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Functional Consequences of Anorexia Nervosa Individuals with anorexia nervosa may exhibit a range of functional limitations associated with the disorder. D ifferential Diagnosis Other possible causes of either significantly low body weight or significant weight loss should be considered in the differential diagnosis of anorexia nervosa, especially when the presenting features are atypical. Acute weight loss associated with a medical condition can occasionally be followed by the onset or recurrence of anorexia nervosa, which can initially be masked by the comorbid medical condition. Individuals with substance use disorders may experience low weight due to poor nutritional intake but generally do not fear gaining weight and do not manifest body image disturbance. Individuals with bulimia nervosa exhibit recurrent episodes of binge eating, engage in inappropriate behavior to avoid weight gain. Comorbidity Bipolar, depressive, and anxiety disorders commonly co-occur with anorexia nervosa. Many individuals with anorexia nervosa report the presence of either an anxiety disorder or symp to ms prior to onset of their eating disorder. Alcohol use disorder and other substance use disorders may also be comorbid with anorexia nervosa, especially among those with the binge-eating/purging type. Recurrent inappropriate compensa to ry behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise. The binge eating and inappropriate compensa to ry behaviors both occur, on average, at least once a week for 3 months. Specify if: In partial remission: After full criteria for bulimia nervosa were previously met, some, but not all, of the criteria have been met for a sustained period of time. In full remission: After full criteria for bulimia nervosa were previously met, none of the criteria have been met for a sustained period of time. Specify current severity: the minimum level of severity is based on the frequency of inappropriate compensa to ry behaviors (see below).
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The weight of available evidence supports the superior performance characteristics (interrater reliability, as well as convergent, discriminant, and face validity) of simpler, less differentiated approaches to diagnosis of sleep-wake disorders. A predominant complaint of dissatisfaction witli sleep quantity or quality, associated with one (or more) of the following symp to ms: 1. The insomnia is not better explained by and does not occur exclusively during the course of another sleep-wake disorder. Specify if: With non-sleep disorder mental comorbidity, including substance use disorders With other medical comorbidity With other sleep disorder Coding note: the code 780. The diagnosis of insomnia disorder is given whether it occurs as an independent condition or is comorbid with another mental disorder. Insomnia may also manifest as a clinical feature of a more predominant mental disorder. With comorbid insomnia and a mental disorder, treatment may also need to target both conditions. Rather, the diagnosis of insomnia disorder is made with concurrent specification of the clinically comorbid conditions. Diagnostic Features the essential feature of insomnia disorder is dissatisfaction with sleep quantity or quality with complaints of difficulty initiating or maintaining sleep. Different manifestations of insomnia can occur at different times of the sleep period.
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Prevaience Prevalence of delayed sleep phase type in the general population is approximately 0. Clinical expression may vary across the lifespan depending on social, school, and work obligations. Exacerbation is usually triggered by a change in work or school schedule that requires an early rise time. Thus, delayed sleep phase type in adolescents should be differentiated from the common delay in the timing of circadian rhythms in this age group. In the familial form, the course is persistent and may not improve sig^iificantly with age. Genetic fac to rs may play a role in the pathogenesis of familial and sporadic forms of delayed sleep phase type, including mutations in circadian genes. Diagnostic i/larl(ers Confirmation of the diagnosis includes a complete his to ry and use of a sleep diary or actigra phy. The period covered should include weekends, when social and occupational obligations are less strict, to ensure that the individual exhibits a consistently delayed sleep-wake pattern. Biomarkers such as salivary dim light mela to nin onset should be obtained only when the diagnosis is unclear. Functional Consequences of Delayed Sleep Phase Type Excessive early day sleepiness is prominent.
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Apart from the impact of the delusion(s) or its ramifications, functioning is not markedly impaired, and behavior is not obviously bizarre or odd. If manic or major depressive episodes have occurred, these have been brief relative to the duration of the delusional periods. Specify whether: Ero to manie type: this subtype applies when the central theme of the delusion is that another person is in love with the individual. Grandiose type: this subtype applies when the central theme of the delusion is the conviction of having some great (but unrecognized) talent or insight or having made some important discovery. Somatic type: this subtype applies when the central theme of the delusion involves bodily functions or sensations. Unspecified type: this subtype applies when the dominant delusional belief cannot be clearly determined or is not described in the specific types. Specify if: With bizarre content: Delusions are deemed bizarre if they are clearly implausible, not understandable, and not derived from ordinary life experiences. Subtypes In ero to manie type, the central theme of the delusion is that another person is in love with the individual. Less commonly, the individual may have the delusion of having a special relationship with a prominent individual or of being a prominent person (in which case the actual individual may be regarded as an impos to r). The individual with the delusion usually confronts the spouse or lover and attempts to intervene in the imagined infidelity. The affected individual may engage in repeated attempts to obtain satisfaction by legal or legislative action.
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