1. •Failure to conform with respect to lawful behavior
2. •Deceitfulness
3. •Impulsivity
4. •Aggressiveness
5. •Disregard for safety of self and others
6. •Irresponsibility
7. •Lack of remorse
8. •Cannot be diagnosed before age 18

• Excessive emotionality and attention-seeking

• Needs to be the center of attention

• Sexually provocative

• Personality Disorders

• Very suggestible

• Rapidly shifting emotions

• Rarely given diagnosis

• Pervasive pattern of instability in relationships, self-image and affect
• Frantic efforts to avoid real of imagined abandonment
• Unstable relationships, self-image and emotions
• Identity disturbance
• Personality Disorders
• Impulsivity
• Suicidal threats, gestures , Affective instability, Chronic feelings of emptiness
• Intense, inappropriate anger
• Transient paranoia or dissociation
• Personality Disorders
• Much more commonly diagnosed in girls/women
• Must diagnose with caution in adolescents, as some level of these symptoms is developmentally appropriate

• Grandiosity, need for admiration, lack of empathy
• Exaggerated sense of self
• Requires excessive admiration
• Lack of empathy
• Arrogant, haughty

• Pervasive distrust and suspiciousness
• Feels others are exploiting him or her
• Reads hidden meanings in others behavior
• Holds grudges
• Mistrusts sexual partners/spouse
• feeling that others are undermineing you
• reads hidden meaning into benign activities
• bears grudges
• overly sensitive to preseived attacks 

• Very similar (but not exact) criteria to PTSD, but symptoms persist for 3 days to 1 month after the event
• Often becomes PTSD – i.e., persists more than 1 month
• Greater emphsis on dissassociative symptoms.
•  Requires 3 of the following:

 numbness, reduced awarness, depersonalization, amnesia

A) The Development of emotional or behavioral symptoms in responce to an identifable stressor occuring within 3 months of the onset of the stressor.

B) The symptoms are clinically significant , as evidenced by one or both of the following:

1) Marked distress that is out of porportion to the severity or intensity of the stressor.

2) Significant impairment in in social, occupational, and other important areas of functioning.

C) the stress related disturbance does not meet the criteria for another mental disorder and is not merely an exacerbation of pre-existing mental disorder.

D) The symptoms do not meet normal bereavement.

E) The disorder is time-limited, beginning within 3 months of the stressful event, and symptoms lessen within 6 months upon removal of the stressor or when new adaptation occurs.

Problematic pattern of alochol use leading to clinically significant imairment or distress, as manifested by 2 or more criteria within a 12 month period.

1. Taking larger amounts over time than was intended
2. Unsuccessful attempts to cut down
3. Great deal of time spent involved with substance
4. Craving
5. Recurrent use despite failure to meet major obligations
6. Continued use despite social/interpersonal problems
7. Other activities given up due to use
8. Recurrent use in situations that are physically hazardous
9. Continued use despite physical or psychological problems caused by use
10. Tolerance
11. Need for use of increased amounts to achieve desired effect,
12. Diminished effect with use of same amount
13. All substances specified in manual list tolerance
14. Tolerance can occur even when a substance use problem does not

1. Restriction of energy intake leading to significantly low body weight
2. Intense fear of gaining weight
3. Disturbance in body image
4. Specify if:
5. Severity specifiers based on body weight

• Social inhibition,
• feelings of inadequacy,
• hypersensitivity to negative evaluation

1. Avoids occupational activities for fear of evaluation
2. Great difficulty in relationships for fear of rejection
3. Views self as inept
4. Preoccupied with possibility of being criticized
5. Almost indistinguishable from social anxiety disorder
6. Avoids being the center of attention
7. blushes easily
8. is self doubting

Recurrent binge eating

1. Eating, within a 2-hour period, an excessive amount of food
2. Sense of lack of control over eating at these times

Episodes associated with 3 or more of the following:

1. Eating more rapidly
2. Eating until feeling uncomfortable
3. Eating large amounts when not hungry
4. Eating alone due to embarrassment
5. Feeling disgusted with oneself afterward

“Break up for the last time”

“on and off relationship”

“needs” someone,

“lots of fights”,

Cannot “hold it together”

“best friend” “now that they are on speaking terms again”

“can’t stand to be alone” engages in “risky sexual behavior”, binge drinking “only when I am mad”, fells has “anger issues”, “suicidal since teenage years” no one ‘understands me”, “they seem to get me then pull away”

--Recurrent binge eating

§Eating, within a 2-hour period, an excessive amount of food

§Sense of lack of control over eating at these times

Recurrent inappropriate compensatory behavior to prevent weight gain – vomiting, laxatives, fasting, exercise

§ least once a week for 3 months

§Self-evaluation influenced by body shape and weight

§Specify if in full or partial remission

Severity based on number of episodes

One or more symptoms of altered voluntary motor or sensory function

Incompatibility between symptoms and recognized medical conditions

e.g., “glove anesthesia”
-Not better explained by another mental or medical disorder
-Significant distress or impairment in functioning
   

Specify symptom type:
        Weakness or paralysis
       Abnormal movement
       seizures
       Speech symptoms
       Anesthesia or sensory loss
Special sensory symptoms
Mixed symptoms

Conversion disorder is less likely to involve intense concern or fear about symptoms

•Pervasive and excessive need to be taken care of, leading to clinging and dependent behavior.

• Difficulty making decisions
• Difficulty disagreeing with others or expressing a contrary opinion
• Extremely uncomfortable being alone
• Has difficulty expressing disagreement with others

A problematic pattern of drug use leading to clinically significant impairment or distress, as manifested by two or more criteria w/i 12 mth period.

Caffeine

• No abuse or dependence, but intoxication and related disorders can occur
• Symptoms include diarrhea, cardiac arrhythmia, restlessness, GI problems, sleep disturbance, weight loss
• Cannabis
• Smoking or ingesting parts of the cannabis plant
• Psychoactive substance is THC

 Cannabis

• Smoking or ingesting parts of the cannabis plant
• Psychoactive substance is THC
• World’s most commonly used illicit substance
• Can cause hallucinations in very high amounts
• Over time can cause anhedonia and a lack of motivation
• Can be mixed with other drugs, such as PCP or formaldehyde
• New to DSM-5, Cannabis Withdrawal is a formal disorder
• 
  

Hallucinogens

• PCP or other hallucinogens
• Recent use in this part of the country down from that quoted in the manual
• Intoxication
• Anxiety
• Depression
• Ideas of reference
• Fear of losing mind
• Hallucinations, perceptual distortions
• No withdrawal
• Persisting perception disorder – “flashbacks” – involve the re-experiencing of these symptoms several months or longer after stopping use

 Inhalants

• Cleaning fluids, gasoline, white out
• Symptoms include belligerence, euphoria, impaired judgment, apathy, and many possible physical complications, including stupor or coma or death
• No withdrawal
• Given the variety of chemicals, fact that they are legal and the fact that inhalant use by itself rarely is why someone seeks treatment, data on prevalence is difficult to obtain

  Tobacco (formerly nicotine)

• Rates of cigarette use are much higher in those with other mental disorders
• Specific withdrawal symptoms – such as insomnia, irritability, restlessness and increased appetite – are observed
• No intoxication diagnosis

Opioid

• Heroin, various prescription painkillers, cough suppressants
• Intoxication includes euphoric feelings, followed by apathy, dysphoria, psychomotor agitation or retardation
• Drowsiness, slurred speech, impaired memory, nodding off occur
• Snorted, smoked or used IV

Factitious Disorder

• For the Self: Falsification of physical or psychological symptoms
• Individual presents self as ill
• No obvious external reward
• Another (by Proxy)
• Same symptoms, but the symptoms are falsified in another person
• Factitious Disorder differs from Malingering (not a disorder) in that in Factitious Disorder the falsification occurs in an effort to take on the “sick role,” whereas in malingering there is an obvious gain for falsifying symptoms (e.g., avoiding legal consequences, finding a bed for the night)

• Preoccupation with having a serious illness
• No somatic symptoms or only mild symptoms
• High level of anxiety about health
• Either performs excessive health related behaviors (repeatedly checks self body for signs of illness) or exhibits maladaptive avoidance
• At least 6 months duration, and not better explained by another mental illness

Specify if:

• Care-seeking
• Care-avoiding
• Differs from Somatic Symptom Disorder in that the focus is on having an illness rather than specifically on the symptoms experienced
• If any symptoms are experienced, they are few and/or mild

• a pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openess, and effeciency, beginning by early adulthood and present in a variety of context.

Orderliness, perfectionism, mental and interpersonal control
• Preoccupied with details and rules
• Perfectionism
• Excessively devoted to work and productivity
• Miserly
• Over-conscientious and scrupulous
• Rigid, stubborn

_{Exposure to threatened death, serious injury or sexual violence}

1. Directly experienced the event
2. Witnessed it as it occurred to others
3. Learned that it happened to a close family member or friend
4. Repeated exposure to details of the event

One or more intrusive symptoms related to event

•Intrusive or distressing memories of the event
•Distressing dreams of the event
•Flashbacks
•Prolonged psychological distress at exposure to cues of the event

Marked physiological reactions to cues of the event

Negative emotional state, detachment, inability to experience positive emotions

• Inability to remember aspects of the event
• persistent negitive beliefs about oneself and the world
• Self blame for the event
• Negitive emotional state, detachment, in ability to experience positive emotions

Marked alterations in arousal and reactivity associated with traumatic events

• Irritability
• Hypervigilance
• Sleep or concentration disturbance
• Exaggerated startle response

"Some abnormal thoughts feelings and behaviors related to pain."

Medical condition is present, but psychological factors are in a variety of possible ways “interfering” with the medical condition

*Psychological or behavioral factors adversely effect the medical condition:

*Psychological factors have influenced the course of the condition

*Psychological factors interfere with treatment

*Psychological factors constitute well-established health risks for the individual

*Psychological factors influence the underlying pathophysiology, precipitating or exacerbating factors

*Specify if

*Mild – increases medical risk

*Moderate – aggravates underlying condition

*Severe – results in hospitalization or ED visit

*Extreme – life threatening

Schizoid Personality Disorder

• ^{_{Little interest in relationships, inc. being in a family}}
• ^{_{Chooses solitary activities}}
• ^{_{Little if any interest in sexual experiences w/ another person}}
•  ^{_{lacks close friends or confidents other then 1st degree relatives}}
• ^{_{takes pleasure in few if any activities}}
• ^{_{indefferent to praise or critism}}
• ^{_{Show emotional coldness, detachment or flattened affect.}}
• ^{_{schizoid personality has a way that pulled one's attention toward ones inner life, and away from the external world.}}

Schizotypal Personality Disorder

*LACKING DISIRE FOR CLOSE RELATIONSHIPS*

•Social and interpersonal deficits as well as cognitive or perceptual distortions and eccentricities
•Ideas of reference
•Odd beliefs thinking or speech
•Suspiciousness or paranoia
•Lack of close friends, or sexual experiences

•Inappropriate or constricted affect

Does not hold the belief as absolutely fixed, believes that these odd things exist, may not have experienced them.  Howeve: cognititively intact.

1 or more somatic symptoms that are distressing or result in significant disruption in daily life

*Excessive thoughts, feelings or behaviors related to the symptoms manifested by at least 1 of the following:

*Disproportionate and persistent concern about seriousness of symptom

*High level of anxiety about the symptom

*Excessive time and energy devoted to symptom or health concerns

*At least 6 month duration

*Specify if:

*With predominant pain 

*Persistent – severe symptoms, marked impairment and at least 6 month duration

*Somatic Symptom and Related Disorders

*Mild – 1 symptom

*Moderate – 2 or more symptoms

*Severe – 2 or more symptoms and multiple somatic complaints

Requires the presence of at least two physical, psychological, and social consequences of the drug use.

Cluster of cognitive, behavioral and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems

• Intoxication – reversible substance-specific syndrome due to recent ingestion of the substance, Does not apply to tobacco
• Withdrawal – substance specific problematic behavioral change, with physiological and cognitive concomitants, that is due to the cessation of or reduction in heavy, prolonged use
• Substance-induced disorders are used when the symptoms (mood, psychotic, etc) are in excess of those typically associated with the substance