Complete loss of memory for one’s life history (personal identity) – more common among combat veterans, sexual assault victims, individuals experiencing extreme emotional stress or conflict.
According to the APA, the primary change to schizoaffective disorder is the requirement that a major mood episode be present for a majority of the disorder’s total duration after Criterion A is met. This change was made on both conceptual and psychometric grounds, making schizoaffective disorder a longitudinal instead of cross-sectional diagnosis (more comparable with schizophrenia, bipolar disorder and major depressive disorder, which are bridged by this condition). The change was also made to improve the reliability, diagnostic stability and validity of the disorder, while recognizing that the characterization of clients with both psychotic and mood symptoms, either concurrently or at different points in their illness, is a clinical challenge.
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This classification may be used when criteria are met for catatonia during the course of a neurodevelopmental, psychotic, bipolar, depressive, or other mental disorder. The catatonia specifier is appropriate when the clinical picture is characterized by marked psychomotor disturbance and involves at least three of the 12 diagnostic features listed in Criterion A:
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Also new to the DSM-5 are descriptive and course specifiers applicable after 12 months to all schizophrenia spectrum and other psychotic disorders except for brief psychotic disorder (subsides after one month) and schizophreniform disorder (replaced with schizophrenia disorder after a duration of six months). These specifiers include the following:
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F25.0 Schizoaffective Disorder, Bipolar Type, severe hallucinations, moderate delusions (erotomanic and persecutory), moderate abnormal psychomotor behavior, moderate negative symptoms, equivocal disorganized speech, continuous episode, currently in partial remission, without catatonia.
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The DSM-5 diagnostic conceptualization offers a contextualized framework in “developing a comprehensive treatment plan that is informed by the individual’s cultural and social context” (, p. 19) by rating primary symptoms of psychosis in order of severity so as to promote prognostic decision-making.
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Catatonia (marked psychomotor disturbance such as unresponsiveness to agitation) is now a specifier that can be used outside of schizophrenia spectrum and other psychotic disorders, such as with neurodevelopmental disorders, bipolar disorders, depressive disorders, neurocognitive disorders, medical disorders, and as a side effect of some psychotropic medications. For clients to receive this specifier, three of 12 symptoms must be present (without a specific time duration or frequency).
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The cardinal symptoms evident in manic and hypomanic episodes remain unchanged in the DSM-5. However, some important linguistic clarifications are added to curtail the trend of diagnosing children and adolescents with a bipolar-related disorder for manifesting impairing irritability, marked anger, and physical aggression. According to the fourth edition of the DSM, children and adolescents manifest depression, not mania or hypomania, through an irritable and cranky mood expressed by “persistent anger, a tendency to respond to events with angry outbursts or blaming others, or an exaggerated sense of frustration of minor matters” (APA, 1994). This description aligns with research from Kessler (2010) indicating that irritability in major depressive disorder is associated with early age of onset, lifetime persistence, comorbidity with anxiety and impulse-control disorders, fatigue and self-reproach during episodes. In the opinion of Ellen Leibenluft, a National Institute of Mental Health senior investigator who conducts research on whether children with impairing irritability (severe mood dysregulation) should be diagnosed with bipolar disorder, the vast majority of irritability in children is not bipolar disorder. Her longitudinal data in both clinical and community samples indicate that nonepisodic irritability in children and adolescents is common. According to Leibenluft, who served on the DSM-5 Childhood and Adolescent Disorders Work Group, nonepisodic irritability is associated with an elevated risk for anxiety and unipolar depressive disorders in adulthood, but not bipolar disorder. Her data also suggest that children and adolescents with impairing irritability have lower familial rates of bipolar disorder than do those with bipolar disorder, as well as differing brain mechanisms mediating pathophysiologic abnormalities. Because of these factors, she advocates for thorough assessment and differential diagnosis in this population by spending ample time with the child and parents, obtaining abundant information, and carefully considering all relevant clinical material (see her 2011 article, “Severe mood dysregulation, irritability and the diagnostic boundaries of bipolar disorder in youths.”