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DSM-S does not separate the diagnoses of substance abuse and dependence as in DSM-IV. Rather criteria are provided for substance use disorder, accompanied by criteria for intoxication, withdrawal, substance-induced disorders, and unspecified substance-related disorders, where relevant. Within substance use disorders, the DSM-IV recurrent substance-related legal problems criterion has been deleted from DSM-S, and a new criterion—craving, or a strong de- sire or urge to use a substance—has been added. In addition, the threshold for substance use disorder diagnosis in DSM—S is set at two or more criteria, in contrast to a threshold of one or more criteria for a diagnosis of DSM—IV substance abuse and three or more for DSM-IV depen- dence. Cannabis withdrawal and caffeine withdrawal are new disorders (the latter was in

DSM-IV Appendix B, ”Criteria Sets and Axes Provided for Further Study").

Severity of the DSM-S substance use disorders is based on the number of criteria en- dorsed. The DSM-IV specifier for a physiological subtype is eliminated in DSM-S, as is the

DSM-IV diagnosis of polysubstance dependence. Early remission from a DSM-S substance use disorder is defined as at least 3 but less than 12 months without meeting substance use disorder criteria (except craving), and sustained remission is defined as at least 12 months without meeting criteria (except craving). Additional new DSM-S specifiers include ”in a controlled environment” and ”on maintenance therapy” as the situation warrants.

816 Highlights of Changes From DSM-IV to DSM-5The DSM-IV diagnoses of dementia and amnestic disorder are subsumed under the newly named entity maj or neurocognitive disorder (NCD). The term dementia is not precluded from use in the etiological subtypes where that term is standard. Furthermore, DSM-S now recog- nizes a less severe level of cognitive impairment, mild NCD, which is a new disorder that per- mits the diagnosis of less disabling syndromes that may nonetheless be the focus of concern and treatment. Diagnostic criteria are provided for both of these disorders, followed by diag- nostic criteria for different etiological subtypes. In DSM-IV, individual diagnoses were desig- nated for dementia of the Alzheimer’s type, vascular dementia, and substance-induced dementia, whereas the other neurodegenerative disorders were classified as dementia due to another medical condition, with HIV, head trauma, Parkinson’s disease, Huntington’s disease,

Pick’s disease, Creutzfeldt-Jakob disease, and other medical conditions specified. In DSM-S, major or mild NCD due to Alzheimer's disease and major or mild vascular NCD have been re— tained, while new separate criteria are now presented for major or mild frontotemporal NCD,

NCD with Lewy bodies, and NCDs due to traumatic brain injury, a substance/ medication,

HIV infection, prion disease, Parkinson’s disease, Huntington’s disease, another medical con- dition, and multiple etiologies, respectively. Unspecified NCD is also included as a diagnosis.

The criteria for personality disorders in Section II of DSM-5 have not changed from those in

DSM-IV. An alternative approach to the diagnosis of personality disorders was developed for Personality Disorders”). For the general criteria for personality disorder, presented in

Section III, a revised personality functioning criterion (Criterion A) has been developed based on a literature review of reliable clinical measures of core impairments central to per- sonality pathology. A diagnosis of personality disorder—trait specified, based on moderate or greater impairment in personality functioning and the presence of pathological personal- ity traits, replaces personality disorder not otherwise specified and provides a much more in- formative diagnosis for individuals who are not optimally described as having a specific personality disorder. A greater emphasis on personality functioning and trait—based criteria increases the stability and empirical bases of the disorders. Personality functioning and per- sonality traits also can be assessed whether or not the individual has a personality disor- der—a feature that provides clinically useful information about all individuals.

An overarching change from DSM-IV is the addition of the course specifiers ”in a controlled environment” and ”in remission” to the diagnostic criteria sets for all the paraphilic disor- ders. These specifiers are added to indicate important changes in an individual’s status. In

DSM-S, paraphilias are not ipsofucto mental disorders. There is a distinction between paraphil- ias and paraphilic disorders. A paraphilic disorder is a paraphilia that is currently causing dis- tress or impairment to the individual or a paraphilia whose satisfaction has entailed personal harm, or risk of harm, to others. A paraphilia is a necessary but not a sufficient condition for having a paraphilic disorder, and a paraphilia by itself does not automatically justify or require clinical intervention. The distinction between paraphilias and paraphilic disorders was im- plemented without making any changes to the basic structure of the diagnostic criteria as they had existed since DSM-III-R. The change proposed for DSM-S is that individuals who meet both Criterion A and Criterion B would now be diagnosed as having a paraphilic disorder. A diagnosis would not be given to individuals whose symptoms meet Criterion A but not Cri- terion B—that is, to individuals who have a paraphilia but not a paraphilic disorder.

*:._ , Glossary of affect A pattern of observable behaviors that is the expression of a subjectively experi- enced feeling state (emotion). Examples of affect include sadness, elation, and anger. In contrast to mood, which refers to a pervasive and sustained emotional ”climate,” affect refers to more fluctuating changes in emotional "weather." What is considered the nor- mal range of the expression of affect varies considerably, both within and among dif- ferent cultures. Disturbances in affect include blunted Significant reduction in the intensity of emotional expression.

flat Absence or near absence of any sign of affective expression.

inappropriate Discordance between affective expression and the content of speech or ideation.

labile Abnormal variability in affect with repeated, rapid, and abrupt shifts in af- fective expression.

restricted or constricted Mild reduction in the range and intensity of emotional ex- pression.

affective blunting See AFFECT.agitation (psychomotor) See PSYCHOMOTOR AGITATION.agnosia Loss of ability to recognize objects, persons, sounds, shapes, or smells that occurs in the absence of either impairment of the specific sense or significant memory loss.

alogia An impoverishment in thinking that is inferred from observing speech and lan- guage behavior. There may be brief and concrete replies to questions and restriction in the amount of spontaneous speech (termed poverty of speech). Sometimes the speech is adequate in amount but conveys little information because it is overconcrete, overab— stract, repetitive, or stereotyped (termed poverty of content).

amnesia An inability to recall important autobiographical information that is inconsis- tent with ordinary forgetting.

anhedonia Lack of enjoyment from, engagement in, or energy for life’s experiences; def- icits in the capacity to feel pleasure and take interest in things. Anhedonia is a facet of the broad personality trait domain DETACHMENT.

anosognosia A condition in which a person with an illness seems unaware of the exis- tence of his or her illness.

antagonism Behaviors that put an individual at odds with other people, such as an ex- aggerated sense of self—importance with a concomitant expectation of Special treat— ment, as well as a callous antipathy toward others, encompassing both unawareness of others’ needs and feelings, and a readiness to use others in the service of self-enhance- ment. Antagonism is one of the five broad PERSONALITY TRAIT DOMAINS defined in Sec- tion 111 ”Alternative DSM-S Model for Personality Disorders.”

SMALL CAPS indicate term found elsewhere in this glossary. Glossary definitions were informed by

DSM-5 Work Groups, publicly available Internet sources, and previously published glossaries for mental disorders (World Health Organization and American Psychiatric Association).

818 Glossary of Technical Terms antidepressant discontinuation syndrome A set of symptoms that can occur after abrupt cessation, or marked reduction in dose, of an antidepressant medication that had been taken continuously for at least 1 month.

anxiety The apprehensive anticipation of future danger or misfortune accompanied by a feeling of worry, distress, and / or somatic symptoms of tension. The focus of antici- pated danger may be internal or external.

anxiousness Feelings of nervousness or tenseness in reaction to diverse situations; frequent worry about the negative effects of past unpleasant experiences and future negative possi- bilities; feeling fearful and apprehensive about uncertainty; expecting the worst to happen.

Anxiousness is a facet of the broad personality trait domain N EGATIVE AFFECI'IVITY.

arousal The physiological and psychological state of being awake or reactive to stimuli.

asociality A reduced initiative for interacting with other people.attention The ability to focus in a sustained manner on a particular stimulus or activity.

finishing tasks or in concentrating on work.attention seeking Engaging in behavior designed to attract notice and to make oneself the focus of others’ attention and admiration. Attention seeking is a facet of the broad personality trait domain ANTAGONISM.

autogynephilia Sexual arousal of a natal male associated with the idea or image of being a woman.

avoidance The act of keeping away from stress-related circumstances; a tendency to cir- cumvent cues, activities, and situations that remind the individual of a stressful event experienced.

avolition An inability to initiate and persist in goal-directed activities. When severe enough to be considered pathological, avolition is pervasive and prevents the person from com- pleting many different types of activities (e.g., work, intellectual pursuits, self-care).

bereavement The state of having lost through death someone with whom one has had a close relationship. This state includes a range of grief and mourning responses.

biological rhythms See CIRCADIAN RHYTHMS.callousness Lack of concern for the feelings or problems of others; lack of guilt or re- morse about the negative or harmful effects of one’s actions on others. Callousness is a facet of the broad personality trait domain ANTAGONISM.

catalepsy Passive induction of a posture held against gravity. Compare with WAXY FLEX-

cataplexy Episodes of sudden bilateral loss of muscle tone resulting in the individual collapsing, often occurring in association with intense emotions such as laughter, an— ger, fear, or surprise.

circadian rhythms Cyclical variations in physiological and biochemical function, level of sleep-wake activity, and emotional state. Circadian rhythms have a cycle of about 24 hours, ultradian rhythms have a cycle that is shorter than 1 day, and infmdian rhythms have a cycle that may last weeks or months.

ences, including DEPERSONALIZATION, DEREALIZATION, and DISSOCIATION; mixed sleep- wake state experiences; and thought-control experiences. Cognitive and perceptual dysregulation is a facet of the broad personality trait domain PSYCHOTICISM.

coma State of complete loss of consciousness.Glossary of Technical Terms 819 compulsion Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession, or according to rules that must be applied rig- idly. The behaviors or mental acts are aimed at preventing or reducing anxiety or dis- tress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutral- ize or prevent or are clearly excessive.

conversion symptom A loss of, or alteration in, voluntary motor or sensory functioning, with or without apparent impairment of consciousness. The symptom is not fully ex- plained by a neurological or another medical condition or the direct effects of a sub- stance and is not intentionally produced or feigned.

deceitfulness Dishonesty and fraudulence; misrepresentation of self; embellishment or fabrication when relating events. Deceitfulness is a facet of the broad personality trait domain ANTAGONISM.

defense mechanism Mechanisms that mediate the individual’s reaction to emotional conflicts and to external stressors. Some defense mechanisms (e.g., projection, splitting, acting out) are almost invariably maladaptive. Others (e.g., suppression, denial) may be either maladaptive or adaptive, depending on their severity, their inflexibility, and the context in which they occur.

delusion A false belief based on incorrect inference about external reality that is firmly vertible and obvious proof or evidence to the contrary. The belief is not ordinarily ac- cepted by other members of the person’s culture or subculture (i.e., it is not an article of religious faith). When a false belief involves a value judgment, it is regarded as a delusion only when the judgment is so extreme as to defy credibility. Delusional conviction can sometimes be inferred from an overvalued idea (in which case the individual has an un- reasonable belief or idea but does not hold it as firmly as is the case with a delusion). De- lusions are subdivided according to their content. Common types are listed below: bizarre A delusion that involves a phenomenon that the person’s culture would re- gard as physically impossible.

delusional jealousy A delusion that one's sexual partner is unfaithful.

erotomanic A delusion that another person, usually of higher status, is in love with the individual.

grandiose A delusion of inflated worth, power, knowledge, identity, or special re- lationship to a deity or famous person.

mixed type Delusions of more than one type (e.g., EROTOMANIC, GRANDIOSE, PERSE-

CUTORY, SOMATIC) in which no one theme predominates.mood-congruent See MOOD-CONGRUENT PSYCHOTIC FEATURES.mood-incongruent See MOOD—INCONGRUENT PSYCHOTIC FEATURES.of being controlled A delusion in which feelings, impulses, thoughts, or actions are experienced as being under the control of some external force rather than be- ing under one’s own control.

of reference A delusion in which events, objects, or other persons in one’s immedi- ate environment are seen as having a particular and unusual significance. These delusions are usually of a negative or pejorative nature but also may be grandiose in content. A delusion of reference differs from an idea of reference, in which the false belief is not as firmly held nor as fully organized into a true belief.

persecutory A delusion in which the central theme is that one (or someone to whom one is close) is being attacked, harassed, cheated, persecuted, or conspired against.

820 Glossary of Technical Terms somatic A delusion whose main content pertains to the appearance or functioning of one’s body.

thought broadcasting A delusion that one’s thoughts are being broadcast out loud so that they can be perceived by others.

thought insertion A delusion that certain of one’s thoughts are not one’s own, but rather are inserted into one’s mind.

depersonalization The experience of feeling detached from, and as if one is an outside observer of, one’s mental processes, body, or actions (e.g., feeling like one is in a dream; a sense of unreality of self, perceptual alterations; emotional and / or physical numbing; temporal distortions; sense of unreality).

depressivity Feelings of being intensely sad, miserable, and / or hopeless. Some patients describe an absence of feelings and/ or dysphoria; difficulty recovering from such moods; pessimism about the future; pervasive shame and/ or guilt; feelings of inferior self—worth; and thoughts of suicide and suicidal behavior. Depressivity is a facet of the broad personality trait domain DETACHMENT.

derealization The experience of feeling detached from, and as if one is an outside ob- server of, one’s surroundings (e.g., individuals or objects are experienced as unreal, dreamlike, foggy, lifeless, or visually distorted).

detachment Avoidance of socioemotional experience, including both WTTHDRAWAL from interpersonal interactions (ranging from casual, daily interactions to friendships and inti- mate relationships [i.e., H\1TIMACY AVOIDANCED and RESTRICTED AFFECTIVITY, particularly limited hedonic capacity. Detachment is one of the five pathological PERSONALITY TRAIT

DOMAINS defined in Section III "Altemative DSM-5 Model for Personality Disorders.” disinhibition Orientation toward immediate gratification, leading to impulsive behav- ior driven by current thoughts, feelings, and external stimuli, without regard for past learning or consideration of future consequences. RIGID PERFECTIONISM, the opposite pole of this domain, reflects excessive constraint of impulses, risk avoidance, hyper- responsibility, hyperperfectionism, and rigid, rule—governed behavior. Disinhibition is one of the five pathological PERSONALITY TRAIT DOMAINS defined in Section 111 ”Al- ternative DSM-S Model for Personality Disorders." disorder of sex development Condition of significant inborn somatic deviations of the reproductive tract from the norm and / or of discrepancies among the biological indica- tors of male and female.

disorientation Confusion about the time of day, date, or season (time); where one is (place); or who one is (person).

dissociation The splitting off of clusters of mental contents from conscious awareness.

Dissociation is a mechanism central to dissociative disorders. The term is also used to describe the separation of an idea from its emotional significance and affect, as seen in the inappropriate affect in schizophrenia. Often a result of psychic trauma, dissociation may allow the individual to maintain allegiance to two contradictory truths while re- maining unconscious of the contradiction. An extreme manifestation of dissociation is dissociative identity disorder, in which a person may exhibit several independent per- sonalities, each unaware of the others.

distractibility Difficulty concentrating and focusing on tasks; attention is easily divert- ed by extraneous stimuli; difficulty maintaining goal-focused behavior, including both planning and completing tasks. Distractibility is a facet of the broad personality trait domain DISINHIBITION.

dysarthria A disorder of speech sound production due to structural or motor impair- ment affecting the articulatory apparatus. Such disorders include cleft palate, muscle

Glossary of Technical Terms 821 disorders, cranial nerve disorders, and cerebral palsy affecting bulbar structures (i.e., lower and upper motor neuron disorders).

dyskinesia Distortion of voluntary movements with involuntary muscle activity.of depression, discontent, and in some cases indifference to the world around them.

dyssomnias Primary disorders of sleep or wakefulness characterized by INSOMNIA or

HYPERSOMNIA as the major presenting symptom. Dyssomnias are disorders of the amount, quality, or timing of sleep. Compare with PARASOMNIAS.

dysthymia Presence, while depressed, of two or more of the following: 1) poor appetite or overeating, 2) insomnia or hypersomnia, 3) low energy or fatigue, 4) low self—esteem, 5) poor concentration or difficulty making decisions, or 6) feelings of hopelessness.

dystonia Disordered tonicity of muscles.eccentricity Odd, unusual, or bizarre behavior, appearance, and / or speech having strange and unpredictable thoughts; saying unusual or inappropriate things. Eccentric- ity is a facet of the broad personality trait domain PSYCHOTICISM.

echolalia The pathological, parrotlike, and apparently senseless repetition (echoing) of a word or phrase just spoken by another person.

echopraxia Mimicking the movements of another.emotional lability Instability of emotional experiences and mood; emotions that are easily aroused, intense, and/ or out of proportion to events and circumstances. Emo- tional lability is a facet of the broad personality trait domain NEGATIVE AFFECTIVITY.

empathy Comprehension and appreciation of others’ experiences and motivations; tol- erance of differing perspectives; understanding the effects of own behavior on others.

episode (episodic) A specified duration of time during which the patient has developed or experienced symptoms that meet the diagnostic criteria for a given mental disorder. De- pending on the type of mental disorder, episode may denote a certain number of symptoms or a specified severity or frequency of symptoms. Episodes may be further differentiated as a single (first) episode or a recurrence or relapse of multiple episodes if appropriate.

ings of well-being, elation, happiness, excitement, and joy.fatigability Tendency to become easily fatigued. See also FATIGUE.fatigue A state (also called exhaustion, tiredness, lethargy, languidness, languor, lassi- tude, and listlessness) usually associated with a weakening or depletion of one’s phys- ical and / or mental resources, ranging from a general state of lethargy to a specific, work-induced burning sensation within one’s muscles. Physical fatigue leads to an in- ability to continue functioning at one’s normal level of activity. Although widespread in everyday life, this state usually becomes particularly noticeable during heavy exer- cise. Mental fatigue, by contrast, most often manifests as SOMNOLENCE (sleepiness).

fear An emotional response to perceived imminent threat or danger associated with urges to flee or fight.

flashback A dissociative state during which aspects of a traumatic event are reexperi- enced as though they were occurring at that moment.

flight of ideas A nearly continuous flow of accelerated speech with abrupt changes from topic to topic that are usually based on understandable associations, distracting stimuli, or plays on words. When the condition is severe, speech may be disorganized and incoherent.

822 Glossary of Technical Terms gender The public (and usually legally recognized) lived role as boy or girl, man or woman. Biological factors are seen as contributing in interaction with social and psy- chological factors to gender development.

gender assignment The initial assignment as male or female, which usually occurs at birth and is subsequently referred to as the ”natal gender.” gender dysphoria Distress that accompanies the incongruence between one’s experi- enced and expressed gender and one’s assigned or natal gender.

gender experience The unique and personal ways in which individuals experience their gender in the context of the gender roles provided by their societies.

gender expression The specific ways in which individuals enact gender roles provided in their societies.

gender identity A category of social identity that refers to an individual’s identification as male, female or, occasionally, some category other than male or female.

gender reassignment A change of gender that can be either medical (hormones, sur- gery) or legal (government recognition), or both. In case of medical interventions, often referred to as sex reassignment.

geometric hallucination See HALLUCINATION.grandiosity Believing that one is superior to others and deserves special treatment; self- centeredness; feelings of entitlement; condescension toward others. Grandiosity is a facet of the broad personality trait domain ANTAGONISM.

grimace (grimacing) Odd and inappropriate facial expressions unrelated to situation (as seen in individuals with CATATONIA).

hallucination A perception-like experience with the clarity and impact of a true percep- tion but without the external stimulation of the relevant sensory organ. Hallucinations should be distinguished from ILLUSIONS, in which an actual external stimulus is misperceived or misinterpreted. The person may or may not have insight into the non— veridical nature of the hallucination. One hallucinating person may recognize the false sensory experience, whereas another may be convinced that the experience is grounded in reality. The term hallucination is not ordinarily applied to the false perceptions that occur during dreaming, while falling asleep (hypnagogic), or upon awakening (hypno— pompic). Transient hallucinatory experiences may occur without a mental disorder.

auditory A hallucination involving the perception of sound, most commonly of voice.

geometric Visual hallucinations involving geometric shapes such as tunnels and funnels, spirals, lattices, or cobwebs.

gustatory A hallucination involving the perception of taste (usually unpleasant).

mood-congruent See MOOD-CONGRUENT PSYCHOTIC FEATURES.mood-incongruent See MOOD-INCONGRUENT PSYCHOTIC FEATURES.olfactory A hallucination involving the perception of odor, such as of burning rub- ber or decaying fish.

somatic A hallucination involving the perception of physical experience localized within the body (e.g., a feeling of electricity). A somatic hallucination is to be dis- medical condition, from hypochondriacal preoccupation with normal physical sensations, or from a tactile hallucination.

tactile A hallucination involving the perception of being touched or of something being under one’s skin. The most common tactile hallucinations are the sensation

Glossary of Technical Terms 823 of electric shocks and formication (the sensation of something creeping or crawl- ing on or under the skin).

visual A hallucination involving sight, which may consist of formed images, such as of people, or of unformed images, such as flashes of light. Visual hallucinations should be distinguished from ILLUSIONS, which are misperceptions of real external stimuli.

hostility Persistent or frequent angry feelings; anger or irritability in response to minor slights and insults; mean, nasty, or vengeful behavior. Hostility is a facet of the broad personality trait domain ANTAGONISM.

hyperacusis Increased auditory perception.hyperorality A condition in which inappropriate objects are placed in the mouth.