DSM-5 SUMMARY SET 1 1
DSM-5 Summary Set 1, Summaries of Bipolar and Related Disorders, Depressive and
Anxiety Disorders
Shanna L. Crawford
Department of Behavioral Sciences, Liberty University
DSM-5 SUMMARY SET 1 2
All of the following information was taken from the Diagnostic and Statistical Manual 5th
Edition (American Psychiatric Association, 2013) unless otherwise noted.
Bipolar and Related Disorders
Overview
Bipolar and related disorders can be defined by the presence, severity, and length
of manic symptoms (Kring & Johnson, 2021). Someone experiencing a full
manic episode can also suffer from major depressive episodes throughout their
life (APA, 2013). Many medical conditions, abused substances, and medications
can create a manic-like experience (APA, 2013). Mania and depression sit on
opposing poles and thus these disorders are classified as “bipolar” since a lot of
people who encounter mania will also encounter depression at some point in their
life span (Kring & Johnson, 2021). All of the disorders are not better explained
by a substance, other medical conditions, or by any other psychological disorders.
Included in bipolar and related disorders are bipolar I disorder,:bipolar II
disorder,:cyclothymic disorder, substance/medication-induced bipolar and related
disorder,:bipolar and related disorder due to another medical condition,:other
specified bipolar and related disorder, and:unspecified bipolar and related disorder
(APA, 2013).
Disorders
Bipolar I Disorder
A specific period of abnormally elated or irritable mood, with increasing energy
lasting at least 1 week, present almost all day, almost every day (APA, 2013). It
is required that there is one manic episode in one’s lifetime in order to diagnose
bipolar I disorder. Bipolar I disorder can include a hypomania episode, which
must last 4 days and has the same requirements as manic episodes. It also may,
but not required, include a major depressive episode, which requires 5 symptoms
and presents itself within a consistent 2-week period.
Bipolar II Disorder
In bipolar II disorder, at least one hypomanic and one major depressive episode
have happened, meeting all the criterion for each, and there can never have been a
manic episode, if there is one manic episode, then the diagnosis becomes bipolar I
disorder for a lifetime (APA, 2013). If a hypomanic episode causes consequential
distress in occupational, social, or other areas of functioning, then it also becomes
a diagnosis of bipolar I disorder. Major depressive episodes may cause such
distress, but not hypomania. Depressive symptoms mixed with hypomanic
symptoms are more common in females diagnosed with bipolar II disorder
(Suppes et al., 2005; see also Kring & Johnson, 2021).
Cyclothymic Disorder
There have been, for a minimum of 2 years in adults (1 year for children),
numerous times of hypomanic symptoms and depressive symptoms that do not
meet the criterion for hypomanic episodes and major depressive episodes (APA,
DSM-5 SUMMARY SET 1 3
2013). During this 2-year period, these symptoms must be present at least 50% of
the time and the person cannot be symptom free greater than 2 months at a single
time. Full criteria for a hypomanic, manic, or major depressive episode never
have been met. Once a person encounters one of these episodes, then the
diagnosis changes to the proper disorder. A person has a 15-50% chance of
developing bipolar I or II disorder once they have been diagnosed with
cyclothymic disorder (APA, 2013).
Substance/Medication-Induced Bipolar and Related Disorder
Shortly after introduction to a substance either intoxication or withdrawal will
happen. This substance is able to produce elated or irritable mood, it may or may
not present with a depressed mood, symptoms continue about 1 month after
discontinuing substance, extreme intoxication, or withdrawal, and symptoms are
approximately the same as mania, depression, or hypomania (APA, 2013). The
key anomaly is when mania or hypomania appear after an antidepressant
prescription is used and the symptoms persist in addition to the physiological
medication effects (APA, 2013). One difference in manic, hypomanic, and major
depressive episode is the timeframe. If one of these episodes appears during an
antidepressant treatment; continues at full symptom level, lasting past the
physiological treatment effect, due to a substance/medication-induced episode;
then the diagnosis would change to bipolar I, bipolar II, or major depressive
disorder.
Bipolar and Related Disorder Due to Another Medical Condition
Evidence is presented through physical examination, history, or labs that there has
been a direct pathophysiological disturbance and the consequence is due to a
separate medical condition. This disturbance is a distinct period of unnaturally
elated or irritable mood and increased energy that overshadows in the clinical
sense. In most cases, these elevated moods (mania or hypomania episodes),
might present themselves prior to the appearance of the medical condition. The
exception would be chronic medical conditions, which could bring on a manic or
hypomanic episode. The most well-known conditions to cause manic or
hypomanic disorder are multiple sclerosis (Joffe et al., 1987; see also APA, 2013),
Cushing’s disease (Haskett, 1985; see also APA, 2013), and traumatic brain
injuries as well as stroke (Mustafa et al., 2005; see also APA, 2013).
Other Specified Bipolar and Related Disorder
Bipolar symptoms present while causing extreme distress in occupational, social,
and other areas of functioning, however, they do not satisfy the complete criteria
for bipolar I, hypomania, bipolar II, or major depressive disorder. This has a
short-duration of one of these disorders, such as less than 2 years for cyclothymia
or 2-3 days for hypomanic episode rather the required 4 day minimum. The
counselor will choose to specify a reason why it did not meet the criteria.
Unspecified Bipolar and Related Disorder
This diagnosis is used primarily with emergency services, when not enough
information is received to make a specific diagnosis. Unspecified bipolar and
related disorder is just like Other specified bipolar and related disorder except for
this one exception; it is used when clinicians choose to not give a specific reason
why the criteria is being met.
DSM-5 SUMMARY SET 1 4
Risk and Prognostic Factors
This is a biological review of the risks of bipolar I disorder. The strongest and
most common factor is hereditary risks. There is a 10-time increase for adults
with relatives who have bipolar I disorder for them to share it genetically (APA,
2013). Females have a higher rate of experiencing depression, mixed states, rapid
cycling, and eating disorders, than males do (McElroy et al., 2011; Suppes et al.,
2005; see also APA, 2013). Neurotransmitters have been researched in bipolar I
disorder: norepinephrine, dopamine, and serotonin; and researchers are not sure if
a person has too much or too little neurotransmitters, or if there are changes
within the receptors (Kring & Johnson, 2021). Serotonin plays a part in
depression, dopamine has to do with pleasure, energy, and motivation (Depue &
Iacono, 1989; see also Kring & Johnson, 2021). Regions of and chemicals in the
brain are very involved in bipolar I disorder.
DSM-5 SUMMARY SET 1 5
All of the following information was taken from the Diagnostic and Statistical Manual 5th
Edition (American Psychiatric Association, 2013) unless otherwise noted.
Depressive Disorders
Overview
Depressive disorder was included with bipolar and related disorders in the DSM-
IV but has been separated in the DSM-5. This disorder is commonly featured by
sadness, irritableness, or emptiness, and may be sustained with cognitive and
somatic changes that substantially affect the act of functioning (APA, 2013).
Depression that is bereavement-related usually occurs with other susceptibilities
to depressive disorders, and may recover with antidepressants. This is different
than major depressive disorder. Persistent depressive disorder (dysthymia) is a
chronic expression of depression since it lasts 2 years with adults and 1 year with
children. Researchers have proved that treatment of premenstrual dysphoric
disorder starts right after ovulation and stops a few days after menses (APA,
2013). All of these disorders are not better explained by a substance, other
medical conditions, or by any other psychological disorders.
Included in depressive disorders are disruptive mood dysregulation disorder,
major depressive disorder, persistent depressive disorder (dysthymia),
premenstrual dysphoric disorder, substance/medication-induced depressive
disorder, depressive disorder due to another medical condition, other specified
depressive disorder, and unspecified depressive disorder (APA, 2013).
Disorders
Disruptive Mood Dysregulation Disorder
This disorder was created to differentiate bipolar and disruptive irritability and
uncontrollable severe behavior problems, in children between the ages of 6 to 12
years. The onset is usually before 10 years. The behavior problems include
extreme temper outbursts, usually verbal or physical that is totally out of
proportion in duration or intensity to the situation, and inconsistent to age level
(APA,2013). There are outbursts three plus times per week, and temper ranges
between angry and irritable for most of the day, almost every day (APA, 2013).
Symptoms must be present for 12 months or more and may not be symptom free
consecutively for 3 or more months. They also must present themselves in 2-3
settings, such as school, home, or with peers, and is extreme in one of these
settings (APA, 2013). This disorder is principally male.
Major Depressive Disorder
During a consistent 2-week period, there must be at least 5 symptoms present, and
either loss of pleasure or interest or depressed mood must be present. The
symptoms will create extreme distress in occupational, social, or other areas of
functioning. This disorder belongs to the depressive disorders because it can
never have had a manic or hypomanic episode, therefore, it is not part of the
bipolar disorders. Major depressive disorder has a high rate of mortality due to
DSM-5 SUMMARY SET 1 6
suicide (APA, 2013). This disorder may come on at any age, but most likely is
increased significantly at puberty, it peaks in the 20s, but onset late in life is
common. With psychotic features, MDD might develop into schizophrenia. It is
more prevalent in females.
Persistent Depressive Disorder (Dysthymia)
This disorder is when a person is depressed for most days for 2 years or more in
adults and in children the duration is 1 year or more where mood may be irritable.
There must be two or more symptoms present, while depressed (APA, 2013). A
person has never been symptom free for over 2 months at one time. Full criteria
has never been met for a hypomanic or manic episode, or cyclothymic disorder
(APA, 2013). What makes the difference between major depressive disorder and
persistent depressive disorder is duration. Symptoms create an extreme
impairment in occupational, social, or other areas of functioning. Several regions
of the brain are involved with this disorder (Hasler and Northoff, 2011; see also
APA, 2013).
Premenstrual Dysphoric Disorder
With most menstrual cycles within the last year, five or more symptoms are
present in the week before onset of menses, begins improving in a few days after
menses, and becomes absent within postmenses (APA, 2013). These symptoms
have caused extreme interference with social events and relationships. There are
two scales that measure the severity of this disorder, the Visual Analogue Scale
for symptoms of premenstrual mood and the Premenstrual Tension Syndrome
Rating Scale which is a self-report or observer test (APA, 2013). The difference
between this disorder and bipolar disorder, major depressive disorder, or
persistent depressive disorder is timing, it only happens during menses.
Substance/Medication-Induced Depressive Disorder
This disorder is marked by depression and significant loss of pleasure or interest
in most activities and evidenced by physical examination, history, or labs that
these symptoms are brought on soon after or during medication exposure or
substance intoxication or withdrawal (APA, 2013). This disorder develops within
a few weeks to 1 month after using a substance capable of causing such a
depressive state. This diagnosis is not to be made when the symptoms exclusively
occur during delirium. Certain medications can cause depression and so, good
judgement is to be used as to whether the symptoms are from treatment or this is a
true depressive disorder (APA, 2013). If symptoms occur prior to exposure of
substance, then another depressive disorder is taking place.
Depressive Disorder Due to Another Medical Condition
This disorder is marked by depression and significant loss of pleasure or interest
in most activities and evidenced by physical examination, history, or labs that the
disruptions are a direct link to a physical consequence of other medical conditions
(APA, 2013). It does not exclusively occur during delirium. Extreme distress in
occupational, social, or other areas of functioning happen. The clinician must
include the name of the medical condition within the mental disorder name (APA,
2013). A medical condition onset can bring on a major depressive episode or an
adjustment disorder, so it is essential that the two be differentiated.
Other Specified Depressive Disorder
DSM-5 SUMMARY SET 1 7
Symptoms of a depressive disorder that create extreme impairment in
occupational, social, or other areas of functioning, but do not satisfy the complete
criteria of any of the depressive disorders (APA, 2013). The clinician has chosen
to specify a reason why it does not satisfy the criteria of a specific depressive
disorder. They may record short-duration of depressive episode, because it does
not meet the proper duration for any other.
Unspecified Depressive Disorder
Symptoms of a depressive disorder that create extreme impairment in
occupational, social, or other areas of functioning, but do not satisfy the complete
criteria of any of the depressive disorders (APA, 2013). The clinician has chosen
not to specify a reason why it does not satisfy the criteria of a specific depressive
disorder. It is used in emergency settings since there is not enough information to
make a detailed diagnosis.
Risk and Prognostic Factors
This is a biological review of major depressive disorder. More than the general
population, family members of the first-degree of parents with major depressive
disorder have a two-four times greater chance of experiencing this disorder with
greater risks for early-onset (Sullivan et al., 2000; see also APA, 2013). The rate
is about 40% for heritability, and neuroticism is a well-known risk and has a
genetic susceptibility (Kendler et al., 2004; see also APA, 2013). Disabling or
chronic medical conditions will also escalate the chance for major depressive
episodes, and illnesses like morbid obesity, cardiovascular disease, and diabetes
can be complicated by these depressive episodes (APA, 2013). These depressive
episodes will most likely become major depressive episodes (APA, 2013). With
major depressive disorder, impairment may happen and may be mild, but may end
up with total incapacity to the point that a person cannot take care of their basic
needs or become catatonic (APA, 2013). More often than not, a person
experiences physical pain or illness, which keeps them from interacting in
different types of functions.
DSM-5 SUMMARY SET 1 8
All of the following information was taken from the Diagnostic and Statistical Manual 5th
Edition (American Psychiatric Association, 2013) unless otherwise noted.
Anxiety Disorders
Overview
Anxiety is an expectancy of future threat and is usually accompanied by urgency
of preparation of future peril and muscle tension with avoidant behavior (APA,
2013). An emotional response to a perceived or real immediate threat is described
as fear. Fear is associated with the fight or flight emotion. The level of anxiety or
fear are sometimes reduced by extensive avoidant behavior. Panic attacks are a
key feature of anxiety disorders. Anxiety disorders are different from normal
behavior in that they are persistent and excessive beyond appropriate
developmental periods, and normally last more than 6 months (APA, 2013).
Children express it in selective mutism and separation anxiety disorder. All of
these disorders are not better explained by a substance, other medical conditions,
or by any other psychological disorders.
Included in anxiety disorders are separation anxiety disorder, selective mutism,
specific phobia, social anxiety disorder (social phobia), panic disorder, panic
attack specifier, agoraphobia, generalized anxiety disorder, substance/medication-
induced anxiety disorder, anxiety disorder due to another medical condition, other
specified anxiety disorder, unspecified anxiety disorder (APA, 2013).
Disorders
Separation Anxiety Disorder
Age inappropriate, excessive anxiety or fear regarding separation from attached
figures, evidenced by three or more symptoms. Persistent avoidance, anxiety, or
fear lasting in children and adolescents – 4 or more weeks, and in adults – 6 or
more months (APA, 2013). A significant feature is the disproportionate anxiety
or fear regarding separation from attachment figures or home. Children with this
disorder may display shadowing the parent, clinging behavior, or will not go into
another room alone. Bedtime is the most difficult time for children and they may
refuse to sleep over at a friend’s or go to camp. Children may have physical
symptoms such as vomiting or headaches.
Selective Mutism
A person speaks at home, but has continued failure to speak in particular social
situations where the person or child is expected to speak, such as school or work
(APA, 2013). Selective mutism interferes with occupational or educational
achievement or social relationships and this disruption lasts 1 month or more. It
is not better diagnosed as a communication disorder. This disorder is notable by
extreme social anxiety and almost always, children with this disorder are given
that additional diagnosis of social anxiety disorder (Viana et al., 2009; see also
APA, 2013). Selective mutism is actually a rare disorder and is not included in
childhood disorders as a diagnostic category (APA, 2013).
DSM-5 SUMMARY SET 1 9
Specific Phobia
A distinct anxiety or fear of a particular situation or object, such as, heights,
blood, needles, flying, and animals, and happens almost every time the person
comes in contact with the situation or object (APA, 2013). This fear is expressed
in children by throwing tantrums, crying, clinging, or freezing. The anxiety or
fear is disproportionate against the actual danger proposed and lasts 6 or more
months, which helps separate it from transient fears. It is not uncommon for a
person to have more than one specific phobia (75% of people), usually three
situations or objects (Stinson et al., 2007; see also APA, 2013).
Social Anxiety Disorder (Social Phobia)
In social anxiety disorder, the main feature in adults, is extreme anxiety or fear of
social situations where a person might be negatively observed or exposed by
others; in children, it must happen among their peers. (APA, 2013). They fear
they will show signs of anxiety, such as trembling, blushing, or staring, and be
rejected for it (APA, 2013). People with this disorder will overemphasize the
negative circumstances, and the clinician makes the judgement of being
disproportionate. Duration is normally 6 or more months and it must significantly
interfere with a person’s regular routine and relationships, causing extreme
distress in areas of functioning. The average age of onset is 13 years of age, but
can onset between 8 and 15 (APA, 2013).
Panic Disorder
Panic disorder is repetitive unexpected panic attacks which are sudden surges of
extreme discomfort or fear that comes to a peak within a few minutes, in which
for a full-symptom attack, at least four of 13 cognitive and physical symptoms
happen (APA, 2013). A full-symptom attack must have more than one
unexpected panic attack to be diagnosed with panic disorder (APA, 2013).
“Unexpected” means a panic attack has no obvious trigger for the occurrence.
There are nocturnal panic attacks, waking during sleep in a full state of panic.
Panic Attack Specifier
A panic attack is a sudden flood of extreme discomfort or fear that comes to a
peak within a few minutes, in which four or more of 13 cognitive and physical
symptoms happen (APA, 2013). It can begin from an anxious or calm state. An
attack can be unexpected or expected and the determination is made by a
clinician. Required to diagnose panic disorder is the presence of recurring
unexpected panic attacks (APA, 2013).
Agoraphobia
The key feature of agoraphobia is extreme anxiety or fear provoked by a real or
an expected encounter with a great variety of situations. This requires the
authorization of symptoms to occur in two or more of five situations; using public
transportation, being in enclosed spaces, standing in line or being in a crowd, or
being outside the house alone (APA, 2013). Such anxiety may cause the fear that
something horrific may happen, no way of escape, no help available, or
embarrassing or incapacitating symptoms may occur; these are panic-like
symptoms. Avoidance may be so extreme; a person may become totally
homebound.
Generalized Anxiety Disorder
DSM-5 SUMMARY SET 1 10
Extreme worry and anxiety that occurs most days for 6 or more months, over
several activities or events, and the person has difficulty controlling the worry
(APA, 2013). This disorder occurs with three or more of the following
symptoms: feeling on edge, easily fatigued, blank mind or difficulty
concentrating, irritability, disturbed sleep, and muscle tension, for children, four
are required (APA, 2013). Persons with GAD may also encounter somatic
symptoms, have a magnified startle response, headaches, or irritable bowel
syndrome (APA, 2013). The average age of onset is 30 years (Kessler et al.,
2012; see also APA, 2013).
Substance/Medication-Induced Anxiety Disorder
Symptoms of anxiety or panic are due to the influence of a medication or
substance exposure and develops soon after or during substance intoxication or
withdrawal, and these medications or substances or able to produce these
symptoms (APA, 2013). After discontinuation, anxiety or panic symptoms
improve within days to a month. Toxins and heavy metals can produce these
symptoms also.
Anxiety Disorder Due to Another Medical Condition
Anxiety or panic symptoms are due to other medical conditions, and are indicated
by physical examination, history, and labs (APA, 2013). There is usually a
marked physical element to the anxiety, such as shortness of breath. It must cause
extreme impairment to areas of functioning. Several conditions include anxiety as
a symptom; such as, endocrine disease, cardiovascular disorders, respiratory
illness, metabolic disturbances, and neurological illness (APA, 2013).
Other Specified Anxiety Disorder
Symptoms of anxiety disorder that create extreme impairment in occupational,
social, or other areas of functioning, but do not satisfy the complete criteria of any
of the anxiety disorders (APA, 2013). The clinician has chosen to specify a
reason why it does not satisfy the criteria of a specific anxiety disorder. They
may record generalized anxiety not occurring for the proper duration.
Unspecified Anxiety Disorder
Symptoms of anxiety disorder that create extreme impairment in occupational,
social, or other areas of functioning, but do not satisfy the complete criteria of any
of the anxiety disorders (APA, 2013). The clinician has chosen not to specify a
reason why it does not satisfy the criteria of a specific anxiety disorder. It is used
in emergency settings since there is not enough information to make a detailed
diagnosis.
Risk and Prognostic Factors
This is a biological review of generalize anxiety disorder. Neuroticism (negative
behavior), inhibition of behavior, and harm avoidance are noted with generalized
anxiety disorder (APA, 2013). The risk of experiencing GAD being genetic is
one-third. Those genetic aspects overlay the risk for neuroticism, and are shared
with the other anxiety disorders, and with mood disorders, especially major
depressive disorder (Goldberg et al., 2009; see also APA, 2013).
DSM-5 SUMMARY SET 1 11
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