DSM 5 Criteria

Question 1

Delusional Disorder

Answer 1

A. One (or more) delusions within a duration of 1 month or longer
B. Criterion A for Schizophrenia has never been met: 2 or more of the following present for a significant portion of time during a one month period (Delusions, Hallucinations, Disorganized speech, Grossly disorganized or catatonic behavior, Negative symptoms)
C. Funtioning is not markedly impaired and behavior is not obviously bizarre
D. Manic/depressive episodes have been brief in relative to the duration of delusional periods
E. Disturbance is not attributable to substance abuse or neurological condition

Specifiers: Erotomanic Type (another person is in love w. individual), Grandiose Type, Jealous Type, Persecutory Type, Somatic Type, Mixed Type, Unspecified Type , With Bizarre Content, Acute, Partial remission, Full remission

Differential DIagnosis: Body Dysmorphic Disorder, OCD

Question 2

Brief Psychotic Disorder

Answer 2

A. 1+ of the following symptoms (1,2, or 3):
1. Delusions
2. Hallucinations
3. Disorganized Speech
4. Grossly Disorganized/Catatonic behavior.
B. Duration is at least one day, less than one month
*Do not include a symptom if it is culturally sanctioned
Specifiers: With marked stressor, Without marked stressor, With postpartum onset, With catatonia
Differential Diagnosis: Major depressive disorder or bipolar disorder with psychotic features, schizophrenia, catatonia, substance abuse, medical condition

Question 3

Schizophreniform Disorder

Answer 3

A. 2+ of the following for at least one month (1, 2, or 3).
1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized or catatonic behavior
5. Negative sympotms.
B. Duration is between 1 and 6 months
C. SAD & depress/bipolar d/o w psychotic features have been R/O
D. Disturbance not due to physiological effects of a substance or AMC

Specifiers: with good prognostic features (2+ of the following: onset w/in 4 weeks of change in behavior, confusion or perplexity, good premorbid social & occupat fx, absence of blunted affect), without good prognostic features, with catatonia

Differential Diagnosis: Schizoaffective Disorder, Depressive Disorder/Bipolar Disorder with Psychotic Features (No MD or Manic symptoms have occurred concurrently with active–phase symtoms, If mood episodes have occurred theyhave been minimal), Substance abuse, Medical condition

Question 4

Schizophrenia

Answer 4

A. 2+ for 1 month (1, 2, or 3)
1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized or catatonic behavior
5. Negative symptoms
B. Level of fx in one or more major life areas is below premorbid level.
C. Continuous signs of disturbance for 6 months (must include 1 month of criterion A symptoms, may include prodromal or residual phases)

Specifiers: First episode/acute, partial remission, full remission, Multiple edisodes/acute, partial remission, full remission, With catatonia

Differential Diagnosis: Schizoaffective disorder, Depressive/Bipolar with psychotic features, Substance abuse, Medical condition, Autis Spectrum/Communication Disorder (Additional diagnosis of Schizophrenia only made if prominent delusions or hallucinations are present for 1 month)

Question 5

Schizoaffective disorder

Answer 5

A. Major mood episode concurrent with criterion A of schizophrenia
B. Delusions or hallucinations for 2+ weeks in the absence of a major mood episode
C. Mood symptoms are present for the majority of the total active and residual portions

Specifiers: Bipolar type, Depressive type, with catatonia, First Episode/Multiple Episodes/Continuous, Acute/Partial Remission/Remission

Differential Diagnosis: Substance abuse, Medcal Condition

Question 6

Catatonia associated with another mental disorder (catatonia specifier)

Answer 6

3+ of the following:

1. Stupor (no psychomotor activity)
2. Catalespy (posture passive against gravity)
3. Waxy flexibility (slight, even resistence)
4. Mutism (no or very little verbal response)
5. Negativism (No response to instructions)
6. Posturing (spontaneous/active maintenance)
7. Mannerism (odd caricature)
8. Stereotypy (repetitive movements)
9. Agitation, not influenced by external stimuli
10. Grimacing
11. Echolalia (mimicking speech)
12. Echopraxia (mimicking movements)

Question 7

Manic Episode

Answer 7

A. Abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal–directed activity or energy lasting at least 1 week and present most of the day, nearly every day
B. 3+ of the following symptoms that mark a change in behavior.
1. Inflated self–esteem or grandiosity
2. Decreased need for sleep
3. More talkative than usual or pressure to keep talking
4. Flight of ideas or subjective experience that thoughts are racing
5. Distractibility
6. Increase in goal–directed activity or psychomotor agitation
7. Excessive involvement in activities that have a high potential for painful consequences
C. Mood disturbance is severe to cause marked impairment or to necessitate hospitalization
D. Not due to substance or medical condition

Question 8

Hypomanic Episode

Answer 8

A. Abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal–directed activity or energy lasting at least 4 days and present most of the day, nearly every day
B. 3+ of the following symptoms that mark a change in behavior.
1. Inflated self–esteem or grandiosity
2. Decreased need for sleep
3. More talkative than usual or pressure to keep talking
4. Flight of ideas or subjective experience that thoughts are racing
5. Distractibility
6. Increase in goal–directed activity/ psychomotor agitation
7. Excessive involvement in activities that have a high potential for painful consequences
C. Change in fx that is uncharacteristic of individual
D. Disturbance in mood and change in fx are observable by others
E. NOT severe enough to cause marked impairment or to necessitate hospitalization
F. Not attributable to substance, medical condition, or antidepressant tx

Question 9

Major Depressive Episode

Answer 9

A. 5+ of the following during the same 2 week period and represent a change in fx (at least 1 sx = 1 or 2)
1. Depressed mood most of the day, nearly every day
2. Markedly diminished interest or pleasure in all, or almost all, activities
3. Significant weight loss when not dieting or weight gain or decrease/increase in appetite
4. Insomnia or hypersomnia
5. Psychomotor agitation or retardation
6. Fatigue or loss of energy
7. Feelings of worthlessness or excessive or inappropriate guilt
8. Diminished ability to think or concentrate or indecisiveness
9. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan
B. Causes distress or impairment
C. Not due to a substance or medical condition

Question 10

Bipolar I Disorder

Answer 10

A. Meet criteria for a manic episode. Manic episode may or may not have been preceded by or followed by a hypomanic or major depressive episode.

Specifiers: with anxious distress, with mixed features, with rapid cycling, with melancholic features, with atypical features, with mood–(in)congruent psychotic features, with catatonia, with peripartum onset, with seasonal pattern

Differential Diagnosis: Schizoaffective Disorder, Schizophrenia, Schizophreniform Disorder, Delusional Disorder, Other (un)specified schiophrenia spectrum or psychotic disorder

Question 11

Bipolar II Disorder

Answer 11

A.Current or past hypomanic episode and a current or past major depressive episode
B. Never had a manic episode
D. Symptoms of depression or unpredictability of alteration between periods of depression and hypomania causes distress or impairement

Specifiers: anxious distress, mixed features, rapid cycling, melancholic features, atypical features, mood–(in)congruent psychotic features, catatonia, peripartum onset, seasonal pattern, partial/full remission, Mild/moderate/severe

Differential Diagnosis: Schizoaffective Disorder, Schizophrenia, Schizophreniform Disorder, Delusional Disorder, Other (un)specified schiophrenia spectrum or psychotic disorder

Question 12

Cyclothymia

Answer 12

A. At least 2 years numerous periods of hypomanic sx that don’t meet criteria for episode and numerous periods with depressive sx that don’t meet criteria for episode
B. Present at least half the time and not been without for more than 2 months at a time
C. Criteria for MD, manic, or hypomanic episode never met.

Specifiers: with anxious distress

Differential Diagnosis: Schizoaffective Disorder, Schizophrenia, Schizophreniform Disorder, Delusional Disorder, Other (un)specified schiophrenia spectrum or psychotic disorder, Substance use, Medical condition (ie. hyperthyroidism)

Question 13

Disruptive Mood Dysregulation Disorder

Answer 13

A. Severe recurrent temper outbusts manifested verbally and/or behaviorally that are grossly out of proportion in intensity and duration to the situation or provocation
B. Outbust inconsistet with developmental level
C. 2+ outbusts per week
D. Persistantly irritable mood most of the day, nearly every day
E. Criteria A–D present for 12+ mos
F. Criteria A and D present and sever in 2+ settings
G. Must be diagnosed btwn ages 6 and 18
H. Onset before age 10
I. No distinct period in which full symptom criteria for manic or hypomanic episode is met
J. Behaviors do not occur exclusively during MD episode

Question 14

Major Depressive Disorder

Answer 14

A. 5+ of the following during the same 2 week period and represent a change in fx (at least 1 sx = 1 or 2)
1. Depressed mood most of the day, nearly every day
2. Markedly diminished interest or pleasure in all, or almost all, activities (Anhedonia)
3. Significant weight loss when not dieting or weight gain or decrease/increase in appetite
4. Insomnia or hypersomnia
5. Psychomotor agitation or retardation
6. Fatigue or loss of energy
7. Feelings of worthlessness or excessive or inappropriate guilt
8. Diminished ability to think or concentrate or indecisiveness
9. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan
B. Causes distress or impairment
C. Not due to a substance or medical condition
D. Not better explained by a psychotic disorder
E. Never been a manic or hypomanic episode

Specifiers: with anxious distress, with mixed features, with melancholic features, with atypical features, with mood–(in)congruent psychotic features, with catatonia, withperipartum onset, with seasonal pattern

Differential Diagnosis: Schizoaffective Disorder, Schizophrenia, Schizophreniform Disorder, Delusional Disorder, Other (un)specified schiophrenia spectrum or psychotic disorder, Substance use, Medical condition (ie. hyperthyroidism)

Question 15

Persistent Depressive Disorder (Dysthymia)

Answer 15

A. Depressed mood most of the day, for more days than not, for at least 2 years
B. 2 +
1. Poor appetite or overeating
2. Insomnia or hypersomnia
3. Low energy or fatigue
4. Low self–esteem
5. Poor concentration or difficulty making decisions
6. Feelings of hopelessness
C. Never been without symptoms for more than 2 months at a time
D. Criteria for MDD may be continuously present for 2 years
E. Never been manic or hypomanic episode
F. Not better explained by a psychotic disorder
G. Not due to substance or medical condition
H. Causes distress or impairment

Specifiers: with anxious distress, with mixed features, with melancholic features, with atypical features, with mood–(in)congruent psychotic features, with catatonia, withperipartum onset, with seasonal pattern

Differential Diagnosis: Schizoaffective Disorder, Schizophrenia, Schizophreniform Disorder, Delusional Disorder, Other (un)specified schiophrenia spectrum or psychotic disorder, Substance use, Medical condition (ie. hyperthyroidism)

Question 16

Premenstrual Dysphoric Disorder

Answer 16

A. In the majority of menstural cycles, 5+ sx present in the week before onset of menses, start to improve within a few days after onset of menses, and become minimal or absent in the week postmenses
B. 1+ Sx:
1. Marked affective lability
2. Marked irritability, anger, or increased personal conflict
3. Marked depressed mood, hopelessness, or self–depricating thoughts
4. Marked anxiety or tension
C. 1+ Sx additionally present:
1. Decreased interest in usual activities
2. Difficulty in concentration
3. Marked lack of energy
4. Change in appetite, overeating, cravings
5. Hypersomnia or insomnia
6. Feeling overwhelmed
7. Physical symptoms such a breat swelling/tenderness, joint pain, bloating, or weight gain
D. Clinically significant distress or impairment
E. Not simply exacerbation of another disorder
F. At least 2 symptomatic cycles
G. Not attributable to substance or medical condition

Question 17

Separation Anxiety Disorder

Answer 17

A. Developmentally inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached
B. 3+ of the following:
1. Recurrent excessive distress when anticipating or experiencing serparation from home or major attachment figure
2. Persistant and excessive worry about losing major attachment figures or possible harm to them
3. Persistant and excessive worry about experiencing an event that causes separation
4. Persistant reluctance or refusal to leave home because of fear of separation
5. Persistant and excessive fear of being alone
6. Peristant reluctance or refusal to sleep away from attachment figure
7. Repeated nightmares involving theme of separation
8. Repeated somatization when separation is anticipated or occurs
B. Sx last 6+ mos in adults, 1+ month in child
C. Clinically significant impairment

Differential Diagnosis: ASD, Psychotic Disorder, Agoraphobia, GAD, Illness Anxiety Disorder

Question 18

Selective Mutism

Answer 18

A. Consistant failure to speak in specific social situations in which here is an expectation for speaking
B. Sx interfere with communication
C. Sx 1+ mos
D. Failure to speak is not attributable to lack of language or knowledge

Differential Diagnosis: ASD, Communication Disorder

Question 19

Specific Phobia

Answer 19

A. Marked fear or anxiety about a specific object or situation
B. Object/situation provokes immediate fear or anxiety
C. Actively avoided or endured with intense fear or anxiety
D. Out of proportion to actual danger posed by specific object
E. Persistent – lasting 6 months
F. Distress and impairment

Specifiers: animal, natural enviornment, blood–injection–injury, situational, other

Differential Diagnosis: PD, Agoraphobia, OCD, PTSD, Separation Anxiety, Social Anxiety Disorder

Question 20

Social Anxiety Disorder (Social Phobia)

Answer 20

A. Marked fear or anxiety in one or more social situations in which the individual is exposed to possible scrutiny by others
B. Fear that they will act in a way or show anxiety symptoms that will be negatively evaluated
C. Social situations almost always provoke fear or anxiety
D. Social situations are avoided or endured with intense fear or anxiety
E. Out of proportion to actual threat
F. Persistent for 6+ months
G. Distress and impairment in Fx

Specifiers: Performance only

Differential Diagnosis: Substance abuse, medical condition, PD, Body dysmorphic disorder, ASD

Question 21

Panic Disorder

Answer 21

A. Recurrent unexpected panic attacks. Abrupt surge of intense fear or intense discomfort that reaches a peak within minutes and has 4+:
1. Palpitations, pounding heart, or accelerated heart rate
2. Sweating
3. Trembling or shaking
4. Sensations of shortness of breath or smothering
5. Feelings of choking
6. Chest pain or discomfort
7. Nausea or abdominal distress
8. Chills or heat sensations
9. Paresthesias (numbness or tingling)
10. Derealization or depersonalization
12. Fear of losing control or going crazy
13. Fear of dying
B. At least one of the attacks followed by a month of 1. persistent concern or worry about additional panic attacks
2. Significant maladaptive change in behavior related to the attacks and designed to avoid having panic attacks

Differential Diagnosis: substance use, medical condition, SAD, SP, OCD, PTSD

Question 22

Agoraphobia

Answer 22

A. Marked fear or anxiety about 2+:
1. Using public transportation
2. Being in open spaces
3. Being in enclosed spaces
4. Standing in line or being in a crowd
5. Being outside of the home alone
B. Avoids these situations because of thoughts that escape might be difficult or help might not be available in the event of developing panic–like symptoms
C. Situations almost always provoke fear or anxiety
D. Actively avoiding situations that produce anxiety
E. Out of proportion to actual danger posed
F. Persistent Sx for 6+ months
G. Distress and impairment

Differential Diagnosis: SP, OCD, BDD, SAD

Question 23

Generalized Anxiety Disorder

Answer 23

A. Excessive anxiety or worry occurring more days than not for 6+ mos
B. Difficulty controlling worry
C. 3+ Sx:
1. Restlessness or feeling keyed up or on edge
2. Being easily faigued
3. Difficulty concentrating or mind going blank
4. Irritability
5. Muscle tension
6. Sleep disturbance
D. Distress or impairment

Differential Diagnosis: PD, SAD, OCD, PTSD, Anorexia Nervosa, Somatic Symptom Disorder, BDD, Illness Anxiety Disorder, Schizophrenia, Delusional Disorder

Question 24

Obsessive–Compulsive Disorder

Answer 24

A. Presence of obsessions, compulsions, or both
Obsessions:
1. Recurrent and persistent thoughts, urges, or images that are intrusive and unwanted and that cause anxiety or distress
2.Attempts to ignore or suppress such thoughts, urges, or images or to neutralize them

Compulsions:
1. Repetitive behaviors or mental acts that you feel driven to do in response to an obsession or rules
2. Aimed at preventing or reducing anxiety or distress or preventing some dreaded event or situation
B. o/c are time consuming or cause distress or impairment

Specifiers: With good/fail insight, With poor insight, With absent insight/delusional beliefs, Tic–related

Differential Diagnosis: GAD, BDD, Hoarding Disorder, Trichomania, Illness Anxiety Disorder, Eating disorder, ADHD, MDD, ASD

Question 25

Body Dysmorphic Disorder

Answer 25

A. Preoccupation with one or more perceived defects or flaws in physical appearance
B. Performed repetitive or mental acts in response
C. Distress or impairment
D. Not better explained by eating disorder

Specifiers: With muscle dysmorphia, With good/fail insight, With poor insight, With absent insight/delusional beliefs

Question 26

Posttraumatic Stress Disorder

Answer 26

A. Exposure to actual or threatened death, serious injury, or sexual violence in 1+ ways:

1. Direct experience
2. Witnessing event
3. Learning event occurred to a close family member or friend
4. Experiencing repeated or extreme exposure to aversive details of event through work

B. Presence of 1+ intrusion symptoms:

1. Recurrent, involuntary, and intrusive distressing memories of event
2. Distressing dreams in which content/affect are related to event
3. Dissociative reactions – feels like event is recurring (flashback)
4. Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the event
5. Physiological reactions to internal or external cues

C. Persistent avoidance of stimuli associated with the event

1. Avoidance or efforts to avoid distressing memories, thoughts, or feelings
2. Avoidance or efforts to avoid external reminders

D. Negative alterations in cognitions and mood associated with event – 2+:

1. Inability to remember an important aspect of the event
2. Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world
3. Persistent distorted cognitions about the cause or consequences of event, self–blame
4. Persistent negative emotional state
5. Markedly diminished interest or participation in significant activities
6. Feelings of detachment or estrangement from others.
7. Persistent inability to experience positive emotions

E. Marked alterations in arousal and reactivity associated with the traumatic event – 2+:

1. Irritable behavior or angry outbursts
2. Reckless or self–destructive behavior
3. Hypervigilance
4. Exaggerated startle response
5. Problems with concentration
6. Sleep disturbance

F. Duration is more than one month
G. Distress and impairment

Specifiers: with dissociative symptoms (depersionalization or derealization) or with delayed expression

Differential Diagnosis: Substance use or medical condition

Question 27

Acute Stress Disorder

Answer 27

A. Exposure to actual or threatened death, serious injury, or sexual violence in 1+ ways:

1. Direct experience
2. Witnessing event
3. Learning event occurred to a close family member or friend
4. Experiencing repeated or extreme exposure to aversive details of event through work

B. Presence of 9+ symptoms:
1. Recurrent, involuntary, and intrusive distressing memories of event
2. Distressing dreams in which content/affect are related to event
3. Dissociative reactions – feels like event is recurring (flashback)
4. Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the event
5. Persistent inability to experience positive emotions
6. Avoidance or efforts to avoid distressing memories, thoughts, or feelings
7. Avoidance or efforts to avoid external reminders
8. Marked alterations in arousal and reactivity associated with the traumatic event – 2+:
9. Irritable behavior or angry outbursts
10. Hypervigilance
11. Exaggerated startle response
12. Problems with concentration
13. Sleep disturbance
C. 3 days to 1 month after trauma exposure
D. clinically significant impairment

Differential Diagnosis: Substance use or medical condition, Breif psychotic disorder

Question 28

Adjustment Disorder

Answer 28

A. The development of emotional or behavioral sx in response to identifiable stressors occurring within 3 mos of onset
B. Clinically significant sx. At least 1:
1. Marked distress that is out of proportion to severity of stressor
2. Impairment in fx

Specifiers: with depressed mood, with anxiety, with mixed anxiety and depressed mood, with disturbance of conduct, with mixed disturbance of emotions and conduct, unspecified

Differential DIagnosis: Normal breavement

Question 29

Dissociative Identity Disorder

Answer 29

A. Disruption of identity characterized by 2+ distinct personality states, which may be described in some cultures as an experience of possession. marked discontinuity in sense of self and sense of agency, accompanied by related alteration in perception, cognition, affect, behavior, consciousness, memory, and/or sensory–motor fx.
B. Recurrent gaps in the recall of everyday events, important personal info, and/or traumatic events not consistent with ordinary forgetting
C. Distress and impairment
D. Not a normal part of a broadly accepted cultural or religious practice
E. Not due to substance or medical condition

Question 30

Dissociative Amnesia

Answer 30

A. Inability to recall important autobiographical information, usually of a traumatic or stressful nature, that is not consistent with ordinary forgetting
B. Distress and impairment
C. Not due to substance or neurological or medical condition

Specifiers: with dissociative fugue

Differential Diagnosis: DID, PTSD, ASD, somatic symptom disorder, or neurocognitive disorders

Question 31

Depersonalization/Derealization Disorder

Answer 31

A. Persistent or recurrent experiences of depersonalization or derealization or both

Depersonalization: experiences of unreality, detachment, or being an outside observer with respect to one’s thoughts, feelings, sensations, body, or actions

Derealization: experiences of unreality or detachment with respect to surroundings

B. During experiences, reality testing remains intact
C. Clinial distress or impairment

Differential DIagnosis: Schizophrenia, PD, MDD, ASD, PTSD, DID

Question 32

Somatic Symptom Disorder

Answer 32

A. 1+ somatic symptoms that are distressing
B. Excessive thoughts, feelings, or behaviors related to sx, 1+ of the following:
1. Disproportionate or persistent thoughts about seriousness of sx
2. Persistently high level of anxiety about sx
3. Excessive time and energy devoted to concern
C. 6+ mos symptomatic

Specifiers: with predominant pain, persistent, Mild/Moderate/Severe

Question 33

Illness Anxiety Disorder

Answer 33

A. Preoccupation with having or acquiring a serious illness
B. Somatic symptoms are not present or very mild in intensity . Worry is excessive.
C. High level of anxiety about health
D. Excessive health related activities or avoidance
E. 6+ mos of sx

Specifier: Care–seeker type, Care–avoidant type

Differential Diagnosis: GAD, BDD, SSD, OCD, Delusional Disorder

Question 34

Factitious Disorder

Answer 34

Imposed on self or other:
A. Falsification of physical or psychological sx
B. Individual presents to others as ill, impaired, or injured
C. Deceptive behavior is evident even without obvious external rewards

Specifier: single episode, recurrent

Question 35

Anorexia Nervosa

Answer 35

A. Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.
B. Intense fear of gaining weight or becoming fat or persistent behavior that interferes with weight gain, even thought at a significantly low weight.
C. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self–evaluation, or persistent lack of recognition of the seriousness of the current low body weight

Coding: restricting type, binge–eating/purging type

Specifiers: in partial/full remission

Question 36

Bulimia Nervosa

Answer 36

A. Recurrent episodes of binge eating. characterized by both:
1. Eating, in a discrete period of time an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances
2. Sense of lack of control over eating during the episode
B. Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self–induced vomiting misuse of laxatives, diuretics, or other medications; fasting or excessive exercise
C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months
D. Self–evaluation is unduly influenced by body shape and weight
E. The disturbance does not occur exclusively during episodes of AN

Specifiers: in partial/full remission, Mild ( 1–3x/week), Moderate (4–7x/week), Severe (8–13x/week), Extreme (14+x/week)

Question 37

Binge–Eating Disorder

Answer 37

A. Recurrent episodes of binge eating. characterized by both:
1. Eating, in a discrete period of time an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances
2. Sense of lack of control over eating during the episode
B. Episode is associated with 3+:
1. Eating much more rapidly than normal
2. Eating until feeling uncomfortably full
3. Eating large amounts of food when not feeling physically hungry
4. Eating alone because of feeling embarrassed by how much one is eating
5. Feeling disgusted with oneself, depressed, or very guilty afterward
C. Distress regarding binge eating
D. Occurs at least once a week for 3 months
E. Not associated with use of inappropriate compensatory behaviors and does not occur exclusively in the course of AN or BN

Question 38

Gender Dysphoria

Answer 38

Adolescents and Adults:
A. Marked incongruence between one’s experienced/expressed gender and assigned gender. Duration of at least 6 months and manifested by 2+:
1. Marked incongruence between one’s experience/expressed gender and primary or secondary sex characteristics
2. Strong desire to be rid of one’s primary and/or second sex characteristics because of incongruence
3. Strong desire for the primary and/or second sex characteristics of the other gender
4. Strong desire to be of the other gender
5. Strong desire to be treated as the other gender
6. Strong conviction that one has typical feelings and reactions of the other gender
B. Distress or impairment

Specifier: with a disorder of sex development, posttransition

Question 39

Substance Use Disorder

Answer 39

A. Problematic pattern of use leading to distress or impairment as manifested by at least 2+ over 12 months:

1. substance is taken in larger amounts or over longer period than intended
2. Persistent desire or unsuccessful efforts to cut down on or control use
3. Great deal of time spent in activities necessary to obtain, use, or recover from substance
4. Craving or a strong desire or urge to use substance
5. Recurrent use resulting in a failure to fulfill major role obligations
6. Continued use despite having persistent or recurrent social or interpersonal problems
7. Important activities given up or reduced because of use
8. Recurrent use in situations where it is physically hazardous
9. Use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by substance
10. Tolerance as defined by either
    a: Need for markedly increased amounts to achieve intoxication or desired effect
    b: Markedly diminished effect with continued use of same amount
11. Withdrawal as defined by either:
    a: Characteristic withdrawal syndrome for substance
    b: Substance or closely related substance is taken to relieve or avoid withdrawal symptoms

Question 40

Paranoid Personality Disorder

Answer 40

A. Pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning in early adulthood and present in a variety of contexts at indicated by 4+:
1. Suspects without sufficient basis that others are exploiting, harming, or deceiving him or her
2. Preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates
3. Reluctant to confide in others bc of unwarrented fear that th einfo will be used maliciously against them
4. Reads hidden demeaning or threatening meanings into benign remarks or events
5. Persistently bears grudges
6. Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack
7. Recurrent suspicious without justification regarding fidelity of spouse or sexual partner
B. Not due to a psychotic disorder or another medical condition

GAS SCUM (4+ of 7)
1) persistently bears GRUDGES
2) perceives ATTACKS not apparent & quick to react/counterattack
3) SUSPICIOUS of exploitation/harm/deceit
4) SPOUSAL infidelity suspected without justification
5) reluctant to CONFIDE in others due to fear of unwarranted maliciousness
6) UNJUSTIFIED doubts of loyalty/trustworthiness of friends/associates
7) reads hidden demeaning/threatening MEANING in benign events/comments
Cluster A

Question 41

Schizoid Personality Disorder

Answer 41

A. Pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning in early adulthood and present in a variety of contexts, as indicated by 4+:
1. Neither desires nor enjoys close relationships, including familial
2. Almost always chooses solitary activities
3. Has little, if any, interest in having sexual experiences with another person
4. Takes pleasure in few, if any, activities
5. Lacks close friends or confidants other than first–degree relatives
6. Appears indifferent to the praise or criticism of others
7. Shows emotional coldness, detachment, or flattened affectivity
B. Does not occur exclusively in course of psychotic disorder and not due to another medical condition

DISTANT (5+ of 7)
1) shows emotional coldness, DETACHMENT or flat affect
2) appears INDIFFERENT to criticism/praise
3) SEXUAL experiences of little/no interest
4) almost always chooses solitary TASKS/activities
5) ABSENCE of close friends beyond 1st degree relatives
6) NEITHER desires/enjoys close relationships/being part of family
7) TAKES pleasure in few/no activities
Cluster A (like a void”)”

Question 42

Schizotypal Personality Disorder

Answer 42

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, beginning by early adulthood and present in a variety of contexts as present by 5+:
1. Ideas of reference
2. Odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms
3. Unusual perceptual experiences, including bodily illusions
4. Odd thinking and speech
5. Suspciousness or paranoid ideation
6. Inappropriate or constricted affect
7. Behavior or appearance that is odd, eccentric, or peculiar
8. Lack of close friends or confidants other than first degree relatives
9. Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self
B. Not exclusively during course of psychotic disorder or ASD

ME PECULIAR (5+ of 10)
1) MAGICAL thinking/odd beliefs
2) EXPERIENCES unusual perceptions including bodily illusions
3) PARANOID ideation/suspiciousness
4) ECCENTRIC behavior/appearance
5) CONSTRICTED/inappropriate affect
6) UNUSUAL/odd thinking & speech
7) LACKS close friends
8) IDEAS of reference (not delusions of reference)
9) ANXIETY in social situations associated with social situations (not negative judgments) that doesn’t diminish with familiarity
10) RULE out psychosis or autism spectrum d/o
Cluster A (wears a pickle”)”

Question 43

Antisocial Personality Disorder

Answer 43

A. Pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 and indicated by 3+:
1. Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest
2. Deceitfulness, as indicated by repeated lying, use of aliases, or conning other for personal profit or pleasure
3. Impulsivity or failure to plan ahead
4. Irritability and aggressiveness, as indicated by repeated physical fights or assaults
5. Reckless disregard for safety of self or others
6. Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations
7. Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another
B. At least 18 years old
C. Evidence of conduct disorder with onset before 15
D. Not exclusively during course of schizophrenia or bipolar

CORRUPT + C (3+ of 7 and C)
1) CONFORMITY to law/social norms lacking, evidenced by repeated acts that are grounds for arrest
2) consistent irresponsibility, evidenced by repeated failure to honor financial/occupational OBLIGATIONS
3) RECKLESS disregard for safety of self/others
4) lacking REMORSE, evidenced by indifference to/rationalization of hurting/stealing from/mistreated others
5) UNDERHANDED (deceitful, lying, conning others repeatedly)
6) impulsivity/failure to PLAN ahead
7) TEMPER (repeated fights/assaults due to irritability/aggressiveness)
+ evidence of CONDUCT d/o before 15 yo
Cluster B

Question 44

Borderline Personality Disorder

Answer 44

A. Pervasive pattern of instability of interpersonal relationships, self–image, and affects and marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by 5+:

1. Frantic efforts to avoid real or imagined abandonment
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
3. Identity disturbance: markedly and persistently unstable self–image or sense of self
4. Impulsivity in at least 2 areas that are potentially self–damaging
5. Recurrent suicidal behavior, gestures, or threats or self–mutilating behavior
6. Affective instability due to a marked reactivity of mood
7. Chronic feelings of emptiness
8. Inappropriate, intense anger or difficulty controlling anger
9. Transient stress–related paranoid ideation or severe dissociative symptoms

IMPAIR EASe (5+ of 9)
1) IMPULSIVITY in 2+ potentially damaging areas: sex, spending, substances, reckless driving, binge eating, etc.)
2) MOOD instability & marked reactivity
3) transient, stress–related PARANOID ideation / severe dissociation
4) frantic efforts to avoid real/imagined ABANDONMENT
5) IDENTITY disturbance: unstable sense of self/self–image
6) unstable/intense RELATIONSHIPS characterized by alternating idealization/devaluation
7) chronic feelings of EMPTINESS
8) inappropriate intense/difficulty controlling ANGER
9) recurrent SUICIDAL/parasuicidal behavior
Cluster B

Question 45

Histrionic Personality Disorder

Answer 45

A. Pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts, as indicated by 5+:

1. Uncomfortable in situations where not center of attention
2. Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior
3. Displays rapidly shifting and shallow expression of emotions
4. Consistently uses physical appearance to draw attention to self
5. Has a style of speech that is excessively impressionistic and lacking in detail
6. Shows self–dramatization theatricality, and exaggerated expression of emotion
7. Suggestible
8. Considers relationships to be more intimate than they actually are

PRAISE ME (5+ of 8)
1) inappropriately PROVOCATIVE/seductive behavior
2) RELATIONSHIPS considered more intimate than they are.
3) uncomfortable in situations where he/she not center of ATTENTION
4) suggestible/easily INFLUENCED by others/circumstances
5) STYLE of speech excessively impressionistic/lacking in detail
6) rapidly shifting & shallow EMOTIONS
7) MADE UP: consistently uses physical appearance to draw attention
8) self–dramatization, theatricality & EXAGGERATED emotions
Cluster B

Question 46

Narcissistic Personality Disorder

Answer 46

A. Pervasive pattern of grandiosity. need for admiration, and lack of empathy beginning by early adulthood and present in a variety of contexts as indicated by 5+:

1. Has a grandiose sense of self–importance
2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
3. Believes that they are special” and unique and can only be understood by or should associate with other special or high–status people 4. Requires excessive admiration 5. Sense of entitlement 6. Interpersonally 7. Lack empathy: is unwilling to recognize or identify with the feelings and needs of othersexploitative 8. Often envious of others or believes that others are envious of them 9. Shows arrogant, haughty behaviors or attitudes CLUSTER B

Question 47

Avoidant Personality Disorder

Answer 47

A. Pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood and present in a variety of contexts as indicated by 4+:

1. Avoids occupational activities that involve significant interpersonal contact because of fears of criticism, disapproval, or rejection
2. Unwilling to get involved with people unless certain of being liked
3. Shows restraint within intimate relationships because of the fear of being shamed or ridiculed
4. Preoccupied with being criticized or rejected in social situations
5. Inhibited in new interpersonal situations because of feelings of inadequacy
6. Views self as socially inept, personally unappealing, or inferior to others
7. Usually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing

CRINGES (4+ of 7)
1) unwilling to get involved with others unless CERTAIN of being liked
2) preoccupation with being REJECTED/criticized in social situations
3) shows restraint in INTIMATE relationships d/t fear of shame/ridicule
4) inhibited in NEW relationships d/t feelings of inadequacy
5) GETS around (avoids) occupational activities w/ significant interpersonal contact d/t fear of rejection/disapproval/criticism
6) reluctant to take risks/engage in new activities d/t fear of EMBARRASSMENT
7) views SELF as socially inept/unappealing/inferior
Cluster C

Question 48

Dependent Personality Disorder

Answer 48

A. Pervasive and excessive need to be taken care of that leads to submissive and clinging behaviors and fears of separation, beginning by early adulthood and present in a variety of contexts as indicated by 5+:

1. Difficulty making everyday decisions without an excessive amount of advice and reassurance from others
2. Needs other to assume responsibility for most major areas of his or her life
3. Difficulty expressing disagreement with others because of fear of loss or support or approval
4. Difficulty initiating projects or doing things on his or her own (because of a lack of self–confidence)
5. Goes to excessive lengths to obtain nuturance and support from others to the point of volunteering to do things that are unpleasant
6. Feels uncomfortable or helpless when alone because of exaggerated fears of being able to care for self
7. Urgently seeks another relationship as a source of care and support when a close relationship ends
8. Unrealistically preoccupied with fears of being left to take care of himself or herself

RELIANCE (4+ of 8)
1) difficulty making decisions w/o excessive advice/REASSURANCE
2) difficulty EXPRESSING disagreement d/t unrealistic fear of loss of support/approval
3) needs others to take responsibilities for most major areas of LIFE
4) difficulty INITIATING projects/doing independent things d/t lack of confidence
5) feels uncomfortable/helpless when ALONE d/t exaggerated fears of inability to care for self
6) goes to excessive lengths to get NURTURANCE/support to point of doing unpleasant things
7) COMPANIONSHIP as source of support/care urgently sought when relationship ends
8) exaggerated fears of being left to care for self
Cluster C

Question 49

Obsessive–Compulsive Personality Disorder

Answer 49

A. Pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts, as indicated by 4+:

1. Preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost
2. Shows perfectionism that interferes with task completion
3. Excessively devoted to work and productivity to the exclusion of leisure activities and friendships
4. Overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values
5. Unable to discard worn–out or worthless objects even when they have no sentimental value
6. Reluctant to delegate tasks or to work with others unless they submit to exactly their way of doing things
7. Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes
8. Shows rigidity and stubbornness

LAW FIRMS (4+ of 8)
1) LOSES point of activity d/t preoccupation w/ details/rules/lists/order/organization or schedules
2) ABILITY to complete tasks compromised by perfectionism
3) unable to discard WORTHLESS /worn–out objects even with no sentimental value
4) FRIENDSHIPS/leisure activities excluded d/t excessive devotion to work/productivity
5) INFLEXIBLE/scrupulous/overconscientious over morality/ethics/values (not d/t culture or religion)
6) RELUCTANT to delegate unless others do exactly as he says
7) MISERLY spending style; money viewed as something to hoard for future catastrophes
8) STUBBORN/rigidity
Cluster C

Question 50

Cluster A personality disorders

Answer 50

Weird” Paranoid Schizoid Schizotypal

Question 51

Cluster B personality disorders

Answer 51

Wild” Borderline Antisocial histrionic Narcissistic

Question 52

Cluster C personality disorders

Answer 52

Worried” Avoidant Dependant Obsessive Compulsive ASD

Question 53

Autism Spectrum Disorder

Answer 53

A. Persistent deficits in social communication and social interaction accoss multiple contexts , as manifested by the following, currently or by history:
1. Deficits in social–emotional reciprocity
2. Deficits on nonverbal communicative behaviors used for social interaction
3. Deficits in developing, maintaining, and understanding relationships
B. Restricted, repetitive patterns of behavior, interests, and activities, as manifested by 2+ of the following:
1. Stereotyped or repetitive motor movements, use of objects, or speech
2. Insistence on sameness, inflexible adherence to routines, ritualized patterns of verbal or nonverbal behavior
3. Highly resticted, fixated interested that are abnormal in intensity or focus
4. Hyper/Hypo reactivity to sensory input
C. Sx present in early developmental period
D. Clinically significant impairment

Specifiers: With(out) accompanying intellectual/language impairment, associated with known medical or genetic condition, associated wit known neurodevelopmental, mental, or behavioral disorder, with catatonia

Differential Diagnosis: Intellectual Developmental Disorder, Global Developmental Delay