The following is a listing of some common disorders and and a very brief description of each. The following information is from the DSM IV (The Diagnostic And Statistical Manual of Mental Disorders Fourth Edition).

Eating Disorders

Eating Disorders are characterized by severe disturbances in eating behavior. This section includes two specific diagnoses, Anorexia Nervosa and Bulimia Nervosa. Anorexia Nervosa is characterized by a refusal to maintain a minimally normal body weight. Bulimia Nervosa is characterized by repeated episodes of binge eating followed by inappropriate compensatory behaviors such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise. A disturbance in perception of body shape and weight is an essential feature of both Anorexia Nervosa and Bulimia Nervosa. An Eating Disorder Not Otherwise Specified category is also provided for coding disorders that do not meet criteria for a specific Eating Disorder. Simple obesity is included in the International Classification of Diseases (ICD) as a general medical condition, but does not appear in DSM-IV because it has not been established that it is consistently associated with a psychological or behavioral syndrome. However, when there is evidence that psychological factors are of importance in the etiology or course of a particular case of obesity, this can be indicated by noting the presence of Psychological Factors Affecting Medical Condition.

Diagnostic criteria for Anorexia Nervosa

A. Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to maintenance of body weight less than 85% of that expected; or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected).

B. Intense fear of gaining weight or becoming fat, even though underweight.

C. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.

D. In postmenarcheal females, amenorrhea, i.e., the absence of at least three consecutive menstrual cycles. (A woman is considered to have amenorrhea if her periods occur only following hormone, e.g., estrogen, administration.)

Specify types:

Restricting Type: during the current episode of Anorexia Nervosa, the person has not regularly engaged in binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)

Binge-Eating/Purging Type: during the current episode of Anorexia Nervosa, the person has regularly engaged in binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)

Features of Anorexia

When seriously underweight, many individuals with Anorexia Nervosa manifest depressive symptoms such as depressed mood, social withdrawal, irritability, insomnia, and diminished interest in sex. Such individuals may have symptomatic presentations that meet criteria for Major Depressive Disorder. Because these features are also observed in individuals without Anorexia Nervosa who are undergoing starvation, many of the depressive features may be secondary to the physiological sequelae of semistarvation. Symptoms of mood disturbance must therefore be reassessed after partial or complete weight restoration.

Obsessive-compulsive features, both related and unrelated to food, are often prominent. Most individuals with Anorexia Nervosa are preoccupied with thoughts of food. Some collect recipes or hoard food. Observations of behaviors associated with other forms of starvation suggest that obsessions and compulsions related to food may be caused or exacerbated by undernutrition. When individuals with Anorexia Nervosa exhibit obsessions and compulsions that are not related to food, body shape, or weight, an additional diagnosis of Obsessive-Compulsive Disorder may be warranted.

Other features sometimes associated with Anorexia Nervosa include concerns about eating in public, feelings of ineffectiveness, a strong need to control one's environment, inflexible thinking, limited social spontaneity, and overly restrained initiative and emotional expression.

Bulimia Nervosa

In Bulimia Nervosa, individuals exhibit recurrent episodes of binge eating, engage in inappropriate behavior to avoid weight gain (e.g., self-induced vomiting), and are overly concerned with body shape and weight. However, unlike individuals with Anorexia Nervosa, Binge-Eating/Purging Type, individuals with Bulimia Nervosa are able to maintain body weight at or above a minimally normal level.

Individuals with Bulimia Nervosa typically are within the normal weight range, although some may be slightly underweight or overweight. The disorder occurs but is uncommon among moderately and morbidly obese individuals. There are suggestions that, prior to the onset of the Eating Disorder, individuals with Bulimia Nervosa are more likely to be overweight than their peers. Between binges, individuals with Bulimia Nervosa typically restrict their total caloric consumption and preferentially select low-calorie ("diet") foods while avoiding foods they perceive to be fattening or likely to trigger a binge.

There is an increased frequency of depressive symptoms (e.g., low self-esteem) or Mood Disorders (particularly Dysthymic Disorder and Major Depressive Disorder) in individuals with Bulimia Nervosa. In many or most individuals, the mood disturbance begins at the same time as or following the development of Bulimia Nervosa, and individuals often ascribe their mood disturbances to Bulimia Nervosa. However, in some individuals, the mood disturbance clearly precedes the development of Bulimia Nervosa. There may also be an increased frequency of anxiety symptoms (e.g., fear of social situations) or Anxiety Disorders. These mood and anxiety disturbances frequently remit following effective treatment of Bulimia Nervosa. Substance Abuse or Dependence, particularly involving alcohol and stimulants, occurs in about one-third of individuals with Bulimia Nervosa. Stimulant use often begins in an attempt to control appetite and weight. Probably between one-third and one-half of individuals with Bulimia Nervosa also have personality features that meet criteria for one or more Personality Disorders (most frequently Borderline Personality Disorder).

Preliminary evidence suggests that individuals with Bulimia Nervosa, Purging Type, show more symptoms of depression and greater concern with shape and weight than individuals with Bulimia Nervosa, Nonpurging Type.

MORE INFORMATION AVAILABLE AT:,
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ANXIETY DISORDERS SYNOPSIS

Panic Attack is a discrete period in which there is the sudden onset of intense apprehension, fearfulness, or terror, often associated with feelings of impending doom. During these attacks, symptoms such as shortness of breath, palpitations, chest pain or discomfort, choking or smothering sensations, and fear of "going crazy" or losing control are present.

Agoraphobia is anxiety about, or avoidance of, places or situations from which escape might be difficult (or embarrassing) or in which help may not be available in the event of having a Panic Attack or panic-like symptoms.

Panic Disorder Without Agoraphobia is characterized by recurrent unexpected Panic Attacks about which there is persistent concern. Panic Disorder with Agoraphobia is characterized by both recurrent unexpected Panic Attacks and Agoraphobia.

Agoraphobia Without History of Panic Disorder is characterized by the presence of Agoraphobia and panic-like symptoms without a history of unexpected Panic Attacks.

Specific Phobia is characterized by clinically significant anxiety provoked by exposure to a specific feared object or situation, often leading to avoidance behavior.

Social Phobia is characterized by clinically significant anxiety provoked by exposure to certain types of social or performance situations, often leading to avoidance behavior.

Obsessive-Compulsive Disorder is characterized by obsessions (which cause marked anxiety or distress) and/or by compulsions (which serve to neutralize anxiety).

Frequently there is avoidance of situations that involve the content of the obsessions, such as dirt or contamination. For example, a person with obsessions about dirt may avoid public restrooms or shaking hands with strangers. Hypochondriacal concerns are common, with repeated visits to physicians to seek reassurance. Guilt, a pathological sense of responsibility, and sleep disturbances may be present. There may be excessive use of alcohol or of sedative, hypnotic, or anxiolytic medications. Performing compulsions may become a major life activity, leading to serious marital, occupational, or social disability. Pervasive avoidance may leave an individual housebound.

Posttraumatic Stress Disorder is characterized by the reexperiencing of an extremely traumatic event accompanied by symptoms of increased arousal and by avoidance of stimuli associated with the trauma.

Individuals with Posttraumatic Stress Disorder may describe painful guilt feelings about surviving when others did not survive or about the things they had to do to survive. Phobic avoidance of situations or activities that resemble or symbolize the original trauma may interfere with interpersonal relationships and lead to marital conflict, divorce, or loss of job. The following associated constellation of symptoms may occur and are more commonly seen in association with an interpersonal stressor (e.g., childhood sexual or physical abuse, domestic battering, being taken hostage, incarceration as a prisoner of war or in a concentration camp, torture): impaired affect modulation; self-destructive and impulsive behavior; dissociative symptoms; somatic complaints; feelings of ineffectiveness, shame, despair, or hopelessness; feeling permanently damaged; a loss of previously sustained beliefs; hostility; social withdrawal; feeling constantly threatened; impaired relationships with others; or a change from the individual's previous personality characteristics.Click Here for more on PTSD.

Acute Stress Disorder is characterized by symptoms similar to those of Posttraumatic Stress Disorder that occur immediately in the aftermath of an extremely traumatic event.

Generalized Anxiety Disorder is characterized by at least 6 months of persistent and excessive anxiety and worry.

Anxiety Disorder Due to a General Medical Condition is characterized by prominent symptoms of anxiety that are judged to be a direct physiological consequence of a general medical condition.

Substance-Induced Anxiety Disorder is characterized by prominent symptoms of anxiety that are judged to be a direct physiological consequence of a drug of abuse, a medication, or toxin exposure.

Anxiety Disorder Not Otherwise Specified is included for coding disorders with prominent anxiety or phobic avoidance that do not meet criteria for any of the specific Anxiety Disorders defined in this section (or anxiety symptoms about which there is inadequate or contradictory information).

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Mood Disorders (Depression, Bi-Polar etc.)

Major Depressive Disorder is characterized by one or more Major Depressive Episodes (i.e., at least 2 weeks of depressed mood or loss of interest accompanied by at least four additional symptoms of depression).

Dysthymic Disorder is characterized by at least 2 years of depressed mood for more days than not, accompanied by additional depressive symptoms that do not meet criteria for a Major Depressive Episode. Click Here for more on Dysthymia.

Depressive Disorder Not Otherwise Specified is included for coding disorders with depressive features that do not meet criteria for Major Depressive Disorder, Dysthymic Disorder, Adjustment Disorder With Depressed Mood, or Adjustment Disorder With Mixed Anxiety and Depressed Mood (or depressive symptoms about which there is inadequate or contradictory information).

Bipolar I Disorder is characterized by one or more Manic or Mixed Episodes, usually accompanied by Major Depressive Episodes.

Completed suicide occurs in 10%-15% of individuals with Bipolar I Disorder. Child abuse, spouse abuse, or other violent behavior may occur during severe Manic Episodes or during those with psychotic features. Other associated problems include school truancy, school failure, occupational failure, divorce, or episodic antisocial behavior. Other associated mental disorders include Anorexia Nervosa, Bulimia Nervosa, Attention- Deficit/Hyperactivity Disorder, Panic Disorder, Social Phobia, Substance-Related Disorders.Click Here for more on Bipolar disorder.

Bipolar II Disorder is characterized by one or more Major Depressive Episodes accompanied by at least one Hypomanic Episode.

Cyclothymic Disorder is characterized by at least 2 years of numerous periods of hypomanic symptoms that do not meet criteria for a Manic Episode and numerous periods of depressive symptoms that do not meet criteria for a Major Depressive Episode.

Bipolar Disorder Not Otherwise Specified is included for coding disorders with bipolar features that do not meet criteria for any of the specific Bipolar Disorders defined in this section (or bipolar symptoms about which there is inadequate or contradictory information).

Mood Disorder Due to a General Medical Condition is characterized by a prominent and persistent disturbance in mood that is judged to be a direct physiological consequence of a general medical condition.

Substance-Induced Mood Disorder is characterized by a prominent and persistent disturbance in mood that is judged to be a direct physiological consequence of a drug of abuse, a medication, another somatic treatment for depression, or toxin exposure.

Mood Disorder Not Otherwise Specified is included for coding disorders with mood symptoms that do not meet the criteria for any specific Mood Disorder and in which it is difficult to choose between Depressive Disorder Not Otherwise Specified and Bipolar Disorder Not Otherwise Specified (e.g., acute agitation).

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Dissociative Disorders

The essential feature of the Dissociative Disorders is a disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment. The disturbance may be sudden or gradual, transient or chronic. The following disorders are included in this section:

Dissociative Amnesia is characterized by an inability to recall important personal information, usually of a traumatic or stressful nature, that is too extensive to be explained by ordinary forgetfulness.

Dissociative Fugue is characterized by sudden, unexpected travel away from home or one's customary place of work, accompanied by an inability to recall one's past and confusion about personal identity or the assumption of a new identity.

Dissociative Identity Disorder (formerly Multiple Personality Disorder) is characterized by the presence of two or more distinct identities or personality states that recurrently take control of the individual's behavior accompanied by an inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness. Click Here for More.

Depersonalization Disorder is characterized by a persistent or recurrent feeling of being detached from one's mental processes or body that is accompanied by intact reality testing.

Dissociative Disorder Not Otherwise Specified is included for coding disorders in which the predominant feature is a dissociative symptom, but that do not meet the criteria for any specific Dissociative Disorder.

Dissociative symptoms are also included in the criteria sets for Acute Stress Disorder, Posttraumatic Stress Disorder, and Somatization Disorder. An additional Dissociative Disorder diagnosis is not given if the dissociative symptoms occur exclusively during the course of one of these disorders. In some classifications, conversion reaction is considered to be a dissociative phenomenon; however, in DSM-IV, Conversion Disorder is placed in the "Somatoform disorders" section to emphasize the importance of considering neurological or other general medical conditions in the differential diagnosis.

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Personality Disorders

Paranoid Personality Disorder is a pattern of distrust and suspiciousness such that others' motives are interpreted as malevolent.

Associated Features and Disorders

Individuals with Paranoid Personality Disorder are generally difficult to get along with and often have problems with close relationships. Their excessive suspiciousness and hostility may be expressed in overt argumentativeness, in recurrent complaining, or by quiet, apparently hostile aloofness. Because they are hypervigilant for potential threats, they may act in a guarded, secretive, or devious manner and appear to be "cold" and lacking in tender feelings. Although they may appear to be objective, rational, and unemotional, they more often display a labile range of affect, with hostile, stubborn, and sarcastic expressions predominating. Their combative and suspicious nature may elicit a hostile response in others, which then serves to confirm their original expectations.

Because individuals with Paranoid Personality Disorder lack trust in others, they have an excessive need to be self-sufficient and a strong sense of autonomy. They also need to have a high degree of control over those around them. They are often rigid, critical of others, and unable to collaborate, although they have great difficulty accepting criticism themselves. They may blame others for their own shortcomings.

Because of their quickness to counterattack in response to the threats they perceive around them, they may be litigious and frequently become involved in legal disputes. Individuals with this disorder seek to confirm their preconceived negative notions regarding people or situations they encounter, attributing malevolent motivations to others that are projections of their own fears. They may exhibit thinly hidden, unrealistic grandiose fantasies, are often attuned to issues of power and rank, and tend to develop negative stereotypes of others, particularly those from population groups distinct from their own. Attracted by simplistic formulations of the world, they are often wary of ambiguous situations. They may be perceived as "fanatics" and form tightly knit "cults" or groups with others who share their paranoid belief systems.

Schizoid Personality Disorder is a pattern of detachment from social relationships and a restricted range of emotional expression.

Schizotypal Personality Disorder is a pattern of acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behavior.

Antisocial Personality Disorder - Formerly known as psychpaths is a pattern of disregard for, and violation of, the rights of others.

Individuals with Antisocial Personality Disorder frequently lack empathy and tend to be callous, cynical, and contemptuous of the feelings, rights, and sufferings of others. They may have an inflated and arrogant self-appraisal (e.g., feel that ordinary work is beneath them or lack a realistic concern about their current problems or their future) and may be excessively opinionated, self-assured, or cocky. They may display a glib, superficial charm and can be quite voluble and verbally facile (e.g., using technical terms or jargon that might impress someone who is unfamiliar with the topic). Lack of empathy, inflated self-appraisal, and superficial charm are features that have been commonly included in traditional conceptions of psychopathy and may be particularly distinguishing of Antisocial Personality Disorder in prison or forensic settings where criminal, delinquent, or aggressive acts are likely to be nonspecific. These individuals may also be irresponsible and exploitative in their sexual relationships. They may have a history of many sexual partners and may never have sustained a monogamous relationship. They may be irresponsible as parents, as evidenced by malnutrition of a child, an illness in the child resulting from a lack of minimal hygiene, a child's dependence on neighbors or nonresident relatives for food or shelter, a failure to arrange for a caretaker for a young child when the individual is away from home, or repeated squandering of money required for household necessities. These individuals may receive dishonorable discharges from the armed services, may fail to be self-supporting, may become impoverished or even homeless, or may spend many years in penal institutions. Individuals with Antisocial Personality Disorder are more likely than people in the general population to die prematurely by violent means (e.g., suicide, accidents, and homicides). Individuals with this disorder may also experience dysphoria, including complaints of tension, inability to tolerate boredom, and depressed mood. They may have associated Anxiety Disorders, Depressive Disorders, Substance-Related Disorders, Somatization Disorder, Pathological Gambling, and other disorders of impulse control.

Borderline Personality Disorder is a pattern of instability in interpersonal relationships, self-image, and affects, and marked impulsivity.

Individuals with Borderline Personality Disorder may have a pattern of undermining themselves at the moment a goal is about to be realized (e.g., dropping out of school just before graduation; regressing severely after a discussion of how well therapy is going; destroying a good relationship just when it is clear that the relationship could last). Some individuals develop psychotic-like symptoms (e.g., hallucinations, body-image distortions, ideas of reference, and hypnagogic phenomena) during times of stress. Individuals with this disorder may feel more secure with transitional objects (i.e., a pet or inanimate possession) than in interpersonal relationships. Premature death from suicide may occur in individuals with this disorder, especially in those with co-occurring Mood Disorders or Substance-Related Disorders. Physical handicaps may result from self-inflicted abuse behaviors or failed suicide attempts. Recurrent job losses, interrupted education, and broken marriages are common. Physical and sexual abuse, neglect, hostile conflict, and early parental loss or separation are more common in the childhood histories of those with Borderline Personality Disorder. Common co- occurring Axis I disorders include Mood Disorders, Substance-Related Disorders, Eating Disorders (notably Bulimia), Posttraumatic Stress Disorder, and Attention- Deficit/Hyperactivity Disorder. Borderline Personality Disorder also frequently co- occurs with the other Personality Disorders.

Histrionic Personality Disorder is a pattern of excessive emotionality and attention seeking.

Narcissistic Personality Disorder is a pattern of grandiosity, need for admiration, and lack of empathy.

Avoidant Personality Disorder is a pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation.

Dependent Personality Disorder is a pattern of submissive and clinging behavior related to an excessive need to be taken care of.

Obsessive-Compulsive Personality Disorder is a pattern of preoccupation with orderliness, perfectionism, and control.

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Schizophrenia

Schizophrenia is warranted only if prominent delusions or hallucinations are present for at least a month. The characteristic symptoms of Schizophrenia involve a range of cognitive and emotional dysfunctions that include perception, inferential thinking, language and communication, behavioral monitoring, affect, fluency and productivity of thought and speech, hedonic capacity, volition and drive, and attention. The diagnosis involves the recognition of a constellation of signs and symptoms associated with impaired occupational or social functioning.

Schizophrenia is a disturbance that lasts for at least 6 months and includes at least 1 month of active-phase symptoms (i.e., two [or more] of the following: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms). Definitions for the Schizophrenia subtypes (Paranoid, Disorganized, Catatonic, Undifferentiated, and Residual) are also included in this section.

The individual with Schizophrenia may display inappropriate affect (e.g., smiling, laughing, or a silly facial expression in the absence of an appropriate stimulus), which is one of the defining features of the Disorganized Type. Anhedonia (mild depression) is common and is manifested by a loss of interest or pleasure. Dysphoric mood may take the form of depression, anxiety, or anger. There may be disturbances in sleep pattern (e.g., sleeping during the day and nighttime activity or restlessness). The individual may show a lack of interest in eating or may refuse food as a consequence of delusional beliefs. Often there are abnormalities of psychomotor activity (e.g., pacing, rocking, or apathetic immobility). Difficulty concentrating is frequently evident and may reflect problems with focusing attention or distractibility due to preoccupation with internal stimuli.

Although basic intellectual functions are classically considered to be intact in Schizophrenia, some indications of cognitive dysfunction are often present. The individual may be confused or disoriented or may have memory impairment during a period of exacerbation of active symptoms or in the presence of very severe negative symptoms. Lack of insight is common and may be one of the best predictors of poor outcome, perhaps because it predisposes the individual to noncompliance with treatment. Depersonalization, derealization, and somatic concerns may occur and sometimes reach delusional proportions. Motor abnormalities (e.g., grimacing, posturing, odd mannerisms, ritualistic or stereotyped behavior) are sometimes present. The life expectancy of individuals with Schizophrenia is shorter than that of the general population for a variety of reasons.

Suicide is an important factor, because approximately 10% of individuals with Schizophrenia commit suicide. Risk factors for suicide include being male, age under 30 years, depressive symptoms, unemployment, and recent hospital discharge. There is conflicting evidence with regard to whether the frequency of violent acts is greater than in the general population.

Schizophreniform Disorder is characterized by a symptomatic presentation that is equivalent to Schizophrenia except for its duration (i.e., the disturbance lasts from 1 to 6 months) and the absence of a requirement that there be a decline in functioning.

Schizoaffective Disorder is a disturbance in which a mood episode and the active-phase symptoms of Schizophrenia occur together and were preceded or are followed by at least 2 weeks of delusions or hallucinations without prominent mood symptoms.

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Other Psychotic Disorders

The term psychotic has historically received a number of different definitions, none of which has achieved universal acceptance. The narrowest definition of psychotic is restricted to delusions or prominent hallucinations, with the hallucinations occurring in the absence of insight into their pathological nature. A slightly less restrictive definition would also include prominent hallucinations that the individual realizes are hallucinatory experiences. Broader still is a definition that also includes other symptoms of Schizophrenia (i.e., disorganized speech, grossly disorganized or catatonic behavior).

Delusional Disorder is characterized by at least 1 month of nonbizarre delusions without other active-phase symptoms of Schizophrenia.

Brief Psychotic Disorder is a psychotic disturbance that lasts more than 1 day and remits by 1 month.

Shared Psychotic Disorder is a disturbance that develops in an individual who is influenced by someone else who has an established delusion with similar content.

Diagnostic Features

The essential feature of Shared Psychotic Disorder is a delusion that develops in someone who is involved in a close relationship with another person who already has a Psychotic Disorder. The individual comes to share the delusional beliefs of the other person in whole or in part. Schizophrenia is the most common diagnosis of the other person, although other diagnoses may include Delusional Disorder or Mood Disorder With Psychotic Features. The content of the shared delusional beliefs can include relatively bizarre delusions (e.g., that radiation is being transmitted into an apartment from a hostile foreign power, causing indigestion and diarrhea), mood-congruent delusions (e.g., that the primary case will soon receive a film contract for $2 million, allowing the family to purchase a much larger home with a swimming pool), or the nonbizarre delusions that are characteristic of Delusional Disorder (e.g., the FBI is tapping the family telephone and trailing family members when they go out). Usually the other person in Shared Psychotic Disorder is dominant in the relationship and gradually imposes the delusional system on the more passive and initially healthy second person. Individuals who come to share delusional beliefs are often related by blood or marriage and have lived together for a long time, sometimes in relative social isolation. If the relationship with the primary case is stopped, the delusional beliefs of the other individual usually diminish or disappear. Although most commonly seen in relationships of only two people, Shared Psychotic Disorder can occur among a larger number of individuals, especially in family situations in which the parent is the primary case and the children, sometimes to varying degrees, adopt the parent's delusional beliefs.

In Psychotic Disorder Due to a General Medical Condition, the psychotic symptoms are judged to be a direct physiological consequence of a general medical condition.

In Substance-Induced Psychotic Disorder, the psychotic symptoms are judged to be a direct physiological consequence of a drug of abuse, a medication, or toxin exposure.

Psychotic Disorder Not Otherwise Specified is included for classifying psychotic presentations that do not meet the criteria for any of the specific Psychotic Disorders defined in this section or psychotic symptomatology about which there is inadequate or contradictory information.

Impulse Control Disorders

The essential feature of Impulse-Control Disorders is the failure to resist an impulse, drive, or temptation to perform an act that is harmful to the person or to others. For most of the disorders in this section, the individual feels an increasing sense of tension or arousal before committing the act and then experiences pleasure, gratification, or relief at the time of committing the act. Following the act there may or may not be regret, self-reproach, or guilt. The following disorders are included in this section:

Intermittent Explosive Disorder is characterized by discrete episodes of failure to resist aggressive impulses resulting in serious assaults or destruction of property.

The essential feature of Intermittent Explosive Disorder is the occurrence of discrete episodes of failure to resist aggressive impulses that result in serious assaultive acts or destruction of property. The degree of aggressiveness expressed during an episode is grossly out of proportion to any provocation or precipitating psychosocial stressor. The aggressive episodes are not due to the direct physiological effects of a substance or a general medical condition (e.g., head trauma, Alzheimer's disease. The individual may describe the aggressive episodes as "spells" or "attacks" in which the explosive behavior is preceded by a sense of tension or arousal and is followed immediately by a sense of relief. Later the individual may feel upset, remorseful, regretful, or embarrassed about the aggressive behavior.

Kleptomania is characterized by the recurrent failure to resist impulses to steal objects not needed for personal use or monetary value.

Pyromania is characterized by a pattern of fire setting for pleasure, gratification, or relief of tension.

Pathological Gambling is characterized by recurrent and persistent maladaptive gambling behavior.

Trichotillomania is characterized by recurrent pulling out of one's hair for pleasure, gratification, or relief of tension that results in noticeable hair loss.

The essential feature of Trichotillomania is the recurrent pulling out of one's own hair that results in noticeable hair loss. Sites of hair pulling may include any region of the body in which hair may grow (including axillary, pubic, and perirectal regions), with the most common sites being the scalp, eyebrows, and eyelashes. Hair pulling may occur in brief episodes scattered throughout the day or in less frequent but more sustained periods that can continue for hours. Stressful circumstances frequently increase hair-pulling behavior, but increased hair pulling also occurs in states of relaxation and distraction (e.g., when reading a book or watching television). An increasing sense of tension is present immediately before pulling out the hair. For some, tension does not necessarily precede the act but is associated with attempts to resist the urge. There is gratification, pleasure, or a sense of relief when pulling out the hair. Some individuals experience an "itchlike" sensation in the scalp that is eased by the act of pulling hair.

Impulse-Control Disorder Not Otherwise Specified is included for coding disorders of impulse control that do not meet the criteria for any of the specific Impulse-Control Disorders described above or in other sections of the manual.

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Sleep Disorders

Diagnostic Features

The essential feature of Primary Insomnia is a complaint of difficulty initiating or maintaining sleep or of sleep that isn't restful, that lasts for at least 1 month and causes distress or impairment in social, occupational, or other important areas of functioning.

Individuals with Insomnia most often report both difficulty falling asleep and intermittent wakefulness during sleep. Less commonly, these individuals may complain only of nonrestful sleep, feeling that their sleep was restless, light, or of poor quality. A preoccupation with sleep, and distress due to the inability to sleep, may create a vicious cycle: the more the individual tries to sleep, the more frustrated and distressed the individual becomes and the less he or she is able to sleep. Lying in a bed in which the individual has frequently spent sleepless nights may cause frustration and conditioned arousal. The individual may fall asleep more easily when not trying to do so (e.g., while watching television, reading, or riding in a car). Some individuals report that they sleep better away from their own bedrooms and their usual routines. Chronic insomnia may lead to decreased feelings of well-being during the day (e.g., deterioration of mood and motivation; decreased attention, energy, and concentration; and an increase in fatigue and malaise).

Sleep Disorder Related to Another Mental Disorder involves a prominent complaint of sleep disturbance that results from a diagnosable mental disorder (often a Mood Disorder or Anxiety Disorder) but that is sufficiently severe to warrant independent clinical attention. Presumably, the pathophysiological mechanisms responsible for the mental disorder also affect sleep-wake regulation.

Sleep Terrors The essential feature of Sleep Terror Disorder is the repeated occurrence of sleep terrors, that is, abrupt, awakening usually accompanied by screaming, crying or jerking movements such as lunging forward. They are accompanied by intense fear. The individual generally does not recall much of the dream and is often difficult to console. They may experience tachycardia, rapid breathing, sweating and pupil dialation. To be a disorder, the individual must experience significant impairment in social, occupational or social functioning as a result of the symptoms.

Nightmare Disorder

The essential feature of Nightmare Disorder is repeated occurrences of frightening dreams that lead to awakenings from sleep. The nightmares usually occur in a lengthy, elaborate dream sequence that is highly anxiety provoking. They may occur after the individual experiences a traumatic life event. To be a disorder, the individual must experience significant impairment in social, occupational or social functioning as a result of the symptoms.

Sleep Walking DisorderThe essential feature of Sleepwalking Disorder is repeated episodes of rising from bed and walking about. It generally occurs during the first third of the sleeping period. The person may stare blankly, and may be unresponsive to communications from others. Upon awakening, the individual generally has little knowledge of the event. To be a disorder, the individual must experience significant impairment in social, occupational or social functioning as a result of the symptoms.

Narcolepsy

The essential features of Narcolepsy are repeated irresistible attacks of refreshing sleep. The "nap" or sleep attack, temporarily relieves the individuals desire for sleep but it generally returns within a few hours. The attacks must occur daily over a period of three months or more.

InsomniaThe essential features of Insomnia are difficulty initiating or maintaining sleep. Or, they may sleep without feeling rested afterwards, for at least a month. To be a disorder, the individual must experience significant impairment in social, occupational or social functioning as a result of the symptoms.

HypersomniaThe essential feature of Hypersomnia is excessive sleepiness for at least 1 month. This may manifest in the individual experiencing prolonged sleep episodes, or they may have daytime sleep episodes almost daily. To be a disorder, the individual must experience significant impairment in social, occupational or social functioning as a result of the symptoms.

Sleep Disorder Due to a General Medical Condition involves a prominent complaint of sleep disturbance that results from the direct physiological effects of a general medical condition on the sleep-wake system.

Substance-Induced Sleep Disorder involves prominent complaints of sleep disturbance that result from the concurrent use, or recent discontinuation of use, of a substance (including medications).

SOMATOFORM DISORDERS

The common feature of the Somatoform Disorders is the presence of physical symptoms that suggest a general medical and are not fully explained by a general medical condition. The physical symptoms are not intentional (i.e., under voluntary control). Somatoform Disorders differ from Psychological Factors Affecting Medical Condition in that there is no diagnosable general medical condition to fully account for the physical symptoms. These disorders are often encountered in general medical settings.

Somatization Disorder (historically referred to as hysteria) is a poly-symptomatic disorder that begins before age 30, extends over a period of years, and is characterized by a combination of pain, gastrointestinal, sexual, and pseudo-neurological symptoms.

There also must be a history of at least two gastrointestinal symptoms other than pain. Most individuals with the disorder describe the presence of nausea and abdominal bloating. Vomiting, diarrhea, and food intolerance are less common. Gastrointestinal complaints often lead to frequent X-ray examinations and can result in abdominal surgery that in retrospect was unnecessary. There must be a history of at least one sexual or reproductive symptom other than pain. In women, this may consist of irregular menses, menorrhagia, or vomiting throughout pregnancy. In men, there may be symptoms such as erectile or ejaculatory dysfunction. Both women and men may be subject to sexual indifference. Finally, there must also be a history of at least one symptom, other than pain, that suggests a neurological condition (conversion symptoms such as impaired coordination or balance, paralysis or localized weakness, difficulty swallowing or lump in throat, aphonia, urinary retention, hallucinations, loss of touch or pain sensation, double vision, blindness, deafness, or seizures; dissociative symptoms such as amnesia; or loss of consciousness other than fainting. The symptoms in each of the groups have been listed in the approximate order of their reported frequency. Finally, the unexplained symptoms in Somatization Disorder are not intentionally feigned or produced.

Somatoform Disorder is characterized by unexplained physical complaints, lasting at least 6 months, that are of less severity than are seen with Somatization Disorder. this is a very common outlet for stress. For instance, one might become nausiated prior to speaking in public, or while studying for a final exam, one might have diarehea for a time. It is rather common for people to turn their unexpressed feelings of stress, fear and anxiety into physical symptoms. Research is beggining to put together the link between physical illnes and unexpressed emotions.

Conversion Disorder involves unexplained symptoms or deficits affecting voluntary motor or sensory function that suggest a neurological or other general medical condition, (i.e. stress related blindness, or paralysis of a limb). Psychological factors are judged to be associated with the symptoms or deficits.

Years ago when people suffered from paralysis of a limb with no medical explanation, or were blind although their eyes were normal, they were labeled as being hysterical. It is now understood that extreme stress, anxiety or fear can contribute to a conversion disorder. The stress or fear is "converted" to a part of the body, often a part of the body that when disabled will render the client unable to perform the activities that had brought on the original stress. Such cases prove that the mind/body connection is very strong, and that our minds can create ingenious, subconcious ways of surviving psychological pain.

Pain Disorder is characterized by pain as the predominant focus of clinical attention. In addition, psychological factors are judged to have an important role in its onset, severity, exacerbation, or maintenance.

Hypochondriasis is the preoccupation with the fear of having, or the idea that one has, a serious disease based on the person's misinterpretation of bodily symptoms or bodily functions.

The term Hypochondria is often missused to label people who are always ill or seem to have one complaint after another. Hypochondia is actually the constant fear that one has a serious disease or illness such as cancer. Often these people will hear about the symptoms of a disease and begin to believe they have the illness. A mild headache will be feared to be a brain tumor. A pain in a joint will be interpreted as a rare, crippling arthritis. Someone who is always ill or in pain may actually have a somatiform disorder (see above for interpretation) rather than hypochondriasis. Or a person who is never truly ill but feigns illness may be diagnosed with melingering or a facticious disorder rather than with hypochondriasis.

Body Dysmorphic Disorder is the preoccupation with an imagined or exaggerated defect in physical appearance.

The essential feature of Body Dysmorphic Disorder is a preoccupation with a defect in one's body. The defect is either imagined, or, if a slight physical anomaly is present, the individual's concern is markedly excessive. The preoccupation must cause significant distress or impairment in social, occupational, or other important areas of functioning. The preoccupation is not better accounted for by another mental disorder (e.g., dissatisfaction with body shape and size in Anorexia Nervosa).

Complaints commonly involve imagined or slight flaws of the face or head such as hair thinning, acne, wrinkles, scars, vascular markings, paleness or redness of the complexion, swelling, facial asymmetry or disproportion, or excessive facial hair. Other common preoccupations include the shape, size, or some other aspect of the nose, eyes, eyelids, eyebrows, ears, mouth, lips, teeth, jaw,chin, cheeks, or head. However, any other body part may be the focus of concern (e.g., the genitals, breasts, buttocks, abdomen, arms, hands, feet, legs, hips, shoulders, spine, larger body regions, or overall body size). The preoccupation may simultaneously focus on several body parts. Although the complaint is often specific (e.g., a "crooked" lip or a "bumpy" nose), it is sometimes vague (e.g., a "falling" face or "inadequately firm" eyes). Because of embarrassment over their concerns, some individuals with Body Dysmorphic Disorder avoid describing their "defects" in detail and may instead refer only to their general ugliness.

Most individuals with this disorder experience marked distress over their supposed deformity, often describing their preoccupations as "intensely painful," "tormenting," or "devastating." Most find their preoccupations difficult to control, and they may make little or no attempt to resist them. As a result, they often spend hours a day thinking about their "defect," to the point where these thoughts may dominate their lives. Significant impairment in many areas of functioning generally occurs. Feelings of self-consciousness about their "defect" may lead to avoidance of work or public situations

Somatoform Disorder Not Otherwise Specified is included for coding disorders with somatoform symptoms that do not meet the criteria for any of the specific Somatoform Disorders.