Category Archives: Mental Health Diagnosis

Feeding and Eating Disorders: DSM-5 Diagnostic Codes





Feeding disorders: Overview

Some of the more common feeding disorders in infants and young children include pica, rumination disorder, and avoidant/restrictive food intake disorder. These disorders can be very complex and difficult to treat. Successful feeding requires a nurturing relationship between the child and caregiver. Among individuals with feeding disorders, frequently a serious disruption has occurred, or some type of psychopathology has been found between the child and caregiver. The temperament of the child may also be a factor in the development of feeding difficulties. As in eating disorders, feeding disorders feature avoidant and restrictive food intake although unlike with eating disorders, feeding disorders usually are first identified in early childhood rather than in the adolescent years. Currently, prevalence rates for feeding disorders are not well defined.

Eating Disorders: Overview

Eating disorders in adolescents and adults are very similar to feeding disorders in children and infants in that they are very complex, multifaceted and difficult to treat. Also, like feeding disorders, eating disorders have a significant impact upon an individual’s daily functioning. Eating disorders affect a person’s diet in very significant, negative ways. The disorder can be manifested in various ways including eating either very small amounts or absolutely no food at all (NIMH, 2013). Disorders can affect every aspect of an individual’s life including their physical and emotional health as well as their relationships with others. The eating disorders described in this section include anorexia nervosa, bulimia nervosa and binge eating disorder.

Prevalence Rates and Risk of Eating Disorders:

It is believed that as many as 20 million women and possibly 10 million men have suffered from some type of eating disorder at some time in their lives. It is believed that the rates of eating disorder have increased since the 1950’s. The American Psychiatric Association (2013) concluded that the prevalence rates of eating disorders vary significantly, but as published in the DSM-5, the prevalence rate for anorexia nervosa is approximately 0. 4% among the general population and bulimia nervosa is 1% to 1.5% over a 12-month period of time.

Eating disorders are most often first identified in the adolescent years. Issues related to image, weight and body shape that seem to underlie eating disorders may possibly even begin at a much younger age with approximately 40% to 60% of elementary school girls identifying some concern for their body weight or of becoming fat.
Although eating disorders are more frequently seen in females, males may also be at risk. Most often, men with eating disorders are more focused on making their bodies larger and more muscular as opposed to women who seem to be more interested in making their bodies lighter and smaller.




Cause of Feeding Disorders:

Issues associated with feeding are common among infants and small children although not all of these problems result in feeding disorders. However, it is important to recognize that without intervention, sometimes these difficulties can result in a feeding disorder. The specific interventions require a recognition of developmental and medical causation which may then necessitate specific interventions by either parents, medical or mental health professionals.

Clinicians should consider the characteristics of both the children and caregivers interdependently rather than separately. It is especially important to look at maternal factors when considering the cause of feeding disorders in recognition of the fact that maternal depression, anxiety and other eating disorder symptoms in pregnancy have been found to predict feeding difficulties.

The temperament of the child is also very important. It has been found that many of the children with feeding difficulties seem to have a difficult temperament including displays of angry moods, temper tantrums and aggression.

Cause of Eating Disorders:

As with feeding disorders, eating disorders may be caused by a variety of biological, behavioral, genetic and psychological factors (NIMH, 2013). While some researchers seem to focus on cultural considerations among individuals with eating disorders, it is difficult to identify the relative level of socio-cultural considerations in the development of these disorders. It is imperative to consider eating disorders from a holistic perspective and recognize that the interaction between genetic factors, social and cultural factors such as media images determine their relative contributions.

Many clinicians and researchers focus more on the social and cultural aspects in that the beauty ideals of Western culture seem to overemphasize thinness among women, resulting in a higher level of risk in the development of an eating disorder. Although mainstream media seems to focus on the thinness ideal of media images possibly underlying anorexia nervosa, many people are exposed to these same images and do not develop eating disorders.

Feeding and Eating Disorders Treatment:

Because of the multifactorial social and psychological etiology of feeding and eating disorders which makes these disorders so difficult to treat, treatment also needs to be multi-dimensional in most cases. The specific treatment will be according to the specific presentation and individual, social, psychological, and interpersonal factors involved, with special attention to behavioral, physical and emotional health. Also, of consideration will be the necessary level of care, which can range from inpatient to residential to outpatient treatment. The specific treatment venue will frequently depend upon the severity and/or the presentation of the symptoms.

Because of the secretive nature of eating disorders, these disorders often severely isolate individuals and cause them to be very reluctant to see a therapist or talk to a doctor. It is very common among these patients to refuse treatment for their condition. Psychologists and mental health professionals need to focus on the development of an appropriate, supportive therapeutic relationship and help the individual to understand why treatment may be necessary.

Some of the more common therapeutic treatments for eating disorders are cognitive behavioral therapy, interpersonal psychotherapy and dialectical behavior therapy. Cognitive behavioral therapy is often used for people who experience anorexia and bulimia whereas interpersonal psychotherapy seems to be more effective for individuals battling binge eating. While dialectical behavior therapy has been used to treat various eating disorders, it is often used for patients who have tried other therapeutic interventions and have not been successful.

Special Concerns for Individuals with Eating Disorders:

It is of special concern for counselors and mental health clinicians treating individuals with eating disorders to consider the high level of mortality. The mortality rates of eating disorders may be as high as 4% for anorexia nervosa, 3.9% for bulimia nervosa and 5.2% for eating disorder NOS (Crow et al., 2009). Also due to the complex nature of eating disorders in both the development and treatment, counselors will most likely need to collaborate with various other treatment professionals including physicians, psychiatrists, dietitians and other medical professionals to assist with appropriate treatment.

Additional information related to the specific feeding and eating disorders follow below.

Feeding and Eating Disorders: DSM-5 Diagnostic Codes

The following specifiers apply to feeding and eating disorders where indicated:
Specify if: In Remission
Specify if: In partial remission, In full remission
Specify current severity: Mild, Moderate, Severe, Extreme

307.52 (___.__) Pica
(F98.3) In children
(F50.8) In adults

307.53 (F98.21) Rumination Disorder

307.59 (F50.8) Avoidant/Restrictive Food Intake Disorder

307.1 (___.__) Anorexia Nervosa

Specify whether:
(F50.01) Restricting Type
(F50.02) Binge-eating/purging type

307.51 (F50.2) Bulimia Nervosa

307.51 Binge-eating disorder

307.59 (F50.8) Other Specified Feeding or Eating Disorder

307.50 Unspecified Feeding or Eating disorder

Some information adapted by Paul Susic Ph.D. Licensed Psychologist from the following sources
.
References:

American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.

Crow, S. J., Peterson, C. B., Swanson, S. A., Raymond, N.C. Specker, S., Eckert, E. D., & Mitchell, J. E. (2009). Increased mortality in bulimia nervosa and other eating disorders. American Journal of Psychiatry, 166, 1342-1346.

National Institute of Mental Health. (2013). Eating disorders. Retrieved from http: //www.nimh.nih.gov/health/topics/eating-disorders/index.shtml


Somatic Symptom and Related Disorders: DSM-5 Diagnostic Codes




Somatic Symptom and Related Disorders: Overview

Somatic symptom and related disorders are indicated by the presence of somatic and/or physical concerns, unpleasant thoughts, distress and impairment. People who experience these symptoms usually present to medical professionals for what they believe to be real, distressing physical symptoms. Sharma and Manjula (2013) have concluded that as many as one third to one half of all medical complaints cannot be explained.

Frequently individuals experiencing symptoms that can be defined within the category of somatic symptoms and related disorders are referred by physicians after exhaustive attempts to identify and diagnose the source of physical symptoms. Due to the significant comorbidity between these physical manifestations and depression and anxiety disorders, mental health professionals often find that they are dealing with significant physical distress along with mental health issues.

Changes from DSM-4-TR to DSM-5:

The DSM-4-TR category of Somatoform Disorders was changed to Somatic Symptom and Related Disorders in the DSM-V. Psychologists and other mental health professionals will now find two new diagnostic categories in this section including somatic symptom disorder and illness anxiety disorder. Individuals experiencing somatic concerns with or without current medical conditions can be diagnosed with the new category of somatic symptom disorder if they have both unexplained somatic symptoms and inappropriate or maladaptive reactions to those symptoms (APA, 2013).




The previous diagnosis of hypochondriasis was eliminated by the APA Somatic Symptoms Disorders work group because they believed that it was unnecessarily stigmatizing to patients. Also, they discontinued pain disorder as it was too difficult to determine whether pain was actually due to psychological or physical causes. (APA, 2013).

Diagnosis of Somatic Symptom and Related Disorders:

Because the signs and symptoms of somatic disorders are primarily physical, the initial focus needs to be on completing a comprehensive medical examination to determine the specific apparent cause of the concern. The DSM-5 allows for the consideration of diagnosable health issues along with the distressing reactions to those issues. Therefore, the initial diagnosis may include (a) if there are medical conditions present and (b) whether the individual’s reaction will be in excess to what would be expected in relation to those medical concerns.

The coexistence or comorbidity between somatic symptoms and mental health symptoms such as depression and anxiety is enormous. Frequently there seems to be significant cultural aspects to expressing depression and anxiety related symptoms somatically. Also, somatic and anxiety symptoms are often seen among individuals with substance use issues and patients who have experienced trauma making it imperative to also consider the possibility of PTSD in the differential diagnosis.

Cause and Treatment:

Somatoform disorders were initially considered to be psychodynamic reactions to stressors in which the patient was believed to be converting psychological issues into physical symptoms in attempting to cope with the stress. There are currently several models for potentially explaining the cause of somatic symptoms and related disorders. The APA (2013) have identified early traumatic experiences, social learning and social and cultural norms as well as biological and genetic vulnerability. So (2008) has concluded:

Ethnographic fieldwork has long indicated the presence of a specific type of culturally mediated illness where the individual suffering from psychological issues expresses distress in the form of physical symptoms and somatic complaints, with no known organic cause. In Western psychiatry this phenomenon is commonly labeled somatization disorder (p.68)

Most researchers have found a paucity of research into somatic symptom and related disorders due to their rarity. Sharma and Manjula (2013) have stated:

The basic premise of any psychological intervention in disorders with somatic symptoms is that somatization is a universal phenomenon and is a direct consequence of common psychological disorders such as anxiety or depression resulting in autonomic arousal symptoms or somatic complaints; it may be an idiom for help-seeking for severe social adversities such as poverty, domestic violence, stigma, associated with mental illness (p.117).

Referral for treatment usually occurs within the primary care setting and includes psychiatric or psychological consultation and intervention, reattribution therapy, cognitive behavioral therapy and/or a problem-solving approach (Sharma & Manjula (2013). In most cases, cognitive behavioral therapy has been found to be the most effective. Treatments for what was previously referred to as hypochondriasis in the DSM-4-TR and now defined as somatic symptom disorder or illness anxiety disorder frequently involves cognitive behavioral therapy, medication and psychoeducation.

Psychoeducation may be most appropriate when used for milder concerns and seems to concentrate on facilitating increased coping strategies and recognizing the role of stress in physical manifestations, as well as training in relaxation instead of attempts to convince individuals that their symptoms are unreal or “only in their heads”. Among the antidepressants, fluoxetine seems to be most helpful especially for symptoms that were formally referred to as hypochondriasis.

As with all counseling related therapeutic interventions, the therapeutic relationship is absolutely essential when working with people with somatic symptom and related disorders, especially given the fact that individuals may have experienced significant frustration from the medical conditions and healthcare providers who have a lack of understanding of the etiology of their symptoms. Because of the lack of understanding by both patients and clinicians, individuals experiencing these somatic symptoms can become very frustrated, feeling misunderstood, and will be quick to discontinue treatment if they feel that they are not being taken seriously.

Please see the following pages for specific symptoms and treatment information related to each diagnosis within the category of somatic symptom and related disorders.

Somatic Symptom and Related Disorders: DSM-5 Diagnostic Codes

300.82 (F45.1) Somatic Symptom Disorder
Specify if: With predominant pain
Specify if: Persistent
Specify current severity: Mild, Moderate, Severe

300.7 (F45.21) Illness Anxiety Disorder
Specify whether: Care seeking type, Care avoidant type

300.11 (___.__) Conversion Disorder (Functional Neurological Symptom Disorder)

(F44.4) With weakness or paralysis
(F44.4) With abnormal movement
(F44.4) With swallowing symptoms
(F44.4) With speech symptom
(F44.5) With attacks or seizures
(F44.6) With anesthesia or sensory loss
(F44.6) With special sensory symptom
(F44.7) With mixed symptoms
Specify if: Acute episode, persistent
Specify if: With psychological stressor (specify stressor), Without psychological stressor

316 (F54) Psychological Factors Affecting Other Medical Conditions
Specify current severity: Mild, Moderate, Severe, Extreme

300.19 (F68.10) Factitious Disorder (includes Factitious Disorder Imposed on Self, Factitious Disorder Imposed on Another)
Specify Single episode, Recurrent episodes

300.89 (F45.8) Other Specified Somatic Symptom and Related Disorder

300.82 (F45.9) Unspecified Somatic Symptom and Related Disorder

Some information adapted by Paul Susic Ph.D. Licensed Psychologist from the following sources.

References:

American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.

Sharma, M.P., & Manjula, M. (2013). Behavioral and psychological management of somatic symptom disorders: An overview. International Review of Psychiatry, 25, 116-124. doi:10.3109/09540261.2012.746649

So, J.K. (2008). Somatization as cultural idiom of distress: Rethinking mind and body in a multicultural society. Counseling Psychology Quarterly, 21, 167-174. doi:10.1080/09515070802066854



Signs of Nursing Home Neglect and Elder Abuse




By: Aaron Crane

Moving a loved one into a nursing home is a difficult decision. Families doing this expect their loved one to be treated properly and with dignity. The unfortunate truth is that nursing home neglect happens more often than one expects, affecting millions of people in America every single year.




Vulnerability of Nursing Home Residents

Nursing home residents are most often not able to care for themselves any longer and are admitted into such a living situation because of their personal vulnerability to injury or death if not cared for in supervised accommodations. Most residents are over the age of 65, although some may be younger people with disabilities.

Many of these residents do not have another place to live due to limited personal resources or few family members in close proximity. Families unable to care for their elderly loved ones may place them in a home to ensure they receive the best possible attention and treatment that cannot be provided at home. Lack of space, financial issues, long work hours, other obligations and situations may apply that prevent families from caring for their own family members in a family environment.

Neglect of Nursing Home Residents

One in three residents of nursing homes suffer from neglect, according to recent studies of American eldercare homes. Neglect is a failure to provide the attention and services required for personal security and comfort of residents. Neglect is not always an intentional act by nursing home staff or management. It is the existence of the situation that causes danger, harm and anxiety to people living in these homes, however.

Federal and state laws regulate how nursing homes must be operated. Neglect can be attributed to overlooking issues of importance, ignoring resident needs and even direct actions of staff leading to grief or misery of residents, whether or not physical harm occurs.

Warning Signs of Nursing Home Neglect

Nursing home residents who do not have regular contact with family members are more often the victims of neglect than those who are frequently visited by family members. Family visitations should include careful observance of the elderly person to look for any signs of neglect or abuse.

Bed sores, stiff joints and other physical signs may be present to indicate there is a problem of neglect when the individual is left in one position for too long on a bed or in a chair. Medical neglect can occur when ailments or injuries are not treated or are improperly handled. There may also be signs of behavioral changes in the elderly person, staff behavior changes toward the patient or limited access to your loved one. Malnutrition and dehydration may also be present. You may have noticed increased frequency of trips to the E.R., hospital or other medical facilities.

Prevention of Nursing Home Neglect

There are many ways that nursing home neglect may occur. But many incidents can be prevented. By being aware and observant of the circumstances of your loved one’s living arrangements, behaviors and care, you can be quick to notice nursing home neglect, should it occur.

Ongoing and regular family contact is the best way to keep nursing home neglect from happening. A thorough background check should be conducted into the performance of a particular nursing home before family members are admitted to the facility. Medical boards provide information about infractions or problems at a nursing home, in regard to abuse and neglect. Caretakers should be screened through background checks by a nursing home prior to employment. This can be confirmed before admitting someone you love into such a facility.

When Nursing Home Neglect or Abuse Occurs

When nursing home neglect or abuse is suspected, it should be promptly reported to law enforcement. Such abuse or neglect can lead to criminal activity at the facility, if left unchecked. When injuries are discovered, medical attention should be provided through licensed medical professionals outside of the nursing home to ensure the victim is treated and issues causing the problem are resolved.

A Lawyer Helps in Cases of Nursing Home Neglect or Abuse

Whenever nursing home neglect or abuse occurs, it is important to contact a legal representative. This lawyer should be experienced in nursing home care issues and protection of victims living in these facilities. The lawyer can investigate the problems of the facility and gather evidence of abuse or neglect for the case. Lawyers may recommend hiring an expert witness who can help substantiate claims of neglect and abuse and in regard to injuries suffered by the victim. A qualified lawyer can help locate other victims within the establishment who may have suffered the same abuse or neglect.

If you know someone that is victim of elder abuse due to nursing home neglect, contact Cantor Crane today.

Article Source:
http://www.articlebiz.com/article/1051637355-1-signs-of-nursing-home-neglect-and-elder-abuse/


Dissociative Disorders: DSM-V Diagnostic Codes




Dissociative Disorders: Overview

In order to diagnose and treat dissociative disorders, you need to understand the basic concept that dissociation refers to a disconnection or lack of connection between two things that are associated with each other. The DSM-V published by the American Psychiatric Association in 2013 states that dissociative disorders “are characterized by disruption of and/or discontinuity of the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior.” They also go on to state that dissociation symptoms are “”a” unbidden and unpleasant intrusions into awareness and behavior, with accompanying losses of continuity in subjective experience (i.e. “positive” dissociative symptoms); and/or “b” and inability to access information or to control mental functions that normally are readily amenable to access or control; (i.e. ‘negative’ dissociative symptoms” (APA, 2013, p. 826).

Some research indicates that about three quarters of people will experience disassociation after a traumatic experience. It is believed that the brain tries to protect itself when individuals experience distressing, traumatic circumstances, although most people will not go on to develop a dissociative disorder.

Diagnostic Considerations:

The International Society for the Study of Trauma and Dissociation (2013) have addressed five different types of dissociation considered in the DSM-V: depersonalization, derealization, amnesia, identity confusion, and identity alteration. Depersonalization is usually referred to as a “sense of being detached from, or “not in” one’s body,” whereas derealization is a sense of the world not being real. Amnesia is a loss in the ability to retrieve information that has previously been stored, which an individual should remember. Identity confusion refers to an unusual change in an individual’s sense of self. Identity alteration “is the sense of being markedly different from another part of oneself…subtler forms of identity alteration can be observed when a person uses different voice tones, range of language, or facial expressions” (ISSTD, 2003, para.7).




As with other mental health disorders, dissociative symptoms may overlap with other disorders, and may be caused by medical illness or be related to substance use and abuse. Neurological conditions have been found that seem to mimic dissociative disorders such as traumatic brain injuries, seizures and neurocognitive disorders.
Substances of use and abuse have also been known to trigger dissociative symptoms such as marijuana, hallucinogenics, ecstasy, ketamine, and salvia (APA, 2013). All clients who present to mental health clinicians with dissociative symptoms need to be referred for a medical evaluation to determine whether treatment is ethically within their field of expertise.

Traumatic experiences are always at the very core of the development of dissociative symptoms. Psychologists and mental health clinicians always need to consider the possibility of a diagnosis of posttraumatic stress disorder or acute stress disorder, in order to determine whether these diagnoses would better address the dissociative symptoms. Clients and patients with dissociative disorders sometimes describe out of body experiences, sometimes have been known to believe they are possessed or even hear voices that may cause a clinician to believe the patient has a psychotic disorder or the psychotic symptoms associated with depression.

Dissociative disorders are comorbid with several other mental health diagnosis including anxiety, depression and substance use disorders. Among children, disassociation has frequently been misidentified as behavioral concerns such as inattention ADHD and temper tantrums as well as oppositional defiant disorder.

Prevalence:

The prevalence rate of these disorders is relatively high, usually estimated to be in the range of 2% to 10% of the general population. Individuals experiencing these disorders are vulnerable and at high risk. They are known to be at a very high risk of comorbid disorders and suicidal behaviors.

Cause:

While researchers have concluded that there does not appear to be a genetic component to dissociation, there does appear to be environmental and biological factors involved. In almost all cases, dissociative disorders appear to be linked to traumatic experiences, frequently early in life. Some of precipitating experiences for children and adolescents seem to involve emotional, physical and sexual abuse; experiencing violence; the death or loss of loved ones; chronic neglect; physical injury, accidents, disasters and medical procedures. In the case of dissociative identity disorder, the American Psychiatric Association (2013) have identified a 90% prevalence rate of childhood abuse and neglect. Depersonalization/derealization disorder seems to be linked to the experience of interpersonal conflicts and emotional abuse.

Treatment:

Among adults, dissociative disorders seem to be some of the most difficult mental conditions to treat. Although dissociative disorders are almost always associated with trauma, some of the traditional treatments for acute posttraumatic stress disorder such as exposure therapy are ineffective and frequently even counterproductive with these individuals. The effectiveness of medications has also had mixed reviews.

Treatment for dissociative disorders is usually conducted on a individual basis in an outpatient setting over a long period of time. Many of the treatments are psychodynamic in nature, also incorporating other approaches such as cognitive behavioral therapy, dialectical behavior therapy, eye movement desensitization and reprocessing and hypnosis. Most people with dissociative identity disorder receive medications to relieve the distressing symptoms.

Specific information related to each of the dissociative disorders and related treatments are on the following pages below.

Dissociative Disorders: DSM-V Diagnostic Codes

300.14 (F44.81) Dissociative Identity Disorder

300.12 (F44.0) Dissociative Amnesia

Specify if:

300.13 (F44.1) With dissociative fugue

300.6 (F48.1) Depersonalization/Derealization Disorder

300.15 (F44.89) Other Specified Dissociative Disorder

300.15 (F44.9) Unspecified Dissociative Disorder

References:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.

International Society for the Study of Dissociation. (2004). Guidelines for the evaluation and treatment of dissociative symptoms in children and adolescents. Journal of Trauma & Dissociation, 5, 119-150. doi: 10. 1300/J229v05n03_09


Disruptive, Impulse-Control, and Conduct Disorders: DSM-V Diagnostic Codes





Disruptive, Impulse-Control, and Conduct Disorders: Overview

Basic characteristics of disorders that fall within the category of disruptive, impulse-control, and conduct disorders are aggressive and self-destructive behaviors, destruction of property, conflict with authority figures, disregard for personal or social norms, and persistent outbursts of anger disproportionate to the situation (APA, 2013). Behaviors within this category are behaviors that infringe upon or violate the rights of others or vary significantly from the norms of society.

It is important to understand that nearly all children and adolescents experience symptoms of defiance, disobedience, and breaking rules at some point in their childhood development. In disruptive, impulse-control, and conduct disorders the behaviors are much more frequent, pervasive and result in impairment to the individual’s lives. These behaviors also significantly exceed the normative behaviors for their culture, age and gender.

Diagnostic Considerations:

Although the underlying cause of these disorders vary, they all seem to share the common characteristics of problems in regulating behaviors and emotions. All of these disorders result in significant impairment in daily functioning. These disorders are less common in females than males and the age of onset tends to be in childhood or adolescence. It is considered very rare for these types of behaviors to first manifest themselves in adulthood. There appears to be a developmental relationship between conduct disorder and oppositional defiant disorder in that individuals who receive a diagnosis of conduct disorder in their preadolescent years frequently have been diagnosed with oppositional defiant disorder at an earlier point in time. Approximately two thirds of children diagnosed with oppositional defiant disorder still meet the diagnostic criteria three years later. One of the higher risk indicators for conduct disorder is an earlier onset and diagnosis of oppositional defiant disorder. Researchers have concluded that children are three times more likely to receive a diagnosis of conduct disorder if they were previously diagnosed with oppositional defiant disorder. Also, mental health clinicians need to closely monitor clients with conduct disorder as there is a very strong connection between conduct disorder and antisocial personality disorder. Approximately 40% of individuals diagnosed with conduct disorder eventually meet the criteria for a diagnosis of antisocial personality disorder.




Developmental Causation:

There has been much research over the years related to the cause and/or etiology of disruptive, impulse control and conduct disorders. The most common causative factors include environmental, emotional, familial, and genetic factors. Although grouped together, there appear to be various and at times different developmental pathways to each disorder. Research has not currently identified many genetic factors associated with the disruptive behavior disorders although the genetic links to ADHD appear to be significant. Also, the biological contributions to disruptive or conduct disorders appear to be very limited. Most research and clinical experience seem to identify environmental causation to be the most significant. Negative experiences within the family including substance abuse by caregivers, caregiver criminality, low socioeconomic status, severe family dysfunction, negative interactions between parent and children, modeling of aggression, and abuse and neglect have been identified as some of the higher risk factors associated with the development of these disorders.

Some cognitive deficits have also been identified which include social-cognitive information processing and issues related to being rejected by peers. Neurological research has identified brain structures within the limbic system which is associated with the formation of emotions and memories in the frontal lobe, which is involved in planning and controlling impulses, and have also been identified as having some connection to disruptive and conduct disorders. In addition to the neurological irregularities, there has been some suggestion that imbalances in testosterone may also play some role in the development of disruptive behavioral and impulse control behaviors.

Treatment:

Treatment for the disruptive, impulse-control and conduct disorders can be very complex due to the various risk and etiological factors. Evidence-based treatments for these disorders usually falls within the categories of parent and family interventions, cognitive behavioral therapy and psychopharmacological treatment.

Psychosocial treatments or counseling related interventions usually seem to focus on parent training approaches which include improving positive time between parents and children, modeling behaviors, behavioral reinforcement of rewards and consequences and the development of positive coping skills for dealing with difficult behaviors.
Cognitive behavioral therapy can help to modify cognitive distortions which seem to underly disruptive behaviors. These therapeutic approaches assist children and adolescents to develop better problem-solving skills focused on improving control, recognizing social difficulties and triggers for their disruptive behaviors, and pursuing more effective alternatives. Interventions focusing on the parents and appropriate medications are also very common.
For very young children, parent training should be the primary treatment approach. For more chronic or severe behaviors, psychologists and mental health clinicians should consider a multidimensional treatment approach that involves teachers, parents, and mental health providers.

Individuals diagnosed with pyromania and kleptomania have been found to respond to psychopharmacological interventions. Also, cognitive behavioral therapy and dialectical therapy have been found to be helpful in some circumstances.

Individual diagnostic codes related to disruptive, impulse control and conduct disorders along with specific etiological and treatment information can be found on the following pages.

Disruptive, Impulse-Control, and Conduct Disorders: DSM-V Diagnostic Codes

313.81 (F91.3) Oppositional Defiant Disorder
Specify current severity: Mild, Moderate, Severe

312.34 (F63.81) Intermittent Explosive Disorder

___.__ (___,__) Conduct Disorder

Specifiy whether:
312.81 (F91.1) Childhood-onset type

312.32 (F91.2) Adolescent-onset type

312.89 (F91.9) Unspecified onset

Specify if: With limited prosocial emotions
Specify current severity: Mild, Moderate, Severe

301.7 (F60.2) Antisocial Personality Disorder

312.33 (F63.1) Pyromania

312.32 (F63.3) Kleptomania

312.89 (F91.8) Other Specified Disruptive, Impulse-Control, and Conduct Disorder

312.9 (F91.9) Unspecified Disruptive, Impulse-Control, and Conduct Disorder

Some information adapted by Paul Susic Ph.D. Licensed Psychologist from the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) of the American Psychiatric Association (2013)



Trauma and Stressor-Related Disorders: DSM-V Diagnostic Codes




Trauma and Stressor-Related Disorders: New category

The trauma and stressor related disorders category is a new chapter in the DSM-V. This category now includes post traumatic stress disorder, acute stress disorder, reactive attachment disorder (RAD), adjustment disorders and the new diagnostic category, disinhibited social engagement disorder (DSED). In the previous DSM-IV-TR, acute stress disorder and posttraumatic stress disorder were included in the anxiety disorders category. These disorders are now included in the same diagnostic category in the DSM-V because of their common roots in external events.

Trauma and Stressor-Related Disorders: Overview

Besides being placed in the new category, a significant change includes the necessity for the stressor criterion for posttraumatic stress disorder and acute stress disorder to be met. The stressor or traumatic event can be either directly or indirectly experienced or witnessed by an individual receiving a diagnosis of either post traumatic stress disorder or acute stress disorder. The traumatic event can be experienced by a family member or friend, having a significant effect on the individual receiving the diagnosis.

The term trauma usually refers to a significant response to a very distressing experience such as a terrible accident, sexual assault, abuse, combat or exposure to natural or human disasters. Stressful events can be either emotionally or physically harmful or both and can involve either a single experience or repetitive events over a period of time. Traumatic events can affect different people in very different ways, but have the overall experience of threatening their physical, emotional or spiritual welfare. The trauma is always experienced as overwhelming the individual’s ability to cope.

Some of the more common traumatic events have included sexual and physical assault, robbery, combat, terrorist attacks being kidnapped and taken hostage, being tortured, disasters, child abuse, automobile accidents and life-threatening illnesses. Traumatic events may also include witnessing a person’s death or serious injury through violence, war, accidents or natural disasters.




Prevalence:

The prevalence rate of traumatic related disorders is very high among the general population in the United States. The lifetime prevalence rate among men is 3.6% with a rate of 9.7% among women. The rate among children does not seem to be currently available although it is recognized that children who have experienced traumatic events are also at very high risk of developing posttraumatic stress disorder. The prevalence rates of acute stress disorder are between 6% and 94% depending upon the type of stressor involved. It is estimated that approximately 1% of children under the age of five have some degree of reactive attachment disorder. Children who are placed in foster care or are orphaned are at a much higher risk of developing reactive attachment disorder. Adjustment disorders are estimated to be between 2% and 8% in community-based samples of children, adolescents and among the elderly.

Diagnosis:

The onset of traumatic stress related disorders also increases the risk of associated mental health disorders such as anxiety, depression, sleeping and eating disorders, problems with substance use and suicidal ideation. It is also common for individuals diagnosed with a traumatic or stress related disorder to also have symptoms of somatic symptom disorder and/or attention deficit hyperactivity disorder and impulse control disorders. Many children who survived traumatic events are also misdiagnosed as having attention deficit hyperactivity disorder. Children diagnosed with reactive attachment disorder are also frequently mistaken for children with attention deficit hyperactivity disorder or oppositional defiant disorder and frequently have behavioral problems during childhood and throughout their adolescent years.

Important information:

It is important for mental health counselors and clinicians to understand that with the new category of traumatic stress related disorders that the most fundamental feature is trauma rather than anxiety serving as the precipitant to the development of the disorder.
Specific information and treatment information related to each of the individual diagnosis within the category of trauma and stress related disorders follows on subsequent pages.

Trauma and Stressor-Related Disorders: DSM-V Diagnostic Codes

313.89 (F94.1) Reactive Attachment Disorder
Specify if: Persistent
Specify current severity: Severe

313.89 (F94.2) Disinhibited Social Engagement Disorder

Specify if: Persistent
Specify current severity: Severe

309.81 (F43.10) Posttraumatic Stress Disorder (includes Posttraumatic Stress Disorder for Children 6 Years and Younger)

Specify whether: With dissociative symptoms
Specify if: With delayed expression

308.3 (F43.0) Acute Stress Disorder

___.__ (___.__) Adjustment Disorders

Specify whether:
309.0 (F43.21) With depressed mood
309.24 (F43.22) With anxiety
309.28 (F43.23) With mixed anxiety and depressed mood
309.3 (F43.24) With disturbance of conduct
309.4 (F43.25) With mixed disturbance of emotions and conduct
309.9 (F43.20) Unspecified
309.89 (F43.8) Other Specified Trauma-and Stressor-Related Disorder
309.9 (F43.9) Unspecified Trauma-and Stressor-Related Disorder

Diagnostic Information and Criterion for Trauma and Stressor-Related Disorders adapted from the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition American Psychological Association by Paul Susic Ph.D. Licensed Psychologist



Schizophrenia Spectrum and Other Psychotic Disorders DSM-5 Diagnostic Codes:





Schizophrenia Spectrum and Other Psychotic Disorders DSM-5 Diagnostic Codes: Overview

Psychiatric diagnosis that fall within the category of schizophrenia spectrum and other psychotic disorders are characterized by abnormalities in one or more of the following five categories: hallucinations, delusions, disorganized thinking, disorganized or abnormal motor behavior (including catatonia) negative symptoms. This section includes information related to each of the specific schizophrenia spectrum and other psychotic disorders included in the DSM-5. These include delusional disorder, brief psychotic disorder, schizophreniform disorder, schizophrenia, schizoaffective disorder, substance/medication-induced psychotic disorder, psychotic disorder due to another medical condition and catatonia.

Psychotic disorders involve a variety of both positive and negative as well as some related cognitive symptoms. Positive symptoms involve thoughts and behaviors that you would not usually expect while negative symptoms involve the absence of expected experiences. Some of the basic positive symptoms include hallucinations and delusions, as well as thinking or movement disorders in which the individual seems to lose touch with reality. Hallucinations are sensory experiences such as visual and auditory hallucinations, olfactory hallucinations, gustatory hallucinations (tasting), or tactile or somatic hallucinations in which a person feels things that are not really there or do not seem to have an actual physical stimulus. Delusions are rigid beliefs that do not seem to have any basis in reality and from which an individual cannot be persuaded otherwise. Auditory hallucinations seem to be the most common and tactile hallucinations are frequently associated with withdrawal or intoxication from substances. Olfactory and gustatory hallucinations often indicate a possible underlying medical problem. Disorganized thoughts often referred to as thought disorder involves disruptions in thinking in such a way that communication becomes difficult. Disorganized or abnormal motor behavior frequently referred to as movement disorder, includes agitation, recurrent motions or an inability to respond or move in relation to specific stimuli such as with catatonia.

Negative symptoms within the schizophrenia spectrum category include a lack of motivation, pleasure or engagement in what are believed to be normal activities of daily living or the normal experiencing of emotion. Problems with cognitive symptoms are usually related to having a difficulty with executive functioning, memory or attention.

Schizophrenia Spectrum and Other Psychotic Disorders: Prevalence

According to the APA (2013) psychotic disorders are fairly uncommon, citing prevalence rates of disorders within the schizophrenia spectrum category to range from 0.2% to 0.7%. These do not account for any cross-cultural considerations that are not identified in the DSM-5 but seem to be commonly found in specific cultures throughout the world.




Individuals who experience psychotic disorders have various characteristics and experiences. For about 50% of the individuals diagnosed within this category, they experience a lifelong struggle of trying to maintain their symptoms and a modest level of functioning in their lives. A small minority of individuals who have a later age of onset and frequently a higher level of functioning, seem to be able to manage their symptoms more adequately over their lifetime.

The presence of positive symptoms of psychosis does not always indicate the presence of a psychotic disorder. Medical conditions and substance use and abuse can also lead to the onset and often the exacerbation of psychotic symptoms. In many or most cases, it is probably better for a mental health clinician to refer clients with psychotic symptoms for a thorough medical examination.

Cause and Treatment:

At the present time, researchers have not determined the cause of schizophrenia and other psychotic disorders. Medical conditions and substance use as well as other mental health conditions can lead or contribute to the severity of schizophrenia spectrum and other psychotic disorders. Studies have found a strong genetic connection among individuals with schizophrenia spectrum disorders and have identified various physiological conditions associated with psychosis. Individuals with first-degree relatives who have a condition within the schizophrenia spectrum may be as much as 10 times higher risk of developing the symptoms of psychotic disorders. Neuroscientific researchers have found that individuals with schizophrenic spectrum disorders have different brain structures and physiological components from those who do not.

The main focus of the treatment of schizophrenia and related disorders includes medications for the relief of symptoms and the management of relapse. Psychological interventions are used to promote coping, and for preventing relapse, providing assistance through supportive measures to attain the highest level of functioning in an individual’s activities of daily life.

The same treatment principles seem to apply to all disorders within the schizophrenic spectrum. In the acute phase, clinicians will try to manage the most acute symptoms through medication management and supportive services. Following the medication management of the acute symptoms, clinicians may then focus more on psychosocial treatments to reduce stress and assist the client and their families through psychoeducation and supportive services to maintain a relatively higher managed level of psychosis that allows them to function at the highest level possible in their lives. Finally, as they continue with their medications, clinicians can then attend to preventing relapse through psychological treatments which include skills training, psychoeducation, cognitive behavioral therapy, family interventions, supported employment and other psychological support services within the treatment community. Strong therapeutic relationships have been identified to be very important in assisting and promoting more positive attitudes and compliance with medications.

Please see below the specific schizophrenia spectrum and other psychotic disorders diagnostic codes as well as important diagnostic and treatment information.

Schizophrenia Spectrum and Other Psychotic Disorders DSM-5 Diagnostic Codes:

301.22 (F21) Schizotypal (Personality) Disorder

297.1 (F22) Delusional Disorder

Specify whether: Erotomanic type, Grandiose type, Jealous type, Persecutory type, Somatic type, Mixed type, Unspecified type

298.8 (F23) Brief Psychotic Disorder

Specify if: With marked stressor(s), Without marked stressor(s), With postpartum onset

295.40 (F20.81) Schizophreniform Disorder

Specify if: With good prognostic features, Without good prognostic features

295.90 (F20.9) Schizophrenia

___.__ (__.__} Schizoaffective Disorder
Specify whether:

295.70 (F25.0) Bipolar Type

295.70 (F25.1) Depressive Type

___.__ (__.__) Substance/Medication-Induced Psychotic Disorder

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 Condition
Specify whether:

293.81 (F06.2) With Delusions

293.82 (F06.0) With Hallucinations

293.89 (F0 61) Catatonia Associated With Another Mental Disorder (Catatonia Specifier)

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

293.89 (F06.1) Unspecified Catatonia
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

298.9 (F29) Unspecified Schizophrenia Spectrum and Other Psychotic Disorder

Diagnostic Information and Criterion for Schizophrenia Spectrum and Other Psychotic Disorders adapted from the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition American Psychological Association by Paul Susic Ph.D. Licensed Psychologist


Obsessive-Compulsive and Related Disorders: DSM-5 Diagnostic Codes




Obsessive-Compulsive and Related Disorders: Introduction

Conditions which fall within the category of Obsessive-Compulsive and Related Disorders all share some key features of obsessions and compulsions. Obsessions are recurrent, persistent and intrusive anxiety provoking thoughts or images resulting in subsequent repetitive behaviors referred to as compulsions. Obsessions may include thoughts, feelings, ideas and sensations that compel a person to do specific behaviors or compulsions. Some of the more common obsessions include excessive counting, ruminating about physical flaws, hoarding and picking at one’s skin. Some of the resulting rituals which are common among individuals diagnosed with obsessive-compulsive disorder frequently include recurrent handwashing, frequently checking doors and locks and avoidance of specific situations. For an individual to be considered for a diagnosis of obsessive-compulsive disorder it must be disruptive to their daily existence and functioning. Disorders listed in this category all share the common feature of excessive preoccupation along with the subsequent engagement in repetitive behaviors.

Changes from the DSM-4 TR to the DSM-5:

There were significant changes from previous editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM). Obsessive-compulsive disorder was previously classified in the DSM-4 TR as an anxiety disorder. The new DSM-5 has created a standalone chapter separate from the other anxiety disorders. This also follows revisions within the ICD 10 CM which also classifies OCD separately from anxiety disorders. However, there should never be any confusion as to the close relationship between obsessive-compulsive disorders and anxiety disorders. When the separation of obsessive-compulsive disorder from anxiety disorders was anticipated prior to the publication of the new DSM-5, psychiatrists supported the move significantly more often than other mental health clinicians, with only 40% to 45% of other mental health professionals supporting the move to the new category. Many psychologists, counselors and other mental health professionals did not support the change because of the fact that most treatment protocols for obsessive-compulsive disorder are also similar for anxiety and other related disorders. As is the case with most anxiety related disorders and depression, comorbidity is frequently the rule rather than the exception.




Some of the new disorders that fall within this category include excoriation (skin picking) disorder, substance/medication -induced obsessive compulsive and related disorder, hoarding disorder and obsessive-compulsive and related disorder due to another medical condition. Also, the diagnosis of trichotillomania (hair pulling disorder) was moved from the DSM-4 TR classification of impulse control disorders to this new classification of Obsessive-Compulsive and Related Disorders in the DSM-5.

Diagnosis:

An important aspect of diagnosis is to differentiate obsessive-compulsive disorder from other mental health disorders by the key features of obsessive preoccupation and repetitive behaviors. Once this has been accomplished, diagnosis can proceed.

Diagnosis of obsessive-compulsive disorder can be challenging in that there is a high level of comorbidity with other diagnosis. It is very common for a person with this diagnosis to also exhibit

symptoms of anxiety disorders and depression; eating disorder; somatoform disorder; hypochondriasis; impulse-control disorder, especially kleptomania; and attention deficit hyperactivity disorder (ADHD). Also, there is a significant amount of literature considering the comorbidity between obsessive-compulsive disorder and Tourette’s syndrome.

Prevalence:

It has been estimated that as many as one in 100 or 2 to 3 million adults currently have obsessive-compulsive disorder. Among children it is estimated that nearly one in 200 or 500,000 children and adolescents may receive this diagnosis. These estimates do not include other related disorders. Hoarding is believed to affect about 4% of the general population. Trichotillomania may affect as many as 2.5 million Americans, and as many as 3.8% of college students are believed to exhibit symptoms of excoriation.

Treatment for Obsessive-Compulsive and Related Disorders:

The most commonly reported treatments include a combination of medication and psychological treatments. Some studies have found cognitive behavioral therapy to be more effective than treatment with drugs or often has been found to be an appropriate replacement after the initial symptoms have been reduced. The International Obsessive-Compulsive Disorder Foundation has recommended exposure and response prevention (ERP), which is a type of cognitive behavioral therapy and has concluded that this type of therapy may reduce the symptoms by as much as 60% to 80% for active participants in therapy.

General information on obsessive-compulsive disorder can be found on subsequent pages along with information specific to each diagnosis within the new DSM-5 category of Obsessive-Compulsive and Related Disorders.

Obsessive-Compulsive and Related Disorders DSM-5 Diagnostic Codes:

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

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

300.3 (F42) Hoarding Disorder
Specify if: With excessive acquisition

312.39 (F63.2) Trichotillomania (hair pulling disorder)

698.4 (L96.1) Excoriation (skin picking) Disorder

294.8 (F06.8) Obsessive-Compulsive and Related Disorder Due to Another Medical Condition
Specify if: With obsessive-compulsive disorder-like symptoms, With appearance preoccupations, With hoarding symptoms, With hair pulling symptoms, With skin picking symptoms.

300.3 (F42) Other Specified Obsessive-Compulsive and Related Disorder

300.3 (F42) Unspecified Obsessive-Compulsive and Related Disorder

Diagnostic Information and Criterion for Obsessive-Compulsive and Related Disorders adapted from the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition American Psychological Association by Paul Susic Ph.D. Licensed Psychologist



Schizoid Personality Disorder Symptoms and DSM-V Diagnosis




F60.1 (301.20) Schizoid Personality Disorder: Overview

Individuals with schizoid personality disorder are indifferent to social experiences and interpersonal relationships. There is usually a lifelong history of very restricted emotional expression and feeling, unsociability, reclusiveness and emotional coldness.

Persons with schizoid personality disorder have little interest in relationships, even family relationships. They usually prefer isolated experiences which rarely involve other people. They typically have few to no friends, take no pleasure in activities with others and most often have no interest in intimate relationships and sex with others. Emotional reactions to others are usually cold, elusive and they have difficulty experiencing emotions in general. Usually they are uninterested in and not responsive to the assessments of others or even to encouragement or criticism.




The symptoms of schizoid personality disorder cannot occur only during a psychotic episode such as with schizophrenia and cannot be attributed to antisocial personality disorder. The symptoms must significantly impair the individuals functioning to warrant a diagnosis of this personality disorder.

Although this disorder may affect as many as 3.1% of the population in the United States, these individuals will usually not seek treatment. The impairment in social and occupational functioning is very significant.

Treatment of Schizoid Personality Disorder

Treatment for this disorder may be conducted using cognitive behavioral therapy along with a psychodynamic theoretical perspective when conceptualized within the perspective of attachment theory. Several psychological theorists and clinicians have concluded that the role of the counselor may be crucial in that this individual seems to need a model for interpersonal relationships. Also, it is important to recognize that people with this disorder may experience brief psychotic episodes when experiencing significant levels of stress.

Additional Considerations: Schizoid Personality Disorder:

Schizoid personality disorder seems to occur more often among men than women. It is important for the therapist to consider the cultural context when working with and diagnosing individuals with schizoid personality disorder as some cultures seem to emphasize defensive behaviors and detachment more than others. Also, additional consideration needs to be given to individuals who have changed cultures such as immigrants who experience issues related to acculturation.

Differential Diagnosis of Schizoid Personality Disorder
:
When considering whether an individual has schizoid personality disorder, the clinician needs to be careful that the symptoms are not related to substance use, another medical condition such as those that affect the central nervous system and medication use. It is also important to understand that this diagnosis should not be given if the symptoms only occur within the context of psychosis.

F60.1 (301.20) Schizoid Personality Disorder Diagnostic Criteria:

A. A pervasive pattern of detachment from social relationships and a very restricted range of expression of emotions in interpersonal experiences, usually beginning in early adulthood and manifested in a variety of contexts, as well as indicated by four or more of the following symptoms:

1. Neither enjoys nor desires close interpersonal relationships, including being part of a family experience.
2. Almost always chooses solitary activities.
3. Has little to no interest in having sexual relationships with others.
4. Takes pleasure in a very limited number of activities.
5. Has no close friends or confidants besides first-degree relatives.
6. Is indifferent to the praise or criticism of others.
7. Seems cold emotionally, detached or has a very flattened affect.

B. The symptoms do not occur exclusively during the course of schizophrenia, bipolar disorder or a depressive disorder with psychotic features, another psychotic disorder, an autism spectrum disorder and is not attributable to the physiological effects of another medical condition

Note: If the above symptoms and criteria are met prior to the onset of schizophrenia, add “premorbid” such as “schizoid personality disorder (premorbid).”

Adapted from the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-V) American Psychiatric Association by Paul Susic Ph.D. Licensed Psychologist


Personality Disorders Symptoms and DSM-V Diagnosis




Personality Disorders Symptoms and Diagnosis: An overview

Personality disorders symptoms are not always easy to distinguish from relatively normal behaviors, although the consequences can be tremendously different. Personality disorders are groups of traits and characteristics that have become very rigid and dysfunctional, severely limiting functioning and most often resulting in severe distress and impairment. These thinking and behavioral patterns have usually been identified in these individual for a long time and in most cases since late adolescence or early adulthood.

The characteristics associated with personality disorders should probably be considered dimensional rather than categorical in that they are also seen in normal individuals to a significantly lesser degree. The DSM-V however has continued the traditional structure of categories that has been used over the last 30 years.

Common Characteristics of the Personality Disorders:

In order to receive a diagnosis of a personality disorder there needs to be an enduring pattern of negative behaviors, thoughts, feelings and sensations that are substantially different from the individual’s culture. This pattern includes an individual’s affect, cognition, control of impulses, and interpersonal relationships. This pattern of behaving and thinking has to apply in a broad-based manner over the individual’s personal and social life.




Personality disorders usually begin in adolescence (sometimes childhood) or early adulthood and manifest themselves in many social and personal contexts and cause a high level of distress and disability in an individual’s working and educational experience, as well as social and personal functioning. These characteristics cannot be associated with substance abuse, other mental disorders, physical illness, other personality disorders or personality changes associated with other medical conditions. The hallmark of personality disorders is their level of early onset (most commonly late teens), intensity of characteristics and pervasive nature in that it affects multiple aspects of an individual’s life including work, personal and social life.

A couple of the problems associated with the recognition and diagnosis of personality disorders is that they are frequently overlooked and at other times may be over-diagnosed. Two of the more notorious over diagnosed personality disorders are probably the narcissistic and borderline personality disorders. In DSM-V Made Easy, James Morrissey identified several things for a clinician keep in mind when making a diagnosis of personality disorder.

1. Verify the duration of the symptoms. Make sure that your patient’s symptoms have been present at least since early adulthood (before age 15 for antisocial personality disorder).
2. Verify that the symptoms affect several areas of the patient’s life.
3. Make sure that the patient fully qualifies for the particular diagnosis in question.
4. If the patient is under age 18, make sure that the symptoms have been present for at least the past 12 months.
5. Rule out other mental pathology that may be more accurate and have greater potential for doing harm.
6. Search for other personality disorders. Evaluate the entire history to learn whether any additional personality disorders are present.
7. Record all personality and non-personality mental diagnosis.

The following are the most commonly diagnosed personality disorders:


Cluster A Personality Disorders:

The Cluster A personality disorders usually involve behaviors described as suspicious, cold, withdrawn and/or irrational.

F60.0 (301.0) Paranoid Personality Disorder
F60.1 (301.20) Schizoid Personality Disorder
F21 (301.22) Schizotypal Personality Disorder

Cluster B Personality Disorders:

People who experience Cluster B Personality Disorders usually tend to be dramatic, very emotional and attention seeking with shallow, fluctuating moods. They often have intense interpersonal problems.

F60.2 (301.7) Antisocial Personality Disorder
F60,3 (301.83) Borderline Personality Disorder
F60.4 (301.50) Histrionic Personality Disorder
F60.81 (301.81) Narcissistic Personality Disorder

Cluster C Personality Disorders:

The Cluster C Personality Disorders usually feature characteristics of being typically tense, anxious and being over controlled.

F60.6 (301.82) Avoidant Personality Disorder
F60.7 (301.6) Dependent Personality Disorder
F60.5 (301.4) Obsessive-Compulsive Personality Disorder

Other Personality Conditions:

F07.0 (301.1) Personality Change Due to Another Medical Condition
F60.89 (301.89) Other Specified Personality Disorder
F60.9 (301.9) Unspecified Personality Disorder

By Paul Susic Ph.D. Licensed Psychologist