Neurodevelopmental Disorders

1. Intellectual Disability (Intellectual Developmental Disorder)

DSM Criteria:
●​ A. Deficits in intellectual functions such as reasoning, problem-solving, planning,
abstract thinking, judgment, academic learning, and learning from experience,
confirmed by both clinical assessment and individualized, standardized intelligence
testing (e.g., IQ score approximately 70 or below).
●​ B. Deficits in adaptive functioning that result in failure to meet developmental and
sociocultural standards for personal independence and social responsibility. The
deficits limit functioning in one or more activities of daily life, such as
communication, social participation, and independent living.
●​ C. Onset during the developmental period (i.e., prior to age 18).
Prevalence:
●​ Intellectual Disability affects approximately 1-3% of the global population.
●​ Mild ID is the most common form, comprising about 85% of all cases.
●​ Moderate ID accounts for about 10%, while severe and profound ID together make
up 5% of cases.
Gender Distribution:
●​ ID is more common in males than females, with a male-to-female ratio of
approximately 1.5:1.
●​ This disparity is likely due to X-linked genetic conditions (e.g., Fragile X syndrome).
Age of Onset:
●​ Typically diagnosed in childhood, as developmental delays become noticeable before
age 18.
Geographic and Socioeconomic Factors:
●​ Higher prevalence rates are observed in low- and middle-income countries, often
due to limited access to healthcare, malnutrition, and preventable conditions (e.g.,
birth complications, infections).
●​ Socioeconomic factors, such as poverty and educational access, also play a
significant role.
Etiology:
●​ Genetic factors: Down syndrome, Fragile X syndrome, Rett syndrome, Prader-Willi
syndrome.
 ●​ Prenatal factors: Maternal infections (e.g., rubella), drug use (e.g., alcohol),
exposure to toxins.
●​ Perinatal factors: Prematurity, birth asphyxia, low birth weight.
●​ Postnatal factors: Lead poisoning, severe neglect, trauma, infections.
Prognosis:
●​ Varies depending on the severity and underlying cause.
●​ Mild cases often improve with early intervention and can lead an independent life
with some support.
●​ Severe cases may require lifelong care.
Treatment:
●​ Educational interventions: Tailored teaching methods and behavior modification
programs.
●​ Speech and occupational therapy: To address communication, motor skills, and
daily living tasks.
●​ Psychiatric medications: For associated mood or behavioral problems.
Comorbidity:
●​ Autism Spectrum Disorder (ASD)
●​ Attention-Deficit/Hyperactivity Disorder (ADHD)
●​ Anxiety and mood disorders
●​ Epilepsy
Differential Diagnosis:
●​ Global Developmental Delay: In children under age 5 when the severity of
intellectual disability cannot be reliably assessed.
●​ Learning Disabilities: These are specific deficits in academic skills, not related to
general intellectual functioning.
●​ Communication Disorders: Disorders like speech sound disorder, which focus on
communication rather than intellectual and adaptive functioning.

2. Communication Disorders
DSM Criteria for Each Disorder:
Language Disorder:
●​ A. Persistent difficulties in the acquisition and use of language across modalities
(spoken, written, or sign language), due to deficits in comprehension or production.
 ●​ B. The language abilities are substantially below those expected for age, resulting
in functional limitations in communication, social participation, academic
achievement, or occupational performance.
●​ C. Onset in the early developmental period.
●​ D. The difficulties are not better explained by intellectual disability, global
developmental delay, or another mental disorder.
Speech Sound Disorder:
●​ A. Difficulty pronouncing words correctly, leading to impairments in
communication.
●​ B. The speech difficulties result in limited speech intelligibility or communicative
effectiveness.
●​ C. Onset before age 6.
●​ D. The difficulties are not better explained by hearing loss, structural
abnormalities, or other medical conditions.
Childhood-Onset Fluency Disorder (Stuttering):
●​ A. Disturbances in the normal fluency and time patterning of speech that are
inappropriate for the individual’s age, and include repetitions, prolongations, and
blocks.
●​ **B. The speech disturbances cause anxiety about speaking or limitations in effective
communication.
●​ C. Onset in early childhood.
Social (Pragmatic) Communication Disorder:
●​ A. Deficits in the social use of verbal and nonverbal communication (e.g., greeting
others, sharing information appropriately).
●​ B. The deficits result in functional impairments in social communication and
interaction.
●​ C. Onset in early childhood.
Etiology:
●​ Genetic factors: Family history of communication disorders.
●​ Environmental: Low socioeconomic status, neglect, or inconsistent language
exposure.
●​ Neurological: Abnormalities in brain regions that process speech and language.
Prognosis:
●​ Can improve with early intervention.
●​ Language disorder may persist but treatment can help manage symptoms.
Treatment:
●​ Speech and language therapy.
●​ Parent training and early childhood interventions.
Comorbidity:
●​ Attention-Deficit/Hyperactivity Disorder (ADHD)
●​ Autism Spectrum Disorder (ASD)
●​ Social anxiety disorder
Differential Diagnosis:
●​ Hearing impairment: Exclusion of language disorder if hearing loss is detected.
●​ Intellectual Disability: Communication deficits are expected in ID, but speech and
language difficulties in ID are secondary to cognitive impairment.
●​ Autism Spectrum Disorder (ASD): May overlap with social communication issues
but includes a broader range of symptoms.

3. Autism Spectrum Disorder (ASD)

DSM-5 Criteria:
A. Persistent deficits in social communication and social interaction across multiple
contexts, as manifested by the following, currently or by history (examples are illustrative,
not exhaustive):
1.​ Deficits in social-emotional reciprocity: This includes, but is not limited to,
abnormalities in back-and-forth conversation, failure to initiate or respond to social
interactions, and reduced sharing of interests, emotions, or affect.
2.​ Deficits in nonverbal communicative behaviors used for social interaction: This
includes abnormalities in eye contact, body language, gestures, facial expressions, and
difficulties in understanding or using nonverbal communication.
3.​ Deficits in developing, maintaining, and understanding relationships: This
includes difficulties adjusting behavior to different social contexts, difficulties in
making friends, and a lack of interest in peers.
B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at
least two of the following:
1.​ Stereotyped or repetitive motor movements, use of objects, or speech: This
includes simple motor stereotypes, lining up toys or flipping objects, echolalia,
idiosyncratic phrases.
2.​ Insistence on sameness, inflexible adherence to routines, or ritualized patterns of
behavior: This can include extreme distress at small changes, difficulty with
transitions, or rigid thinking patterns.
 3.​ Highly restricted, fixated interests that are abnormal in intensity or focus: This
includes strong attachment to unusual objects, or highly focused interests in topics
such as numbers, patterns, or specific details.
4.​ Hyper- or hypo-reactivity to sensory input or unusual interest in sensory aspects
of the environment: This can include an apparent indifference to pain or temperature,
adverse responses to specific sounds or textures, or excessive smelling or touching of
objects.
C. Symptoms must be present in the early developmental period (but may not become
fully manifest until social demands exceed limited capacities, or may be masked by learned
strategies later in 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 or global
developmental delay. Intellectual disability and autism spectrum disorder frequently
co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability,
social communication should be below that expected for general developmental level.
subtypes that are now subsumed under Autism Spectrum Disorder (ASD) in DSM-5:
1.​ Autistic Disorder (referred to as "Classic Autism" in some contexts)
o​ Characterized by severe deficits in social interaction, communication, and
restricted, repetitive behaviors.
2.​ Asperger's Disorder (now considered part of the autism spectrum under ASD in
DSM-5)
o​ Typically involves fewer or no language delays and milder social challenges.
However, there are still impairments in social interaction and restricted,
repetitive behaviors.
3.​ Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS) (also
considered part of ASD now)
o​ Used when individuals do not meet the full criteria for Autistic Disorder but
still exhibit some signs of social and communication challenges and repetitive
behaviors.
4.​ Childhood Disintegrative Disorder (now considered part of ASD under DSM-5)
o​ A rare condition where a child develops typically for the first few years of life
but then experiences a significant loss of social, communication, and motor
skills.
In DSM-5, ASD is characterized by Severity Levels, which were added to provide more
information on the degree of support required:
1.​ Level 1: Requiring support
 o​ Individuals with some social and communication difficulties but can function
with minimal support.
2.​ Level 2: Requiring substantial support
o​ Individuals who have significant social and communication deficits and need
substantial support for daily functioning.
3.​ Level 3: Requiring very substantial support
o​ Individuals who have severe deficits in social communication and exhibit very
restricted, repetitive behaviors that greatly interfere with functioning.
Etiology:
●​ Genetic factors:
o​ Genetic mutations or copy number variations (CNVs) linked to ASD.
o​ Family history: Higher prevalence in first-degree relatives.
o​ Syndromic autism (e.g., Rett syndrome, Fragile X syndrome) where a known
genetic condition is associated with ASD.
●​ Neurobiological factors:
o​ Structural brain differences: Reduced brain volume and differences in the
cerebellum, amygdala, and hippocampus.
o​ Abnormalities in neurotransmitter systems: Differences in serotonin,
dopamine, and oxytocin.
●​ Environmental factors:
o​ Advanced parental age.
o​ Maternal exposure to toxins or infections during pregnancy (e.g., rubella,
valproate).
o​ Low birth weight and prematurity.
●​ Other:
o​ No definitive cause for most cases; ASD is considered a complex interaction
of genetic and environmental factors.
Prognosis:
●​ Prognosis is highly variable:
o​ Some individuals with ASD show significant developmental improvements
with early intervention and live relatively independent lives.
o​ Others, particularly those with intellectual disability, may need lifelong
support.
 o​ Social communication deficits tend to persist throughout life, though many
individuals with ASD learn strategies to adapt in social settings.
o​ Autism-related challenges often improve as individuals age, particularly with
speech and social communication skills.
Treatment:
●​ Behavioral interventions:
o​ Applied Behavior Analysis (ABA): One of the most well-researched
interventions, focusing on reinforcement to promote positive behaviors and
reduce undesired ones.
o​ Discrete Trial Training (DTT): A structured form of ABA focusing on
teaching skills in small, incremental steps.
o​ Pivotal Response Training (PRT): Focuses on pivotal areas such as
motivation and self-management.
●​ Speech and language therapy:
o​ To improve communication skills, including both verbal and non-verbal
communication (gestures, eye contact, etc.).
●​ Occupational therapy:
o​ Focuses on improving motor skills, sensory processing, and daily living skills.
●​ Medications:
o​ Medications for associated symptoms, such as anxiety, irritability, or
aggression (e.g., selective serotonin reuptake inhibitors (SSRIs),
antipsychotics).
o​ Medications for co-occurring conditions like ADHD or sleep disorders.
●​ Social skills training:
o​ Group interventions to teach individuals appropriate social behaviors.
Comorbidity:
●​ Intellectual disability: A significant proportion of individuals with ASD also have
intellectual disabilities (IQ below 70).
●​ Attention-Deficit/Hyperactivity Disorder (ADHD): Co-occurs frequently,
particularly with hyperactivity and impulsivity symptoms.
●​ Anxiety disorders: Social anxiety, generalized anxiety, and specific phobias are
common in individuals with ASD.
●​ Epilepsy: Around 20-30% of individuals with ASD experience epilepsy.
●​ Sleep disorders: Difficulty falling asleep, frequent waking, and other sleep problems
are common in ASD.
Differential Diagnosis:
●​ Intellectual Disability (ID): Autism can be distinguished by the presence of
stereotyped behaviors, restricted interests, and social communication deficits that are
not typical of ID alone.
●​ Social (Pragmatic) Communication Disorder: Characterized by deficits in social
communication but lacks the restricted and repetitive behaviors that define ASD.
●​ Schizophrenia: While both can involve social withdrawal and odd behaviors, ASD
does not involve the presence of hallucinations or delusions as seen in schizophrenia.
●​ Childhood-Onset Mood Disorder: In contrast to ASD, mood disorders like
depression or bipolar disorder involve prominent mood symptoms, which are not a
defining feature of ASD.
●​ Anxiety Disorders: Although ASD individuals may also present with anxiety, it is the
hallmark of ASD that includes social communication deficits and repetitive behaviors.
●​ Selective Mutism: Characterized by failure to speak in certain social situations, but
the social interaction deficits and repetitive behaviors of ASD are not present.
Epidemiology:
●​ Prevalence:
o​ As of recent studies, approximately 1 in 36 children in the United States are
identified as having ASD (Centers for Disease Control and Prevention, 2023).
o​ ASD is more common in males (4:1 ratio) than females, though females may
present with more subtle symptoms and a later diagnosis and more if
comorbidity of ID.
●​ Age of onset:
o​ Symptoms typically emerge by age 2, with a diagnosis often made between
ages 3 and 5, although some children may not be diagnosed until later.
●​ Cultural and geographic variation:
o​ The prevalence of ASD varies based on diagnostic practices and public
awareness.
o​ Higher recognition in Western countries, but under-recognition and late
diagnosis are more common in non-Western societies.

4. Attention-Deficit/Hyperactivity Disorder (ADHD)

DSM Criteria:
●​ A. A persistent pattern of inattention and/or hyperactivity-impulsivity that
interferes with functioning or development, characterized by:
 1.​ Inattention: Six or more symptoms of inattention for at least six months (e.g.,
careless mistakes, difficulty sustaining attention).
2.​ Hyperactivity and Impulsivity: Six or more symptoms of
hyperactivity-impulsivity for at least six months (e.g., fidgeting, interrupting
others, difficulty staying seated).
●​ B. Symptoms must be present in two or more settings (e.g., home, school, work).
●​ C. Clear evidence that symptoms interfere with or reduce the quality of social,
academic, or occupational functioning.
●​ D. Symptoms must be present before age 12.
●​ E. Symptoms are not better explained by another mental disorder (e.g., mood
disorder, anxiety disorder, psychotic disorder).
Etiology:
●​ Genetic: Strong familial aggregation; potential heritability.
●​ Neurobiological: Differences in dopamine and norepinephrine regulation.
●​ Environmental: Prenatal exposure to alcohol, tobacco, lead, or other toxins.
Prognosis:
●​ Often persists into adulthood.
●​ Early intervention and appropriate treatment help manage symptoms effectively.
Treatment:
●​ Stimulant medications (e.g., methylphenidate, amphetamines).
●​ Behavioral therapy: Cognitive-behavioral therapy (CBT), parent training.
●​ Environmental modifications: Structured environments and academic
accommodations.
Comorbidity:
●​ Oppositional Defiant Disorder (ODD)
●​ Conduct Disorder
●​ Anxiety and depression
●​ Learning Disabilities
Differential Diagnosis:
●​ Bipolar disorder: Symptoms of irritability and impulsivity can overlap but the mood
symptoms are more severe in bipolar disorder.
●​ Learning Disabilities: Can present with attention problems but are specific to
learning tasks rather than global inattention.
 ●​ Anxiety Disorders: Can cause concentration difficulties but ADHD includes
hyperactivity and impulsivity.

Schizophrenia Spectrum and Other Psychotic Disorders

The Schizophrenia Spectrum and Other Psychotic Disorders category includes a wide
range of disorders marked by abnormalities in perception, thought, and behavior, often
including hallucinations, delusions, and disorganized thinking. Below are the disorders
included in this spectrum:
1.​ Schizophrenia
2.​ Schizoaffective Disorder
3.​ Delusional Disorder
4.​ Brief Psychotic Disorder
5.​ Schizophreniform Disorder
6.​ Substance/Medication-Induced Psychotic Disorder
7.​ Psychotic Disorder Due to Another Medical Condition
8.​ Catatonia (Can be a specifier for any of the above disorders)
9.​ Other Specified and Unspecified Psychotic Disorders

Schizophrenia
DSM-5 Diagnostic Criteria:
A. Characteristic symptoms: 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 thinking (speech)
4.​ Grossly disorganized or abnormal motor behavior (including catatonia)
5.​ Negative symptoms (diminished emotional expression, avolition)
B. Social/Occupational Dysfunction: For a significant portion of the time since the onset of
the disturbance, one or more major areas of functioning (work, interpersonal relationships, or
self-care) are markedly below the level achieved prior to the onset.
C. Duration: 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 treated) that meet Criterion A
(active-phase symptoms) and may include periods of prodromal or residual symptoms.
D. Schizoaffective Disorder and Mood Disorder Exclusion: Schizophrenia is not better
explained by a schizoaffective disorder or mood disorder with psychotic features.
E. Substance/Medical Condition Exclusion: 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. Autism Spectrum Disorder: If there is a history of autism spectrum disorder or a
communication disorder in childhood, the additional diagnosis of schizophrenia is made only
if prominent delusions or hallucinations are also present for at least 1 month.
Etiology:
●​ Genetics: Strong hereditary component. Risk increases with a first-degree relative
with schizophrenia. Monozygotic twins have a higher concordance rate (~50%).
●​ Neurobiological Factors: Dopamine dysregulation, especially overactivity in the
mesolimbic pathway and underactivity in the mesocortical pathway. Structural brain
abnormalities, including enlarged ventricles, reduced gray matter, and cortical
atrophy.
●​ Environmental Factors: Prenatal exposure to infections, malnutrition, or stress.
Childhood trauma, cannabis use, and urban upbringing also increase risk.
Prognosis:
●​ Chronic, with episodes of symptom exacerbation and periods of symptom remission.
●​ Long-term outcomes vary, with some individuals recovering well, while others
experience persistent disability.
●​ Early intervention can improve prognosis and reduce the severity of symptoms.
●​ High risk of suicide and homelessness if untreated.
Treatment:
●​ Antipsychotic medications (e.g., atypical antipsychotics such as risperidone,
quetiapine, olanzapine, and typical antipsychotics such as haloperidol) are the
cornerstone of treatment.
●​ Psychosocial interventions:
o​ Cognitive Behavioral Therapy (CBT) to address distorted thinking patterns
and reduce paranoia.
o​ Family therapy to reduce stress and improve coping mechanisms.
o​ Assertive Community Treatment (ACT) for intensive support in community
settings.
 ●​ Rehabilitation programs for improving social skills, vocational skills, and
independent living.
Comorbidity:
●​ Substance use disorders (especially cannabis and alcohol use).
●​ Depression and anxiety disorders.
●​ Obsessive-compulsive disorder.
●​ Polydipsia (excessive drinking of water).
●​ Increased risk for suicide.
Differential Diagnosis:
●​ Schizoaffective Disorder: Includes both mood episode (e.g., depression or mania)
and psychotic symptoms, but the psychotic symptoms must persist without mood
symptoms for at least 2 weeks.
●​ Mood Disorders with Psychotic Features: Involves mood disturbance with
psychotic symptoms; however, psychotic symptoms only occur during the mood
episodes.
●​ Delusional Disorder: Focused on delusions without the pervasive functional
impairment seen in schizophrenia.
●​ Substance-Induced Psychotic Disorder: Psychotic symptoms that result from
intoxication or withdrawal from substances or drugs.
●​ Personality Disorders (e.g., Paranoid Personality Disorder) may present with
suspiciousness but lack delusions and hallucinatory experiences.
Epidemiology:
●​ Prevalence: Affects approximately 0.3-0.7% of the global population.
●​ Age of onset: Typically emerges in late adolescence to early adulthood (18-25 years
in men and 25-35 years in women).
●​ Gender: Males are often diagnosed earlier and tend to have more severe outcomes.
●​ Cultural Factors: The prevalence and presentation can vary across cultures, with
some cultures interpreting hallucinations differently (e.g., as spiritual experiences).

Other Disorders in the Schizophrenia Spectrum and Psychotic Disorders

Schizoaffective Disorder
●​ A. An uninterrupted period of illness during which there is a major mood episode
(manic or depressive) concurrent with Criterion A of schizophrenia.
●​ B. Delusions or hallucinations for at least 2 weeks in the absence of a major mood
episode.
 ●​ C. Symptoms that meet criteria for a major mood episode are present for the majority
of the total duration of the illness.
●​ D. The disturbance is not due to a substance or medical condition.
Differential Diagnosis
●​ Schizophrenia: Lacks significant mood episodes.
●​ Bipolar Disorder with Psychotic Features: Psychotic symptoms only occur during
mood episodes.
●​ Major Depressive Disorder with Psychotic Features: Psychosis is mood-congruent.
●​ Substance/Medication-Induced Psychotic Disorder: Linked to substance use.
●​ Psychotic Disorder Due to Another Medical Condition: Direct result of a medical
condition.
Epidemiology
●​ Lifetime prevalence: 0.3%.
●​ Onset: Early adulthood, typically between 20-30 years.
●​ Gender: More common in females (likely due to the depressive subtype).
Etiology
●​ Genetic: Family history of schizophrenia, bipolar disorder, or both.
●​ Neurochemical: Dysregulation of dopamine and serotonin pathways.
●​ Psychosocial: Stress and trauma as potential triggers.
Prognosis
●​ Better than schizophrenia but worse than mood disorders.
●​ Factors affecting prognosis: Younger age of onset, negative symptoms, and
substance use predict worse outcomes.
Treatment
●​ Antipsychotics (e.g., paliperidone) for psychotic symptoms.
●​ Mood stabilizers (e.g., lithium, valproate) for mood symptoms.
●​ Antidepressants if depressive episodes are present.
●​ Psychotherapy: CBT and psychoeducation.
Delusional Disorder
●​ A. The presence of one or more delusions with a duration of 1 month or longer.
●​ B. Criterion A for schizophrenia has never been met.
 ●​ C. Apart from the impact of the delusion(s), functioning is not markedly impaired,
and behavior is not obviously odd or bizarre.
Differential Diagnosis
●​ Schizophrenia: Includes hallucinations and broader functional impairment.
●​ Obsessive-Compulsive Disorder (OCD): Intrusive thoughts without fixed delusions.
●​ Paranoid Personality Disorder: Pervasive distrust without fixed delusions.
Epidemiology
●​ Prevalence: 0.2% in the general population.
●​ Onset: Usually middle to late adulthood.
Etiology
●​ Genetic predisposition: Family history of schizophrenia or delusional disorder.
●​ Personality traits: Paranoid traits may predispose to delusional beliefs.
Prognosis
●​ Variable; can be chronic but may remain stable without significant deterioration.
●​ Factors affecting prognosis: Insight into the delusion improves outcomes.
Treatment
●​ Antipsychotics: Limited efficacy but still first-line.
●​ CBT: Helps in reality testing and managing distress.
Brief Psychotic Disorder
●​ A. Presence of one (or more) of the following symptoms: delusions, hallucinations,
disorganized speech, or disorganized behavior.
●​ **B. Duration of the episode is at least 1 day but less than 1 month, with eventual
full return to premorbid functioning.
Differential Diagnosis
●​ Schizophrenia: Symptoms persist for more than 6 months.
●​ Schizophreniform Disorder: Lasts more than 1 month but less than 6 months.
●​ Substance-Induced Psychosis: Symptoms linked to substance use.
●​ Personality Disorders: May present with transient psychosis under stress.
Epidemiology
●​ Prevalence: Rare, about 0.1%-0.2%.
●​ Onset: Adolescence or early adulthood, often triggered by stress.
Etiology
●​ Psychosocial stressors: Acute stressors like trauma or bereavement.
●​ Genetic: Family history of psychosis may increase risk.
Prognosis
●​ Generally good, with full recovery in most cases.
●​ Recurrence is possible if stressors persist.
Treatment
●​ Antipsychotics: Short-term use during the episode.
●​ Psychotherapy: Crisis intervention and stress management
Schizophreniform Disorder
●​ A. Two (or more) of the following symptoms, each present for a significant portion
of time during a 1-month period (or less if successfully treated): delusions,
hallucinations, disorganized thinking (speech), grossly disorganized or abnormal
motor behavior, negative symptoms.
●​ B. The duration of the episode is at least 1 month but less than 6 months.
Differential Diagnosis
●​ Schizophrenia: Symptoms persist beyond 6 months.
●​ Mood Disorders with Psychotic Features: Mood symptoms are prominent.
●​ Brief Psychotic Disorder: Symptoms last less than 1 month.
Epidemiology
●​ Prevalence: 0.2% to 0.5%.
●​ Onset: Adolescence or early adulthood, similar to schizophrenia.
Etiology
●​ Genetic: Strong family history link with schizophrenia.
●​ Neurobiological: Dopamine dysregulation.
Prognosis
●​ 1/3 recover fully; 2/3 may progress to schizophrenia or schizoaffective disorder.
Treatment
●​ Antipsychotics: Same as schizophrenia.
●​ Psychotherapy: Supportive therapy and psychoeducation
Substance/Medication-Induced Psychotic Disorder
 ●​ A. Presence of one or both of the following:
1.​ Delusions
2.​ Hallucinations
●​ **B. There is evidence from the history, physical examination, or laboratory findings
of history of substance use or withdrawal, or exposure to medications known to
induce psychosis.
Differential Diagnosis
●​ Schizophrenia: Symptoms not substance-related.
●​ Delirium: Includes fluctuating consciousness.
●​ Mood Disorders with Psychotic Features: Psychosis only occurs during mood
episodes.
Epidemiology
●​ Prevalence: Higher among individuals with substance use disorders.
Etiology
●​ Substances involved: Alcohol, cannabis, cocaine, amphetamines, hallucinogens.
●​ Withdrawal states: Especially alcohol and benzodiazepine withdrawal.
Prognosis
●​ Usually resolves after cessation of substance use.
●​ Recurrence is possible with continued use.
Treatment
●​ Detoxification: Managing withdrawal symptoms.
●​ Antipsychotics: Short-term use if needed.
●​ Substance use treatment: Behavioral therapy and relapse prevention.
Psychotic Disorder Due to Another Medical Condition
●​ Psychosis is due to a medical condition (e.g., brain injury, epilepsy, tumors,
infections).
Catatonia
●​ A marked disturbance in motor behavior and other symptoms, including extreme
immobility or excessive movement, mutism, posturing, and echolalia, which can be
present in any of the above disorders.
Differential Diagnosis
●​ Schizophrenia: Often presents with catatonia.
 ●​ Mood Disorders: Catatonia can occur in severe mood disorders.
●​ Neurological conditions: Stroke, encephalitis.
Epidemiology
●​ More common in schizophrenia, mood disorders, and medical conditions.
Etiology
●​ Neurochemical: Dopamine and GABA dysregulation.
●​ Medical causes: Infections, autoimmune diseases.
Prognosis
●​ Good with early treatment.
Treatment
●​ Benzodiazepines (e.g., lorazepam).
●​ ECT: Effective in refractory cases.
Other Specified and Unspecified Psychotic Disorders
●​ Used when the psychotic symptoms do not fit the criteria for any of the above specific
disorders.

Summary:
The Schizophrenia Spectrum and Other Psychotic Disorders encompasses a range of
conditions involving psychosis, with schizophrenia being the most prominent. These
disorders are characterized by delusions, hallucinations, disorganized thinking, and
negative symptoms, and their severity can vary. Schizophrenia requires long-term treatment
and support, including antipsychotic medications and psychosocial interventions. Early
diagnosis and comprehensive care improve the prognosis and quality of life for affected
individuals.

Bipolar and Related Disorders

The Bipolar and Related Disorders category includes disorders characterized by extreme
mood swings, involving episodes of mania (elevated mood, energy, and activity) and
depression (low mood, energy, and activity). These mood swings can vary in severity and
frequency, and the disorders under this category include:
1.​ Bipolar I Disorder
2.​ Bipolar II Disorder
3.​ Cyclothymic Disorder
4.​ Substance/Medication-Induced Bipolar and Related Disorder
 5.​ Bipolar and Related Disorder Due to Another Medical Condition
6.​ Other Specified and Unspecified Bipolar and Related Disorders

Bipolar and Related Disorders (DSM-5)

1. Bipolar I Disorder
Diagnostic Criteria:
A. Manic Episode:
●​ Duration: The manic episode must last at least 1 week or be so severe that immediate
hospitalization is required.
●​ Symptoms (Must include at least three of the following, or four if the mood is
irritable):
1.​ Inflated self-esteem or grandiosity.
2.​ Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).
3.​ More talkative than usual or pressure to keep talking.
4.​ Flight of ideas or racing thoughts.
5.​ Distractibility (attention too easily drawn to irrelevant external stimuli).
6.​ Increase in goal-directed activities (either socially, at work or school, or
sexually) or physical restlessness.
7.​ Engagement in activities that hold potential for painful consequences (e.g.,
unrestrained spending sprees, sexual indiscretions, foolish investments).
B. Major Depressive Episode:
●​ For a diagnosis of Bipolar I, a Major Depressive Episode is not required but may
occur.
C. The manic episode causes clinically significant distress or impairment in social,
occupational, or other important areas of functioning, or requires hospitalization to
prevent harm, or there are psychotic features.
D. The episode is not attributable to the physiological effects of a substance or another
medical condition.
Duration of Episodes:
●​ Manic episodes typically last at least 1 week, unless hospitalized.
●​ A Major Depressive Episode lasts at least 2 weeks.
Etiology:
●​ Genetic: Strong genetic component; first-degree relatives of individuals with bipolar
disorder are at increased risk.
 ●​ Neurobiological: Dysfunction in dopamine, serotonin, and noradrenaline systems,
and abnormalities in brain regions like the prefrontal cortex and amygdala.
●​ Environmental: Stressful life events, sleep disturbances, substance abuse, or trauma
can trigger episodes.
Prognosis:
●​ Chronic course with episodes of mania and depression, which can increase in
frequency over time without intervention.
●​ Early intervention and consistent treatment significantly improve long-term
prognosis.
Treatment:
●​ Pharmacotherapy:
o​ Mood stabilizers (e.g., lithium, valproate), atypical antipsychotics (e.g.,
olanzapine, quetiapine), and antidepressants.
o​ Electroconvulsive Therapy (ECT) for severe or resistant cases.
●​ Psychotherapy:
o​ Cognitive Behavioral Therapy (CBT), Interpersonal and Social Rhythm
Therapy (IPSRT), and psychoeducation.
Comorbidity:
●​ Anxiety disorders, substance use disorders, ADHD, and personality disorders
(especially borderline personality disorder).
Differential Diagnosis:
●​ Major Depressive Disorder: No manic or hypomanic episodes.
●​ Cyclothymic Disorder: Chronic mood instability with subthreshold episodes.
●​ Schizophrenia Spectrum Disorders: Manic symptoms overlapping with psychotic
symptoms.
●​ Substance-induced mood disorders: Drug-induced mania.
Epidemiology:
●​ Prevalence: Lifetime prevalence 0.6% for Bipolar I Disorder.
●​ Age of Onset: Typically late adolescence to early adulthood (18-25 years).
●​ Gender: Affects men and women equally.

2. Bipolar II Disorder
Diagnostic Criteria:
A. A current or past hypomanic episode and a current or past major depressive episode
are required for diagnosis.
B. There has never been a manic episode.
C. The symptoms cause clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
Hypomanic Episode:
●​ Duration: At least 4 days (less severe than mania).
●​ Symptoms: Similar to mania but not severe enough to cause significant impairment in
social or occupational functioning.
Major Depressive Episode:
●​ Symptoms include those seen in Bipolar I (depressed mood, loss of interest, fatigue,
feelings of worthlessness, suicidal ideation, etc.).
Etiology:
●​ Genetic: Strong familial risk.
●​ Neurobiological: Similar to Bipolar I Disorder with possible dopaminergic
dysregulation.
Treatment:
●​ Pharmacotherapy: Mood stabilizers, antidepressants, and atypical
antipsychotics.
●​ Psychotherapy: CBT and IPSRT for stabilization and mood management.
Comorbidity:
●​ Anxiety disorders, substance use disorders, and ADHD.
Differential Diagnosis:
●​ Major Depressive Disorder: Differentiated by presence of hypomanic episodes.
●​ Cyclothymic Disorder: Chronic mood instability without full episodes of depression
or hypomania.

3. Cyclothymic Disorder
Diagnostic Criteria:
A. For at least 2 years (1 year for children and adolescents), the presence of numerous
periods with hypomanic symptoms and numerous periods with depressive symptoms
that do not meet the full criteria for a hypomanic episode or major depressive episode.
B. The symptoms cause clinically significant distress or impairment.
C. The symptoms cannot be better explained by another mood disorder or substance
use.
Duration: Symptoms must persist for at least 2 years (1 year for children/adolescents).

4. Substance/Medication-Induced Bipolar and Related Disorder

Diagnostic Criteria:
●​ Symptoms of bipolar disorder (mania or hypomania) occur during or after substance
intoxication, withdrawal, or medication use.
●​ Duration: Symptoms must persist beyond the expected duration of intoxication or
withdrawal.

5. Bipolar and Related Disorder Due to Another Medical Condition

Diagnostic Criteria:
●​ Symptoms of mania or depression are secondary to a medical condition (e.g., brain
injury, stroke, multiple sclerosis).

6. Other Specified and Unspecified Bipolar and Related Disorders

●​ Used for cases that do not meet full criteria for Bipolar I, Bipolar II, or Cyclothymic
Disorder but show some bipolar-like symptoms.

Summary of DSM-5 Features:

●​ Bipolar disorders are chronic, involve episodes of mania, hypomania, and
depression, and can cause significant impairment.
●​ Genetic and neurobiological factors play a large role in the development.
●​ Mood stabilizers and atypical antipsychotics are the primary treatment options,
along with psychotherapy.
●​ Cyclothymic disorder is characterized by chronic fluctuations in mood but without
full episodes.

If you need further information or clarification on any section, feel free to ask!
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You said:
Depressive Disorders
ChatGPT said:
ChatGPT
Here is a detailed breakdown of the Depressive Disorders from the DSM-5, which includes
the necessary diagnostic criteria (A-Z), comorbidity, differential diagnosis, and other sections
such as etiology, prognosis, and epidemiology:

1. Major Depressive Disorder (MDD)

Diagnostic Criteria:
A. Five (or more) of the following symptoms are present during the same 2-week period and
represent a change from previous functioning. At least one of the symptoms must be either
(1) depressed mood or (2) loss of interest or pleasure.
1.​ Depressed mood most of the day, nearly every day, as indicated by subjective report
or observation made by others (in children and adolescents, this can be an irritable
mood).
2.​ Markedly diminished interest or pleasure in all, or almost all, activities most of the
day.
3.​ Significant weight loss when not dieting, weight gain, or decrease or increase in
appetite.
4.​ Insomnia or excessive sleeping.
5.​ Psychomotor agitation or retardation (restlessness or slowed movements).
6.​ Fatigue or loss of energy.
7.​ Feelings of worthlessness or excessive guilt.
8.​ Diminished ability to think or concentrate, or indecisiveness.
9.​ Recurrent thoughts of death, suicidal ideation, or suicide attempt.
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 physiological effects of a substance or another
medical condition.
D. The occurrence of the depressive episode is not better explained by another mental
disorder, such as schizoaffective disorder or schizophrenia.
E. There has never been a manic episode or hypomanic episode (this excludes Bipolar I and
II disorders).
Etiology:
●​ Genetic: Family history of depression increases risk.
 ●​ Neurobiological: Dysfunction in serotonergic, dopaminergic, and noradrenergic
systems.
●​ Environmental: Stressful life events, trauma, and adverse childhood experiences.
Prognosis:
●​ Untreated, MDD can be chronic and debilitating.
●​ Relapse is common, but proper treatment can lead to remission.
●​ The course can be episodic, with many individuals experiencing recurrent episodes.
Treatment:
●​ Pharmacotherapy: SSRIs, SNRIs, TCAs, MAOIs, and atypical antidepressants.
●​ Psychotherapy: Cognitive Behavioral Therapy (CBT), Interpersonal Therapy
(IPT), psychodynamic therapy.
●​ Electroconvulsive Therapy (ECT) for severe or treatment-resistant cases.
Comorbidity:
●​ Anxiety disorders, substance use disorders, eating disorders, personality
disorders, chronic medical conditions (e.g., diabetes, heart disease).
Differential Diagnosis:
●​ Bipolar disorder: Must differentiate from manic or hypomanic episodes.
●​ Generalized Anxiety Disorder (GAD): Anxiety and worry must be more pervasive
than mood disturbance.
●​ Adjustment Disorder: Symptoms emerge in response to an identifiable stressor, not
prolonged or recurrent.
●​ Medical conditions: Thyroid disorders, vitamin deficiencies, and neurological
conditions (e.g., stroke, Parkinson's disease).
Epidemiology:
●​ Prevalence: Around 7% of adults in the U.S. experience MDD annually.
●​ Age of onset: Can begin at any age but is more common in late adolescence to early
adulthood.
●​ Gender: Women are twice as likely as men to be diagnosed.

2. Persistent Depressive Disorder (PDD) (also known as Dysthymia)

Diagnostic Criteria:
A. Depressed mood for most of the day, for more days than not, for at least 2 years (1 year
for children and adolescents). During this period, the individual has never been without
symptoms for more than 2 months at a time.
B. Two (or more) of the following symptoms:
1.​ Poor appetite or overeating.
2.​ Insomnia or excessive sleeping.
3.​ Low energy or fatigue.
4.​ Low self-esteem.
5.​ Poor concentration or difficulty making decisions.
6.​ Feelings of hopelessness.
C. During the 2-year period (1 year for children and adolescents), the individual has never
had a manic episode or hypomanic episode (this excludes Bipolar I and II disorders).
D. The symptoms cause clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
Etiology:
●​ Genetic: Family history of depression increases risk.
●​ Neurobiological: Similar to MDD, involving imbalances in serotonin, dopamine, and
norepinephrine.
●​ Environmental: Chronic stress, childhood trauma, and difficult life events.
Prognosis:
●​ Chronic course: PDD can be long-lasting, often fluctuating in severity.
●​ Those with PDD may develop MDD later, in what is called double depression.
Treatment:
●​ Pharmacotherapy: Antidepressants, particularly SSRIs and SNRIs.
●​ Psychotherapy: CBT, Interpersonal Therapy (IPT), mindfulness-based
therapies.
Comorbidity:
●​ Anxiety disorders, substance use, and personality disorders.
Differential Diagnosis:
●​ Major Depressive Disorder: MDD requires that symptoms are more severe and last
for a minimum of 2 weeks.
●​ Bipolar Disorder: Distinguish by the absence of hypomanic or manic episodes.
●​ Adjustment Disorder: Symptoms in response to an identifiable stressor, not
persistent over time.
Epidemiology:
 ●​ Prevalence: Approximately 1.5% in the general population.
●​ Age of onset: Typically begins in early adulthood, with chronicity over time.
●​ Gender: More common in women than men.

3. Disruptive Mood Dysregulation Disorder (DMDD)

Diagnostic Criteria:
A. Severe temper outbursts that are out of proportion to the situation and are inconsistent with
developmental level.
B. The temper outbursts occur, on average, three or more times per week.
C. The mood between outbursts is irritable or angry most of the day, nearly every day, and
is observable by others (e.g., parents, teachers).
D. The symptoms must be present for 12 or more months, with no more than a 3-month
period without symptoms.
E. The diagnosis should not be made for the first time before age 6 years or after age 18
years.
F. The behavior is not better explained by another disorder, such as Bipolar Disorder or
Oppositional Defiant Disorder.
Etiology:
●​ Genetic: Family history of mood disorders and externalizing behaviors.
●​ Neurobiological: Impaired regulation of mood and aggression.
●​ Environmental: Childhood trauma, exposure to family conflict, or inconsistent
discipline.
Prognosis:
●​ DMDD often leads to depression and anxiety in adolescence.
Treatment:
●​ Pharmacotherapy: Antidepressants and mood stabilizers.
●​ Psychotherapy: CBT and parenting interventions to manage irritability and
outbursts.
Comorbidity:
●​ Oppositional Defiant Disorder, ADHD, anxiety disorders, and depressive
disorders.
Differential Diagnosis:
●​ Bipolar Disorder: Unlike bipolar disorder, DMDD involves chronic irritability
without periods of elevated mood.
 ●​ Oppositional Defiant Disorder: DMDD involves severe mood dysregulation and
temper outbursts.
Epidemiology:
●​ Prevalence rates are approximately 2-5% of children.
●​ Onset typically occurs before age 10 years.

4. Premenstrual Dysphoric Disorder (PMDD)

Diagnostic Criteria:
A. In the majority of menstrual cycles, at least five symptoms must be present in the final
week before the onset of menses, and begin to improve within a few days after the onset of
menses.
1.​ Marked mood swings, irritability, or anger.
2.​ Marked anxiety, tension, or sadness.
3.​ Decreased interest in usual activities.
4.​ Subjective sense of being overwhelmed or out of control.
5.​ Physical symptoms: fatigue, sleep disturbances, joint or muscle pain, and headaches.
Etiology:
●​ Genetic: Family history of mood disorders increases risk.
●​ Hormonal: Fluctuations in estrogen and progesterone levels may play a role.
Prognosis:
●​ Symptoms are short-term, related to the menstrual cycle.
●​ Treatment with SSRIs, CBT, and hormonal therapy can be effective.

Summary of Depressive Disorders:

●​ Depressive disorders are characterized by pervasive low mood and loss of interest in
activities, leading to significant impairment.
●​ Treatment includes medications and psychotherapies, and a chronic course is
common without intervention.
●​ Genetic, neurobiological, and environmental factors all contribute to the
development of these disorders.
ANXIETY DISORDERS

Anxiety disorders listed in the DSM-5 under the Anxiety Disorders category, which
include:
1.​ Generalized Anxiety Disorder (GAD)
2.​ Panic Disorder
3.​ Specific Phobia
4.​ Social Anxiety Disorder (Social Phobia)
1. Generalized Anxiety Disorder (GAD)
Diagnostic Criteria:
A. Excessive anxiety and worry 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 symptoms
(with at least some symptoms present for more days than not in the past 6 months):
1.​ Restlessness or feeling keyed up or on edge.
2.​ Being easily fatigued.
3.​ Difficulty concentrating or mind going blank.
4.​ Irritability.
5.​ Muscle tension.
6.​ Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).
D. The anxiety, worry, or physical symptoms cause clinically significant distress or
impairment in social, occupational, or other important areas of functioning.
E. The disturbance is not attributable to the physiological effects of a substance or another
medical condition.
F. The disturbance is not better explained by another mental disorder (e.g., panic disorder,
social anxiety disorder, obsessive-compulsive disorder, etc.).
Etiology:
●​ Genetic: Family history increases risk.
●​ Neurobiological: Dysregulation of the GABA, serotonin, and norepinephrine
systems.
●​ Environmental: Stressful life events, childhood adversity, and trauma.
Prognosis:
 ●​ Chronic course, often with periods of exacerbation and remission.
●​ The course can vary; some individuals experience complete remission with treatment,
while others continue to experience symptoms throughout their life.
Treatment:
●​ Pharmacotherapy: SSRIs, SNRIs, benzodiazepines (for short-term use),
buspirone.
●​ Psychotherapy: Cognitive Behavioral Therapy (CBT), Relaxation techniques,
Mindfulness-based Stress Reduction.
Comorbidity:
●​ Depressive disorders, panic disorder, social anxiety disorder, substance use
disorders, other anxiety disorders.
Differential Diagnosis:
●​ Panic Disorder: Panic attacks, unlike GAD, are abrupt and episodic.
●​ Social Anxiety Disorder: Social anxiety is specific to social or performance
situations.
●​ Obsessive-Compulsive Disorder: GAD is excessive worry without compulsive
behaviors.
Epidemiology:
●​ Prevalence: Approximately 3.1% of the U.S. adult population annually.
●​ Age of onset: Onset is often in childhood or adolescence but can also occur in
adulthood.
●​ Gender: More common in women than men (2:1 ratio).

2. Panic Disorder
Diagnostic Criteria:
A. Recurrent, unexpected panic attacks (a sudden surge of intense fear or discomfort that
reaches a peak within minutes), and during which time four (or more) of the following
symptoms occur:
1.​ Palpitations, pounding heart, or accelerated heart rate.
2.​ Sweating.
3.​ Trembling or shaking.
4.​ Sensations of shortness of breath or smothering.
5.​ Feelings of choking.
6.​ Chest pain or discomfort.
 7.​ Nausea or abdominal distress.
8.​ Dizziness, lightheadedness, or faintness.
9.​ Chills or heat sensations.
10.​Paresthesias (numbness or tingling sensations).
11.​Derealization or depersonalization.
12.​Fear of losing control or "going crazy".
13.​Fear of dying.
B. At least one of the attacks has been followed by 1 month or more of one or both of the
following:
1.​ Persistent concern or worry about additional panic attacks or their consequences
(e.g., losing control, having a heart attack).
2.​ A significant maladaptive change in behavior related to the attacks (e.g., avoiding
exercise or unfamiliar situations).
C. The disturbance is not attributable to the physiological effects of a substance or another
medical condition.
D. The disturbance is not better explained by another mental disorder (e.g., social anxiety
disorder, specific phobia, OCD, PTSD).
Etiology:
●​ Genetic: Family history of panic disorder or other anxiety disorders increases risk.
●​ Neurobiological: Dysregulation in the norepinephrine, serotonin, and GABA
systems, particularly in the amygdala and limbic system.
●​ Environmental: Stressful life events, trauma, or childhood adversity.
Prognosis:
●​ Often chronic, though treatment can significantly reduce or eliminate panic attacks.
●​ Comorbidity with depressive disorders and substance use disorders is common.
Treatment:
●​ Pharmacotherapy: SSRIs, SNRIs, benzodiazepines (for short-term relief), tricyclic
antidepressants (TCAs).
●​ Psychotherapy: Cognitive Behavioral Therapy (CBT) with exposure-based
techniques, Panic-Focused Cognitive Behavioral Therapy (PFCBT).
Comorbidity:
●​ Agoraphobia, social anxiety disorder, major depressive disorder, substance use
disorders.
Differential Diagnosis:
 ●​ Agoraphobia: Involves the avoidance of places or situations due to fear of panic
attacks or other embarrassing symptoms.
●​ Generalized Anxiety Disorder: GAD involves worry across a wide range of topics,
not focused on panic attacks.
●​ Medical conditions: Cardiovascular diseases, hyperthyroidism, vestibular disorders.
Epidemiology:
●​ Prevalence: Approximately 2-3% of the population in the U.S.
●​ Age of onset: Typically late adolescence to early adulthood (but can occur at any
age).
●​ Gender: More common in women than men (2:1 ratio).

3. Specific Phobia
Diagnostic Criteria:
A. Marked fear or anxiety about a specific object or situation (e.g., flying, heights, animals,
injections).
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 object or
situation.
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 another mental disorder (e.g.,
obsessive-compulsive disorder, posttraumatic stress disorder).
Etiology:
●​ Genetic: Family history of anxiety disorders or specific phobias.
●​ Neurobiological: Dysfunction in the amygdala, which processes fear responses.
●​ Environmental: Traumatic experiences or modeling of fearful behaviors.
Prognosis:
●​ Chronic if untreated, but exposure therapy and CBT can be highly effective in
treatment.
Treatment:
●​ Pharmacotherapy: SSRIs, SNRIs for anxiety management, benzodiazepines for
short-term relief.
 ●​ Psychotherapy: Cognitive Behavioral Therapy (CBT) with exposure therapy.
Comorbidity:
●​ Panic disorder, generalized anxiety disorder, social anxiety disorder.
Differential Diagnosis:
●​ Obsessive-Compulsive Disorder: OCD involves intrusive thoughts and compulsive
behaviors, not just fear of specific objects or situations.
●​ Posttraumatic Stress Disorder: PTSD involves fear due to past trauma, often with
flashbacks and avoidance behaviors.
Epidemiology:
●​ Prevalence: Around 12.5% of adults in the U.S.
●​ Age of onset: Often begins in childhood or adolescence.
●​ Gender: More common in women than men (2:1 ratio).

4. Social Anxiety Disorder (Social Phobia)

Diagnostic Criteria:
A. Marked fear or anxiety about one or more social situations where the individual is exposed
to possible scrutiny by others (e.g., interactions, being observed, performing in front of
others).
B. The individual fears that they will act in a way (or show anxiety symptoms) that will be
negatively evaluated (e.g., humiliated, embarrassed, rejected, or looked down upon).
C. The social situations almost always provoke fear or anxiety.
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.
F. The fear, anxiety, or avoidance is persistent, typically lasting 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 disturbance is not attributable to the physiological effects of a substance or another
medical condition.
I. The disturbance is not better explained by another mental disorder.
Etiology:
●​ Genetic: Family history of social anxiety disorder or other anxiety disorders.
●​ Neurobiological: Dysregulation in the serotonin system, heightened amygdala
activity.
 ●​ Environmental: Negative social experiences in childhood, peer rejection.
Prognosis:
●​ Chronic if untreated, but can significantly improve with psychotherapy.
Treatment:
●​ Pharmacotherapy: SSRIs, SNRIs, beta-blockers for situational anxiety.
●​ Psychotherapy: Cognitive Behavioral Therapy (CBT), exposure therapy, social
skills training.
Comorbidity:
●​ Depressive disorders, other anxiety disorders, substance use disorders.
Differential Diagnosis:
●​ Avoidant Personality Disorder: Avoidance due to feelings of inadequacy, not fear of
embarrassment.
●​ Generalized Anxiety Disorder: GAD involves worry about a broad range of topics,
not just social situations.
Epidemiology:
●​ Prevalence: Approximately 7-13% in the U.S. population.
●​ Age of onset: Typically begins in adolescence or early adulthood.
●​ Gender: More common in women than men.

Summary of Anxiety Disorders:

●​ Anxiety disorders involve excessive and persistent fear, anxiety, and related
behaviors (e.g., avoidance).
●​ They are typically chronic and cause significant impairment in social, occupational,
or other areas of life.
●​ Pharmacotherapy (e.g., SSRIs, SNRIs, benzodiazepines) and Cognitive Behavioral
Therapy (CBT) are the most common treatments.
●​ They often have a genetic, neurobiological, and environmental basis, with
comorbidities such as depression, substance use, and other anxiety disorders.

1. Obsessive-Compulsive Disorder (OCD)

Diagnostic Criteria:
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 as
intrusive and unwanted, and that 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, checking) or mental acts (e.g.,
praying, counting) that the individual feels driven to perform in response to an
obsession or according to rigid rules.
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 either 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 hour per 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 physiological effects of a
substance (e.g., a drug of abuse, medication) or another medical condition.
D. The disturbance is not better explained by the symptoms of another mental disorder (e.g.,
body dysmorphic disorder, hoarding disorder, trichotillomania (hair-pulling disorder),
**excoriation (skin-picking) disorder).
Etiology:
●​ Genetic: Family history of OCD increases risk.
●​ Neurobiological: Dysfunction in the orbitofrontal cortex, caudate nucleus, and
anterior cingulate cortex. Serotonin dysregulation is involved.
●​ Environmental: Stressful life events, infections (e.g., PANDAS - Pediatric
Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections).
Prognosis:
●​ Chronic if untreated, though symptoms can be managed with treatment.
●​ Onset is typically in adolescence or young adulthood, though it can begin in
childhood.
●​ Symptoms may fluctuate in severity over time.
Treatment:
●​ Pharmacotherapy: SSRIs (e.g., fluoxetine, sertraline), clomipramine (TCA), and
antipsychotics for treatment-resistant cases.
 ●​ Psychotherapy: Cognitive Behavioral Therapy (CBT) with exposure and
response prevention (ERP), which helps patients face their fears without engaging in
compulsive behaviors.
Comorbidity:
●​ Tic disorders, depression, anxiety disorders, substance use disorders, eating
disorders.
Differential Diagnosis:
●​ Body Dysmorphic Disorder: BDD is focused on perceived physical flaws, whereas
OCD revolves around intrusive thoughts and compulsions.
●​ Trichotillomania (Hair-Pulling Disorder) and Excoriation (Skin-Picking) Disorder:
These involve repetitive behaviors but are not motivated by the same obsessive fears
or anxieties.
●​ Obsessive-Compulsive Personality Disorder (OCPD): OCPD involves a pervasive
preoccupation with orderliness, perfectionism, and control, without the intrusive
thoughts and compulsive behaviors of OCD.
Epidemiology:
●​ Prevalence: Approximately 1-2% of the population.
●​ Age of onset: Typically late adolescence to early adulthood; however, onset can
also occur in childhood.
●​ Gender: Prevalence is similar in men and women, though onset may be earlier in
men.

2. Hoarding Disorder
Diagnostic Criteria:
A. Persistent difficulty discarding or parting with possessions, regardless of their actual
value.
B. This difficulty is due to a strong need to save the items and to distress associated with
discarding them.
C. The difficulty discarding possessions results in the accumulation of possessions that
congest and clutter active living areas and substantially impair the intentional use of these
areas. If living areas are uncluttered, it is only because of the interventions of others (e.g.,
family members, cleaners).
D. The hoarding causes clinically significant distress or impairment in social, occupational,
or other important areas of functioning.
E. The hoarding is not attributable to another medical condition (e.g., brain injury,
cerebrovascular disease).
F. The hoarding is not better explained by obsessive-compulsive disorder, depression, or
delusional beliefs.
Etiology:
●​ Genetic: Family history of hoarding disorder increases risk.
●​ Neurobiological: Dysfunction in areas of the brain associated with decision-making,
cognitive flexibility, and impulse control.
●​ Environmental: Stressful life events, trauma, and certain family dynamics.
Prognosis:
●​ Chronic and tends to worsen with age if untreated.
●​ Symptoms can impair quality of life and social functioning.
Treatment:
●​ Cognitive Behavioral Therapy (CBT) with a focus on organization skills and
de-cluttering.
●​ Medications (SSRIs) may help with co-occurring anxiety or depressive symptoms.
Comorbidity:
●​ Obsessive-Compulsive Disorder (OCD), major depressive disorder, anxiety
disorders.
Differential Diagnosis:
●​ Obsessive-Compulsive Disorder: OCD involves distress about specific items or
actions, whereas hoarding involves a broader, persistent pattern of collecting and
difficulty discarding.
●​ Schizophrenia: Hoarding in schizophrenia can be related to delusions, unlike the
cognitive and emotional distress seen in hoarding disorder.
Epidemiology:
●​ Prevalence: About 2-6% of the general population.
●​ Age of onset: Symptoms typically begin in childhood or adolescence but become
more severe in adulthood.
●​ Gender: More common in men than women.

3. Body Dysmorphic Disorder (BDD)

Diagnostic Criteria:
A. Preoccupation with one or more defects or flaws in physical appearance that are not
observable or are only slight to others.
B. At some point during the course of the disorder, the individual has engaged in repetitive
behaviors (e.g., mirror checking, excessive grooming) or mental acts (e.g., comparing
appearance with others) in response to the appearance concerns.
C. The preoccupation causes clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
D. The appearance preoccupation is not better explained by concerns with body fat or weight
in an individual whose symptoms meet the diagnostic criteria for anorexia nervosa.
Etiology:
●​ Genetic: Family history of BDD, OCD, or eating disorders.
●​ Neurobiological: Possible serotonergic dysfunction.
●​ Environmental: Negative experiences, such as bullying or trauma, can contribute to
the development of BDD.
Prognosis:
●​ Chronic, with potential for significant distress and impairment.
●​ High risk of co-occurring depression, anxiety, and suicidal behavior.
Treatment:
●​ Cognitive Behavioral Therapy (CBT) focused on addressing distorted body image.
●​ Pharmacotherapy: SSRIs are commonly used to treat symptoms.
Comorbidity:
●​ OCD, depression, eating disorders, social anxiety disorder, substance use
disorders.
Differential Diagnosis:
●​ Anorexia Nervosa: BDD involves distress over specific features, while anorexia
involves a focus on weight and body fat.
●​ OCD: OCD's obsessions focus on cleanliness or order, whereas BDD is focused on
perceived physical flaws.
Epidemiology:
●​ Prevalence: Around 2.4% in the U.S. population.
●​ Age of onset: Usually occurs in adolescence.
●​ Gender: More common in women, though men can also be affected.

4. Trichotillomania (Hair-Pulling Disorder)

Diagnostic Criteria:
A. Recurrent pulling out of one’s hair, resulting in hair loss.
B. Repeated attempts to decrease or stop hair-pulling.
C. The hair-pulling causes clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
D. The hair-pulling is not attributable to another medical condition (e.g., dermatological
condition).
E. The hair-pulling is not better explained by another mental disorder (e.g.,
obsessive-compulsive disorder).
Etiology:
●​ Genetic: Family history of trichotillomania or other impulse control disorders.
●​ Neurobiological: Disruptions in the dopaminergic system or serotonin function.
●​ Environmental: Stress and anxiety can trigger episodes of hair-pulling.
Prognosis:
●​ Can be chronic and difficult to treat.
●​ Relapses are common.
Treatment:
●​ Cognitive Behavioral Therapy (CBT) with a focus on habit reversal training.
●​ Medications such as SSRIs or antipsychotics in treatment-resistant cases.
Comorbidity:
●​ Obsessive-Compulsive Disorder (OCD), anxiety disorders, depression.
Differential Diagnosis:
●​ OCD: OCD is driven by intrusive thoughts, whereas trichotillomania is more about
tension before pulling hair and relief afterward.
●​ Excoriation (Skin-Picking) Disorder: Involves repetitive skin picking, whereas
trichotillomania involves hair-pulling.
Epidemiology:
●​ Prevalence: About 1-2% of the population.
●​ Age of onset: Typically begins in childhood or adolescence.
●​ Gender: More common in women.

5. Excoriation (Skin-Picking) Disorder

Diagnostic Criteria:
A. Recurrent skin picking resulting in skin lesions.
B. Repeated attempts to decrease or stop skin-picking.
C. The skin-picking causes clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
D. The skin-picking is not attributable to another medical condition (e.g., dermatological
condition).
E. The skin-picking is not better explained by another mental disorder (e.g.,
obsessive-compulsive disorder).
Etiology:
●​ Genetic: Family history of excoriation or other impulse control disorders.
●​ Neurobiological: Dysfunction in the dopaminergic system.
●​ Environmental: Stressful life events or underlying anxiety triggers.
Prognosis:
●​ Chronic if untreated, with potential for significant scarring or infection.
Treatment:
●​ Cognitive Behavioral Therapy (CBT) with habit reversal training.
●​ SSRIs or other medications for treatment-resistant cases.
Comorbidity:
●​ Obsessive-Compulsive Disorder (OCD), anxiety disorders, depression.
Differential Diagnosis:
●​ OCD: OCD obsessions and compulsions are more pervasive and focused on
contamination or order.
●​ Dermatillomania: It’s specifically about skin picking rather than general anxiety or
OCD.
Epidemiology:
●​ Prevalence: Around 1-5%.
●​ Age of onset: Usually in adolescence.
●​ Gender: More common in women.

These are all the disorders under Obsessive-Compulsive and Related Disorders from
DSM-5 with complete diagnostic criteria and other relevant sections. Let me know if you
need further details!
4o mini
You said:
included all?
ChatGPT said:
ChatGPT
Yes, I have included all the disorders under the Obsessive-Compulsive and Related
Disorders category as outlined in DSM-5:
1.​ Obsessive-Compulsive Disorder (OCD)
2.​ Hoarding Disorder
3.​ Body Dysmorphic Disorder (BDD)
4.​ Trichotillomania (Hair-Pulling Disorder)
5.​ Excoriation (Skin-Picking) Disorder
I have covered the DSM-5 diagnostic criteria (A-Z), along with etiology, prognosis,
treatment, comorbidity, differential diagnosis, and epidemiology for each of these
disorders.
Let me know if you need any further clarification or more details on any specific disorder!
4o mini
You said:
trauma and Stressor Related Disorders,
ChatGPT said:
ChatGPT
Here is the detailed breakdown of Trauma- and Stressor-Related Disorders as per DSM-5,
covering diagnostic criteria, etiology, prognosis, treatment, comorbidity, differential
diagnosis, and epidemiology:

1. Posttraumatic Stress Disorder (PTSD)

Diagnostic Criteria:
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 the event(s) in person.
●​ Learning that the traumatic event(s) occurred to a close family member or close
friend.
 ●​ 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).
B. Presence of intrusion symptoms associated with the traumatic event(s), beginning after
the traumatic event(s) occurred, as evidenced by one or more of the following:
1.​ Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s).
2.​ Recurrent distressing dreams related to the traumatic event(s).
3.​ Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the
traumatic event(s) were recurring.
4.​ Intense or prolonged psychological distress at exposure to internal or external cues
that symbolize or resemble an aspect of the traumatic event(s).
5.​ Marked physiological 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), as evidenced by
one or both of the following:
1.​ Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or
closely associated with the traumatic event(s).
2.​ Avoidance of or efforts to avoid external reminders (e.g., people, places,
conversations, activities, objects, situations) that arouse distressing memories,
thoughts, or feelings about 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:
1.​ Inability to remember an important aspect of the traumatic event(s).
2.​ Persistent and exaggerated negative beliefs or expectations about oneself, others, or
the world.
3.​ Persistent distorted cognitions about the cause or consequences of the traumatic
event(s) that lead the individual to blame themselves or others.
4.​ Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).
5.​ Markedly diminished interest or participation in significant activities.
6.​ Feelings of detachment or estrangement from others.
7.​ Persistent inability to experience positive emotions (e.g., happiness, satisfaction, or
loving feelings).
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:
 1.​ Irritable behavior and angry outbursts (with little or no provocation), typically
expressed as verbal or physical aggression toward people or objects.
2.​ Reckless or self-destructive behavior.
3.​ Hypervigilance.
4.​ Exaggerated startle response.
5.​ Problems with concentration.
6.​ 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 physiological effects of a substance (e.g.,
medication, alcohol) or another medical condition.
Etiology:
●​ Genetic: Family history of PTSD or trauma-related disorders increases risk.
●​ Neurobiological: Dysregulation in HPA axis and neurotransmitters (e.g., serotonin,
dopamine). Dysfunction in the amygdala and prefrontal cortex is also noted.
●​ Environmental: Early childhood trauma, exposure to chronic stress, and lack of
social support.
Prognosis:
●​ PTSD can be chronic but may improve with proper treatment.
●​ Onset can occur immediately after trauma or delayed (months or even years after the
event).
●​ Symptoms may fluctuate, and individuals can have periods of exacerbation during
stress.
Treatment:
●​ Cognitive Behavioral Therapy (CBT), particularly Trauma-Focused CBT
(TF-CBT), is the most effective form of psychotherapy.
●​ Exposure Therapy: A form of CBT that helps individuals safely confront memories
of traumatic events.
●​ EMDR (Eye Movement Desensitization and Reprocessing): Used for trauma
processing.
●​ Medications: SSRIs (e.g., sertraline, paroxetine) are FDA-approved for PTSD.
Other medications such as antipsychotics or benzodiazepines may be used for
specific symptoms.
Comorbidity:
 ●​ Depression, anxiety disorders, substance use disorders, bipolar disorder,
borderline personality disorder, somatic symptom disorder.
Differential Diagnosis:
●​ Acute Stress Disorder: Symptoms last for at least 3 days but less than 1 month.
●​ Adjustment Disorder: Occurs in response to stressors but does not involve the same
intense emotional symptoms as PTSD.
●​ Panic Disorder: Involves recurrent panic attacks rather than trauma-related
symptoms.
●​ Depression: Can overlap with PTSD symptoms, but the focus is on mood rather than
trauma re-experiencing.
Epidemiology:
●​ Prevalence: Approximately 6-8% of the U.S. population will experience PTSD.
●​ Gender: More common in women, though men are at higher risk following certain
traumatic events (e.g., combat).
●​ Age of onset: PTSD can occur at any age but typically manifests after a traumatic
event.

2. Acute Stress Disorder (ASD)

Diagnostic Criteria:
A. Exposure to actual or threatened death, serious injury, or sexual violation, in one (or
more) of the following ways:
1.​ Directly experiencing the traumatic event(s).
2.​ Witnessing the event(s) in person.
3.​ Learning that the traumatic event(s) occurred to a close family member or close
friend.
4.​ Experiencing repeated or extreme exposure to aversive details of the traumatic
event(s).
B. Presence of nine (or more) symptoms from the following categories:
1.​ Intrusion symptoms: Recurrent, involuntary, and intrusive distressing memories or
dreams about the event.
2.​ Negative mood: Inability to experience positive emotions.
3.​ Dissociation: Altered sense of reality, dissociative amnesia.
4.​ Avoidance: Efforts to avoid distressing memories, thoughts, feelings, or reminders
associated with the trauma.
 5.​ Arousal: Sleep disturbances, hypervigilance, exaggerated startle response.
C. Duration of the disturbance is 3 days to 1 month after trauma exposure.
D. The disturbance causes clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
E. The disturbance is not attributable to the physiological effects of a substance or other
medical condition.
Etiology:
●​ Genetic: Family history of trauma-related disorders.
●​ Neurobiological: Similar to PTSD, there is dysregulation in the HPA axis and
serotonergic systems.
●​ Environmental: Severity of the trauma, lack of support, and pre-existing
psychological conditions.
Prognosis:
●​ Symptoms often resolve within 3 months, but those who develop PTSD may continue
to experience symptoms for longer periods.
Treatment:
●​ Trauma-Focused Cognitive Behavioral Therapy (TF-CBT).
●​ Supportive counseling.
●​ Medications such as SSRIs for concurrent symptoms of anxiety or depression.
Comorbidity:
●​ Posttraumatic Stress Disorder, depression, anxiety disorders.
Differential Diagnosis:
●​ PTSD: PTSD lasts longer than 1 month.
●​ Adjustment Disorder: More generalized distress in response to life changes, without
trauma-related symptoms.
Epidemiology:
●​ Prevalence: Affects up to 20% of individuals exposed to trauma.
●​ Age of onset: Can occur immediately after the traumatic event.

3. Adjustment Disorder
Diagnostic Criteria:
A. The development of emotional or behavioral symptoms in response to an identifiable
stressor(s) occurring within 3 months of the onset of the stressor(s).
B. These symptoms or behaviors are clinically significant, as evidenced by one or both of the
following:
1.​ Marked distress that is out of proportion to the severity or intensity of the stressor,
taking into account the external context and cultural factors that may influence
symptom severity and expression.
2.​ Significant impairment in social, occupational, or other important areas of
functioning.
C. The symptoms do not represent normal bereavement.
D. Once the stressor or its consequences have terminated, the symptoms do not persist for
more than an additional 6 months.
Etiology:
●​ Genetic: Familial tendency toward mood disorders or maladaptive responses to stress.
●​ Environmental: Stressors like divorce, job loss, or financial problems.
●​ Psychological: Pre-existing personality traits such as high sensitivity to stress.
Prognosis:
●​ Symptoms typically resolve once the stressor is removed or the individual adapts.
Treatment:
●​ Cognitive Behavioral Therapy (CBT), supportive therapy.
●​ Medications are used to manage symptoms of depression or anxiety (e.g., SSRIs).
Comorbidity:
●​ Mood disorders, anxiety disorders, substance use disorders.
Differential Diagnosis:
●​ PTSD: Adjustment disorder does not involve trauma-related re-experiencing.
●​ Depression: Adjustment disorder is triggered by identifiable stressors and is shorter
in duration.
Epidemiology:
●​ Prevalence: Around 5-20% of outpatient mental health cases.
●​ Age of onset: Can occur at any age but is more common in individuals under stress
(e.g., adolescents, young adults).

These are the Trauma- and Stressor-Related Disorders from DSM-5. Let me know if you'd
like further details on any of these!
4o mini
You said:
Dissociative Disorders
ChatGPT said:
ChatGPT
Here is a detailed breakdown of Dissociative Disorders as per DSM-5, including diagnostic
criteria, etiology, prognosis, treatment, comorbidity, differential diagnosis, and epidemiology:

1. Dissociative Identity Disorder (DID)

Diagnostic Criteria:
A. Disruption of identity characterized by two or more distinct personality states, which
may be described in some cultures as an experience of possession. This disruption involves
marked discontinuity in the sense of self and sense of agency, accompanied by related
alterations in affect, behavior, consciousness, memory, perception, cognition, and/or
sensory-motor functioning. These alterations may be observed by others or reported by the
individual.
B. Recurrent gaps in the recall of everyday events, personal information, and/or traumatic
events that are inconsistent with ordinary forgetting.
C. The symptoms cause clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
D. The disturbance is not a normal part of a broadly accepted cultural or religious practice.
E. The symptoms are not attributable to the physiological effects of a substance (e.g.,
blackouts or chaotic behavior during alcohol intoxication) or a medical condition (e.g.,
complex partial seizures).
Etiology:
●​ Trauma: Severe and chronic childhood trauma, especially physical or sexual abuse,
is a primary risk factor.
●​ Dissociation: A coping mechanism for trauma, where dissociation becomes the way
to avoid emotional pain.
●​ Neurobiological: Dysfunction in the HPA axis, emotional regulation, and memory
systems.
●​ Genetic: Familial predisposition to dissociative disorders.
●​ Psychosocial: Emotional neglect, insecure attachment, and early parental trauma.
Prognosis:
●​ Chronic if untreated, but symptoms can improve with appropriate treatment.
●​ Individuals may experience relapses or symptom exacerbation under stress.
Treatment:
●​ Psychotherapy is the primary treatment, especially Trauma-Focused CBT,
Dialectical Behavior Therapy (DBT), and integrative or psychodynamic
therapies.
●​ Cognitive Processing Therapy (CPT) for trauma recovery.
●​ Medications such as antidepressants or antipsychotics may be used for associated
symptoms like depression or anxiety but are not the primary treatment.
Comorbidity:
●​ Posttraumatic Stress Disorder (PTSD), major depressive disorder, borderline
personality disorder, substance use disorders, anxiety disorders, somatic
symptom disorder.
Differential Diagnosis:
●​ Borderline Personality Disorder (BPD): Both involve identity disturbances, but
DID features dissociative symptoms and identity fragmentation, while BPD involves
pervasive emotional dysregulation.
●​ Psychotic Disorders: Dissociative states in DID are not related to psychotic
symptoms like delusions or hallucinations.
●​ Seizure Disorders: Dissociative episodes may mimic seizures, but they don’t involve
the neurological changes seen in epilepsy.
Epidemiology:
●​ Prevalence: Around 1-3% of the population, though it may be underreported.
●​ Gender: More common in women, with a female-to-male ratio of about 9:1.
●​ Age of onset: Symptoms typically appear in childhood or adolescence, often
emerging after trauma.

2. Dissociative Amnesia
Diagnostic Criteria:
A. Inability to recall important autobiographical information, usually of a traumatic or
stressful nature, that is inconsistent with ordinary forgetting.
B. The symptoms cause clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
C. The disturbance is not attributable to the physiological effects of a substance (e.g.,
blackout or brain injury) or a medical condition (e.g., complex partial seizures).
D. The disturbance is not better explained by Dissociative Identity Disorder or other
psychological conditions such as depression or posttraumatic stress disorder (PTSD).
Etiology:
●​ Trauma: Often linked to stressful or traumatic events, such as sexual assault, war
experiences, or natural disasters.
●​ Psychosocial stressors: Major life stressors or transitions.
●​ Neurobiological: Abnormalities in memory processing and emotional regulation.
Prognosis:
●​ The memory loss may be temporary, but in severe cases, it may persist.
●​ Recovery is often possible, especially with psychotherapy, although some individuals
may experience ongoing difficulties with memory retrieval.
Treatment:
●​ Psychotherapy, especially Trauma-Focused CBT, to process trauma and recover
lost memories.
●​ Hypnotherapy is sometimes used to help retrieve memories, though it is
controversial and may lead to false memories.
●​ Medications are typically not indicated but may be used for associated symptoms
(e.g., antidepressants for co-occurring depression or anxiety).
Comorbidity:
●​ Posttraumatic Stress Disorder (PTSD), major depressive disorder, anxiety
disorders, borderline personality disorder.
Differential Diagnosis:
●​ Dissociative Identity Disorder (DID): DID involves multiple distinct identities and
identity fragmentation, while dissociative amnesia primarily involves memory loss.
●​ Major Depressive Disorder: Depressive episodes may include memory issues, but
these are typically not as pervasive as dissociative amnesia.
Epidemiology:
●​ Prevalence: More common in individuals who have experienced significant trauma
(up to 2-7%).
●​ Age of onset: Typically during or after a traumatic event.
●​ Gender: More common in women, although it can affect anyone.

3. Depersonalization/Derealization Disorder
Diagnostic Criteria:
A. The presence of persistent or recurrent experiences of depersonalization, derealization, or
both:
 1.​ Depersonalization: Experiencing detachment or unreality regarding one's thoughts,
feelings, sensations, body, or actions (e.g., feeling like a robot, being outside of
oneself).
2.​ Derealization: Experiencing the external world as unreal, dreamlike, distant, or
distorted.
B. During the depersonalization or derealization experiences, reality testing remains intact
(i.e., the individual knows that their experiences are not real).
C. The symptoms cause clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
D. The disturbance is not attributable to the physiological effects of a substance (e.g., drug
use) or another medical condition (e.g., seizures).
E. The disturbance is not better explained by another mental disorder (e.g., psychotic
disorder, PTSD, major depressive disorder).
Etiology:
●​ Chronic stress or trauma: High levels of stress, abuse, or childhood trauma can
trigger dissociative symptoms.
●​ Neurobiological: Disruptions in the serotonergic system and dopaminergic system,
and abnormal activation of the limbic system.
●​ Psychological factors: High emotional reactivity or history of severe anxiety
disorders.
Prognosis:
●​ Chronic in some cases, though many individuals experience relief with treatment.
●​ Symptoms may wax and wane, especially during periods of stress.
Treatment:
●​ Cognitive Behavioral Therapy (CBT) and mindfulness-based therapies to help
individuals regain connection to themselves and the world.
●​ Medication: SSRIs, SNRIs, and benzodiazepines for comorbid anxiety or
depression.
Comorbidity:
●​ Anxiety disorders, depression, posttraumatic stress disorder (PTSD), borderline
personality disorder.
Differential Diagnosis:
●​ Psychotic Disorders: In psychosis, individuals may have delusions or hallucinations,
whereas in depersonalization/derealization, the individual maintains reality testing.
●​ PTSD: Depersonalization/derealization symptoms are related to traumatic events but
are experienced as a coping mechanism rather than re-experiencing trauma.
Epidemiology:
●​ Prevalence: About 2% of the general population.
●​ Gender: Affects both men and women equally.
●​ Age of onset: Typically begins in adolescence or young adulthood

Specifiers
Autism Spectrum Disorder (ASD) Specifiers:
1. Severity Levels
The DSM-5 requires clinicians to specify the severity of symptoms across two core
domains:
●​ Social communication
●​ Restricted, repetitive behaviors
Severity Levels for Each Domain:
●​ Level 1: Requiring support
o​ Social Communication: Difficulty initiating social interactions; atypical
responses to social cues; decreased interest in social interactions.
o​ Restricted Behaviors: Inflexibility of behavior causes significant interference
in functioning in one or more contexts. Difficulty switching between activities.
●​ Level 2: Requiring substantial support
o​ Social Communication: Marked deficits in verbal and nonverbal
communication; reduced or abnormal responses to social overtures.
o​ Restricted Behaviors: Inflexibility, difficulty coping with change, and
repetitive behaviors are obvious to observers and interfere with functioning in
multiple settings.
●​ Level 3: Requiring very substantial support
o​ Social Communication: Severe deficits in communication and social skills.
Minimal response to social approaches.
 o​ Restricted Behaviors: Extreme difficulty coping with change and engaging in
repetitive behaviors that severely disrupt functioning in all areas.
Note: These levels are meant to capture a general sense of functioning and support needs, but
individualized assessment is essential.

2. With or Without Accompanying Intellectual Impairment:

●​ Description:
o​ This specifier indicates whether the individual has intellectual impairments,
which may vary from mild to severe.
●​ Importance:
o​ Intellectual functioning often differs between verbal and nonverbal domains,
requiring separate assessments. For example:

▪​ Verbal skills may lag significantly behind nonverbal reasoning.

▪​ Tools: Untimed, nonverbal tests are recommended to assess potential

strengths in individuals with limited verbal abilities.

3. With or Without Accompanying Language Impairment:

●​ Description:
o​ This specifier highlights the individual's language abilities, which can range
from nonverbal to fluent speech.
●​ Examples of Language Descriptions:
o​ No intelligible speech: Nonverbal
o​ Single words only: Limited to basic, single-word expressions
o​ Phrase speech: Can use short phrases but struggles with full sentences
o​ Speaks in full sentences: Capable of full sentences but may have unusual
phrasing
o​ Fluent speech: Talks freely but may show unusual intonation or content
Note: Clinicians must separately assess receptive (understanding) and expressive (speaking)
language skills, as receptive abilities often lag in ASD.

4. Associated With a Known Medical or Genetic Condition or Environmental Factor:

●​ Description:
 o​ This specifier is used when there is an identified medical, genetic, or
environmental factor linked to the individual's ASD diagnosis.
●​ Examples:
o​ Genetic Disorders:

▪​ Rett syndrome

▪​ Fragile X syndrome

▪​ Down syndrome

o​ Medical Conditions:

▪​ Epilepsy

o​ Environmental Factors:

▪​ Prenatal exposure to valproate

▪​ Fetal alcohol syndrome

▪​ Very low birth weight

5. Associated With Another Neurodevelopmental, Mental, or Behavioral Disorder:

●​ Description:
o​ This specifier is used when the individual also meets the criteria for other
disorders.
●​ Common Comorbid Conditions:
o​ Neurodevelopmental Disorders:

▪​ ADHD

▪​ Developmental coordination disorder

▪​ Tic disorders or Tourette’s disorder

o​ Mental Disorders:

▪​ Anxiety disorders

▪​ Depressive disorders

▪​ Bipolar disorders
 o​ Behavioral Disorders:

▪​ Disruptive behavior and impulse-control disorders

o​ Other:

▪​ Feeding, elimination, or sleep disorders

▪​ Self-injurious behaviors (SIB)

6. With Catatonia:
●​ Description:
o​ This specifier is used if the individual presents with catatonia, a state
characterized by motor immobility, abnormal movements, or reduced
responsiveness.
●​ Diagnostic Criteria for Catatonia: (Separate from ASD)
o​ Mutism
o​ Stupor
o​ Posturing
o​ Waxy flexibility
o​ Echolalia (repetition of another’s speech)
o​ Echopraxia (mimicking another’s movements)

Let me now elaborate each DSM-5 specifier for the Schizophrenia Spectrum and Other
Psychotic Disorders exactly as required, ensuring no omissions or simplifications. I will
include detailed descriptions of what each specifier means and how they are applied.

1. Schizophrenia – Specifiers and Their Meanings:

●​ First episode, currently in acute episode:​
The first manifestation of the disorder meeting diagnostic criteria, with active
symptoms such as delusions, hallucinations, or disorganized behavior.​

●​ First episode, currently in partial remission:​

A period after an acute episode during which some symptoms persist but are not as
severe or disabling as during the acute phase.​
 ●​ First episode, currently in full remission:​
A complete resolution of symptoms with no remaining signs of the disorder
following the first episode.​

●​ Multiple episodes, currently in acute episode:​

More than one occurrence of active symptoms, with the individual currently
experiencing another acute phase.​

●​ Multiple episodes, currently in partial remission:​

The individual has experienced multiple episodes and is now in a partial recovery
phase from the most recent episode.​

●​ Multiple episodes, currently in full remission:​

The person has fully recovered from multiple episodes, showing no symptoms at the
moment.​

●​ Continuous:​
Symptoms persist for most of the illness course, with minimal or no periods of
remission.​

●​ Unspecified:​
Used when there is insufficient information to specify the course of the illness.​

●​ With catatonia:​
The individual exhibits catatonic symptoms such as stupor, mutism, or posturing
(refer to catatonia diagnostic criteria below).​

2. Schizophreniform Disorder – Specifiers:

●​ With good prognostic features:​
Indicates a better prognosis if the individual meets at least two of the following:​
 o​ Onset of prominent psychotic symptoms within 4 weeks of the first noticeable
change in behavior.
o​ Confusion or perplexity at the height of the psychotic episode.
o​ Good premorbid social or occupational functioning.
o​ Absence of blunted or flat affect.
●​ Without good prognostic features:​
None or only one of the above features is present, indicating a worse prognosis.​

●​ With catatonia:​
Catatonic symptoms are present, such as mutism or bizarre postures.​

3. Schizoaffective Disorder – Specifiers:

●​ Bipolar type:​
If a manic episode is part of the clinical presentation, major depressive episodes may
also occur.​

●​ Depressive type:​
Applies if only major depressive episodes are present without manic episodes.​

●​ With catatonia:​
Catatonic features are present.​

●​ Course specifiers:​

o​ First episode (acute, partial, full remission).

o​ Multiple episodes (acute, partial, full remission).
o​ Continuous or unspecified course.
4. Brief Psychotic Disorder – Specifiers:
●​ With marked stressors (brief reactive psychosis):​
Symptoms occur in response to significant life stressors, such as trauma or loss.​

●​ Without marked stressors:​

No clear stressors are linked to the onset of psychotic symptoms.​

●​ With postpartum onset:​

Symptoms emerge within four weeks postpartum.​

●​ With catatonia:​
Presence of catatonic symptoms.​

5. Delusional Disorder – Specifiers:

●​ Types of delusions:​

o​ Erotomanic type: Belief that someone is in love with them.

o​ Grandiose type: Belief of having great talent or insight.
o​ Jealous type: Belief that a partner is unfaithful.
o​ Persecutory type: Belief of being conspired against.
o​ Somatic type: Belief of bodily dysfunction or illness.
o​ Mixed type: No one delusional theme predominates.
o​ Unspecified type: Dominant delusional theme cannot be determined.
●​ With bizarre content:​
Delusions are clearly implausible or not understandable within cultural norms (e.g.,
organs have been replaced by alien technology).​

●​ Course specifiers:​
 o​ First episode (acute, partial, full remission).
o​ Multiple episodes (acute, partial, full remission).
o​ Continuous or unspecified course.

6. Catatonia (Across Disorders) – Criteria and Descriptions:

Catatonia is diagnosed when 3 or more of the following symptoms are present:
●​ Stupor: No psychomotor activity; not actively relating to the environment.
●​ Catalepsy: Passive induction of a posture held against gravity.
●​ Waxy flexibility: Slight resistance to positioning by the examiner.
●​ Mutism: No or minimal verbal response (not due to aphasia).
●​ Negativism: Opposition or no response to instructions or stimuli.
●​ Posturing: Active maintenance of a posture against gravity.
●​ Mannerism: Odd, exaggerated actions.
●​ Stereotypy: Repetitive, non-goal-directed movements.
●​ Agitation: Not influenced by external stimuli.
●​ Grimacing: Facial contortions or grimaces.
●​ Echolalia: Repeating another’s speech.
●​ Echopraxia: Mimicking another’s movements.

7. Substance/Medication-Induced Psychotic Disorder – Specifiers:

●​ With onset during intoxication:​
Symptoms develop during substance use or intoxication.​

●​ With onset during withdrawal:​

Symptoms occur as the substance is leaving the system during withdrawal.​

8. Psychotic Disorder Due to Another Medical Condition – Specifiers:

●​ With delusions:​
The primary symptom is delusions.​
 ●​ With hallucinations:​
The primary symptom is hallucinations.​

●​ With catatonia:​
Catatonic symptoms are present.​

Bipolar and Related Disorders – DSM-5 Specifiers (Detailed)

Here’s a complete breakdown of the DSM-5 specifiers for disorders within the Bipolar and
Related Disorders category, including their meanings and clinical significance.

1. Bipolar I Disorder – Specifiers:

●​ Current or most recent episode:​

o​ Manic
o​ Hypomanic
o​ Depressed
o​ Unspecified
●​ Severity and course specifiers:​

o​ Mild
o​ Moderate
o​ Severe
o​ With psychotic features (mood-congruent or mood-incongruent)
o​ In partial remission
o​ In full remission
o​ Unspecified
●​ Specifiers that apply to the current or most recent episode:​

o​ With anxious distress:​

Presence of at least two symptoms of anxiety (restlessness, difficulty
concentrating, fear of losing control). Severity is specified as mild, moderate,
moderate-severe, or severe.​

o​ With mixed features:​

Depressive symptoms present during a manic/hypomanic episode or manic
symptoms present during a depressive episode.​

o​ With rapid cycling:​

Four or more mood episodes in the past 12 months (manic, hypomanic, or
depressive).​

o​ With melancholic features:​

Loss of pleasure in almost all activities or lack of reactivity to pleasurable
stimuli, along with other specific depressive symptoms (early awakening,
weight loss, excessive guilt).​

o​ With atypical features:​

Mood reactivity (mood brightens in response to positive events) along with
other atypical symptoms (weight gain, hypersomnia, leaden paralysis).​

o​ With psychotic features:​

▪​ Mood-congruent psychotic features: Delusions/hallucinations that

match the mood episode (e.g., grandiosity in mania).

▪​ Mood-incongruent psychotic features: Delusions/hallucinations that

do not match the mood episode.
o​ With catatonia:​
Presence of catatonic symptoms (refer to previous list for criteria).​
 o​ With peripartum onset:​
Onset of mood symptoms occurs during pregnancy or within four weeks
postpartum.​

o​ With seasonal pattern:​

A regular seasonal pattern in the onset and remission of mood episodes.​

2. Bipolar II Disorder – Specifiers:

●​ Current or most recent episode:​

o​ Hypomanic
o​ Depressed
●​ Specifiers (same as Bipolar I Disorder):​

o​ With anxious distress

o​ With mixed features
o​ With rapid cycling
o​ With melancholic features
o​ With atypical features
o​ With psychotic features (mood-congruent or mood-incongruent)
o​ With catatonia
o​ With peripartum onset
o​ With seasonal pattern

3. Cyclothymic Disorder – Specifiers:

●​ With anxious distress:​
Anxiety symptoms present alongside mood instability. Severity can be classified as
mild, moderate, moderate-severe, or severe.
4. Substance/Medication-Induced Bipolar and Related Disorder – Specifiers:
●​ With onset during intoxication:​
Symptoms begin while the person is intoxicated by a substance.​

●​ With onset during withdrawal:​

Symptoms occur as the substance is leaving the system during withdrawal.​

5. Bipolar and Related Disorder Due to Another Medical Condition – Specifiers:

●​ With manic features:​
Manic symptoms predominate.​

●​ With manic- or hypomanic-like episode:​

Symptoms resemble a manic or hypomanic episode but do not meet full criteria.​

●​ With mixed features:​

Symptoms include features of both mania and depression.​

6. Other Specified Bipolar and Related Disorder – Examples of Specified Presentations:

●​ Short-duration hypomanic episodes (2–3 days) with major depressive episodes.
●​ Hypomanic episodes without prior major depressive episodes.
●​ Short-duration cyclothymia (less than 24 months).

Depressive Disorders – DSM-5 Specifiers (Detailed)

Here’s a complete breakdown of all DSM-5 specifiers for the disorders within the
Depressive Disorders category, including their clinical meanings and criteria.

1. Major Depressive Disorder (MDD) – Specifiers:

●​ Severity and course specifiers:​

o​ Mild
o​ Moderate
o​ Severe
o​ With psychotic features (mood-congruent or mood-incongruent)
o​ In partial remission
o​ In full remission
o​ Unspecified
●​ Specifiers that apply to the current or most recent episode:​

o​ With anxious distress:​

Presence of at least two of the following:​

▪​ Feeling keyed up or tense

▪​ Feeling unusually restless

▪​ Difficulty concentrating due to worry

▪​ Fear of something awful happening

▪​ Fear of losing control​

Severity is classified as mild, moderate, moderate-severe, or severe.
o​ With mixed features:​

▪​ At least three manic/hypomanic symptoms present during a depressive

episode.
o​ With melancholic features:​

▪​ One of the following:

 ▪​ Loss of pleasure in almost all activities

▪​ Lack of reactivity to pleasurable stimuli

▪​ At least three additional symptoms, including profound despondency,

early morning awakening, significant weight loss, or excessive guilt.
o​ With atypical features:​

▪​ Mood reactivity (mood brightens in response to positive events) and at

least two of the following:

▪​ Weight gain or increased appetite

▪​ Hypersomnia

▪​ Leaden paralysis (heavy, leaden feelings in arms or legs)

▪​ Long-standing pattern of interpersonal rejection sensitivity.

o​ With psychotic features:​

▪​ Mood-congruent: Delusions/hallucinations consistent with depressive

themes (e.g., guilt, death).

▪​ Mood-incongruent: Delusions/hallucinations inconsistent with

depressive themes.
o​ With catatonia:​
Presence of catatonic symptoms (refer to detailed criteria previously
provided).​

o​ With peripartum onset:​

Onset of depressive symptoms during pregnancy or within four weeks
postpartum.​

o​ With seasonal pattern:​

 ▪​ A regular relationship between the onset of depressive episodes and a
particular time of year.

▪​ Full remission also occurs at a characteristic time of year.

2. Persistent Depressive Disorder (Dysthymia) – Specifiers:

●​ Specifiers (same as Major Depressive Disorder):​

o​ With anxious distress

o​ With mixed features
o​ With melancholic features
o​ With atypical features
o​ With psychotic features
o​ With peripartum onset
o​ With seasonal pattern
●​ Course specifiers:​

o​ In partial remission
o​ In full remission
●​ Additional specifier:​

o​ Early onset: Before age 21.

o​ Late onset: Age 21 or older.

3. Disruptive Mood Dysregulation Disorder – Specifiers:

●​ No additional specifiers unique to this disorder, but severity can be noted based on
symptom impact and impairment.

4. Premenstrual Dysphoric Disorder (PMDD) – Specifiers:

●​ With anxious distress:​
Anxiety symptoms during the premenstrual phase.​
 ●​ With atypical features:​
Symptoms such as hypersomnia, leaden paralysis, and weight gain.​

5. Substance/Medication-Induced Depressive Disorder – Specifiers:

●​ With onset during intoxication:​
Symptoms develop while under the influence of a substance.​

●​ With onset during withdrawal:​

Symptoms develop during withdrawal from a substance.​

6. Depressive Disorder Due to Another Medical Condition – Specifiers:

●​ With depressive features:​
Depressive symptoms predominate but do not meet full criteria for a major
depressive episode.​

●​ With major depressive-like episode:​

Full criteria for a major depressive episode are met.​

●​ With mixed features:​

Presence of at least three manic/hypomanic symptoms during a depressive episode.​

Anxiety Disorders – DSM-5 Specifiers (Detailed)

Here’s a detailed breakdown of all DSM-5 specifiers for disorders within the Anxiety
Disorders category, including their clinical meanings and criteria.

1. Generalized Anxiety Disorder (GAD) – Specifiers:

 ●​ With anxious distress:​
The presence of at least two symptoms of anxiety during the course of the disorder,
including:​

o​ Feeling keyed up or tense

o​ Feeling unusually restless
o​ Difficulty concentrating due to worry
o​ Fear of something awful happening
o​ Fear of losing control
●​ Severity can be rated as mild, moderate, moderate-severe, or severe.​

●​ With comorbid depressive disorder:​

When both generalized anxiety disorder and a depressive disorder (e.g., major
depressive disorder or persistent depressive disorder) are present.​

●​ With substance/medication-induced anxiety disorder:​

Anxiety symptoms develop as a result of substance intoxication or withdrawal.​

2. Panic Disorder – Specifiers:

●​ With agoraphobia:​
When panic attacks are coupled with avoidance of situations due to fear of being
unable to escape or get help during a panic attack.​

●​ With anxious distress:​

Presence of anxiety symptoms in addition to the panic disorder.​

●​ With comorbid depressive disorder:​

When panic disorder occurs alongside a depressive disorder.​

●​ With substance/medication-induced anxiety disorder:​

Anxiety symptoms occur as a result of substance use or withdrawal.​
 ●​ With other mental disorders:​
When panic disorder co-occurs with other psychiatric disorders like OCD or social
anxiety disorder.​

3. Specific Phobia – Specifiers:

●​ Animal Type:​
Fear of animals or insects.​

●​ Natural Environment Type:​

Fear of heights, storms, water, etc.​

●​ Blood-injection-injury Type:​
Fear of blood, injury, or receiving injections.​

●​ Situational Type:​
Fear of specific situations like elevators, flying, or driving.​

●​ Other Type:​
Fear of other specific objects or situations not covered by the above categories.​

4. Social Anxiety Disorder (Social Phobia) – Specifiers:

●​ Performance Only:​
Social anxiety disorder is restricted to public speaking or performance situations,
without anxiety in other social interactions.​

●​ With anxious distress:​

The individual experiences other symptoms of anxiety (restlessness, difficulty
concentrating, etc.) during social situations.​
 ●​ With comorbid depressive disorder:​
When social anxiety disorder is accompanied by a depressive disorder.​

●​ With substance/medication-induced anxiety disorder:​

Anxiety is a result of substance use or withdrawal.​

5. Agoraphobia – Specifiers:
●​ With panic attacks:​
Agoraphobia is associated with recurrent panic attacks, leading to avoidance of
places where panic attacks might occur.​

●​ With anxious distress:​

Agoraphobia is compounded by anxiety symptoms such as restlessness, difficulty
concentrating, or excessive worry.​

●​ With comorbid depressive disorder:​

The person experiences both agoraphobia and a depressive disorder.​

6. Separation Anxiety Disorder – Specifiers:

●​ With comorbid depressive disorder:​
When separation anxiety disorder occurs with a depressive disorder.​

●​ With anxious distress:​

Symptoms of generalized anxiety, such as fear of losing control or excessive worry,
present alongside separation anxiety.​

7. Selective Mutism – Specifiers:

 ●​ With comorbid anxiety disorder:​
When selective mutism is accompanied by another anxiety disorder, such as social
anxiety disorder.​

●​ With comorbid depressive disorder:​

When selective mutism is accompanied by a depressive disorder.​

8. Other Specified Anxiety Disorder – Specifiers:

●​ Generalized Anxiety Disorder not meeting full criteria​
When a person experiences symptoms similar to generalized anxiety disorder but
does not meet all diagnostic criteria.​

●​ Panic Disorder with limited symptom attacks​

Panic-like symptoms occurring in a specific situation, without the full criteria for a
panic attack.​

●​ Social Anxiety Disorder not meeting full criteria​

When a person experiences significant social anxiety but does not meet all criteria for
social anxiety disorder.​

9. Unspecified Anxiety Disorder – Specifiers:

This specifier is used when anxiety symptoms are present but the specific nature of the
anxiety disorder is not clear or has not been fully assessed.

Obsessive-Compulsive and Related Disorders – DSM-5 Specifiers (Detailed)

Here’s a detailed breakdown of all DSM-5 specifiers for disorders within the
Obsessive-Compulsive and Related Disorders category, including their clinical meanings
and criteria.

1. Obsessive-Compulsive Disorder (OCD) – Specifiers:

 ●​ With good or fair insight:​

o​ The individual recognizes that their obsessions and compulsions are excessive
or unreasonable.
●​ With poor insight:​

o​ The individual believes that their obsessions and compulsions are probably
true or reasonable.
●​ With absent insight/delusional beliefs:​

o​ The individual is completely convinced that their obsessions and compulsions

are true, or they believe they have a delusional belief.
●​ With tic-related features:​

o​ The individual has a current or past history of a tic disorder, such as Tourette’s
disorder, which may co-occur with the obsessions and compulsions.

2. Body Dysmorphic Disorder – Specifiers:

●​ With muscle dysmorphia:​

o​ Preoccupation is specifically related to the perceived inadequacy of muscle

development or body build.
●​ With good or fair insight:​

o​ The individual recognizes that the concerns about their appearance are
excessive or unrealistic.
●​ With poor insight:​

o​ The individual has a somewhat realistic view, but still believes that their
appearance is significantly flawed.
 ●​ With absent insight/delusional beliefs:​

o​ The individual is fully convinced that their appearance is severely flawed, to

the point of holding a delusional belief.

3. Hoarding Disorder – Specifiers:

●​ With excessive acquisition:​

o​ The individual acquires excessive amounts of items, even when they are not
needed or have little value.
●​ With good or fair insight:​

o​ The individual recognizes that their hoarding behavior is problematic.

●​ With poor insight:​

o​ The individual has some awareness but minimizes the severity of the issue.
●​ With absent insight/delusional beliefs:​

o​ The individual does not recognize the extent of their hoarding or believes that
hoarding is necessary for reasons that others would not understand.

4. Trichotillomania (Hair-Pulling Disorder) – Specifiers:

●​ With good or fair insight:​

o​ The individual recognizes that hair-pulling behavior is excessive or

unreasonable.
●​ With poor insight:​

o​ The individual believes the hair-pulling is somewhat reasonable or justified.

 ●​ With absent insight/delusional beliefs:​

o​ The individual is completely convinced that hair-pulling is necessary or

appropriate, and they may even view it as a positive behavior.

5. Excoriation (Skin-Picking) Disorder – Specifiers:

●​ With good or fair insight:​

o​ The individual recognizes that their skin-picking behavior is excessive and

may lead to harm.
●​ With poor insight:​

o​ The individual believes their skin-picking is somewhat justified, but they have
some awareness of the issue.
●​ With absent insight/delusional beliefs:​

o​ The individual is completely convinced that the skin-picking behavior is

necessary or justified and does not see it as a problem.

6. Other Specified Obsessive-Compulsive and Related Disorder – Specifiers:

●​ Body-focused repetitive behavior disorder (other than trichotillomania or
excoriation disorder):​

o​ When the individual exhibits repetitive behaviors that do not fit the criteria for
other OCD-related disorders (e.g., nail-biting or lip-chewing).
●​ Obsessive-compulsive disorder subthreshold:​

o​ The individual has obsessive-compulsive symptoms but does not meet the full
diagnostic criteria for OCD.
●​ Hoarding with insufficient frequency:​
 o​ When hoarding behaviors are present, but not to the degree that would meet
the diagnostic threshold for hoarding disorder.

7. Unspecified Obsessive-Compulsive and Related Disorder – Specifiers:

●​ This specifier is used when obsessive-compulsive or related symptoms are present but
the precise nature of the disorder is unclear, or the specific diagnosis has not been
determined.

Dissociative Disorders – DSM-5 Specifiers (Detailed)

Here’s a detailed breakdown of all DSM-5 specifiers for disorders within the Dissociative
Disorders category, including their clinical meanings and criteria.

1. Dissociative Identity Disorder (DID) – Specifiers:

●​ With posttraumatic amnesia:​

o​ The individual experiences significant memory loss, typically involving an

inability to recall key aspects of their life or traumatic events, often linked to
dissociative states.
●​ With dissociative fugue:​

o​ The individual unexpectedly travels away from their usual location, and upon
arrival, is unable to recall significant personal information, including their
identity or past history.
●​ With a history of severe abuse in childhood:​

o​ This specifier is used when the dissociative identity disorder is associated with
a history of severe trauma or abuse during childhood, such as physical,
emotional, or sexual abuse.
●​ With dissociative amnesia:​

o​ In cases where dissociative amnesia is present, it refers to the inability to recall

autobiographical information, usually following traumatic or stressful events,
but is not explained by ordinary forgetfulness.
 ●​ With a history of multiple personalities:​

o​ This specifier highlights that the individual has a history of multiple identities,
which may manifest at different times, each identity potentially having
different memories, behaviors, and preferences.

2. Dissociative Amnesia – Specifiers:

●​ With dissociative fugue:​

o​ The person experiences dissociative amnesia but also engages in unexpected

travel or wandering, during which they cannot recall important personal
information, often involving identity confusion.
●​ With no dissociative fugue:​

o​ The individual experiences amnesia but does not engage in dissociative fugue
behavior, meaning they do not have periods of travel or loss of identity.
●​ With a history of trauma or stress:​

o​ The amnesia is specifically linked to a history of trauma, abuse, or extreme

stress, which is thought to contribute to the memory loss or dissociative
symptoms.
●​ With amnesia for a traumatic event:​

o​ This specifier is used when the individual has amnesia that is specifically
related to a particular traumatic event or series of events, such as witnessing or
experiencing abuse, accidents, or violence.

3. Depersonalization/Derealization Disorder – Specifiers:

●​ With persistent symptoms:​
 o​ The individual experiences ongoing depersonalization or derealization
symptoms that are chronic and persist over an extended period of time,
potentially interfering with their daily life.
●​ With intermittent symptoms:​

o​ The symptoms are episodic, occurring in fits and starts rather than
continuously, and may vary in intensity over time.
●​ With or without insight:​

o​ This specifier is used to describe the individual's awareness of their condition.

With insight means the person recognizes the symptoms as being excessive or
abnormal, while without insight means the individual may not recognize their
symptoms as being part of a mental health disorder.

4. Other Specified Dissociative Disorder – Specifiers:

●​ Dissociative trance disorder:​

o​ The individual exhibits a sudden shift in consciousness or identity, which is

often associated with certain cultural or religious experiences but becomes
problematic or disruptive in nature.
●​ Dissociative disorder not otherwise specified (NOS):​

o​ When the dissociative symptoms do not meet the full criteria for any of the
specific dissociative disorders but still cause significant distress or
impairment.

5. Unspecified Dissociative Disorder – Specifiers:

●​ This specifier is used when the individual’s dissociative symptoms are clear, but the
specific disorder has not been determined, or the clinician does not have sufficient
information to make a precise diagnosis.

ICD-11 codes
1. Neurodevelopmental Disorders:
 ●​ Autism Spectrum Disorder (ASD)​
ICD-11 Code: 6A02​
(Note: Includes autism, Asperger syndrome, childhood disintegrative disorder, and
pervasive developmental disorder NOS)​

●​ Attention-Deficit/Hyperactivity Disorder (ADHD)​

ICD-11 Code: 6A05​

●​ Intellectual Disabilities (Intellectual Developmental Disorder)​

ICD-11 Code: 6A00​

●​ Specific Learning Disorder​

ICD-11 Code: 6A02.1​

●​ Developmental Language Disorder​

ICD-11 Code: 6A03​

2. Schizophrenia Spectrum and Other Psychotic Disorders:

●​ Schizophrenia​
ICD-11 Code: 6A20​

●​ Schizoaffective Disorder​
ICD-11 Code: 6A21​

●​ Delusional Disorder​
ICD-11 Code: 6A22​

●​ Brief Psychotic Disorder​

ICD-11 Code: 6A23​
 ●​ Schizophreniform Disorder​
ICD-11 Code: 6A24​

●​ Other Primary Psychotic Disorders​

ICD-11 Code: 6A25​

3. Bipolar and Related Disorders:

●​ Bipolar I Disorder​
ICD-11 Code: 6A60​

●​ Bipolar II Disorder​
ICD-11 Code: 6A61​

●​ Cyclothymic Disorder​
ICD-11 Code: 6A62​

●​ Other Bipolar Disorders​

ICD-11 Code: 6A63​

4. Depressive Disorders:
●​ Major Depressive Disorder (MDD)​
ICD-11 Code: 6A70​

●​ Persistent Depressive Disorder (Dysthymia)​

ICD-11 Code: 6A71​

●​ Disruptive Mood Dysregulation Disorder​

ICD-11 Code: 6A72​
 ●​ Other Depressive Episodes​
ICD-11 Code: 6A73​

●​ Premenstrual Dysphoric Disorder (PMDD)​

ICD-11 Code: 6A74​

5. Anxiety Disorders:
●​ Generalized Anxiety Disorder (GAD)​
ICD-11 Code: 6B00​

●​ Panic Disorder​
ICD-11 Code: 6B01​

●​ Agoraphobia​
ICD-11 Code: 6B02​

●​ Social Anxiety Disorder (Social Phobia)​

ICD-11 Code: 6B03​

●​ Specific Phobias​
ICD-11 Code: 6B04​

●​ Separation Anxiety Disorder​

ICD-11 Code: 6B05​

●​ Selective Mutism​
ICD-11 Code: 6B06​

●​ Other Specified Anxiety Disorder​

ICD-11 Code: 6B07​
 ●​ Unspecified Anxiety Disorder​
ICD-11 Code: 6B08​

6. Obsessive-Compulsive and Related Disorders:

●​ Obsessive-Compulsive Disorder (OCD)​
ICD-11 Code: 6B20​

●​ Body Dysmorphic Disorder​

ICD-11 Code: 6B21​

●​ Hoarding Disorder​
ICD-11 Code: 6B22​

●​ Trichotillomania (Hair-Pulling Disorder)​

ICD-11 Code: 6B23​

●​ Excoriation (Skin-Picking) Disorder​

ICD-11 Code: 6B24​

●​ Other Specified Obsessive-Compulsive or Related Disorder​

ICD-11 Code: 6B25​

●​ Unspecified Obsessive-Compulsive or Related Disorder​

ICD-11 Code: 6B26​

7. Trauma- and Stressor-Related Disorders:

 ●​ Post-Traumatic Stress Disorder (PTSD)​
ICD-11 Code: 6B40​

●​ Acute Stress Disorder​

ICD-11 Code: 6B41​

●​ Adjustment Disorders​
ICD-11 Code: 6B42​

●​ Other Specified Trauma- and Stressor-Related Disorder​

ICD-11 Code: 6B43​

●​ Unspecified Trauma- and Stressor-Related Disorder​

ICD-11 Code: 6B44​

8. Dissociative Disorders:
●​ Dissociative Identity Disorder (DID)​
ICD-11 Code: 6B64​

●​ Dissociative Amnesia​
ICD-11 Code: 6B65​

●​ Depersonalization/Derealization Disorder​
ICD-11 Code: 6B66​

●​ Other Specified Dissociative Disorder​

ICD-11 Code: 6B67​

●​ Unspecified Dissociative Disorder​

ICD-11 Code: 6B68​