Psychopathology & Diagnostic Reasoning: DSM-5 Criteria Explained for NRNP-6635-11

Understanding the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition) criteria is essential for making accurate psychiatric diagnoses. The DSM-5 provides a comprehensive framework for diagnosing mental health disorders, outlining specific criteria for each condition. In psychiatric nursing, understanding these criteria allows clinicians to make informed decisions about treatment and care planning. This guide will cover common psychiatric disorders, the associated DSM-5 diagnostic criteria, and red flags that may indicate the need for further investigation or differential diagnosis.

Common Disorders and DSM-5 Criteria

Below is an overview of some of the most common psychiatric disorders, their DSM-5 criteria, and key considerations for diagnostic reasoning.

1. Generalized Anxiety Disorder (GAD)

DSM-5 Criteria for GAD:

Excessive anxiety and worry for at least 6 months, occurring more days than not.
Difficulty controlling the worry.
Three or more of the following symptoms are present:
- Restlessness or feeling keyed up or on edge.
- Being easily fatigued.
- Difficulty concentrating or mind going blank.
- Irritability.
- Muscle tension.
- Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).
Clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Red Flags for GAD:

Excessive worry about multiple areas (e.g., work, health, family) for no clear reason.
Symptoms lasting over 6 months without improvement.
Impact on daily functioning and well-being (e.g., frequent absenteeism from work or school).
Comorbid symptoms such as sleep disturbances and irritability.

2. Major Depressive Disorder (MDD)

DSM-5 Criteria for MDD:

Depressed mood most of the day, nearly every day, for at least 2 weeks.
Anhedonia (loss of interest or pleasure in activities once enjoyed).
At least five or more of the following symptoms must be present during the same 2-week period:
- Significant weight loss or gain, or changes in appetite.
- Insomnia or excessive sleeping.
- Psychomotor agitation or retardation (restlessness or slowed movements).
- Fatigue or loss of energy.
- Feelings of worthlessness or excessive guilt.
- Difficulty concentrating or making decisions.
- Thoughts of death or suicide, or suicide attempt.
Impairment in social, occupational, or other areas of functioning.

Red Flags for MDD:

Severe impairment in functioning (e.g., inability to perform daily activities, work, or social interactions).
Suicidal thoughts or self-harm behaviors, especially in the presence of hopelessness or despair.
Persistent feelings of worthlessness or excessive guilt.
Symptoms lasting for more than 2 weeks, without significant improvement.

3. Bipolar Disorder (I and II)

DSM-5 Criteria for Bipolar I Disorder:

At least one manic episode lasting at least 1 week, most of the day, nearly every day.
- Symptoms include inflated self-esteem, decreased need for sleep, talkativeness, flight of ideas, distractibility, and involvement in high-risk activities (e.g., spending sprees, sexual indiscretions).
Depressive episodes may also occur, but are not required for diagnosis.

DSM-5 Criteria for Bipolar II Disorder:

At least one hypomanic episode (similar to mania but less severe and shorter in duration) and at least one major depressive episode.
No history of manic episodes (which distinguishes it from Bipolar I Disorder).

Red Flags for Bipolar Disorder:

Mood swings that include periods of extremely elevated or irritable mood followed by deep periods of depression.
Impulsive behaviors or risky decisions during manic or hypomanic phases.
Sleep disturbances: Need for little sleep during manic episodes (e.g., staying awake for days without feeling fatigued).
Mood episodes lasting at least 1 week or longer, or depressive episodes that last for 2 weeks or more.

4. Schizophrenia

DSM-5 Criteria for Schizophrenia:

Two or more of the following, present for a significant portion of time during a 1-month period:
- Delusions (false beliefs).
- Hallucinations (false perceptions, such as hearing voices).
- Disorganized speech (incoherence or tangential speech).
- Grossly disorganized or catatonic behavior (e.g., inability to move or rigid posture).
- Negative symptoms (e.g., emotional flattening, reduced ability to function).
Functional impairment in work, interpersonal relationships, or self-care.
Continuous signs of the disorder for at least 6 months, including at least 1 month of active-phase symptoms.

Red Flags for Schizophrenia:

Delusions and hallucinations (especially auditory hallucinations, such as hearing voices).
Disorganized thinking or speech that makes it difficult to follow a conversation.
Severe impairment in social and occupational functioning.
Negative symptoms such as apathy, lack of motivation, or inability to maintain relationships.

5. Attention-Deficit/Hyperactivity Disorder (ADHD)

DSM-5 Criteria for ADHD:

Inattention or hyperactivity-impulsivity that interferes with functioning or development, characterized by:
- Inattention: Failure to pay close attention to details, difficulty sustaining attention, not following through on tasks, disorganization.
- Hyperactivity-impulsivity: Fidgeting, inability to stay seated, talking excessively, difficulty waiting turn, interrupting others.
Symptoms are present for at least 6 months and must be inconsistent with the developmental level.
Symptoms must be present in two or more settings (e.g., home, school, work).

Red Flags for ADHD:

Chronic inattention and difficulty concentrating in school or work.
Impulsivity or hyperactivity that is inconsistent with developmental age.
Difficulty maintaining relationships due to inability to focus, organize, or control impulses.
Symptoms must persist for at least 6 months, with early onset (before age 12).

6. Post-Traumatic Stress Disorder (PTSD)

DSM-5 Criteria for PTSD:

Exposure to a traumatic event (actual or threatened death, serious injury, or sexual violence) either through direct experience, witnessing, or learning of the event happening to a loved one.
Intrusion symptoms: Recurrent, involuntary, and distressing memories or flashbacks.
Avoidance of reminders associated with the trauma.
Negative alterations in mood or cognition, including feelings of detachment, guilt, or inability to experience positive emotions.
Arousal symptoms: Hypervigilance, exaggerated startle response, irritability, and sleep disturbances.
Symptoms lasting more than 1 month and causing significant distress or impairment.

Red Flags for PTSD:

Flashbacks and intrusive memories of a traumatic event.
Hypervigilance (e.g., always being on edge or easily startled).
Avoidance of reminders of the trauma (e.g., avoiding places or conversations related to the event).
Negative mood changes and emotional numbness, including feelings of guilt or shame.

7. Obsessive-Compulsive Disorder (OCD)

DSM-5 Criteria for OCD:

Obsessions: Recurrent, persistent thoughts, urges, or images that are intrusive and cause anxiety or distress.
Compulsions: Repetitive behaviors or mental acts the individual feels driven to perform in response to an obsession or according to rigid rules.
Time-consuming (e.g., takes more than 1 hour per day) and causes significant distress or impairment in social, occupational, or other important areas of functioning.

Red Flags for OCD:

Intrusive thoughts or urges that are difficult to control.
Repetitive behaviors or rituals (e.g., washing hands, checking locks) performed to reduce anxiety or prevent harm.
Significant time spent on compulsions, leading to disruptions in daily life.

Conclusion: Tips for Psychiatric Diagnosis

Comprehensive History: Always begin with a thorough patient history, including any significant life events, trauma, or medical conditions.
Symptom Clarity: Ensure the symptoms meet the required criteria for diagnosis. Many disorders share similar features, so criteria specificity is key.
Screening Tools: Utilize validated screening tools (e.g., Beck Depression Inventory, GAD-7) to help quantify and assess symptoms.
Differential Diagnosis: Consider alternative diagnoses if symptoms overlap. For example, anxiety and depression can often present similarly but require different treatment approaches.
Consultation: Collaborate with a multidisciplinary team when in doubt or if the diagnosis is unclear.

By systematically applying DSM-5 criteria and recognizing red flags, mental health professionals can ensure accurate diagnoses and provide effective treatment plans tailored to the patient’s needs.

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