American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed, text revision (DSM-IV-TR)

955 Pages·2005·164.6 MB·English

1
DIAGNOSTIC AND STATISTICAL
MANUAL OF
•
MENTAL DISORDERS
FOURTH EDITION
•
TEXT REVISION
• - -
•
i
I
,
•
,
Published by the
American Psychiatric Association
Washington, DC
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Copyright © 2000 American Psychiatric Association
DSM, DSM-JV, and DSM-IV-TR are trademarks of the American Psychiatric Association. Use
of these terms is prohibited without permission of the American Psychiatric Association.
ALL RIGHTS RESERVED. Unless authorized in writing by the APA, no part of this book may
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Correspondence regarding copyright permissions should be directed to the DSM Permissions,
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ington, DC 20005.
Manufactured in the United States of America on acid-free paper.
American Psychiatric Association
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www.psych.org
The correct citation for this book is American Psychiatric Association: Diagnostic and Statistical
MaJlJlal of Mf'Jlta/ Disorders, Fourth Edition, Text Re,rision .. Washington, DC, American Psychi
atric Association, 2()()() ..
library of Congress Cataloging-in-Publication Data
Diagnostic .md statistical manual of mental disorders: OS},,·I-IV .. -Ith ed .. , text revision ..
p. ; cm.
Prepared by the Task Force on DSM-IV and othercommittecs and workgroups of the Amer-
ican PsychiatriC Association. .
Includes index ..
ISBN Q...S9O-U.-024-6 (casebound: alk. . paper)-ISBN 0-890-12-025-4 (pbk..: alk. . paper)
1 .. t-,'Ienlal illness Classification-Handbooks, manuals, etc. . 2 .. Mental ilIness-Diagnosis
Handbooks, manuals, etc. I.. Tille: OSM-IV. . II.. American Psychiatric Association .. Ill. American
Psychiatric Association .. Task Force on OSM-IV ..
[DNLM: 1. Mental Oisorders--classification. . 2 .. Mental Disorders--diagnosis.
WM 15 0536 2000J
RC455 .. 2 .. CI. 0536 2000
616 .. S9'075-d.c21
00-02-1852
British library Cataloguing in Publication Data
crr
A record is available from the British Library ..
Text Design- Anne Barnes
Manufacturing-R.. R.. Donnelley & Sons Comp.m y
Contents
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Task Force on DSM-IV .... ..... . . .. ... .......... . • . •.. .... xi
W ork Groups for the DSM-IV-TR Text Revision ............... xv
Acknow ledgments f or DSM-IV-TR .. ............. •. •. •. .... xix
Acknow ledgments for
DSM-IV Text Revision ..... ... . • .. . • .•. ..• .• .......•..... xxi
. . ..
I ntro d uctlon ......... . ....... .. ...........•.......... XXIII
Cauti o nary Statement . . ... . . .. . . .. . . .. . ...... ... ..... xxxvii
Use of t he Manual ... . ...... . . • . • .•. • . • . • . • . • . . . . ..... . .. 1
DSM-IV-TR Classification ..... . . . . . . . . . .•. .. ...... ... ..... 13
Multiaxial Assessment ... .... .. ......•. . . . . .. .... ... . . .. . 27
Disorders Usually First Diagnosed in
Infancy, Childh ood, or Ado lescence . ....... •. • .•. • .•. • . ... .39
Delirium, Dementia, and Amnestic and
Other Cognitive Disorders . .... . . . . . ..................... 135
Mental Disorders Due to a General Medical Condition .. .. .... 181
Substan ce-Related Disorders ...... ........ . ....... .... . . . 191
Schizoph renia and
Other Psychotic Disorders . ..... .. ... . ............. . ..... 297
Mood Di sorders . .. .... .... .. . . . . . . . . . . . . . . . . . . . .. ... . . 345
Anxiety Disorders .... . ...•. • ... • .•............ .. . . . . .. .429
Somatoform Disorders . . .. ..... .. ..... . . . . ...... . . .. ... .485
Factitious Disorders ... .. .• . •. •.•.•. • . • .. .. . ... .. •. ..... 513
Dissociative Disorders . . ....... . ....... .. . . . .. . . . .... ... . 519
Sexual and Gender Identity Disorders . ...... ... . .. •. •. ..... 535
Eating Disorders ...... ................ •.• . • . • . • . • . • . ... 583
Sleep Disorders ... .............. ....................... 597
Impulse-Control Disorders Not Elsewhere Classified .... . . .... 663
Adjustment Disorders .................................. 679
Personality Disorders .............•.• . • . . . . . ....... . .... 685
Other Conditions That May Be a
Focus of Clinical Attention ........• .•.• . • . ... ... . .... . .. 731
Additional Codes ...... ..............•.•. ..... . . . . ..... 743
Appendix A
Decision Trees for Differential Diagnosis . ................. . 745
Appendix B
Criteria Sets and Axes Provided for Further Study ......•.... . 759
Appendix C
Glossary of Technica l Terms .....•.•. • .•.................. 819
Appendix D
Highlights of Changes in
DSM-IV Text Revision ..............•. •.•. •.•.•.• ........ 829
Appendix E
Alphabetical Listing of
DSM-IV-TR Diagnoses and Codes ......•.•.•.•............ 845
Appendix F
Numerical Listing of
DSM-IV-TR Diagnoses and Codes ........•...•.•.• . • . . . ... 857
Appendix G
ICD-9-CM Codes for Selected General Medical
-
Conditions and Medication-Induced Disorders . ..... . . . .... . 867
Appendix H
DSM-IV Classification -
(W ith ICD-1O Codes) ..... • .•.•. • .•.•.•.•.•.•. • ... .. ..... 883
Appendix I
Outline for Cultural Fo rmulation and
Glossary of Culture-Bound Syndromes ........ •.• .•. . . ... .. 897
Appendix J
DSM-IV Cont ribut ors .... ... . . ...•.•.• . • . • . • . ........... 905
Appendix K
DSM-IV Text Revisio n Advisers . . .. .... . ................... 929
Index .. . ... ..... . ........... . ........ . .... . . . . . . .. . . . 933
TASK FORCE ON DSM-IV
A LLEN FRANCES, M.D.
C/zairpersoll
H AROLD ALAN PlNCUS, M .D .
\'i ce-Clw irpersoll
MiCHAEL B. FIR5f, lvLD.
Editor, Text (llld Criteria
Nancy Coover Andreasen, M.D., Ph.D. Chester W. Schmidt M.D.
David H. Barlow, Ph.D. Marc Alan Schuckit, M.D.
Magda Campbell, M.D. David Shaffer, M.D.
Dennis P. Cantwell, M.o. Robert L Spitzer, M.D.
Special Adviser
Ellen Frank, Ph.D.
Gary ]. Tucker, M.D.
Judith H. Gold, M.D.
B. Timothy Walsh, M.D.
John Gunderson, tvl.D.
Thomas A. Widiger, PhD .
Robert E. Hales, M.D.
Researcll Coordil/ator
Kenneth S. Kendler, M.D.
Janet B. W. Williams, OSW.
J.
David Kupfer, M.D.
Jolm C. Urbaitis, M.D.
i'vlichael R. Liebowitz, M.D.
Assembly Liaisoll
Juan Enrique rvlezzich, M.D., Ph.D.
J.
James Hudziak, M.D.
Peter E. Nathan, Ph.D.
Residellt Fellow (1990---1993)
Roger Peele, M.D.
Jwuus
Gonzales, M.D.
Darrel A. Regier, M.D., M.P.H. Residellt Fellow (1988-1990)
A. John Rush, M.D.
Ruth Ross, M.A
Science Editor
aney E. VettoreJ]o, M.U.P.
Administrative Coordinator
,
Wendy Wakefield Davis, Ed.M.
Editorial Coordilwtor
Cindy D. Jones
Adm illisl rative Assistallt
Nancy Sydnor-Greenberg, M.A
Admillistmtiue COllsllltallt
Myriam Kline, M.s.
Focused Field-Trial Coordil/ator
James W. Thompson, MD., M,P.H.
Videotape Field-Trial Coordillator
The DSM-JV Text Revision Work Groups are listed on pp. xv-)':vii .
•
XI
•
• •
XII DSM-IV Work Groups
Anxiety Disorders Work Group
c.
Michael R. Liebowitz, M.D. James Ballenger, M.D.
ChairpersoJl
Jonathan Davidson, M.D.
David H. Barlow, Ph.D.
Edna Foa, Ph.D.
V ice-ClUl; 'persoll
Abby Fyer, M.D.
Delirium, Dementia, and Amnestic and
Other Cognitive Disorders Work Group
Gary 1. Tucker, M.D. Marshall Folslem, M.D.
Chairperson
Gary Lloyd Gottlieb, M.D.
Michael Popkin, M.D.
Igor Grant, M.D.
Vice·C/mirpersoll
Benjamin Liptzin, M.D.
Eric Douglas Caine, M.D.
Disorders Usually First Diagnosed During Infancy,
Childhood, or Adolescence Work Group
David Shaffer, M.D. Rachel Klein, Ph.D.
Co-Chairperson
Benjamin Lahey, Ph.D.
r-,'Iagda Campbell, M.D.
Rolf Loeber, Ph.D.
Co-Clmirpersoll
Jeffrey Newcom, M.D.
J.
Susan Bradley, M.D.
Rhea Paul, Ph.D.
Dennis P. Cantwell, M.D.
Judith H. L. Rapoport, M.D.
Gabrielle A. Carlson, M.D.
Sir Michael Rutter, M.D.
Donald Jay Cohen, M.D.
Fred Volkmar, M.D.
Barry Garfinkel, M.D.
John S. Werry, M.D.
Eating Disorders Work Group
8. Timothy Walsh, M.D. Katherine A. Halmi, M.D.
Chnirpersoll
James Mitchell, M.D.
Paul Garfinkel, M.D.
G. Terence Wilson, Ph.D.
Mood Disorders Work Group
A. John Rush, M.D. David Dunner, M.D.
Chairpersoll
Ellen Frank, Ph.D.
Martin B. Keller, 1\11.0.
Donald F. Klein, M.D.
V ice-CJw irpersoll
Mark S. Bauer, M.D.
/
• • •
DSM-IV Work Groups XIII
Multiaxial Issues Wo rk Group
Janet B. W. vVilliams, OSW. Juan Enrique Mezzich, M.D.,\Ph.D.
Cllnirpersoll
Roger Peelc, M.D.
Howard H. Goldman, M.D., Ph.D.
Stephen Setterberg, M.D.
V ice-OlllirpersoJ/
Andrew Edward Skodal II, M.D.
Alan M. Gruenberg, M.D.
Persona lity Disorders Work Group
Jolm Gunderson, M.D. Theodore Millon, Ph.D.
C/iairperson
Bruce Pfohl. M.D.
Robert M. A. Hirschfeld, MD.
Tracie Shea, Ph.D.
V ice-Clmi
rperSOIl
Larry Siever, M.D.
Roger Blashfield, Ph.D.
Thomas A. Widiger, Ph.D.
Susan Jean Fiester, M.D.
Premenstrual Dysphoric Diso rder Work Group
Judith H. Gold, M.D. Sally Severino, M.D.
Clwirpersoll
Nada Logan Stotland, M.D.
Jean Endicott, Ph.D.
Ellen Frank, Ph.D.
Barbara Parry, M.D. COli slI/tal/ t
Psychiatric Systems Interface Disorders
(Adjustment, Dissociative, Factitious, Impulse-Control, and
Somatoform Disorders and Psychologica l Factors Affecti ng
Medical Conditions) Work Group
Robert E. Hales, M.D. Steven A. King, M D.
Clw;rpersoll
Ronald L. Martin, M.D.
C. Robert Cloninger, M.D.
Katharine Anne Phillips, M.D.
V ice-Clwi rpersoll
David A. Spiegel, M.D.
Jonathan F. Borus, M.D.
Alan Stoudemire, M.D.
Jr.,
Jack Denning Burke, M.D., M.P.H.
James J. Strain, M.D.
Joe P. Fagan, M.D.
Michael G. Wise, M.D.
Schizophrenia and Other Psychotic Disorders Work Group
Nancy Coover Andreasen, M.D., Ph.D. Samuel Keith, M.D.
Cllairpersoll
Kenneth S. Kendler, M.D.
John M. Kane, M.D.
1l1Omas McGlashan, M.D.
V ice-Cllai rpersoll
-
XIV DSM-IV Work Groups
Sexual Disorders Wo rk Group
Chester W. Schmidt, M.D. Leslie Schover, Ph.D.
Chairperson
Taylor Seagraves, rvl.D.
Raul Schiavi, M.D.
Thomas Nathan Wise, M.D.
Sleep Diso rders Work Group
David J. Kupfer, M.D. Roger Peele, M.D.
Chairperson
Quentin Regestein, M.D.
Charles F. Reynolds III, M.D.
Michael Sateia, 1\'1.0.
Vice-ella irpersol!
MichaellllOrpy, M.D.
Daniel Buysse, M.D.
Substance-Related Disorders Work Group
Marc Alan Schuckit, M.D. Linda B. Cottler, Ph.D.
Chairpersoll
Thomas Crowley, M.D.
John E. Helzer, M.D.
Peter E. Nathan, Ph.D.
Vi ce-C/In; 'persoll
George E. Woody, M.D.
Committee o n Psychiatric Diag nosis a nd Assessment
Layton McCurdy, M.D. Jerry M. Lewis, M.D.
C/wirpersol! (1987- 1994) Consultant (1 988-1994)
Kenneth Z. Altshuler, M.D. (1987-1992) Daniel J. Luchins, M.D.
COllsultant (1987-1991)
Thomas F. Anders, M.D. (1988-1994)
Katharine Anne Phillips, M.D.
Susan Jane Blumenthal, M.D. (1990-
COl/slt/tant (1992-1994)
1993)
Cynthia Pearl Rose, M.D.
Leah Joan Dickstein, M.D. (1988-1991)
Consultant (1990-1994)
Lewis J. Judd, M.D. (1988-1994)
Louis Alan Moench, M.D.
Gerald L. KIerman, M.D. (deceased)
Assembly LiaiSOIi (1991- 1994)
(1988-1991 )
Steven K. Dobscha, M.D.
Stuart C. Yudofsky, M.D. (1992-1994)
Resident Fellow (1990-1992)
Jack D. Blaine, M.D.
Mark Zinunerman, M.D.
Consultant (1987-1992)
Residellt Fellow (1992- 1994)
Joint Committee of th e Board of Trust ees and
Assembly of Dist rict Branches on
Issues Related to DSM-IV
Ronald A. Shellow, M.D. Leah Joan Dickstein, M.D.
ClUlirperson
Arthur John Farley, M .D.
Harvey Bluestone, M.D.
Carol Ann Bernstein, M.D.
,
WORK GROUPS FOR THE DSM-IV TEXT REVISION
MICHAEL B. FIRST, M .D.
Co-Chilirpersolllllld Editor
H AROLD ALAN P INCUS, M.D.
Co-C/mirpersoll
Laurie E. McQueen, M.s.s.\,V. Yoshie Satake, B.A.
DSM Project Mallllger D9 vI Program Coordilwtor
Anxiety Disorders Text Revision Work Group
Murray B. Stein, M.D. Michelle Craske, Ph.D.
CI/lIirpersoJl
Edna Foa, Ph.D.
Jonathan Abramowitz, Ph.D.
Thomas Mellman, M.D.
Gordon Asmtmdson, Ph.D.
Ron Norton, Ph.D.
Jean C. Beckham, Ph.D.
Fr,mklin Schneier, M.D.
Timothy Brown, Ph.D., Psy.D.
Richard Zinbarg. Ph.D.
Delirium, Dementia, and Amnestic and
Other Cognitive Disorders and Mental Disorders
Due to a General Medical Condition Text Revision Work Group
Eric Douglas Caine, M.D. Jesse Fann, M.D., M.P.H.
Disorde rs Usually First Diagnosed During Infancy,
Childhood, or Adolescence Text Revision Work Group
David Shaffer, M.D. Ami Klin, Ph.D.
Clmirpersoll
Pine, M .D.
Dani~
J.
Donald Cohen, M.D.
Mark A. Riddle, M.D.
Stephen Hinshaw, Ph.D.
Fred R. Volkmar, M.D.
Ramel G. Klein, Ph.D.
Charles Z,e anah, M.D.
Eating Disorders Text Revision Work Group
Ka tharine L. Locb, Ph.D. B. Timothy Walsh, MD.
Medication-Induced Movement Disorders
Text Revision Work Group
Gerard Addonizio, M.D. Alan Cdenberg, M.D.
Lenard Adler, .M.D. James Jefferson, M D.
Burton Angrist, M.D. Dilip Jeste M.D.
t
Daniel Casey, M.D. Peler Wei den, M.D.
xv
,