ANXIETY DISORDERS

 Excessive fear and anxiety and related behavioral disturbances

 Fear – emotional response to real or perceived imminent threat (e.g. arousal for
fight or flight, thoughts of immediate danger, escape behaviors)
 Anxiety – anticipation of future threat (e.g. muscle tension, vigilance, cautious or
avoidant behaviors)
 Panic attack – particular type of fear response prominent within anxiety disorders
 Anxiety disorders are best differentiated by the types of situations feared or avoided
and content of associated thoughts or beliefs
 Transient fear or anxiety (often stress-induced and temporary) vs. Anxiety disorder
(persistent, usually 6 months or more)
 Fear or anxiety is excessive or out of proportion
 Sex Ratio: Female-Male: 2:1
 Panic attacks (may be expected – response to typically feared object or situation;
unexpected – occurs for no apparent reason)
 Generalized Anxiety Disorder – persistent and excessive anxiety and worry about
various domains which are difficult to control in addition to physical symptoms
such as restlessness, easily fatigued, difficulty concentrating, irritability, muscle
tension and sleep disturbance
 Panic Disorder – recurrent unexpected panic attacks and persistently worried of
having more panic attacks which may cause maladaptive behaviors
 Agoraphobia – fear and anxiety of “unsafe” situations (e.g. public transportation,
open spaces, enclosed places, standing in line or being in a crowd, being outside
home alone) where panic-like symptoms may occur and help or escape is unlikely
 Specific Phobia – fear, anxiety or avoidance of circumscribed objects or situations
that is out of proportion to actual risk (subtypes: animal, natural environment,
blood-injection-injury, situational, other)
 Social Anxiety Disorder (Social Phobia) – fear, anxiety or avoidance of social
interactions and situations where scrutiny is possible in addition to cognitive
ideation of being negatively evaluated or offending others
 Separation Anxiety Disorder – fear or anxiety about developmentally
inappropriate separation from attachment figures; nightmares and physical
symptoms may be present
 Selective Mutism – consistent failure to speak in social situations even though
individual speaks in other situations which leads to significant consequences on
achievement or interferes social communication (usually diagnosed in addition to
social anxiety disorder)
 Substance/Medication-Induced Anxiety Disorder – anxiety due to substance
intoxication or withdrawal or exposure to a medication treatment
 Anxiety Disorder Due to Another Medical Condition – anxiety symptoms are
direct pathophysiological consequence of another medical condition
 Other Specified Anxiety Disorder – anxiety-like symptoms that cause clinically
significant distress or impairment but does not meet full criteria and clinician
specifies the reason (e.g. limited symptom attacks, generalized anxiety not occurring
more days than not)
  Unspecified Anxiety Disorder - anxiety-like symptoms that cause clinically
significant distress or impairment but does not meet full criteria and clinician does
not choose to communicate the reason and there is insufficient information to make
more specific diagnosis (e.g. emergency room settings)

DEPRESSIVE DISORDERS
 Presence of sad, empty or irritable mood accompanied by somatic and cognitive
changes significantly affecting one’s capacity to function
 In grief, the predominant affect is feelings of emptiness and loss, in major depressive
episode it is persistent depressed mood and inability to anticipate happiness or
pleasure
 Disruptive Mood Dysregulation Disorder – chronic, severe persistent (non-
episodic) irritability through frequent verbal and/or behavioral temper outbursts in
response to frustration and persistent irritable or angry mood between the
outbursts
 Major Depressive Disorder – persistent depressed mood and/or loss of interest or
pleasure nearly most of the day every day for at least two weeks (plus 4 more
symptoms)
 Persistent Depressive Disorder (Dysthymia) – depressed mood most of the day, 
for more days than not, for at least 2 years (plus 2 more symptoms)
 Premenstrual Dysphoric Disorder – mood lability, irritability, dysphoria and
anxiety symptoms accompanied by behavioral and physical symptoms that occur
repeatedly during premenstrual phase and remit around onset of menses or shortly
thereafter
 Substance/Medication-Induced Depressive Disorder – prominent and persistent
depressed mood and/or anhedonia that developed during or soon after intoxication,
withdrawal or exposure to substance/medication which is capable of producing said
symptoms
 Depressive Disorder Due to Another Medical Condition – prominent and
persistent depressed and/or anhedonia that is the direct pathophysiological
consequence of another medical condition
 Other Specified Depressive Disorder – presentations of depressed mood with
clinically significant impairment that do not meet criteria for duration or severity
(e.g. recurrent brief depression, short-duration depressive episode (4-13 days),
depressive episode with insufficient symptoms)
 Unspecified Depressive Disorder – presentations of depressed mood with
clinically significant impairment that do not meet full criteria and clinician does not
wish to specify the reason, possibly due to insufficient information
 Specifiers:  With anxious distress, With mixed features, With melancholic features,
With atypical features, With psychotic features, With catatonia, With peripartum
onset, With seasonal pattern; In partial remission, In full remission; Severity: Mild,
Moderate, Severe

BIPOLAR AND RELATED DISORDERS

 Manic episode: abnormal, persistent elevated, expansive or irritable mood and
abnormal, persistent increased goal-directed activity or energy most of the day,
nearly every day for at least one week (any duration if hospitalized) plus 3
additional symptoms
 Hypomanic episode: abnormal, persistent elevated, expansive or irritable mood and
abnormal, persistent increased goal-directed activity or energy most of the day,
nearly every day for at least 4 days plus 3 additional symptoms
 Major depressive episode: depressed mood or loss of interest or pleasure and 4
additional symptoms most of the day, nearly every day for at least 2 weeks
 Highly comorbid with anxiety disorders (75%)
 Bipolar I Disorder – at least one lifetime manic episode (hypomanic episode or
major depressive episode may occur but not required)
 Bipolar II Disorder – at least one hypomanic episode and at least one major
depressive episode, never been a manic episode
 Cyclothymic Disorder – numerous distinct sub-criteria periods with hypomanic
symptoms and periods of depressive symptoms present at least half the time for at
least 2 years (has not been without symptoms for more than 2 months at a time)
 Substance/Medication-Induced Bipolar and Related Disorder – prominent and
persistent elevated, expansive or irritable mood and/or depressed mood or
anhedonia that developed during or soon after intoxication, withdrawal or exposure
to substance/medication which is capable of producing said symptoms
 Known Substances/Medications: Sedative, hypnotic or anxiolytic; Amphetamine (or
other stimulant); Cocaine
 Exceptions: Case of hypomania/mania that occurs after and persists beyond
physiological effects of antidepressant medication or treatment (such as ECT)
 Bipolar and Related Disorder Due to Another Medical Condition – prominent
and persistent elevated, expansive or irritable mood and increased activity or
energy that are the direct pathophysiological consequences of another medical
condition (e.g. Cushing’s disease, multiple sclerosis, stroke, traumatic brain injury)
 Other Specified Bipolar and Related Disorder – bipolar-like symptoms that cause
clinically significant distress or impairment but does not meet full criteria and
clinician specifies the reason (e.g. short-duration hypomanic episodes (2-3 days)
and major depressive episodes, hypomanic episode without prior major depressive
episode, short-duration cyclothymia)
 Unspecified Bipolar and Related Disorder – bipolar-like symptoms that cause
clinically significant distress or impairment but does not meet full criteria and
clinician does not choose to communicate the reason, possibly due to insufficient
information
 Specifiers – With anxious distress, With mixed features, With rapid cycling, With
melancholic features, With atypical features, With psychotic features, With
catatonia, With peripartum onset, With seasonal pattern; In partial remission, In full
remission; Mild, Moderate, Severe
OBSESSIVE-COMPULSIVE AND RELATED DISORDERS
 Presence of obsessions (e.g. recurrent and persistent, intrusive thoughts, urges or
images) and compulsions (e.g. repetitive behaviors or mental acts driven in response
to obsessions)
 Obsessive-Compulsive Disorder – repetitive and persistent, time-consuming
intrusive obsessions (which individual attempts to ignore or suppress) by means of
compulsions; common dimensions: cleaning, symmetry, forbidden thoughts
(sex/aggression/religion) and harm
 Body Dysmorphic Disorder – cognitive symptom related to perceived defects or
flaws in physical appearance and repetitive behaviors or mental acts in response to
appearance concerns
 Hoarding Disorder – cognitive symptom related to perceived need to save
possessions
 Trichotillomania (Hair-Pulling Disorder) – recurrent and repetitive hair-pulling
behaviors resulting in hair loss and repeated attempts to decrease or stop hair-
pulling
 Excoriation (Skin-Picking Disorder) – recurrent and repetitive skin-picking
behaviors  resulting in skin lesions and repeated attempts to decrease or stop skin-
picking
 Substance/Medication-Induced Obsessive-Compulsive and Related Disorder –
obsessive-compulsive symptoms due to substance intoxication/withdrawal or to a
medication
 Obsessive-Compulsive and Related Disorder Due to Another Medical
Condition – obsessive-compulsive-like symptoms that are direct pathophysiological
consequence of medical disorder
 Other Specified Obsessive-Compulsive and Related Disorder – obsessive-
compulsive-like symptoms that cause clinically significant distress or impairment
but does not meet full criteria and clinician specifies the reason (e.g. body-focused
repetitive disorder, obsessional jealousy)
 Unspecified Obsessive-Compulsive and Related Disorder – obsessive-
compulsive-like symptoms that cause clinically significant distress or impairment
but does not meet full criteria and clinician does not choose to communicate the
reason and there is insufficient information to make more specific diagnosis (e.g.
emergency room settings)