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264 Obsessiv e-Com pulsi ve and Rela ted Disor ders distress or impairment in social, occupa tional, or other important areas of func tioning and are not bette r explained by tricho tillomania (hair-pulling disorder), excoria tion (skin picki ng) disorder, stereot ypic movement disor der, or nonsu icidal self-injury. ... |
Trauma and Stressor-Related Disorders Trauma-and stressor-related disorders include disorders in which exposure to a traumatic or stressful event is listed explicitly as a diagnostic criterion. These include reactive attachment disorder, disinhibited social engagement disorder, posttraumatic stress disor der (PTSD), a... |
266 Trauma-and Stressor-Related Disorders 2. Repeated changes of primary caregivers that limit opportun ities to form stable at tachments (e. g., frequent changes in foster care). 3. Rearing in unusual settings that severely limit opportun ities to form selective at tachments (e. g., institutions with high child-to-c... |
Reactive Attachment Disorder 267 Dev elop ment and Cou rse Conditions of social neglect are often present in the first months of life in children diag nosed with reactive attachment disorder, even before the disorder is diagnosed. The clin ical features of the disorder manifest in a similar fashion between the ages o... |
268 Trauma-and Stressor-Related Disorders tic spectrum disorder exhibit selective impairments in social communica tive behaviors, such as intentional communication (i. e., impairment in communication that is deliberate, goal-directed, and aimed at influencing the behavior of the recipient). Children with reac tive att... |
Disinhibited Social Engagement Disorder 269 D. The care in Criterion C is presumed to be responsible for the disturbed behavior in Cri terion A (e. g,1 the disturbances in Criterion A began following the pathogenic care in Criterion C). E. The child has a developmental age of at least 9 months. Specif y if: Persistent... |
270 Trauma-and Stressor-Related Disorders Disinhibited social engagement disorder has been described from the second year of life through adolescen ce. There are some differences in manifestations of the disorder from early childhood through adolescence. At the youngest ages, across many cultures, children show reticen... |
Posttraumatic Stress Disorder 271 Posttrauma tic Stress Disorder Dia gnos tic Criteria 309. 81 (F43. 1 0) Posttr aumatic Stress Disorder Note: The following criteria apply to adults, adolescents, and children older than 6 years. For children 6 years and younger, see corresponding criteria below. A. Exposure to actual o... |
272 Trauma-and Stressor-Related Disorders 2. Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e. g., "I am bad," "No one can be trusted," ''The world is completely dangerous," "My whole nervous system is permanen tly ruined"). 3. Persistent, distorted cognitions about the... |
Posttraumatic Stress Disorder 273 Note: Witnessing does not include events that are witnessed only in electronic me dia, television, movies, or pictures. \ 3. Learning that the traumatic event(s) occurred to a parent or caregiving figure. B. Presence of one (or more) of the following intrusion symptoms associated with... |
274 Trauma-and Stressor-Related Disorders F. The disturbance causes clinically significant distress or impairment in relationships with parents, siblings, peers, or other caregivers or with school behavior. G. The disturbance is not attributable to the physiological effects of a substance (e. g., medication or alcohol)... |
Posttraumatic Stress Disorder 275 sonal assault, suicide, serious accident, and serious injury. The disorder may be especially severe or long-la,sting when the stressor is interpersonal and intentional (e. g., torture, sex ual violence ). ' The traumatic event can be reexperienced in various ways. Commonly, the indivi... |
276 Trauma-and Stressor-Related Disorders caused by cars or trucks) and those not related to the traumatic event (e. g., being fearful of suffering a heart attack) (Criterion E3). Individuals with PTSD may be very reactive to un expected stimuli, displaying a heightened startle response, or jumpiness, to loud noises o... |
Posttraumatic Stress Disorder 277 Frequently, an individua l's reaction to a trauma initially meets criteria for acute stress disorder in the immediate aftermath of the trauma. The symptoms of PTSD and the rela tive predominance of different symptoms may vary over time. Duration of the symptoms also varies, with compl... |
278 Trauma-and Stressor-Related Disorders Peritr aumatic factors Environmental. These include severity (dose) of the trauma (the greater the magnitude of trauma, the greater the likelihood of PTSD), perceived life threat, personal injury, in terpersonal violence (particularly trauma perpetrated by a caregiver or invol... |
Posttraumatic Stress Disorder 279 ing is exhibited across social, interpersonal, developmental, educational, physical health, and occupational domains. In community and veteran samples, PTSD is associated with poor social and family relationships, absenteeism from work, lower income, and lowered ucational and occupati... |
280 Trauma-and Stressor-Related Disorder s psychotic features; delirium; substance/medication-induced disorders; and psychotic dis orders due to another medical condition. Traumatic brain injury. When a brain injury occurs in the context of a traumatic event (e. g., traumatic accident, bomb blast, acceleration/ decele... |
Acute Stress Disorder 281 2. Recurrent distressing dreams in which the content and/or affect of the dream are related to the event(s). Note: In children, there may be frightening dreams without recognizable content. 3. Dissociative reactions (e. g., flashbacks) in which the individual feels or acts as if the traumatic ... |
282 Trauma-and Stressor-Related Disorders violence, physical attack, active combat, mugging, childhood physical and/ or sexual vio lence, being kidnapped, being taken hostage, terrorist attack, torture), natural or human made disasters (e. g., earthquake, hurricane, airplane crash), and severe accident (e. g., severe... |
Acute Stress Disorder 283 Some individuals with the disorder do not have intrusive memories of the event itself, but instead exprience intense psychological distress or physiological reactivity when they are exposed to triggering events that resemble or symbolize an aspect of the traumatic event (e. g., windy days for ... |
284 Trauma-and Stressor-Related Disorders caregivers. In the case of bereave ment following a death that occurred in traumatic cir cumstances, the symptoms of acute stress disorder can involve acute grief reactions. In such cases, reexperiencing, dissociative, and arousal symptoms may involve reactions to the loss, su... |
Acute Stress Disorder 285 Genetic and phy siological. Females are at greater risk for developing acute stress dis order. \ Elevated reactivity, as reflected by acoustic startle response, prior to trauma exposure increases the risk for developing acute stress disorder. Cultur e-Rela ted Diagno stic Issues The profile o... |
286 Trauma-and Stressor-Related Disorders Dissociative disorders. Severe dissociative responses (in the absence of characteristic acute stress disorder symptoms) may be diagnosed as derealizat ion/ depersonalization disorder. If severe amnesia of the trauma persists in the absence of characteristic acute stress disorde... |
Adjustment Disorders 287 D. The symptoms do not represent normal bereavement. E. Once the strssor or its consequences have terminated, the symptoms do not persist for more than an additional 6 months. Specify whether: 309. 0 (F43. 21) With depressed mood: Low mood, tearfulness, or feelings of hope lessness are predomi... |
288 Trauma-and Stressor-Related Disorders Risk and Prognos tic Factors Environmental. Individuals from disadvantaged life circumstances experience a high rate of stressors and may be at increased risk for adjustment disorders. Culture-Reia ted Diag nos tic Issues The context of the individual's cultural setting should ... |
Other Specified Trauma-and Stressor-Related Disorder 289 Psychologic al factors affecting other medical conditions. In psychological factors af fecting other mdical conditions, specific psychological entities (e. g., psychological symp toms, behaviors, other factors) exacerbate a medical condition. These psychologic ... |
290 Trauma-and Stressor-Related Disorders Unspecified Trauma-and Stresso r-Rela ted Disorder 309. 9 (F43. 9) This category applies to presentations in which symptoms characteristic of a trauma-and stressor-related disorder that cause clinically significant distress or impairment in social, oc cupational, or other impo... |
Dissociative Disorders Disso ciative disorder s are characterized by a disruption of and/or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior. Dissociative symptoms can potentially dis rupt every area of psychological funct... |
292 Dissociative Disorders fragmentation of identity may vary with culture (e. g., possession-form presentations) and cir cumstance. Thus, individuals may experience discontinuities in identity and memory that may not be immediately evident to others or are obscured by attempts to hide dysfunction. In dividuals with ... |
Dissociative Identity Disorder 293 identities. When alternate personality states are not directly observed, the disorder can be identified by two clusters of symptoms : 1) sudden alterations or discontinuities in sense of self and sense ol agency (Criterion A), and 2) recurrent dissociative amnesias (Criterion B). Crit... |
294 Dissociative Disorder s der. The identities that arise during possession-form dissociative identity disorder present recurrently, are unwanted and involuntary, cause clinically significant distress or impair ment (Criterion C), and are not a normal part of a broadly accepted cultural or religious practice (Criteri... |
Dissociative Identity Disorder 295 United States, Canada, and Europe among those with the disorder is about 90%. Other forms of traumatizing experiences, including childhood medical and surgical procedures, war, childhood prostitution, and terrorism, have been reported. Course modifiers. Ongoing abuse, later-life retra... |
296 Dissociative Disorders their dissociat ive and post traumatic symp toms. Long-term supportive treatment may slowly increase these individuals' ability to manage their symptoms and decrease use of more restrictive levels of care. Differential Diagnosis Other specified dissociative disorder. The core of dissociative ... |
Dissociative Identity Disorder 297 flashbacks. Individuals with dissociative identity disorder experience these symptoms as caused by alter flate identities, do not have delusional explanations for the phenomena, and often describe the symptoms in a personified way (e. g., "I feel like someone else wants to cry with my... |
298 Dissociative Disorder s Individuals with dissociative identity disorder usually exhibit a large number of co morbid disorders. In particular, most develop PTSD. Other disorders that are highly co morbid with dissociat ive identity disorder include depressive disorders, trauma-and stressor-related disorders, perso... |
Dissociative Amnesia 299 (i. e., procedural knowledge). Generalized amnesia has an acute onset; the perplexity, dis orientation, anq purposeless wandering of individuals with generalized amnesia usually bring them to the attention of the police or psychiatric emergency servi ces. Generalized amnesia may be more common... |
300 Dissociative Disorder s cedents. Dissociative amnesia is more likely to occur with 1) a greater number of adverse childhood experiences, particularly physical and / or sexual abuse, 2) interpersonal vio lence; and 3) increased severity, frequency, and violence of the trauma. Genetic and physiological. There are no... |
Dissociative Amnesia 301 disturbances. In dissociat ive amnesia, memory deficits are primarily for autobiographical information; inllectual and cognitive abilities are preserved. Substance-related disorders. In the context of repeated intoxication with alcohol or other substanc es/medi cations, there may be episodes of... |
302 Dissociative Disorders Normal and age-related changes in memory. Memory decrements in major and mild neurocognitive disorders differ from those of dissociative amnesia, which are usually as sociated with stressful events and are more specific, extensive, and/ or comp lex. Comor bidity As dissociative amnesia begin... |
Depersonalization/Derealization Disorder 303 "I know I have feelings but I don't feel them "), thoughts (e. g., "My thoughts don't feel like my own," "hea'\ filled with cotton "), whole body or body parts, or sensations (e. g., touch, proprioception, hunger, thirst, libido). There may also be a diminished sense of agen... |
304 Dissociative Disorders the symptoms. Less than 20% of individuals experience onset after age 20 years and only 5% after age 25 years. Onset in the fourth decade of life or later is highly unusual. Onset can range from extremely sudden to gradual. Duration of depersonalizat ion/ derealizat ion disorder episodes can ... |
Depersonalization/Derealization Disorder 305 individuals often demonstrate may appear incongruent with the extreme emotional pain reported by those with the disorder. Impairment is often experienced in both interpersonal and occupational spheres, largely due to the hypoemotionality with others, subjective diffi culty ... |
306 Dissociative Disorders about 15% of all cases of depersonalization/ derealization disorder, the symptoms are pre cipitated by ingestion of such substances. If the symptoms persist for some time in the ab sence of any further substance or medication use, the diagnosis of depersonalization / derealization disorder ... |
Unspecified Dissociative Disorder 307 micro-amnesias; transient stupor; and/or alterations in sensory-mo tor functioning (e. g., analgesia, pralysis). 4. Dissociative trance: This condition is characterized by an acute narrowing or com plete loss of awareness of immediate surroundings that manifests as profound unre ... |
Somatic Symptom and Related Disorders Soma tic sym ptom disorder and other disorders with prominent somatic symp toms constitute a new category in DSM-5 called somatic symptom and related disorders. This chapter includes the diagnoses of somatic symptom disorder, illness anxiety disorder, con version disorder (functi... |
310 Somatic Symptom and Related Disorders to these symptoms ). However, medically unexplained symptoms remain a key feature in conversion disorder and pseudocyesis (other specified somatic symptom and related dis order) because it is possible to demonstrate definitively in such disorders that the symp toms are not co... |
Somatic Symptom Disorder 311 Soma tic Sym ptom Disor der Dia gnostic Criteria 300. 82 (F45. 1) A. One or more somatic symptoms that are distressing or result in significant disruption of daily life. B. Excessive thoughts, feelings, or behavior s related to the somatic symptoms or associ ated health concerns as manifes... |
312 Somatic Symptom and Related Disorders Individuals typically experience distress that is principally focused on somatic symp toms and their significance. When asked directly about their distress, some individuals de scribe it in relation to other aspects of their lives, while others deny any source of distress oth... |
Somatic Symptom Disorder 313 In children, the most common symptoms are recurrent abdominal pain, headache, fa tigue, and nausa. A single prominent symptom is more common in children than in adults. While young children may have somatic complaints, they rarely worry about "ill ness" per se prior to adolescence. The pa... |
314 Somatic Sym ptom and Related Disorders Differ ential Diagno sis If the somatic symptoms are consistent with another mental disorder (e. g., panic disorder), and the diagnostic criteria for that disorder are fulfilled, then that mental disorder should be considered as an alternative or additional diagnosis. A separa... |
Illness Anxiety Disorder 315 present, the degree of impairment is more marked than would be expected from the phys ical illness alone, When an individual's symptoms meet diagnostic criteria for somatic symptom disorder, the disorder should be diagnosed; however, in view of the frequent co morbidity, especially with a... |
316 Somatic Symptom and Related Disorders alarmed about illness, such as by hearing about someone else falling ill or reading a health related news story. Their concerns about undiagnosed disease do not respond to appro priate medical reassurance, negative diagnostic tests, or benign cour se. The physician's at temp... |
Illness Anxiety Disorder 317 hood abuse or of a serious childhood illness may predispose to development of the disor der in adulthood, Course modifiers. Approximately one:third to one-half of individuals with illness anx iety disorder have a transient form, which is associated with less psychiatric comorbidity, more ... |
318 Somatic Symptom and Related Disorders order, concerns are limited to the individual's physical appearance, which is viewed as defective or flawed. Major depressive disorder. Some individuals with a major depressi ve episode rumi nate about their health and worry excessively about illness. A separate diagnosis of i... |
Conversion Disorder (Functional Neurological Symptom Disorder) Specif y if: Acute episo e: Symptoms present for less than 6 months. Persistent: Symptoms occurring for 6 months or more. Specif y if: With psychological stressor (specify stressor ) Without psychologicai stressor Diagno stic Featu res 319 Many clinicians u... |
320 Somatic Symptom and Related Disorders vance of this stress or trauma may be suggested by a close temporal relationship. However, while assessment for stress and trauma is important, the diagnosis should not be withheld if none is found. Conversion disorder is often associated with dissociative symptoms, such as dep... |
Conversion Disorder (Functional Neurological Symptom Disorder) 321 Func tional Cons equenc es of Conver sion Disorder Individuals with conversion symptoms may have substantial disability. The severity of dis ability can be similar to that experienced by individuals with comparable medical diseases. Differential Diag n... |
322 Dia gnostic Criteria Somatic Symptom and Related Disorders Psychologic al Facto rs Affect ing Other Medical Cond itions 316 (F54) A. A medical symptom or condition (other than a mental disorder) is present. B. Psychological or behavioral factors adversely affect the medical condition in one of the following ways: 1... |
Psychological Factors Affecting Other Medical Conditions 323 This diagnosis should be reserved for situations in which the effect of the psychological factor on the medical condition is evident and the psychological factor has clinically sig nificant effects on the course or outcome of the medical condition. Abnormal ... |
324 Somatic Symptom and Related Disorders vidual with angina that is precipitated whenever he becomes enraged would be diagnosed as having psychological factors affecting other medical conditions, whereas an individual with angina who developed maladaptive anticipatory anxiety would be diagnosed as hav ing an adjustme... |
Factitious Disorder Fac titious Dis order Imposed on Another (Previously Fac titious Disor der by Proxy) 325 A. Falsification of physical or psychological signs or symptoms, or induction of injury or disease, in another, associated with identified deception. B. The individual presents another individual (victim) to oth... |
326 Somatic Symptom and Related Disorders order imposed on another, in which the parent's actions represent abuse and maltreat ment of a child), such criminal behavior and mental illness are not mutually exclusive. The diagnosis of factitious disorder emphasizes the objective identification of falsification of signs a... |
Other Specified Somatic Symptom and Related Disorder 327 Other Specified Soma tic Symptom and ' Rela ted Disorder 300. 89 (F45. 8) This category applies to presentations in which symptoms characteristic of a somatic symptom and related disorder that cause clinically significant distress or impairment in so cial, occup... |
Feedin g and Eatin g Disorders Feeding and eating disorders are characterized by a persistent disturbance ofeat ing or eating-related behavior that results in the altered consumption or absorption of food and that significantly impairs physical health or psychosocial functioning. Diagnos tic criteria are provided for... |
330 Feeding and Eating Disorders Coding note: The ICD-9-CM code for pica is 307. 52 and is used for children or adults. The ICD-1 0-CM codes for pica are (F98. 3) in children and (F50. 8) in adults. Specify if: In remission: After full criteria for pica were previously met, the criteria have not been met for a sustaine... |
Pica 331 Cultur e-Rela ted Diagno stic Is sues In some populations, the eating of earth or other seemingly nonnutritive substances is believed to be of spiritual, medicinal, or other social value, or may be a culturally supported or socially normative practice. Such behavior does not warrant a diagnosis of pica (Criter... |
332 Feeding and Eating Disorders Rumi nation Disorder Dia gnos tic Criteria 307. 53 (F98. 21 ) A. Repeated regurgitation of food over a period of at least 1 month. Regurgitated food may be re-chewed, re-swallo wed, or spit out. B. The repeated regurgitation is not attributable to an associated gastrointestinal or other... |
Rumination Disorder 333 hand over the mouth or coughing. Some will avoid eating with others because of the ac knowledged soc,_ial undesirability of the behavior. This may extend to an avoidance of eat ing prior to social situations, such as work or school (e. g., avoiding breakfast because it may be followed by regur... |
334 Feeding and Eating Disor ders Avo idant/R estri ctive Food Intake Disorder Diagnos tic Criteria 307. 59 (F50. 8) A. An eating or feeding disturbance (e. g., apparent lack of interest in eating or food; avoid ance based on the sensory characteristics of food; concern about aversive conse quences of eating) as mani... |
Avoidan VRestrictive Food Intake Disorder 335 activities, such as eating with others, or to sustain relationships as a result of the distur bance would inicate marked interference with psychosocial functioning (Criterion A4). Avoidant/ restrictive food intake disorder does not include avoidance or restriction of food ... |
336 Feeding and Eating Disor ders potential. In older children, adolescents, and adults, social functioning tends to be ad versely affected. Regardless of the age, family function may be affected, with heightened stress at mealtimes and in other feeding or eating contexts involving friends and relatives. Avoidant/ res... |
Avoidant/Re strictive Food Intake Disorder 337 tions, especially those with ongoing symptoms such as vomiting, loss of appetite, nausea, ab dominal pain, OJ\ diarrhea. A diagnosis of avoidant/ restrictive food intake disorder requires that the disturbance of intake is beyond that directly accounted for by physical sym... |
338 Feeding and Eating Disorders be best made in the context of a clinical relationship over time. In some individuals, avoid ant/restrictive food intake disorder might precede the onset of anorexia nervosa. Obsessive-compulsive disorder. Individuals with obsessive-compulsive disorder may present with avoidance or res... |
Anorexia Nervosa 339 C. Disturbance in the way in which one's body weight or shape is experienced, undue in fluence of bo_dy weight or shape on self-evaluation, or persis tent lack of recognition of the seriousness of the current low body weight. Coding note: The ICD-9-CM code for anorexia nervosa is 307. 1, which is ... |
340 Feeding and Eating Disorders Criterion A requires that the individual's weight be significantly low (i. e., less than minimally normal or, for children and adolescents, less than that minimally expected). Weight assessment can be challenging because normal weight range differs among indi viduals, and different thr... |
Anorexia Nervosa 341 Asso ciated Featu res Supp orting Diagno sis The semi-starva hon of anorexia nervosa, and the purging behaviors sometimes associated with it, can result in significant and potentially life-threatening medical conditions. The nutritional compromise associated with this disorder affects most major or... |
342 Feeding and Eating Disorder s individuals more likely have a longer duration of illness, and their clinical presentation may include more signs and symptoms of long-standing disorder. Clinicians should not exclude anorexia nervosa from the differential diagnosis solely on the basis of older age. Many individuals ha... |
Anorexia Nervosa 343 Hematology. Leukopenia is common, with the loss of all cell types but usually with ap parent lymphytosis. Mild anemia can occur, as well as thrombocytopenia and, rarely, bleeding problems. Serum chemistry. Dehydration may be reflected by an elevated blood urea nitrogen level. Hypercholesterolemia ... |
344 Feeding and Eating Disorder s Differential Diagnosis Other possible causes of either significantly low body weight or significant weight loss should be considered in the differential diagnosis of anorexia nervosa, especially when the presenting features are atypical (e. g., onset after age 40 years). Medical condit... |
Bulimia Nervosa 345 or symptoms prior to onset of their eating disorder. OCD is described in some individuals with anorexia nrvosa, especially those with the restricting type. Alcohol use disorder and other substance use disorders may also be comorbid wit h anorexia nervosa, especially among those with the binge-eati n... |
346 Feeding and Eating Disorders may affect the clinician's estimation of whether the intake is excessive. For example, a quantity of food that might be regarded as excessive for a typical meal might be consid ered normal during a celebration or holiday meal. A "discrete period of time" refers to a limited period, usu... |
Bulimia Nervosa 347 self-esteem (Criterion D). Individuals with this disorder may closely resemble those with anorexia nervo,sa in their fear of gaining weight, in their desire to lose weight, and in the level of dissatisfaction with their bodies. However, a diagnosis of bulimia nervosa should not be given when the dis... |
348 Feeding and Eating Disorders symptoms meet criteria for binge-eating disorder or other specified eating disorder. Diag nosis should be based on the current (i. e., past 3 months) clinical presentation. Risk and Prognos tic Fac tors Temperamental. Weight concerns, low self-esteem, depressive symptoms, social anxi ... |
Bulimia Nervosa 349 Suicide Risk Suicide risk is elevated in bulimia nervosa. Comprehensive evaluation of individuals with this disorder should include assessment of suicide-related ideation and behaviors as well as other risk factors for suicide, including a history of suicide attempts. Func tional Conse quenc es of B... |
350 Feeding and Eating Disorders ing effective treatment of the bulimia ner vosa. The lifetime prevalence of substance use, particularly alcohol or stimulant use, is at least 30% among individuals with bulimia ner vosa. Stimulant use often begins in an attempt to control appetite and weight. A substan tial percentage... |
Binge-Eating Disorder 351 nitely larger than most people would eat in a similar period of time under similar circum stances (Criteriqn A1). The context in which the eating occurs may affect the clinician's estimation of whether the intake is excessive. For example, a quantity of food that might be regarded as excessiv... |
352 Feeding and Eating Disorders Dev elopm ent and Cour se Little is known about the develop ment of binge-eating disorder. Both binge eating and loss-of-control eating without objectively excessive consumption occur in children and are associated with increased body fat, weight gain, and increases in psychological sym... |
Other Specified Feeding or Eating Disorder 353 weight and shape are higher in obese individuals with the disorder than in those without the disorder. Sond, rates of psychiatric comorbidity are significant ly higher among obese individuals with the disorder compared with those without the disorder. Third, the long-term ... |
354 Feeding and Eating Disorders 5. Night eating syndrome: Recurrent episodes of night eating, as manifested by eating after awakening from sleep or by excessive food consumption after the evening meal. There is awareness and recall of the eating. The night eating is not better explained by external influences such as ... |
Elimin ation Distress Elimina tion disorders all involve the inappropriate elimination of urine or feces and are usually first diagnosed in childhood or adolescence. This group of disorders in cludes enuresis, the repeated voiding of urine into inappropriate places, and encopresis, the repeated passage of feces into i... |
356 Elimination Disorders be intentional. To qualify for a diagnosis of enuresis, the voiding of urine must occur at least twice a week for at least 3 consecutive months or must cause clinically significant dis tress or impairment in social, academic (occupational), or other important areas of func tioning (Criterion... |
Encopresis 357 Culture-R Iated Diagno stic Issues Enuresis has bee'n reported in a variety of European, African, and Asian countries as well as in the United States. At a national level, prevalence rates are remarkably similar, and there is great similarity in the developmental trajectories found in different countries... |
358 Elimination Disorders Specify whether: With constipation and overflow incontinence: There is evidence of constipation on physical examination or by history. Without constipa tion and overflow incontinence: There is no evidence of constipa tion on physical examination or by history. Subtypes Feces in the with const... |
Other Specified Elimination Disorder 359 Prevalence It is estimated that approximately 1% of 5-year-olds have encopresis, and the disorder is more common in males than in females. Dev elopment and Course Encopresis is not diagnosed until a child has reached a chronological age of at least 4 years (or for children with ... |
360 Elimination Disorders Unspecified Elimination Disor der This category applies to presentations in which symptoms characteristic of an elimination disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full cr... |
Sleep-Wake Disorders The DSM-5 classifi cation of sleep-wake disorders is intended for use by general mental health and medical clinicians (those caring for adult, geriatric, and pediatric pa tients). Sleep-wake disorders encompass 10 disorders or disorder groups: insomnia disor der, hypersomnolence disorder, narcole... |
362 Sleep-Wake Disorders 2nd Edition (ICSD-2) elaborated numerous diagnostic subtypes. DSM-IV was prepared for use by mental health and general medical clinicians who are not experts in sleep medicine. ICSD-2 reflected the science and opinions of the sleep specialist community and was pre pared for use by specialists.... |
Insomnia Disorder Specify if: Episodic: Sy{Tlptoms last at least 1 month but less than 3 months. Persistent: Symptoms last 3 months or longer. Recurrent: Two (or more) episodes within the space of 1 year. 363 Note: Acute and short-term insomnia (i. e., symptoms lasting less than 3 months but oth erwise meeting all cri... |
364 Sleep-Wake Disorders Aside from the frequency and duration criteria required to make the diagnosis, addi tional criteria are useful to quantify insomnia severity. These quantitative criteria, while arbitrary, are provided for illustrative purpose only. For instance, difficulty initiating sleep is defined by a subj... |
Insomnia Disorder 365 that meet criteria for insomnia disorder. Insomnia disorder is the most prevalent of all sleep disorders. primary care settings, approximately 10%-20% of individuals complain of significant insomnia sym ptoms. Insomnia is a more prevalent compla int among fe males than among males, with a gender ... |
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