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The Diagnostic and Statistical Manual of Mental Disorders: DSM-5 (5th ed., 2013) defines elimination disorders—encopresis and enuresis—as the excretion of feces or urine, respectively, in areas other than those deemed socially acceptable, such as the toilet. For a psychiatrist to give this diagnosis, a child must experience at least one such elimination per month (encopresis) or two per week (enuresis) for a minimum of three consecutive months—or, in the case of enuresis, "clinically significant distress or impairment in social, academic (occupational) or other important areas of functioning"—once the child has reached the age at which proper waste disposal is considered a normal developmental skill. In general, children who suffer from elimination disorders do not have control of their bodily functions; therefore, the disorders are often considered the result of a physical condition or abnormality. However, children who do have rectal and bladder control will occasionally discharge urine or fecal matter voluntarily. This is usually an indication of an underlying psychological problem that requires thorough psychiatric evaluation.