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Treatment Plan

2

Eating Disorder

Students Name: Rudy Hernandez

Institutional Affiliation: University Ana G Mendez

Introduction

Los estudios epidemiológicos han afirmado que la incidencia de trastornos alimentarios está aumentando entre los adolescentes. Las investigaciones recientes realizadas sobre el mismo muestran que las niñas son las más afectadas en comparación con los niños. El estudio muestra que en los últimos 50 años los casos de trastornos alimentarios han aumentado rápidamente. La tasa de prevalencia notificada de anorexia nerviosa es de casi el 0,5% entre las niñas de entre 15 y 19 años. Alrededor del 1 al 5% de las adolescentes cumplen los criterios de bulimia nerviosa. McBride sostiene que los adolescentes saben poco sobre su imagen corporal y las preocupaciones relacionadas con el peso y deben ser guiados por un nutricionista sobre la necesidad de mantener una dieta saludable en lugar de centrarse en sus imágenes corporales. El comportamiento sobre la forma y la imagen del cuerpo se ha sugerido como el posible factor de riesgo para el desarrollo de trastornos alimentarios entre las generaciones más jóvenes. Este artículo examinará la evidencia sobre la influencia de los medios de comunicación en el desarrollo de los trastornos alimentarios.

Muchos investigadores han argumentado que los medios de comunicación desempeñan un papel en el aumento de casos de trastornos alimentarios. La mayoría de los medios de comunicación juegan un papel central en la creación e intensificación de la noción de insatisfacción corporal. En consecuencia, la mayoría de los jóvenes siguen las pautas sin la orientación de ningún experto en nutrición. Hoy en día, la mayoría de los niños, niñas y adolescentes crecen en entornos diferentes a los que solíamos conocer, el entorno está cambiando en materia de tecnología y medios de comunicación. Casi todas las partes del mundo están inundadas de medios de comunicación. películas, revistas, películas, diseñadores de moda y música. Los niños o adolescentes están mucho más expuestos porque ven hasta 5 h de televisión al día.

En los últimos años, varios artículos en revistas han propuesto una concepción entre la belleza femenina delgada y el cuerpo masculino musculoso. Formas corporales e imágenes representadas por los medios de comunicación contribuyen mucho a los trastornos alimentarios porque los jóvenes ven eso como un impulso para las formas corporales. A través de rangos psicológicos, la insatisfacción corporal y los trastornos alimentarios han aumentado significativamente. Por ejemplo, las mujeres y los modelos masculinos que aparecen en los medios de comunicación de la sociedad occidental son vistos como el cuerpo ideal en casi todos los adolescentes del mundo. Con el tiempo, el ideal cultural de la forma y el tamaño del cuerpo de la mujer se ha vuelto considerablemente más delgado (Celik & Kaya 2018). Por otro lado, el tamaño y la forma del cuerpo de los hombres se han vuelto más fuertes y musculosos. Estos cambios y estándares culturales bien pueden explicar por qué los adolescentes están preocupados por sus cuerpos y no están satisfechos con sus imágenes corporales y están dispuestos a probar una variedad de prácticas de pérdida de peso corporal, todo en nombre de un cuerpo perfecto.

Los jóvenes son vulnerables a la influencia de los medios de comunicación sobre la forma y el peso del cuerpo, porque algunos de ellos no están equipados emocionalmente. Además, los jóvenes pasan la mayor parte de su tiempo libre en el canal de medios, ya sea a través del canal de audio o visual. En los canales de los medios, los jóvenes se vuelven propensos a hábitos alimenticios que pueden conducir a la talla corporal que desean (Consoli et al 2019). Otros canales, como las redes sociales, se están convirtiendo en los deportes candentes para avergonzar el cuerpo, en los que un adolescente sano puede ser percibido como informe y uno delgado como modelo. El cambio de actitud hacia determinados tamaños corporales hace que los jóvenes prefieran determinados comportamientos alimentarios para alcanzar un determinado tamaño y forma corporal.

Conclusión

En conclusión, más adolescentes están preocupados por su peso, tamaño de forma e imagen corporal más que nunca. Como resultado, terminan haciendo muchas dietas, ya sea para perder peso o para mantener un cierto tamaño corporal; esta podría ser la razón principal por la que los jóvenes son más propensos a sufrir trastornos alimentarios. Los medios pueden cambiar estas nociones incorporando todos los personajes en su plataforma digital sin enfocarse en ciertos tamaños y formas corporales.

References

Celik, C. B., & Kaya, O. S. (2018). Examination of Eating Attitudes in Terms of Interpersonal Relationships and Life Satisfaction in Late Adolescence. Psychiatry and Behavioral Sciences, 8(2), 570.

Consoli, A., Berthoumieu, S. Ç., Raffin, M., Thuilleaux, D., Poitou, C., Coupaye, M., … & Bonnot, O. (2019). Effect of topiramate on eating behaviors in Prader-Willi syndrome: TOPRADER double-blind randomized placebo-controlled study. Translational psychiatry, 9(1), 1-8.

McBride, C., Costello, N., Ambwani, S., Wilhite, B., & Austin, S. B. (2019). Digital manipulation of images of models’ appearance in advertising: Strategies for action through law and corporate social responsibility incentives to protect public health. American journal of law & medicine, 45(1), 7-31.

5

Treatment Plan

8

Clinical Intervention II

Psychosocial Case Study

Rudy Hernandez

University Ana G Mendez

34831_SWGR_607-O_2212_921_ASF: CLINICAL INTERVENTION II

Prof. Gonzalez

April 25, 2022

Clinical Intervention II

Psychosocial Case Study

Presenting Problem

Marci is a college student who has been having problems with alcohol, cigarette and marijuana. She started her habit at a young age due to peer pressure and family intervention influences. Drug and substance use have made her anxious, and she is developing depression. She says that she is worried about her habit because it has affected her life in so many ways. She is not on good terms with her parents due to excess alcohol consumption and smoking marijuana. Increased alcohol consumption has made her encounter accidents while driving, and this has happened to her more than twice. Through these accidents, she has been physically harmed. She is facing problems with the authorities due to being involved in accidents. She is facing the problem of addiction, such that she is unable to stay without using these substances. Her family has played a big part in her habitual drug and substance use (Buckner et al., 2021).

Background Information/History

The history of Marci is based on family inherited characteristics. Both Joan and John’s maternal and paternal sides (Marci’s mother and father, respectively) had issues with alcoholism. John’s grandfather was a drunkard. John started taking alcohol when he tasted from his father’s stash. He drank too much when Marci was young, but now he has seized, although he faces problems with family and work. Joan (Marci’s mother) started using marijuana when she was young, and she has been fighting anxiety and depression for some years. She was also addicted to tobacco and smoking cigarettes. Joan’s father was an alcohol addict, and he used to abuse his family when drunk. Joan says that he died due to a road accident thought to be a result of drunkardness. Joan’s brother is a drunkard as well, and it is believed he follows in his father’s footsteps. Marci’s brother, Jacob, once drank beer when he was 16 years old but did not like it. Her younger sister hates alcohol and cigarettes, which she says is due to their bad smell (Dugosh & Cacciola., 2018).

Medical History

Marci has never gone through treatment in her drug and substance life. She was once given some pills to relieve her anxiety and depression but did not take them. However, increased worry and fear have made her think of taking them. During the counselling session, she was somehow upset and said though she was caught using marijuana, she feels like starting to use it again because she feels no severe problems in her body. She says that generally, she has not experienced any problems with alcohol, cigarette or marijuana. Though she denies having any problems, she is addicted to drug abuse, and she was just resisting undergoing treatment because she wanted to continue drinking and smoking (Buckner et al., 2021).

Education

Marci was a great performer during her early ages, and she scored A’s and B’s. Currently, she is in junior college, but instead of focusing on education, she is obsessed with drug and substance use. When she started consuming alcohol, marijuana and cigarettes, her commitment to education varnished, her parents once realized that she had started taking marijuana, and they noticed that her academic performance was going down. They thought of calling the dean head of academics to inform him about Marci’s habit, but Marci threatened to quit school. Due to this, her relationship with her parents was soured, and they were not happy with her. During the interview, she responded with an anxious tone when she was questioned about poor performance in school. She was dreaming of becoming an attorney, but drug and substance use overtook the zeal she had for her life (Dugosh & Cacciola., 2018).

Employment History

Marci is currently unemployed. She used to work as a waitress in the past, and sometimes she would work as a bar attendant in search of extra cash. She has been fired severally from different workplaces due to unprofessionalism. She was accused of absenteeism and destruction of property. Being fired everywhere does not seem to be normal. She could be failing to report for a job, and property destruction would result from anxiety and depression. She could not work effectively and efficiently because she was drunk almost every day, and therefore, hangovers could not make her go to work. The work that she did for a long time was that of a waitress, where she served for six months. The employees could not tolerate her for long because she could only make organizations suffer. Though she was determined to become someone important in her life, drugs and substance could not allow her to get time to work (Dugosh & Cacciola., 2018).

Substance Abuse History

Marci started smoking cigarettes when she was 16 years old. A year ago, she stopped smoking for six months, but she has admitted that she can do without it. She learned to smoke marijuana from a high school boyfriend who used to use marijuana daily and combine it with alcohol during the weekend. She first drank wine when they had gone for church missions in Latin America. When she was 18 years old, she started drinking alcohol seriously, and she could do with four different beverages. She would then go Friday night clubbing with friends, and then on Saturday afternoon, she would drink about two glasses of wine after lunch. Later on Saturday nights, she could go to parties with friends, and she took several bottles of alcohol. She used to drink too much to miss some lessons in school due to oversleeping. However, she has seized using marijuana since her arrest, and she is now taking a few bottles of alcohol and wine a week (Buckner et al., 2021).

Mental Status Examination

From the interview, Marci did not show any mental impairment. However, she denied having any compulsions or obsession. She also denied having any problems, but she admitted that she would feel paranoid. Her mental intelligence seemed to be above average. Although she seemed to be ok, she happened to complain to her friends about anxiety and feeling depressed, which had increased over the past few months after failing to use marijuana. Nothing she seemed to be doing abnormally, and she passed the alcohol serial test. She also denied having any learning disability or any ideas to commit suicide. She also denied any kind of hallucinations and did not show any psychotic problems. However, research shows that most drug and substance users deny having any kind of problems, and therefore more diagnostic analysis needs to be done to determine their real problems (Buckner et al., 2021).

Diagnostic Impression

Diagnosis of substance use disorder ICD-10-CM

The primary diagnosis is substance use disorder 304.10 (F13.20). This is because Marci has been obsessed with many problems that result from substance use. She continues to use the substances despite having several problems. Behaviours developed from substance use clearly show that she requires a diagnosis so as to identify possible treatment. She has currently increased her consumption of alcohol and smoking marijuana. Although she has stayed without smoking marijuana for six months after she was caught, she says that she is still craving it and if she gets the means to smoke without being seen, she will do it. All her daily activities are revolved around substance use. She has failed to fulfil her obligations at school and places of work. Despite all these challenges, she never stopped engaging in substance use. she has been unable to withdraw from substance use and has developed compulsive drug-seeking behaviour. All these problems made me choose substance use as the primary diagnosis that should be done on Marci because it’s a main problem affecting her.

Depressive (ICD-9-CM and ICD-10-CM) and anxiety (ICD-9-CM and ICD-10-CM) Substance-induced disorder

Substance-induced depressive disorder (ICD-9-CM and ICD-10-CM) is one of the secondary diagnoses Marci needs. This is because Marci has been complaining of depression which has lasted for a long and it increased when she stopped using marijuana for some time. The problem arose after she started using drugs and other substances, which affected her greatly. She also experiences a history of depression from her parents, specifically Joan, her mother, who underwent depression when she was taking marijuana. The process of withdrawal from taking marijuana has prolonged Marci’s impact of depression. The other secondary diagnosis is substance-induced anxiety disorder (ICD-9-CM and ICD-10-CM), ICD-9-CM started as a result of the use of marijuana, and it has extensively increased. Marci says that she has been worrying so much about her life currently, and she has informed her friends about the anxiety she is experiencing. After marijuana withdrawal, her anxiety rate increased, and she felt affected. Her anxiety and depression were mainly caused by alcohol and marijuana use and became more effective as she continued using those substances.

Alcohol and cannabis diagnosis ICD-10-CM

The tertiary diagnosis is alcohol and cannabis use disorder. Marci was experiencing an alcohol use disorder 303.90 (F10.20) and cannabis use disorder 304.30 (F12.20) that resulted in various problems in her life. She started failing in school and even failed to attend some classes. She also had problems with her employees, and she could not be maintained in a workplace for long. She also had a bad relationship with her parents after realizing she was too much into alcohol and cannabis. She was very much addicted such that she could even drive when drunk. She was involved in several accidents where the relevant authority realized that she had some alcoholic percentages in her blood. She faced physical bruises and cuts when she was involved in accidents. From her historical background, it was evident that her family had problems with alcohol and marijuana use. Regular usage resulted in her being depressed and feeling anxious over many things in her life. She was dreaming of becoming an attorney, but substance use made her give away her dreams.

Diagnostic Impression for The Client

Diagnosis of this patient requires several evaluations that may help in treatment. The client needs several laboratory tests that can help determine the level of addiction and the amount of substance in her blood. She should also provide her family background on substance use, how she started using substances and whether she has undergone any medication or visited any other psychiatrist (LeTendre & Reed., 2017). Several alcoholic and cannabis tests need to be done to identify this client’s problems that have made her so much into substance abuse. Assessments also need to be thoroughly done, for example, using the ADHUD and CAGE tests and other oral tests (van der Burg et al., 2019). Apart from these tests, the client needs a mental diagnosis using the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria. Repetitive assessments and tests need to be done because the client denies being obsessed with some problems like psychotic disorder and hallucinations. Apart from family relationships, the client needs to be done an assessment to determine how she relates with members of society. The client should also analyze how substance use has affected her education, work, and life in general (Duresso., 2021).

References

Buckner, J. D., Morris, P. E., Abarno, C. N., Glover, N. I., & Lewis, E. M. (2021). Biopsychosocial model social anxiety and substance use revised. Current psychiatry reports23(6), 1-9.

Dugosh, K. L., & Cacciola, J. S. (2018). Clinical assessment of substance use disorders. UpToDate. Retrieved February.

Duresso, S. (2021). Psychopharmacological Perspectives and Diagnosis of Substance Use Disorder. In Addictions-Diagnosis and Treatment. IntechOpen.

LeTendre, M. L., & Reed, M. B. (2017). The effect of adverse childhood experience on clinical diagnosis of a substance use disorder: Results of a nationally representative study. Substance use & misuse52(6), 689-697.

van der Burg, D., Crunelle, C. L., Matthys, F., & van den Brink, W. (2019). Diagnosis and treatment of patients with comorbid substance use disorder and adult attention-deficit and hyperactivity disorder: a review of recent publications. Current Opinion in Psychiatry32(4), 300-306.

Treatment Plan

You will use the bioppsychosocial case study to select (4) treatment plan Problem/Symptoms. However, you must use at least 3-4 literature (books and/or journals) to elaborate on the problem/symptom and justify why it is an issue that should be addressed in the treatment plan. You will use APA 7th edition to write your assignment.  This is a 6-7 page paper. The following must be the outline you use to develop each treatment plan problem/goal and objectives:

Treatment Plan Problem/Symptom #1 (you must use literature citation to justify the problem/symptom for the treatment plan).

Goal

Objectives

Length of Time (indicate how long this treatment plan goal will be addressed–3 months/6 months) Why? 

Intervention Modality: (MI, Problem-solving, CBT, etc) make sure to use literature citation to elaborate on the intervention modality you selected.

I attached a document with samples of goals and objectives to help you with this assignment.

Treatment Plan

TREATMENT PLAN GOALS / OBJECTIVES


Note: Always make objectives measurable, e.g., 3 out of 5 times, 100%, learn 3 skills, etc., unless they are measurable on their own as in “List and discuss [issue] weekly…”

Abuse/Neglect

Goal: Explore and resolve issues relating to history of abuse/neglect victimization

· Share details of the abuse/neglect with therapist as able to do so

· Learn about typical long term/residual effects of traumatic life experiences

· Develop two strategies to help cope with stressful reminders/memories

Alcohol/Drugs and Other Addictions

Goal: Be free of drug/alcohol use/abuse

· Avoid people, places and situations where temptation might be overwhelming

· Explore dynamics relating to being the [child/husband/wife] of an [alcoholic/addict] and discuss them each week at support group meetings

· Learn five triggers for alcohol & drug use

· Reach ____ days/months/years of clean/sober living

Adoption/Foster Care Placement

Goal: Explore and resolve issues related to adoption/out-of-home placement

· Discuss ongoing concerns and issues related to adoptive and/or biological parents during weekly sessions

· Talk about his/her wishes with regard to permanency planning

Anger

Goal: Increase and practice ability to manage anger

· Walk away from situations that trigger strong emotions (100%)

· Be free of tantrums/explosive episodes

· Learn two positive anger management skills

· Learn three ways to communicate verbally when angry

· Be able to express anger in a productive manner without destroying property or personal belongings

· Be able to express anger without yelling and using foul language

· Explore and resolve conflict with ____ (list triggers)

· Get through an entire day without an angry mood swing (or breaking/punching…)

· Get through a whole week without fighting with ____

· Take a time-out when things get upsetting

· Learn and practice anger management skills especially in situations where people are not treating him/her respectfully


Anxiety

Goal: Develop strategies to reduce symptoms, or

Reduce anxiety and improve coping skills

· Be free of panic episodes (100%)

· Recognize and plan for top five anxiety-provoking situations

· Learn two new ways of coping with routine stressors

· Report feeling more positive about self and abilities during therapy sessions

· Develop strategies for thought distraction when fixating on the future

Behavior Problems

Goal: Improve overall behavior (and attitude/mood), or

Maintain positive behavior (and attitude/mood)

· Be free of _____ behavior

· Develop a reward system to address ___ (target problem)

· Learn two ways to manage frustration in a positive manner

· Share two positive experiences each week in which X is proud of how he/she has behaved

· Stay free of fights

· Stay free of drug & alcohol use and abuse (100%)

· Be free of violent behavior

· Be able to keep hands and feet to self

· Be able to express anger in a productive manner without destroying property or personal belongings

· Be free of threats to self and others

· Complete daily tasks (e.g. chores, pet care, self care, etc.)

· Avoid leaving clothing/toys/personal stuff all around the house

· Listen to parent and follow simple directions with one prompt

· Put all dishes, glasses, cups, and food items back in the kitchen after meals/snacks

· Clean up after himself/herself

· Admit and accept personal responsibility for own actions/behavior

· Be respectful of adults and avoid talking back

· Get through a whole week without fighting with ____

· Avoid behavior that would result in a loss of custody

· Be able to play with others peacefully for ____ minutes

· Come home each day by ______ (time)

· Keep parents informed about where you are and when you will be home

· Be in bed by _____ each night

· Be free of bedwetting

· Be free of wet/soiled underwear

· If an accident happens, be responsible and clean it up

· Be free of any behavior that could result in loss of job

· Remain free of behaviors which would lead to arrest

· Comply with all aspects of probation/parole and avoid behavior that could violate

· Eat/swallow only items intended to be food


Communication Skills

Goal: Learn and use effective communication strategies

· Talk nice or do not say anything at all

· Learn three ways to communicate verbally when angry

· Be able to express anger in a productive manner without destroying property or personal belongings

· Be able to express anger without yelling and using foul language

· Be able to express wants and needs through spoken language

· Be able to ask questions and tell about instances

· Be able to stick up for self assertively

· Speak in a clear and concise manner so others fully understand him/her

· Learn to express feelings verbally without acting out

Crime

Goal: Remain free of behaviors which would lead to arrest/violation

· Keep working and comply with all aspects of probation

· Be able to express anger in a productive manner without destroying property or personal belongings

· Be free of threats to self and others

· Comply with all aspects of probation/parole and avoid behavior that could violate

· Be free of violent behavior

· Stay free of drug & alcohol use and abuse (100%)

Decision Making

Goal: Improve decision making skills

· Make short and simple “to do” lists and complete three tasks each day

· Celebrate little successes each day using positive self talk and/or journaling

· Be able to weigh options and make simple decisions within 5 minutes

· List three options for any major decisions and then discuss with therapist or family

Depression

Goal: Improve overall mood

· Be free of suicidal thoughts

· Call crisis hotline if having suicidal thoughts

· Report feeling more positive about self and abilities

· Get 7-8 hours of restful sleep every night

· Avoid napping/sleeping to escape other people and activities

· Shower, dress, and then do something every day

· Report feeling happy/better overall mood

· Make short and simple “to do” lists and complete three tasks each day

· Celebrate little successes each day using positive self talk and/or journaling

· Get through a day/week without a crying spell

· Develop strategies for thought distraction when ruminating on the past


Eating Disorders

Goal: Resolve eating disorder

· Eat a balanced diet of foods and maintain good overall health

· Gain ____ pounds

· Loose ____ pounds

· Be free of binge eating/purging

· Remove junk foods from home and limit future purchases

· Recognize/list environmental and situational triggers and develop alternative behaviors for coping with them

· Recognize emotional triggers and develop alternative ways of strategies for meeting emotional needs

Enuresis and Encopresis

Goal: Be free of wetting/soiling

· Avoid drinking near bedtime

· Eat high-fiber foods and avoid foods that constipate

· Go to the bathroom before going out of the house

· Sit on the toilet for 10-15 minutes after meals

· Avoid hiding wet/soiled clothing

· Take responsibility for helping clean up (e.g., put wet/soiled items in soak bucket)

Expression of Feelings, Wants and Needs

Goal: Learn appropriate ways to express different feelings

· Share two positive experiences each week in which client is proud of how he/she has behaved

· Gain knowledge of different feelings

· Turn to adults for help when feeling sad, angry or negative feelings

· Express feelings verbally rather than whine and/or cry about them

· Learn to express feelings verbally without acting out

Family Conflict

Goal: Learn and use conflict resolution skills

· Recognize patterns of family conflict discuss weekly in therapy

· Avoid angry outbursts by walking away from stressful situations

· Get through X days out of 7 without fighting with siblings

· Be respectful of ____: Listen, follow directions and avoid talking back

· Be able to live together peacefully, free of all angry physical contact

· Learn three ways to communicate verbally when angry

· Be able to express anger without yelling and using foul language

· Explore and resolve conflict with ____

· Be able to stick up for self assertively, not aggressively

· Be respectful of adults/don’t talk back

· Get through a whole week without fighting with ____

· Speak in a clear and concise manner so others fully understand him/her

· Learn to express feelings verbally without acting out

Grief and Loss

Goal: Explore and resolve grief and loss issues

· Give sorrow words – discuss issues of grief weekly with therapist

· Continue to explore and resolve issues of grief/loss as they arise

· Get through a week without a crying spell

· Learn about the typical 2-7 year process of grieving the loss of a loved one

· Explore spirituality and the role it plays in redefining views about the meaning and purpose of life

· Create (write/draw) a soul sketch of the deceased loved one

· Plan a memorial service for the anniversary of the loss

· Develop appropriate rituals to remember and honor _____

Harm to self or others

Goal: Be free of thoughts of self-harm/self mutilation, or

Be free of thoughts to harm to others

· Learn two ways to manage frustration in a positive manner

· Explore triggers of thoughts to harm self or others

· Call crisis hotline when needed

· Report feeling more positive about self and abilities

· Explore and resolve stress from ____

· Develop a crisis plan and share it with key people

· Remove weapons from the home [and other means]

· List three emergency contacts who will be able to stay with you till a crisis passes

Health Issues

Goal: Manage physical healthcare conditions and cope with related stress

· Learn as much as possible about the condition(s) and needed treatment

· Take medications/treatments as prescribed on a daily basis

· Attend all scheduled appointments with the doctor

· Maintain good overall physical health and healthcare practices

· Report any medication concerns to the prescribing doctor ASAP

· Seek additional advocacy services from _____

· Seek additional support from _____


Hyperactivity

Goal: Improve overall behavior, or

Maintain positive behavior

· Be able to keep hands and feet to self

· Complete daily tasks (e.g. chores, pet care, self care, etc.)

· Listen to parent/teacher and follow simple directions with one prompt

· Behave in an age-appropriate manner

· Maintain passing grades

· Will be able to focus attention and complete school-related tasks each day

· Listen and take notes in all classes

· Will review homework and other projects with parents on the day they are assigned

· Be respectful of adults and avoid talking back

· Be able to play with others peacefully for ____ minutes

· Be free of any behavior that could result in detention/suspension

· Develop a reward system to address ____ (target problem)

Medication Management

Goal: Medication management

· Take medications as prescribed on a daily basis

· Attend all scheduled appointments with the psychiatrist

· Maintain good overall physical health and healthcare practices

· Report any medication concerns to the doctor ASAP

Mood Management

Goal: Maintain stability of mood, or

Improve overall mood, or

Maintain even mood, or

Increase ability to manage moods

· Learn two ways to manage frustration in a positive manner

· Be free of suicidal thoughts; call crisis hotline if having suicidal thoughts

· Report feeling more positive about self and abilities

· Report feeling happy/better mood (4 days out of 7)

· Get 7-8 hours of restful sleep every night

· Get through a week without a crying spell

Parenting

Goal: Improve parenting skills

· Set two limits and stick with a plan that will require more responsible behavior

· Focus on positive behavior and give attention then, rather than focus on negative things

· Learn and be able to effectively use transactional analysis to stay in “adult” mode

· Use “I” statements rather than You” when communicating with _____

· Develop and consistently use a behavior modification plan, to increase/eliminate _____


Personal Hygiene and Self-care

Goal: Improve personal hygiene and attentiveness to independent/age appropriate self-care

· Brush teeth ____ times each day and floss _____

· Shower (take a bath) every day

· Use antiperspirant / deodorant every day after showering

· Brush/comb hair every morning

· Do a thorough job of wiping after toileting (100%)

Physical Health Issues

Goal: Cope with stress of physical health issues and chronic pain

· Explore and resolve thoughts and feelings that arise as a result of medical conditions and medications

· Learn two new strategies for coping with the above thoughts and feelings

· Reduce weight by _____ pounds

· Exercise for 20 minutes every day

· Learn strategies to advocate for him/herself with medical personnel

· Quit smoking (or drinking)

· Take medications as prescribed on a daily basis

· Attend all scheduled appointments with physicians

· Maintain good overall physical health and healthcare practices

· Report any medication concerns to the doctor ASAP

· Make and keep an appointment with _____ (dentist) for needed diagnosis and treatment

Relationships

Goal: Establish/maintain civil and supportive behavior

· Avoid angry outbursts by walking away from stressful situations

· Be free of affairs

· Be able to live together peacefully, free of all angry physical contact

· Learn three ways to communicate verbally when angry

· Explore peer and dating relationships to improve X’s chance of staying safe and legal

· Be able to keep hands to self

· Be able to express anger without yelling and using foul language

· Explore and resolve conflict with ____

· Be able to stick up for self assertively

· Be respectful of parents/don’t talk back

· Get through a whole week without fighting with ____

· Speak in a clear and concise manner so others fully understand him/her

· Be able to play with others peacefully for ____ minutes

· Learn to express feelings verbally without acting out

· Associate with healthy people and continue to make new friends

· Continue to explore relationship issues and slowly see new opportunities for dating

· Figure out why relationships fail and better plan for finding next partner

· Associate with people outside of work and make one or two new friends

School Issues

· Go to school every day

· Behave in an age-appropriate manner

· Maintain passing grades

· Will be able to focus attention and complete school-related tasks each day

· Listen and take notes in all classes

· Be free of suspensions and detentions

· Will review homework and other projects with parents on the day they are assigned

Self Image

Goal: Explore and resolve issues related to self image

· Discuss life events that led to and/or reinforce a negative self image during weekly therapy

· Use positive self talk daily

· Exercise daily (or _____ times per week)

· Drop _____ pounds

· Report feeling more positive about self and abilities

· Return to school and work on getting _____ (degree/diploma/GED)

· Change jobs to one that…(offers more pay and/or better suits skill set)

· Openly discuss issues relating to sexuality and become comfortable with sexual identity

· Explore spirituality and the role it plays in the meaning and purpose of life

· Engage in volunteer work and/or other meaningful activity at least three hours each week

Sleep Problems

Goal: Get 7-8 hours of restful sleep each night

· Limit consumption of food and drinks before bed

· Limit intake of caffeine (coffee, tea, soda) and chocolate after _____ (noon meal)

· Cut back on things that may impede normal sleep patterns (e.g., alcohol and some medications)

· Be in bed by _____ each night

· Have 30 minutes of quiet time before going to bed each night (e.g., read, meditate)

· Avoid overly stimulating shows/movies/video games before bedtime

· Avoid watching TV and chatting on the phone while in bed

· If not asleep in 20 minutes, get up and do something for a bit, rather than try to force sleep

· Leave a paper and pen to write worries down instead of ruminating on them

· Learn best practices for sleep (cooler room, limit caffeine, calming time before bed)

· Listen to relaxation/meditation music to aid falling asleep


Social Skills

Goal: Improve social skills

· Speak in a clear and concise way so others fully understand him/her

· Learn to express feelings verbally without acting out

· Make a new same-age friend

· Spend two hours playing with peers each week

Stress

Goal: Be able to cope with routine life stressors and take things in stride

· Assess personal risk traits and resiliency traits and discuss the role each plays in coping with daily stresses during the time between therapy sessions

· Learn two ways to manage frustration in a positive manner

· Get 7-8 hours of restful sleep every night

· Talk out routine stress events during weekly therapy sessions

· Explore and resolve residual stress from ____ (e.g., years as a first responder)

· Foster two new activities/interests that will help mitigate stress

· Exercise 20-30 minutes per day

· Learn and use meditation and relaxation techniques daily

Suicide

Goal: Be free of suicidal thoughts/attempts

· Explore and resolve stress from ____

· Call crisis hotline if having suicidal thoughts

· Develop a crisis plan and share it with key people

· Remove weapons from the home [and other means]

· List three emergency contacts who will be able to stay with you till a crisis passes

Thought Disorder

Goal: Improve ability to see world as others do

· Be free of false perceptions and [see/hear/smell/feel] things as others do

· Be free of false beliefs

· Be free of thoughts that others are out to get you

· Spend 2-3 hours each week visiting with others

· Visit the clubhouse and/or the consumer drop-in-center each week

· Report feeling comfortable spending time with others


Trauma

Goal: Explore and resolve issues related to ____ (traumatic event)

· Explore and resolve residual stress from ____ (e.g., years as a first responder)

· Share details of the trauma with therapist, as able to do so

· Reframe negative perceptions, when possible, and focus on finding meaning and drawing strength from the event

· Learn about typical long term/residual effects of traumatic life experiences

· Explore spirituality and the role it plays in life after traumatic events

· Learn about the typical 2-7 year process of rebuilding life after trauma

Vocational/Educational

Goal: Find a new job, or Keep present job, or Re-enter the work force

· Earn G.E.D.

· Explore options for returning to school/training

· Become an active member of a local clubhouse

· Complete college/technical school

· Develop a resume

· Seek two people who will serve as references

· Be free of any behavior that could result in loss of job/educational grants

· Find and settle into a new job

1

TREATMENT PLAN INTERVENTIONS (FOCUSING ON: ______)

1. Acceptance (of limitations/reality)

1. Accountability

1. ACOA Issues

1. Anger Management (e.g., punch bag/pillow)

1. Art Therapy

1. Assertiveness Training

1. Behavior Modification (e.g., rewards)

1. Best Practices for ____ (e.g., better sleep)

1. Bibliotherapy

1. Building on Strengths

1. Career Counseling

1. Coaching

1. Cognitive-Behavioral Therapy

1. Communication Skills

1. Community

1. Conflict Resolution

1. Couples Therapy

1. Crisis Planning

1. Defusing/Debriefing

1. Dignity/Self-worth

1. Discipline

1. Drug & Alcohol Referral

1. Education (e.g., graduation/GED)

1. Empathy

1. Empowerment

1. Encouragement

1. Expression of Feelings

1. Fair Fighting Skills

1. Family Therapy

1. Feedback Loops

1. Forgiveness

1. Gestalt Therapy

1. Getting a Job (Better Job)

1. Goal Planning/Orientation

1. Good Choices/Bad Choices

1. Good Touch/Bad Touch

1. Gratitude

1. Grief/Loss/Bereavement Issues

1. Homework Assignments

1. Humility

1. Increasing Coping Skills

1. Independence

1. Journaling

1. Letting Go

1. Life Skills Training

1. Listening

1. Logical Consequences of Behavior

1. Magic Question (3 wishes/magic wand)

1. Making Friends

1. MISA/MICA Issues (Dual Dx Treatment)

1. Modeling Appropriate Behaviors

1. Money Management

1. Monitoring of _____

1. Motivation

1. Narrative Therapy

1. Normalization

1. Parent Effectiveness Training/Skills

1. Partializing (breaking down goals into manageable pieces)

1. Patience

1. Perseverance

1. Personal Hygiene

1. Play Therapy

1. Portion Control (Weight Control)

1. Positive Self-talk

1. Primal Screams

1. Priority Setting

1. Practice Exercises

1. Processing _____ (e.g., guilty feelings)

1. Psychodrama

1. Psychoeducation

1. Reality Therapy

1. Recognizing _____ (e.g., self destructive patterns of behavior)

1. Refer to ______

1. Reframing

1. Rehearsal

1. Relapse Prevention

1. Relationship Issues

1. Relaxation Techniques (e.g., breathing)

1. Responsibility for Actions

1. Role Playing

1. Self-care Skills

1. Self-direction (Independence)

1. Sexual Identity Issues

1. Sexuality

1. Solution-focused Therapy

1. Spiritual Exploration

1. Starting Over

1. Stop-Think-Act

1. Strength Focus/Listing

1. Stress Inoculation

1. Stress Management

1. Supportive Relationships

1. Talk Therapy

1. Therapeutic Stories & Worksheets

1. Timeouts

1. Transactional Analysis (P-A-C)

1. Trigger Recognition

1. Twelve Step

1. Socialization

1. Social Skills Training

1. Social-Vocational Training

1. Values Clarification

1. Verbal Communication Skills

1. Weight Control/Loss

1. Workbooks

Treatment Plan

DIAGNOSTIC AND STATISTICAL
MANUAL OF

MENTAL DISORDERS
F I F T H E D I T I O N

DSM-5™

American Psychiatric Association

Officers 2012–2013
PRESIDENT DILIP V. JESTE, M.D.

PRESIDENT-ELECT JEFFREY A. LIEBERMAN, M.D.
TREASURER DAVID FASSLER, M.D.
SECRETARY ROGER PEELE, M.D.

Assembly
SPEAKER R. SCOTT BENSON, M.D.

SPEAKER-ELECT MELINDA L. YOUNG, M.D.

Board of Trustees
JEFFREY AKAKA, M.D.

CAROL A. BERNSTEIN, M.D.
BRIAN CROWLEY, M.D.

ANITA S. EVERETT, M.D.
JEFFREY GELLER, M.D., M.P.H.

MARC DAVID GRAFF, M.D.
JAMES A. GREENE, M.D.

JUDITH F. KASHTAN, M.D.
MOLLY K. MCVOY, M.D.
JAMES E. NININGER, M.D.
JOHN M. OLDHAM, M.D.

ALAN F. SCHATZBERG, M.D.
ALIK S. WIDGE, M.D., PH.D.

ERIK R. VANDERLIP, M.D.,
MEMBER-IN-TRAINING TRUSTEE-ELECT

Washington, DC
London, England

DIAGNOSTIC AND STATISTICAL
MANUAL OF

MENTAL DISORDERS
F I F T H E D I T I O N

DSM-5™

Copyright © 2013 American Psychiatric Association

DSM and DSM-5 are trademarks of the American Psychiatric Association. Use of these terms
is prohibited without permission of the American Psychiatric Association.

ALL RIGHTS RESERVED. Unless authorized in writing by the APA, no part of this book may
be reproduced or used in a manner inconsistent with the APA’s copyright. This prohibition
applies to unauthorized uses or reproductions in any form, including electronic applications.

Correspondence regarding copyright permissions should be directed to DSM Permissions,
American Psychiatric Publishing, 1000 Wilson Boulevard, Suite 1825, Arlington, VA 22209-
3901.

Manufactured in the United States of America on acid-free paper.

ISBN 978-0-89042-554-1 (Hardcover) 2nd printing June 2013

ISBN 978-0-89042-555-8 (Paperback) 2nd printing June 2013

American Psychiatric Association
1000 Wilson Boulevard
Arlington, VA 22209-3901
www.psych.org

The correct citation for this book is American Psychiatric Association: Diagnostic and Statisti-
cal Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Associa-
tion, 2013.

Library of Congress Cataloging-in-Publication Data
Diagnostic and statistical manual of mental disorders : DSM-5. — 5th ed.

p. ; cm.
DSM-5
DSM-V
Includes index.
ISBN 978-0-89042-554-1 (hardcover : alk. paper) — ISBN 978-0-89042-555-8 (pbk. : alk. paper)
I. American Psychiatric Association. II. American Psychiatric Association. DSM-5 Task Force.
III. Title: DSM-5. IV. Title: DSM-V.
[DNLM: 1. Diagnostic and statistical manual of mental disorders. 5th ed. 2. Mental Disorders—
classification. 3. Mental Disorders—diagnosis. WM 15]
RC455.2.C4
616.89’075—dc23

2013011061

British Library Cataloguing in Publication Data
A CIP record is available from the British Library.

Text Design—Tammy J. Cordova

Manufacturing—R. R. Donnelley

Contents

DSM-5 Classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii

Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xli

Section I
DSM-5 Basics

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5

Use of the Manual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19

Cautionary Statement for Forensic Use of DSM-5 . . . . . . . . . . . .25

Section II
Diagnostic Criteria and Codes

Neurodevelopmental Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . .31

Schizophrenia Spectrum and Other Psychotic Disorders . . . . . .87

Bipolar and Related Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . .123

Depressive Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .155

Anxiety Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .189

Obsessive-Compulsive and Related Disorders . . . . . . . . . . . . .235

Trauma- and Stressor-Related Disorders . . . . . . . . . . . . . . . . . .265

Dissociative Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .291

Somatic Symptom and Related Disorders . . . . . . . . . . . . . . . . .309

Feeding and Eating Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . .329

Elimination Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .355

Sleep-Wake Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .361

Sexual Dysfunctions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .423

Gender Dysphoria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .451

Disruptive, Impulse-Control, and Conduct Disorders . . . . . . . . 461

Substance-Related and Addictive Disorders . . . . . . . . . . . . . . . 481

Neurocognitive Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 591

Personality Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 645

Paraphilic Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 685

Other Mental Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 707

Medication-Induced Movement Disorders
and Other Adverse Effects of Medication . . . . . . . . . . . . . . . . 709

Other Conditions That May Be a Focus of Clinical Attention . . 715

Section III
Emerging Measures and Models

Assessment Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 733

Cultural Formulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 749

Alternative DSM-5 Model for Personality Disorders . . . . . . . . . 761

Conditions for Further Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . 783

Appendix
Highlights of Changes From DSM-IV to DSM-5 . . . . . . . . . . . . . 809

Glossary of Technical Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . 817

Glossary of Cultural Concepts of Distress . . . . . . . . . . . . . . . . . 833

Alphabetical Listing of DSM-5 Diagnoses and Codes
(ICD-9-CM and ICD-10-CM) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 839

Numerical Listing of DSM-5 Diagnoses and Codes
(ICD-9-CM) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 863

Numerical Listing of DSM-5 Diagnoses and Codes
(ICD-10-CM) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 877

DSM-5 Advisors and Other Contributors . . . . . . . . . . . . . . . . . . 897

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 917

DSM-5 Task Force
DAVID J. KUPFER, M.D.

Task Force Chair
DARREL A. REGIER, M.D., M.P.H.

Task Force Vice-Chair
William E. Narrow, M.D., M.P.H.,

Research Director
Susan K. Schultz, M.D., Text Editor
Emily A. Kuhl, Ph.D., APA Text Editor

Dan G. Blazer, M.D., Ph.D., M.P.H.
Jack D. Burke Jr., M.D., M.P.H.
William T. Carpenter Jr., M.D.
F. Xavier Castellanos, M.D.
Wilson M. Compton, M.D., M.P.E.
Joel E. Dimsdale, M.D.
Javier I. Escobar, M.D., M.Sc.
Jan A. Fawcett, M.D.
Bridget F. Grant, Ph.D., Ph.D. (2009–)
Steven E. Hyman, M.D. (2007–2012)
Dilip V. Jeste, M.D. (2007–2011)
Helena C. Kraemer, Ph.D.
Daniel T. Mamah, M.D., M.P.E.
James P. McNulty, A.B., Sc.B.
Howard B. Moss, M.D. (2007–2009)

Charles P. O’Brien, M.D., Ph.D.
Roger Peele, M.D.
Katharine A. Phillips, M.D.
Daniel S. Pine, M.D.
Charles F. Reynolds III, M.D.
Maritza Rubio-Stipec, Sc.D.
David Shaffer, M.D.
Andrew E. Skodol II, M.D.
Susan E. Swedo, M.D.
B. Timothy Walsh, M.D.
Philip Wang, M.D., Dr.P.H. (2007–2012)
William M. Womack, M.D.
Kimberly A. Yonkers, M.D.
Kenneth J. Zucker, Ph.D.
Norman Sartorius, M.D., Ph.D., Consultant

APA Division of Research Staff on DSM-5
Darrel A. Regier, M.D., M.P.H.,

Director, Division of Research
William E. Narrow, M.D., M.P.H.,

Associate Director
Emily A. Kuhl, Ph.D., Senior Science

Writer; Staff Text Editor
Diana E. Clarke, Ph.D., M.Sc., Research

Statistician

Lisa H. Greiner, M.S.S.A., DSM-5 Field
Trials Project Manager

Eve K. Moscicki, Sc.D., M.P.H.,
Director, Practice Research Network

S. Janet Kuramoto, Ph.D. M.H.S.,
Senior Scientific Research Associate,
Practice Research Network

Amy Porfiri, M.B.A.
Director of Finance and Administration

Jennifer J. Shupinka, Assistant Director,
DSM Operations

Seung-Hee Hong, DSM Senior Research
Associate

Anne R. Hiller, DSM Research Associate
Alison S. Beale, DSM Research Associate
Spencer R. Case, DSM Research Associate

Joyce C. West, Ph.D., M.P.P.,
Health Policy Research Director, Practice
Research Network

Farifteh F. Duffy, Ph.D.,
Quality Care Research Director, Practice
Research Network

Lisa M. Countis, Field Operations
Manager, Practice Research Network

Christopher M. Reynolds,
Executive Assistant

APA Office of the Medical Director
JAMES H. SCULLY JR., M.D.

Medical Director and CEO

Editorial and Coding Consultants
Michael B. First, M.D. Maria N. Ward, M.Ed., RHIT, CCS-P

DSM-5 Work Groups

ADHD and Disruptive Behavior Disorders
DAVID SHAFFER, M.D.

Chair

F. XAVIER CASTELLANOS, M.D.
Co-Chair

Paul J. Frick, Ph.D., Text Coordinator
Glorisa Canino, Ph.D.
Terrie E. Moffitt, Ph.D.
Joel T. Nigg, Ph.D.

Luis Augusto Rohde, M.D., Sc.D.
Rosemary Tannock, Ph.D.
Eric A. Taylor, M.B.
Richard Todd, Ph.D., M.D. (d. 2008)

Anxiety, Obsessive-Compulsive Spectrum, Posttraumatic,
and Dissociative Disorders

KATHARINE A. PHILLIPS, M.D.
Chair

Michelle G. Craske, Ph.D., Text
Coordinator

J. Gavin Andrews, M.D.
Susan M. Bögels, Ph.D.
Matthew J. Friedman, M.D., Ph.D.
Eric Hollander, M.D. (2007–2009)
Roberto Lewis-Fernández, M.D., M.T.S.
Robert S. Pynoos, M.D., M.P.H.

Scott L. Rauch, M.D.
H. Blair Simpson, M.D., Ph.D.
David Spiegel, M.D.
Dan J. Stein, M.D., Ph.D.
Murray B. Stein, M.D.
Robert J. Ursano, M.D.
Hans-Ulrich Wittchen, Ph.D.

Childhood and Adolescent Disorders
DANIEL S. PINE, M.D.

Chair

Ronald E. Dahl, M.D.
E. Jane Costello, Ph.D. (2007–2009)
Regina Smith James, M.D.
Rachel G. Klein, Ph.D.

James F. Leckman, M.D.
Ellen Leibenluft, M.D.
Judith H. L. Rapoport, M.D.
Charles H. Zeanah, M.D.

Eating Disorders
B. TIMOTHY WALSH, M.D.

Chair

Stephen A. Wonderlich, Ph.D.,
Text Coordinator

Evelyn Attia, M.D.
Anne E. Becker, M.D., Ph.D., Sc.M.
Rachel Bryant-Waugh, M.D.
Hans W. Hoek, M.D., Ph.D.

Richard E. Kreipe, M.D.
Marsha D. Marcus, Ph.D.
James E. Mitchell, M.D.
Ruth H. Striegel-Moore, Ph.D.
G. Terence Wilson, Ph.D.
Barbara E. Wolfe, Ph.D. A.P.R.N.

Mood Disorders
JAN A. FAWCETT, M.D.

Chair

Ellen Frank, Ph.D., Text Coordinator
Jules Angst, M.D. (2007–2008)
William H. Coryell, M.D.
Lori L. Davis, M.D.
Raymond J. DePaulo, M.D.
Sir David Goldberg, M.D.
James S. Jackson, Ph.D.

Kenneth S. Kendler, M.D.
(2007–2010)

Mario Maj, M.D., Ph.D.
Husseini K. Manji, M.D. (2007–2008)
Michael R. Phillips, M.D.
Trisha Suppes, M.D., Ph.D.
Carlos A. Zarate, M.D.

Neurocognitive Disorders
DILIP V. JESTE, M.D. (2007–2011)

Chair Emeritus

DAN G. BLAZER, M.D., PH.D., M.P.H.
Chair

RONALD C. PETERSEN, M.D., PH.D.
Co-Chair

Mary Ganguli, M.D., M.P.H.,
Text Coordinator

Deborah Blacker, M.D., Sc.D.
Warachal Faison, M.D. (2007–2008)

Igor Grant, M.D.
Eric J. Lenze, M.D.
Jane S. Paulsen, Ph.D.
Perminder S. Sachdev, M.D., Ph.D.

Neurodevelopmental Disorders
SUSAN E. SWEDO, M.D.

Chair

Gillian Baird, M.A., M.B., B.Chir.,
Text Coordinator

Edwin H. Cook Jr., M.D.
Francesca G. Happé, Ph.D.
James C. Harris, M.D.
Walter E. Kaufmann, M.D.
Bryan H. King, M.D.
Catherine E. Lord, Ph.D.

Joseph Piven, M.D.
Sally J. Rogers, Ph.D.
Sarah J. Spence, M.D., Ph.D.
Rosemary Tannock, Ph.D.
Fred Volkmar, M.D. (2007–2009)
Amy M. Wetherby, Ph.D.
Harry H. Wright, M.D.

Personality and Personality Disorders1

ANDREW E. SKODOL, M.D.
Chair

JOHN M. OLDHAM, M.D.
Co-Chair

Robert F. Krueger, Ph.D., Text
Coordinator

Renato D. Alarcon, M.D., M.P.H.
Carl C. Bell, M.D.
Donna S. Bender, Ph.D.

Lee Anna Clark, Ph.D.
W. John Livesley, M.D., Ph.D. (2007–2012)
Leslie C. Morey, Ph.D.
Larry J. Siever, M.D.
Roel Verheul, Ph.D. (2008–2012)

1 The members of the Personality and Personality Disorders Work Group are responsible for the
alternative DSM-5 model for personality disorders that is included in Section III. The Section II
personality disorders criteria and text (with updating of the text) are retained from DSM-IV-TR.

Psychotic Disorders
WILLIAM T. CARPENTER JR., M.D.

Chair

Deanna M. Barch, Ph.D., Text
Coordinator

Juan R. Bustillo, M.D.
Wolfgang Gaebel, M.D.
Raquel E. Gur, M.D., Ph.D.
Stephan H. Heckers, M.D.

Dolores Malaspina, M.D., M.S.P.H.
Michael J. Owen, M.D., Ph.D.
Susan K. Schultz, M.D.
Rajiv Tandon, M.D.
Ming T. Tsuang, M.D., Ph.D.
Jim van Os, M.D.

Sexual and Gender Identity Disorders
KENNETH J. ZUCKER, PH.D.

Chair

Lori Brotto, Ph.D., Text Coordinator
Irving M. Binik, Ph.D.
Ray M. Blanchard, Ph.D.
Peggy T. Cohen-Kettenis, Ph.D.
Jack Drescher, M.D.
Cynthia A. Graham, Ph.D.

Martin P. Kafka, M.D.
Richard B. Krueger, M.D.
Niklas Långström, M.D., Ph.D.
Heino F.L. Meyer-Bahlburg, Dr. rer. nat.
Friedemann Pfäfflin, M.D.
Robert Taylor Segraves, M.D., Ph.D.

Sleep-Wake Disorders
CHARLES F. REYNOLDS III, M.D.

Chair

Ruth M. O’Hara, Ph.D., Text Coordinator
Charles M. Morin, Ph.D.
Allan I. Pack, Ph.D.

Kathy P. Parker, Ph.D., R.N.
Susan Redline, M.D., M.P.H.
Dieter Riemann, Ph.D.

Somatic Symptom Disorders
JOEL E. DIMSDALE, M.D.

Chair

James L. Levenson, M.D., Text
Coordinator

Arthur J. Barsky III, M.D.
Francis Creed, M.D.
Nancy Frasure-Smith, Ph.D. (2007–2011)

Michael R. Irwin, M.D.
Francis J. Keefe, Ph.D. (2007–2011)
Sing Lee, M.D.
Michael Sharpe, M.D.
Lawson R. Wulsin, M.D.

Substance-Related Disorders
CHARLES P. O’BRIEN, M.D., PH.D.

Chair

THOMAS J. CROWLEY, M.D.
Co-Chair

Wilson M. Compton, M.D., M.P.E.,
Text Coordinator

Marc Auriacombe, M.D.
Guilherme L. G. Borges, M.D., Dr.Sc.
Kathleen K. Bucholz, Ph.D.
Alan J. Budney, Ph.D.
Bridget F. Grant, Ph.D., Ph.D.
Deborah S. Hasin, Ph.D.

Thomas R. Kosten, M.D. (2007–2008)
Walter Ling, M.D.
Spero M. Manson, Ph.D. (2007-2008)
A. Thomas McLellan, Ph.D. (2007–2008)
Nancy M. Petry, Ph.D.
Marc A. Schuckit, M.D.
Wim van den Brink, M.D., Ph.D.

(2007–2008)

DSM-5 Study Groups

Diagnostic Spectra and DSM/ICD Harmonization
STEVEN E. HYMAN, M.D.

Chair (2007–2012)

William T. Carpenter Jr., M.D.
Wilson M. Compton, M.D., M.P.E.
Jan A. Fawcett, M.D.
Helena C. Kraemer, Ph.D.
David J. Kupfer, M.D.

William E. Narrow, M.D., M.P.H.
Charles P. O’Brien, M.D., Ph.D.
John M. Oldham, M.D.
Katharine A. Phillips, M.D.
Darrel A. Regier, M.D., M.P.H.

Lifespan Developmental Approaches
ERIC J. LENZE, M.D.

Chair

SUSAN K. SCHULTZ, M.D.
Chair Emeritus

DANIEL S. PINE, M.D.
Chair Emeritus

Dan G. Blazer, M.D., Ph.D., M.P.H.
F. Xavier Castellanos, M.D.
Wilson M. Compton, M.D., M.P.E.

Daniel T. Mamah, M.D., M.P.E.
Andrew E. Skodol II, M.D.
Susan E. Swedo, M.D.

Gender and Cross-Cultural Issues
KIMBERLY A. YONKERS, M.D.

Chair

ROBERTO LEWIS-FERNÁNDEZ, M.D., M.T.S.
Co-Chair, Cross-Cultural Issues

Renato D. Alarcon, M.D., M.P.H.
Diana E. Clarke, Ph.D., M.Sc.
Javier I. Escobar, M.D., M.Sc.
Ellen Frank, Ph.D.
James S. Jackson, Ph.D.
Spiro M. Manson, Ph.D. (2007–2008)
James P. McNulty, A.B., Sc.B.

Leslie C. Morey, Ph.D.
William E. Narrow, M.D., M.P.H.
Roger Peele, M.D.
Philip Wang, M.D., Dr.P.H. (2007–2012)
William M. Womack, M.D.
Kenneth J. Zucker, Ph.D.

Psychiatric/General Medical Interface
LAWSON R. WULSIN, M.D.

Chair

Ronald E. Dahl, M.D.
Joel E. Dimsdale, M.D.
Javier I. Escobar, M.D., M.Sc.
Dilip V. Jeste, M.D. (2007–2011)
Walter E. Kaufmann, M.D.

Richard E. Kreipe, M.D.
Ronald C. Petersen, Ph.D., M.D.
Charles F. Reynolds III, M.D.
Robert Taylor Segraves, M.D., Ph.D.
B. Timothy Walsh, M.D.

Impairment and Disability
JANE S. PAULSEN, PH.D.

Chair

J. Gavin Andrews, M.D.
Glorisa Canino, Ph.D.
Lee Anna Clark, Ph.D.
Diana E. Clarke, Ph.D., M.Sc.
Michelle G. Craske, Ph.D.

Hans W. Hoek, M.D., Ph.D.
Helena C. Kraemer, Ph.D.
William E. Narrow, M.D., M.P.H.
David Shaffer, M.D.

Diagnostic Assessment Instruments
JACK D. BURKE JR., M.D., M.P.H.

Chair

Lee Anna Clark, Ph.D.
Diana E. Clarke, Ph.D., M.Sc.
Bridget F. Grant, Ph.D., Ph.D.

Helena C. Kraemer, Ph.D.
William E. Narrow, M.D., M.P.H.
David Shaffer, M.D.

DSM-5 Research Group
WILLIAM E. NARROW, M.D., M.P.H.

Chair

Jack D. Burke Jr., M.D., M.P.H.
Diana E. Clarke, Ph.D., M.Sc.
Helena C. Kraemer, Ph.D.

David J. Kupfer, M.D.
Darrel A. Regier, M.D., M.P.H.
David Shaffer, M.D.

Course Specifiers and Glossary
WOLFGANG GAEBEL, M.D.

Chair

Ellen Frank, Ph.D.
Charles P. O’Brien, M.D., Ph.D.
Norman Sartorius, M.D., Ph.D.,

Consultant
Susan K. Schultz, M.D.

Dan J. Stein, M.D., Ph.D.
Eric A. Taylor, M.B.
David J. Kupfer, M.D.
Darrel A. Regier, M.D., M.P.H.

xiii

DSM-5
Classification

Before each disorder name, ICD-9-CM codes are provided, followed by ICD-10-CM codes
in parentheses. Blank lines indicate that either the ICD-9-CM or the ICD-10-CM code is not
applicable. For some disorders, the code can be indicated only according to the subtype or
specifier.

ICD-9-CM codes are to be used for coding purposes in the United States through Sep-
tember 30, 2014. ICD-10-CM codes are to be used starting October 1, 2014.

Following chapter titles and disorder names, page numbers for the corresponding text
or criteria are included in parentheses.

Note for all mental disorders due to another medical condition: Indicate the name of
the other medical condition in the name of the mental disorder due to [the medical condi-
tion]. The code and name for the other medical condition should be listed first immedi-
ately before the mental disorder due to the medical condition.

Neurodevelopmental Disorders (31)

Intellectual Disabilities (33)

___.__ (___.__) Intellectual Disability (Intellectual Developmental Disorder) (33)
Specify current severity:

317 (F70) Mild
318.0 (F71) Moderate
318.1 (F72) Severe
318.2 (F73) Profound

315.8 (F88) Global Developmental Delay (41)

319 (F79) Unspecified Intellectual Disability (Intellectual Developmental
Disorder) (41)

Communication Disorders (41)
315.32 (F80.2) Language Disorder (42)

315.39 (F80.0) Speech Sound Disorder (44)

315.35 (F80.81) Childhood-Onset Fluency Disorder (Stuttering) (45)
Note: Later-onset cases are diagnosed as 307.0 (F98.5) adult-onset fluency

disorder.

315.39 (F80.89) Social (Pragmatic) Communication Disorder (47)

307.9 (F80.9) Unspecified Communication Disorder (49)

xiv DSM-5 Classification

Autism Spectrum Disorder (50)
299.00 (F84.0) Autism Spectrum Disorder (50)

Specify if: Associated with a known medical or genetic condition or envi-
ronmental factor; Associated with another neurodevelopmental, men-
tal, or behavioral disorder

Specify current severity for Criterion A and Criterion B: Requiring very
substantial support, Requiring substantial support, Requiring support

Specify if: With or without accompanying intellectual impairment, With
or without accompanying language impairment, With catatonia (use
additional code 293.89 [F06.1])

Attention-Deficit/Hyperactivity Disorder (59)

___.__ (___.__) Attention-Deficit/Hyperactivity Disorder (59)
Specify whether:

314.01 (F90.2) Combined presentation
314.00 (F90.0) Predominantly inattentive presentation
314.01 (F90.1) Predominantly hyperactive/impulsive presentation

Specify if: In partial remission
Specify current severity: Mild, Moderate, Severe

314.01 (F90.8) Other Specified Attention-Deficit/Hyperactivity Disorder (65)

314.01 (F90.9) Unspecified Attention-Deficit/Hyperactivity Disorder (66)

Specific Learning Disorder (66)

___.__ (___.__) Specific Learning Disorder (66)
Specify if:

315.00 (F81.0) With impairment in reading (specify if with word reading
accuracy, reading rate or fluency, reading comprehension)

315.2 (F81.81) With impairment in written expression (specify if with spelling
accuracy, grammar and punctuation accuracy, clarity or
organization of written expression)

315.1 (F81.2) With impairment in mathematics (specify if with number sense,
memorization of arithmetic facts, accurate or fluent
calculation, accurate math reasoning)

Specify current severity: Mild, Moderate, Severe

Motor Disorders (74)
315.4 (F82) Developmental Coordination Disorder (74)

307.3 (F98.4) Stereotypic Movement Disorder (77)
Specify if: With self-injurious behavior, Without self-injurious behavior
Specify if: Associated with a known medical or genetic condition, neuro-

developmental disorder, or environmental factor
Specify current severity: Mild, Moderate, Severe

Tic Disorders

307.23 (F95.2) Tourette’s Disorder (81)

307.22 (F95.1) Persistent (Chronic) Motor or Vocal Tic Disorder (81)
Specify if: With motor tics only, With vocal tics only

DSM-5 Classification xv

307.21 (F95.0) Provisional Tic Disorder (81)

307.20 (F95.8) Other Specified Tic Disorder (85)

307.20 (F95.9) Unspecified Tic Disorder (85)

Other Neurodevelopmental Disorders (86)
315.8 (F88) Other Specified Neurodevelopmental Disorder (86)

315.9 (F89) Unspecified Neurodevelopmental Disorder (86)

Schizophrenia Spectrum
and Other Psychotic Disorders (87)

The following specifiers apply to Schizophrenia Spectrum and Other Psychotic Disorders
where indicated:
aSpecify if: The following course specifiers are only to be used after a 1-year duration of the dis-

order: First episode, currently in acute episode; First episode, currently in partial remission;
First episode, currently in full remission; Multiple episodes, currently in acute episode; Mul-
tiple episodes, currently in partial remission; Multiple episodes, currently in full remission;
Continuous; Unspecified

bSpecify if: With catatonia (use additional code 293.89 [F06.1])
cSpecify current severity of delusions, hallucinations, disorganized speech, abnormal psycho-

motor behavior, negative symptoms, impaired cognition, depression, and mania symptoms

301.22 (F21) Schizotypal (Personality) Disorder (90)

297.1 (F22) Delusional Disordera, c (90)
Specify whether: Erotomanic type, Grandiose type, Jealous type, Persecu-

tory type, Somatic type, Mixed type, Unspecified type
Specify if: With bizarre content

298.8 (F23) Brief Psychotic Disorderb, c (94)
Specify if: With marked stressor(s), Without marked stressor(s), With

postpartum onset

295.40 (F20.81) Schizophreniform Disorderb, c (96)
Specify if: With good prognostic features, Without good prognostic fea-

tures

295.90 (F20.9) Schizophreniaa, b, c (99)

___.__ (___.__) Schizoaffective Disordera, b, c (105)
Specify whether:

295.70 (F25.0) Bipolar type
295.70 (F25.1) Depressive type

___.__ (___.__) Substance/Medication-Induced Psychotic Disorderc (110)
Note: See the criteria set and corresponding recording procedures for

substance-specific codes and ICD-9-CM and ICD-10-CM coding.
Specify if: With onset during intoxication, With onset during withdrawal

___.__ (___.__) Psychotic Disorder Due to Another Medical Conditionc (115)
Specify whether:

293.81 (F06.2) With delusions
293.82 (F06.0) With hallucinations

xvi DSM-5 Classification

293.89 (F06.1) Catatonia Associated With Another Mental Disorder (Catatonia
Specifier) (119)

293.89 (F06.1) Catatonic Disorder Due to Another Medical Condition (120)

293.89 (F06.1) Unspecified Catatonia (121)
Note: Code first 781.99 (R29.818) other symptoms involving nervous and

musculoskeletal systems.

298.8 (F28) Other Specified Schizophrenia Spectrum and Other Psychotic
Disorder (122)

298.9 (F29) Unspecified Schizophrenia Spectrum and Other Psychotic
Disorder (122)

Bipolar and Related Disorders (123)
The following specifiers apply to Bipolar and Related Disorders where indicated:
aSpecify: With anxious distress (specify current severity: mild, moderate, moderate-severe, severe);

With mixed features; With rapid cycling; With melancholic features; With atypical features;
With mood-congruent psychotic features; With mood-incongruent psychotic features; With
catatonia (use additional code 293.89 [F06.1]); With peripartum onset; With seasonal pattern

___.__ (___.__) Bipolar I Disordera (123)
___.__ (___.__) Current or most recent episode manic
296.41 (F31.11) Mild
296.42 (F31.12) Moderate
296.43 (F31.13) Severe
296.44 (F31.2) With psychotic features
296.45 (F31.73) In partial remission
296.46 (F31.74) In full remission
296.40 (F31.9) Unspecified
296.40 (F31.0) Current or most recent episode hypomanic
296.45 (F31.71) In partial remission
296.46 (F31.72) In full remission
296.40 (F31.9) Unspecified
___.__ (___.__) Current or most recent episode depressed
296.51 (F31.31) Mild
296.52 (F31.32) Moderate
296.53 (F31.4) Severe
296.54 (F31.5) With psychotic features
296.55 (F31.75) In partial remission
296.56 (F31.76) In full remission
296.50 (F31.9) Unspecified
296.7 (F31.9) Current or most recent episode unspecified

296.89 (F31.81) Bipolar II Disordera (132)
Specify current or most recent episode: Hypomanic, Depressed
Specify course if full criteria for a mood episode are not currently met: In

partial remission, In full remission
Specify severity if full criteria for a mood episode are currently met:

Mild, Moderate, Severe

DSM-5 Classification xvii

301.13 (F34.0) Cyclothymic Disorder (139)
Specify if: With anxious distress

___.__ (___.__) Substance/Medication-Induced Bipolar and Related Disorder (142)
Note: See the criteria set and corresponding recording procedures for

substance-specific codes and ICD-9-CM and ICD-10-CM coding.
Specify if: With onset during intoxication, With onset during withdrawal

293.83 (___.__) Bipolar and Related Disorder Due to Another Medical Condition
(145)

Specify if:
(F06.33) With manic features
(F06.33) With manic- or hypomanic-like episode
(F06.34) With mixed features

296.89 (F31.89) Other Specified Bipolar and Related Disorder (148)

296.80 (F31.9) Unspecified Bipolar and Related Disorder (149)

Depressive Disorders (155)
The following specifiers apply to Depressive Disorders where indicated:
aSpecify: With anxious distress (specify current severity: mild, moderate, moderate-severe,

severe); With mixed features; With melancholic features; With atypical features; With mood-
congruent psychotic features; With mood-incongruent psychotic features; With catatonia
(use additional code 293.89 [F06.1]); With peripartum onset; With seasonal pattern

296.99 (F34.8) Disruptive Mood Dysregulation Disorder (156)

___.__ (___.__) Major Depressive Disordera (160)
___.__ (___.__) Single episode
296.21 (F32.0) Mild
296.22 (F32.1) Moderate
296.23 (F32.2) Severe
296.24 (F32.3) With psychotic features
296.25 (F32.4) In partial remission
296.26 (F32.5) In full remission
296.20 (F32.9) Unspecified
___.__ (___.__) Recurrent episode
296.31 (F33.0) Mild
296.32 (F33.1) Moderate
296.33 (F33.2) Severe
296.34 (F33.3) With psychotic features
296.35 (F33.41) In partial remission
296.36 (F33.42) In full remission
296.30 (F33.9) Unspecified

300.4 (F34.1) Persistent Depressive Disorder (Dysthymia)a (168)
Specify if: In partial remission, In full remission
Specify if: Early onset, Late onset
Specify if: With pure dysthymic syndrome; With persistent major depres-

sive episode; With intermittent major depressive episodes, with current

xviii DSM-5 Classification

episode; With intermittent major depressive episodes, without current
episode

Specify current severity: Mild, Moderate, Severe

625.4 (N94.3) Premenstrual Dysphoric Disorder (171)

___.__ (___.__) Substance/Medication-Induced Depressive Disorder (175)
Note: See the criteria set and corresponding recording procedures for

substance-specific codes and ICD-9-CM and ICD-10-CM coding.
Specify if: With onset during intoxication, With onset during withdrawal

293.83 (___.__) Depressive Disorder Due to Another Medical Condition (180)
Specify if:

(F06.31) With depressive features
(F06.32) With major depressive-like episode
(F06.34) With mixed features

311 (F32.8) Other Specified Depressive Disorder (183)

311 (F32.9) Unspecified Depressive Disorder (184)

Anxiety Disorders (189)

309.21 (F93.0) Separation Anxiety Disorder (190)

313.23 (F94.0) Selective Mutism (195)

300.29 (___.__) Specific Phobia (197)
Specify if:

(F40.218) Animal
(F40.228) Natural environment
(___.__) Blood-injection-injury
(F40.230) Fear of blood
(F40.231) Fear of injections and transfusions
(F40.232) Fear of other medical care
(F40.233) Fear of injury
(F40.248) Situational
(F40.298) Other

300.23 (F40.10) Social Anxiety Disorder (Social Phobia) (202)
Specify if: Performance only

300.01 (F41.0) Panic Disorder (208)

___.__ (___.__) Panic Attack Specifier (214)

300.22 (F40.00) Agoraphobia (217)

300.02 (F41.1) Generalized Anxiety Disorder (222)

___.__ (___.__) Substance/Medication-Induced Anxiety Disorder (226)
Note: See the criteria set and corresponding recording procedures for

substance-specific codes and ICD-9-CM and ICD-10-CM coding.
Specify if: With onset during intoxication, With onset during withdrawal,

With onset after medication use

DSM-5 Classification xix

293.84 (F06.4) Anxiety Disorder Due to Another Medical Condition (230)

300.09 (F41.8) Other Specified Anxiety Disorder (233)

300.00 (F41.9) Unspecified Anxiety Disorder (233)

Obsessive-Compulsive and Related Disorders (235)
The following specifier applies to Obsessive-Compulsive and Related Disorders where indicated:
aSpecify if: With good or fair insight, With poor insight, With absent insight/delusional beliefs

300.3 (F42) Obsessive-Compulsive Disordera (237)
Specify if: Tic-related

300.7 (F45.22) Body Dysmorphic Disordera (242)
Specify if: With muscle dysmorphia

300.3 (F42) Hoarding Disordera (247)
Specify if: With excessive acquisition

312.39 (F63.3) Trichotillomania (Hair-Pulling Disorder) (251)

698.4 (L98.1) Excoriation (Skin-Picking) Disorder (254)

___.__ (___.__) Substance/Medication-Induced Obsessive-Compulsive and
Related Disorder (257)

Note: See the criteria set and corresponding recording pro

Treatment Plan

Psychological Treatment Plan

****DUE SATURDAY JANUARY 22, 2022

****PLEASE FOLLOW ALL INSTRUCTION THOROUGHLY****

****PLEASE READ ALL ATTACHMENTS COMPLETELY****

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