Diagnosis 2

F68.10 (300.19) - Factitious Disorder Criteria

IMPOSED ON ANOTHER (previously "by proxy") A. Falsification of physical or psychological signs or symptoms, or induction of injury or disease in another, associated with identified deception B. Individual presents another individual (victim) to others as ill, impaired or injured C. Deceptive behavior is evident even in the absence of obvious external rewards D. The behavior is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder Specify is: Single episode Recurrent episode (2 or more) * Perpetrator received DX - no the victim

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

-Presentation in which symptoms characteristic of an obsessive-compulsive and related disorder that causes clinically significant distress or impairment in functioning but do not meet full criteria for any disorder. -Examples are: Body dysmorphic-like disorder with actual flaws Body dysmorphic-like disorder without repetitive behaviors Body-focused repetitive behavior disorder Obsessional jealousy Cultural disorders

Dissociative Disorders

-Dissociative states refers to the "splitting off" from the conscious awareness of some ordinarily familiar information, emotion, or mental function. -Selected mental contents are removed or dissociated from conscious experience, but continue to produce motor or sensory effects. -These are the elsewhere disorders: Part of the person (memory, identify) is elsewhere and not available at the present time. -In dissociative states, people can appear unconscious and focus selectively on the environment (sleepwalking, trance), act bizarrely (running "amok," going "berserk"), lose their identity and wander away from home (fugue), lose memory without wandering away from home (amnesia), assume an alien identify (multiple personality, witchcraft, possession), or be brainwashed. -Some dissociative states are not pathological, and to some extent, are highly adaptive.

F54 (316) - Psychological Factors Affecting Other Medical Conditions

A medical symptom or condition (other than mental disorder) is present Psychological or behavioral factors adversely affect the medical condition in one of the following ways: Factors have influenced the course of the medical condition as shown by a close temporal association between the psych factors and the development or exacerbation of, or delayed recover fro, the medical condition The factors interfere with the treatment of the medical condition Factors constitute additional well-established health risks to individual The factors influence the underlying pathophysiology, precipitating or exacerbating symptoms or necessitating medical attention. Psych or behavioral factors of "B" not better explained by another mental disorder Specify if: Mild Moderate Severe Extreme

F94.1 (313.89) Reactive Attachment Disorder Criteria

A. A consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers, manifested by the following: 1. The child rarely or minimally seeks comfort when distressed 2. The child rarely or minimally responds to comfort when distressed B. A persistent social & emotional disturbance characterized by at least 2 of the following: 1. Minimal social & emotional responsiveness to others 2. Limited Positive affect 3. Episodes of unexplained irritability, sadness or fearfulness that are evident even during nonthreatening interactions with adult caregivers C. The child has experienced a patterns of extremes of insufficient care as evidenced by at least 1 of the following: 1. Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation & affect met by caregivers 2. Repeated changes of primary caregivers that limit opportunities to form stable attachments 3. Rearing in unusual settings that severely limit opportunities to form selective attachments D. The care in Criterion C presumed to be responsible for the disturbed behavior in Criterion A E. The criteria are not met for autism spectrum disorder F. The disturbance is evident before age 5 yrs G. The child has a developmental age of at least 9 yrs Specify if: Persistent: The disorder as been present for more than 12-months Specify current severity: Severe when exhibits all symptoms, at high levels

L98.1 (698.4) - Excoriation

A. Recurrent skin picking resulting in skin lesions B. Repeated attempts to decrease or stop skin picking C. Cause clinically significant distress or impairment in functioning D. Not attributable to the physiological effects of a substance or other medical condition E. Not better explained by sxs of another mental disorder

F94.2 (313.89) Disinhibited Social Engagement Disorder Criteria

A. A pattern of behavior in which a child actively approached & interacts with unfamiliar adults & exhibits at least 2 of the following: 1. Reduced or absent reticence in approaching & interacting with unfamiliar adults 2. Overly familiar verbal or physical behavior (not consistent with culturally sanctioned & with age-appropriate social boundaries). 3. Diminished or absent checking back with adult caregiver after venturing away, even in unfamiliar settings 4. Willingness to go off with an unfamiliar adult with minimal or no hesitation. B. Behaviors in Criterion A are not limited to impulsivity (as ADHD) but include socially disinhibited behaviors C. The child has experienced a patterns of extremes of insufficient care as evidenced by at least 1 of the following: 1. Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation & affect met by caregivers 2. Repeated changes of primary caregivers that limit opportunities to form stable attachments 3. Rearing in unusual settings that severely limit opportunities to form selective attachments D. The care in Criterion C is presumed to be responsible for the disturbed behavior in Criterion A E. The child has a developmental age of at least 9-years Specify if: Persistent: The disorder as been present for more than 12-months Specify current severity: Severe when exhibits all symptoms, at high levels

F44.0 (300.12) - Dissociative Amnesia Criteria

A. An inability to recall important autobiographical information, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting (most localized or selective) B. Cause clinically significant distress/impairment in functioning C. No attributable to substances, neurological or medical condition D. Not better explained by DID, PTSD, ASD, Somatic SX Disorder, or other neurocognitive Disorder With Dissociative Fugue: (300.13) Apparently purposeful travel or bewildered wandering that is associated with amnesia for identity or other autobiographical information

Substance Induced Anxiety Disorder- Criteria

A. Anxiety or panic attacks predominate the clinical picture B. Evidence from hx, exam or lab that is consequence of either: -Symptoms develop during or soon after substance intoxication or withdrawal or after exposure to medication -Involved substance/Medication use capable of producing sxs C. Not better accounted for by anxiety disorder that is not substance induced. Evidence of an independent anxiety disorder could include the following -Sxs precede the onset of the use, persist for substantial period of time after cessation of acute withdrawal or severe intoxication, other evidence suggesting the existence independent of use D. Does not occur exclusively during course of delirium E. Causes clinically significant distress/impairment of functioning Should be made if symptoms in excess of those usually associated with substance use

F94.0 (312.23) - Selective Mutism Criteria

A. Consistent failure to speak in specific social situation in which there is an expectation for speaking despite speaking in other situations B. Disturbance interferes with educational or occupational achievement or with social communication C. Duration of disturbance at least 1-month (not limited to first month of school) D. Failure to speak not attributable to lack of knowledge or, or comfort with, the spoken language required in the social situation E. Not better explained by a communication disorder or does not occur exclusively during autism, schizophrenia or other psychotic disorder

F93.0 (309.21) - Separation Anxiety Disorder

A. Developmentally inappropriate & excessive fear or anxiety concerning separation from those they are attached, evidenced in at least 3: -Recurrent excessive distress when anticipating or experiencing separation from home or major attachment figure -Persistent & excessive worry about losing attachment figure(s) or possible harm to them -Persistent & excessive worry about experiencing untoward events that will cause separation -Persistent reluctance to go out (from home) for fear of separation -Persistent & excessive fear of or reluctance about being alone or with out figure in any setting -Persistence reluctance or refusal to sleep away from home or to go to sleep without figure -Repeated nightmares involving separation -Repeated complaints of physical symptoms when occurs or anticipated B. The Fear, anxiety or avoidance is persistent, at least 4-weeks in children & adolescents, & typically 6-months+ in adults C. Causes clinically significant functional distress D. Not better explained by other mental disorder autism resistance to change, delusions about separating, agoraphobia, GAD, other illness anxiety

F41.1 (300.02) - Generalized Anxiety Disorder

A. Excessive anxiety & worry (apprehensive expectation), occurring more days that not for 6-months, about a number of events or activities (e.g., work or school performance) B. Difficulty controlling the worry C. Anxiety & worry associated with 3 or more of following (with at least some present for more days that not for 6-months) - only 1 required in children: -Restlessness or feeling keyed up or edgy -Being easily fatigued -Difficulty concentrating or mind going blank -Irritability -Muscle tension -Sleep disturbance (falling/staying asleep/unsatisfying sleep D. The anxiety, worry or physical symptoms cause clinically significant distress or impairment in social, occupational or other important functional areas. E. The disturbance not attributable to the effects of substance or general medical condition F. The disturbance not better explained by another mental disorder

F43.10 (309.81) - PTSD FOR CHILDREN 6 & under

A. Exposure to actual or threatened death, serious injury or sexual violence in 1 (or more) of the following ways: 1. Directly experiencing traumatic event(s) 2. Witnessing, in person, event as occurs to others 3. Learning that event occurred to a parent or caregiver Note: Witnessing does not include events witnessed through electronic media, TV, movies, or exposure unless work related. B. Presence of 1 (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred: -Recurrent, involuntary, intrusive, distressing memories (repetitive play) -Recurrent, distressing dreams in which content &/or affect of dreams are related to event(s) (frightening without recognizable content) -Dissociative reactions (e.g. flashbacks) -individual feels or acts as if the traumatic event(s) were recurring (trauma specific reenactment may occur) -Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble some aspect of event -Marked physiological reactions to reminders C. 1 or more of following sxs, representing either persistent avoidance of stim. associated with event(s) or negative alterations in cognitions & mood associated with event(s), must be present, beginning after the events or worsen after event(s): Persistent Avoidance of Stimuli: 1. Avoidance of or efforts to avoid distressing memories, thoughts or feelings, associated with event(s) 2. Avoidance of or efforts to avoid people, places, conversations or interpersonal situations that arouse recollections Negative Alteration in Cognitions: 3. Substantially increased frequency of negative emotional states 4. Markedly diminished interest or participation in significant activities, including constriction of play 5. Socially withdrawn behavior 6. Persistent reduction in expression of positive emotions D. Alterations in arousal & reactivity associated with the event(s), beginning or worsening after the event(s) occurred, as evidenced by 2 or more of: -Irritable behavior & angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression towards people or objects -Hypervigilence -Exaggerated startle response -Problems with concentration -Sleep disturbance (difficulty falling or stating asleep) E. Duration of the disturbance is more than 1-month F. The disturbance causes clinically significant distress or impairment G. Not attributable to the physiological effects of a substance or medical condition Specify if: With dissociative symptoms Depersonalization Derealization Specify if: With delayed expression

F43.0 (308.3) - Acute Stress Disorder Criteria

A. Exposure to actual or threatened death, serious injury or sexual violence in 1 (or more) of the following ways: 1. Directly experiencing traumatic event(s) 2. Witnessing, in person, event as occurs to others 3. Learning that occurred to close family member or friend. In cases of actual or threatened death - must have been violent or accidental 4. Experiencing repeated or extreme exposure to aversive details of traumatic event(s) Note: A4-not apply to exposure through electronic media, TV, movies, or exposure unless work related Person's response involved intense fear, helplessness or horror B. Presence of 9 or more from any of the 5 categories beginning or worsening after the event(s): Intrusion Symptoms: -Recurrent, involuntary, intrusive, distressing memories (repetitive play) -Recurrent, distressing dreams in which content &/or affect of dreams are related to event(s) (frightening without recognizable content) -Dissociative reactions (e.g. flashbacks) -individual feels or acts as if the traumatic event(s) were recurring (trauma specific reenactment may occur) -Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble some aspect of event Negative Mood: -Persistent inability to experience positive emotions Dissociative Symptoms: -An altered sense of the reality of one's surroundings or oneself (being in a daze, time slowing) -Inability to remember an important aspect of the event(s) (typically due to dissociative amnesia) Avoidance Symptoms: -Efforts to avoid distressing memories, thoughts or feelings, associated with event(s) -Efforts to avoid external reminders that arouse distressing memories, thoughts or feelings, associated with event(s) Arousal Symptoms: -Sleep disturbance (difficulty falling or stating asleep) -Irritable behavior & angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression towards people or objects -Hypervigilence -Problems with concentration -Exaggerated startle response C. Duration of the disturbance is 3-days to 1-month after exposure Note: Typically begin immediately after event, but persist for 3-days to 1-month need for DX D. The disturbance causes clinically significant distress or impairment E. Not attributable to the physiological effects of a substance or medical condition and not better explained by a brief psychotic disorder

F40.10 (300.23) - Social Anxiety Disorder (Social Phobia) Criteria

A. Marked fear or anxiety about 1 or more social situations where exposed to possible scrutiny by others. (social interactions, being observed, performing) * in children, anxiety must occur in peer settings & not just during interactions with adults. B. Fears that will act in a way or show anxiety sxs that will be negatively evaluated (humiliating or embarrassing, lead to rejection or offend other). C. Social situations almost always provoke fear or anxiety * in children, fear or anxiety may be expressed by crying, clinging, tantrums, freezing, shrinking, failing to speak) D. Social situations are avoided or endured with intense fear/anxiety E. Fear/anxiety out of proportion to the actual threat of situation or sociocultural context F. Fear, anxiety or avoidance is persistent and typically 6-months or more G. Fear, anxiety or avoidance causes clinically significant distress or impairment in functioning H. Symptoms not directly caused by a general medical condition or substance/medication use. I. Not better explained by another mental disorder J. If other medical condition is present, symptoms are clearly unrelated or excessive (Parkinson's, obesity, injury, disfigurement) Specify if Performance only: restricted to speaking or performing in public

F40.00 (300.22) - Agoraphobia Criteria

A. Marked fear or anxiety about 2 or more of following 5 situations -Using public transportations (trains cars, etc..) -Being in open spaces -Being in enclosed places (shops, theaters) -Standing in line or being in a crowd -Being outside of the home B. The individual fear or avoids these situations because thoughts that escape might be difficult or help not available if develops panic-like sxs or other incapacitating or embarrassing sxs C. The agoraphobic situations almost always provoke fear or anxiety D. The situations are actively avoided, require presence of a companion or endured with intense fear or anxiety E. Fear or anxiety is out of proportion to the actual danger posed by the agoraphobic situations and to the sociocultural context. F. The fear, anxiety, or avoidance is persistent, typically lasting for 6-months or more. G. The fear, anxiety or avoidance causes clinically significant distress or impairment in functioning H. If another medical condition is present, fear, anxiety or avoidance clearly excessive I. Not better explained by the symptoms of another mental disorder Agoraphobia is diagnosed irrespective of the presence of panic disorder - if meets both criteria both used.

F40.2XX (300.29) - Specific Phobia Criteria

A. Marked fear or anxiety about seeing a specific object or situation (in children may be crying, tantrums, freezing or clinging) B. Phobic stimulus almost always immediately provokes immediate fear or anxiety C. Stimulus is actively avoided or endured with intense fear or anxiety D. The fear or anxiety out of proportion to actual danger posed by stimulus or sociocultural context E. Lasting 6-mo or more F. Either marked distress about fear or markedly interferes with daily routines or functioning (social/job) G. Symptoms are not better explained by another anxiety or mental disorder

Substance/Medication-Induced O-C and Related Disorder Criteria

A. Obsessions, compulsions, skin picking hair pulling, other body-focused repetitive behaviors, or other sxs of this category predominate the clinical picture B. Evidence from hx, exam or lab that is consequence of either: 1. Symptoms develop during or soon after substance intoxication or withdrawal or after exposure to medication 2. Involved substance/Medication use capable of producing sxs C. Not better accounted for by anxiety disorder that is not substance induced. Evidence of an independent anxiety disorder could include the following -Sxs precede the onset of the use, persist for substantial period of time after cessation of acute withdrawal or severe intoxication, other evidence suggesting the existence independent of use D. Does not occur exclusively during course of delirium E. Causes clinically significant distress/impairment of functioning

F06.8 (294.8) Obsessive-Compulsive & Related Disorder Due To A General Medical Condition

A. Obsessions, compulsions, skin picking hair pulling, other body-focused repetitive behaviors, or other sxs of this category predominate the clinical picture B. Evidence from hx, exam or lab that is consequence of medical condition C. Not better accounted for by another mental disorder D. Does not occur exclusively during course of delirium E. Causes clinically significant distress/impairment of functioning Specify if: With obsessive-compulsive disorder-like symptoms With appearance preoccupations With hoarding symptoms With hair pulling symptoms With skin picking symptoms

F45.1 (300.82) - Somatic Symptom Disorder Criteria

A. One or more somatic symptoms that are distressing or result in significant disruption of daily life -Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns as manifested by at least 1 of the following: -Disproportionate & persistent thoughts about the seriousness of sxs -Persistently high levels of anxiety about health or sxs B. Excessive time & energy devoted to these sxs or health concerns C. Although any one sx may not be continuously present, the state of being symptomatic is persistent (usually more than 6-months). Specify if: With predominate pain Specify if: Persistent (more than 6-months) Specify current severity Mild Moderate Severe

Conversion Disorder Criteria

A. One or more symptoms of altered voluntary motor or sensory function. B. Clinical findings provide evidence of incompatibility between symptoms and recognized neurological or medical condition. C. Symptom or deficit not better explained by another medical or mental disorder D. Causes clinically significant distress or impairment of functioning or warrants medical evaluation One ICD-9-CM code for all symptom types, while ICD-10-CM code will depend on symptoms type

F42 (300.3) - Hoarding Disorder criteria

A. Persistent difficulty discarding or parting with possessions, regardless of their actual value B. This difficulty is due to perceived need to save the items & distress associated with discarding them C. The difficulty discarding possessions results in accumulation of possessions that congest & clutter active living areas & substantially compromises their intended use. If living areas are uncluttered - only because of interventions from 3rd party D. Hoarding causes clinically significant distress or impairment in functioning E. Not attributable to another medical condition F. Not better explained by symptoms of another mental disorder Specify if: With excessive acquisition: (no available space) With good or fair insight With poor insight With absent insight/delusional beliefs

F45.22 (300.7) - Body Dysmorphic Disorder

A. Preoccupation with 1 or more perceived defects or flaws in physical appearance that are not observable or appear slight to others B. At some point during course, has performed repetitive behaviors (mirror checking, skin picking) or mental acts (comparing to others) in response to appearance concerns C. Preoccupations cause clinically significant distress or impairment in functioning D. Appearance preoccupation is not better explained by concerns with body fat or weight in someone who meets criteria for an eating disorder Specify if: With muscle dysmorphia With good insight With poor insight With absent insight/delusional beliefs

F45.21 (300.7) - Illness Anxiety D/O Criteria

A. Preoccupation with having or acquiring a serious illness B. Somatic sxs are not present or, if present, are only mild in intensity. If another medical condition is present or there is a high risk for developing a medical condition, the preoccupation is clearly excessive or disproportionate. C. High level of anxiety about health and the individual is easily alarmed about personal health status. D. The individual performs excessive health-related behaviors (body checks) or exhibits maladaptive avoidance (missed appts) E. Preoccupations present for at least 6-months Not better accounted for by another mental disorder (Somatic Sx Disorder, Panic Disorder, GAD, Body Dysmorphic Disorder, OCD, Delusional Disorder) Specify if: Care seeking type Care Avoidant Type

F42 (300.3) - OCD Criteria

A. Presence of obsessions or compulsion or both -Obsessions defined by both 1. Recurrent and persistent thoughts, impulses or images experiences, at some point in disturbance, as intrusive and unwanted & that cause marked distress or anxiety in most individuals 2. Attempts to ignore or suppress, or to neutralize them with some action or other thought -Compulsions defined by both: 1. Repetitive behaviors or mental acts that feels driven to perform in response to an obsession or according to rules that must be applied rigidly 2. Behaviors or mental acts re aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation. however, these behaviors or mental acts are not connected in realistic way with what a attempting to neutralize or prevent, or are clearly excessive B. The obsessions or compulsions are time-consuming or cause clinically significant distress or impairment in functioning C. Obsessive-compulsive symptoms not attributable to the physiological effects of a substance or another medical condition D. Disturbance is not better explained by symptoms of another mental disorder Specify if -With good or fair insight: recognizes disorder beliefs are definitely or probably not true or that they may or may not be true -With poor insight: thinks beliefs are probably true -With absent insight/delusional beliefs: completely convinced that beliefs are true -Tic related: current or past history

F48.1 (300.6) - Depersonalization/Derealization Disorder Criteria

A. Presence of persistent or recurrent experiences of depersonalization, derealization or both B. During these experiences, reality testing remains intact C. Causes clinically significant distress or impairment D. Depersonalization causes clinically significant distress or impairment in functioning E. Not attributable to substance or medical condition F. Not better explained by another mental disorder, such as Schizophrenia, Panic Disorder, MDD, ASD, PTSD or other Dissociative Disorder

F63.2 (312.39) - Trichotillomania

A. Recurrent pulling out of one's hair, resulting in hair loss B. Repeated attempts to decrease or stop pulling hair C. Causes clinically significant distress or impairment in functioning D. Not attributable to another medical condition E. Not better explained by another mental disorder

F41.0 (300.01) - Panic Disorder Criteria

A. Recurrent unexpected panic attacks: abrupt surge of intense fear or discomfort that reach a peak within minutes, and during which 4 or more sxs occur: -Palpitations, pounding heart, or accelerated heart rate -Sweating -Trembling & shaking -Sensations of shortness of breath or smothering -Feelings of choking -Chest pain or other chest discomfort -Nausea or other abdominal discomfort -Dizzy, lightheaded, faint or unsteady feeling -Chills or hot flashes -Paresthesia (numbness or tingling sensations) -Derealization/Depersonalization -Fears of loss of control or becoming insane -Fear of dying B. At least one of the attacks has been followed by 1-month (or more) of 1 or both of following C. Persistent concern or worry about additional panic attacks or their consequences (losing control, heart attack, etc.) D. Significant maladaptive change in behavior related to the attach (designed to avoid attacks) E. Not attributable to physiological effects of a substance or other medical condition F. Not better explained by another mental disorder (not only in response to social situation, , or toward specific stimuli, or when at risk of separation from key attachment figure)

Adjustment Disorder Criteria

A. The development of emotional or behavioral symptoms in response to an identifiable stressor(s) occurring within 3-months of the onset of stressor(s) B. These symptoms or behaviors are clinically significant as evidence by one or both of following: 1. Marked distress that is out of proportion to the severity or intensity of the stressor, taking into account the external context & cultural factors that might influence symptoms severity & presentation 2. Significant impairment in social or occupation(school) functioning C. The stress related disturbance does not meet criteria for another mental disorder & is not merely an exacerbation of a preexisting mental disorder D. Symptoms do not represent Bereavement E. Once stressors or consequences has terminated, symptoms do not persist for more than 6-months

F43.10 (309.81) - Post Traumatic Stress Disorder Criteria

Applies to adults, & youth over 6-years (other criteria for younger) A. Exposure to actual or threatened death, serious injury or sexual violence in 1 (or more) of the following ways: 1. Directly experiencing traumatic event(s) 2. Witnessing, in person, event as occurs to others 3. Learning that occurred to close family member or friend. In cases of actual or threatened death - must have been violent or accidental 4. Experiencing repeated or extreme exposure to aversive details of traumatic event(s) Note: A4-not apply to exposure through electronic media, TV, movies, or exposure unless work related. B. Presence of 1 (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred: 1. Recurrent, involuntary, intrusive, distressing memories (thoughts, images, perceptions) (children - repetitive play) 2. Recurrent, distressing dreams in which content &/or affect of dreams are related to event(s) (children - frightening without recognizable content) 3. Dissociative reactions (e.g. flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring (such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings) (children - trauma specific reenactment may occur) 4. Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble some aspect of event 5. Marked physiological reactivity on exposure to internal or external cues that symbolize or resemble and aspect of event (rapid heart beat, elevated blood pressure C. Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by 1 or both of the following: 1. Avoidance of or efforts to avoid distressing memories, thoughts or feelings, associated with event(s) 2. Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the event(s) D. in cognitions & mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by 2 (or more) of the following 1. Inability to remember an important aspect of the event(s) - typically due to dissociative amnesia & not other factors - e.g. TBI, substances) -Persistent & exaggerated negative beliefs or expectations about oneself, others r the world (everything dangerous, I am bad, etc.) -Persistent, distorted cognitions about the cause or consequences of the event(s) that lead to self blame or blame of others -Persistent negative emotional state (fear, horror, shame, guilt, anger) -Marked diminished interest or participation in significant activities -Feelings of detachment or estrangement form others -Persistent inability to experience positive emotions (inability to experience happiness, satisfaction, r loving feelings) E. Marked alterations in arousal & reactivity associated wit the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following -Irritable behavior & angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression towards people or objects -Reckless or self-destructive behavior -Hypervigilence -Exaggerated startle response -Problems with concentration -Sleep disturbance (difficulty falling or stating asleep) F. Duration of the disturbance is more than 1-month G. The disturbance causes clinically significant distress or impairment H. Not attributable to the physiological effects of a substance or medical condition

F45.8 (300.89) - Other Specified Somatic & Related Disorder

Brief somatic symptom disorder Brief illness anxiety disorder Pseudocyesis

F44.89(300.15) - Other Specified Dissociative Disorder

Chronic & recurrent syndromes of mixed dissociative symptoms Identity disturbance due to prolonged & intense coercive persuasion Acute dissociative reactions to stressful events

F40.2XX (300.29)- Specific Phobia Criteria Coding Notes

Code based on stimulus (each new code with ICD-10): F40.218 - Animal Type (spiders, snakes) F40.228 - Natural Environment Type (thunderstorms, heights) F40.23x - Blood-Injection-Injury Type F40.230 - Fear of blood F40.231 - Fear of injection/transfusion F40.232 - Fear of other medical care F40.233 - Fear of injury F40.248 - Situation Type (airplane, closed in) F40.298 - Other Type (situations that might lead to illness, choking, vomiting) When more than 1 stimulus is present code all that apply F40.2XX Specific Phobia Criteria Coding F40.218 - Animal Type (spiders, snakes) F40.228 - Natural Environment Type (thunderstorms, heights) F40.23x - Blood-Injection-Injury Type F40.230 - Fear of blood F40.231 - Fear of injection/transfusion F40.232 - Fear of other medical care F40.233 - Fear of injury F40.248 - Situation Type (airplane, closed in) F40.298 - Other Type (situations that might lead to illness, choking, vomiting)

Conversion Disorder Coding

F44.4 - With weakness or paralysis F44.4 - With abnormal movement F44.4 - With swallowing symptoms F44.4 - With speech symptoms F44.5 - With attacks or seizures F44.6 - With anesthesia or sensory loss F44.6 - With special sensory symptoms F44.7 - With mixed symptoms Specify if: Acute episode Persistent Specify if: With psychological stressor Without psychological stressor

Coding & Subtypes Adjustment Disorder

F43.21 (309.0) - With Depressed Mood e.g., Low mood, tearfulness, feelings of hopelessness F43.22 (309.24) - With Anxiety e.g., nervousness, worry, jitteriness F43.23 (309.28) - With Mixed Anxiety & Depressed Mood F43.24 (309.3) - With Disturbance of Conduct Violation of rights or others or age appropriate norms & rules (truancy, vandalism, fighting) F43.25 (309.4) - With Mixed disturbance of Emotions & Conduct F43.20 (309.9) - Unspecified Maladaptive reactions not classifiable above V

Dissociative Disorders

Dissociative Identity Disorder Dissociative Amnesia Depersonalization/Derealization Disorder Other Specified Dissociative Disorder Unspecified Dissociative Disorder

The type of alteration dictates the type of dissociative disorder:

Dissociative amnesia-consciousness is altered and significant personal events forgotten. Dissociative fugue-identity and motor behavior are altered

patients unexpectedly travel far from home, assume a new identify, forgetting their old one. Dissociative identify disorder-(multiple personality disorder) patients feel as if they are outside of their mind or body, as an observer. Residual Category: Dissociative disorder not otherwise specified (covers brainwashing and trance disorder) Almost all patients with dissociative disorder report being physically or sexually abused as children.Dissociation into different identities defends against traumas by isolating the horror, sectioning off the child's negative self-images, and permitting a modicum of self-control.

F44.81 (300.14) - DID Criteria A. Disruption of identity characterized by two or more distinct personality states, which may be described in some cultures as an experience of possession. The disruptions in identity involved marked discontinuity in sense of self and sense of agency, accompanied by related alterations in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning. These signs & sxs may be observed by others or reported by the individual B. Recurrent gaps (amnesia) in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting. C. Clinically significant distress/impairment in functioning. D. Not a normal part of accepted cultural or religious practice (in children not better explained by fantasy or imaginary friends) E. Not attributable to alcohol or medical condition

F68.10 (300.19) - Factitious Disorder Criteria

IMPOSED ON SELF A. Falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception B. Individual presents self to others as ill, impaired or injured C. Deceptive behavior is evident even in the absence of obvious external rewards D. The behavior is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder Specify is: Single episode Recurrent episode (2 or more)

OC and Related Disorders

Obsessive Compulsive Disorder Body Dysmorphic Disorder Hoarding Disorder Trichotillomania Disorder Excoriation (Skin Picking) Disorder Substance/Medication-Induced Obsessive-Compulsive & Related Disorders Obsessive-Compulsive & Related Disorders Due to General Medical Condition Other Specified Obsessive-Compulsive & Related Disorders Unspecified Obsessive-Compulsive & Related Disorders

F43.8 (309.89) - Other Specified Trauma & Stressor-Related Disorder

Presentation in which symptoms characteristic of a trauma & stressor related disorder that causes clinically significant distress or impairment in functioning but do not meet full criteria for any disorder. Examples are: Adjustment-like disorders with delayed onset of symptoms that occur more than 3-months after the stressor Adjustment-like disorders with prolonged duration of more than 6-months without prolonged duration of stressor Persistent complex bereavement disorder

Anxiety Disorders

Separation Anxiety Disorder Selective Mutism Specific Phobia Social Anxiety Disorder (Social Phobia) Panic Disorder Agoraphobia Generalized Anxiety Disorder Substance/Medication-Induced Anxiety Disorder Anxiety Disorder Due to General Medical Condition Other Specified Anxiety Disorder Unspecified Anxiety Disorder

Trauma and Stressor Related Disorders

Reactive Attachment Disorder Disinhibited Social Engagement Disorder Posttraumatic Stress Disorder Acute Stress Disorder Adjustment Disorder Other specified Trauma & Stressor-Related Disorder Unspecified Trauma & Stressor-Related Disorder

Adjustment Disorder Criteria - Differential Diagnosis

Residual category used to describe presentation in response to stressor that do not meet criteria for another disorder If symptoms meet criteria for Major Depressive Episode, then can't diagnose Adjustment Disorder Usually not diagnosed with Personality Disorders as they are exacerbated by stress, unless symptom response to stressor not typical in Personality Disorder Like PTSD and ASD, response to stressor. but severity of stressor less important and symptoms have more variety Bereavement usually diagnosed instead when reaction is an expectable response - is response is excessive or more prolonged, then Adjustment may be acceptable

Factitious disorder should be distinguished from:

Somatoform Disorder Malingering Antisocial personality disorder Schizophrenics

F43.10 (309.81) - PTSD Coding Notes

Specify if: With dissociative symptoms (beside meeting criteria, also experiences persistent or recurrent of the following) Depersonalization: persistent or recurrent experiences of feeling detached from, as if outside observer, one's mental processes or body Derealization: persistent or recurrent experiences of unreality of surroundings (world dream-like) Specify if: With delayed expression (if full criteria not met until 6-months after event)

Dissociative Fugue (further information)

These patients flee from home or their customary locale, forget (or are confused about) their previous identity, and adopt a partial one. Patients usually behave with sufficient skill to go unnoticed by a casual observer. Fugues typically are precipitated by an acute stressor and consist of a several-day excursion with minimal social contact. There may be some perplexity and disorientation but if they dominate then it is amnesia and not fugue. Other fugues are more elaborate, lasting weeks to months. Afterwards, patients can't remember what transpired during the fugue. In contrast to amnesia patients, who are aware of their memory loss, fugue victims are usually not aware.

Dissociation may also occur in or while:

crystal gazing, intense prayer, "mass hysteria," religious revivals, healing ceremonies, hypnosis, attending lectures, and even while reading Most dissociative states are activated by a psychosocial trigger, arise suddenly, and end abruptly. These are the elsewhere disorders: Part of the During normal intervals, people are partly or totally amnestic for their dissociative episodes (posthypnotic suggestion). Dissociative experiences are common.

Obsessions:

recurrent & persistent thoughts, urges or images experienced as intrusive & unwanted Not pleasurable or experienced voluntarily Attempts to ignore (avoiding triggers) or neutralize with another action or thought (washing, checking)

Compulsions

repetitive behaviors or mental acts that feel driven to perform in response to an obsession or rules that must be applied rigidly. Typically performed in response to an obsession - aim to reduce stress from obsession or prevent feared event Not connected in realistic way to feared event Not done for pleasure