DSM5 - Cereno

NEURODEVELOPMENTAL
DISORDERS
personal, social, academic, or occupational functioning deficits that manifest early in development, usually before child enters gradeschool.

INTELLECTUAL DISABILITY 319 AUTISM SPECTRUM DISORDER
– Diagnostic Criteria Speech Sound Disorder 315.39 (F80.0) – Diagnostic Criteria
Criterion A deficits in general mental abilities – Diagnostic Criteria A. Persistent deficits in reciprocal social communication and social
Criterion B deficits in adaptive functioning A. Persistent difficulty with speech sound production that interaction.
Criterion C onset is during the developmental period interferes with speech intelligibility and prevents verbal – deficits in social-emotional reciprocity.
– Specifiers communication. – deficits in nonverbal communicative behaviors used for social interaction.
– deficits in developing, maintaining, and understanding relationships.
1. Mild B. Disturbance causes limitations in effective communication
C. Onset is in the early developmental period. B. Restricted, repetitive patterns of behavior, interests, or activities.
– support needed in academic and complex daily living tasks to
Manifested by at least two:
meet age-related expectations. D. Difficulties not attributed to congenital or acquired conditions. – Stereotyped or repetitive motor movements, use of objects, or speech.
– social judgment and interactions are immature for age – Insistence on sameness, inflexible adherence to routines.
2. Moderate Childhood-Onset Fluency Disorder (Stuttering) 315.35 (F80.81) – Highly restricted, fixated interests that are abnormal in intensity or focus.
– conceptual skills markedly behind peers. – Diagnostic Criteria – Hyperactivity to sensory input or unusual interest in sensory aspects of
– extended period of teaching and time needed. A. Disturbance in normal fluency and time patterning of speech that the environment.
3. Severe are inappropriate for the individual’s age, persist over time. C. Onset is during early developmental period.
– little understanding of written language and numbers. – sound and syllable repetitions. D. Symptoms cause clinically significant impairment in functioning.
– limited spoken language (1 word or phrase only) – sound prolongations of consonants as well as vowels. E. Disturbances are not better explained by intellectual disability or
– broken words (pauses within a word). global developmental delay.
– require support and supervision for all activities. – audible or silent blocking.
4. Profound – Specifiers
– circumlocutions (word substitution to avoid problematic words).
– express self largely through nonverbal communication – words produced with excess physical tension. level 3 Requiring very substantial support
– dependent on others for all aspects of daily physical care, – monosyllabic whole-word repetitions (“I-I-I-I see). – severe deficits in verbal and nonverbal social communication
health, and safety. B. Disturbance causes anxiety about speaking skills cause severe impairments in functioning.
Onset is in the early developmental period. – great distress and extreme difficulty changing focus or action.
– Prevalence of 1% that vary by age. 6 per 1,000. C.
level 2 Requiring substantial support
D. Disturbance not attributable to speech-motor or sensory deficit,
– limited social interaction with limited and abnormal response.
Global Developmental Delay 315.8 dysfluency associated with neurological insult.
– distress and difficulty changing focus or action.
– reserved for individuals under the age of 5 years. level 1 Requiring support
– diagnosed when an individual fails to meet expected developmental Social (Pragmatic) Communication Disorder 315.39 (F80.80) – difficulty initiating social interaction with unsuccessful response.
milestones in several areas of intellectual functioning. – Diagnostic Criteria – inflexibility of behavior cause significant interference with
A. Persistent difficulties in the social use of verbal and nonverbal functioning. Difficulty switching activities.
communication as manifested of the following – Prevalence of 1%
COMMUNICATION DISORDEERS – difficulties in greeting and sharing information.

– inability to change communication to match context or needs of listener,
– deficits in language, speech, and communication. such as speaking differently in classroom than on playground.
– Speech is the production of sounds and includes articulation, fluency, – difficulties following rules for conversation and storytelling such as taking ATTENTION-DEFICIT/HYPERACTIVITY DISORDER 314
voice, and resonance quality. turns, rephrasing when misunderstood, using signals. – Diagnostic Criteria
– Language includes form, function & use of symbols for c ommunication. – difficulties understanding idioms, humor, metaphors. A. A persistent pattern of inattention and /or hyperactivity-
– Communication includes any verbal or nonverbal behavior that B. Deficits result in functional limitations in effective impulsivity that interferes with functioning.
influences another individual. communication, social participation and relationships, academic Characterized (1) inattention or (2) hyperactivity.
– Diagnostic category achievement, or occupational performance. For children, 6 symptoms for at least 6 months.
1. Language Disorder C. Onset during early developmental period. For adolescents and adults (17 and older), 5 symptoms.
2. Speech Sound Disorder D. Symptoms not attributable to another medical or neurological 1. Inattention
– often fails to give attention to details.
3. Childhood-Onset Fluency Disorder (stuttering) condition.
– difficulty sustaining attention in tasks or activities.
4. Social Communication Disorder – does not seem to listen when spoken to directly.
– does not follow instructions and fails to finish works, duties.
Language Disorder 315.39 (F80.9) – difficulty organizing tasks and activities.
– Diagnostic Criteria – avoids, dislikes to engage in mental tasks.
A. Persistent difficulties in acquisition and use of language due to – loses things necessary for tasks or activities.
– easily distracted by extraneous stimuli.
deficits in comprehension and production of vocabulary, – often forgetful in daily activities.
structure, and discourse. 2. Hyperactivity and impulsivity
– reduce vocabulary (world knowledge and use). – fidgets or taps hands or feet in seat.
– limited sentence structure based on grammar and morphology. – leaves seat when remaining seated is expected.
– discourse impairment (use vocabulary and connect sentence to explain – runs about or climbs in situations where it is inappropriate.
and have a conversation). – unable to play or engage in leisure activities quietly.
B. Language abilities are quantifiably below the expected for age. – “on the go”
– limitations in effective communication, social participation, academic – talks excessively.
achievement, or occupational performance. – blurts out answer before a question has even completed.
C. Onset is in early developmental period. – has difficulty waiting for their turn.
D. Difficulties are not connected to sensory impairment, motor – interrupts or intrudes on others.
dysfunction, or other neurological condition. B.Symptoms are present prior to age 12.
C.Symptoms are present in 2 or more settings.
D.Clear evidence that symptoms interfere with functioning.
E.Symptoms do not occur exclusively during the course of
schizophrenia or psychotic disorder, and are not better
explained by another mental disorder.
– Prevalence of 5% in children and 2.5% in adults.
By: CHELSEA GLYCE E. CERENO

SPECIFIC LEARNING DISORDER 315 Tic Disorders
– Diagnostic Criteria – a tic is a sudden, rapid, recurrent, nonrhythmic motor movement or
A. Persistent difficulties learning and using academic skills. vocalization.
At least one symptom for 6 months. – Diagnostic Criteria
– inaccurate or slow and effortful word reading. TOURETTE’S DISORDER
– difficulty understanding the meaning of what is read. A. Both multiple motor and one or more vocal tics have been present.
– difficulties with spelling. B. Tics may wax and wane in frequency but persisted for more than 1 year.
– difficulties with written expression. C. Onset is before 18 years old.
– difficulties with mathematical reasoning. D. Not attributed to physiological effects of substance or another medical
B. The affected academic skills are quantifiably below expected or condition.

individual’s chronological age and cause significant interference
PERSISTENT (chronic) MOTOR OR VOCAL TIC DISORDER
with academic and occupational performance. A. Either multiple motor or vocal tics have been present.
C. Learning difficulties begin during school age years. Specify if: with motor tics only
D. Learning difficulties are not better accounted by intellectual with vocal tics only
disability and other mental or neurological disorders. B. Tics may wax and wane in frequency but persisted for more than 1 year.
– Prevalence of 5-15% among school-age children. C. Onset is before 18 years of age.
D. Disturbance not attributed to physiological effects of substance or another
medical condition.
E. Criteria have never been met for Tourette’s disorder.
MOTOR DISORDERS
Developmental Coordination Disorder 315.4 (F81) PROVISIONAL TIC DISORDER
A. Single or multiple motor and/or vocal tics.
– Diagnostic Criteria B. Tics have been present for less than 1 year since first tic onset.
A. Acquisition and execution of coordinated motor skills is below C. Onset is before 18 years.
expected chronological age. Manifested as clumsiness, slowness, D. Disturbance not attributed to physiological effects of a substance or another
and inaccuracy of performance of motor skills. medical conditioning.
B. Significantly and persistently interferes with daily activities. E. Criteria have never been met for Tourette’s disorder or Persistent (chronic)
C. Onset during early developmental period. motor or vocal tic disorder.
D. Not better explained by intellectual disability or other – Prevalence of Tourette’s disorder ranges from 3 to 8 per 1,000 in
neurological condition affecting movement. school-age children. Males are more commonly affected with a ratio of
– Prevalence of 5% in children ages 5-11 years, 6% in 7 years. Males are 2:1 to 4:1.
more often affected than females with ratio between 2:1 and 7:1.
Stereotypic Movement Disorder 307.3 (F98.4)

– Diagnostic Criteria
A. Repetitive, seemingly driven, and apparently purposeless motor
behavior (hand shaking, waving, body rocking, head banging,
self-biting, hitting own body).
B. Interferes with social, academic, or other activities and may
result in self-injury.
C. Onset is in the early developmental period.
D. Not attributed to physiological effects of a substance or
neurological condition.
– Specify if
With self-injurious behavior
Without self-injurious behavior
– Severity Specifiers
1. Mild – symptoms are easily suppressed by sensory stimulus or
distraction.
2. Moderate – symptoms require explicit protective measures and
behavioral modification.
Severe – continuous monitoring and protective measures are required to
prevent serious injury.

SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOTIC DISORDERS
Include schizophrenia, other psychotic disorders, schizotypal (personality) disorder. Defined by abnormalities in one or more of the five domains:
delusions, hallucinations, disorganized thinking (speech), grossly disorganized or abnormal motor behavior (including catatonia), and negative symptoms.
KEY FEATURES THAT DEFINE PSYCHOTIC DISORDERS Schizophreniform Disorder Substance/ Medication-Induced Psychotic Disorder
Delusions – fixed beliefs not amenable to change considering evidence. – Diagnostic Criteria – Diagnostic Criteria
Persecutory delusions – belief that one is going to be harmed. A. Two or more symptoms present for at least 1-month period. A. Presence of delusions and/or hallucinations.
Referential delusions – belief that gestures, comments are directed to oneself. At least one of these must be 1, 2, or 3. B. Evidence from the history, physical examination, or laboratory
Grandiose delusions – belief of having exceptional abilities, wealth, fame. 1. Delusions findings of both:
Erotomanic delusions – belief that another person is in love with him or her. 2. Hallucinations 1. Symptoms developed during substance intoxication, withdrawal, or
Nihilistic delusions – conviction that a major catastrophe will occur.
3. Disorganized speech after exposure.
Somatic delusions – preoccupations regarding health and organ function.
4. Grossly Disorganized or Catatonic behavior. 2. Involved substance is capable of producing the symptoms.
Hallucinations – vivid and clear perception that occur without an external stimulus.
5. Negative Symptoms C. Disturbance is not better explained by a psychotic disorder that is not
Disorganized Thinking (Speech) – formal thought disorder inferred from speech.
Derailment or Loose Associations – switch from one topic to another. B. Episode lasts at least 1 month but less than 6 months. substance medication-induced.
Tangentiality – answers are obliquely or completely unrelated to the questions. C. Schizoaffective disorder and depressive or bipolar disorder with D. Disturbance does not occur exclusively during a delirium state.
Incoherence or Word Salad – nearly incomprehensible disorganized speech. psychotic features have been ruled out. E. Disturbance causes clinically significant distress or impairment.
Grossly Disorganized or Abnormal Motor Behavior (Including Catatonia) D. Disturbance is not attributable to the physiological effects of a
– Grossly disorganized or abnormal motor behavior manifest itself ranging from substance or another medical condition.
childlike silliness to unpredictable agitation.
Psychotic Disorder due to Another Medical Condition
– Catatonic behavior is marked decrease in reactivity to environment.
Negative Symptoms
Schizophrenia A. Prominent hallucinations and delusions.
Diminished emotional expression – decreased expression of emotion, eye contact, speech – involve a range of cognitive, behavioral, and emotional dysfunction. – Hallucinations can occur in any sensory modality
intonation, and hand gestures. – Diagnostic Criteria (visual, olfactory, gustatory, tactile, or auditory).
Avolition – decreased motivated self-initiated purposeful activities. A. Two or more symptoms present for at least 1-month period. May vary from simple and unformed to highly complex and organized.
At least one of these must be 1, 2, or 3. – Delusions may have variety of themes
1. Delusions (somatic, grandiose, religious, and persecutory).
SCHIZOTYPAL (PERSONALITY) DISORDER 2. Hallucinations B. There is evidence that the disturbance is the direct pathophysiological
Delusional Disorder 297.1 (F22) 3. Disorganized speech consequence of another medical condition.
– Diagnostic Criteria 4. Grossly Disorganized or Catatonic behavior. C. Disturbance is not better explained by another mental disorder.
5. Negative Symptoms
A. Presence of one or more delusions for 1 month or longer. B. D. Disturbance does not occur exclusively during a delirium state.
B. Criterion A has never been met for schizophrenia. Level of functioning in one or more major areas is markedly below the
E. Disturbance causes clinically significant distress or impairment.
level achieved prior to the onset.
C. Apart from delusions, other functioning is not markedly impaired – Specifiers
and behavior is not obviously bizarre or odd. C. Continuous signs persist for at least 6 months. Include 1 month of
the assessment of cognition, depression, and mania symptom domains is vital
D. Manic or major depressive episodes have occurred. symptoms that meet Criterion A. for making critically important distinction between various schizophrenia
E. Disturbance is not attributed to physiological effects of a substance D. Schizoaffective disorder and depressive or bipolar disorder with spectrum and other disorder.
or not better explained by other mental disorder. psychotic features have been ruled out. – Lifetime prevalence of 0.21% to 054%.
– Central theme of delusion (Subtypes) E. Disturbance is not attributable to the physiological effects of a – Individuals older than 65 years have greater prevalence of 0.74%.
substance or another medical condition.
1. Erotomanic type - delusion of a person being in love with individual.
F. Diagnosis of Schizophrenia is made only if prominent delusions or
2. Grandiose type - delusion of having great talent, insight, discovery.
3. Jealous type- delusion that the spouse or lover is unfaithful. hallucinations are present for at least 1 month, for those with a CATATONIA
4. Persecutory type - central theme of delusion that individual is being history of autism spectrum disorder or a communication disorder of – Marked psychomotor disturbance or abnormality associated with another
conspired against, cheated, poisoned, followed, harassed. childhood onset mental disorder. Catatonia is not treated as independent class.
5. Somatic type - delusion involves bodily functions or sensations. – Course specifiers Catatonia Associated with Another Mental Disorder
6. Mixed type - no one delusional theme predominates. 1. Acute Episode – full symptom and time criteria are fulfilled. A. The clinical picture is dominated by three or more of the ff. symptoms.
7. Unspecified type- dominant delusional belief cannot be clearly 2. Partial Remission – improvement after previous episode is 1. Stupor – no psychomotor activity.
determined. maintained. 2. Catalepsy – passive induction of posture against gravity.
– Course specifiers 3. Full Remission – time after previous episode during which no 3. Waxy flexibility – slight or resistance positioning
1. Acute Episode – full symptom and time criteria are fulfilled. disorder-specific symptoms are present. 4. Mutism – no or very little verbal response.
2. Partial Remission – improvement after previous episode is 4. Multiple Episode – minimum of two episodes (after a first episode, a 5. Negativism – opposition or no response to external stimuli.
remission, and minimum of one relapse). 6. Posturing – active maintenance of a posture against gravity.
maintained.
7. Mannerism – odd circumstantial caricature of normal actions.
3. Full Remission – time after a previous episode during which no – Lifetime prevalence of 0.3%-0.7%. 8. Stereotypy – repetitive, abnormal, non-goal-directed movements.
disorder-specific symptoms are present. 9. Agitation – not influence by external stimuli.
– Lifetime prevalence of 0.2%. Most frequent subtype is persecutory. Jealous Schizoaffective Disorder 10. Grimacing
type is most common in males. – Diagnostic Criteria 11. Echolalia – mimicking another’s speech.
A. An uninterrupted period of illness with major depressive or manic 12. Echopraxia – mimicking another’s movement.
Brief Psychotic Disorder 298.8 (F23) episode.
– Diagnostic Criteria B. Delusions or hallucinations for 2 or more weeks in the absence of a Catatonia Due to Another Medical Condition
A. Presence of one or more symptoms. major mood episode. A. The clinical picture is dominated by three or more off the following
At least one of these must be 1, 2, or 3. C. Symptoms that meet criteria for a major mood episode are present for symptoms: stupor, catalepsy, waxy flexibility, mutism, negativism, posturing,
1. Delusions the majority of the total duration of active and residual portions of the mannerism, stereotypy, agitation, grimacing, echolalia, echopraxia.
2. Hallucinations illness. B. Evidence from history, physical examination, or laboratory findings.
3. Disorganized speech D. Disturbance is not attributable to effects of a substance or medical C. Disturbance not better explained by another mental disorder.
4. Grossly Disorganized or Catatonic behavior. condition D. Disturbance does not occur exclusively during a delirium state.
B. Duration of episode is at least 1 day but less than 1 month. – Subtypes E. Disturbance causes clinically significant distress or impairment.
C. Not better explained by major depressive, bipolar disorder with Bipolar type – major depressive episodes with manic episodes.
psychotic features, schizophrenia or catatonia, and not attributable to Depressive type – only major depressive episodes are present.
physiological effects of a substance.
– Prevalence of 0.3% higher in females than males.
– Specifiers – Lifetime risk of suicide is 5%.
1. with marked stressor(s)
2. without marked stressor(s)
3. with postpartum onset
– Prevalence in the US account for 9%. Psychotic disturbance that meet
criterion A and C are more common. More common in females than in males.

BIPOLAR AND RELATED DISORDERS
A bridge between schizophrenia spectrum and depressive disorders in terms of symptomatology, family history, and genetics.
Include bipolar I disorder (manic-depressive disorder), bipolar II disorder (one episode of major depression and hypomanic), and cyclothymic disorder (2 years of hypomanic and depressive episodes).

Manic Episode CYCLOTHYMIC DISORDER
– often described as Euphoric, excessively cheerful, high, feeling on top of the world.
A. For at least 2 years (1 year in children and adolescents), there have been
A. Period of abnormally and persistently elevated, expansive, or irritable chronic, fluctuating mood disturbance involving periods of hypomanic
mood, lasting at least 1 week and present most of the day, every day. symptoms and depressive symptoms.
B. During mood disturbance, 3 symptoms present to significant degree: – Symptoms are insufficient number, severity, pervasiveness, or duration to meet
1. Inflated self-esteem. full criteria for both hypomanic episode and major depressive episode.
2. Decreased need for sleep. B. Symptoms present for more than 2 months and the hypomanic and
3. More talkative than usual. depressive periods present at least half the time of the 2-year period.
4. Flight of ideas. C. Criteria for major depressive, manic, or hypomanic episode have never
5. Distractibility. been met.
6. Increase in goal-directed activity.
D. Symptoms in Criterion A are not better explained by schizophrenia
7. Excessive involvement in activities with painful consequences.
spectrum and other psychotic disorder.
C. Mood disturbance is sufficiently severe to cause marked impairment
E. Symptoms are not attributable to the physiological effects of a substance or
in social and occupational functioning.
another medical condition.
D. Episode is not attributable to the physiological effects of a substance.
F. Symptoms cause clinically significant distress or impairment.
Hypomanic Episode
A. Period of abnormally and persistently elevated, expansive, or irritable SPECIFIERS:
mood, lasting at least 4 consecutive days, most of the day, every day.
B. During mood disturbance, 3 symptoms present to significant degree:
1. Inflated self-esteem.
2. Decreased need for sleep.
3. More talkative than usual.
4. Flight of ideas.
5. Distractibility.
6. Increase in goal-directed activity.
7. Excessive involvement in activities with painful consequences.
C. Episode is associated with unequivocal change in functioning.
D. Disturbance in mood and change in function are observable by others.
E. Episode is not severe enough to cause marked impairments.
F. Episode is not attributable to the physiological effects of a substance.

Major Depressive Episode
A. Five or more of the symptoms present for 2-week period.
At least one symptom is either (1) depressed mood or (2) loss of interest.
1. Depressed mood most of the day, every day.
2. Markedly diminished interest or pleasure in all activities.
3. Significant weight loss when not dieting or gaining weight.
4. Insomnia or hypersomnia nearly every day.
5. Psychomotor agitation or retardation nearly every day.
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive guilt.
8. Diminished ability to think or concentrate.
9. Recurrent thought of death or committing suicide.
B. Symptoms cause clinically significant distress or impairment.
C. Episode is not attributable to the physiological effects of a substance
or another medical condition.

BIPOLAR I DISORDER
A. Criteria have been met for at least one manic episode.
B. The Occurrence of the manic and major depressive episode(s) is not better
explained by schizoaffective disorder, schizophrenia, schizophreniform,
delusional disorder, or other psychotic disorder.

BIPOLAR II DISORDER
A. Criteria are met for at least one hypomanic episode (4 consecutive days) and
at least one major depressive episode (at least 2 weeks).
B. There has never been a manic episode.
C. Occurrence not better explained by schizophrenia spectrum and other
psychotic disorders.
D. Symptoms cause clinically significant distress or impairment in social,
occupational, or other important areas of functioning.

DEPRESSIVE DISORDERS
A common feature is the presence of sad, empty, or irritable mood, accompanied by somatic and cognitive changes that significantly affect the capacity to function.
The disorders differ on duration, timing, or presumed etiology.

PREMENSTRUAL DYSPHORIC DISORDER SPECIFIERS:
DISRUPTIVE MOOD DYSREGULATION DISORDER – Diagnostic Criteria With Anxious Distress – presence of at least two of the following symptoms during
– Diagnostic Criteria A. In the majority of menstrual cycle, at least five symptoms present a majority of days of major depressive episode or dysthymia:
A. Severe recurrent temper outbursts manifested verbally (verbal rages) week before the onset of mens and become minimal or absent in the 1. Feeling tense.
and/or behaviorally (physical aggression toward people or property). 2. Feeling unusually restless.
week postmenses.
3. Difficulty concentrating because of worry.
B. Outbursts are inconsistent with developmental level. B. One or more of the following must be present 4. Fear that something awful will happen.
C. Outbursts occur three or more times per week. 1. Marked affective lability (mood swings). 5. Feeling that individual might lose control of self.
D. Mood between temper outbursts is persistently irritable or angry 2. Marked irritability or anger. Increased interpersonal conflicts.
most of the day, every day, and is observable by others. 3. Marked depressed mood. With mixed features – presence of at least three of the following manic/
E. Symptoms present for 12 or more months. 4. Marked anxiety, tension. hypomanic symptoms are present during major depressive episode:
1. Expansive mood
Not had a period lasting 3 consecutive months without all the symptoms. C. One or more of the following must additionally be present. 2. Grandiosity
F. Criteria A and D present in at least 3 settings. 1. Decreased interest in usual activities. 3. More talkative than usual
G. Diagnosis should not be made for the first time, before age 6 years or 2. Subjective difficulty in concentration. 4. Flight of ideas
after age 18 years. 3. Marked lack of energy. 5. Increase in energy
4. Marked change in appetite. 6. Excessive involvement in activities with painful consequences.
H. Onset must be before age 10 years.
I. There has never been a distinct period lasting more than 1 day which
5. Hypersomnia or insomnia 7. Decreased need for sleep
6. Sense of being overwhelmed or out of control.
the full symptoms for manic or hypomanic episodes have been met. 7. Physical symptoms such as breast tenderness or swelling, joint or muscle
With melancholic features
J. Behaviors do not occur exclusively during an episode of major A. One is present during most severe period of episode:
pain, bloating, or weight gain. 1. Loss of pleasure in almost all activities.
depressive disorder, and are not better explained by another mental D. Symptoms associated with clinically significant distress or 2. Lack of reactivity to usually pleasurable stimuli.
disorder. interference. B. Three or more of the following:
K. Symptoms are not attributable to physiological effects of a substance E. Disturbance is not merely an exacerbation of the symptoms of another 1. A distinct quality of depressed/ empty mood.
or to another medical condition. disorder such as major depressive disorder, panic disorder, or a 2. Depression regularly worse in the morning.
– Prevalence among children and adolescents falls in the 2%-5% range. Rates personality disorder. 3. Early-morning awakening.
higher in males and school-age children. F. Criterion A should be confirmed by prospective daily ratings during at
4. Psychomotor agitation or retardation.
5. Significant anorexia or weight loss.
least two symptomatic cycles. 6. Excessive or inappropriate guilt.
– If symptoms are not confirmed, “provisional” should be noted after the
MAJOR DEPRESSIVE DISORDER name of the diagnosis (“Premenstrual Dysphoric Disorder, Provisional”). With atypical features – these features predominate during majority of days of
– Diagnostic Criteria G. Symptoms not attributable to physiological effects of a substance or major depressive episode or dysthymia:
A. Five or more symptoms present for 2-week period and represent a A. Mood reactivity – mood brightens to actual or potential positive events.
change from previous functioning. B. Two or more of the following:
– Delusions and hallucinations in the late luteal phase are present, but rare. 1. Significant weight gain or increase in appetite.
At least one symptom is either (1) depressed mood or (2) loss of interest. – Prevalence of 1.8% and 5.8% of menstruating women. 2. Hypersomnia
1. Depressed mood most of the day, every day.
2. Markedly diminished interest or pleasure in almost all activities.
3. Leaden paralysis
4. Long-standing pattern of interpersonal rejection sensitivity that result to impairment.
3. Significant weight loss or weight gain. C. Criteria not met for “with melancholic features” or “with catatonia” during same
4. Insomnia or hypersomnia. OTHER SPECIFIED DEPRESSIVE DISODER
episode.
5. Psychomotor agitation or retardation. – symptoms cause clinically significant distress or impairment but do not
6. Fatigue or loss of energy. meet full criteria for any of the disorders in the depressive disorder With psychotic features – delusions and/or hallucinations are present.
7. Feelings of worthlessness or excessive guilt. diagnostic class. With catatonia – can apply to an episode of depression if catatonic features are
8. Diminished ability to think or concentrate.
Recurrent Brief Depression present during most of the episode (psychomotor disturbance/ abnormality).
9. Recurrent thoughts of death or committing suicide.
B. Symptoms cause clinically significant distress or impairment. – concurrent presence of depressed mood with at least four symptoms of With peripartum onset – if symptoms occur during pregnancy or in the 4 weeks
C. Episode is not attributable to the physiological effects of a substance depression for 2-3 days, at least once per month. following delivery.
or to another medical condition. Short-duration Depressive Episode With seasonal pattern – applies to recurrent major depressive disorder.
D. Occurrence of the major depressive episode is not better explained by – depressed affect and at least four of the eight symptoms of major depressive
schizophrenia spectrum and other psychotic disorders. episode associated with clinically significant distress or impairment for more
E. There has never been a manic episode or a hypomanic episode. than 4 days, but less than 14 days.

Depressive Episode with Insufficient Symptoms
PERSISTENT DEPRESSIVE DISORDER (Dysthymia) – at least one of the eight symptoms of major depressive episode associated
– Diagnostic Criteria with clinically significant distress or impairment for at least 2 weeks.
A. Depressed mood that occurs for most of the day, for at least 2 years.
B. Two or more of the following:
1. Poor appetite or overeating SEVERITY SPECIFIERS:
2. Insomnia or hypersomnia Mild – two symptoms.
3. Low energy or fatigue Moderate – three symptoms.
4. Low self-esteem Moderate-Severe – four or five symptoms.
5. Poor concentration or indecisiveness Severe – four or five symptoms with motor agitation.
6. Feelings of hopelessness
C. The individual has never been without the symptoms of Criterion A
and B during the 2-year period, for more than 2 months at a time.
D. Symptoms meet for major depressive disorder criteria for 2 years.
E. There has never been a manic episode, hypomanic episode, and
criteria never met cyclothymic disorder.
F. Disturbance not better explained by other psychotic disorder.
G. Symptoms not attributable to physiological effects of a substance or
H. Symptoms cause clinically significant distress or impairment.

ANXIETY DISORDERS
Disorders that share features of excessive fear and anxiety with related behavioral disturbance.

Fear is the emotional response to real and perceived imminent threat. Anxiety is anticipation of future threat.
SEPARATION ANXIETY DISORDER PANIC DISORDER
– Diagnostic Criteria – Diagnostic Criteria GENERALIZED ANXIETY DISORDER
A. Developmentally inappropriate and excessive fear or anxiety A. Recurrent unexpected panic attacks, evident in four or more of – Diagnostic Criteria
concerning separation, evident in at least three of the following. the following symptoms: A. Excessive anxiety or worry for at least 6 months, about a
1. when anticipating or experiencing separation from major 1. Palpitations number of events or activities.
attachment figures. 2. Sweating B. Difficult to control the worry.
2. worry about losing attachment figure or possible harm to them. 3. Trembling or shaking C. Anxiety and worry are associated with three or more of the ff.
3. worry about experiencing an untoward event that causes 4. Shortness of breath 1. Restlessness
separation. 5. Feelings of choking 2. Being easily fatigued.
4. refusal to go out because of fear of separation. 6. Chest pain 3. Difficulty concentrating or mind going black
5. being alone or without attachment figure at any settings. 7. Nausea 4. Irritability
6. refusal to sleep away or without attachment figure. 8. Feeling dizzy 5. Muscle tension
7. nightmares involving the theme of separation. 9. Chills or heat sensations 6. Sleep disturbance
8. complaints of physical symptoms when separated. 10. Paresthesia or numbness
D. Cause clinically significant distress or impairment
B. Symptoms persistent at least 4 weeks in children and 11. Derealization or feelings of unreality
E. Not attributable to physiological effects of a substance.
adolescents. 6 months or more in adults. 12. Fear of losing control
13. Fear of dying F. Disturbance not better explained by another mental disorder.
C. Disturbance cause clinically significant distress or impairment.
D. Disturbance is not better explained by another medical disorder. B. At least 1 attack has followed by 1 month or more of the ff.: – Prevalence of 0.9% among adolescents and 2.9% among adults.
1. Persistent worry about additional panic attacks Females twice likely to experience it.
– 12-month prevalence among children is 4%, 0. 1.6% among 2. Significant maladaptive change in behavior related to the
adolescents, and 0.9%-1.9% among adults. attacks.
C. Disturbance is not attributable to physiological effects of a
SELECTIVE MUTISM substance or another medical condition.
– Diagnostic Criteria D. Disturbance is not better explained by another mental
A. Consistent failure to speak or respond in social situation which disorder.
there is an expectation for speaking. – Panic attack or abrupt surge can occur from a calm state or anxious
B. Disturbance interferes achievement or social communication. state.
C. Duration is at least 1 month. – Onset on puberty (14 years) and peak during adulthood.
D. Failure to speak is not attributable to lack of knowledge. – Prevalence of 2%-3% in adults and adolescents. Females are more
E. Disturbance is not better explained by communication disorder. frequently affected at a rate of 2:1.
– Prevalence ranges between 0.03 and 1%.
– Onset is before 5 years of age.
AGORAPHOBIA
SPECIFIC PHOBIA A. Fear or anxiety about two or more of the following situations:
– Diagnostic Criteria 1. Using public transportation.
A. Marked fear or anxiety about specific object or situation. 2. Being in open spaces (parking lots, market, bridges)
B. The phobic object always provokes immediate fear or anxiety. 3. Being in enclosed spaces (shops, theaters, cinemas)
C. The phobic object is actively avoided with intense fear or anxiety. 4. Being in a crowd.
D. Fear or anxiety is out of proportion to the actual danger posed by 5. Being outside or home alone.
specific object. B. Fears or avoids the situations because of thoughts that escape
E. Persistent for 6 months or more. might be difficult or help might not be available.
F. Cause clinically significant distress or impairment. C. Agoraphobic situations always provoke fear or anxiety.
G. Disturbance is not better explained by other mental disorder. D. Agoraphobic situations are actively avoided or require
– Approximately 75% of individuals fear more than one object or event. presence of companion.
– Prevalence of 5% in children, and 16% in 13-17 years old. E. Fear or anxiety is out of proportion to the actual danger.
– Individual with phobias are up to 60% likely to make suicide attempt. F. Persistent lasting for 6 months or more.
G. Causes clinically significant distress or impairment.
H. If another medical condition is present, the fear, anxiety, or
SOCIAL ANXIETY DISORDER (Social Phobia) avoidance is clearly excessive.
– Diagnostic Criteria I. Not better explained by symptoms of another mental disorder.
A. Marked fear or anxiety about one or more social situation. – Prevalence every year approximately 1.7% of adolescents and adults.
B. Fear that the individual will show anxiety symptoms that will be Females twice likely to experience agoraphobia.
negatively evaluated, or lead to rejection.
C. Social situations always provoke fear or anxiety.
D. Social situations are avoided with intense fear or anxiety.
E. Fear or anxiety is out of proportion to the actual threat posed by
the social situation.
F. Persistent for 6 months or more.
G. Cause clinically significant distress or impairment.
H. Fear, anxiety, or avoidance not attributable to physiological
effects of a substance.
I. Not better explained by symptoms of other mental disorder.
J. If another medical condition is present, the fear or anxiety is
clearly unrelated.

OBSESSIVE–COMPULSIVE AND RELATED DISORDERS
Characterized by presence of obsession and/or compulsion

OBSESSIVE-COMPLUSIVE DISORDER TRICHOTILLOMANIA (Hair Pulling Disorder)
– Diagnostic Criteria – Diagnostic Criteria
A. Presence of obsession, compulsion, or both. A. Recurrent pulling out of one’s hair, resulting in hair loss.
Obsessions B. Repeated attempts to decrease or stop hair pulling.
1. Recurrent and persistent thought, urges, or images that are experienced
C. Causes clinically significant distress or impairment.
during disturbance, as intrusive and unwanted.
2. The individual attempts to ignore or suppress thoughts, urges, or images to D. Hair pulling not attributable to another medical condition.
neutralize them with other thought or action. E. Hair pulling not better explained by another mental disorder.
Compulsions – Hair pulling may occur in brief episodes scattered throughout the day,
1. Repetitive behaviors or mental acts that the individual feels driven to
perform in response to an obsession.
can continue for hours. Pulling hair may endure for months or years.
2. Behaviors or mental acts are aimed at preventing or reducing anxiety or – Prevalence of 1%-2% in adults and adolescents. Females are more
distress. These behaviors or mental acts are not connected in a realistic way frequently affected with a ration of 10:1.
B.
with what they are designed to neutralize or prevent.
The obsession or compulsion are time-consuming or cause

clinically significant distress or impairment. EXCORIATION (Skin Picking) DISORDER
C. Symptoms not attributable to physiological effects of substance. – Diagnostic Criteria
D. Disturbance not better explained by another mental disorder. A. Recurrent skin picking, resulting in skin lesions or wound.
– Specify if: B. Repeated attempts to decrease or stop skin picking.
With good or fair insight – recognition that OCD beliefs may or may not be true. C. Causes clinically significant distress or impairment.
With poor insight – thinking that OCD beliefs are probably true. D. Skin picking not attributable to physiological effects of a
With absent insight/ delusional beliefs – completely convinced beliefs are true. substance.
– Specify if: E. Skin pulling not better explained by another mental disorder.
Tic-related – individual has current or history of tic disorder. – Most common picked sites are face, arms, and hands.
– Prevalence of 1.1%-1.8%. Females are highly affected. – Prevalence of 1.4% in adults. Three quarters or more are female.
– Mean age onset is 19.5 years, and 25% of cases started by 14 years. – Onset during adolescents. May come and go for weeks, months, or
years at a time.
BODY DYSMORPHIC DISORDER
A. Preoccupation with one or more perceived defects or flaws in
physical appearance that are not observable by others.
B. The individual has performed repetitive behaviors (mirror checking,
excessive grooming, reassurance seeking) or mental acts (comparing appearance
with others) in response to the appearance concerns.
C. Causes clinically significant distress or impairment.
D. Appearance not better explained by concerns with body fat or
wright in an individual whose symptoms meet diagnostic criteria
for an eating disorder.
– Specify if:
With muscled dysmorphia – the individual is preoccupied with the idea that his
body build is too small or insufficiently muscular.
– Specify if:
With good or fair insight
With poor insight
With absent insight/ delusional beliefs
– Prevalence of 2.5% in females and 2.2% in males.
– Suicide attempts are high in adolescents.

HOARDING DISORDER
A. Persistent difficulty discarding or parting with possessions,
regardless of actual value.
B. Difficulty is due to the perceived need to save the items and to
the distress associated with discarding them.
C. Difficulty discarding items result in accumulation of possession
that congest and fill living areas.
D. Causes clinically significant distress or impairment.
E. Hoarding is not attributable to another medical condition.
F. Hoarding is not better explained by another mental disorder.
– Specify if:
With good or fair insight – hoarding-related beliefs and behaviors are problematic.
With poor insight – mostly convinced beliefs are not problematic despite evidence.
With absent insight/ delusional beliefs – completely convinced beliefs are not
problematic despite evidence.
– Prevalence of 2%-6%. Three times more prevalent in older adults ages
55-94 years.

TRAUMA- AND STRESSOR-RELATED DIRORDERS
Exposure to a traumatic or stressful event. Symptoms can be well understood within an anxiety- or fear- based context.

REACTIVE ATTACHMENT DISORDER D. Negative alterations in cognitions and mood associated with ACUTE STRESS DISORDER
– Diagnostic Criteria traumatic events, as evidence by two or more: – Diagnostic Criteria
A. Consistent pattern of inhibited, emotionally drawn behavior toward 1. Inability to remember important aspect of traumatic event. A. Exposure to actual or threatened death, serious injury, or sexual
2. Persistent and exaggerated negative beliefs or expectations. violation in one or more ways:
adult caregiver, manifested by both:
3. Persistent, distorted cognitions about the cause or consequences of
1. Child rarely or minimally seeks comfort when distressed. 1. Directly experiencing traumatic events
traumatic event that lead to blaming self or others.
2. Child rarely or minimally responds to comfort when distressed. 2. Witnessing in person as it occurred to others
4. Persistent negative emotional state
B. Persistent social and emotional disturbance characterized by at 5. Diminished interest or participation in significant activities. 3. Learning event occurred to close family member or friend
least two: 6. Feelings of detachment or estrangement from others. 4. Experiencing repeated or extreme exposure.
1. Minimal social and emotional responsiveness. 7. Inability to experience positive emotions. B. Presence of nine of the following from any category:
2. Limited positive affect. E. Marked alterations in arousal and reactivity associated with traumatic Intrusion Symptoms
3. Episodes of unexplained irritability, sadness, or fearfulness even 1. Recurrent, involuntary, intrusive distressing memories
event, as evidence by two or more:
during nonthreatening interactions. 2. Recurrent distressing dreams
1. Irritable behavior or angry outbursts
C. Child has experienced a pattern of extremes of insufficient care as 2. Recklessness 3. Dissociative reaction as if traumatic events were recurring.
evidenced by at least one: 3. Hypervigilance 4. Prolonged psychological distress or reaction in response to cues that
1. Social neglect or deprivation from caregiver. 4. Exaggerated startle response resemble an aspect of traumatic event
2. Repeated changes of caregiver that limit opportunities to form 5. Problems with concentration Negative Mood
stable attachment. 6. Sleep disturbance 5. Inability to experience positive mood
3. Rearing in unusual settings that severely limit opportunities to F. Duration is more than 1 month. Dissociative Symptoms
form selective attachment. 6. Altered sense of reality of surroundings or self
G. Causes clinically significant distress or impairment.
D. The care in Criterion C is responsible for Criterion A behavior. 7. Inability to remember important aspect of traumatic event
H. Not attributable to physiological effects of a substance. Avoidance Symptoms
E. Criteria not met for autism spectrum disorder
F. Disturbance evident before 5 years 8. Efforts to avoid distressing memories
– Diagnostic Criteria for 6 years and younger 9. Efforts to avoid external reminders
G. Child has developmental age of at least 9 months. Arousal Symptoms
A. Exposure to actual or threatened death, serious injury, sexual violence
– Specify if Persistent – disorder present for more than 12 months. in one or more ways: 10. Sleep disturbance
1. Directly experiencing traumatic event 11. Irritable behavior and angry outbursts
12. Hypervigilance
DISINHIBITED SOCIAL ENGAGEMENT DISORDER 2. Witnessing in person the event
13. Problems with concentration
– Diagnostic Criteria 3. Learning the event occurred to a close family member or friend.
14. Exaggerated startle response
A. A pattern of behavior in which a child actively approaches and B. Presence of one or more symptoms, after traumatic event:
C. Duration is 3 days to 1 month after trauma exposure.
interacts with unfamiliar adults and at least two: 1. Recurrent, involuntary, and intrusive distressing memories. D. Causes clinically significant distress or impairment
2. Recurrent distressing dreams related to traumatic event.
1. Reduced or absent reticence in approaching and interacting with
3. Dissociative reactions in which the individual feels or acts as if the E. Not attributable to the physiological effects of a substance.
unfamiliar adults.
2. Overly familiar verbal or physical behavior. traumatic event were recurring.
4. Intense or prolonged psychological distress at exposure to cues that
3. Diminished or absent checking back with adult caregiver after
resemble an aspect of the traumatic event.
ADJUSTMENT DISORDER
venturing away, in unfamiliar setting. – Diagnostic Criteria

4. Willingness to go off with unfamiliar adult with minimal or no 5. Marked physiological reactions to cues that resemble the event.
C. Persistent avoidance of stimuli as evidence by one or both: A. Development of emotional or behavioral symptoms in response to
hesitation. identifiable stressors occurring within 3 months.
Persistent Avoidance of Stimuli
B. Behaviors in Criterion A are not limited to impulsivity but include
1. Efforts to avoid activities, places or physical reminders of the event. B. Symptoms or behaviors are clinically significant, by one or both:
socially disinhibited behavior.
C. The child has experienced pattern of extremes insufficient care as
2. Efforts to avoid people, conversation, or interpersonal situations that
arouse recollection of traumatic event.
1.
2.
Marked distress out of proportion to severity of the stressor.
Significant impairment in social, occupation and other functioning.
evidence by at least one:
1. Social neglect or deprivation from caregiver.
Negative Alteration in Cognition C. Disturbance does not meet the criteria of another mental disorder
1. Substantially increased frequency of negative emotional state. D. Symptoms do not represent normal bereavement/ grieving.
2. Repeated changes of caregiver that limit opportunities to form 2. Markedly diminished interest or participation to activities. E. Once stressor have terminated, symptoms do not persist for more
stable attachments.
3. Rearing in unusual setting that severely limit opportunities to
3. Socially withdrawn behavior. than additional 6 months.
4. Persistent reduction in expression of positive emotions. – Prevalence of 5% to 20% in outpatient.
form selective attachments. D. Alteration in arousal and reactivity associated with traumatic events.
D. The care in Criterion C is responsible for Criterion A behavior. 1. Irritable behavior and angry outbursts
E. The child has a developmental age of at least 9 months. 2. Hypervigilance
– Specify if Persistent – disorder present for more than 12 months. 3. Exaggerated startle response
– Occurs in only about 20% of children. 4. Problems with concentration
5. Sleep disturbance
E. Duration is more than 1 month.
POSTTRAUMATIC STRESS DISORDER (PTSD) F. Disturbance causes clinically significant distress or impairment.
– Diagnostic Criteria for 6 years and older G. Disturbance not attributable to physiological effects of a substance.
A. Exposure to actual or threatened death, serious injury, or sexual
violence in one or more ways. – Specify
1. Directly experiencing traumatic event
With dissociative symptoms – in response to the stressor, the individual
2. Witnessing in person the event
experiences persistent or recurrent symptoms of either:
3. Learning the event occurred to a close family member or friend. 1. Depersonalization – persistent feeling of detach sense of oneself.
4. Experiencing repeated or extreme exposure to details of event. 2. Derealization – persistent or recurrent distorted or unreal view of surroundings.
B. Presence of one or more symptoms, after the traumatic event. With delayed expression – full diagnostic criteria not met until 6 months after
1. Recurrent, involuntary, and intrusive distressing memories. the event.
2. Recurrent distressing dreams related to traumatic event.
3. Dissociative reactions in which the individual feels or acts as if the – Prevalence at age 75 years is 8.7%.
traumatic event were recurring. – Symptoms begin within first 3 months after the trauma.
4. Intense or prolonged psychological distress at exposure to cues that
resemble an aspect of the traumatic event.
5. Marked physiological reactions to cues that resemble the event.
C. Persistent avoidance of stimuli as evidence by one or both:
1. Efforts to avoid distressing memories associated to traumatic event.
2. Efforts to avoid external reminders associated with traumatic event.

DISSOCIATIVE DISORDERS
characterized y a disruption of the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior.
symptoms are unbidden intrusions into awareness or behavior, and inability to access information or control mental functions.

DISSOCIATIVE IDENTITY DISODER DEPERSONALIZATION/ DEREALIZATION DISORDER
A. Presence of two or more distinct personality states or an A. Presence of persistent or recurrent experiences of
experience of possession. depersonalization, derealization, or both;
B. Recurrent gaps in the recall of everyday events, important 1. Depersonalization – experiences of unreality or
personal information, and/or traumatic events that are detachment from mind, body, or self.
Ex. Distorted sense of time, unreal or absent self, emotional or
inconsistent with ordinary forgetting.
physical numbing.
C. Symptoms causes clinically significant distress or
2. Derealization – experiences of unreality or detachment
impairment.
from surroundings.
D. Disturbance is not a normal part of broadly accepted cultural Ex. Individuals or objects perceived as foggy, dream-like, life-
or religious practice. less, or visually distorted.
In children, symptoms not better explained by imaginary playmates B. Reality testing remains intact
or fantasy play.
C. Cause clinically significant distress or impairment
E. Symptoms are not attributable to physiological effects of a
D. Not attributable to physiological effects of a substance
substance.
E. Not better explained by another mental disorder.
– Manifest in three primary ways
– Prevalence range of 0.8% to 2.8% with gender ration of 1:1.
1. Gaps in remote memory of personal life events.
Ex. Period of childhood or adolescence, some important life events,
– Mean age onset is 16 years.
death of parent, giving birth, getting married.
2. Lapses in dependable memory
Ex. what happened today, how to do their job, use computer, read,
drive.
3. Discovery of evidence of everyday actions and tasks that
they do not recollect doing.
Ex. finding unexplained objects in shopping bags, discovering injuries,
discovering drawings or writings that they must have created.
– Prevalence of 1.6% for males and 1.4% for females.
– Suicide risk of 70% for outpatients.

DISSOCIATIVE AMNESIA
A. Inability to recall important autobiographical information
that should be successfully stored in memory and ordinarily
would be readily remembered.
B. Symptoms cause clinically significant distress or
impairment.
C. Disturbance not attributable to physiological effects of a
substance.
D. Disturbance not better explained by dissociative identity
disorder posttraumatic stress disorder, acute stress
disorder, somatic symptom disorder, or major or mild
neurocognitive disorder.
– Localized amnesia is the failure to recall events during a limited/
circumscribed period of time.
Selective amnesia – recall some, but not all, of the events during
circumscribed period of time.
– Generalized amnesia is a complete loss of memory for one’s life
history.
Systemized amnesia – loses memory for a specific category of
information.
(memories relating to family, a particular person,
childhood)
Continuous amnesia – individual forgets each new events as it occurs.
– Prevalence of 1.0% for males; 2.6% for females.

SOMATIC SYMPTOM AND RELATED DISORDERS
the prominence of somatic (body) symptoms associated with marked impairment of health status.

SOMATIC SYMPTOM DISORDER PSYCHOLOGICAL FACTORS AFFECTING OTHER MEDICAL
– Diagnostic Criteria CONDITIONS
A. One or more somatic symptoms that are distressing or have – Diagnostic Criteria
significant disruption of daily life. A. A medical condition other than a mental disorder is present.
B. Excessive thoughts, feelings, or behaviors related to somatic B. Psychological or behavioral factors affect the medical
symptoms, manifested by at least one: condition in one of the following ways:
1. Persistent thoughts about the seriousness of symptoms. 1. Close temporal association between psychological factors and
2. Persistently high level of anxiety about health. the development/ delayed recovery from medical condition.
3. Excessive time and energy devoted to health concerns. 2. The factors interfere with the treatment of medical condition.
C. Symptoms persistent typically more than 6 months. 3. The factors constitute additional well-established health risks
– Specify if: for the individual.
with predominant pain – symptoms predominantly involve pain. 4. The factors influence the underlying pathophysiology,
Persistent – more than 6 months. precipitating or exacerbating symptoms or necessitating
– Severity medical attention.
Mild – one symptoms specified in criterion B is fulfilled. C. Factors in criterion B are not better explained by another
Moderate – two or more symptoms mental disorder.
Severe – two or more symptoms in criterion B and three multiple – Severity
somatic complains. Mild – increases medical risk.
– Prevalence of 5%-7%/ Moderate – aggravates underlying medical condition.
Severe – results in medical hospitalization or emergency room visit.
Extreme – life-threatening risk.
ILLNESS ANXIETY DISORDER
– aka hypochondrias
– Diagnostic Criteria FACTITIOUS DISORDER
A. Preoccupation with having or acquiring serious illness. – Diagnostic Criteria
B. Somatic symptoms are not present or, if present, are only mild in Imposed on Self
intensity. A. Falsification of physical or physiological signs or symptoms, or
C. There is a high level of anxiety about health. induction of injury or disease, associated with identified
D. The individual performs excessive health-related behaviors deception.
(check for signs) or exhibits maladaptive avoidance (avoid B. Individual presents himself or herself to others as ill, impaired,
doctor appointments and hospitals). or injured
E. Illness preoccupation present for at least 6 months. C. Deceptive behavior evident even in absence of obvious
F. The illness-related preoccupation is not better explained by rewards.
another mental disorder. D. Behavior is not better explained by another mental disorder
– Specifiers such as delusional disorder.
Care-seeking type – medical care, including physician visits or Imposed on Another
undergoing tests and procedures. A. Falsification of signs, symptoms, injury or diseases in another,
Care-avoidant type – medical care is rarely used. associated with identified deception.
B. The individual presents another individual (victim) to others
as ill, impaired, or injured.
CONVERSION DISORDER C. Deceptive behavior evident even in absence of obvious
– Functional Neurological Symptom Disorder rewards.
– Diagnostic Criteria D. Behavior is not better explained by another mental disorder.
A. One or more symptoms of altered voluntary motor – Diagnosis requires demonstrating that individual is taking
B. Clinical findings provide evidence of incompatibility between the surreptitious actions to misrepresent, simulate, or cause signs or
symptom and condition. symptoms of illness or injury in absence of obvious external r ewards.
C. Symptom is not better explained by another mental disorder.
D. Symptoms causes clinically significant distress or impairment.
– Symptom type
with weakness or paralysis
with abnormal movement
with swallowing symptoms
with speech symptoms
with attacks or seizures
with anesthesia or sensory loss
with special sensory symptom
with mixed symptom
– Prevalence of 5%. Incidence of individual persistent conversion
symptoms is estimated to be 2-5/100,000 per year.

FEEDINGS AND EATING DISORDERS ELIMINATION DISORDERS
characterized a persistent disturbance of eating or eating-related behavior that results in the altered consumption or absorption of Inappropriate elimination of urine or feces. Usually diagnosed in
food that significantly impairs physical health or psychological functioning. childhood or adolescence.

PICA BULIMIA NERVOSA ENURESIS
– Diagnostic Criteria – Diagnostic Criteria – Diagnostic Criteria
A. Persistent eating of nonnutritive, nonfood substances for at least A. Recurrent episodes of binge eating. Characterized by: A. Repeated voiding of urine into bed or clothes.
1 month. 1. Eating a significantly large amount of food in discrete period of B. Frequency of at least twice a week for at least 3 consecutive
B. The eating is inappropriate to the developmental level of the time. months or presence of clinically significant distress or
individual. 2. A sense of lack of control over eating during the episode. impairment.
C. The eating behavior is not part of culturally spotted or socially B. Recurrent inappropriate compensatory/ purging behaviors in C. Chronological age is at least 5 years.
normative practice. order to prevent weight gain. D. Behavior is not attributable to physiological effects of substance.
D. If eating behavior occurs in the context of another mental Ex. self-induced vomiting, misuse of laxatives, diuretics or other – Specifiers
medications, fasting, or excessive exercise.
disorder or medical condition, it is sufficiently severe to warrant Nocturnal only – only during nighttime sleep.
C. Binge eating and purging behaviors both occur at least once a
additional clinical attention. Diurnal only – during waking hours.
week for 3 months.
– Minimum age of 2 years is suggested for a pica diagnosis. Nocturnal and diurnal – combination.
D. Self-evaluation is unduly influenced by body shape and weight.
– Prevalence of pica increase with the severity of intellectual disability – Prevalence of 5%-10% among 5 years old, 3%-5% among 110 years
E. Disturbance does not occur exclusively during the episodes of
old, and 1% among 15 years and older.
anorexia nervosa.
– Severity
RUMINATION DISORDER
Mild – 1-3 episodes of purging behaviors per week.
– Diagnostic Criteria ENCOPRESIS
Moderate – 4-7 episodes
A. Repeated regurgitation of food for at least 1 month. – Diagnostic Criteria
Regurgitation – re-chewed, re-swallowed, spit out. Severe – 8-13 episodes
A. Repeated passage of feces into inappropriate places.
B. Repeated regurgitation is not attributable to an associated Extreme – 14 or more episodes
B. At least one such event occurs each month for 3 months.
gastrointestinal or other medical condition. – Binge eating is characterized more by an abnormality in the amount of
C. Chronological age is at least 4 years old.
C. The eating disturbance does not occur exclusively during the food consumed than by a craving for specific nutrient.
D. Behavior is not attributable to physiological effects of substance.
course of anorexia nervosa. – Prevalence of 1%-5% in females with 10:1 female-to-male ratio.
– Specifiers
D. If symptoms occur in the context of another mental disorder, – begins in adolescence or young adulthood.
with constipation and overflow incontinence – evidence of constipation
they are sufficiently severe to warrant additional clinical on physical examination or by history.
attention. without constipation and overflow incontinence – no evidence.
– Specify if BINGE EATING DISORDER
In remission – after a full criteria for rumination disorder were – Diagnostic Criteria
A. Recurrent episodes of binge eating characterized by:
previously met, the criteria have not been met for a
1. Eating large amount of food in discrete period of time.
sustained period of time.
2. A sense of lack of control over eating during the episode.
B. Binge eating episodes associated with three or more:
1. Eating much more rapidly than normal.
ANOREXIA NERVOSA 2. Eating until feeling uncomfortably full.
– Diagnostic Criteria 3. Eating large amounts of food when not physically hungry.
A. Restriction of energy intake relative to requirements, leading to 4. Eating alone because of feeling embarrassed of how much one is
significant low body weight in the context of age, sex, eating.
developmental trajectory, and physical health. 5. Feeling disgusted with oneself, depressed, or very guilty
B. Intense fear of gaining weight or becoming fat. afterward .
C. Disturbance in the way in which one’s body weight or shape is C. Marked distress regarding binge eating is present.
experienced or persistent lack of recognition of the seriousness D. Occurs at least once a week for 3 months.
of the current low body weight. E. Binge eating is not associated with recurrent use of
– Types inappropriate compensatory/ purging behaviors as in bulimia
Restricting type – during the last 3 months, the individual has not nervosa.
engaged in recurrent episodes of binge eating or – Occurs in normal weight/ over weight and obese individuals.
purging behavior. Weight loss is accomplished – Prevalence of 1.6% in females and 0.8% in males.
primarily through dieting, fasting, and excessive
exercise.
Bing-eating/ purging type – during the last 3 months, the individual
has engaged in recurrent episodes of binge
eating or purging behavior.
– Prevalence of 0.4% in young females with 10:1 female to male ratio.
– Begins during adolescence or young adulthood.
– Suicide risk of 12 per 100,000 per year.

SLEEP-WAKE DISORDERS
Present with sleep-wake complaints of dissatisfaction regarding quality, timing, and amount of sleep. Resulting in daytime distress and impairment.

INSOMNIA NARCLEPSY SLEEP-RELATED HYPOVENTILATION
A. Predominant complaint of dissatisfaction with sleep quantity A. Recurrent episodes of irrepressible need to sleep, lapsing A. Polysomnography demonstrates episodes of decreased
or quality, associated with one or more symptoms into sleep, or napping occurring within the same day, at least respiration associated with elevated CO2 levels.
1. Sleep-onset Insomnia – difficulty initiating sleep at bedtime. three times per week for 3 months. B. Disturbance not better explained by another sleep disorder.
2. Sleep maintenance Insomnia – frequent or prolonged B. Presence of at least one: – Subtypes
awakening throughout the night. 1. Episodes of cataplexy, at least few times per month Idiopathic hypoventilation – not attributable to any identified
3. Late Insomnia – early-morning awakening with inability to a. In individuals with long-standing disease, brief condition.
return to sleep. episodes of sudden bilateral loss of muscle tone with Congenital Central Alveolar Hypoventilation – perinatal period
B. Cause clinically significant distress or impairment. maintained consciousness, precipitated by laughter or with shallow breathing, or cyanosis and apnea during sleep.
C. Occurs at least 3 nights per week. joking. Comorbid Sleep-Related Hypoventilation – occurs as a
D. Present for at least 3 months. b. In individuals within 6 months of onset, spontaneous consequence of medical condition or medications.
E. Occurs despite adequate opportunity for sleep. grimaces or jaw-opening episodes, without obvious
F. Not better explained by and does not occur exclusively emotional triggers.
during the course of another sleep-wake disorder. 2. Hypocretin deficiency, measured using cerebrospinal CIRCADIAN RHYTHM SLEEP-WAKE DISORDERS
G. Coexisting mental disorders and medical conditions do not fluid. – Diagnostic Criteria
adequately explain the predominant complaint of insomnia. 3. Nocturnal sleep polysomnography showing rapid eye A. A persistent or recurrent pattern of sleep disruption that is
– Prevalence of 6%-10% with 1.44:1 ratio. More common in movement (REM) sleep latency less than or equal to 15 primarily due to an alteration of circadian system or
adulthood. minutes. misalignment between endogenous circadian rhythm and
– Nonrestorative Sleep is a complaint of poor sleep quality that does – Prevalence of 0.02%-0.04%. sleep-wake schedule.
not leave the individual rested upon awakening despite adequate – Onset is typically in children and adolescents, but rarely older B. Leads to excessive sleepiness or insomnia, or both.
duration. adults. C. Causes clinically significant distress or impairment.
– Specifiers – Two peaks of onset are at ages 15-25 years, and ages 20-25 years. – Subtypes
Situation or Acute Insomnia – lasts a few days/weeks, associated with
rapid changes in sleep schedules or environment.
1. Delayed Sleep Phase type
– inability to fall asleep and awaken at desired or acceptable
Persistent Insomnia – longer due to conditioning factors and BREATHING-RELATED SLEEP DISORDERS earlier time.
heightened arousal. OBSTRUCTIVE SLEEP APEA HYPOPNEA 2. Advance Sleep Phase type
Recurrent Insomnia – associated with occurrence of stressful events. – inability to remain awake or asleep at desire or acceptable
A. Either (1) or (2): later times.
HYPERSOMNOLENCE DISORDER 1. 5 obstructive apneas/ hypopneas per hour of sleep. Either 3. Irregular Sleep-Wake type
– Diagnostic Criteria of: – temporarily disorganized sleep-wake pattern. The timing
A. Excessive sleepiness despite 7-hour main sleep, with at least a. Nocturnal breathing disturbances of sleep-wake periods is variable throughout the 24-hour
one: – snoring, snorting/ gasping, breathing pauses during period.
1. Excessive quantity of sleep – extended nocturnal or sleep. 4. Non-24-hour Sleep-Wake type
involuntary sleep. b. Daytime sleepiness, fatigue, or unrefreshing sleep despite – pattern of sleep-wake cycles not synchronized to 24-hour
2. Deteriorated quality of wakefulness – difficulty being fully sufficient opportunities to sleep. environment.
awake. 2. 15 or more obstructive apneas and/or hypopneas per four 5. Shift Work type
3. Sleep inertia – impaired performance and reduced vigilance of sleep. – insomnia during major sleep period and or excessive
following awakening from prolonged main sleep of more – Prevalence of more than 20% of adults. sleepiness during major wake period associated with a shift
than 9 hours. – Apnea is the total absence of airflow. work schedule.
B. Occurs at least three times per week, for at least 3 months. – Hypopnea is the reduction in airflow. 6. Unspecified type
C. Accompanied by significant distress or impairment. – Specifiers
D. Not better explained by and does not occur exclusively Episodic – symptoms last at least 1 month but less than 3 months.
during the course of another sleep disorder. CENTRAL SLEEP APNEA Persistent – 3 months or longer.
E. Not attributable to physiological effects of a substance. – Diagnostic Criteria Recurrent – two or more episodes occur within the space of 1 year.
F. Coexisting mental and medical disorders do not adequately A. Evidence by polysomnography of five or more central
explain the predominant complaint of hypersomnolence. apneas per hour of sleep.
– Severity B. Disorder not better explained by another current sleep
Mild – difficulty maintaining daytime alertness 1-2 days/week. disorder.
Moderate – 3-4 days/week. – Specifiers
Severe – 5-7 days/week. Idiopathic Central Sleep Apnea – repeated episodes of apneas and
hypopneas during sleep cause by variability in respiratory
effort but without evidence of airway obstruction.
Cheyne-Stokes breathing – pattern of periodic crescendo-
decrescendo variation in tidal volume that results in central
apneas and hypopneas in frequency at least five events per
hour, accompanied by frequent arousal.
Central Sleep Apnea Comorbid with Opioid Use

PARASOMNIAS (SLEEP –WAKE DISORDERS)
Characterized by abnormal behavioral, experiential, or physiological events occurring in association with sleep.

NON-RAPID EYE MOVEMENT SLEEP AROUSAL DISORDERS RESTLESS LEG SYNDROME
A. Recurrent episode of incomplete awakening from sleep, A. Urge to move the legs in response to uncomfortable and
occur during the first third of major sleep episode, unpleasant sensations in the legs characterized by
accompanied by either 1. Begins or worsen during period of rest or inactivity.
1. Sleepwalking – repeated episodes of rising from bed during 2. Partially or totally relieved by movement.
sleep and walking with blank, staring face. 3. Worse in the evening or occurs only in the evening.
2. Sleep terrors – repeated episodes of abrupt terror arousals B. Occur at least three times per week and persisted for at least
from sleep, usually beginning with panicky scream with 3 months.
rapid breathing, sweating, mydriasis (dilation of pupil of C. Accompanied by significant distress or impairment.
the eye), and tachycardia (abnormal rapid heart rate). D. Not attributable to another mental disorder or medical
B. No or little dream imagery is recalled. condition.
C. Amnesia for the episodes is present. E. Not attributable to physiological effects of a drug of abuse or
D. Cause clinically significant distress or impairment. medication.
E. Not attributable to physiological effects of a substance. – Prevalence of 2% to 7.2%.
F. Coexisting mental and medical disorders do not explain the – Onset before age 20 years.
episodes of sleepwalking and sleep terrors.

SUBSTANCE/MEDICATION-INDUCED SLEEP DISORDER
NIGHTMARE DISORDER – Diagnostic Criteria
– Diagnostic Criteria A. A prominent and severe disturbance in sleep.
A. Repeated occurrences of extended, extremely dysphoric, and B. Evidence from history, physical examination, or laboratory
well-remembered dreams that involves threats to survival or findings in both (1) and (2):
security. Occur during second half of major sleep episode. 1. Symptoms developed during or soon after substance
B. On awakening, the individual rapidly becomes oriented and intoxication, withdrawal, or exposure to a medication.
alert 2. Involved substance/ medication is capable of producing
C. Cause clinically significant distress or impairment. the symptoms.
D. Not attributable to physiological effects of substance. C. Disturbance is not better explained by a sleep disorder that
E. Coexisting mental and medical disorders do not adequately is not substance/ medication-induced.
explain the predominant complain of dysphoric dreams. D. Disturbance does not occur exclusively during the course of
– Specifiers a delirium.
Acute – duration of period of nightmares is 1month or less. E. Disturbance cause clinically significant distress or
Subacute – duration is greater the 1 month but less than 6 months. impairment.
Persistent – duration is 6 months or greater. – Subtypes:
– Severity 1. Insomnia type – difficulty falling asleep or maintaining sleep.
Mild – less than one episode per week on average. 2. Daytime sleepiness type – predominant complaint of excessive
Moderate – one or more episodes per week on average. sleepiness/ fatigue during waking hours.
Severe – episodes nightly. 3. Parasomnia type – abnormal behavioral events during sleep.
– Prevalence of 1.3% to 3.9%. 4. Mixed type
– Onset is ages 3 and 6 years. – Specifiers:
With onset during intoxication
With onset during discontinuation/ withdrawal
RAPID EYE MOVEMENT SLEEP BEHAVIOR DISORDER
A. Repeated episodes of arousal during sleep associated with
vocalization and or complex moto behaviors (kicking,
jumping out of bed, falling, thrusting, or hitting)
B. Behaviors arise during rapid eye movement (REM) sleep and
occur more than 90 minutes after sleep onset.
C. Upon awakening, the individual is completely awake, alert,
not confused nor disoriented.
D. Either of the following
1. REP sleep without atonia on polysomnographic
recording.
2. History suggestive of Rem sleep behavior disorder and
an established synucleinopathy diagnosis.
E. Behaviors cause clinically significant distress or impairment
F. Not attributable to physiological effects of a substance.
G. Coexisting mental and medical disorders do not explain the
episodes.

SEXUAL DYSFUNCTION GENDER DYSPHORIA
Characterized by clinically significant disturbance in a person’s ability to respond sexually or to experience sexual pleasure. Distress between expressed gender and assigned gender.

Subtypes FEMALE SEXUAL INTEREST/ AROUSAL DISORDER Sex – biological indicators of male and female.
Lifelong – sexual problem that has been present from first sexual – Diagnostic Criteria Gender – lived role, expressed identification as male or female.
experience. A. Lack of, or significantly reduced sexual interest/ arousal,
Acquired – sexual disorder developed after a period of relatively manifested by at least three.
normal sexual function. B. Symptoms persisted for 6 months. In Children
Generalized – sexual difficulties not limited to certain types of
C. Cause clinically significant distress (mild, moderate, s evere). – Diagnostic Criteria
stimulation, situation, or partners.
D. Not better explained by a nonsexual mental disorder or as a A. Marked incongruence between expressed gender and
Situational – sexual difficulties that only occur within certain types of
stimulation, situations, or partners. consequence of severe relationship distress, and is not assigned gender of at least 6 months’ duration. Manifested
attributable to another medical condition. by six or more.
Factors – previously termed hypoactive sexual desire disorder. 1. A strong desire to be of other gender.
Partner factors – partner’s sexual problem, health status. 2. A strong preference for cross-dressing.
Relationship factors – poor communication, discrepancies in desire for 3. A strong preference for cross-gender roles in fantasy play.
sexual activity.
GENITO-PELVIC PAIN/ PENETRATION DISORDER 4. A strong preference for toys, games, or activities of the
Individual Vulnerability factors – poor body image, history of sexual – Diagnostic Criteria opposite gender.
or emotional abuse. A. Persistent or recurrent difficulties with one or more. 5. A strong preference for playmates of opposite gender.
Cultural or Religious factors – inhibitions related prohibitions against 1. Vaginal penetration during intercourse. 6. A strong rejection for toys of own gender.
sexual activity or pleasure, attitude toward sexuality. 2. Marked vulvovaginal or pelvic pain during penetration. 7. A strong dislike of one’s sexual anatomy.
Medical factors – relevant to prognosis, course, or treatment. 3. Marked fear or anxiet a result of vaginal penetration. 8. A strong desire for sex characteristics that match
4. Marked tensing or tightening of pelvic floor muscles. expressed gender.
B. Persisted for 6 months. B. Associated with clinically significant distress or impairment.
DELAYED EJACULATION C. Clinically cause significant distress (mild, moderate, severe). – Sex ratio of boys to girls range from 2:1 to 4.5:1
– Diagnostic Criteria D. Not better explained by a nonsexual mental disorder or as a
consequence of severe relationship distress, and is not
A. Either must be experienced on almost all occasions of sexual
activity without the individual desiring delay. attributable to another medical condition. In Adolescents and Adults
1. Marked delay in ejaculation – Diagnostic Criteria
2. Marked infrequency or absence of ejaculation. A. Marked incongruence between expressed gender and
B. Symptoms persisted for 6 months. MALE HYPOACTIVE SEXUAL DESIRE DISORDER assigned gender of at least 6 months’ duration. Manifested
C. Cause clinically significant distress (mild, moderate, s evere). – Diagnostic Criteria by two or more.
D. Not better explained by a nonsexual mental disorder or as a A. Persistent or recurrent deficient sexual/ erotic thoughts and 1. Marked incongruence between expressed gender and sex
desire for sexual activity. Judged by the clinician. characteristics.
B. Persisted for 6 months. 2. Strong desire to be rid of one’s sex characteristics.
attributable to another medical condition. 3. A strong desire sex characteristic of opposite gender.
– Prevalence of 1%. C. Clinically cause significant distress (mild, moderate, severe).
4. A strong desire to be of the other gender.
D. Not better explained by a nonsexual mental disorder or as a
5. A strong desire to be treated as the other gender.
6. A strong conviction that one has feelings and reactions of
ERECTILE DISORDER attributable to another medical condition. the other gender.
– Diagnostic Criteria – Prevalence of 6% ages 18-24 years and 41% ages ee66-74 years. B. Associated with clinically significant distress or impairment.
A. One or more is experienced on almost all sexual activity. – Sex ratio of males to females range from 1:1 to 6.1:1
1. Marked difficulty obtaining an erection.
2. Marked difficulty maintaining an erection. PREMATURE (EARLY) EJACULATION
3. Marked decrease in erectile rigidity. – Diagnostic Criteria
B. Symptoms persisted for 6 months. A. Persistent or recurrent pattern of ejaculation during
C. Cause clinically significant distress (mild, moderate, s evere). intercourse within 1 minute following vaginal penetration
D. Not better explained by a nonsexual mental disorder or as a and before the individual wishes it.
consequence of severe relationship distress, and is not B. Present for at least 6 months and experience on almost all
attributable to another medical condition. sexual activity.
– Prevalence of 13%-21% of men ages 40-80 years. C. Cause clinically significant distress (mild, moderate, severe).
FEMALE ORGASMIC DISORDER attributable to another medical condition.
A. Either must be experienced on almost all sexual activity.
B. Symptoms persisted for 6 months.
C. Cause clinically significant distress (mild, moderate, s evere).
attributable to another medical condition.
– Many women require clitoral stimulation to reach orgasm.
– Prevalence of 10% to 42%.

DISRUPTIVE, IMPULSE-CONTROL, AND CONDUCT DISORDER
Problems in the self-control emotions, manifested in behaviors that violate the rights of others and that bring self into significant conflict with societal norms or authority figures.

OPPOSITIONAL DEFIANT DISORDER CONDUCT DISORDER PYROMANIA
A. Pattern of four or more symptoms from any category, with 6 A. Repetitive and persistent pattern of behavior in which rules A. Deliberate and purposeful fire setting on more than one
months’ duration. or basic rights of others are violated. Manifested by three or occasion.
Angry or Irritable Mood more, within 12-month period with at least one criterion B. Tension or affective arousal before the act.
1. Often loses temper. present in 6-month period. C. Fascination, interest, curiosity, or attraction to fire.
2. Often touchy or easily annoyed. Aggression to People and Animals D. Pleasure, gratification, or relief when setting fires.
3. Often angry and resentful 1. often bullies, threatens, or intimidates others. E. Fire setting is not done for monetary gain, conceal
Argumentative or Defiant Behavior 2. Often initiates physical fights.
4. Often argues with authority figures/ adults. criminal activity, express anger or vengeance, improve
3. Has used a weapon that can cause serious harm. one’s living circumstances, response to delusion or
5. Often actively defies or refuses to comply with rules.
4. Has been physically cruel to people. hallucination, or as a result of impaired judgment.
6. Often deliberately annoy others.
5. Has been physical cruel to animals.
7. Often blame others for own mistakes/ misbehavior.
Vindictiveness F. Fire setting not better explained by conduct disorder,
manic episode, or antisocial personality disorder.
6. Has stolen while confronting a victim.
7. Has forced someone into sexual activity.
8. Has been spiteful or vengeful twice within 6 months. – Prevalence of 3.3%.
Destruction of Property
B. Associated with distress in the individual or others in
8. Has deliberately engaged in fire setting with intentions.
immediate social context.
9. Has deliberately destroyed other’s property.
C. Behaviors do not occur exclusively during course of Deceitfulness of Theft KLEPTOMANIA
psychotic, substance use, depressive, or bipolar disorder. 10. Has broken into someone else’s house. – Diagnostic Criteria
– Prevalence of 3.3%. 11. Often lies to obtain goods or favors. A. Recurrent failure to resist impulses to steal objects that
– Severity specifiers: 12. Has stolen items of nontrivial value. are not needed for personal use.
1. Mild – symptoms confined to only one setting. Serious Violations of Rules B. Increasing sense of tension immediately before
2. Moderate – symptoms present in two settings. 13. Often stays out at night despite parental prohibitions. committing the theft.
3. Severe – symptoms present in three or more settings. 14. Has run away from home overnight at least twice. C. Pleasure, gratification, or relief at the time of stealing.
15. Is often truant from school, before age 13 years. D. Stealing is not committed to express anger or vengeance
B. Disturbance cause clinically significant impairment. and is not in response to delusion or hallucination.
INTERMITTENT EXPLOSIVE DISORDER C. If individual is age 18 years or older, criteria are not met for E. Stealing is not better explained by conduct disorder, manic
– Diagnostic Criteria antisocial personality disorder. episode, or antisocial personality disorder.
A. Recurrent behavioral outbursts representing failure to – Prevalence range from 2% to more than 10%. – Prevalence ranges from 0.3%-0.6% with a 3:1 female-male ratio.
control aggressive impulses, manifested by either. – Subtype
1. Verbal Aggression or Physical Aggression occurring twice Childhood-onset type – at least one symptoms prior to age 10 years.
weekly, for 3 months. Adolescent-onset type – no symptom prior to age 10 years.
2. Three behavioral outbursts involving destruction of Unspecified onset – criteria met, but not enough information.
property and/or physical assault involving physical injury – Specifiers if
against animals or others, within 12-month period. with limited prosocial emotions – individual must have displayed
B. Magnitude of aggressiveness expressed during the recurrent at least two of the following characteristics persistent over 12-
outbursts is grossly out of proportion to stressors. month period and in multiple relationships and settings.
C. Recurrent aggressive outbursts are not premediated and are Lack of remorse or guilt
not committed to achieve tangible objective. – does not feel bad or guilty for doing wrong.
D. Aggressive outbursts cause marked distress or impairment, Callous-lack of empathy
or are associated with financial or legal consequences. – unconcerned about feelings of others. Cold and uncaring.
Unconcerned about performance
E. Chronological age is at least 6 years.
– unconcern about poor problematic performance at school, work,
F. Outbursts not better explained by another mental disorder or other important activities.
and are not attributable to another medical condition. Shallow or deficient affect
– More prevalent among younger individuals. – does not express feelings or show emotions to others.
– ages 6-18 years should not receive this diagnosis when outbursts
occur in the context of an adjustment disorder.

SUBSTANCE-RELATED AND ADDICTIVE DISORDERS
two groups: Substance Use disorders and Substance-Induced disorders
Substance Use Disorders ALCOHOL-RELATED DISORDERS CANNABIS RELATED DISORDERS

– a cluster of cognitive, behavioral, and physiological symptoms indicating
Alcohol Use Disorder Cannabis Use Disorder
that an individual continues using the substance despite significant
Alcohol Cannabis
substance-related problems. – used to alleviate unwanted effects of other substances or use as substitute when – weed, pot. Herb, grass, reefer, Maryjane, dagga, dope, bhang, skunk, boom,
– Important characteristic: an underlying change in brain circuits. they are not available. gangster, kif, and ganja.
Criterion A – associated with cannabis, cocaine, heroin, sedatives, hypnotics or anxiolytics. – smoked, ingested orally, vaporized.
– Problematic pattern of substance use leads to clinically significant – Prevalence of 4.6% among 12-17 years old and 8.5% in adults. – low dose produce anxiety & euphoria. High dose produce hallucinations.
impairment or distress within 12-month period. – Diagnostic Markers – Prevalence of 3.4% among minors and 1.5% among adults.
– Manifested by at least 2 symptoms 1. Gamma-glutamyltransferase (GGT) – Laboratory test is indicator of modest
Impaired Control elevation or high-normal levels (>35 units). Cannabis Intoxication
1. Taking larger amounts or longer period than was originally intended. 2. Carbohydrate-deficient transferrin (CDT) – Higher levels of sensitivity and C. Two or more symptoms within 2 hours of use.
2. Persistent desire to cut down use and multiple unsuccessful efforts. specificity. Help identify heavy drinkers. 1. Conjunctival injection
3. Spending great deal of time obtaining, using substance, or recovering 2. Increased appetite
from effects. Alcohol Intoxication 3. Dry mouth
4. Daily activities revolve around the substance. C. One or more symptoms developed during or after alcohol use. 4. Tachycardia
Social Impairment 1. Slurred speech
5. Recurrent substance use result in failure to fulfill obligations. 2. Incoordination Cannabis Withdrawal
6. Continue substance use despite persistent interpersonal problems 3. Unsteady gait B. Three or more symptoms within 1 week after cessation or reduction.
caused by its effects. 4. Nystagmus 1. Irritability, anger, or aggression
7. Important activities given up or reduced because of substance use. 5. Impairment in attention or memory 2. Nervousness or anxiety
Risky Use 6. Stupor or coma 3. Sleep difficulty
8. Recurrent substance use in physically hazardous situations. – Average age at first intoxication is 15 years. 4. Decreased appetite or weight loss
9. Use despite of knowledge of having persistent physical or psychological – Prevalence of 44% 12th-grade students and 7-% college students. 5. Restlessness
problem caused by the substance. 6. Depressed mood
– Degree of intoxication increases with blood or breath alcohol level.
Pharmalogical Criteria 7. At least 1 symptom cause clinically significant disocomfort
10. Tolerance – requiring a markedly increased dose to achieve the desired
effects.
Alcohol Withdrawal
11. Withdrawal – blood or tissue concentration of substance decline in an B. Two or more symptoms, within hours to days after reduction.
individual who had maintained prolonged heavy use of the substance. 1. Autonomic hyperactivity (sweating or greater pulse rate) HALLUCINOGEN-RELATED DISORDERS
2. Increased hand tremor Phencyclidine Use Disorder
– Severity Specifiers 3. Insomnia
Mild – two or three symptoms. 4. Nausea or vomiting
Phencyclidine
Moderate – four or five symptoms. – include “angel dust”, ketamine, cyclohexamine, and dizocilpine.
5. Transient visual, tactile or auditory hallucinations
Severe – six or more symptoms. – were developed as dissociative anesthetics in 1950s.
6. Psychomote agitation
– low dose produce feelings of separation from mind and body.
7. Anxiety
– high doses result to stupor and coma.
Substance-Induced Disorders 8. Generalized tonic-clonic seizures.
– smoked, taken orally, snorted, or injected.
– Prevalence of 50% of middle-class.
Substance Intoxication Criterion
A. Development due to recent ingestion of a substance. – Diagnostic Markers Phencyclidine Intoxication
B. Clinically significant problematic behavioral or psychological changes that Autonomic Hyperactivity – high but galling blood alcohol levels and a history of
C. Two or more symptoms, within 1 hour.
developed during/ shortly after ingestion. prolonged heavy drinking indicate a likelihood of alcohol withdrawal.
1. Vertical or horizontal nystagmus
D. Symptoms are not attributable to another medical condition and are not better 2. Hypertension or tachycardia
explained by another mental disorder. 3. Numbness
– most common changes involve disturbances of perception, wakefulness, thinking, CAFFEIN-RELATED DISORDERS 4. Ataxia
judgment, psychomotor behavior, and interpersonal behavior. Caffeine Intoxication 5. Dysarthria
– intoxication may persist beyond the time when substance is detectable in body. B. Five or more symptoms, during or shorty after caffeine use 6. Muscle rigidity
Substance Withdrawal Criterion 1. Restlessness 7. Seizures or coma
A. Cessation (end) or reduction in substance use have been heavy and prolonged. 2. Nervousness 8. Hyperacusis
C. Causes clinically significant distress or impairment in functioning. 3. Excitement
D. Symptoms are not due to another medical condition and are not better 4. Insomnia Other Hallucinogen Use Disorder
explained by another mental disorder. 5. Flushed face Hallucinogen
6. Diuresis – produce alterations of perception, mood, and cognition in users.
Substance/Medication-Induced Mental Disorder Criterion 7. Gastrointestinal disturbance – includes phenylalkylamines and MMDS (ecstasy), LSD and morning glory seeds.
A. The disorder represents a clinically significant symptomatic presentation of a 8. Muscle twitching – smoked, injected, snorted, or taken orally.
relevant mental disorder. 9. Rambling flow of thought and speech – Prevalence of 0.5% in minors and 0.1% in adults.
B. There is evidence from the history, physical examination or laboratory 10. Tachycardia or cardiac arrhythmia
findings of both 11. Periods of inexhaustibility Other Hallucinogen Intoxication
1. The disorder developed during or within 1 month of substance 12. Psychomotor agitation C. Perceptual changes occurring in a state of full wakefulness and alertness
intoxication or withdrawal or taking a medication.
2. The involved substance is capable of producing mental disorder.
C. Cause clinically significant distress or impairment in functioning. that developed during or shortly after use.
C. The disorder is not better explained by an independent mental disorder. And – Prevalence of 7% experience five or more symptoms. D. Two or more symptoms, during or shorty after use.
include the following. 1. Pupil dilation
1. The disorder preceded the onset of severe intoxication or withdrawal Caffeine Withdrawal 2. Tachycardia
or exposure to the medication B. Reduction is followed within 24 hours by three or more symptoms. 3. Sweating
2. The full mental disorder persisted for a substantial period of time, after 1. Headache 4. Palpitations
the cessation of acute withdrawal or severe intoxication. This criterion 2. Marked fatigue or drowsiness 5. Blurring of vision
does not apply to substance-induced neurocognitive disorders or 3. Dysphoric mood, depressed mood, or irritability 6. Tremors
hallucinogen. 4. Difficulty concentrating 7. Incoordination
D. The disorder does not occur exclusively during the course of a delirium. 5. Flu-like symptoms
E. The disorder causes clinically significant distress or impairment in functioning.

INHALANT-RELATED DISORDERS SEDATIVE, HYPNOTIC, or ANXIOLYTIC-RELATED TOBACCO-RELATED DISORDERS
Inhalant Use Disorder DISORDERS Tobacco Use Disorder
Inhalant Sedative, Hypnotic, or Anxiolytic Use Disorder Tobacco
– cause damage to the heart, kidneys, brain, liver, bone marrow, and other organs. – used to avoid or relieve withdrawal symptoms.
– starve the body of oxygen and force heart to beat rapidly. Sedative – smoked, dipped, snuffed, chewed.
– users may experience nosebleed, vomit, or lose sense of hearing or smell. – aka tranquillizer, reduce excitement or irritability, and promote calming effect. – Cigarettes are the most common used tobacco product, represent over 90%.
– high dose result in slurred speech, unsteady gait, poor judgment, slow reflexes.
Volatile Hydrocarbons
Carbamates – safer than barbiturate, produce sedation.
– toxic gases from glues, fuels, paints, and other volatile compounds.
Antihistamines – premedication before, and induce sedation after anesthesia.
Tobacco Withdrawal
– produce psychoactive effects. B. Four or more symptoms within 24 hours after cessation or reduction.
– Prevalence of 0.4% ages 12-17 years, 0.1% ages 18-29 years. Hypnotic
– soporific drug, aka sleeping pills 1. Irritability, frustration, or anger
2. Anxiety
– initiate, sustain or lengthen sleep for insomnia patients.
Inhalant Intoxication Barbiturates – drug valuable for short-term treatment of severe insomnia. 3. Difficulty concentrating
C. Two or more symptoms, during or shorty after use. Anxiolytic 4. Increased appetite
1. Dizziness – antipanic or antianxiety agent. Aka minor tranquilizers 5. Restlessness
2. Nystagmus Benzodiazepines – treat short/long-term severe and disabling anxiety. 6. Depressed mood
3. Incoordination Antihistamines – anxiolytic properties treat anxiety and tension. 7. Insomnia
4. Slurred speech
5. Unsteady gait Sedative, Hypnotic, or Anxiolytic Intoxication
6. Lethargy
C. One or more symptoms, during or shortly after substance use.
7. Depressed reflexes
8. Psychomotor retardation 1. Slurred speech
9. Tremor 2. Incoordination
10. Generalized muscle weakness 3. Unsteady gait
11. Blurred vision or diplopia 4. Nystagmus
12. Stupor or coma 5. Impairment in cognition
13. Euphoria 6. Stupor or coma

Sedative, Hypnotic, or Anxiolytic Withdrawal
OPIOID-RELATED DISORDERS B. Two or more, within several hours to few days after reduction.
Opioid Use Disorder 1. Autonomic hyperactivity
compulsive, prolonged self-administration used for no legitimate medical purpose. 2. Hand tremor
Opioid 3. Insomnia
– heroin, morphine, codeine, oxycodone, propoxyphene. 4. Nausea or vomiting
– cause dry mouth and nose, slow gastrointestinal activity, impaired visual acuity. 5. Transient visual, tactile, or auditory hallucinations
– pain reliever, produce morphine like effect. 6. Psychomotor agitation
– Prevalence of 0.36% among adults. 7. Anxiety
– Onset is late teens or early 20s. 8. Grand mal seizures
– Diagnostic Markers
Routine Urine Toxicology Test
STIMULANT-RELATED DISORDERS
Opioid Intoxication
C. Pupillary constriction and at least 1 symptom during or shorty after use. Stimulant Use Disorder
1. Drowsiness or coma Stimulant
2. Slurred speech – “uppers”
3. Impairment in attention or memory – produce instant feeling of well-being, confidence, and euphoria.
– long term use result to chaotic behavior, social isolation, aggressive behavior, and
Opioid Withdrawal sexual dysfunction.
Amphetamine – performance and cognitive enhancer.
B. Three or more, within minutes to days after opioid reduction or antagonist.
– treatment for ADHD and narcolepsy.
1. Dysphoric mood
Ephedrine – appetite suppressant, concentration aid, and decongestant.
2. Nausea or vomiting
Methamphetamine – treat ADHD and obesity.
3. Muscle aches
Cocaine – short term use produce alertness, extreme happiness and energy,
4. Lacrimation or rhinorrhea
hypersensitivity to sight, sound and touch, paranoia (extreme distrust).
5. Pupil dilation, piloerection, or sweating
6. Diarrhea
7. Yawning Stimulant Withdrawal
8. Fever B. Dysphoric mood and two or more symptoms, within few hours to several
9. Insomnia days after reduction.
1. Fatigue
2. Vivid, unpleasant dreams
3. Insomnia and hypersomnia
4. Increased appetite.
5. Psychomotor retardation or agitation

NEUROCOGNITIVE DISORDERS
Impaired cognition has not been present since birth or very early life, and thus represents a decline from previously attained level of functioning.

Neurocognitive Domains MAJOR AND MILD NEUROCOGNITIVE DISORDER Substance-Induced MND
Cognitive Attention – Diagnostic Criteria
Sustained attention – maintenance of attention over time. A. Significant cognitive decline from previous level of Due to HIV
Selective attention – maintenance of attention despite distractors. performance
Divided attention – Attending two tasks within the same time. 1. Concern that there has been significant decline in cognitive Due to Prion Disease
Executive Functioning function. Prion Disease – hallucinations, fatigue, confusion, difficulty speaking,
Planning – interpret sequential picture or object arrangement. 2. Substantial impairment in cognitive performance, unsteady gait, rapidly developing dementia.
Decision making – process of deciding. documented by standardized neuropsychological testing or
Working memory – ability to hold information and manipulate.
assessment.
Feedback/ Error utilization – benefit from feedback to solve problems. Due to Parkinson’s Disease
B. For Major Neurocognitive Disorder
Overriding habits/ inhibition – choose complex and effortful solution. – Cognitive deficits interfere with independence in everyday
Parkinson’s Disease – tremor/ shaking of hands, slowed movement, rigid
Mental/ Cognition flexibility – ability to shift between two concepts. muscles, impaired posture and balance, etc.
activities.
Learning and Memory
For Mild Neurocognitive Disorder
Immediate memory span – repeat a list of words and digits. Due to Huntington’s Disease
– Deficits do not interfere with independence in everyday
Recent memory – process of encoding new information. Huntington’s Disease – involuntary jerking or writhing movements,
activities.
Free call – recall as many as possible.
C. Deficits do not occur exclusively in context of delirium. muscle problems , slow or abnormal eye
Cued call – providing sematic uses such as “name/ list all the…”
D. Deficits are not better explained by another mental disorder. movements.
Recognition memory – asks about specific items
Language – Specifiers:
Expressive language – confrontational naming, fluency, or phonemic. Probable disease – there is evidence of causative genetic mutation from
Grammar and syntax – omission of incorrect use of articles, prepositions. family history or genetic testing.
Receptive language – comprehension Possible disease –no evidence of causative genetic mutation.
Perceptual-Motor
Visual perception – visual defect or attention neglect. Specify whether due to:
Visuoconstructional – drawing, copying, block assembly. Alzheimer’s
Praxis – ability to imitate gestures or pantomime. Criteria met for either
Gnosis – awareness and recognition of faces and colors
Major Neurocognitive Disorder – clear evidence of decline in memory,
Social Cognition
learning, and at least one cognitive domain, with progressive, gradual
Recognition of emotions – identification of emotion decline in cognition.
Theory of mind – considering other’s mental state or experience.
Mild Neurocognitive Disorder – clear evidence of decline in memory
and learning, with progressive, gradual decline in cognition.
DELIRIUM
– Diagnostic Criteria Frontotemporal ND
A. Disturbance in attention and awareness. Criteria met for either
B. Disturbance develops hours to few days, represents change 1. Behavioral Variant
from baseline attention and awareness, and fluctuate in – Three or more symptoms
– behavioral inhibition
severity. – apathy or inertia
C. Additional disturbance in cognition. – loss of sympathy or empathy
D. Disturbances not better explained by another neucognitive – perseverative, stereotyped or compulsive/ ritualistic behavior
disorder. – hyperorality and dietary changes.
E. There is evidence from history, physical examination, or – Prominent decline in social cognition and/or executive abilities.
laboratory findings that the disturbance is direct 2. Language Variant
physiological consequence of another medical condition, a. Prominent decline in language ability
substance intoxication or withdrawal. – speech production, word finding, object naming, grammar, etc.

– Specify if
with Lewy Bodies
Acute – lasting a few hours or days.
Either Probable (2 features) or Possible (1 feature) MND.
Persistent – lasting weeks or months. 1. Core diagnostic features
– Severity – fluctuating cognition with variations in attention and alertness.
Hyperactive – psychomotor activity accompanied by mood – recurrent visual hallucinations.
lability, agitation, and/or refusal to cooperate with – spontaneous features of parkinsonism, with onset subsequent to
medical care. cognitive decline.
Hypoactive – psychomotor activity accompanied by 2. Suggestive diagnostic features
– meets criteria for rapid eye movement sleep behavior disorder.
sluggishness and lethargy that approaches to
– severe neuroleptic sensitivity.
stupor.
– Prevalence from 1% to 14% as age increases. Due to Traumatic Brain injury
Evidence of traumatic injury with one or more symptoms
1. Loss of consciousness.
2. Posttraumatic amnesia.
3. Disorientation and confusion
4. Neurological signs

PERSONALITY DISORDERS
Enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment.

CLUSTER A CLUSTER B CLUSTER C
PARANOID PERSONALITY DISORDER ANTISOCIAL PERSONALITY DISORDER AVOIDANT PERSONALITY DISORDER
– Diagnostic Criteria – a.k.a. psychopathy, sociopathy, dissocial personality disorder.
Pervasive pattern of social inhibition, feelings of inadequacy, and
A. Pervasive distrust and suspiciousness of others, indicated by four – Diagnostic Criteria
hypersensitivity to negative evaluation. Indicated by five or more.
or more symptoms. A. Pervasive pattern of disregard for and violation of rights of 1. Avoids occupational activities that involve significant interpersonal
1. Suspects without sufficient basis. others, occurring since age 15 years. Indicated by three or more. contact because of fears of criticism, disapproval, or rejection.
2. Preoccupied with unjustified doubts. 1. Failure to confirm to social norms with lawful behaviors. 2. Unwilling to get involved with people unless certain of being liked.
3. Reluctant to confide in others because of unwarranted fear. 2. Deceitfulness – repeated lying, using alias, cone others. 3. Shows restraint within intimate relationships because of fear of being
4. Reads hidden threatening meanings into remarks or events. 3. Impulsivity or failure to plan ahead shamed or ridiculed.
5. Persistently bear grudges. 4. Irritability and aggressiveness. 4. Preoccupied with being criticized or rejected in social situations
6. Perceives attacks on character or reputation that are not 5. Reckless disregard for safety 5. Inhibited in new interpersonal situations due to inadequacy feelings.
apparent to others. 6. Consistent irresponsibility 6. Views self as socially inept, personally unappealing, or inferior.
7. Has recurrent suspicions, without justification regarding sexual 7. Lack of remorse. 7. Reluctant to take personal risks or to engage in any new activities due
partner. B. The individual is at least age 18 years. to embarrassment.
B. Does not occur exclusively during the course of, and is not C. There is evidence of conduct disorder with onset before age 15.
attributable to the physiological effects of another medical D. Occurrence of antisocial behavior is not exclusively during
condition. course of schizophrenia or bipolar disorder.
DEPENDENT PERSONALITY DISORDER
Pervasive and excessive need to be taken care that leads to submissive
and clinging behaviors and fears of separation.
SCHIZOID PERSONALITY DISORDER BORDERLINE PERSONALITY DISORDER Indicated by five or more.
– Diagnostic Criteria Pervasive pattern of instability of interpersonal relationships, self- 1. Difficulty making everyday decisions without excessive advice.
A. Pervasive pattern of detachment from social relationships and a image, and impulsivity. Indicated by five or more symptoms. 2. Needs others to assume responsibility
1. Frantic efforts to avoid real or imagined abandonment. 3. Difficulty expressing disagreement due to fear of loss of support.
restricted range of expression of emotions in interpersonal
2. Pattern of unstable and intense interpersonal relationships by 4. Difficulty initiating projects
settings. Indicated by four or more symptoms. alternating between extremes of idealization and devaluation. 5. Goes to excessive lengths to obtain nurturance and support
1. Neither desire nor enjoy close relationships. 3. Identity disturbance – unstable self-image or sense of self. 6. Feels uncomfortable or helpless when alone
2. Almost always chooses solitary activities. 4. Impulsivity in potentially self-damaging areas (sex, binge eating, 7. Urgently seeks another relationship as source of care and support.
3. Has little or no interest having sexual experiences. reckless driving, substance use). 8. Unrealistically preoccupied with fears of being left to take care of self
4. Takes pleasure in few, if any, activities. 5. Recurrent suicidal behavior
6. Affective instability due to marked reactivity of mood.
5. Lacks lose friends or confidants.
7. Chronic feelings of emptiness. OBSESSIVE-COMPULSIVE PERSONALITY DISORDER
6. Appears indifferent to the praise or criticism of others. 8. Inappropriate, intense or difficulty controlling anger. Pervasive pattern of preoccupation with orderliness, perfectionism, and
7. Shows emotional coldness, detachment, or flattened affectivity. 9. Transient, stress-related paranoid ideation or severe dissociative mental and interpersonal control. Indicated by four or more symptoms.
B. Does not occur exclusively during the course of, and is not symptoms. 1. Preoccupied with details, rules, lists, order, organization, or schedules.
attributable to the physiological effects of another medical 2. Shows perfectionism that interferes with task completion.
condition. HISTRIONIC PERSONALITY DISORDER 3. Excessively devoted to work and productivity
Pervasive pattern of excessive emotionality and attention seeking, 4. Over conscientious, scrupulous, and inflexible about matters of
SCHIZOTYPAL PERSONALITY DISORDER indicated by five or more symptoms. morality, ethics, or values.
– Diagnostic Criteria 1. Uncomfortable in situations being the center of attention. 5. Is unable to discard worn-out or worthless objects, with no
2. Interaction characterized by inappropriate sexually seductive or
A. Pervasive pattern of social and interpersonal deficits marked by sentimental value.
provocative behavior.
reduced capacity for close relationships, indicated by five or 3. Displays rapidly shifting and shallow expression of emotions. 6. Reluctant to delegate tasks to others, unless they submit to exactly
more symptoms. 4. Use physical appearance to draw attention. his/her own way to do things.
1. Ideas of reference (belief that everything is related to them). 5. Has a style of speech that is excessively impressionistic. 7. Adopts a miserly spending style toward both self and others.
2. Odd beliefs or magical thinking. 6. Show self-dramatization, theatricality, and exaggerated emotions. 8. Shows rigidity and stubbornness.
3. Unusual perceptual experiences, including illusions. 7. Is suggestible/ easily influenced.
8. Considers relationships to be more intimate than they actually are.
4. Odd thinking and speech.
5. Suspiciousness or paranoid ideation.
6. Inappropriate or constricted effect. NARCISSISTIC PERSONALITY DISORDER
7. Behavior or appearance is odd, eccentric or peculiar. Pervasive pattern of grandiosity, need for admiration, and lack of
8. Lack of close friends or confidants. empathy. Indicated by five or more symptoms.
9. Excessive social anxiety, even with family. 1. Has grandiose sense of self-importance.
2. Preoccupied with fantasies of success, power, brilliance, beauty.
B. Does not occur exclusively during the course of, and is not
3. Belief of being “special” and only understood by other “special” people
attributable to the physiological effects of another medical 4. Requires excessive admiration
condition. 5. Has a sense of entitlement – unreasonable favorable treatment.
6. Is interpersonally exploitive – takes advantage to achieve own ends.
7. Lacks empathy – unwilling to recognize others’ feelings and needs.
8. Often envious of others.
9. Shows arrogant, haughty behaviors or attitudes.

PARAPHILIC DISORDERS
Intense and persistent sexual interest other than on genital stimulation or preparatory fondling with phenotypically normal, physically mature, consenting human partners.

ANOMALOUS ACTIVITY PREFERENCES ANOMALOUS TARGET PREFERENCES
Courtship Disorders PEDOPHILIC DISORDER
VOYEURISTIC DISORDER
A. Intense sexually arousing fantasies, sexual urges, or behaviors
involving sexual activity with children, ages 13 years or younger,
A. Recurrent and intense sexual arousal from observing/ spying.
within 6-month period.
Unsuspecting naked person, within 6-month period. Manifested
B. Sexual urges cause marked distress or interpersonal difficulty.
by fantasies, urges, or behaviors.
C. At least 16 years of age, or 5 years older than the child.
B. Sexual urges acted with a nonconsenting person, or cause
clinically significant distress or impairment. FETISHISTIC DISORDER
C. At least 18 years of age. – Diagnostic Criteria
EXHIBITIONISTIC DISORDER A. Recurrent and intense sexual arousal from either use of
nonliving object or body part, within 6-month period. Manifested
by fantasies, urges, or behaviors.
A. Recurrent and intense sexual arousal from exposure of genitals
B. Sexual urges cause clinically significant distress or impairment.
to unsuspecting person, within 6-month period. Manifested by
fantasies, urges, or behaviors. TRANSVESTIC DISORDER
B. Sexual urges acted with a nonconsenting person, or cause – Diagnostic Criteria
clinically significant distress or impairment. A. Recurrent and intense sexual arousal from cross dressing.
Manifested by fantasies, urges, or behavior.
FROTTEURISTIC DISORDER
A. Recurrent and intense sexual arousal from touching or rubbing
against nonconsenting person, within 6-month period.
Manifested by fantasies, urges, or behaviors.
B. Sexual urges acted with a nonconsenting person, or cause
clinically significant distress or impairment.
Algolagnic Disorders
SEXUAL MASOCHISM DISORDER
A. Recurrent and intense sexual arousal from being humiliated,
beaten, or suffering, manifested by fantasies, urges, or behaviors.
SEXUAL SADISM DISORDER

A. Recurrent and intense sexual arousal from physical or
psychological suffering of another person, manifested by
fantasies, urges, or behaviors.

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