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366 Sleep-Wake Disorders Risk and Progno stic Facto rs While the risk and prognostic factors discussed in this section increase vulnerability to in somnia, sleep disturbances are more likely to occur when predisposed individuals are ex posed to precipitating events, such as major life events (e. g., illness, separati... |
Insomnia Disorder 367 related psychophysiological symptoms (e. g., tension headache, muscle tension or pain, gastrointestinal Sfinptoms ). Func tional Cons equenc es of Insom nia Disorder Interpersonal, social, and occupational problems may develop as a result of insomnia or excessive concern with sleep, increased dayt... |
368 Sleep-Wake Disorders Substance/medication-induc ed sleep disorder, insomnia type. Substance/ medication induced sleep disorder, insomnia type, is distinguished from insomnia disorder by the fact that a substance (i. e., a drug of abuse, a medication, or exposure to a toxin) is judged to be etiologically related to... |
Hypersomnolence Disorder 369 F. Coexisting mental and medical disorders do not adequately explain the predominant complaint of ypersomnolence. Specify if: With mental disorder, including substance use disorders With medical condition With another sleep disorder Coding note: The code 780. 54 (G47. 1 0) applies to all th... |
370 Sleep-Wake Disorders experiencing a sudden sleep "attack. " Unintentional sleep episodes typically occur in low stimulation and low-activity situations (e. g., while attending lectures, reading, watching television, or driving long distances), but in more severe cases they can manifest in high attention situation... |
Hypersomnolence Disorder 371 months after the infection. Hypersomnolence can also appear within 6--18 months follow ing a head trauma. Genetic and physiologic al. Hyperso mnolence may be familial, with an autosomal dominant mode of inheritance. Diagnos tic Marke rs Nocturnal polysomnography demonstrates a normal to p... |
372 Sleep-Wake Disorders related sleep disorders are suggested by a history of loud snoring, pauses in breathing during sleep, brain injury, or cardiovascular disease and by the presence of obesity, oro pharyngeal anatomical abnormalities, hypertension, or heart failure on physical examina tion. Polysomnographic stud... |
Narcolepsy 373 b. In children or in individuals within 6 months of onset, spontaneous grimaces or jaw-opening episodes with tongue thrusting or a global hypotonia, without any obviolls emotional triggers. 2. Hypocretin deficiency, as measured using cerebrospinal fluid (CSF) hypocretin-1 immunoreactivity values (less th... |
374 Sleep-Wake Disorders lepsy with cataplexy but without hypocretin deficiency, test results for human leukocyte antigen (HLA) DQBl *06:02 may be negative. Seizures, falls of other origin, and conversion disorder (functional neurological symptom disorder) should be excluded. In narcolepsy secondary to infectious (e. g... |
Narcolepsy 375 before or upon falling asleep or hypnopompic hallucinations just after awakening. These hallucinations are distinct from the less vivid, nonhallucinatory dreamlike mentation at sleep onset that occurs in normal sleepers. Nightmares and vivid dreaming are also fre quent in narcolepsy, as is REM sleep beh... |
376 Sleep-Wak e Disorders ducing narcolepsy a few months later. Head trauma and abrupt changes in sleep-wake patterns (e. g., job changes, stress) may be additional triggers. Genetic and physiological. Monozygotic twins are 25%-32% concordant for narcolepsy. The prevalence of narcolepsy is 1%-2% in first-degree relativ... |
Narcolepsy 377 guished based on distinctive clinical and laboratory features. Individuals with hypersom nolence typically have longer and less disrupted nocturnal sleep, greater dif ficulty awakening, more persistent daytime sleepiness (as opposed to more discrete "sleep at tacks" in narcolep sy), longer and less ref... |
378 Sleep-Wake Disorders sity, especially when the narcolepsy is untreated. Rapid weight gain is common in young children with a sudden disease onset. Comorbid sleep apnea should be considered if there is a sudden aggravation of preexisting narcolepsy. Rela tionsh ip to Internati onal Classifica tion of Sleep Disorders... |
Obstructive Sleep Apnea Hypopnea 379 elevated arousal index (arousal index greater than 30) or reduced stages in deep sleep (e. g., percentage stage N3 [slow-wave sleep ] less than 5%). \ Diag nos tic Featu res Obstructive sleep apnea hypopnea is the most common breathing-related sleep disorder. It is characterized by ... |
380 Sleep-Wake Disorders airway. With growth of the airway and regression of lymphoid tissue during later child hood, there is reduction in prevalence. Then, as obesity prevalence increases in midlife and females enter menopause, obstructive sleep apnea hypopnea again increases. The course in older age is unclear; the... |
Obstructive Sleep Apnea Hypopnea 381 Obstructive sleep apnea hypopnea has a strong genetic basis, as evidenced by the sig nificant familia Laggregation of the apnea hypopnea index. The prevalence of obstructive \ sleep apnea hypopnea is approximately twice as high among the first-degree relatives of probands with obst... |
382 Sleep-Wake Disorders asymptomatic individuals who snore and do not have abnormalities on overnight polysom nograph y). Individuals with obstructive sleep apnea hypopnea may additionally report nocturnal gasping and choking. The presence of sleepiness or other daytime symptoms not explained by other etiologies sugg... |
Central Sleep Apnea 383 nea should receive that diagnosis, even in the presence of concurrent substance use that is exacerbating the condition. \ Comorbid ity Systemic hypertension, coronary artery disease, heart failure, stroke, diabetes, and increased mortality are consistently associated with obstructive sleep apnea... |
384 Note: See the section "Diagnostic Features" in text. Specify current severity: Sleep-Wake Disorders Severity of central sleep apnea is graded according to the frequency of the breathing disturbances as well as the extent of associated oxygen desaturation and sleep frag mentation that occur as a consequence of repe... |
Central Sleep Apnea 385 use of long-acting opioid medications is often associated with impairment of respiratory con trol leading to central sleep apnea. \ Ass ocia ted Featu res Supporting Diagnosis Individuals with central sleep apnea hypopneas can manifest with sleepiness or insomnia. There can be compla ints of sl... |
386 Sleep-Wake Disorders Func tional Con seq uenc es of Centr al Sleep Apnea Idiopathic central sleep apnea has been reported to cause symptoms of disrupted sleep, in cluding insomnia and sleepiness. Cheyne-Stokes breathing with comorbid heart failure has been associated with excessive sleepiness, fatigue, and insomni... |
Sleep-Rela ted Hypoventilation 387 Sleep-Rela ted Hypo vent ilation Diagno stic Criteria A. Polysomnograpy demonstrates episodes of decreased respiration associated with el evated C02 levels. (Note: In the absence of objective measurement of C02, persistent low levels of hemoglobin oxygen saturation unassociated with ... |
388 Sleep-Wake Disorders can be present. With progression of ventilatory insufficiency, blood gas abnormalities ex tend into wakefulness. Features of the medical condition causing sleep-related hypoven tilation can also be present. Episodes of hypoventilation may be associated with frequent arousals or bradytachy car... |
Sleep-Re lated Hypoventilation 389 Gender-Related Diag nos tic Issues Gender distributions for sleep-related hypoventilation occurring in association with co morbid conditions reflect the gender distributions of the comorbid conditions. For exam ple, COPD is more frequently present in males and with increasing age. D... |
390 Sleep-Wake Disorder s most relevant to the mental health provider, with medication use (e. g., benzodiazepines, opi ates). Congenital central alveolar hypoventilation often occurs in association with autonomic dysfunction and may occur in association with Hirschsprung's disease. COPD, a disorder of lower airway ob... |
Circadian Rhythm Sleep-Wake Disorders 391 307. 45 (G47. 24) Non-24-hour sleep-wake type: A pattern of sleep-wake cycles that is not synchronized to the 24-hour environment, with a consistent daily drift (usually to later and later times) of sleep onset and wake times. 307. 45 (G47. 26) Shift work type: Insomnia during ... |
392 Sleep-Wake Disorders Risk and Prognostic Factors Genetic and physiological. Predisposing factors may include a longer than average cir cadian period, changes in light sensitivity, and impaired homeostatic sleep drive. Some in dividuals with delayed sleep phase type may be hypersensitive to evening light, which ca... |
Circadian Rhythm Sleep-Wake Disorders 393 Adv anced Sleep Phase Type Spec ifier s Advanced sleep phase type may be documented with the specified "familial. " Although the prevalence of familial advanced sleep phase type has not been established, a family history of advanced sleep phase is present in individuals with ad... |
394 Sleep-Wake Disorders Risk and Prognostic Factors Environmental. Decreased late afternoon/ early evening exposure to light and/ or expo sure to early morning light due to early morning awakening can increase the risk of ad vanced sleep phase type by advancing circadian rhythms. By going to bed early, these individ... |
Circadian Rhythm Sleep-Wake Disorders 395 circadian rhythm. There is no major sleep period, and sleep is fragmented into at least three periods d\lring the 24-hour day. Associ ated Featu res Supportin g Diagnosis Individuals with irregular sleep-wake type typically present with insomnia or excessive sleepiness, dependi... |
396 Sleep-Wake Disorders Comor bidity Irregular sleep-wake type is often comorbid with neurodegenerative and neurodevelop mental disorders, such as major neurocognitive disorder, intellectual disability (intellec tual developmental disorder), and traumatic brain injury. It is also comorbid with other medical conditio... |
Circadian Rhythm Sleep-Wake Disorders 397 high frequency of mental disorders involving social isolation and cases of non-24-hour sleep-wake type, developing after a change in sleep habits (e. g., night shift work, job loss), behavioral factors in combination with physiological tendency may precipitate and per petuate ... |
398 Sleep-Wake Disorders Dev elopme nt and Cour se Shift work type can appear in individuals of any age but is more prevalent in individuals older than 50 years and typically worsens with the passage of time if the disruptive work hours persist. Although older adults may show similar rates of circadian phase adjust me... |
Non-Rapid Eye Movement Sleep Arousal Disorder s 399 Paraso mni as Parasomnias are disorders characterized by abnormal behavioral, experiential, or physio logical events occurring in association with sleep, specific sleep stages, or sleep-wake tran sitions. The most common parasomnias-non-rapid eye movement (NREM) sle... |
400 Sleep-Wake Disorders Diag nostic Featu res The essential feature of non-rapid eye movement (NREM) sleep arousal disorders is the repeated occurrence of incomplete arousals, usually beginning during the first third of the major sleep episode (Criterion A), that typically are brief, lasting 1-10 minutes, but may be p... |
Non-Rapid Eye Movement Sleep Arousal Disorder s 401 sexual activity (e. g., masturbation, fondling, groping, sexual intercourse) occur as complex behaviors arisin from sleep without conscious awareness. 1his condition is more common in males and may result in serious interpersonal relationship problems or medicolegal c... |
402 Sleep-Wake Disorders Diagno stic Markers NREM sleep arousal disorders arise from any stage of NREM sleep but most commonly from deep NREM sleep (slow-wave sleep). They are most likely to appear in the first third of the night and do not commonly occur during daytime naps. During the episode, the polysomnogram may b... |
Non-Rapid Eye Movement Sleep Arousal Disorders 403 daytime sleepiness. In some individuals, a breathing-related sleep disorder may precipi tate episodes of sleepwalking. \ REM sleep behavior disorder. REM sleep behavior disorder may be difficult to distin-guish from NREM sleep arousal disorders. REM sleep behavior dis... |
404 Sleep-Wake Disorders Rela tionsh ip to Interna tional Classifica tion of Sleep Disor ders The International Classification of Sleep Disorders, 2nd Edition, includes "confusional arousal" as a NREM sleep arousal disorder. Nightmare Disorder Diagno stic Criteria 307. 47 (F51. 5) A. Repeated occurrences of extended, e... |
Nightmare Disorder 405 almost exclusively during rapid eye movement (REM) sleep and can thus occur through out sleep but are more likely in the second half of the major sleep episode when dreaming is longer and mo're intense. Factors that increase early-night REM intensity, such as sleep fragmentation or deprivation, ... |
406 Sleep-Wake Disorders Culture-R elated Diagno stic Issue s The significance attributed to nightmares may vary by culture, and sensitivity to such be liefs may facilitate disclosure. Gend er-Rela ted Diagno stic Is sue s Adult females report having nightmares more frequently than do adult males. Nightmare content di... |
Rapid Eye Movement Sleep Behavior Disorder 407 are often repetitive in nature or reflect epileptogenic features such as the content of diurnal auras (e. g., unmotivated dread), phosphenes, or ictal imagery. Disorders of arousal, espe cially confusiona ) arousals, may also be present. Breathing-related sleep disorders.... |
408 Sleep-Wake Disorders C. Upon awakening from these episodes, the individual is completely awake, alert, and not confused or disoriented. D. Either of the following: 1. REM sleep without atonia on polysomnographic recording. 2. A history suggestive of REM sleep behavior disorder and an established synuclein opathy d... |
Rapid Eye Movement Sleep Behavior Disorder 409 toms in young individuals, particularly young females, should raise the possibility of narcolepsy or medication-induced REM sleep behavior disorder. \ Risk and Prog nostic Factors Genetic and physiologic al. Many widely prescribed medications, including tricyclic antidepre... |
410 Sleep-Wake Disorders Obstructive sleep apnea. Obstructive sleep apnea may result in behaviors indistin guishable from REM sleep behavior disorder. Polysomnographic monitoring is necessary to differentiate between the two. In this case, the symptoms resolve following effective treatment of the obstructive sleep apn... |
Restless Legs Syndrome 411 Diagno stic Featu res Restless legs synarome (RLS) is a sensorimotor, neurological sleep disorder characterized by a desire to move the legs or arms, usually associated with uncomfortable sensations typically described as creeping, crawling, tingling, burning, or itching (Criterion A). The di... |
412 Sleep-Wake Disorders duration of sitting or lying down in the day to sitting or lying down in the evening or night. Nocturnal worsening tends to persist even in the context of pediatric RLS. As with RLS in adults, there is a significant negative impact on sleep, mood, cognition, and function. Im pairment in childr... |
Substance/Medication-Induced Sleep Disorder 413 a negative impact on mood, and 47. 6% reporting a lack of energy. The most common conse quences of RLS are sleep disturbance, including reduced sleep time, sleep fragmentation, and overall distulbance; depression, generalized anxiety disorder, panic disorder, and post t... |
414 Sleep-Wake Disorders 1. The symptoms in Criterion A developed during or soon after substance intoxication or after withdrawal from or exposure to a medication. 2. The involved substance/medication is capable of producing the symptoms in Crite rion A. C. The disturbance is not better explained by a sleep disor der ... |
Substance/M edication-Induced Sleep Di sorder 415 ICD-10-CM With use With use disorder, Without disorder, moderate use ICD-9-CM mild or severe disorder Alcohol 291. 82 F10. 182 F10. 282 F10. 982 Caffeine 292. 85 F15. 182 F15. 282 F15. 982 Cannabis 292. 85 F12. 188 F12. 288 F12. 988 Opioid 292. 85 F11. 182 F11. 282 F11.... |
416 Sleep-Wake Disorders during discontinuation /withdrawal), followed by the subtype designation (i. e., insomnia type, daytime sleepiness type, parasomnia type, mixed type). For example, in the case of insomnia occurring during withdrawal in a man with a severe lorazepam use disorder, the diagnosis is F13. 282 severe... |
Substance/Medication-Induced Sleep Disorder 417 Alcohol. Alcohol-i nduced sleep disorder typically occurs as insomnia type. During acute intoxication, alcohol produces an immediate sedative effect depending on dose, ac companied by inreased stages 3 and 4 non-rapid eye movement (NREM) sleep and re duced rapid eye mov... |
418 Sleep-Wake Disorder s ing the withdrawal phase. Drugs like 3,4-methylenedioxymethamphetamine (MDMA; "ec stasy") and related substances lead to restless and disturbed sleep within 48 hours of intake; frequent use of these compounds is associated with persisting symptoms of anxiety, depres sion, and sleep disturban... |
Substance/Medication-Induced Sleep Disorder 419 Diag nos tic Markers Each of the subs\ance /medicat ion-induced sleep disorders produces electroencephalo graphic sleep patterns that are associated with, but cannot be considered diagnostic of, other disorders. The electroencephalographic sleep profile for each substanc... |
420 Sleep-Wake Disorders suggest a diagnosis of sleep disorder associated with another medical condition. Con versely, sleep symptoms that appear only after the initiation of a particular medication / substance suggest a substance/medication-induced sleep disorder. If the disturbance is comorbid with another medical c... |
Other Specified Hypersomnolence Disorder 421 insomnia disorder category is used in situations in which the clinician chooses not to specify the reason that the criteria are not met for insomnia disorder or a specific sleep-wake dis order, and includes presentations in which there is insufficient information to make a ... |
422 Sleep-Wake Disorder s Unspecified Sleep-Wake Disorder 780. 59 (G47. 9) This category applies to presentations in which symptoms characteristic of a sleep-wake disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not mee... |
Sexual Dysfun ction s Sexual dysfunctions include delayed ejaculation, erectile disorder, female orgasmic disorder, female sexual inter est/ arousal disorder, genito-pelvic pain/pe netration disorder, male hypoactive sexual desire disorder, premature (early) ejaculation, substan ce/ medication induced sexual dysfuncti... |
424 Sexual Dysfunctions order), then only the other mental disorder diagnosis should be made. If the problem is thought to be better explained by the use I misuse or discontinuation of a drug or substance, it should be diagnosed accordingly as a substance/medication-induced sexual dysfunction. If the sexual dysfunction... |
Delayed Ejaculation 425 sexual activity because of a repetitive pattern of difficulty ejaculating. Some sexual partners may report feeling less sexually attractive because their partner cannot ejaculate easily. In addition to the subtypes "lifelong/acquired" and "generali zed/situational," the fol lowing five factors ... |
426 Sexual Dysfunctions terns; men who require highly ritualized activity to ejaculate during partnered sexual activity). Another medical illness or injury may produce delays in ejaculation independent of psychological issues. For example, inability to ejaculate can be caused by interruption of the nerve supply to the ... |
Erectile Disorder 427 Speci fy current severity: Mild: Evidence of mild distress over the symptoms in Criterion A. Moderate: Evidence of moderate distress over the symptoms in Criterion A. Severe: Evidence of severe or extreme distress over the symptoms in Criterion A. Diagno stic Featu res The essential feature of ere... |
428 Sexual Dysfunctions limiting or responsive to psychological interventions, whereas, as noted above, acquired erectile disorder is more likely to be related to biological factors and to be persistent. The incidence of erectile disorder increases with age. A minority of men diagnosed as having moderate erectile failu... |
Female Orgasmic Disorder 429 Substance/m edication use. Another major differential diagnosis is whether the erectile problem is secondary to substance/ medication use. An onset that coincides with the be ginning of substance/ medication use and that dissipates with discontinuation of the sub stance/medication or dose... |
430 Sexual Dysfunctions stressors and is not attributable to the effects of a substance/m edication or another medical condition. Specify whether: Lifelong: The disturbance has been present since the individual became sexually active. Acquired: The disturbance began after a period of relatively normal sexual function. ... |
Female Orgasmic Disorder 431 despite rarely or never experiencing orgasm. Orgasmic difficulties in women often co occur with problems related to sexual interest and arousal. In addition to the subtypes "lifelong/ acquired" and "generaliz ed/ situational," the fol lowing five factors must be considered during assessme... |
432 Sexual Dysfunctions psychological, sociocultural, and physiological factors likely interact in complex ways to influence women's experience of orgasm and of orgasm difficulties. Culture-Rela ted Diagno stic Issues The degree to which lack of orgasm in women is regarded as a problem that requires treat ment may var... |
Female Sexual Interest/Arousal Disorder 433 Fem ale Sexual Interest/Aro usal Disor der Dia gnostic Criteria 302. 72 (F52. 22) A. Lack of, or significantly reduced, sexual interest/arousal, as manifested by at least three of the following: 1. Absent/reduced interest in sexual activity. 2. Absent/reduced sexual/erotic th... |
434 Sexual Dysfunctions ing lack of signs of physical sexual arousal may be the primary features. Because sexual desire and arousal frequently coexist and are elicited in response to adequate sexual cues, the criteria for female sexual interest/ arousal disorder take into account that difficulties in desire and arousal... |
Female Sexual Interest/Arousal Disorder 435 5) medical factors relevant to prognosis, course, or treatment. Note that each of these factors may contribute djfferently to the presenting symptoms of different women with this disorder. Prevalenc e The prevalence of female sexual interest/ arousal disorder, as defined in t... |
436 Sexual Dysfunctions desire reported by a woman from a certain ethnocultural group meets criteria for female sexual interest/ arousal disorder must take into account the fact that different cultures may pathologize some behaviors and not others. Gender-Related Diagno stic Issues By definition, the diagnosis of femal... |
Genito-Pelvic Pain/Penetration Disorder 437 lems. Low desire appears to be comorbid with depression, sexual and physical abuse in adulthood, globl mental functioning, and use of alcohol. Gen ito-Pelvic Pain/Pene tration Disor der Dia gnostic Criteria 302. 76 (F52. 6) A. Persistent or recurrent difficulties with one (or... |
438 Sexual Dysfunctions ulation); other genito-pelvic pain may be spontaneous as well as provoked. Genito-pelvic pain can also be usefully characterized qualitatively (e. g., ''burning," "cutting," "shooting/' "throb bing"). The pain may persist for a period after intercourse is completed and may also occur during uri... |
Genito-Pelvic Pain/Penetration Disorder 439 Dev elopm ent and Course The developmer\t and course of genito-pelvic pain/penetration disorder is unclear. Because women generally do not seek treatment until they experience problems in sexual functioning, it can, in general, be difficult to characterize genito-pelvic pain/... |
440 Sexual Dysfunctions Differenti al Diag nosis Another medical conditio n. In many instances, women with genito-pelvic pain/pene tration disorder will also be diagnosed with another medical condition (e. g., lichen scle rosus, endometriosis, pelvic inflammatory disease, vulvovag inal atrophy). In some cases, treati... |
Male Hypoactive Sexual Desire Disorder 441 Specify whether: Lifelong: Tille disturbance has been present since the individual became sexually active. Acquired: The disturbance began after a period of relatively normal sexual function. Specify whether: Generai ized: Not limited to certain types of stimulation, situation... |
442 Sexual Dysfunctions ment. Each of these factors may contribute differently to the presenting symptoms of dif ferent men with this disorder. Preva lence The prevalence of male hypoactive sexual desire disorder varies depending on country of origin and method of assessment. Approximately 6% of younger men (ages 18-2... |
Premature (Early) Ejaculation 443 ence of desire across men and women, and the fact that desire fluctuates over time and is dependent on contextual factors, men do report a significantly higher intensity and fre quency of sexual desire compared with women. Differ ential Diagnosis Nonsexual mental disorders. Nonsexual ... |
444 Sexual Dysfunctions Specify whether: Generalized: Not limited to certain types of stimulation, situations, or partners. Situational: Only occurs with certain types of stimulation, situations, or partners. Specify current severity: Mild: Ejaculation occurring within approxima tely 30 seconds to 1 minute of vaginal p... |
Premature (Early) Ejaculation 445 having a normal ejaculatory latency, known as acquired premature (early) ejaculation. There is far less known about acquired premature (early) ejaculation than about lifelong premature (early) ejaculation. The acquired form likely has a later onset, usually appearing during or af ter ... |
446 Sexual Dysfunctions Ejaculatory concerns that do not meet diagnostic criteria. It is necessary to identify males with normal ejaculatory latencies who desire longer ejaculatory latencies and males who have episodic premature (early) ejaculation (e. g., during the first sexual encounter with a new partner when a sho... |
Substance/Medication-Induced Sexual Dysfunction 447 use disorder. If there is no comorbid 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 sexual dysfunction. ICD-10-CM With use With use disord... |
448 Sexual Dysfunctions nificant role in the development of the sexual dysfunction, each should be listed separately (e. g., 292. 89 cocaine-induced sexual dysfunction with onset during intoxication, moderate; 292. 89 fluoxetine-induced sexual dysfunction, with onset after medication use). ICD-1 0-CM. The name of the s... |
Substance/Medication-Induced Sexual Dysfunction 449 Many nonpsychiatric medications, such as cardiovascular, cytotoxic, gastrointestinal, and hormonal agents, are associated with disturbances in sexual function. Illicit substance use is associated with decreased sexual desire, erectile dysfunction, and difficulty reach... |
450 Sexual Dysfunctions Func tional Conse quenc es of Substa nce/M edication-In duced Sexu al Dysfu nction Medication-induced sexual dysfunction may result in medication noncompliance. Diff erential Diagnosis Non-substance/ medication-induc ed sexual dysfuncti ons. Many mental conditions, such as depressive, bipolar, a... |
Gender Dysphoria In this chap ter, there is one overarching diagnosis of gender dysphoria, with sepa rate developmentally appropriate criteria sets for children and for adolescents and adults. The area of sex and gender is highly controversial and has led to a proliferation of terms whose meanings vary over time and w... |
452 Gender Dysphoria Gender Dysphor ia Dia gnos tic Criteria Gender Dys phoria in Childr en 302. 6 (F64. 2) A. A marked incongruence between one's experienced/expressed gender and assigned gender, of at least 6 months' duration, as manifested by at least six of the following (one of which must be Criterion A1): 1. A st... |
Gender Dysphoria 453 B. The condition is associated with clinically significant distress or impairment in social, occupational.._ or other important areas of functioning. Specify if: With a disorder of sex development (e. g., a congenital adrenogen ital disorder such as 255. 2 [E25. 0] congenital adrenal hyperplasia or... |
454 Gender Dysphoria rarely, they may state that they find their penis or testes disgusting, that they wish them re moved, or that they have, or wish to have, a vagina. In young adolescents with gender dysphoria, clinical features may resemble those of children or adults with the condition, depending on developmental ... |
Gender Dysphoria 455 crete, behavioral manner than those for adolescents and adults. Many of the core criteria draw on well-dofumented behavioral gender differences between typically developing boys and girls. Young children are less likely than older children, adolescents, and adults to express extreme and persistent ... |
456 Gender Dysphoria dysphoria during childhood. Expressions of anatomic dysphoria are more common and salient in adolescents and adults once secondary sex characteristics have develop ed. Adolescent and adult natal males with early-onset gender dysphoria are almost al ways sexually attracted to men (androphilic ). Ad... |
Gender Dysphoria 457 factors under consideration, especially in individuals with late-onset gender dysphoria (ad olescence, adulthpod}, include habitual fetishistic transvestism developing into autogyne philia (i. e., sexual arousal associated with the thought or image of oneself as a woman) and other forms of more g... |
458 Gender Dysphoria ment or pressure to dress in attire associated with their assigned sex. Also in adolescents and adults, preoccupation with cross-gender wishes often interferes with daily activities. Relationship difficulties, including sexual relationship problems, are common, and func tioning at school or at wor... |
Other Specified Gender Dysphoria 459 pressive disorders. In prepubertal children, increasing age is associated with having more behavioral or emotional problems; this is related to the increasing non-acceptance of gen der-variant behavior by others. In older children, gender-variant behavior often leads to peer ostrac... |
Disrupti ve, Impuls ive, Con trol and Con duct Dysphoria Disruptive, impul se-contr ol, and conduct disorders include conditions involv ing problems in the self-control of emotions and behaviors. While other disorders in DSM-5 may also involve problems in emotional and/ or behavioral regulation, the disorders in this ... |
462 Disruptive, Impulse-Control, and Conduct Disorders pairment associated with the behaviors indicative of the diagnosis be considered relative to what is normative for a person's age, gender, and culture when determining if they are symptomatic of a disorder. The disruptive, impulse-control, and conduct disorders hav... |
Oppositional Defiant Disorder Moderate : Some symptoms are present in at least two settings. Severe: Sol"f\e symptoms are present in three or more settings. Spe cifier s 463 It is not uncommon for individuals with oppositional defiant disorder to show symptoms only at home and only with family members. However, the per... |
464 Disruptive, Impulse-Contr ol, and Conduct Disorders Assoc iated Fea tures Supporti ng Diagnosis In children and adolescents, oppositional defiant disorder is more prevalent in families in which child care is disrupted by a succession of different caregivers or in families in which harsh, inconsistent, or neglectful... |
Oppositional Defiant Disorder 465 Culture-Rela ted Diagno stic Issues The prevalence Of the disorder in children and adolescents is relatively consistent across countries that differ in race and ethnicity. Func tional Conse quenc es of Opp ositi onal Defi ant Disorder When oppositional defiant disorder is persistent th... |
466 Disruptive, Impulse-Contr ol, and Conduct Disorders Comorbid ity Rates of oppositional defiant disorder are much higher in samples of children, adoles cents, and adults with ADHD, and this may be the result of shared temperamental risk fac tors. Also, oppositional defiant disorder often precedes conduct disorder,... |
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