Decision Trees for Decision Trees for Differential Diagnosis.Differential Diagnosis.

Decision Trees for Decision Trees for Differential Diagnosis.Differential Diagnosis.

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Differential Diagnosis of Mental Disorders Due to a General Medical Condition

Differential Diagnosis of Substance-Induced

Disorders

Differential Diagnosis of Psychotic Disorders

Differential Diagnosis of Mood Disorders

Differential Diagnosis of Anxiety Disorders

Differential Diagnosis of Somatoform Disorders

Is there a disturbance of consciousness and a change in cognition

Symptoms that are due to the direct physiological effects of a general Symptoms that are due to the direct physiological effects of a general medical conditionmedical condition

Yes No

Evidence that the disturbance has more than one etiology

(e.g., substance and general medical condition)

Yes No

Memory impairment?

Yes No

Delirium Due to a General Medical

Condition

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Delirium Due to Multiple Etiologies

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At least one additional cognitive deficit

Yes No

Evidence that the disturbance has more than one etiology (e.g.,

cerebrovascular disease and Alzheimer’s disease)

Yes No

Dementia Due to Multiple

Etiologies

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Evidence that cerebrovascular disease is etiologically related to the

disturbance

Yes No

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Vascular Dementia

Disturbance due to central nervous system condition or systemic

condition known to cause dementia

Yes No

Dementia Due to a General Medical

Condition

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Gradual onset and continuing cognitive decline

Yes No

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Dementia of the Alzheimer’s Type

Dementia Not Otherwise Specified

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Amnestic Disorder due to a General Medical

Condition

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Prominent delusions or hallucinations

predominate

Yes No

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Psychotic Disorder Due to a General Medical Condition

Prominent and persistent mood disturbance

predominates

Yes No

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Mood Disorder Due to a General Medical

Condition

Prominent anxiety, panic attacks, obsessions, or

compulsions predominate

Yes No

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Anxiety Disorder due to a General Medical

Condition

Clinically significant sexual dysfunction exclusively due to a

general medical condition

Yes No

Sexual Dysfunction Due to a General Medical Condition

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Disturbance in sleep sufficiently severe to warrant independent

clinical attention

Yes No

Sleep Disorder Due to a General Medical

Condition

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Catatonia?

Yes No

Catatonic Disorder Due to a General Medical Condition

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Change in previous personal pattern

Yes No

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Personality Change Due to a General Medical

Condition

Clinically significant symptoms etiologically related to a general

medical condition that do not meet criteria for a specific Mental Disorder Due to a General Medical Condition

Yes No

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Mental Disorder Not Otherwise Specified

Due to a General Medical Condition

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No Mental Disorder (Symptoms that are not

clinically significant)

Symptoms must be due to the direct physiological effects of a substance

A disturbance of consciousness and a change in cognition that are in excess of that usually seen in intoxication or withdrawal and

that warrant independent clinical attention

Yes No

Evidence that the disturbance has more than one etiology

(e.g., substance and general medical condition)

Yes No

Persistent memory impairment

Yes No

Onset of delirium during withdrawal from a substance

Yes No

Substance-Induced Withdrawal

Delirium

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Substance Induced

Intoxication Delirium

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Delirium Due to Multiple Etiologies

At least one additional cognitive

deficit

Yes No

Evidence that the disturbance has more than one etiology

(e.g., substance and general medical condition)

Yes No

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Substance-Induced Persisting Dementia

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Dementia Due to Multiple Etiologies

Substance-Induced Persisting Amnestic

Disorder

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Delusions or hallucinations predominate, are in excess of that usually seen in intoxication

or withdrawal, and warrant independent clinical attention

Yes No

Substance-Induced Psychotic Disorder –

Specify if onset during intoxication or withdrawal

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A mood disturbance predominates, is in excess of that usually seen in

intoxication or withdrawal, and warrants independent clinical attention.

Yes No

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Substance-Induced Mood Disorder – Specify if onset during

intoxication or withdrawal

Anxiety, panic attacks, or obsessions or compulsions predominate; are in

excess of that usually seen in intoxication or withdrawal; and warrant

independent clinical attention

Yes No

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Substance-Induced Anxiety Disorder – Specify if onset during intoxication

or withdrawal

Clinically significant sexual dysfunction exclusively due to a substance, is in excess

of that usually seen in intoxication, and warrants independent clinical attention

Yes No

Substance-Induced Sexual Dysfunction

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Disturbance is sleep that is sufficiently severe to warrant independent clinical

attention and is in excess of that usually seen in intoxication or withdrawal

Yes No

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Substance-Induced Sleep Disorder – Specify if onset

during intoxication or withdrawal

Development of a reversible syndrome due to recent use of a substance

Yes No

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Substance IntoxicationSubstance Intoxication

Development of a syndrome Development of a syndrome due to reduction or cessation of due to reduction or cessation of

use of substanceuse of substance

Yes No

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Substance WithdrawalSubstance Withdrawal

Clinically significant symptoms Clinically significant symptoms due to a substance that do not due to a substance that do not

meet criteria for one of the meet criteria for one of the Substance-Induced DisordersSubstance-Induced Disorders

Yes No

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Substance-Related Disorder Substance-Related Disorder Not Otherwise SpecifiedNot Otherwise Specified

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No Substance-Induced No Substance-Induced Disorder (substance-induced Disorder (substance-induced

symptoms that are not clinically symptoms that are not clinically significant)significant)

Delusions, hallucinations, disorganized Delusions, hallucinations, disorganized speech, or grossly disorganized behaviorspeech, or grossly disorganized behavior

Due to the direct Due to the direct physiological effects of a physiological effects of a general medical conditiongeneral medical condition

Yes No

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Psychotic Disorder Due Psychotic Disorder Due to a General Medical to a General Medical

ConditionCondition

Due to the direct physiological Due to the direct physiological effects of a substance (e.g., a effects of a substance (e.g., a

drug of abuse, a medication, or drug of abuse, a medication, or a toxin)a toxin)

Yes No

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Substance-Induced Psychotic Substance-Induced Psychotic DisorderDisorder

Symptoms of active phase of Symptoms of active phase of Schizophrenia, lasting at least Schizophrenia, lasting at least

1 month1 month

Yes No

Major Depressive or Manic Major Depressive or Manic Episode concurrent with active-Episode concurrent with active-

phase symptomsphase symptoms

Yes No

Total duration of mood Total duration of mood episodes has been brief episodes has been brief

relative to duration of active relative to duration of active and residual periodsand residual periods

Yes No

Duration at least 6 monthsDuration at least 6 months

Yes No

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SchizophreniaSchizophrenia

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Schizophreniform DisorderSchizophreniform Disorder

At least 2 weeks of delusions At least 2 weeks of delusions or hallucinations in the absence or hallucinations in the absence of prominent mood symptomsof prominent mood symptoms

Yes No

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Schizoaffective DisorderSchizoaffective Disorder

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Mood Disorder with Psychotic Mood Disorder with Psychotic Features (see Features (see Mood Disorders tree)

Nonbizarre delusions lasting at Nonbizarre delusions lasting at least 1 monthleast 1 month

Yes No

Total duration of mood episodes Total duration of mood episodes has been brief relative to duration has been brief relative to duration

of delusional periodsof delusional periods

Yes No

Apart from delusions, Apart from delusions, functioning not markedly functioning not markedly

impairedimpaired

Yes No

Delusions occur only Delusions occur only during mood episodesduring mood episodes

Yes No

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Delusional DisorderDelusional Disorder

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Psychotic Disorder Not Psychotic Disorder Not Otherwise SpecifiedOtherwise Specified

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Mood Disorder with Mood Disorder with Psychotic Features (see Psychotic Features (see

Mood Disorders tree)

Duration more than 1 day but Duration more than 1 day but less than 1 monthless than 1 month

Yes No

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Brief Psychotic DisorderBrief Psychotic Disorder

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Psychotic Disorder Not Psychotic Disorder Not Otherwise SpecifiedOtherwise Specified

Depressed, elevated, expansive, or irritable moodDepressed, elevated, expansive, or irritable mood

Due to the direct Due to the direct physiological effects of a physiological effects of a general medical conditiongeneral medical condition

Yes No

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No Mood Disorder (mood No Mood Disorder (mood symptoms that are not clinically symptoms that are not clinically significant)significant)

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Mood Disorder Due to a Mood Disorder Due to a General Medical ConditionGeneral Medical Condition

Due to the direct physiological Due to the direct physiological effects of a substance (i.e., a effects of a substance (i.e., a drug of abuse, a medication, drug of abuse, a medication,

or a toxin)or a toxin)

Yes No

Start Over

Substance-Induced Substance-Induced Mood DisorderMood Disorder

Next

Determine type of present and Determine type of present and past mood episodespast mood episodes

Elevated, expansive, or irritable Elevated, expansive, or irritable mood, at least 1-week duration; mood, at least 1-week duration;

marked impairment or marked impairment or hospitalizationhospitalization

Yes No

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Manic EpisodeManic Episode

Mixed Diagnosis

Elevate, expansive, or irritable Elevate, expansive, or irritable mood, at least 4-day duration; mood, at least 4-day duration; changes observable by others changes observable by others but less severe than a Manic but less severe than a Manic

EpisodeEpisode

Yes No

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Hypomanic EpisodeHypomanic Episode

Mixed Diagnosis

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Major Depressive EpisodeMajor Depressive Episode

Mixed Diagnosis

At least 2 weeks of depressed At least 2 weeks of depressed mood or loss of interest plus mood or loss of interest plus

associated symptoms, and not associated symptoms, and not better accounted for by better accounted for by

Bereavement Bereavement

Yes No

Criteria met for Manic Criteria met for Manic Episode and Major Episode and Major

Depressive Episode nearly Depressive Episode nearly every day for at least 1 weekevery day for at least 1 week

Yes No

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Mixed Diagnosis

Mixed EpisodeMixed Episode

Has ever had a Manic Episode Has ever had a Manic Episode or a Mixed Episodeor a Mixed Episode

Yes No

Psychotic symptoms occur at Psychotic symptoms occur at times other than during Manic times other than during Manic

or Mixed Episodesor Mixed Episodes

Yes No

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Bipolar I DisorderBipolar I Disorder

Occurred exclusively during Occurred exclusively during Schizoaffective Disorder (review Schizoaffective Disorder (review

Psychotic Disorders tree)

Yes No

Start Over

Schizoaffective Disorder, Schizoaffective Disorder, Bipolar TypeBipolar Type

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Bipolar Disorder Not Otherwise Bipolar Disorder Not Otherwise Specified (superimposed on a Specified (superimposed on a

Psychotic Disorder)Psychotic Disorder)

Has ever had a Hypomanic Has ever had a Hypomanic Episode and at least one Major Episode and at least one Major

Depressive EpisodeDepressive Episode

Yes No

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Bipolar II DisorderBipolar II Disorder

2+ years of hypomanic 2+ years of hypomanic symptoms and periods of symptoms and periods of

depressed mooddepressed mood

Yes No

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Cyclothymic DisorderCyclothymic Disorder

Clinically significant Clinically significant manic/hypomanic symptoms manic/hypomanic symptoms that do not meet criteria for a that do not meet criteria for a

specific Bipolar Disorderspecific Bipolar Disorder

Yes No

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Bipolar Disorder NOSBipolar Disorder NOS

Has ever had a Major Has ever had a Major Depressive EpisodeDepressive Episode

Yes No

Psychotic symptoms occur at Psychotic symptoms occur at times other than during Major times other than during Major

Depressive EpisodesDepressive Episodes

Yes No

Start Over

Major Depressive DisorderMajor Depressive Disorder

Occurred exclusively during Occurred exclusively during Schizoaffective Disorder Schizoaffective Disorder

(review (review Psychotic Disorders tree)

Yes No

Start Over

Schizoaffective Disorder, Schizoaffective Disorder, Depressive TypeDepressive Type

Start Over

Depressive Disorder NOS Depressive Disorder NOS (superimposed on Psychotic (superimposed on Psychotic

Disorder)Disorder)

Depressed mood, more days Depressed mood, more days than not, for at least 2 years than not, for at least 2 years with associated symptomswith associated symptoms

Yes No

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Dysthymic DisorderDysthymic Disorder

Depressed mood not meeting Depressed mood not meeting criteria for one of the previous criteria for one of the previous Mood Disorders that develops Mood Disorders that develops

in response to a stressorin response to a stressor

Yes No

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Adjustment Disorder Adjustment Disorder with Depressed Moodwith Depressed Mood

Clinically significant depressive Clinically significant depressive symptoms that do not meet symptoms that do not meet criteria for a specific Mood criteria for a specific Mood

DisorderDisorder

Yes No

Start Over

Depressive Disorder NOSDepressive Disorder NOS

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No Mood Disorder (mood No Mood Disorder (mood symptoms that are not clinically symptoms that are not clinically

significant)significant)

Symptoms of anxiety, fear, avoidance, or Symptoms of anxiety, fear, avoidance, or increased arousalincreased arousal

Due to the direct physiological Due to the direct physiological effects of a general medical effects of a general medical

conditioncondition

Yes No

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Anxiety disorder due to a Anxiety disorder due to a general medical conditiongeneral medical condition

Due to the direct physiological Due to the direct physiological effects of a substance (e.g., a drug effects of a substance (e.g., a drug

of abuse, a medication, a toxin)of abuse, a medication, a toxin)

Yes No

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Substance-Induced Substance-Induced Anxiety DisorderAnxiety Disorder

Recurrent unexpected Panic Recurrent unexpected Panic Attacks plus a month of worry, Attacks plus a month of worry,

concern about attacks, or concern about attacks, or change in behavior change in behavior

Yes No

Agoraphobia, i.e., anxiety about Agoraphobia, i.e., anxiety about being in places from which escape being in places from which escape might be difficult or embarrassing might be difficult or embarrassing

in the event of having a Panic in the event of having a Panic AttackAttack

Yes No

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Panic Disorder with AgoraphobiaPanic Disorder with Agoraphobia

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Panic Disorder Without Panic Disorder Without Agoraphobia Agoraphobia

Agoraphobia, i.e., anxiety about Agoraphobia, i.e., anxiety about being in places from which being in places from which escape might be difficult or escape might be difficult or

embarrassing in the event of embarrassing in the event of having panic-like symptomshaving panic-like symptoms

Yes No

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Agoraphobia without Agoraphobia without History of Panic DisorderHistory of Panic Disorder

Anxiety concerning separation Anxiety concerning separation from attachment figures with from attachment figures with

onset in childhoodonset in childhood

Yes No

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Separation Anxiety DisorderSeparation Anxiety Disorder

Fear of humiliation or Fear of humiliation or embarrassment in social or embarrassment in social or

performance performance

Yes No

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Social Phobia (Social Anxiety Social Phobia (Social Anxiety Disorder)Disorder)

Fear cued by object or situationFear cued by object or situation

Yes No

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Specific PhobiaSpecific Phobia

Obsessions or compulsionsObsessions or compulsions

Yes No

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Obsessive-Compulsive Obsessive-Compulsive DisorderDisorder

6-month period of excessive 6-month period of excessive anxiety and worry plus anxiety anxiety and worry plus anxiety

symptomssymptoms

Yes No

Occurs exclusively during a Occurs exclusively during a Mood or Psychotic DisorderMood or Psychotic Disorder

See mood disorders tree No

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Generalized Anxiety DisorderGeneralized Anxiety Disorder

Anxiety in response to a severe Anxiety in response to a severe traumatic eventtraumatic event

Yes No

Reexperiencing of event, Reexperiencing of event, increased arousal, and increased arousal, and

avoidance of stimuli associated avoidance of stimuli associated with traumatic event with traumatic event

Yes No

Duration of more than 1 monthDuration of more than 1 month

Yes No

No Anxiety Disorder No Anxiety Disorder (symptoms of fear, anxiety, (symptoms of fear, anxiety, or avoidance that are not or avoidance that are not

clinically significant)clinically significant)

Start Over

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Posttraumatic Stress Posttraumatic Stress DisorderDisorder

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Acute Stress DisorderAcute Stress Disorder

Anxiety that does not meet Anxiety that does not meet criteria for one of the above criteria for one of the above

Anxiety Disorders and Anxiety Disorders and develops in response to a develops in response to a

stressorstressor

Yes No

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Adjustment Disorder Adjustment Disorder with Anxietywith Anxiety

Clinically significant symptoms Clinically significant symptoms that do not meet criteria for a that do not meet criteria for a

specific Anxiety Disorderspecific Anxiety Disorder

Yes No

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Anxiety Disorder NOSAnxiety Disorder NOS

Physical Complaints or irrational anxiety about illness or appearancePhysical Complaints or irrational anxiety about illness or appearance

Physical complaints are fully Physical complaints are fully explained by a general medical explained by a general medical condition and complaints are condition and complaints are

not in excess of expectednot in excess of expected

Yes No

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No Anxiety Disorder No Anxiety Disorder (symptoms of fear, anxiety, or (symptoms of fear, anxiety, or

avoidance that are not clinically avoidance that are not clinically significant)significant)

Specific General Medical Specific General Medical Condition (no somatoform Condition (no somatoform

disorder)disorder)

Next

Psychological factors adversely Psychological factors adversely affect general medical affect general medical

conditioncondition

Next

Psychological Factor Psychological Factor Affecting Medical ConditionAffecting Medical Condition

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Physical symptoms are Physical symptoms are intentionally producedintentionally produced

Yes No

External incentives are absentExternal incentives are absent

Yes No

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Factitious DisorderFactitious Disorder

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MalingeringMalingering

History of multiple physical History of multiple physical complaints with at least 4 pain complaints with at least 4 pain symptoms, 2 gastrointestinal symptoms, 2 gastrointestinal

symptoms, 1 sexual symptom, symptoms, 1 sexual symptom, and 1 pseudoneurological and 1 pseudoneurological

symptomsymptom

Yes No

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Somatization DisorderSomatization Disorder

Symptom or deficit affecting Symptom or deficit affecting voluntary motor or sensory voluntary motor or sensory

functionfunction

Yes No

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Conversion DisorderConversion Disorder

Symptom or deficit affecting Symptom or deficit affecting sexual functioningsexual functioning

Yes No

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Sexual DysfunctionSexual Dysfunction

Pain is focus of clinical Pain is focus of clinical attention, and psychological attention, and psychological factors have important rolefactors have important role

Yes No

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Pain DisorderPain Disorder

Other physical complaints Other physical complaints lasting at least 6 monthslasting at least 6 months

Yes No

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Undifferentiated Somatoform Undifferentiated Somatoform DisorderDisorder

Preoccupation with idea of Preoccupation with idea of having a serious diseasehaving a serious disease

Yes No

Belief is of delusional intensityBelief is of delusional intensity

Yes No

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HypochondriasisHypochondriasis

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See See Psychotic Disorders tree

Preoccupation with imagined Preoccupation with imagined defect in appearancedefect in appearance

Yes No

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Body Dysmorphic Disorder (if Body Dysmorphic Disorder (if delusional, also see delusional, also see

Psychotic Disorders tree)

Clinically significant Clinically significant somatoform symptoms that do somatoform symptoms that do not meet criteria for a specific not meet criteria for a specific

Somatoform DisorderSomatoform Disorder

Yes No

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Somatoform Disorder NOSSomatoform Disorder NOS

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No Somatoform Disorder No Somatoform Disorder (somatoform symptoms that (somatoform symptoms that are not clinically significant)are not clinically significant)