These patients are bothered by repeated thoughts or behaviors that appear senseless, even to them

In this disorder, physically normal patients believe that parts of their bodies are misshapen or ugly

An individual accumulates so many objects (perhaps of no value) that they interfere with life and living

Pulling hair from various parts of the body is often accompanied by feelings of “tension and release”

Patients so persistently pick at their skin that they traumatize it

Obsessions and compulsions can be caused by various medical conditions

Various sub- stances can lead to obsessive–compulsive symptoms that don’t fulfill criteria for any of the above-mentioned disorders

Obsessive–Compulsive and Related Disorders

There is evidence of pathogenic care in a child who habitually doesn’t seek comfort from parents or surrogates

There is evidence of pathogenic care in a child who fails to show normal reticence in the company of strangers

These adolescents or adults repeatedly relive a severely traumatic event, such as combat or a natural disaster

Children repeatedly relive a severely traumatic event, such as car accidents, natural disasters, or war

This condition is much like posttraumatic stress disorder, except that it begins during or immediately after the stressful event and lasts a month or less

Following a stressor, an individual develops symptoms that disappear once the cause of stress has subsided

Primary Trauma- and Stressor-Related Disorders

this chronic condition is characterized by unexplained physical symptoms. It is found almost exclusively in women

The pain in question has no apparent physical or physiological basis, or it far exceeds the usual expectations, given the patient’s actual physical condition

These patients complain of isolated symptoms that seem to have no physical cause

this is a disorder in which physically healthy people have an unfounded fear of a serious, often life-threatening illness such as cancer or heart disease—but little in the way of somatic symptoms

Patients who want to occupy the sick role (perhaps they enjoy the attention of being in a hospital) consciously fabricate symptoms to attract attention from health care professionals

A person induces symptoms in someone else, often a child, possibly for the purpose of gaining attention

Primary Somatic Symptom Disorders

Other Causes of Somatic Complaints

Despite the fact that they are severely underweight, these patients see themselves as fat

These patients eat in binges, then prevent weight gain by self-induced vomiting, purging, and exercise. Although appearance is important to their self-evaluations, they do not have the body image distortion characteristic of anorexia nervosa

These patients eat in binges, but do not try to compensate by vomiting, exercising, or using laxatives

The patient eats material that is not food

The person persistently regurgitates and re-chews food already eaten

An individual’s failure to eat enough leads to weight loss or a failure to gain weight

Primary Feeding and Eating Disorders

Other Causes of Abnormal Appetite and Weight

A user has taken a substance frequently enough to produce clinically important distress or impaired functioning, and to result in certain behavioral characteristics. Found in connection with all classes of drugs but caffeine, substance use disorder can even develop accidentally, especially from the use of medicine to treat chronic pain.

This acute clinical condition results from recent overuse of a sub- stance. Anyone can become intoxicated; this is the only substance-related diagnosis likely to apply to a person who uses a substance only once. All drugs but nicotine have a specific syndrome of intoxication.

This collection of symptoms, specific for the class of substance, devel- ops when a person who has frequently used a substance discontinues it or markedly reduces the amount used. All substances except phencyclidine (PCP), the other hallucinogens, and the inhalants have an officially recognized withdrawal syndrome

Specific Classes Involved in Substance Abuse

What is a delirium?

Profound, temporary loss of memory may occur in persons who suffer from dissociative amnesia or dissociative identity disorder

Cluster A Personality Disorders

These people are suspicious and quick to take offense. They often have few confidants and may read hidden meaning into innocent remarks

These patients care little for social relationships, have a restricted emotional range, and seem indifferent to criticism or praise. Tending to be solitary, they avoid close (including sexual) relationships

Interpersonal relationships are so difficult for these people that they appear peculiar or strange to others. They lack close friends and are uncomfortable in social situations. They may show suspiciousness, unusual perceptions or thinking, eccentric speech, and inappropriate affect

Cluster B Personality Disorders

The irresponsible, often criminal behavior of these people begins in childhood or early adolescence with truancy, running away, cruelty, fighting, destructiveness, lying, and theft. In addition to criminal behavior, as adults they may default on debts or otherwise behave irresponsibly; act recklessly or impulsively; and show no remorse for their behavior

These impulsive people engage in behavior harmful to themselves (sexual adventures, unwise spending, excessive use of substances or food). Affectively unstable, they often show intense, inappropriate anger. They feel empty or bored, and they frantically try to avoid abandonment. They are uncertain about who they are, and they lack the ability to maintain stable interpersonal relationships

Overly emotional, vague, and desperate for attention, these people need constant reassurance about their attractiveness. They may be self-centered and sexually seductive

These people are self-important and often preoccupied with envy, fantasies of success, or ruminations about the uniqueness of their own problems. Their sense of entitle- ment and lack of compassion may cause them to take advantage of others. They vigorously reject criticism and need constant attention and admiration

Cluster C Personality Disorders

These timid people are so easily wounded by criticism that they hesitate to become involved with others. They may fear the embarrassment of showing emotion or of saying things that seem foolish. They may have no close friends, and they exaggerate the risks of undertaking pursuits outside their usual routines

These people so much need the approval of others that they have trouble making independent decisions or starting projects; they may even agree with others whom they know to be wrong. They fear abandonment, feel helpless when they are alone, and are miserable when relationships end. They are easily hurt by criticism and will even volunteer for unpleasant tasks to gain the favor of others

Perfectionism and rigidity characterize these people. They are often workaholics, and they tend to be indecisive, excessively scrupulous, and preoccupied with detail They insist that others do things their way. They have trouble expressing affection, tend to lack generosity, and may even resist throwing away worthless objects they no longer need

Schizophrenia and Schizophrenia-Like Disorders

For at least 6 months, these patients have had two or more of these five types of psychotic symptom: delusions, disorganized speech, hallucinations, negative symptoms, and catatonia or other markedly abnormal behavior. Ruled out as causes of the psychotic symptoms are significant mood disorders, substance use, and general medical condi- tions

These patients have two or more of several behavioral characteristics. The specifier can be applied to disorders that include psychosis, mood disorders, autistic spectrum disorder, and other medical conditions

This category is for patients who have the basic symptoms of schizophrenia but have been ill for only 1–6 months—less than the time specified for schizophrenia

For at least 1 month, these patients have had basic schizophrenia symptoms; at the same time, they have prominent symptoms of mania or depression

These patients will have had at least one of the basic psychotic symptoms for less than 1 month

Other Psychotic Disorders

These patients have delusions, but not the other symptoms of schizo- phrenia

For at least 2 weeks, the patient feels depressed (or cannot enjoy life) and has problems with eating and sleeping, guilt feelings, low energy, trouble concen- trating, and thoughts about death

For at least 1 week, the patient feels elated (or sometimes only irritable) and may be grandiose, talkative, hyperactive, and distractible. Bad judgment leads to marked social or work impairment; often patients must be hospitalized

This is much like a manic episode, but it is briefer and less severe. Hospitalization is not required

DEPRESSIVE DISORDERS

These patients have had no manic or hypomanic episodes, but have had one or more major depressive episodes. Major depressive disorder will be either recurrent or single episode

There are no high phases, and it lasts much longer than typical major depressive disorder. This type of depression is not usually severe enough to be called an episode of major depression (though chronic major depression is now included here)

A child’s mood is persistently negative between frequent, severe explosions of temper

A few days before her menses, a woman experiences symptoms of depression and anxiety

There must be at least one manic episode; most patients with bipolar I have also had a major depressive episode

This diagnosis requires at least one hypomanic episode plus at least one major depressive episode

These patients have had repeated mood swings, but none that are severe enough to be called major depressive episodes or manic episodes

BIPOLAR AND RELATED DISORDERS

Mood disorder specifiers

These depressed patients eat a lot and gain weight, sleep excessively, and have a feeling of being sluggish or paralyzed. They are often excessively sensitive to rejection

This term applies to major depressive episodes characterized by some of the “classic” symptoms of severe depression. These patients awaken early, feeling worse than they do later in the day. They lose appetite and weight, feel guilty, are either slowed down or agitated, and do not feel better when something happens that they would normally like

A patient has symptoms of anxiety, tension, restlessness, worry, or fear that accompanies a mood episode

There are features of either motor hyperactivity or inactivity. Catatonic features can apply to major depressive episodes and to manic episodes

Manic, hypomanic, and major depressive episodes may have mixtures of manic and depressive symptoms

A manic, hypomanic, or major depressive episode (or a brief psychotic disorder) can occur in a woman during pregnancy or within a month of having a bab

Manic and major depressive episodes can be accompanied by delusions, which can be mood-congruent or -incongruent

Within 1 year, the patient has had at least four episodes (in any combination) fulfilling criteria for major depressive, manic, or hypomanic episodes

These patients experience repeated panic attacks—brief episodes of intense dread accompanied by a variety of physical and other symptoms, together with worry about having additional attacks and other related mental and behavioral changes

Patients with this condition fear situations or places such as entering a store, where they might have trouble obtaining help if they became anxious

In this condition, patients fear specific objects or situations. Examples include animals; storms; heights; blood; airplanes; being closed in; or any situation that may lead to vomiting, choking, or developing an illness.

These patients imagine themselves embarrassed when they speak, write, or eat in public or use a public urinal

A child elects not to talk, except when alone or with select intimates

Although they experience no episodes of acute panic, these patients feel tense or anxious much of the time and worry about many different issues

The patient becomes anxious when separated from a parent or other attachment figure

Primary Anxiety Disorders

These people are suspicious and quick to take offense. They often have few confidants and may read hidden meaning into innocent remarks

These patients care little for social relationships, have a restricted emotional range, and seem indifferent to criticism or praise. Tending to be solitary, they avoid close (including sexual) relationships

Interpersonal relationships are so difficult for these people that they appear peculiar or strange to others. They lack close friends and are uncomfortable in social situations. They may show suspiciousness, unusual perceptions or thinking, eccentric speech, and inappropriate affect

The irresponsible, often criminal behavior of these people begins in childhood or early adolescence with truancy, running away, cruelty, fighting, destructiveness, lying, and theft. In addition to criminal behavior, as adults they may default on debts or otherwise behave irresponsibly; act recklessly or impulsively; and show no remorse for their behavior

These impulsive people engage in behavior harmful to themselves (sexual adventures, unwise spending, excessive use of substances or food). Affectively unstable, they often show intense, inappropriate anger. They feel empty or bored, and they frantically try to avoid abandonment. They are uncertain about who they are, and they lack the ability to maintain stable interpersonal relationships

Overly emotional, vague, and desperate for attention, these people need constant reassurance about their attractiveness. They may be self-centered and sexually seductive

These people are self-important and often preoccupied with envy, fantasies of success, or ruminations about the uniqueness of their own problems. Their sense of entitle- ment and lack of compassion may cause them to take advantage of others. They vigorously reject criticism and need constant attention and admiration

These timid people are so easily wounded by criticism that they hesitate to become involved with others. They may fear the embarrassment of showing emotion or of saying things that seem foolish. They may have no close friends, and they exaggerate the risks of undertaking pursuits outside their usual routines

These people so much need the approval of others that they have trouble making independent decisions or starting projects; they may even agree with others whom they know to be wrong. They fear abandonment, feel helpless when they are alone, and are miserable when relationships end. They are easily hurt by criticism and will even volunteer for unpleasant tasks to gain the favor of others

Perfectionism and rigidity characterize these people. They are often workaholics, and they tend to be indecisive, excessively scrupulous, and preoccupied with detail They insist that others do things their way. They have trouble expressing affection, tend to lack generosity, and may even resist throwing away worthless objects they no longer need

These people are self-important and often preoccupied with envy, fantasies of success, or ruminations about the uniqueness of their own problems. Their sense of entitlement and lack of compassion may cause them to take advantage of others. They vigorously reject criticism and need constant attention and admiration

Patients strongly identify with the gender other than their own assigned gender role, with which they are uncomfortable. Some request sex reassignment surgery to relieve this discomfort