Explore Disorders

A neurodevelopmental pattern of inattention and/or hyperactivity-impulsivity that is inconsistent with developmental level, present in multiple settings, with several symptoms evident before age twelve.

A neurodevelopmental condition marked by persistent differences in social communication/interaction across contexts, together with restricted, repetitive patterns of behavior, interests, or activities, present from early in development.

Disturbances in the normal fluency and time patterning of speech -- sound and syllable repetitions, prolongations, broken words, or blocking -- that are inappropriate for the individual's age, with onset in the early developmental period.

Marked impairment in the acquisition and execution of coordinated motor skills, substantially below what is expected for chronological age, that significantly interferes with daily activities and is not explained by a general medical or neurological condition.

A diagnosis used for children under 5 who fail to meet expected developmental milestones across several areas of intellectual functioning, when severity level cannot yet be reliably assessed through standardized testing.

A neurodevelopmental disorder with onset during the developmental period, defined by deficits in both intellectual functioning (reasoning, problem-solving, abstract thinking) and adaptive functioning (conceptual, social, and practical skills needed for independence), not by IQ score alone.

Persistent difficulties in the acquisition and use of language across modalities (spoken, written, signed), due to deficits in comprehension or production, resulting in functional limitations that are substantially below age expectations.

A residual classification for presentations with symptoms characteristic of a neurodevelopmental disorder that cause clinically significant distress or impairment but do not meet full criteria for any specific neurodevelopmental disorder.

One or more motor tics or vocal tics (but not both), present for more than a year since first tic onset, with onset before age 18 and not attributable to a substance or another medical condition.

The presence of single or multiple motor and/or vocal tics, present for less than a year since first tic onset, distinguishing it from the longer-duration Persistent (Chronic) Motor or Vocal Tic Disorder and Tourette's Disorder.

Persistent difficulties in the social use of verbal and nonverbal communication (using communication for social purposes, adjusting communication to context/listener, following conversational rules, understanding non-literal language), without the restricted/repetitive behaviors, interests, or activities required for Autism Spectrum Disorder.

Persistent difficulties learning and using academic skills (reading, written expression, and/or mathematics), with performance well below what's expected for age, present despite adequate instruction, and not better explained by intellectual disability, uncorrected sensory problems, or other neurological/mental conditions.

Persistent difficulty with speech sound production that interferes with speech intelligibility or prevents effective verbal communication, not attributable to a physical, structural, neurological, or hearing-related cause.

Repetitive, purposeless, driven motor behavior (e.g., hand-flapping, body-rocking, self-biting) with onset in the early developmental period, causing interference with activities or resulting in self-injury.

Multiple motor tics and one or more vocal tics, present at some point during the illness (not necessarily concurrently), persisting for more than 1 year since first tic onset, with onset before age 18.

Sudden onset of 1+ of delusions, hallucinations, disorganized speech, or grossly disorganized/catatonic behavior, lasting at least 1 day but less than 1 month, with eventual full return to premorbid level of functioning.

A distinct psychomotor syndrome marked by markedly decreased, excessive, or abnormal motor activity (e.g., stupor, catalepsy, waxy flexibility, mutism, negativism, posturing, mannerisms, stereotypy, agitation, grimacing, echolalia, echopraxia), diagnosed when at least 3 of 12 characteristic features are present, regardless of the underlying condition it accompanies.

One or more delusions lasting a month or longer, with functioning that is not markedly impaired and behavior not obviously bizarre or odd outside the direct impact of the delusion, and without the broader symptom picture of Schizophrenia.

A residual classification for presentations with psychotic-spectrum symptoms (delusions, hallucinations, disorganized speech/behavior, negative symptoms) causing clinically significant distress or impairment that do not meet full criteria for any specific disorder in this chapter.

Prominent hallucinations or delusions judged, based on history, physical examination, or laboratory findings, to be the direct pathophysiological consequence of another medical condition, not occurring exclusively during delirium.

An uninterrupted period of illness featuring a major mood episode (depressive or manic) concurrent with active-phase schizophrenia symptoms, plus a period of at least two weeks of delusions or hallucinations WITHOUT a major mood episode, with mood symptoms present for the majority of the total illness duration.

A disorder involving at least two of five core symptom domains (delusions, hallucinations, disorganized speech, grossly disorganized/catatonic behavior, negative symptoms), with continuous signs persisting for at least six months and significant functional decline.

The same core active-phase psychotic symptoms as Schizophrenia (delusions, hallucinations, disorganized speech, grossly disorganized/catatonic behavior, negative symptoms), but with a total duration of at least 1 month and less than 6 months -- functioning as a time-bound diagnosis given either when an episode is still resolving within that window or, if it later exceeds 6 months, before being reclassified as Schizophrenia.

Prominent delusions and/or hallucinations that develop during or soon after substance intoxication or withdrawal, or after exposure to a medication, with evidence from history, exam, or labs that the substance/medication is etiologically related to the psychotic symptoms.

A prominent and persistent disturbance of mood characterized by elevated, expansive, or irritable mood, with or without depressed mood, that is judged, from history, physical exam, or laboratory findings, to be the direct pathophysiological consequence of another medical condition (such as Cushing's disease, multiple sclerosis, or a stroke affecting mood-regulating circuitry).

A condition defined by the occurrence of at least one manic episode -- a distinct period of abnormally and persistently elevated, expansive, or irritable mood with increased energy, lasting at least one week (or requiring hospitalization).

A bipolar-spectrum disorder defined by at least one hypomanic episode AND at least one major depressive episode, with the critical exclusion that a full manic episode has never occurred -- the depressive episodes are typically the more functionally impairing and treatment-seeking component.

Numerous periods of hypomanic symptoms and numerous periods of depressive symptoms, neither reaching the severity or duration threshold for a full hypomanic or major depressive episode, persisting for at least two years (one year in children/adolescents).

A residual classification for presentations with symptoms characteristic of a bipolar and related disorder causing clinically significant distress or impairment that do not meet full criteria for Bipolar I, Bipolar II, or Cyclothymic Disorder.

A prominent and persistent disturbance of mood characterized by elevated, expansive, or irritable mood, with or without depressed mood, that developed during or soon after substance intoxication, withdrawal, or exposure to a medication capable of producing manic/hypomanic-type symptoms, where the substance/medication is judged etiologically related to the disturbance.

A prominent and persistent disturbance of mood characterized by depressed mood or markedly diminished interest/pleasure that is judged, from history, physical exam, or laboratory findings, to be the direct pathophysiological consequence of another medical condition (such as hypothyroidism, stroke, or Parkinson's disease).

Severe, recurrent temper outbursts grossly out of proportion to the situation, occurring 3+ times per week, against a backdrop of persistently irritable or angry mood between outbursts, with onset before age 10 -- designed to reduce over-diagnosis of pediatric Bipolar Disorder.

A discrete episode of persistently low mood and/or loss of interest lasting at least two weeks, accompanied by a cluster of physical, cognitive, and behavioral changes severe enough to impair functioning.

A residual classification for presentations with depressive symptoms causing clinically significant distress or impairment that do not meet full criteria for Major Depressive Disorder, Persistent Depressive Disorder, or another named depressive disorder, where the clinician documents the specific reason.

A chronic, lower-grade depressive mood present for most of the day, more days than not, for at least two years in adults (one year in children/adolescents) -- persistence rather than intensity is the defining feature.

A pattern of mood, physical, and behavioral symptoms occurring in the final week before menses, improving within a few days after onset, and minimal or absent in the week post-menses -- confirmed by prospective daily ratings across two or more cycles.

A prominent and persistent disturbance of mood characterized by depressed mood or markedly diminished interest/pleasure that developed during or soon after substance intoxication, withdrawal, or exposure to a medication capable of producing depressive symptoms, where the substance/medication is judged etiologically related to the disturbance.

A residual classification for presentations with depressive symptoms causing clinically significant distress or impairment that do not meet full criteria for a named depressive disorder, used when there is insufficient information to specify the reason.

A residual classification used when a presentation clearly involves mood symptoms causing clinically significant distress or impairment, but there is not yet enough information to determine whether a depressive or bipolar disorder is the better fit.

Marked fear or anxiety about two or more situations (using public transportation, being in open spaces, being in enclosed places, standing in line or being in a crowd, or being outside the home alone) due to thoughts that escape might be difficult or help unavailable if panic-like or embarrassing symptoms occur.

Prominent anxiety or panic attacks that are judged, from history, physical exam, or laboratory findings, to be the direct pathophysiological consequence of another medical condition (such as hyperthyroidism, pheochromocytoma, or a cardiac arrhythmia).

Excessive, hard-to-control worry about multiple everyday domains (work, health, finances, relationships), present more days than not for at least six months, accompanied by physical tension symptoms.

A residual classification for presentations with prominent anxiety or avoidance symptoms causing clinically significant distress or impairment that do not meet full criteria for Generalized Anxiety Disorder, Panic Disorder, Social Anxiety Disorder, a specific phobia, or another named anxiety disorder.

Recurrent, unexpected panic attacks -- abrupt surges of intense fear peaking within minutes -- followed by at least a month of persistent concern about additional attacks or significant related behavior change.

Consistent failure to speak in specific social situations where speaking is expected (e.g., at school) despite speaking normally in other situations (e.g., at home), interfering with academic, occupational, or social functioning, and not attributable to a communication disorder or lack of knowledge/comfort with the language.

Developmentally inappropriate and excessive fear or anxiety concerning separation from major attachment figures, persisting for at least 4 weeks in children/adolescents (6+ months in adults), causing significant distress or impairment.

Marked, persistent fear or anxiety about one or more social situations in which the person may be scrutinized by others, driven by fear of negative evaluation.

Marked, persistent fear or anxiety about a specific object or situation, disproportionate to the actual danger, that is actively avoided or endured with intense distress.

Prominent anxiety, panic attacks, or obsessions/compulsions that developed during or soon after substance intoxication, withdrawal, or exposure to a medication capable of producing anxiety symptoms, where the substance/medication is judged etiologically related to the disturbance.

Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear only slight to others, accompanied by repetitive behaviors or mental acts in response.

Recurrent skin picking resulting in skin lesions, with repeated attempts to decrease or stop the behavior.

Persistent difficulty discarding or parting with possessions, regardless of actual value, due to a perceived need to save items and distress associated with discarding, resulting in accumulation that congests and clutters living areas to the point of compromising their intended use.

Prominent obsessions, compulsions, or body-focused repetitive behaviors that are judged, from history, physical exam, or laboratory findings, to be the direct pathophysiological consequence of another medical condition (such as a basal ganglia lesion or certain autoimmune conditions affecting the brain).

The presence of obsessions (intrusive, unwanted, distressing thoughts/urges/images), compulsions (repetitive behaviors or mental acts performed to reduce the distress), or both, that are time-consuming or significantly impairing.

A residual classification for presentations with obsessive-compulsive-spectrum symptoms causing clinically significant distress or impairment that do not meet full criteria for Obsessive-Compulsive Disorder, Body Dysmorphic Disorder, Hoarding Disorder, Trichotillomania, or Excoriation Disorder.

Prominent obsessions, compulsions, hair-pulling, skin-picking, or other body-focused repetitive behaviors that developed during or soon after substance intoxication, withdrawal, or exposure to a medication capable of producing such symptoms, where the substance/medication is judged etiologically related to the disturbance.

Recurrent pulling out of one's own hair, resulting in hair loss, with repeated attempts to decrease or stop the behavior.

Intrusion, negative mood, dissociative, avoidance, and arousal symptoms following exposure to actual or threatened death, serious injury, or sexual violence, lasting 3 days to 1 month -- functioning as PTSD's short-duration counterpart and a strong predictor of who will go on to develop PTSD.

Emotional or behavioral symptoms developing in response to an identifiable stressor, occurring within three months of the stressor's onset, that are out of proportion to what would normally be expected or cause significant impairment, and do not meet criteria for another specific mental disorder.

A pattern of culturally inappropriate, overly familiar behavior with unfamiliar adults — reduced or absent reticence, willingness to go off with a stranger with minimal or no hesitation — arising from the same kind of documented history of grossly insufficient early care as Reactive Attachment Disorder, but presenting as indiscriminate sociability rather than withdrawal.

A residual classification for presentations with trauma- or stressor-related symptoms causing clinically significant distress or impairment that do not meet full criteria for PTSD, Acute Stress Disorder, an Adjustment Disorder, or another named disorder in this chapter.

A condition that can develop after exposure to actual or threatened death, serious injury, or sexual violence, involving intrusive re-experiencing, avoidance, negative changes in mood/cognition, and heightened arousal lasting more than a month.

A persistent and pervasive grief response following bereavement, characterized by intense yearning/longing for the deceased or preoccupation with them, along with additional grief symptoms, that exceeds expected social, cultural, or religious norms and causes significant impairment, present nearly every day for at least a month, at least 12 months after the death (6 months for children/adolescents).

A pattern of markedly disturbed and developmentally inappropriate attachment behaviors in which a child rarely or minimally seeks or responds to comfort when distressed, together with a persistent social/emotional disturbance, arising from a documented history of grossly insufficient care (extreme neglect, repeated changes of primary caregivers, or rearing in unusual settings that limit attachment opportunities).

Persistent or recurrent experiences of depersonalization (detachment from one's own thoughts, feelings, body, or actions, as if an outside observer) and/or derealization (detachment from surroundings, as if the world is unreal or dreamlike), with intact reality testing throughout.

An inability to recall important autobiographical information, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting and not attributable to a substance or a neurological/medical condition; may include a specifier for dissociative fugue, involving apparently purposeful travel or bewildered wandering associated with amnesia for identity or other important autobiographical information.

A disruption of identity characterized by two or more distinct personality states (or an experience of possession, in some cultural contexts), involving marked discontinuity in sense of self and agency, accompanied by recurrent gaps in recall of everyday events, personal information, and/or traumatic events beyond ordinary forgetting.

A residual classification for presentations with dissociative symptoms (disruption in identity, memory, consciousness, or perception) causing clinically significant distress or impairment that do not meet full criteria for Dissociative Identity Disorder, Dissociative Amnesia, or Depersonalization/Derealization Disorder.

One or more symptoms of altered voluntary motor or sensory function (e.g., weakness, abnormal movements, seizure-like episodes, sensory loss) that is incompatible with recognized neurological or medical conditions on clinical examination, and not deliberately produced.

Falsification of physical or psychological signs/symptoms, or induction of injury or disease, associated with identified deception, in the absence of obvious external rewards -- distinguishing it from both genuine illness and from malingering.

A preoccupation with having or acquiring a serious illness, in the absence of significant somatic symptoms, driven by anxiety about health rather than by the physical symptoms themselves.

A residual classification for presentations with somatic symptoms or health-related distress and behavior causing clinically significant distress or impairment that do not meet full criteria for Somatic Symptom Disorder, Illness Anxiety Disorder, Functional Neurological Symptom Disorder, or Factitious Disorder.

A diagnosis used when psychological or behavioral factors adversely affect a diagnosed medical condition by influencing its course, interfering with treatment, contributing to health risks, or affecting the underlying pathophysiology -- distinct from a somatic symptom disorder, since a genuine, diagnosed medical condition is present.

One or more distressing somatic symptoms, accompanied by excessive thoughts, feelings, or behaviors related to those symptoms, causing significant disruption to daily life.

Persistent restriction of energy intake leading to significantly low body weight, intense fear of weight gain or persistent behavior interfering with weight gain, and disturbance in self-perceived weight/shape.

An eating or feeding disturbance (e.g., sensory-based avoidance, fear of aversive consequences like choking, apparent lack of interest in eating) leading to significant nutritional/energy deficiency, dependence on supplements, or marked interference with functioning -- critically, without the body-image disturbance that defines Anorexia Nervosa.

Recurrent episodes of binge eating -- eating an objectively large amount of food with a sense of loss of control -- occurring at least weekly for three months, without the regular compensatory behaviors seen in Bulimia Nervosa.

Recurrent episodes of binge eating paired with recurrent inappropriate compensatory behaviors to prevent weight gain, occurring at least weekly for three months, with self-evaluation unduly influenced by body shape and weight.

A residual classification for presentations with feeding or eating disturbances causing clinically significant distress or impairment that do not meet full criteria for Anorexia Nervosa, Bulimia Nervosa, Binge-Eating Disorder, Pica, Rumination Disorder, or Avoidant/Restrictive Food Intake Disorder.

Persistent eating of nonnutritive, nonfood substances over a period of at least 1 month, inappropriate to the developmental level of the individual, not part of a culturally supported or socially normative practice, and severe enough to warrant independent clinical attention if occurring alongside another mental disorder or medical condition.

Repeated regurgitation of food over a period of at least 1 month, which may be re-chewed, re-swallowed, or spit out, not attributable to an associated gastrointestinal or other medical condition, and not occurring exclusively during the course of another eating disorder.

Repeated passage of feces into inappropriate places (e.g., clothing, floor), whether involuntary or intentional, occurring at least once monthly for at least 3 months, in a child with a chronological or developmental age of at least 4 years, not attributable solely to a substance or a general medical condition other than through a mechanism involving constipation.

Repeated voiding of urine into bed or clothes, whether involuntary or intentional, occurring at least twice weekly for at least 3 months (or causing clinically significant distress/impairment), in a child with a chronological or developmental age of at least 5 years, not attributable to a substance or a general medical condition.

A residual classification for presentations with urinary or fecal elimination symptoms causing clinically significant distress or impairment that do not meet full criteria for Enuresis or Encopresis, most often due to route of elimination, frequency, or age of onset.

Repeated episodes of apnea and hypopnea during sleep caused by reduced respiratory effort from the brain's breathing control centers, distinguished from Obstructive Sleep Apnea Hypopnea by the absence of airway obstruction as the primary mechanism.

A persistent or recurrent pattern of sleep disruption primarily due to an alteration of the circadian system or a misalignment between an individual's internal circadian rhythm and the sleep-wake schedule required by their environment, resulting in excessive sleepiness, insomnia, or both.

Excessive sleepiness despite a main sleep period of at least 7 hours, with at least one of: recurrent lapses into sleep during the day, a prolonged main sleep episode of more than 9 hours that is non-restorative, or difficulty being fully awake after abrupt awakening -- occurring at least 3 times weekly for at least 3 months.

Predominant dissatisfaction with sleep quantity or quality, with difficulty initiating sleep, difficulty maintaining sleep, or early-morning awakening with inability to return to sleep, occurring at least 3 nights per week for at least 3 months, causing clinically significant distress or impairment, despite adequate opportunity for sleep.

Recurrent, irrepressible need to sleep, lapsing into sleep, or napping occurring within the same day, at least three times per week for three months, typically accompanied by cataplexy, hypocretin deficiency, or characteristic REM sleep abnormalities.

Repeated occurrences of extended, extremely dysphoric, well-remembered dreams involving threats to survival, security, or physical integrity, usually occurring in the second half of a major sleep period, with rapid orientation and alertness on waking, causing clinically significant distress or impairment.

Recurrent episodes of incomplete awakening from sleep, usually occurring during the first third of the major sleep episode, accompanied by either sleepwalking or sleep terrors, with limited or no dream recall and relative unresponsiveness to efforts to communicate during the episode.

Evidence by polysomnography of at least 5 obstructive apneas or hypopneas per hour of sleep, with either nocturnal breathing disturbances (snoring, snorting/gasping, breathing pauses during sleep) or daytime sleepiness not better explained by another condition.

A residual classification for presentations with sleep-wake disturbances causing clinically significant distress or impairment that do not meet full criteria for Insomnia Disorder, Hypersomnolence Disorder, Narcolepsy, a breathing-related sleep disorder, or another named sleep-wake disorder.

Repeated episodes of vocalization or complex motor behavior during REM sleep, occurring because the normal muscle paralysis (atonia) of REM sleep fails, often resulting in the person physically acting out dream content.

An urge to move the legs, usually accompanied by uncomfortable sensations, that begins or worsens during rest, is partially or totally relieved by movement, and is worse in the evening or at night.

Episodes of decreased breathing (hypoventilation) during sleep associated with elevated carbon dioxide levels, confirmed by polysomnography, distinguished from apnea-based sleep-disordered breathing by the underlying pattern of inadequate ventilation rather than discrete breathing pauses.

A prominent and severe disturbance of sleep that developed during or soon after substance intoxication or withdrawal, or after exposure to a medication capable of producing sleep disturbance, where the substance/medication is judged etiologically related to the disturbance and the sleep disturbance is severe enough to warrant independent clinical attention.

A marked delay in, or marked infrequency or absence of, ejaculation during partnered sexual activity despite adequate sexual stimulation and the desire to ejaculate, causing clinically significant distress.

Marked difficulty obtaining or maintaining an erection until completion of sexual activity, or marked decrease in erectile rigidity, on almost all or all occasions of sexual activity, for a minimum duration of approximately 6 months, causing clinically significant distress.

Marked delay in, marked infrequency of, or absence of orgasm, or markedly reduced intensity of orgasmic sensation, on almost all or all occasions of sexual activity, for a minimum duration of approximately 6 months, causing clinically significant distress.

Absent or significantly reduced sexual interest/arousal, evidenced by at least 3 of 6 specific indicators (e.g., absent/reduced interest, sexual/erotic thoughts, initiation, pleasure, response to cues, genital/nongenital sensations), for a minimum duration of approximately 6 months, causing clinically significant distress.

Persistent or recurrent difficulties with vaginal penetration, marked vulvovaginal or pelvic pain during intercourse or penetration attempts, marked fear or anxiety about pain in anticipation of penetration, or marked tensing/tightening of pelvic floor muscles during attempted penetration, for a minimum duration of approximately 6 months.

Persistently or recurrently deficient or absent sexual/erotic thoughts or fantasies and desire for sexual activity, judged by the clinician taking into account factors affecting sexual functioning (age, general/sociocultural context of the person's life), for a minimum duration of approximately 6 months, causing clinically significant distress.

A residual classification for presentations with sexual dysfunction causing clinically significant distress that do not meet full criteria for a named sexual dysfunction, most often due to duration, frequency, or symptom-count thresholds.

A persistent or recurrent pattern of ejaculation occurring during partnered sexual activity within approximately 1 minute following vaginal penetration and before the individual wishes it, on almost all or all occasions of sexual activity, for a minimum duration of approximately 6 months, causing clinically significant distress.

A clinically significant disturbance in sexual function that developed during or soon after substance intoxication, withdrawal, or exposure to a medication capable of producing sexual dysfunction, where the substance/medication is judged etiologically related to the disturbance.

A marked incongruence between an adolescent's or adult's experienced/expressed gender and assigned gender, lasting at least 6 months, evidenced by at least 2 of 6 criteria (e.g., incongruence between experienced gender and primary/secondary sex characteristics, strong desire to be rid of one's sex characteristics, strong desire for the sex characteristics of the experienced gender), associated with clinically significant distress or impairment.

A marked incongruence between a prepubertal child's experienced/expressed gender and assigned gender, lasting at least 6 months, evidenced by a distinct set of developmentally-specific criteria (e.g., a strong desire to be the other gender, strong preference for cross-gender roles/toys/activities, strong rejection of typically gender-associated toys/activities), associated with clinically significant distress or impairment.

A residual classification for presentations with marked incongruence between experienced/expressed gender and assigned gender, causing clinically significant distress or impairment, that do not meet full duration or symptom-count criteria for Gender Dysphoria in Children or Gender Dysphoria in Adolescents and Adults.

A repetitive, persistent pattern of behavior that violates the basic rights of others or major age-appropriate societal norms, spanning aggression, property destruction, deceitfulness, and serious rule violations.

Recurrent behavioral outbursts representing a failure to control aggressive impulses, grossly out of proportion to the provocation, that are impulsive/anger-based rather than premeditated, causing distress or impairment, in a person typically age 6+.

A recurrent failure to resist impulses to steal objects that are not needed for personal use or their monetary value, driven by rising tension before the act and relief or gratification during it -- not by anger, revenge, delusion, or material need.

A recurrent pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness toward authority figures, lasting at least 6 months, evidenced by symptoms with at least one non-sibling individual, that is developmentally atypical and causes distress or impairment.

A residual classification for presentations with disruptive, impulse-control, or conduct-related symptoms causing clinically significant distress or impairment that do not meet full criteria for Oppositional Defiant Disorder, Conduct Disorder, Intermittent Explosive Disorder, Kleptomania, or Pyromania.

Deliberate, purposeful fire-setting on more than one occasion, preceded by tension or emotional arousal and followed by pleasure, gratification, or relief, without a motive like profit, revenge, or concealing a crime.

A problematic pattern of alcohol use leading to clinically significant impairment or distress, assessed across a cluster of behavioral, physiological, and craving-related indicators within a 12-month period.

Clinically significant symptoms following recent caffeine consumption (Caffeine Intoxication) or following abrupt reduction/cessation of regular caffeine use (Caffeine Withdrawal) -- notably, DSM-5-TR does not include a formal Caffeine Use Disorder in its main diagnostic section.

A problematic pattern of cannabis use leading to clinically significant impairment or distress, evidenced by at least 2 of 11 criteria spanning impaired control, social impairment, risky use, and pharmacological indicators (tolerance, withdrawal), within a 12-month period.

Persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress, evidenced by 4 or more of 9 criteria within a 12-month period -- the only non-substance behavioral addiction formally recognized in DSM-5-TR's Substance-Related and Addictive Disorders chapter.

A problematic pattern of hallucinogen use (phencyclidine-type or other hallucinogens such as LSD or psilocybin) leading to clinically significant impairment or distress, evidenced by at least 2 of 11 characteristic indicators within a 12-month period, plus recognized hallucinogen-induced conditions including intoxication and, distinctively, Hallucinogen Persisting Perception Disorder.

A category covering problematic use of, and intoxication from, volatile hydrocarbon-based substances (such as glues, aerosols, paint thinners, and fuels) inhaled for their psychoactive effects, distinguished from other substance classes by the specific substances involved and their acute and potentially serious toxic effects.

A problematic pattern of opioid use leading to clinically significant impairment or distress, reflected in a cluster of behavioral, physiological, and craving-related symptoms occurring within a 12-month period.

A residual category covering substance use disorders, intoxication, and withdrawal involving a substance not covered by the ten specifically named classes in this chapter (such as anabolic steroids, nitrous oxide, or other over-the-counter or unknown substances), or presentations where the specific substance cannot be identified.

A problematic pattern of use of sedative, hypnotic, or anxiolytic medications (e.g., benzodiazepines, barbiturates, and similar prescription sedative/sleep medications) leading to clinically significant impairment or distress, evidenced by at least 2 of 11 characteristic indicators within a 12-month period, with a recognized, medically significant withdrawal syndrome similar in profile to alcohol withdrawal.

A problematic pattern of amphetamine-type substance, cocaine, or other stimulant use leading to clinically significant impairment or distress, evidenced by at least 2 of 11 criteria spanning impaired control, social impairment, risky use, and pharmacological indicators, within a 12-month period.

A problematic pattern of tobacco/nicotine use leading to clinically significant impairment or distress, evidenced by at least 2 of 11 characteristic indicators within a 12-month period, with a recognized withdrawal syndrome (irritability, frustration/anger, anxiety, difficulty concentrating, increased appetite, restlessness, depressed mood, insomnia) distinct from, but using the same diagnostic framework as, other substance use disorders.

An acute, fluctuating disturbance in attention and awareness, developing over a short period, with an additional cognitive disturbance, that is a direct physiological consequence of an underlying medical condition, substance, or other cause.

A progressive neurocognitive disorder marked by early, prominent changes in personality, behavior, or language, with relative sparing of memory and visuospatial function in its earliest stages -- distinguishing it from the memory-first presentation typical of Alzheimer's disease.

A significant cognitive decline from a previous level of performance in one or more cognitive domains, with evidence from history, physical exam, or laboratory findings that the cognitive disturbance is the direct pathophysiological consequence of a medical condition not separately named elsewhere in this chapter (such as normal-pressure hydrocephalus, a brain tumor, or vitamin B12 deficiency).

A major or mild neurocognitive disorder whose cognitive decline is attributable to cerebrovascular disease, typically showing a stepwise course tied to vascular events or evidence of significant cerebrovascular disease on history, exam, or imaging.

A progressive decline in one or more cognitive domains (most characteristically memory and learning), caused by Alzheimer's disease pathology, at either a Major (interferes with independence) or Mild (independence preserved) level.

A neurocognitive disorder attributable to documented HIV infection, with cognitive decline not better explained by non-HIV conditions, including HIV-associated opportunistic infections or malignancies affecting the central nervous system.

A neurocognitive disorder attributable to Huntington's disease, a genetic, progressive neurodegenerative condition featuring characteristic choreiform movements alongside executive dysfunction and, often, mood and behavioral changes.

A neurocognitive disorder attributable to more than one underlying etiological process occurring together -- for example, Alzheimer's disease pathology combined with cerebrovascular disease -- rather than any single cause fully accounting for the clinical picture.

A neurocognitive disorder that develops in the context of established Parkinson's disease, with motor symptoms (tremor, rigidity, bradykinesia) typically preceding the onset of cognitive decline by a substantial period.

A rapidly progressive neurocognitive disorder attributable to a prion disease (such as Creutzfeldt-Jakob disease), typically featuring motor features including myoclonus, ataxia, or rigidity alongside cognitive decline.

A neurocognitive disorder that arises following an impact to the head or another mechanism of rapid brain movement within the skull, with cognitive symptoms presenting immediately after the injury or after recovery of consciousness and persisting past the acute post-injury period.

A neurocognitive disorder meeting full criteria for a major or mild neurocognitive disorder, for which, despite a thorough workup, no specific underlying etiology can be identified or confirmed.

A neurocognitive disorder characterized by fluctuating cognition, recurrent detailed visual hallucinations, spontaneous parkinsonism, and REM sleep behavior disorder, occurring together as a core diagnostic cluster.

Persistent neurocognitive impairment that remains after the period of acute intoxication or withdrawal has passed, attributable to the persisting effects of substance or medication use rather than to intoxication, withdrawal, or delirium alone.

A residual classification used when a presentation clearly meets criteria for a neurocognitive disorder (evidence of cognitive decline affecting independence or requiring accommodation), but there is not enough information to specify a subtype or etiology, or the clinician chooses not to specify.

A pervasive pattern of disregard for and violation of the rights of others, beginning by age 15, with evidence of Conduct Disorder before age 15 and the pattern continuing into adulthood (diagnosed at 18+).

A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood and present across contexts.

A pervasive pattern of instability in interpersonal relationships, self-image, and affect, together with marked impulsivity, beginning by early adulthood and present across a range of contexts.

A pervasive and excessive need to be taken care of that leads to submissive, clinging behavior and fears of separation, resulting in difficulty making everyday decisions without excessive advice and reassurance from others.

A pervasive pattern of excessive emotionality and attention-seeking, including discomfort when not the center of attention, rapidly shifting and shallow emotional expression, and a tendency to view relationships as more intimate than they actually are.

A pervasive pattern of grandiosity, need for admiration, and lack of empathy, present since early adulthood across a variety of contexts.

A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, distinct from Obsessive-Compulsive Disorder's intrusive obsessions and compulsions.

A residual classification for an enduring, pervasive pattern of inner experience and behavior that meets the general criteria for a personality disorder but does not meet full criteria for any of the ten specific named personality disorders.

A pervasive pattern of distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present across a variety of contexts.

A persistent personality disturbance representing a change from the individual's previous characteristic personality pattern, judged from history, physical exam, or laboratory findings to be the direct pathophysiological consequence of another medical condition (such as a frontal lobe lesion, traumatic brain injury, or an endocrine disorder).

A pervasive pattern of detachment from social relationships and a restricted range of emotional expression, with a genuine preference for solitary activities rather than social anxiety driving the withdrawal.

A pervasive pattern of social and interpersonal deficits marked by acute discomfort with close relationships, along with cognitive or perceptual distortions and eccentricities of behavior, without meeting full criteria for a psychotic disorder.

Recurrent and intense sexual arousal from exposing one's genitals to an unsuspecting person, over a period of at least 6 months, where the person has acted on these urges with a nonconsenting person or the arousal/urges cause clinically significant distress or impairment.

Recurrent and intense sexual arousal from either the use of nonliving objects or a highly specific focus on nongenital body part(s), over a period of at least 6 months, causing clinically significant distress or impairment. Objects specifically excluded are those designed for genital stimulation (e.g., vibrators) or cross-dressing garments (covered under Transvestic Disorder).

Recurrent and intense sexual arousal from touching or rubbing against a nonconsenting person, over a period of at least 6 months, where the person has acted on these urges with a nonconsenting person or the arousal/urges cause clinically significant distress or impairment.

The residual category for presentations of a paraphilia causing clinically significant distress or impairment (or involving harm/risk of harm to a nonconsenting person) that do not meet full criteria for any of the 8 specifically named paraphilic disorders. Other Specified is used when the clinician specifies the particular paraphilia (e.g., telephone scatologia, necrophilia, zoophilia, coprophilia, klismaphilia, urophilia); Unspecified is used when the clinician does not specify or lacks sufficient information.

Recurrent, intense sexually arousing fantasies, urges, or behaviors involving sexual activity with a prepubescent child or children (generally age 13 or younger), over a period of at least 6 months, where the person has acted on these urges or the urges/fantasies cause marked distress or interpersonal difficulty. The individual must be at least age 16 and at least 5 years older than the child; a diagnosis is not made for a late adolescent in an ongoing sexual relationship with a 12- or 13-year-old.

Recurrent and intense sexual arousal from the act of being humiliated, beaten, bound, or otherwise made to suffer, over a period of at least 6 months, causing clinically significant distress or impairment. Unlike the disorders defined by nonconsenting partners, this diagnosis does not require a nonconsenting third party — its Criterion B is distress or impairment alone.

Recurrent and intense sexual arousal from the physical or psychological suffering of another person, over a period of at least 6 months, where the person has acted on these urges with a nonconsenting person or the urges/fantasies cause clinically significant distress or impairment.

Recurrent and intense sexual arousal from cross-dressing, over a period of at least 6 months, causing clinically significant distress or impairment. DSM-5-TR notes this diagnosis is currently applied almost exclusively to heterosexual (or bisexual) men.

Recurrent and intense sexual arousal from observing an unsuspecting person who is naked, disrobing, or engaging in sexual activity, over a period of at least 6 months, where the person has acted on these urges with a nonconsenting person or the arousal/urges cause clinically significant distress or impairment. The diagnosis requires the individual experiencing the arousal to be at least 18 years old.

A V/Z-code classification for the normal process of grieving the death of a loved one, used when grief itself -- not a diagnosable mental disorder -- is the focus of clinical attention.

A V/Z-code classification (not a mental disorder) for intellectual functioning that falls below average but above the threshold used for Intellectual Disability, when this is the focus of clinical attention.

The intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives such as avoiding work, obtaining financial compensation, evading criminal prosecution, or obtaining drugs.

A group of conditions -- including neuroleptic-induced parkinsonism, tardive dyskinesia, acute dystonia, akathisia, and neuroleptic malignant syndrome -- that arise as adverse motor effects of psychotropic or other medications, most often antipsychotics, and are included for their clinical importance to differential diagnosis and treatment monitoring even though they are not themselves mental disorders.

A residual classification of last resort for presentations with symptoms of a mental disorder causing clinically significant distress or impairment that do not meet full criteria for any specific mental disorder in the manual, and that are not judged to be due to another medical condition.

A residual classification for presentations with mental or behavioral symptoms judged to be the direct pathophysiological consequence of another medical condition, causing clinically significant distress or impairment, that do not meet full criteria for any specific mental disorder due to another medical condition described elsewhere in the manual.