Disorders PDF

DISORDERS D. EXCLUSION CRITERIA: NOT EXPLAINED BY OTHER MENTAL DISORDERS (E.G., AUTISM 1. SEPARATION ANXIETY SPECTRUM DISORDER (SAD) DISORDER, PSYCHOTIC DISORDERS). A....

DISORDERS D. EXCLUSION CRITERIA: NOT EXPLAINED BY OTHER MENTAL DISORDERS (E.G., AUTISM 1. SEPARATION ANXIETY SPECTRUM DISORDER (SAD) DISORDER, PSYCHOTIC DISORDERS). A. —------------------------------------------------------- EXCESSIVE FEAR OR ANXIETY ABOUT 2. SELECTIVE MUTISM SEPARATION FROM A. FAILURE TO SPEAK: CONSISTENT ATTACHMENT FIGURES. FAILURE TO SPEAK IN SPECIFIC SOCIAL SITUATIONS WHERE SPEAKING IS EXPECTED, DESPITE SPEAKING IN 1. AT LEAST 3 OF THE FOLLOWING: OTHER SITUATIONS. 1.RECURRENT DISTRESS B. INTERFERENCE: INTERFERES WITH ANTICIPATING OR EXPERIENCING EDUCATIONAL/OCCUPATIONAL SEPARATION. ACHIEVEMENT OR 2. PERSISTENT WORRY ABOUT LOSING SOCIAL COMMUNICATION. ATTACHMENT FIGURES OR HARM BEFALLING THEM. C.DURATION: DURATION OF AT LEAST 1 3. PERSISTENT WORRY ABOUT MONTH (NOT UNTOWARD EVENTS CAUSING LIMITED TO THE FIRST MONTH OF SEPARATION. SCHOOL). 4.RELUCTANCE/REFUSAL TO GO OUT OR AWAY FROM HOME. D. EXCLUSION: NOT DUE TO LACK OF 5.FEAR OF BEING ALONE OR WITHOUT LANGUAGE ATTACHMENT FIGURES. KNOWLEDGE OR COMFORT, AND NOT 6. RELUCTANCE/REFUSAL TO SLEEP EXPLAINED BY AWAY FROM HOME. OR SLEEPING COMMUNICATION DISORDERS. WITHOUT MAJOR ATTACHMENT FIGURE 7.NIGHTMARES ABOUT SEPARATION. E. EXCLUSION: NOT EXPLAINED BY 8.PHYSICAL SYMPTOMS DURING OR COMMUNICATION ANTICIPATING SEPARATION. DISORDERS OR AUTISM SPECTRUM DISORDER, B. DURATION: AT LEAST 4 WEEKS IN SCHIZOPHRENIA, OR OTHER CHILDREN, PSYCHOTIC DISORDERS. TYPICALLY 6 MONTHS OR MORE IN —------------------------------------------------------- ADULTS. 3. SPECIFIC PHOBIA C. IMPACT: THE DISTURBANCE CAUSES A. MARKED FEAR OR ANXIETY ABOUT A CLINICALLY SPECIFIC OBJECT SIGNIFICANT DISTRESS OR OR SITUATION. IMPAIRMENT IN SOCIAL, ACADEMIC, OCCUPATIONAL, OR OTHER B. IMMEDIATE FEAR OR ANXIETY WHEN IMPORTANT ENCOUNTERING AREAS OF FUNCTIONING. THE PHOBIC TRIGGER. C.ACTIVE AVOIDANCE OR INTENSE OR ANXIETY. FEAR WHEN FACED WITH THE PHOBIC TRIGGER. D.AVOIDANCE OR INTENSE FEAR OF SOCIAL SITUATIONS. D. FEAR OR ANXIETY IS DISPROPORTIONATE TO THE E.FEAR IS DISPROPORTIONATE TO THE ACTUAL DANGER. ACTUAL THREAT. E. PERSISTS FOR AT LEAST 6 MONTHS F.PERSISTENT FOR AT LEAST 6 AND CAUSES MONTHS, CAUSING DISTRESS OR IMPAIRMENT. DISTRESS. F. NOT EXPLAINED BY OTHER MENTAL G.CAUSES CLINICALLY SIGNIFICANT DISORDERS. IMPAIRMENT. Specify if: H.NOT DUE TO SUBSTANCE USE OR CODE BASED ON THE SPECIFIC PHOBIC ANOTHER MEDICAL STIMULUS: CONDITION. ANIMAL I.NOT BETTER EXPLAINED BY (E.G., SPIDERS, INSECTS, DOGS) SYMPTOMS OF ANOTHER MENTAL DISORDER. NATURAL ENVIRONMENT (E.G., HEIGHTS, STORMS, WATER) J: FEAR NOT RELATED TO OTHER MEDICAL CONDITIONS. BLOOD-INJECTION-INJURY (E.G., NEEDLES, MEDICAL SPECIFIER: PROCEDURES) PERFORMANCE ONLY: SITUATIONAL FEAR RESTRICTED TO PUBLIC (E.G., AIRPLANES, ELEVATORS, SPEAKING OR ENCLOSED PLACES) PERFORMING. —------------------------------------------------ OTHER: (E.G., CHOKING, VOMITING, 5. PANIC DISORDER LOUD SOUNDS) PANIC ATTACKS - A panic attack is an 4. SOCIAL ANXIETY DISORDER abrupt surge of intense fear or intense A.FEAR OR ANXIETY IN SOCIAL discomfort that reaches a peak within SITUATIONS WITH minutes, POSSIBLE SCRUTINY. A.RECURRENT UNEXPECTED PANIC B.FEAR OF NEGATIVE EVALUATION, ATTACKS HUMILIATION, OR REJECTION. 01.4 OR MORE OF THE FOLLOWING: C.SOCIAL SITUATIONS ALMOST 1.- PALPITATIONS OR ACCELERATED ALWAYS PROVOKE FEAR HEART RATE. 2.- SWEATING. 3.- TREMBLING OR SHAKING. C. SITUATIONS ALMOST ALWAYS 4.- SHORTNESS OF BREATH OR PROVOKE FEAR OR ANXIETY. SMOTHERING SENSATION. 5.- FEELING OF CHOKING. D. AVOIDANCE, COMPANION 6.- CHEST PAIN OR DISCOMFORT. REQUIREMENT, OR INTENSE 7.- NAUSEA OR ABDOMINAL DISTRESS. 8.- DIZZINESS OR FEELING FAINT. FEAR. 9.- CHILLS OR HEAT SENSATIONS. 10.- NUMBNESS OR TINGLING E.FEAR OR ANXIETY SENSATIONS. (PARESTHESIAS) DISPROPORTIONATE TO DANGER. 11.- DEREALIZATION OR DEPERSONALIZATION. F.PERSISTENCE FOR AT LEAST 6 12.- FEAR OF LOSING CONTROL OR MONTHS. "GOING CRAZY." G.CAUSES CLINICALLY SIGNIFICANT 13.- FEAR OF DYING. DISTRESS OR IMPAIRMENT. B.ONE ATTACK FOLLOWED BY 1 MONTH H. OR MORE OF: 1.PERSISTENT CONCERN ABOUT MORE EXCESSIVE FEAR IF ANOTHER ATTACKS. MEDICAL CONDITION 2.MALADAPTIVE BEHAVIOR CHANGES. PRESENT. C.NOT DUE TO SUBSTANCES OR I.NOT BETTER EXPLAINED BY OTHER MEDICAL CONDITION. MENTAL DISORDERS. D.NOT BETTER EXPLAINED BY ANOTHER DISORDER. NOTE: AGORAPHOBIA IS DIAGNOSED —------------------------------------------------------- IRRESPECTIVE OF THE PRESENCE OF PANIC DISORDER. IF AN 7. AGORAPHOBIA INDIVIDUAL’S PRESENTATION MEETS CRITERIA FOR A.FEAR OR ANXIETY ABOUT TWO OR PANIC DISORDER MORE SITUATIONS: AND AGORAPHOBIA, BOTH DIAGNOSES 1.- USING PUBLIC TRANSPORTATION. SHOULD BE ASSIGNED. 2.- BEING IN OPEN SPACES. 3.- BEING IN ENCLOSED PLACES. 8. GENERALIZED ANXIETY DISORDER 4.- STANDING IN LINE OR BEING IN A A.EXCESSIVE ANXIETY AND WORRY CROWD. FOR AT LEAST 6 5.- BEING OUTSIDE OF THE HOME MONTHS. ALONE. B.DIFFICULTY CONTROLLING THE WORRY. B.FEAR OF DIFFICULTY ESCAPING OR GETTING HELP IF C.THREE OR MORE OF THE NEEDED. FOLLOWING SYMPTOMS:  GAD 1.- RESTLESSNESS OR FEELING ON Panic disorder EDGE Social anxiety disorder 2.- EASILY FATIGUED. Specific phobias. 3.- DIFFICULTY CONCENTRATING OR MIND GOING BLANK. 4.- IRRITABILITY. 02.MEDICATION 5.- MUSCLE TENSION. SSRI & SNRI 6.- SLEEP DISTURBANCE. Selective Serotonin Reuptake Inhibitors D.CAUSES CLINICALLY SIGNIFICANT (SSRIs) DISTRESS OR IMPAIRMENT. Serotonin- Norepinephrine E.NOT ATTRIBUTABLE TO SUBSTANCE Reuptake Inhibitors OR MEDICAL (SNRIs): CONDITION. F.NOT BETTER EXPLAINED BY ANOTHER MENTAL APPLICABILITY DISORDER. Recommended in conjunction with therapy for moderate to severe —-------------------------------------- cases or when therapy alone is TREATMENTS insufficient. 03.EXPOSURE THERAPY 1. COGNITIVE-BEHAVIORAL Gradually exposing individuals to THERAPY (CBT) feared stimuli or situations in a controlled manner to reduce anxiety responses. CBT is a structured therapy that TECHNIQUES aims toidentify and modify Systematic desensitization maladaptive thoughts,beliefs, and Virtual reality exposure behaviors associated with anxiety In vivo exposure.. disorders. APPLICABILITY TECHNIQUES Phobias Panic disorder PTSD. Cognitive restructuring Exposure therapy 04.MINDFULNESS-BASED Systematic desensitization, INTERVENTIONS Relaxation training, Cultivating present- moment awareness and Problem-solving skills. acceptance, which can help individuals manage anxiety symptoms and reduce APPLICABILITY reactivity to stressors. TECHNIQUES  Mindfulness meditation Symmetry and Order Mindful breathing exercises (4-7-8) Intrusive Thoughts Body Scans Fear of Harm Unwanted Impulses APPLICABILITY GAD COMPULSION Social anxiety disorder are the thoughts or actions used to PTSD. suppress the obsessions and provide relief. —------------------------------------------------------- Checking ANXIETY DISORDER Cleaning and Washing 1. Separation Anxiety Disorder Counting and Ordering (SAD) Repeating 2. Generalized Anxiety Disorder Mental Rituals 3. Panic Disorder 4. Social Anxiety Disorder 5. Agoraphobia 6. Selective Mutism type of compulsion (rituals) 1. Symmetry - Needing things to be symmetrical or aligned. Putting —------------------------------------------------------- things in certain order. 2. Counting 3. Forbidden thoughts - Fears, urges OCD AND BODY DYSMORPHIC to harm self or others. Checking, DISORDER avoidance, repeated requests for Obsessions are recurrent and persistent reassurance. thoughts, urges, or images that are 4. Contamination - Fears of germs or experienced as intrusive and unwanted, contaminants. Repetitive hand whereas compulsions are repetitive washing, using gloves and masks to behaviors or mental acts that an individual do daily tasks. feels driven to perform in response to an 5. Unsure obsession or according to rules that must be 6. Hoarding - Fears of throwing applied rigidly anything away. Collecting/saving objects with little or no actual sentimental value. 1. Obsessive Compulsive Disorder Obssession, suicidal rate (high) 01. PRESENCE OF OBSESSIONS AND Need to monitor, 44% suicidal COMPULSIONS ideation and 11% attempt Obsessions are intrusive thoughts causing OCD involves internal fears, not anxiety. Compulsions are repetitive external threats like in other anxiety behaviors aimed at reducing anxiety disorder 02. TIME-CONSUMING OR DISTRESSING OBSESSION SYMPTOMS are intrusive and mostly nonsensical Obsessions or compulsions take more than thoughts, images, or urges that the 1 hour per day or cause significant distress individual tries to resist or eliminate. or impairment in daily functioning 03. INSIGHT SPECIFICATION Contamination With Good or Fair Insight: Individual recognizes the irrationality of build being too small or insufficiently OCD beliefs. muscular. With Poor Insight: Individual believes OCD beliefs are 04. INSIGHT SPECIFICATION probably true. With Good or Fair Insight: Individual With Absent recognizes that BDD beliefs are not true or Insight/Delusional Beliefs: Individual is may not be true. With Poor Insight: convinced OCD beliefs are true Individual thinks BDD beliefs are probably true. With Absent Insight/Delusional Beliefs: Individual is completely convinced BDD beliefs are true 2. Body Dysmorphic Disorder (BDD) as “imagined ugliness” Body Dysmorphic Disorder (BDD) causes individuals to 3. Trichotillomania - Hair pulling obsess over perceived flaws disorder in their appearance, leading RECURRENT HAIR-PULLING to distress and avoidance of Recurrent pulling out of one ' s hair, social situations. leading to hair loss. - People with BDD complain of persistent,intrusive, and horrible ATTEMPTS TO STOP Repeated attempts thoughts about their appearance, to decrease or stop hair pulling and they engage in such compulsive behaviors as repeatedly looking in CLINICALLY SIGNIFICANT DISTRESS mirrors to check their physical OR IMPAIRMENT Hair pulling results in features. distress or impairment in daily life. sees themselves as opposite Hair pulling may occur from any of what their appearance is region of the body in which hair grows; the most common sites are 01. PREOCCUPATION WITH PERCEIVED the scalp, eyebrows, and eyelids, DEFECTS while less common sites are axillary, Preoccupation with one or more perceived facial, pubic, and perirectal regions. defects or flaws in physical appearance, not A. Recurrent pulling out of one’s hair, observable or appear slight to others. resulting in hair loss. B. Repeated attempts to decrease or stop 02. REPETITIVE BEHAVIORS OR hair pulling. MENTAL ACTS C. The hair pulling causes clinically Engaging in repetitive behaviors or mental significant distress or impairment in social, acts related to appearance concerns, like occupational, or other important areas of mirror checking, excessive grooming, or functioning. comparing looks with others. D. The hair pulling or hair loss is not attributable to another medical condition 03. MUSCLE DYSMORPHIA (e.g., a dermatological condition). SPECIFICATION Preoccupation with body  E. The hair pulling is not better explained movement disorder, or intention to harm by the symptoms of another mental disorder oneself in nonsuicidal self-injury). (e.g., attempts to improve a perceived defect or flaw in appearance in body dysmorphic disorder). 5. Hoarding Disorder Hoarding Disorder is a mental health 4. Excoriation Disorder - skin condition causing difficulty discarding picking possessions, leading to clutter and distress. RECURRENT SKIN PICKING Recurrent 01. PERSISTENT DIFFICULTY skin picking resulting in skin lesions. DISCARDING POSSESSIONS Difficulty discarding possessions regardless of their ATTEMPTS TO STOP Repeated attempts value. to decrease or stop skin picking 02. PERCEIVED NEED TO SAVE ITEMS CLINICALLY SIGNIFICANT DISTRESS Difficulty is due to a perceived need to save OR IMPAIRMENT Skin picking leads to items and distress associated with distress or impairment in daily discarding them. functioning 03. ACCUMULATION OF POSSESSIONS Accumulation of possessions that congest recurrent picking at one’s own skin and clutter living areas, compromising their The most commonly picked sites are intended use. the face, arms, and hands, but many individuals pick from multiple body 04. SPECIFIER: EXCESSIVE sites. Individuals may pick at healthy ACQUISITION Accompanied by excessive skin, at minor skin irregularities, at acquisition of items not needed or with no lesions such as pimples or calluses, available space or at scabs from previous picking. 05. INSIGHT SPECIFICATION A. Recurrent skin picking resulting in skin With Good or Fair Insight: Individual lesions. recognizes hoarding-related beliefs and B. Repeated attempts to decrease or stop behaviors as problematic. skin picking. With Poor Insight: Individual is mostly C. The skin picking causes clinically convinced hoarding-related beliefs and significant distress or impairment in social, behaviors are not problematic despite occupational, or other important areas of evidence. functioning. With Absent Insight/Delusional Beliefs: D. The skin picking is not attributable to the Individual is completely convinced hoarding- physiological effects of a substance (e.g., related beliefs and behaviors are not cocaine) or another medical condition (e.g., problematic despite evidence scabies). E. The skin picking is not better explained by symptoms of another mental —------------------------------------------------------- disorder (e.g., delusions or tactile hallucinations in a psychotic disorder, TRAUMA AND STRESSOR RELATED attempts to improve a perceived defect or DISORDER flaw in appearance in body dysmorphic disorder, stereotypies in stereotypic  1. Reactive Attachment Disorder approaching adults without when distressed, they show no inhibitions or consulting a caregiver consistent effort to obtain comfort, Can’t control self, sometimes support, nurturance, or protection involved in criminal activity to from caregivers appease adults. The child will rarely seek caregiver support or respond to caregiver 01. PATTERN OF BEHAVIOR (at least offers for protection, support, and 2) -Child actively approaches and interacts nurturance. They might show lack of with unfamiliar adults. responsiveness, limited positive -Verbal or physical behavior that exceeds affect, and heightened emotionality social boundaries. like fearfulness and intense - May not check back with their adult sadness. Disturbance must be caregiver after venturing away, even in evident before age 5 unfamiliar settings. - Readily go off with unfamiliar adults 01. INHIBITED BEHAVIOR TOWARDS without hesitation or reservation. CAREGIVERS Child rarely seeks or responds to comfort 02. PATTERN OF INSUFFICIENT CARE when distressed. Child has experienced extremes of insufficient care, evidenced by: Social 02. PERSISTENT SOCIAL AND neglect or deprivation. Repeated changes of EMOTIONAL DISTURBANCE primary caregivers. Rearing in settings Requires minimal emotional limiting opportunities to form attachments. responsiveness, limited positive affect episodes of irritability, sadness, or fearfulness during nonthreatening 03. RELATIONSHIP BETWEEN CARE interactions AND BEHAVIOR The disturbed behavior is presumed to 03. PATTERN OF INSUFFICIENT CARE result from the inadequate care experienced Experiencing social neglect, changing by the child. caregivers frequently, and growing up in environments with limited attachment 04. DURATION AND SEVERITY opportunities can have negative effects. Specify if Persistent: Present for more than 12 months. Specify current severity: Severe if all symptoms manifest at relatively high Persistent Specifier Severity Specification levels The disorder persists for more than 12 months Severity is classified as severe when all symptoms are present at high levels 3. Acute Stress Disorder 3 days to 1 month Acute Stress Disorder (ASD) is a short-term psychological condition 2. Disinhibited Social Engagement caused by trauma, with symptoms Disorder including intrusive memories, Early and persistent harsh nightmares, avoidance behaviors, punishment in child-rearing can lead negative mood, and increased to a child displaying inappropriate arousal. Untreated ASD can lead to attachment behaviors, such as  Posttraumatic Stress Disorder Reexperiencing Symptoms (PTSD). Victims often relive the traumatic event through memories and nightmares. Flashbacks occur when memories suddenly 1. TRAUMA EXPOSURE resurface with intense emotions, making Exposure to death, injury, or violence victims feel as if they are reliving the event. through direct experience, witnessing, learning, or repeated exposure. 01. INTRUSIVE MEMORIES AND FLASHBACKS 02. SYMPTOMS CRITERIA Experiencing distressing memories, Intrusion Symptoms: nightmares, and flashbacks of a traumatic Distressing memories, dreams, event. FLASHBACK, NOT JUST flashbacks. MEMORIES Negative Mood: 02.AVOIDANCE SYMPTOMS Inability to feel positive emotions. They may avoid reminders of the traumatic Dissociative Symptoms event, including places, people, activities, or Altered reality, memory issues. situations that bring back memories of the Avoidance Symptoms trauma. They may also avoid talking about Trying to avoid reminders. the event. Arousal Symptoms: Sleep issues, irritability, hypervigilance 03. HYPERAROUSAL AND REACTIVITY Hypervigilant and being easily startled, feeling tense or on edge, having difficulty sleeping, experiencing angry outbursts, and 03.DURATION AND TIMING. Symptoms having difficulty concentrating persist for 3 days to 1 month after trauma exposure. Onset typically immediate but 04. NEGATIVE CHANGES IN THINKING must persist for at least 3 days to meet AND MOOD criteria. Persistent negative thoughts, guilt, shame, reduced interest in activities, and social 04 FUNCTIONAL IMPAIRMENT detachment. Tendency to blame self for the The disturbance causes clinically significant traumatic event. distress or impairment in social, 05.DURATION AND IMPAIRMENT occupational, or other important areas of Symptoms lasting more than one month, functioning. causing significant distress or impairment in social, occupational, or other important areas of functioning. 4. Post Traumatic Stress Disorder e development of characteristic symptoms following exposure to SPECIFIER With dissociative symptoms one or more traumatic events (SEVERE CASES) Traumatic Event Exposure Confirm if the individual' s symptoms align PTSD typically arises from exposure to a with the criteria for posttraumatic stress traumatic event where an individual disorder. Additionally, when faced with the experiences or witnesses death, serious stressor, the individual encounters ongoing injury, or sexual violation. or recurring symptoms from either of the following: 1. Depersonalization: Continual Selective Serotonin Reuptake Inhibitors experiences of feeling detached from one ' s (SSRIs) Antidepressant medications like mental processes or body, as if observing sertraline, paroxetine, and fluoxetine are from an external standpoint (e.g., feeling commonly prescribed to manage PTSD like being in a dream; sensing an unreal symptoms, including depression, anxiety, aspect of self, body, or time passage). and intrusive thoughts. 2. Derealization: Persistent experiences of surroundings feeling unreal (e.g., perceiving the world as dreamlike, distant, or 5. Adjustment Disorder distorted). Specify if: With delayed Life event that can cause expression: If the full diagnostic criteria are adjustment (break- up, resigning/ not met until at least 6 months after the retirement from work) event (although the onset and expression of Adjustment disorders involve some symptoms may be immediate). anxious or depressive reactions to life stress, impacting functioning PREVALENCE without being as severe as acute Remarkably low prevalence in populations stress disorder or PTSD. Stressors of trauma victims may not be traumatic but still lead to TRAGIC RATES coping difficulties and impairment in PTSD is higher in prevalence amonng various areas of life, requiring women who have experienced repeated intervention sexual assaults resolve within 6 months of the termination of the stressor or its consequences WHY DO OTHERS DEVELOP TRAUMA EASIER THAN OTHERS? SEVERITY OF TRAUMA 01.. ONSET AND RESPONSE PERSONAL VULNERABILITY LACK OF SOCIAL SUPPORT Development of emotional or behavioral COPING MECHANISM symptoms within 3 months of an identifiable SUBSEQUENT STRESSORS stressor BIOLOGICAL FACTORS 02. CLINICAL SIGNIFICANCE (1 or more) 1. Feeling distress that goes beyond the TREATMENT OF POSTTRAUMATIC typical response to a stressor, taking into STRESS DISORDER account external factors and cultural norms. COGNITIVE BEHAVIORAL THERAPY 2. Showing significant difficulties in different (CBT) aspects of life like social interactions, work, or other important activities. Process traumatic memories, change negative thought patterns, and develop coping skills to manage symptoms. 03. TERMPORAL DURATION THE TRICK IS IN ARRANGING THE Symptoms do not persist for more than 6 REEXPOSURE SO THAT IT WILL months after the stressor ends. Symptoms BE THERAPEUTIC RATHER THAN resolve within 6 months after the stressor TRAUMATIC ends PSYCHOANALYTIC THERAPY Reliving emotional trauma to relieve emotional suffering is called CATHARSIS. Subtypes of Adjustment Disorder: F43.21: With depressed mood F43.22: With anxiety F43.23: With mixed anxiety and depressed Emotional numbness mood Feeling life is meaningless F43.24: With disturbance of conduct Intense loneliness F43.25: With mixed disturbance of emotions —------------------------------------------------------- and conduct F43.20: Unspecified Acute: Duration Specifiers: Symptoms persist for less than 6 months. Persistent (chronic): Symptoms persist for 6 months or longer, typically in response to chronic stressors or those with enduring consequence 6. Prolonged Grief Disorder Grief that lasted 2 yrs and above Involves persistent and intense grief after a close person ' s death, with symptoms like yearning for the deceased, avoidance of reminders, emotional pain, and loneliness. It differs from other disorders and is not linked to substance use or medical issues 01. TIME FRAME Death of a close person at least 12 months ago (6 months for children/adolescents). 02. PERSISTENT GRIEF RESPONSE Intense yearning/longing for the deceased. Preoccupation with thoughts or memories of the deceased. 03. EXCEEDS CULTURAL NORMS Duration and severity exceed expected social, cultural, or religious norms 04. ADDITIONAL SYMPTOMS Identity disruption Disbelief about the death Avoidance of reminders Intense emotional pain Difficulty in relationships and activities