Cognitive and perceptual Odd or unusual thought processes and experiences, including depersonalization, derealization, and dissociative experiences; mixed sleep-wake state experiences; thought-control experiences.
Proposed criterla sets are presented for conditions on which future research is en- couraged. The specific items, thresholds, and durations contained in these research crite- ria sets were set by expert consensus—informed by literature review, data reanalysis, and field trial results, where available—and are intended to provide a common language for researchers and clinicians who are interested in studying these disorders. It is hoped that such research will allow the field to better understand these conditions and will inform decisions about possible placement in forthcoming editions of DSM. The DSM-S Task
Force and Work Groups subjected each of these proposed criteria sets to a careful empir- ical review and invited wide commentary from the field as well as from the general public.
The Task Force determined that there was insufficient evidence to warrant inclusion of these proposals as official mental disorder diagnoses in Section 11. These proposed criteria sets are not intended for clinical use; only the criteria sets and disorders in Section II of
DSM—5 are officially recognized and can be used for clinical purposes.
A. At least one of the following symptoms is present in attenuated form, with relatively in- tact reality testing, and is of sufficient severity or frequency to warrant clinical attention: 1. Delusions.
2. Hallucinations.
3. Disorganized speech.
B. Symptom(s) must have been present at least once per week for the past month.
C. Symptom(s) must have begun or worsened in the past year.
D. Symptom(s) is sufficiently distressing and disabling to the individual to warrant clinical attention.
E. Symptom(s) is not better explained by another mental disorder, including a depressive or bipolar disorder with psychotic features, and is not attributable to the physiological effects of a substance or another medical condition.
F. Criteria for any psychotic disorder have never been met.
Attenuated psychotic symptoms, as defined in Criterion A, are psychosis—like but below the threshold for a full psychotic disorder. Compared with psychotic disorders, the symptoms are less severe and more transient, and insight is relatively maintained. A diagnosis of atten- uated psychosis syndrome requires state psychopathology associated with functional impairment rather than long-standing trait pathology. The psychopathology has not pro- gressed to full psychotic severity. Attenuated psychosis syndrome is a disorder based on the manifest pathology and impaired function and distress. Changes in experiences and behav- iors are noted by the individual and / or others, suggesting a change in mental state (i.e., the symptoms are of sufficient severity or frequency to warrant clinical attention) (Criterion A).
tent, including persecutory ideas of reference. The individual may have a guarded, distrust- ful attitude. When the delusions are moderate in severity, the individual views others as untrustworthy and may be hypervigilant or sense ill will in others. When the delusions are severe but still within the attenuated range, the individual entertains loosely organized be- liefs about danger or hostile intention, but the delusions do not have the fixed nature that is necessary for the diagnosis of a psychotic disorder. Guarded behavior in the interview can interfere with the ability to gather information. Reality testing and perspective can be elic- ited with nonconfirming evidence, but the propensity for viewing the world as hostile and dangerous remains strong. Attenuated delusions may have grandiose content presenting as an unrealistic sense of superior capacity. When the delusions are moderate, the individual harbors notions of being gifted, inﬂuential, or special. When the delusions are severe, the in- dividual has beliefs of superiority that often alienate friends and worry relatives. Thoughts of being special may lead to unrealistic plans and investments, yet skepticism about these at- titudes can be elicited with persistent questioning and confrontation.