296.xx Major Depressive Disorder
   .2  Single Episode
   .3x Recurrent   
   .x1 Mild
   .x2 Moderate
   .x3 Severe Without Psychotic Features
   .x4 Severe With Psychotic Features
   .x5 In Partial Remission
   .x6 In Full Remission
300.4 Dysthymic Disorder
311 Depressive Disorder NOS

296.xx Bipolar I Disorder, Single Manic Episode
         Specify if MRE Mixed
   .40 MRE Hypomanic
   .4x MRE Manic
   .6x MRE Mixed
   .5x MRE Depressed
   .7   MRE Unspecified
296.89 Bipolar II Disorder
296.80 Bipolar Disorder NOS
301.13 Cyclothymic Disorder

300.01 Panic Disorder Without Agoraphobia
300.21 Panic Disorder With Agoraphobia
300.22 Agoraphobia Without History of Panic Disorder
300.29 Specific Phobia
300.23 Phobia   Specify if: Generalized
300.3  Obsessive-Compulsive Disorder
309.81 Posttraumatic Stress Disorder
308.3  Acute Stress Disorder 
300.02 Generalized Anxiety Disorder
300.00 Anxiety Disorder NOS

303.90  Alcohol Dependence
305.00  Alcohol Abuse
291.89  Alcohol-Induced Mood Disorder

309.xx Adjustment Disorder
   .0  With Depressed Mood
   .24 With Anxiety
   .28 With Mixed Anxiety and Depressed Mood
   .3  With Disturbance of Conduct
   .4  With Mixed Disturbance of Emotions and Conduct
   .9  Unspecified

301.0   Paranoid Personality Disorder
301.20  Schizoid Personality Disorder
301.22  Schizotypal Personality Disorder
301.7   Antisocial Personality Disorder
301.83  Borderline Personality Disorder
301.50  Histrionic Personality Disorder
301.81  Narcissistic Personality Disorder
301.82  Avoidant Personality Disorder
301.6   Dependent Personality Disorder
301.4   Obsessive-Compulsive Personality Disorder
301.9   Personality Disorder NOS

V61.20  Parent-Child Relational Problem
V61.10  Partner Relational Problem  
V61.8   Sibling Relational Problem
V62.81  Relational Problem NOS
V61.21  Physical Abuse of Child
V61.21  Sexual Abuse of Child
V61.21  Neglect of Child
V62.82  Bereavement
V62.3   Academic Problem
V62.2   Occupational Problem
313.82  Identity Problem
V62.89  Religious or Spiritual Problem
V62.4   Acculturation Problem
V62.89  Phase of Life Problem
V61.12  Physical Abuse of Adult (if by partner)
V62.83  Physical Abuse of Adult (if by person other than partner)
V61.12  Sexual Abuse of Adult (if by partner)
V62.83  Sexual Abuse of (if by person other than partner)
V15.81  Noncompliance With Treatment
V65.2   Malingering
V71.01  Adult Antisocial Behavior
V71.02  Child or Adolescent Antisocial Behavior
V62.89  Borderline Intellectual Functioning

 

AXIS IV

Problems with primary support group - e.g., death of a family member; health problems in family; disruption of family by separation, divorce, or estrangement; removal from the home; remarriage of parent; sexual or physical abuse; parental overprotection; neglect of child; inadequate discipline; discord with siblings; birth of a sibling

Problems related to the social environment - e.g., death or loss of friend; inadequate social support; living alone; difficulty with acculturation; discrimination; adjustment to life-cycle transition (such as retirement)

Educational problems - e.g., illiteracy; academic problems; discord with teachers or classmates; inadequate school environment

Occupational problems - e.g., unemployment; threat of job loss; stressful work schedule; difficult work conditions; job dissatisfaction; job change; discord with boss or coworkers

Housing problems - e.g., homelessness; inadequate housing; unsafe neighborhood; discord with neighbors or landlord

Economic problems - e.g., extreme poverty; inadequate finances; insufficient welfare support

Problems related to interaction with the legal system/ crime—e.g., arrest; incarceration; litigation; victim of crime

Other psychosocial and environmental problems—e.g., exposure to disasters, war, other hostilities; discord with nonfamily caregivers such as counselor, social worker, or physician; unavailability of social service agencies

Complete List of DSM-IV Codes

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Criteria for Major Depressive Episode

1. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either depressed mood or (2) loss of interest or pleasure. Note: Do not include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations.
1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood.
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)
3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains.
4. Insomnia or hypersomnia nearly every day
5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
6. Fatigue or loss of energy nearly every day
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
2. The symptoms do not meet criteria for a Mixed Episode.
3. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
4. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).
5. The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.

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Diagnostic criteria for 300.4 Dysthymic Disorder

1. Depressed mood for most of the day, for more days than not, as indicated either by subjective account or observation by others, for at least 2 years. Note: In children and adolescents, mood can be irritable and duration must be at least 1 year. 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
6. feelings of hopelessness
2. During the 2-year period (1 year for children or adolescents) of the disturbance, the person has never been without the symptoms in Criteria A and B for more than 2 months at a time.
3. No Major Depressive Episode (see Criteria for Major Depressive Episode) has been present during the first 2 years of the disturbance (1 year for children and adolescents); i.e., the disturbance is not better accounted for by chronic Major Depressive Disorder, or Major Depressive Disorder, In Partial Remission. Note: There may have been a previous Major Depressive Episode provided there was a full remission (no significant signs or symptoms for 2 months) before development of the Dysthymic Disorder. In addition, after the initial 2 years (1 year in children or adolescents) of Dysthymic Disorder, there may be superimposed episodes of Major Depressive Disorder, in which case both diagnoses may be given when the criteria are met for a Major Depressive Episode.
4. There has never been a Manic Episode (see Criteria for Manic Episode), a Mixed Episode (see Criteria for Mixed Episode), or a Hypomanic Episode (see Criteria for Hypomanic Episode), and criteria have never been met for Cyclothymic Disorder.
5. The disturbance does not occur exclusively during the course of a chronic Psychotic Disorder, such as Schizophrenia or Delusional Disorder.
6. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).
7. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Specify if:
Early Onset: if onset is before age 21 years
Late Onset: if onset is age 21 years or older

Specify (for most recent 2 years of Dysthymic Disorder):
With Atypical Features (see Atypical Features Specifier)

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Criteria for 311 Depressive Disorder Not Otherwise Specified

The Depressive Disorder Not Otherwise Specified category includes disorders with depressive features that do not meet the criteria for Major Depressive Disorder, Dysthymic Disorder, Adjustment Disorder With Depressed Mood (see Here), or Adjustment Disorder With Mixed Anxiety and Depressed Mood (see Here). Sometimes depressive symptoms can present as part of an Anxiety Disorder Not Otherwise Specified (see 300.00 Anxiety Disorder Not Otherwise Specified). Examples of Depressive Disorder Not Otherwise Specified include

1. Premenstrual dysphoric disorder: in most menstrual cycles during the past year, symptoms (e.g., markedly depressed mood, marked anxiety, marked affective lability, decreased interest in activities) regularly occurred during the last week of the luteal phase (and remitted within a few days of the onset of menses). These symptoms must be severe enough to markedly interfere with work, school, or usual activities and be entirely absent for at least 1 week postmenses (see Premenstrual Dysphoric Disorder for suggested research criteria).
2. Minor depressive disorder: episodes of at least 2 weeks of depressive symptoms but with fewer than the five items required for Major Depressive Disorder (see Minor Depressive Disorder for suggested research criteria).
3. Recurrent brief depressive disorder: depressive episodes lasting from 2 days up to 2 weeks, occurring at least once a month for 12 months (not associated with the menstrual cycle) (see Recurrent Brief Depressive Disorder for suggested research criteria)
4. Postpsychotic depressive disorder of Schizophrenia: a Major Depressive Episode that occurs during the residual phase of Schizophrenia (see Postpsychotic Depressive Disorder of Schizophrenia for suggested research criteria).
5. A Major Depressive Episode superimposed on Delusional Disorder, Psychotic Disorder Not Otherwise Specified, or the active phase of Schizophrenia. Situations in which the clinician has concluded that a depressive disorder is present but is unable to determine whether it is primary, due to a general medical condition, or substance induced.

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Diagnostic criteria for 296.0x Bipolar I Disorder, Single Manic Episode

Presence of only one Manic Episode (see Criteria for Manic Episode) and no past Major Depressive Episodes.

Note: Recurrence is defined as either a change in polarity from depression or an interval of at least 2 months without manic symptoms.
The Manic Episode is not better accounted for by Schizoaffective Disorder and is not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

Specify if:
Mixed: if symptoms meet criteria for a Mixed Episode (see Criteria for Mixed Episode)

If the full criteria are currently met for a Manic, Mixed, or Major Depressive Episode, specify its current clinical status and/or features:
Mild, Moderate, Severe Without Psychotic Features/Severe With Psychotic Features (see Specifiers Describing Current or Most Recent Episode)
With Catatonic Features (see Catatonic Features Specifier)
With Postpartum Onset (see Postpartum Onset Specifier)

If the full criteria are not currently met for a Manic, Mixed, or Major Depressive Episode, specify the current clinical status of the Bipolar I Disorder or features of the most recent episode:
In Partial Remission, In Full Remission (see Specifiers Describing Current or Most Recent Episode)
With Catatonic Features (see Catatonic Features Specifier)
With Postpartum Onset (see Postpartum Onset Specifier)

 

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Diagnostic criteria for 296.89 Bipolar II Disorder

Presence (or history) of one or more Major Depressive Episodes (see Criteria for Major Depressive Episode).

1. Presence (or history) of at least one Hypomanic Episode (see Criteria for Hypomanic Episode).
2. There has never been a Manic Episode (see Criteria for Manic Episode) or a Mixed Episode (see Criteria for Mixed Episode).
   
3. The mood symptoms in Criteria A and B are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.
   
4. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

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296.80 Bipolar Disorder Not Otherwise Specified

The Bipolar Disorder Not Otherwise Specified category includes disorders with bipolar features that do not meet criteria for any specific Bipolar Disorder. Examples include:

1. Very rapid alternation (over days) between manic symptoms and depressive symptoms that meet symptom threshold criteria but not minimal duration criteria for Manic, Hypomanic, or Major Depressive Episodes
2. Recurrent Hypomanic Episodes without intercurrent depressive symptoms
3. A Manic or Mixed Episode superimposed on Delusional Disorder, residual Schizophrenia, or Psychotic Disorder Not Otherwise Specified
4. Hypomanic Episodes, along with chronic depressive symptoms, that are too infrequent to qualify for a diagnosis of Cyclothymic Disorder
5. Situations in which the clinician has concluded that a Bipolar Disorder is present but is unable to determine whether it is primary, due to a general medical condition, or substance induced

 

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Diagnostic criteria for 301.13 Cyclothymic Disorder

1. For at least 2 years, the presence of numerous periods with hypomanic symptoms (see Criteria for Hypomanic Episode) and numerous periods with depressive symptoms that do not meet criteria for a Major Depressive Episode. Note: In children and adolescents, the duration must be at least 1 year.
2. During the above 2-year period (1 year in children and adolescents), the person has not been without the symptoms in Criterion A for more than 2 months at a time.
3. No Major Depressive Episode (Criteria for Major Depressive Episode), Manic Episode (Criteria for Manic Episode), or Mixed Episode (see Criteria for Mixed Episode) has been present during thefirst 2 years of the disturbance.
   Note: After the initial 2 years (1 year in children and adolescents) of Cyclothymic Disorder, there may be superimposed Manic or Mixed Episodes (in which case both Bipolar I Disorder and Cyclothymic Disorder may be diagnosed) or Major Depressive Episodes (in which case both Bipolar II Disorder and Cyclothymic Disorder may be diagnosed).
4. The symptoms in Criterion A are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.
5. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism).
6. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

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Criteria for Manic Episode

1. A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary).
2. During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:
1. inflated self-esteem or grandiosity
2. decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
3. more talkative than usual or pressure to keep talking
4. flight of ideas or subjective experience that thoughts are racing
5. distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
6. increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
7. excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)
3. The symptoms do not meet criteria for a Mixed Episode (see Criteria for Mixed Episode).
4. The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.
5. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).

Note: Manic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar I Disorder.

 

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Criteria for Hypomanic Episode

1. A distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual nondepressed mood.
2. During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:
1. inflated self-esteem or grandiosity
2. decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
3. more talkative than usual or pressure to keep talking
4. flight of ideas or subjective experience that thoughts are racing
5. distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
6. increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
7. excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., the person engages in unrestrained buying sprees, sexual indiscretions, or foolish business investments)
3. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic.
4. The disturbance in mood and the change in functioning are observable by others.
5. The episode is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features.
6. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).

Note: Hypomanic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar II Disorder.

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Criteria for Mixed Episode

The criteria are met both for a Manic Episode (see Criteria for Manic Episode) and for a Major Depressive Episode (see Criteria for Major Depressive Episode) (except for duration) nearly every day during at least a 1-week period. The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).
Note: Mixed-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar I Disorder.

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Psychiatry Resident (PGY4)
Site Last Updated September 12, 2007