DSM -5

Question 1

A. A period of abnormally & persistently elevated, expansive, or irritable mood and abnormally & persistently increased goal-directed activity or energy, lasting at least 1 week and present most of the day, nearly every day

B. During the period of mood disturbance & increased every or activity, 3 or more of the following symptoms are present:

1. Inflated self-esteem or grandiosity
2. Decreased need for sleep (feels rested after 3 hours)
3. More talkative than usual
4. Flight of ideas or subjective experience that thoughts are racing
5. Distractibility
6. Increase in goal-directed activity or psychomotor agitation (purposeless activity)
7. Excessive involvement in activities that have high potential for painful consequences (unrestrained buying sprees, sexual indiscretions, or foolish business investments)

C. The mood disturbance is severe to cause impairment in social or occupational functioning or require hospitalization to prevent harm to self or others

D. Episode isn’t attributable to effects of drug abuse, medication, or other medical condition

Answer 1

Bipolar 1 Disorder - Manic Episode

Question 2

A. A period of abnormally & persistently elevated, expansive, or irritable mood and abnormal activity or energy lasting at least 4 consecutive days and present most of the day, nearly every day

B. During the period of mood disturbance & increased every or activity, 3 or more of the following symptoms are present:

1. Inflated self-esteem or grandiosity
2. Decreased need for sleep (feels rested after 3 hours)
3. More talkative than usual
4. Flight of ideas or subjective experience that thoughts are racing
5. Distractibility
6. Increase in goal-directed activity or psychomotor agitation (purposeless activity)
7. Excessive involvement in activities that have high potential for painful consequences (unrestrained buying sprees, sexual indiscretions, or foolish business investments)

C. The episode is associated with an unequivocal change in functioning that’s uncharacteristic of the person

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

E. Episode isn’t severe enough to cause marked impairment in social or occupational functioning or to require hospitalization.

F. Episode isn’t attributable to effects of drug abuse, medication, or other medical condition

Answer 2

Bipolar 1 Disorder - Hypomanic Episode

Question 3

A. Five or more of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least 1 of the symptoms is either depressed mood or loss of interest in pleasure:

1. Depressed mood most of the day, nearly every day, as indicated through self-report (feels sad, empty, or hopeless) or observation made by others –> in children and adolescents, it can be irritable mood
2. Diminished interest or pleasure in almost all activities most of the day, nearly every day
3. Significant weight loss when not dieting or weight gain (more than 5% change in a month), or decrease or increase in appetite nearly every day –> in children, consider failure to make expected weight gain
4. Insomnia or hypersomnia nearly every day
5. Psychomotor agitation or retardation nearly every day
6. Fatigue or loss of energy nearly e ery day
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or plan for committing suicide

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

C. Episode isn’t attributable to the physiological effects of a substance or another medical condition

Answer 3

Bipolar 1 Disorder - Major Depressive Episode

Question 4

A. Five or more of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least 1 of the symptoms is either depressed mood or loss of interest in pleasure:

1. Depressed mood most of the day, nearly every day, as indicated through self-report (feels sad, empty, or hopeless) or observation made by others –> in children and adolescents, it can be irritable mood
2. Diminished interest or pleasure in almost all activities most of the day, nearly every day
3. Significant weight loss when not dieting or weight gain (more than 5% change in a month), or decrease or increase in appetite nearly every day –> in children, consider failure to make expected weight gain
4. Insomnia or hypersomnia nearly every day
5. Psychomotor agitation or retardation nearly every day
6. Fatigue or loss of energy nearly e ery day
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or plan for committing suicide

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

C. Episode isn’t attributable to the physiological effects of a substance or another medical condition

• Criteria have been met for at least one hypomanic episode and at least one major depressive episode
• There has never been a manic episode
• The occurrence of the hypomanic episode(s) and major depressive episode(s) is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder
• The symptoms of depression or the unpredictability caused by frequent alternation between periods of depression and hypomania causes clinical significant distress or impairment in social, occupational, or other important areas of functioning

Answer 4

Bipolar II Disorder - Major Depressive Episode

Question 5

A. A period of abnormally & persistently elevated, expansive, or irritable mood and abnormal activity or energy lasting at least 4 consecutive days and present most of the day, nearly every day

B. During the period of mood disturbance & increased every or activity, 3 or more of the following symptoms are present:

1. Inflated self-esteem or grandiosity
2. Decreased need for sleep (feels rested after 3 hours)
3. More talkative than usual
4. Flight of ideas or subjective experience that thoughts are racing
5. Distractibility
6. Increase in goal-directed activity or psychomotor agitation (purposeless activity)
7. Excessive involvement in activities that have high potential for painful consequences (unrestrained buying sprees, sexual indiscretions, or foolish business investments)

C. The episode is associated with an unequivocal change in functioning that’s uncharacteristic of the person

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

E. Episode isn’t severe enough to cause marked impairment in social or occupational functioning or to require hospitalization.

F. Episode isn’t attributable to effects of drug abuse, medication, or other medical condition

• Criteria have been met for at least one hypomanic episode and at least one major depressive episode
• There has never been a manic episode
• The occurrence of the hypomanic episode(s) and major depressive episode(s) is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder
• The symptoms of depression or the unpredictability caused by frequent alternation between periods of depression and hypomania causes clinical significant distress or impairment in social, occupational, or other important areas of functioning

Answer 5

Bipolar II Disorder - Hypomanic Episode

Question 6

A. For at least 2 years (at least 1 year in children and adolescents), there have been numerous periods with hypomanic symptoms that don’t meet criteria for a hypomanic episode and numerous periods with depressive symptoms that don’t meet criteria for a major depressive episode

B. During the above 2-period (1 year in children and adolescents), the hypomanic and depressive periods have been present for at least half the time and the individual has not been without the symptoms for more than 2 months at a time

C. Criteria for a major depressive, manic, or hypomanic episode have never been met

D. The symptoms in criterion A are not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder

E. The symptoms aren’t atrributable to the physiological effects of a substance (i.e. drug of abuse, a medication) or another medical condition

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

Answer 6

Cyclothymic Disorder

Question 7

A. A prominent and persistent disturbance in mood that predominates in the clinical picture and is characterized by elevated, expansive, or irritable mood, with or without depressed mood, or markedly diminished interest or pleasure in all, or almost all, activities

B. There is evidence from the history, physical examination, or lab findings of both:

1. The symptoms in criterion A developed during or soon after substance intoxication or withdrawal or after exposure to a medication
2. The involved substance/medication is capable of producing the symptoms in criterion A

C. The disturbance is not better explained by bipolar or related disorder that isn’t substance/medication induced

D. The disturbance does not occur exclusively during the course of a delirium

E. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

Answer 7

Substance/Medication-Induced Bipolar and Related Disorders

Question 8

A. A prominent and persistent period of abnormally elevated, expansive, or irritable mood and abnormally increased activity or energy that predominates in the clinical picture

B. There is evidence from the history, physical examination, or lab findings that the disturbance is the direct pathophysiological consequence of another medical condition

C. The disturbance is not better explained by another mental disorder

D. The disturbance does not occur exclusively during the course of delirium

E. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning, or necessitates hospitalization or prevent harm to self or others, or there are psychotic features

Answer 8

Bipolar and Related Disorders Due to Another Medical Condition

Question 9

A. The following 3 criteria must be met:

1. Deficits in intellectual functions, such as reasoning, problem solving, planning, abstract thinking, judgment, academic learning, and learning from experience, confirmed by both clinical assessment and individualized, standardized intelligence testing
2. Deficits in adaptive functioning that result in failure to meet developmental and sociocultural standards for personal independence and social responsibility. Without ongoing support, the adaptive deficits limit functioning in 1 or more activities of daily life, such as communication, social participation, and independent living, across multiple environments, such as home, school, work, and community
3. Onset of intellectual and adaptive deficits during the developmental period

Answer 9

Intellectual Developmental Disability

Question 10

This diagnosis is reserved for individuals under the age of 5 years when the clinical severity level cannot be reliably assessed during early childhood. This category is diagnosed when an individual fails to meet expected developmental milestones in several areas of intellectual functioning, and applies to individuals who are unable to undergo systematic assessments of intellectual functioning, including children who are too young to participate in standardized testing. This category required reassessment after a period of time.

Answer 10

Global Developmental Delay

Question 11

This category is reserved for individuals over the age of 5 years when assessment of the degree of intellectual disability (intellectual developmental disorder) by means of locally available procedures is rendered difficult or impossible because of associated sensory or physical impairments, as in blindness or prelingual deafness; locomotor disability; or presence of severe problem behaviors or co-occurring mental disorder. This category should only be used in exceptional circumstances and requires reassessment after a period of time.

Answer 11

Unspecified Intellectual Developmental Disorder

Question 12

A. Persistent difficulties in the acquisition and use of language across modalities (spoken, written, sign language, or other) due to deficits in comprehension or production that include the following:

1. Reduced vocabulary (word knowledge and use)
2. Limited sentence structure (ability to put words and word endings together to form sentences based on the rules of grammar and morphology)
3. Impairments in discourse (ability to use vocabulary and connect sentences to explain or describe a topic or series of events or have a conversation)

B. Language abilities are substantially and quantifiably below those expected for age, resulting in functional limitations in effective communication, social participation, academic achievement, or occupational performance, individually or in any combination

C. Onset of symptoms is in the early developmental period

D. The difficulties are not attributable to hearing or any other sensory impairment, moto dysfunction, or another medical or neurological condition and are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay

Answer 12

Language Disorder

Question 13

A. Persistent difficulty with speech sound production that interferes with the speech intelligibility or prevents verbal communication of messages

B. The disturbance causes limitations in effective communication that interfere with social participation, academic achievement, or occupational performance, individually or in any combination

C. Onset of symptoms is in the early developmental period

D. The difficulties are not attributable to congenital or acquired conditions, such as cerebral palsy, cleft palate, deafness or hearing loss, traumatic brain injury, or other medical or neurological conditions

Answer 13

Speech Sound Disorder

Question 14

A. Disturbances in the normal fluency and time patterning of speech that are inappropriate for the individual’s age and language skills, persist over time, and are characterized by frequent and marked occurrences of one (or more) of the following:

1. Sound and syllable repetitions
2. Sound prolongations of consonants as well as vowels
3. Broken words (i.e. pauses within a word)
4. Audible or silent blocking (filled or unfilled pauses in speech)
5. Circumlocutions (word substitutions to avoid problematic words)
6. Words produced with an excess of physical tension
7. Monosyllabic whole-word repetitions (i.e. “I-I-I-I see him”)

B. The disturbance causes anxiety about speaking or limitations in effective communication, social participation, or academic or occupational performance, individually or in any combination

C. The onset or symptoms is in the early developmental period

D. The disturbance is not attributable to a speech-motor or sensory deficit, dysfluency associated with neurological insult (i.e. stroke, tumor, or trauma), or another medical condition and is not better explained by another mental disorder

Answer 14

Childhood-Onset Fluency Disorder (Stuttering)

Question 15

A. Persistent difficulties in the social use of verbal and nonverbal communication as manifested by all of the following:

1. Deficits in using communication for social purposes, such as greeting and sharing information, in a manner that is appropriate for the social context
2. Impairment of the ability to change communication to match context or the needs of the listener, such as speaking differently in a classroom than on a playground, talking differently to a child than to an adult, and avoiding use of overly formal language
3. Difficulties following rules for conversation and storytelling, such as taking turns in conversation, rephrasing when misunderstood, and knowing how to use verbal and nonverbal signals to regulate interaction
4. Difficulties understanding what is not explicitly stated (i.e. making inferences) and non-literal or ambiguous meanings of language (i.e. idioms, humor, metaphors, multiple meanings that depend on the context for interpretation)

B. The deficits result in functional limitations in effective communication, social participation, social relationships, academic achievement, or occupational performance, individually or in combination

C. The onset of the symptoms is in the early developmental periods (but deficits may not become fully manifest until social communication demands exceed limited capacities)

D. The symptoms are not attributable to another medical or neurological condition or to low abilities in the domains of the word structure and grammar, and are not better explained by autism spectrum disorder, intellectual disability (intellectual developmental disorder), global developmental delay, or another mental disorder

Answer 15

Social (Pragmatic) Communication Disorder

Question 16

This category applies to presentations in which symptoms characteristic of communication disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for communication disorder or for any of the disorders in the neurodevelopmental disorders diagnostic class. This category is used in situations in which the clinician chooses NOT to specify the reason that the criteria are not met for communication disorder or for a specific neurodevelopmental disorder, and includes presentations in which there is insufficient information to make a more specific diagnosis.

Answer 16

Unspecified Communication Disorder

Question 17

A. Persistent deficits in social communication and social interaction across multiple contexts, manifested by the following, currently or by history:

1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions
2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication
3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers

B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two or the following, currently or by history:

1. Stereotypes or repetitive motor movements, use of objects, or speech (i.e. simple motor stereotypes, lining up toys or flipping objects, echolalia, idiosyncratic phrases)
2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (i.e. extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day)
3. Highly restricted, fixated interests that are abnormal in intensity or focus (i.e. strong attachment to or preoccupation with unusual objects, excessively circumscribed or perserverative interests)
4. Hyper-or hyporeactivity to sensory input or unusual interest in sensory aspects or the environment (i.e. apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement)

C. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies later in life)

D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning

E. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and this disorder frequently co-occur; to make comorbid diagnoses of this disorder and intellectual disability, social communication should be below that expected for general developmental level

Answer 17

Autism Spectrum Disorder

Question 18

A. A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development as characterized by numbers 1 and/or 2:

1. Inattention: 6 (or more) of the following symptoms have persisted for at least 6 months to a degree that’s inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities:
   - Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities (i.e. overlooks or misses details, work is inaccurate)
   - Often has difficulty sustaining attention in tasks or play activities (i.e. has difficulty remaining focused during lectures, conversations, or lengthy ready)
   - Often doesn’t seem to listen when spoken to directly (i.e. mind seems elsewhere, even in the absence of any obvious distraction)
   - Often doesn’t follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (i.e. starts tasks but quickly loses focus and is easily sidetracked)
   - Often has difficulty organizing tasks and activities (i.e. difficulty managing sequential tasks; difficulty keeping materials and belongings in order; messy, disorganized work; has poor time management; fails to meet deadlines)
   - Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (i.e. schoolwork or homework; for older adolescents and adults, preparing reports, completing forms, reviewing length papers)
   - Often loses things necessary for tasks or activities (i.e. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, cell phones)
   - Is often easily distracted by extraneous stimuli (for older adolescents and adults, may include unrelated thoughts)
   - Is often forgetful in daily activities (i.e. doing chores, running errands; for older adolescents and adults, returning calls, paying bills, keeping appointments)
2. Hyperactivity and impulsivity: 6 (or more) of the following symptoms have persisted for at least 6 months to a degree that’s inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities:
   - Often fidgets with or taps hands or feet or squirms in seat
   - Often leaves seat in situations when remaining seated is expected (i.e. leaves his or her place in the classroom, in the office or other workplace, or in other situations that require remaining in place)
   - Often runs about or climbs in situations where it’s inappropriate (in adolescents or adults, may be limited to feeling restless)
   - Often unable to play or engage in leisure activities quietly
   - If often “on the go”, acting as if “driven by a motor”
   - Often talks excessively
   - Often blurts out an answer before a question has been completed (i.e. completes people’s sentences; cannot wait for turn in conversation)
   - Often has difficulty waiting their turn in line
   - Often interrupts or intrudes on others (i.e. butts into conversations, games, or activities; may start using other people’s things without asking or receiving permission; for adolescents and adults, may intrude into or take over what others are doing

B. Several inattentive or hyperactive-impulsive symptoms where present prior to age 12 years

C. Several inattentive or hyperactive-impulsive symptoms are present in 2 or more settings (i.e. home, school, or work; with friends or relatives; in other activities)

D. There is clear evidence that the symptoms interfere with, or reduce the quality of, social, academic, or occupational functioning

E. The symptoms don’t occur exclusively during the course of schizophrenia or another psychotic disorder and are not better explained by another mental disorder

Answer 18

Attention-Deficit/Hyperactivity Disorder

Question 19

This category applies to presentations in which symptoms characteristic of ADHD that cause clinically significant distress or impairment in important areas of functioning predominate but do not meet the full criteria for ADHD or any of the disorders in the neurodevelopmental disorders diagnostic class. This category is used in situations in which the clinician chooses to communicate the specific reason that the presentation doesn’t meet the criteria for ADHD.

Answer 19

Other Specified Attention-Deficit/Hyperactivity Disorder

Question 20

This category applies to presentations in which symptoms characteristic of ADHD that cause clinically significant distress or impairment in important areas of functioning predominate but do not meet the full criteria for ADHD or any of the disorders in the neurodevelopmental disorders diagnostic class. This category is used in situations in which the clinician chooses NOT to specify the reason that the criteria are not met for ADHD or for a specific neurodevelopmental disorder, and includes presentations in which there is insufficient information to make a more specific diagnosis.

Answer 20

Unspecified Attention-Deficit/Hyperactivity Disorder

Question 21

A. Difficulties learning and using academic skills, as indicated by the presence of at least 1 of the following symptoms that have persisted for lat least 6 months, despite the provision of interventions that target those difficulties:

1. Inaccurate or slow and effortful word reading (i.e. reads single words aloud incorrectly or slowly and hesitantly, frequently guesses words, has difficulty sounding out words)
2. Difficulty understanding the meaning of what is read *(i.e. may read text accurately but doesn’t understand the sequence, relationships, inferences, or deeper meanings of what’s read)
3. Difficulties with spelling
4. Difficulties with written expression
5. Difficulties mastering number sense, number facts, or calculation (i.e. has a poor understanding of numbers, their magnitude, and relationship; counts on fingers to add single digit numbers instead of recalling the math fact as peers do; gets lost in the midst of arithmetic computation and may switch procedures)
6. Difficulties with mathematical reasoning (i.e. has severe difficulty applying mathematical concepts, facts, or procedures to solve quantitative problems)

B. The affected academic skills are substantially and quantifiably below those expected for the individual’s chronological age, and cause significant interference with academic or occupational performance, or with activities of daily living, as confirmed by individually administered standardized achievement measures and comprehensive clinical assessment. For individuals age 17 years and older, a documented history of impairing learning difficulties may be substituted for standardized assessment.

C. The learning difficulties began during school-age years but may not become fully manifest until the demands for those affected academic skills exceed the individual’s limited capacities (i.e. as in timed tests, reading or writing lengthy complex reports for a tight deadline, excessively heavy academic loads)

D. The learning difficulties are not better accounted for by intellectual disabilities, uncorrected visual or auditory acuity, or other mental or neurological disorders, psychosocial adversity, lack of proficiency in the language of academic instruction, or inadequate educational instruction

Answer 21

Specific Learning Disorder

Question 22

A. The acquisition and execution of coordinated motor skills is substantially below that expected given the individual’s chronological age and opportunity for skill learning and use. Difficulties are manifested as clumsiness as well as slowness and inaccuracy of performance of motor skills (i.e. catching an object, using scissors or cutlery, handwriting, riding a bike, etc.)

B. The motor skills in Criterion A significantly and persistently interferes with activities of daily living appropriate to chronological age (i.e. self-care and self-maintenance) and impacts academic/school productivity, prevocational and vocational activities, leisure, and play

C. Onset of symptoms is in the early developmental period

D. The motor skills deficits are not better explained by intellectual disability or visual impairment and are not attributable to a neurological condition affecting movement

Answer 22

Developmental Coordination Disorder

Question 23

A. Repetitive, seemingly driven, and apparently purposeless motor behavior (i.e. hand shaking or waving, body rocking, head banging, self-biting, hitting own body)

B. The repetitive motor behavior interferes with social, academic, or other activities and may result in self-injury

C. Onset is in the early developmental period

D. The repetitive motor behavior is not attributable to the physiological effects of a substance or neurological condition and is not better explained by another neurodevelopmental or mental disorder

Answer 23

Stereotypic Movement Disorder

Question 24

A. Both multiple motor and one or more vocal tics have been present at some time during the illness, although not necessarily concurrently

B. The tics may wax and wane in frequency but have persisted for more than 1 year since first tic onset

C. Onset is before age 18 years

D. The disturbance is not attributable to the physiological effects of a substance or another medical condition

Answer 24

Tic Disorders - Tourette’s Disorder

Question 25

A. Single or multiple motor or vocal tics have been present during the illness, but not both motor and vocal

B. The tics may wax and wane in frequency but have persisted for more than 1 year since first tic onset

C. Onset is before age 18 years

D. The disturbance is not attributable to the physiological effects of a substance or another medical condition

E. Criteria have never been met for Tourette’s disorder

Answer 25

Tic Disorders - Persistent (Chronic) Motor or Vocal Tic Disorder

Question 26

A. Single or multiple motor and/or vocal tics

B. The tics have been present for less than 1 year since first tic onset

C. Onset is before age 18 years

D. The disturbance is not attributable to the physiological effects of a substance or another medical condition

E. Criteria have never been met for Tourette’s disorder or persistent (chronic) motor or vocal tic disorder

Answer 26

Tic Disorders - Provisional Tic Disorder

Question 27

A. The presence of 1 (or more) delusions with a duration of 1 month or longer

B. Criterion A for schizophrenia has never been met

C. Apart from the impact of the delusion(s) or its ramifications, functioning is not markedly impaired, and behavior is not obviously bizarre or odd

D. If manic or major depressive episodes have occurred, these have been brief relative to the duration of the delusional periods

E. The disturbance is not attributable to the physiological effects of a substance or another medical condition and is not better explained by another mental disorder

Answer 27

Delusional Disorder

Question 28

A. Presence of 1 (or more) of the following symptoms; at least one of these must be 1, 2, or 3:

1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized or catatonic behavior

B. Duration of an episode of the disturbance is at least 1 day but less than 1 month, with eventual full return to premorbid level of functioning

C. The disturbance is not better explained by major depressive disorder or bipolar disorder with psychotic features or another psychotic disorder such as schizophrenia or catatonia, and is not attributable to the physiological effects of a substance or another medical condition

Answer 28

Brief Psychotic Disorder

Question 29

A. Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least one of these must be 1, 2, or 3:

1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized or catatonic behavior
5. Negative symptoms (i.e. diminished emotional expression or avolition)

B. An episode of the disorder lasts at least 1 month but less than 6 months. When the diagnosis must be made without waiting for recovery, it should be qualified as “provisional”

C. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either 1) no major depressive or manic episodes have occurred concurrently with the active-phase symptoms or 2) if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of the illness

D. The disturbance is not attributable to the physiological effects of a substance or another medical conditon

Answer 29

Schizophreniform Disorder

Question 30

A. Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least one of these must be 1, 2, or 3:

1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized or catatonic behavior
5. Negative symptoms (i.e. diminished emotional expression or avolition)

B. For a significant portion of the time since the onset of the disturbance, level of functioning in 1 or more major areas, such as work, interpersonal relations, or self-care is markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, there is failure to achieve expected level of interpersonal, academic, or occupational functioning)

C. Continuous signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or by 2 or more symptoms listed in Criterion A present in odd beliefs or unusual perceptual experiences

D. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either 1) no major depressive or manic episodes have occurred concurrently with the active-phase symptoms or 2) if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of the illness

E. The disturbance is not attributable to the physiological effects of a substance or another medical condition

F. If there is a history of autism spectrum disorder or a communication disorder of childhood onset, the additional diagnosis of this disorder is made only if prominent delusions or hallucinations, in addition to the other required symptoms of this disorder, are also present for at least 1 month (or less is successfully treated)

Answer 30

Schizophrenia

Question 31

A. An uninterrupted period of illness during which there is a major mood episode (major depressive or manic) concurrent with Criterion A of schizophrenia

B. Delusions or hallucinations for 2 or more weeks in the absence of a major mood episode (depressive or manic) during the lifetime duration of the illness

C. Symptoms that meet criteria for a major mood episode are present for the majority of the total duration of the active and residual portions of the illness

D. The disturbance is not attributable to the effects of a substance or another medical condition

Answer 31

Schizoaffective Disorder

Question 32

A. Presence of 1 or both of the following symptoms:

1. Delusions
2. Hallucinations

B. There is evidence from the history, physical examination, or lab findings of:

1. The symptoms in Criterion A developed during or soon after substance intoxication or withdrawal or after exposure to a medication
2. The involved substance/medication is capable of producing symptoms in Criterion A

C. The disturbance is not better explained by a psychotic disorder that is not substance/medication-induced. Such evidence of an independent psychotic disorder could include the following:
- The symptoms preceded the onset of the substance/medication use; the symptoms persist for a substantial period of time (i.e. about 1 month) after the cessation of acute withdrawal of severe intoxication; or there is other evidence or an independent non-substance/medication-induced psychotic disorder

D. The disturbance does not occur exclusively during the course of a delirium

E. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

Answer 32

Substance/Medication-Induced Psychotic Disorder

Question 33

A. Prominent hallucinations or delusions

B. There is evidence from the history, physical examination, or lab findings that the disturbance is the direct pathophysiological consequence of another medical condition

C. The disturbance is not better explained by another mental disorder

D. The disturbance does not occur exclusively during the course of a delirium

E. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

Answer 33

Psychotic Disorder Due to Another Medical Condition

Question 34

A. The clinical picture is dominated by 3 (or more) of the following symptoms:

1. Stupor (no psychomotor activity; not actively relating to environment)
2. Catalepsy (passive induction of a posture held against gravity)
3. Waxy flexibility (slight, even resistance to a positioning by an examiner)
4. Mutism (no or very little verbal response)
5. Negativism (opposition or no response to instructions or external stimuli)
6. Posturing (spontaneous and active maintenance of a posture against gravity)
7. Mannerism (odd, circumstantial caricature of normal actions)
8. Stereotypy (repetitive, abnormally frequent, non-goal-directed movements)
9. Agitation, not influenced by external stimuli
10. Grimacing
11. Echolalia (mimicking another’s speech)
12. Echopraxia (mimicking another’s movements)

Answer 34

Catatonia Specifier

Question 35

A. The clinical picture is dominated by 3 (or more) of the following symptoms:

1. Stupor (no psychomotor activity; not actively relating to environment)
2. Catalepsy (passive induction of a posture held against gravity)
3. Waxy flexibility (slight, even resistance to a positioning by an examiner)
4. Mutism (no or very little verbal response)
5. Negativism (opposition or no response to instructions or external stimuli)
6. Posturing (spontaneous and active maintenance of a posture against gravity)
7. Mannerism (odd, circumstantial caricature of normal actions)
8. Stereotypy (repetitive, abnormally frequent, non-goal-directed movements)
9. Agitation, not influenced by external stimuli
10. Grimacing
11. Echolalia (mimicking another’s speech)
12. Echopraxia (mimicking another’s movements)

B. There is evidence from the history, physical examination, and lab findings that the disturbance is the direct pathophysiological consequence of another medical condition

C. The disturbance is not better explained by another mental disorder

D. The disturbance does not occur exclusively during the course of a delirium

E. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

Answer 35

Catatonic Disorder Due to Another Medical Condition

Question 36

A. Severe recurrent temper outbursts manifested verbally and/or behaviorally that are grossly out or proportion in intensity or duration to the situation or provocation

B. The temper outbursts are inconsistent with developmental level

C. The temper outbursts occur, on average, three or more times per week

D. The mood between temper outbursts is persistently irritable or angry most of the day, nearly every day, and is observable by others

E. Criteria A-D have been present for 12 or more months. Throughout that time, the individual has not had a period lasting 3 or more consecutive months without all of the symptoms in Criteria A-D

F. Criteria A and D are present in at least 2 of 3 settings (i.e. at home, at school, with peers) and are severe in at least one of these

G. The diagnosis should not be made for the first time before age 6 years or after the age of 18 years

H. By history or observation, the age at onset of Criteria A-E is before 10 years

I. There has never been a distinct period lasting more than 1 day during which the full symptom criteria, except duration, for a manic or hypomanic episode have been met

J. The behaviors do not occur exclusively during an episode of major depressive disorder and are not better explained by another mental disorder

K. The symptoms are not attributable to the physiological effects of a substance or to another medical or neurological condition

This diagnosis cannot coexist with oppositional defiant disorder, intermittent explosive disorder, or bipolar disorder. If an individual has ever experienced a manic or hypomanic episode, this diagnosis should not be assigned.

Answer 36

Disruptive Mood Dysregulation Disorder

Question 37

A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least 1 of the symptoms is either 1) depressed mood or 2) loss of interest of pleasure:

1. Depressed mood most of the day, nearly every day, as indicated by either subjective report or observation made by others (in children and adolescents, this can be described as an irritable mood)
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
3. Significant weight loss when not dieting or weight gain (change of more than 5% of body weight in 1 month), or decrease or increase in appetite nearly every day (in children, consider failure to make expected weight gain)
4. Insomnia or hypersomnia nearly every day
5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
6. Fatigue or loss of energy nearly every day
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

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

C. The episode is not attributable to the physiological effects of a substance or to another medical condition

D. There has never been a manic or hypomanic episode

Answer 37

Major Depressive Disorder

Question 38

A. Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 years (in children and adolescents, mood can be irritable and duration must be at least 1 year)

B. Presence, while depressed, of 2 (or more) of the following:

1. Poor appetite or overeating
2. Insomnia or hypersomnia
3. Low energy or fatigue
4. Low self-esteem
5. Poor concentration or difficulty making decisions
6. Feelings of hopelessness

C. During the 2-year period of the disturbance, the individual has never been without the symptoms in Criteria A and B for more than 2 months at a time

D. Criteria for major depressive disorder may be continuously present for 2 years

E. There has never been a manic or hypomanic episode, and criteria have never been met for cyclothymic disorder

Answer 38

Persistent Depressive Disorder (Dysthymia)

Question 39

A. In the majority of menstrual cycles, at least 5 symptoms must be present in the final week before the onset of menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week postmenses

B. One (or more) of the following symptoms must be present:

1. Marked affective lability (i.e. mood swings; feeling suddenly sad or tearful, increased sensitivity to rejection)
2. Marked irritability or anger in increased interpersonal conflicts
3. Marked depressed mood, feelings of hopelessness, or self-deprecating thoughts
4. Marked anxiety, tension, and/or feelings of being keyed up or on edge

C. One (or more) of the following symptoms must additionally be present, to reach a total of 5 symptoms when combined with symptoms from Criterion B:

1. Decreased interest in usual activities
2. Subjective difficulty in concentration
3. Lethargy, easy fatigability, or marked lack of energy
4. Marked changed in appetite
5. Hypersomnia or insomnia
6. A sense of being overwhelmed or out of control
7. Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of bloating, or weight gain

The symptoms in Criteria A-C must have been met for most menstrual cycles that occurred in the preceding year

Answer 39

Premenstrual Dysphoric Disorder

Question 40

A. A prominent and persistent disturbance in mood that predominates in the clinical picture and is characterized by depressed mood or markedly diminished interested or pleasure in all, or almost all, activities

B. There is evidence from the history, physical examination, or lab findings of both 1 and 2:

1. The symptoms in Criterion A developed during or soon after substance intoxication or withdrawal or after exposure to a medication
2. The involved substance/medication is capable of producing the symptoms in Criterion A

Answer 40

Substance/Medication-Induced Depressive Disorder

Question 41

A. A prominent and persistent period of depressed mood or markedly diminished interest or pleasure in all, or almost all, activities that predominates in the clinical picture

B. There is evidence from the history, physical examination, and lab findings that the disturbance is the direct pathophysiological consequence of another medical condition

C. The disturbance does not occur exclusively during the course of a delirium

Answer 41

Depressive Disorder Due to Another Medical Condition

Question 42

This category applies to individuals in which symptoms that are characteristic of a depressive disorder don’t meet the full criteria for any of the disorders in the depressive disorders diagnostic class.

Answer 42

Other Specified Depressive Disorder