DSM criteria

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criteria for major depressive episode: CRITERIA FOR MAJOR DEPRESSIVE EPISODE

A. 5+ of the following symptoms present during the same 2-week period and represent a change from previous functioning;
at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure

1. depressed mood most of the day
2. markedly diminished interested or
pleasure in all or almost all activities most of the day
3. change in weight/appetite
4. insomnia or hypersomnia
5. psychomotor agitation or retardation
6. fatigue/loss of energy
7. feelings of worthlessness or guilt
8. diminished ability to think /
concentrate
9. recurrent thoughts of death/suicidal
ideation

B. Symptoms do not meet criteria for mixed episode

C. Clinically significant distress/impairment in social, occupational, other important areas

D. Not due to a substance or general medical condition

E. Symptoms not better accounted for by bereavement
criteria for mixed episode: CRITERIA FOR MIXED EPISODE

A. Criteria for both manic and major depressive episodes met nearly every day during at least a one week period.

B. Mood disturbance severe enough to cause marked impairment, or to necessitate hospitalization, or with psychotic features

C. Symptoms not due to substance use, or general medical condition.
criteria for manic episode: CRITERIA FOR MANIC EPISODE

A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting 1 week (or any duration if hospitalized)

B. 3 + symptoms during period of mood disturbance (four if irritable) and present to a significant degree

1. inflated self-esteem, grandiosity
2. decreased need for sleep
3. more talkative, feels need to talk
4. flight of ideas, thoughts racing
5. distractibility
6. inc. in goal directed activity, psychomotor agitation
7. excessive involvement in activities that have high potential for painful consequences

C. Symptoms do not meet Mixed Episode criteria

D. Severe enough to cause impairment

E. Not due to substance use, or medical condition
criteria for hypomanic episode: CRITERIA FOR HYPOMANIC EPISODE

A. Distinct period of persistently elevated, expansive, irritable mood, lasting 4 days, different from usual nondepressed mood.

B. 3 + Symptoms during period of mood

1. inflated self-esteem, grandiosity
2. decreased need for sleep
3. more talkative, feels need to talk
4. flight of ideas, thoughts racing
5. distractibility
6. inc. in goal directed activity, psychomotor agitation
7. excessive involvement in activities
that have high potential for painful consequences

C. Episode is associated with unequivocal change in functioning that is uncharacteristic

D. Disturbance in mood/change in function observable by others

E. No psychotic features, no marked impairment

F. Symptoms not due to substance, general medical condition
criteria for MDD, single episode (296.2x): DIAGNOSTIC CRITERIA FOR 296.2X MAJOR DEPRESSIVE DISORDER, SINGLE EPISODE

A. Presence of single Major Depressive Episode

B. Not better accounted for by schizoaffective, not superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or psychotic disorder NOS

C. Never been a manic episode, mixed episode, hypomanic episode.

Specify
§ Mild, moderate, severe w/o psychotic features
§ Severe w/ psychotic features
§ Chronic
§ With Catatonic Features
§ With melancholic features
§ With atypical features
§ With postpartum onset
criteria for MDD, recurrent (296.3): DIAGNOSTIC CRITERIA FOR 296.3 MAJOR DEPRESSIVE DISORDER, RECURRENT

A. Presence of 2+ major depressive episodes

B. Not better accounted for by schizoaffective, not superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or psychotic disorder NOS

C. Never been a manic episode, mixed episode, hypomanic episode.

Specify
§ Mild, moderate, severe w/o psychotic features
§ Severe w/ psychotic features
§ Chronic
§ With Catatonic Features
§ With melancholic features
§ With atypical features
§ With postpartum onset
criteria for dysthymic disorder (300.4): DIAGNOSTIC CRITERIA FOR 300.4
DYSTHYMIC DISORDER

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

B. Presence, while depressed of 2+ of following:

1. poor appetite or overeating
2. insomnia, hypersomnia
3. low energy, fatigue
4. low self-esteem
5. poor concentration, difficulty making
decisions
6. feelings of hopelessness

C. During the 2 year period of the disturbance, the person has ever been without the symptoms in A and B for more than 2 months at a time

D. No major depressive episode has been present during the first 2 years of the disturbance

E. There has never been a manic, mixed, or hypomanic episode

F. Disturbance does not occur exclusively during the course of a chronic psychotic disorder

G. Not due to substance, general medical condition

H. Symptoms cause clinically significant distress/impairment
criteria for bipolar I disorder, single manic episode (296.0X): DIAGNOSTIC CRITERIA FOR 296.0X BIPOLAR I DISORDER, SINGLE MANIC EPISODE

A. Presence of only one manic episode and not past major depressive episodes

B. Manic episode not better accounted for by schizoaffective, not superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or psychotic disorder NOS

Specify
§ Mixed
§ Mild, moderate, severe w/o psychotic features
§ Severe w/ psychotic features
§ With Catatonic Features
§ With postpartum onset
criteria for bipolar II disorder (296.89): DIAGNOSTIC CRITERIA FOR 296.89 BIPOLAR II DISORDER

A. Presence or history of 1+ major depressive episodes

B. Presence or history of at least one hypomanic episode

C. No manic/mixed episode

D. Not better accounted for by schizoaffective, not superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or psychotic disorder NOS

E. Clinically significant distress/impairment in social, occupational, or other areas of functioning
criteria for cyclothymic disorder (301.13): DIAGNOSTIC CRITERIA FOR 301.13 CYCLOTHYMIC DISORDER

A. For at least 2 years, the presence of numerous periods with hypomanic symptoms and numerous periods with depressive symptoms that do not meet criteria for a Major Depressive Episode

B. During the above 2 year period the person has not been without the symptoms in A for more than 2 months at a time

C. No major depressive, manic, mixed episode in first two years of disturbance

D. Not better accounted for by schizoaffective, not superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or psychotic disorder NOS

E. Not due to substance, general medical condition

F. Symptoms cause significant distress/impairment
criteria for panic attack: CRITERIA FOR PANIC ATTACK

A panic attack is not a codable disorder. Code the specific diagnosis in which panic attack occurs.

A discrete period of intense fear or discomfort, in which 4+ of the following symptoms developed abruptly and reached a peak w/in ten minutes.

1. Palpitations, pounding heart,
accelerated heart rate
2. Sweating
3. Trembling or shaking
4. Sensations of shortness of breath or
smothering
5. Feeling of choking
6. Chest pain or discomfort
7. Nausea or abdominal distress
8. Feeling dizzy, unsteady, lightheaded, faint
9. Derealization or depersonalization
10. Fear of losing control or going crazy
11. Fear of dying
12. Paresthesias
13. Chills or hot flashes
criteria for agoraphobia: CRITERIA FOR AGORAPHOBIA

Agoraphobia is not a codable disorder
Code the specific diagnosis in which the agoraphobia occurs.

A. Anxiety about being in places or situations from which escape might be difficult or in which help may not be available in the event of having an unexpected or situationally predisposed panic attack or panic disorders. Agoraphobic fears typically involve characteristic clusters of situations that include being outside the home alone; being in a crowd or standing in a line; being on a bridge; and traveling in a bus, train, automobile.

B. the situations are avoided, or else are endured with marked distress or with anxiety about having a panic attack or panic-like symptoms, or require the presence of a companion.

C. The anxiety or phobic avoidance is not better accounted for by another mental disorder, such as social phobia, specific phobia, obsessive compulsive disorder, PTSD
criteria for panic disorder without agoraphobia (300.01): DIAGNOSTIC CRITERIA FOR 300.01 PANIC DISORDER WITHOUT AGORAPHOBIA

A. Both (1) and (2):

1. Recurrent, unexpected Panic Attacks
2. At least one of the attacks has been followed by 1+ month of 1+ of the following:
§ Persistent concern about additional attacks
§ Worry about implications of attack or its consequences
§ A significant change in behavior related to attack

B. Absence of agoraphobia

C. Panic attacks are not due to substance or general medical condition

D. Panic attacks are not better accounted for by another mental disorder.
criteria for panic disorder with agoraphobia (300.21): DIAGNOSTIC CRITERIA FOR 300.21 PANIC DISORDER WITH AGORAPHOBIA

E. A Both (1) and (2):

1. Recurrent, unexpected Panic Attacks
2. At least one of the attacks has been followed by 1+ month of 1+ of the following:
§ Persistent concern about additional attacks
§ Worry about implications of attack or its consequences
§ A significant change in behavior related to attack

F. Presence of agoraphobia

G. Panic attacks are not due to substance or general medical condition

Panic attacks are not better accounted for by another mental disorder.
criteria for agoraphobia without history of panic disorder (300.22): DIAGNOSTIC CRITERIA FOR 300.22 AGORAPHOBIA WITHOUT HISTORY OF PANIC DISORDER

A. The presence of agoraphobia related to the fear of developing panic-like symptoms.

B. Criteria have never been met for panic disorder

C. The disturbance is not due to a substance or general medical disorder

D. If associated general medical condition is present, fear described in A is clearly in excess of that usually associated with the condition.
criteria for specific phobia (300.29): DIAGNOSTIC CRITERIA FOR 300.29 SPECIFIC PHOBIA

A. Marked and persistent fear that is excessive or unreasonable cued by the presence or anticipation of a specific object or situation.

B. Exposure to the phobic stimulus almost invariable provokes an immediate anxiety response that may take the form of a situationally bound or situationally predisposed panic attack

C. Person recognizes that the fear is excessive or unreasonable

D. Phobic situation is avoided or else endured with intense anxiety or distress

E. Avoidance, anxious anticipation, or distress in the feared situation interferes significantly with the personâ€™s normal routine, or there is marked distress about the phobia

F. In individuals under age 18 years, the duration is at least 6 months.
criteria for social phobia (300.23) (aka social anxiety disorder): DIAGNOSTIC CRITERIA FOR 300.23 SOCIAL PHOBIA

A. A marked and persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears he/she will act in a way that will be humiliating or embarrassing.

B. Exposure to the feared social situation almost invariably provokes anxiety, which may take the form of a situationally bound or situationally predisposed panic attack

C. The person recognizes that the fear is excessive or unreasonable.

D. The feared social or performance situations are avoided or else endured with intense anxiety or distress.

E. The avoidance, anxious anticipation or distress interferes significantly with the personâ€™s normal routine

F. In individuals under 18 duration is 16+ months

G. The fear of avoidance is not due to substance or general medical condition or better accounted for by another mental disorder

H. If a general medical condition is present, the fear in A is unrelated to it.
criteria for obsessions: Obsessions as defined by 1,2,3, and 4:

1. recurrent and persistent thoughts, impulses
or images that are experienced at some time during the disturbance as intrusive and inappropriate and that cause marked anxiety or distress

2. thoughts, impulses or images are not simply excessive worries about real life problems.

3. person attempts to ignore or suppress such thoughts, impulses, or images or to neutralize them with some other thought or action

4. the person recognizes that the thoughts, etc are a product of his/her own mind
criteria for compulsions: Compulsions as defined by 1 and 2:

1. repetitive behaviors or mental acts that the person feels driven to perform I response to an obsession, or according to rigid rules
2. behaviors/mental acts are aimed at preventing/reducing distress or preventing some dreaded event or situation. However, these behaviors either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive
criteria for OCD (300.3): DIAGNOSTIC CRITERIA FOR 300.3 OBSESSIVE-COMPULSIVE DISORDER

A. Either obsessions or compulsions

B. At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable

C. The obsessions or compulsions cause marked distress, are time consuming, or significantly interfere with the personâ€™s normal routine

D. If another Axis I disorder is present, the content of the obsessions or compulsions is not restricted to it

E. The disturbance is not due to the direct physiological effects of a substance or general medical condition.
criteria for PTSD (309.81): DIAGNOSTIC CRITERIA FOR 309.81 PTSD

A. Person has been exposed to a traumatic event in which both of the following were present:

1. person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others
2. the personâ€™s response involved intense fear, helplessness or horror

B. The traumatic event is persistently reexperienced in 1+ of the following ways

1. recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions
2. recurrent distressing dreams o the event
3. acting or feeling as if the traumatic event were recurring
4. intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
5. physiological reactivity on exposure to internal/external cues that symbolize or resemble an aspect of the traumatic event

C. persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness

D. Persistent symptoms of increased arousal (not present before the trauma)

E. Duration of the disturbance is more than 1 month

F. Disturbance causes clinically significant distress or impairment

Acute: less than 3 months
Chronic: 3+ months duration
criteria for GAD (300.02): DIAGNOSTIC CRITERIA FOR 300.02 GENERALIZED ANXIETY DISORDER

A. excessive anxiety and worry, occurring more days than not for at least 6 months, about a number of events or anxieties

B. Person finds it difficult to control worry

C. Anxiety and worry assoc with 3+ of the following symptoms, with at least some symptoms present more days than not for the past 6 months

1. restlessness or feeling keyed up, on edge
2. being easily fatigued
3. difficulty concentrating or mind going blank
4. irritability
5. muscle tension
6. sleep disturbance

D. focus of anxiety/worry is not confined to features of an Axis 1 disorder, being contaminated, being away from home, gaining weight, having multiple physical complaints, having a serious illness, or PTSD

E. anxiety, worry, physical symptoms cause clinically significant distress

F. Disturbance not due to substance, general medical condition, does not occur exclusively during mood or psychotic disorder or PDD

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