Diagnostic and Statistical Manual of Mental Disorders
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Diagnostic and Statistical Manual of Mental Disorders

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Learn about the DSM, the Diagnostic and statistical manual of mental

Learn about the DSM, the Diagnostic and statistical manual of mental

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  • Consolidation of DSM IV chronic major depressive disorder and dysthymic disorder

Diagnostic and Statistical Manual of Mental Disorders Diagnostic and Statistical Manual of Mental Disorders Presentation Transcript

  • Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. DSM 5 Roy Q. Sanders, MD
  • 2 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Bernard "Hap" Kliban
  • 3 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Why Change? Coordination with ICD nomenclature –Special consideration for ICD-11 –In October 2014 the US will adopt ICD-10 Integration of latest research and clinical experience Enhanced specificity
  • 4 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Bernard "Hap" Kliban
  • 5 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Bernard "Hap" Kliban
  • 6 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Definition of a Mental Disorder “A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress of disability in social, occupational, or other important activities. An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behavior (e.g. political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above.”
  • 7 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Bernard "Hap" Kliban
  • 8 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Bernard "Hap" Kliban
  • 9 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Bernard "Hap" Kliban
  • 10 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved.
  • 11 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Bernard "Hap" Kliban
  • 12 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Assessment System  Non axial  Listing of diagnoses starting with the most pertinent  Separate notations • Psychosocial & contextual factors  ICD-9 V codes & ICD-10 Z codes • Disability  No GAF  WHO Disability Assessment Scale (WHODAS)
  • 13 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Diagnostic Specifiers  If meet full criteria • Severity = mild, moderate, severe, extreme  Many disorders – number of symptoms • Descriptive = insight, environment • Course = partial remission, full remission, recurrent  If do not meet full criteria • Other Specified Disorder  Reason not meet criteria • Unspecified disorder  No reason given for not meeting criteria
  • 14 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Diagnostic Considerations  Number of diagnoses can not be made if patient has certain other diagnosis  All diagnoses require distress/ impairment  Most disorder categories have medical condition/ substance related version of disorder • Substance/ Medication-Induced Disorder • Disorder Due to Another Medical Condition
  • 15 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Bernard "Hap" Kliban
  • 16 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Intellectual Disabilities Intellectual Disability (Intellectual Developmental Disorder = ICD)  Deficits in • Intellectual functions • Adaptive functioning  Onset during developmental period  Severity = adaptive functioning, not IQ • Mild, moderate, severe, profound • Conceptual, social, practical domains
  • 17 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Intellectual Disabilities Global Developmental Delay  < 5 years  Several areas of delay  Unable to undergo systematic assessment Unspecified Intellectual Disability  > 5 years  Unable to assess due to sensory/ physical impairments, behavior
  • 18 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Changes  Name  Developmental period not age  Increased emphasis on adaptive function  Severity by adaptive functioning not IQ
  • 19 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Communication Disorders Language Disorder  Persistent difficulties in acquisition & use of language across modalities • Deficits in comprehension or production  Reduced vocabulary  Limited sentence structure  Impairments in discourse  Below age/ impaired function  Onset, early developmental period
  • 20 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Communication Disorders Speech Sound Disorder  Persistent difficulty with speech sound production • Speech intelligibility • Prevents verbal communication of messages  Limitations in effective communication  Onset, early developmental period
  • 21 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Communication Disorders Childhood-Onset Fluency Disorder (Stuttering)  Speech fluency/ time patterning disturbances • Inappropriate for age & language skills • Persist over time • Frequent/ marked occurrences  Various specific sound/ speech abnormalities  Impairment  Onset, early developmental period
  • 22 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Communication Disorders Social (Pragmatic) Communication Disorder  Persistent difficulties – social use of verbal & nonverbal communication • Social • Change with context/ listener • Rules of conversation/ story-telling • Non explicit  Functional limitations  Onset, early developmental period
  • 23 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved.
  • 24 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Changes  Name changes  Consolidation of several disorders  New disorder • Target those with social uses of communication
  • 25 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Autism Spectrum Disorders  Persistent deficits • Social communication/ interaction • Restricted, repetitive pattern of behavior, interests, activities  Present, early developmental period; may manifest later  Impairment, assess each deficit separately  Severity (each deficit) • Requiring support, requiring substantial support, requiring very substantial support  Specifiers • With/ without accompanying intellectual impairment • With/ without accompanying language impairment • Associated with known medical or genetic condition or environmental factor • Associated with another neurodevelopmental, mental, or behavioral disorder • With catatonia
  • 26 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Changes  Consolidation of all variants into 1 disorder  Specifiers to indicate specific characteristics
  • 27 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Attention-Deficit/Hyperactivity Disorder  Persistent pattern • inattention and/or hyperactivity-impulsivity • 6 or more symptoms (5 for > 17 years), either category • > 6 months  Several symptoms • < 12 year; > 2 settings  Interferes with functioning or development  Specify • Combined, primarily inattentive, primarily hyperactive/ impulsive • Severity • Partial remission
  • 28 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved.
  • 29 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Changes  Examples in criterion items to describe symptoms for broader range of ages  Onset prior to age 12 years  Specifiers rather than subtypes  Fewer symptoms required for adults  Can diagnose with autism spectrum disorder
  • 30 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Specific Learning Disorder Specific Learning Disorder  Difficulties learning & using academic skills • > 1 symptom  Reading, comprehension, spelling, written, numbers, math reasoning • > 6 months despite targeted interventions  Impairment, below developmental level  Begin in school age  Specify • reading, written expression, mathematics • severity
  • 31 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Changes  Combine several diagnoses  Specifiers
  • 32 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Motor Disorders Developmental Coordination Disorder  Acquisition/ execution of coordinated motor skills • Below expected developmental level  Impairment  Onset, early developmental level
  • 33 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Motor Disorders Stereotypic Movement Disorders  Repetitive, seemingly driven, apparently purposeful motor behavior  Interference/ impairment  Onset, early developmental period  Specify • With/ without self-injurious behavior • Associated with medical, genetic, neurodevelopmental disorder, environmental factor • Severity
  • 34 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Tic Disorders Tourette’s Disorder  Multiple motor & vocal tics, present at some time (don’t have to be concurrent)  > 1 year  onset < 18 years
  • 35 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved.
  • 36 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Tic Disorders Persistent (Chronic) Motor or Vocal Tic Disorder  Single or multiple motor or vocal tics  > 1 year  onset < 18 years  specify • Motor or vocal
  • 37 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Changes  Specifiers to Stereotypic Movement Disorder  Tic criteria standardized across manual
  • 38 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Schizophrenia Spectrum & Other Psychotic Disorders Key Features  Delusions  Hallucinations  Disorganized Thinking (Speech)  Grossly Disorganized or Abnormal Motor Behavior (including Catatonia)  Negative Symptoms
  • 39 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Bernard "Hap" Kliban
  • 40 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Schizophrenia Spectrum & Other Psychotic Disorders Delusional Disorder  > 1 delusions  > 1 month  Specify • Erotomanic, Grandiose, Jealous  Adequate functioning/ not bizarre, Persecutory, Somatic, Mixed, Unspecified • With bizarre content • First/ multiple episodes • Acute/ partial remission/ full remission • Continuous • Severity  Each symptom, 0-4; last 7 days
  • 41 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Schizophrenia Spectrum & Other Psychotic Disorders Brief Psychotic Disorder  > 1 symptoms  > 1 = delusions, hallucinations, disorganized speech, disorganized/ catatonic behavior  > 1 day < 1 month, full return to pre-morbid functioning  Specify • With/ without marked stressors • With postpartum onset • With catatonia • Severity (don’t have to use)  Each symptom, 0-4; last 7 days
  • 42 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Schizophrenia Spectrum & Other Psychotic Disorders Schizophreniform Disorder  > 2 symptoms, significant period of time during 1 month (less if treated) • > 1 = delusions, hallucinations, disorganized speech, disorganized/ catatonic behavior, negative symptoms • > 1 month < 6 months  Specify • With/ without good prognostic features • With catatonia • Severity  Each symptoms, 0-4; last 7 days
  • 43 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Schizophrenia Spectrum & Other Psychotic Disorders Schizophrenia  > 2 symptoms, significant period of time during 1 month (less if treated) • > 1 = delusions, hallucinations, disorganized speech, disorganized/ catatonic behavior, negative symptoms  Impaired functioning  Continuous signs > 6 months  Specify • First/ multiple episodes; continuous • Acute/partial or full remission • With catatonia • Severity  Primary symptoms, 0-4; last 7 days
  • 44 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Schizophrenia Spectrum & Other Psychotic Disorders Schizoaffective Disorder  Uninterrupted period of illness • Major mood episode • Concurrent criterion A, schizophrenia  Lifetime, delusions/ hallucinations > 2 wks without mood symptoms  Major mood symptoms present, majority of time  Specify • Bipolar/ depressive • With catatonia • First/ multiple episodes; continuous • Acute/partial or full remission • With catatonia • Severity  Each symptoms, 0-4; last 7 days
  • 45 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Schizophrenia Spectrum & Other Psychotic Disorders Catatonia Associated with Another Mental Disorder (Catatonia Specifier)  Clinical picture dominated by > 3 of • Stupor, catalepsy, waxy flexibility, mutism, negativism, posturing, mannerism, stereotypy, agitation, grimacing, echolalia, echopraxia  Code with mental disorder
  • 46 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Schizophrenia Spectrum & Other Psychotic Disorders Catatonic Disorder Due to Another Medical Condition  Clinical picture dominated by > 3 of • Stupor, catalepsy, waxy flexibility, mutism, negativism, posturing, mannerism, stereotypy, agitation, grimacing, echolalia, echopraxia  Evidence (hx, PE, lab) • Direct pathophysiological consequence of another medical condition  Code – include medical condition
  • 47 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Changes Delusion Disorder  Delusions no longer have to be non bizarre Schizophrenia  No subtypes  2 criterion A for diagnosis  > 1 criterion A • Delusions, hallucinations, disorganized speech  Dimensional rating scale in section III
  • 48 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Changes Schizoaffective Disorder  Longitudinal not cross sectional  Major mood episode present most of disorder duration after criterion A met Catatonia  Can be a specifier  Criteria been standardized across manual  Diagnosis with specifiers • Medical condition • Mental disorder
  • 49 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Bipolar and Related Disorders
  • 50 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Manic Episode  Distinct period of abnormally & persistently elevated, expansive or irritable mood  Abnormally & persistently increased goal directed activity  > 1 week, most of day, nearly every day (any duration if hospitalized)  > 3 symptoms (4 if irritable) • Grandiosity, less sleep, talkative, racing thoughts, distractibility, goal directed activity, high risk behavior  Impairment
  • 51 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Hypomanic Episode  Distinct period of abnormally & persistently elevated, expansive or irritable mood  Abnormally & persistently increased goal directed activity  > 4 days, most of day, nearly every day (any duration if hospitalized)  > 3 symptoms (4 if irritable) • Grandiosity, less sleep, talkative, racing thoughts, distractibility, goal directed activity, high risk behavior  Change in function, observable by others
  • 52 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Major Depressive Episode  > 5 symptoms, same 2 week period, change in functioning • > 1 = depressed mood, loss of interest/ pleasure • Depressed mood (kids = irritability), loss of interest/ pleasure, weight loss (kids = failure to gain), sleep changes, agitation/ retardation, fatigue, worthlessness/ guilt, poor concentration, death/ suicide  Distress/ impairment  Can diagnose in presence of major stressors: bereavement, disaster, illness, disability, etc)
  • 53 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved.  Must meet criteria for manic episode  May be preceded by and followed by hypomanic or major depressive episodes  Specify • Type of most recent/ current episode • Severity  Mild, moderate, severe • Presence of psychotic features • Remission status • With anxiety, mixed features, rapid cycling, melancholic features, atypical features, mood congruent/ mood incongruent psychotic features, catatonia, peripartum onset, seasonal pattern Bipolar I Disorder
  • 54 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved.  Meet criteria for current/ past hypomanic episode and  Criteria for current/ past major depressive episode  No manic episodes  Specifiers • Type of most recent/ current episode • With anxious distress, mixed features, rapid cycling, mood-congruent psychotic features, with mood incongruent psychotic features, catatonia, peripartum onset, seasonal pattern • In partial/ full remission • Severity  Mild, moderate, severe Bipolar II Disorders
  • 55 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved.  > 2 years (> 1 year in kids), numerous periods with hypomanic symptoms and periods of depressive symptoms, not meet criteria  Symptoms present at least 50% time, not been without symptoms for > 2 months at a time  Not met criteria for major depressive, manic, hypomanic episodes  Specify • With anxious distress Cyclothymic Disorder
  • 56 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Changes  Manic/ Hypomanic Episodes • Increased energy/ activity as criterion A symptom  Specifiers • With mixed features (Mixed Episode eliminated) • With anxious distress
  • 57 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Depressive Disorders
  • 58 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Depressive Disorders Disruptive Mood Dysregulation Disorder  Severe recurrent temper outbursts, verbal or behavior, out of proportion in intensity/ duration  Inconsistent with developmental level  On average, > 3 times a week  Intervening mood, consistently irritable/ angry most of day  > 12 months, < 3 months without all symptoms  Present in 2 of 3 settings, at least 1 severe  Onset before 10 years, not make diagnosis before 6 years/ after 18 years  Not with ODD, IED, Bipolar
  • 59 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Bernard "Hap" Kliban
  • 60 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Depressive Disorders Major Depressive Disorder  Major depressive episode  Specify • Type of most recent/ current episode • Severity • Presence of psychotic features • Remission status • With anxiety, mixed features, rapid cycling, melancholic features, atypical features, mood congruent/ mood incongruent psychotic features, catatonia, peripartum onset, seasonal pattern
  • 61 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Depressive Disorders Persistent Depressive Disorder (Dysthymia)  Depressed mood, most of day, most days, > 2 years (kids = irritability, 1 year)  While depressed, > 2 symptoms • Appetite change, sleep change, fatigue, low self-esteem, poor concentration, hopelessness  Never been without symptoms, > 2 months  Criteria for major depressive disorder may > 2 years  Specify • Severity • Remission status • With anxiety, mixed features, melancholic features, atypical features, mood congruent/ mood incongruent psychotic features, catatonia, peripartum onset • Early/ late onset • With pure dysthymic syndrome, persistent depressive episode, intermittent major depressive episodes, with/ without current episodes
  • 62 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved.
  • 63 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Depressive Disorders Premenstrual Dysphoric Disorder  Majority of menstrual cycles, preceding year • > 5 symptoms in final week before onset of menses • Improve within few days after onset of menses • Minimal or absent in week post menses • > 1 symptoms  Marked affective lability, irritability/ anger/conflicts, depression, anxiety • > 1 symptoms  Decreased interest/ concentration, fatigue, appetite change, sleep change, overwhelmed, physical symptoms  Impairment
  • 64 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Changes  Added Mood Dysregulation Disorder • Children with extreme behavioral dyscontrol • Persistent, not episodic irritability • Decrease diagnosis of pediatric bipolar  Major Depressive Episode • Can be diagnosed in presence of major stressors including bereavement • More detailed explanation to help with diagnosis during bereavement • Additional specifiers
  • 65 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Changes  Moved Premenstrual Dysphoric Disorder into diagnostic section from study section  Persistent Depressive Disorder • Integration of Chronic Major Depressive Disorder and Dysthymic Disorder
  • 66 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Anxiety Disorders
  • 67 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved.
  • 68 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Anxiety Disorders Separation Anxiety Disorder  Developmentally inappropriate/ excessive fear or anxiety re separation from individuals attached to  > 3 symptoms • separation, loss, harm, go out, being alone, sleep, nightmares, physical symptoms  Persistent, > 4 weeks in kids, > 6 months in adults  Impairment
  • 69 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Anxiety Disorders Selective Mutism  Consistent failure to speak in social situations where expected to despite speaking in other situations  Impairment  > 1 month (not 1st month of school)  Not language/ speech problem
  • 70 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Anxiety Disorders Specific Phobia  Marked fear/ anxiety about specific object/ situation (kids = crying, tantrums, freezing)  Phobic object - immediate fear, avoided  Out of proportion  Persistent, > 6 months  Impairment  Specifiers • Animal, natural environment, blood-injection- injury, situation, other
  • 71 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Anxiety Disorders Social Anxiety Disorder (Social Phobia)  Marked fear/ anxiety, > 1 social situations, exposed to possible scrutiny by others (kids must be with peers)  Fear act in way/ show anxiety that negatively evaluated by others  Social situations almost always provoke fear, avoided/ endured (kids – crying, tantrums, freezing, clinging, shrinking, not talking)  Out of proportion  Persistent, > 6 months  Impairment  Specifier • Performance only
  • 72 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Anxiety Disorders Panic Disorder  Recurrent unexpected panic attacks • From calm or anxious state; abrupt surge of intense fear/ discomfort; peak within minutes; > 4 symptoms  At least 1 attack followed by > 1 mo of > 1 • Persistent concern/ worry about attacks • Significant maladaptive behavior change
  • 73 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Anxiety Disorders Agoraphobia  Marked fear/ anxiety about > 2 of • Public transportation • Open spaces • Enclosed places • In line/ crowd • Outside of home alone  Fear, no help/ escape not possible, panic  Situations cause anxiety/ avoided  Out of proportion  > 6 months  Impairment
  • 74 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Anxiety Disorders Generalized Anxiety Disorder  Excessive anxiety/ work, more days than not, > 6 months, about number of events  Difficult to control anxiety  Associated with > 3 (only 1 in kids) or more • Restlessness, fatigue, difficulty concentration, irritability, muscle tension, sleep disturbance  Impairment
  • 75 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Changes  OCD and PTSD in different categories  Selective Mutism and Separation Anxiety moved into this category  Separation Anxiety Disorder • Criterion descriptions broadened to cover lifespan • Eliminated requirement for onset before 18 • Adult duration = 6 months or more
  • 76 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Changes  Specific Phobia and Social Anxiety Disorders • Eliminate recognition that excessive/unreasonable • Duration = 6 months for all ages  Social Anxiety • Specifier  Generalized deleted  Added performance only
  • 77 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Changes  Panic Attacks • Standard criteria • Specifier for multiple disorders  Panic Disorder/ Agoraphobia • Unlinked, separate disorders with own criteria
  • 78 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Obsessive-Compulsive and Related Disorders
  • 79 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Obsessive-Compulsive and Related Disorders Obsessive-Compulsive Disorder  Presence of obsessions, compulsions or both • Obsessions = recurrent & persistent thoughts, urges, images; intrusive & unwanted; marked anxiety & distress; attempts to ignore, suppress, neutralize • Compulsions = repetitive behaviors in response to obsession or rigid rules; aim to prevent/ reduce anxiety/ distress/ dreaded event; no realistic connection (kids may not be able articulate these aims)  Time consuming or distress/ impairment  Specify • With good/ fair/ poor insight • With absent insight/ delusional beliefs • Tic-related
  • 80 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Obsessive-Compulsive and Related Disorders Body Dysmorphic Disorder  Preoccupation, > 1 defects/ flaws in appearance/ not observable by others  Repetitive behaviors in response to concerns  Distress/ impairment  Specify • With muscle dysmorphia • With good/ fair/ poor insight • With absent insight/ delusional beliefs
  • 81 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Obsessive-Compulsive and Related Disorders Hoarding Disorder  Persistent difficulty discarding/ parting with possessions regardless of value  Perceived need to save item & distress with discarding  Accumulation of possessions congest/ clutter active living areas  Distress/ impairment  Specify • With excessive acquisition • With good/ fair/ poor insight • With absent insight/ delusional beliefs
  • 82 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Bernard "Hap" Kliban
  • 83 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Obsessive-Compulsive and Related Disorders Trichotillomania (Hair-Pulling Disorder)  Recurrent pulling out of hair/ hair loss  Repeated attempts to stop/ decrease  Distress/ impairment
  • 84 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Obsessive-Compulsive and Related Disorders Excoriation (Skin-Picking) Disorder  Recurrent skin picking, cause skin lesions  Repeated attempts to decrease/ stop  Distress/ impairment
  • 85 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Changes  New category  New disorders  OCD • Insight specifier refined  Body Dysmorphic Disorder • moved into this category from somatoform • Insight specifier expanded • Muscle dysmorphia specifier • Delusional variant no longer coded as delusional disorder  Trichotillomania moved from impulse control disorder into this category
  • 86 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Trauma and Stressor- Related Disorders
  • 87 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Trauma- and Stressor-Related Disorders Reactive Attachment Disorder  Consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers  Rarely/ minimally seeks/ responds to comfort when distressed  Persistent social & emotional disturbance, > 2 • Minimal social & emotional responsiveness to others • Limited positive affect • Episodes – unexplained irritability, sadness, fearfulness, even during non threatening interactions with caretakers  Experienced pattern, insufficient care, > 1 • Social neglect/ deprivation, basic needs • Repeated changes in caretakers, limit stable attachments • Rearing, unusual situations, limit selective attachments  Care presumed to be responsible for attachment issues  Specifiers • persistent, > 12 months • severity
  • 88 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved.
  • 89 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Trauma- and Stressor-Related Disorders Disinhibited Social Engagement Disorder  Behavior pattern – actively approaches and interacts with unfamiliar adults and exhibits > 2 symptoms • Reduced/ absent reticence with unfamiliar adults; overly familiar verbal & physical behavior; diminished or absent checking back with adult caregiver after venturing away; willingness to go off with unfamiliar adult with minimal or no hesitation  Symptoms not limited to impulsivity but include socially disinhibited behavior  Experienced pattern, insufficient care, > 1 • Social neglect/ deprivation, basic needs • Repeated changes in caretakers, limit stable attachments • Rearing, unusual situations, limit selective attachments  Care presumed to be responsible for attachment issues  Specifiers • persistent, > 12 months • severity
  • 90 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Trauma- and Stressor-Related Disorders Posttraumatic Stress Disorder, Criteria, > 6 years  Exposure to actual/ threatened death, injury, serious violence, > 1 • Experiencing, witnessing, learning about close others, repeated/ extreme exposure to aversive details  Presence > 1, intrusion symptoms  Persistent avoidance of associated stimuli, > 1  Negative alterations in cognitions & mood, > 2  Marked alterations in arousal/ reactivity, > 2  Duration > 1 month; distress/ impairment  Specify • With dissociative symptoms (depersonalization, derealization) • With delayed expression
  • 91 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved.
  • 92 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Trauma- and Stressor-Related Disorders Posttraumatic Stress Disorder, Criteria, < 6 years  Exposure to actual/ threatened death, injury, serious violence, > 1 • Experiencing, witnessing  Presence > 1, intrusion symptoms  Persistent avoidance of associated stimuli, > 1  Negative alterations in cognitions & mood, > 2  Marked alterations in arousal/ reactivity, > 2  Duration > 1 month  Distress/ impairment  Specify • With dissociative symptoms (depersonalization, derealization) • With delayed expression
  • 93 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Trauma- and Stressor-Related Disorders Acute Stress Disorder  Exposure to actual/ threatened death, injury, serious violence, > 1 • Experiencing, witnessing, learning about close others, repeated/ extreme exposure to aversive details  > 9 symptoms from categories of intrusion, negative mood, dissociation, avoidance, arousal  Duration, immediately after, 3 days to 1 mo  Distress/ impairment
  • 94 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Trauma- and Stressor-Related Disorders Adjustment Disorder  Emotional/ behavioral symptoms in response to identifiable stressor, within 3 months  Distress out of proportion  Impairment  Not normal bereavement  Specify • With depressed mood, anxiety, mixed anxiety & depressed mood, disturbance of conduct, mixed disturbance of emotions & conduct, unspecified
  • 95 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Changes Reactive Attachment Disorder  split into 2 diagnoses • Reactive Attachment Disorder  Poorly formed/ absent attachments  Similar to ADHD and Disruptive Behavior Disorders • Disinhibited Social Engagement Disorder  Insecure/ more secure attachments  Similar to depression and other internalizing disorders
  • 96 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Changes PTSD  Stressor criterion more explicit about what qualifies as traumatic  Elimination of subjective reaction  Expansion to 4 symptom clusters from 3 • Intrusion • Avoidance • Negative alterations in mood and cognition  Includes persistent negative emotion states • Alterations in arousal and reactivity  Adds irritable behavior, angry outbursts, reckless/ self-destructive behavior  Separate criteria for children under 6
  • 97 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Changes Acute Stress Disorder  Explicit qualification of traumatic events • Direct, witnessed, indirect  Eliminate subjective reaction Adjustment Disorder  Re-conceptualization as heterogeneous group of stress response syndromes  Occur after exposure to traumatic or distressing event
  • 98 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Dissociative Disorders
  • 99 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Bernard "Hap" Kliban
  • 100 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Dissociative Disorders Dissociative Identity Disorder  Disruption of identity, > 2 distinct personality states  Recurrent gaps in everyday events, personal information, traumatic events  Distress/ impairment  Not accepted culture/ religion  Kids – not imaginary friends/ fantasy play
  • 101 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Dissociative Disorders Dissociative Amnesia  Inability to recall important autobiographical information, usually traumatic/ stressful • Most often localized/ selective for specific events; generalized for identity, life history  Distress/ impairment  Code • With/ without dissociative fugue
  • 102 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Bernard "Hap" Kliban
  • 103 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Dissociative Disorders Depersonalization/ Derealization Disorder  Presence of persistent/ recurrent experiences of depersonalization, derealization or both  Reality testing during episodes intact  Distress/ impairment
  • 104 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Changes  New names • Derealization added to depersonalization disorder  Dissociative Fugue • No longer separate diagnosis • Specifier for dissociative amnesia  Dissociative Identity Disorder • Symptoms of identity disruption can be reported as well as observed • Recall gaps can be for everyday events not just trauma • Additional descriptions of cultural phenomena in exclusion criteria
  • 105 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Somatic Symptom and Related Disorders
  • 106 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved.
  • 107 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Somatic Symptom and Related Disorders Somatic Symptom Disorder  > 1 somatic symptoms, distressing/ impair  Excessive thoughts, feelings, behaviors related to symptoms, health concerns, > 1 • Disproportionate, persistent thoughts about seriousness • Persistently high level of anxiety • Excessive time & energy devoted  Symptoms persistent, > 6 months  Specify • With predominant pain • Persistent • Severity • Mild = 1 • Moderate = > 2 • Severe = > 2 and multiple somatic symptoms (or one very severe)
  • 108 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Somatic Symptom and Related Disorders Illness Anxiety Disorder  Preoccupation, having/ acquiring serious illness  No/ mild somatic symptoms  High level anxiety about health  Excessive health related behaviors  Present > 6 months  Specify • Care seeking type/ care avoidant type
  • 109 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Somatic Symptom and Related Disorders Conversion Disorder (Functional Neurological Symptom Disorder)  > 1 symptoms of altered voluntary motor or sensory function  Clinical findings, evidence of no compatibility between symptom & recognized medical/ neurological conditions  Specifiers  With weakness or paralysis; with abnormal movement; with swallowing symptoms; with speech symptom; with attacks or seizures; with anesthesia or sensory loss, with special sensory symptom; with mixed symptoms  Acute/ persistent  With/ without psychological stressor
  • 110 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Somatic Symptom and Related Disorders Psychological Factors Affecting Other Medical Conditions  Medical symptoms/ disorder present  Psychological/ behavioral factors adversely affect medical condition, 1 of following ways • Temporal association between factors & disease exacerbation • Factors interfere with treatment of medical condition • Factors constitute health risks • Factors influence underlying pathophysiology  Specify • Severity  Mild, moderate, severe, extreme
  • 111 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Somatic Symptom and Related Disorders Factitious Disorders  Factitious Disorder Imposed on Self  Falsification of physical/ psychological signs, symptoms; induction of injury, disease associated with deception in self  Presents as ill, impaired, injured  Deceptive behavior evident even in absence of obvious external rewards  Specify • Single/ recurrent episodes
  • 112 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Somatic Symptom and Related Disorders Factitious Disorders  Factitious Disorder Imposed on Another  Falsification of physical/ psychological signs, symptoms; induction of injury, disease associated with deception in another  Presents other as ill, impaired, injured  Deceptive behavior evident even in absence of obvious external rewards  Perpetrator receives diagnosis  Specify • Single/ recurrent episodes
  • 113 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Changes  Renaming of category  Renaming/ reorganization of disorders  De-emphasis on unexplained medical symptoms  Emphasis on maladaptive thoughts/ feelings/ behavior  Consolidation of disorders • Somatic Symptom Disorder • Illness Anxiety Disorder Conversion Disorder • Criteria modified to emphasize importance of neurological exam and that psychological factors may not be evident at diagnosis Psychological Factors Affecting a Medical Condition • Moved to disorder section from other conditions  No longer describe variants in disorder name Factitious Disorder • Renamed, of self and of other
  • 114 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Feeding and Eating Disorders
  • 115 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved.
  • 116 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Feeding and Eating Disorders Pica  Persistent eating of nonnutritive, nonfood substances, > 1 month  Inappropriate for developmental level  Not cultural or socially normative
  • 117 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Feeding and Eating Disorders Rumination Disorder  Repeated regurgitation of food, > 1 month  Not GI or other medical condition  Not another eating disorder  Specify • In remission
  • 118 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Feeding and Eating Disorders Avoidant/ Restrictive Food Intake Disorder  Eating/ feeding disturbance, persistent failure to meet nutritional/ energy assoc with > 1 • Weight loss/ failure to gain • Significant nutritional deficiency • Dependent on supplementary feedings • Interference with psychosocial functioning  Not no available food/ assoc cultural practice  Not another eating disorder  Specify if in remission
  • 119 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Feeding and Eating Disorders Anorexia Nervosa  Restriction of energy intake, low body weight  Intense fear of gaining weight/ becoming fat; persistent behavior interferes with weight gain  Disturbance in way body weight/ shape experienced, undue influence on self-esteem. Lack of recognition of seriousness of low weight  Specify • Restricting type / binge-eating/ purging type • Partial/ full remission • Severity  BMI
  • 120 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Feeding and Eating Disorders Bulimia Nervosa  Recurrent episodes of binge eating • Eating in discrete period of time, larger amount of food than most eat • Sense of lack of control  Recurrent inappropriate compensatory behaviors, prevent weight gain  Eating & compensation, on avg, once a week for 3 months  Self evaluation unduly influenced by body shape & weight  Specify • Partial/ full remission • Severity  Average frequency of episodes of inappropriate compensatory behaviors per week
  • 121 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Feeding and Eating Disorders Binge Eating Disorder  Recurrent episodes of binge eating  Episodes associated with > 3  Eating more rapidly than normal, until uncomfortably full, not physically hungry, alone because embarrassed, disgusted with self  Distress  On avg, once a week, 3 months  Specify • Partial/ full remission • Severity  Number of binge eating episodes per week
  • 122 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Changes  Name changes  Avoidant/ Restrictive Food Intake Disorder • Was Feeding Disorder of Infancy  Expanded criteria
  • 123 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Changes Anorexia Nervosa • Amenorrhea requirement eliminated • Wording changed to help with identification of low body weight; additional guidance provided  Bulimia Nervosa • Reduction in frequency for binge eating & inappropriate compensatory behavior  Binge Eating Disorder • Moved to disorder section from study section • Frequency criteria changed, matches BN
  • 124 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Elimination Disorders
  • 125 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Elimination Disorders Enuresis  Repeated voiding of urine, bed/ clothes, involuntary, intentional  > 2 week/ 3 months or distress  > 5 years  Specify • Nocturnal only • Diurnal only • Nocturnal and diurnal
  • 126 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Elimination Disorders Encopresis  Repeated passage of feces into inappropriate places, involuntary or intentional  At least 1 event each month for > 3 months  > 4 years  Specifier • With constipation and overflow incontinence • Without constipation and overflow incontinence
  • 127 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Changes  Own category
  • 128 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Sleep-Wake Disorders
  • 129 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Sleep-Wake Disorders Insomnia Disorder  Predominant complaint of dissatisfaction with sleep quantity or quality, assoc with > 1 • Difficulty initiating sleep • Difficulty maintaining sleep • Early morning awakening, inability to return to sleep  Distress/ impairment  > 3 nights/ week; > 3 months  Occurs despite adequate opportunity  Specify • With non sleep disorder mental comorbidity • With other medical comorbidity • With other sleep disorder
  • 130 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved.
  • 131 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Sleep-Wake Disorders Hypersomnolence Disorder  Self reported excessive sleepiness despite sleep > 7 hours  At least 1 of the following • Recurrent periods of sleep/ lapses, same day • Non-restorative main sleep > 9 hours • Difficulty being awake after abrupt awakening  > 3 times/ week; > 3 months  Distress/ impairment  Specify • With mental disorder, medical condition, another sleep disorder • Acute/ subacute/ persistent • Severity  Difficulty maintaining daytime alertness
  • 132 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Sleep-Wake Disorders Narcolepsy  Recurrent episodes of irrepressible need to sleep, lapsing into sleep, napping; > 3 times/ week for 3 months  Presence > 1 • Cataplexy, few times a month • Hypocretin deficiency • Nocturnal sleep polysomnography, REM sleep latency < 15 min, multiple sleep latency < 8 min  Specify • Narcolepsy without cataplexy but with hypocretin deficiency • Narcolepsy with cataplexy but without hypocretin deficiency • Autosomal dominant cerebellar ataxia, deafness and narcolepsy • Autosomal dominant natcolepsy, obesity and type 2 diabetes • Narcolepsy secondary to another medical condition • Severity  Frequency of cataplexy
  • 133 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Sleep-Wake Disorders Breathing-Related Sleep Disorders Obstructive Sleep Apnea Hypopnea  Evidence by polysomnography of > 5 obstructive apneas/ hypopneas per hour of sleep and either • Nocturnal breathing disturbances • Daytime sleepiness, fatigue, unrefreshing sleep  Evidence of polysomnography >15 per hour regardless of symptoms  Specify • Severity  Apnea hyponea index
  • 134 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Sleep-Wake Disorders Breathing-Related Sleep Disorders Central Sleep Apnea  Evidence by polysomnography of > 5 central apneas per hour of sleep  Not another sleep disorder  Specify • Idiopathic central sleep apnea • Cheyne-Stokes breathing • Central sleep apnea comorbid with opiod use • Severity  Frequency of breathing disturbances, extent of associated oxygen desaturation and sleep fragmentation
  • 135 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Sleep-Wake Disorders Breathing-Related Sleep Disorders Sleep-Related Hypoventilation  Polysomnography – episodes of decreased respiration associated with elevated CO2  Not another sleep disorder  Specify • Idiopathic hypoventilation • Congenital central alveolar hypoventilation • Comorbid sleep-related hypoventilation • Severity  Degree of hypoxemia & hypercarbia present during sleep, evidence of end organ impairment due abn
  • 136 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Sleep-Wake Disorders Breathing-Related Sleep Disorders Circadian Rhythm Sleep-Wake Disorders  Persistent pattern of sleep disruption due to alteration of circadian system or misalignment between system and individual schedule  Excessive sleepiness or insomnia or both  Distress/ impairment  Specify • Delayed sleep phase type; familial; overlapping with non 24 hour sleep-wake type • Advanced sleep phase type; familial • Irregular sleep phase type • Non 24 hour sleep wake type • Shift work type • Episodic/ persistent/ recurrent
  • 137 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Sleep-Wake Disorders Parasomnias Non Rapid Eye Movement Sleep Arousal Disorders  Recurrent episodes of incomplete awakening from sleep, usually 1st third of sleep, with 1 of • Sleepwalking • Sleep terrors  Little/ no dream recall  Amnesia for events  Distress/ impairment  Specify • Sleepwalking type  with sleep-related eating/ sexual behavior • Sleep terror type
  • 138 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Sleep-Wake Disorders Parasomnias Nightmare Disorder  Repeated, dysphoric, scary, remembered dreams, second half of sleep  Awakening, rapidly alert  Distress/ impairment  Specify • During sleep onset • With associated non sleep/ other medical/ other sleep disorder • Acute/ subacute/persistent • Severity  Frequency of episodes per week
  • 139 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Sleep-Wake Disorders Parasomnias Rapid Eye Movement Sleep Behavior Disorder  Repeated episodes of arousal during sleep associated with vocalization/ complex motor behaviors  Arise during REM, > 90 minutes after onset  Awakening, completely alert  Either • REM sleep without atonia or polysomnography • History suggestive of REM sleep behavior and synucleinopathy diagnosis  Distress/ impairment
  • 140 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Sleep-Wake Disorders Restless Legs Syndrome  Urge to move legs, accompanied by/ response to uncomfortable leg sensation  Begins/ worsens during rest/ inactivity  Relieved by movement  Worse in evening  > 3 times/ week, > 3 months  Distress/ impairment
  • 141 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Changes  Eliminated sleep disorders due to mental disorder & medical condition, replaced with expanded specifiers  Science and development information integrated  Insomnia renamed  Narcolepsy • Separated from hypersomnolence disorder • Multiple specifiers  Moved from study to disorder section • REM Sleep Disorder • Restless Leg Syndrome
  • 142 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Changes Breathing-related sleep disorders  3 distinct groups • Obstructive Sleep Apnea Hypopnea • Central Sleep Apnea • Sleep-Related Hypoventilation  Specific diagnostic criteria  Circadian Rhythm Sleep Disorders • Expanded subtypes • Jet lag removed
  • 143 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Sexual Dysfunctions
  • 144 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved.
  • 145 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Sexual Dysfunctions Delayed Ejaculation  Either symptom, almost all or all occasions, partnered sexual activity, without individual desiring delay • Marked delay in ejaculation • Marked infrequency/ absence of ejaculation  > 6 months  Distress  Specify • Lifelong/ acquired • Generalized/ situational • Severity  Distress over symptoms
  • 146 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Sexual Dysfunctions Erectile Disorder  Experienced almost all/ all occasions of sexual activity • Marked difficulty in obtaining erection • Marked difficulty in maintaining erection until completion • Marked decrease in erectile rigidity  > 6 months  Distress  Specify • Lifelong/ acquired • Generalized/ situational • Severity  Distress over symptoms
  • 147 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved.
  • 148 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Sexual Dysfunctions Female Orgasmic Disorder  Experienced almost all/ all occasions of sexual activity • Marked delay/ infrequency/absence orgasm • Marked reduced intensity of orgasmic sensations  > 6 months  Distress  Specify • Lifelong/ acquired • Generalized/ situational • Severity  Distress over symptoms
  • 149 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Sexual Dysfunctions Female Sexual Interest/ Arousal Disorder  Lack of/decreased sexual interest/ arousal, > 3 • Absent/ decreased interest, sexual/ erotic thoughts/ fantasies, no/ decreased initiation, unreceptive, absent/ reduced sexual excitement, less interest/ arousal in response, decreased response during sexual activity  > 6 months  Distress  Specify • Lifelong/ acquired • Generalized/ situational • Severity  Distress over symptoms
  • 150 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Sexual Dysfunctions Male Hypoactive Sexual Desire Disorder  Persistent/ recurrent deficient sexual, erotic thoughts, fantasies, desire for sexual activity  > 6 months  Distress  Specify • Lifelong/ acquired • Generalized/ situational • Severity  Distress over symptoms
  • 151 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved.
  • 152 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Sexual Dysfunctions Genito-Pelvic Pain/ Penetration Disorder  Persistent/ recurrent difficulties, > 1 • Vaginal penetration during intercourse • Vulvovaginal/ pelvic pain during intercourse/ penetration • Fear/ anxiety about pain re penetration • Tensing/ tightening, pelvic floor muscles during attempted penetration  Duration > 6 months  Distress  Specify • Lifelong/ acquired • Severity  Distress over symptoms
  • 153 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Sexual Dysfunctions Premature (Early) Ejaculation  Persistent/ recurrent pattern of ejaculation during partnered sexual activity, within 1 minute  > 6 months, almost all/ all occasions  Specify • Lifelong/ acquired • Generalized/ situational • Severity  Timing of ejaculation related to vaginal penetration/ start of sexual activity
  • 154 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Changes  Added disorders, gender specific  Disorders consolidated, renamed  All disorders • Minimal duration of 6 months • More precise criteria for severity • Additional information in text on factors • Partner, relationship, individual vulnerability, cultural/ religious, medical • 2 subtypes  Lifelong/ acquired  Generalized/ situational
  • 155 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Gender Dysphoria
  • 156 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Bernard "Hap" Kliban
  • 157 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Gender Dysphoria Gender Dysphoria in Children  Marked incongruence between experienced/ expressed gender and assigned gender, > 6 months, > 6 symptoms  Distress  Specify • With disorder of sex development
  • 158 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Gender Dysphoria Gender Dysphoria in Adults  Marked incongruence between experienced/ expressed gender and assigned gender, > 2 months, > 6 symptoms  Distress  Specify • With disorder of sex development • Posttransition
  • 159 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Changes  New category  New name  Emphasis on gender incongruence rather than cross gender identification  Emphasis on emotional component  Gender used rather than sex  No subtyping for sexual orientation  Separate criteria for children and adults  Children • Strong desire instead of expression of desire • Desire necessary but not sufficient, more restrictive  Adolescents/ Adults • Cross gender identification and aversion to own gender merged • Posttransition (after > 1 treatment/ procedure) specifier
  • 160 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Disruptive, Impulse-Control and Conduct Disorders Oppositional Defiant Disorder  Pattern of • angry/ irritable mood • defiant/ oppositional behavior • vindictiveness  > 6 months; > 4 symptoms  Distress  Specify • Severity  Number of settings symptoms expressed in
  • 161 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Disruptive, Impulse-Control and Conduct Disorders Intermittent Explosive Disorder  Recurrent behavioral outbursts, failure to control aggressive impulses, manifested by • Verbal aggressiveness, on avg, 2x/ week over 3 months • Behavioral outbursts, property damage, injury, > 3 over 12 months  Out of proportion  Not premeditated  Distress  > 6 years
  • 162 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Disruptive, Impulse-Control and Conduct Disorders Conduct Disorder  Repetitive, persistent behavior pattern, > 3 symptoms, past 12 months, 1 criterion in last 6 months • Aggression to people & animals • Destruction of property • Deceitfulness or Theft • Serious violations of rules  Impairment  If > 18 years, not meet antisocial PD  Specify • Childhood (< 10 years)/ adolescent onset • Limited prosocial emotions  > 2 symptoms, persistent, > 12 months, multiple relationships/ settings  Lack of remorse/ guilt; callous- lack of empathy; unconcerned about performance; shallow or deficient affect  Severity
  • 163 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Disruptive, Impulse-Control and Conduct Disorders Pyromania  Deliberate, purposeful fire setting, >1  Tension or affective arousal  Fascination/ interest in fire  Pleasure, gratification when witnessing  Not monetary gain, expression of sociopolitical ideology, conceal criminal activity, express anger/ vengeance, improve one’s living circumstances, in response to delusion/ hallucination, impaired judgment
  • 164 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved.
  • 165 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Disruptive, Impulse-Control and Conduct Disorders Kleptomania  Recurrent failure to resist impulses to steal object, not needed for personal object  Increasing sense of tension immediately before  Pleasure, gratification at time of theft  Not anger, vengeance, not response to hallucination/ delusion
  • 166 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved.
  • 167 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Changes  New category  Include disruptive and impulse control disorders  Disorders with emotional and behavioral self control  ODD • 3 types: angry/ irritable; argumentative/ defiant; vindictiveness • Conduct disorder exclusion removed
  • 168 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Changes Conduct Disorder  Additional specifier re prosocial emotions Intermittent Explosive Disorder  Expanded criteria for outbursts • Added verbal, nondestructive/ non-injurious physical aggression • More specific criteria for frequency • Outbursts = impulsive, anger based  Marked distress/ impairment • Marked distress • Occupational/ interpersonal functioning impairment • Negative financial or legal consequences  Minimal age of 6 years/equivalent development level
  • 169 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Substance Related and Addictive Disorders
  • 170 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Substance Related and Addictive Disorders Substance Induced Disorders  Intoxication  Withdrawal  Use Disorder  Specify • Early/ sustained remission • Controlled environment/ maintenance therapy • Severity  Number of symptoms
  • 171 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Substance Related and Addictive Disorders Substances  Alcohol  Caffeine (Use Disorder in Study section)  Cannabis  Phencyclidine  Other Hallucinogen  Inhalant  Opioid  Sedative, Hypnotic, Anxiolytic  Stimulant  Tobacco
  • 172 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Substance Related and Addictive Disorders  Some substances • Specifiers based on primary symptoms, substances  Severity = Number of symptoms/ 11 criteria • Mild = 2-3 • Moderate = 4-5 • Severe = > 6  Remission • Early = > 3 but < 12 months not meet criteria (except craving) • Sustained = > 12 months not meet criteria (except Craving)
  • 173 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Substance Related and Addictive Disorders Non Substance Related Disorders Gambling Disorder  Persistent, problematic gambling behavior  Impairment/ distress  > 4 symptoms, 12 months  Specify • Episodic/ persistent • Early/ sustained remission • Severity  Number of criteria met
  • 174 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Changes  Gambling disorder added  Abuse and dependence no longer separated  Criteria • Intoxication • Withdrawal • Substance Induced Disorders  Added cannabis and caffeine withdrawal
  • 175 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Changes Substance Use Disorders  Legal problems deleted  Craving/ strong desire to use added  Threshold changed to > 2 symptoms  Physiological subtype eliminated  Polysubstance dependence eliminated  Severity based on symptoms  Additional specifiers • Remission, environment, maintenance
  • 176 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Neurocognitive Disorders
  • 177 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Neurocognitive Disorders Delirium  Disturbance in attention  Develops over short period of time  Additional disturbance in cognition  Specifier • Substance intoxication/ withdrawal • Medication induced • Another medical condition • Multiple etiologies • Acute/ persistent • Hyperactive/ hypoactive/ mixed level of activity
  • 178 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Neurocognitive Disorders Neurocognitive Disorders  Mild  Major  Defined cognitive domains • Complex attention • Executive function • Learning and memory • Language • Perceptual-motor • Social cognition
  • 179 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Neurocognitive Disorders Major Neurocognitive Disorder  Significant cognitive decline from previous performance level in > 1 domains • Concern of individual, informant, clinician that been significant decline • Substantial impairment in cognitive performance on testing/ clinical performance  Interfere with independence in everyday activities  Not delirium
  • 180 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Neurocognitive Disorders Mild Neurocognitive Disorder  Modest cognitive decline from previous level of performance in > 1 cognitive domains • Concern of individual, informant, clinician that been significant decline • Modest impairment in cognitive performance on testing/ clinical performance  Not interfere with capacity of independence in everyday activities  Not delirium
  • 181 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Neurocognitive Disorders Subtypes  Alzheimer’s disease  Vascular disease  Frontotemporal  Lewy bodies  Traumatic brain injury  Substance/ medication  HIV infection  Prion disease  Parkinson’s disease  Huntington’s disease  Another medical condition  Multiple etiologies
  • 182 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Neurocognitive Disorders  Specifiers  With/ without behavioral disturbances  Severity (major) • Difficulties with basic activities of daily living
  • 183 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Changes  New term – Neurocognitive disorder  Category includes dementia and amnesia  New disorders • Broader range of etiologies • Expanded to cover wider range of function and ages • Includes less severe dysfunction • Previous dementia subtypes now organized as separate, independent disorders
  • 184 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Personality Disorders
  • 185 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Bernard "Hap" Kliban
  • 186 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Personality Disorders  Paranoid  Schizoid  Schizotypal  Antisocial  Borderline  Histrionic  Narcissistic  Avoidant  Dependent  Obsessive-Compulsive
  • 187 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Personality Disorders General Criteria  Enduring pattern of inner experience that deviates markedly from cultural experiences, > 2 manifestations • Cognition • Affectivity • Interpersonal functioning • Impulse control  Pattern, inflexible & pervasive across broad range of personal and social situations  Distress/ impairment  Pattern stable & enduring; from adolescence/ early adulthood
  • 188 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Personality Disorders Paranoid  Distrust and suspiciousness of others, motives interpreted as malevolent  > 4 symptoms • Suspicious without basis of being exploited/ harm/deception; preoccupied with unjustified doubts about loyalty; reluctant to confide, fear information used against; reads hidden demeaning/ threatening meaning in remarks; bears grudges; attacks on character; suspicious of fidelity
  • 189 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Personality Disorders Schizoid  Detachment from social relationships and restricted range of expression of emotions in interpersonal settings  > 4 • not desire/ enjoy close relationships; chooses solitary activities; no interest in sexual relationship; pleasure in few activities; lacks close friends; indifferent to feedback from others; emotional coldness/ detachment
  • 190 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Personality Disorders Schizotypal Disorder  Social and interpersonal deficits, acute discomfort with/ reduced capacity for close relationships; cognitive/ perceptual distortions/ behavior eccentricities  > 5 • Ideas of reference, odd beliefs/ magical thinking, influences behavior; unusual perceptual experiences; odd thinking and speech; suspiciousness/ paranoid delusion
  • 191 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Personality Disorder Antisocial  Disregard for and violation of rights of others  Since 15 years  > 3  Failure to conform to social norms related to lawful behaviors; deceitfulness; impulsivity; irritability/ aggressiveness; reckless disregard for safety of self/ others; consistent irresponsibility; lack of remorse  > 18 years  Evidence of conduct disorder < 15 years
  • 192 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Personality Disorders Borderline  Instability of interpersonal relationships, self-image, affects; marked impulsivity  > 5  Frantic efforts to avoid real or imagined abandonment; unstable and intense interpersonal relationships, alternat between extremes of idealization and devaluation; identit disturbance; impulsivity in 2 areas; recurrent suicidal/ self mutilating behavior; affective instability due to marked reactivity of mood; chronic feelings of emptiness; inappropriate, intense anger; transient, stress related paranoid ideation, severe dissociative symptoms
  • 193 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Personality Disorders Histrionic  Excessive emotionality and attention seeking  > 5 • Uncomfortable when not center of attention; interaction with others characterized by inappropriate sexual behavior; rapidly shifting and shallow expression of emotions; uses physical appearance to draw attention to self; speech style, excessively impressionistic and lacking in detail; self-dramatization, theatricality; suggestible; considers relationships more intimate than are
  • 194 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved.
  • 195 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Personality Disorders Narcissistic  Grandiosity (fantasy or behavior), need for admiration, lack of empathy  > 5 • grandiose sense of self-importance, preoccupied with fantasies of unlimited success, etc; believes is special/ unique; requires excessive admiration; sense of entitlement; interpersonally exploitative; lacks empathy; envious of others; arrogant
  • 196 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Bernard "Hap" Kliban
  • 197 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Personality Disorder Avoidant  Social inhibition, feelings of inadequacy, hypersensitivity to negative evaluation  > 4 • Avoids occupational activities that require interpersonal contact, fear of criticism, disapproval, rejection; unwilling to get involved with others unless certain liked; restraint in intimate relationships, fear of being shamed/ ridiculed; preoccupied with being criticized or rejected in social situations; inhibited in new interpersonal situations due to feelings of inadequacy; views self as socially inept/ personally unappealing/ inferior to others; unusually reluctant to take risks/ engage in new activities
  • 198 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Personality Disorder Dependent  Excessive need to be taken care of, submissive and clinging behavior and fears of separation  > 5 • Difficulty making everyday decisions, needs excessive advice and reassurance from others; needs others to assume responsibility in most areas of life; difficulty expressing disagreement with others due to fear of loss of support; difficulty initiating projects or doing things on own, lack of self confidence; excessive lengths to obtain nurturance and support from others; uncomfortable/ helpless when alone, fears of being unable to care for self; urgently seeks another relationships as soon as one ends; unrealistically preoccupied with fears of being left to care for self
  • 199 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Personality Disorders Obsessive Compulsive  Preoccupation with orderliness, perfectionism, mental/ interpersonal control; at expense of flexibility, openness, efficiency  > 4 • Preoccupied with details, rules, lists, order, organization, schedules that major point of activity lost; perfectionism that interferes with task completion; excessively devoted to work and productivity to exclusion of leisure activities and friendships; overconscientious, scrupulous, inflexible about matters of morality, ethics, values
  • 200 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved.
  • 201 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Changes  None  Alternative approach in Section III
  • 202 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Paraphilic Disorders
  • 203 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Paraphilic Disorders  Exhibitionistic disorder  Fetishistic disorder  Frotteuristic disorder  Pedophilic disorder  Sexual masochism disorder  Sexual sadism disorder  Transvestic disorder  Voyeuristic disorder
  • 204 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Bernard "Hap" Kliban
  • 205 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Paraphilic Disorders  Not exhaustive list • Disorders emphasized common, involve actions that considered criminal because others involved  Paraphilia • Any intense and persistent sexual interest  other than sexual interest, genital stimulation or preparatory fondling with phenotypically normal physically mature, consenting human partners • Necessary but not sufficient for disorder  Paraphilic disorder • Distress or impairment to individual • Satisfaction entails harm or risk of harm to others
  • 206 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Paraphilic Disorders Voyeuristic Disorder  Recurrent and intense sexual arousal from observing unsuspecting person, naked, disrobing, sex, as manifested by fantasies, urges, behaviors, > 6 months  Acted on urges with non-consenting person or urges cause distress  > 18 years  Specifiers • In controlled environment • In full remission
  • 207 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Paraphilic Disorders Exhibitionistic Disorder  Recurrent and intense sexual arousal, exposure of genitals to unsuspected persons as manifested by fantasies, urges, behaviors, > 6 months  Acted on urges with non consenting person or in distress  Specifiers • Sexually aroused by exposing genitals  Prepubertal children; physically mature individuals; prepubertal children and physically mature individuals • In controlled environment/ in full remission
  • 208 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Paraphilic Disorders Frotteuristic Disorder  Recurrent and intense sexual arousal from touching or rubbing against non consenting person as manifested by fantasies, urges, behaviors, > 6 months  Acted on urges with non consenting person or in distress  Specifiers • In controlled environment/ in full remission
  • 209 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Paraphilic Disorder Sexual Masochism Disorder  Recurrent and intense sexual arousal from act of being humiliated, beaten, bound or otherwise made to suffer as manifested by fantasies, urges, behaviors, > 6 months  Cause distress  Specifiers • With asphyxiophilia • In controlled environment/ in full remission
  • 210 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Bernard "Hap" Kliban
  • 211 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Paraphilic Disorders Sexual Sadism Disorder  Recurrent and intense sexual arousal from physical or psychological suffering of another person as manifested by fantasies, urges, behaviors, > 6 months  Acted on urges with non consenting person or in distress  Specifiers • In controlled environment/ in full remission
  • 212 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Paraphilic Disorders Pedophilic Disorder  Recurrent and intense sexual arousing fantasies, sexual urges or behaviors involving sexual activity with a prepubescent child or children (< 13 years), > 6 months  Acted on urges or in distress  > 16 years old and > 5 years old than child • Not include late adolescent in sexual relationship with 12 or 13 year old  Specifiers • Exclusive/ non exclusive • Sexually attracted to  Males, females, both • Limited to incest
  • 213 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Paraphilic Disorders Fetishistic Disorder  Recurrent and intense sexual arousal from either uses of non living objects or highly specific focus on non genital body parts as manifested by fantasies, urges, behaviors, > 6 months  Cause distress  Objects not limited to clothing used for cross dressing or devices specifically designed for purpose of tactile genital stimulation  Specifiers • Body parts, nonliving objects, other • In controlled environment/ in full remission
  • 214 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Bernard "Hap" Kliban
  • 215 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Paraphilic Disorders Transvestic Disorder  Recurrent and intense sexual arousal from cross dressing as manifested by fantasies, urges, behaviors, > 6 months  Cause distress  Specifiers • With fetishism/ autogynephilia • In controlled environment/ in full remission
  • 216 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Bernard "Hap" Kliban
  • 217 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Changes  Emphasize paraphilias vs paraphilic disorders • Paraphilia necessary but not sufficient • Paraphilias - consenting adults not necessarily disorders  No change in basic structure of diagnostic criteria  Transvestic Disorder • no longer just restricted to heterosexual males  Specifiers – controlled environment/ in remission  Disorder • Individual in distress/impaired • Satisfaction causes personal harm or risk of harm to others • Have to meet criteria for A and B
  • 218 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Assessment Measures WHODAS Domains  Understanding and communicating  Getting around  Self Cares  Getting along with people  Life Activities • Household • Work or school  Participation in Society
  • 219 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Conditions for Further Study  Attenuated Psychosis Syndrome  Depressive Episodes with Short Duration Hypomania  Persistent Complex Bereavement Disorder  Caffeine Use Disorder  Internet Gaming Disorder  Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure  Suicidal Behavior Disorder  Nonsuicidal Self-Injury
  • 220 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Conditions for Further Study Attenuated Psychosis Syndrome  > 1, attenuated form, relatively intact reality testing; sufficient severity/ frequency to warrant clinical attention • Delusions, hallucinations, disorganized speech  > 1 symptom/ week for past month  Began or worsened in past year  Distressing/ impairing
  • 221 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Conditions for Further Study  Depressive Episodes with Short-Duration Hypomania  Lifetime experience > 1 major depressive episode  > 2 lifetime episodes of hypomanic periods, involve required criterion symptoms but insufficient duration (> 2 days but < 4 consecutive days) to meet criteria for hypomanic episode  Change in functioning, uncharacteristic  Change observable by others  No marked impairment
  • 222 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Conditions for Further Study Persistent Complex Bereavement Disorder  Experience death of someone, had close relationship with  Since death, > 1 symptom, more days than not, clinically significant degree, > 12 months (adults), > 6 months (children) • Persistent yearning for deceased, intense sorrow and emotional pain in response to death; preoccupied with deceased; preoccupation with circumstances of death  Since death, > 6 symptom, more days than not, clinically significant degree, > 12 months (adults), > 6 months (children) • Reactive distress to death • Social/ identity disruption  Distress/ impairment  Out of proportion  Specifier • With traumatic bereavement
  • 223 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Conditions for Further Study Caffeine Use Disorder  Substance use criteria Internet Gaming Disorder  Persistent and recurrent use of Internet to engage in games, often with others, distress/ impairment, > 5 symptoms, > 12 months • Preoccupation with Internet games • Withdrawal • Tolerance • Unsuccessful control • Loss of other interests • Excessive use despite knowledge of problems • Deceived others about extent of playing • Use to relieve negative mood • Jeopardized or lost relationship due to gaming  Specifier • Severity
  • 224 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved.
  • 225 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved.
  • 226 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Conditions for Further Study Neurobehavioral Disorder associated with Prenatal Alcohol Exposure  More than minimal exposure to alcohol during gestation,  Impaired neurocognitive functioning, > 1 sx  Impaired self-regulation, > 1 sx  Impairment in adaptive functioning, > 2 sx  Onset in childhood  Distress/ Impairment
  • 227 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Conditions for Further Study Suicidal Behavior Disorder  Within last 24 months, made a suicide attempt  Not non suicidal self injury  Not just suicidal ideation or preparation  Not during delirium or confusion  Not for political or religious objective  Specifier • Current (< 12 months since last attempt) • In early remssion (12-24 months since last attempt
  • 228 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Conditions for Further Study Nonsuicidal Self-Injury  In last year, > 5 days, intentional self-inflicted damage to body surface, likely to induce bleeding, bruising, pain  > 1 expectations • Relief from negative feeling or cognitive state • Resolve interpersonal difficulty • Induce positive feeling state  Associated with > 1 • Interpersonal difficulties or negative feelings/ thoughts • Preoccupation with behavior, difficult to control, prior • Frequent thinking about self-injury  Not socially sanctioned  Distress/ impairment
  • 229 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Additional Information www.psychiatry.org/dsm5 www.dsm5.org  Additional assessment measures  Cultural Formulation Interview  Supportive/ additional references  Questions  Insurance/ coding PsychiatryOnline.org  Online subscription  E-book  Modules  Assessment tools
  • 230 Marcus Autism Center is an affiliate of Children’s Healthcare of Atlanta. ©2006 Children’s Healthcare of Atlanta Inc. All rights reserved. Bernard "Hap" Kliban