Intellectu
al
Disorders
Disorder
Overview
# of Criteria
must be met
Diagnostic Criteria
A. deficits in intellectual functioning -reasoning problem solving planning, abstract
thinking, judgment, academic learning,
learning from experience, confirmed by
intellgience tests
B. deficits in
adaptive functioning across home, school,
work, community
C. Onset of
intellectual and adaptive deficits during
developmental period
Specifiers
Mild -- difficulties in learning, need support,
immaure and inaccurate perception of social cues,
limited understanding of risk, fx age-approp in
personal care, need support
MOD -- markeldly
behind in intellect, marked difference in social
domain, need support and teaching in practical
domain
SEVERE -- attainment of
conceptual skills is limited, spoken language is
limited, requires support in all activities
Profound -- physical world, limited understanding of
language, dependent in all areas
Differential Diagnosis
Intellectual Disability
(Intellectual
Developmental Disorder)
Deficits in intellectual, social, practical areas of
functioning: manifest in reasoning, problem solving,
abstract thinking, confirmed by intelligence tests.
Adaptive functioning deficits manifested in failure to
live independently and to be socially responsible.
defiticts limit fx in home, school, community
Developme
nt
Global Developmental
Delay
Under 5, when clinical severity level cannot be
relably assessed during early childhood. Diagnosed
when individual fails to meet expected
developmental milesetones in several areas of
intellectual functioning and applies to individuals
who are unable to undergo systematic assessment
of intellecutail fx -- too young for IQ,
UNDER age
of 5
requires reassessment
after a period of time
Unspecified Intellectual
Disability (intelletual
development disorder)
when assessment is difficult or impossible because
of associated sensory or physical impairments, as in
blindness, prelingual deafness, locomotor diaability,
presence of severe problem behaviors or cooccuring mental disorder
OVER the
age of 5
only used in exceptional
circumstances and
requires reassessment
after a period of time
Language Disorder
persistent difficulties with onset in early
development, in the learning and use of language in
its various forms, due to deficits in comprehension
or production. Defcitis manifested in rediuced
vocab, inability to express oneself due to limited
sentence structure, and impaired discursive abilities.
Difficulties are not contributed to an underlying
medical condx
A. acquisition and use of langugae across
modalities due to deficits in comprehension
or production that include:
1. reduced vocab, 2. limited sentence
early
structure, 3. impairmens in discourse
B.
developme All four: A-D
language abilities are substantially and
nt
quantifiably below expected for age C.
symptoms began in early development D. not
due to hearing or sensry, motor, or medical
or neuroloical or global developmental delay
Commun
ication
Disorders
All three:
ABC
early
developme All four: A-D
nt
speech sound disorder
major and mild
neurocogntive disorders,
communication disorders
and SLD, Autism Spectrum
Disorder
A. difficulty with speech sound production B.
disturbance causes limitations in efective
comm C. onset is early development, D. not
due to hearing loss, etc.
Childhood-onset fluency
disorder
A. Disturbance in normal fluency and time
patterning of speech and can cause 1. sound
A- 1 or
syllable rep 2. prolongations of consonents,
more,
Bbroken words, etc.B. Causes anxiety, C. onset
D
is in early development D. not speech motor
etc
social (pragmatic)
communication disorder
A- All, B-D
A. Persistent difficulties in social use of verbal
and nonverbal comm 1. social purposes,
greetings, etc. 2. impairment to change
comm to match context of needs of listner 3.
dificulties following rules for conversation 4.
difficulties understanding what is not
explcitly states B. deficits rresult in limitations
of comm, social participation, C. Onset is
early developmental period, but may
manifest later D. not attributed to something
else
All -- A-E
A. Deficits in social comunication and
interacton (3), B. Restricted and repetitive
patterns of behavior (4), C. present in early
developmental period D. clinically significant
impairment in social, occupational, or other
important areas E. not beter explained by...
with or without accompanying intellectual
impairment, with or withou accompanying language
impairment, associated with known medical or
genetic condition or environmental factor, associaed
with another neurodevelopmental mental, or
behavioral disorder, with catatonia Levels:
Level 1. requiring support
2.
requiring substantial support
3.
requiring very substantial support
Inellectual disability, global
developmenta delay,
frequently co-occur with
intellectual disability,
social
A. inattention or hyperacitivity 1. inattention
A - 1 and/or 6 o more ( a - i) 2. hyper/impulsivity6 or more
prior to age
2;
B- (a-i)
B. several symptoms prior to age
12
E
12
C. present in two or more settings D.
impaired fx E. not due to anything else
Combined presentation, Predominantly inattentive,
Predominantly hyperactive/impulsive presentation,
In patial remission,
Mild: few symptoms in excess to those required
Mod: symptoms or fx impairment between mild and
severe
severe: many
symptoms in excess of those required to make the
diagnosis or several symptoms that are sever, are
prsesent and result in marked impairment
ODD, intermittent
explosive, other
neurodevelopmental
unspecified comm
disorder
Autism
Spectru
m
Disorder
Onset
early
developme
nt but may
manifest
later
Autism spectrum disorder
symptoms of communication disorder rthat cause
clinically significant distress in social, occ, or other fx
but do not meet full criteria --when clinical chooses
NOT to specify the reason the criteria are not met -insufficient information
persistent problems in social interaction and
communiction across wide range of activities,
reduced ability to share emotions and interests, and
poor ability to communicate and understand verbal
Autism Spectrum Disorder
and nonverbal cues, and gestures repetitious
behaviors and patterns, insistence on sameness in
routines, fixations on restricted interests.
Heightened sensitivity or lack thereof to
environmnetal stimuli
AttentionDeficit/Hyperactivity
Disorder
chronic inability to pay attention and
impuslive/hyperactivity that impairs fx and
development. Frequently unable to sustain interest
in an activity or maintain mentl focus required by a
task. Easily distracted and forgetful of routine
activities. inability to sit still or remain quiet.
garrulous and impatient
Other Specified Attention
Deficit Hyperactivity
Disorder
symptoms characteristic of ADHD but do not meet
full criteria and assessor chooses to state the reason
they do not meet criteria
Unspecified
do not meet full criteria, assessor chooses not to
specify why
ADHD
early
developme
nt but may
manifest
later
SLD
problems in learning across a rage of academic
activities. Manifested in poor writing skills and
reading comprehension, and/or learning numerical
Specific Learning Disorder concents. Condition persists despite intervention to
improved academci skils and not better explained by
intellectual disabiltiies, specfic sensory deficits, or
other extraneous factors
A- 1 or
more; B-D
A. Difficulties in learning for at least six
months (1-6; at least one) B. belowe
expected for choronological age C. behin
during school-aged years, D. not better
explained by soemthing else
Developmental
Coordination Disorder
excessive clumsiness and awkwardness as
manifested by poor learning and performance of
coordinated motor skills, with performance
significantly below accepted age norms
early
developme
nt
A-D
A. Acquisition and execution of coordinated
motor skills substantially below excpected
given chron. Age; manifested in clumsiness,
slowness, and inaccuracy of performance of
motor skills B. deficits significantly and
persistently intefere with DLA, C. Onset in
early development, D. not better explained...
Stereotypic Movement
Dsorder
repetitive, seemingly driven, apparently purposeless
motor bx
early
developme
nt
A-D
A. repetitive, seemingly driven, apparently
purposeless motor bx B. interferes with fx C.
early dev D. not attributable…
Tic Disorders
Motor
Disorders
Scool-age;
symptoms
persist for
At least 6
months
Other Specified Tic
Disorder
Unspecified Tic Disorder
tics are sudden, rapid, recurrent, nonrhythmic
motor movements or vocalizations
Do not meet full criteria, assessor CHOOSES to
specify why
do not meet full criteria, assessor chooses not to
specify why
Other
ex: neurodevelopmental disorder associated with
prenatal alcohol exposure
Unspecified
do not meet full criteria, assessor chooses not to
specify why
neurodevelop
mental
disorders
before 18
Tourettes -- A. both multiple motor and one
or more vocal tics present at some time,
althought not necessarily concurrent.B. Tics
wax and wane but persistent for more than a
year since first onset, C. onset before 18;
D. not attributable to anything else
Persistent Chronic Motor or Vocal Tic
Disorder A. single or multiple motor OR tics
present, but not both (same B-D) Provisional
Tic Disorder A. single or multiple motor or
vocal tics -- not present at the same time
with impairment in reading
impairment in written expression
impairment in mathematics
Moderate, Severe
w/
w/
Mild,
Rx, intellectual disorder,
ADHD, ASD, joint
hypermobility syndrome
N/a
W/ self-injurious bx or W/o
assoc. w known med, genet, or neuro, or
environmental factor Mild, Mod, Sev
for PCMVTD -- specify motor or vocal only
normal variations in ac.
Attainment, intellectual
disability, neurological
issues, neurocogntiive
disorders, ADHD
If
normal development, ASD,
Tic Disorders, OCD,
neurological
Provisional vs. Tourettes:
Tourettes has both
happening at the same
time and provisional has
both but never active at
the same time
Disorder
Overview
Onset
Delusional Disorder
Enduring delusions that may be accompanied b nonprominent hallucinations pertinent to the nature of
the delusion itself; fx is not significantly affected
apart from bx specfiically related to delusions. Bx
generally does not appear to be odd or peculiar.
types of delusions are in column I
1 month or
longer
Schizophrenia
At least two of the following symptoms are
manifested for a period lasting between 1 month &
six months: hallucinations, delsions, disorganized
incoherent speech, grossly disorganized or catatonic
behavior, negative symptoms, such as reduced
emotional expressiveness, or avolition. condition has
had a negative impact on the ability to fx in occ,
academia, interpseronal, or self-care
Early
childhood,
adolescence,
adulthood
total
symptoms at
least 6
months
Brief Psychotic
Disorder
schizophreniform
# of Criteria
must be met
Diagnostic Criteria
Specifiers
Differential Diagnosis
Delusion
al
Disorder
A. Presence of 1 or more delusions with
duration of 1 month or longer B. Criterion A
for schhizphrenia never met --hallucinations if
present are not related to delusional theme C.
functioning is not markedly impaired and bx is
not bizarre or odd D. if manic or depressive
episodes occur, these are brief relative to
duration of delusional periods E. not explained
by anything else
Type of delusion (erotomanic, grandiose, jealous,
persecutory, somatic, mixed, unspecified)
with or without bixarre content, first episode
currently accute episode, first episode currently in
partial/full remission --> mult episodes same
current severity -- 0-4 scale mild to severe
Not schizophrenia if-- there is nothing
other than delusions -- no hallucinations,
disorganized behavior, etc.
Not depressive or bipolar or
schizoaffective if mood epsiodes are brief
in compairson to all delusional episodes
A. two or more each present for some of the
time in a 1 month period of delusions, hall,
disorg speech, grossly disorganized bx,
negative symptoms B. level of fx in one seting
is impaired C. continuous signs of distubance
for 6 months -- at least one month of criteria A
A. 2 or more;
D. rule out schizoaffective bc either no
B-F
depressive or manic episodes, or mood
episodes are minorty of duration of active and
residual phases E. no physiological effects of
substance F. if ASD or comm disorder, must
have hallucinations or delusions for over a
month
First episode, currently acute episode
First
Episode, currently in partial remission First
episode, currently in full remission multiple
episodes, currently in acute episode
multiple,
mult in partial remiss or mult in full remiss;
specify if with catatonia and current severity
6 months total of symptoms
no
mood episodes for the duration of active
phase
IF they
haven't met the six month mark, give
schizophreniform dx
characterized by hallucinations, delusions,
disorganized incoherent speech, or grossly
disorganized or catatonic bs. Duration of cx is 1 day
to 1 month
A. presents of at least one of the following -A- 1 or more
must be either 1. delusions, 2. hallucinations 3.
1 day to one
but must
disorganized speech and 4. grossly disorganzed
month
have A1 A2 or
or catatonic bx
B. duration I between 1 day
A3; B-C
and 1 month C. not better explained…
if with marked stressor or without
if
with postpartum onset
if with
catatonia
provide current
severity -- 0-4 point scale symptoms that are
culturally accepted can't be added
To be brief psychotic, has to be less than
1 month
BRIEF -->
Schizophreniform ---> Schizophrenia
At least two of the following are manifested for a
period of 1 month to up to 6 months: hallucinations,
delusions, disorganized incoherent speech, grossly
disorganized or catatonic bx, negative symptoms
1-6 months
An illness characterized by a continuous period
wherein the major symptoms of schizophrenia are
present and for the majority of the duration of the
current mood epsiodes (depressive or manic) are
present
LIFETIME
uninterrupted
period of two
or more
weeks
Schizoph
renia
Brief
Psychotic
Disorder
A-E
A. Presence of 2 or more during a one-month
With good prognostic features -- good premorbid
A- 1 or more
period -- 1. delusions 2. hallucinations 3.
fx, confusion or perplexity, onset of psychotic
but must
disorganized speech 4. grossly disorganized
symptoms
bx within four weeks f first change in fx
have A1 A2 or 5. negative symptoms B. epsidoe lasts more
w/o good prognostic features -- if two or more of
A3; B-D
than a month but less than 6 C. others
the above
ruled not present
w/ catatonia
out D. not attributable to…
current severity
diagosis if -- episode lasts between 1 and
6 months and individual is already
recovered
when an individual is symptomatic for less
than 6 mos required for schizophrenia but
has not yet recovered --on the way to
schizo
Scizophreniform
Schizoaffective
Disorder
A-D all
A. Uninterrupted period with major mood
disorder and criterion A for schizophrenia B.
Bipolar or Depressive Type; with Catatonia; first
delusions or hallucinations for two or more
episode acute or partial rem or full remis OR mult
weeks in the ABSENCE of a major mood
episodes: acute, partial or full
OR continuous:
episode during a LIFETIME duration of the
symptoms
continue for full duration
illness C. symptoms that meet criteria for
a
severity 0-4
major mood epsidode present for the majority
of the total dratio of active and residual
portions D. no attributable to other stuff
Schizoaffective Disorder
Substace induced
psychotic disorder
psychotic disorder due
to Rx
Others not studied
Catatonia associated with another mental disorder or
med cond
unspecified catatonia
other specified schizophrenia spectrum or other
psychotic disorder or
unspecified schizophrenia spectrum and other
psychotic disorder
x
Has to have a mood episode present the
whole time
has to
have psychotic features present with
absence of mood episode for at least 2
weeks
Terms
Delusions:
• Promdromal phase
– showing signs of deterioration prior to full blown symptoms
• referential – belief that certain gestures, comments, environmental cues are directed at oneself
• grandiose – when an individual believes he or she has exceptional abilities, wealth or fame
• erotomanic -- when an individual believes falsely that another person is in love with him or her
• jealous type – central theme of delusion is that his or her lover is unfaithful
• nihilistic – a major catastrophe will occur
• somatic – preoccupations regarding health and organ function
• mixed – no one delusional theme predominates
• unspecified – when dominand delusional belief cannot be clearly determined or is not described in the
specific types ex: referential without persecutory or grandiose component
• bizarre if clearly implausible and not understandable to same-culture peers
o ex: thought withdrawal, thought insertion, delusions of control
Hallucinations: – perception-like experiences that occur without an external stimulus. Vivid and clear, with the
full force and impact of normal perceptions, and not under voluntary control
• hypnagogic—hallucinations occurring while falling asleep
• hypnopompic – waking up
• both considered normal
Negative symptoms:
– decreased motivation
• Alogia – diminished speech output
• Anhedonia – decreased ability to experience pleasure
• Asociality – lack of interest in social interactions
• Avolition
Course of schizophrenia:
Promdromal phase – showing signs of deterioration prior to full blown symptoms
• Active symptoms phase – full blown symptoms are present
• Residual phase – some but not all symptoms remain, similar to prodromal phase
•
Disorder
Separatio
n Anxiety
Disorder
Overview
Onset
Inordinate anxiety upon separation from parties the individual has
formed a close emotional attachment to, as manifested by the
presence of at least three of the following: repeated intense anxiety
at least four
when anticipating or experiencing separation from home or significant
weeks in children
Separation Anxiety
other, incessiant rumination over the prospect of harm coming to
or teens ; 6 or
Disorder
signfiicant attachments, chronic refusal or unwillingness to venture
more months in
out away from attachment figures, refuseal or unwillingness to sleep
adults
away from home while separated from attachment figures, recurring
nightmares about separation, recurring pysical problemms when
anticipating or experiencing separation
# Criteria
A- 3/8 B-D
Selective
Mutism
Selective Mutism
Characterized by reticence in situations where speaking is expected;
condition interferes with social, educational, or vocational aspects of
life, condition lasts at least one month, reticence is not due to
dificulties w vocab or language
Specific Phobia
characterized by a disproportionate fear response to a specfic object
or situation; the fear response is almost always immediately elicited b
the presence of the phobic object or situation; the phobia-producing
entity is actively avoided or only tolerated with great anxiety; the fear
is manifested out of proportion to the actual danger posed by the
entity; fear and avoidance responses typically persist for at least 6
months
At least one
month -- not first
month of school
at least six
months
A-E
A-G
Diagnostic Criteria
A. Developmentally inappropriate & excessive fear or anxiety about separation from home or
attachment figures, needing 3 of 8 (page 190-191).
B. The fear, anxiety, or avoidance is persistent, lasting at least 4 weeks in children and
adolescents and typically 6 or more months in adults.
C. Causing clinically significant distress or impairment in social, occupational or other
important areas of functioning.
D. Not better explained by other mental disorder
Specifiers
Differential Diagnosis
N/A
other anxiety disorders, bereavement
A. Consistent failure to speak in situations where there is an expectation to speak despite
speaking in other situations.
Interferes with educational/occupational achievement or social communication.
B. At least one month (not limited to the first month of school).
C. Not attributable to lack of knowledge of, or comfort with, the spoken language required in
the social situation.
D. Not better explained by a communication disorder and E. does not occur exclusively during
ASD, schizophrenia, or another psychotic disorder.
A. Marked fear or anxiety about a specific object or situation
Note: In children, it may be expressed by crying, tantrums, freezing, or clinging.
B.The object/situation almost always provokes immediate fear or anxiety
C.The object/situation is actively avoided or endured with intense fear or anxiety
D.Fear or anxiety is out of proportion to the actual danger and to the sociocultural context
E.Typically lasting 6 months or more
F.Causing clinically significant distress or impairment
G.Not better explained by another mental disorder
Terms
Fear – emotional response to real or perceived imminent threat
Anxiety – anticipation of future threat
F40.218 Animal
F40.228 Natural Environment
(storms, water, heights, etc.)
F40.23x Blood-Injection-Injury
F40.248 Situational (airplanes,
elevators, etc.)
F40.298 Other (loud sounds,
clowns, etc.)
Natural environment – storms, water,
heights, etc.
Situational – airplanes, elevators, etc.
Panic Attack – type of fear response
Other – loud sounds, clowns, etc.
Specific
Phobia
Social Anxiety
Disorder
Indicated by inordinate fear of situations in which the person may be
subject to evaluation by others; such situations may include scenarios
conisting of meetings, conversations with unfamiliar parties, being
observed, or giving speeches or presentations. the person is greatly
concerned that they will behave in inappropriate ways that would be
negative construed and lead to rejection, embarrassment, ridicule, or
being offended. Social situations are avoided or endured with great
anxiety.
6 months or
more
Panic Disorder
In order to qualify as a disorder, a condition must include repeated
panic attacks and at least FOUR of the following symptoms: rapid
heartbeat, sweating, shaking, shortness of breath, choking sensation,
chest pain/discomfort, nausea / gastrointestinal distress, vertigo or
sensation of loss of balance or feeling faint and light-headed,
sensations of heat or cold, parathesias, derealization, fear of losing
emotional control, fear of dying. AT LEAST ONE PANIC ATTACK HAS
BEEN FOLLOWED BY ONE MONTH Of one or both of following: chronic
worry about experiencing additional panic, a marked effort to engage
in bx to avoid panic attacks
1 attack + 1
month of
symptoms
Social
Anxiety
Disorder
Panic
Disorder
Agoraphobia
significant anxiety about at least two of the following scenarios:
utilizing public transportation, being in open spaces, being in enclosed
spaces, being in a crowd, being alone outside one's home; these
typically at least
situations are avoided and almost always elicit distress and anxiety.
six months
fear responses typically last at least six months and agoraphobic
scenarios typically require individuals to be accompanied or are
endured while experiencing intense fear
Agoraph
obia
GAD
inordinate worry about a variety of scenarios, occurring more days
than not and lasting AT LEAST six months. The person finds it difficult
to not ruminate about worry-causing scenarios. At east THREE
symptoms must be present with ONE lasting SIX MONTHS -- agitation,
loss of energy, difficulty focusing, irritability, muscle tension, difficulty
sleeping
at least six
months
A-J
A- 4/13 B1or2 C-D
A - 2+; B-I
A. Fear or anxiety of social situations in which the person may be scrutinized by others
B. Person fears their behaviors (symptoms) will be negatively evaluated by others
C. The social situation almost always provokes fear or anxiety
D. Social situations are avoided or endured with intense fear or anxiety
E. It is out of proportion to the actual threat posed by situation and to the sociocultural
environment
F. Typically lasting 6 months or more
G. Causes clinically significant distress or impairment in social, occupational, or other
important areas of functioning
I. & J. Exclusions
Specify if:
Performance only – if restricted
to speaking or performing in
public
When the presence of a panic
attack is identified, it should be
A. Recurrent unexpected panic attacks - Discrete period with a sudden onset and quick peak
noted as a specifier.
(within 10 minutes) of intense fear and/or discomfort, needing 4 of 13 symptoms (page 208).
Needs four of the 13 symptoms
B. At least 1 attack is followed by 1 month or more of one or both:
on page 214.
1.Persistent concern or worry about additional panic attacks or their consequences
2.Significant maladaptive change in behavior related to the attacks
C.Not attributable to physiological effects of a substance effect or another medical condition NOTE: Culture-specific symptoms
should not count as one of the 4
D.Not attributable to another mental disorder
required symptoms.
A. Marked fear or anxiety about 2 or more of 5 situations:
1.Using public transportation2. Being in open spaces
3. Being in enclosed spaces 4. Standing in line or being in a crowd 5. Being outside of the
home alone
B. Person fears or avoids due to thoughts that escape might be difficult or help might not be
available if panic-like or other incapacitating or embarrassing symptoms occur
C. Situation almost always provokes the fear or anxiety
D.Situations are avoided, require a companion, or are endured with intense fear or anxiety E.
Out of proportion to the situation and to the sociocultural context F.Typically lasting 6 months
or more
G.Causes clinically significant distress or impairment H.If another medical condition does exist,
response is excessive I. Exclusion
In children – symptoms must also happen in
the presence of other children, not just
adults
A panic attack is a sudden, unexpected
intense fear response during which anxiety
rapidly escalates within a fiew minutes.
Avoidance behaviors
Differ from fear or anxiety that is developmental appropriate or
transient
Primary determination about symptoms being excessive is made by
the clinician
A. Excessive anxiety or worry, occurring more days than not for at least 6 months, about a
number of events or activities
B. Person finds it difficult to control the worry
C. Associated with 3 or more symptoms:
1. Restlessness or feeling keyed up or on edge
2. Being easily fatigued 3. Difficulty concentrating or mind going blank 4. Irritability 5. Muscle
tension 6. Sleep disturbance
C. Causing clinically significant distress or impairment
D. Not attributable to the physiological effects of a substance or another medical condition
E. Exclusion of another mental disorder
Cognitive Behavioral Therapy (CBT)
Eye Movement Desensitization and Reprocessing
(EMDR)
Dialectical Behavior Therapy (DBT)
Systematic Desensitization/Exposure Therapy
Generalized Anxiety Disorder
Rx Anxiety
disorder
evidence that panic attacks transpire concurrently with
or following substance intoxication, withdrawal, or
following exposure to Rx, the substance/meds under
consideration is capable of bringing about severe anxiety
A. Panic attacks or anxiety is predominant in presentation
B. Evidence of both:
1. Symptoms in A developed during or soon after substance intoxication or
withdrawal or exposure to medication
2. Involved substance is capable of producing the symptoms in A
C. Not better explained by another anxiety disorder
D. Does not occur exclusively during a delirium
E. Causes clinically significant distress or impairment
Substance/Rx Induced Anx Dis
Other Med Cx
A. Panic attacks or anxiety is predominant in presentation
B. Evidence that the disturbance is the direct pathophysiological
consequence of another medical condition
C. Not better explained by another mental disorder
D. Does not occur exclusively during a delirium
E. Causes clinically significant distress or impairment
Anx Dis due to other Med Cx
Used when symptoms cause clinically significant distress or impairment but
DO NOT meet full criteria for any anxiety disorders.
The clinician chooses to communicate the specific reason criteria is not met.
Examples: Limited-symptom attacks, Generalized anxiety NOT occurring
more days than not, Other cultural concepts of distress
Other Spec Anx Dis
Used when symptoms cause clinically significant distress or impairment but
DO NOT meet full criteria for any anxiety disorders.
The clinician chooses NOT to communicate the specific reason criteria is not
met.
Unspec Anx Dis
With onset during
intoxication
With onset during
withdrawal
With onset after
medication use
Mindfulness therapies
Complementary and alternative practices
Stress and relaxation techniques
Meditation
Yoga
Acupuncture
Medication
Disorder
Disruptiv
e Mood
Dysregul
ation
Major
Depressiv
e Disorder
DMDD
Overview
Onset
6-18; 1 yr with at
Characterized by frequent outburts of temper over a period least 9 mos of
lasting AT LEAST 1 YEAR with no mre than a 3-month period symptoms; onset
of symptoms has
without outburts. On average, outbursts occur three or
to have been
more times weekly, and individual's mood is chronically
irritable and angry. Diagnosis is typically between ages 6-18 present before
age 10
# Criteria
Diagnostic Criteria
A-J
A. severe recurrent verbal and bx temper outbursts that are grossly out of proprotion to the
situation or provocation B. inconsistent with developmental level C. avg of 3+ times/wk D.
mood beween tantrums is irrituable or angry, most of the day, nearly every day, and
observable by others E. A-d have been present more than 12 months without 3 or more
consecutive months without symptoms. F. Symptoms present in 2 or more settigs and
severe in at least 1 G. diagnosis between 6 and 18 H. onset present b efore age 10 I.
symptoms for hypomanic or manic have never been met for more than 1 day H/J Exclusions
Specifiers
A- 5 of 9
B-E
A. two weeks of symtposm that represent a change in previous fx. Need 5
of 9 sx with 1 being depressed mood or loss of interest of pleasure others:
weight change, insomnia or hypersomnia nearly every day, psychomotor
agitation or retardation nearly every day; fatigue or losso f energy nearly
every day; feelings of worthlessness or guil; diminished ability to think or
concentrate; recurrent thoughts of death B. cuase clinically significant
distress or impairment C. not attributable to effects of substance or other
medical conditon D. not part of another mental disorder E. no histroy of
manic or hypomanic episodes
code based on severity or course
specifier: mild, mod severe based on
number and intensity of symptoms
--with anxious distress, mixed
features, melancholic features,
atypical features, mood-congruent
or incongruent psuchotic features; w
catatonial with peripartum onset,
with seasonal pattern -in partial or
full remission
Grief -- the feelings of intense sadness,
rumination, insomnia, poor appetite, weight
loss may rememble dep ep -- may be
understandable or considered appropriate to
the loss, the presnecne of MDE in addition to
the normal response may be carefully
considered. this decision is based on clinical
judgment bsaed n the individual's hx and
cultural norms
A, B- 2+, C-H
A. Depressed mood, most of the day, for more days than not, reported or
observed, for at least 2 yrs --kids = irritable and for 1 yr; B. 2 or more: ack
of appetite or overeating, insomnia or hypersomnia, fatigue, low selfesteem, difficulty concentrating and indecisive, hopeless C. In 2 yd period
never without symptoms for more than 2 mnths at a time, criteria for
MDD continuously present for 2 years;E never manic or hypanic or
cyclothymic F not better explained by another mental disorder G. not
attributable to the effects of substance or other med cx H. causes clin sig
dis
mood-congruent or incongruent
psuchotic ; w catatonial with
peripartum onset
same as MDD but early or late onset: early
onset before 21 and late onset after 21; with
pure dysthymic syndrome: MDE not met in at
least 2 yrs; w persistent MDE; w intermittent
MDE, w current episode; w intermittent mde,
w/o current episode ALSO mid, mod, severe
Characterized by the symptoms of major
depressive episode
Persisten
t
Depressi
ve
Disorder
(dysthym
ia)
PDD
Symptoms represent an amalgamation of
symptoms of chronic major depressive disrder
and dysthymic disorder. Chronic depressed
moood persists at least 2 years while depressed,
at least two of the following occur: lack of
appetite or overeating, insomnia or
hypersomnia, fatigue, low self-esteem, difficulty
concentrating and indecisive, hopeless never
w/o symptoms for more than 2 mos
premenst
rual
dysphori
c
disorder
PDD
symptoms present during the majority of
menstrual cycles, at least five sx met before
week of menses,
Sub/Rx
disturbance in mood by depressed mood or
diminished interest or pleasure in all or almost
all activities evidence -- during or soon after
substance intoxication or withdrawal or
exposure to meds involved substance is capable
of proudcing symptoms - not better explained by
another depressive episode
with onset during intoxication or
during withdrawal
Dep
Disorder
due to
another
medical
condition
evidence that the disturbance is direct
pathophysiological consequence of another
medical condition
w depressed features with major
depressive-like epsidoe; with mixed
features
Other
specified
when symptoms or impairment do not meet
criteria, but clinician chooses to communicate
the reason criteria is not met
unspecifi
ed
depressiv
e
disorder
when distress do not meet full criteria for any
depressive disorders, but clinician chooses not to
communicate the specific reason
Substanc
e
induced
MDD
2 year -- at
least one year
for children
A, B 1+, C 1+
must have 5
between b &
C, D-G
ex: recurrent brief depression; short-duration depressive episode,
depressive episode with insufficient symptoms
Terms
common feature is sad, empy or iritable
mood ACCOMPANIED by somatic and
cognitive cahnges that SIGNIFICANTLY affect
the person's ability to fx
MDD
Two weeks
Differential Diagnosis
Beck's negative cognitive triad -- negative
view of self, future, world
atypical -weight gain, hypersomnia, leaden paralysis,
interpersonal rejection sensitivity
peripartum--during or in the four weeks
after delivery
Disorder
bipolar
disorders
Overview
Onset
# Criteria
Diagnostic Criteria
Specifiers
Differential
Diagnosis
Terms
1. inflated self-esteem or grandiosity
2. decreased need for sleep
3. more talkative than usual or pressured speech
4. flight of ideas or racing thoughts
5. distractibility
6. increase on goal-directed activity (social, work, or
sexually) or psychomotor agitation
7. excessive pleasurable activities (high potential for
painful consequences)
Main feature of Bipolar disorders is a disturbance of mood
These disorders are dependent on the pattern of mood episodes
3 types of mood episodes:
Manic episode
Hypomanic episode
Depressive episode
Episodes - do not have codes, cannot be diagnosed separately, & are not diagnoses
A distinct period of abnormally and persistently elevated , expansive, or irritable mood AND abnormally & persistently increased goal-directed activity or energy, lasting at least one week OR needing
hospitalization
3 or more symptoms (4 if mood is only irritable) which represent a noticeable change from usual behavior (on page 124)
Causes marked impairment OR necessitates hospitalization OR includes psychotic features
Exclusion
A manic episode may have been preceded or followed by a hypomanic or major depressive episode.
mani episode
Same as manic episode BUT lasting at least 4 consecutive days & present most of the day, nearly every day
3 or more symptoms (4 if mood is only irritable) which represent a noticeable change from usual behavior (page 124)
Change is unequivocally a change in functioning that is uncharacteristic of person
Disturbance & change in functioning is observable by others
Not severe enough to cause marked impairment or need for hospitalization
Exclusion
hypomanic
Bipolar 1
BP1
At least 1 manic episode
Exclusion
Bipolar II Disorder – recurrent Major Depressive Episode with
Hypomanic Episodes. Conditions for a current or previous
hypomanic episode are met and the conditions for a current or
previous major depressive disorder must also be met
Bipolar II Disorder
BP2
Cyclothymic disorder
cyclothymic
a period of at least two years, the symptoms for a hypomania or
depression have appeared several times but the criteria for the
episode have never been met. During the two year period,
hypomanic and depressive episodes have occurred at least half
the time and the patient has not been symptom free for more
than 2 months at a time
Substance/Medication-Induced Bipolar & Related Disorder
Bipolar & Related Disorder Due to Another Medical Condition
Other Specified Bipolar & Related Disorder
Unspecified Bipolar & Related Disorder
Other disorders
Coding & Recording is based on current or most recent episode
Current severity & psychotic features are indicated only if FULL
criteria are currently met for a manic or depressive episode
A. at least one hypomanic episode AND one major depressive
episode B. No history of a manic episdoe C. exclusion D. cuasing
clinically significance or impairment
Numerous episodes with hypomanic & depressive symptoms that
do not meet full criteria, for 2 years (1 in minors)
For at least half the time of last 2 years & person has not been
without symptoms for more than 2 months at a time
Full criteria for a mood episode have never been met
Exclusion
Causing clinically significant distress or impairment
Exclusion
With anxious distress
With mixed features
With rapid cycling
With melancholic features
With atypical features
With mood-congruent psychotic features
With mood-incongruent psychotic features
With catatonia
With peripartum onset
With seasonal pattern
NOTE: If there are psychotic features, the episode is, by
definition, manic
Note : Hypomanic
episodes are common in BPI disorder but are not
required to make a diagnosis of BPI.
Remission specifiers are only indicated if full criteria is
NOT currently met for manic, hypomanic, or major
depressive episode
Specify current or most recent episode:
Hypomanic or depressed
Specify if: (same specifiers – page 134-135)
Specify course if full criteria are not currently met:
In partial remission
In full remission
Specify severity if full criteria for a mood episode are
currently met: Mild, Moderate, or Severe
Specify if: with anxious distress
Chronic – full criteria met for 2 years of MD episode,
can be applied to most recent episode
Catatonic – 2 of 5 criteria, p. 418
Disorder
Overview
"Main feature is a disruption in Consciousness Memory Identity
Perception" THE ESSENtial features of these disroders is the
disruption in the integration of consciousness as this relates to
memory, identity, and perception of the environment. Such
disturbances may be gradual, transient, or chronic.
Dissociati
ve
Identity
Disorder
DID
DA
essential features include rthe presencee of two or more distinct
personality states or identities that recurrently assume control of the
individual's bx, accompanied with the inability to recall important
personal information that is too extensive to be accounted for by
ordinary forgetfulness
The inability to recall important personal information,
usually of a traumatic or stressful nature, that cannot be
explained with ordinary forgetfulness
Onset
# Criteria
Diagnostic Criteria
Depersona
lization/de
realization
disorder
Differential Diagnosis
Terms
2 or more
personality
states
A-D
A. 2 or more distinct personality states involving marked discontinuity in
sense of self and agency, accompanied by related alterations in affect,
behavior, consciousness, memory, perception, cognition, and/or sensorymotor functioning
B. Recurrent gaps in the recall of every day events, important personal
information, and/or traumatic events that are inconsistent with ordinary
forgetting
C. Causing clinically significant distress or impairment
D. Not a normal part of a broadly accepted cultural of religious practice
E. Exclusion
A. Inability to recall important personal information, usually of
traumatic or stressful nature, that is inconsistent with ordinary
forgetting
B. Causes significant distress or impairment
C. Exclusion -- no sub
D. Exclusion -- not did, ptsd, acute stress, somatic system
disorder, or neurocognitive disorder
Dissociative Amnesia
characterized by a persistent and recurring feeling of
being estranged from oneself, of being a spectator of
one's own life, and of being detached from one's mental
processes or boy that is accompanied by intact reality
testing (individual is aware that this is only a feeling of
self-alienation and not reality as such)
Specifiers
Amnesia – forget important personal events (usually traumatic), too extensive
to be forgetfulness
Fugue – sudden travel away from home, inability to recall past or identity,
assuming new one
DID – multiple identities
Depersonalization – feeling of being detached from one’s mental processes or
body
NOS – possession trance disorder which is very controversial
A - 1 or both
B-E
A. Persistent or recurrent personalization, derealization, or
both
Depersonalization - Experience of unreality, detachment, or
being an outside observer with respect to one’s thoughts,
feelings, body, or action
Derealization – experiences of unreality or detachment with
respect to surroundings
B. Reality testing remains intact
C. Causing clinically significant distress or impairment
D. Exclusion
E. Exclusion
if with dissociative
fugue: apparently
purposeful travel or
bewildered wandering
that is assoc w
amneisa for id or other
important autiobio
info
"Localized - Events around a certain period of time, usually first few hours
Selective - Recalls some but not all events around a period of time
LESS COMMON:
Generalized Entire life
Continuous - Subsequent to a specific time up to the present
Systematized - For certain categories
depersonalization -- perceptual alterations, distorted sense
of ime, unreal or absent self, emotional and/or physical
numbing
derealization
-- eindividuals or objects are experienced as unreal,
dreamlike, foggy, lifeless, or visually distorted
Disorder
Overview
indicated by the presence of obsessions ) and/or
compulsions The reptitive rituals are causally
unconnected to the obsessions they are attempting to
counteract and/or are excessive in their application.
obsessions and or compulsions endure, lasting at least
Obsessive Compulsive
OCD Disorder
an hour a day
Onset
# Criteria
A. Preoccupation with one of more perceived defects of flaws in physical
appearance that are not observable or appear slight to others
B. Behaviors or mental acts in response to the appearance concerns
C. Causing clinically significant distress or impairment
D. Exclusion
indicated by inordiante attention to at least one
perceived falw in physical appearance that is
unnoticeable or appears slight to other observers.
Individual engages in repetitive behaviors as a means of
Body Dysmorphic disorderobtaining reassurance about appearance concerns.
Hoarding disorder
trichotillomania
indicated by chronic difficulty in getting rid of
possessions egardless of their value. The bx stems from a
need to save items and the associated distress of being
without them. The accumulation of hoarded items is so
excessive so as to make living areas difficult to inhabit.
repetitive puling of one's own hair resulting in hair loss,
accompanied by repeated attempts to cease this
behavior
excoriation
repeated skin-picking behaviors resulting in skin lesions,
accompanied by repeated attempts to cease this bx
substance/ med
there is evidence that the symptoms of obsessivecompulsive disorder transpire concurrently with or
following substance intoxiation, withdrawal, or following
exposure to a medication; the substance/medication
under consideration is capable of bringing about severe
anxiety
Diagnostic Criteria
A. Obsessions, compulsions, or both
Obsessions are both
1. recurrent and persistent thoughts, urges, or images, that are
experienced, at some time during the disturbance, as intrusive and
unwanted, and that in most individuals cause marked distress or
impairment 2. attempts to ignore or suppress to neutralize then with other
thought or action
Compulsions are both
1. repetitive behaviors that the individual feels driven to perform in
response to and obsession or according to rules that must be applied 2.
The behavior or mental acts are aimed at preventing or reducing anxiety or
distress, or preventing some dreaded event or situationB. Time consuming
A- ob or
or cause clinically significant distress or impairment C. Exclusion D.
comp or both Exclusion
A. Persistent difficulty discarding or parting with possessions, regardless of
their actual value
B. Difficulty is due to a perceived need to save the items and to distress
associated with discarding them
C. Results in accumulation of possessions that congest and clutter active
living areas and compromises their intended use.
D. Causing clinically significant distress or impairment
E. Exclusion
E. Exclusion
a-e
Recurrent pulling out of one’s hair, resulting in hair loss
Repeated attempts to decrease or stop
Causing clinically significant distress or impairment
Exclusion
Exclusion
Recurrent skin picking, resulting in skin lesions
Repeated attempts to decrease or stop
Causing clinically significant distress or impairment
Exclusion
Exclusion
others: Obsessive-Compulsive and Related Disorder Due to Another
Medical Condition
Other Specified Obsessive-Compulsive and Related Disorder
Unspecified Obsessive-Compulsive and Related Disorder
Specifiers
Differential Diagnosis
With good or fair insight-- individual recongizes that obsessive-compulsive disorder
beliefs are definitely or probably not true or that they may or may not be true.
With poor insight: individual thinks obsessive-compulsive disorder beleifs are
probably true
With
absent insight/delusional beliefs: individual is completely convinced that the beliefs
are true
individual recognizes that the body dysmorphic disorder beliefs are definitely or
probably not true or that they may or may not be true
With poor insight -- the
indidiviual thinks the body
With absent
insight/delusional beliefs Specify if With Muscle Dysphoria
specify if with
excessive acquisition
based on insight
Terms
obsessions: unwanted, intrusive
thoughts or images that are
experiened repeatedly and bring
@ distress; person treis to
counteract and alleviate these
thoughts and images with outher
thoughts and axns
compulsions: repeptitive
ritualized actions that the
individual feels compelled to
perform in order to alleviate the
distress caused by obsessions
Disorder
Overview
chronic pattern of emotionally withdrawn bx wih adult
careetakers manifested before age 5, and child is
developmentally at least 9 months old. Cond is revealed by
presence of both the following: child rarely seeks comfort when
distressed, child is minimally responsive to the comfort provided
when distressed. At least two of the following:minimal social
responsiveness, minimal positive affect, periods of inexplicable
irritability, fear, or sadness during periods of nonthreatening
interaction with adult caretakers. extremely insufficient care:
severe neglect, instability and frequnet changes in adult
caretakers, being raised in settings that severely limit the
Reactive attachment
RAD disorder
availability of attachments to caretakers.
Disinhibited
Social
Engagement
Disorder
DSED
manifested by a child's pattern of seeking out and interacting
with unfamiliar adults, and the presence of at least two of the
following: lack of retcence when interactign with unfamiliar
adults, overly familiar physical or verbal bx with unfamiliar
adults, little regard for reconnecting with adult caretakers even
in un familiar enviornments, unhesitatingly accompanying
unfamiliar adults
Onset
# Criteria
9 mos - 5 yrs
over 1 yr =
persistent
over 9
months
A. pattern of bx child actively approaches and interacts wih unfamiliar aduts - reduced or
absence retiecence in approaching or interacting withunfamiliar aduls, overly familiar verbal or
physical bs diministhed or absent checking back with adult caregiver, willingness to go off with
an unfamiliar adult B. bx in A are not just impulsivity C. child is expereincing pattern of extremes
A- 2+, B, C 1+, of insufficient care as evidenced by at least 1: social neglect to form attachment, repeated
D-E
changes of caregivers, rearing in unusual setting, D. C is caused by A. E. 9 months or older
condition lasts at least a month and results from experiencing
actual or threatened death, serious injury, or sexual violence as
manifested by at least one: direclty experiencing or witnessing a
traumatic event, becoming aware of close friends or family
suffering traumatic event, repeated exposure to aversive aspects
of traumatic events; at least 1 intrusion symptom, avoidance
symptoms, negative mood; arousal symptoms
must be over
6 years old - A, B 1+, C 1+,
lasts 1 month D 2+, E-J
PTSD for under PTSD
6
Same A, one or more intrusion, avoidance or negative mood or
congition, avoidance beginning or worsening after the event;
alterations in arousal or reactivity, needing two or more
alterations in arousal, lasts more than a month
younger than
6; lasts 1 yr
Acute Stress Disorder
ASD
symptoms of the disorder are the same as those for PTSD. At
least 9 symotms manifest starting immediately after the trauma
and lasting from 3 days to a month
3 days to 1
month
Adjustment disorder
AD
manifested by the papearance of emotional or behavioral
symptoms as a reaction to definitieve sress-inducing events, with
such symptoms making their appearance within 3 months of the
event. Symptoms include one or both of the following: severe
distress disproportionate tothe intensity of the event, signficiant
deterioriation in key areas of functioning. once the stressproducing events or the consequences have ceased, symptoms
endure for no longer than 6 months
PTSD
Other and
unspecified
trauma and
stress-related
disorder
PTSD
Diagnostic Criteria
A. consistent pattern of inhibited, emotionally withdrawn behavior tward adult caregivers,
manifested by BOTH: child rarely seeks comfort when distressed, child is minimally responsive to
the comfort provided when distressed B. A persistent social and emotional distrubance
characterized by at least two of the following: 1. minimal social and 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. experienced a
pattern of extremes of insufficient care as evidenced by at least one of the following: 1. social
neglect or deprivation inthe form of persistant lack of having basic emotional needs for comfort,
stimulation, or affection met by caregivers, 2, repeated changes in caregivers that limit ability to
form stable attchments 3. rearing in unusual settings that severely limit opportunities to form
A - both B- 2/, selective attachments D. criterion C is responsible for A. E. not ASD, F. disturbances evident
C - at least 1 before 5 G. at least 9 months
within 3
months of
events for no
longer than 6
months
intrusion symptoms: recurring distressing memories, frequent nightmares, flashbacks that may
have dissociative reactions, intense reactive distress whenin presence of cues that serve as a
reminder of traumatic event, severe physiological reactions upon exposure to cues resembling
aspects of the traumatic event
avoidance symptoms: attempts to avoid
distressing thoughts, feelings, or memories reminiscient of event, avoidance of external stimuli
that may serve as reminders of the traumatic events
negative mood: dissociative amneisa, negative attitudes about self, others, world, self blame
Arousal symptoms: unprovoked irritability and temper tantrums, irresponsible self-destructive
activities, hypervigilance, heightened startle reaction, difficutly in focusing and concentrating,
disrupted sleep patterns
Specifiers
Differential Diagnosis
persistent -- disorder has been present for more than 12 moths
persistent -- over 12
months
w dissociative
symptoms derealization,
depersonalization,
with delayed
expression -- don’t
meet full criteria for 6
months after event
same
SAME AS ABOVE - acute stress is less than a month --> then PTSD
A. development of emo/bx probs in response to stressor, B. clinically significant evidenced by 1
or both: marked distress that is out of proportion to severity of stressor, significant impairment
C. symptoms do not meet other disorder D. not mormal bereavement E. stressor ro its
consequences have terminated E
with depressed mood,
anxiety, mixed anxiety
and depressed mood,
disturbance of
conduct, mixed
disturbance of
emotions and conduct,
unspecified
Terms
Disorder
Overview
Onset
# Criteria
A. Persistent eating of non-nutritive, non-food substances for at least
one month
B.
Inappropriate to developmental level
C.
Culturally and socially inappropriate
D. If
the eating behavior occurs in the context of another mental disorder (e.
g. intellectual disability [intellectual developmental disorder], autism
spectrum disorder, schizophrenia, or medical condition (including
pregnancy), it is sufficiently severe to warrant additional clinical
attention
one month
-minimum
age of two
years
PICA
Diagnostic Criteria
PICA
A. Repeated regurgitation of food, at least one month. May be rechewed, re-swallowed, or spit out.
B. Not
attributable to GI or AMC
C.
Exclusion of other eating disorder
D.
sufficiency exclusion
Rumination RUMIN
Specifiers
in remission
-- criteria has
not been met
for a
sustained
period of
time
Differential
Diagnosis
Terms
in remission
-- criteria has
not been met
for a
sustained
period of
time
anorexia/bulimia
A- 1+
eating or feeding disturbance --lack of interest in eating or food;
avoidance based on the sensory characteristics of food; concern about
aversive consequences of eating; persistent failure to meet
Avoidant/Restrictive
Av/Res Food
appropriate
Intake Disorder
nutritional and/or energy needs associated A criterion
coding
based on
three
month
periods
Anorexia Nervosa
Anorexia
bx occur
at least
1x wk for
3mos
BULIMIA NERVOSA
BULIMIA
A. Disturbance of eating or feeeding AEB failing to meet appropriate
nutritional &/or energy needs, associated with one or more:
1. significant weight loss or failure to make expected gains
2.
significant nutritional deficiency
3.
dependence on enternal feeding or nutritional supplements
4. marked interference with psychosocial fx
B.
not because lack of available food or cultural
C. other eating disorder exclusion
D.
exclusions: not caused by other menta/medical conditions, or severe
enough to warrant additional clinical attention
A. restriction of required energy intake, leading to signficantly low body
weight, taking into account age, sex, developmental trajectory, and
physical health. Signficantly low weight.
B. intense fear of gaining weight or of becoming fat OR persistent
behavior that interferes with weight gain, even though at a significantly
low weight.
C. Disturbance in the way
one's weight or shape is experienced OR undue influence of weight or
shape on self-evaluation OR lack of recognition of the seriousness of low
body weight
A. recurrent episodes of binge eating. An episode is characterized by:
1. Binging during a discrete period of time (within any two hour period)
an amount of food that is definitely larger than what most individuals
would eat in a similar period of time under similar circumstances.
2. sense of lack of control over eating during the episode (feeling that
one cannot stop eating or control what or how much one is eating)
B. recurrent appropriate compensatory behaviors to prevent weight gain
-- self-induced vomiting, misuse of laxatives, diuretics, or orther
medications; fasting or excessive exercise
C. the binge eating and inappropriate compensatory behaviors both
occur, on average, at least once a week for 3 months
restricting
type or bingeeating type
partial/full
remission
currenty
severity
in partial or
full remission
mild mod
severe
extreme
restricting type: during the three months not engaged
in epsidoes of binging or purging behavior. Weight loss
is accomplished primarily through dieting, fasting, or
excessive exercise.
Binge-eating/purging
type: for last three months, individiual engaged in
recurrent episodes of binge eating or purging behavior
Mild, Mod, Severe, Extreme based on BMI