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Disorders - P
Borderline pattern
The Padrão borderline specifier may be applied to individuals whose padrão of personality disturbance is characterised by a pervasive padrão of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, as indicated by many of the following: Frantic efforts to avoid real or imagined abandonment; A padrão of unstable and intense interpersonal relationships; Identity disturbance, manifested in markedly and persistently unstable self-image or sense of self; A tendency to act rashly in states of high negative affect, leading to potentially self-damaging behaviours; Recurrent episodes of self-harm; Emotional instability due to marked reactivity of mood; Chronic feelings of emptiness; Inappropriate intense anger or difficulty controlling anger; Transient dissociative symptoms or psychotic-like features in situations of high affective arousal.
Panic attacks in mood episodes
In the context of a atual mood episódio (manic, depressive, mixed, or hypomanic), there have been recurrent panic attacks (i.e., at least two) during the past month that occur specifically in response to anxiety-provoking cognitions that are features of the mood episódio. If panic attacks occur exclusively in response to such thoughts, panic attacks should be recorded using this qualifier rather than assigning an additional co-occurring diagnosis of Transtorno de pânico. If some panic attacks over the course of the depressive or mixed episódio have been unexpected and not exclusively in response to depressive or anxiety-provoking thoughts, a separate diagnosis of Transtorno de pânico should be assigned.
Paraphilic disorder involving solitary behaviour or consenting individuals
Paraphilic transtorno involving solitary behaviour or consenting individuals is characterised by a persistent and intense padrão of atypical sexual arousal — manifested by sexual thoughts, fantasies, urges, or behaviours — that involves consenting adults or solitary behaviours. One of the following two elements must be present: 1) the person is markedly distressed by the nature of the arousal padrão and the distress is not simply a consequence of rejection or feared rejection of the arousal padrão by others; or 2) the nature of the paraphilic behaviour involves significant risk of injury or death either to the individual or to the partner (e.g., asphyxophilia).
Partial dissociative identity disorder
parcial Transtorno dissociativo de identidade is characterised by disruption of identity in which there are two or more distinct personality states (dissociative identities) associated com marked discontinuities in the sense of self and agency. Each personality state includes its own padrão of experiencing, perceiving, conceiving, and relating to self, the body, and the environment. One personality state is dominant and normally functions in daily life, but is intruded upon by one or more non-dominant personality states (dissociative intrusions). These intrusions may be cognitive, affective, perceptual, motor, or behavioural. They are experienced as interfering com the functioning of the dominant personality state and are typically aversive. The non-dominant personality states do not recurrently take executive control of the individual’s consciousness and functioning, but there may be occasional, limited and transient episodes in which a distinct personality state assumes executive control to engage in circumscribed behaviours, such as in response to extreme emotional states or during episodes of self-harm or the reenactment of traumatic memories. The symptoms are not better explained by another mental, behavioural or neurodevelopmental transtorno and are not due to the direct effects of a substance or medication on the central nervous system, including abstinência effects, and are not due to a disease of the nervous system or a sleep-wake transtorno. The symptoms result in significant impairment in personal, family, social, educational, occupational or other important areas of functioning.
Pedophilic disorder
Pedophilic transtorno is characterised by a sustained, focused, and intense padrão of sexual arousal—as manifested by persistent sexual thoughts, fantasies, urges, or behaviours—involving pre-pubertal children. In addition, in order for Pedophilic transtorno to be diagnosed, the individual must have acted on these thoughts, fantasies or urges or be markedly distressed by them. This diagnosis does not apply to sexual behaviours among pre- or post-pubertal children com peers who are close in age.
Personality traits or coping style affecting disorders or diseases classified elsewhere
All diagnostic requirements for Psychological or behavioural factors affecting transtornos or diseases classified elsewhere are met. The individual exhibits personality traits or coping styles that do not meet the diagnostic requirements for a mental, behavioural, or neurodevelopmental transtorno that adversely affect the manifestation, treatment, or course of a transtorno or disease classified in another chapter (e.g., pathological denial of the need for surgery in a patient com cancer; hostile, pressured behaviour contributing to heart disease).
Pica
Pica is characterised by the regular consumption of non-nutritive substances, such as non-food objects and materials (e.g., clay, soil, chalk, plaster, plastic, metal and paper) or raw food ingredients (e.g., large quantities of salt or corn flour) that is persistent or grave enough to require clinical attention in an individual who has reached a developmental age at which they would be expected to distinguish between edible and non-edible substances (approximately 2 years). That is, the behaviour causes damage to health, impairment in functioning, or significant risk due to the frequency, amount or nature of the substances or objects ingested.
Positive symptoms in primary psychotic disorders
Positive symptoms in primary psychotic transtornos include persistent delusions, persistent hallucinations (most commonly verbal auditory hallucinations), disorganised thinking (formal thought transtorno such as loose associations, thought derailment, or incoherence), grossly disorganised behaviour (behaviour that appears bizarre, purposeless and not goal-directed) and experiences of passivity and control (the experience that one's feelings, impulses, or thoughts are under the control of an external force). The rating should be made based on the severity of positive symptoms during the past week.
Possession trance disorder
Possession trance transtorno is characterised by trance states in which there is a marked alteration in the individual’s state of consciousness and the individual’s customary sense of personal identity is replaced by an external ‘possessing’ identity and in which the individual’s behaviours or movements are experienced as being controlled by the possessing agent. Possession trance episodes are recurrent or, if the diagnosis is based on a single episódio, the episódio has lasted for at least several days. The possession trance state is involuntary and unwanted and is not accepted as a part of a collective cultural or religious practice. The symptoms do not occur exclusively during another dissociative transtorno and are not better explained by another mental, behavioural or neurodevelopmental transtorno. The symptoms are not due to the direct effects of a substance or medication on the central nervous system, including abstinência effects, exhaustion, or to hypnagogic or hypnopompic states, and are not due to a disease of the nervous system or a sleep-wake transtorno. The symptoms result in significant distress or significant impairment in personal, family, social, educational, occupational or other important areas of functioning.
Prominent anxiety symptoms in mood episodes
In the context of a atual depressive, manic, mixed, or hypomanic episódio, prominent and clinically significant anxiety symptoms (e.g., feeling nervous, anxious or on edge, not being able to control worrying thoughts, fear that something awful will happen, having trouble relaxing, motor tension, autonomic symptoms) have been present for most of the time during the episódio. If there have been panic attacks during a atual depressive or mixed episódio, these should be recorded separately. When the diagnostic requirements for both a mood transtorno and an anxiety or fear-related transtorno are met, the anxiety or fear-related transtorno should also be diagnosed.
Prominent personality traits or patterns
Trait domain qualifiers may be applied to Personality transtornos or Personality Difficulty to describe the characteristics of the individual’s personality that are most prominent and that contribute to personality disturbance. Trait domains are continuous com normal personality characteristics in individuals who do not have Transtorno de personalidade or Personality Difficulty. Trait domains are not diagnostic categories, but rather represent a set of dimensions that correspond to the underlying structure of personality. As many trait domain qualifiers may be applied as necessary to describe personality functioning. Individuals com more grave personality disturbance tend to have a greater number of prominent trait domains.
Psychological or behavioural factors affecting disorders or diseases classified elsewhere
Psychological and behavioural factors affecting transtornos or diseases classified elsewhere are those that may adversely affect the manifestation, treatment, or course of a condition classified in another chapter of the ICD. These factors may adversely affect the manifestation, treatment, or course of the transtorno or disease classified in another chapter by: interfering com the treatment of the transtorno or disease by affecting treatment adherence or care seeking; constituting an additional health risk; or influencing the underlying pathophysiology to precipitate or exacerbate symptoms or otherwise necessitate medical attention. This diagnosis should be assigned only when the factors increase the risk of suffering, disability, or death and represent a focus of clinical attention, and should be assigned together com the diagnosis for the relevant other condition.
Psychological symptoms affecting disorders or diseases classified elsewhere
All diagnostic requirements for Psychological or behavioural factors affecting transtornos or diseases classified elsewhere are met. The individual exhibits psychological symptoms that do not meet the diagnostic requirements for a mental, behavioural, or neurodevelopmental transtorno that adversely affect the manifestation, treatment, or course of a transtorno or disease classified in another chapter (e.g., depressive symptoms interfering com rehabilitation following surgery).
Psychomotor symptoms in primary psychotic disorders
Psychomotor symptoms in primary psychotic transtornos include psychomotor agitation or excessive motor activity, usually manifested by purposeless behaviours such as fidgeting, shifting, fiddling, inability to sit or stand still, wringing of the hands, psychomotor retardation, or a visible generalised slowing of movements and speech, and catatonic symptoms such as excitement, posturing, waxy flexibility, negativism, mutism, or stupor. The rating should be made based on the severity of psychomotor symptoms during the past week.
Psychotic symptoms in dementia
In addition to the cognitive disturbances characteristic of Demência, the atual clinical picture includes clinically significant delusions or hallucinations.
Psychotic disorder induced by multiple specified psychoactive substances
Psychotic transtorno induced by multiple specified psychoactive substances is characterised by psychotic symptoms (e.g., delusions, hallucinations, disorganised thinking, grossly disorganised behaviour) that develop during or soon after intoxicação com or abstinência from multiple specified psychoactive substances. The intensity or duration of the symptoms is substantially in excess of psychotic-like disturbances of perception, cognition, or behaviour that are characteristic of intoxicação com or abstinência from multiple specified psychoactive substances. The amount and duration of uso of the multiple specified psychoactive substances must be capable of producing psychotic symptoms. The symptoms are not better explained by a primary mental transtorno (e.g., Esquizofrenia, a Mood transtorno com psychotic symptoms), as might be the case if the psychotic symptoms preceded the onset of the uso of the multiple specified psychoactive substances, if the symptoms persist for a substantial period of time after cessation of the uso of the multiple specified psychoactive substances or abstinência from the multiple specified psychoactive substances, or if there is other evidence of a pre-existing primary mental transtorno com psychotic symptoms (e.g., a history of prior episodes not associated com the uso of the multiple specified psychoactive substances).
Psychotic disorder induced by other specified psychoactive substance
Psychotic transtorno induced by outro especificado psychoactive substance is characterised by psychotic symptoms (e.g., delusions, hallucinations, disorganised thinking, grossly disorganised behaviour) that develop during or soon after intoxicação com or abstinência from a specified psychoactive substance. The intensity or duration of the symptoms is substantially in excess of psychotic-like disturbances of perception, cognition, or behaviour that are characteristic of intoxicação com or abstinência from a specified psychoactive substance. The amount and duration of uso of the specified psychoactive substance must be capable of producing psychotic symptoms. The symptoms are not better explained by a primary mental transtorno (e.g., Esquizofrenia, a Mood transtorno com psychotic symptoms), as might be the case if the psychotic symptoms preceded the onset of the uso of the specified psychoactive substance, if the symptoms persist for a substantial period of time after cessation of the uso of the specified psychoactive substance or abstinência from the specified psychoactive substance, or if there is other evidence of a pre-existing primary mental transtorno com psychotic symptoms (e.g., a history of prior episodes not associated com the uso of the specified psychoactive substance).
Psychotic disorder induced by unknown or unspecified psychoactive substance
Psychotic transtorno induced by unknown or não especificado psychoactive substance is characterised by psychotic symptoms (e.g., delusions, hallucinations, disorganised thinking, grossly disorganised behaviour) that develop during or soon after intoxicação com or abstinência from an unknown or não especificado psychoactive substance. The symptoms are not better explained by a primary mental transtorno (e.g., Esquizofrenia, a Mood transtorno com psychotic symptoms), as might be the case if the psychotic symptoms preceded the onset of the uso of the unknown or não especificado psychoactive substance, if the symptoms persist for a substantial period of time after cessation of the uso of the unknown or não especificado psychoactive substance or abstinência from the unknown or não especificado psychoactive substance, or if there is other evidence of a pre-existing primary mental transtorno com psychotic symptoms (e.g., a history of prior episodes not associated com the uso of the unknown or não especificado psychoactive substance).
Pyromania
Pyromania is characterised by a recurrent failure to control strong impulses to set fires, resulting in multiple acts of, or attempts at, setting fire to property or other objects, in the absence of an apparent motive (e.g., monetary gain, revenge, sabotage, political statement, attracting attention or recognition). There is an increasing sense of tension or affective arousal prior to instances of fire setting, persistent fascination or preoccupation com fire and related stimuli (e.g., watching fires, building fires, fascination com firefighting equipment), and a sense of pleasure, excitement, relief or gratification during, and immediately after the act of setting the fire, witnessing its effects, or participating in its aftermath. The behaviour is not better explained by intellectual impairment, another mental and behavioural transtorno, or substance intoxicação.