Emotional and behavioral disorders (EBD; sometimes called emotional disturbance or serious emotional disturbance) refer to a disability classification used in educational settings that allows educational institutions to provide special education and related services to students that have poor social or academic adjustment that cannot be better explained by biological abnormalities or a developmental disability.

The classification is often given to students that need individualized behavior supports to receive a free and appropriate public education, but would not be eligible for an individualized education program under another disability category of the Individuals with Disabilities Education Act (IDEA).

The likely course and outcome of mental disorders varies and is dependent on numerous factors related to the disorder itself, the individual as a whole, and the social environment. Some disorders are transient, while others may be more chronic in nature.

Even those disorders often considered the most serious and intractable have varied courses i.e. schizophrenia, psychotic disorders, and personality disorders. Long-term international studies of schizophrenia have found that over a half of individuals recover in terms of symptoms, and around a fifth to a third in terms of symptoms and functioning, with some requiring no medication. At the same time, many have serious difficulties and support needs for many years, although "late" recovery is still possible. The World Health Organization concluded that the long-term studies' findings converged with others in "relieving patients, carers and clinicians of the chronicity paradigm which dominated thinking throughout much of the 20th century."

Around half of people initially diagnosed with bipolar disorder achieve syndromal recovery (no longer meeting criteria for the diagnosis) within six weeks, and nearly all achieve it within two years, with nearly half regaining their prior occupational and residential status in that period. However, nearly half go on to experience a new episode of mania or major depression within the next two years. Functioning has been found to vary, being poor during periods of major depression or mania but otherwise fair to good, and possibly superior during periods of hypomania in Bipolar II.

Emotional dysregulation in children can be associated with externalizing behaviors including

- exhibiting more extreme emotions

- difficulty identifying emotional cues

- difficulty recognizing their own emotions

- focusing on the negative

- difficulty controlling their attention

- being impulsive

- difficulty decreasing their negative emotions

- difficulty calming down when upset

Mental retardation is coded on Axis II of the DSM-IV-TR. The diagnostic criteria necessary in order to diagnose intellectual disability consists of:

There are varying degrees of intellectual disability, which are identified by an IQ test.

Mental retardation, Severity Unspecified: This unspecified diagnosis is given when there is a strong assumption that the child is mentally retarded, but cannot be tested because the individual is too impaired, not willing to take the IQ test or is an infant.

Pediatricians are often the first health professionals to assess and raise suspicions of RAD in children with the disorder. The initial presentation varies according to the child's developmental and chronological age, although it always involves a disturbance in social interaction. Infants up to about 18–24 months "may" present with non-organic failure to thrive and display abnormal responsiveness to stimuli. Laboratory investigations will be unremarkable barring possible findings consistent with malnutrition or dehydration, while serum growth hormone levels will be normal or elevated.

The core feature is severely inappropriate social relating by affected children. This can manifest itself in two ways:

1. Indiscriminate and excessive attempts to receive comfort and affection from any available adult, even relative strangers (older children and adolescents may also aim attempts at peers).

2. Extreme reluctance to initiate or accept comfort and affection, even from familiar adults, especially when distressed.

While RAD is likely to occur in relation to neglectful and abusive treatment, automatic diagnoses on this basis alone cannot be made, as children can form stable attachments and social relationships despite marked abuse and neglect.

The name of the disorder emphasizes problems with attachment but the criteria includes symptoms such as failure to thrive, a lack of developmentally appropriate social responsiveness, apathy, and onset before 8 months.

Behaviors that are apparent in those with internalizing disorders include depression, withdrawal, anxiety, and loneliness. There are also behavioral characteristics involved with internalizing disorders. Some behavioral abnormalities include poor self-esteem, suicidal behaviors, decreased academic progress, and social withdrawal. Internalizing one's problems, like sadness, can cause the problems to grow into larger burdens such as social withdrawal, suicidal behaviors or thoughts, and other unexplained physical symptoms.

Emotional dysregulation in children can be associated with internalizing behaviors including

- exhibiting emotions too intense for a situation

- difficulty calming down when upset

- difficulty decreasing negative emotions

- being less able to calm themselves

- difficulty understanding emotional experiences

- becoming avoidant or aggressive when dealing with negative emotions

- experiencing more negative emotions

Intermittent explosive disorder (sometimes abbreviated as IED) is a behavioral disorder characterized by explosive outbursts of anger and violence, often to the point of rage, that are disproportionate to the situation at hand (e.g., impulsive screaming triggered by relatively inconsequential events). Impulsive aggression is not premeditated, and is defined by a disproportionate reaction to any provocation, real or perceived. Some individuals have reported affective changes prior to an outburst (e.g., tension, mood changes, energy changes, etc.).

The disorder is currently categorized in the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5) under the "Disruptive, Impulse-Control, and Conduct Disorders" category. The disorder itself is not easily characterized and often exhibits comorbidity with other mood disorders, particularly bipolar disorder. Individuals diagnosed with IED report their outbursts as being brief (lasting less than an hour), with a variety of bodily symptoms (sweating, stuttering, chest tightness, twitching, palpitations) reported by a third of one sample. Aggressive acts are frequently reported accompanied by a sensation of relief and in some cases pleasure, but often followed by later remorse.

The current DSM-5 criteria for Intermittent Explosive Disorder include:

- Recurrent outbursts that demonstrate an inability to control impulses, including either of the following:

- Verbal aggression (tantrums, verbal arguments or fights) or physical aggression that occurs twice in a week-long period for at least three months and does not lead to destruction of property or physical injury (Criterion A1)

- Three outbursts that involve injury or destruction within a year-long period (Criterion A2)

- Aggressive behavior is grossly disproportionate to the magnitude of the psychosocial stressors (Criterion B)

- The outbursts are not premeditated and serve no premeditated purpose (Criterion C)

- The outbursts cause distress or impairment of functioning, or lead to financial or legal consequences (Criterion D)

- The individual must be at least six years old (Criterion E)

- The recurrent outbursts cannot be explained by another mental disorder and are not the result of another medical disorder or substance use (Criterion F)

It is important to note that DSM-5 now includes two separate criteria for types of aggressive outbursts (A1 and A2) which have empirical support:

- Criterion A1: Episodes of verbal and/or non damaging, nondestructive, or non injurious physical assault that occur, on average, twice weekly for three months. These could include temper tantrums, tirades, verbal arguments/fights, or assault without damage. This criterion includes high frequency/low intensity outbursts.

- Criterion A2: More severe destructive/assaultive episodes which are more infrequent and occur, on average, three times within a twelve-month period. These could be destroying an object without regard to value, assaulting an animal or individual. This criterion includes high-intensity/low-frequency outbursts.

The internalizing disorders, with high levels of negative affectivity, include depressive disorders, anxiety disorders, obsessive-compulsive and related disorders, trauma and stressor-related disorders, and dissociative disorders. Others like bulimia, and anorexia also come under this category.

Reactive attachment disorder (RAD) is described in clinical literature as a severe and relatively uncommon disorder that can affect children. RAD is characterized by markedly disturbed and developmentally inappropriate ways of relating socially in most contexts. It can take the form of a persistent failure to initiate or respond to most social interactions in a developmentally appropriate way—known as the "inhibited form". Due to recent revision in the DSM-5 the "disinhibited form" is now considered a separate diagnosis named "Disinhibited attachment disorder".

RAD arises from a failure to form normal attachments to primary caregivers in early childhood. Such a failure could result from severe early experiences of neglect, abuse, abrupt separation from caregivers between the ages of six months and three years, frequent change of caregivers, or a lack of caregiver responsiveness to a child's communicative efforts. Not all, or even a majority of such experiences, result in the disorder. It is differentiated from pervasive developmental disorder or developmental delay and from possibly comorbid conditions such as intellectual disability, all of which can affect attachment behavior. The criteria for a diagnosis of a reactive attachment "disorder" are very different from the criteria used in assessment or categorization of attachment "styles" such as insecure or disorganized attachment.

Children with RAD are presumed to have grossly disturbed internal working models of relationships that may lead to interpersonal and behavioral difficulties in later life. There are few studies of long-term effects, and there is a lack of clarity about the presentation of the disorder beyond the age of five years. However, the opening of orphanages in Eastern Europe following the end of the Cold War in the early-1990s provided opportunities for research on infants and toddlers brought up in very deprived conditions. Such research broadened the understanding of the prevalence, causes, mechanism and assessment of disorders of attachment and led to efforts from the late-1990s onwards to develop treatment and prevention programs and better methods of assessment. Mainstream theorists in the field have proposed that a broader range of conditions arising from problems with attachment should be defined beyond current classifications.

Mainstream treatment and prevention programs that target RAD and other problematic early attachment behaviors are based on attachment theory and concentrate on increasing the responsiveness and sensitivity of the caregiver, or if that is not possible, placing the child with a different caregiver. Most such strategies are in the process of being evaluated. Mainstream practitioners and theorists have presented significant criticism of the diagnosis and treatment of alleged reactive attachment disorder or the theoretically baseless "attachment disorder" within the controversial form of psychotherapy commonly known as attachment therapy. Attachment therapy has a scientifically unsupported theoretical base and uses diagnostic criteria or symptom lists markedly different to criteria under ICD-10 or DSM-IV-TR, or to attachment behaviors. A range of treatment approaches are used in attachment "therapy", some of which are physically and psychologically coercive, and considered to be to attachment "theory". Many constitute abuse.

A mental disorder, also called a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such features may be persistent, relapsing and remitting, or occur as a single episode. Many disorders have been described, with signs and symptoms that vary widely between specific disorders. Such disorders may be diagnosed by a mental health professional.

The causes of mental disorders are often unclear. Theories may incorporate findings from a range of fields. Mental disorders are usually defined by a combination of how a person behaves, feels, perceives, or thinks. This may be associated with particular regions or functions of the brain, often in a social context. A mental disorder is one aspect of mental health. Cultural and religious beliefs, as well as social norms, should be taken into account when making a diagnosis.

Services are based in psychiatric hospitals or in the community, and assessments are carried out by psychiatrists, psychologists, and clinical social workers, using various methods but often relying on observation and questioning. Treatments are provided by various mental health professionals. Psychotherapy and psychiatric medication are two major treatment options. Other treatments include social interventions, peer support, and self-help. In a minority of cases there might be involuntary detention or treatment. Prevention programs have been shown to reduce depression.

Common mental disorders include depression, which affects about 400 million, dementia which affects about 35 million, and schizophrenia, which affects about 21 million people globally. Stigma and discrimination can add to the suffering and disability associated with mental disorders, leading to various social movements attempting to increase understanding and challenge social exclusion.

Separation anxiety disorder

- excessive stress when separated from home or family

- fear of being alone

- refusal to sleep alone

- clinginess

- excessive worry about safety

- excessive worry about getting lost

- frequent medical complaints with no cause

- refusal to go to school

Selective mutism

- unable to speak in certain social situations, even though they are comfortable speaking at home or with friends

- difficulty maintaining eye contact

- may have blank facial expressions

- stiff body movements

- may have a worrisome personality

- may be incredibly sensitive to sound

- difficulty with verbal and non-verbal expression

- may appear shy, when in reality, they have a fear of people.

Reactive attachment disorder of infancy or early childhood

- withdrawing from others

- aggressive attitude towards peers

- awkwardness or discomfort

- watching others but not engaging in social interaction

Stereotypic movement disorder

- head banging

- nail biting

- hitting or biting oneself

- hand waving or shaking

- rocking back and forth

In the DSM-5 the disorder has been renamed somatic symptom disorder (SSD), and includes SSD with predominantly somatic complaints (previously referred to as somatization disorder), and SSD with pain features (previously known as pain disorder).

Borderline personality disorder may be characterized by the following signs and symptoms:

- Markedly disturbed sense of identity

- Frantic efforts to avoid real or imagined abandonment and extreme reactions to such

- Splitting ("black-and-white" thinking)

- Impulsivity and impulsive or dangerous behaviours

- Intense or uncontrollable emotional reactions that often seem disproportionate to the event or situation

- Unstable and chaotic interpersonal relationships

- Self-damaging behavior

- Distorted self-image

- Dissociation

- Frequently accompanied by depression, anxiety, anger, substance abuse, or rage

The most distinguishing symptoms of BPD are marked sensitivity to rejection or criticism, and intense fear of possible abandonment. Overall, the features of BPD include unusually intense sensitivity in relationships with others, difficulty regulating emotions, and impulsivity. Other symptoms may include feeling unsure of one's personal identity, morals, and values; having paranoid thoughts when feeling stressed; dissociation and depersonalization; and, in moderate to severe cases, stress-induced breaks with reality or psychotic episodes.

Avoidant individuals often choose jobs of isolation so that they do not have to interact with the public regularly, due to their anxiety and fear of embarrassing themselves in front of others. Some with this disorder may fantasize about idealized, accepting, and affectionate relationships, due to their desire to belong. Individuals with the disorder tend to describe themselves as uneasy, anxious, lonely, unwanted and isolated from others. They often feel themselves unworthy of the relationships they desire, so they shame themselves from ever attempting to begin them.

People with avoidant personality disorder are preoccupied with their own shortcomings and form relationships with others only if they believe they will not be rejected. Loss and social rejection are so painful that these individuals will choose to be alone rather than risk trying to connect with others (see rejection sensitivity). They often view themselves with contempt, while showing an increased inability to identify traits within themselves that are generally considered as positive within their societies.

- Hypersensitivity to rejection and criticism

- Self-imposed social isolation

- Extreme shyness or anxiety in social situations, though the person feels a strong desire for close relationships

- Avoids physical contact because it has been associated with an unpleasant or painful stimulus

- Feelings of inadequacy

- Drastically reduced or absent self-esteem

- Self-loathing, autophobia or self-harm

- Mistrust of others or oneself; exhibits heightened self-doubt

- Emotional distancing related to intimacy

- Highly self-conscious

- Self-critical about their problems relating to others

- Heightened attachment-related anxiety, which may include a fear of abandonment

- Problems in occupational functioning

- Lonely self-perception, although others may find the relationship with them meaningful

- Feeling inferior to others

- Substance abuse and/or dependence

- In some extreme cases, agoraphobia

- Uses fantasy as a form of escapism to interrupt painful thoughts

Whereas vanity involves a quest to aggrandize the appearance, BDD is experienced as a quest to merely normalize the appearance. Although delusional in about one of three cases, the appearance concern is usually nondelusional, an overvalued idea.

The bodily area of focus can be nearly any, yet is commonly face, hair, stomach, thighs, or hips. Some half dozen areas can be a roughly simultaneous focus. Many seek dermatological treatment or cosmetic surgery, which typically do not resolve the distress. On the other hand, attempts at self-treatment, as by skin picking, can create lesions where none previously existed.

BDD shares features with obsessive-compulsive disorder, but involves more depression and social avoidance. BDD often associates with social anxiety disorder. Some experience delusions that others are covertly pointing out their flaws. Cognitive testing and neuroimaging suggest both a bias toward detailed visual analysis and a tendency toward emotional hyperarousal.

Most generally, one experiencing BDD ruminates over the perceived bodily defect up to several hours daily, uses either social avoidance or camouflaging with cosmetics or apparel, repetitively checks the appearance, compares it to that of other persons, and might often seek verbal reassurances. One might sometimes avoid mirrors, repetitively change outfits, groom excessively, or restrict eating.

BDD's severity can wax and wane, and flareups tend to yield absences from school, work, or socializing, sometimes leading to protracted social isolation, with some becoming housebound for extended periods. Social impairment is usually greatest, sometimes approaching avoidance of all social activities. Poor concentration and motivation impair academic and occupational performance. The distress of BDD tends to exceed that of either major depressive disorder or type-2 diabetes, and rates of suicidal ideation and attempts are especially high.

Somatization disorder (also Briquet's syndrome) is a mental disorder characterized by recurring, multiple, and current, clinically significant complaints about somatic symptoms, although it is no longer considered a clinical diagnosis. It was recognized in the DSM-IV-TR classification system, but in the latest version DSM-5, it was combined with undifferentiated somatoform disorder to become "somatic symptom disorder", a diagnosis which no longer requires a specific number of somatic symptoms. ICD-10, the latest version of the International Statistical Classification of Diseases and Related Health Problems, still includes somatization syndrome.

International Statistical Classification of Diseases and Related Health Problems, mostly known as "ICD", assigns codes to classify diseases, symptoms, complaints, social behaviors, injuries, and such medical-related findings.

ICD 10 classifies adjustment disorders under F40-F48 and under neurotic, stress-related and somatoform disorders.

People with BPD may feel emotions with greater ease, depth and for a longer time than others do. A core characteristic of BPD is affective instability, which generally manifests as unusually intense emotional responses to environmental triggers, with a slower return to a baseline emotional state. People with BPD often engage in idealization and devaluation of others, alternating between high positive regard for people and great disappointment in them. In Marsha Linehan's view, the sensitivity, intensity, and duration with which people with BPD feel emotions have both positive and negative effects. People with BPD are often exceptionally enthusiastic, idealistic, joyful, and loving. However, they may feel overwhelmed by negative emotions ("anxiety, depression, guilt/shame, worry, anger, etc."), experiencing intense grief instead of sadness, shame and humiliation instead of mild embarrassment, rage instead of annoyance, and panic instead of nervousness.

People with BPD are also especially sensitive to feelings of rejection, criticism, isolation, and perceived failure. Before learning other coping mechanisms, their efforts to manage or escape from their very negative emotions may lead to emotional isolation, self-injury or suicidal behavior. They are often aware of the intensity of their negative emotional reactions and, since they cannot regulate them, they shut them down entirely. This can be harmful to people with BPD, since negative emotions alert people to the presence of a problematic situation and move them to address it which the person with BPD would normally be aware of only to cause further distress. People with BPD may feel emotional relief after cutting themselves.

While people with BPD feel euphoria (ephemeral or occasional intense joy), they are especially prone to dysphoria (a profound state of unease or dissatisfaction), depression, and/or feelings of mental and emotional distress. Zanarini et al. recognized four categories of dysphoria that are typical of this condition: extreme emotions, destructiveness or self-destructiveness, feeling fragmented or lacking identity, and feelings of victimization. Within these categories, a BPD diagnosis is strongly associated with a combination of three specific states: feeling betrayed, "feeling like hurting myself", and feeling out of control. Since there is great variety in the types of dysphoria experienced by people with BPD, the amplitude of the distress is a helpful indicator of borderline personality disorder. In addition to intense emotions, people with BPD experience emotional "lability"; or in other words, changeability. Although the term emotional lability suggests rapid changes between depression and elation, the mood swings in people with this condition actually fluctuate more frequently between anger and anxiety and between depression and anxiety.

The IDEA requires that a student must exhibit one or more of the following characteristics over a long duration, and to a marked degree that adversely affects their educational performance, to receive an EBD classification:

- Difficulty to learn that cannot be explained by intellectual, sensory, or health factors.

- Difficulty to build or maintain satisfactory interpersonal relationships with peers and teachers.

- Inappropriate types of behavior (acting out against self or others) or feelings (expresses the need to harm self or others, low self-worth, etc.) under normal circumstances.

- A general pervasive mood of unhappiness or depression.

- A tendency to develop physical symptoms or fears associated with personal or school problems.

The term "EBD" includes students diagnosed with schizophrenia, but does not apply to students who are "socially maladjusted", unless it is determined that they also meet the criteria for an EBD classification.

Estimates of prevalence and gender distribution have varied widely via discrepancies in diagnosis and reporting. In American psychiatry, BDD gained diagnostic criteria in the "DSM-IV", but clinicians' knowledge of it, especially among general practitioners, is constricted. Meanwhile, shame about having the bodily concern, and fear of the stigma of vanity, makes many hide even having the concern.

Via shared symptoms, BDD is commonly misdiagnosed as social-anxiety disorder, obsessive-compulsive disorder, major depressive disorder, or social phobia. Correct diagnosis can depend on specialized questioning and correlation with emotional distress or social dysfunction. Estimates place the Body Dysmorphic Disorder Questionnaire's sensitivity at 100% (0% false negatives) and specificity at 92.5% (7.5% false positives).

Personality disorders (PD) are a class of mental disorders characterized by enduring maladaptive patterns of behavior, cognition, and inner experience, exhibited across many contexts and deviating markedly from those accepted by the individual's culture. These patterns develop early, are inflexible, and are associated with significant distress or disability. The definitions may vary somewhat, according to source. Official criteria for diagnosing personality disorders are listed in the "Diagnostic and Statistical Manual of Mental Disorders" (DSM) and the of the "International Classification of Diseases" (ICD). The DSM-5 lists personality disorders in the same way as other mental disorders, rather than on a separate 'axis', as previously.

Personality, defined psychologically, is the set of enduring behavioral and mental traits that distinguish between individual humans. Hence, personality disorders are defined by experiences and behaviors that differ from societal norms and expectations. Those diagnosed with a personality disorder may experience difficulties in cognition, emotiveness, interpersonal functioning, or impulse control. In general, personality disorders are diagnosed in 40–60% of psychiatric patients, making them the most frequent of psychiatric diagnoses.

Personality disorders are characterized by an enduring collection of behavioral patterns often associated with considerable personal, social, and occupational disruption. Personality disorders are also inflexible and pervasive across many situations, largely due to the fact that such behavior may be ego-syntonic (i.e. the patterns are consistent with the ego integrity of the individual) and are therefore perceived to be appropriate by that individual. This behavior can result in maladaptive coping skills and may lead to personal problems that induce extreme anxiety, distress, or depression. These behaviour patterns are typically recognized in adolescence, the beginning of adulthood or sometimes even childhood and often have a pervasive negative impact on the quality of life.

Many issues occur with classifying a personality disorder. Because the theory and diagnosis of personality disorders occur within prevailing cultural expectations, their validity is contested by some experts on the basis of inevitable subjectivity. They argue that the theory and diagnosis of personality disorders are based strictly on social, or even sociopolitical and economic considerations.

The basis of the diagnosis is the presence of a precipitating stressor and a clinical evaluation of the possibility of symptom resolution on removal of the stressor due to the limitations in the criteria for diagnosing AD. In addition, the diagnosis of AD is less clear when patients are exposed to stressors long-term, because this type of exposure is associated with AD and major depressive disorder (MDD) and generalized anxiety disorder (GAD).

Some signs and criteria used to establish a diagnosis are important. First, the symptoms must clearly follow a stressor. The symptoms should be more severe than would be expected. There should not appear to be other underlying disorders. The symptoms that are present are not part of a normal grieving for the death of family member or other loved one.

Adjustment disorders have the ability to be self-limiting. Within five years of when they are originally diagnosed, approximately 20%–50% of the sufferers go on to be diagnosed with psychiatric disorders that are more serious.

The core symptom of depersonalization-derealization disorder is the subjective experience of "unreality in one's self", or detachment from one's surroundings. People who are diagnosed with depersonalization also experience an urge to question and think critically about the nature of reality and existence.

Individuals who experience depersonalization can feel divorced from their own personal physicality by sensing their body sensations, feelings, emotions and behaviors as not belonging to themselves. As such, a recognition of one's self breaks down. Depersonalization can result in very high anxiety levels, which can intensify these perceptions even further.

Individuals with depersonalization describe feeling disconnected from their physicality; feeling as if they are not completely occupying their own body; feeling as if their speech or physical movements are out of their control; feeling detached from their own thoughts or emotions; and experiencing themselves and their lives from a distance. While depersonalization involves detachment from one's "self", individuals with derealization feel detached from their "surroundings", as if the world around them is foggy, dreamlike, or visually distorted. Some people with depersonalization disorder also have visual alterations such as rapid fluctuations in light. While the exact cause of these perceptual changes has not been determined, it is thought that they may be due to previous drug use. These perceptual changes differ from true hallucinatory phenomena, as they are closer to being optical distortions or illusions rather than psychotic breaks from reality. Individuals with the disorder commonly describe a feeling as though time is "passing" them by and they are not in the notion of the present. These experiences which strike at the core of a person's identity and consciousness may cause a person to feel uneasy or anxious.

Factors that tend to diminish symptoms are comforting personal interactions, intense physical or emotional stimulation, and relaxation. Distracting oneself (by engaging in conversation or watching a movie, for example) may also provide temporary relief. Some other factors that are identified as relieving symptom severity are diet and/or exercise, while alcohol and fatigue are listed by some as worsening their symptoms.

First experiences with depersonalization may be frightening, with patients fearing loss of control, dissociation from the rest of society and functional impairment. The majority of people with depersonalization-derealization disorder misinterpret the symptoms, thinking that they are signs of serious psychosis or brain dysfunction. This commonly leads to an increase of anxiety experienced by the patient, and obsession, which contributes to the worsening of symptoms.

Occasional, brief moments of mild depersonalization can be experienced by many members of the general population; however, depersonalization-derealization disorder occurs when these feelings are strong, severe, persistent, or recurrent and when these feelings interfere with daily functioning.