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

A panic attack is a discrete period of intense fear or discomfort, in which four (or more) of the following symptoms developed abruptly and reached a peak within 10 minutes:

palpitations, pounding heart, or accelerated heart rate
sweating
trembling or shaking
sensations of shortness of breath or smothering
feeling of choking
chest pain or discomfort
nausea or abdominal distress
feeling dizzy, unsteady, lightheaded, or faint
derealization (feelings of unreality) or depersonalization (being detached from oneself)
fear of losing control or going crazy
fear of dying
paresthesias (numbness or tingling sensations)
chills or hot flushes

Recurrent failure to resist impulses to steal objects that are not needed for personal use or for their monetary value.
Increasing sense of tension immediately before committing the theft.

Pleasure, gratification, or relief at the time of committing the theft.

The stealing is not committed to express anger or vengeance and is not in response to a delusion or a hallucination.

Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving the act of observing an unsuspecting person who is naked, in the process of disrobing, or engaging in sexual activity.
The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Recurrent pulling out of one's hair resulting in noticeable hair loss.
An increasing sense of tension immediately before pulling out the hair or when attempting to resist the behavior.

Pleasure, gratification, or relief when pulling out the hair.

The disturbance is not better accounted for by another mental disorder and is not due to a general medical condition (e.g., a dermatological condition).

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

Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving the use of nonliving objects (e.g., female undergarments).
The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

The fetish objects are not limited to articles of female clothing used in cross-dressing (as in Transvestic Fetishism) or devices designed for the purpose of tactile genital stimulation (e.g., a vibrator).

Irresistible attacks of refreshing sleep that occur daily over at least 3 months.
The presence of one or both of the following:

cataplexy (i.e., brief episodes of sudden bilateral loss of muscle tone, most often in association with intense emotion)

recurrent intrusions of elements of rapid eye movement (REM) sleep into the transition between sleep and wakefulness, as manifested by either hypnopompic or hypnagogic hallucinations or sleep paralysis at the beginning or end of sleep episodes
The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or another general medical condition.

The development of multiple cognitive deficits manifested by both:

memory impairment (impaired ability to learn new information or to recall previously learned information)
one (or more) of the following cognitive disturbances:
aphasia (language disturbance)
apraxia (impaired ability to carry out motor activities despite intact motor function)
agnosia (failure to recognize or identify objects despite intact sensory function)
disturbance in executive functioning (i.e., planning, organizing, sequencing, abstracting)
The cognitive deficits above each cause significant impairment in social or occupational functioning and represent a significant decline from a previous level of functioning. The course is characterized by gradual onset and continuing cognitive decline. The deficits do not occur exclusively during the course of a delirium.

The cognitive deficits above are not due to any of the following:

other central nervous system conditions that cause progressive deficits in memory and cognition (e.g., cerebrovascular disease, Parkinson's disease, Huntington's disease, subdural hematoma, normal-pressure hydrocephalus, brain tumor)
systemic conditions that are known to cause dementia (e.g., hypothyroidism, vitamin B-12 or folic acid deficiency, niacin deficiency, hypercalcemia, neurosyphilis, HIV infection)
substance-induced conditions

A history of many physical complaints beginning before age 30 years that occur over a period of several years and result in treatment being sought or significant impairment in social, occupational, or other important areas of functioning.
Each of the following criteria must have been met, with individual symptoms occurring at any time during the course of the disturbance:

four pain symptoms: a history of pain related to at least four different sites or functions (e.g., head, abdomen, back, joints, extremities, chest, rectum, during menstruation, during sexual intercourse, or during urination)


two gastrointestinal symptoms: a history of at least two gastrointestinal symptoms other than pain (e.g., nausea, bloating, vomiting other than during pregnancy, diarrhea, or intolerance of several different foods)


one sexual symptom: a history of at least one sexual or reproductive symptom other than pain (e.g., sexual indifference, erectile or ejaculatory dysfunction, irregular menses, excessive menstrual bleeding, vomiting throughout pregnancy)


one psuedoneurological symptom: a history of at least one symptom or deficit suggesting a neurological condition not limited to pain (conversion symptoms such as impaired coordination or balance, paralysis or localized weakness, difficulty swallowing or lump in throat, aphonia, urinary retention, hallucinations, loss of touch or pain sensation, double vision, blindness, deafness, seizures; dissociative symptoms such as amnesia; or loss of consciousness other than fainting)
Either (1) or (2):
after appropriate investigation, each of the symptoms in Criterion_B cannot be fully explained by a known general medical condition or the direct effects of a substance (e.g., a drug of abuse, a medication)


when there is a related general medical condition, the physical complaints or resulting social or occupational impairment are in excess of what would be expected from the history, physical examination, or laboratory findings
The symptoms are not intentionally feigned or produced (as in Factitious Disorder or Malingering).

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:

Aggression to people and animals

often bullies, threatens, or intimidates others
often initiates physical fights
has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun)
has been physically cruel to people
has been physically cruel to animals
has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery)
has forced someone into sexual activity

Destruction of property

has deliberately engaged in fire setting with the intention of causing serious damage
has deliberately destroyed others' property (other than by fire setting)

Deceitfulness or theft

has broken into someone else's house, building, or car
often lies to obtain goods or favors or to avoid obligations (i.e., "cons" others)
has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery)

Serious violations of rules

often stays out at night despite parental prohibitions, beginning before age 13 years
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)
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.

Several discrete episodes of failure to resist aggressive impulses that result in serious assaultive acts or destruction of property.
The degree of aggressiveness expressed during the episodes is grossly out of proportion to any precipitating psychosocial stressors.

The aggressive episodes are not better accounted for by another mental disorder (e.g., Antisocial Personality Disorder, Borderline Personality Disorder, a Psychotic Disorder, a Manic Episode, Conduct Disorder, or Attention-Deficit/Hyperactivity Disorder) and are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., head trauma, Alzheimer's disease).

Either obsessions or compulsions:
Obsessions as defined by (1), (2), (3), and (4):

recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress

the thoughts, impulses, or images are not simply excessive worries about real-life problems

the person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action

the person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind (not imposed from without as in thought insertion)

Related Topics:

OCD Screening Quiz

Treatment Options
Online Resources



Compulsions as defined by (1) and (2):

repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly

the behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive
--- And: ---

At some point during course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable.

Note: This does not apply to children.

The obsessions or compulsions cause marked distress, are time consuming (take more than 1 hour a day), or significantly interfere with the person's normal routine, occupational (or academic) functioning, or usual social activities or relationships.

If another disorder is present, the content of the obsessions or compulsions is not restricted to it.

The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

Sexual Masochism:

Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving the act (real, not simulated) of being humiliated, beaten, bound, or otherwise made to suffer.
The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.