DEPRESSIVE DISORDERS

Characterized by frequent outbursts of temper over a period lasting at least 1 year with no more than a 3-month period without outbursts. On average outbursts occur three or more times weekly, and individual's mood is chronically irritable and angry. Diagnosis is typically made between ages 6 and 18.

Characterized by the symptoms of major depressive episode including:

• Feelings of sadness, tearfulness, emptiness or hopelessness.
• Angry outbursts, irritability or frustration, even over small matters.
• Loss of interest or pleasure in most or all normal activities, such as sex, hobbies or sports.
• Sleep disturbances, including insomnia or sleeping too much.
• Tiredness and lack of energy, so even small tasks take extra effort.
• Reduced appetite and weight loss or increased cravings for food and weight gain.
• Anxiety, agitation or restlessness.
• Slowed thinking, speaking or body movements.
• Feelings of worthlessness or guilt, fixating on past failures or self-blame.
• Trouble thinking, concentrating, making decisions and remembering things
• Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide.
• Unexplained physical problems, such as back pain or headaches.

Symptoms represent an amalgamation of symptoms of chronic major depressive disorder and dysthymic disorder. Chronic depressed mood persists at least 2 years. While depressed, at least two of the following conditions are manifest: lack of appetite or overeating, insomnia or hyper dominos, fatigue, low self-esteem, difficulty in concentrating and indecisive, hopelessness.

Three necessary conditions must be met in order for this diagnosis to apply:

• Symptoms must be present during the majority of menstrual cycles; at least five of these symptoms must manifest during the final week before the onset of menses, improvement should be noticeable within a few days after the beginning of menses; symptoms should be minimal or abate the week after menses.
• At least one of the following symptoms must manifest: severe mood swings and increased emotional sensitivity, irritability and interpersonal friction, significantly depressed mood, considerable anxiety and emotional agitation.
• At least one of the following symptoms must be manifest for a cumulative total of at least five when combined with the symptoms in 2 above: decreased interest in daily activities, difficulty in focusing and concentration, significant lethargy, marked changes in eating habits (overeating or fixating on certain foods), insomnia or hypersomnia, feelings of being overwhelmed, noticeable physical changes such as bloating, weight gain, swelling of joints, or muscle pain.

Inordinate anxiety upon separation from parties the individual has formed a close emotional attachment to, as manifested by the presence of at least three of the following conditions: repeated intense anxiety when anticipating or experiencing separation from home or significant others, incessant rumination over the prospect of harm coming to significant attachments, chronic refusal or unwillingness to venture out away from home due to fear of separation, chronic and significant anxiety about being left alone and separated from attachment figures, refusal or unwillingness to sleep away from home while separated from attachment figures, recurring nightmares about separation, recurring physical problems (headaches, nausea, gastrointestinal distress) when anticipating or experiencing separation.

Characterized by reticence in situations where speaking is expected; condition interferes with social, educational, or vocational aspects of life; condition lasts at least 1 month; reticence is not due to difficulties with vocabulary or language (e.g., learning a foreign language).

Characterized by a disproportionate fear response to a specific object or situation; the fear response is almost always immediately elicited by the presence of the phobic object or situation; the phobias producing entity is actively avoided or only tolerated with great anxiety; the fear manifested is out of proportion to the actual danger posed by the phobia-producing entity; fear and avoidance responses typically persist for at least 6 months.

Indicated by inordinate fear of situations in which the person may be subject to evaluation by others; such situations may include scenarios consisting of meetings, conversations with unfamiliar parties, being observed, or giving speeches or presentations. The person is greatly concerned that they may behave in inappropriate ways that would be d negatively construed (leading to rejection, embarrassment, ridicule, or being offended). Social situations are avoided or endured with great anxiety.

A panic attack is a sudden, unexpected, intense fear response during which anxiety rapidly escalates within minutes. In order to qualify as a panic disorder a condition must include repeated panic attacks and at least four of the following symptoms: rapid heartbeat, sweating, shaking, shortness of breath, choking sensation, chest pain/discomfort, nausea or to gastrointestinal distress, vertigo or sensation of loss of 3 a balance or feeling faint and light-headed, sensations of heat or cold, paresthesias, derealization, fear of losing emotional control, fear of dying.

At least one of the panic attacks has been followed by at least 1 month of one or both of the following: chronic worry about experiencing additional panic attacks (and their possible consequences), a marked effort to engage in behaviors to avoid panic attacks.

Significant anxiety about at least two of the following scenarios: utilizing public transportation, being in open spaces, being in enclosed spaces, being in a crowd, being alone outside one's home.

Inordinate worry about a variety of scenarios, occurring more days than not and lasting at least 6 months. The person finds it difficult to not ruminate about worry-causing scenarios. At least three of the following symptoms must be present (with at least one lasting at least 6 months): agitation, loss of energy, difficulty focusing, irritability, muscular tension, difficulty sleeping.

There is evidence that panic attacks transpire con-currently withdrawal, or following exposure to a medication; the substance/medication under consideration is capable of bringing about severe anxiety.

Indicated by the presence of obsessions (unwanted, intrusive thoughts or images that are experienced repeatedly and bring about distress; person tries to counteract and alleviate these thoughts and images with other thoughts or actions) and/or compulsions (repetitive ritualized actions that the individual feels compelled to perform in order to alleviate the distress caused by obsessions). The repetitive rituals are causally unconnected to the obsessions they are attempting to counteract and/or are excessive in their application (for instance, repeatedly checking and rechecking that a door is indeed locked when one confirmation would suffice). Obsessions and/or compulsions endure, lasting at least an hour a day.

Indicated by inordinate attention to at least one perceived flaw in physical appearance that is unnoticeable or appears slight to other observers. Individual engages in repetitive behaviors as a means of obtaining reassurance about appearance concerns.

Indicated by chronic difficulty in getting rid of possessions regardless of their value. This behavior stems from a need to save items and the associated distress of being without them. The accumulation of hoarded items is so excessive so as to make living areas difficult to inhabit.

Repetitive pulling of one's own hair resulting in hair loss, accompanied by repeated attempts to cease this behavior.

Repeated skin-picking behaviors resulting in skin lesions, accompanied by repeated attempts to cease this behavior.

There is evidence that the symptoms of obsessive-compulsive disorder transpire concurrently with or following substance intoxication, withdrawal, or following exposure to a medication; the substance/ medication under consideration is capable of bringing about severe anxiety.