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Major Depressive Disorder 163 The essential feature of a major depressive episode is a period of at least 2 weeks during which there is e\ther depressed mood or the loss of interest or pleasure in nearly all activi ties (Criterion A). In children and adolescents, the mood may be irritable rather than sad. The individu... |
164 Depressive Disorders substantial effort. The efficiency with which tasks are accomplished may be reduced. For example, an individual may complain that washing and dressing in the morning are ex hausting and take twice as long as usual. The sense of worthlessness or guilt associated with a major depressive episode ... |
Major Depressive Disorder 165 Although an extensive literature exists describing neuroanatomical, neuroendocrino logical, and neurophysiological correlates of major depressive disorder, no laboratory test has yielded results of sufficient sensitivity and specificity to be used as a diagnostic tool for this disorder. U... |
166 Depressive Disorders Despite consistent differences between genders in prevalence rates for depressive disor ders, there appear to be no clear differences by gender in phenomenology, course, or treat ment response. Similarly, there are no clear effects of current age on the course or treatment response of major d... |
Major Depressive Disorder 167 Gender-Rela ted Diagno stic Issues Although the most reproducible finding in the epidemiology of major depressive disorder has been a higher prevalence in females, there are no clear differences between genders in symptoms, course, treatment response, or functional consequences. In women, ... |
168 Depressive Disorders Adjustment disorder with depressed mood. A major depressive episode that occurs in response to a psychosocial stressor is distinguished from adjustment disorder with de pressed mood by the fact that the full criteria for a major depressive episode are not met in adjustment disorder. Sadness. F... |
Persistent Depressive Disorder (Dysthymia) 169 number of individuals will have depressive symptoms that have persisted longer than 2 years but will not meet criteria for persistent depressive disorder. If full criteria for a major de pressive episode have been met at some point during the current episode of illness, t... |
170 Depressive Disorders way"), they may not be reported unless the individual is directly prompted. During the 2-year period (1 year for children or adolescents), any symptom-free intervals last no longer than 2 months (Criterion C). Prevalence Persistent depressive disorder is effectively an amalgam of DSM-IV dysthym... |
Premenstrual Dysphoric Disorder 171 criteria are sufficient for a diagnosis of a major depressive episode at any time during this pe riod, then the diagnosis of major depression should be noted, but it is coded not as a separate diagnosis but rather as a specifier with the diagnosis of persistent depressive disorder. ... |
172 Depressive Disorders 2. Marked irritability or anger or increased interpersonal conflicts. 3. Marked depressed mood, feelings of hopelessness, or self-deprecating thoughts. 4. Marked anxiety, tension, and/or feelings of being keyed up or on edge. C. One (or more) of the following symptoms must additionally be prese... |
Premenstrual Dysphoric Disorder 173 nosis. Symptoms are of comparable severity (but not duration) to those of another mental disorder, such a a major depressive episode or generalized anxiety disorder. In order to confirm a provisional diagnosis, daily prospect ive symptom ratings are required for at least two symptoma... |
174 Depressive Disorders Daily Rating of Severity of Problems and the Visual Analogue Scales for Premenstrual Mood Symptoms, have undergone validation and are commonly used in clinical trials for premenstrual dysphoric disorder. The Premenstrual Tension Syndrome Rating Scale has a self-report and an observer version, b... |
Substance/Medication-Induced Depressive Disorder 175 may be due to the use of hormones rather than to the underlying condition of premen strual dysphoric; disorder. If the woman stops hormones and the symptoms disappear, this is consistent with substance /medication-induced depressive disorder. Comor bidi ty A major d... |
176 Depressive Disorders CM code depends on whether or not there is a comorbid substance use disorder present for the same class of substance. If a mild substance use disorder is comorbid with the substance induced depressive disorder, the 4th position character is "1,"and the clinician should record "mild [substance]... |
Substance/Medication-Induced Depressive Disorder 177 code, for ICD-9-CM a separate diagnostic code is given for the substance use disorder. For example, in the ase of depressive symptoms occurring during withdrawal in a man with a severe cocaine use disorder, the diagnosis is 292. 84 cocaine-induced depressive disorder... |
178 Depr essive Disorder s can induce depressive mood disturbance s. Clinical judgment is essential to determine whether the medication is truly associat ed with inducing the depressive disorder or whether a primary depressive disorder happened to have its onset while the person was receiving the treatment. For example... |
Substance /Medic ation-Induced Depr essive Disorder 179 tors common to all drugs include history of major depressive disorder, history of drug induced depresston, and psychosocial stressors. Environmental. There are also risks factors pertaining to a specific type of medication (e. g., increased immune activation prio... |
180 Depr essive Disorde rs Primary depressive disorder. A substance/medication-induced depressive disorder is distinguished from a primary depressive disorder by the fact that a substance is judged to be etiologically related to the symptoms, as described earlier (see section "Development and Course" for this disorder)... |
Depr essive Disorder Due to Another Medical Condition 181 Speci fy if: (F06. 31) With depressive features: Full criteria are not met for a major depr essive episo de. ' (F06. 32) With major depressive-like episode: Full criteria are met (except Criterion C) for a major depr essive episode. (F06. 34) With mixed features... |
182 Depressive Disor ders some cases, onset of the depression is weeks to months following the CV A. In the largest series, the duration of the major depressive episode following stroke was 9-11 months on average. Similarly, in Huntington 's disease the depressive state comes quite early in the course of the illness. W... |
Other Specified Depr essive Disorder 183 condition, b) the probability that the associated medical condition has a potential to pro mote or cause a depressive disorder, and c) a course of the depressive symptoms shortly after the onset or worsening of the medical condition, especially if the depressive symp toms remi... |
184 Depr essive Disor ders significant distress or impairment that persist for at least 2 weeks in an individual whose presenta tion has never met criteria for any other depr essive or bipolar disor der, does not currently meet active or residual criteria for any psychotic disorder, and does not meet criteria for mixed... |
Specifi ers for Depr essive Disor ders 185 6. Increased or excessive involvement in activities that have a high pote ntial for painful conseque nces (e. g., enga ging in unrestraine d buying spre es, sexual in discr ettons, foolish business investments). 7. Decr eased need for sleep (feeling rested desp ite sleeping l... |
186 Depr essive Disorder s B. Two (or more) of the fo llowing: 1. Sign ificant weight gain or increase in appetite. 2. Hyper somnia. 3. Leaden paralysis (i. e., heavy, leaden feelings in arms or legs). 4. A long-standing pattern of interpe rsonal rejection sensit ivity (not limited to epi sodes of mood disturbance) th... |
Specifi ers for Depr essive Disor ders 187 attac ks. Prospective studies have demons trated that mood and anxiety sympt oms during pregnancy, as well as the "baby blues," incr ease the risk for a post partum major depressive episode. Peripartum-onset mood episodes can present either with or without psychotic features. ... |
188 Depr essive Disorders in bipolar I disorder. In some individuals, the onset of manic or hypomanic episodes may also be linked to a particular seas on. The prevalence of winter-type seas onal pattern appear s to vary with latitu de, age, and sex. Prevalence increases with higher latitudes. Age is also a strong predi... |
Anxiety Disorders Anxi ety disorder s include disorders that share features of excessive fear and anxi ety and related behavioral disturbances. Fear is the emotional response to real or per ceived imminent threat, whereas anxiety is anticipation of future threat. Obviously, these two states overlap, but they also dif... |
190 Anxie ty Disorders diately induced by the phobic situation, to a degree that is persistent and out of proportion to the actual risk posed. There are various types of specific phobias: animal; natural envi ronment; blood-injection-injury; situational; and other situations. In social anxiety disorder (social phobia)... |
Separ ation Anxie ty Disor der 191 2. Persis tent and excessive worr y about losing major attachment figur es or about pos sible harm to them, such as illness, injury, disaste rs, or death. 3. Persis ten and excessive worry about exper iencing an untoward event (e. g., getting lost, being kidna pped, having an acciden... |
192 Anxiety Dis orders dividual's separation anxiety (e. g., destruction of the family through fire, murder, or other catastrophe) (Criterion A7). Physical symptoms (e. g., headaches, abdo minal complaints, nausea, vomiting) are common in children when separation from major attachment fig ures occurs or is anticipated... |
Separ ation Anxi ety Disorder 193 The manifestations of separation anxiety disorder vary with age. Younger children are more reluctant to go to school or may avoid school altogether. Younger children may not express worries or specific fears of definite threats to parents, home, or themselves, and the anxiety is manife... |
194 Anxi ety Disorders difficulty sleeping alone; in adolescents, not going away to college; in adults, not leaving the parental home, not traveling, not working outside the home). Differential Diagnosis Generalized anxiety disorder. Separation anxiety disorder is distinguished from gener alized anxiety disorder in th... |
Selective Mutism 195 Personality disorders. Dependent personality disorder is characterized by an indis criminate tendency to rely on others, whereas separation anxiety disorder involves con cern about the proximity and safety of main attachment figures. Borderline personality disorder is characterized by fear of aba... |
196 Anxiety Disorder s nication disorder, although no particular association with a specific communication dis order has been identified. Even when these disorders are present, anxiety is present as well. In clinical settings, children with selective mutism are almost always given an addi tional diagnosis of another ... |
Specific Phobia 197 asking to use the restroom ). Severe impairment in school and social functioning, including that resulting from teasing by peers, is common. In certain instances, selective mutism may serve as a compensatory strategy to decrease anxious arousal in social encounters. Differ ential Diagnosis Communica... |
198 Anxiety Disorders Specify if: Code based on the phobic stimulus: 300. 29 (F40. 218) Animal (e. g., spiders, insects, dogs). 300. 29 (F40. 228) Natural environment (e. g., heights, storms, water). 300. 29 (F40. 23x) Blood-injection-injury (e. g., needles, invasive medical procedures). Coding note: Select specific IC... |
Specific Phobia 199 ance behaviors are often obvious (e. g., an individual who fears blood refusing to go to the doctor) but are sometimes less obvious (e. g., an individual who fears snakes refusing to look at pictures that resemble the form or shape of snakes). Many individuals with specific phobias have suffered ove... |
200 Anxiety Disorders watching someone drown), an unexpected panic attack in the to be feared situation (e. g., an unexpected panic attack while on the subway), or informational transmission (e. g., ex tensive media coverage of a plane crash). However, many individuals with specific phobia are unable to recall the spe... |
Specific Phobia 201 Culture-Rela ted Diagno stic Issues In the United States, Asians and Latinos report significantly lower rates of specific phobia than non-Latina whites, African Americans, and Native Americans. In addition to having lower prevalence rates of specific phobia, some countries outside of the United Stat... |
202 Anxiety Disorder s Panic disorder. Individuals with specific phobia may experience panic attacks when con fronted with their feared situation or object. A diagnosis of specific phobia would be given if the panic attacks only occurred in response to the specific object or situation, whereas a di agnosis of panic d... |
Social Anxiety Disorder (Social Phobia) 203 E. The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context. \ F. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more. G. The fear, anxiety, or avoidance causes clinically si... |
204 Anxiety Disorders ance can be extensive (e. g., not going to parties, refusing school) or subtle (e. g., overpre paring the text of a speech, diverting attention to others, limiting eye contact). The fear or anxiety is judged to be out of proportion to the actual risk of being nega tively evaluated or to the cons... |
Social Anxiety Disorder (Social Phobia) 205 Developm ent and Course Median age at onset of social anxiety disorder in the United States is 13 years, and 75% of individuals have an age at onset between 8 and 15 years. The disorder sometimes emerges out of a childhood history of social inhibition or shyness in U. S. and ... |
206 Anxiety Disorders Immigrant status is associated with significantly lower rates of social anxiety disorder in both Latino and non-Latino white groups. Prevalence rates of social anxiety disorder may not be in line with self-reported social anxiety levels in the same culture-that is, societies with strong collectivi... |
Social Anxiety Disorder (Social Phobia) 207 home, whereas those with social anxiety disorder may be uncomfortable when social sit uations occur at home or in the presence of attachment figures. \ Specific phobias. Individuals with specific phobias may fear embarrassment or humil iation (e. g., embarrassment about fai... |
208 Anxiety Disorders Co mor bidi ty Social anxiety disorder is often comorbid with other anxiety disorders, major depressive disorder, and substance use disorders, and the onset of social anxiety disorder generally precedes that of the other disorders, except for specific phobia and separation anxiety dis order. Chro... |
Panic Disorder 209 C. The disturbance is not attributable to the physiological effects of a substa nce (e. g., a drug of abus e, a medic ation) or another medical condition (e. g., hyperthyr oidism, car diopul monar Y disorders). D. The disturbance is not better explained by another men tal disorder (e. g., the panic ... |
210 Anxiety Disorders Ass ociated Featu res Supporti ng Diagnosis One type of unexpected panic attack is a nocturnal panic attack (i. e., waking from sleep in a state of panic, which differs from panicking after fully waking from sleep). In the United States, this type of panic attack has been estimated to occur at lea... |
Panic Disorder 211 tend to attribute their panic attacks to certain stressful situations, such as a medical pro cedure or social setting. Older individuals may retrospectively endorse explanations for the panic attack'(which would preclude the diagnosis of panic disorder), even if an attack might actually have been un... |
212 Anxiety Disorders of panic attacks. Some clinical presentations of ataque de nervios fulfill criteria for condi tions other than panic attack (e. g., other specified dissociative disorder). These syndromes impact the symptoms and frequency of panic disorder, including the individual's attribu tion of unexpectedne... |
Panic Disorder 213 the case of only limited-symptom unexpected panic attacks, an other specified anxiety dis order or unspecified anxiety disorder diagnosis should be consider ed. \ Anxiety disorder due to another medical condition. Panic disorder is not diagnosed if the panic attacks are judged to be a direct physiol... |
214 Anxiety Disorders with alcohol or medication s. Comorbidit y with other anxiety disorders and illness anxiety disorder is also common. Panic disorder is significantly comorbid wit h numerous general medical symptoms and conditions, including, but not limited to, dizziness, cardiac arrhythmias, hyperthy roidism, as... |
Panic Attack Specifier 215 intensity is literally only a few minutes. A panic attack can arise from either a calm state or an anxious state, and time to peak intensity should be assessed independently of any preceding anxiety. That is, the start of the panic attack is the point at which there is an abrupt increase in d... |
216 Anxiety Disorders to use the word "discomfort" to describe panic attacks. Older individuals with "panicky feelings" may have a hybrid of limited-symp tom attacks and generalized anxiety. In addition, older individuals tend to attribute panic attacks to certain situations that are stressful (e. g., medical procedure... |
Agoraphobia 217 Func tional Cons equenc es of Panic Atta cks In the context of, co-occur ring mental disorders, including anxiety disorders, depressive disorders, bipolar disorder, substance use disorders, psychotic disorders, and personality disorders, panic attacks are associated with increased symptom severity, high... |
218 Anxiety Disorders toms or other incapacita ting or embarrassing symptoms (e. g., fear of falling in the el derly; fear of incontinence). C. The agoraphobic situations almost always provoke fear or anxiety. D. The agoraphobic situations are actively avoided, require the presence of a companion, or are endured with ... |
Agoraphobia 219 daily routines, choosing a job nearby to avoid using public transportation, arranging for food delivery to avoid entering shops and supermarkets) as well as cognitive (e. g., using distraction to get through agoraphobic situations) in nature. The avoidance can become so severe that the person is complet... |
220 Anxiety Disorders course and outcome of agoraphobia are associated with substantially elevated risk of sec ondary major depressive disorder, persistent depressive disorder (dysthymia), and sub stance use disorders. The clinical features of agoraphobia are relatively consistent across the lifespan, although the ty... |
Agoraphobia 221 Specific phobia, situational type. Differentiating agoraphobia from situational specific phobia can be challenging in some cases, because these conditions share several symptom characteristics anl:i criteria. Specific phobia, situational type, should be diagnosed versus ago raphobia if the fear, anxiet... |
222 Anxiety Disorders Gen eralized Anxi ety Disorder Dia gnostic Criteria 300. 02 (F41. 1) A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance). B. The individual finds it difficult to c... |
Generalized Anxiety Disorder 223 more pervasive, pronounced, and distressing; have longer duration; and frequently occur without precipitants. The greater the range of life circumst ances about which a person worries (e. g., finances, children's safety, job performance), the more likely his or her symp toms are to mee... |
224 Anxiety Disorders be. The advent of chronic physical disease can be a potent issue for excessive worry in the elderly. In the frail elderly, worries about safety-and especially about falling-may limit activities. In those with early cognitive impairment, what appears to be excessive worry about, for example, the wh... |
Generalized Anxiety Disorder 225 demonst rate different patterns of comorbidity consistent with gender differences in the prevalence of disorders. In females, comorbidity is largely confined to the anxiety disor ders and unipolar depression, whereas in males, comorbidity is more likely to extend to the substance use d... |
226 Anxiety Disorders agnosed separately if the excessive worry has occurred only during the course of these conditions. Comor bidity Individuals whose presentation meets criteria for generalized anxiety disorder are likely to have met, or currently meet, criteria for other anxiety and unipolar depressive disor ders. ... |
Substance/Medication-Induced Anxiety Disorder 227 time heavy use of the substance), then the 4th position character is "9," and the clinician should record only the substance-induced anxiety disorder. ICD-10-CM With use With use disorder, Without disorder, moderate use ICD-9-CM mild or severe disorder Alcohol 291. 89 F... |
228 Anxiety Disorders arately (e. g., 292. 89 methylphenidate-induced anxiety disorder, with onset during intoxica tion; 292. 89 salbutamol-induced anxiety disorder, with onset after medication use). ICD-1 0-CM. The name of the substance/ medication-induced anxiety disorder begins with the specific substance (e. g., c... |
Substan ce/M edication-Induced Anxi ety Disorder 229 lants (including cocaine), and other (or unknown) substances. Panic or anxiety can occur in association with withdrawal from the following classes of substances: alcohol; opioids; sed atives, hypnotics, ' and anxiolytics; stimulants (including cocaine); and other (o... |
230 Anxiety Disorders medical condition should be diagnosed. The history often provides the basis for such a judgment. At times, a change in the treatment for the other medical condition (e. g., med ication substitution or discontinuation) may be needed to determine whether the medica tion is the causative agent (in ... |
Anxi ety Disor der Due to Another Medic al Condi tion 231 hensive assessment of multiple factors is necessary to make this judgment. Several aspects of the clinical pre,sentation should be consider ed: 1) the presence of a clear temporal asso ciation between the onset, exacerbation, or remission of the medical conditi... |
232 Anxiety Disorders a substance, or exposur e to a toxin, a substance /medication-induced anxiety disorder should be consider ed. Certain medications are known to increase anxiety (e. g., corticoste roids, estrogens, metoclopram ide), and when this is the case, the medication may be the most likely etiology, althoug... |
Other Specified Anxiety Disorder 233 Other Sp ecifie d Anxi ety Disorder 300. 09 (F41. 8) This category applies to presentations in which symptoms characteristic of an anxiety dis order that cause clinically significant distress or impairment in social, occupational, or oth er important areas of functioning predomina... |
Obsessive-Compulsive and Related Disorders Obse ssiv e-com pulsi ve and related disorders include obsessive-compulsive disorder (OCD), body dysmorphic disorder, hoarding disorder, trichotillomania (hair pulling disorder), excoriation (skin-picking) disorder, substance/medication-induced ob sessive-compulsive and rela... |
236 Obsessiv e-Compulsive and Related Disorders ing, ordering, and counting compulsions); forbidden or taboo thoughts (e. g., aggressive, sexual, and religious obsessions and related compulsions ); and harm (e. g., fears of harm to oneself or others and related checking compulsio ns). The tic-related specifier of OCD i... |
Obsessiv e-Compulsive Disorder 237 Obsess ive-Co mpu lsive Disorder Diagnostic Criteria A. Presence of obsessions, compulsions, or both: Obsessions are defined by (1) and (2): 300. 3 (F42) 1. Recurrent and persistent thoughts, urges, or images that are experienc ed, at some time during the disturbance, as intrusive and... |
238 Obsessive-Co mpulsive and Related Disorders Specifier s Many individuals with obsessive-compulsive disorder (OCD) have dysfunctional beliefs. These beliefs can include an inflated sense of responsibility and the tendency to overesti mate threat; perfectionism and intolerance of uncertainty; and over-importance of ... |
Obsessive-Compulsive Disorder 239 ordering, and counting compulsions); forbidden or taboo thoughts (e. g., aggressive, sexual, or religious obse{lsions and related compulsions); and harm (e. g., fears of harm to oneself or others and checking compulsio ns). Some individuals also have difficulties discarding and accumul... |
240 Obsessiv e-Compulsive and Related Disorders may develop the sudden onset of obsessive-compulsive symptoms, which has been asso ciated with different environmental factors, including various infectious agents and a post-infectious autoimmune syndrome. Genetic and physiological. The rate of OCD among first-degree re... |
Obsessive-C ompulsive Disorder 241 The result can be few significant relationships outside the family and a lack of autonomy and financial in'\ependence from their family of origin. In addition, some individuals with OCD try to impose rules and prohibitions on family members because of their disorder (e. g., no one in ... |
242 Obsessive-C ompulsive and Related Disorder s disorder), and substance use (e. g., alcohol use disorder). However, these behaviors differ from the compulsions of OCD in that the person usually derives pleasure from the activity and may wish to resist it only because of its deleterious consequences. Obsessive-co mpul... |
Body Dysmorphic Disorder 243 Specify if: With muscle dysmorph ia: The individual is preoccupied with the idea that his or her body build is too small or insufficiently muscular. This specifier is used even if the indi vidual is preoccupied with other body areas, which is often the case. Specify if: Indicate degree of ... |
244 Obsessive-Compulsive and Related Disorders androgenic steroids and other substances to try to make their body bigger and more mus cular. Body dysmorphic disorder by proxy is a form of body dysmorphic disorder in which individuals are preoccupied with defects they perceive in another person's appear ance. Insight ... |
Body Dysmorphic Disorder 245 Risk and Prognostic Facto rs Environmental. ' Body dysmorphic disorder has been associated with high rates of child hood neglect and abuse. Genetic and physiological. The prevalence of body dysmorphic disorder is elevated in first-degree relatives of individuals with obsessive-compulsive d... |
246 Obsessive-C ompulsive and Related Disorders sive appearance-related preoccupations and repetitive behaviors that are time-consuming, are usually difficult to resist or control, and cause clinically significant distress or impair ment in functioning. Physical defects that are clearly noticeable (i. e., not slight) ... |
Hoarding Disorder 247 (apotemnophilia) (which is not a DSM-5 disorder) involves a desire to have a limb ampu tated to correct {In experience of mismatch between a person's sense of body identity and his or her actual anatomy. However, the concern does not focus on the limb's appearance, as it would in body dysmorphic ... |
248 Obsessive-Compulsi ve and Related Disorders Spe cifier s With excessive acquisition. Approximat ely 80%-90% of individuals with hoarding disorder display excessive acquisition. The most frequent form of acquisition is excessive buying, followed by acquisition of free items (e. g., leaflets, items discarded by other... |
Hoarding Disorder 249 particularly when there is poor insight, the individual may not report distress, and the im pairment may be apparent only to those around the individual. However, any attempts to discard or clear the possessions by third parties result in high levels of distress. Ass ocia ted Featu res Supporting... |
250 Obsessive-Compulsi ve and Related Disorders Culture-Rela ted Diagno stic Issues While most of the research has been done in Western, industrialized countries and urban communities, the available data from non-Western and developing countries suggest that hoarding is a universal phenomenon with consistent clinical f... |
Trichoti llomania (Hair-Pulling Disor der) 251 ing onerous rituals (e. g., not discarding objects in order to avoid endless washing or check ing rituals). In OCD, the behavior is generally unwanted and highly distressing, and the individual ex periences no pleasure or reward from it. Excessive acquisition is usually ... |
252 Obsessive-C ompulsive and Rela ted Disorders pulling may endure for months or years. Criterion A requires that hair pulling lead to hair loss, although individuals with this disorder may pull hair in a widely distributed pattern (i. e., pulling single hairs from all over a site) such that hair loss may not be clear... |
Trichotillomania (Hair-Pulling Disorder) 253 Dev elopment and Course Hair pulling mat be seen in infants, and this behavior typically resolves during early devel opment. Onset of hair pulling in trichotillomania most commonly coincides with, or follows the onset of, puberty. Sites of hair pulling may vary over time. T... |
254 Obsessive-Co mpulsive and Related Disorders Neurodevelopmental disorders. In neurodevelop mental disorders, hair pulling may meet the definition of stereotypies (e. g., in stereotypic movement disorder). Tics (in tic dis orders) rarely lead to hair pulling. Psychotic disorder. Individuals with a psychotic disorder... |
Excoriation (Skin-Picking) Disorder 255 endure for months or years. Criterion A requires that skin picking lead to skin lesions, al though individu. _als with this disorder often attempt to conceal or camouflage such lesions (e. g., with makeup or clothing). Individuals with excoriation disorder have made repeated att... |
256 Obsessiv e-Compulsive and Related Disorders Func tional Cons equen ces of Excoria tion (Skin-Pick ing) Disorder Excoriation disorder is associated with distress as well as with social and occupational im pairment. The majority of individuals with this condition spend at least 1 hour per day picking, thinking about... |
Substance/Medication-Induced Obsessive-Compulsive and Related Disorder 257 Comor bidi ty Excoriation disdrder is often accompanied by other mental disorders. Such disorders in clude OCD and trichotillomania (hair-pulling disorder), as well as major depressive dis order. Repetitive body-focused symptoms other than ski... |
258 Obsessiv e-Compulsive and Related Disorders substance use disorder (e. g., after a one-time heavy use of the substance), then the 4th position character is "9," and the clinician should record only the substance-induced ob sessive-co mpulsive and related disorder. ICD-10-CM With use With use disorder, Without diso... |
Substance/Medication-Induced Obsessive-Co mpulsive and Related Disorder 259 When recording the name of the disorder, the comorbid substance use disorder (if any) is listed first, follo\"ed by the word "with," followed by the name of the substance-induced ob sessive-compulsive and related disorder, followed by the spec... |
260 Obsessive-Compulsive and Related Disorders ally suffice to categorize the symptom presentation. A diagnosis of an obsessive-compulsive and related disorder should be made in addition to substance intoxication when the symp toms are judged to be in excess of those usually associated with intoxication and are suf f... |
Obsessive-C ompulsive and Related Disorder Due to Another Medical Condition 261 D. The disturbance does not occur exclusively during the course of a delirium. E. The disturba. pce causes clinically significant distress or impairment in social, occupa tional, or other important areas of functioning. Spec ify if: With o... |
262 Obsessiv e-Compulsive and Related Disorders ical manifestation of rheumatic fever, which is in turn due to Group A streptococcal in fection. Sydenha m's chorea is characterized by a combination of motor and nonmotor features. Nonmotor features include obsessions, compulsions, attention deficit, and emo tional lab... |
Other Specified Obsessive-Com pulsive and Related Disorder 263 or other appropriate laboratory evaluation. Symptoms that occur during or shortly after (i. e., within 4 we,eks of) substance intoxication or withdrawal or after medication use may be especially indicative of a substance /medication-induced obsessive-compul... |
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