Author: Manasvi Specialists

Trichotillomania (Hair-Pulling Disorder)

Trichotillomania (Hair-Pulling Disorder)

Psychiatry

Trichotillomania (Hair-Pulling Disorder)

Diagnostic Criteria

  1. Recurrent pulling out of one’s hair, resulting in hair loss.
  2. Repeated attempts to decrease or stop hair pulling.
  3. The hair pulling causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  4. The hair pulling or hair loss is not attributable to another medical condition (e.g., a dermatological condition).
  5. The hair pulling is not better explained by the symptoms of another mental disorder (e.g., attempts to improve a perceived defect or flaw in appearance in body dimorphic disorder).

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Excoriation (Skin-Picking) Disorder

Excoriation (Skin-Picking) Disorder

Psychiatry

Excoriation (Skin-Picking) Disorder

Diagnostic Criteria

  1. Recurrent skin picking resulting in skin lesions.
  2. Repeated attempts to decrease or stop skin picking.
  3. The skin picking causes clinically significant distress or impairment is social, occupational, or other important areas of functioning.
  4. The skin picking is not attributable to the physiological effects of a substance (e.g., cocaine) or another medical condition (e.g., scabies).
  5. The skin picking is not better explained by symptoms of another mental disorder (e.g., delusions or tactile hallucinations in a psychotic disorder, attempts to improve a perceived defect or flaw in appearance in body dimorphic disorder, stereotypes in stereotypic movement disorder, or intention to harm oneself in no suicidal self-injury).

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Specific Phobia

Specific Phobia

Psychiatry

Specific Phobia

Diagnostic Criteria

A) Marked fear or anxiety about a specific object or situation (e.g., flying, heights, and animals, receiving an injection, seeing blood).

Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, or clinging.

B) The phobic object or situation almost always provokes immediate fear or anxiety.

C) The phobic object or situation is actively avoided or endured with intense fear or anxiety.

D) The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation and to the sociocultural context.

E) The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

F) The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

G) The disturbance is not better explained by the symptoms of another mental disorder, including fear, anxiety, and avoidance of situations associated with panic-like symptoms or other incapacitating symptoms (as in agoraphobia); objects or situations related to obsessions (as in obsessive-compulsive disorder); reminders of traumatic events (as in separation anxiety disorder); or social situations (as is social anxiety disorder).

Specify if:

Code based on the phobic stimulus: Like animal (e.g. Spiders, insects, dogs)

Natural environment (e.g. Heights, storm, water)

Blood-injection-injury (e.g. Needles, invasive medical procedures)

Situational (e.g. Aeroplanes, elevators, enclosed spaces)

Other. (E.g. Situations that may lead to choking or vomiting, in children such as loud sounds or costume characters)

Coding note: When more than one phobic stimulus is present, code all ICD-10-CM codes that apply (e.g., fear of snakes and flying, F40.218 specific phobia, animal, and specific phobia, situational).

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Social Anxiety Disorder (Social Phobia)

Social Anxiety Disorder (Social Phobia)

Psychiatry

Social Anxiety Disorder (Social Phobia)

Diagnostic Criteria

A) Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g., giving a speech).

Note: In children, the anxiety must occur in peer setting and not just during interactions with adults.

B) The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).

C) The social situations almost always provoke fear or anxiety.

Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.

D) The social situations are avoided or endured with intense fear or anxiety.

E) The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.

F) The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

G) The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

H) The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

I) The fear, anxiety, or avoidance is not better explained disorder, or autism spectrum disorder.

J) If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

Specify if:

Performance only: If the fear is restricted to speaking or performing in public.

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Panic Attack Specifier

Panic Attack Specifier

Psychiatry

Panic Attack Specifier

Note: Symptoms are presented for the purpose of identifying a panic attack; however, panic attack is not a mental disorder and cannot be coded. Panic attacks can occur in the context of any anxiety disorder as well as other mental disorders (e.g., depressive disorders, posttraumatic stress disorder, substance use disorders) and some medical conditions (e.g., cardiac, respiratory, vestibular, gastrointestinal). When the presence of a panic attack is identified, it should be noted as a specified (e.g., ‘’posttraumatic stress disorder with panic attacks”). For panic disorder, the presence of panic attack is contained within the criteria for the disorder and panic attack is not used as a specified.

An abrupt surge of intense fear or intense discomfort that reaches a peak within minutes and during which time four (or more) of the following symptoms occur:

Note: The abrupt surge can occur from a calm state or an anxious state.

  1. Palpitations, pounding heart, or accelerated heart rate.
  2. Sweating.
  3. Trembling or shaking.
  4. Sensations of shortness of breath or smothering.
  5. Feelings of choking.
  6. Chest pain or discomfort.
  7. Nausea or abdominal distress.
  8. Feeling dizzy, unsteady, light-headed, or faint.
  9. Chills or heart sensations.
  10. Paresthesias (numbness or tingling sensations).
  11. Derealization (feelings of unreality) or depersonalization (being detached from oneself).
  12. Fear of losing control or “going crazy.”
  13. Fear of dying.

Note: Culture-specific symptoms (e.g., tinnitus, neck soreness, headache, uncontrollable screaming or crying) may be seen. Such symptoms should not count as one of the four required symptoms.

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Separation Anxiety Disorder

Separation Anxiety Disorder

Psychiatry

Separation Anxiety Disorder

Diagnostic Criteria

A. Developmentally inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached, as evidenced by at least three of the following:

  1. Recurrent excessive distress when anticipating or experiencing separation from home or from major attachment figures.
  2. Persistent and excessive worry about losing major attachment figures or about possible harm to them, such as illness, injury, disasters, or death.
  3. Persistent and excessive worry about experiencing an untoward event (e.g., getting lost, being kidnapped, having an accident, becoming ill) that causes separation from a major attachment figure.
  4. Persistent reluctance or refusal to go out, away from home, to school, to work , or elsewhere because of fear of separation.
  5. Persistent and excessive fear of or reluctance about being alone or without major attachment figures at home or in other settings.
  6. Persistent reluctance or refusal to sleep away from home or to go to sleep without being near a major attachment figure.
  7. Repeated nightmares involving the theme of separation.
  8. Repeated complaints of physical symptoms (e.g., headaches, stomachaches, nausea, vomiting) when separation from major attachment figures occurs or is anticipated.

B. The fear, anxiety, or avoidance is persistent, lasting at least 4 weeks in children and adolescents and typically 6 months or more in adults.

C. The disturbance causes clinically significant distress or impairment in social, academic, occupational, or other important areas of functioning.

D. The disturbance is not better explained by another mental disorder, such as refusing to leave home because of excessive resistance to change in autism spectrum disorder; delusions or hallucinations concerning separation in psychotic disorders; refusal to go outside without a trusted companion in agoraphobia; worries about ill health or other harm befalling significant others in generalized anxiety disorder; or concerns about having an illness in illness anxiety disorder.

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