Depressive / low mood Persistent depressed mood most of the day Loss of interest or pleasure (anhedonia) Insomnia or hypersomnia Fatigue or loss of energy Appetite or weight change Worthlessness or excessive guilt Reduced concentration or indecisiveness Psychomotor agitation or retardation Recurrent thoughts of death or suicidal ideation Chronic low-grade depression most days for years Onset during pregnancy or postpartum Clear seasonal pattern of episodes
Elevated / expansive mood Abnormally elevated, expansive, or irritable mood Persistently increased energy or goal-directed activity Decreased need for sleep without fatigue Grandiosity or inflated self-esteem Pressured speech or more talkative than usual Flight of ideas or racing thoughts Marked distractibility Risky, impulsive, or consequential behavior Episode caused hospitalization, psychosis, or marked impairment Discrete episode lasting ≥4 days Discrete episode lasting ≥7 days
Anxiety and panic Excessive worry about multiple domains, hard to control Muscle tension, restlessness, or feeling keyed up Irritability or sleep disturbance from worry Recurrent unexpected panic attacks Persistent worry about further attacks or behavior change Marked fear of social scrutiny or negative evaluation Avoidance of social or performance situations Fear/avoidance of crowds, transit, or leaving home alone Circumscribed fear of a specific object or situation Developmentally excessive distress at separation
Trauma and stressor-related Exposure to actual/threatened death, serious injury, or sexual violence Intrusive memories, nightmares, or flashbacks Avoidance of trauma reminders Negative alterations in cognition and mood after the event Hyperarousal, startle, hypervigilance, or irritability Dissociation, derealization, or depersonalization Symptoms present less than 1 month since the event Identifiable non-traumatic stressor within 3 months Distress out of proportion to the stressor Bereavement-related distress after a death
Obsessive-compulsive and related Recurrent intrusive obsessions causing marked anxiety Repetitive compulsions or mental rituals Rituals consume >1 hour/day or cause marked impairment Preoccupation with perceived appearance defect Persistent difficulty discarding possessions with clutter Recurrent hair pulling or skin picking with attempts to stop
Psychosis and thought disorder Delusions Hallucinations Disorganized speech / formal thought disorder Grossly disorganized or catatonic behavior Negative symptoms Continuous signs of disturbance ≥6 months Disturbance ≥1 month but <6 months Disturbance <1 month with return toward baseline Prominent mood episode concurrent with psychosis Nonbizarre delusions with otherwise preserved functioning
Neurocognitive and attention Progressive decline from prior cognitive baseline Cognitive deficits interfere with independence Modest decline without loss of independence Acute fluctuating attention and awareness Persistent inattention, disorganization, careless errors Hyperactivity or impulsivity Several symptoms present before age 12 Symptoms present in two or more settings Persistent deficits in social communication and reciprocity Restricted, repetitive behaviors, interests, or sensory patterns Present from early developmental period
Substance and behavioral use Loss of control: larger amounts or longer than intended Craving or strong desire to use Failure to fulfill role obligations due to use Use in physically hazardous situations Tolerance Withdrawal symptoms or use to relieve them Primary substance: alcohol Primary substance: opioids Primary substance: stimulants Primary substance: cannabis
Eating, sleep, somatic, and personality Restriction of intake with significantly low weight Intense fear of weight gain or body image disturbance Recurrent binge eating with loss of control Compensatory behaviors Dissatisfaction with sleep quantity/quality ≥3 nights/week Distressing somatic symptoms with disproportionate health thoughts Pervasive instability of relationships, self-image, and affect Impulsivity, self-harm, or chronic emptiness Longstanding pattern across contexts since adolescence