1
Q
A 7-year-old child assigned male at birth has, for the past 10 months, repeatedly insisted they are a girl and becomes intensely distressed when referred to as a boy. They strongly prefer traditionally feminine clothing, consistently choose female roles in make-believe play, prefer girls as playmates, and express a strong dislike of their genital anatomy. The child has a documented 46,XY disorder of sex development (complete androgen insensitivity syndrome) in the medical record. Symptoms cause impairment at school and at home.
A
Gender dysphoria in children — With a disorder/difference of sex development
2
Q
A 28-year-old person assigned male at birth reports a long-standing, persistent incongruence between experienced gender and primary/secondary sex characteristics for many years, with significant distress and occupational impairment. They have transitioned to full-time living as a woman, have legally changed their gender marker, and are receiving ongoing gender-affirming hormone therapy; they are preparing for a gender-affirming surgical procedure.
A
Gender dysphoria in adolescents and adults — Posttransition
3
Q
A 19-year-old person assigned female at birth reports a strong desire to be treated as another gender and to prevent development of further secondary sex characteristics. They meet the full symptom pattern for gender dysphoria in adolescents/adults and are significantly distressed, but the symptoms have been present for only 3 months.
A
Other specified gender dysphoria — Brief gender dysphoria (duration < 6 months)
4
Q
A 16-year-old presents with prominent distress related to gender incongruence and avoidance of social situations. A caregiver reports the teen has expressed discomfort with developing secondary sex characteristics, but the interview is cut short and the teen declines to answer key questions about duration and specific symptoms. There is not enough information to determine whether full criteria are met or to specify why they are not met, but the presentation involves clinically significant distress/impairment.
A
Unspecified gender dysphoria — Insufficient information to make a more specific diagnosis
5
Q
After surviving a serious car accident two years ago, Maya has recurrent intrusive memories, nightmares, avoidance of driving, negative beliefs about safety, emotional numbing, hypervigilance, and exaggerated startle response lasting over a year.
A
Posttraumatic stress disorder, with delayed expression
6
Q
James experienced combat trauma and reports flashbacks, irritability, reckless behavior, insomnia, and dissociative episodes where he feels detached from his body.
A
Posttraumatic stress disorder, with dissociative symptoms, depersonalization
7
Q
Following years of childhood abuse, Lina experiences chronic affect dysregulation, persistent negative self-concept, difficulties in relationships, and trauma re-experiencing symptoms.
A
Complex posttraumatic stress disorder
8
Q
After prolonged domestic violence, Eric struggles with emotional numbing, shame, unstable relationships, and intrusive trauma memories.
A
Complex posttraumatic stress disorder
9
Q
Within days of a sexual assault, Olivia experiences intrusive memories, dissociation, avoidance, sleep disturbance, and hyperarousal lasting for two weeks.
A
Acute stress disorder
10
Q
Following a workplace explosion, Aaron reports flashbacks, negative mood, and heightened startle response for three weeks.
A
Acute stress disorder
11
Q
After being laid off, Priya develops marked distress, tearfulness, anxiety, and difficulty concentrating that began within one month of the stressor.
A
Adjustment disorder with mixed anxiety and depressed mood
12
Q
Following a divorce, Ben becomes withdrawn and begins skipping work and social obligations, causing functional impairment.
A
Adjustment disorder with disturbance of conduct
13
Q
Ava reports recurrent gaps in memory and the presence of two distinct identity states with differing behaviors and affect, associated with severe childhood trauma.
A
Dissociative identity disorder
14
Q
During therapy, Michael alternates between identity states with different voices, mannerisms, and autobiographical memories, without substance use.
A
Dissociative identity disorder, with multiple distinct personality states
15
Q
Lena has PTSD-like symptoms following repeated emotional abuse but does not meet full diagnostic criteria.
A
Other specified trauma- and stressor-related disorder, subthreshold PTSD
16
Q
Following prolonged stress, Marco experiences adjustment-like symptoms that persist longer than six months after the stressor.
A
Other specified trauma- and stressor-related disorder
17
Q
Sasha presents with trauma-related symptoms, but insufficient information is available due to acute intoxication.
A
Unspecified trauma- and stressor-related disorder
18
Q
Emergency clinicians note trauma-related distress, but a full assessment cannot be completed.
A
Unspecified trauma- and stressor-related disorder
19
Q
Over the past year, Alex drinks alcohol daily and often consumes far more than intended. He has tried to cut down multiple times without success, spends much of his time drinking or recovering, and continues despite worsening gastritis and relationship problems. He experiences tremors and anxiety when he stops drinking.
A
Alcohol Use Disorder (severe, currently using, with physiological dependence)
20
Q
For 8 months, Brianna has been using prescription opioids in larger amounts than prescribed and has been unable to stop despite wanting to. She spends significant time obtaining pills, has developed tolerance, and experiences nausea, muscle aches, and irritability when she runs out.
A
Opioid Use Disorder (moderate, currently using, on agonist therapy)
21
Q
For the past 2 years, Carlos uses cocaine on weekends but increasingly during the week. He reports strong cravings, missed work obligations, and continued use despite chest pain and worsening anxiety. He requires larger amounts to achieve the same effect.
A
Stimulant (Cocaine) Use Disorder (severe, currently using)
22
Q
During college, Dana frequently uses cannabis and has difficulty cutting back. She has stopped attending classes, spends most of her time using, and continues despite failing grades and conflict with family. She reports tolerance and irritability when not using.
A
Cannabis Use Disorder (moderate, currently using)
23
Q
For the past year, Evan uses benzodiazepines daily beyond prescribed doses. He has tried to stop but develops rebound anxiety, tremors, and insomnia. He continues using despite memory problems and poor academic performance.
A
Sedative, Hypnotic, or Anxiolytic Use Disorder (severe, currently using, with physiological dependence)
24
Q
For 6 months, Farah smokes cigarettes shortly after waking and throughout the day. She has unsuccessfully attempted to quit multiple times and continues despite chronic cough and shortness of breath. She experiences irritability and restlessness when she tries to stop.
A
Tobacco Use Disorder (moderate, currently using)
25
Over the past year, Jordan has repeatedly used MDMA at parties and festivals, often in larger amounts than planned. He continues despite memory problems and dehydration-related ER visits and reports strong cravings before events.
Hallucinogen Use Disorder (mild, currently using)
26
For the past 9 months, Kim frequently inhales aerosol sprays to feel lightheaded. She has missed school, continues despite nosebleeds and headaches, and feels compelled to use daily. She experiences nausea and agitation when unable to access inhalants.
Inhalant Use Disorder (moderate, currently using)
27
For 7 months, Leo uses methamphetamine daily and has been unable to stop. He reports intense cravings, paranoia, insomnia, and weight loss, and continues despite losing housing and employment.
Stimulant (Amphetamine-Type) Use Disorder (severe, currently using)
28
After abruptly stopping heavy alcohol use, Maria develops tremors, sweating, nausea, anxiety, and insomnia within 24 hours. Symptoms interfere with functioning but resolve with medical management.
Alcohol Withdrawal (without perceptual disturbances)
29
Within minutes of smoking cannabis, Noah experiences intense anxiety, panic, and derealization requiring reassurance in the emergency department. Symptoms resolve as intoxication wears off.
Cannabis Intoxication (with anxiety)
30
After heavy cocaine use, Olivia develops suspiciousness, auditory hallucinations, and agitation. Symptoms begin during intoxication and resolve after several days of abstinence.
Stimulant-Induced Psychotic Disorder (with onset during intoxication)
31
During opioid intoxication, Paul presents with constricted pupils, slurred speech, and impaired attention, requiring emergency monitoring. Symptoms resolve as the drug wears off.
Opioid Intoxication (with perceptual disturbances)
32
Following abrupt cessation of benzodiazepines, Quinn experiences severe anxiety, tremors, perceptual disturbances, and seizures, requiring inpatient treatment.
Sedative, Hypnotic, or Anxiolytic Withdrawal (with perceptual disturbances)
33
For the past year, Riley engages in problematic gambling behaviors, repeatedly betting more money than intended, chasing losses, and continuing despite significant financial debt and relationship strain.
Gambling Disorder (persistent, episodic pattern)
34
For the last 10 months, Uma previously met full criteria for alcohol use disorder but has not used alcohol for over 4 months while attending outpatient treatment. She continues to experience cravings but has maintained abstinence.
Alcohol Use Disorder (in early remission)
35
Tariq met criteria for opioid use disorder in the past but has not used opioids for over 2 years and no longer experiences cravings or functional impairment.
Opioid Use Disorder (in sustained remission)
36
During an initial evaluation, Sam reports problematic substance use with impairment but provides insufficient information to determine which substance is primarily responsible or whether criteria are fully met.
Unspecified Substance-Related Disorder (provisional)
37
Emily has chronic abdominal pain for several years. Medical evaluations have not identified a sufficient cause, yet she spends hours daily researching illnesses, frequently seeks reassurance from physicians, and feels overwhelmed and anxious about her symptoms.
Somatic symptom disorder, persistent, moderate
38
Carlos reports multiple physical complaints including headaches and fatigue. He remains highly distressed and repeatedly seeks medical testing despite reassurance, though symptoms fluctuate in intensity.
Somatic symptom disorder, mild
39
Hannah has minimal physical symptoms but is convinced she has cancer. She repeatedly checks her body, seeks reassurance online, and avoids doctor visits due to fear of bad news.
Illness anxiety disorder, care-avoidant type
40
Ben has no significant somatic symptoms but frequently visits multiple physicians for reassurance that he does not have a serious neurological illness.
Illness anxiety disorder, care-seeking type
41
Ava suddenly developed paralysis of her left leg after a stressful life event. Neurological exams and imaging are normal, and symptoms are inconsistent with known neurological conditions.
Functional neurological symptom disorder, with weakness or paralysis
42
Noah presents with recurrent non-epileptic seizure-like episodes without EEG abnormalities, often occurring during periods of emotional stress.
Functional neurological symptom disorder, with attacks or seizures
43
Liam has poorly controlled asthma due to continued smoking and nonadherence to treatment, despite understanding the medical risks.
Psychological factors affecting other medical conditions, persistent
44
Sophie’s chronic migraines worsen significantly during periods of high stress and emotional suppression.
Psychological factors affecting other medical conditions, episodic
45
Rachel intentionally falsifies symptoms and alters lab samples to appear ill, leading to repeated hospitalizations, without external incentives.
Factitious disorder imposed on self
46
Daniel repeatedly induces infections by contaminating wounds, seeking attention and sympathy from medical staff.
Factitious disorder imposed on self, recurrent episodes
47
A caregiver repeatedly brings her child to the hospital reporting seizures that are later discovered to be fabricated.
Factitious disorder imposed on another
48
A parent exaggerates and induces symptoms in their dependent to assume the sick role by proxy.
Factitious disorder imposed on another, recurrent behavior
49
A 36-year-old man reports recurrent sexual arousal from secretly watching strangers undress through apartment windows. He acted on these urges for years but has not done so for over 2 years after court-mandated treatment and reports no current urges.
Voyeuristic Disorder, in full remission
50
A 29-year-old man experiences intense sexual arousal from exposing his genitals to unsuspecting adults in public spaces. He is currently incarcerated and has no access to potential victims.
Exhibitionistic Disorder, in a controlled environment (sexually aroused by exposing genitals to physically mature individuals)
51
A 42-year-old man reports repeated sexual arousal from rubbing against non-consenting women in crowded spaces. He meets full criteria but has not engaged in the behavior since entering a secure inpatient program.
Frotteuristic Disorder, in a controlled environment
52
A 31-year-old individual reports intense sexual arousal from being bound and humiliated. The urges cause significant shame and relationship impairment. He also reports past engagement in breath-restriction behaviors to enhance arousal.
Sexual Masochism Disorder, with asphyxiophilia
53
A 38-year-old man reports sexual arousal only when another person experiences genuine fear and pain. He acted on these urges with a non-consenting partner over several months.
Sexual Sadism Disorder
54
A 47-year-old man reports persistent sexual attraction exclusively to prepubescent girls. He has experienced these urges since adolescence and reports attraction only to children within his family.
Pedophilic Disorder, exclusive type, limited to incest, sexually attracted to females
55
A 34-year-old man reports sexual arousal almost exclusively from wearing and touching leather boots. These urges cause distress and impair his relationship. He is currently in therapy and reports no recent behaviors.
Fetishistic Disorder, nonliving objects, in full remission
56
A 45-year-old married man reports sexual arousal from cross-dressing and also reports arousal from imagining himself as female. His urges cause marital distress but he is currently restricted from acting on them due to treatment.
Transvestic Disorder, with autogynephilia, in a controlled environment
57
A client reports persistent sexual arousal from making obscene phone calls that cause distress and impairment, but the presentation does not meet criteria for another specific paraphilic disorder.
Other Specified Paraphilic Disorder (telephone scatologia)
58
A client presents with clinically significant distress related to paraphilic urges but refuses to disclose sufficient detail to meet criteria for a specific disorder.
Unspecified Paraphilic Disorder
59
A woman reports lifelong lack of sexual interest, absent erotic thoughts, and minimal pleasure during sexual activity across all situations for over 6 months, causing significant distress.
Female Sexual Interest/Arousal Disorder, lifelong, generalized, moderate
60
A man reports persistently low sexual desire and absent sexual fantasies beginning in adulthood, present across all contexts for over 6 months.
Male Hypoactive Sexual Desire Disorder, acquired, generalized, moderate
61
A man reports marked difficulty achieving and maintaining erections only with his partner following relationship conflict. Symptoms began 8 months ago.
Erectile Disorder, acquired, situational, mild
62
A woman reports severe pain, fear, and pelvic muscle tightening during attempted vaginal penetration for over 6 months, leading to avoidance of intercourse.
Genito-Pelvic Pain/Penetration Disorder, acquired, severe
63
A man reports ejaculation occurring within approximately one minute of vaginal penetration across most sexual encounters for over 6 months.
Premature (Early) Ejaculation, acquired, generalized, moderate
64
A woman reports marked delay and infrequency of orgasm with significantly reduced intensity despite adequate stimulation for over 6 months.
Female Orgasmic Disorder, acquired, generalized, moderate
65
A man reports marked delay and infrequent ejaculation in nearly all sexual encounters for over 6 months, causing significant distress.
Delayed Ejaculation, acquired, generalized, moderate
66
A client reports onset of erectile difficulties shortly after starting an SSRI, with no prior sexual functioning issues.
Substance/Medication-Induced Sexual Dysfunction
67
A client reports aversion to sexual contact causing distress, but symptoms do not meet criteria for a specific sexual dysfunction and the reason is specified.
Other Specified Sexual Dysfunction (sexual aversion)
68
A client presents with distressing sexual dysfunction symptoms but provides insufficient information to determine a specific diagnosis.
Unspecified Sexual Dysfunction
69
A 22-year-old college student reports two weeks of depressed mood, anhedonia, insomnia, fatigue, guilt, and difficulty concentrating following no clear stressor. No prior episodes.
Major Depressive Disorder, single episode, moderate
70
A 40-year-old has had four prior depressive episodes and currently presents with severe depressed mood, psychomotor retardation, weight loss, and auditory hallucinations telling them they are worthless.
Major Depressive Disorder, recurrent, severe, with mood-congruent psychotic features
71
A 30-year-old experiences a depressive episode every winter for the past four years, marked by hypersomnia, increased appetite, and low energy, with full remission each spring.
Major Depressive Disorder, recurrent, with seasonal pattern, atypical features
72
A 19-year-old reports feeling depressed most days since early high school, with fatigue, low self-esteem, and hopelessness, never symptom-free longer than one month.
Persistent Depressive Disorder, early onset, with pure dysthymic syndrome
73
A 55-year-old reports chronic depressed mood for three years with intermittent full major depressive episodes, currently meeting criteria for MDD.
Persistent Depressive Disorder, late onset, with intermittent major depressive episodes, with current episode
74
A 28-year-old experiences marked irritability, mood swings, anxiety, and breast tenderness during the week before menses, resolving shortly after menstruation, for over a year.
Premenstrual Dysphoric Disorder
75
A 34-year-old reports recurrent premenstrual depression, food cravings, insomnia, and feeling out of control, confirmed across multiple cycles via daily symptom tracking.
Premenstrual Dysphoric Disorder
76
A patient develops depressed mood and anhedonia within days of stopping heavy alcohol use, with improvement after sustained abstinence.
Substance-Induced Depressive Disorder, with onset during withdrawal
77
A 47-year-old develops persistent low mood after starting interferon treatment, with no prior history of depression.
Medication-Induced Depressive Disorder, with onset during medication use
78
A 62-year-old with hypothyroidism presents with persistent depressed mood and fatigue directly attributable to endocrine dysfunction.
Depressive Disorder Due to Another Medical Condition
79
A patient with a recent stroke shows loss of pleasure and depressed mood temporally related to neurological injury.
Depressive Disorder Due to Another Medical Condition
80
A 25-year-old reports depressive episodes lasting 5–7 days occurring monthly, causing impairment but never lasting two weeks.
Other Specified Depressive Disorder, recurrent brief depression
81
A 31-year-old presents with depressed mood and anhedonia lasting 10 days, with four total symptoms.
Other Specified Depressive Disorder, short-duration depressive episode
82
A patient presents with depressive symptoms and distress in an emergency setting, but limited history is available.
Unspecified Depressive Disorder
83
A client reports feeling depressed and impaired but declines full assessment, preventing determination of specific criteria.
Unspecified Depressive Disorder
84
For the past 2 months, Daniel has believed that coworkers are inserting thoughts into his mind through hidden devices in the office walls. He hears voices commenting on his actions daily. His speech is tangential, and he has stopped showering and going to work. Symptoms have been present for over one month but less than six months.
Schizophreniform Disorder (with good prognostic features)
85
Over the past 4 years, Maya has experienced persistent auditory hallucinations and fixed persecutory delusions that neighbors are monitoring her. She shows flat affect, social withdrawal, and disorganized speech, and has been unable to maintain employment. Symptoms have been continuous for well over 6 months.
Schizophrenia (multiple episodes, currently in acute episode)
86
For the past 10 months, Eric has had a single, well‑systematized delusion that his spouse is being replaced by an identical impostor. Aside from the delusion, his functioning is largely intact and he does not display disorganized speech or negative symptoms.
Delusional Disorder (persecutory type)
87
Six weeks after the death of her mother, Sofia develops auditory hallucinations and disorganized speech, along with a depressed mood, insomnia, and feelings of worthlessness. Psychotic symptoms occur only during periods of severe mood disturbance and resolve as her mood stabilizes.
Major Depressive Disorder with Psychotic Features (mood‑congruent)
88
For the past 3 years, Noah has experienced episodes of mania with grandiosity and decreased need for sleep, as well as periods of depression. During both mood episodes and for several weeks outside of them, he hears voices commenting on his behavior.
Schizoaffective Disorder, Bipolar Type (continuous)
89
Within two weeks of starting high‑dose corticosteroids, Lila develops paranoid delusions and visual hallucinations. She has no prior history of psychosis. Symptoms significantly improve after the medication is tapered.
Substance/Medication‑Induced Psychotic Disorder (with onset during medication use)
90
After a stroke affecting the temporal lobe, Marcus begins experiencing visual hallucinations and paranoid beliefs that were not present before the medical event. Neurology confirms symptom onset following the stroke.
Psychotic Disorder Due to Another Medical Condition (with hallucinations)
91
For the past 3 weeks, Aiden has displayed severe disorganization, mutism alternating with agitation, and bizarre behavior such as standing motionless for hours. Symptoms began suddenly after a major stressor and resolved within one month.
Brief Psychotic Disorder (with marked stressor)
92
For over a year, Lina has shown emotional flatness, lack of motivation, minimal speech, and social withdrawal following a prior psychotic episode. She no longer has delusions or hallucinations, but negative symptoms persist.
Schizophrenia (residual phase)
93
During a psychiatric intake, Jordan reports hallucinations and delusional beliefs causing impairment, but provides limited information and collateral data are unavailable. The clinician documents a diagnosis pending further evaluation.
Unspecified Schizophrenia Spectrum and Other Psychotic Disorder (provisional)
94
For the past 9 months, Jordan has felt on edge most days and worries about multiple areas at once—grades, parents’ health, finances, and “what if something goes wrong” scenarios. They describe the worry as hard to control and say it keeps them up at night. They feel tense, irritable, and fatigued, and their concentration drifts during lectures, leading to missed assignments and conflict at work.
Generalized Anxiety Disorder (severity: moderate)
95
Over the last 6 weeks, Mei has had several sudden episodes of intense fear that peak within minutes, with pounding heart, sweating, trembling, chest tightness, nausea, and fear she might die. Since the most recent episode, she constantly worries another attack will happen and has stopped exercising and avoids being alone in public. Medical workups have been unremarkable.
Panic Disorder (severity: moderate)
96
For more than a year, Luis becomes intensely anxious in multiple situations: riding the bus, standing in long lines, and being in crowded stores. He fears he could panic or become dizzy and that escape would be difficult or help unavailable. He now only goes out if a friend accompanies him and has turned down jobs that require commuting.
Agoraphobia (severity: severe)
97
For 2 years, Aisha has been terrified of public speaking and presentations, fearing others will notice her shaking and judge her as incompetent. She can socialize casually with friends, but any performance situation triggers sweating, trembling, and avoidance. She has skipped required presentations, risking course failure.
Social Anxiety Disorder (performance only)
98
Since childhood, Sam has had an immediate surge of fear when seeing dogs, even small ones on leashes. They avoid parks and friends’ homes with pets and experience racing heart and shaking if a dog approaches. This has persisted for years and limits daily activities.
Specific Phobia (animal type)
99
Rina faints or nearly faints at the sight of needles and becomes intensely anxious before any blood draw. She avoids medical appointments and needed labs, leading to delayed care. The fear is out of proportion to actual danger and has lasted well over 6 months.
Specific Phobia (blood-injection-injury type)
100
After a minor elevator stall two years ago, Malik experiences immediate panic in elevators and enclosed stairwells. He takes long routes to avoid tall buildings and has missed work meetings on higher floors. The fear has persisted and causes significant impairment.
Specific Phobia (situational type)
101
Talia becomes intensely anxious during thunderstorms and will not leave home if rain is forecast. During storms she trembles, cries, and hides in a closet until it passes. This pattern has persisted for more than 6 months and disrupts school and work.
Specific Phobia (natural environment type)
102
Chris experiences extreme fear when encountering loud balloons, anticipating a pop and feeling immediate panic symptoms. They avoid parties and stores with balloon displays and have stopped attending family events. The fear has lasted for years and is clearly excessive.
Specific Phobia (other type)
103
Within days of abruptly stopping heavy benzodiazepine use, Devon develops marked anxiety with restlessness, sweating, tremulousness, and sudden surges of fear. Symptoms began during withdrawal and improve when medically managed, and there was no history of similar anxiety at baseline. The anxiety causes inability to work and repeated ER visits.
Substance/Medication-Induced Anxiety Disorder (with onset during withdrawal)
104
After developing hyperthyroidism, Priya began having persistent anxiety and recurrent surges of fear with palpitations and shortness of breath that feel like panic. The anxiety started after the medical condition worsened and improves as thyroid levels normalize. The symptoms cause significant distress and avoidance of leaving home alone.
Anxiety Disorder Due to Another Medical Condition (with panic attacks)
105
Eli has repeated episodes of anxiety and worry that cause distress, but their symptoms don’t fully meet criteria for a specific anxiety disorder. They experience brief, limited-symptom panic-like spells (e.g., sudden racing heart and dizziness) that peak quickly but do not reach four symptoms. The presentation is clinically significant and has interfered with work.
Other Specified Anxiety Disorder (limited-symptom attacks)
106
In an intake at a crisis clinic, Morgan reports significant anxiety and impairment but is unable or unwilling to provide enough detail to determine which anxiety disorder criteria are met. The clinician documents the diagnosis to guide immediate care and plans to clarify later with additional information.
Unspecified Anxiety Disorder (provisional)
107
For 10 months, Nora has intrusive, unwanted contamination thoughts and fears she’ll make her family sick. She spends hours washing and disinfecting to reduce distress, missing work and social events. When asked, she admits the fear may be exaggerated but still believes it’s “probably true,” and she struggles to consider alternative explanations.
Obsessive-Compulsive Disorder (with poor insight)
108
For years, Ken is preoccupied with a perceived defect in his muscles, convinced he looks “too small” despite being visibly muscular. He spends hours checking mirrors, comparing himself to others, and seeking reassurance, and he avoids beaches and gyms at busy times. The preoccupation causes major distress and impairment.
Body Dysmorphic Disorder (with muscle dysmorphia)
109
Over the past 5 years, Dana has been unable to discard newspapers, broken appliances, and bags of free items, feeling intense distress at the idea of throwing anything away. The clutter blocks hallways and makes the kitchen unusable. Dana also repeatedly brings home more items from thrift stores and curbside piles, worsening the congestion.
Hoarding Disorder (with excessive acquisition)
110
For 8 months, Marisol repeatedly pulls hair from her scalp when stressed, leaving noticeable bald patches. She has tried to stop, wears hats to hide the hair loss, and avoids dating and swimming. The behavior is distressing and interferes with daily functioning.
Trichotillomania (Hair-Pulling Disorder) (severity: moderate)
111
For more than a year, Alex repeatedly picks at skin on their arms and face until it bleeds, creating lesions and scars. They’ve made multiple attempts to stop, but the urge intensifies during stress and boredom. The behavior causes shame, infections, and missed social activities.
Excoriation (Skin-Picking) Disorder (severity: moderate)
112
Casey is intensely preoccupied with a real but minor facial scar that others barely notice, believing it makes them “deformed.” They spend hours camouflaging it and checking mirrors, and they avoid social situations due to distress about their appearance.
Other Specified Obsessive-Compulsive and Related Disorder (body dysmorphic-like disorder with actual flaws)
113
Taylor is preoccupied with a perceived defect in their nose shape and avoids photos, but they do not engage in repetitive behaviors like mirror checking, grooming, or mental comparisons. The preoccupation still causes marked distress and avoidance.
Other Specified Obsessive-Compulsive and Related Disorder (body dysmorphic-like disorder without repetitive behaviors)
114
When stressed, Jay repeatedly bites the inside of their cheeks and picks at cuticles until they bleed, despite trying to stop. The behavior is recurrent and impairing but does not fit hair-pulling or skin-picking presentations exactly.
Other Specified Obsessive-Compulsive and Related Disorder (body-focused repetitive behavior disorder)
115
For the last year, Sienna has recurrent, intrusive doubts about a partner’s fidelity and engages in repetitive checking—reviewing messages, asking for reassurance, and mentally replaying conversations for hours. The jealousy feels uncontrollable and causes severe relationship conflict and distress.
Other Specified Obsessive-Compulsive and Related Disorder (obsessional jealousy)
116
After moving to a new city, Hiro becomes convinced others can see him as “offensive-looking” and feels intense fear of causing discomfort, leading to avoidance of eye contact and social interactions. He spends significant time checking his face and rehearsing apologies before leaving home, and he avoids crowded places.
Other Specified Obsessive-Compulsive and Related Disorder (shubo-kyofu)
117
In recent months, Arun experiences sudden episodes of intense fear that his genitals are shrinking and might disappear into his body. During episodes he repeatedly checks and seeks reassurance, and he avoids being alone due to panic. Medical evaluation is normal, and the symptoms cause significant impairment.
Other Specified Obsessive-Compulsive and Related Disorder (koro)
118
Mina is preoccupied with the belief that she emits a foul body odor that others find offensive, despite repeated reassurance and no evidence. She repeatedly showers, changes clothes, and avoids close proximity to people. The preoccupation causes marked distress and avoidance.
Other Specified Obsessive-Compulsive and Related Disorder (jikoshu-kyofu)
119
Soon after starting a stimulant medication at a high dose, Omar develops intrusive, repetitive thoughts about symmetry and feels driven to perform ordering rituals for hours each day. The symptoms began after medication exposure and improve when the medication is discontinued and treated. The rituals cause significant impairment.
Substance/Medication-Induced Obsessive-Compulsive and Related Disorder (with onset after medication use)
120
Following a traumatic brain injury, Renee develops new-onset intrusive aggressive images and repetitive checking rituals that were not present before the injury. Neurology notes correlate symptom onset with the medical condition. The behaviors are time-consuming and impair daily functioning.
Obsessive-Compulsive and Related Disorder Due to Another Medical Condition (with obsessive-compulsive symptoms)
121
In an emergency evaluation, Pat presents with prominent obsessive-compulsive symptoms causing impairment, but there is insufficient information to determine whether the symptoms are due to substances, a medical condition, or another specific OCRD. The clinician documents an interim diagnosis pending further assessment.
Unspecified Obsessive-Compulsive and Related Disorder (provisional)
122
For over a year, Chloe has difficulty falling asleep most nights, often lying awake for hours despite adequate opportunity for sleep, leading to daytime fatigue.
Insomnia disorder, sleep-onset type, persistent
123
Mark reports waking repeatedly throughout the night and being unable to return to sleep, resulting in poor sleep quality and impaired concentration.
Insomnia disorder, sleep-maintenance type, episodic
124
Despite sleeping 9–10 hours nightly, Jenna experiences excessive daytime sleepiness and takes long, unrefreshing naps nearly every day for four months.
Hypersomnolence disorder, persistent
125
Paul reports recurrent episodes of extreme sleepiness lasting several weeks at a time.
Hypersomnolence disorder, recurrent
126
Tyler experiences sudden episodes of muscle weakness triggered by laughter, excessive daytime sleepiness, and vivid hypnagogic hallucinations.
Narcolepsy, with cataplexy
127
MRI and CSF studies show hypocretin deficiency in a patient with daily sleep attacks.
Narcolepsy, due to hypocretin deficiency
128
A partner reports loud snoring and witnessed apneas. The patient wakes unrefreshed and has daytime sleepiness.
Obstructive sleep apnea hypopnea
129
Despite CPAP prescription, symptoms persist due to poor adherence.
Obstructive sleep apnea hypopnea, persistent
130
An adult reports frequent, well-remembered nightmares involving threats to safety that cause significant distress.
Nightmare disorder, persistent
131
Nightmares worsen during periods of stress.
Nightmare disorder, episodic
132
In the evenings, Sarah experiences an irresistible urge to move her legs accompanied by uncomfortable sensations, relieved by movement.
Restless legs syndrome
133
Symptoms of feeling pins and needles in legs with an uncontrollable urge to move them before bed worsen during pregnancy.
Restless legs syndrome, associated with pregnancy
134
After starting stimulant medication, Leo develops severe difficulty initiating sleep.
Substance/medication-induced sleep disorder, insomnia type
135
Chronic alcohol use leads to disrupted sleep and frequent awakenings.
Substance/medication-induced sleep disorder, alcohol-induced
136
Over the past 3 years, Mr. H., a 74-year-old man, has experienced a gradual decline in memory, repeatedly forgetting recent conversations and misplacing items. He has difficulty with word-finding and navigation in familiar neighborhoods. Neuropsychological testing shows significant impairment in memory and executive functioning, and he now requires help managing finances and medications.
Major Neurocognitive Disorder due to Alzheimer’s Disease (probable, with gradual onset and continuing decline)
137
Ms. L., a 69-year-old woman, reports increasing forgetfulness over the last 18 months, such as forgetting appointments and recent events, but she remains independent in daily functioning. Cognitive testing shows modest decline in memory compared to prior functioning.
Mild Neurocognitive Disorder due to Alzheimer’s Disease (probable)
138
Mr. S., age 76, shows stepwise cognitive decline following multiple strokes. He has impaired attention and executive functioning, slowed processing speed, and difficulty with planning. Neuroimaging confirms cerebrovascular disease, and he needs assistance with complex tasks.
Major Neurocognitive Disorder due to Vascular Disease (probable)
139
After a major stroke one year ago, Mrs. A., age 72, experiences mild difficulties with attention and planning but remains independent in daily activities. Cognitive testing confirms decline from baseline.
Mild Neurocognitive Disorder due to Vascular Disease (probable)
140
Over the past 2 years, a 63-year-old man has developed prominent personality changes, disinhibition, apathy, and loss of empathy, with relatively preserved memory early on. He shows compulsive behaviors and poor judgment, interfering with work and relationships.
Major Neurocognitive Disorder due to Frontotemporal Degeneration (behavioral variant)
141
Ms. R., age 68, presents with progressive language difficulties, including word-finding pauses and impaired naming, while memory is initially preserved. She can no longer communicate effectively at work.
Major Neurocognitive Disorder due to Frontotemporal Degeneration (language variant)
142
Mr. D., age 75, has progressive cognitive decline with fluctuating attention, recurrent well-formed visual hallucinations, and spontaneous parkinsonian symptoms. Symptoms interfere significantly with daily functioning.
Major Neurocognitive Disorder with Lewy Bodies (probable)
143
Ms. T., age 71, reports mild cognitive decline with fluctuations in attention and vivid visual hallucinations but remains largely independent in daily activities.
Mild Neurocognitive Disorder with Lewy Bodies (possible)
144
Mr. K., age 70, has a long history of Parkinson’s disease and now shows progressive decline in executive functioning and visuospatial skills that interfere with daily functioning.
Major Neurocognitive Disorder due to Parkinson’s Disease
145
Ms. J., age 66, with longstanding Parkinson’s disease, has developed mild difficulties with planning and attention but continues to manage daily activities independently.
Mild Neurocognitive Disorder due to Parkinson’s Disease
146
After a severe traumatic brain injury 3 years ago, a 45-year-old man shows persistent deficits in attention, memory, and executive functioning that significantly interfere with occupational functioning.
Major Neurocognitive Disorder due to Traumatic Brain Injury
147
Following a mild concussion, a 32-year-old woman experiences ongoing difficulties with concentration and memory that represent a decline from baseline but do not interfere with independence.
Mild Neurocognitive Disorder due to Traumatic Brain Injury
148
Mr. P., age 58, with a history of chronic alcohol use, shows progressive memory impairment, confabulation, and executive dysfunction requiring supervision in daily activities.
Major Neurocognitive Disorder due to Alcohol (with confabulation)
149
Ms. G., age 54, with long-term HIV infection, demonstrates cognitive slowing, impaired attention, and memory decline that interferes with work performance.
Major Neurocognitive Disorder due to HIV Infection
150
A 60-year-old patient receiving chemotherapy develops noticeable decline in attention, processing speed, and memory that interferes with occupational functioning.
Major Neurocognitive Disorder due to Another Medical Condition (chemotherapy-related)
151
During an initial evaluation, Mr. Q. presents with cognitive decline and functional impairment, but insufficient information is available to determine the specific etiology.
Unspecified Major Neurocognitive Disorder
152
A 67-year-old woman reports subjective cognitive decline and mild deficits on testing, but the etiology is unclear and does not meet criteria for a specific mild neurocognitive disorder.
Unspecified Mild Neurocognitive Disorder
153
An 82-year-old hospitalized man develops sudden confusion over 24 hours, with fluctuating alertness, impaired attention, disorganized thinking, and visual hallucinations. Symptoms worsen at night and improve intermittently. Workup reveals a urinary tract infection.
Delirium due to Another Medical Condition (acute onset, fluctuating course)
154
A 70-year-old woman abruptly becomes agitated, disoriented, and unable to sustain attention after surgery. She is restless, pulling at IV lines, and symptoms fluctuate throughout the day.
Delirium (hyperactive type, due to another medical condition)
155
A 78-year-old man in the ICU becomes lethargic, minimally responsive, and inattentive over two days. He appears withdrawn and sleepy, with waxing and waning awareness.
Delirium (hypoactive type, due to another medical condition)
156
A 65-year-old patient alternates between agitation and lethargy over several days, with impaired attention and fluctuating consciousness following pneumonia.
Delirium (mixed level of activity, due to another medical condition)
157
Within hours of alcohol cessation, a 60-year-old man develops confusion, tremors, autonomic instability, and vivid visual hallucinations. Symptoms fluctuate and require inpatient treatment.
Substance/Medication-Induced Delirium (with onset during withdrawal)
158
During an emergency evaluation, a patient presents with acute confusion and inattention, but insufficient information is available to determine the underlying cause.
Unspecified Delirium
159
A 29-year-old has recurrent episodes of verbal aggression involving yelling and threats occurring at least twice per week for the past 4 months. The outbursts are impulsive, anger-based, and grossly out of proportion to the stressor. No physical injury or property damage occurs.
Intermittent Explosive Disorder, verbal aggression ≥2x/week for ≥3 months
160
A 34-year-old has had three separate episodes in the last year where sudden anger outbursts led to destruction of property. The behavior was not premeditated and was out of proportion to the triggering events.
Intermittent Explosive Disorder, physical aggression with property damage (≥3 outbursts in 12 months)
161
A 23-year-old deliberately sets fires on multiple occasions and reports fascination with fire, tension prior to the act, and relief afterward. The behavior is not motivated by financial gain, revenge, intoxication, or psychosis.
Pyromania, recurrent deliberate fire-setting with tension before and relief after
162
A 37-year-old repeatedly steals inexpensive items they do not need, experiences increasing tension before stealing, and guilt afterward. Episodes often follow identifiable stressors and periods of depressed mood.
Kleptomania, recurrent theft with tension before and guilt afterward
163
A client presents with impulsive aggressive outbursts that cause significant distress and impairment, but the frequency of episodes is below the threshold required for Intermittent Explosive Disorder.
Other Specified Disruptive, Impulse-Control, and Conduct Disorder (insufficient frequency of outbursts)
164
A client demonstrates persistent difficulty controlling aggressive impulses with clear occupational impairment. The clinician does not specify why full criteria for a specific impulse-control disorder are not met.
Unspecified Disruptive, Impulse-Control, and Conduct Disorder
165
Jordan experiences a 10-day period of extreme irritability, sleeping only 2 hours nightly, engaging in reckless driving, and claiming divine powers. He required inpatient hospitalization due to dangerous behavior.
Bipolar I disorder, current episode manic, severe, with mood-congruent psychotic features
166
Taylor has a history of manic episodes with inflated self-esteem and excessive spending, alternating with long periods of depressed mood. The most recent episode involved increased energy and agitation rather than euphoria.
Bipolar I disorder, current episode manic, moderate, with mixed features
167
Elena reports multiple depressive episodes lasting over a month, along with distinct 4–5 day periods of increased productivity, reduced sleep, and elevated mood that never caused major impairment.
Bipolar II disorder, current episode depressed, severe
168
Marcus experiences hypomanic episodes marked by talkativeness and increased goal-directed activity, followed by weeks of low mood, guilt, and appetite disturbance.
Bipolar II disorder, current episode depressed, moderate, with anxious distress
169
Riley has experienced fluctuating periods of mild depressive symptoms and hypomanic symptoms for over two years, without meeting full criteria for major mood episodes.
Cyclothymic disorder
170
Since middle school, Aiden has had chronic mood swings involving bursts of energy and optimism alternating with low mood and pessimism, present more days than not.
Cyclothymic disorder, early onset
171
Priya developed grandiosity, pressured speech, and insomnia shortly after starting corticosteroid treatment. Symptoms resolved after the medication was tapered.
Substance/medication-induced bipolar and related disorder, corticosteroid-induced, with onset during treatment
172
After using cocaine heavily, Leo experienced elevated mood, decreased need for sleep, and impulsive behavior lasting several days.
Substance/medication-induced bipolar and related disorder, stimulant-induced
173
Nina developed manic symptoms following a traumatic brain injury, including impulsivity and decreased sleep, which improved as her neurological condition stabilized.
Bipolar and related disorder due to another medical condition, with manic features
174
Owen showed mood elevation and increased energy in the context of untreated Cushing’s disease.
Bipolar and related disorder due to another medical condition, with hypomanic features
175
Sam experiences hypomanic symptoms lasting only 2 days that recur frequently but never meet full duration criteria.
Other specified bipolar and related disorder, short-duration hypomanic episodes
176
Ava has hypomanic episodes without a history of major depressive episodes.
Other specified bipolar and related disorder, hypomanic episodes without prior major depressive episode
177
Chris presents with clear manic symptoms, but insufficient information is available due to intoxication at evaluation.
Unspecified bipolar and related disorder
178
Dana shows bipolar-spectrum symptoms, but full assessment cannot be completed in an emergency setting.
Unspecified bipolar and related disorder
179
A 19-year-old college student has a BMI significantly below normal, intensely fears weight gain, restricts calories, and perceives themselves as overweight despite medical instability.
Anorexia Nervosa, restricting type
180
A 24-year-old individual is markedly underweight and engages in binge eating followed by self-induced vomiting while maintaining a distorted body image.
Anorexia Nervosa, binge-eating/purging type
181
A patient with anorexia nervosa presents with severe bradycardia, hypotension, and electrolyte imbalance.
Anorexia Nervosa, severe
182
A 21-year-old reports recurrent binge eating episodes followed by vomiting and laxative use at least once a week for three months, with self-evaluation overly influenced by body shape.
Bulimia Nervosa, moderate
183
A 35-year-old engages in frequent binge eating and compensatory behaviors multiple times daily without being underweight.
Bulimia Nervosa, severe
184
A 29-year-old experiences recurrent binge eating episodes with loss of control, marked distress, and no compensatory behaviors.
Binge-Eating Disorder, moderate
185
A 46-year-old reports binge eating episodes nearly daily with feelings of guilt, eating rapidly, and eating when not hungry.
Binge-Eating Disorder, severe
186
A 10-year-old child avoids many foods due to sensory sensitivity, resulting in significant weight loss and nutritional deficiency.
Avoidant/Restrictive Food Intake Disorder, sensory-based avoidance
187
A 17-year-old avoids eating after a choking incident, leading to weight loss and dependence on supplements.
Avoidant/Restrictive Food Intake Disorder, fear-based avoidance
188
An adult with iron-deficiency anemia compulsively eats ice daily.
Pica
189
A 14-year-old repeatedly regurgitates food after meals, rechews it, and reswallows without nausea or disgust.
Rumination Disorder
190
An adult with intellectual disability exhibits chronic regurgitation not attributable to a GI condition.
Rumination Disorder
191
A 23-year-old meets all criteria for bulimia nervosa except binge eating occurs less than once per week.
Other Specified Feeding or Eating Disorder, bulimia nervosa of low frequency
192
A patient presents with significant weight loss and body image disturbance but remains within normal weight range.
Other Specified Feeding or Eating Disorder, atypical anorexia nervosa
193
A patient presents with disordered eating and distress but insufficient information is available to determine a specific diagnosis.
Unspecified Feeding or Eating Disorder
194
An emergency department evaluation reveals eating-related impairment, but the patient declines further assessment.
Unspecified Feeding or Eating Disorder
195
Ethan has long believed that coworkers are secretly mocking him and plotting to undermine him, despite no evidence. He interprets neutral comments as insults and refuses to confide in others due to fear information will be used against him. His suspiciousness has persisted for years and causes conflict at work.
Paranoid Personality Disorder
196
Marisol prefers solitary activities and shows little interest in friendships or romantic relationships. She appears emotionally cold, rarely expresses pleasure, and is indifferent to praise or criticism. This pattern has been consistent since early adulthood.
Schizoid Personality Disorder
197
Darius believes he has special telepathic abilities and often dresses in eccentric clothing. He reports sensing others’ thoughts and feels intense social anxiety tied to paranoid fears. His speech is odd and metaphorical, and he has few close relationships.
Schizotypal Personality Disorder
198
Jordan demonstrates a long pattern of disregarding others’ rights, repeatedly lying, impulsively quitting jobs, and engaging in reckless behavior. He shows little remorse after hurting others and has a history of conduct problems before age 15.
Antisocial Personality Disorder
199
Lena has intense, unstable relationships marked by fear of abandonment. She alternates between idealizing and devaluing partners, engages in self-harm when distressed, and reports chronic feelings of emptiness. Under stress, she experiences brief dissociative episodes.
Borderline Personality Disorder
200
Theo is excessively emotional and attention-seeking, often using dramatic speech and physical appearance to draw focus. He feels uncomfortable when not the center of attention and rapidly shifts emotions. Relationships are perceived as more intimate than they are.
Histrionic Personality Disorder
201
Vanessa has a grandiose sense of self-importance, exaggerates achievements, and expects special treatment. She lacks empathy and becomes enraged when criticized, believing others are envious of her success.
Narcissistic Personality Disorder
202
Amir avoids social interactions due to fears of criticism and rejection. He desires relationships but is reluctant to engage unless certain of acceptance. He views himself as socially inept and inferior.
Avoidant Personality Disorder
203
Clara relies heavily on others to make everyday decisions and fears being alone. She urgently seeks new relationships when one ends and tolerates mistreatment to maintain support.
Dependent Personality Disorder
204
Victor is preoccupied with order, perfectionism, and control, spending excessive time organizing details and refusing to delegate tasks. His rigidity interferes with completing projects and maintaining relationships.
Obsessive-Compulsive Personality Disorder
205
A 28-year-old woman presents to therapy after several friends expressed concern about her behavior in social situations. During the intake session, she frequently shifts between laughing and crying while telling stories about recent events. She describes casual acquaintances as her “closest friends” and states that people often misunderstand how “deep” her relationships are. She frequently interrupts the therapist to discuss her appearance and asks if the therapist thinks she is attractive. Her speech is vague and lacks specific details, and she often exaggerates emotional reactions to minor events. She reports feeling extremely uncomfortable when she is not the center of attention in social settings.
Histrionic Personality Disorder
206
A 34-year-old man has a long history of arrests for fraud, theft, and assault beginning in his late teens. He frequently lies to coworkers and romantic partners to obtain money or favors. When confronted about his behavior, he insists that people who get taken advantage of are simply “too naive.” He has been fired from multiple jobs due to failing to show up for work and ignoring responsibilities. He often engages in reckless behaviors such as dangerous driving and physical fights but shows no guilt when others are harmed.
Antisocial Personality Disorder
Psychopathology
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