A- There is a pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years, as indicated by three (or more) of the following:

1- failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest
2- deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure
3- impulsivity or failure to plan ahead
4- irritability and aggressiveness, as indicated by repeated physical fights or assaults
5- reckless disregard for safety of self or others
6- consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations
7- lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another

A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1- has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)
2- is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
3- believes that he or she is "special" and unique and can only be understood by, or should associate with, other special or high-status people (or institutions)
4- requires excessive admiration
5- has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations
6- is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends
7- lacks empathy: is unwilling to recognize or identify with the feelings and needs of others
8- is often envious of others or believes that others are envious of him or her
9- shows arrogant, haughty behaviors or attitudes

Core Problems in Psychotic Phase
1- Social and/or Occupational Impairment
2- Apathy
3- Delusions or Hallucinations
4- Disorganized or Bizarre Behavior
5- Decreased Speech, Emotion and Movement

Associated Problems in Psychotic Phase
1- Reckless or Impulsive Behavior
2- Obsessive Thinking or Compulsive Rituals
3- Prolonged Anxiety, Tension or Worry
4- Fidgeting, Pacing, or Hyperactivity
5- Sad or Depressed Mood
6- Irritability or Hostility
7- Feeling Worthless or Guilty
8- Fatigue (Physically Tired All Day)
9- Poor Concentration or Attention
10- Sleeping Problem
11- Appetite or Eating Problem
12- Poor Sexual Interest or Ability
13- Overly Dependent Behavior
14- Poor Physical Health

delusions that the person (or someone to whom the person is close) is being malevolently treated in some way

A marked and persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that he or she will act in a way (or show anxiety symptoms) that will be humiliating or embarrassing. Note: In children, there must be evidence of the capacity for age-appropriate social relationships with familiar people and the anxiety must occur in peer settings, not just in interactions with adults.

Exposure to the feared social situation almost invariably provokes anxiety, which may take the form of a situationally bound or situationally predisposed Panic Attack. Note: In children, the anxiety may be expressed by crying, tantrums, freezing, or shrinking from social situations with unfamiliar people.

The person recognizes that the fear is excessive or unreasonable. Note: In children, this feature may be absent.
The feared social or performance situations are avoided or else are endured with intense anxiety or distress.

The avoidance, anxious anticipation, or distress in the feared social or performance situation(s) interferes significantly with the person's normal routine, occupational (academic) functioning, or social activities or relationships, or there is marked distress about having the phobia.
In individuals under age 18 years, the duration is at least 6 months.

The fear or avoidance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition and is not better accounted for by another mental disorder (e.g., Panic Disorder With or Without Agoraphobia, Separation Anxiety Disorder,

Body Dysmorphic Disorder, a Pervasive Developmental Disorder, or Schizoid Personality Disorder).

If a general medical condition or another mental disorder is present, the fear in Criterion A is unrelated to it, e.g., the fear is not of Stuttering, trembling in Parkinson's disease, or exhibiting abnormal eating behavior in Anorexia Nervosa or Bulimia Nervosa.

1- The person has been exposed to a traumatic event in which both of the following were present:
- the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others
- the person's response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior

2- The traumatic event is persistently reexperienced in one (or more) of the following ways:
- recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed.
- recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content.
- acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated). Note: In young children, trauma-specific reenactment may occur.
- intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event

3- Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:
- efforts to avoid thoughts, feelings, or conversations associated with the trauma
- efforts to avoid activities, places, or people that arouse recollections of the trauma
- inability to recall an important aspect of the trauma
- markedly diminished interest or participation in significant activities
- feeling of detachment or estrangement from others
- restricted range of affect (e.g., unable to have loving feelings)
- sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)

4- Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:
- difficulty falling or staying asleep
- irritability or outbursts of anger
- difficulty concentrating
- hypervigilance
- exaggerated startle response

5- Duration of the disturbance (symptoms in Criteria B, C, and D) is more than 1 month.

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

Reduced ability to maintain attention to external stimuli and to appropriately shift attention to new external stimuli. Thus at least 1 of:
1- Questions had to be repeated because attention wandered
2- Perseverated answers to previous questions

Disorganized thinking

Confusion developed over a short period of time

Fluctuating level of confusion

At least 2 out of 6 of:
1- Reduced level of consciousness
2- Perceptual disturbances
3- Disturbance of sleep-wake cycle
4- Increased or decreased psychomotor activity
5- Disorientation to time, place, or person
6- Memory impairment

Either of the following:
1- Evidence that an organic factor initiated and maintained this confusion
2- Confusion cannot be accounted for by any nonorganic mental disorder

Both multiple motor and one or more vocal tics have been present at some time during the illness, although not necessarily concurrently. (A tic is a sudden, rapid, recurrent, nonrhythmic, stereotyped motor movement or vocalization.)

The tics occur many times a day (usually in bouts) nearly every day or intermittently throughout a period of more than 1 year, and during this period there was never a tic-free period of more than 3 consecutive months.

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

The onset is before age 18 years.

The disturbance is not due to the direct physiological effects of a substance (e.g., stimulants) or a general medical condition (e.g., Huntington's disease or postviral encephalitis).

Qualitative impairment in social interaction, as manifested by at least two of the following:
1- marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction
2- failure to develop peer relationships appropriate to developmental level
3- a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people)
4- lack of social or emotional reciprocity

Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:
1- encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
apparently inflexible adherence to specific, nonfunctional routines or rituals
2- stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)
3- persistent preoccupation with parts of objects

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

There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years).

There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood.

Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia.

A pattern of negativistic, hostile, and defiant behavior lasting at least 6 months, during which four (or more) of the following are present:
1- often loses temper
2- often argues with adults
3- often actively defies or refuses to comply with adults' requests or rules
4- often deliberately annoys people
5- often blames others for his or her mistakes or misbehavior
6- is often touchy or easily annoyed by others
7- is often angry and resentful
8- is often spiteful or vindictive
Note: Consider a criterion met only if the behavior occurs more frequently than is typically observed in individuals of comparable age and developmental level.

The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.

The behaviors do not occur exclusively during the course of a Psychotic or Mood Disorder.

Criteria are not met for Conduct Disorder, and, if the individual is age 18 years or older, criteria are not met for Antisocial Personality Disorder.

In adults, mania is usually episodic with an elevation of mood and increased energy and activity. In children, mania is commonly chronic rather than episodic, and usually presents in mixed states with irritability, anxiety and depression. In adults and children, during depression there is lowering of mood and decreased energy and activity. During a mixed episode both mania and depression can occur on the same day.

A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of three (or more) of the following criteria in the past 12 months, with at least one criterion present in the past 6 months:

1- often bullies, threatens, or intimidates others
2- often initiates physical fights
3- has used a weapon that can cause serious physical harm to others
4- has been physically cruel to people
5- has been physically cruel to animals
6- has stolen while confronting a victim
7- has forced someone into sexual activity
8- has deliberately engaged in fire setting with the intention of causing serious damage
9- has deliberately destroyed others' property (other than by fire setting)
10- has broken into someone else's property
11- often lies to obtain goods or favors or to avoid obligations
12- has stolen items of nontrivial value without confronting a victim
13- often stays out at night despite parental prohibitions, beginning before age 13 years
14- has run away from home overnight at least twice while living in parental or parental surrogate home (or once without returning for a lengthy period)
15- is often truant from school, beginning before age 13 years

The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.

If the individual is age 18 years or older, criteria are not met for Antisocial Personality Disorder.