DSM-5 Diagnostic Criteria

Question 1

Schizophrenia

Answer 1

A. The presence of 2 (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated), with at least 1 of them being (1), (2), or (3):

(1) delusions,
(2) hallucinations,
(3) disorganized speech,
(4) grossly disorganized or catatonic behaviour, and
(5) negative symptoms

B. Social or occupational dysfunction

C. Continuous signs for at least 6 months

D. Exclude schizo-affective or mood disorder

E. Exclude another medical condition and substances

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

Question 2

Schizo-affective disorder

Answer 2

A. An uninterrupted period of illness during which there is a major mood episode, concurrent with symptoms that meet criterion A for schizophrenia.

B. During the same period of illness, there have been delusions or hallucinations for at least 2 weeks in the absence of prominent mood symptoms.

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

D. Exclude substances and general medical conditions.

Question 3

Catatonia

Answer 3

• Stupor (no psychomotor activity, not actively relating to the environment)
• Cataplexy (passive induction of posture held against gravity)
• Waxy flexibility (slight and even resistance to positioning by the examiner)
• Mutism (no or very little verbal response in the absence of aphasia)
• Negativism (opposition or no response to instructions or external stimuli)
• Posturing (spontaneous and active maintenance of posture against gravity)
• Mannerisms (odd caricature of normal actions)
• Stereotypy
• Agitation not influenced by external stimuli
• Grimacing
• Echolalia
• Echopraxia

Question 4

Schizophreniform Disorder

Answer 4

Similar to Schizophrenia with symptoms lasting at least one month but less than six months.

Question 5

Delusional Disorder

Answer 5

A. The presence of 1 or more delusions over a time period of at least one month.

B. Criterion A for Schizophrenia has never been met. (Hallucinations, if present, not prominent and are related to the delusional theme)

C. Functioning is not markedly impaired and behaviour is not obviously odd or bizarre.

D. If mood episodes have occurred concurrently with delusions, their total duration has 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.

Question 6

Brief Psychotic Disorder

Answer 6

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

1. delusions
2. hallucinations
3. disorganized speech (e.g., frequent derailment or incoherence)
4. grossly disorganized or catatonic behaviour

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

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

Question 7

Substance/Medication-Induced Psychotic Disorder

Answer 7

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

1. Delusions
2. Hallucinations

B. There is evidence from the history, physical examination, or laboratory findings that either (1) or (2):

1. the symptoms in Criterion A developed during, or within a month of, substance intoxication or withdrawal
2. medication used is etiologically related to the disturbance.

C. The disturbance is not better accounted for by a psychotic disorder that is not substance induced. Evidence that the symptoms are better accounted for by a psychotic disorder that is not substance induced might include the following: the symptoms precede the onset of the substance use (or medication use); the symptoms persist for a substantial period of time (e.g., about a month) after the cessation of acute withdrawal or severe intoxication, or are substantially in excess of what would be expected given the type or amount of the substance used or the duration of use; or there is other evidence that suggests the existence of an independent nonsubstance-induced psychotic disorder (e.g., a history of recurrent nonsubstance-related episodes).

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.

Question 8

Manic Episode

Answer 8

A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently goal-directed behavior or energy, lasting at least 1 week and present most of the day, nearly every day (or any duration if hospitalization is necessary).

B. During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms have persisted (four if the mood is only irritable) are present to a significant degree and represent a noticeable change from usual behaviour:

 1. Inflated self-esteem or grandiosity

 2. Decreased need for sleep (e.g., feels rested after only 3 hours of sleep)

 3. More talkative than usual or pressure to keep talking

 4. Flight of ideas or subjective experience that thoughts are racing

 5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed.

 6. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation

 7. Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).

C. The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.

D. The episode is not attributable to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or another medical condition.

Question 9

Bipolar 1

Answer 9

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, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.

Specify:
With anxious distress
With mixed features
With rapid cycling
With melancholic features
With atypical features
With mood-congruent psychotic features
With mood-incongruent psychotic features
With catatonia
With peripartum onset
With seasonal pattern

Question 10

Hypomanic Episode

Answer 10

A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased 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 and increased energy or activity, three (or more) of the following symptoms have persisted (four if the mood is only irritable), represent a noticeable change from usual behavior, and have been present to a significant degree:

 1. inflated self-esteem or grandiosity

 2. decreased need for sleep (e.g., feels rested after only 3 hours of sleep)

 3. more talkative than usual or pressure to keep talking

 4. flight of ideas or subjective experience that thoughts are racing

 5. distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed.

 6. increase in goal-directed activity (at work, at school, or sexually) or psychomotor agitation

 7. excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).

B. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic.

C. The disturbance in mood and the change in functioning are observable by others.

D. The episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization. If there are psychotic features, the episode is, by definition, manic.

E. The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication or other treatment).

Question 11

Bipolar 2

Answer 11

A. Criteria have been met for at least one hypomanic episode and at least one major depressive episode

B. There has never been a manic episode.

C. 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.

D. The symptoms of depression or the unpredictability caused by frequent alternation between periods of depression and hypomania causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Specify if:
With anxious distress
With mixed features
With catatonia.
With mood-congruent psychotic features
With peripartum onset
With seasonal pattern: Applies only to the pattern of major depressive episodes.
With rapid cycling

Question 12

Dysthymic Disorder (Persistent Depressive Disorder)

Answer 12

A. Depressed mood for most of the day, for more days than not, as indicated by subjective account or observation by others, for at least 2 years.

B. Presence while depressed of two or more of the following:
• Poor appetite or overeating
• Insomnia or hypersomnia
• Low energy or fatigue
• Low self-esteem
• Poor concentration or difficulty making decisions
• Feelings of hopelessness

C. During the 2 year period of the disturbance, the person has never been without symptoms from the above two criteria for more than 2 months at a time.

D. Criteria for MDD may be continuously present for 2 years, in which case patients should be given comorbid diagnoses of persistent depressive disorder and MDD.

E. There has never been a manic episode, a mixed episode, or a hypomanic episode and the criteria for cyclothymia have never been met.

F. The symptoms are not better explained by a psychotic disorder.

G. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse or a medication) or a general medical condition.

H. The symptoms cause clinically significant distress or impairment in important areas of functioning.

Question 13

Panic Attack

Answer 13

A. An abrupt surge of intense fear or intense discomfort that reaches a peak within minutes and during which time four or more of the following symptoms occur.

• Palpitations, pounding heart, or accelerated heart rate
• Sweating
• Trembling or shaking
• Shortness of breath or feeling of smothering
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal distress
• Feeling dizzy, unsteady, lightheaded, or faint
• Chills or heat sensations
• Paresthesias (ie, numbness or tingling sensations)
• Derealization (ie, feeling of unreality) or depersonalization (ie, being detached from oneself)
• Fear of losing control or going crazy
• Fear of dying

During the episode, patients have the urge to flee or escape and have a sense of impending doom (as though they are dying from a heart attack or suffocation). Other symptoms may include headache, cold hands, diarrhea, insomnia, fatigue, intrusive thoughts, and ruminations.

Question 14

Panic Disorder

Answer 14

A. Recurrent and unexpected panic attacks
≥1 attack has been followed by 1 month or more of 1 or both of the following
• Persistent concern about additional attacks or their consequences
• A significant maladaptive change in behavior related to the attacks

B. The panic attacks are not due to the direct physiological effects of a substance (e.g., a drug of abuse or a medication) or a general medical condition

C. The panic attacks are not better accounted for by another mental disorder.

Question 15

Panic Disorder

Answer 15

A. Recurrent and unexpected panic attacks
≥1 attack has been followed by 1 month or more of 1 or both of the following
• Persistent concern about additional attacks or their consequences
• A significant maladaptive change in behavior related to the attacks

B. The panic attacks are not due to the direct physiological effects of a substance (e.g., a drug of abuse or a medication) or a general medical condition

C. The panic attacks are not better accounted for by another mental disorder.

Question 16

Obsessive-Compulsive Disorder

Answer 16

A. Presence of obsessions, compulsions, or both:

Obsessions are defined by:
 1. Recurrent and persistent thoughts, urges or images that are experienced, at some time during the disturbance, as intrusive, unwanted, and that in most individuals cause marked anxiety or distress.
 2. The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some thought or action (i.e., by performing a compulsion).

Compulsions are defined by:

 1. Repetitive behaviors (e.g., hand washing, ordering checking) or mental acts (e.g., praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession, or according to the rules that must be applied rigidly.
 2. The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation. However, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive.

B. The obsessions or compulsions are time consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

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

D. The disturbance is not due to the direct physiological effects of a substance (e.g., drug of abuse, a medication) or a general medical condition.

Question 17

Generalized Anxiety Disorder

Answer 17

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The person finds it difficult to control the worry.

C. The anxiety and worry are associated with three or more of the following six symptoms (with at least some symptoms present for more days than not for the past 6 months).

1. Restlessness or feeling keyed up or on edge
2. Being easily fatigued
3. Difficulty concentrating or mind going blank
4. Irritability
5. Muscle tension
6. Sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

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

Question 18

Post-Traumatic Stress Disorder

Answer 18

A. Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:

 1. Directly experiencing the traumatic event(s).
 2. Witnessing, in person, the event(s) as it occurred to others.
 3. Learning that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental.
 4. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse). Note: Criterion A4 does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related.

B. Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred:

 1. Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). Note: In children older than 6 years, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed.
 2. Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). Note: In children, there may be frightening dreams without recognizable content.
 3. Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.) Note: In children, trauma-specific reenactment may occur in play.
 4. Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
 5. Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).

C. Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by one or both of the following:

 1. Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
 2. Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).

D. Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:

 1. Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia, and not to other factors such as head injury, alcohol, or drugs).
 2. Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., “I am bad,” “No one can be trusted,” “The world is completely dangerous,” “My whole nervous system is permanently ruined”).
 3. Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others.
 4. Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).
 5. Markedly diminished interest or participation in significant activities.
 6. Feelings of detachment or estrangement from others.
 7. Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).

E. Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:

 1. Irritable behavior and angry outbursts (with little or no provocation), typically expressed as verbal or physical aggression toward people or objects.
 2. Reckless or self-destructive behavior.
 3. Hypervigilance.
 4. Exaggerated startle response.
 5. Problems with concentration.
 6. Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep).

F. Duration of the disturbance (Criteria B, C, D and E) is more than 1 month.

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

H. The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.

Question 19

Acute Stress Disorder

Answer 19

A. Exposure to actual or threatened death, serious injury, or sexual violation in one (or more) of the following ways:
1. Directly experiencing the traumatic event(s).
2. Witnessing, in person, the event(s) as it occurred to others.
3. Learning that the event(s) occurred to a close family member or close friend.
Note: In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental.
4. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains, police officers repeatedly exposed to details of child abuse).

B. Presence of nine or more of the following symptoms from any of the five categories of intrusion, negative mood, dissociation, avoidance, and arousal, beginning or worsening after the traumatic event(s) occurred:

Intrusion Symptoms
1. Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). Note: In children, repetitive play may occur in which themes or aspects of the traumatic event(s) occurred.

 2. Recurrent distressing dreams in which the content and/or effect of the dream are related to the event(s). Note: In children, there may be frightening dreams without recognizable content.
 3. Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.) Note: In children, trauma-specific reenactment may occur in play.
 4. Intense or prolonged psychological distress or marked physiological reactions in response to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).

Negative Mood
5. Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).

Dissociative Symptoms
6. An altered sense of the reality of one’s surroundings or oneself (e.g., seeing oneself from another’s perspective, being in a daze, time slowing).

 7. Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs).

Avoidance Symptoms
8. Efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).

 9. Efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).

Arousal Symptoms
10. Sleep disturbance (e.g., difficulty falling or staying asleep, restless sleep).

 11. Irritable behavior and angry outbursts (with little or no provocation), typically expressed as verbal or physical aggression toward people or objects.
 12. Hypervigilance.
 13. Problems with concentration.
 14. Exaggerated startle response.

Question 20

Adjustment Disorder

Answer 20

A. The development of emotional or behavioral symptoms in response to an identifiable stressor(s) occurring within 3 months of the onset of the stressor(s).

B. These symptoms or behaviors are clinically significant, as evidenced by one or both of the following:

 1. Marked distress that is out of proportion to the severity or intensity of the stressor, taking into account the external context and the cultural factors that might influence symptom severity and presentation.
 2. Significant impairment in social, occupational, or other important areas of functioning.

C. The stress-related disturbance does not meet the criteria for another mental disorder and is not merely an exacerbation of a preexisting mental disorder.

D. The symptoms do not represent normal bereavement.

E. Once the stressor (or its consequences) has terminated, the symptoms do not persist for more than an additional 6 months.

Specify whether:

309. 0 (F43.21) With depressed mood: Low mood, tearfulness, or feelings of hopelessness are predominant.
310. 24 (F43.22) With anxiety: Nervousness, worry, jitteriness, or separation anxiety is predominant.
311. 28 (F43.23) With mixed anxiety and depressed mood: A combination of depression and anxiety is predominant.
312. 3 (F43.24) With disturbance of conduct: Disturbance of conduct is predominant.
313. 4 (F43.25) With mixed disturbance of emotions and conduct: Both emotional symptoms (e.g., depression, anxiety) and a disturbance of conduct are predominant.
314. 9 (F43.20) Unspecified: For maladaptive reactions that are not classifiable as one of the specific subtypes of adjustment disorder.

Question 21

Cyclothymic Disorder

Answer 21

A. For at least two years (at least one year in children and adolescents) there have been numerous periods with hypomanic symptoms that do not meet criteria for a hypomanic episode and numerous periods with depressive symptoms that do not meet criteria for a major depressive episode.

B. During the above two-year period (one 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 two months at a time.

C. Criteria for a major depressive, manic, or hypomanic episode have never been met. [If such episodes appear later, the diagnosis would be changed to bipolar I or bipolar II disorder, as appropriate.]

D. The symptoms aren’t better explained by another mental disorder.

E. The symptoms aren’t caused by a substance (i.e., medication or drug of abuse) or another medical condition.

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

Question 22

Agoraphobia

Answer 22

A. A marked fear or anxiety about two (or more) of the following five situations:

 1. Using public transportation
 2. Being in open spaces
 3. Being in enclosed spaces (e.g., shops, theaters, cinemas)
 4. Standing in line or being in a crowd
 5. Being outside the home alone.

B. The situations are avoided (e.g., travel is restricted) or else are endured with marked distress or with anxiety about having a panic attack or panic-like symptoms, or require the presence of a companion.

C. The agoraphobic situations almost always provoke fear or anxiety.

D. The fear or anxiety is out of proportion to the actual danger posed by the agoraphobic situations and to the sociocultural context.

E. The fear, anxiety, or avoidance is persistent, typically lasting 6 months or more.

F. The fear, anxiety, or avoidance causes clinically significant distress or impairment in important areas of functioning.

G. The anxiety or phobic avoidance is not better accounted for by another mental disorder.

Question 23

Social Phobia

Answer 23

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g., giving a speech).
Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.
The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).

B. The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.

C. The social situations almost always provoke fear or anxiety.
Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.

D. The social situations are avoided or endured with intense fear or anxiety.

F. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

G. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

H. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

I. The fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

J. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

Question 24

Simple Phobia

Answer 24

A. Marked fear or anxiety about a specific object or situation (e.g., flying, heights, animals, receiving an injection, seeing blood).

B. The phobic object or situation almost always provokes immediate fear or anxiety.

C. The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation and to the sociocultural context.

D. The phobic object or situation is actively avoided or endured with intense fear or anxiety.

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

F. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

G. The disturbance is not better explained by the symptoms of another mental disorder, including fear, anxiety, and avoidance of situations associated with panic-like symptoms or other incapacitating symptoms (as in agoraphobia); objects or situations related to obsessions (as in obsessive-compulsive disorder); reminders of traumatic events (as in posttraumatic stress disorder); separation from home or attachment figures (as in separation anxiety disorder); or social situations (as in social anxiety disorder).

Specify type:

1. Animal Type (e.g., spiders, insects, dogs)
2. Natural Environment Type (e.g., heights, storms, water)
3. Blood-Injection-Injury Type (e.g., needles, invasive medical procedures)
4. Situational Type (e.g., airplanes, elevators, enclosed places)
5. Other Type (e.g., phobic avoidance of situations that may lead to choking, vomiting, or contracting an illness; in children, avoidance of loud sounds or costumed characters)

Question 25

Delirium

Answer 25

A. Disturbance in attention (reduced ability to direct, focus, sustain, and shift attention) and awareness.

B. The disturbance develops over a short period of time (usually hours to days), represents a change from baseline, and tends to fluctuate during the course of the day.

C. An additional disturbance in cognition (memory deficit, disorientation, language, visuospatial ability, or perception).

D. The disturbances are not better explained by another preexisting, evolving, or established neurocognitive disorder, and do not occur in the context of a severely reduced level of arousal, such as coma.

E. There is evidence from the history, physical examination, or laboratory findings that the disturbance is caused by a medical condition, substance intoxication or withdrawal, or medication side effect.

Question 26

Major Depressive Disorder

Answer 26

A. Five or more of the following symptoms have been present during the same two week period and represent a change from previous functioning. At least one symptom is either (1) depressed mood or (2) loss of interest or pleasure. NOTE: Exclude symptoms that are clearly due to another medical condition.

 a. Depressed most of the day, nearly every day, as indicated by either subjective report or observation made by others (children or adolescents may have an irritable mood)
 b. Marked diminished interest in pleasure in all, or almost all, activities most of the day, nearly every day (subjective account or observation)
 c. Significant weight loss when not dieting or weight gain (change of >5% of body weight in a month) or a change in appetite present nearly every day
 d. Insomnia/hypersomnia nearly every day
 e. Psychomotor agitation or retardation nearly every day (observable by others)
 f. Fatigue or loss of energy nearly every day
 g. Feelings of worthlessness or excessive on inappropriate guilt nearly every day (subjective or observed)
 h. Diminished concentration or indecisiveness nearly every day (subjective or observed)
 i. Recurring thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan or a suicide tempt or a specific plan for committing suicide

B. Causes significant distress or dysfunction in important areas of functioning.

C. Episode is not attributable to a substance or another medical condition.

D. The major depressive episode is not better explained by schizo-affective disorder, schizophrenia, schizophreniform disorder, delusional disorder, specified or unspecified schizophrenia, or other psychotic disorder.

E. No previous manic or hypomanic episode (this exclusion does not apply if all manic-like or hypomanic-like episodes were caused by a substance or other medical condition)

Specify:
•With anxious distress
• With mixed features
• With melancholic features
• With atypical features
• With mood-congruent psychotic features
• With mood-incongruent psychotic features
• With catatonia
• With peripartum onset
• With seasonal pattern