical condition (e.g., head trauma, Alzheimer’s disease)
3. a substance (e.g., a drug of abuse, a medication).
4. adjustment disorder should not be considered for this diagnosis.

Does not feel bad or guilty when :]501‫عليه تعليق [أحمد‬
he or she does something wrong (exclude remorse when
expressed only when caught and/or facing punishment)..
Disregards and is unconcerned :]502‫عليه تعليق [أحمد‬
about the feelings of others.
Does not show concern about :]503‫عليه تعليق [أحمد‬
poor/problematic performance at school, at work, or in other
important activities
Does not express feelings or :]504‫عليه تعليق [أحمد‬
show emotions to others, except in ways that seem shallow,
insincere, or superficial or when emotional expressions are
used for gain
Conduct Disorder
A. A repetitive and persistent pattern of behavior in which the basic rights of others or major age-
appropriate societal norms or rules are violated, 3/15 in the past 12 months ( + 1/15 in past 6
months):
Aggression to People and Animals
1. Often bullies, threatens, or intimidates others.
2. Often initiates physical fights.
3. Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken
bottle, knife, gun).
4. Has been physically cruel to people.
5. Has been physically cruel to animals.
6. Has stolen while confronting a victim (e.g., mugging‫سطو‬, purse snatching‫خطف المحفظة‬, extor-
tion‫ اغتصاب‬، ‫ابتزاز‬, armed robbery‫)سطو مسلح‬.
7. Has forced someone into sexual activity.
Destruction of Property
8. Has deliberately engaged in fire setting with the intention of causing serious damage.
9. Has deliberately destroyed others’ property (other than by fire setting).
Deceitfulness or Theft
10. Has broken into someone else’s house, building, or car.
11. Often lies to obtain goods or favors or to avoid obligations (i.e., “cons” ‫ يخدع‬others).
12. Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without
breaking and entering; forgery‫)تزوير‬.
Serious Violations of Rules
13. Often stays out at night despite parental prohibitions, (before age 13 years).
14. Has run away from home at least twice overnight, or once without returning for a lengthy peri-
od.
15. Is often truant from school, beginning before age 13 years.
B. impairment in functioning.
C. DD: exclude antisocial personality disorder.
Specify whether:
Childhood-onset type: ≥ 1 symptom prior to age 10 years.
Adolescent-onset type: no symptom prior to age 10 years.
Unspecified onset: not enough information available.
Specify if:
With limited prosocial emotions: persistently over at least 12 months and in multiple relation-
ships and settings 2/4:
1. Lack of remorse or guilt
2. Callous—lack of empathy
3. Unconcerned about performance.
4. Shallow or deficient affect
Specify current severity:
Mild: Few if any conduct problems in excess of those required to make the diagnosis are present,
and conduct problems cause relatively minor harm to others (e.g., lying, truancy, staying out after
dark without permission, other rule breaking).
Moderate: The number of conduct problems and the effect on others are intermediate between
those specified in “mild” and those in “severe” (e.g., stealing without confronting a victim, vandal-
ism).
Severe: Many conduct problems in excess of those required to make the diagnosis are present, or
conduct problems cause considerable harm to others (e.g., forced sex, physical cruelty, use of a
weapon, stealing while confronting a victim, breaking and entering).
Disruptive, Impulse-Control, and Conduct Disorders 37
Pyromania
A. Deliberate and purposeful fire setting on more than one occasion.
B. Tension or affective arousal before the act.
C. Fascination with, interest in, curiosity about, or attraction to fire and its situational contexts
(e.g., paraphernalia, uses, consequences).
D. Pleasure, gratification, or relief when setting fires or when witnessing or participating in their
aftermath.
E. The fire setting is not done for monetary gain, as an expression of sociopolitical ideology, to
conceal criminal activity, to express anger or vengeance, to improve one’s living circumstances, in
response to a delusion or hallucination, or as a result of impaired judgment (e.g., in major neu-
rocognitive disorder, intellectual disability [intellectual developmental disorder], substance intoxica-
tion).
F. The fire setting is not better explained by conduct disorder, a manic episode, or anti-social person-
ality disorder.

Kleptomania
A. Recurrent failure to resist impulses to steal objects that are not needed for personal use or for
their monetary value.
B. Increasing sense of tension immediately before committing the theft.
C. Pleasure, gratification, or relief at the time of committing the theft.
D. The stealing is not committed to express anger or vengeance and is not in response to a de-
lusion or a hallucination.
E. The stealing is not better explained by conduct disorder, a manic episode, or anti-social personality
disorder.
Other Specified Disruptive, Impulse-Control, and Conduct Disorder

This category applies to presentations in which symptoms characteristic of a disruptive, impulse-

control, and conduct disorder that cause clinically significant distress or impairment in social, occupa-
tional, or other important areas of functioning predominate but do not meet the full criteria for any of
the disorders in the disruptive, impulse-control, and conduct disorders diagnostic class. The other
specified disruptive, impulse-control, and conduct disorder category is used in situations in which the
clinician chooses to communicate the specific reason that the presentation does not meet the criteria
for any specific disruptive, impulse-control, and conduct disorder. This is done by recording “other
specified disruptive, impulse-control, and conduct disorder” followed by the specific reason (e.g., “re-
current behavioral outbursts of insufficient frequency”).

Unspecified Disruptive, Impulse-Control, and Conduct Disorder

This category applies to presentations in which symptoms characteristic of a disruptive, impulse-

control, and conduct disorder that cause clinically significant distress or impairment in social, occupa-
tional, or other important areas of functioning predominate but do not meet the full criteria for any of
the disorders in the disruptive, impulse-control, and conduct disorders diagnostic class. The unspeci-
fied disruptive, impulse-control, and conduct disorder category is used in situations in which the clini-
cian chooses not to specify the reason that the criteria are not met for a specific disruptive, impulse-
control, and conduct disorder, and includes presentations in which there is insufficient information to
make a more specific diagnosis (e.g., in emergency room settings).
 Substance-Related and Addictive Disorders
Diagnosis of SUD? : 2 of the following within 12 months:
1.Taken in larger amounts or over a longer period than was intended. ‫بياخد كميات أكبر أو لمدة أطول من اللي كان مخططلها‬
Diagnostic criteria

2.A persistent desire or unsuccessful efforts to cutdown or control use. ‫رغبة مستمرة أو محاوالت غير ناجحة للتبطيل أو ضبط‬
‫االستخدام‬

3. A great deal of time is spent in activities necessary to obtain, use, or recover from its effects.
‫ او استخدام او التخلص من آثار المخدر‬،‫استهالك وقت كبير في تحصيل‬

4.Craving, or a strong desire or urge to use. ‫رغبة وإلحاح قوي لالستخدام‬

5.Recurrent use resulting in a failure to fulfill major role obligations at work, school, or home.
‫استخدام متكرر يؤدي إلى الفشل في الوفاء بااللتزامات في العمل أو المدرسة أو المنزل‬

6.Continued use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by
the effects of substance. ‫االستمرار في االستخدام رغم مواجهة مشاكل اجتماعية أو في العالقات الشخصية بسبب المخدر‬

7.Important social, occupational, or recreational activities are given up or reduced because of substance use.

8.Recurrent use in situations in which it is physically hazardous.‫االستخدام المتكرر في المواقف التي يكون فيها االستخدام خطر على‬
‫الجسم‬

9. use is continued despite knowledge of having a persistent or recurrent physical or psychological problem
that is likely to have been caused or exacerbated by it.‫االستمرار في التعاطي رغم ادراك وجود مشاكل نفسية وصحية بسبب التعاطي‬

10.Tolerance
A need for markedly increased amounts of substance to achieve intoxication or desired effect.‫ رفع الجرعة للحصول على نفس األثر‬:‫التعود‬
.‫المرغوب‬
A markedly diminished effect with continued use of the same amount of alcohol.‫لم يعد يحصل على األثر المطلوب بنفس الجرعة‬

11.Withdrawal,
a.The characteristic withdrawal syndrome ‫االنسحاب ا‬
B. Substance is taken to relieve or avoid withdrawal symptoms. ‫تعاطي المخدر لتجنب او عالج اعراض االنسحاب‬
Not present in tobacco, phencyclidine, hallucinogens, inhalants
Mild: Presence of 2–3 symptoms. Moderate: Presence of 4–5 symptoms. Severe: ≥ 6 symptoms
Specify if:
In early remission: After full criteria for Drug use disorder were previously met, none of the criteria for sedative,
hypnotic, or anxiolytic use disorder have been met for 3 - 12 months (with the exception that Criterion A4, “Crav-
ing, or a strong desire or urge to use substance,” may be met).
In sustained remission: After full criteria for sedative, hypnotic, or anxiolytic use disorder were previously met,
none of the criteria for sedative, hypnotic, or anxiolytic use disorder have been met at any time during a period of
12 months or longer (with the exception that Criterion A4, “Craving, or a strong desire or urge to use the sub-
stance,” may be met).
Specify if:
In a controlled environment: the individual is in an environment where access to substance is restricted.
For Opioid:
On maintenance therapy: This additional specifier is used if the individual is taking a prescribed agonist medica-
tion such as methadone or buprenorphine and none of the criteria for opioid use disorder have been met for that
class of medication (except tolerance to, or withdrawal from, the agonist). This category also applies to those indi-
viduals being maintained on a partial agonist, an agonist/antagonist, or a full antagonist such as oral naltrexone or
depot naltrexone.
For tobacco:
On maintenance therapy: The individual is taking a long-term maintenance medication, such as nicotine re-
placement medication, and no criteria for tobacco use disorder have been met for that class of medication (except
tolerance to, or withdrawal from, the nicotine replacement medication).
 Alcohol
behavioral & psychological
inappropriate sexual or ag-
gressive behavior,
mood lability,
impaired judgment
Physical 1/6
1. Slurred speech.
2. Incoordination.
cannabis
behavioral or psychological
-↓ motor coordination,
-euphoria, anxiety,
-sensation of slowed time,
-impaired judgment,
-social withdrawal
2/4 within 2 hours of can-
nabis use:
Opioid Anxiolytic stimulants Nicotine
behavioral or psycholog- behavioral / psychologic inappro- behavioral / psychological
ical priate sexual or aggressive behav- -euphoria or affective blunting;
initial euphoria followed ior, -changes in sociability;
by apathy, mood lability -hypervigilance;
dysphoria, impaired judgment. -interpersonal sensitivity;
psychomotor agitation C. Physical 1/6 -anxiety, tension, or anger;
/retardation, 1. Slurred speech. -stereotyped behaviors;
impaired judgment 2. Incoordination. -impaired judgment

INTOXICATION
3. Unsteady gait. 1. Conjunctival injection.
4. Nystagmus. 2. Increased appetite.
5. Impairment in attention or 3. Dry mouth.
memory. 4. Tachycardia.
6. Stupor or coma. perceptual disturbances:
-Hallucinations with intact
reality testing
- auditory, visual, tactile
illusions occur in the absence
of a delirium.
1.Autonomic hyperactivity 3/7 within approximately
sweating 1 week after Criterion A:
pulse >100 1. Irritability, anger, or ag-
2/8 gression.
2. Increased hand tremor. 2. Nervousness or anxiety.
3. Insomnia. 4. Decreased appetite or
WITHDRAWAL
Pupillary constriction /
dilation
1/3 after use
1. Drowsiness or coma.
2. Slurred speech.
3. Impairment in atten-
tion or memory.
perceptual disturbances:
hallucinations + intact
reality testing
auditory, visual, or tactile
illusions occur in the ab-
sence of a delirium.
2/9 within minutes -
several days after Cessa-
tion/antagonist
1. Dysphoric mood.
2. Nausea or vomiting.
3. Muscle aches.
3. Unsteady gait. 2/8 after use:
4. Nystagmus. 1. Tachycardia / bradycardia.
5. Impairment in attention or 2. Pupillary dilation.
memory. 3. ↑ or ↓ blood pressure.
6. Stupor or coma. 4. Perspiration or chills.
5. Nausea or vomiting.
6. Evidence of weight loss.
7. Psychomotor agitation or retardation.
8. Muscular weakness/respiratory depres-
sion/chest pain/cardiac arrhythmias.
9. Confusion, seizures, dyskinesias, dystoni-
as, or coma.
With perceptual disturbances:
hallucinations with intact reality testing
auditory, visual, or tactile illusions in the
absence of a delirium.
2/8 within several hours to a few Dysphoric mood + physiological 4/7 24 hours
days after the cessation changes within a few hours to several days after Abrupt
/reduction after cessation/reduction: cessation
1. Autonomic hyperactivity (e.g., 1. Fatigue. of/reduction 1.
sweating or pulse rate greater than 2. Vivid, unpleasant dreams. Irritability, frus-
100 bpm). 3. Insomnia or hypersomnia. tration, or anger.

4. Nausea or vomiting. weight loss. 4. Lacrimation / rhinor- 2. Hand tremor. 4. Increased appetite. 2. Anxiety.
5. Transient visual, tactile, 5. Restlessness. rhea. 3. Insomnia. 5. Psychomotor retardation or agitation. 3. Difficulty
or auditory hallucinations or 6. Depressed mood. 5. Pupillary dilation, 4. Nausea or vomiting. concentrating.
illusions. 7. one physical symptoms: -- piloerection, or sweating. 5. Transient visual, tactile, or 4. Increased
6. Psychomotor agitation. abdominal pain, 6. Diarrhea. auditory hallucinations or illu- appetite.
7. Anxiety. -shakiness/tremors, 7. Yawning. sions. 5. Restlessness.
8. Generalized tonic-clonic -sweating, 8. Fever. 6. Psychomotor agitation. 6. Depressed
seizures. -fever, 9. Insomnia 7. Anxiety. mood.
If With perceptual disturb- -chills, 8. Grand mal seizures. 7. Insomnia.
ances: -headache. perceptual disturbances: halluci-
visual / tactile nations with intact reality testing
reality testing: Pre- auditory, visual, or tactile illu-
sent/absent sions occur in the absence of a
delirium: Present delirium.
Caffeine Intoxication Caffeine withdrawal
Recent consumption of a D. Prolonged daily use of
high dose of 250 mg). caffeine.
A. ≥ 5/12 during, or shortly E. Abrupt cessation of or
afte use: reduction in caffeine
use, followed within 24
1. Restlessness.
2. Nervousness. hours by three(or more)
3. Excitement. of the following signs or
4. Insomnia. symptoms:
5. Flushed face. 1. Headache.
6. Diuresis. 2. Marked fatigue or
7. Gastrointestinal drowsiness.
3. Dysphoric mood,
disturbance.
depressed mood, or
8. Muscle twitching.
irritability.
9. Rambling flow of
4. Difficulty concentrat-
thought and
ing.
speech.
5. Flu-like symptoms
10. Tachycardia or car-
(nausea, vomiting, or
diac arrhythmia.
muscle
11. Periods of inex-
pain/stiffness).
haustibility.
F. The signs or symptoms
12. Psychomotor agita-
in Criterion B cause clin-
tion.
ically significant distress
B. distress or impaired or impairment in social,
functioning. occupational, or other
C. DD: exclude another
important areas of func-
medical condition and
tioning.
mental disorder
G. The signs or symptoms
are not associated with
the physiological effects
of another medical con-
dition (e.g., migraine, vi-
ral illness) and are not
better explained by an-
other mental disorder,
including intoxication or
withdrawal from another
substance.
Phencyclidine intoxica-
tion
A. Recent use of phency-
clidine (or a pharmaco-
logically similar sub-
stance).
B. Clinically significant
problematic behavioral
changes (e.g., belliger-
ence, assaultiveness,
impulsiveness, unpre-
dictability, psychomotor
agitation, impaired
judgment) that devel-
oped during, or shortly
after, phencyclidine use.
C. Within 1 hour, two (or
more) of the following
signs or symptoms:
Note: When the drug is
smoked, “snorted,” or
used intravenously, the
onset may be particular-
ly rapid.
1. Vertical or horizontal
nystagmus.
2. Hypertension or
tachycardia.
3. Numbness or dimin-
ished responsive-
ness to pain.
4. Ataxia.
5. Dysarthria.
6. Muscle rigidity.
7. Seizures or coma.
8. Hyperacusis.
D. DD: exclude another
medical condition and
mental disorder
hallucinogen Intoxication
A. Recent use of a hallucino-
gen (other than phencycli-
dine).
B. Clinically significant prob-
lematic behavioral or psy-
chological changes (e.g.,
marked anxiety or depres-
sion, ideas of reference,
fear of “losing one’s mind,”
paranoid ideation, impaired
judgment) that developed
during, or shortly after, hal-
lucinogen use.
C. Perceptual changes occur-
ring in a state of full wake-
fulness and alertness (e.g.,
subjective intensification of
perceptions, depersonaliza-
tion, derealization, illusions,
hallucinations, synesthesia)
that developed during, or
shortly after, hallucinogen
use.
D. Two (or more) of the follow-
ing signs developing dur-
ing, or shortly after, halluci-
no-gen use:
1. Pupillary dilation.
2. Tachycardia.
3. Sweating.
4. Palpitations.
5. Blurring of vision.
6. Tremors.
7. Incoordination.
E. DD: exclude another medi-
cal condition and mental
disorder
Hallucinogen Persisting inhalants Intoxication
Perception Disorder
Following cessation of A. Recent intended or
use of a hallucinogen, unintended short-term,
the reexperiencing of high-dose exposure to in-
one or more of the halant sub-stances, includ-
perceptual symptoms ing volatile hydrocarbons
that were experienced
such as toluene or gaso-
while intoxicated with
line.
the hallucinogen (e.g.,
geometric hallucina- B. Clinically signifi-
tions, false perceptions cant problematic behavior-
of movement in the al or psychological chang-
peripheral visual fields, es (e.g., bel-ligerence, as-
flashes of color, inten- saultiveness, apathy, im-
sified colors, trails of paired judgment) that de-
images of moving ob- veloped during, or shortly
jects, positive afterim-
after, exposure to inhal-
ages, halos around
ants.
objects, macropsia
C. Two (or more) of
and micropsia).
B. The symptoms in the following signs or
Criterion A cause clini- symptoms developing dur-
cally significant dis- ing, or shortly af-ter, inhal-
tress or impairment in ant use or exposure:
social, occupational, or 1.Dizziness.
other important areas 2.Nystagmus.
of functioning. 3.Incoordination.
C. DD: another medi- 4.Slurred speech.
cal condition (e.g., an-
5.Unsteady gait.
atomical
6.Lethargy.
lesions and infections
of the brain, visual epi- 7.Depressed reflexes.
lepsies) & mental dis- 8.Psychomotor retardation.
order (e.g., delirium, 9.Tremor.
major neurocognitive 10.Generalized muscle
disorder, weakness.
schizophrenia) or hyp- 11.Blurred vision or di-
nopompic hallucina- plopia.
tions. 12.Stupor or coma.
13.Euphoria.
D.DD: exclude another
medical condition and
mental disorder
Gambling Disorder
A. Persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress, 4/9
in a 12-month period:
1. Needs to gamble with increasing amounts of money in order to achieve the desired excitement.
2. Is restless or irritable when attempting to cut down or stop gambling.
3. Has made repeated unsuccessful efforts to control, cut back, or stop gambling.
4. Is often preoccupied with gambling (e.g., having persistent thoughts of reliving past gambling experiences,
handicapping or planning the next venture, thinking of ways to get money with which to gamble).
5. Often gambles when feeling distressed (e.g., helpless, guilty, anxious, depressed).
6. After losing money gambling, often returns another day to get even (“chasing ”one’s losses).
7. Lies to conceal the extent of involvement with gambling.
8. Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of
gambling.
9. Relies on others to provide money to relieve desperate financial situations causedby gambling.
B. The gambling behavior is not better explained by a manic episode.
Specify if:
Episodic: Meeting diagnostic criteria at more than one time point, with symptoms subsiding between periods of
gambling disorder for at least several months.
Persistent: Experiencing continuous symptoms, to meet diagnostic criteria for multiple years.
Specify if:
In early remission: After full criteria for gambling disorder were previously met, none of the criteria for gambling
disorder have been met for 3- 12 months.
In sustained remission: After full criteria for gambling disorder were previously met, none of the criteria for gam-
bling disorder have been met during a period of 12 months or longer.
Specify current severity:
Mild: 4–5 criteria met.
Moderate: 6–7 criteria met.
Severe: 8–9 criteria met.
 Neurocognitive Disorders
Delirium
(i.e., reduced ability to direct, :]505‫عليه تعليق [أحمد‬ A. A disturbance in attention and awareness.
focus, sustain, and shift attention) B. 1. Onset: acute. 2. course: fluctuating.
(reduced orientation to the :]506‫عليه تعليق [أحمد‬ C. An additional disturbance in cognition
environment) D. DD: Exclude other neurocognitive disorder
The disturbance develops over a :]507‫عليه تعليق [أحمد‬ DD: severely reduced level of arousal, such as coma.
short period of time (usually hours to a few days), E. There is evidence that the disturbance is a direct physiological consequence of another medical condition,
represents a change from baseline attention and awareness, substance intoxication or withdrawal, or exposure to a toxin, or is due to multiple etiologies.
and tends to fluctuate in severity :]508‫عليه تعليق [أحمد‬ Specify whether:
during the course of a day Substance intoxication delirium
(e.g., memory deficit, :]509‫عليه تعليق [أحمد‬ Substance withdrawal delirium
disorientation, language, visuospatial ability, or perception).
Medication-induced delirium.
from the history, physical :]510‫عليه تعليق [أحمد‬
examination, or laboratory findings
Delirium due to another medical condition
Delirium due to multiple etiologies
This diagnosis should be made :]511‫عليه تعليق [أحمد‬
instead of substance intoxication when the symptoms in Specify if:
Criteria A and C predominate in the clinical picture and when Acute: Lasting a few hours or days. Persistent: Lasting weeks or months.
they are sufficiently severe to warrant clinical attention. Specify if:
This diagnosis should be made :]512‫عليه تعليق [أحمد‬ Hyperactive / Hypoactive / Mixed level of activity.
instead of substance withdrawal when the symptoms in
Criteria A and C predominate in the clinical picture and when
Other Specified Delirium
they are sufficiently severe to warrant clinical attention. delirium symptoms that cause + significant distress or impairment + do not meet the full criteria for delirium + specific
reason
This diagnosis applies when the :]513‫عليه تعليق [أحمد‬
symptoms in Criteria A and C arise as a side effect of a example:
medication taken as prescribed Attenuated delirium syndrome: This syndrome applies in cases of delirium in which the severity of cognitive im-
pairment falls short of that required for the diagnosis, or in which some, but not all, diagnostic criteria for delirium are
There is evidence from the :]514‫عليه تعليق [أحمد‬
history, physical examination, or laboratory findings that the met.
disturbance is attributable to the physiological consequences Unspecified Delirium
of another medical condition. delirium symptoms that cause + significant distress or impairment + do not meet the full criteria for delirium + no
There is evidence from the :]515‫عليه تعليق [أحمد‬ specific reason
history, physical examination, or laboratory findings that the
delirium has more than one etiology (e.g., more than one Major Neurocognitive Disorder
etiological medical condition; another medical condition plus A. Evidence of significant cognitive decline from a previous level of performance in one or more cognitive
substance intoxication or medication side effect). domains (1.complex attention 2.executive function, 3.learning and memory, 4.language, 5.perceptual-motor, 6. so-
The individual has a hyperactive :]516‫عليه تعليق [أحمد‬ cial cognition) based on:
level of psychomotor activity that may be accompanied by
mood lability, agitation, and/or refusal to cooperate with
1. Concern of the individual, a knowledgeable informant, or the clinician
medical care. 2. standardized neuropsychological testing or quantified clinical assessment.
The individual has a hypoactive :]517‫عليه تعليق [أحمد‬ B. interfere with independence in everyday activities (i.e., at a minimum, requiring assistance with complex in-
level of psychomotor activity that may be accompanied by strumental activities of daily living such as paying bills or managing medications).
sluggishness and lethargy that approaches stupor. C. Not in the context of a delirium.
: The individual has a normal :]518‫عليه تعليق [أحمد‬ D. DD: another mental disorder (e.g., major depressive disorder, schizophrenia).
level of psychomotor activity even though attention and
Specify whether due to:
awareness are disturbed. Also includes individuals whose
activity level rapidly fluctuates Alzheimer’s disease Prion disease
Frontotemporal lobar degeneration Parkinson’s disease
Lewy body disease Huntington’s disease
Vascular disease Another medical condition
‫أحمد[ تعليق عليه‬519]: (specify disturbance): If the cog- Traumatic brain injury Multiple etiologies
nitive disturbance is accompanied by a clinically significant Substance/medication use Unspecified
behavioral disturbance (e.g., psychotic symptoms, mood HIV infection
disturbance, agitation, apathy, or other behavioral symp- Specify:
toms).
With / Without behavioral disturbance
‫أحمد[ تعليق عليه‬520]: If the cognitive disturbance is not Specify current severity: Mild: Difficulties with instrumental activities of daily living
accompanied by any clinically significant behavioral disturb-
Moderate: Difficulties with basic activities of daily living (e.g., feeding, dressing).
ance.
Severe: Fully dependent.
(e.g., housework, managing :]521‫عليه تعليق [أحمد‬
money).

‫أحمد[ تعليق عليه‬522]: (specify disturbance): If the cog-
nitive disturbance is accompanied by a clinically significant
behavioral disturbance (e.g., psychotic symptoms, mood
disturbance, agitation, apathy, or other behavioral symp-
toms).
A. The criteria are met for major or mild neurocognitive disorder.
‫أحمد[ تعليق عليه‬523]: If the cognitive disturbance is not
accompanied by any clinically significant behavioral disturb-
ance.
C. Criteria are met for either probable or possible Alzheimer’s disease as follows:
Of Alzheimer's gene mutation :]524‫عليه تعليق [أحمد‬
Of Alzheimer's gene mutation :]525‫عليه تعليق [أحمد‬
D. DD: cerebrovascular disease, another neurodegenerative disease, the effects of a substance, or another mental,
Mild Neurocognitive Disorder
A. Evidence of modest cognitive decline from a previous level of performance in one or more cognitive domains
(complex attention, executive function, learning and memory, language, perceptual-motor, or social cognition)
based on:
1. Concern of the individual, a knowledgeable informant, or the clinician that there has been a mild decline
in cognitive function; and
2. documented by standardized neuropsychological testing or, in its absence, another quantified clinical as-
sessment.
B. The cognitive deficits do not interfere with capacity for independence in everyday activities (i.e., complex
instrumental activities of daily living such as paying bills or managing medications are preserved, but greater effort,
compensatory strategies, or accommodation may be required).
C. not in the context of a delirium.
D. DD another mental disorder (e.g.,major depressive disorder, schizophrenia).
Specify whether due to:
Alzheimer’s disease Prion disease
Frontotemporal lobar degeneration Parkinson’s disease
Lewy body disease Huntington’s disease
Vascular disease Another medical condition
Traumatic brain injury Multiple etiologies
Substance/medication use Unspecified
HIV infection
Specify:
With / Without behavioral disturbance
Major or Mild Neurocognitive Disorder Due to Alzheimer’s Disease
B. There is insidious onset and gradual progression of impairment in one or more cognitive domains (for major
neurocognitive disorder, at least two domains must be impaired).
For major neurocognitive disorder:
Probable Alzheimer’s disease is diagnosed if either of the following is present; otherwise, possible Alzheimer’s
disease should be diagnosed.
1. Genetic evidence: 1. family history or 2. genetic testing.
2. Clinical evidence: All three of the following are present:
a. Clear evidence of decline in memory and learning and at least one other cognitive domain (based on
detailed history or serial neuropsychological testing).
b. Steadily progressive, gradual decline in cognition, without extended plateaus.
c. No evidence of mixed etiology (i.e., absence of other neurodegenerative or cerebrovascular disease, or
another neurological, mental, or systemic disease or condition likely contributing to cognitive decline).
For mild neurocognitive disorder:
Probable Alzheimer’s disease : Genetic evidence: 1. family history or 2. genetic testing
Possible Alzheimer’s disease no genetic evidence , but clinical evidence (same 3 items in major Alzheimer’s)
neurological, or systemic disorder.
Major or Mild Frontotemporal Neurocognitive Disorder
A. The criteria are met for major or mild neurocognitive disorder.
B. The disturbance has insidious onset and gradual progression.
C. Either (1) or (2):
1. Behavioral variant:
a. 3/5:
1 Behavioral disinhibition.
2 Apathy or inertia.
 3 Loss of sympathy or empathy.
4 Perseverative, stereotyped or compulsive/ritualistic behavior.
5 Hyperorality and dietary changes.
b. Prominent decline in social cognition and/or executive abilities.
2. Language variant:
a. Prominent decline in language ability, in the form of speech production, word finding, object naming, gram-
mar, or word comprehension.
D. Relative sparing of learning and memory and perceptual-motor function.
E. DD cerebrovascular disease, another neurodegenerative disease, the effects of a substance, or another mental,
neurological, or systemic disorder.
Probable frontotemporal neurocognitive disorder is diagnosed if either of the following is present; otherwise, pos-
sible frontotemporal neurocognitive disorder should be diagnosed:
1. Genetic evidence: family history or genetic testing.
2. Imaging evidence: Evidence of disproportionate frontal and/or temporal lobe involvement from neuroimaging.
Possible frontotemporal neurocognitive disorder no genetic evidence + neuroimaging has not been performed.

Major or Mild Neurocognitive Disorder With Lewy Bodies

A. The criteria are met for major or mild neurocognitive disorder.
B. The disorder has an insidious onset and gradual progression.
C. The disorder meets a combination of core diagnostic features and suggestive diagnostic features for either proba-
ble or possible neurocognitive disorder with Lewy bodies.
For probable major or mild neurocognitive disorder with Lewy bodies, the individual has two core features, or
one suggestive feature + one or more core features.
For possible major or mild neurocognitive disorder with Lewy bodies, the individual has only one core fea-
ture, or one or more suggestive features.
1. Core diagnostic features:
a. Fluctuating cognition with pronounced variations in attention and alertness.
b. Recurrent Vivid visual hallucinations that are well formed and detailed.
c. Spontaneous features of parkinsonism, with onset subsequent to the development of cognitive decline.
2. Suggestive diagnostic features:
a. REM sleep behavior disorder.
b. Severe neuroleptic sensitivity.
D. DD cerebrovascular disease, another neurodegenerative disease, the effects of a substance, or another mental,
neurological, or systemic disorder.
Major or Mild Vascular Neurocognitive Disorder
A. The criteria are met for major or mild neurocognitive disorder.
B. The clinical features are consistent with a vascular etiology, as suggested by either of the following:
1. Onset of the cognitive deficits is temporally related to one or more cerebrovascular events.
2. Evidence for decline is prominent in complex attention (including processing speed) and frontal-executive func-
tion.
C. There is evidence of the presence of cerebrovascular disease from history, physical examination, and/or neuroim-
aging considered sufficient to account for the neurocognitive deficits.
D. The symptoms are not better explained by another brain disease or systemic dis-order.
Probable vascular neurocognitive disorder is diagnosed if one of the following is present; otherwise possible
vascular neurocognitive disorder should be diagnosed:
1. (neuroimaging-supported).
2. The neurocognitive syndrome is temporally related to one or more documented cerebrovascular events.
3. Both clinical and genetic (e.g., cerebral autosomal dominant arteriopathy with subcortical infarcts and leu-
koencephalopathy) evidence of cerebrovascular disease is present.
Possible vascular neurocognitive disorder is diagnosed if the clinical criteria are met but neuroimaging is not
available and the temporal relationship of the neurocognitive syndrome with one or more cerebrovascular events is
not established.
Major or Mild Neurocognitive Disorder Due to Traumatic Brain Injury

A. The criteria are met for major or mild neurocognitive disorder.

B. There is evidence of a traumatic brain injury—that is, an impact to the head or other mechanisms of rapid move-
ment or displacement of the brain within the skull, with one or more of the following:
1.Loss of consciousness.
2.Posttraumatic amnesia.
3.Disorientation and confusion.
4.Neurological signs (e.g., neuroimaging demonstrating injury; a new onset of seizures; a marked worsening of a
preexisting seizure disorder; visual field cuts; anosmia; hemiparesis).
C. The neurocognitive disorder presents immediately after the occurrence of the traumatic brain injury or immediately
after recovery of consciousness and persists past the acute post-injury period.

Substance/Medication-Induced Major or Mild Neurocognitive Dis-

order
A. The criteria are met for major or mild neurocognitive disorder.
B. The neurocognitive impairments do not occur exclusively during the course of adelirium and persist beyond the
usual duration of intoxication and acute withdrawal.
C. The involved substance or medication and duration and extent of use are capableof producing the neurocognitive
impairment.
D. The temporal course of the neurocognitive deficits is consistent with the timing ofsubstance or medication use and
abstinence (e.g., the deficits remain stable or improve after a period of abstinence).
E. The neurocognitive disorder is not attributable to another medical condition or isnot better explained by another
mental disorder.
Specify if:
Persistent: Neurocognitive impairment continues to be significant after an extended period of abstinence.
Major or Mild Neurocognitive Disorder Due to HIV Infection
A. The criteria are met for major or mild neurocognitive disorder.
B. There is documented infection with human immunodeficiency virus (HIV).
C. The neurocognitive disorder is not better explained by non-HIV conditions, including secondary brain diseases
such as progressive multifocal leukoencephalopathy or cryptococcal meningitis.
D. The neurocognitive disorder is not attributable to another medical condition and is not better explained by a mental
disorder.
Major or Mild Neurocognitive Disorder Due to Prion Disease
A. The criteria are met for major or mild neurocognitive disorder.
B. There is insidious onset, and rapid progression of impairment is common.
C. There are motor features of prion disease, such as myoclonus or ataxia, or bio-marker evidence.
D. DD: another medical and mental.

Major or Mild Neurocognitive Disorder Due to Parkinson’s Dis-

ease
A. The criteria are met for major or mild neurocognitive disorder.
B. The disturbance occurs in the setting of established Parkinson’s disease.
C. There is insidious onset and gradual progression of impairment.
D. The neurocognitive disorder is not attributable to another medical condition and is not better explained by another
mental disorder.
Major or mild neurocognitive disorder probably due to Parkinson’s disease should be diagnosed if 1 and 2 are
both met.
Major or mild neurocognitive disorder possibly due to Parkinson’s disease should be diagnosed if 1 or 2 is met:
1. There is no evidence of mixed etiology (i.e., absence of other neurodegenerative or cerebrovascular disease or
another neurological, mental, or systemic disease or condition likely contributing to cognitive decline).
2. The Parkinson’s disease clearly precedes the onset of the neurocognitive disorder.

Major or Mild Neurocognitive Disorder Due to Huntington’s Dis-

ease

A. The criteria are met for major or mild neurocognitive disorder.

B. There is insidious onset and gradual progression.
C. There is clinically established Huntington’s disease, or risk for Huntington’s disease based on family history or ge-
netic testing.
D. The neurocognitive disorder is not attributable to another medical condition and is not better explained by another
mental disorder.

Major or Mild Neurocognitive Disorder Due to Another Medical

Condition
A. The criteria are met for major or mild neurocognitive disorder.
B. There is evidence from the history, physical examination, or laboratory findings that the neurocognitive disorder is
the pathophysiological consequence of another medical condition.
C. The cognitive deficits are not better explained by another mental disorder or another specific neurocognitive disor-
der (e.g., Alzheimer’s disease, HIV infection).

Major or Mild Neurocognitive Disorder Due to Multiple Etiologies

A. The criteria are met for major or mild neurocognitive disorder.
B. There is evidence from the history, physical examination, or laboratory findings that the neurocognitive disorder is
the pathophysiological consequence of more than one etiological process, excluding substances (e.g., neurocogni-
tive disorder due to Alzheimer’s disease with subsequent development of vascular neurocognitive disorder).
Note: Please refer to the diagnostic criteria for the various neurocognitive disorders due to specific medical condi-
tions for guidance on establishing the particular etiologies.
C. The cognitive deficits are not better explained by another mental disorder and donot occur exclusively during the
course of a delirium.

Unspecified Neurocognitive Disorder

This category applies to presentations in which symptoms characteristic of a neurocognitive disorder that cause clini-
cally significant distress or impairment in social, occupational, or other important areas of functioning predominate but
do not meet the full criteria for any of the disorders in the neurocognitive disorders diagnostic class. The unspecified
neurocognitive disorder category is used in situations in which the precise etiology cannot be determined with suffi-
cient certainty to make an etiological attribution.
 Personality Disorders
GENERAL PERSONALITY DISORDER
A. An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the indi-
vidual’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 im-
portant areas of functioning.
D. The pattern is stable and of 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 medi-
cation) or another medical condition (e.g., head trauma).

Cluster A: “Odd” Group

Paranoid Personality Disorder
- Distrust since early adulthood
- 4 out of 7 symptoms: suspects deception, doubts loyalty of friends, reluctant to confide, reads hidden meanings, bears
grudges, perceives personal attacks on character, unwarranted suspicions of partner
Schizoid Personality Disorder
- Detached social relationships
- 4 out of 7 symptoms: doesn’t desire close relationships, solitary activities, no interest in a sex partner, few close friends,
little pleasure in activities, indifferent to praise or criticism, emotional coldness or flat affect
Schizotypal Personality Disorder
- Eccentricities and few close relationships
- 5 out of 9 symptoms: odd behavior, magical thinking (ESP, superstitions), ideas of reference, illusions, odd thinking and
speech, paranoia, inappropriate or constricted affect, few close friends, excessive social anxiety
Cluster B: “Dramatic” Group
Borderline Personality Disorder
- Unstable relationships, unstable self image, unstable affects and impulsivity
- 5 out of 9 symptoms: frantically avoids abandonment, idealizes then devalues relationships, identity disturbance, danger-
ous impulsivity, recurrent suicidal thoughts or self-mutilation, affective instability, chronic empty feeling, anger control
problems, transient dissociation or paranoia
Histrionic Personality Disorder
- Excessive emotions and attention seeking
- 5 out of 8 symptoms: center of attention, sexually seductive, shallow and unstable emotions, dresses to draw attention,
emotional speech without substance, theatrical, suggestible and easily influenced, feels relationships are more intimate then
they really are
Narcissistic Personality Disorder
- Grandiosity, need for admiration and lack of empathy since early adulthood
- 5 out of 9 symptoms: grandiosity, fantasies of unlimited power and success, sees self as “special” and only associates with
others of high status, needs admiration, sense of entitlement, interpersonally exploitative, lacks empathy, envious of others,
arrogant
Antisocial Personality Disorder
- Evidence of conduct disorder before age 15
- Disregards other’s rights since age 15
- 3 out of 7 symptoms: repeated unlawful acts, deceitfulness, impulsivity, repeated physical fights, disregard for safety, con-
sistent irresponsibility, lack of remorse
 CLUSTER C WITHDRAWN GROUP
Avoidant Personality Disorder
- Inhibited, inadequate and hypersensitive
- 4 out of 7 symptoms: avoids occupations dealing with people, avoids people unless they’ll be liked, restrained in close re-
lationships, fears social rejection, social inhibition, feels socially inept, few new activities or risks
Dependent Personality Disorder
- Excessive need to be taken care of
- Submissive and clingy behavior
- Fears of separation
- 5 out of 8 symptoms: difficulty making decisions, doesn’t take responsibility, avoids conflict, poor initiation of projects,
craves nurturance, helpless when alone, urgently seeks out relationships when one ends, fears being left to take care of
themselves
Obsessive-Compulsive Personality Disorder
- Orderly, perfectionism and in control
-4 out of 8 symptoms: overly preoccupied by details; interfering perfectionism, workaholic, overly strict values, pack rat,
micromanages others, miserly, rigid and stubborn

OTHER PERSONALITY DISORDERS

Personality Change Due to Another Medical Condition

A. A persistent personality disturbance that represents a change from the individual’s previous characteristic per-
sonality pattern.
Note: In children, the disturbance involves a marked deviation from normal development or a significant change
in the child’s usual behavior patterns, lasting at least 1 year.
B. There is evidence 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 (including an-other mental disorder due to
another medical condition).
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.
Specify whether:
Labile type: If the predominant feature is affective lability.
Disinhibited type: If the predominant feature is poor impulse control as evidenced by sexual indiscretions, etc.
Aggressive type: If the predominant feature is aggressive behavior.
Apathetic type: If the predominant feature is marked apathy and indifference.
Paranoid type: If the predominant feature is suspiciousness or paranoid ideation. Other type: If the presenta-
tion is not characterized by any of the above subtypes. Combined type: If more than one feature predominates
in the clinical picture. Unspecified type

Other Specified Personality Disorder

This category applies to presentations in which symptoms characteristic of a personality disorder that cause clinical-
ly significant distress or impairment in social, occupational, or other important areas of functioning predominate but
do not meet the full criteria for any of the disorders in the personality disorders diagnostic class. The other specified
personality disorder category is used in situations in which the clinician chooses to communicate the specific reason
that the presentation does not meet the criteria for any specific personality disorder. This is done by recording “other
specified personality disorder” followed by the specific reason (e.g., “mixed personality features”).
Unspecified Personality Disorder
This category applies to presentations in which symptoms characteristic of a personality disorder that cause clinical-
ly significant distress or impairment in social, occupational, or other important areas of functioning predominate but
do not meet the full criteria for any of the disorders in the personality disorders diagnostic class. The unspecified
personality disorder category is used in situations in which the clinician chooses not to specify the reason that the
criteria are not met for a specific personality disorder, and includes presentations in which there is insufficient infor-
mation to make a more specific diagnosis.
Medication-Induced
Movement Disorders and
Other Conditions That May
Be a Focus of Clinical
Attention
Medication-Induced Movement Disorders and Other Adverse Effects of Medications
332.1 (G21.11) Neuroleptic-Induced Parkinsonism
332.1 (G21.19) Other Medication-Induced Parkinsonism
333.92 (G21.0) Neuroleptic Malignant Syndrome
333.72 (G24.02) Medication-Induced Acute Dystonia
333.99 (G25.71) Medication-Induced Acute Akathisia
333.85 (G24.01) Tardive Dyskinesia
333.72 (G24.09) Tardive Dystonia
333.99 (G25.71) Tardive Akathisia
333.1 (G25.1) Medication-Induced Postural Tremor
333.99 (G25.79) Other Medication-Induced Movement Disor-
der
995.29 (T43.205_) Antidepressant Discontinuation Syndrome 995.20 (T50.905_) Other Adverse
Effect of Medication
Other Conditions That May Be a Focus of Clinical Attention
Relational Problems
Abuse and Neglect
Educational and Occupational Problems
Housing and Economic Problems
Other Problems Related to the Social Environment
Problems Related to Crime or Interaction With the Legal System
Other Health Service Encounters for Counseling and Medical Advice
Problems Related to Other Psychosocial, Personal, and Environmental Circumstances Other Circumstances of Per-
sonal History

MEDICATION-INDUCED MOVEMENT DISORDERS AND OTHER ADVERSE

EFFECTS OF MEDICATION

TABLE 19–1. Medication-induced movement disorders and other adverse effects of medication

ICD-9-CM ICD-10-CM
code code Description

332.1 G21.11 Neuroleptic-induced parkinsonism

332.1 G21.19 Other medication-induced parkinsonism

333.92 G21.0 Neuroleptic malignant syndrome

333.72 G24.02 Medication-induced acute dystonia
333.99 G25.71 Medication-induced acute akathisia
333.85 G24.01 Tardive dyskinesia

333.72 G24.09 Tardive dystonia

333.99 G25.71 Tardive akathisia

333.1 G25.1 Medication-induced postural tremor

333.99 G25.79 Other medication-induced movement disorder

Antidepressant discontinuation syndrome

995.29 T43.205A Initial encounter

995.29 T43.205D Subsequent encounter
995.29 T43.205S Sequelae

Other adverse effect of medication

995.20 T50.905A Initial encounter
995.20 T50.905D Subsequent encounter
995.20 T50.905S Sequelae
Source. Reprinted from Nussbaum AM: The Pocket Guide to the DSM-5TM Diagnostic Exam. Washington, DC, American Psychiatric Publish-
ing, 2013. Copyright 2013, American Psychiatric Association. Used with permission.

Neuroleptic-Induced Parkinsonism and Other Medication-Induced

Parkinsonism
Parkinsonian tremor, muscular rigidity, akinesia (i.e., loss of movement or difficulty initiating movement), or bradykinesia (i.e.,
slowing movement) developing within a few weeks of starting or raising the dosage of a medication (e.g., a neuroleptic) or after
reducing the dosage of a medication used to treat extrapyramidal symptoms.
Neuroleptic Malignant Syndrome
Although neuroleptic malignant syndrome is easily recognized in its classic fullblown form, it is often heterogeneous in onset,
presentation, progression, and outcome. The clinical features described below are those considered most important in making the
diagnosis of neuroleptic malignant syndrome based on consensus recommendations.
Patients have generally been exposed to a dopamine antagonist within 72 hours prior to symptom development. Hyperthermia
(100.4 F or 38.0 C on at least two occasions, measured orally), associated with profuse diaphoresis, is a distinguishing feature of
neuroleptic malignant syndrome, setting it apart from other neurological side effects of antipsychotic medications. Extreme eleva-
tions in temperature, reflecting a breakdown in central thermoregulation, are more likely to support the diagnosis of neuroleptic
malignant syndrome. Generalized rigidity, described as “lead pipe” in its most severe form and usually unresponsive to antipar-
kinsonian agents, is a cardinal feature of the disorder and may be associated with other neurological symptoms (e.g., tremor, si-
alorrhea, akinesia, dystonia, trismus, myoclonus, dysarthria, dysphagia, rhabdomyolysis). Creatine kinase elevation of at least
four times the upper limit of normal is commonly seen. Changes in mental status, characterized by delirium or altered conscious-
ness ranging from stupor to coma, are often an early sign. Affected individuals may appear alert but dazed and unresponsive, con-
sistent with catatonic stupor. Autonomic activation and instability—manifested by tachycardia (rate 25% above baseline), dia-
phoresis, blood pressure elevation (systolic or diastolic 25% above baseline) or fluctuation ( 20 mmHg diastolic change or 25
mmHg systolic change within 24 hours), urinary incontinence, and pallor—may be seen at any time but provide an early clue to
the diagnosis. Tachypnea (rate 50% above baseline) is common, and respiratory distress—resulting from metabolic acidosis,
hypermetabolism, chest wall restriction, aspiration pneumonia, or pulmonary emboli—can occur and lead to sudden respiratory
arrest.
A workup, including laboratory investigation, to exclude other infectious, toxic, metabolic, and neuropsychiatric etiologies or
complications is essential. Although several laboratory abnormalities are associated with neuroleptic malignant syndrome, no
single abnormality is specific to the diagnosis. Individuals with neuroleptic malignant syndrome may have leukocytosis, metabol-
ic acidosis, hypoxia, decreased serum iron concentrations, and elevations in serum muscle enzymes and catecholamines. Findings
from cerebrospinal fluid analysis and neuroimaging studies are generally normal, whereas electroencephalography shows general-
ized slowing. Autopsy findings in fatal cases have been nonspecific and variable, depending on complications.

Medication-Induced Acute Dystonia

Abnormal and prolonged contraction of the muscles of the eyes (oculogyric crisis), head, neck (torticollis or retrocollis), limbs, or
trunk developing within a few days of starting or raising the dosage of a medication (such as a neuroleptic) or after reducing the
dosage of a medication used to treat extrapyramidal symptoms.
Medication-Induced Acute Akathisia
Subjective complaints of restlessness, often accompanied by observed excessive movements (e.g., fidgety movements of the legs,
rocking from foot to foot, pacing, inability to sit or stand still), developing within a few weeks of starting or raising the dosage of
a medication (such as a neuroleptic) or after reducing the dosage of a medication used to treat extrapyramidal symptoms.

Tardive Dyskinesia
Involuntary athetoid or choreiform movements (lasting at least a few weeks) generally of the tongue, lower face and jaw, and ex-
tremities (but sometimes involving the pharyngeal, diaphragmatic, or trunk muscles) developing in association with the use of a
neuroleptic medication for at least a few months.
Symptoms may develop after a shorter period of medication use in older persons. In some patients, movements of this type
may appear after discontinuation, or after change or reduction in dosage, of neuroleptic medications, in which case the condition
is called neuroleptic withdrawal-emergent dyskinesia. Because withdrawal-emergent dyskinesia is usually time-limited, lasting
less than 4–8 weeks, dyskinesia that persists beyond this window is considered to be tardive dyskinesia.

Tardive Dystonia and Tardive Akathisia

Tardive syndrome involving other types of movement problems, such as dystonia or akathisia, which are distinguished by their
late emergence in the course of treatment and their potential persistence for months to years, even in the face of neuroleptic dis-
continuation or dosage reduction.

Medication-Induced Postural Tremor

Fine tremor (usually in the range of 8–12 Hz) occurring during attempts to maintain a posture and developing in association with
the use of medication (e.g., lithium, antidepressants, valproate). This tremor is very similar to the tremor seen with anxiety, caf-
feine, and other stimulants.

Other Medication-Induced Movement Disorder

This category is for medication-induced movement disorders not captured by any of the specific disorders listed above. Examples
include 1) presentations resembling neuroleptic malignant syndrome that are associated with medications other than neuroleptics
and 2) other medication-induced tardive conditions.
Antidepressant Discontinuation Syndrome
Initial Encounter Subsequent Encounter Sequelae
Antidepressant discontinuation syndrome is a set of symptoms that can occur after an abrupt cessation (or marked reduction in
dose) of an antidepressant medication that was taken continuously for at least 1 month. Symptoms generally begin within 2–4
days and typically include specific sensory, somatic, and cognitive-emotional manifestations. Frequently reported sensory and
somatic symptoms include flashes of light, “electric shock” sensations, nausea, and hyperresponsivity to noises or lights. Nonspe-
cific anxiety and feelings of dread may also be reported. Symptoms are alleviated by restarting the same medication or starting a
different medication that has a similar mechanism of action—for example, discontinuation symptoms after withdrawal from a
serotonin-norepinephrine reuptake inhibitor may be alleviated by starting a tricyclic antidepressant. To qualify as antidepressant
discontinuation syndrome, the symptoms should not have been present before the antidepressant dosage was reduced and are not
better explained by another mental disorder (e.g., manic or hypomanic episode, substance intoxication, substance withdrawal,
somatic symptom disorder).
Discontinuation symptoms may occur following treatment with tricyclic antidepressants (e.g., imipramine, amitriptyline,
desipramine), serotonin reuptake inhibitors (e.g., fluoxetine, paroxetine, sertraline), and monoamine oxidase inhibitors (e.g.,
phenelzine, selegiline, pargyline). The incidence of this syndrome depends on the dosage and half-life of the medication being
taken, as well as the rate at which the medication is tapered. Short-acting medications that are stopped abruptly rather than ta-
pered gradually may pose the greatest risk. The short-acting selective serotonin reuptake inhibitor (SSRI) paroxetine is the agent
most commonly associated with discontinuation symptoms, but such symptoms occur for all types of antidepressants.
Unlike withdrawal syndromes associated with opioids, alcohol, and other substances of abuse, antidepressant discontinuation
syndrome has no pathognomonic symptoms. Instead, the symptoms tend to be vague and variable and typically begin 2–4 days
after the last dose of the antidepressant. For SSRIs (e.g., paroxetine), symptoms such as dizziness, ringing in the ears, “electric
shocks in the head,” an inability to sleep, and acute anxiety are described. The antidepressant use prior to discontinuation must
not have incurred hypomania or euphoria (i.e., there should be confidence that the discontinuation syndrome is not the result of
fluctuations in mood stability associated with the previous treatment). The antidepressant discontinuation syndrome is based sole-
ly on pharmacological factors and is not related to the reinforcing effects of an antidepressant. Also, in the case of stimulant aug-
mentation of an antidepressant, abrupt cessation may result in stimulant withdrawal symptoms (see “Stimulant Withdrawal” in
Chapter 16, “Substance-Related and Addictive Disorders”) rather than the antidepressant discontinuation syndrome described
here

Serotonin syndrome: