Mental Disorders

• Author: Thomas E. Bush/David A. Morton III/David Traver/Sarah H. Bohr/Curtis J. Fisher/Kimberly V. Cheiken
• Pages: 377-502

12-377

Chapter 12

Mental Disorders

Part I – Adults

§12.00 Mental Disorders

§12.01 Category of Impairments, Mental

§12.02 Organic Mental Disorders

§12.03 Schizophrenic, Paranoid and Other Psychotic Disorders

§12.04 Affective Disorders

§12.05 Intellectual Disability

§12.06 Anxiety-Related Disorders

§12.07 Somatoform Disorders

§12.08 Personality Disorders

§12.09 Substance Addiction Disorders

§12.10 Autistic and Other Pervasive Developmental Disorders

Part II – Children

§112.00 Mental Disorders

§112.01 Category of Impairments, Mental

§112.02 Organic Mental Disorders

§112.03 Schizophrenic, Paranoid, and Other Psychotic Disorders

§112.04 Mood Disorders

§112.05 Intellectual Disability

§112.06 Anxiety Disorders

§112.07 Somatoform, Eating, and Tic Disorders

§112.08 Personality Disorders

§112.09 Psychoactive Substance Dependence Disorders

§112.10 Autistic and Other Pervasive Developmental Disorders

§112.11 Attention Deficit Hyperactivity Disorder

§112.12 Developmental and Emotional Disorders of Newborn and Younger Infants

Part III – Forms

§12.02F Organic Mental Disorders

§12.03F Schizophrenia, Paranoid and Other Psychotic Mental Disorders

§12.04F Affective Disorders

§12.05F Mental Retardation and Subaverage Intellectual Functioning

§12.06F Anxiety-Related Disorders

§12.07F Somatoform or Eating Disorders

§12.08F Personality Disorders

§12.09F Substance Addiction Disorders

§12.10F Autistic and Other Pervasive Development Disorders

§112.11F Attention Deficit Hyperactivity Disorder

§112.12F Development and Emotional Disorders of Newborn and Younger Infants

Long Forms on Digital Access Only

§12.02F(L) Organic Mental Disorders

§12.03F(L) Schizophrenia, Paranoid and Other Psychotic Mental Disorders

§12.04F(L) Affective Disorders

§12.05F(L) Mental Retardation and Subaverage Intellectual Functioning

§12.06F(L) Anxiety-Related Disorders

§12.07F(L) Somatoform or Eating Disorders

§12.08F(L) Personality Disorders

§12.09F(L) Substance Addiction Disorders

§12.10F(L) Autistic and Other Pervasive Development Disorders

§112.11F(L) Attention Deficit Hyperactivity Disorder

§112.12F(L) Development and Emotional Disorders of Newborn and Younger Infants

(See Forms 12.02, 12.03, 12.04, 12.05, 12.06, 12.07, 12.08, 12.09, 12.10, 12.11, 12.12 to solicit treating source medical information relevant

to the above adult and corresponding child listings.)

§12.00 SOCIAL SECURITY DISABILITY COLLECTION 378

Form Reference:

See Forms 12.02, 12.03, 12.04, 12.05, 12.06, 12.07, 12.08,

12.09, 12.10, 12.11, 12.12 to solicit treating source medical infor-

mation relevant to the above adult and corresponding child listings.

General Legal Text Cross-References:

See Bohr’s Social Security Issues Annotated (James Publishing),

§312, regarding specific court cases involving mental impairments.

Part I – Adults

§12.00 Mental Disorders

[The applicable Listing of Impairments introduces each chapter

and is typeset in Helvetica. Author comments follow each Listing

subsection and are typeset in Times.]

SSA Listing of Impairments

A. Introduction: The evaluation of disability on the basis of men-

tal disorders requires documentation of a medically determinable

impairment(s), consideration of the degree of limitation such im-

pairment(s) may impose on the individual’s ability to work, and

consideration of whether these limitations have lasted or are expect-

ed to last for a continuous period of at least 12 months. The listings

for mental disorders are arranged in nine diagnostic categories: Or-

ganic mental disorders (listing 12.02); schizophrenic, paranoid and

other psychotic disorders (listing 12.03); affective disorders (listing

12.04); mental retardation1 (listing 12.05); anxiety-related disorders

(listing 12.06); somatoform disorders (listing 12.07); personality dis-

orders (listing 12.08); substance addiction disorders (listing 12.09);

and autistic disorder and other pervasive developmental disorders

(listing 12.10).

Each listing, except listings 12.05 and 12.09, consists of a state-

ment describing the disorder(s) addressed by the listing, paragraph

A1b criteria (a set of medical findings), and paragraph B criteria (a

set of impairment-related functional limitations). There are addition-

al functional criteria (paragraph C criteria) in listings 12.02, 12.03,

12.04, and 12.06 discussed herein. We will assess the paragraph B

criteria before we apply the paragraph C criteria. We will assess the

paragraph C criteria only if we find that the paragraph B criteria are

not satisfied. We will find that you have a listed impairment if the

diagnostic description in the introductory paragraph and the criteria

of both paragraphs A and B (or A and C, when appropriate) of the

listed impairment are satisfied.

The criteria in paragraph A substantiate medically the presence

of a particular mental disorder. Specific symptoms, signs, and lab-

oratory findings in the paragraph A criteria of any of the listings in

this section cannot be considered in isolation from the description

of the mental disorder contained at the beginning of each listing

category. Impairments should be analyzed or reviewed under the

mental category(ies) indicated by the medical findings. However,

we may also consider mental impairments under physical body sys-

tem listings, using the concept of medical equivalence, when the

mental disorder results in physical dysfunction. (See, for instance,

§12.00D.1.2 regarding the evaluation of anorexia nervosa and other

eating disorders.)

The criteria in paragraphs B and C describe impairment-related

functional limitations that are incompatible with the ability to do any

gainful activity. The functional limitations in paragraphs B and C

must be the result of the mental disorder described in the diagnostic

description, which is manifested by the medical findings in para-

graph A. The structure of the listing for mental retardation (listing

12.05) is different from that of the other mental disorders listings.

Listing 12.05 contains an introductory paragraph with the diagnos-

tic description for mental retardation. It also contains four sets of

criteria (paragraphs A through D). If your impairment satisfies the

diagnostic description in the introductory paragraph and any one

of the four sets of criteria, we will find that your impairment meets

the listing. Paragraphs A and B contain criteria that describe disor-

ders we consider severe enough to prevent your doing any gainful

activity without any additional assessment of func-

tional limitations. For paragraph C, we will assess the degree of

functional limitation the additional impairment(s) imposes to deter-

mine if it significantly limits your physical or mental ability to do

basic work activities, i.e., is a “severe” impairment(s), as defined in

§§404.1520(c) and 416.920(c). If the additional impairment(s) does

not cause limitations that are “severe” as defined in §§404.1520(c)

and 416.920(c), we will not find that the additional impairment(s)

imposes “an additional and significant work-related limitation of

function,” even if you are unable to do your past work because of

the unique features of that work. Paragraph D contains the same

functional criteria that are required under paragraph B of the other

mental disorders listings.

The structure of the listing for substance addiction disorders, list-

ing 12.09, is also different from that for the other mental disorder

listings. Listing 12.09 is structured as a reference listing; that is, it

will only serve to indicate which of the other listed mental or physi-

cal impairments must be used to evaluate the behavioral or physical

changes resulting from regular use of addictive substances.

The listings are so constructed that an individual with an im-

pairment(s) that meets or is equivalent in severity to the criteria of a

listing could not reasonably be expected to do any gainful activity.

These listings are only examples of common mental disorders that

are considered severe enough to prevent an individual from doing

any gainful activity. When you have a medically determinable severe

mental impairment that does not satisfy the diagnostic description or

the requirements of the paragraph A criteria of the relevant listing,

the assessment of the paragraph B and C criteria is critical to a de-

termination of equivalence. If your impairment(s) does not meet or

is not equivalent in severity to the criteria of any listing, you may

or may not have the residual functional capacity (RFC) to do sub-

stantial gainful activity (SGA). The determination of mental RFC

is crucial to the evaluation of your capacity to do SGA when your

impairment(s) does not meet or equal the criteria of the listings, but

is nevertheless severe.

RFC is a multidimensional description of the work-related abili-

ties you retain in spite of your medical impairments. An assessment

of your RFC complements the functional evaluation necessary for

paragraphs B and C of the listings by requiring consideration of

an expanded list of work-related capacities that may be affected

by mental disorders when your(s) impairment is severe but neither

meets nor is equivalent in severity to a listed mental disorder.

B. Need for Medical Evidence: We must establish the existence

of a medically determinable impairment(s) of the required duration

by medical evidence consisting of symptoms, signs, and laborato-

ry findings (including psychological test findings). Symptoms are

your own description of your physical or mental impairment(s). Psy-

chiatric signs are medically demonstrable phenomena that indicate

1 The SSA renamed the mental retardation Listings 12.05 and 112.05 “Intellectual Disability” per FR Vol. 78 No. 148, 8-1-2013, effective 9-3-13. The terms

should be taken to mean the same thing, and despite SSA’s change, “mental retardation” is still widely used and present in medical records.

1b The SSA calls the various parts of a listing “paragraphs.” Perhaps this decision was to avoid confusion with various parts of federal regulations, e.g., Parts

404, 416, etc. However, in a book like this with its added and various explanatory text paragraphs, use of the word “paragraphs” for parts of listings would be

worse in regard to potential confusion. Therefore, this book uses the word “part” for the various parts of listings. However, where the source of text is federal,

the word “paragraph” has been retained.

379 MENTAL DISORDERS §12.00

specific psychological abnormalities, e.g., abnormalities of behavior,

mood, thought, memory, orientation, development, or perception, as

described by an appropriate medical source. Symptoms and signs

generally cluster together to constitute recognizable mental disorders

described in the listings. The symptoms and signs may be intermit-

tent or continuous depending on the nature of the disorder.

C. Assessment of Severity: We measure severity according to the

functional limitations imposed by your medically determinable men-

tal impairment(s). We assess functional limitations using the four

criteria in paragraph B of the listings: activities of daily living; social

functioning; concentration, persistence, or pace; and episodes of de-

compensation. Where we use “marked” as a standard for measuring

the degree of limitation, it means more than moderate but less than

extreme. A marked limitation may arise when several activities or

functions are impaired, or even when only one is impaired, as long

as the degree of limitation is such as to interfere seriously with your

ability to function independently, appropriately, effectively, and on

a sustained basis. See §§404.1520a and 416.920a.

1. Activities of daily living include adaptive activities such as clean-

ing, shopping, cooking, taking public transportation, paying bills,

maintaining a residence, caring appropriately for your grooming and

hygiene, using telephones and directories, and using a post office. In

the context of your overall situation, we assess the quality of these

activities by their independence, appropriateness, effectiveness, and

sustainability. We will determine the extent to which you are capable

of initiating and participating in activities independent of supervi-

sion or direction.

We do not define “marked” by a specific number of activities of

daily living in which functioning is impaired, but by the nature and

overall degree of interference with function. For example, if you

do a wide range of activities of daily living, we may still find that

you have a marked limitation in your daily activities if you have

serious difficulty performing them without direct supervision, or in

a suitable manner, or on a consistent, useful, routine basis, or without

undue interruptions or distractions.

2. Social functioning refers to your capacity to interact independent-

ly, appropriately, effectively, and on a sustained basis with other

individuals. Social functioning includes the ability to get along with

others, such as family members, friends, neighbors, grocery clerks,

landlords, or bus drivers. You may demonstrate impaired social func-

tioning by, for example, a history of altercations, evictions, firings,

fear of strangers, avoidance of interpersonal relationships, or social

isolation. You may exhibit strength in social functioning by such

things as your ability to initiate social contacts with others, commu-

nicate clearly with others, or interact and actively participate in group

activities. We also need to consider cooperative behaviors, consider-

ation for others, awareness of others’ feelings, and social maturity.

Social functioning in work situations may involve interactions with

the public, responding appropriately to persons in authority (e.g., su-

pervisors), or cooperative behaviors involving coworkers.

We do not define “marked” by a specific number of different

behaviors in which social functioning is impaired, but by the nature

and overall degree of interference with function. For example, if you

are highly antagonistic, uncooperative, or hostile but are tolerated by

local storekeepers, we may nevertheless find that you have a marked

limitation in social functioning because that behavior is not accept-

able in other social contexts.

3. Concentration, persistence and pace refer to the ability to sus-

tain focused attention and concentration long enough to permit the

timely and appropriate completion of tasks commonly found in work

settings. Limitations in concentration, persistence, or pace are best

observed in work settings, but may also be reflected by limitations

in other settings. In addition, major limitations in this area can often

be assessed through clinical examination or psychological testing.

Wherever possible, however, a mental status examination or psycho-

logical test data should be supplemented by other available evidence.

On mental status examinations, concentration is assessed by

tasks such as having you subtract serial sevens or serial threes from

100.2 In psychological tests of intelligence or memory, concentration

is assessed through tasks requiring short-term memory or through

tasks that must be completed within established time limits.

In work evaluations, concentration, persistence, or pace is as-

sessed by testing your ability to sustain work using appropriate

production standards, in either real or simulated work tasks (e.g.,

filing index cards, locating telephone numbers, or disassembling and

reassembling objects). Strengths and weaknesses in areas of concen-

tration and attention can be discussed in terms of your ability to work

at a consistent pace for acceptable periods of time and until a task is

completed, and your ability to repeat sequences of action to achieve

a goal or an objective.

We must exercise great care in reaching conclusions about your

ability or inability to complete tasks under the stresses of employ-

ment during a normal workday or workweek based on a time-limited

mental status examination or psychological testing by a clinician, or

based on your ability to complete tasks in other settings that are less

demanding, highly structured, or more supportive. We must assess

your ability to complete tasks by evaluating all the evidence, with an

emphasis on how independently, appropriately, and effectively you

are able to complete tasks on a sustained basis.

We do not define “marked” by a specific number of tasks that

you are unable to complete, but by the nature and overall degree of

interference with function. You may be able to sustain attention and

persist at simple tasks but may still have difficulty with complicated

tasks. Deficiencies that are apparent only in performing complex

procedures or tasks would not satisfy the intent of this paragraph B

criterion. However, if you can complete many simple tasks, we may

nevertheless find that you have a marked limitation in concentra-

tion, persistence, or pace if you cannot complete these tasks without

extra supervision or assistance, or in accordance with quality and

accuracy standards, or at a consistent pace without an unreasonable

number and length of rest periods, or without undue interruptions

or distractions.

4. Episodes of decompensation are exacerbations or temporary in-

creases in symptoms or signs accompanied by a loss of adaptive

functioning, as manifested by difficulties in performing activities of

daily living, maintaining social relationships, or maintaining con-

centration, persistence, or pace. Episodes of decompensation may be

demonstrated by an exacerbation in symptoms or signs that would

ordinarily require increased treatment or a less stressful situation

(or a combination of the two). Episodes of decompensation may

be inferred from medical records showing significant alteration in

medication; or documentation of the need for a more structured

psychological support system (e.g., hospitalizations, placement in

a halfway house, or a highly structured and directing household); or

other relevant information in the record about the existence, severity,

and duration of the episode.

The term repeated episodes of decompensation, each of extended

duration in these listings means three episodes within 1 year, or an

average of once every 4 months, each lasting for at least 2 weeks. If

you have experienced more frequent episodes of shorter duration or

less frequent episodes of longer duration, we must use judgment to

determine if the duration and functional effects of the episodes are

of equal severity and may be used to substitute for the listed finding

in a determination of equivalence.

2 Subtraction of serial 7’s cannot be done by most mentally healthy people, a fact not generally appreciated. At least one study showed that most healthy

high school students cannot do so and, in the author’s experience, most adults cannot do so either. At the other extreme, there are people of very advanced age

who can serially subtract 7’s in their head without error.