Reference
Guide | Reference

120  Appendix G: Common Failure Modes

Purpose. Reduce common misreads that lead to premature or incorrect labels. Provide quick guardrails without adding workflow. Optional reference material; not required for routine use.

120.1 Common Failure Modes (quick scan)

120.1.1 Panic-like symptoms vs medical or substance effects

  • Look for: acute medical red flags, syncope, abnormal vitals, recent stimulant use, withdrawal.
  • Guardrail: document competing explanations and use rule-out compendium as needed.

120.1.2 Trauma hyperarousal vs psychosis

  • Look for: context-linked intrusions, dissociation, preserved insight vs fixed delusions or formal thought disorder.
  • Guardrail: avoid hard labeling on a single encounter; note uncertainty.

120.1.3 Executive dysfunction vs mood episode

  • Look for: long-standing attention problems, sleep/circadian disruption, medication effects.
  • Guardrail: rate domains separately before assuming a primary mood episode.

120.1.4 Grief response vs mood episode

  • Look for: loss-linked sadness, preserved positive affect, fluctuating intensity.
  • Guardrail: document time-course and context; avoid premature pathologizing.

120.1.5 Neurodevelopmental traits vs personality pathology

  • Look for: early-onset social communication differences, sensory sensitivity, stable trait profile.
  • Guardrail: do not assign personality labels without developmental history.

120.1.6 Sleep or circadian disruption as primary driver

  • Look for: delayed sleep phase, insomnia preceding mood or threat symptoms.
  • Guardrail: treat sleep as a contributor before final labeling.

120.1.7 Substance or medication effects vs primary syndrome

  • Look for: symptom onset after initiation or dose change, intoxication, withdrawal.
  • Guardrail: label as contributor and reassess once stabilized.

120.2 Documentation Guardrails

  • Use “competing explanations” and “provisional” labels when uncertain.
  • Record confidence level and a planned reassessment interval.