30-Days of Mental Illness Awareness Challenge – Day 13

Today’s question: If you know the criteria of your illness(es) which ones do you think you meet? Or what are your most common symptoms?

Wow, this is going to be a long post given I have 16 diagnosed mental health illnesses and I do know the criteria for all of them (if I didn’t they are a quick Google search away). I have recently gone over my sleep disorder diagnoses and is covered in the post, Sleep and Sleep Disorders, so I will not go over those again here. For a complete list of my diagnoses, please see About Me, which contains a list of my diagnoses. Before going into the diagnostic criteria for my illnesses, I want to say that anyone diagnosed with any type of mental health illness should take the time to find out what the criteria for that diagnosis is. As a patient we should arm ourselves with as much information about any illness affecting us as that gives us a better understand into the illness and we can spot discrepancies in the diagnosis (for mental health issues at least).

296.34 Major depressive disorder, recurrent; severe with psychotic features

Prior to getting a diagnosis of major depressive disorder, one first must receive a diagnosis of major episode, which is as follows. Those item of the criteria that I meet are in italics.

A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

  1. depressed mood most of the day, nearly every day, as indicated by either subjective report or observation made by others.
  2. markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
  3. significant weight loss when not dieting or weight, or decrease or increase in appetite nearly every day.
  4. insomnia or hypersomnia nearly every day
  5. psychomotor agitation or retardation nearly every day.
  6. fatigue or loss of energy nearly every day
  7. feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
  8. diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)
  9. recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

B. The symptoms do not meet criteria for a Mixed Episode.

C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).

E. The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.

Recurrent

A. Presence of two or more Major Depressive Episodes. Note: To be considered separate episodes, there must be an interval of at least 2 consecutive months in which criteria are not met for a Major Depressive Episode.
B. The Major Depressive Episodes are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.
C. There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode.

This has always been on diagnosis that I’ve never had problems with; the only criteria I didn’t meet as number 3 which is about weight gain or loss. This criterion doesn’t apply to me due to my eating disorder, so it does apply someplace else, just not in my depression diagnosis.

300.02 Generalized anxiety disorder

A. At least 6 months of “excessive anxiety and worry” about a variety of events and situations. Generally, “excessive” can be interpreted as more than would be expected for a particular situation or event. Most people become anxious over certain things, but the intensity of the anxiety typically corresponds to the situation.

B. There is significant difficulty in controlling the anxiety and worry. If someone has a very difficult struggle to regain control, relax, or cope with the anxiety and worry, then this requirement is met.

C. The presence for most days over the previous six months of 3 or more (only 1 for children) of the following symptoms:

  1. Feeling wound-up, tense, or restless
  2. Easily becoming fatigued or worn-out
  3. Concentration problems
  4. Irritability
  5. Significant tension in muscles
  6. Difficulty with sleep

D. The symptoms are not part of another mental disorder.

E. The symptoms cause “clinically significant distress” or problems functioning in daily life. “Clinically significant” is the part that relies on the perspective of the treatment provider. Some people can have many of the aforementioned symptoms and cope with them well enough to maintain a high level of functioning.

F. The condition is not due to a substance or medical issue

300.21 Panic disorder, with agoraphobia

A. Both (1) and (2):

(1) recurrent unexpected Panic Attacks

(2) at least one of the attacks has been followed by 1 month (or more) of one (or more) of the following:

  1. persistent concern about having additional attacks
  2. worry about the implications of the attack or its consequences
  3. a significant change in behavior related to the attacks

B. Presence or Absence of Agoraphobia

C. The Panic Attacks are not due to the direct physiological effects of a substance or a general medical condition.

D. The Panic Attacks not better accounted for by another mental disorder, such as Social Phobia, Specific Phobia, Obsessive-Compulsive Disorder, Posttraumatic Stress Disorder, or Separation Anxiety Disorder.

300.3 Obsessive-compulsive disorder

A. Either obsessions or compulsions:

Obsessions are as defined by (1), (2), (3), and (4):

  1. recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress
  2. the thoughts, impulses, or images are not simply excessive worries about real-life problems
  3. the person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action
  4. the person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind (not imposed from without as in thought insertion)

Compulsions as defined by (1) and (2):

  1. repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly
  2. the behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or are clearly excessive

B. At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable.

C. The obsessions or compulsions cause marked distress, are time consuming (take more than 1 hour a day), or significantly interfere with the person’s normal routine, occupational (or academic) functioning, or usual activities or relationships.

D. If another Axis I disorder is present, the content of the obsessions or compulsions is not restricted to it.

E. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

300.7 Body dysmorphic disorder

  1. Preoccupation with an imagined defect in appearance. If a slight physical anomaly is present, the person’s concern is markedly excessive.
  2. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  3. The preoccupation is not better accounted for by another mental disorder (e.g., dissatisfaction with body shape and size in Anorexia Nervosa).

301.82 Avoidant personality disorder

A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

  1. avoids occupational activities that involve significant interpersonal contact, because of fears of criticism, disapproval, or rejection
  2. is unwilling to get involved with people unless certain of being liked
  3. shows restraint within intimate relationships because of the fear of being shamed or ridiculed
  4. is preoccupied with being criticized or rejected in social situations
  5. is inhibited in new interpersonal situations because of feelings of inadequacy
  6. views self as socially inept, personally unappealing, or inferior to others
  7. is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing

301.83 Borderline personality disorder, with self-harm – class III

BPD is manifested by a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

  1. Frantic efforts to avoid real or imagined abandonment.
  2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. This is called “splitting.”
  3. Identity disturbance: markedly and persistently unstable self-image or sense of self.
  4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in (5).
  5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
  6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).
  7. Chronic feelings of emptiness.
  8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
  9. Transient, stress-related paranoid ideation or severe dissociative symptoms.

307.1  Anorexia nervosa, with purging tendencies, with self-harm – class III

  1. Refusal to maintain body weight at or above a minimally normal weight for age and height, for example, weight loss leading to maintenance of body weight less than 85% of that expected or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected.
  2. Intense fear of gaining weight or becoming fat, even though underweight.
  3. Disturbance in the way one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
  4. In postmenarcheal females, amenorrhea, i.e., the absence of at least 3 consecutive menstrual cycles. A woman having periods only while on hormone medication (e.g. estrogen) still qualifies as having amenorrhea.

Type

Restricting Type: During the current episode of Anorexia Nervosa, the person has not regularly engaged in binge-eating or purging behavior (self-induced vomiting or misuse of laxatives, diuretics, or enemas).

301.6 Dependent Personality Disorder

A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

  1. Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others.
  2. Needs others to assume responsibility for most major areas of his or her life.
  3. Has difficulty expressing disagreement with others because of fear of loss of support or approval.
  4. Has difficulty initiating projects or doing things on his or her own (because of lack of self-confidence in judgment or abilities rather than a lack of motivation or energy).
  5. Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant.
  6. Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself.
  7. Urgently seeks another relationship as a source of care and support when a close relationship ends.
  8. Is unrealistically preoccupied with fears of being left to take care of himself or herself.

308.3 Acute Stress Disorder

A. The person has been exposed to a traumatic event in which both of the following were present:

  1. the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others
  2. the person’s response involved intense fear, helplessness, or horror

B. Either while experiencing or after experiencing the distressing event, the individual has three (or more) of the following dissociative symptoms:

  1. a subjective sense of numbing, detachment, or absence of emotional responsiveness
  2. a reduction in awareness of his or her surroundings (e.g., “being in a daze”)
  3. derealization
  4. depersonalization
  5. dissociative amnesia (i.e., inability to recall an important aspect of the trauma)

C. The traumatic event is persistently re-experienced in at least one of the following ways: recurrent images, thoughts, dreams, illusions, flashback episodes, or a sense of reliving the experience; or distress on exposure to reminders of the traumatic event.

D. Marked avoidance of stimuli that arouse recollections of the trauma (e.g., thoughts, feelings, conversations, activities, places, people).

E. Marked symptoms of anxiety or increased arousal (e.g., difficulty sleeping, irritability, poor concentration, hypervigilance, exaggerated startle response, motor restlessness).

F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or impairs the individual’s ability to pursue some necessary task, such as obtaining necessary assistance or mobilizing personal resources by telling family members about the traumatic experience. 

G. The disturbance lasts for a minimum of 2 days and a maximum of 4 weeks and occurs within 4 weeks of the traumatic event. 

H. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition, is not better accounted for by Brief Psychotic Disorder, and is not merely an exacerbation of a preexisting Axis I or Axis II disorder.

309.28 Adjustment disorder, with mixed anxiety and depressed mood

A. The development of emotional or behavioral symptoms in response to an identifiable stressor(s) occurring within 3 months of the onset of the stressor(s).

B. These symptoms or behaviors are clinically significant as evidenced by either of the following:

  1. marked distress that is in excess of what would be expected from exposure to the stressor
  2. significant impairment in social or occupational (academic) functioning

C. The stress-related disturbance does not meet the criteria for another specific Axis I disorder and is not merely an exacerbation of a preexisting Axis I or Axis II disorder.

D. The symptoms do not represent Bereavement.

E. Once the stressor (or its consequences) has terminated, the symptoms do not persist for more than an additional 6 months.

Specify if:

Acute: if the disturbance lasts less than 6 months

if the disturbance lasts for 6 months or longer Adjustment Disorders are coded based on the subtype, which is selected according to the predominant symptoms.

The specific stressor(s) can be specified on Axis IV.

309.0 With Depressed Mood
309.24 With Anxiety
309.28 With Mixed Anxiety and Depressed Mood
309.3 With Disturbance of Conduct
309.4 With Mixed Disturbance of Emotions and Conduct
309.9 Unspecified

309.81 Posttraumatic stress disorder

Diagnostic criteria for PTSD include a history of exposure to a traumatic event that meets specific stipulations and symptoms from each of four symptom clusters: intrusion, avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity. The sixth criterion concerns duration of symptoms; the seventh assesses functioning; and, the eighth criterion clarifies symptoms as not attributable to a substance or co-occurring medical condition.

Two specifications are noted including delayed expression and a dissociative subtype of PTSD, the latter of which is new to DSM-5. In both specifications, the full diagnostic criteria for PTSD must be met for application to be warranted.

Criterion A: stressor

The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, as follows: (1 required)

  1. Direct exposure.
  2. Witnessing, in person.
  3. Indirectly, by learning that a close relative or close friend was exposed to trauma. If the event involved actual or threatened death, it must have been violent or accidental.
  4. Repeated or extreme indirect exposure to aversive details of the event(s), usually in the course of professional duties (e.g., first responders, collecting body parts; professionals repeatedly exposed to details of child abuse). This does not include indirect non-professional exposure through electronic media, television, movies, or pictures.

Criterion B: intrusion symptoms

The traumatic event is persistently re-experienced in the following way(s): (1 required)

  1. Recurrent, involuntary, and intrusive memories.
  2. Traumatic nightmares.
  3. Dissociative reactions (e.g., flashbacks) which may occur on a continuum from brief episodes to complete loss of consciousness. Note: Children may reenact the event in play.
  4. Intense or prolonged distress after exposure to traumatic reminders.
  5. Marked physiologic reactivity after exposure to trauma-related stimuli.

Criterion C: avoidance

Persistent effortful avoidance of distressing trauma-related stimuli after the event: (1 required)

  1. Trauma-related thoughts or feelings.
  2. Trauma-related external reminders (e.g., people, places, conversations, activities, objects, or situations).

Criterion D: negative alterations in cognitions and mood

Negative alterations in cognitions and mood that began or worsened after the traumatic event: (2 required)

  1. Inability to recall key features of the traumatic event (usually dissociative amnesia; not due to head injury, alcohol or drugs).
  2. Persistent (and often distorted) negative beliefs and expectations about oneself or the world (e.g., “I am bad,” “The world is completely dangerous.”).
  3. Persistent distorted blame of self or others for causing the traumatic event or for resulting consequences.
  4. Persistent negative trauma-related emotions (e.g., fear, horror, anger, guilt or shame).
  5. Markedly diminished interest in (pre-traumatic) significant activities.
  6. Feeling alienated from others (e.g., detachment or estrangement).
  7. Constricted affect: persistent inability to experience positive emotions.

Criterion E: alterations in arousal and reactivity

Trauma-related alterations in arousal and reactivity that began or worsened after the traumatic event: (2 required)

  1. Irritable or aggressive behavior.
  2. Self-destructive or reckless behavior.
  3. Hypervigilance.
  4. Exaggerated startle response.
  5. Problems in concentration.
  6. Sleep disturbance.

Criterion F: duration

Persistence of symptoms (in Criteria B, C, D and E) for more than one month.

Criterion G: functional significance

Significant symptom-related distress or functional impairment (e.g., social, occupational).

Criterion H: exclusion

Disturbance is not due to medication, substance use, or other illness.

Specify if: With dissociative symptoms.

In addition to meeting criteria for diagnosis, an individual experiences high levels of either of the following in reaction to trauma-related stimuli:

  1. Depersonalization: experience of being an outside observer of or detached from oneself (e.g., feeling as if “this is not happening to me” or one were in a dream).
  2. Derealization: experience of unreality, distance, or distortion (e.g., “things are not real”).

Specify if: With delayed expression.

Full diagnosis is not met until at least 6 months after the trauma(s), although onset of symptoms may occur immediately.

So there you have it, my messed up self! In most of my diagnoses I go overboard and am an overachiever when it comes to symptoms; not something one really should strive for in life.

Peace, love, and contentment,
Izzy

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