A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by at least one of the following:

1) "Role": Recurrent failure to fulfill major role obligations at work, school, or home.

2) "Risk": Recurrent use in situations in which use is physically hazardous.

3) "Run-ins": Recurrent substance-related legal problems.

4) "Relationships": Continued use despite persistent interpersonal problems caused or exacerbated by use.

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

1) Tolerance, as defined by either:

       a) A need for markedly increased amts to

           achieve desired effect

       b) Markedly diminished effect with continued

           use of the same amt

2) Withdrawal, as manifested by either: 

       a) The characteristic withdrawal syndrome

           for the substance

       b) The same (or closely related) substance

           is taken to relieve or avoid withdrawal sx

3) The substance is taken in larger amts or over a longer period than intended.

4) Use continues despite a persistent desire or repeated efforts to cut down or control use.

5) A great deal of time is spent obtaining or using the substance or recovering from its effects

6) Important social, occupational, or recreational activities are reduced or given up b/c of use.

7) Use is continued despite knowledge of a persistent physical or psychological problem caused or exacerbated by the substance.

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1 & 2 - physiologic dependence

3 & 4 - loss of control

5 & 6 - use becomes a central focus of life

7        - use despite health consequences

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Specifiers:

     with or without physiological dependence

     in a controlled environment

     early full remission

     early partial remission

     sustained full remission

     sustained partial remission

early:         > 1 mo. but < 12 mo.

sustained:  > 12 mo.

full:           has met no criteria during that time

partial:      has met at least 1 criteria for abuse

                or dependence, but not full criteria for

                dependence

Alcohol withdrawal

A) Cessation in, or reduction of, alcohol use that has been heavy and prolonged.

B) At least two of the following developing in several hours to a few days after change in use:

     1. autonomic hyperactivity (sweating, HR, BP)

     2. hand tremor

     3. insomnia

     4. nausea and/or vomiting

     5. transient visual, tactile, or auditory

         hallucinations or illusions 

     6. psychomotor agitation

     7. anxiety

     8. tonic-clonic seizures

C) The sx cause clinically significant distress or impairment in functioning

specifier: with or without perceptual disturbance

A) At least five of the following sx are present for the same 2-week period; sx must incl. at least one of the first two; sx must represent a change from previous function:

     1) Depressed mood, subjectively reported

        (feels sad or empty), or observed (tearful).

     2) Markedly diminished Interest in nearly all

         activities; markedly diminished pleasure 

         derived from activities.

     3) Feelings of excessive or inappropriate 

         Guilt or worthlessness. (Guilt is not

         merely about being sick).

     4) Sleep changes, either insomnia or

         hypersomnia.

     5) Psychomotor agitation or retardation

         observable by others.

     6) Changes in Appetite, either increased or

         decreased, or unintended changes in

         weight.

     7) Diminished Concentration, or

           indecisiveness.

     8) Decreased Energy, fatigue.

     9) Recurrent Suicidal ideation, or recurrent

         thoughts of death, or any suicide plan or

         attempt.

"DIG SPACES"

#1, 2, & 3 occur every day for most of the day.

#4, 5, 6, 7, & 8 occur every day

In children, #1 can be an irritable mood, and #6 can be failure to gain weight rather than weight loss.

B) The sx cause clinically significant distress or impairment in important areas of functioning.

C) The sx are not better accounted for by bereavement. In order to qualify as a depressive episode, bereavement sx must persist longer than 2 mo., cause marked functional impairment, or involve psychomotor retardation, morbid preocupation with worthlessness, psychotic sx, or suicidal ideation.

A) A distinct period of either abnormally & persistently:

      1) Elevated or  expansive mood    OR

       2) Irritable mood,

lasting at least one week (or any duration if hospitalizationis necessary).

B) If the mood is euphoric, at least three of the following sx are also present. If the mood is irritable, at least four are present:

     1) Distractibility

      2) Decreased need for sleep ("Insomnia")

     3) Grandiosity, inflated self-esteem

     4) Flight of ideas, or racing thoughts

     5) Increase in goal-directed Activity or

         psychomotor agitation

     6) Speech is pressured or increased in amt

     7) Excessive involvement in pleasurable

        activities w/o regard for risks & negative

        consequences ("Thoughtless behavior")

"DIG FAST"

C) The mood disturbance causes marked impairment in important areas of functioning, OR poses significant risk of harm to self or others (requiring hospitalization) OR involves psychotic features.

A) All the criteria for BOTH a manic episode and a major depressive episode are met nearly every day during at least a one week period.

B) The mood disturbance causes marked impairment in important areas of functioning, OR poses significant risk of harm to self or others (requiring hospitalization) OR involves psychotic features.

A) A distinct period of either abnormally & persistently:

      1) Elevated or  expansive mood    OR

       2) Irritable mood,

lasting at least four days that is clearly different from the usual non-depressed mood.

B) If the mood is euphoric, at least three of the following sx are also present. If the mood is irritable, at least four are present:

     1) Distractibility

      2) Decreased need for sleep ("Insomnia")

     3) Grandiosity, inflated self-esteem

     4) Flight of ideas, or racing thoughts

     5) Increase in goal-directed Activity or

         psychomotor agitation

     6) Speech is pressured or increased in amt

     7) Excessive involvement in pleasurable

        activities w/o regard for risks & negative

        consequences ("Thoughtless behavior")

"DIG FAST"

C) There is an unequivocal change in functioning that is uncharacteristic of the person.

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

E) The mood disturbance does NOT cause marked impairment in important areas of functioning, does NOT pose significant risk of harm to self or others (requiring hospitalization), and does NOT involves psychotic features.

A) Presence of at least one major depressive episode.

B) There has never been a (primary) manic, mixed, or hypomanic episode.

(Manic, mixed, or hypomanic episodes may have occured if they were substance-induced or due to a general medical condition)

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Modifiers:

Mild / Moderate / Severe

With or without psychotic features

Chronic

With catatonic features

With melancholic features

With atypical features

With postpartum onset

Recurrent

Chronic: full criteria met continuously for at least 2 years.

Recurrent: there have been at least two separate episodes with at least two months in between.

the specifier "with catatonic features" can be applied to a mood episode if the clinical picture is dominated by at least two of the following:

     1) Motoric immobility as evidenced by

         catalepsy (incl. waxy flexibility) or stupor.

     2) Excessive motor activy that is apparently

         purposeless & not influenced by external

         stimuli

     3) Mutism or extreme negativism - an

        apparently motiveless resistance to all

        instructions, or maintenance of rigid posture

        against attempts to be moved

     4) Posturing, stereotyped movements,

         prominent mannerisms, or prominent

         grimacing

     5) Echolalia or echopraxia

The modifier "with atypical features" can be applied to a depressive episode if the following features predominate during the most recent two weeks for a major depressive episode, or two years for dysthymia:

A) Mood reactivity: mood brightens in response to positive events

B) At least two of the following features are present:

     1) Significant weight gain or increase in

        appetite

     2) Hypersomnia

     3) Leaden paralysis - heavy feeling in

         extremities

     4) Long-standing pattern of sensitivity to

        interpersonal rejection that results in

        significant impairment (sensitivity is not

        limited to episodes of mood disturbance).

The specifier "with melancholic features" can be applied when the following features predominate during the worst period of the disturbance:

A) Either of the following:

     1) Loss of pleasure in all, or almost all

         activities

     2) Lack of reactivity to usually pleasurable

        stimuli; mood does not improve, even

        temporarily, in response to positive events

B) At least three of the following:

     1) The quality of the depressed mood is

         distinct from the mood felt at times of

         normal sadness (e.g. during bereavement).

     2) Depression regularly worse in the morning.

     3) Early morning awakening (at least 2 hrs

         earlier than usual).

     4) Marked psychomotor retardation or

        agitation.

     5) Significant weight loss or marked decrease

        in appetite.

     6) Excessive or inappropriate guilt.

A) Depressed mood for most of the day, for more days than not, for at least two years.

B) Presence while depressed of at least two of the following:

     1) Poor appetite or overeating

     2) Insomnia or hypersomnia

     3) Low energy or fatigue

     4) Low self-esteem

     5) Poor concentration or difficulty making

         decisions

     6) Feelings of hopelessness

C) During the two-year period, there have never been more than two months without symptoms.

D) The symptoms cause clinically significant distress or impairment in important areas of functioning.

Note: In children, mood can be irritable, and duration need only be one year rather than two.

A) Presence or history of at least one (primary) manic or mixed episode

Usually, there will also be history or presence of a major depressive episode, but this is not required.

There can also be history or presence of hypomanic episodes, but this is not required.

B) Mood symptoms do not occur exclusively during times when psychosis is present (which would be schizoaffective disorder)

A) Presence or history of at least one major depressive episode

B) Presence or history of al least one hypomanic episode

C) There has never been a manic or mixed episode.

D) The symptoms cause clinically significant distress or impairment in important areas of functioning.

A) For at least two years there are numerous periods with hypomanic sx and numerous periods with depressive sx

B) Sx have not met full criteria for either a major depressive episode nor for a manic episode

C) During the two year period there have been no sx-free periods lasting more than two months

D) The sx cause clinically significant distress or impairment in important areas of functioning.

Note: In children, the duration need only be one year rather than two.