Comps - Psychopathology (Disorders) Flashcards
Neurodevelopmental Disorders
A group of disorders that present in early childhood; characterized by marked deficits in brain processing that result in impairments in social, personal, or academic performance.
Intellectual Developmental Disorder
Deficits in intellectual ability such as, reasoning, problem solving, planning, abstract thinking, judgment, academic learning, and learning from experience. Onset during developmental period. (Severity Specifiers range from mild-profound).
Intellectual Functioning
Reasoning, problem solving, planning, abstract thinking, judgment, academic learning, and learning from experience.
Adaptive Functioning
Failure to meet developmental and sociocultural standards for personal independence and social responsibility. Without ongoing support, the adaptive deficits limit functioning in one or more activities of daily life, such as communication, social participation, and independent living, across multiple environments, such as home, school, work, and community.
ID Comorbidities
ADHD, ASD, MDD, GAD, BP1/2
ID Cultural Considerations
Beliefs about supernatural influences and punishment for presumes of actual wrongdoing by the parents. Males are more likely than females to be diagnosed with mild and severe.
ID Etiology
Genetics, teratogens exposure in utero, brain malformations, TBI, seizure disorders.
ID Differentials
Neurocognitive Disorders: Dementia, Alzheimer’s (Progression of loss of cognitive symptoms versus stable (ID)). SLD: reading, written, math, combination (Limited to learning deficits, no intellectual/adaptive). ASD (Social-communication and behavior deficits; ID is stable. Complicates ID assessment).
Autism Spectrum Disorder
Persistent deficits in social communication and interaction across multiple contexts (social-emotional reciprocity, nonverbal communication, and difficulties in relationships) in social interaction. Restrictive patterns of behavior, interests, or activities (stereotypes/repetitive motor movements, insistence on sameness, highly restricted/fixated interests/sensory sensitivity). Onset during the developmental period. (Specifiers range from “requiring support” to “requiring very substantial support.”
Social-Emotional Reciprocity
Abnormal social approach; reduced sharing of interests, emotions, or affect; difficulty in social interactions.
Nonverbal Communication
Abnormal eye contact/body language/gestures/facial expressions.
Difficulties in Relationships
Adjusting behaviors, engaging in imaginative play, absence of interest in peers.
Stereotyped/Repetitive Motor Movements
Stimming, rocking.
Insistence on Sameness
Routines, food, clothes
Highly Restricted/Fixated Interests
Strong attachment/preoccupation
Sensory Sensitivity
Textures, sounds, temperature
ASD Comorbidities
MDD, GAD, ID, SLD, ADHD, ARFID
ASD Cultural Considerations
Males diagnosed more than females. African American children are misdiagnosed with adjustment or conduct disorder. Age discrepancies in diagnosis of diverse kids.
ASD Etiology
High heritability, advanced parental age, teratogens.
ASD Differentials
ADHD (Developmental course, absence of restricted/repetitive behaviors/unusual interests). ID (Social communication and interaction are significantly impaired relative to the development of nonverbal skills (ASD). No apparent discrepancy between level of social communication skills and other intellectual skills (ID)). OCD (Contamination, organization, compulsions (OCD - repetitive behavior). Motor movements (ASD - repetitive behavior)). Schizophrenia (Positive symptoms, normal childhood development). Personality Disorders (Developmental course is earlier in ASD).
Attention Deficit / Hyperactivity Disorder
A persistent pattern of inattention, hyperactivity, and/or impulsivity. Symptoms must have been present prior to the age of 12 though diagnosis can happen at any time. Present in 2 or more settings, and interferes with social, academic, or occupational functioning. Specifiers for inattentive type, hyperactive type, or combined type.
Inattention
Difficulty with attention to details, sustaining attention, listening, following through on instructions, organizing tasks/activities. Avoids tasks that require sustained mental effort. Loses things often, easily distracted, forgetful in daily activities.
Hyperactivity and Impulsivity
Fidgets, leaves seat often/climbs appropriately, unable to engage in leisure activities, often “on the go,” talks excessively, blurts out an answer, difficulty waiting turn, interrupts others.
ADHD Comorbidities
ODD, ASD, PD, SUDs
ADHD Cultural Considerations
More common in males than females. Underdetection may lead to misdiagnosis of ODD. High prevalence in white youth may be influenced by parental demand for diagnosis
ADHD Etiology
Reduced behavior inhibition, negative emotionality, novelty seeking increases risk. Low birth weight, prenatal exposure to smoking. High heritability, visual/hearing impairments, metabolic abnormalities, nutritional deficiencies.
ADHD Differentials
ODD (Characterized by negativity, hostility, and defiance). Intermittent Explosive Disorder (Serious aggression toward others and do not experience difficulty with attention). Bipolar Disorder 1/2 (Symptoms are episodic, accompanied by elevated mood, grandiosity, etc.).
Schizophrenia and Related Disorders
A category of disorders that involve a dissconection from reality. Usually chronic but sometimes temporary.
Delusional Disorder
The presence of one or more delusions with no other features of psychosis. If they have manic or major depressive episodes, they are brief. Functioning is not markedly impaired. Present in episodes either one or multiple. Multiple types.
Delusions
Fixed beliefs that are not amenable to change in light of conflicting evidence.
Positive Symptom
Things that are present that should not be there.
Negative Symptom
Things that are not present that should be there. Diminished emotional response.
Delusional Disorder Comorbidities
N/A
Delusional Disorder Cultural Considerations
Have to take into account cultural relativity (i.e., religious background).
Delusional Disorder Etiology
Heritability (if you have a family member that has schizophrenia, you are more likely to have delusional disorder).
Delusional Disorder Differentials
Schizophrenia and Schizophreniform (Delusions are more disorganized and part of their disorganized presentation. Delusions have more convictions about their beliefs in delusional disorder - the delusions are their reality and convinced). OCD (Anxiety is driving behavior and compensatory behavior). Bipolar 1/2 (Delusions present when you have a mood episode).
Brief Psychotic Disorder
A psychotic disturbance that lasts for one day to one month and does not occur during a manic or depressive episode, and is not better explained by the effects of medication. Must have either delusions, hallucinations, disorganized speech, and grossly disorganized or catatonic behavior. Specifiers include whether the psychosis is in response to something or not.
Hallucinations
Perception-like experiences that occur without an external stimulus.
Disorganized Speech
An inability to form logical or coherent thoughts.
Grossly Disorganized or Catatonic Behavior
Marked decrease in reactivity to environment.
Brief Psychotic Disorder Comorbidities
N/A
Brief Psychotic Disorder Cultural Considerations
Religiosity and bereavement considerations.
Brief Psychotic Disorder Etiology
N/A
Brief Psychotic Disorder Differentials
Other Medical Conditions (If the results (labs or exams) indicate that positive symptoms (e.g., delusions or hallucinations) are due to a medical condition, then it is not brief psychotic disorder). Substance-Related Disorders (If a person only has positive symptoms when they are using a drug, it is not brief psychotic disorder). Other Psychotic Disorders (Symptom time-frame – More than a month could be schizophreniform or schizophrenia).
Schizophreniform Disorder
Experiences at least 2 psychotic symptoms (e.g., delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and/or negative symptoms) that last for at least 1 month but less than 6 months. Does not occur during a manic or depressive episode. Symptoms must be present for the majority of a 1-month period.
Schizophreniform Disorder Comorbidities
N/A
Schizophreniform Disorder Cultural Considerations
N/A
Schizophreniform Disorder Etiology
Genetics
Schizophreniform Disorder Differentials
Substance-Related Disorders (If a person only has positive symptoms when they are using a drug, it is not schizophreniform). Other Psychotic Disorders (Symptom time-frame – More than a month could be schizophrenia and less than a month could be brief psychotic disorder). Major Neurocognitive Disorders (There is a loss of intellectual and adaptive functioning that people with schizophreniform do not experience).
Schizophrenia
Experiences a break from reality that includes hallucinations, delusions, disorganized speech, grossly disorganized or catatonic behavior, and/or negative symptoms (at least 2 for the majority of a 1-month period). Symptoms cause marked impairment, persist for at least six months, and are in the absence of a schizoaffective, manic, or depressive episode.
Schizophrenia Comorbidities
SUDs, GAD, PD (schizotypal or schizoid)
Schizophrenia Cultural Considerations
Women’s onset is later than men’s. Women’s symptoms are more affect-laden. Women’s psychotic symptoms are worse during menses. Cultural differences and interpretations of visual and auditory hallucinations – Level of fear and content of positive symptoms are different between cultural groups.
Schizophrenia Etiology
Environments (urban, refugees, migrant, socially oppressed) mixed with being socially oppressed (discrimination, deprivation, SES). ACEs (trauma and neglect). Genetics and pregnancy and birth complications.
Schizophrenia Differentials
Other Psychotic Disorders (Symptom time-frame – More than a month could be schizophreniform and less than a month could be brief psychotic disorder). ASD (Deficits in social communication and interaction (rooted in a neurodevelopmental basis), similar to schizophrenia (rooted in lack of reality testing), but the etiology is different).
Schizoaffective Disorder
Experiences a break from reality that includes hallucinations, delusions, disorganized speech, grossly disorganized or catatonic behavior, and/or negative symptoms (at least 2 for the majority of a 1-month period). An uninterrupted major mood episode (major depressive or manic) with positive or negative schizophrenia symptoms. Delusions or hallucinations for 2 or more weeks without a major mood episode. Specifiers include bipolar or depressive type.
Schizoaffective Disorder Comorbidities
SUDs and GAD
Schizoaffective Disorder Cultural Considerations
SES. Misdiagnosis of schizophrenia for African American and Hispanic populations – Evaluate for psychotic and mood symptoms).
Schizoaffective Disorder Etiology
Genetics.
Schizoaffective Disorder Differentials
Schizophrenia (Two weeks of psychotic symptoms without a major mood episode). Bipolar and Depressive Disorders (The psychotic symptoms are only occurring during mood episodes).
Bipolar and Related Disorders
A group of disorders characterized by shifts between to emotional extremes in episodes. Sometimes they have psychotic features.
Manic Episode
A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week, in which symptoms are present (any duration if hospitalization). Symptoms include: Inflated self-esteem or grandiosity, Decreased need for sleep, More talkative than usual or pressure to keep talking, Flight of ideas or subjective experience that thoughts are racing, Distractibility, Increase in goal-directed activity or psychomotor agitation, Excessive involvement in high-risk activities. The episode causes marked impairment, hospitalization, and/or there are psychotic features.
Hypomanic Episode
A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 4 consecutive days in which symptoms are present. Symptoms include: Inflated self-esteem or grandiosity, Decreased need for sleep, More talkative than usual or pressure to keep talking, Flight of ideas or subjective experience that thoughts are racing, Distractibility, Increase in goal-directed activity or psychomotor agitation, Excessive involvement in high-risk activities. The episode is not severe enough to cause marked impairment, hospitalization, and there are no psychotic features.
Major Depressive Episode
A distinct period of abnormally lowered mood that lasts for at least 2 weeks in which symptoms are present. Symptoms include: Depressed mood most of the day; nearly every day, Markedly diminished interest or pleasure in all or most activities, Significant weight loss or gain, Insomnia or hypersomnia, psychomotor agitation or retardation, fatigue or loss of energy, Feelings of worthlessness or excessive/inappropriate guilt, Diminished ability to think or concentrate, Recurrent thoughts of death.
Bipolar I Disorder
A disorder characterized by extreme shifts between manic and depressive episodes. You need to have an abnormally and persistently elevated, expansive, or irritable mood for at least 1 week and is present most of the day nearly every day. You need 3 or more symptoms of a manic episode.
Bipolar I Disorder Comorbidities
GAD, SUDs, BPD, ASPD
Bipolar I Disorder Cultural Considerations
Women have more mood symptoms. Black individuals with bipolar disorder are often misdiagnosed with schizophrenia.
Bipolar I Disorder Etiology
Childhood adversity. Heritability – Genetic processes strongly affect predisposition to bipolar disorder, with heritability estimates around 90% in some twin studies.
Bipolar I Disorder Differentials
MDD (You have to meet the criteria for a manic episode for it to be BP1). BP2 (Symptom time duration is less (no manic episode)). BPD (Mood lability and impulsivity must represent a distinct episode of illness).
Bipolar II Disorder
A disorder characterized by extreme shifts between hypomanic episodes and depressive episodes. You need to have an abnormally and persistently elevated, expansive, or irritable mood for at least 4 days and is present most of the day nearly every day. You need 3 or more symptoms of a hypomanic episode and 5 or more of a major depressive episode. Never experienced a manic episode.
Bipolar II Disorder Comorbidities
SUDs, GAD, autoimmune disorders
Bipolar II Disorder Cultural Considerations
Women are more likely to experience hypomania with mixed depressive features. Women are more likely to experience rapid cycling. Childbirth can trigger a hypomanic episode in 10-20% of women.
Bipolar II Disorder Etiology
Genetics
Bipolar II Disorder Differentials
MDD (Never a manic or hypomanic episode). Schizophrenia (No major depressive episodes). BP1 (Has mania).
Cyclothymic Disorder
A disorder characterized by extreme shifts between mood disturbances that exhibit symptoms of hypomanic and depressive symptoms that do not meet the full criteria for either episode that has persisted for at least 2 years. Symptoms have been present for at least half the time and the individual has not been without the symptoms for more than 2 months at a time.
Cyclothymic Disorder Comorbidities
SUDs, sleep disorders
Cyclothymic Disorder Cultural Considerations
N/A
Cyclothymic Disorder Etiology
Genetic. May be an increased familial risk of substance-related disorders.
Cyclothymic Disorder Differentials
Bipolar and related disorder due to another medical condition (Another medical condition explains the person’s mood and episodes). BPD (Mood instability in borderline personality disorder occurs in the domains of anxiety, irritability, and sadness, whereas elation, euphoria, and/or increased energy are not characteristic features of borderline personality disorder).
Depressive Disorders
A group of disorders characterized by frequent or presistant bouts of lowered mood and reccurent thoughts of death.
Major Depressive Disorder
Five or more of the following symptoms occur and persist during the same 2-week period: Depressed mood, Markedly diminished interest or pleasure in all or almost all activities, Significant weight gain or loss, Insomnia or hypersomnia, Psychomotor agitation or retardation, Fatigue or loss of energy, Feelings of worthlessness or excessive/inappropriate guilt, Diminished ability to think or concentrate, Recurrent thoughts of death. Can sometimes include psychotic features.
Major Depressive Disorder Comorbidities
SUDs, GAD, PTSD
Major Depressive Disorder Cultural Considerations
Women are more internalizing and men are more externalizing – Women experience sleep disturbance, appetite fluctuation, gastro; Men experience more maladaptive coping - substance-use. The chronicity of major depressive disorder appears to be higher among African Americans and Caribbean Blacks. Overdiagnosis of schizophrenia for minority groups instead of MDD.
Major Depressive Disorder Etiology
Neuroticism. ACEs – Women may be disproportionately at risk for ACEs. Heritability.
Major Depressive Disorder Differentials
Bipolar Disorders (Manic or hypomanic episodes). Substance-induced Depressive Disorder. Other Depressive Disorders. Schizoaffective (Delusions or hallucinations are present for at least 2 weeks in the absence of a major depressive episode).
Persistent Depressive Disorder
Depressed mood for most of the day, for more days than not, for at least 2 years. Additionally two of the following: Poor appetite or overeating, Insomnia or hypersomnia, Low energy or Fatigue, Low self-esteem, Poor concentration, Feelings of hopelessness. During the 2-year period, the person has never been without the aforementioned symptoms for more than 2 months at a time.
Persistent Depressive Disorder Comorbidities
GAD, SUDs
Persistent Depressive Disorder Cultural Considerations
Perceived abnormality or tolerance of chronic depressive symptoms may vary across cultures.
Persistent Depressive Disorder Etiology
Neuroticism. Parental loss. Poor global functioning.
Persistent Depressive Disorder Differentials
Major Depressive Disorder (Periods of euthymia). Bipolar Disorders (Manic and hypomanic episodes).
Anxiety Disorders
A category of mental disorders characterized by an exsessive amount of fear in response to real, or precived stuations; or a feeling of discomfort/fear in anticipation to these events.
Social Anxiety Disorder
Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others and lasts for at least 6 months. Possible fear that they will show anxiety symptoms and others will make negative judgments accordingly. Fear negative evaluation. Social situations almost always provoke fear or anxiety and are avoided or endured with intense fear. The fear or anxiety is disproportionate to the social situation.
Social Anxiety Disorder Comorbidities
Other anxiety disorders, MDD, SUDs
Social Anxiety Disorder Cultural Considerations
Earlier age of onset for Whites vs Latinx. Immigrant status is associated with lower rates of SAD. Women report a greater number of social fears and comorbid MDD and other anxiety disorders. Men are more likely to fear dating, have ODD, CD, or ASPD, and use alcohol and drugs to relieve symptoms.
Social Anxiety Disorder Etiology
Behavioral inhibition – This is strongly genetic. Negative social experiences. Childhood maltreatment and adversity. Ethnic discrimination and racism.
Social Anxiety Disorder Differentials
Agoraphobia (Fear and avoid social situations because escape might be difficult - not because of the scrutiny of others). ASD (Lack of social communication capacity. Social communication deficits (i.e., social-emotional reciprocity)). GAD (Social worries are common, but the focus is more on the nature of ongoing relationships rather than on fear of negative evaluation).
Panic Disorder
Recurrent unexpected panic attacks with 4 or more symptoms of a panic attack, which causes unpredictable minutes-long episodes of intense dread in which a person experiences terror. Additionally for at least one month after one (or more) of the attacks, there’s significant dread due to anticipating an episode, or maladaptive behaviors regarding the episodes.
Panic Attack
Palpitations, sweating, trembling, shortness of breath, choking, chest pain, nausea, dizziness, unreality, fear of dying, hot or cold flashes, paresthesia (numbness or tingling sensations), derealization or depersonalization, fear of losing control or “going crazy,” fear of dying.
Panic Disorder Comorbidities
Anxiety disorders, MDD, SUDs, Bipolar disorders
Panic Disorder Cultural Considerations
Diagnosed 2 times higher in women. How panic attacks are defined between cultural groups varies.
Panic Disorder Etiology
Neuroticism, anxiety sensitivity, behavioral inhibition, negative experiences with drugs, identifiable stressors, history of trauma, ACEs, genetics.
Panic Disorder Differentials
Anxiety disorder due to another medical condition. Substance/medication-induced anxiety disorder.
Agoraphobia
Marked fear or anxiety about two or more of the following situations that is out of proportion with any actual danger: Use of public transport, being in open spaces (parking lots, marketplaces, or bridges), being in enclosed spaces (shops, theaters, cinemas), standing in line or being in a crowd, being outside of the home alone. These fears are based in the belief that escape may be difficult in the case of panic-like symptoms or embarrassing symptoms. These situations are actively avoided or endured with intense fear. The fear or anxiety is disproportionate to the agoraphobic situation.
Agoraphobia Comorbidities
Anxiety disorders, depressive disorders, PTSD, alcohol use disorder
Agoraphobia Cultural Considerations
Women have different patterns of comorbid disorders than men. Men have higher rates of comorbid SUDs.
Agoraphobia Etiology
Behavioral inhibition. Neuroticism. Negative events in childhood. Heritability for agoraphobia is 61%.
Agoraphobia Differentials
Separation Anxiety Disorder (The thoughts are about detachment from significant others and the home environment). Social Anxiety Disorder (The focus is on fear of being negatively evaluated). MDD (The person may avoid leaving home because of apathy, loss of energy, low self-esteem, and anhedonia). Panic Disorder (Agoraphobia should not be diagnosed if the avoidance behaviors associated with the panic attacks do not extend to avoidance of two or more agoraphobic situations).
Generalized Anxiety Disorder
Excessive anxiety or worry, occurring for more days than not for at least 6 months about multiple events that cause clinically significant distress and/or impairment. This worry is characterized by three or more of the following six symptoms: Restlessness/feeling keyed up or on edge, being easily fatigued, difficulty concentrating or going mind-blank, irritability, muscle tension, and/or sleep disturbance.
Generalized Anxiety Disorder Comorbidities
Other anxiety disorders, unipolar depression.
Generalized Anxiety Disorder Cultural Considerations
Diagnosed more in women (55-60%). Cultural variation and expression of GAD symptoms – It is important to consider the social and cultural context when evaluating whether worries about certain situations are excessive.
Generalized Anxiety Disorder Etiology
Behavioral inhibition. Neuroticism. Childhood adversity. Genetics.
Generalized Anxiety Disorder Differentials
Social Anxiety Disorder (Often have anticipatory anxiety that is focused on upcoming social situations where they will be evaluated by others). OCD (The obsessions are inappropriate ideas that take the form of intrusive and unwanted thoughts, urges, or images). ADHD (Difficulty with inattention and hyperactivity but it is not due to fear or worry).
Obsessive-Compulsive or Related Disorders
A category of disorders similar to anxiety disorders but are characterized by the pervasive presence of obssesions.
Obssesions
Recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted, and that in most individuals cause marked anxiety or distress. The individual attempts to ignore or suppress/neutralize such thoughts, urges, or images, with some other thought or action (i.e., by performing a compulsion).
Compulsions
Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly. The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.
Obsessive-Compulsive Disorder
Presence of obsessions, compulsions, or both. These are time-consuming, and cause clinically significant, or impairment in social/occupation/professional fields or other important areas of functioning.
Obsessive-Compulsive Disorder Comorbidities
Anxiety disorders, depressive disorders, bipolar disorders, tic disorders, ADHD
Obsessive-Compulsive Disorder Cultural Considerations
Attributions of OCD vary cross-culturally. Men have an earlier age at onset than women. Onset in girls is more typically in adolescence. OCD is slightly more common in women than men.
Obsessive-Compulsive Disorder Etiology
Higher negative emotionality. Behavioral inhibition in childhood. Stressful childhood events. Genetics.
Obsessive-Compulsive Disorder Differentials
Anxiety Disorders (The thoughts present in GAD are usually about real-life concerns). Eating Disorders (Limited to concerns about weight and food). OCPD (Not characterized by intrusive thoughts, images, or urges, or by repetitive behaviors that are performed in response to these intrusive symptoms – It involves an enduring and pervasive maladaptive pattern of excessive perfectionism and rigid control).
Trauma and Stressor Related Disorders
A group of disorders characterized by a period of prolonged distress following a major traumatic or stressful event.
Post-Traumatic Stress Disorder (In children)
Most of the qualifying features of PTSD except trauma reenactment/symbolism can occur in play.
Posttraumatic Stress Disorder
A disorder characterized by at least one: direct experience, witnessing, learning about, or repeated exposure to traumatic events (death, serious injury, sexual violence). There is at least one symptom: recurrent distressing memories, dreams, flashbacks, and/or psychological or physiological distress at reminders. Efforts to avoid distressing memories, thoughts, feelings, or external reminders. There are at least two negative alterations in mood: memory gaps, negative beliefs about self/world, self-blame, negative emotions, detachment, lack of interest in activities, and/or inability to feel positive emotions. There are at least two marked alterations in arousal and reactivity: irritability, reckless behavior, hypervigilance, exaggerated startle response, concentration issues, and/or sleep disturbance. Symptoms last more than one month.
Posttraumatic Stress Disorder Comorbidities
Depressive disorders, bipolar disorders, anxiety disorder, SUDs
Posttraumatic Stress Disorder Cultural Considerations
More common among men than woman. Factors such as religious persecution, genocide, and sociocultural context. Exposure to discrimination and acculturative stress in migrants. Non-Western groups often report fewer avoidance behaviors and more somatic symptoms. Cultural concepts of distress influence PTSD expression. In some cultures, it is normal to respond to trauma with negative beliefs about oneself or spiritual attributions.
Posttraumatic Stress Disorder Etiology
Predisposition or exposure to trauma. Childhood emotional problems or prior diagnoses. Depressed mood, anxiousness, neuroticism. Lower SES and education. ACEs. Epigenetic factors. Severity of trauma. Repeated upsetting reminders. Forced migration.
Posttraumatic Stress Disorder Differentials
Adjustment Disorders (The diagnosis of an adjustment disorder is used when the response to a stressor that meets PTSD Criterion A does not meet all other PTSD criteria). Acute Stress Disorder (The symptom pattern in acute stress disorder is restricted to a duration of 3 days to 1 month following exposure to the traumatic event). Psychotic Disorders (Flashbacks in PTSD must be distinguished from illusions, hallucinations, and other perceptual disturbances that may occur in schizophrenia, brief psychotic disorder, and other psychotic disorders. PTSD flashbacks are distinguished from these other perceptual disturbances by being directly related to the traumatic experience and by occurring in the absence of other psychotic or substance-induced features).
Acute Stress Disorder
Meets the full criteria for PTSD except the disturbance lasts from 3 days to one month. If the disturbance is longer, the diagnosis should be reassessed.
Acute Stress Disorder Comorbidities
N/A
Acute Stress Disorder Cultural Considerations
More common among women than men. Acute stress reactions may be shaped by cultural values and norms. Some cultural groups may display variants of dissociative responses (e.g., possession).
Acute Stress Disorder Etiology
Prior mental disorder, high levels of negative emotion responses, avoidant coping style. History of prior trauma.
Acute Stress Disorder Differentials
PTSD (The timeframe (more than 1 month is PTSD)). Adjustment Disorders. Panic Disorder (Only if panic attacks are unexpected and there is anxiety about future attacks or maladaptive changes in behavior associated with fear of dire consequences of the attacks).
Adjustment Disorder
An emotional disturbance caused by an identifiable stressor occurs within 3 months of the onset of the stressor. One or both must be present: Distress is out of proportion to the severity of the stressor. Significant impairment in social, occupational, or other areas of functioning. Once the stressor or its consequences have ended, the symptoms do not persist for more than an additional 6 months.
Adjustment Disorder Comorbidities
OCD, depressive disorders, bipolar disorders
Adjustment Disorder Cultural Considerations
Migrants and refugees may experience stressful major contextual and cultural changes.
Adjustment Disorder Etiology
Disadvantaged life circumstances.
Adjustment Disorder Differentials
MDD (If the person has symptoms that meet criteria fora MDD in response to a stressor, the diagnosis of an adjustment disorder is not applicable). PTSD and Acute Stress Disorder (Timing and symptom profile – Acute Stress Disorder: can only occur between 3 days and 1 month of exposure to a stressor; PTSD: cannot be diagnosed until at least 1 month has passed since the traumatic stressor). Normative Stress Reactions (When the magnitude of distress is what would normally be expected).
Prolonged Grief Disorder
The death occurred at least 12 months ago. The grief has persisted by one or both: intense longing for the deceased individual or a preoccupation with the missing person. Since the death, the individual experiences at least three of the following symptoms: Identity disruption, a marked sense of disbelief about the death, avoidance of reminders that the person is dead, intense emotional pain related to the death, difficulty reintegrating with their prior relationships, emotional numbness, feelings that life is meaningless, and intense loneliness.
Prolonged Grief Disorder Comorbidities
MDD, PTSD, SUDs
Prolonged Grief Disorder Cultural Considerations
Across cultures, nightmares about the deceased may be especially distressing because of their attributed significance. The prevalence of hallucinations of the deceased or of grief-related somatic symptoms may vary. Higher prevalence of symptoms in African Americans relative to non-Hispanic Whites.
Prolonged Grief Disorder Etiology
Increased dependency on the deceased prior to the death.
Prolonged Grief Disorder Differentials
Normal Grief (Not as severe grief reactions). Depressive Disorders (In prolonged grief disorder, the distress is focused on feelings of loss and separation from a loved one rather than generalized low mood). PTSD (Avoidance in PTSD is manifested by avoidance of memories, thoughts, or feelings associated with the traumatic event that led to the death of the loved one (NOT reminders that the loved one is no longer present)).
Feeding and Eating Disorders
A group of disorders characterized by persistent disturbance of eating behavior, leading to altered consumption or absorption of food that significantly impairs physical health and/or psychosocial functioning.
Anorexia Nervosa
Restriction of energy intake leading to significantly low body weight. Intense fear of gaining weight or becoming fat. Disturbance in how they perceive their body.
Anorexia Nervosa Comorbidities
Anxiety disorders, depressive disorders, SUDs, bipolar disorders
Anorexia Nervosa Cultural Considerations
Fat phobia in Asia. “Paper test” in Korea. Mental health service utilization is significantly lower in the US among ethnic and racialized groups. More diagnosed in women than men.
Anorexia Nervosa Etiology
Display obsessional traits in childhood. Settings in which thinness is valued (cultural expectations). Genetics.
Anorexia Nervosa Differentials
Body Dysmorphic Disorder (Preoccupation with an imagined defect in bodily appearance). MDD (Do not have either a desire for excessive weight loss or an intense fear of gaining weight). Bulimia Nervosa (Exhibit recurrent episodes of binge eating, engage in inappropriate behavior to avoid weight gain, and are overly concerned with body shape and weight).
Bulimia Nervosa
An eating disorder characterized by recurrent episodes of binge eating, followed by compensatory behaviors meant to prevent weight gain (i.e., self-induced vomiting; misuse of laxatives or diuretics; fasting; excessive exercise). The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months. Self-evaluation is influenced by body and the disturbance occurs outside of AN episodes.
Binge Eating
Eating, in a discrete period of time, an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances, as well as a lack of control over eating during the episode.
Bulimia Nervosa Comorbidities
Depressive disorders, anxiety symptoms, SUDs
Bulimia Nervosa Cultural Considerations
More common in girls, women, and gay men.
Bulimia Nervosa Etiology
Weight concerns. Low self-esteem. SAD. Idealization of a thin body. Childhood obesity. Child sexual and physical abuse.
Bulimia Nervosa Differentials
Anorexia Nervosa (Binge-eating behavior occurs only during episodes of anorexia nervosa). Binge-Eating Disorder (Some individuals binge eat but do not engage in regular inappropriate compensatory behaviors).
Binge-Eating Disorder
Recurrent episodes of binge eating, associated with 3 of the 5: Eating more rapidly than normal, Eating until feeling uncomfortable full, Eating large amounts of food when not feeling physically hungry, Eating alone because of feeling embarrassed by how much one is eating, and/or Feeling disgusted with oneself, depressed, or very guilty afterward. The binge eating occurs, on average, at least once a week for 3 months.
Binge-Eating Disorder Comorbidities
MDD, alcohol use disorder
Binge-Eating Disorder Cultural Considerations
Black individuals may report fewer symptoms of distress associated with binge eating and present for treatment with higher frequency of binge eating compared with White individuals. Clinical presentations of binge-eating disorder differ across ethnoracial groups in the US.
Binge-Eating Disorder Etiology
Genetics (appears to run in families).
Binge-Eating Disorder Differentials
Bulimia Nervosa (Absence of compensatory behaviors (e.g., purging, driven to exercise)). Bipolar and Depressive Disorders (Increased eating in the context of a MDE may or may not associated with loss of control).
Gender Dysphoria
A marked incongruence between one’s expressed gender and assigned gender for at least 6 months as manifested by at least 2 symptoms (for adolescents and adults): A strong desire to be rid of one’s characteristics because of a marked incongruence with one’s expressed gender, the characteristics of the other gender, to be of the other gender, to be treated as the other gender, has typical feelings and reactions of the other gender.
Gender Dysphoria Comorbidities
ASD, anxiety disorders, depressive disorders
Gender Dysphoria Cultural Considerations
The equivalent of gender dysphoria has been reported in people living in cultural contexts with institutionalized gender identity categories other than men/boys or women/girls.
Gender Dysphoria Etiology
Gender nonconformity.
Gender Dysphoria Differentials
Nonconformity to Gender Roles (“Tomboyism”).
Personality Disorders
A group of disorders characterized by reccurent, persistant, and pervasive patterns of behaviors that cause clinically significant distress and/or interpersonal impairment.
General Personality Disorder
An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture in two or more of the following ways: Cognition, affectivity, interpersonal functioning, and/or impulse control.
Cluster A Personality Disorders
Odd/eccentric disorders: Paranoid, Schizoid, and Schizotypal
Cluster B Personality Disorders
Dramatic/emotional/erratic disorders: Antisocial, Borderline, Histrionic, and Narcissistic
Cluster C Personality Disorders
Anxious/fearful disorders: Avoidant, Dependent, and Obssesive-Compulsive
Paranoid Personality Disorder
A pervasive distrust and suspiciousness of others as characterized by four or more of the following symptoms: Suspicion without sufficient basis that others are exploiting/harming/deceiving them, is preoccupied with doubts about the trustworthiness or loyalty of others close to them, is reluctant to confide in others out of fear that the information will be used against them, reads hidden demeaning/threatening meanings into benign remarks/events, persistently bears grudges, perceives attacks on their character that are not apparent to others and prepares to counterattack, and/or has recurrent unwarranted suspicion of the faithfulness or loyalty of spouses or sexual partners.
Paranoid Personality Disorder Comorbidities
Delusional disorder, schizophrenia, MDD, agoraphobia, OCD, SUDs, schizotypal PD, schizoid PD, narcissistic PD, avoidant PD, borderline PD
Paranoid Personality Disorder Cultural Considerations
More common in men than women. Migrants, members of socially oppressed ethnic and racialized populations, and other groups facing social adversity, racism, and discrimination may display guarded or defensive behaviors because of unfamiliarity or in response to the neglect, hostility, or indifference of the majority society. Some cultural groups develop low generalized trust, especially of outgroup members, which may lead to behaviors that can be misjudged as paranoid.
Paranoid Personality Disorder Etiology
SES inequality. Marginalization. Racism. Social stress and childhood maltreatment.
Paranoid Personality Disorder Differentials
Schizotypal PD (Includes symptoms such as magical thinking, unusual perceptual experiences, and odd thinking and speech). Schizoid PD (Strange, eccentric, cold, and aloof, but they do not usually have prominent paranoid ideation. Avoidant PD (May be reluctant to confide in others, but more from fear of being embarrassed or found inadequate than from fear of others’ malicious intent).
Schizoid Personality Disorder
A pervasive pattern of detachment from social relationships and a restricted range of emotions as evidenced by four or more of the following: Neither desires nor enjoys close relationships, almost always chooses solitary activities, has little or no interest in sexual relations with others, takes pleasure in few or no activities, lacks close friends or confidants other than first-degree relatives, appears indifferent to the praise or criticism of others, and/or show emotional coldness, detachment, or flattened affectivity.
Schizoid Personality Disorder Comorbidities
MDD, schizotypal PD, paranoid PD, avoidant PD
Schizoid Personality Disorder Cultural Considerations
Those who have moved from rural to metropolitan environments may react with “emotional freezing” that may last for several months and manifest as solitary activities, constricted affect, and other deficits in communication. Immigrants from other countries are sometimes mistakenly perceived as cold, hostile, or indifferent, which may be a response to social ostracism from the host society.
Schizoid Personality Disorder Etiology
May have increased prevalence in the relatives of people with schizophrenia or schizotypal PD.
Schizoid Personality Disorder Differentials
ASD (Differentiated by stereotyped behaviors and interests). Psychotic Disorders (These disorders are all characterized by a period of persistent psychotic symptoms – Schizoid can only be given if it was present before the onset of psychotic symptoms and must persist when the psychotic symptoms are in remission). Schizotypal PD (Cognitive and perceptual distortions). Paranoid PD (Suspicious and paranoid ideation).
Schizotypal Personality Disorder
A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior evidenced by at least five of the following: Ideas of reference, odd beliefs or magical thinking, unusual perceptual experiences, odd thinking and speech, suspiciousness or paranoid ideation, inappropriate or constricted affect, behavior or appearance is odd/eccentric, lack of close friends or confidants other than first-degree relatives, and/or excessive social anxiety based in paranoid fears.
Schizotypal Personality Disorder Comorbidities
Brief psychotic disorder, schizophreniform, delusional disorder, schizophrenia, schizoid PD, paranoid PD, avoidant PD, borderline PD
Schizotypal Personality Disorder Cultural Considerations
Slightly more common in women. Pervasive culturally determined characteristics, particularly those regarding supernatural and religious beliefs and practices, can appear to be schizotypal to the uninformed clinician.
Schizotypal Personality Disorder Etiology
Highly stable genetic factors and transient environmental factors.
Schizotypal Personality Disorder Differentials
Neurodevelopmental Disorders (Has a primacy and severity of the disorder in language and by the characteristic features of impaired language. Greater lack of social awareness and emotional reciprocity and stereotyped behaviors and interests). Paranoid and Schizoid PD (Lack of cognitive or perceptual distortions, eccentricity, or oddness). Avoidant PD (An active desire for relationships is constrained by a fear of rejection).
Antisocial Personality Disorder
A pervasive pattern of disregard for and violation of the rights of others represented by at least three of the following: Failure to conform to social norms with respect for lawful behaviors, deceitfulness as indicated by repeated lying/use of aliases/conning others, impulsivity/failure to plan ahead, irritability/aggressiveness as indicated by repeated physical fights or altercations, reckless disregard for the safety of self or others, consistent irresponsibility as indicated by repeated failure to honor work or financial obligations, and/or lack of remorse or empathy.
Antisocial Personality Disorder Comorbidities
Anxiety disorders, mood disorders, SUDs, borderline PD, histrionic PD, narcissistic PD
Antisocial Personality Disorder Cultural Considerations
3 times as common in men than in women – Concern that ASPD is underdiagnosed in females. Women with ASPD are more likely to have experienced childhood and adult adverse experiences (e.g., sexual abuse). Comorbid SUDs are more common in men. Comorbid mood and anxiety disorders are more common in women. Low SES and urban settings. People from socially oppressed groups may be at higher risk for misdiagnosis or overdiagnosis because they are more likely to be misdiagnosed with conduct disorder in adolescence.
Antisocial Personality Disorder Etiology
Child abuse or neglect. Unstable or erratic parenting or inconsistent parental discipline.
Antisocial Personality Disorder Differentials
Narcissistic PD (Does not include characteristics of impulsivity, aggression, and deceit. More needy of admiration and envy of others. Usually lack the history of conduct disorder in childhood or criminal behavior in adulthood). Histrionic PD (Tend to be more exaggerated in their emotions). Borderline PD (More emotionally unstable and less aggressive).
Borderline Personality Disorder
A pervasive pattern of instability in interpersonal relationships, self-image, and affects, and marked impulsivity as indicated by five or more of the following: Frantic efforts to avoid real or imagined abandonment, a pattern of unstable and intense relationships characterized by intense alterations between idealization and devaluation, identity disturbance, impulsivity in at least two potentially damaging areas, recurrent suicidal behavior, affective instability, chronic feelings of emptiness, inappropriate anger/irritability, transient paranoid or dissociative symptoms.
Borderline Personality Disorder Comorbidities
Depressive disorders, bipolar disorders, SUDs, panic disorder, social anxiety disorder, eating disorders, PTSD, ADHD.
Borderline Personality Disorder Cultural Considerations
The presence of BPD must be evaluated in light of cultural norms to make a valid diagnosis.
Borderline Personality Disorder Etiology
Childhood abuse and emotional neglect. About 5 times more common among first-degree biological relatives.
Borderline Personality Disorder Differentials
Histrionic PD (Lack of self-destructiveness, angry disruptions in close relationships, and chronic feelings of deep emptiness and loneliness). Antisocial PD (Manipulative to gain profit, power, or some other material gratification). Dependent PD (Reacts to abandonment with increasing appeasement and submissiveness and urgently seeks a replacement relationship to provide caregiving and support).
Histrionic Personality Disorder
A pervasive pattern of excessive emotionality and attention seeking characterized by at least five of the following: Is uncomfortable in situations in which they are not the center of attention, interaction with others is characterized by inappropriate sexually seductive behavior, displays rapidly shifting and shallow expressions of emotion, consistently uses physical appearance to draw attention to themselves, has a style of speech that is excessively impressionistic and lacking in detail, shows self-dramatization/theatricality/exaggerated emotional expressions, is suggestible, and/or considers relationships more intimate than they actually are.
Histrionic Personality Disorder Comorbidities
Borderline PD, narcissistic PD, paranoid PD, dependent PD, antisocial PD, SUDs
Histrionic Personality Disorder Cultural Considerations
Diagnosed more frequently in females. The presence of histrionic personality disorder should be distinguished from reactive and contextual expression of these traits, arising in response to socialization pressures in competitive peer groups.
Histrionic Personality Disorder Etiology
N/A
Histrionic Personality Disorder Differentials
Borderline PD (Distinguished by self-destructiveness, angry disruptions in close relationships, and chronic feelings of deep emptiness and identity disturbance). Antisocial PD (Less exaggerated in their emotions. Manipulative to gain profit, power, or some other material gratification). Narcissistic PD (They usually want praise for their “superiority.” May exaggerate the intimacy of their relationships with other people, but they are more apt to emphasize the “VIP” status or wealth of their friends).
Narcissistic Personality Disorder
A pervasive pattern of grandiosity, need for admiration, and lack of empathy characterized by at least five or more of the following: Has a grandiose sense of self-importance, is preoccupied with fantasies of unlimited success/power/brilliance/perfect love, believes that they are special and should only associate with other special people, requires excessive admiration, has a sense of entitlement, is interpersonally exploitative, lacks empathy, is envious of others, shows arrogant or haughty behaviors.
Narcissistic Personality Disorder Comorbidities
PDD, MDD, anorexia nervosa, SUDs, histrionic PD, borderline PD, antisocial PD, paranoid PD
Narcissistic Personality Disorder Cultural Considerations
More diagnosed in men than women. Narcissistic traits may be elevated in sociocultural contexts that emphasize individualism and personal autonomy over collectivists goals.
Narcissistic Personality Disorder Etiology
N/A
Narcissistic Personality Disorder Differentials
Histrionic, Antisocial, and Borderline PDs (Lack of grandiosity). Borderline PD (A lack of stability of self-image and self-control, self-destructiveness, impulsivity, separation insecurity, and emotional hyperreactivity). Antisocial PD (May be more indifferent and less sensitive to others’ reactions or criticism). Obsessive-Compulsive PD (Tend to be more immersed in perfectionism related to order and rigidity).
Avoidant Personality Disorder
A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation characterized by at least four of the following: Avoids occupational activities that involve significant interpersonal contact out of fear of rejection/humiliation, is unwilling to get involved with others unless certain of being liked, shows restraint in intimate relationships out of fear of being shamed/ridiculed, is preoccupied of being criticized/rejected in social situations, is inhibited in new social settings because of feelings of inadequacy, views self as socially inept/interpersonally unappealing/inferior to others, and/or is usually reluctant to take personal risks.
Avoidant Personality Disorder Comorbidities
Depressive disorders, anxiety disorders (SAD), schizoid PD
Avoidant Personality Disorder Cultural Considerations
More common in women than men. There may be variation in the degree to which different cultural and ethnic groups regard diffidence and avoidance as appropriate. Avoidant behavior may be the result of problems in acculturation following migration. In some sociocultural contexts, marked avoidance might occur following social embarrassment (“loss of face”) or failure to meet major life goals rather than temperamental shyness.
Avoidant Personality Disorder Etiology
N/A
Avoidant Personality Disorder Differentials
Social Anxiety Disorder (Negative self-concept in social anxiety disorder may be unstable and less pervasive and entrenched). Schizoid and Schizotypal PDs (May be content with and even prefer their social isolation). Paranoid PD (Characterized by a reluctance to confide in others, but not attributable to a fear of humiliation or being found inadequate than to a fear of others’ malicious intent).
Dependent Personality Disorder
A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation as evidenced by at least five of the following: Has difficulty making everyday decisions, needs others to assume responsibility for major areas of their life, has difficulty expressing disagreement because of fear of loss of support/approval, has difficulty initiating projects or doing things on their own, goes to excessive lengths to obtain nurturance and support from others, feels uncomfortable or helpless when alone, urgently seeks a new relationship after leaving a previous one, and/or is unrealistically preoccupied with fears of being left to care for themselves.
Dependent Personality Disorder Comorbidities
Borderline PD, avoidant PD, histrionic PD
Dependent Personality Disorder Cultural Considerations
More frequently diagnosed in women than men. Age and cultural factors need to be considered in evaluating the diagnostic threshold of each criterion. An emphasis on passivity, politeness, and deferential treatment is characteristic of some societies and may be misinterpreted as traits of dependent personality disorder.
Dependent Personality Disorder Etiology
N/A
Dependent Personality Disorder Differentials
Separation Anxiety (Disorder in Adults
Obsessive-Compulsive Personality Disorder
A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control manifested by at least four of the following: Is preoccupied with rules/details/lists, shows perfectionism that interferes with task completion, is excessively devoted to work, is inflexible about matters of morality/ethics, is unable to discard worn-out/worthless objects, is reluctant to delegate work to others, adopts a miserly approach to spending money, and/or shows rigidity or stubbornness.
Obsessive-Compulsive Personality Disorder Comorbidities
Anxiety disorders, OCD
Obsessive-Compulsive Personality Disorder Cultural Considerations
Should not include those behaviors that reflect habits, customs, or interpersonal styles that are culturally sanctioned. Certain cultural communities place substantial emphasis on work and productivity, and some members of sociocultural groups may at times rigidly embrace codes of conduct; work demands; restrictive social environments; rules of behavior; or standards that emphasize overconscientiousness, moral scrupulosity, and striving for perfectionism that may be reinforced by norms of the cultural group.
Obsessive-Compulsive Personality Disorder Etiology
N/A
Obsessive-Compulsive Personality Disorder Differentials
OCD (The presence of true obsessions and compulsions). Narcissistic PD (More likely to believe that they have achieved perfection. Lack generosity but will indulge themselves). Schizoid PD (Fundamental lack of capacity for intimacy which is why there is an apparent formality and social detachment).
Suicidal Behavior
Self-destructive behavior with evidence of the intent to end ones life. (Condition that may be a Focus of Clinical Attention)
Nonsuicidal Self-injury
Intentional, self-inflicted damage to ones own body without suicidal intent. (Condition that may be a Focus of Clincial Attention)
Depersonalization
Experiences of unreality, detachment, or being an outside observer with respect to one’s thoughts, feelings, sensations, body, or actions (e.g., perceptual alterations, distorted sense of time, unreal or absent self, emotional and/or physical numbing).
Derealization
Experiences of unreality or detachment with respect to surroundings (e.g., individuals or objects are experienced as unreal, dreamlike, foggy, lifeless, or visually distorted).
