Pediatric Psychiatry Diagnostic Criteria App

This app contains DSM-5 diagnostic criteria for pediatric psychiatric and behavioral disorders, providing a comprehensive resource for quick reference. It is designed to offer detailed criteria and descriptions for a wide range of conditions, enabling users to access crucial information swiftly and efficiently

Ideal for students and learners, this app supports educational and clinical purposes by facilitating easy navigation through diagnostic criteria. Its user-friendly interface ensures that essential information is readily available, making it a valuable tool for those studying or working in the field of pediatric psychiatry and behavioral health

DSM-5 Diagnostic Criteria for 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. Persistent high level of anxiety about health and 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 >6 months).

Specify if:

• With predominant pain (previously known as “pain disorder” in DSM-IV-TR): for individuals whose somatic symptoms predominantly involve pain.
• Persistent: A persistent course is characterized by severe symptoms, marked impairment, and long duration (>6 months).

DSM-5 Diagnostic Criteria for Conversion Disorder or Functional Neurologic Symptom Disorder

A. One or more symptoms of altered voluntary motor or sensory function.

B. Clinical findings provide evidence of incompatibility between the symptom and recognized neurologic or medical conditions.

C. The symptom is not better explained by another medical or mental disorder.

D. The symptom causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation.

Specify symptom type: weakness or paralysis, abnormal movements, swallowing symptoms, speech symptom, attacks/seizures, anesthesia/sensory loss, special sensory symptom (e.g., visual, olfactory, hearing), or mixed symptoms.

DSM-5 Diagnostic Criteria for Factitious Disorders

Factitious Disorder Imposed on Self

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.

D. The behavior is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder.

Specify if: single episode or recurrent episodes.

Factitious Disorder Imposed on Another (Previously “Factitious Disorder by Proxy”)

A. Falsification of physical or psychological signs or symptoms, or induction of injury or disease, in another, associated with identified deception.

B. The individual presents another individual (victim) to others as ill, impaired, or injured.

C. The deceptive behavior is evident even in the absence of obvious external rewards.

D. The behavior is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder.

Note: The perpetrator, not the victim, receives this diagnosis.

Specify if: single episode or recurrent episodes.

DSM-5 Diagnostic Criteria for 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 and hospitals).

E. Illness preoccupation has been present for at least 6 months, but the specific illness that is feared may change over that time.

F. The illness-related preoccupation is not better explained by another mental disorder.

Specify whether: care-seeking type or care-avoidant type.

DSM-5 Diagnostic Criteria for Other Specified/Unspecified Somatic Symptom and Related Disorders

Other Specified

This category applies to presentations in which symptoms characteristic of a somatic symptom and related disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet full criteria for any of the disorders in the somatic symptom and related disorders diagnostic class.

Examples of presentations that can be specified using the “other specified” designation include the following:

• 1. Brief somatic symptom disorder: duration of symptoms is <6 months.
• 2. Brief illness anxiety disorder: duration of symptoms is <6 months.
• 3. Illness anxiety disorder without excessive health-related behaviors: Criterion D for illness anxiety disorder is not met.
• 4. Pseudocyesis: a false belief of being pregnant that is associated with objective signs and reported symptoms of pregnancy.

Unspecified

This category applies to presentations in which symptoms characteristic of a somatic symptom and related disorder that cause clinically significant distress or impairment in functioning predominate but do not meet criteria for any of the other disorders in the somatic symptom and related disorders diagnostic class.

DSM-5 Diagnostic Criteria for Psychological Factors Affecting Other Medical Conditions

A. A medical symptom or condition (other than a mental disorder) is present.

B. Psychological or behavioral factors adversely affect the medical condition in one of the following ways:

• 1. The factors have influenced the course of the medical condition, as shown by a close temporal association between the psychological factors and the development or exacerbation of, or delayed recovery from, the medical condition.
• 2. The factors interfere with the treatment of the medical condition (e.g., poor adherence).
• 3. The factors constitute additional well-established health risks for the individual.
• 4. The factors influence the underlying pathophysiology, precipitating or exacerbating symptoms or necessitating medical attention.

C. The psychological and behavioral factors in Criterion B are not better explained by another mental disorder (e.g., panic disorder, major depressive disorder, posttraumatic stress disorder).

Specify if: mild, moderate, severe, or extreme.

DSM-5 Diagnostic Criteria for Tic Disorders

Tourette Disorder

A. Both multiple motor and one or more 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 >1 year since first tic onset.

C. Onset is before age 18 years.

D. The disturbance is not attributable to the physiologic effects of a substance (e.g., cocaine) or another medical condition (e.g., Huntington disease, postviral encephalitis).

Persistent (Chronic) Motor or Vocal Tic Disorder

A. Single or multiple motor or vocal tics have been present during the illness, but not both motor and vocal.

B. The tics may wax and wane in frequency but have persisted for >1 year since first tic onset.

C. Onset is before age 18 years.

D. The disturbance is not attributable to the physiologic effects of a substance (e.g., cocaine) or another medical condition (e.g., Huntington disease, postviral encephalitis).

E. Criteria have never been met for Tourette disorder.

Specify if:

• With motor tics only
• With vocal tics only

Provisional Tic Disorder

A. Single or multiple motor and/or vocal tics.

B. The tics have been present for <1 year since first tic onset.

C. Onset is before age 18 years.

D. The disturbance is not attributable to the physiologic effects of a substance (e.g., cocaine) or another medical condition (e.g., Huntington disease, postviral encephalitis).

E. Criteria have never been met for Tourette disorder or persistent (chronic) motor or vocal tic disorder.

DSM-5 Diagnostic Criteria for Specific Phobia

A. Marked fear or anxiety about a specific object or situation (e.g., flying, heights, animals, receiving an injection, seeing blood).
Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, or clinging.

B. The phobic object or situation almost always provokes immediate fear or anxiety.

C. The phobic object or situation is 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 6 months or more.

F. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

G. The disturbance is not better explained by the symptoms of another mental disorder, including fear, anxiety, and avoidance of situations associated with panic-like symptoms or other incapacitating symptoms (as in agoraphobia); objects or situations related to obsessions (as in obsessive-compulsive disorder); remainders of traumatic events (as in posttraumatic stress disorder); separation from home or attachment figures (as in separation anxiety disorder); or social situations (as in social anxiety disorder).

Specify if:

• Animal (e.g., spiders, insects, dogs).
• Natural environment (e.g., heights, storms, water).
• Blood-injection-injury (e.g., needles, invasive medical procedures).
• Situational (e.g., airplanes, elevators, enclosed places).
• Other (e.g., situations that may lead to choking or vomiting; in children, e.g., loud sounds or costumed characters).

DSM-5 Diagnostic Criteria for 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 (i.e., by performing a compulsion).

Compulsions are defined by (1) and (2):

1. Repetitive behaviors (e.g., handwashing, 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.

B. The obsessions or compulsions are time-consuming (e.g., take more than 1 hr/day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

C. The obsessive-compulsive symptoms are not attributable to the physiologic effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

D. The disturbance is not better explained by the symptoms of another mental disorder (e.g., excessive worries, as in generalized anxiety disorder; preoccupation with appearance, as in body dysmorphic disorder; difficulty discarding or parting with possessions, as in hoarding disorder; hair pulling, as in trichotillomania [hair-pulling disorder]; skin picking, as in excoriation [skin-picking] disorder; stereotypies, as in stereotypic movement disorder; ritualized eating disorder, as in eating disorders; preoccupation with substances or gambling, as in substance-related and addictive disorders; preoccupation with having an illness, as in illness anxiety disorder; sexual urges or fantasies, as in paraphilic disorders; impulses, as in disruptive, impulse-control, and conduct disorders; guilty ruminations, as in schizophrenia spectrum and other psychotic disorders; or repetitive patterns of behavior, as in autism spectrum disorder).

Specify if:

• With good or fair insight: The individual recognizes that obsessive-compulsive disorder beliefs are definitely or probably not true or that they may or may not be true.
• With poor insight: The individual thinks obsessive-compulsive disorder beliefs are probably true.
• With absent insight/delusional beliefs: The individual is completely convinced that obsessive-compulsive disorder beliefs are true.

Specify if:

• Tic-related: The individual has a current or past history of a tic disorder.

DSM-5 Diagnostic Criteria for 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).

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 or 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.

H. The fear, anxiety, or avoidance is not attributable to the physiologic effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

I. The fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

J. If another medical condition (e.g., Parkinson disease, obesity, disfigurement from burns or injury) is present, the anxiety or avoidance is clearly unrelated or is excessive.

Specify if: Performance only: If the fear is restricted to speaking or performing in public.

DSM-5 Diagnostic Criteria for 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):

• 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).

Note: Only one item is required in children.

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiologic effects of a substance (e.g., a drug of abuse, a medication) or other medical condition (e.g., hyperthyroidism).

F. The disturbance is not better explained by another mental disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder [social phobia], contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, remainders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

DSM-5 Diagnostic Criteria for 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:

Note: The abrupt surge can occur from a calm state or an anxious state.

• Palpitations, pounding heart, or accelerated heart rate.
• Sweating.
• Trembling or shaking.
• Sensations of shortness of breath or smothering.
• Feelings of choking.
• Chest pain or discomfort.
• Nausea or abdominal distress.
• Feeling dizzy, unsteady, light-headed, or faint.
• Chills or hot sensations.
• Paresthesias (numbness or tingling sensations).
• Derealization (feeling of unreality) or depersonalization (being detached from oneself).
• Fear of losing control or “going crazy.”
• Fear of dying.

Note: Culture-specific symptoms (e.g., tinnitus, neck soreness, headache, uncontrollable screaming or crying) may be seen. Such symptoms should not count as one of the four required symptoms.

B. At least one of the attacks has been followed by 1 month (or more) of one or both of the following:

• Persistent concern or worry about additional panic attacks or their consequences (e.g., losing control, having a heart attack, “going crazy”).
• 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).

C. The disturbance is not attributable to the physiologic effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism, cardiopulmonary disorders).

D. The disturbance is not better explained by another mental disorder (e.g., the panic attacks do not occur only in response to feared social situations, as in social anxiety disorder; in response to circumscribed phobic objects or situations, as in specific phobia; in response to obsessions, as in obsessive-compulsive disorder; or in response to reminders of traumatic events, as in posttraumatic stress disorder; or in response to separation from attachment figures, as in separation anxiety disorder).

DSM-5 Diagnostic Criteria for Agoraphobia

A. Marked fear or anxiety about two (or more) of the following five situations:

• Using public transportation (e.g., automobiles, buses, trains, ships, planes).
• Being in open spaces (e.g., parking lots, marketplaces, bridges).
• Being in enclosed places (e.g., shops, theaters, cinemas).
• Standing in line or being in a crowd.
• Being outside of the home alone.

B. The individual fears or avoids these situations because of thoughts that escape might be difficult or help might not be available in the event of developing panic-like symptoms or other incapacitating or embarrassing symptoms (e.g., fear of falling in the elderly, fear of incontinence).

C. The agoraphobic situations almost always provoke fear or anxiety.

D. The agoraphobic situations are actively avoided, require the presence of a companion, or are endured with intense fear or anxiety.

E. The fear or anxiety is out of proportion to the actual danger posed by the agoraphobic situations 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.

H. If another medical condition (e.g., inflammatory bowel disease, Parkinson disease) is present, the fear, anxiety, or avoidance is clearly excessive.

I. The fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder—for example, the symptoms are not confined to specific phobia or situational type; do not involve only social situations (as in social anxiety disorder); and are not related exclusively to obsessions (as in obsessive-compulsive disorder), reminders of traumatic events (as in posttraumatic stress disorder), or fear of separation (as in separation anxiety disorder).

Note: Agoraphobia is diagnosed irrespective of the presence of panic disorder. If an individual’s presentation meets criteria for panic disorder and agoraphobia, both diagnoses should be assigned.

DSM-5 Diagnostic Criteria for Posttraumatic Stress Disorder

Note: The following criteria apply to adults, adolescents, and children older than 6 years. For children 6 years and younger, see corresponding criteria below.

A. Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:

• Directly experiencing the traumatic event(s).
• Witnessing, in person, the event(s) as it occurred to others.
• Learning that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental.
• Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse).

Note: Criterion A4 does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related.

B. Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred:

• Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). Note: In children older than 6 years, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed.
• Recurrent distressing dreams in which the content and/or effect of the dream are related to the traumatic event(s). Note: In children, there may be frightening dreams without recognizable content.
• Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. Note: Such reactions may occur on a continuum, with the more extreme expression being a complete loss of awareness of present surroundings.
• Intense or prolonged psychologic distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
• Marked physiologic reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).

C. Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by one or both of the following:

• Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
• Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).

D. Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:

• Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs).
• Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., “I am bad,” “No one can be trusted,” “The world is completely dangerous,” “My whole nervous system is permanently ruined”).
• Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others.
• Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).
• Markedly diminished interest or participation in significant activities.

DSM-5 Diagnostic Criteria for Posttraumatic Stress Disorder—continued

E. Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:

• Irritable behavior and angry outbursts (with little or no provocation) typically expressed by verbal or physical aggression toward people or objects.
• Reckless or self-destructive behavior.
• Hypervigilance.
• Exaggerated startle response.
• Problems with concentration.
• Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep).

F. Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month.

G. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

H. The disturbance is not attributable to the physiologic effects of a substance (e.g., medication, alcohol) or another medical condition.

Specify whether:

• With dissociative symptoms: The individual’s symptoms meet the criteria for posttraumatic stress disorder, and in addition, in response to the stressor, the individual experiences persistent or recurrent symptoms of either of the following:
  • Depersonalization: Persistent or recurrent experiences of feeling detached from, and as if one were an outside observer of, one’s mental processes or body (e.g., feeling as though one were in a dream; feeling a sense of unreality of self or body or of time moving slowly).
  • Derealization: Persistent or recurrent experiences of unreality of surroundings (e.g., the world around the individual is experienced as unreal, dreamlike, distant, or distorted).
  Note: To use this subtype, the dissociative symptoms must not be attributable to the physiologic effects of a substance (e.g., blackouts, behavior during alcohol intoxication) or another medical condition (e.g., complex partial seizures).
• With delayed expression: If the full diagnostic criteria are not met until at least 6 months after the event (although the onset and expression of some symptoms may be immediate).

POSTTRAUMATIC STRESS DISORDER FOR CHILDREN 6 YEARS AND YOUNGER

A. In children 6 years and younger, exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:

• Directly experiencing the traumatic event(s).
• Witnessing, in person, the event(s) as it occurred to others, especially primary caregivers. Note: Witnessing does not include events that are only in electronic media, television, movies, or pictures.
• Learning that the traumatic event(s) occurred to a parent or caregiving figure.

B. Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred:

• Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). Note: Spontaneous and intrusive memories may not necessarily appear distressing and may be expressed as play reenactment.
• Recurrent distressing dreams in which the content and/or effect of the dream is related to the traumatic event(s). Note: It may not be possible to ascertain that the frightening content is related to the traumatic event.
• Dissociative reactions (e.g., flashbacks) in which the child feels or acts as if the traumatic event(s) were recurring. Note: Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings. Such trauma-specific reenactment may occur in play.
• Intense or prolonged psychologic distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).

C. One (or more) of the following symptoms, representing either persistent avoidance of stimuli associated with the traumatic event(s) or negative alterations in cognitions and mood associated with the traumatic event(s), must be present, beginning after the event(s) or worsening after the event(s):

• PERSISTENT AVOIDANCE OF STIMULI
  • Avoidance of or efforts to avoid activities, places, or physical reminders that arouse recollections or the traumatic event(s).
  • Avoidance of or efforts to avoid people, conversations, or interpersonal situations around recollections of the traumatic event(s).
• NEGATIVE ALTERATIONS IN COGNITIONS
  • Substantially increased frequency of negative emotional states (e.g., fear, guilt, sadness, shame, confusion).
  • Markedly diminished interest or participation in significant activities, including constriction of play.
  • Socially withdrawn behavior.
  • Persistent reduction in expression of positive emotions.

D. Alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:

• Irritable behavior and angry outbursts (with little or no provocation), typically expressed as verbal and physical aggression toward people or objects (including extreme temper tantrums).
• Hypervigilance.
• Exaggerated startle response.
• Problems with concentration.
• Sleep disturbance (e.g., difficulty falling asleep or staying asleep or restless sleep).

E. The duration of the disturbance is more than 1 month.

F. The disturbance causes clinically significant distress or impairment in relationships with parents, siblings, peers, or other caregivers or with school behavior.

G. The disturbance is not attributable to the physiologic effects of a substance (e.g., medication or alcohol) or another medical condition.

DSM-5 Diagnostic Criteria for Posttraumatic Stress Disorder—continued

Specify whether:

• With dissociative symptoms: The individual’s symptoms meet the criteria for posttraumatic stress disorder, and the individual experiences persistent or recurrent symptoms of either of the following:
  • Depersonalization: Persistent or recurrent experiences of feeling detached from, and as if one were an outside observer of, one’s mental processes or body (e.g., feeling as though one were in a dream; feeling a sense of unreality of self or body or of time moving slowly).
  • Derealization: Persistent or recurrent experiences of unreality of surroundings (e.g., the world around the individual is experienced as unreal, dreamlike, distant, or distorted).
  Note: To use this subtype, the dissociative symptoms must not be attributable to the physiologic effects of a substance (e.g., blackouts, behavior during alcohol intoxication) or another medical condition (e.g., complex partial seizures).
• With delayed expression: If the full diagnostic criteria are not met until at least 6 months after the event (although the onset and expression of some symptoms may be immediate).

Diagnostic Criteria for Pediatric Acute-Onset Neuropsychiatric Syndrome

CRITERION 1

Abrupt, dramatic onset of obsessive-compulsive disorder or severely restricted food intake.

CRITERION 2

Concurrent presence of additional neuropsychiatric symptoms with similarly severe and acute onset from at least two of the following seven categories:

• Anxiety.
• Emotional lability or depression.
• Irritability, aggression, or severely oppositional behaviors.
• Behavioral (developmental) regression.
• Deterioration in school performance.
• Sensory or motor abnormalities.
• Somatic signs and symptoms, including sleep disturbances, enuresis, or urinary frequency.

CRITERION 3

Symptoms are not better explained by a known neurologic or medical disorder, such as Sydenham chorea, systemic lupus erythematosus, Tourette disorder, autoimmune encephalitis, or others. The diagnostic workup of patients with suspected PANS must be comprehensive enough to rule out these and other relevant disorders. The nature of the co-occurring symptoms will dictate the necessary assessments, which may include MRI scans, lumbar puncture, electroencephalograms, or other diagnostic tests.

DSM-5 Diagnostic Criteria for Major Depressive Episode

A. Five (or more) of the following symptoms have been present during the same 2-wk 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 most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, 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 (as indicated by either subjective account or observation).
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 (observable by others, not merely subjective feelings of restlessness or being slowed down).
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 (either by subjective account or as observed by others).
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or 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.

C. The episode is not attributable to the physiologic effects of a substance or to another medical condition.
Note: Criteria A-C represent a major depressive episode.

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 spectrum and other psychotic disorders.

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

DSM-5 Diagnostic Criteria for Persistent Depressive 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 yr.
Note: In children and adolescents, mood can be irritable and duration must be at least 1 yr.

B. Presence, while depressed, of two (or more) of the following:

1. Poor appetite or overeating.
2. Insomnia or hypersomnia.
3. Low energy or fatigue.
4. Low self-esteem.
5. Poor concentration or difficulty making decisions.
6. Feelings of hopelessness.

C. During the 2 yr period (1 yr for children or adolescents) of the disturbance, the individual has never been without the symptoms in Criteria A and B for more than 2 mo at a time.

D. Criteria for a major depressive disorder may be continuously present for 2 yr.

E. There has never been a manic episode or a hypomanic episode, and criteria have never been met for cyclothymic disorder.

F. The disturbance is not better explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.

G. The symptoms are not attributable to the physiologic effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hypothyroidism).

H. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Note: Because the criteria for a major depressive episode include four symptoms that are absent from the symptom list for persistent depressive disorder (dysthymia), a very limited number of individuals will have depressive symptoms that have persisted longer than 2 yr but will not meet criteria for persistent depressive disorder. If full criteria for a major depressive episode have been met at some point during the current episode of illness, they should be given a diagnosis of major depressive disorder. Otherwise, a diagnosis of other specified depressive disorder or unspecified depressive disorder is warranted.

DSM-5 Diagnostic Criteria for Disruptive Mood Dysregulation Disorder

A. Severe recurrent temper outbursts manifested verbally (e.g., verbal rages) and/or behaviorally (e.g., physical aggression toward people or property) that are grossly out of proportion in intensity or duration to the situation or provocation.

B. The temper outbursts are inconsistent with developmental level.

C. The temper outbursts occur, on average, three or more times per week.

D. The mood between temper outbursts is persistently irritable or angry most of the day, nearly every day, and is observable by others (e.g., parents, teachers, peers).

E. Criteria A-D have been present for 12 or more months. Throughout that time, the individual has not had a period lasting 3 or more consecutive months without all of the symptoms in Criteria A-D.

F. Criteria A and D are present in at least two of three settings (i.e., at home, at school, with peers) and are severe in at least one of these.

G. The diagnosis should not be made for the first time before age 6 yr or after age 18 yr.

H. By history or observation, the age at onset of Criteria A-E is before 10 yr.

I. There has never been a distinct period lasting more than 1 day during which the full symptom criteria, except duration, for a manic or hypomanic episode have been met.
Note: Developmentally appropriate mood elevation, such as occurs in the context of a highly positive event or its anticipation, should not be considered as a symptom of mania or hypomania.

J. The behaviors do not occur exclusively during an episode of major depressive disorder and are not better explained by another mental disorder (e.g., autism spectrum disorder, posttraumatic stress disorder, separation anxiety disorder, persistent depressive disorder [dysthymia]).
Note: The diagnosis cannot coexist with oppositional defiant disorder, intermittent explosive disorder, or bipolar disorder, though it can coexist with others, including major depressive disorder, attention-deficit/hyperactivity disorder, conduct disorder, and substance use disorders. Individuals whose symptoms meet criteria for both disruptive mood dysregulation disorder and oppositional defiant disorder should only be given the diagnosis of disruptive mood dysregulation disorder. If an individual has ever experienced a manic or hypomanic episode, the diagnosis of disruptive mood dysregulation disorder should not be assigned.

K. The symptoms are not attributable to the physiologic effects of a substance or to another medical or neurologic condition.

DSM-5 Diagnostic Criteria for a Manic Episode

A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 wk and present most of the day, nearly every day (or any duration if hospitalization is necessary).

B. During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms (four if the mood is only irritable) are present to a significant degree and represent a noticeable change from usual behavior:

1. Inflated self-esteem or grandiosity.
2. Decreased need for sleep (e.g., feels rested after only 3 hr of sleep).
3. More talkative than usual or pressure to keep talking.
4. Flight of ideas or subjective experience that thoughts are racing.
5. 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 (i.e., purposeless non–goal-directed activity).
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 mood disturbance 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.

D. The episode is not attributable to the physiologic effects of a substance (e.g., a drug of abuse, a medication, other treatment) or to another medical condition.
Note: A full manic episode that emerges during antidepressant treatment (e.g., medication, electroconvulsive therapy) but persists at a fully syndromal level beyond the physiologic effect of that treatment is sufficient evidence for a manic episode and, therefore, a bipolar I diagnosis.

Note: Criteria A-D constitute a manic episode. At least one lifetime manic episode is required for the diagnosis of bipolar I disorder.

DSM-5 Diagnostic Criteria for a Hypomanic Episode

A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least four consecutive days and present most of the day, nearly every day.

B. During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms (four if the mood is only irritable) have persisted, represent a noticeable change from usual behavior, and have been present to a significant degree:

1. Inflated self-esteem or grandiosity.
2. Decreased need for sleep (e.g., feels rested after only 3 hr of sleep).
3. More talkative than usual or pressure to keep talking.
4. Flight of ideas or subjective experience that thoughts are racing.
5. 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 (i.e., purposeless non–goal-directed activity).
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 disturbance 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.

F. The episode is not attributable to the physiologic effects of a substance (e.g., a drug of abuse, a medication, other treatment) or to another medical condition.
Note: A full hypomanic episode that emerges during antidepressant treatment (e.g., medication, electroconvulsive therapy) but persists at a fully syndromal level beyond the physiologic effect of that treatment is sufficient evidence for a hypomanic episode diagnosis. However, caution is indicated so that one or two symptoms (particularly increased irritability, edginess, or agitation following antidepressant use) are not taken as sufficient for diagnosis of a hypomanic episode, nor necessarily indicative of a bipolar diathesis.

Note: Criteria A-F constitute a hypomanic episode. Hypomanic episodes are common in bipolar I disorder but are not required for the diagnosis of bipolar I disorder.

DSM-5 Diagnostic Criteria for Anorexia Nervosa

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.

Specify whether:

• Restricting type (ICD-10-CM code F50.01): 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.
• Binge-eating/purging type (ICD-10-CM code F50.02): 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).

Specify if:

• 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.
• In full remission: After full criteria for anorexia nervosa were previously met, none of the criteria has been met for a sustained period of time.

Specify current severity: The minimum level of severity is based, for adults, on current BMI (see the following) or, for children and adolescents, on BMI percentile. The ranges below are derived from World Health Organization categories for thinness in adults; for children and adolescents, corresponding BMI percentiles should be used. The level of severity may be increased to reflect clinical symptoms, the degree of functional disability, and the need for supervision.

• Mild: BMI ≥17 kg/m²
• Moderate: BMI 16-16.99 kg/m²
• Severe: BMI 15-15.99 kg/m²
• Extreme: BMI <15 kg/m²

DSM-5 Diagnostic Criteria for Bulimia Nervosa

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 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.

E. The disturbance does not occur exclusively during episodes of anorexia nervosa.

Specify if:

• 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.
• In full remission: After full criteria for bulimia nervosa were previously met, none of the criteria has been met for a sustained period of time.

Specify current severity: The minimum level of severity is based on the frequency of inappropriate compensatory behaviors (see the following). The level of severity may be increased to reflect other symptoms and the degree of functional disability.

• 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.

DSM-5 Diagnostic Criteria for Avoidant/Restrictive Food Intake Disorder

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) as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following:

• 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.

Specify if:

• 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.

DSM-5 Diagnostic Criteria for Oppositional Defiant Disorder

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.

DSM-5 Diagnostic Criteria for Intermittent Explosive Disorder

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. Chronologic 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 disease) or to the physiological effects 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 clinical attention.

DSM-5 Diagnostic Criteria for Conduct Disorder

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 3 of the following 15 criteria in the past 12 months from any of the following categories, 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.

DSM-5 Diagnostic Criteria for Brief Psychotic Disorder

A. Presence of one (or more) of the following symptoms. At least one of these must be (1), (2), or (3):

• 1. Delusions
• 2. Hallucinations
• 3. Disorganized speech (e.g., frequent derailment or incoherence)
• 4. Grossly disorganized or catatonic behavior

Note: Do not include a symptom if it is a culturally sanctioned response.

B. Duration of an episode of the disturbance is at least 1 day but less than 1 month, with eventual full return to premorbid level of functioning.

C. The disturbance is not better explained by major depressive or bipolar disorder with psychotic features or another psychotic disorder such as schizophrenia or catatonia, and is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

Specify if:

• With marked stressor(s) (brief reactive psychosis): If symptoms occur in response to events that, singly or together, would be markedly stressful to almost anyone in similar circumstances in the individual’s culture.
• Without marked stressor(s): If the symptoms do not occur in response to events that, singly or together, would be markedly stressful to almost anyone in similar circumstances in the individual’s culture.
• With postpartum onset: If onset is during pregnancy or within 4 weeks postpartum.

DSM-5 Diagnostic Criteria for Schizophreniform Disorder

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. Delusions
• 2. Hallucinations
• 3. Disorganized speech (e.g., frequent derailment or incoherence)
• 4. Grossly disorganized or catatonic behavior
• 5. Negative symptoms (i.e., diminished emotional expression or avolition)

B. An episode of the disorder lasts at least 1 month but less than 6 months. When the diagnosis must be made without waiting for recovery, it should be qualified as “provisional.”

C. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either (1) no major depressive or manic episodes have occurred concurrently with the active-phase symptoms or (2) if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of the illness.

D. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

Specify if:

• With good prognostic features: This specifier requires the presence of at least two of the following features: onset of prominent psychotic symptoms within 4 weeks of the first noticeable change in usual behavior or functioning; confusion or perplexity; good premorbid social and occupational functioning; and absence of blunted or flat affect.
• Without good prognostic features: This specifier is applied if two or more of the previous features have not been present.

DSM-5 Diagnostic Criteria for 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. Delusions
• 2. Hallucinations
• 3. Disorganized speech (e.g., frequent derailment or incoherence)
• 4. Grossly disorganized or catatonic behavior
• 5. 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 before the onset (or when the onset is in childhood or adolescence, there is failure to achieve expected level of interpersonal, academic, or occupational functioning).

C. Continuous signs of the disturbance persist for at least 6 months. This 6 month period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or by two or more symptoms listed in Criterion A present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).

D. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either (1) no major depressive or manic episodes have occurred concurrently with the active-phase symptoms or (2) if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of the illness.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

F. If there is a history of autism spectrum disorder or a communication disorder of childhood onset, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations, in addition to the other required symptoms of schizophrenia, are also present for at least a month (or less if successfully treated).

Proposed Diagnostic Criteria for Autoimmune Psychosis

For a diagnosis of possible autoimmune psychosis:

The patient must have current psychotic symptoms of abrupt onset (rapid progression of <3 months) with at least one of the following:

• Currently or recently diagnosed with a tumor
• Movement disorder (catatonia or dyskinesia)
• Adverse response to antipsychotics, raising suspicion of neuroleptic malignant syndrome (rigidity, hyperthermia, or raised creatine kinase)
• Severe or disproportionate cognitive dysfunction
• A decreased level of consciousness
• The occurrence of seizures that are not explained by a previously known seizure disorder
• A clinically significant autonomic dysfunction (abnormal or unexpectedly fluctuant blood pressure, temperature, or heart rate)

If a patient has possible autoimmune psychosis, they should be investigated as per section 5 (“Consensus multimodal approach to the systematic investigation of patients with suspected autoimmune psychosis”), including electroencephalography, MRI, serum autoantibodies, and CSF analysis (including CSF autoantibodies). The results should lead to a diagnosis of non-autoimmune psychosis or probable/definite autoimmune psychosis.

For a diagnosis of probable autoimmune psychosis:

The patient must have current psychotic symptoms of abrupt onset (rapid progression of <3 months) with at least one of the seven clinical criteria listed previously for possible autoimmune psychosis and at least one of the following:

• CSF pleocytosis of >5 white blood cells/μL
• Bilateral brain abnormalities on T2 weighted fluid-attenuated inversion recovery MRI highly restricted to the medial temporal lobes

Or two of the following:

• Electroencephalogram encephalopathic changes (i.e., spikes, spike-wave activity, or rhythmic slowing [intermittent rhythmic delta or theta activity] focal changes, or extreme delta brush)
• CSF oligoclonal bands or increased IgG index
• The presence of a serum antineuronal antibody detected by cell-based assay

After exclusion of alternative diagnoses.

For a diagnosis of definite autoimmune psychosis:

The patient must meet the criteria for probable autoimmune psychosis with IgG class antineuronal antibodies in CSF.

Note that these criteria do not exclude a diagnosis being made in a patient with an acute onset (<3 months) of psychosis, even if that patient has had a previous psychotic, other psychiatric, or encephalopathic episode that resolved.

DSM-5 Diagnostic Criteria for Substance/Medication Induced Psychotic Disorder

A. Presence of one or both of the following symptoms:

• Delusions
• Hallucinations

B. There is evidence from the history, physical examination, or laboratory findings of both (1) and (2):

• The symptoms of Criterion A developed during or soon after substance intoxication or withdrawal or after exposure to a medication.
• The involved substance/medication is capable of producing the symptoms in Criterion A.

C. The disturbance is not better explained by a psychotic disorder that is not substance/medication induced.

D. The disturbance does not occur exclusively during the course of a delirium.

E. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Specify if:

• With onset during intoxication: If the criteria are met for intoxication with the substance and the symptoms develop during intoxication.
• With onset during withdrawal: If the criteria are met for withdrawal from the substance and the symptoms develop during, or shortly after, withdrawal.

DSM-5 Diagnostic Criteria for Psychotic Disorder Due to Another Medical Condition

A. Prominent hallucinations or delusions.

B. There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct pathophysiologic consequence of another medical condition.

C. The disturbance is not better explained by another mental disorder.

D. The disturbance does not occur exclusively during the course of a delirium.

E. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Specify whether:

• With delusions: If delusions are the predominant symptom.
• With hallucinations: If hallucinations are the predominant symptom.

Catatonia

Excitement: Extreme hyperactivity; constant motor unrest, which is apparently nonpurposeful.

Immobility/stupor: Extreme hypoactivity, immobility; minimally responsive to stimuli.

Mutism: Verbally unresponsive or minimally responsive.

Staring: Fixed gaze, little or no visual scanning of environment, decreased blinking.

Posturing/catalepsy: Maintains posture(s), including mundane (e.g., sitting or standing for hours without reacting).

Grimacing: Maintenance of odd facial expressions.

Echopraxia/echolalia: Mimics of examiner’s movements/speech.

Stereotypy: Repetitive, non–goal-directed motor activity (e.g., finger play; repeatedly touching, patting, or rubbing self).

Mannerisms: Odd, purposeful movements (hopping or walking tiptoe, saluting passersby, exaggerated caricatures of mundane movements).

Verbigeration: Repetition of phrases or sentences.

Rigidity: Maintenance of a rigid posture despite efforts to be moved.

Negativism: Apparently motiveless resistance to instructions or to attempts to move/examine the patient; contrary behavior does the opposite of the instruction.

Waxy flexibility: During reposturing of the patient, offers initial resistance before allowing themselves to be repositioned (similar to that of bending a warm candle).

Withdrawal: Refusal to eat, drink, or make eye contact.

Impulsivity: Suddenly engaging in inappropriate behavior (e.g., runs down the hallway, starts screaming, or takes off clothes) without provocation; afterward, cannot explain.

Automatic obedience: Exaggerated cooperation with examiner’s request, or repeated movements that are requested once.

Passive obedience (mitgehen): Raising arm in response to light pressure of finger, despite instructions to the contrary.

Negativism (gegenhalten): Resistance to passive movement that is proportional to strength of the stimulus; response seems automatic rather than willful.

Ambitendency: Appears stuck in indecisive, hesitant motor movements.

Grasp reflex: Striking the patient’s open palm with two extended fingers of the examiner’s hand results in automatic closure of the patient’s hand.

Perseveration: Repeatedly returns to the same topic or persists with the same movements.

Combativeness: Belligerence or aggression, usually in an undirected manner, without explanation.

Autonomic abnormality: Abnormality of body temperature (fever), blood pressure, pulse rate, respiratory rate, inappropriate sweating.

DSM-5 Criteria for Catatonia Due to Another Medical Condition

A. The clinical picture is dominated by three (or more) of the following symptoms:

• Stupor: No psychomotor activity; not actively relating to environment.
• Catalepsy: Passive induction of a posture held against gravity.
• Waxy flexibility: Slight, even resistance to positioning by examiner.
• Mutism: No, or very little, verbal response [Note: not applicable if there is an established aphasia].
• Negativism: Opposing or not responding to instructions or external stimuli.
• Posturing: Spontaneous and active maintenance of a posture against gravity.
• Mannerism: Odd, circumstantial caricature of normal actions.
• Stereotypy: Repetitive, abnormally frequent, non–goal-directed movements.
• Agitation: Not influenced by external stimuli.
• Grimacing:
• Echolalia: Mimicking another’s speech.
• Echopraxia: Mimicking another’s movements.

B. There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct pathophysiologic consequence of another medical condition.

C. The disturbance is not better explained by another mental disorder (e.g., a manic episode).

D. The disturbance does not occur exclusively during the course of a delirium.

E. The disturbance causes clinically significant distress or impairment in social, occupational, or other areas of functioning.

Coding note: Include the name of the medical condition in the name of the mental disorder (e.g., F06.1 catatonic disorder due to hepatic encephalopathy). The other medical condition should be coded and listed separately immediately before the catatonic disorder due to the medical condition (e.g., K71.90 hepatic encephalopathy; F06.1 catatonic disorder due to hepatic encephalopathy).

DSM-5 Diagnostic Criteria for Delirium

A. A disturbance in attention (i.e., reduced ability to direct, focus, sustain, and shift attention) and awareness (reduced orientation to the environment).

B. The disturbance develops over a short period of time (usually hours to a few days), represents a change from baseline attention and awareness, and tends to fluctuate in severity during the course of a day.

C. An additional disturbance in cognition (e.g., memory deficit, disorientation, language, visuospatial ability, or perception).

D. The disturbances in Criteria A and C are not explained by another preexisting, established, or evolving neurocognitive disorder and do not occur in the context of a severely reduced level of arousal, such as coma.

E. There is evidence from the history, physical examination, or laboratory findings that the disturbance is a direct physiologic consequence of another medical condition, substance intoxication or withdrawal (i.e., due to a drug of abuse or to a medication), or exposure to a toxin, or is due to multiple etiologies.

DSM-5 Delirium Subtypes

Hyperactive delirium - Increased psychomotor activity and mood lability:

• Confusion
• Psychosis
• Disorientation
• Agitation
• Hypervigilance
• Hyper-alertness
• Combativeness
• Loud, pressured speech
• Behavioral dysregulation
• Pulling at lines/catheters

Hypoactive delirium - Decreased psychomotor activity:

• Sluggishness
• Lethargy
• Stupor
• Confusion
• Apathy

Mixed delirium - Normal level of psychomotor activity:

• Poor attention
• Decreased awareness
• Rapid fluctuation of activity level

DSM-5 Diagnostic Criteria for ADHD

A. A persistent pattern of inattention and/or hyperactivity/impulsivity that interferes with functioning or development, as characterized by (1) and/or (2):

1. Inattention: Six (or more) of the following symptoms of inattention have persisted for ≥6 mo to a degree that is inconsistent with development level and that negatively affects directly on social and academic/occupational activities:

• 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).
• Often has difficulty sustaining attention in tasks or play activities.
• Often does not seem to listen when spoken to directly.
• Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not the result of oppositional behavior or failure to understand instructions).
• Often has difficulty organizing tasks and activities.
• Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (e.g., schoolwork, homework).
• Often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, tools).
• Is often easily distracted by extraneous stimuli.
• Is often forgetful in daily activities.

2. Hyperactivity/impulsivity: Six (or more) of the following symptoms of hyperactivity/impulsivity have persisted for ≥6 mo to a degree that is inconsistent with development level and that negatively affects directly on social and academic/occupational activities:

• Often fidgets with hands or feet or squirms in seat.
• Often leaves seat in classroom or in other situations in which remaining seated is expected.
• Often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness).
• Often has difficulty playing or engaging in leisure activities quietly.
• Is often “on the go” or often acts as if “driven by a motor.”
• Often talks excessively.
• Often blurts out answers before questions have been completed.
• Often has difficulty awaiting turn.
• Often interrupts or intrudes on others (e.g., butts into conversations or games).

B. Several inattentive or hyperactive/impulsive symptoms were present before 12 yr of age.

C. Several inattentive or hyperactive/impulsive symptoms are present in two or more settings (e.g., at school [or work] or at home) and are documented independently.

D. There is clear evidence of clinically significant impairment in social, academic, or occupational functioning.

E. Symptoms do not occur exclusively during the course of schizophrenia, or another psychotic disorder, and are not better accounted for by another mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication or withdrawal).

CODE BASED ON TYPE:

• 314.01 Attention-deficit/hyperactivity disorder, combined presentation: if both Criteria A1 and A2 are met for the past 6 mo.
• 314.00 Attention-deficit/hyperactivity disorder, predominantly inattentive presentation: if Criterion A1 is met but Criterion A2 is not met for the past 6 mo.
• 314.01 Attention-deficit/hyperactivity disorder, predominantly hyperactive-impulsive presentation: if Criterion A2 is met but Criterion A1 is not met for the past 6 mo.

Specify if:

• Mild: Few, if any, symptoms in excess of those required to make the diagnosis are present, and if the symptoms result in no more than minor impairments in social and occupational functioning.
• Moderate: Symptoms or functional impairment between “mild” and “severe” are present.
• Severe: Many symptoms in excess of those required to make the diagnosis, or several symptoms that are particularly severe, are present, or the symptoms result in marked impairment in social or occupational functioning.

DSM-5 Diagnostic Criteria for Specific Learning Disability with Impairment in Written Expression

A. Difficulties learning and using academic skills that have persisted for at least 6 months, despite the provision of interventions that target those difficulties. Difficulties with written expression (e.g., makes multiple grammatical or punctuation errors within sentences; employs poor paragraph organization; written expression of ideas lacks clarity).

B. The affected academic skills are substantially and quantifiably below those expected for the individual’s chronologic age and cause significant interference with academic or occupational performance or with activities of daily living, as confirmed by individually administered standardized achievement measures and comprehensive clinical assessment. For individuals age 17 years and older, a documented history of impairing learning difficulties may be substituted for the standardized assessment.

C. The learning difficulties begin during school-age years but may not become fully manifest until the demands for those affected academic skills exceed the individual’s limited capacities (e.g., as in timed tests, reading or writing lengthy complex reports for a tight deadline, excessively heavy academic loads).

D. The learning difficulties are not better accounted for by intellectual disabilities, uncorrected visual or auditory acuity, other mental or neurologic disorders, psychosocial adversity, lack of proficiency in the language of academic instruction, or inadequate educational instruction.

315.2 (F81.81) With impairment in written expression:

• Spelling accuracy
• Grammar and punctuation accuracy
• Clarity or organization of written expression

Specify current severity:

• Mild: Some difficulties learning skills in one or two academic domains, but of mild enough severity that the individual may be able to compensate or function well when provided with appropriate accommodations or support services, especially during the school years.
• Moderate: Marked difficulties learning skills in one or more academic domains, so that the individual is unlikely to become proficient without some intervals of intensive and specialized teaching during the school years. Some accommodations or supportive services at least part of the day at school, in the workplace, or at home may be needed to complete activities accurately and efficiently.
• Severe: Severe difficulties learning skills, affecting several academic domains, so that the individual is unlikely to learn those skills without ongoing intensive individualized and specialized teaching for most of the school years. Even with an array of appropriate accommodations or services at home, at school, or in the workplace, the individual may not be able to complete all activities efficiently.

DSM-5 Diagnostic Criteria for Communication Disorders

Language Disorder

A. Persistent difficulties in the acquisition and use of language across modalities (i.e., spoken, written, sign language, or other) due to deficits in comprehension or production that include the following:

• Reduced vocabulary (word knowledge and use).
• Limited sentence structure (ability to put words and word endings together to form sentences based on the rules of grammar and morphology).
• Impairments in discourse (ability to use vocabulary and connect sentences to explain or describe a topic or series of events or have a conversation).

B. Language abilities are substantially and quantifiably below those expected for age, resulting in functional limitations in effective communication, social participation, academic achievement, or occupational performance, individually or in any combination.

C. Onset of symptoms is in the early developmental period.

D. The difficulties are not attributable to hearing or other sensory impairment, motor dysfunction, or another medical or neurologic condition and are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay.

Speech Sound Disorder

A. Persistent difficulty with speech sound production that interferes with speech intelligibility or prevents verbal communication of messages.

B. The disturbance causes limitations in effective communication that interfere with social participation, academic achievement, or occupational performance, individually or in any combination.

C. Onset of symptoms is in the early developmental period.

D. The difficulties are not attributable to congenital or acquired conditions, such as cerebral palsy, cleft palate, deafness or hearing loss, traumatic brain injury, or other medical or neurologic conditions.

Social (Pragmatic) Communication Disorder

A. Persistent difficulties in the social use of verbal and nonverbal communication as manifested by all of the following:

• Deficits in using communication for social purposes, such as greeting and sharing information, in a manner that is appropriate for the social context.
• Impairment of the ability to change communication to match context or the needs of the listener, such as speaking differently in a classroom than on a playground, talking differently to a child than to an adult, and avoiding use of overly formal language.
• Difficulties following rules for conversation and storytelling, such as taking turns in conversation, rephrasing when misunderstood, and knowing how to use verbal and nonverbal signals to regulate interaction.
• Difficulties understanding what is not explicitly stated (e.g., making inferences) and nonliteral or ambiguous meanings of language (e.g., idioms, humor, metaphors, multiple meanings that depend on the context for interpretation).

B. The deficits result in functional limitations in effective communication, social participation, social relationships, academic achievement, or occupational performance, individually or in combination.

C. The onset of the symptoms is in the early developmental period (but deficits may not become fully manifest until social communication demands exceed limited capacities).

D. The symptoms are not attributable to another medical or neurologic condition or to low abilities in the domains of word structure and grammar and are not better explained by autism spectrum disorder, intellectual disability (intellectual developmental disorder), global developmental delay, or another mental disorder.

DSM-5 Diagnostic Criteria for Childhood-Onset Fluency Disorder

A. Disturbances in the normal fluency and time patterning of speech that are inappropriate for the individual’s age and language skills, persist over time, and are characterized by frequent and marked occurrences of one (or more) of the following:

• Sound and syllable repetitions.
• Sound prolongations of consonants and vowels.
• Broken words (e.g., pauses within a word).
• Audiable or silent blocking (filled or unfilled pauses in speech).
• Circumlocutions (word substitutions to avoid problematic words).
• Words produced with an excess of physical tension.
• Monosyllabic whole-word repetitions (e.g., “I-I-I-I see him”).

B. The disturbance causes anxiety about speaking or limitations in effective communication, social participation, or academic or occupational performance, individually or in any combination.

C. The onset of symptoms is in the early developmental period. Note: Later-onset cases are diagnosed as 307.0 [F98.5] adult-onset fluency disorder.

D. The disturbance is not attributable to a speech-motor or sensory deficit, dysfluency associated with neurologic insult (e.g., stroke, tumor, trauma), or another medical condition and is not better explained by another mental disorder.

DSM-5 Diagnostic Criteria for Autism Spectrum Disorder

A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history:

• Deficits in social-emotional reciprocity.
• Deficits in nonverbal communicative behaviors used for social interaction.
• Deficits in developing, maintaining, and understanding relationships.

B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history:

• Stereotyped or repetitive motor movements, use of objects, or speech.
• Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior.
• Highly restricted, fixated interests that are abnormal in intensity or focus.
• Hyperreactivity or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment.

C. Symptoms must be present in the early developmental period (may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life).

D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.

E. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay.

Associated Features of Autism Not in DSM-5 Criteria

Atypical language development and abilities

• Age <6 yr: Frequently disordered and delayed in comprehension; two thirds have difficulty with expressive phonology and grammar.
• Age ≥6 yr: Disordered pragmatics, semantics, and morphology, with relatively intact articulation and syntax (i.e., early difficulties are resolved).

Motor abnormalities:

• Motor delay.
• Hypotonia.
• Catatonia.
• Deficits in coordination, movement preparation and planning, praxis, gait, and balance.