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A major depressive episode involves 5 or more symptoms during the same 2-week period, representing a change from previous functioning. At least one symptom must be depressed mood or loss of interest/pleasure.

Symptoms

• Depressed mood most of the day, nearly every day.
• Markedly diminished interest or pleasure in most activities.
• Significant weight loss/gain or changes in appetite.
• Insomnia or excessive sleeping.
• Psychomotor agitation or slowing.
• Fatigue or loss of energy.
• Feelings of worthlessness or excessive/inappropriate guilt.
• Difficulty thinking, concentrating, or making decisions.
• Recurrent thoughts of death, suicidal ideation, suicide planning, or suicide attempt.

Additional criteria

• Symptoms cause clinically significant distress or impairment.
• The episode is not attributable to a substance or another medical condition.
• A diagnosis of MDD also requires consideration of whether there has ever been a manic or hypomanic episode, because this can point toward a bipolar disorder instead.

GAD involves excessive anxiety and worry about multiple areas of life.

Key criteria

• Excessive anxiety and worry occur more days than not for at least 6 months.
• The person finds it difficult to control the worry.
• In adults, anxiety/worry is associated with 3 or more of the following:
  • Restlessness or feeling keyed up/on edge.
  • Becoming easily fatigued.
  • Difficulty concentrating or the mind going blank.
  • Irritability.
  • Muscle tension.
  • Sleep disturbance.
• Symptoms cause clinically significant distress or impairment.
• Symptoms are not attributable to substances, medications, or another medical condition.
• Symptoms are not better explained by another mental disorder.

ADHD involves a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.

Inattention symptoms may include

• Difficulty paying close attention or making careless mistakes.
• Difficulty sustaining attention.
• Appearing not to listen when spoken to directly.
• Difficulty following through on instructions or completing tasks.
• Difficulty organizing activities.
• Avoiding or disliking tasks requiring sustained mental effort.
• Frequently losing necessary items.
• Being easily distracted.
• Forgetfulness in daily activities.

Hyperactivity/impulsivity symptoms may include

• Fidgeting or tapping hands/feet.
• Leaving one's seat when remaining seated is expected.
• Running/climbing inappropriately or feeling restless.
• Difficulty engaging quietly in activities.
• Acting as though "driven by a motor."
• Excessive talking.
• Blurting out answers.
• Difficulty waiting one's turn.
• Interrupting or intruding on others.

Additional criteria

• Children generally require 6 or more symptoms in the relevant symptom domain; individuals age 17+ generally require 5 or more.
• Symptoms persist for at least 6 months.
• Several symptoms were present before age 12.
• Several symptoms occur in 2 or more settings, such as home, school, work, or social settings.
• There is clear evidence that symptoms interfere with or reduce the quality of functioning.
• Symptoms are not better explained by another mental disorder.

PTSD develops following exposure to actual or threatened death, serious injury, or sexual violence, under qualifying circumstances.

Symptom clusters

• Intrusion symptoms: unwanted distressing memories, nightmares, flashbacks, or intense emotional/physical reactions to trauma reminders.
• Avoidance: avoiding distressing memories, thoughts, feelings, people, places, conversations, or situations associated with the trauma.
• Negative changes in cognition and mood: difficulty remembering aspects of the trauma, persistent negative beliefs, distorted blame, diminished interest, detachment, inability to experience positive emotions, or persistent negative emotional states.
• Changes in arousal/reactivity: irritability, angry outbursts, reckless behavior, hypervigilance, exaggerated startle response, concentration problems, or sleep disturbance.

Additional criteria

• Symptoms from the required clusters persist for more than 1 month.
• Symptoms cause clinically significant distress or impairment.
• Symptoms are not attributable to substances or another medical condition.

Symptoms develop in response to an identifiable psychosocial stressor.

Key criteria

• Emotional or behavioral symptoms begin within 3 months of the stressor.
• Symptoms may include sadness, tearfulness, hopelessness, anxiety, worry, nervousness, irritability, or behavioral disturbances.
• The distress is out of proportion to the severity or intensity of the stressor, considering the person's context and culture.
• Symptoms cause significant impairment in social, occupational, educational, or other important areas of functioning.
• Symptoms do not meet criteria for another mental disorder and are not simply an exacerbation of a preexisting disorder.
• Symptoms are not better explained by normal bereavement and do not represent prolonged grief disorder.
• Once the stressor or its consequences have ended, symptoms generally do not persist for more than 6 additional months.

Types

Adjustment disorder with depressed mood, with anxiety, with mixed anxiety and depressed mood, with disturbance of conduct, with mixed disturbance of emotions and conduct, or unspecified.

Bipolar disorders are primarily distinguished by episodes of mania, hypomania, and depression.

Manic episode

• A distinct period of abnormally and persistently elevated, expansive, or irritable mood and increased activity or energy.
• Lasts at least 1 week, most of the day, nearly every day, unless hospitalization is necessary.
• At least 3 symptoms are present, or 4 if the mood is only irritable:
  • Inflated self-esteem or grandiosity.
  • Decreased need for sleep.
  • More talkative than usual or pressured speech.
  • Racing thoughts or flight of ideas.
  • Distractibility.
  • Increased goal-directed activity or psychomotor agitation.
  • Excessive involvement in activities with high potential for painful consequences, such as reckless spending or sexual behavior.
• Causes marked functional impairment, requires hospitalization, or includes psychotic features.
• Not attributable to substances or another medical condition.

Bipolar I

At least one manic episode is required. A major depressive episode is common but not required for the diagnosis.

Bipolar II

Requires at least one hypomanic episode and one major depressive episode, with no history of a manic episode. Hypomania lasts at least 4 consecutive days and represents a noticeable change in functioning but does not cause the severe impairment characteristic of mania.

Schizophrenia involves significant disturbances in thought processes, perception, emotional responsiveness, and behavior.

At least 2 of the following for a significant portion of a 1-month period

• Delusions.
• Hallucinations.
• Disorganized speech.
• Grossly disorganized or catatonic behavior.
• Negative symptoms, such as diminished emotional expression or avolition.

Additional criteria

• At least one symptom must be delusions, hallucinations, or disorganized speech.
• There is significant impairment in work, interpersonal relationships, self-care, or another major area of functioning.
• Continuous signs of the disturbance persist for at least 6 months, including at least 1 month of active-phase symptoms.
• Schizoaffective disorder and depressive or bipolar disorder with psychotic features must be ruled out.
• The disturbance cannot be attributable to substances or another medical condition.
• Special diagnostic considerations apply when there is a history of autism spectrum disorder or a childhood-onset communication disorder.

Acute Stress Disorder is a trauma- and stressor-related disorder that occurs during the early post-trauma period.

Key criteria

• Exposure to actual or threatened death, serious injury, or sexual violence under qualifying circumstances.
• Development of 9 or more symptoms from categories involving intrusion, negative mood, dissociation, avoidance, and arousal.
• Examples include intrusive memories, nightmares, flashbacks, inability to experience positive emotions, altered sense of reality, inability to remember aspects of the event, avoidance, sleep disturbance, hypervigilance, irritability, concentration difficulties, and exaggerated startle response.
• Symptoms last from 3 days to 1 month following trauma exposure.
• Symptoms cause clinically significant distress or impairment.
• Symptoms are not attributable to substances or another medical condition and are not better explained by a brief psychotic disorder.

Important clinical distinction

Acute Stress Disorder occurs during the early post-trauma period (3 days to 1 month), whereas PTSD requires symptoms lasting more than 1 month. Adjustment disorder differs because the triggering stressor does not necessarily involve exposure to death, serious injury, or sexual violence.