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Diagnosing: Use this abridged version of the DSM-5 to make your
diagnoses. For each criterion, note the specific symptom the person
described in the case study has that meets that criterion. For criteria that do
not apply, write N/A. (See the sample at the end of this document for how to
complete this portion.) Finally, delete all of the disorders that you are not
doing. Email me the document with the subject heading “Period [x]
Diagnoses” when you are done.
Skits/Discussion: You will also be using this document for the discussion
portion of your presentations. After each criterion, indicate how that criterion
was included in your skit (just like you did with the diagnosis forms). For
criteria that do not apply, write N/A. You will be projecting this document
after each skit, so make sure it is presentation-worthy (e.g., no spelling
errors, formatting is neat, etc.). Also, be sure you understand what each
criterion means and how to pronounce all words. Email me the document
with the subject heading “Period [x] Discussion” when you are done.
Autism Spectrum Disorder
A. Persistent deficits in social communication and social interaction across multiple contexts, as
manifested by the following:
1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach
and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or
affect; to failure to initiate or respond to social interactions.
2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for
example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye
contact and body language, or deficits in understanding and use of gestures; to total lack of
facial expression and nonverbal communication.
3. Deficits in developing, maintaining, and understanding relationships, ranging, for example,
from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing
imaginative play or in making friends; to absence of interest in peers.
B. Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least
two of the following:
1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor
stereotypes, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or
nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid
thinking patterns, greeting rituals, need to take same route or eat same food every day).
3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong
attachment to or preoccupation with unusual objects, excessively circumscribed or
perseverated interests).
4. Hyper-or hyporeactivity to sensory input or unusual interest in sensory aspects of environment
(e.g., apparent indifference to pain/temperature, adverse response to specific sounds or
textures, excessive smelling or touching of objects, visual fascination with lights or movement).
C. Symptoms must be present in the early developmental period.
D. Symptoms cause clinically significant impairment in social, occupational, or other important areas
of functioning.
Attention-Deficit/Hyperactivity Disorder
A. A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or
development, as characterized by (1) and/or (2):
Inattention: Six (or more) of the following symptoms have persisted for at least 6 months to a
degree that is inconsistent with developmental level and that negatively impacts directly on social
and academic/occupational activities:
a. Often fails to give close attention to details or makes careless mistakes in schoolwork, at work,
or during other activities (e.g., overlooks or misses details, work is inaccurate).
b. Often has trouble holding attention in tasks or play activities (e.g., has difficulty remaining
focused during lectures, conversations, or lengthy readings).
c. Often does not seem to listen when spoken to directly.
d. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in
the workplace (e.g., starts tasks but quickly loses focus and is easily sidetracked).
e. Often has trouble organizing tasks and activities (e.g, difficulty managing sequential tasks,
difficulty keeping materials and belongings in order, messy and disorganized work, poor time
management, fails to meet deadlines).
f. Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of
time (e.g., schoolwork, homework, preparing reports, completing forms, reviewing lengthy
papers).
g. Often loses things necessary for tasks and activities (e.g., school materials, pencils, books,
tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
h. Is often easily distracted.
i. Is often forgetful in daily activities (e.g., doing chores, running errands, returning calls, paying
bills, keeping appointments).
Hyperactivity and Impulsivity: Six (or more) of the following symptoms have persisted for at
least 6 months to a degree that is inconsistent with developmental level and that negatively
impacts directly on social and academic/occupational activities:
a.
b.
c.
d.
e.
f.
g.
h.
i.
Often fidgets with or taps hands or feet, or squirms in seat.
Often leaves seat in situations when remaining seated is expected.
Often runs about or climbs in situations where it is not appropriate.
Often unable to play or take part in leisure activities quietly.
Is often "on the go," acting as if "driven by a motor.”
Often talks excessively.
Often blurts out an answer before a question has been completed.
Often has trouble waiting his or her turn.
Often interrupts or intrudes on others (e.g., butts into conversations or games).
B. Several inattentive or hyperactive-impulsive symptoms were present before age 12 years.
C. Several symptoms are present in two or more setting, (e.g., at home, school or work, with friends
or relatives, in other activities).
D. There is clear evidence that the symptoms interfere with, or reduce the quality of, social,
academic, or occupational functioning.
Tourette’s Disorder
A. Both multiple motor and one or more verbal vocal tics have been present at some time during the
illness, although not necessarily concurrently.
B. The tics may wax and wane in frequency but have persisted for more than one year since first tic
onset.
C. Onset is before age 18 years.
Delusional Disorder
A. The presence of one (or more) delusions with a duration of 1 month or longer.
C. Apart from the impact of the delusion(s) or its ramifications, functioning is not markedly impaired,
and behavior is not obviously bizarre or odd.
Schizophrenia
A. Two (or more) of the following, each present for a significant portion of time during a 1-month
period (or less if successfully treated). At least one of these must be (1), (2), or (3):
1.
2.
3.
4.
5.
Delusions.
Hallucinations.
Disorganized speech (e.g., frequent derailment or incoherence).
Grossly disorganized or catatonic behavior.
Negative symptoms (i.e., diminished emotional expression or avolition).
B. For a significant portion of the time since the onset of the disturbance, level of functioning in one
or more major areas, such as work, interpersonal relations, or self-care, is markedly below the
level achieved prior to the onset.
C. Continuous signs of the disturbance persist for at least 6 months.
Bipolar I Disorder
A. Criteria have been met for at least one manic episode.
Manic Episode
A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and
abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and
present most of the day, nearly every day.
B. During the period of mood disturbance and increased energy and activity, three (or more) of the
following symptoms have persisted (four if the mood is only irritable), represent a noticeable
change from usual behavior, and have been present to significant degree:
1.
2.
3.
4.
5.
Inflated self-esteem or grandiosity.
Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).
More talkative then usual or pressure to keep talking.
Flight of ideas or subjective experience that thoughts are racing.
Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as
reported or observed.
6. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor
agitation.
7. Excessive involvement in activities that have a high potential for painful consequences (e.g.,
engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).
C. The episode is sufficiently severe to cause marked impairment in social or occupational
functioning or to necessitate hospitalization to prevent harm to self or others, or there are
psychotic features.
Bipolar II Disorder
A. Criteria have been met for at least one hypomanic episode and at least one major depressive
episode.
B. There has never been a manic episode.
C. The symptoms of depression or the unpredictability caused by frequent alternation between
periods of depression and hypomania causes clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
Hypomanic Episode
A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and
abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and
present most of the day, nearly every day.
B. During the period of mood disturbance and increased energy and activity, three (or more) of the
following symptoms have persisted (four if the mood is only irritable), represent a noticeable
change from usual behavior, and have been present to significant degree:
1.
2.
3.
4.
5.
Inflated self-esteem or grandiosity.
Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).
More talkative then usual or pressure to keep talking.
Flight of ideas or subjective experience that thoughts are racing.
Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as
reported or observed.
6. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor
agitation.
7. Excessive involvement in activities that have a high potential for painful consequences (e.g.,
engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).
C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the
individual when not symptomatic.
D. The disturbance in mood and the change in functioning are observable by others.
E. The episode is not severe enough to cause marked impairment in social or occupational functioning or to
necessitate hospitalization. If there are psychotic features, the episode is, by definition, manic.
Major Depressive Episode
A. Five (or more) of the following symptoms have been 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, nearly every day, as indicated by either subjective report
(e.g., feels sad, empty, or hopeless) or observation made by others (e.g., appears tearful).
(Note: In children and adolescents, can be irritable mood.)
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly
every day.
3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of
body weight in a month), or decrease or increase in appetite nearly every day. (Note: In
children, consider failure to make expected weight gain.)
4. Insomnia or hypersomnia nearly every day.
5. Psychomotor agitation or retardation nearly every day.
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly
every day (not merely self-reproach or guilt about being sick).
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day.
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a
specific plan, a suicide attempt, or a specific plan for committing suicide.
B. The symptoms cause clinically significant distress or impairment in social, occupational, or other
important areas of functioning.
Cyclothymic Disorder
A. For at least 2 years (at least 1 year in children and adolescents), there have been numerous
periods with hypomanic symptoms that do not meet criteria for a hypomanic episode and
numerous periods with depressive symptoms that do not meet the criteria for a major depressive
episode. [see criteria for hypomania and depression under Bipolar II]
B. During the above 2-year period (1 year in children and adolescents), the hypomanic and
depressive periods have been present for at least half the time and the individual has not been
without the symptoms for more than 2 months at a time.
C. Criteria for major depressive, manic, or hypomanic episode have never been met.
Premenstrual Dysphoric Disorder
A. In the majority of menstrual cycles, at least five symptoms must be present in the final week
before the onset of menses, start to improve within a few days after the onset of menses, and
become minimal or absent in the week postmenses.
B. One (or more) of the following symptoms must be present:
1. Marked affective liability (e.g., mood swings; feeling suddenly sad or tearful, or increased
sensitivity to rejection).
2. Marked irritability or anger or increased interpersonal conflicts.
3. Marked depressed mood, feelings or hopelessness, or self-deprecating thoughts.
4. Marked anxiety, tension, and/or feelings of being keyed up or on edge.
C. One (or more) of the following symptoms must additionally be present, to reach a total of five
symptoms when combined with symptoms from Criterion B above.
1.
2.
3.
4.
5.
6.
7.
Decreased interest in usual activities (e.g., work, school, friends, or hobbies).
Subjective difficulty in concentration.
Lethargy, easy fatigability, or marked lack of energy.
Marked change in appetite; overeating; or specific food cravings.
Hypersomnia or insomnia.
A sense of being overwhelmed or out of control.
Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a physical
sensation of “bloating”, or weight gain.
D. The symptoms are associated with clinically significant distress or interference with work, school,
usual social activities, or relationships with others (e.g., avoidance of social activities; decreased
productivity and efficiency at work, school, or home).
Specific Phobia
A. Marked fear or anxiety about a specific object or situation (e.g., flying, heights, animals, receiving
an injection, seeing blood).
B. The phobic object or situation almost always provokes immediate fear or anxiety.
C. The phobic object or situation in actively avoided or endured with intense fear or anxiety.
D. The fear or anxiety is out of proportion to the actual danger posed by the specific object or
situation and to the sociocultural context.
E. The fear, anxiety or avoidance is persistent, typically lasting for six months or more.
F. The fear, anxiety or avoidance causes clinically significant distress or impairment in social,
occupational, or other important areas or functioning.
Social Anxiety Disorder (Social Phobia)
A. Marked fear or anxiety about one or more social situations in which the individual is exposed to
possible scrutiny by others. Examples include social interactions (e.g. having a conversation,
meeting unfamiliar people), being observed (e.g. eating or drinking), and performing in front of
others (e.g. giving a speech).
Note: In children, the anxiety must occur in peer settings and not just during interactions with
adults.
B. The individual fears that he or she will act in a way or show anxiety symptoms that will be
negatively evaluated (i.e. will be humiliating or embarrassing; will lead to rejection or offend
others).
C. The social situations almost always provoke fear or anxiety.
Note: In children, the fear of anxiety may be expressed by crying, tantrums, freezing, clinging,
shrinking, or failing to speak in social situations.
D. The social situations are avoided or endured with intense fear or anxiety
E. The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the
sociocultural context
F. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.
G. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
Panic Disorder
A. Recurrent unexpected panic attacks. A panic attack is an abrupt surge of intense fear or intense
discomfort that reaches a peak within minutes, and during which time four (or more) of the
following symptoms occur:
1. Palpitations, pounding heart, or accelerated heart rate.
2. Sweating.
3. Trembling or shaking.
4. Sensations of shortness of breath or smothering.
5. Feelings of choking.
6. Chest pain or discomfort.
7. Nausea or abdominal distress.
8. Feeling dizzy, unsteady, light-headed, or faint.
9. Chills or heat sensations.
10. Paresthesias (numbness or tingling sensations).
11. Derealization (feelings of unreality) or depersonalization (being detached from one-self).
12. Fear of losing control or “going crazy.”
13. Fear of dying.
B. At least one of the attacks has been followed by 1 month (or more) of one or both of the following:
1. Persistent concern or worry about additional panic attacks or their consequences (e.g., losing
control, having a heart attack, “going crazy”).
2. A significant maladaptive change in behavior related to the attacks (e.g., behaviors designed to
avoid having panic attacks, such as avoidance of exercise or unfamiliar situations).
Generalized Anxiety Disorder
A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least
6 months, about a number of events or activities (such as work or school performance).
B. The individual finds it difficult to control the worry.
C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at
least some symptoms having been present for more days than not for the past 6 months):
Note: Only one item is required in children.
1.
2.
3.
4.
5.
6.
Restlessness or feeling keyed up or on edge.
Being easily fatigued.
Difficulty concentrating or mind going blank.
Irritability.
Muscle tension.
Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).
D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in
social, occupational, or other important areas of functioning.
Obsessive-Compulsive Disorder
A. Presence of obsessions, compulsions, or both:
Obsessions are defined by (1) and (2):
1. Recurrent and persistent thoughts, urges, or images that are experienced, at some time
during the disturbance, as intrusive and unwanted and that in most individuals cause
marked anxiety or distress.
2. The individual attempts to ignore or suppress such thoughts, urges, or images, or to
neutralize them with some other thought or action (by performing a compulsion).
Compulsions are defined by (1) and (2):
1. Repetitive behavior (e.g., hand washing, ordering, checking) or mental acts (e.g., praying,
counting, repeating words silently) that the individual feels driven to perform in response to
an obsession or according to rules that must be applied rigidly.
2. The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or
preventing some dreaded event or situation; however, these behaviors or mental acts are
not connected in a realistic way with what they are designed to neutralize or prevent, or are
clearly excessive.
Note: Young children may not be able to articulate the aims of these behaviors or mental
acts
B. The obsessions or compulsions are time-consuming (take more than 1 hour per say) or
caused clinically significant distress or impairments in social, occupational, or other important
areas of functioning.
Hoarding Disorder
A. Persistent difficulty discarding or parting with possessions, regardless of their actual value.
B. This difficulty is due to a perceived need to save the items and to distress associated with
discarding them.
C. The difficulty discarding possessions results in the accumulation of possessions that congest and
clutter active living areas and substantially compromises their intended use. If living areas are
uncluttered, it is only because of the interventions of third parties (e.g. family members, cleaners,
authorities).
D. The hoarding causes clinically significant distress or impairment in social, occupational, or other
important areas of functioning (including maintaining a safe environment for self and others).
Trichotillomania (Hair-Pulling Disorder)
A. Recurrent pulling out of one’s hair, resulting in hair loss.
B. Repeated attempts to decrease or stop hair pulling.
C. The hair pulling causes clinically significant distress or impairment in social, occupational, or other
important areas of functioning.
Excoriation (Skin-Picking Disorder)
A. Recurrent skin picking resulting in skin lesions.
B. Repeated attempts to decrease or stop skin picking.
C. The skin picking causes clinically significant distress or impairment in social, occupational, or
other important areas of functioning.
Disinhibited Social Engagement Disorder
A. A pattern of behavior in which a child actively approaches and interacts with unfamiliar adults and
exhibits at least two of the following:
1. Reduced or absent reticence in approaching and interacting with unfamiliar adults.
2. Overly familiar verbal or physical behavior (that is not consistent with culturally sanctioned and
with age-appropriate social boundaries).
3. Diminished or absent checking back with adult caregiver after venturing away, even in
unfamiliar settings.
4. Willingness to go off with an unfamiliar adult with minimal or no hesitation.
B. The behaviors in Criterion A are not limited to impulsivity (as in attention-deficit/hyperactivity
disorder) but include socially disinhibited behavior.
C. The child has experienced a pattern of extremes of insufficient care as evidenced by at least one
of the following:
1. Social neglect or deprivation in the form of persistent lack of having basic emotional needs for
comfort, stimulation, and affection met by caregiving adults.
2. Repeated changes of primary caregivers that limit opportunities to form stable attachments
(e.g., frequent changes in foster care).
3. Rearing in unusual settings that severely limit opportunities to form selective attachments (e.g.,
institutions with high child-to-caregiver ratios).
D. The care in Criterion C is presumed to be responsible for the disturbed behavior in Criterion A
(e.g., the disturbances in Criterion A began following the pathogenic care in Criterion C).
E. The child has a developmental age of at least 9 months.
Posttraumatic Stress Disorder
A. Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the
following ways:
1. Directly experiencing the traumatic event(s).
2. Witnessing, in person, the event(s) as it occurred to others.
3. Learning that the traumatic event(s) occurred to a close relative or close friend.
4. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s).
Note: Criterion A4 does not apply through exposure through electronic media, television,
movies, or pictures, unless this exposure is work-related.
B. Intrusion symptoms (1 or more)
1. Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s).
2. Recurrent, distressing dreams in which the content and/or affect of the dream are related to
the traumatic event(s).
3. Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic
event(s) were recurring.
4. Psychological distress at exposure to reminders of the traumatic event(s).
5. Marked physiologic reactions to exposure to reminders of the traumatic event(s).
C. Avoidance (1 or more)
1. Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely
associated with the traumatic event(s).
2. Avoidance of or efforts to avoid external reminders that arouse distressing memories,
thoughts, or feelings about or closely associated with the traumatic event(s).
D. Negative alterations in cognitions and mood (2 or more)
1. Inability to remember an important aspect of the traumatic event(s).
2. Persistent and exaggerated negative beliefs and expectations about oneself, others, or the
world.
3. Persistent distorted blame of self or others for causing the traumatic event or for resulting
consequences.
4. Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).
5. Markedly diminished interest or participation in significant activities.
6. Feeling alienated from others.
7. Persistent inability to experience positive emotions.
E. Alterations in arousal and reactivity (2 or more)
1. Irritable behavior and angry outbursts.
2. Self-destructive or reckless behavior.
3. Hypervigilance.
4. Exaggerated startle response.
5. Problems with concentration.
6. Sleep disturbance.
F. Duration of the disturbance is more than 1 month.
G. The disturbance causes clinically significant distress or impairment in social, occupational, or
other important areas of functioning.
Acute Stress Disorder
A. Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the
following ways:
1. Directly experiencing the traumatic event(s).
2. Witnessing, in person, the event(s) as it occurred to others.
3. Learning that the traumatic event(s) occurred to a close relative or close friend.
4. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s).
Note: This does not apply through exposure through electronic media, television, movies, or
pictures, unless this exposure is work-related.
B. Presence of nine (or more) of the following symptoms from any of the following five categories:
Intrusion symptoms
1. Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s).
2. Recurrent, distressing dreams in which the content and/or affect of the dream are related to
the traumatic event(s).
3. Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic
event(s) were recurring.
4. Psychological distress or marked physiologic reactions to exposure to reminders of the
traumatic event(s).
Negative Mood
5. Persistent inability to experience positive emotions.
Dissociative Symptoms
6. An altered sense of the reality of one’s surroundings or oneself.
7. Inability to remember an important aspect of the traumatic event(s).
Avoidance Symptoms
8. Efforts to avoid distressing memories, thoughts, or feelings about or closely associated with
the traumatic event(s).
9. Efforts to avoid external reminders that arouse distressing memories, thoughts, or feelings
about or closely associated with the traumatic event(s).
Arousal Symptoms
10. Sleep disturbance.
11. Irritable behavior and angry outbursts.
12. Hypervigilance.
13. Problems with concentration.
14. Exaggerated startle response.
C. Duration of the disturbance is 3 days to 1 month after trauma exposure
D. The disturbance causes clinically significant distress or impairment in social, occupational, or
other important areas of functioning.
Depersonalization/Derealization Disorder
A. The presence of persistent or recurrent experiences of depersonalization, derealization, or both:
1. Depersonalization: Experiences of unreality, detachment, or being an outside observer with
respect to one’s thoughts, feelings, sensations, body, or actions. (e.g., perceptual alterations,
distorted sense of time, unreal or absent self, emotional and/or physical numbing)
2. Derealization: Experiences of unreality or detachment with respect to surroundings (e.g.,
individuals or objects are experienced as unreal, dreamlike, foggy, lifeless, or visually
distorted).
B. During the depersonalization or derealization experiences, reality testing remains intact.
C. The symptoms cause clinically significant distress or impairment in social, occupational, or other
important areas of functioning.
Somatic Symptom Disorder
A. One or more somatic symptoms that are distressing or result in significant disruption of daily life.
B. Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health
concerns as manifested by at least one of the following:
1. Disproportionate and persistent thoughts about the seriousness of one’s symptoms.
2. Persistently high level of anxiety about health or symptoms.
3. Excessive time and energy devoted to these symptoms or health concerns.
C. Although any one somatic symptom may not be continuously present, the state of being
symptomatic is persistent (typically more than 6 months)
Illness Anxiety Disorder
A. Preoccupation with having or acquiring a serious illness.
B. Somatic symptoms are not present or, if present, are only mild in intensity. If another medical
condition is present or there is a high risk for developing a medical condition (e.g., strong family
history is present) the preoccupation is clearly excessive or disproportionate.
C. There is a high level of anxiety about health, and the individual is easily alarmed about personal
health status.
D. The individual performs excessive health related behaviors (e.g., repeatedly checks his or her
body for signs of illness) or exhibits maladaptive avoidance (e.g., avoids doctor appointments or
hospitals)
E. Illness preoccupation has been present for at least 6 months, but the specific illness that is feared
may change over that period of time.
Factitious Disorder
A. Falsification of physical or psychological signs or symptoms, or induction of injury or disease,
associated with identified deception.
B. The individual presents himself or herself to others as ill, impaired, or injured.
C. The deceptive behavior is evident even in the absence of obvious external rewards.
Gender Dysphoria (in children)
A. A marked incongruence between one’s experienced/expressed gender and assigned gender, of at
least 6 months’ duration, as manifested by at least six of the following (one of which must be
Criterion A1):
1. A strong desire to be of the other gender or an insistence that one is the other gender (or some
alternative gender different from one’s assigned gender).
2. In boys, a strong preference for cross-dressing or simulating female attire; or in girls, a strong
preference for wearing only typical masculine clothing and a strong resistance to the wearing
of typical feminine clothing.
3. A strong preference for cross-gender roles in make-believe play or fantasy play.
4. A strong preference for the toys, games, or activities stereotypically used or engaged in by the
other gender.
5. A strong preference for playmates of the other gender.
6. In boys, a strong rejection of typically masculine toys, games, and activities and a strong
avoidance of rough-and-tumble play; or in girls, a strong rejection of typically feminine toys,
games, and activities.
7. A strong dislike of one’s sexual anatomy.
8. A strong desire for the primary and/or secondary sex characteristics.
B. The condition is associated with clinically significant distress or impairment in social, school, or
other important areas of functioning.
Oppositional Defiant Disorder
A. A pattern of energy/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
3. Often argues with authority figures or, for children and adolescents, with adults.
4. Often actively defies or refuses to comply with requests from authority figures or with rules.
5. Often deliberately annoys others.
6. Often blames others for his or her mistakes or misbehavior.
Vindictiveness
7. Has been spiteful or vindictive at least twice within the past 6 months.
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.
Intermittent Explosive Disorder
A. Recurrent behavioral outburst 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.
Conduct Disorder
A. A repetitive and persistent pattern of behavior in which the basic rights of others or major ageappropriate 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 psychical 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 somebody into sexual activity.
Destruction of Property
8. Has deliberately engaged in fire setting with the intention of causing serious damage.
9. Has deliberately destroyed other’s 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 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 paternal 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.
Paranoid Personality Disorder
A. A pervasive distrust and suspiciousness of others such that their motives are interpreted as
malevolent, beginning by early adulthood and present in a variety of contexts, as indicated by four
(or more) of the following:
1. Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her.
2. Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or
associates.
3. Is reluctant to confide in others because of unwarranted fear that the information will be used
maliciously against him or her.
4. Reads hidden demeaning or threatening meanings into benign remarks or events.
5. Persistently bears grudges (i.e., is unforgiving of insults, injuries, or slights).
6. Perceives attacks on his or her character or reputation that are not apparent to others and is
quick to react angrily or to counterattack.
7. Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner.
Antisocial Personality Disorder
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.
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 age 18 years.
C. There is evidence of conduct order with onset before age 15 years.
Borderline Personality Disorder
A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked
impulsivity, beginning by early adulthood and present in a variety of context, as indicated by five (or
more) of the following:
1. Frantic efforts to avoid real or imagined abandonment (Note: Do not include suicidal or selfmutilating behavior covered in Criterion 5.)
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between
extremes of idealization and devaluation.
3. Identity disturbance: markedly and persistently unstable self-image or sense of self.
4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance
abuse, reckless driving, binge eating). (Note: Do not include suicidal or self-mutilating behavior
covered in Criterion 5.)
5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability,
or anxiety usually lasting a few hours and only rarely more than a few days).
7. Chronic feelings of emptiness.
8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper,
constant anger, recurrent physical flights).
9. Transient, stress-related paranoid ideation or severe dissociative symptoms.
Narcissistic Personality Disorder
A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy,
beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the
following:
1. Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects
to be recognized as superior without commensurate achievements).
2. Is preoccupied with fantasies of unlimited success, power brilliance, beauty, or ideal love.
3. Believes that he or she is “special” and unique and can only be understood by, or should
associate with, other special or high-status people (or institutions).
4. Requires excessive admiration.
5. Has a sense of entitlement (i.e., unreasonable expectations or especially favorable treatment or
automatic compliance with his or her expectations).
6. Is interpersonally exploitative (i.e., takes advantage of others to achieve his or her own ends).
7. Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others.
8. Is often envious of others or believes that others are envious of him or her.
9. Shows arrogant, haughty behaviors or attitudes.
Dependent Personality Disorder
A pervasive and excessive need to be taken care of that lead to submissive and clinging behavior
and fears of separation, beginning by early adulthood and present in a variety of contexts, as
indicated by five (or more) of the following:
1. Has difficulty making everyday decisions without an excessive amount of advice and reassurance
from others.
2. Needs others to assume responsibility for most major areas of his or her life.
3. Has difficulty expressing disagreement with others because of fear of loss of support or approval.
4. Has difficulty initiating projects or doing things on his or her own.
5. Goes to excessive lengths to obtain nurturance and support from others, to the point of
volunteering to do things that are unpleasant.
6. Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to
care for himself or herself.
7. Urgently seeks another relationship as a source of care and support when a close relationship
ends.
8. Is unrealistically preoccupied with fears of being left to take care of himself or herself.
Obsessive-Compulsive Personality Disorder
A pervasive pattern of preoccupation with orderliness, perfectionism, and mental interpersonal
control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and
present in a variety of contexts as indicated by four or more of the following:
1. Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the
major point of the activity is lost.
2. Shows perfectionism that interferes with task completion (e.g., in unable to complete a project
because his or her own overly strict standards are not met.).
3. Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships
(not accounted for by obvious economic necessity).
4. Is over conscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not
accounted for by cultural or religious identification).
5. Is unable to discard worn-out or worthless objects, even when they have no sentimental value.
6. Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of
doing things.
7. Adopts a miserly spending style toward both self and others; money is viewed as something to be
hoarded for future catastrophes.
8. Shows rigidity and stubbornness.
SAMPLE:
Major Depressive Disorder
A. Five (or more) of the following symptoms have been 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. She began to lose interest in life about four
months ago.
1. Depressed mood most of the day, nearly every day, as indicated by either subjective report
(e.g., feels sad, empty, or hopeless) or observation made by others (e.g., appears tearful).
(Note: In children and adolescents, can be irritable mood.) For the past four months, she’s
reported depression every day for most of the day.
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly
every day. She says she’s lost interest in life.
3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of
body weight in a month), or decrease or increase in appetite nearly every day. (Note: In
children, consider failure to make expected weight gain.) She lost nine pounds without dieting
because she didn’t feel like eating.
4. Insomnia or hypersomnia nearly every day. She has trouble falling asleep almost every night
and wakes up 3 ½ hours earlier than normal several days a week.
5. Psychomotor agitation or retardation nearly every day. She exhibited psychomotor agitation
according to the therapist.
6. Fatigue or loss of energy nearly every day. She has diminished energy.
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly
every day (not merely self-reproach or guilt about being sick). N/A
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day. She has
diminished concentration.
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a
specific plan, a suicide attempt, or a specific plan for committing suicide. She would rather kill
herself than go to prison.
B. The symptoms cause clinically significant distress or impairment in social, occupational, or other
important areas of functioning. See above; she is distressed and many facets of her life have been
negatively affected by these symptoms.
C. The episode is not attributable to the physiological effects of a substance or to another medical
condition. She does not use any drugs and is in good health (increase in wine consumption does
not appear to have contributed to symptoms).
D. The occurrence of the major depressive episode is not better explained by schizoaffective
disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and
unspecified schizophrenia and other psychotic disorders. No mention of other disorders.
E. There has never been a manic episode or hypomanic episode. She denies any history of prior
manic or hypomanic episodes.