SUBSTANCE-RELATED & ADDICTIVE DISORDERS

The major feature of these disorders is a cluster of cognitive, behavioral, and psychological symptoms indicative of continued substance use despite significant substance-use-related problems. One major consideration is that there is a persistent underlying change in brain chemistry lasting beyond detoxification. The behavioral changes manifested due to the altered brain chemistry may include chronic relapses and intense cravings for the substance when presented with substance-related stimuli. The classes of drugs that comprise these disorders include:

• Alcohol
• Caffeine
• Cannabis
• Hallucinogens
• Inhalants
• Opioids
• Sedatives
• Hypnotics
• Anxiolytics
• Stimulants
• Tobacco

Gambling Disorder: Indicated by persistent and recurrent maladaptive gambling behavior that disrupts personal, family, or vocational pursuits. 

• Complex Attention: sustained attention, divided attention, selective attention, and processing speed.
• Executive Function: planning, decision making, working memory, responding to feedback/error correction, overriding habits/inhibition, and mental flexibility.
• Learning and Memory: immediate memory, recent memory (including free recall, cued recall, and recognition memory), very long- term memory (semantic; autobiographical), and implicit learning.
• Language: expressive language (including naming, word finding, fluency, and grammar, and syntax) and receptive language.
• Perceptual-Motor: includes abilities subsumed under the terms visual perception, visuoconstructional, perceptual-motor, praxis, and gnosis.
• Social Cognition: recognition of emotions and theory of mind.

Essential feature of condition is a disturbance of consciousness and an alteration in cognition that develops over a short interval. Subtypes include delirium due to general medical condition, substance-induced delirium, and delirium due to multiple etiologies.

Indicated by serious cognitive impairment in at least one of the following areas of cognitive functioning: complex attention, executive function, learning and memory, language, perceptual-motor, or social cognition. The cognitive impairment disrupts the performance of daily activities. The cognitive impairment does not manifest solely in the context of delirium. The condition may result from Alzheimer's disease, frontotemporal lobar degeneration, Lewy body dis-ease, vascular disease, traumatic brain injury, substance/ medication use, HIV infection, prion disease, Parkinson's disease, Huntington's disease, another medical condition, multiple etiologies, or an unspecified cause.

• Dementia: Encompassed under major neurocognitive disorder and retained as an alternative. Dementia includes multiple cognitive deficits and is thus a more narrow diagnosis than major neurocognitive disorder.

Indicated by a moderate decrease in cognitive functioning that does not disrupt the performance of daily activities. Other indicators for this condition are similar to major neuro-cognitive disorder.

Enduring patterns of inner experience and behavior that significantly deviates from the expectations of the individual's culture, is pervasive and inflexible, originates in adolescence or early adulthood, is stable over time, and leads to clinically significant distress or impairment in one or more important areas of functioning (e.g., social, academic, or occupational).

Paranoid Personality Disorder: Indicated by a pattern of pervasive distrust and suspiciousness of others, such that their motives are interpreted as malevolent. Events and the actions of others are interpreted in the most negative light possible, and convictions of others' hostility are based on little or no objective evidence.

Schizoid Personality Disorder: Essential features include a pervasive pattern of detachment from social relationships and a restricted range of emotions in interpersonal settings. The individual typically will avoid social interac-tion, prefers solitary activities and interests, and seems to derive little or no pleasure from sensory, bodily, or interpersonal relationships. Affect is usually flat and expressionless, and there is a preference for abstract intellectual interests, such as mechanical, mathematical, or computer-related pursuits.

Schizotypal Personality Disorder: Indicated by repeated instances of lacking adequate social or interpersonal skills, accompanied by acute uneasiness with, and diminished ability to, maintain close relationships. Condition is manifested by early adulthood and is further characterized by perceptual distortions and odd thinking, speech, beliefs, and behavior.

Antisocial Personality Disorder: Essential features include a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood. Deceit, manipulation, and exploitation are central characteristics of this personality disorder. A pattern of impulsivity may also be present, such that decisions are made capriciously, with little or no forethought or planning.

Borderline Personality Disorder: Indicated by a pervasive pattern of instability in interpersonal relationships, of self-image and affects, accompanied by marked impulsivity with an onset in early adulthood and present in a variety of contexts. Individual will often be intensely concerned with abandonment and will go to great lengths to avoid real or imagined abandonment. The perception of impending loss, rejection, separation, abandonment, or the loss of external stability and structure can produce profound alterations in self-image, affect, cognition, and behavior.

Histrionic Personality Disorder: Characterized by pervasive and excessive emotionality and attention-seeking behavior, originating in early adulthood and manifesting in a variety of contexts. Individual feels uncomfortable and unappreciated if he/she is not the center of attention. Individuals with this disorder will often behave in a melodramatic, histrionic, and flirtatious manner.

Narcissistic Personality Disorder: Characterized by a pervasive pattern of grandiosity, need for admiration, and lack of empathy, originating in early adulthood and manifesting in a variety of contexts. The individual has an exaggerated sense of self-importance, often displaying a conceited, boastful demeanor while overestimating his/her abilities and accomplishments.

Avoidant Personality Disorder: Characterized by an inordinate preoccupation with being disapproved of, socially rejected, or criticized. Individual suffers from chronic feelings of inadequacy and is hypersensitive to the possible negative evaluations of others. Typically, significant interpersonal or social involvement is avoided, due to fear of being exposed, ridiculed, or embarrassed. Due to constant need for reassurance, security, and certainty of acceptance, individual often leads a rather isolated or restricted social existence.

Dependent Personality Disorder: Indicated by an inordinate and chronic need to be taken care of, resulting in submissive clinging behavior and a fear of separation, abandonment, or rejection. Due to a self-perception of being unable to function without the help of others, the individual displays a variety of submissive and dependent behaviors so as to elicit caregiving and nurturing behavior from others. Individual tends to be indecisive about even everyday matters and requires much advice and reassurance from others due to his/her extremely passive nature.

Obsessive-Compulsive Personality Disorder: Characterized by a pervasive preoccupation with orderliness, perfectionism, and control, originating in early adulthood and manifesting in a variety of contexts. Individual maintains painstaking attention to rules to the extent that the major point of the activity is lost. Perfectionism interferes with the ability to complete tasks. Individual is overly devoted to work to the exclusion of leisure activities and overconscientious about matters of morality.

Individual may be unable to throw objects away, reluctant to delegate tasks, miserly, and inflexible.

Personality Change Due to Another Medical Condition: Indicated by the presence of a persistent personality disturbance attributed to the direct physiological effects of a general medical condition. The personality disturbance must manifest as a significant change from the individual's previous characteristic personality pattern.