Unit 3: All Disorders in the DSM-5-TR TEST GUIDE (PSY 563) PDF

Unit 3: All Disorders in the DSM-5-TR TEST GUIDE (PSY 563) Oppositional Defiant Disorder (p. 522-523) Diagnostic Code: A. F91.3 – Oppositional Defiant Disorder B. Specify current severity: a. Mild: Symptoms are confined to only one setting (e.g., at home, at school, at work,...

Unit 3: All Disorders in the DSM-5-TR TEST GUIDE (PSY 563) Oppositional Defiant Disorder (p. 522-523) Diagnostic Code: A. F91.3 – Oppositional Defiant Disorder B. Specify current severity: a. Mild: Symptoms are confined to only one setting (e.g., at home, at school, at work, with peers). b. Moderate: Some symptoms are present in at least two settings. c. Severe: Some symptoms are present in three or more settings. (ex: F91.3 Oppositional Defiant Disorder, Mild Severity) Description of the Disorder: Symptoms and Diagnostic Criteria A. A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months as evidenced by at least four symptoms from any of the following categories, and exhibited during interaction with at least one individual who is not a sibling. Angry/Irritable Mood 1. Often loses temper. 2. Is often touchy or easily annoyed. 3. Is often angry and resentful. Argumentative/Defiant Behavior 4. Often argues with authority figures or, for children and adolescents, with adults.  5. Often actively defies or refuses to comply with requests from authority figures or with rules. 6. Often deliberately annoys others. 7. Often blames others for his or her mistakes or misbehavior. Vindictiveness 8. Has been spiteful or vindictive at least twice within the past 6 months. Note: The persistence and frequency of these behaviors should be used to distinguish a behavior that is within normal limits from a behavior that is symptomatic. For children younger than 5 years, the behavior should occur on most days for a period of at least 6 months unless otherwise noted (Criterion A8). For individuals 5 years or older, the behavior should occur at least once per week for at least 6 months, unless otherwise noted (Criterion A8). While these frequency criteria provide guidance on a minimal level of frequency to define symptoms, other factors should also be considered, such as whether the frequency and intensity of the behaviors are outside a range that is normative for the individual’s developmental level, gender, and culture. B. The disturbance in behavior is associated with distress in the individual or others in his or her immediate social context (e.g., family, peer group, work colleagues), or it impacts negatively on social, educational, occupational, or other important areas of functioning. C. The behaviors do not occur exclusively during the course of a psychotic, substance use, depressive, or bipolar disorder. Also, the criteria are not met for disruptive mood dysregulation disorder. Intermittent Explosive Disorder (p. 527) Diagnostic Code: A. F63.81 – Intermittent Explosive Disorder (ex: F63.81 Intermittent Explosive Disorder) Description of the Disorder: Symptoms and Diagnostic Criteria A. Recurrent behavioral outbursts representing a failure to control aggressive impulses as manifested by either of the following: 1. Verbal aggression (e.g., temper tantrums, tirades, verbal arguments or fights) or physical aggression toward property, animals, or other individuals, occurring twice weekly, on average, for a period of 3 months. The physical aggression does not result in damage or destruction of property and does not result in physical injury to animals or other individuals. 2. Three behavioral outbursts involving damage or destruction of property and/or physical assault involving physical injury against animals or other individuals occurring within a 12-month period. B. The magnitude of aggressiveness expressed during the recurrent outbursts is grossly out of proportion to the provocation or to any precipitating psychosocial stressors. C. The recurrent aggressive outbursts are not premeditated (i.e., they are impulsive and/or anger-based) and are not committed to achieve some tangible objective (e.g., money, power, intimidation). D. The recurrent aggressive outbursts cause either marked distress in the individual or impairment in occupational or interpersonal functioning, or are associated with financial or legal consequences. E. Chronological age is at least 6 years (or equivalent developmental level). F. The recurrent aggressive outbursts are not better explained by another mental disorder (e.g., major depressive disorder, bipolar disorder, disruptive mood dysregulation disorder, a psychotic disorder, antisocial personality disorder, borderline personality disorder) and are not attributable to another medical condition (e.g., head trauma, Alzheimer’s disease) or to the physiological effect of a substance (e.g., a drug of abuse, a medication). For children ages 6–18 years, aggressive behavior that occurs as part of an adjustment disorder should not be considered for this diagnosis. Note: This diagnosis can be made in addition to the diagnosis of attention deficit/hyperactivity disorder, conduct disorder, oppositional defiant disorder, or autism spectrum disorder when recurrent impulsive aggressive outbursts are in excess of those usually seen in these disorders and warrant independent clinical attention. Conduct Disorder (p. 530-532) Diagnostic Code: A. Specify whether: a. F91.1 - Childhood-Onset Type: Individuals show at least one symptom characteristic of conduct disorder prior to age 10 years. b. F91.2 - Adolescent-Onset Type: Individuals show no symptom characteristic of conduct disorder prior to age 10 years. c. F91.9 - Unspecified onset: Criteria for a diagnosis of conduct disorder are met, but there is not enough information available to determine whether the onset of the first symptom was before or after age 10 years. B. Specify current severity: a. Mild: Few if any conduct problems in excess of those required to make the diagnosis are present, and conduct problems cause relatively minor harm to others (e.g., lying, truancy, staying out after dark without permission, other rule breaking). b. Moderate: The number of conduct problems and the effect on others are intermediate between those specified in “mild” and those in “severe” (e.g., stealing without confronting a victim, vandalism). c. Severe: Many conduct problems in excess of those required to make the diagnosis are present, or conduct problems cause considerable harm to others (e.g., forced sex, physical cruelty, use of a weapon, stealing while confronting a victim, breaking and entering). (ex: F91.1 Conduct Disorder, Childhood-onset Type, Mild severity) C. Specify if: a. With limited prosocial emotions: To qualify for this specifier, an individual must have displayed at least two of the following characteristics persistently over at least 12 months and in multiple relationships and settings. These characteristics reflect the individual’s typical pattern of interpersonal and emotional functioning over this period and not just occasional occurrences in some situations. Thus, to assess the criteria for the specifier, multiple information sources are necessary. In addition to the individual’s self-report, it is necessary to consider reports by others who have known the individual for extended periods of time (e.g., parents, teachers, co-workers, extended family members, peers). i. Lack of remorse or guilt: Does not feel bad or guilty when he or she does something wrong (exclude remorse when expressed only when caught and/or facing punishment). The individual shows a general lack of concern about the negative consequences of his or her actions. For example, the individual is not remorseful after hurting someone or does not care about the consequences of breaking rules. ii. Callous—lack of empathy: Disregards and is unconcerned about the feelings of others. The individual is described as cold and uncaring. The individual appears more concerned about the effects of his or her actions on himself or herself, rather than their effects on others, even when they result in substantial harm to others. iii. Unconcerned about performance: Does not show concern about poor/problematic performance at school, at work, or in other important activities. The individual does not put forth the effort necessary to perform well, even when expectations are clear, and typically blames others for his or her poor performance. iv. Shallow or deficient affect: Does not express feelings or show emotions to others, except in ways that seem shallow, insincere, or superficial (e.g., actions contradict the emotion displayed; can turn emotions “on” or “off” quickly) or when emotional expressions are used for gain  (e.g., emotions displayed to manipulate or intimidate others). Description of the Disorder: Symptoms and Diagnostic Criteria A. A repetitive and persistent pattern of behavior in which the basic rights of others or major age appropriate societal norms or rules are violated, as manifested by the presence of at least three of the following 15 criteria in the past 12 months from any of the categories below, with at least one criterion present in the past 6 months: Aggression to People and Animals 1. Often bullies, threatens, or intimidates others. 2. Often initiates physical fights. 3. Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun). 4. Has been physically cruel to people. 5. Has been physically cruel to animals. 6. Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery). 7. Has forced someone into sexual activity. Destruction of Property 8. Has deliberately engaged in fire setting with the intention of causing serious damage. 9. Has deliberately destroyed others’ property (other than by fire setting). Deceitfulness or Theft 10. Has broken into someone else’s house, building, or car. 11. Often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others). 12. Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery). Serious Violations of Rules 13. Often stays out at night despite parental prohibitions, beginning before age 13 years. 14. Has run away from home overnight at least twice while living in the parental or parental surrogate home, or once without returning for a lengthy period. 15. Is often truant from school, beginning before age 13 years.  B. The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning. C. If the individual is age 18 years or older, criteria are not met for antisocial personality disorder Antisocial Personality Disorder (p. 748) Diagnostic Code: A. F60.2 - Antisocial Personality Disorder (ex: F60.2 Antisocial Personality Disorder) Description of the Disorder: Symptoms and Diagnostic Criteria A. A pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 years, as indicated by three (or more) of the following: 1. Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest. 2. Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure. 3. Impulsivity or failure to plan ahead. 4. Irritability and aggressiveness, as indicated by repeated physical fights or assaults. 5. Reckless disregard for safety of self or others. **Different than CD!** 6. Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations. 7. Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another. B. The individual is at least 18 years of age. C. There is evidence of conduct disorder with onset before age 15 years. D. The occurrence of antisocial behavior is not exclusively during the course of schizophrenia or bipolar disorder. (A3-6 for criteria is what to look when diagnosing for Antisocial Personality Disorder and look out for age at least least 18 years old) Pyromania (p. 537-538) Diagnostic Code: A. F63.1 - Pyromania (ex: F63.1 Pyromania) Description of the Disorder: Symptoms and Diagnostic Criteria A. Deliberate and purposeful fire setting on more than one occasion. B. Tension or affective arousal before the act. IT FEELS GOOD TO DO ACT OF STEALING ITSELF! C. Fascination with, interest in, curiosity about, or attraction to fire and its situational contexts (e.g., paraphernalia, uses, consequences). D. Pleasure, gratification, or relief when setting fires or when witnessing or participating in their aftermath. E. The fire setting is not done for monetary gain, as an expression of sociopolitical ideology, to conceal criminal activity, to express anger or vengeance, to improve one’s living circumstances, in response to a delusion or hallucination, or as a result of impaired judgment (e.g., in major neurocognitive disorder, intellectual developmental disorder [intellectual disability], substance intoxication). THEY LIKE THE FIRE ITSELF! F. The fire setting is not better explained by conduct disorder, a manic episode, or antisocial personality disorder. Kleptomania (p. 539-540) Diagnostic Code: A. F63.2 - Kleptomania (ex: F63.2 Kleptomania) Description of the Disorder: Symptoms and Diagnostic Criteria A. Recurrent failure to resist impulses to steal objects that are not needed for personal use or for their monetary value. B. Increasing sense of tension immediately before committing the theft. C. Pleasure, gratification, or relief at the time of committing the theft. D. The stealing is not committed to express anger or vengeance and is not in response to a delusion or a hallucination. E. The stealing is not better explained by conduct disorder, a manic episode, or antisocial personality disorder. Pica (p. 371-372) Diagnostic Code: A. Coding note: The ICD-10-CM codes for pica are F98.3 in children and F50.89 in adults. B. Specify if: a. In remission: After full criteria for pica were previously met, the criteria have not been met for a sustained period of time. (ex: F98.3 Pica, in children or F50.89 Pica, in adults) Description of the Disorder: Symptoms and Diagnostic Criteria A. Persistent eating of nonnutritive, nonfood substances over a period of at least 1 month. B. The eating of nonnutritive, nonfood substances is inappropriate to the C. developmental level of the individual. D. The eating behavior is not part of a culturally supported or socially normative practice. E. If the eating behavior occurs in the context of another mental disorder (e.g., intellectual developmental disorder [intellectual disability], autism spectrum disorder, schizophrenia) or medical condition (including pregnancy), it is sufficiently severe to warrant additional clinical attention. Rumination Disorder (p. 374) Diagnostic Code: A. F98.21 - Rumination Disorder B. Specify if: In remission: After full criteria for rumination disorder were previously met, the criteria have not been met for a sustained period of time. (ex: F98.21 Rumination Disorder) Description of the Disorder: Symptoms and Diagnostic Criteria A. Repeated regurgitation of food over a period of at least 1 month. Regurgitated food may be re-chewed, re-swallowed, or spit out. B. The repeated regurgitation is not attributable to an associated gastrointestinal or other medical condition (e.g., gastroesophageal reflux, pyloric stenosis). C. The eating disturbance does not occur exclusively during the course of anorexia nervosa, bulimia nervosa, binge-eating disorder, or avoidant/restrictive food intake disorder. D. If the symptoms occur in the context of another mental disorder (e.g., intellectual developmental disorder [intellectual disability] or another neurodevelopmental disorder), they are sufficiently severe to warrant additional clinical attention. Avoidant/Restrictive Food Intake Disorder (p. 376) Diagnostic Code: C. F50.82 - Avoidant/Restrictive Food Intake Disorder (A/R FID) D. Specify if: a. In remission: After full criteria for avoidant/restrictive food intake disorder were previously met, the criteria have not been met for a sustained period of time. (ex: F50.82 Avoidant/Restrictive Food Intake Disorder) Description of the Disorder: Symptoms and Diagnostic Criteria A. An eating or feeding disturbance (e.g., apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating; afraid of vomiting/choking) associated with one (or more) of the following: (NO MOTIVATION FOR WEIGHT/SHAPE RELATED; NO FEARS OF GAINING WEIGHT) 1. Significant weight loss (or failure to achieve expected weight gain or faltering growth in children). 2. Significant nutritional deficiency. 3. Dependence on enteral feeding or oral nutritional supplements. 4. Marked interference with psychosocial functioning. B. The disturbance is not better explained by lack of available food or by an associated culturally sanctioned practice. C. The eating disturbance does not occur exclusively during the course of anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance in the way in which one’s body weight or shape is experienced. D. The eating disturbance is not attributable to a concurrent medical condition or not better explained by another mental disorder. When the eating disturbance occurs in the context of another condition or disorder, the severity of the eating disturbance exceeds that routinely associated with the condition or disorder and warrants additional clinical attention. Anorexia Nervosa (p. 381) Diagnostic Code: A. Specify whether: F50.01 Restricting type: During the last 3 months, the individual has not engaged in recurrent episodes of binge-eating or purging behavior (i.e., self- induced vomiting or the misuse of laxatives, diuretics, or enemas). This subtype describes presentations in which weight loss is accomplished primarily through dieting, fasting, and/or excessive exercise. F50.02 Binge-eating/purging type: During the last 3 months, the individual has engaged in recurrent episodes of binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas). Coding note: The ICD-10-CM code depends on the subtype. B. Specify current severity: a. Mild: BMI ≥ 17 kg/m2. b. Moderate: BMI 16–16.99 kg/m2. c. Severe: BMI 15–15.99 kg/m2. d. Extreme: BMI < 15 kg/m2. (Ex: F50.01 Anorexia Nervosa, Restricting type, Moderate Severity or F50.02 Anorexia Nervosa, Binge-eating/purging type, Moderate Severity) C. Specify if: a. In partial remission: After full criteria for anorexia nervosa were previously met, Criterion A (low body weight) has not been met for a sustained period, but either Criterion B (intense fear of gaining weight or becoming fat or behavior that interferes with weight gain) or Criterion C (disturbances in self-perception of weight and shape) is still met.  b. In full remission: After full criteria for anorexia nervosa were previously met, none of the criteria have been met for a sustained period of time. Description of the Disorder: Symptoms and Diagnostic Criteria A. Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected. B. Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight. C. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight. Bulimia Nervosa (p. 387-388) Diagnostic Code: A. F50.2 - Bulimia Nervosa B. Specify current severity: Mild: An average of 1–3 episodes of inappropriate compensatory behaviors per week. Moderate: An average of 4–7 episodes of inappropriate compensatory behaviors per week. Severe: An average of 8–13 episodes of inappropriate compensatory behaviors per week. Extreme: An average of 14 or more episodes of inappropriate compensatory behaviors per week. (ex: F50.2 Bulimia Nervosa, Mild Severity)  C. Specify if: a. In partial remission: After full criteria for bulimia nervosa were previously met, some, but not all, of the criteria have been met for a sustained period of time. b. In full remission: After full criteria for bulimia nervosa were previously met, none of the criteria have been met for a sustained period of time. Description of the Disorder: Symptoms and Diagnostic Criteria A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: 1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances. 2. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating). B. Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise. C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months. D. Self-evaluation is unduly influenced by body shape and weight. (self-esteem) E. The disturbance does not occur exclusively during episodes of anorexia nervosa. (meet for AN → NOT BN; meet for BN → NOT AN/BED; meet for BED → NOT AN/BN Binge-Eating Disorder (p. 392-393) Diagnostic Code: A. F50.81 - Binge-Eating Disorder B. Specify current severity: a. Mild: 1–3 binge-eating episodes per week. b. Moderate: 4–7 binge-eating episodes per week.  c. Severe: 8–13 binge-eating episodes per week. d. Extreme: 14 or more binge-eating episodes per week. (ex: F50.81 Binge-Eating Disorder, Moderate Severity) C. Specify if: a. In partial remission: After full criteria for binge-eating disorder were previously met, binge eating occurs at an average frequency of less than one episode per week for a sustained period of time. b. In full remission: After full criteria for binge-eating disorder were previously met, none of the criteria have been met for a sustained period of time. Description of the Disorder: Symptoms and Diagnostic Criteria A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: 1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances. 2. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating). B. The binge-eating episodes are associated with three (or more) of the following: 1. Eating much more rapidly than normal. 2. Eating until feeling uncomfortably full. 3. Eating large amounts of food when not feeling physically hungry. 4. Eating alone because of feeling embarrassed by how much one is eating. 5. Feeling disgusted with oneself, depressed, or very guilty afterward. C. Marked distress regarding binge eating is present. D. The binge eating occurs, on average, at least once a week for 3 months. E. The binge eating is not associated with the recurrent use of inappropriate compensatory behavior as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa. Alcohol Use Disorder (p. 553-554) Examples: Alcohol Diagnostic Code: A. Specify current severity/remissions: F10.10 - Mild: Presence of 2–3 symptoms. F10.11 - Mild, In early remission F10.11 - Mild, In sustained remission F10.20 - Moderate: Presence of 4–5 symptoms. F10.21 - Moderate, In early remission F10.21 - Moderate, In sustained remission F10.20 - Severe: Presence of 6 or more symptoms. F10.21 - Severe, In early remission  F10.21 - Severe, In sustained remission B. Specify if: a. In early remission: no criteria (except craving) for 3-12 months b. In sustained remission: no criteria (except craving) for 12+ months C. Specify if: a. In a controlled environment: This additional specifier is used if the individual is in an environment where access to alcohol is restricted. Description of the Disorder: Symptoms and Diagnostic Criteria A. A problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12- month period: 1. Alcohol is often taken in larger amounts or over a longer period than was intended. 2. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use. 3. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects. 4. Craving, or a strong desire or urge to use alcohol. 5. Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home. 6. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol. 7. Important social, occupational, or recreational activities are given up or reduced because of alcohol use. 8. Recurrent alcohol use in situations in which it is physically hazardous. 9. Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol. 10. Tolerance, as defined by either of the following: a. A need for markedly increased amounts of alcohol to achieve intoxication or desired effect. b. A markedly diminished effect with continued use of the same amount of alcohol. 11. Withdrawal, as manifested by either of the following: a. The characteristic withdrawal syndrome for alcohol (refer to Criteria A and B of the criteria set for alcohol withdrawal). b. Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms. Alcohol Intoxication (p. 561) Diagnostic Code: A. Specify Whether a. Mild alcohol use disorder is comorbid, F10.120 b. Moderate or severe alcohol use disorder is comorbid, F10.220 c. No comorbid alcohol use disorder, F10.920 Coding note: The ICD-10-CM code depends on whether there is a comorbid alcohol use disorder. Description of the Disorder: Symptoms and Diagnostic Criteria A. Recent ingestion of alcohol. B. Clinically significant problematic behavioral or psychological changes (e.g., inappropriate sexual or aggressive behavior, mood lability, impaired judgment) that developed during, or shortly after, alcohol ingestion. C. One (or more) of the following signs or symptoms developing during, or shortly after, alcohol use: 1. Slurred speech. 2. Incoordination. 3. Unsteady gait. 4. Nystagmus. 5. Impairment in attention or memory. 6. Stupor or coma. D. The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication with another substance. Alcohol Withdrawal (p. 392-393) Diagnostic Code: A. Specify if a. With perceptual disturbances: This specifier applies in the rare instance when hallucinations (usually visual or tactile) occur with intact reality  testing, or auditory, visual, or tactile illusions occur in the absence of a delirium. Coding note: The ICD-10-CM code depends on whether or not there is a comorbid alcohol use disorder and whether or not there are perceptual disturbances For alcohol withdrawal, without perceptual disturbances: Mild alcohol use disorder is comorbid, F10.130, Moderate or severe alcohol use disorder is comorbid, F10.230 No comorbid alcohol use disorder, F10.930. For alcohol withdrawal, with perceptual disturbances: Mild alcohol use disorder is comorbid, F10.132 Moderate or severe alcohol use disorder is comorbid, F10.232 No comorbid alcohol use disorder, F10.932 Description of the Disorder: Symptoms and Diagnostic Criteria A. Cessation of (or reduction in) alcohol use that has been heavy and prolonged. B. Two (or more) of the following, developing within several hours to a few days after the cessation of (or reduction in) alcohol use described in Criterion A: 1. Autonomic hyperactivity (e.g., sweating or pulse rate greater than 100 bpm). 2. Increased hand tremor. 3. Insomnia. 4. Nausea or vomiting. 5. Transient visual, tactile, or auditory hallucinations or illusions. 6. Psychomotor agitation. 7. Anxiety. 8. Generalized tonic-clonic seizures. C. The signs or symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. D. The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication or withdrawal from another substance Caffeine Intoxication (p. 569) Examples: Coffee, tea, energy drinks, etc. Diagnostic Code: A. F15.920 - Caffeine Intoxication Description of the Disorder: Symptoms and Diagnostic Criteria A. Recent consumption of caffeine (typically a high dose well in excess of 250 mg). B. Five (or more) of the following signs or symptoms developing during, or shortly after, caffeine use: 1. Restlessness. 2. Nervousness. 3. Excitement. 4. Insomnia. 5. Flushed face. 6. Diuresis. 7. Gastrointestinal disturbance. 8. Muscle twitching. 9. Rambling flow of thought and speech. 10. Tachycardia or cardiac arrhythmia. 11. Periods of inexhaustibility. 12. Psychomotor agitation. C. The signs or symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. D. The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication with another substance. Caffeine Withdrawal (p. 571-572) Diagnostic Code: B. F15.93 - Caffeine Withdrawal Description of the Disorder: Symptoms and Diagnostic Criteria A. Prolonged daily use of caffeine. B. Abrupt cessation of or reduction in caffeine use, followed within 24 hours by three (or more) of the following signs or symptoms: 1. Headache. 2. Marked fatigue or drowsiness. 3. Dysphoric mood, depressed mood, or irritability. 4. Difficulty concentrating. 5. Flu-like symptoms (nausea, vomiting, or muscle pain/stiffness). C. The signs or symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. D. The signs or symptoms are not associated with the physiological effects of another medical condition (e.g., migraine, viral illness) and are not better explained by another mental disorder, including intoxication or withdrawal from another substance. Cannabis Use Disorder (p. 553-554) Examples: Marijuana, yarndi, pot, weed, hash, dope, gunja, joint, stick, chronic, cone, choof, mull, 420, dabs, dabbing, BHO, THC Diagnostic Code: D. Specify current severity/remissions: F12.10 - Mild: Presence of 2–3 symptoms. F12.11 - Mild, In early remission F12.11 - Mild, In sustained remission F12.20 - Moderate: Presence of 4–5 symptoms. F12.21 - Moderate, In early remission F12.21 - Moderate, In sustained remission F12.20 - Severe: Presence of 6 or more symptoms. F12.21 - Severe, In early remission F12.21 - Severe, In sustained remission E. Specify if: a. In early remission: no criteria (except craving) for 3-12 months  b. In sustained remission: no criteria (except craving) for 12+ months F. Specify if: a. In a controlled environment: This additional specifier is used if the individual is in an environment where access to cannabis is restricted. Description of the Disorder: Symptoms and Diagnostic Criteria A. A problematic pattern of cannabis use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12- month period: 1. Cannabis is often taken in larger amounts or over a longer period than was intended. 2. There is a persistent desire or unsuccessful efforts to cut down or control cannabis use. 3. A great deal of time is spent in activities necessary to obtain cannabis, use cannabis, or recover from its effects. 4. Craving, or a strong desire or urge to use cannabis. 5. Recurrent cannabis use resulting in a failure to fulfill major role obligations at work, school, or home. 6. Continued cannabis use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of cannabis. 7. Important social, occupational, or recreational activities are given up or reduced because of cannabis use. 8. Recurrent cannabis use in situations in which it is physically hazardous. 9. Cannabis use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol. 10. Tolerance, as defined by either of the following: a. A need for markedly increased amounts of cannabis to achieve intoxication or desired effect. b. A markedly diminished effect with continued use of the same amount of cannabis. Withdrawal, as manifested by either of the following: c. The characteristic withdrawal syndrome for cannabis (refer to Criteria A and B of the criteria set for cannabis withdrawal). d. Cannabis (or a closely related substance) is taken to relieve or avoid withdrawal symptoms. CONTINUE HERE (DIDNT FINISHED) Cannabis Intoxication (p. 582-583) Diagnostic Code: B. Specify Whether a. Mild alcohol use disorder is comorbid, F10.120 b. Moderate or severe alcohol use disorder is comorbid, F10.220 c. No comorbid alcohol use disorder, F10.920 Coding note: The ICD-10-CM code depends on whether there is a comorbid alcohol use disorder. Description of the Disorder: Symptoms and Diagnostic Criteria E. Recent ingestion of alcohol. F. Clinically significant problematic behavioral or psychological changes (e.g., inappropriate sexual or aggressive behavior, mood lability, impaired judgment) that developed during, or shortly after, alcohol ingestion. G. One (or more) of the following signs or symptoms developing during, or shortly after, alcohol use: 7. Slurred speech. 8. Incoordination. 9. Unsteady gait. 10. Nystagmus. 11. Impairment in attention or memory. 12. Stupor or coma. H. The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication with another substance. Cannabis Withdrawal (p. 584) Diagnostic Code: B. Specify if a. With perceptual disturbances: This specifier applies in the rare instance when hallucinations (usually visual or tactile) occur with intact reality testing, or auditory, visual, or tactile illusions occur in the absence of a delirium. Coding note: The ICD-10-CM code depends on whether or not there is a comorbid alcohol use disorder and whether or not there are perceptual disturbances For alcohol withdrawal, without perceptual disturbances: Mild alcohol use disorder is comorbid, F10.130, Moderate or severe alcohol use disorder is comorbid, F10.230 No comorbid alcohol use disorder, F10.930. For alcohol withdrawal, with perceptual disturbances: Mild alcohol use disorder is comorbid, F10.132 Moderate or severe alcohol use disorder is comorbid, F10.232 No comorbid alcohol use disorder, F10.932 Description of the Disorder: Symptoms and Diagnostic Criteria E. Cessation of (or reduction in) alcohol use that has been heavy and prolonged. F. Two (or more) of the following, developing within several hours to a few days after the cessation of (or reduction in) alcohol use described in Criterion A: 9. Autonomic hyperactivity (e.g., sweating or pulse rate greater than 100 bpm). 10. Increased hand tremor. 11. Insomnia. 12. Nausea or vomiting. 13. Transient visual, tactile, or auditory hallucinations or illusions. 14. Psychomotor agitation. 15. Anxiety. 16. Generalized tonic-clonic seizures. G. The signs or symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. H. The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication or withdrawal from another substance Phencyclidine Use Disorder (p. 587-588) Examples: Angel Dust, PCP, supergrass, boat, tic tac, zoom, shermans, ketamine, cyclohexylamine, dizocilpine, dissociative anesthetics (street drugs) Diagnostic Code: G. Specify current severity/remissions: F10.10 - Mild: Presence of 2–3 symptoms. F10.11 - Mild, In early remission F10.11 - Mild, In sustained remission F10.20 - Moderate: Presence of 4–5 symptoms. F10.21 - Moderate, In early remission F10.21 - Moderate, In sustained remission F10.20 - Severe: Presence of 6 or more symptoms. F10.21 - Severe, In early remission F10.21 - Severe, In sustained remission H. Specify if: a. In early remission: no criteria (except craving) for 3-12 months b. In sustained remission: no criteria (except craving) for 12+ months I. Specify if: a. In a controlled environment: This additional specifier is used if the individual is in an environment where access to alcohol is restricted. Description of the Disorder: Symptoms and Diagnostic Criteria B. A problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12- month period: 12. Alcohol is often taken in larger amounts or over a longer period than was intended. 13. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.  14. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects. 15. Craving, or a strong desire or urge to use alcohol. 16. Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home. 17. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol. 18. Important social, occupational, or recreational activities are given up or reduced because of alcohol use. 19. Recurrent alcohol use in situations in which it is physically hazardous. 20. Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol. 21. Tolerance, as defined by either of the following: a. A need for markedly increased amounts of alcohol to achieve intoxication or desired effect. b. A markedly diminished effect with continued use of the same amount of alcohol. 22. Withdrawal, as manifested by either of the following: e. The characteristic withdrawal syndrome for alcohol (refer to Criteria A and B of the criteria set for alcohol withdrawal). f. Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms. Phencyclidine Intoxication (p. 594-595) Diagnostic Code: C. Specify Whether a. Mild alcohol use disorder is comorbid, F10.120 b. Moderate or severe alcohol use disorder is comorbid, F10.220 c. No comorbid alcohol use disorder, F10.920 Coding note: The ICD-10-CM code depends on whether there is a comorbid alcohol use disorder. Description of the Disorder: Symptoms and Diagnostic Criteria I. Recent ingestion of alcohol.  J. Clinically significant problematic behavioral or psychological changes (e.g., inappropriate sexual or aggressive behavior, mood lability, impaired judgment) that developed during, or shortly after, alcohol ingestion. K. One (or more) of the following signs or symptoms developing during, or shortly after, alcohol use: 13. Slurred speech. 14. Incoordination. 15. Unsteady gait. 16. Nystagmus. 17. Impairment in attention or memory. 18. Stupor or coma. L. The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication with another substance. Other Hallucinogen Use Disorder (p. 590-591) Examples: MDMA (other names: Ecstasy, caps, Eckies, E, XTC, pills, pingers, bikkies, flippers, molly, M&M) LSD (other names: Acid, trips, tabs, microdots, dots, Lucy) Psilocybin (other names: Shrooms, mushies, blue meanies, golden tops, liberty caps) Salvia (other names: Diviner's Sage, Ska María Pastora, Seer's Sage) Diagnostic Code: J. Specify current severity/remissions: F10.10 - Mild: Presence of 2–3 symptoms. F10.11 - Mild, In early remission F10.11 - Mild, In sustained remission F10.20 - Moderate: Presence of 4–5 symptoms. F10.21 - Moderate, In early remission F10.21 - Moderate, In sustained remission  F10.20 - Severe: Presence of 6 or more symptoms. F10.21 - Severe, In early remission F10.21 - Severe, In sustained remission K. Specify if: a. In early remission: no criteria (except craving) for 3-12 months b. In sustained remission: no criteria (except craving) for 12+ months L. Specify if: a. In a controlled environment: This additional specifier is used if the individual is in an environment where access to alcohol is restricted. Description of the Disorder: Symptoms and Diagnostic Criteria C. A problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12- month period: 23. Alcohol is often taken in larger amounts or over a longer period than was intended. 24. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use. 25. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects. 26. Craving, or a strong desire or urge to use alcohol. 27. Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home. 28. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol. 29. Important social, occupational, or recreational activities are given up or reduced because of alcohol use. 30. Recurrent alcohol use in situations in which it is physically hazardous. 31. Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol. 32. Tolerance, as defined by either of the following: a. A need for markedly increased amounts of alcohol to achieve intoxication or desired effect. b. A markedly diminished effect with continued use of the same amount of alcohol. 33. Withdrawal, as manifested by either of the following: g. The characteristic withdrawal syndrome for alcohol (refer to Criteria A and B of the criteria set for alcohol withdrawal). h. Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms. Other Hallucinogen Intoxication (p. 596-597) Diagnostic Code: D. Specify Whether a. Mild alcohol use disorder is comorbid, F10.120 b. Moderate or severe alcohol use disorder is comorbid, F10.220 c. No comorbid alcohol use disorder, F10.920 Coding note: The ICD-10-CM code depends on whether there is a comorbid alcohol use disorder. Description of the Disorder: Symptoms and Diagnostic Criteria M. Recent ingestion of alcohol. N. Clinically significant problematic behavioral or psychological changes (e.g., inappropriate sexual or aggressive behavior, mood lability, impaired judgment) that developed during, or shortly after, alcohol ingestion. O. One (or more) of the following signs or symptoms developing during, or shortly after, alcohol use: 19. Slurred speech. 20. Incoordination. 21. Unsteady gait. 22. Nystagmus. 23. Impairment in attention or memory. 24. Stupor or coma. P. The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication with another substance. Hallucinogen Persisting Perception Disorder (p. 598) Diagnostic Code: C. Specify if a. With perceptual disturbances: This specifier applies in the rare instance when hallucinations (usually visual or tactile) occur with intact reality  testing, or auditory, visual, or tactile illusions occur in the absence of a delirium. Coding note: The ICD-10-CM code depends on whether or not there is a comorbid alcohol use disorder and whether or not there are perceptual disturbances For alcohol withdrawal, without perceptual disturbances: Mild alcohol use disorder is comorbid, F10.130, Moderate or severe alcohol use disorder is comorbid, F10.230 No comorbid alcohol use disorder, F10.930. For alcohol withdrawal, with perceptual disturbances: Mild alcohol use disorder is comorbid, F10.132 Moderate or severe alcohol use disorder is comorbid, F10.232 No comorbid alcohol use disorder, F10.932 Description of the Disorder: Symptoms and Diagnostic Criteria I. Cessation of (or reduction in) alcohol use that has been heavy and prolonged. J. Two (or more) of the following, developing within several hours to a few days after the cessation of (or reduction in) alcohol use described in Criterion A: 17. Autonomic hyperactivity (e.g., sweating or pulse rate greater than 100 bpm). 18. Increased hand tremor. 19. Insomnia. 20. Nausea or vomiting. 21. Transient visual, tactile, or auditory hallucinations or illusions. 22. Psychomotor agitation. 23. Anxiety. 24. Generalized tonic-clonic seizures. K. The signs or symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. L. The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication or withdrawal from another substance Inhalant Use Disorder (p. 601-602) Examples: Gasoline, acetone, nitrous oxide (“galaxy gas”), butane, amyl nitrite (other name: poppers) Diagnostic Code: M. Specify current severity/remissions: F10.10 - Mild: Presence of 2–3 symptoms. F10.11 - Mild, In early remission F10.11 - Mild, In sustained remission F10.20 - Moderate: Presence of 4–5 symptoms. F10.21 - Moderate, In early remission F10.21 - Moderate, In sustained remission F10.20 - Severe: Presence of 6 or more symptoms. F10.21 - Severe, In early remission F10.21 - Severe, In sustained remission N. Specify if: a. In early remission: no criteria (except craving) for 3-12 months b. In sustained remission: no criteria (except craving) for 12+ months O. Specify if: a. In a controlled environment: This additional specifier is used if the individual is in an environment where access to alcohol is restricted. Description of the Disorder: Symptoms and Diagnostic Criteria D. A problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12- month period: 34. Alcohol is often taken in larger amounts or over a longer period than was intended. 35. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use. 36. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects. 37. Craving, or a strong desire or urge to use alcohol. 38. Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home. 39. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.  40. Important social, occupational, or recreational activities are given up or reduced because of alcohol use. 41. Recurrent alcohol use in situations in which it is physically hazardous. 42. Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol. 43. Tolerance, as defined by either of the following: a. A need for markedly increased amounts of alcohol to achieve intoxication or desired effect. b. A markedly diminished effect with continued use of the same amount of alcohol. 44. Withdrawal, as manifested by either of the following: i. The characteristic withdrawal syndrome for alcohol (refer to Criteria A and B of the criteria set for alcohol withdrawal). j. Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms. Inhalant Intoxication (p. 605-606) Diagnostic Code: E. Specify Whether a. Mild alcohol use disorder is comorbid, F10.120 b. Moderate or severe alcohol use disorder is comorbid, F10.220 c. No comorbid alcohol use disorder, F10.920 Coding note: The ICD-10-CM code depends on whether there is a comorbid alcohol use disorder. Description of the Disorder: Symptoms and Diagnostic Criteria Q. Recent ingestion of alcohol. R. Clinically significant problematic behavioral or psychological changes (e.g., inappropriate sexual or aggressive behavior, mood lability, impaired judgment) that developed during, or shortly after, alcohol ingestion. S. One (or more) of the following signs or symptoms developing during, or shortly after, alcohol use: 25. Slurred speech. 26. Incoordination. 27. Unsteady gait. 28. Nystagmus.  29. Impairment in attention or memory. 30. Stupor or coma. T. The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication with another substance. Opioid Use Disorder (p. 608-610) Examples: Codeine, fentanyl, heroin, morphine, methadone, opium, oxycodone, Vicodin, Dilaudid, Demerol, Percocet Diagnostic Code: P. Specify current severity/remissions: F10.10 - Mild: Presence of 2–3 symptoms. F10.11 - Mild, In early remission F10.11 - Mild, In sustained remission F10.20 - Moderate: Presence of 4–5 symptoms. F10.21 - Moderate, In early remission F10.21 - Moderate, In sustained remission F10.20 - Severe: Presence of 6 or more symptoms. F10.21 - Severe, In early remission F10.21 - Severe, In sustained remission Q. Specify if: a. In early remission: no criteria (except craving) for 3-12 months b. In sustained remission: no criteria (except craving) for 12+ months R. Specify if: a. In a controlled environment: This additional specifier is used if the individual is in an environment where access to alcohol is restricted. Description of the Disorder: Symptoms and Diagnostic Criteria E. A problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-  month period: 45. Alcohol is often taken in larger amounts or over a longer period than was intended. 46. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use. 47. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects. 48. Craving, or a strong desire or urge to use alcohol. 49. Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home. 50. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol. 51. Important social, occupational, or recreational activities are given up or reduced because of alcohol use. 52. Recurrent alcohol use in situations in which it is physically hazardous. 53. Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol. 54. Tolerance, as defined by either of the following: a. A need for markedly increased amounts of alcohol to achieve intoxication or desired effect. b. A markedly diminished effect with continued use of the same amount of alcohol. 55. Withdrawal, as manifested by either of the following: k. The characteristic withdrawal syndrome for alcohol (refer to Criteria A and B of the criteria set for alcohol withdrawal). l. Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms. Opioid Intoxication (p. 615-616) Diagnostic Code: F. Specify Whether a. Mild alcohol use disorder is comorbid, F10.120 b. Moderate or severe alcohol use disorder is comorbid, F10.220 c. No comorbid alcohol use disorder, F10.920 Coding note: The ICD-10-CM code depends on whether there is a comorbid alcohol use disorder. Description of the Disorder: Symptoms and Diagnostic Criteria U. Recent ingestion of alcohol. V. Clinically significant problematic behavioral or psychological changes (e.g., inappropriate sexual or aggressive behavior, mood lability, impaired judgment) that developed during, or shortly after, alcohol ingestion. W. One (or more) of the following signs or symptoms developing during, or shortly after, alcohol use: 31. Slurred speech. 32. Incoordination. 33. Unsteady gait. 34. Nystagmus. 35. Impairment in attention or memory. 36. Stupor or coma. X. The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication with another substance. Opioid Withdrawal (p. 617-618) Diagnostic Code: D. Specify if a. With perceptual disturbances: This specifier applies in the rare instance when hallucinations (usually visual or tactile) occur with intact reality testing, or auditory, visual, or tactile illusions occur in the absence of a delirium. Coding note: The ICD-10-CM code depends on whether or not there is a comorbid alcohol use disorder and whether or not there are perceptual disturbances For alcohol withdrawal, without perceptual disturbances: Mild alcohol use disorder is comorbid, F10.130, Moderate or severe alcohol use disorder is comorbid, F10.230 No comorbid alcohol use disorder, F10.930. For alcohol withdrawal, with perceptual disturbances:  Mild alcohol use disorder is comorbid, F10.132 Moderate or severe alcohol use disorder is comorbid, F10.232 No comorbid alcohol use disorder, F10.932 Description of the Disorder: Symptoms and Diagnostic Criteria M. Cessation of (or reduction in) alcohol use that has been heavy and prolonged. N. Two (or more) of the following, developing within several hours to a few days after the cessation of (or reduction in) alcohol use described in Criterion A: 25. Autonomic hyperactivity (e.g., sweating or pulse rate greater than 100 bpm). 26. Increased hand tremor. 27. Insomnia. 28. Nausea or vomiting. 29. Transient visual, tactile, or auditory hallucinations or illusions. 30. Psychomotor agitation. 31. Anxiety. 32. Generalized tonic-clonic seizures. O. The signs or symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. P. The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication or withdrawal from another substance Sedatives, Hypnotics, or Anxiolytics Use Disorder (p. 620-621) Examples: Benzodiazepines (e.g., Librium, Valium, Xanax, Ativan, ”roofies”), barbiturates (e.g., phenobarbital), Quaaludes (other names: ludes, disco biscuits), Lunesta, Sonata, Ambien, sleeping medications Diagnostic Code: S. Specify current severity/remissions: F10.10 - Mild: Presence of 2–3 symptoms. F10.11 - Mild, In early remission F10.11 - Mild, In sustained remission F10.20 - Moderate: Presence of 4–5 symptoms. F10.21 - Moderate, In early remission F10.21 - Moderate, In sustained remission  F10.20 - Severe: Presence of 6 or more symptoms. F10.21 - Severe, In early remission F10.21 - Severe, In sustained remission T. Specify if: a. In early remission: no criteria (except craving) for 3-12 months b. In sustained remission: no criteria (except craving) for 12+ months U. Specify if: a. In a controlled environment: This additional specifier is used if the individual is in an environment where access to alcohol is restricted. Description of the Disorder: Symptoms and Diagnostic Criteria F. A problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12- month period: 56. Alcohol is often taken in larger amounts or over a longer period than was intended. 57. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use. 58. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects. 59. Craving, or a strong desire or urge to use alcohol. 60. Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home. 61. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol. 62. Important social, occupational, or recreational activities are given up or reduced because of alcohol use. 63. Recurrent alcohol use in situations in which it is physically hazardous. 64. Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol. 65. Tolerance, as defined by either of the following: a. A need for markedly increased amounts of alcohol to achieve intoxication or desired effect. b. A markedly diminished effect with continued use of the same amount of alcohol. 66. Withdrawal, as manifested by either of the following: m. The characteristic withdrawal syndrome for alcohol (refer to Criteria A and B of the criteria set for alcohol withdrawal). n. Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms. Sedative, Hypnotic, or Anxiolytic Intoxication (p. 626-627) Diagnostic Code: G. Specify Whether a. Mild alcohol use disorder is comorbid, F10.120 b. Moderate or severe alcohol use disorder is comorbid, F10.220 c. No comorbid alcohol use disorder, F10.920 Coding note: The ICD-10-CM code depends on whether there is a comorbid alcohol use disorder. Description of the Disorder: Symptoms and Diagnostic Criteria Y. Recent ingestion of alcohol. Z. Clinically significant problematic behavioral or psychological changes (e.g., inappropriate sexual or aggressive behavior, mood lability, impaired judgment) that developed during, or shortly after, alcohol ingestion. AA.One (or more) of the following signs or symptoms developing during, or shortly after, alcohol use: 37. Slurred speech. 38. Incoordination. 39. Unsteady gait. 40. Nystagmus. 41. Impairment in attention or memory. 42. Stupor or coma. BB.The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication with another substance. Sedative, Hypnotic, or Anxiolytic Withdrawal (p. 628-629) Diagnostic Code: E. Specify if a. With perceptual disturbances: This specifier applies in the rare instance when hallucinations (usually visual or tactile) occur with intact reality testing, or auditory, visual, or tactile illusions occur in the absence of a delirium. Coding note: The ICD-10-CM code depends on whether or not there is a comorbid alcohol use disorder and whether or not there are perceptual disturbances For alcohol withdrawal, without perceptual disturbances: Mild alcohol use disorder is comorbid, F10.130, Moderate or severe alcohol use disorder is comorbid, F10.230 No comorbid alcohol use disorder, F10.930. For alcohol withdrawal, with perceptual disturbances: Mild alcohol use disorder is comorbid, F10.132 Moderate or severe alcohol use disorder is comorbid, F10.232 No comorbid alcohol use disorder, F10.932 Description of the Disorder: Symptoms and Diagnostic Criteria Q. Cessation of (or reduction in) alcohol use that has been heavy and prolonged. R. Two (or more) of the following, developing within several hours to a few days after the cessation of (or reduction in) alcohol use described in Criterion A: 33. Autonomic hyperactivity (e.g., sweating or pulse rate greater than 100 bpm). 34. Increased hand tremor. 35. Insomnia. 36. Nausea or vomiting. 37. Transient visual, tactile, or auditory hallucinations or illusions. 38. Psychomotor agitation. 39. Anxiety. 40. Generalized tonic-clonic seizures. S. The signs or symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.  T. The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication or withdrawal from another substance Stimulant Use Disorder (p. 632-634) Examples: Cocaine ○ Forms: Cocaine hydrocholoride, freebase, crack ○ Other names: C, coke, crack, nose candy, snow, white lady, toot, Charlie, blow, white dust or stardust Amphetamine-Types: ○ Amphetamines (other names: goey, louee, speed, uppers, whiz) ○ Dextroamphetamine (other names: dexies, kiddie-speed, pep pills, uppers, black beauty) ○ Methamphetamine (other names: meth or crystal meth) Diagnostic Code: V. Specify current severity/remissions: F10.10 - Mild: Presence of 2–3 symptoms. F10.11 - Mild, In early remission F10.11 - Mild, In sustained remission F10.20 - Moderate: Presence of 4–5 symptoms. F10.21 - Moderate, In early remission F10.21 - Moderate, In sustained remission F10.20 - Severe: Presence of 6 or more symptoms. F10.21 - Severe, In early remission F10.21 - Severe, In sustained remission W. Specify if: a. In early remission: no criteria (except craving) for 3-12 months b. In sustained remission: no criteria (except craving) for 12+ months X. Specify if:  a. In a controlled environment: This additional specifier is used if the individual is in an environment where access to alcohol is restricted. Description of the Disorder: Symptoms and Diagnostic Criteria G. A problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12- month period: 67. Alcohol is often taken in larger amounts or over a longer period than was intended. 68. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use. 69. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects. 70. Craving, or a strong desire or urge to use alcohol. 71. Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home. 72. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol. 73. Important social, occupational, or recreational activities are given up or reduced because of alcohol use. 74. Recurrent alcohol use in situations in which it is physically hazardous. 75. Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol. 76. Tolerance, as defined by either of the following: a. A need for markedly increased amounts of alcohol to achieve intoxication or desired effect. b. A markedly diminished effect with continued use of the same amount of alcohol. 77. Withdrawal, as manifested by either of the following: o. The characteristic withdrawal syndrome for alcohol (refer to Criteria A and B of the criteria set for alcohol withdrawal). p. Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms. Stimulant Intoxication (p. 640-641) Diagnostic Code: H. Specify Whether  a. Mild alcohol use disorder is comorbid, F10.120 b. Moderate or severe alcohol use disorder is comorbid, F10.220 c. No comorbid alcohol use disorder, F10.920 Coding note: The ICD-10-CM code depends on whether there is a comorbid alcohol use disorder. Description of the Disorder: Symptoms and Diagnostic Criteria CC. Recent ingestion of alcohol. DD. Clinically significant problematic behavioral or psychological changes (e.g., inappropriate sexual or aggressive behavior, mood lability, impaired judgment) that developed during, or shortly after, alcohol ingestion. EE.One (or more) of the following signs or symptoms developing during, or shortly after, alcohol use: 43. Slurred speech. 44. Incoordination. 45. Unsteady gait. 46. Nystagmus. 47. Impairment in attention or memory. 48. Stupor or coma. FF. The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication with another substance. Stimulant Withdrawal (p. 643) Diagnostic Code: F. Specify if a. With perceptual disturbances: This specifier applies in the rare instance when hallucinations (usually visual or tactile) occur with intact reality testing, or auditory, visual, or tactile illusions occur in the absence of a delirium. Coding note: The ICD-10-CM code depends on whether or not there is a comorbid alcohol use disorder and whether or not there are perceptual disturbances For alcohol withdrawal, without perceptual disturbances: Mild alcohol use disorder is comorbid, F10.130, Moderate or severe alcohol use disorder is comorbid, F10.230 No comorbid alcohol use disorder, F10.930. For alcohol withdrawal, with perceptual disturbances: Mild alcohol use disorder is comorbid, F10.132 Moderate or severe alcohol use disorder is comorbid, F10.232 No comorbid alcohol use disorder, F10.932 Description of the Disorder: Symptoms and Diagnostic Criteria U. Cessation of (or reduction in) alcohol use that has been heavy and prolonged. V. Two (or more) of the following, developing within several hours to a few days after the cessation of (or reduction in) alcohol use described in Criterion A: 41. Autonomic hyperactivity (e.g., sweating or pulse rate greater than 100 bpm). 42. Increased hand tremor. 43. Insomnia. 44. Nausea or vomiting. 45. Transient visual, tactile, or auditory hallucinations or illusions. 46. Psychomotor agitation. 47. Anxiety. 48. Generalized tonic-clonic seizures. W. The signs or symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. X. The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication or withdrawal from another substance Tobacco Use Disorder (p. 645-646) Examples: Cigarettes, chewing tobacco, snuff, cigars, pipe, hookah, and vaping (nicotine) Diagnostic Code: Y. Specify current severity/remissions: F10.10 - Mild: Presence of 2–3 symptoms. F10.11 - Mild, In early remission F10.11 - Mild, In sustained remission F10.20 - Moderate: Presence of 4–5 symptoms.  F10.21 - Moderate, In early remission F10.21 - Moderate, In sustained remission F10.20 - Severe: Presence of 6 or more symptoms. F10.21 - Severe, In early remission F10.21 - Severe, In sustained remission Z. Specify if: a. In early remission: no criteria (except craving) for 3-12 months b. In sustained remission: no criteria (except craving) for 12+ months AA. Specify if: a. In a controlled environment: This additional specifier is used if the individual is in an environment where access to alcohol is restricted. Description of the Disorder: Symptoms and Diagnostic Criteria H. A problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12- month period: 78. Alcohol is often taken in larger amounts or over a longer period than was intended. 79. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use. 80. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects. 81. Craving, or a strong desire or urge to use alcohol. 82. Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home. 83. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol. 84. Important social, occupational, or recreational activities are given up or reduced because of alcohol use. 85. Recurrent alcohol use in situations in which it is physically hazardous. 86. Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol. 87. Tolerance, as defined by either of the following: a. A need for markedly increased amounts of alcohol to achieve intoxication or desired effect. b. A markedly diminished effect with continued use of the same amount of alcohol. 88. Withdrawal, as manifested by either of the following: q. The characteristic withdrawal syndrome for alcohol (refer to Criteria A and B of the criteria set for alcohol withdrawal).  r. Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms. Tobacco Withdrawal (p. 649-650) Diagnostic Code: G. Specify if a. With perceptual disturbances: This specifier applies in the rare instance when hallucinations (usually visual or tactile) occur with intact reality testing, or auditory, visual, or tactile illusions occur in the absence of a delirium. Coding note: The ICD-10-CM code depends on whether or not there is a comorbid alcohol use disorder and whether or not there are perceptual disturbances For alcohol withdrawal, without perceptual disturbances: Mild alcohol use disorder is comorbid, F10.130, Moderate or severe alcohol use disorder is comorbid, F10.230 No comorbid alcohol use disorder, F10.930. For alcohol withdrawal, with perceptual disturbances: Mild alcohol use disorder is comorbid, F10.132 Moderate or severe alcohol use disorder is comorbid, F10.232 No comorbid alcohol use disorder, F10.932 Description of the Disorder: Symptoms and Diagnostic Criteria Y. Cessation of (or reduction in) alcohol use that has been heavy and prolonged. Z. Two (or more) of the following, developing within several hours to a few days after the cessation of (or reduction in) alcohol use described in Criterion A: 49. Autonomic hyperactivity (e.g., sweating or pulse rate greater than 100 bpm). 50. Increased hand tremor. 51. Insomnia. 52. Nausea or vomiting. 53. Transient visual, tactile, or auditory hallucinations or illusions. 54. Psychomotor agitation. 55. Anxiety.  56. Generalized tonic-clonic seizures. AA.The signs or symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. BB.The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication or withdrawal from another substance. Gambling Disorder (p. 661) Diagnostic Code: H. Specify if a. With perceptual disturbances: This specifier applies in the rare instance when hallucinations (usually visual or tactile) occur with intact reality testing, or auditory, visual, or tactile illusions occur in the absence of a delirium. Coding note: The ICD-10-CM code depends on whether or not there is a comorbid alcohol use disorder and whether or not there are perceptual disturbances For alcohol withdrawal, without perceptual disturbances: Mild alcohol use disorder is comorbid, F10.130, Moderate or severe alcohol use disorder is comorbid, F10.230 No comorbid alcohol use disorder, F10.930. For alcohol withdrawal, with perceptual disturbances: Mild alcohol use disorder is comorbid, F10.132 Moderate or severe alcohol use disorder is comorbid, F10.232 No comorbid alcohol use disorder, F10.932 Description of the Disorder: Symptoms and Diagnostic Criteria CC. Cessation of (or reduction in) alcohol use that has been heavy and prolonged. DD. Two (or more) of the following, developing within several hours to a few days after the cessation of (or reduction in) alcohol use described in Criterion A: 57. Autonomic hyperactivity (e.g., sweating or pulse rate greater than 100 bpm). 58. Increased hand tremor. 59. Insomnia. 60. Nausea or vomiting. 61. Transient visual, tactile, or auditory hallucinations or illusions. 62. Psychomotor agitation. 63. Anxiety.