Mental Disorder Listings 12.02-12.04

Understanding SSA’s mental disorder listings is critical to successful SSI/SSDI applications. In this article, we will review the key medical criteria required for listings 12.02 through 12.04. You can also find the listings on SSA’s website here.

Meeting Listings 12.02, 12.03, and 12.04
To meet these listings, the applicant must meet the criteria outlined in Parts A and B or Parts A and C. This article will cover the criteria required for Part A. Articles 5.2-5.8 cover the criteria required for Part B and Article 4.2 covers the criteria required for Part C.
 
  1. Medical criteria that must be present in the medical evidence
  2. Functional criteria that is assessed on a five-point rating scale from “none” to “extreme”
  3. Criteria used to evaluate “serious and persistent mental disorders”
12.02 Neurocognitive disorders
Overview
These disorders are characterized by a clinically significant decline in cognitive functioning. These generally involve damage to the brain, which may have been caused by a head injury related to an accident, an assault, abuse, or combat. They can also result from some serious health problems or extensive alcohol & other drug use
 
For more information on brain injuries, visit our article: Brain Injury Awareness and Education Resources
Symptoms may include (but are not limited to)
  • Disturbances in: memory, executive functioning, visual-spatial functioning, language and speech, perception, insight, or judgment
  • Insensitivity to social standards
Examples of disorders evaluated in this listing
  • Major neurocognitive disorder
  • Dementia of the Alzheimer type
  • Vascular dementia
  • Dementia due to a medical condition such as a metabolic disease (for example, late-onset Tay-Sachs disease)
  • Human immunodeficiency virus (HIV) infection,
  • Vascular malformation
  • Progressive brain tumor
  • Neurological disease (for example, multiple sclerosis, Parkinsonian syndrome, Huntington disease)
  • Traumatic brain injury
  • Substance-induced cognitive disorder associated with drugs of abuse, medications, or toxins

To meet the medical criteria for a neurocognitive disorder (Part A), there must be medical documentation of a significant cognitive decline from a prior level of functioning in one or more of the six cognitive areas:

  1. Complex attention;
  2. Executive function;
  3. Learning and memory;
  4. Language;
  5. Perceptual-motor; or
  6. Social cognition
 
Image of a magnifying glass Diving Deeper: Understanding Cognitive Functioning

Cognitive Area

Definition

Signs and Symptoms

Complex attention

Maintenance of attention over time, despite competing distractors; attending to two tasks in the same time frame

Easily distracted when there are competing events or stimuli (multiple conversations, radio, TV) in the environment, difficulty recalling recently received information such as addresses or instructions

Executive function

Higher-level cognitive processes such as regulating attention, planning, decision-making, responding to feedback and error correction, mental flexibility to shift between two tasks

Abandons complex projects and needs to focus on one task at a time; relies on others to plan daily activities or make decisions

Learning and memory

Ability to recall recent events and keep track of a list of words or items; ability to remember personal events

Frequent repetition during a conversation, requiring reminders to orient to task at hand, inability to keep track of items on a short shopping list or plans for the day

Language

Ability to communicate thoughts to others in a coherent manner and accurately pronounce words; ability to understand language, such as following directions

Inability to recall names of items or people and has difficulties in “finding the right word.” Grammatical errors in speech and idiosyncratic word usage

Perceptual-motor

Ability to plan and then execute movement; coordination of hand-eye movements, balance, fine motor skills such as finger dexterity

Significant difficulties with previously familiar activities such as driving, writing, using tools, or navigating in a familiar environment

Social cognition

Recognizing emotions in others; ability to consider another’s intentions, thoughts, desires, or experience

Behavior that is outside the range of social acceptability and inability to recognize social cues; insensitivity to social standards; focusing excessively on a topic of conversation despite the group’s disinterest or direct feedback; making decisions without regard to safely, such as wearing clothing inappropriate to the weather

Image of male Super SOAR SOAR Tip: Many individuals experiencing homelessness are exposed to conditions or violence that cause significant damage to the brain over time. Be sure to explore less common circumstances if many of the signs and symptoms listed above are present.
12.03 Schizophrenia spectrum and other psychotic disorders
Overview These disorders are characterized by delusions, hallucinations, disorganized speech, or grossly disorganized or catatonic behavior, causing a clinically significant decline in functioning.
Symptoms may include (but are not limited to)
  • Inability to initiate and persist in goal-directed activities
  • Social withdrawal
  • Flat or inappropriate affect
  • Poverty of thought and speech
  • Loss of interest or pleasure
  • Disturbances of mood
  • Odd beliefs and mannerisms
  • Paranoia (Paranoia refers to severe and unfounded fears)
Examples of disorders evaluated in this listing
  • Schizophrenia
  • Schizoaffective disorder
  • Delusional disorder
  • Psychotic disorder due to another medical condition (such as psychosis resulting from central nervous system tumors and infections, strokes, migraines, and various endocrine disorders)
To meet the medical criteria for this listing (Part A), there must be medical documentation of one or more of the following:
  1. Delusions or hallucinations;
  2. Disorganized thinking (speech); or
  3. Grossly disorganized behavior or catatonia
 
Image of a magnifying glassDiving Deeper: Understanding Schizophrenia and other Psychotic Disorders
Delusions are fixed beliefs that are not amenable to change in light of conflicting evidence. Their content may include a variety of themes:
 
  • Persecutory – belief that one is going to be harmed, harassed, and so forth by an individual, organization, or another group. This type of delusion is most common
  • Referential– belief that certain gestures, comments, environmental cues, and so forth are directed at oneself (i.e. the belief that TV personalities are speaking directly to you)
  • Grandiose– when an individual believe that he or she has exceptional abilities, wealth, or fame
  • Erotomanic– when an individual believes falsely that another person is in love with him or her
  • Nihilistic– involved the conviction that a major catastrophe will occur
  • Somatic– focuses on preoccupations regarding health and organ function
  • Bizarre– clearly implausible belief and not understandable to same-culture peers and do not derive from ordinary life experiences (e.g. belief that an outside force has removed his or her internal organs and replaced them with someone else’s without leaving any wounds or scars)
 
Hallucinations are perception-like experiences that occur without external stimulus. They are vivid and clear, with the full force and impact of normal perceptions, and not under voluntary control.
  • Auditory hallucinations are most common, but they can occur in any sensory modality
  • Hallucinations may be a normal part of religious experience in certain cultural contexts
Disorganized thinking (or speech); this symptom must be severe enough to substantially impair effective communication and may involve:
  • Switching from one topic to another (known as derailment or loose association)
  • Providing answers to questions that are only somewhat related or completed unrelated (tangentiality)
  • Speech that is so disorganized that it is nearly incomprehensible (incoherence or “word salad”)
Grossly disorganized behavior or catatonia
  • Grossly disorganized behavior may manifest itself in a variety of ways, ranging from childlike “silliness” to unpredictable agitation.
  • Catatonic behavior is a marked decrease in reactivity to the environment. This can range from resistance to instructions to maintaining a rigid, inappropriate or bizarre posture, to a complete lack of motor and verbal responses. It can also include purposeless and excessive motor activity with no obvious causes.
12.04 Depressive, bipolar, and related disorders
Overview
These disorders are characterized by an irritable, depressed, elevated, or expansive mood, or by a loss of interest or pleasure in all or almost all activities, causing a clinically significant decline in functioning.
Symptoms may include (but are not limited to)
  • Feelings of hopelessness or guilt
  • Suicidal ideation
  • Clinically significant change in body weight or appetite
  • Sleep disturbances
  • Increase or decrease in energy
  • Psychomotor abnormalities
  • Disturbed concentration
  • Pressured speech
  • Grandiosity
  • Reduced impulse control
  • Sadness
  • Euphoria
  • Social withdrawal
Examples of disorders evaluated in this listing
  • Bipolar disorders (I or II)
  • Cyclothymic disorder
  • Major depressive disorder
  • Persistent depressive disorder (dysthymia)
  • Bipolar or depressive disorder due to another medical condition

To meet the medical criteria for this listing (Part A), there must be medical documentation meeting the criteria in either column 1 or column 2:

1. Depressive disorder, characterized by five or more of the following:
2. Bipolar disorder, characterized by three or more of the following:
  1. Depressed mood
  2. Diminished interest in almost all activities
  3. Appetite disturbance with change in weight
  4. Sleep disturbance
  5. Observable psychomotor agitation or retardation
  6. Decreased energy
  7. Feelings of guilt or worthlessness
  8. Difficulty concentrating or thinking
  9. Thoughts of death or suicide
  1. Pressured speech
  2. Flight of ideas
  3. Inflated self-esteem
  4. Decreased need for sleep
  5. Distractibility
  6. Involvement in activities that have a high probability of painful consequences that are not recognized
  7. Increase in goal-directed activity or psychomotor agitation
Image of female Super SOAR SOAR Tip: It is important to remember that the specific diagnoses that someone has received over the years are not as important as the signs and symptoms that they are currently experiencing. Focusing on the symptoms will be key to meeting both the medical criteria and in-turn the functional impairment criteria.