A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period: 

(1) tolerance, as defined by either of the following: 
 (a) a need for markedly increased amounts of the substance to achieve Intoxication or desired effect 
 (b) markedly diminished effect with continued use of the same amount of the substance 

(2) Withdrawal, as manifested by either of the following: 
 (a) the characteristic withdrawal syndrome for the substance (refer to Criteria A and B of the criteria sets for Withdrawal from the specific substances) 
 (b) the same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms

(3) the substance is often taken in larger amounts or over a longer period than was intended 

(4) there is a persistent desire or unsuccessful efforts to cut down or control substance use 

(5) a great deal of time is spent in activities necessary to obtain the substance (e.g., visiting multiple doctors or driving long distances), use the substance (e.g., chain-smoking), or recover from its effects 

(6) important social, occupational, or recreational activities are given up or reduced because of substance use 

(7) the substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance (e.g., current cocaine use despite recognition of cocaine-induced depression, or continued drinking despite recognition that an ulcer was made worse by alcohol consumption) 

Substance Dependence

A. A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within a 12-month period: 

(1) recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; neglect of children or household) 
(2) recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use) 
(3) recurrent substance-related legal problems (e.g., arrests for substance-related disorderly conduct) 
(4) continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with spouse about consequences of Intoxication, physical fights) 

B. The symptoms have never met the criteria for Substance Dependence for this class of substance.

Substance Abuse

A. The development of a substance-specific syndrome due to the cessation of (or reduction in) substance use that has been heavy and prolonged. 

B. The substance-specific syndrome causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. 

C. The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.

Substance Withdrawal

Sexual Disorders and Dysfunctions

A. A strong and persistent cross-gender identification (not merely a desire for any perceived cultural advantages of being the other sex). In children, the disturbance is manifested by four (or more) of the following: 

(1) repeatedly stated desire to be, or insistence that he or she is, the other sex 
(2) in boys, preference for cross-dressing or simulating female attire; in girls, insistence on wearing only stereotypical masculine clothing 
(3) strong and persistent preferences for cross-sex roles in make-believe play or persistent fantasies of being the other sex 
(4) intense desire to participate in the stereotypical games and pastimes of the other sex 
(5) strong preference for playmates of the other sex. In adolescents and adults, the disturbance is manifested by symptoms such as a stated desire to be the other sex, frequent passing as the other sex, desire to live or be treated as the other sex, or the conviction that he or she has the typical feelings and reactions of the other sex. 

B. Persistent discomfort with his or her sex or sense of inappropriateness in the gender role of that sex. In children, the disturbance is manifested by any of the following: in boys, assertion that his penis or testes are disgusting or will disappear or assertion that it would be better not to have a penis, or aversion toward rough-and-tumble play and rejection of male stereotypical toys, games, and activities; in girls, rejection of urinating in a sitting position, assertion that she has or will grow a penis, or assertion that she does not want to grow breasts or menstruate, or marked aversion toward normative feminine clothing. In adolescents and adults, the disturbance is manifested by symptoms such as preoccupation with getting rid of primary and secondary sex characteristics (e.g., request for hormones, surgery, or other procedures to physically alter sexual characteristics to simulate the other sex) or belief that he or she was born the wrong sex. 

C. The disturbance is not concurrent with a physical intersex condition. 

D. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. 

Gender Identity Disorder

A. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving the exposure of one's genitals to an unsuspecting stranger. 

B. The person has acted on these urges, or the sexual urges or fantasies cause marked distress or interpersonal difficulty.

Paraphilias

Exhibitionism

A. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving touching and rubbing against a non-consenting person. 

B. The person has acted on these urges, or the sexual urges or fantasies cause marked distress or interpersonal difficulty.

Paraphilias

Frotteurism

A. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving the act of observing an unsuspecting person who is naked, in the process of disrobing, or engaging in sexual activity. 

B. The person has acted on these urges, or the sexual urges or fantasies cause marked distress or interpersonal difficulty.

Paraphilias

Voyeurism 

A. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child or children (generally age 13 years or younger). 

B. The person has acted on these urges, or the sexual urges or fantasies cause marked distress or interpersonal difficulty.

C. The person is at least age 16 years and at least 5 years older than the child or children in Criterion A. 

Note: Do not include an individual in late adolescence involved in an ongoing sexual relationship with a 12- or 13-year-old. 

Paraphilias

Pedophilia

A. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving acts (real, not simulated) in which the psychological or physical suffering (including humiliation) of the victim is sexually exciting to the person. 

B. The person has acted on these urges with a nonconsenting person, or the sexual urges or fantasies cause marked distress or interpersonal difficulty.

Paraphilias

Sexual Sadism

A. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving the act (real, not simulated) of being humiliated, beaten, bound, or otherwise made to suffer. 

B. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Paraphilias

Sexual Masochism

A. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving the use of nonliving objects (e.g., female undergarments). 

B. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. 

C. The fetish objects are not limited to articles of female clothing used in cross-dressing (as in Transvestic Fetishism) or devices designed for the purpose of tactile genital stimulation (e.g., a vibrator).

Paraphilias

Fetishism

A. Over a period of at least 6 months, in a heterosexual male, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving cross-dressing. 

B. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. 

Specify if: 

With Gender Dysphoria: if the person has persistent discomfort with gender role or identity

Paraphilias

Transvestic Fetishism

A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either 
   (1) depressed mood or
   (2) loss of interest or pleasure. 
Note: Do not include symptoms that are clearly due to a general medical condition, ormood-incongruent delusions or hallucinations. 

(1) depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritablemood. 
(2) markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others) 
(3) significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains. 
(4) Insomnia or Hypersomnia nearly every day 
(5) psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down) 
(6) fatigue or loss of energy nearly every day 
(7) feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick) 
(8) diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others) 
(9) recurrent thoughts of death (not just fear of dying), recurrent suicidalideation without a specific plan, or a suicide attempt or a specific plan for committing suicide 

B. The symptoms do not meet criteria for a Mixed Episode (see p. 335). 

C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. 

D. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism). 

E. The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation

Major Depressive Episode

A. Presence of a single Major Depressive Episode. 

B. The Major Depressive Episode is not better accounted for by Schizoaffective Disorderand is not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified. 

C. There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode.Note: This exclusion does not apply if all of the manic-like, mixed-like, or hypomanic-like episodes are substance or treatment induced or are due to the direct physiological effects of a general medical condition. 

Major Depressive Disorder, Single Episode

A. Presence of two or more Major Depressive Episodes. 
Note: To be considered separate episodes, there must be an interval of at least 2 consecutive months in which criteria are not met for a Major Depressive Episode. 

B. The Major Depressive Episodes are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder,Delusional Disorder, or Psychotic Disorder Not Otherwise Specified. 

C. There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode.Note: This exclusion does not apply if all of the manic-like, mixed-like, or hypomanic-like episodes are substance or treatment induced or are due to the direct physiological effects of a general medical condition. 

Major Depressive Disorder, Recurrent  

A. Depressed mood for most of the day, for more days than not, as indicated either by subjective account or observation by others, for at least 2 years. Note: In children and adolescents, mood can be irritable and duration must be at least 1 year. 

B. Presence, while depressed, of two (or more) of the following: 

(1) poor appetite or overeating 
(2) Insomnia or Hypersomnia
(3) low energy or fatigue 
(4) low self-esteem 
(5) poor concentration or difficulty making decisions 
(6) feelings of hopelessness 

C. During the 2-year period (1 year for children or adolescents) of the disturbance, the person has never been without the symptoms in Criteria A and B for more than 2 months at a time. 

D. No Major Depressive Episode has been present during the first 2 years of the disturbance (1 year for children and adolescents); i.e., the disturbance is not better accounted for by chronic Major Depressive Disorder, or Major Depressive Disorder, In Partial Remission. 
Note: There may have been a previous Major Depressive Episode provided there was a full remission (no significant signs or symptoms for 2 months) before development of the Dysthymic Disorder. In addition, after the initial 2 years (1 year in children or adolescents) of Dysthymic Disorder, there may be superimposed episodes of Major Depressive Disorder, in which case both diagnoses may be given when the criteria are met for a Major Depressive Episode. 

E. There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode, and criteria have never been met for Cyclothymic Disorder. 

F. The disturbance does not occur exclusively during the course of a chronic Psychotic Disorder, such as Schizophrenia or Delusional Disorder. 

G. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism). 

H. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Dysthymic Disorder

A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary). 

B. During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree: 

(1) inflated self-esteem or grandiosity
(2) decreased need for sleep (e.g., feels rested after only 3 hours of sleep) 
(3) more talkative than usual or pressure to keep talking 
(4) flight of ideas or subjective experience that thoughts are racing
(5) distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli) 
(6) increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
(7) excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments) 

C. The symptoms do not meet criteria for a Mixed Episode.

  D. The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features. 

E. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism). 

Manic Episode

A. A distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual non depressed mood. 

B. During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree: 

(1) inflated self-esteem or grandiosity 
(2) decreased need for sleep (e.g., feels rested after only 3 hours of sleep) 
(3) more talkative than usual or pressure to keep talking 
(4) flight of ideas or subjective experience that thoughts are racing 
(5) distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli) 
(6) increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation 
(7) excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., the person engages in unrestrained buying sprees, sexual indiscretions, or foolish business investments) 

C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic. 

D. The disturbance in mood and the change in functioning are observable by others. 

E. The episode is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features. 

F. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).

Hypomanic Episode

A. The criteria are met both for a Manic Episode and for a Major Depressive Episode(except for duration) nearly every day during at least a 1-week period. 

B. The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features. 

C. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism). 

Mixed Episode

A. Presence of only one Manic Episode and no past Major Depressive Episodes. 
Note: Recurrence is defined as either a change in polarity from depression or an interval of at least 2 months without manic symptoms. 

B. The Manic Episode is not better accounted for by Schizoaffective Disorder and is not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified. 

Bipolar I Disorder, Single Manic Episode

A. Currently (or most recently) in a Hypomanic Episode. 

B. There has previously been at least one Manic Episode or Mixed Episode. 

C. The mood symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. 

D. The mood episodes in Criteria A and B are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder,Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

Bipolar I Disorder, Most Recent Episode Hypomanic

A. Currently (or most recently) in a Manic Episode. 

B. There has previously been at least one Major Depressive Episode, Manic Episode, orMixed Episode. 

C. The mood episodes in Criteria A and B are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder,Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

Bipolar I Disorder, Most Recent Episode Manic

A. Currently (or most recently) in a Mixed Episode. 

B. There has previously been at least one Major Depressive Episode, Manic Episode, orMixed Episode. 

C. The mood episodes in Criteria A and B are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder,Delusional Disorder, or Psychotic Disorder Not Otherwise Specified. 

Bipolar I Disorder, Most Recent Episode Mixed 

A. Currently (or most recently) in a Major Depressive Episode. 

B. There has previously been at least one Manic Episode or Mixed Episode. 

C. The mood episodes in Criteria A and B are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder,Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

Bipolar I Disorder, Most Recent Episode Depressed 

A. Criteria, except for duration, are currently (or most recently) met for a Manic,  a Hypomanic, a Mixed, or a Major Depressive Episode. 

B. There has previously been at least one Manic Episode or Mixed Episode. 

C. The mood symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. 

D. The mood symptoms in Criteria A and B are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder,Delusional Disorder, or Psychotic Disorder Not Otherwise Specified. 

E. The mood symptoms in Criteria A and B are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).

Bipolar I Disorder, Most Recent Episode Unspecified

A. Presence (or history) of one or more Major Depressive Episodes.

B. Presence (or history) of at least one Hypomanic Episode. 

C. There has never been a Manic Episode or a Mixed Episode. 

D. The mood symptoms in Criteria A and B are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder,Delusional Disorder, or Psychotic Disorder Not Otherwise Specified. 

E. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Bipolar II Disorder

A. For at least 2 years, the presence of numerous periods with hypomanic symptoms (see p. 338) and numerous periods with depressive symptoms that do not meet criteria for aMajor Depressive Episode. Note: In children and adolescents, the duration must be at least 1 year. 

B. During the above 2-year period (1 year in children and adolescents), the person has not been without the symptoms in Criterion A for more than 2 months at a time. 

C. No Major Depressive Episode, Manic Episode, or Mixed Episode has been present during the first 2 years of the disturbance. 
Note: After the initial 2 years (1 year in children and adolescents) of Cyclothymic Disorder, there may be superimposed Manic or Mixed Episodes (in which case bothBipolar I Disorder and Cyclothymic Disorder may be diagnosed) or Major Depressive Episodes (in which case both Bipolar II Disorder and Cyclothymic Disorder may be diagnosed). 

D. The symptoms in Criterion A are not better accounted for by Schizoaffective Disorderand are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified. 

E. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism). 

F. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Cyclothymic Disorder

A type of Schizophrenia in which the following criteria are met: 

A. Preoccupation with one or more delusions or frequent auditory hallucinations.

 B. None of the following is prominent: disorganized speech, disorganized or catatonicbehavior, or flat or inappropriate affect.

(Schizophrenia) Paranoid Type

A type of Schizophrenia in which the following criteria are met: 

A. All of the following are prominent: 

(1) disorganized speech 
(2) disorganized behavior 
(3) flat or inappropriate affect 

B. The criteria are not met for Catatonic Type.

(Schizophrenia) Disorganized Type

A type of Schizophrenia in which the clinical picture is dominated by at least two of the following: 

(1) motoric immobility as evidenced by catalepsy (including waxy flexibility) or stupor 
(2) excessive motor activity (that is apparently purposeless and not influenced by external stimuli) 
(3) extreme negativism (an apparently motiveless resistance to all instructions or maintenance of a rigid posture against attempts to be moved) or mutism 
(4) peculiarities of voluntary movement as evidenced by posturing (voluntary assumption of inappropriate or bizarre postures), stereotyped movements, prominent mannerisms, or prominent grimacing 
(5) echolalia or echopraxia

(Schizophrenia) Catatonic Type

(Schizophrenia) Undifferentiated Type