DSM-5 Summary PDF

DSM-5 Table of Contents Unspecified Catatonia Acute Stress Disorder Adjustment Disorders Section I: DSM-5 Basics Bipolar and Relat...

DSM-5 Table of Contents Unspecified Catatonia Acute Stress Disorder Adjustment Disorders Section I: DSM-5 Basics Bipolar and Related Disorders Bipolar I Disorder Dissociative Disorders Section II: Diagnostic Criteria & Codes Bipolar II Disorder Dissociative Identity Disorder Cyclothymic Disorder Dissociative Amnesia Neurodevelopmental Disorders Substance/Medication-Induced Bipolar and Depersonalization/Derealization Disorder Intellectual disabilities Related Intellectual disability Bipolar and Related Disorder Due to Another Somatic Symptom and Related Disorders Global Developmental Delay Medical Somatic Symptom Disorder Communication Disorders Illness Anxiety Disorder Language Disorder Conversion Disorder Speech Sound Disorder (previously Depressive Disorders Psychological Factors Affecting Other Medical Phonological) Disruptive Mood Dysregulation Disorder Conditions Social (Pragmatic) Communication Major Depressive Disorder, Single & Recurrent Factitious Disorder Disorder Episodes Feeding and Eating Disorders Autism Spectrum Disorder Persistent Depressive Disorder (Dysthymia) Pica Attention-Deficit/Hyperactivity Disorder Premenstrual Dysphoric Disorder Rumination Disorder ADHD Substance/Medication Induced Depressive Avoidant/Restrictive Food Intake Disorder Specific Learning Disorder Disorder Anorexia Nervosa Motor disorders Depressive Disorder Due to Another Medical Bulimia Nervosa Developmental Coordination Disorder Cond. Binge-Eating Disorder Stereotypic Movement Disorder Tic Disorders Anxiety Disorders Elimination Disorders Tourette’s Disorder Separation Anxiety Disorder Enuresis Persistent (Chronic) Motor or Vocal Tic Selective Mutism Encopresis Disorder Specific Phobia Provisional Tic Disorder Social Anxiety Disorder (Social Phobia) Sleep-Wake Disorders Other Neurodevelopmental Disorders Panic Disorder Insomnia Disorder Other specified Neurodevelopmental Panic Attack (Specifier) Hypersomnolence Disorder Disorder Agoraphobia Narcolepsy Unspecified Neurodevelopmental Generalized Anxiety Disorder Disorder Substance/Medication Induced Anxiety Breathing-Related Sleep Disorders Disorder Obstructive Sleep Apnea Hypopnea Schizophrenia Spectrum and Other Anxiety Disorder Due to Another Medical Cond. Central Sleep Apnea Psychotic Disorders Sleep-Related Hypoventilation Schizotypal (Personality) Disorder Obsessive-Compulsive and Related Circadian Rhythm Sleep- Wake Disorder Delusional Disorder Disorders Brief Psychotic Disorder Obsessive-Compulsive Disorder Parasomnias Schizophreniform Disorder Body Dysmorphic Disorder Non-REM Sleep Arousal Disorder Schizophrenia Hoarding Disorder Sleepwalking Schizoaffective Disorder Trichotillomania (Hair-Pulling Disorder) Sleep Terrors Substance/Medication-Induced Psychotic Excoriation (Skin-Picking) Disorder Nightmare Disorder Disorder Substance/Medication Induced O-C and Related REM Sleep Behavior Disorder Psychotic Disorder Due to Another Disorder Restless Legs Syndrome Medical Condition O-C Disorder Due to Another Medical Cond. Substance/Mediation-Induced Sleep Disorder Catatonia Catatonia Associated with Another Trauma-and Stresssor-Related Disorders Sexual Dysfunctions Mental Disorder Reactive Attachment Disorder Delayed Ejaculation Catatonia Disorder Due to Another Disinhibited Social Engagement Disorder Erectile Disorder Medical Cond. Posttraumatic Stress Disorder Female Orgasmic Disorder Female Sexual Interest/Arousal Disorder Major and Mild Neurocognitive (NC) Voyeuristic Disorder Genito-Pelvic Pain Disorder Disorders Exhibitionistic Disorder Male Hypoactive Sexual Desire Disorder Major/Mild Neurocognitive Disorders Frotteuristic Disorder Premature (Early) Ejaculation Major/Mild NC Disorder Due to Alzheimer’s Sexual Masochism Disorder Substance/Medication-Induced Sexual Disease Sexual Sadism Disorder Dysfunction Major/Mild Frontotemporal NC Disorder Pedophilic Disorder Major/Mild NC Disorder With Lewy Bodies Fetishistic Disorder Gender Dysphoria Major/Mild Vascular NC Disorder Transvestic Disorder Gender Dysphoria Major/Mild NC Disorder Due to Traumatic Brain Injury Other Mental Disorders Substance/Medication-Induced Major/Mild NC Other Specified Mental Disorder Due to Another Disorder Medical Condition Major/Mild NC Disorder Due to HIV Infection Unspecified Mental Disorder Due to Another Major/Mild NC Disorder Due to Prion Disease Medical Condition Disruptive, Impulse-Control, and Conduct Major/Mild NC Disorder Due to Parkinson’s Disorders Disease Medication-Induced Movement Disorders Oppositional Defiant Disorder Major/Mild NC Disorder Due to Huntington’s and Other Adverse Effects of Medication Intermittent Explosive Disorder Disease Conduct Disorder Major/Mild NC Disorder Due to Another Medical Other Conditions That May Be a Focus of Antisocial Personality Disorder Condition Clinical Attention Pyromania Major/Mild NC Disorder Due to Multiple Kleptomania Etiologies Section III: Emerging Measures and Unspecified NC Disorder Models Substance-Related and Addictive Disorders Assessment Measures Substance-Related Disorders Substance Use Disorders Cultural Formulation Substance-Induced Disorders Substance Intoxication and Withdrawal Personality Disorders Alternative DSM-5 Model for Personality Substance/Medication-Induced Mental General Personality Disorders Disorders Disorders Cluster A Personality Disorders Alcohol-Related Disorders Paranoid Caffeine-Related Disorders Schizoid Conditions for Further Study Cannabis-Related Disorders Schizotypal Attenuated Psychosis Syndrome Hallucinogen-Related Disorders Cluster B Personality Disorders Depressive Episodes with Short-Duration Inhalant-Related Disorders Antisocial Hypomania Opioid-Related Disorders Borderline Persistent Complex Bereavement Disorder Sedative-, Hypnotic-, or Anxiolytic-Related Histrionic Caffeine Use Disorder Disorders Narcissistic Internet Gaming Disorder Stimulant-Related Disorders Cluster C Personality Disorders Neurobehavioral Disorder Associated with Tobacco-Related Disorders Avoidant Prenatal Other (or Unknown) Substance-Related Dependent Alcohol Exposure Disorder Obsessive-Compulsive Suicidal Behavior Disorder Non-Substance-Related Disorders Other Personality Disorders Nonsuicidal Self-Injury Gambling Disorder Personality Change Due to Another Medical Condition Appendix Neurocognitive Disorders Delirium Paraphilic Disorders DSM-5 STUDY GUIDE ANXIETY DISORDERS  Excessive fear and anxiety and related behavioral disturbances  Fear – emotional response to real or perceived imminent threat (e.g. arousal for fight or flight, thoughts of immediate danger, escape behaviors)  Anxiety – anticipation of future threat (e.g. muscle tension, vigilance, cautious or avoidant behaviors)  Panic attack – particular type of fear response prominent within anxiety disorders  Anxiety disorders are best differentiated by the types of situations feared or avoided and content of associated thoughts or beliefs  Transient fear or anxiety (often stress-induced and temporary) vs. Anxiety disorder (persistent, usually 6 months or more)  Fear or anxiety is excessive or out of proportion  Sex Ratio: Female-Male: 2:1  Panic attacks (may be expected – response to typically feared object or situation; unexpected – occurs for no apparent reason)  Generalized Anxiety Disorder – persistent and excessive anxiety and worry about various domains which are difficult to control in addition to physical symptoms such as restlessness, easily fatigued, difficulty concentrating, irritability, muscle tension and sleep disturbance  Panic Disorder – recurrent unexpected panic attacks and persistently worried of having more panic attacks which may cause maladaptive behaviors  Agoraphobia – fear and anxiety of “unsafe” situations (e.g. public transportation, open spaces, enclosed places, standing in line or being in a crowd, being outside home alone) where panic-like symptoms may occur and help or escape is unlikely  Specific Phobia – fear, anxiety or avoidance of circumscribed objects or situations that is out of proportion to actual risk (subtypes: animal, natural environment, blood-injection-injury, situational, other)  Social Anxiety Disorder (Social Phobia) – fear, anxiety or avoidance of social interactions and situations where scrutiny is possible in addition to cognitive ideation of being negatively evaluated or offending others  Separation Anxiety Disorder – fear or anxiety about developmentally inappropriate separation from attachment figures; nightmares and physical symptoms may be present  Selective Mutism – consistent failure to speak in social situations even though individual speaks in other situations which leads to significant consequences on achievement or interferes social communication (usually diagnosed in addition to social anxiety disorder)  Substance/Medication-Induced Anxiety Disorder – anxiety due to substance intoxication or withdrawal or exposure to a medication treatment  Anxiety Disorder Due to Another Medical Condition – anxiety symptoms are direct pathophysiological consequence of another medical condition  Other Specified Anxiety Disorder – anxiety-like symptoms that cause clinically significant distress or impairment but does not meet full criteria and clinician specifies the reason (e.g. limited symptom attacks, generalized anxiety not occurring more days than not)   Unspecified Anxiety Disorder - anxiety-like symptoms that cause clinically significant distress or impairment but does not meet full criteria and clinician does not choose to communicate the reason and there is insufficient information to make more specific diagnosis (e.g. emergency room settings) TRAUMA- AND STRESSOR-RELATED DISORDERS  Psychological distress following exposure to a traumatic or stressful event is a required criteria  Most prominent characteristics are anhedonic and dysphoric symptoms, aggressive symptoms or dissociative symptoms  Generally more common in females  Conditions associated with social neglect (inadequate care during childhood): cognitive delays, language delays, developmental delays, stereotypies, reactive attachment, disinhibited social engagement, malnutrition or poor care  Reactive Attachment Disorder – expressed with depressive symptoms and withdrawn behavior and compromised emotional regulation capacity which are caused by serious social neglect  Disinhibited Social Engagement Disorder – marked by culturally inappropriate, overly familiar behavior with relative strangers which is caused by serious social neglect  Posttraumatic Stress Disorder – development of varying characteristics symptoms (e.g. fear-based emotional and behavioral, anhedonic or dysphoric mood and negative cognitions, arousal and reactive-externalizing) following exposure to one or more traumatic events  Acute Stress Disorder – PTSD symptoms lasting from 3 days to 1 month following exposure to the traumatic event/s  Adjustment Disorders – presence of emotional or behavioral symptoms in response to an identifiable stressor; may be single/multiple, recurrent/continuous  Other Specified Trauma- and Stressor Related Disorder – trauma- and stressor-like symptoms that cause clinically significant distress or impairment but do not meet full criteria and clinician specifies the reason (ex. Persistent complex bereavement disorder, adjustment-like disorders with delayed onset of symptoms that occur more than 3 months after the stressor, ataque de nervios)  Unspecified Trauma- and Stressor Related Disorder – trauma- and stressor-like symptoms that cause clinically significant distress or impairment but do not meet full criteria and clinician chooses not to specify the reason and there is insufficient information to make more specific diagnosis (e.g. emergency room settings) OBSESSIVE-COMPULSIVE AND RELATED DISORDERS  Presence of obsessions (e.g. recurrent and persistent, intrusive thoughts, urges or images) and compulsions (e.g. repetitive behaviors or mental acts driven in response to obsessions)  Obsessive-Compulsive Disorder – repetitive and persistent, time-consuming intrusive obsessions (which individual attempts to ignore or suppress) by means of compulsions; common dimensions: cleaning, symmetry, forbidden thoughts (sex/aggression/religion) and harm   Body Dysmorphic Disorder – cognitive symptom related to perceived defects or flaws in physical appearance and repetitive behaviors or mental acts in response to appearance concerns  Hoarding Disorder – cognitive symptom related to perceived need to save possessions  Trichotillomania (Hair-Pulling Disorder) – recurrent and repetitive hair- pulling behaviors resulting in hair loss and repeated attempts to decrease or stop hair-pulling  Excoriation (Skin-Picking Disorder) – recurrent and repetitive skin-picking behaviors resulting in skin lesions and repeated attempts to decrease or stop skin-picking  Substance/Medication-Induced Obsessive-Compulsive and Related Disorder – obsessive-compulsive symptoms due to substance intoxication/withdrawal or to a medication  Obsessive-Compulsive and Related Disorder Due to Another Medical Condition – obsessive-compulsive-like symptoms that are direct pathophysiological consequence of medical disorder  Other Specified Obsessive-Compulsive and Related Disorder – obsessive- compulsive-like symptoms that cause clinically significant distress or impairment but does not meet full criteria and clinician specifies the reason (e.g. body-focused repetitive disorder, obsessional jealousy)  Unspecified Obsessive-Compulsive and Related Disorder – obsessive- compulsive-like symptoms that cause clinically significant distress or impairment but does not meet full criteria and clinician does not choose to communicate the reason and there is insufficient information to make more specific diagnosis (e.g. emergency room settings) SOMATIC SYMPTOM AND RELATED DISORDERS  Emphasis on the distressing (positive) somatic symptoms plus abnormal thoughts, feelings and behaviors in response to them  Commonly encountered in primary care and other medical settings than mental health settings  Highly comorbid with depression and anxiety disorders and medical disorders  Somatic Symptom Disorder – multiple, current, somatic symptoms (e.g. cognitive: attention, worry and fear; behavioral: repeated check-up) that cause clinically significant distress or impairment and may or may not be medically explained  Illness Anxiety Disorder (Hypochondriasis) – enduring preoccupation of having or acquiring serious illness and extensive worries about one’s health (illness becomes part of identity) but no or minimal somatic symptoms  Conversion Disorder (Functional Neurological Symptom Disorder) – neurological symptoms (loss of function) are found but incompatible with neurological pathophysiology  Factitious Disorder – falsification and presentation of symptoms, injury or disease to others, assuming a “sick role” and in the absence of obvious external rewards   Psychological Factors Affecting Other Medical Conditions – one or more clinically significant psychological or behavioral factors that adversely affects medical condition by increasing risk for suffering, death or disability  Other Specified Somatic Symptom and Related Disorder - somatic-like symptoms that cause clinically significant distress or impairment but does not meet full criteria and clinician specifies the reason (e.g. brief somatic symptom disorder, brief illness anxiety disorder, pseudocyesis)  Unspecified Somatic Symptom and Related Disorder - somatic -like symptoms that cause clinically significant distress or impairment but does not meet full criteria and clinician does not choose to communicate the reason and there is insufficient information to make more specific diagnosis (e.g. emergency room settings) DISSOCIATIVE DISORDERS  Disruption and/or discontinuity in normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control and behavior  Positive dissociated symptoms: fragmentation of identity, depersonalization and derealization; Negative dissociated symptoms: amnesia  Depersonalization/Derealization Disorder – persistent depersonalization (unreality or detachment from oneself) and/or derealization (unreality or detachment from one’s surroundings) accompanied by intact reality testing  Dissociative Amnesia – inability to recall autobiographical information which may be generalized (identity and life history), localized (event or period of time) or selective (specific aspect of event) and may or may not involve dissociative fugue (purposeful travel or wandering)  Dissociative Identity Disorder – presence of two or more distinct personality states (or experience of possession) and recurrent episodes of amnesia  Other Specified Dissociative Disorder - dissociative-like symptoms that cause clinically significant distress or impairment but does not meet full criteria and clinician specifies the reason (e.g. dissociative trance, acute dissociative reactions to stressful events)  Unspecified Dissociative Disorder - dissociative-like symptoms that cause clinically significant distress or impairment but does not meet full criteria and clinician does not choose to communicate the reason and there is insufficient information to make more specific diagnosis (e.g. emergency room settings) DEPRESSIVE DISORDERS  Presence of sad, empty or irritable mood accompanied by somatic and cognitive changes significantly affecting one’s capacity to function  In grief, the predominant affect is feelings of emptiness and loss, in major depressive episode it is persistent depressed mood and inability to anticipate happiness or pleasure  Disruptive Mood Dysregulation Disorder – chronic, severe persistent (non- episodic) irritability through frequent verbal and/or behavioral temper outbursts in response to frustration and persistent irritable or angry mood between the outbursts   Major Depressive Disorder – persistent depressed mood and/or loss of interest or pleasure nearly most of the day every day for at least two weeks (plus 4 more symptoms)  Persistent Depressive Disorder (Dysthymia) – depressed mood most of the day, for more days than not, for at least 2 years (plus 2 more symptoms)  Premenstrual Dysphoric Disorder – mood lability, irritability, dysphoria and anxiety symptoms accompanied by behavioral and physical symptoms that occur repeatedly during premenstrual phase and remit around onset of menses or shortly thereafter  Substance/Medication-Induced Depressive Disorder – prominent and persistent depressed mood and/or anhedonia that developed during or soon after intoxication, withdrawal or exposure to substance/medication which is capable of producing said symptoms  Depressive Disorder Due to Another Medical Condition – prominent and persistent depressed and/or anhedonia that is the direct pathophysiological consequence of another medical condition  Other Specified Depressive Disorder – presentations of depressed mood with clinically significant impairment that do not meet criteria for duration or severity (e.g. recurrent brief depression, short-duration depressive episode (4- 13 days), depressive episode with insufficient symptoms)  Unspecified Depressive Disorder – presentations of depressed mood with clinically significant impairment that do not meet full criteria and clinician does not wish to specify the reason, possibly due to insufficient information  Specifiers: With anxious distress, With mixed features, With melancholic features, With atypical features, With psychotic features, With catatonia, With peripartum onset, With seasonal pattern; In partial remission, In full remission; Severity: Mild, Moderate, Severe BIPOLAR AND RELATED DISORDERS  Manic episode: abnormal, persistent elevated, expansive or irritable mood and abnormal, persistent increased goal-directed activity or energy most of the day, nearly every day for at least one week (any duration if hospitalized) plus 3 additional symptoms  Hypomanic episode: abnormal, persistent elevated, expansive or irritable mood and abnormal, persistent increased goal-directed activity or energy most of the day, nearly every day for at least 4 days plus 3 additional symptoms  Major depressive episode: depressed mood or loss of interest or pleasure and 4 additional symptoms most of the day, nearly every day for at least 2 weeks  Highly comorbid with anxiety disorders (75%)  Bipolar I Disorder – at least one lifetime manic episode (hypomanic episode or major depressive episode may occur but not required)  Bipolar II Disorder – at least one hypomanic episode and at least one major depressive episode, never been a manic episode  Cyclothymic Disorder – numerous distinct sub-criteria periods with hypomanic symptoms and periods of depressive symptoms present at least half the time for at least 2 years (has not been without symptoms for more than 2 months at a time)   Substance/Medication-Induced Bipolar and Related Disorder – prominent and persistent elevated, expansive or irritable mood and/or depressed mood or anhedonia that developed during or soon after intoxication, withdrawal or exposure to substance/medication which is capable of producing said symptoms  Known Substances/Medications: Sedative, hypnotic or anxiolytic; Amphetamine (or other stimulant); Cocaine  Exceptions: Case of hypomania/mania that occurs after and persists beyond physiological effects of antidepressant medication or treatment (such as ECT)  Bipolar and Related Disorder Due to Another Medical Condition – prominent and persistent elevated, expansive or irritable mood and increased activity or energy that are the direct pathophysiological consequences of another medical condition (e.g. Cushing’s disease, multiple sclerosis, stroke, traumatic brain injury)  Other Specified Bipolar and Related Disorder – bipolar-like symptoms that cause clinically significant distress or impairment but does not meet full criteria and clinician specifies the reason (e.g. short-duration hypomanic episodes (2-3 days) and major depressive episodes, hypomanic episode without prior major depressive episode, short-duration cyclothymia)  Unspecified Bipolar and Related Disorder – bipolar-like symptoms that cause clinically significant distress or impairment but does not meet full criteria and clinician does not choose to communicate the reason, possibly due to insufficient information  Specifiers – With anxious distress, With mixed features, With rapid cycling, With melancholic features, With atypical features, With psychotic features, With catatonia, With peripartum onset, With seasonal pattern; In partial remission, In full remission; Mild, Moderate, Severe SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOTIC DISORDERS  Abnormalities in at least one of the following domains:  Delusions: fixed beliefs not amenable to change in light of conflicting evidence; may be persecutory, referential, grandiose, erotomanic, nihilistic, somatic or bizarre  Hallucinations: involuntary vivid and clear perception-like experiences that occur without an external stimulus and in the context of clear sensorium  Disorganized thinking (formal thought disorder): inferred from one’s speech such as in derailment or loose association (switching of topics), tangentiality (unrelated answers), incoherence (word salad)  Grossly disorganized or abnormal motor behavior (including catatonia): ranges from childlike silliness to unpredictable agitation; catatonia is marked decrease in reactivity to environment  Negative symptoms: diminished emotional expression, avolition (reduced drive to pursue goal-directed behavior), alogia (diminished speech output), anhedonia (decreased ability to experience pleasure), asociality (apparent lack of interest in social interactions)  Highly comorbid with substance use and anxiety disorders  Schizotypal (Personality) Disorder – pervasive pattern of social and interpersonal deficits, cognitive or perceptual distortions and eccentricities of behavior  Delusional Disorder – at least 1 month of delusion(s) but no other prominent psychotic symptoms  Brief Psychotic Disorder – at least 1 day but less than 1 month sudden onset of at least one positive psychotic symptom: delusions, hallucinations or disorganized speech; may or may not be accompanied by grossly disorganized or catatonic behavior  Schizophreniform Disorder – symptomatic presentation equivalent to schizophrenia but less than 6 months duration (more than 1 month) and decline in functioning not required  Schizophrenia – presence of primary psychotic symptoms for a continuous period of at least 6 months accompanied by marked decline in functioning wherein an active phase occurred for at least 1 month for a significant portion of time (2 or more symptoms)  Schizoaffective Disorder – presence of both prominent mood episode (major depressive or manic) and active-phase symptoms preceded or followed by at least 2 weeks of delusions or hallucinations without prominent mood symptoms; decline in functioning not required  Substance/Medication-Induced Psychotic Disorder – delusions and/or hallucinations that developed during or soon after intoxication, withdrawal or exposure to substance/medication which is capable of producing said symptoms  Known Substances/Medications: Alcohol; Cannabis; Phencyclidine; Other hallucinogen; Inhalant; Sedative, hypnotic or anxiolytic; Amphetamine (or other stimulant); Cocaine  Psychotic Disorder Due to Another Medical Condition – prominent delusions or hallucinations are direct physiological consequence of another medical condition  Known Medical Conditions: neurological conditions (neoplasms, cerebrovascular disease, Huntington’s, multiple sclerosis, epilepsy, auditory or visual nerve injury, deafness, migraine, CNS infections); endocrine conditions (hyper-/hypothyroidism, hyper-hypoadrenocorticism); metabolic conditions (hypoxia, hypercarbia, hypoglycemia); fluid or electrolyte imbalances; hepatic or renal diseases and autoimmune disorders with CNS involvement (lupus)  Catatonia: presence of 3 or more of 12 psychomotor features; essential feature is marked psychomotor disturbance that may involve decreased motor activity, decreased engagement during assessment, or excessive and peculiar motor activity  Stupor: no psychomotor activity, not actively relating to environment  Catalepsy: passive induction of a posture held against gravity  Waxy flexibility: slight, even resistance to positioning by examiner  Mutism: no, or very little, verbal response (exclude if known aphasia)  Negativism: opposition or no response to instructions or external stimuli   Posturing: spontaneous and active maintenance of a posture against gravity  Mannerism: odd, circumstantial caricature of normal actions  Stereotypy: repetitive, abnormally frequent, non-goal-directed movements  Agitation: (not influenced by external stimuli)  Grimacing  Echolalia: mimicking another’s speech  Echopraxia: mimicking another’s movement  Catatonia Associated With Another Mental Disorder (Catatonia Specifier) – presence of 3 or more catatonic psychomotor features during the course of a neurodevelopmental, psychotic, bipolar, depressive or other mental disorder  Catatonic Disorder Due to Another Medical Condition – presence of 3 or more catatonic psychomotor features that are direct physiological consequence of another medical condition  Known Medical Conditions: neurological conditions (neoplasms, head trauma, cerebrovascular disease, encephalitis) and metabolic conditions (hypercalcemia, hepatic encephalopathy, homocystinuria, diabetic ketoacidosis)  Unspecified Catatonia – catatonia-like symptoms cause clinically significant distress or impairment but nature of underling mental disorder or other medical condition is unclear, or full criteria are not met, or insufficient information to make a more specific diagnosis  Other Specified Schizophrenia Spectrum and Other Psychotic Disorder – related symptoms that cause clinically significant distress or impairment but does not meet full criteria and clinician specifies the reason (e.g. persistent auditory hallucinations, attenuated psychosis syndrome, delusional symptoms in partner of individual with delusional disorder)  Unspecified Schizophrenia Spectrum and Other Psychotic Disorder – related symptoms that cause clinically significant distress or impairment but does not meet full criteria and clinician does not choose to communicate the reason, possibly due to insufficient information PERSONALITY DISORDERS  Shared criteria: Pervasive pattern of emotions, cognitions and behaviors + begins by early adulthood (or adolescence) + present in a variety of contexts + does not occur exclusively during the course of another mental disorder + not attributable to another medical condition  General Personality Disorder – enduring pattern of inner experience and behavior that deviates markedly from expectations of one’s culture in at least 2 ways (cognitive, affectivity, interpersonal functioning, impulse control)  Paranoid Personality Disorder – distrust and suspiciousness of others without any justification (indicated by 4 symptoms)  Schizoid Personality Disorder – detachment from social relationships and restricted range of emotional expression in interpersonal settings (indicated by 4 symptoms)  Schizotypal Personality Disorder – social and interpersonal deficits and cognitive or perceptual distortions and eccentricities of behavior (indicated by 4 symptoms)  Antisocial Personality Disorder – disregard for and violation of the rights of others (indicated by 3 symptoms)   Borderline Personality Disorder – instability of interpersonal relationships, self-image and affects and marked impulsivity (indicated by 5 symptoms)  Histrionic Personality Disorder – excessive emotionality and attention seeking (indicated by 5 symptoms)  Narcissistic Personality Disorder – grandiosity, need for admiration and lack of empathy (indicated by 5 symptoms)  Avoidant Personality Disorder – social inhibition, feelings of inadequacy and hypersensitivity to negative evaluation (indicated by 4 symptoms)  Dependent Personality Disorder – excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation (indicated by 5 symptoms)  Obsessive-Compulsive Personality Disorder – preoccupation with orderliness, perfectionism and mental and interpersonal control, at the expense of flexibility, openness and efficiency (indicated by 4 symptoms)  Personality Change Due to Another Medical Condition – persistent personality disturbance due to the direct physiological effects of a medical condition (e.g. frontal lobe lesion)  Other Specified Personality Disorder / Unspecified Personality Disorder – (1) personality pattern meets the general criteria for personality disorder, and traits of several different personality disorders are present, but criteria for any specific personality disorder are not met; or (2) personality pattern meets general criteria but considered to have a personality disorder not included in DSM-5 classification (e.g. passive-aggressive personality disorder) Feeding and Eating Disorders  Persistent disturbance of eating or eating-related behavior that results in the altered consumption or absorption of food and that significantly impairs physical health or psychosocial functioning  Disorders differ substantially in clinical course, outcome and treatment needs  Obesity is not included as mental disorder but associated with several mental disorders such as binge-eating disorder, depressive and bipolar disorder, schizophrenia  Pica – persistent eating of one or more nonnutritive, nonfood substances over a period of at least 1 month  Rumination Disorder – repeated regurgitation of food occurring after feeding or eating over a period of at least 1 month  Avoidant/Restrictive Food Intake Disorder – avoidance or restriction of food intake with no excessive concern about body weight or shape  Anorexia Nervosa – persistent energy intake restriction, intense fear of gaining weight or becoming fat / persistent behavior that interferes with weight gain and disturbance in self-perceived weight or shape (restricting type or binge-eating/purging type)  Bulimia Nervosa – recurrent episodes of binge eating, recurrent inappropriate compensatory behaviors to prevent weight gain and self-evaluation unduly influenced by body shape and weight  Binge-Eating Disorder – recurrent episodes of binge eating without recurrent use of inappropriate compensatory behaviors  Other Specified Feeding or Eating Disorder – related symptoms that cause clinically significant distress or impairment but does not meet full criteria and  clinician specifies the reason (e.g. atypical anorexia nervosa, bulimia nervosa of low frequency and/or limited duration, purging disorder, night eating syndrome)  Unspecified Feeding or Eating Disorder – related symptoms that cause clinically significant distress or impairment but does not meet full criteria and clinician does not choose to communicate the reason, possibly due to insufficient information Elimination Disorders  Nocturnal: Nighttime sleep; Diurnal: Waking hours  Enuresis – repeated voiding of urine into bed or clothes, whether involuntary or intentional (2x a week for 3 months, at least 5 years of age)  Encopresis – repeated passage of feces into inappropriate places, whether involuntary or intentional (once a month for 3 months, at least 4 years of age)  Other Specified Elimination Disorder – related symptoms that cause clinically significant distress or impairment but does not meet full criteria and clinician specifies the reason (e.g. low-frequency enuresis)  Unspecified Elimination Disorder – related symptoms that cause clinically significant distress or impairment but does not meet full criteria and clinician does not choose to communicate the reason, possibly due to insufficient information Sleep and Wake Disorders  Sleep-wake complaints of dissatisfaction regarding quality, timing and amount of sleep  Parasomnias: abnormal behavior, experiential or physiological events occurring in association with sleep, specific sleep stages or sleep-wake transitions  Insomnia Disorder – difficulty initiating sleep (sleep-onset/initial insomnia), difficulty maintaining sleep (sleep maintenance/middle insomnia) and/or early- morning awakening with inability to return to sleep (late insomnia) (3x a week for 3 months)  Hypersomnolence Disorder – self-reported excessive sleepiness despite main sleep period of at least 7 hours (3x a week for 3 months)  Narcolepsy – recurrent daytime naps or lapses into sleep, may be accompanied by cataplexy, hypocretin deficiency or REM sleep latency less than or equal to 15 min (3x a week for 3 months)  Obstructive Sleep Apnea Hypopnea – polysomnographic evidence of at least 5 obstructive apneas or hypopneas per hour of sleep accompanied by either nocturnal breathing disturbances or daytime sleepiness, fatigue or unrefreshing sleep  Central Sleep Apnea – polysomnographic evidence of at least 5 central apneas per hour of sleep  Sleep-Related Hypoventilation – polysomnographic evidence of decreased respiration associated with elevated CO2 levels  Circadian Rhythm Sleep-Wake Disorders – persistent pattern of sleep disruption primarily due to alteration of the circadian system  Non-Rapid Eye Movement Sleep Arousal Disorders – recurrent episodes of incomplete awakening from sleep (sleepwalking or sleep terrors)   Nightmare Disorder – extended, extremely dysphoric and well-remembered dreams involving efforts to avoid threats to survival, security or physical integrity  Rapid Eye Movement Sleep Behavior Disorder – repeated episodes of arousal during sleep associated with vocalization and/or complex motor behaviors  Restless Legs Syndrome – urge to move the legs (or arms) begins or worsens during periods of rest or inactivity, is partially or totally relieved by movement and is worse in the evening than during the day or occurs only in the evening  Substance/Medication-Induced Sleep Disorder – prominent and severe sleep disturbance during or soon after substance intoxication/withdrawal or exposure to medication capable of producing said symptoms  Other Specified Insomnia Disorder – insomnia-like symptoms that cause clinically significant distress or impairment but does not meet full criteria and clinician specifies the reason (e.g. brief insomnia disorder, restricted to nonrestorative sleep)  Unspecified Insomnia Disorder  Other Specified Hypersomnolence Disorder – hypersomnolence-like symptoms that cause clinically significant distress or impairment but does not meet full criteria and clinician specifies the reason (e.g. brief-duration hypersomnolence)  Unspecified Hypersomnolence Disorder  Other Specified Sleep-Wake Disorder – related sleep-wale symptoms that cause clinically significant distress or impairment but does not meet full criteria and clinician specifies the reason (e.g. repeated arousals during REM sleep without polysomnography)  Unspecified Sleep-Wake Disorder Sexual Dysfunctions  Clinically significant disturbance in a person’s ability to respond sexually or to experience sexual pleasure for a duration of at least 6 months  Lifelong: sexual problem that has been present from first sexual experiences / Acquired: sexual disorders that develop after a period of relatively normal sexual function  Generalized: sexual difficulties that are not limited to certain types of stimulation, situations or partners / Situational: sexual difficulties that only occur with certain types of stimulation, situations or partners  Delayed Ejaculation – marked delay in or inability to achieve ejaculation despite adequate sexual stimulation and desire to ejaculate during partnered sexual activities  Erectile Disorder – repeated failure to obtain or maintain erections during partnered sexual activities  Female Orgasmic Disorder – difficulty experiencing orgasm and/or markedly reduced intensity of orgasmic sensations  Female Sexual Interest/Arousal Disorder – lack of or significantly reduced sexual interest/arousal  Genito-Pelvic Pain/Penetration Disorder – difficulty having intercourse, genitor-pelvic pain, fear of pain or vaginal penetration, or tension of the pelvic floor muscles   Male Hypoactive Sexual Desire Disorder – persistent deficient or absent sexual/erotic thoughts or fantasies and desire for sexual activity  Premature (Early) Ejaculation – persistent ejaculation during partnered sexual activity within approximately 1 minute following vaginal penetration and before individual wishes it  Substance/Medication-Induced Sexual Dysfunction – clinically significant sexual disturbance during or soon after substance intoxication/withdrawal or exposure to medication capable of producing said symptoms  Other Specified Sexual Dysfunction – related sexual disturbance that cause clinically significant distress or impairment but does not meet full criteria and clinician specifies the reason (e.g. sexual aversion)  Unspecified Sexual Dysfunction – related sexual disturbance that cause clinically significant distress or impairment but does not meet full criteria and clinician does not choose to communicate the reason, possibly due to insufficient information Gender Dysphoria  Sex: biological indicators of male and female, such as in sex chromosomes, gonads, sex hormones and nonambiguous internal and external genitalia  Gender: lived role in society and/or the identification as male or female could not be uniformly associated with or predicted from the biological indicators  Gender assignment: initial assignment as male or female, occurs usually at birth (natal gender)  Gender-atypical / Gender-nonconforming: somatic features or behaviors that are not typical of individuals with the same assigned gender in a given society and historical era  Gender reassignment: official and legal change of gender  Gender identity: category of social identity and refers to an individual’s identification as male, female or some category other than male or female  Gender dysphoria: general term for individual’s affective/cognitive discontent with the assigned gender  Transgender: broad spectrum of individuals who transiently or persistently identify with a gender different from their natal gender  Transsexual: individual who seeks, or has undergone, a social transition from male to female (or vice-versa) which usually involves cross-sex hormone treatment and genital surgery  Gender Dysphoria – clinically significant distress that may accompany the incongruence between one’s experienced or expressed gender and one’s assigned gender (at least 6 symptoms in children, 2 symptoms in adolescents and adults for at least 6 months)  Other Specified Gender Dysphoria – related symptoms that cause clinically significant distress or impairment but does not meet full criteria and clinician specifies the reason (e.g. brief gender dysphoria  Unspecified Gender Dysphoria – related symptoms that cause clinically significant distress or impairment but does not meet full criteria and clinician  does not choose to communicate the reason, possibly due to insufficient information Paraphilic Disorders  Selected for specific listing and assignment of diagnostic criteria because they are relatively common and some are classed as criminal offenses due to their noxiousness and potential harm to others  Paraphilia: any intense and persistent sexual interest other than in genital stimulation  Anomalous Activity Preferences: sexual interest in activities that equals or exceeds one’s interest in copulation or equivalent interaction with another person  Courtship disorders: resemble distorted components of human courtship behavior / Algolagnic disorders: involve pain and suffering  Anomalous Target Preferences: sexual interest in children, corpses or amputees or in nonhuman animals, such as horses or dogs or in inanimate objects  Paraphilic disorder: paraphilia that causes distress or impairment to individual or paraphilia whose satisfaction entails personal harm, or risk of harm, to others  Shared criteria: Recurrent and intense sexual arousal + as manifested by fantasies, urges or behaviors + acting on these sexual urges with a nonconsenting person or related clinically significant distress or impairment + over the period of at least 6 months  Voyeuristic Disorder – recurrent and intense sexual arousal from observing an unsuspecting person who is naked, disrobing or engaging in sexual activity  Exhibitionistic Disorder – recurrent and intense sexual arousal from exposure of one’s genitals to an unsuspecting person  Frotteuristic Disorder – recurrent and intense sexual arousal from touching or rubbing against a nonconsenting person  Sexual Masochism Disorder – recurrent and intense sexual arousal from the act of being humiliated, beaten, bound or otherwise made to suffer (specifier: with asphyxiophilia)  Sexual Sadism Disorder – recurrent and intense sexual arousal from the physical or psychological suffering of another person  Pedophilic Disorder – recurrent and intense sexual arousal involving sexual activity with a prepubescent child or children (generally 13 years or younger) (must be at least age 16 years and at least 5 years older than the child)  Fetishistic Disorder – recurrent and intense sexual arousal from either use of nonliving objects or highly specific focus on nongenital body part/s  Tranvestic Disorder – recurrent and intense sexual arousal from crossdressing  Other Specified Paraphilic Disorder – paraphilic symptoms that cause clinically significant distress or impairment but does not meet full criteria and clinician specifies the reason (e.g. telephone scatologia, necrophilia, zoophilia, coprophilia, urophilia)  Unspecified Paraphilic Disorder – paraphilic symptoms that cause clinically significant distress or impairment but does not meet full criteria and clinician does not choose to communicate the reason, possibly due to insufficient information Disruptive, Impulse-Control and Conduct Disorders   Conditions involving problems in the self-control of emotions and behaviors that violate the rights of others and/or bring into significant conflict with societal norms or authority figures  Tend to have first onset in childhood or adolescence  Oppositional Defiant Disorder – persistent pattern of 4 symptoms of angry/irritable mood, argumentative/defiant behavior or vindictiveness (1x a week for 6 months)  Intermittent Explosive Disorder – recurrent impulsive or anger-based behavioral outbursts representing failure to control aggressive impulses (either verbal/physical aggression occurring 2x a week for 3 months; or 3 damage of property or physical assault within 12 months)  Conduct Disorder – persistent pattern of behavior in which basic rights of others or societal norms or rules are violated (3 symptoms of aggression to people and animals, destruction of property, deceitfulness or theft, serious violation of rules in the past 12 months)  Antisocial Personality Disorder – pervasive pattern of disregard for and violation of the rights of others (indicated by 3 symptoms)  Pyromania – deliberate and purposeful fire setting on more than one occasion accompanied by pleasure, gratification or relief when setting fires or when witnessing or participating in their aftermath  Kleptomania – recurrent failure to resist impulses to steal objects that are not needed for personal use or for their monetary value accompanied by pleasure, gratification or relief at the time of committing the theft  Other Specified Disruptive, Impulse-Control and Conduct Disorder – related symptoms that cause clinically significant distress or impairment but does not meet full criteria and clinician specifies the reason (e.g. recurrent behavioral outbursts of insufficient frequency)  Unspecified Disruptive, Impulse-Control and Conduct Disorder – related symptoms that cause clinically significant distress or impairment but does not meet full criteria and clinician does not choose to communicate the reason, possibly due to insufficient information Substance-Related and Addictive Disorders  Cluster of cognitive, behavioral and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems  Drugs taken in excess have direct activation of the brain reward system, typically producing feelings of pleasure often referred to as “high”  Also includes gambling disorder  Two main groups: Substance use disorders and substance-induced disorders  Craving: intense desire or urge for the drug that may occur at any time but is more likely when in an environment where the drug previously was obtained or used  Tolerance: requiring a markedly increased dose of the substance to achieve the desired effect or a markedly reduced effect when usual dose is consumed  Withdrawal: syndrome that occurs when blood or tissue concentrations of a substance decline in an individual who had maintained prolonged heavy use of the substance  Substance intoxication: development of a reversible substance-specific syndrome due to recent ingestion of a substance (does not apply to tobacco)  Substance withdrawal: development of a substance-specific problematic behavioral change due to the cessation or reduction in heavy and prolonged substance use  Shared criteria: impaired control, social impairment, risky use and pharmacological criteria  Substance/Medication-Induced Mental Disorder – clinically significant mental disturbance during or soon after substance intoxication/withdrawal or exposure to medication capable of producing said symptoms as evidenced from history, physical examination or lab findings  Alcohol Use Disorder – problematic pattern of alcohol use with at least 2 symptoms within 1 year of impaired control, social impairment, risky use and pharmacological criteria  Alcohol Intoxication – (at least 1 during or shortly after) slurred speech, incoordination, unsteady gait, nystagmus, attention and memory impairment, stupor or coma  Alcohol Withdrawal – (at least 2 within several hours to few days) autonomic hyperactivity, increased hand tremor, insomnia, nausea or vomiting, transient hallucinations or illusions, psychomotor agitation, anxiety or generalized tonic- clonic seizures  Other Alcohol-Induced Disorders – ex. Alcohol-induced psychotic disorder / bipolar disorder / depressive disorder / anxiety disorder / sleep disorder / sexual dysfunction / neurocognitive disorder  Unspecified Alcohol-Related Disorder –  Caffeine Intoxication – excess of 250mg caffeine consumption resulting in (at least 5 during or shortly after) restlessness, nervousness, excitement, insomnia, flushed face, diuresis, GIT disturbance, muscle twitching, rambling flow of thought or speech, tachycardia or cardiac arrhythmia, inexhaustibility or psychomotor agitation  Caffeine Withdrawal – (at least 3 within 24 hours) headache, marked fatigue or drowsiness, dysphoric mood/ depressed mood/irritability, difficulty concentrating, flu-like symptoms (nausea, vomiting, or muscle pain/stiffness)  Other Caffeine-Induced Disorders - e.g. caffeine-induced anxiety disorder / sleep disorder  Unspecified Caffeine-Related Disorder –  Cannabis Use Disorder – problematic pattern of cannabis use with at least 2 symptoms within 1 year of impaired control, social impairment, risky use and pharmacological criteria  Cannabis Intoxication – (at least 2 within 2 hours) conjunctival injection, increased appetite, dry mouth, tachycardia  Cannabis Withdrawal – (at least 3 within 1 week) irritability/anger/aggression, nervousness/anxiety, sleep difficulty, decreased appetite/weight loss, restlessness, depressed mood, physical symptoms (abdominal pain, shakiness/tremors, sweating, fever, chills, headache)  Other Cannabis-Induced Disorders – e.g. cannabis-induced psychotic disorder / anxiety disorder / sleep disorder  Unspecified Cannabis-Related Disorder –  Phencyclidine Use Disorder – problematic pattern of phencyclidine (PCP, angel dust) use with at least 2 symptoms within 1 year of impaired control, social impairment, risky use and pharmacological criteria  Other Hallucinogen Use Disorder – problematic pattern of hallucinogen (MDMA, ecstasy, LSD, DMT) use with at least 2 symptoms within 1 year of impaired control, social impairment, risky use and pharmacological criteria  Phencyclidine Intoxication – (at least 2 within 1 hour) vertical or horizontal nystagmus, hypertension or tachycardia, numbness or diminished responsiveness to pain, ataxia, dysarthria, muscle rigidity, seizures or coma, hyperacusis  Other Hallucinogen Intoxication – (at least 2 during or shortly after) pupillary dilation, tachycardia, sweating, palpitations, blurring of vision, tremors, incoordination  Hallucinogen Persisting Perception Disorder – reexperiencing of one or more perceptual symptoms experienced while intoxicated with hallucinogen (LSD) following cessation  Other Phencyclidine-Induced Disorders – ex. Phencyclidine-induced psychotic disorder / bipolar disorder / depressive disorder / anxiety disorder  Other Hallucinogen-Induced Disorders – ex. Hallucinogen-induced psychotic disorder / bipolar disorder / depressive disorder/ anxiety disorder  Unspecified Phencyclidine-Related Disorder –  Unspecified Hallucinogen-Related Disorder –  Inhalant Use Disorder – problematic pattern of hydrocarbon-based inhalant (glues, fuels, paints) use with at least 2 symptoms within 1 year of impaired control, social impairment, risky use and pharmacological criteria  Inhalant Intoxication – (at least 2 during or shortly after) dizziness, nystagmus, incoordination, slurred speech, unsteady gait, lethargy, depressed reflexes, psychomotor retardation, tremor, generalized muscle weakness, blurred vision or diplopia, stupor or coma, euphoria  Other Inhalant-Induced Disorders – ex. Inhalant-induced psychotic disorder / depressive disorder / anxiety disorder / neurocognitive disorder  Unspecified Inhalant-Related Disorder –  Opioid Use Disorder – problematic pattern of opioid (heroin, morphine, codeine, oxycodone, propoxyphene) use with at least 2 symptoms within 1 year of impaired control, social impairment, risky use and pharmacological criteria  Opioid Intoxication – papillary constriction and (at least 1 during or shortly after) drowsiness or coma, slurred speech, impairment in attention or memory  Opioid Withdrawal – (at least 3 within minutes to several days) dysphoric mood, nausea or vomiting, muscle aches, lacrimation or rhinorrhea, pupillary dilation/piloerection/sweating, diarrhea, yawning, fever, insomnia  Other Opioid-Induced Disorders – ex. Opioid-induced depressive disorder / anxiety disorder / sleep disorder / sexual dysfunction  Unspecified Opioid-Related Disorder –  Sedative, Hypnotic or Anxiolytic Use Disorder – problematic pattern of sedative, hypnotic or anxiolytic (benzodiazepine, carbamate, barbiturate) use with at least 2 symptoms within 1 year of impaired control, social impairment, risky use and pharmacological criteria   Sedative, Hypnotic or Anxiolytic Intoxication – (at least 1 during or shortly after) slurred speech, incoordination, unsteady gait, nystagmus, cognition impairment, stupor or coma  Sedative, Hypnotic or Anxiolytic Withdrawal – (at least 2 within several hours to few days) autonomic hyperactivity, hand tremor, insomnia, nausea or vomiting, transient hallucinations or illusions, psychomotor agitation, anxiety, grand mal seizures  Other Sedative-, Hypnotic- or Anxiolytic-Induced Disorders – ex. Sedative-, hypnotic- or anxiolytic-induced psychotic disorder / bipolar disorder / depressive disorder/ anxiety disorder / sleep disorder / sexual dysfunction / neurocognitive disorder  Unspecified Sedative-, Hypnotic-, or Anxiolytic-Related Disorder –  Stimulant Use Disorder – problematic pattern of stimulant (amphetamine, metamphetamine cocaine) use with at least 2 symptoms within 1 year of impaired control, social impairment, risky use and pharmacological criteria  Stimulant Intoxication – (at least 2 during or shortly after) tachycardia or bradycardia, pupillary dilation, elevated or lowered blood pressure, perspiration or chills, nausea or vomiting, evidence of weight loss, psychomotor agitation or retardation, muscular weakness/respiratory depression/chest pain/cardiac arrhythmias, confusion/seizures/dyskinesias/dystonias/coma  Stimulant Withdrawal – dysphoric mood and (at least 2 within few hours to several days) fatigue, vivid unpleasant dreams, insomnia or hypersomnia, increased appetite, psychomotor retardation or agitation  Other Stimulant -Induced Disorders – stimulant-induced psychotic disorder / bipolar disorder / depressive disorder / anxiety disorder / obsessive-compulsive disorder / sleep disorder / sexual dysfunction  Unspecified Stimulant-Related Disorder –  Tobacco Use Disorder – problematic pattern of tobacco (nicotine) use with at least 2 symptoms within 1 year of impaired control, social impairment, risky use and pharmacological criteria  Tobacco Withdrawal – (at least 4 within 24 hours) irritability/frustration/anger, anxiety, difficulty concentrating, increased appetite, restlessness, depressed mood, insomnia  Other Tobacco-Induced Disorders – tobacco-induced sleep disorder  Unspecified Tobacco Related Disorder –  Other (or Unknown) Substance Use Disorder – problematic pattern of intoxicating substance (not able to be classified: anabolic steroids, nonsteroidal anti-inflammatory drugs, cortisol) use with at least 2 symptoms within 1 year of impaired control, social impairment, risky use and pharmacological criteria  Other (or Unknown) Substance Intoxication – development of reversible substance-specific syndrome attributable to recent ingestion or exposure to substance not listed elsewhere or unknown  Other (or Unknown) Substance Withdrawal – development of substance- specific syndrome shortly after cessation or reduction in substance use  Unspecified Other (or Unknown) Substance-Related Disorder –  Gambling Disorder – clinically significant persistent and recurrent problematic gambling behavior (at least 4 in 1 year) Neurocognitive Disorders  Group of disorders in which the primary clinical deficit is in cognitive function and that are acquired rather than developmental  Neurocognitive domains: Complex attention, Executive function, Learning and memory, Language, Perceptual-motor, Social cognition  Sustained attention: maintenance of attention over time  Selective attention: maintenance of attention despite competing stimuli and/or distracters  Divided attention: attending to two tasks within the same time period  Planning: ability to find the exit to a maze  Decision making: performance of tasks that assess process of deciding in the face of competing alternatives  Working memory: ability to hold information for a brief period and to manipulate it  Feedback/error utilization: ability to benefit from feedback to infer the rules for solving a problem  Overriding habits/inhibition: ability to choose a more complex and effortful solution to be correct  Mental/cognitive flexibility: ability to shift between two concepts, tasks or response rules  Immediate memory span: ability to repeat a list of words or digits  Recent memory: assesses the process of encoding new information through free recall, cued recall and recognition memory  Expressive language: confrontational naming, fluency or phonemic  Grammar and syntax: omission or incorrect use of articles, prepositions, auxiliary verbs  Receptive language: comprehension; performance of actions/activities according to verbal command  Visual perception: line bisection tasks can be used to detect basic visual defect or attentional neglect  Visuoconstructional: assembly of items required hand-eye coordination, such as drawing, copying and block assembly  Perceptual-motor: integrating perception with purposeful movement  Praxis: integrity of learned movements, such as ability to imitate gestures or pantomime use of objects to command  Gnosis: perceptual integrity of awareness and recognition, such as recognition of faces and colors  Recognition of emotions: identification of emotion in images of faces representing a variety of both positive and negative emotions  Theory of mind: ability to consider another person’s mental state (thoughts, desires, intentions) or experience  Delirium – disturbance of attention or awareness accompanied by a change in baseline cognition, that is a direct physiological consequence of another medical condition, substance intoxication or withdrawal, or toxin exposure, or combination of these factors  Other Specified Delirium – delirium-like symptoms that cause clinically significant distress or impairment but does not meet full criteria and clinician specifies the reason (e.g. attenuated delirium syndrome)  Unspecified Delirium – delirium-like symptoms that cause clinically significant distress or impairment but does not meet full criteria and clinician does not choose to communicate the reason, possibly due to insufficient information  Major Neurocognitive Disorder – significant cognitive decline from a previous level of performance in at least one neurocognitive domain which interferes with independence in everyday activities  Mild Neurocognitive Disorder – modest cognitive decline from a previous level of performance in at least one neurocognitive domain which does not interfere with independence in everyday activities but greater effort, compensatory strategies or accommodating may be required  Specifiers – Alzheimer’s disease, frontotemporal lobar degeneration, Lewy body disease, vascular disease, traumatic brain injury, substance/medication use, HIV infection, Prion disease, Parkinson’s disease, Huntington’s disease, another medical condition, multiple etiologies, unspecified  Due to Alzheimer’s Disease – insidious onset and gradual progression of cognitive and behavioral symptoms typically with impairment in memory and learning  Frontotemporal (Lobar Degeneration) – progressive development of behavioral and personality change and/or language impairment (behavioral disinhibition, apathy or inertia, loss of sympathy or empathy, perseverative/stereotyped/compulsive/ritualistic behavior, hyperorality and dietary changes)  With Lewy Bodies (Disease) – core features are pronounced variations in attention and alertness, recurrent detailed visual hallucinations and spontaneous features of Parkinsonism; suggestive features are REM sleep behavior disorder and severe neuroleptic sensitivity  Vascular (Disease) – clinical features consistent with vascular etiology as suggested by relation of onset to at least one cerebrovascular event and prominent decline in complex attention and frontal-executive function domains  Due to Traumatic Brain Injury – clinical features presented immediately after occurrence of traumatic brain injury or immediately after recovery of consciousness as evidenced by loss of consciousness, posttraumatic amnesia, disorientation and confusion, neurological symptoms  Substance/Medication Induced – clinically significant neurocognitive impairment during or soon after substance intoxication/withdrawal or exposure to medication capable of producing said symptoms  Due to HIV Infection – neurocognitive impairment attributable to a documented infection with human immunodeficiency virus (HIV)  Due to Prion Disease – neurocognitive impairment attributable to prion disease (most common type is Creutzfeldt-Jakob disease), with insidious onset and rapid progression of motor features such as myoclonus or ataxia  Due to Parkinson’s Disease – neurocognitive impairment attributable to established Parkinson’s disease  Due to Huntington’s Disease – neurocognitive impairment attributable to clinically established Huntington’s disease or risk based on family history or genetic testing  Due to Another Medical Condition – neurocognitive impairment that is the pathophysiological consequence of another medical condition based on history,  physical examination or laboratory findings (e.g. primary or secondary brain tumors, subdural hematoma, hypothyroidism, epilepsy, multiple sclerosis, deficiencies of thiamine or niacin)  Due to Multiple Etiologies – neurocognitive impairment that is the pathophysiological consequence of more than one etiological process, excluding substances  Unspecified Neurocognitive Disorder – neurocognitive impairment that does not meet the full criteria and in which the precise etiology cannot be determined with sufficient certainty Neurodevelopmental Disorders  Group of conditions with onset in the developmental period, typically manifesting before the child enters grade school, and are characterized by developmental deficits from learning or control of executive functions to global impairments of social skills or intelligence  Speech: expressive production of sounds and includes articulation, fluency, voice and resonance quality  Language: form, function and use of a conventional system of symbols in a rule- governed manner for communication  Communication: any verbal or nonverbal behavior (whether intentional or unintentional) that influences behavior, ideas or attitudes of another individual  Expressive ability: production of vocal, gestural or verbal signals  Receptive ability: process of receiving and comprehending language messages  Pragmatics: social use of language and communication  Intellectual Disability (Intellectual Developmental Disorder) – deficits in general mental abilities (reasoning, problem solving, planning, abstract thinking, judgment, academic learning and learning from experience) and impairment in everyday adaptive functioning in comparison to one’s age, gender and peers (Mild, Moderate, Severe, Profound)  Global Developmental Delay – failure to meet expected developmental milestones in several areas of intellectual functioning and inability to undergo systematic assessment of intellectual functioning (under age of 5 years, requires reassessment after a period of time)  Unspecified Intellectual Disability (Intellectual Developmental Disorder) – assessment of degree of intellectual disability is difficult or impossible because of associated sensory or physical impairments (over age of 5 years, requires reassessment)  Language Disorder – persistent difficulties in acquisition and use of language across modalities due to deficits in comprehension or production of vocabulary, sentence structure and discourse  Speech Sound Disorder – persistent difficulty with speech sound production that interferes with speech intelligibility or prevents verbal communication of messages  Childhood-Onset Fluency Disorder (Stuttering) – disturbance in the normal fluency and motor production of speech (repetitive sounds or syllables, prolongation of consonants or vowel sounds, broken words, blocking or words produced with an excess of physical tension)  Social (Pragmatic) Communication Disorder – persistent difficulties in the social use of verbal and nonverbal communication   Unspecified Communication Disorder – clinically significant symptoms characteristic of communication disorder but do not meet full criteria and reason not specified  Autism Spectrum Disorder – persistent deficits in social communication and social interaction accompanied by excessively repetitive behaviors, restricted interests and insistence on sameness  Attention-Deficit/Hyperactivity Disorder – persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development  Other Specified Attention-Deficit/Hyperactivity Disorder – clinically significant symptoms characteristic of communication disorder but do not meet full criteria (e.g. with insufficient inattention symptoms)  Unspecified Attention-Deficit/Hyperactivity Disorder – clinically significant symptoms characteristic of communication disorder but do not meet full criteria  Specific Learning Disorder – specific deficits in ability to perceive or process information efficiently and accurately; persistent and impairing difficulties with learning foundational academic skills in reading, writing and/or math  Developmental Coordination Disorder – deficits in the acquisition and execution of coordinated motor skills and manifested by clumsiness and slowness or inaccuracy of motor performance  Stereotypic Movement Disorder – repetitive, seemingly driven, and apparently purposeless motor behaviors (hand flapping, body rocking, head banging, self-biting, hitting)  Tic Disorders: presence of motor or vocal tics which are sudden, rapid, recurrent, nonrhythmic, stereotyped motor movements or vocalizations  Tourette’s Disorder – waxing-waning multiple motor and vocal tics present for at least 1 year  Persistent (Chronic) Motor or Vocal Tic Disorder – waxing-waning single or multiple motor or vocal tics (not both at the same time) present for at least 1 year  Other Specified Tic Disorder – clinically significant symptoms characteristic of tic disorder but do not meet full criteria (e.g. with onset after age 18 years)  Unspecified Tic Disorder – clinically significant symptoms characteristic of tic disorder but do not meet full criteria and reason not specified  Other Specified Neurodevelopmental Disorder – clinically significant symptoms characteristic of neurodevelopmental disorder but do not meet full criteria (e.g. neurodevelopmental disorder associated with prenatal alcohol exposure)  Unspecified Neurodevelopmental Disorder – clinically significant symptoms characteristic of neurodevelopmental disorder but do not meet full criteria and reason not specified Residual Categories  Disturbance caused by physiological effects of another medical condition  Other Specified Mental Disorder Due to Another Medical Condition – e.g. Dissociative symptoms  Unspecified Mental Disorder Due to Another Medical Condition  Symptoms characteristic of a mental disorder that cause clinically significant distress or impairment of functioning but do not meet full criteria for any other mental disorder in DSM-5  Other Specified Mental Disorder  Unspecified Mental Disorder  Highlights of Changes from DSM-IV-TR to DSM-5 Changes made to the DSM-5 diagnostic criteria and texts are outlined in this chapter in the same order in which they appear in the DSM-5 classification. This is not an exhaustive guide; minor changes in text or wording made for clarity are not described here. It should also be noted that Section I of DSM-5 con- tains a description of changes pertaining to the chapter organization in DSM-5, the multiaxial system, and the introduction of dimensional assessments (in Section III). Terminology The phrase “general medical condition” is replaced in DSM-5 with “another medical condition” where relevant across all disorders. Neurodevelopmental Disorders Intellectual Disability (Intellectual Developmental Disorder) Diagnostic criteria for intellectual disability (intellectual developmental disorder) emphasize the need for an assessment of both cognitive capacity (IQ) and adaptive functioning. Severity is determined by adaptive functioning rather than IQ score. The term mental retardation was used in DSM-IV. However, intellectual disability is the term that has come into common use over the past two decades among medical, educational, and other professionals, and by the lay public and advocacy groups. Moreover, a federal statue in the United States (Public Law 111-256, Rosa’s Law) replaces the term “mental retarda- tion with intellectual disability. Despite the name change, the deficits in cognitive capacity beginning in the developmental period, with the accompanying diagnostic criteria, are considered to constitute a mental disorder. The term intellectual developmental disorder was placed in parentheses to reflect the World Health Organization’s classification system, which lists “disorders” in the International Classifica- tion of Diseases (ICD; ICD-11 to be released in 2015) and bases all “disabilities” on the International Classification of Functioning, Disability, and Health (ICF). Because the ICD-11 will not be adopted for several years, intellectual disability was chosen as the current preferred term with the bridge term for the future in parentheses. Communication Disorders The DSM-5 communication disorders include language disorder (which combines DSM-IV expressive and mixed receptive-expressive language disorders), speech sound disorder (a new name for phono- logical disorder), and childhood-onset fluency disorder (a new name for stuttering). Also included is social (pragmatic) communication disorder, a new condition for persistent difficulties in the social uses of verbal and nonverbal communication. Because social communication deficits are one component of autism spectrum disorder (ASD), it is important to note that social (pragmatic) communication disorder cannot be diagnosed in the presence of restricted repetitive behaviors, interests, and activities (the oth- er component of ASD). The symptoms of some patients diagnosed with DSM-IV pervasive developmen- tal disorder not otherwise specified may meet the DSM-5 criteria for social communication disorder. Autism Spectrum Disorder Autism spectrum disorder is a new DSM-5 name that reflects a scientific consensus that four previously separate disorders are actually a single condition with different levels of symptom severity in two core domains. ASD now encompasses the previous DSM-IV autistic disorder (autism), Asperger’s disorder, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified. ASD is characterized by 1) deficits in social communication and social interaction and 2) restricted repetitive behaviors, interests, and activities (RRBs). Because both components are required for diagnosis of ASD, social communication disorder is diagnosed if no RRBs are present. Attention-Deficit/Hyperactivity Disorder The diagnostic criteria for attention-deficit/hyperactivity disorder (ADHD) in DSM-5 are similar to those in DSM-IV. The same 18 symptoms are used as in DSM-IV, and continue to be divided into two symp- tom domains (inattention and hyperactivity/impulsivity), of which at least six symptoms in one domain are required for diagnosis. However, several changes have been made in DSM-5: 1) examples have been added to the criterion items to facilitate application across the life span; 2) the cross-situational requirement has been strengthened to “several” symptoms in each setting; 3) the onset criterion has been changed from “symptoms that caused impairment were present before age 7 years” to “several inattentive or hyperactive-impulsive symptoms were present prior to age 12”; 4) subtypes have been replaced with presentation specifiers that map directly to the prior subtypes; 5) a comorbid diagnosis with autism spectrum disorder is now allowed; and 6) a symptom threshold change has been made for adults, to reflect their substantial evidence of clinically significant ADHD impairment, with the cutoff for ADHD of five symptoms, instead of six required for younger persons, both for inattention and for hyperactivity and impulsivity. Finally, ADHD was placed in the neurodevelopmental disorders chapter to reflect brain developmental correlates with ADHD and the DSM-5 decision to eliminate the DSM-IV chapter that includes all diagnoses usually first made in infancy, childhood, or adolescence. Specific Learning Disorder Specific learning disorder combines the DSM-IV diagnoses of reading disorder, mathematics disorder, disorder of written expression, and learning disorder not otherwise specified. Because learning deficits in the areas of reading, written expression, and mathematics commonly occur together, coded speci- fiers for the deficit types in each area are included. The text acknowledges that specific types of read- ing deficits are described internationally in various ways as dyslexia and specific types of mathematics deficits as dyscalculia. Motor Disorders The following motor disorders are included in the DSM-5 neurodevelopmental disorders chapter: devel- opmental coordination disorder, stereotypic movement disorder, Tourette’s disorder, persistent (chron- ic) motor or vocal tic disorder, provisional tic disorder, other specified tic disorder, and unspecified tic disorder. The tic criteria have been standardized across all of these disorders in this chapter. Stereotypic movement disorder has been more clearly differentiated from body-focused repetitive behavior disor- ders that are in the DSM-5 obsessive-compulsive disorder chapter. Schizophrenia Spectrum and Other Psychotic Disorders Schizophrenia Two changes were made to DSM-IV Criterion A for schizophrenia. The first change is the elimination of the special attribution of bizarre delusions and Schneiderian first-rank auditory hallucinations (e.g., two or more voices conversing). In DSM-IV, only one such symptom was needed to meet the diagnostic requirement for Criterion A, instead of two of the other listed symptoms. This special attribution was 2 Highlights of Changes from DSM-IV-TR to DSM-5 removed due to the nonspecificity of Schneiderian symptoms and the poor reliability in distinguishing bizarre from nonbizarre delusions. Therefore, in DSM-5, two Criterion A symptoms are required for any diagnosis of schizophrenia. The second change is the addition of a requirement in Criterion A that the individual must have at least one of these three symptoms: delusions, hallucinations, and disorganized speech. At least one of these core “positive symptoms” is necessary for a reliable diagnosis of schizo- phrenia. Schizophrenia subtypes The DSM-IV subtypes of schizophrenia (i.e., paranoid, disorganized, catatonic, undifferentiated, and residual types) are eliminated due to their limited diagnostic stability, low reliability, and poor validity. These subtypes also have not been shown to exhibit distinctive patterns of treatment response or lon- gitudinal course. Instead, a dimensional approach to rating severity for the core symptoms of schizo- phrenia is included in Section III to capture the important heterogeneity in symptom type and severity expressed across individuals with psychotic disorders. Schizoaffective Disorder The primary change to schizoaffective disorder is the requirement that a major mood episode be pres- ent for a majority of the disorder’s total duration after Criterion A has been met. This change was made on both conceptual and psychometric grounds. It makes schizoaffective disorder a longitudinal instead of a cross-sectional diagnosis—more comparable to schizophrenia, bipolar disorder, and major depres- sive disorder, which are bridged by this condition. The change was also made to improve the reliability, diagnostic stability, and validity of this disorder, while recognizing that the characterization of patients with both psychotic and mood symptoms, either concurrently or at different points in their illness, has been a clinical challenge. Delusional Disorder Criterion A for delusional disorder no longer has the requirement that the delusions must be non- bizarre. A specifier for bizarre type delusions provides continuity with DSM-IV. The demarcation of delusional disorder from psychotic variants of obsessive-compulsive disorder and body dysmorphic disorder is explicitly noted with a new exclusion criterion, which states that the symptoms must not be better explained by conditions such as obsessive-compulsive or body dysmorphic disorder with absent insight/delusional beliefs. DSM-5 no longer separates delusional disorder from shared delusional dis- order. If criteria are met for delusional disorder then that diagnosis is made. If the diagnosis cannot be made but shared beliefs are present, then the diagnosis “other specified schizophrenia spectrum and other psychotic disorder” is used. Catatonia The same criteria are used to diagnose catatonia whether the context is a psychotic, bipolar, depres- sive, or other medical disorder, or an unidentified medical condition. In DSM-IV, two out of five symp- tom clusters were required if the context was a psychotic or mood disorder, whereas only one symp- tom cluster was needed if the context was a general medical condition. In DSM-5, all contexts require three catatonic symptoms (from a total of 12 characteristic symptoms). In DSM-5, catatonia may be diagnosed as a specifier for depressive, bipolar, and psychotic disorders; as a separate diagnosis in the context of another medical condition; or as an other specified diagnosis. Highlights of Changes from DSM-IV-TR to DSM-5 3 Bipolar and Related Disorders Bipolar Disorders To enhance the accuracy of diagnosis and facilitate earlier detection in clinical settings, Criterion A for manic and hypomanic episodes now includes an emphasis on changes in activity and energy as well as mood. The DSM-IV diagnosis of bipolar I disorder, mixed episode, requiring that the individual simulta- neously meet full criteria for both mania and major depressive episode, has been removed. Instead, a new specifier, “with mixed features,” has been added that can be applied to episodes of mania or hy- pomania when depressive features are present, and to episodes of depression in the context of major depressive disorder or bipolar disorder when features of mania/hypomania are present. Other Specified Bipolar and Related Disorder DSM-5 allows the specification of particular conditions for other specified bipolar and related disorder, including categorization for individuals with a past history of a major depressive disorder who meet all criteria for hypomania except the duration criterion (i.e., at least 4 consecutive days). A second condi- tion constituting an other specified bipolar and related disorder is that too few symptoms of hypoma- nia are present to meet criteria for the full bipolar II syndrome, although the duration is sufficient at 4 or more days. Anxious Distress Specifier In the chapter on bipolar and related disorders and the chapter on depressive disorders, a specifier for anxious distress is delineated. This specifier is intended to identify patients with anxiety symptoms that are not part of the bipolar diagnostic criteria. Depressive Disorders DSM-5 contains several new depressive disorders, including disruptive mood dysregulation disorder and premenstrual dysphoric disorder. To address concerns about potential overdiagnosis and overtreat- ment of bipolar disorder in children, a new diagnosis, disruptive mood dysregulation disorder, is includ- ed for children up to age 18 years who exhibit persistent irritability and frequent episodes of extreme behavioral dyscontrol. Based on strong scientific evidence, premenstrual dysphoric disorder has been moved from DSM-IV Appendix B, “Criteria Sets and Axes Provided for Further Study,” to the main body of DSM-5. Finally, DSM-5 conceptualizes chronic forms of depression in a somewhat modified way. What was referred to as dysthymia in DSM-IV now falls under the category of persistent depressive dis- order, which includes both chronic major depressive disorder and the previous dysthymic disorder. An inability to find scientifically meaningful differences between these two conditions led to their combi- nation with specifiers included to identify different pathways to the diagnosis and to provide continuity with DSM-IV. Major Depressive Disorder Neither the core criterion symptoms applied to the diagnosis of major depressive episode nor the req- uisite duration of at least 2 weeks has changed from DSM-IV. Criterion A for a major depressive episode in DSM-5 is identical to that of DSM-IV, as is the requirement for clinically significant distress or impair- ment in social, occupational, or other important areas of life, although this is now listed as Criterion B rather than Criterion C. The coexistence within a major depressive episode of at least three manic symptoms (insufficient to satisfy criteria for a manic episode) is now acknowledged by the specifier “with mixed features.” The presence of mixed features in an episode of major depressive disorder in- 4 Highlights of Changes from DSM-IV-TR to DSM-5 creases the likelihood that the illness exists in a bipolar spectrum; however, if the individual concerned has never met criteria for a manic or hypomanic episode, the diagnosis of major depressive disorder is retained. Bereavement Exclusion In DSM-IV, there was an exclusion criterion for a major depressive episode that was applied to depres- sive symptoms lasting less than 2 months following the death of a loved one (i.e., the bereavement exclusion). This exclusion is omitted in DSM-5 for several reasons. The first is to remove the implication that bereavement typically lasts only 2 months when both physicians and grief counselors recognize that the duration is more commonly 1–2 years. Second, bereavement is recognized as a severe psy- chosocial stressor that can precipitate a major depressive episode in a vulnerable individual, generally beginning soon after the loss. When major depressive disorder occurs in the context of bereavement, it adds an additional risk for suffering, feelings of worthlessness, suicidal ideation, poorer somatic health, worse interpersonal and work functioning, and an increased risk for persistent complex bereavement disorder, which is now described with explicit criteria in Conditions for Further Study in DSM-5 Section III. Third, bereavement-related major depression is most likely to occur in individuals with past personal and family histories of major depressive episodes. It is genetically influenced and is associated with similar personality characteristics, patterns of comorbidity, and risks of chronicity and/or recurrence as non–bereavement-related major depressive episodes. Finally, the depressive symptoms associated with bereavement-related depression respond to the same psychosocial and medication treatments as non–bereavement-related depression. In the criteria for major depressive disorder, a detailed footnote has replaced the more simplistic DSM-IV exclusion to aid clinicians in making the critical distinction be- tween the symptoms characteristic of bereavement and those of a major depressive episode. Thus, al- though most people experiencing the loss of a loved one experience bereavement without developing a major depressive episode, evidence does not support the separation of loss of a loved one from other stressors in terms of its likelihood of precipitating a major depressive episode or the relative likelihood that the symptoms will remit spontaneously. Specifiers for Depressive Disorders Suicidality represents a critical concern in psychiatry. Thus, the clinician is given guidance on assess- ment of suicidal thinking, plans, and the presence of other risk factors in order to make a determination of the prominence of suicide prevention in treatment planning for a given individual. A new specifier to indicate the presence of mixed symptoms has been added across both the bipolar and the depressive disorders, allowing for the possibility of manic features in individuals with a diagnosis of unipolar de- pression. A substantial body of research conducted over the last two decades points to the importance of anxiety as relevant to prognosis and treatment decision making. The “with anxious distress” specifier gives the clinician an opportunity to rate the severity of anxious distress in all individuals with bipolar or depressive disorders. Anxiety Disorders The DSM-5 chapter on anxiety disorder no longer includes obsessive-compulsive disorder (which is included with the obsessive-compulsive and related disorders) or posttraumatic stress disorder and acute stress disorder (which is included with the trauma- and stressor-related disorders). However, the sequential order of these chapters in DSM-5 reflects the close relationships among them. Highlights of Changes from DSM-IV-TR to DSM-5 5 Agoraphobia, Specific Phobia, and Social Anxiety Disorder (Social Phobia) Changes in criteria for agoraphobia, specific phobia, and social anxiety disorder (social phobia) include deletion of the requirement that individuals over age 18 years recognize that their anxiety is excessive or unreasonable. This change is based on evidence that individuals with such disorders often overesti- mate the danger in “phobic” situations and that older individuals often misattribute “phobic” fears to aging. Instead, the anxiety must be out of proportion to the actual danger or threat in the situation, af- ter taking cultural contextual factors into account. In addition, the 6-month duration, which was limited to individuals under age 18 in DSM-IV, is now extended to all ages. This change is intended to minimize overdiagnosis of transient fears. Panic Attack The essential features of panic attacks remain unchanged, although the complicated DSM-IV terminol- ogy for describing different types of panic attacks (i.e., situationally bound/cued, situationally predis- posed, and unexpected/uncued) is replaced with the terms unexpected and expected panic attacks. Panic attacks function as a marker and prognostic factor for severity of diagnosis, course, and comor- bidity across an array of disorders, including but not limited to anxiety disorders. Hence, panic attack can be listed as a specifier that is applicable to all DSM-5 disorders. Panic Disorder and Agoraphobia Panic disorder and agoraphobia are unlinked in DSM-5. Thus, the former DSM-IV diagnoses of panic disorder with agoraphobia, panic disorder without agoraphobia, and agoraphobia without history of panic disorder are now replaced by two diagnoses, panic disorder and agoraphobia, each with separate criteria. The co-occurrence of panic disorder and agoraphobia is now coded with two diagnoses. This change recognizes that a substantial number of individuals with agoraphobia do not experience panic symptoms. The diagnostic criteria for agoraphobia are derived from the DSM-IV descriptors for agora- phobia, although endorsement of fears from two or more agoraphobia situations is now required, be- cause this is a robust means for distinguishing agoraphobia from specific phobias. Also, the criteria for agoraphobia are extended to be consistent with criteria sets for other anxiety disorders (e.g., clinician judgment of the fears as being out of proportion to the actual danger in the situation, with a typical duration of 6 months or more). Specific Phobia The core features of specific phobia remain the same, but there is no longer a requirement that indi- viduals over age 18 years must recognize that their fear and anxiety are excessive or unreasonable, and the duration requirement (“typically lasting for 6 months or more”) now applies to all ages. Although they are now referred to as specifiers, the different types of specific phobia have essentially remained unchanged. Social Anxiety Disorder (Social Phobia) The essential features of social anxiety disorder (social phobia) (formerly called social phobia) remain the same. However, a number of changes have been made, including deletion of the requirement that individuals over age 18 years must recognize that their fear or anxiety is excessive or unreasonable, and duration criterion of “typically lasting for 6 months or more” is now required for all ages. A more sig- nificant change is that the “generalized” specifier has been deleted and replaced with a “performance only” specifier. The DSM-IV generalized speci