DSM-5 Criteria

Question 1

DSM-5 Criteria for Social Anxiety Disorder

Answer 1

A. Individuals show “marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others”
B. The individual “fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (will be humiliating or embarrassing; will lead to rejection or offend others)” (New to DSM-5)
C. Social situations almost always provoke fear or anxiety
D. These situations are avoided or endured with great distress
E. The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context
F. The fear or anxiety must have lasted for 6 months or more
G. The fear, anxiety, or avoidance must cause significant impairment in functioning
H. Can’t be diagnosed if the symptoms are better explained by use of a substance
I. Can’t be diagnosed if the symptoms are better explained by the symptoms of another mental disorder
J. Can’t be diagnosed if the symptoms are better explained by a medical condition
Note: If the anxiety symptoms are related to a medical condition, a diagnosis of SAD may be given if they are clearly excessive, as judged by comparison to other persons with the medical condition

Question 2

Criteria for Panic Attack

Answer 2

• Panic attack: abrupt surge of intense fear or discomfort that’s diagnosed by the presence of 4 or more of 13 physical and cognitive symptoms:
• Palpitations, pounding heart, accelerated heart rate
• Sweating
• Trembling or shaking
• Shortness of breath or smothering sensation
• Feeling of choking
• Chest pain or discomfort
• Nausea or abdominal distress
• Dizzy, unsteady, lightheaded, or faint
• Chills or heat sensations
• Paresthesias (numbness or tingling sensations)
• Derealization (feelings of unreality) or depersonalization (being detached from oneself)
• Fear of losing control or going crazy
• Fear of dying
• Culture‐specific symptoms (not part of the 13) that may be associated with panic attacks: uncontrollable crying or sore neck
• Full-blown panic attack = 4 or more symptoms
• Limited symptom attacks = fewer than 4 symptoms

Question 3

DSM-5 Criteria for Panic Disorder

Answer 3

• Recurrent unexpected panic attacks
• At least one followed by a month or more of persistent concern about having panic attacks or a significant, maladaptive behavioral change related to the attacks
• Panic not better accounted for by another disorder (ex: stimulus-bound phobia)
• A discrete period of fear or discomfort w/ 4 out of 13 symptoms
• Develop abruptly and peak in intensity within 10 minutes
• Lots of cardiovascular and autonomic symptoms, some cognitive

Question 4

DSM-5 Criteria for Agoraphobia

Answer 4

• Marked fear or anxiety about situations from which escape might be difficult or in which help might be unavailable in the event of panic‐like or other incapacitating symptoms (ex: loss of bowel control)
• Diagnosis of agoraphobia requires fear of at least 2 of these:
• Public transportation
• Open spaces (ex: parking lots, marketplaces, or bridges)
• Enclosed places (ex: shops or cinemas)
• Standing in line or being in a crowd
• Being outside of the home alone

Question 5

DSM-5 Criteria for GAD

Answer 5

A. Excessive worry, occurring on more days than not, about a number of events, activities, or topics
B. Worry must persist for at least 6 months, and can involve a wide variety of topics
C. Difficulty controlling the worry
D. Diagnosis of GAD requires the presence of at least 3 out of 6 symptoms reflecting physiological or psychological arousal that accompany the worry
E. Diagnosis can’t be made if the worry is better explained by another mental disorder (ex: mood disorder -> cannot occur exclusively during a mood episode)
F. The worry and associated symptoms must lead to significant distress or impairment in individual’s life
G. Symptoms must not be better accounted for by another disorder (ex: fear of negative evaluation in SAD), by another medical condition, or by the use of a substance

Question 6

List the 6 symptoms related to GAD

Answer 6

• Restlessness, feeling on edge
• Easily fatigued
• Difficulty concentrating
• Irritability
• Muscle tension
• Sleep disturbance

Question 7

DSM-5 Criteria PTSD

Answer 7

A. Individual must have experienced, witnessed, or learned about the traumatic event of a loved one, or have experienced repeated exposure to the aftermath of traumas, such as the experiences of first responders
→ In addition to exposure to a Criterion A event, an individual must also be experiencing a number of symptoms in each of 4 clusters of symptoms: intrusion, avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity (Criteria B, C, D, and E, respectively)
B. Individual must exhibit at least one of the intrusion symptoms
C. Individual must exhibit at least one of the avoidance symptoms
D. Individual must exhibit 2 or more of the negative cognitions and mood symptoms
E Individual must meet at least 2 of the arousal and reactivity symptoms
* All the symptoms of PTSD must have started or worsened after the traumatic event
F. The required number of symptoms from the 4 clusters must be present concurrently for at least 1 month
G. Symptoms must be perceived as distressing or causing functional impairment
* A diagnosis of PTSD with delayed expression can be made in cases where the diagnostic threshold is not met or exceeded until at least 6 months after the traumatic event

Question 8

DSM-5 Criteria Anorexia Nervosa

Answer 8

A. Significantly low body weight resulting from restricted energy intake relative to expenditure
B. Fear of weight gain or of possibility of being overweight or behavior that maintains low weight
C. Body‐image disturbance, overvaluation of shape or weight, or denial of severity of low weight

Specify whether:
- Restricting type: individual does not engage in any binge eating or purging; weight loss is the product of dieting and/or excessive exercise only
- Binge eating/purging type: individual engages in recurrent instances of binge eating or purging over the past 3 months

Question 9

DSM-5 Criteria Bulimia Nervosa

Answer 9

A. Repeated episodes of binge eating in which the individual:
1. Eats in a distinct episode an unusually large amount of food relative to what would be consumed by most individuals
2. Experiences a sense of loss of control over eating
B. Repeated episodes of behaviors intended to compensate for overeating and avoid weight gain, such as vomiting, inappropriate use of laxatives/diuretics/other medications, fasting, or excessive energy
C. Binge eating and purging behaviors occur on average at least once a week for 3 months
D. Individual displays overvaluation of shape or weight
E. Individual does not meet criteria for anorexia nervosa

Question 10

DSM-5 Criteria Binge Eating Disorder

Answer 10

A. Repeated episodes of binge eating in which the individual:
1. Eats in a distinct episode an unusually large amount of food relative to what would be consumed by most individuals
2. Experiences a sense of loss of control over eating
B. Episodes of binge eating are characterized by at least 3 of the following:
1. Increased rate of eating
2. Eating beyond the point of fullness
3. Eating in the absence of physical hunger
4. Eating alone out of embarrassment
5. Feelings of disgust, depression, or guilt after episodes of binge eating
C. Binge eating causes significant distress
D. Binge eating occurs on average at least once a week for 3 months
E. The individual does not meet criteria for either AN or BN

Question 11

What are the symptoms related to the intrusion criterion of PTSD?

Answer 11

Exhibit at least one of these:
- Persistent and distressing memories of the trauma
- Recurrent distressing nightmares about the traumatic event
- Dissociative reactions (ex: flashbacks)
- Intense psychological or physiological responses when exposed to cues (internal or external) that resemble the trauma

Question 12

What are the symptoms related to the avoidance criterion of PTSD?

Answer 12

Exhibit at least one of these:
- Effortful avoidance of internal cues
- Efforts to avoid external reminders of the trauma (ex: places, people, or situations)

Question 13

What are the symptoms related to the negative cognitions and mood criterion of PTSD?

Answer 13

Exhibit 2 or more of these:
- Numbing and amnesia (and inability to have positive feelings)
- Strong negative emotions (ex: guilt, anger, or fear)
- Distorted self‐blame or erroneous blame of others who didn’t cause or intend the event
- Negative beliefs about self, others, and the world

Question 14

What are the symptoms related to the arousal and reactivity criterion of PTSD?

Answer 14

Meet at least 2 of these:
- Sleep difficulties
- Concentration impairment
- Exaggerated startle response
- Hypervigilance
- Irritable or aggressive behaviors
- Reckless or self‐destructive behavior

Question 15

DSM-5 Criteria MDD

Answer 15

○ Formal diagnosis is made when a person meets at least 5 out of 9 symptoms of MDD
→ Of those 5, the person must endorse either dysphoric mood symptom and/or anhedonia symptom
○ The person must report experiencing marked distress or a decrease in functioning for at least 2 weeks during which these symptoms were present for most of the day, for more days than not
○ DSM‐5 specifies that when the depressive symptoms are substance‐induced or are directly attributable to a general medical illness, then MDD is not the appropriate primary diagnosis -> ex: hypothyroidism may meet all the criteria for MDD

Question 16

What are the symptoms of MDD?

Answer 16

• DSM‐5 identifies 9 symptoms of MDD (must meet 5 out of 9 to meet criteria)
  1) Dysphoric mood (sad, empty, or tearful)
  2) Anhedonia (loss of interest or pleasure in almost all activities)
  3) Significant weight gain/loss or change in appetite
  4) Insomnia or hypersomnia
  5) Psychomotor agitation or retardation
  6) Fatigue or loss of energy
  7) Feelings of worthlessness or excessive/inappropriate guilt
  8) Decreased concentration or indecisiveness
  9) Recurrent thoughts of death or suicidal ideation, plan, or attempt

Question 17

What are the symptoms of PDD?

Answer 17

• DSM‐5 identifies 6 symptoms of PDD (must meet at least 2 of 6 symptoms to meet criteria)
  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

Question 18

DSM-5 Criteria PDD

Answer 18

○ A formal diagnosis is made when a person meets at least 2 of 6 symptoms accompanied by the occurrence of a depressed mood for most of the day, for more days than not, for at least 2 years
○ A minimum of 2 symptoms must be present consistently throughout the 2‐year duration
○ Patient must report that the symptoms have never remitted for more than 2 months during the 2‐year period
○ Person must report experiencing marked distress or impairment in social, occupational, or other important areas of functioning

Question 19

What are the specifiers that need to be incorporated into a clinical assessment of PDD?

Answer 19

→ Anxious distress
→ Mixed features
→ Melancholic features
→ Pure dysthymic syndrome: full criteria for MDD have not been met in the previous 2 years
→ Persistent depressive episode: full criteria for major depressive episode have been met at some point in the preceding 2‐year period
→ Intermittent major depressive episode, with current episode: individuals who are currently in a nonchronic major depressive episode
→ Intermittent major depressive episode, without current episode: full criteria for a nonchronic major depressive episode were previously met at some point in the preceding 2 years

Question 20

What are the specifiers for MDD?

Answer 20

→ Recurrent depression: whether this is a single (first) episode of major depression or a recurrent form of depression
→ Level of depression severity (mild, moderate, or severe) -> when assigning a “severe” specifier, clinician also indicates whether psychotic features are part of the clinical presentation
→ Chronic MDD: depression occurs continuously and without remission for at least 2 years
→ Atypical MDD: ~15% of depressed patients, is marked by mood reactivity (mood brightens in response to positive events/potential positive events), hypersomnia, extended fatigue, heightened sensitivity to criticism, and a significant increase in appetite and weight gain
→ Peripartum MDD: major depressive episode occurs during pregnancy or within the 4 weeks following delivery
→ Melancholia and Seasonal pattern -> don’t appear to be of great clinical significance
→ “With mixed features”: patients who meet criteria for MDD and who endorse at least 3 symptoms of a manic or hypomanic episode but don’t meet the full criteria for bipolar disorder
→ “With anxious distress”: individuals who display considerable overlap between symptoms of depression and anxiety

Question 21

DSM-5 Criteria Bipolar Disorder

Answer 21

A. Presence of manic episode where individual experiences elated, expansive, or irritable mood plus persistently increased goal‐directed activity (can be social) or energy
B. At least 3 symptoms must also be present (4 if the mood is only irritable):
C. Symptoms lasting at least 1 week (most of the day, nearly every day) -> must be distinct period (distinct change from normal functioning)
D. Evidence of marked functional impairment (deterioration in family, work, or social functioning), or, if lasting less than 1 week, the need for hospitalization or emergency treatment
E. Not attributable to physiological effects of a substance (ex: drugs) or another medical condition

Question 22

What are the DSM-5 symptoms/behaviours related to a bipolar manic episode?

Answer 22

• Inflated self‐esteem or grandiosity
• Decreased need for sleep (irritability often stems from inability to down-regulate/slow down)
• Racing thoughts or flight of ideas (jump from one idea to the next, appears similar to loose associations in Schizophrenia)
• Rapid or pressured speech (more talkative)
• Reckless and impulsive behavior (excessive involvement in pleasurable activities with a high potential for painful consequences -> ex: shopping sprees, sexual indiscretions)
• Increased energy (increased libido and/or more active or agitated -> can’t sit still)
• Distractibility (reported or observed, can contribute to flight of ideas, can lead to diagnostic difficulties with ADHD)

Question 23

What are the DSM-5 criteria for hypomanic episodes?

Answer 23

○ Defined by symptoms of shorter duration (4 or more days) and noticeable changes in behavior that don’t meet the DSM definition of functional impairment
○ The changes in behavior, mood, or energy must be noticeable to others, but the symptoms don’t cause undue financial, emotional, or practical damage

Question 24

DSM-5 Criteria for AUD

Answer 24

• Experience of a problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least 2 of 11 specified symptoms, occurring within a 12‐month period
  ○ Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home
  ○ Recurrent alcohol use in situations in which it is physically hazardous
  ○ Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol
  ○ Tolerance, the need for greater amounts of the alcohol to achieve the same intoxication level or desired effect, or a markedly diminished effect with continued use of the same amount of alcohol
  ○ Withdrawal, the physiological and cognitive maladaptive symptoms that occur when the blood concentration of alcohol declines after prolonged and heavy use of alcohol
  ○ Alcohol is often taken in larger amounts and/or over longer periods of time than intended.
  ○ Persistent desire or unsuccessful efforts to stop or cut down alcohol use.
  ○ Increased amount of time is spent consuming, obtaining, or recovering from the effects of alcohol.
  ○ Important occupational, social, or recreational activities are given up or reduced because of alcohol use.
  ○ Alcohol consumption continues despite the knowledge of having persistent or recurrent physiological and psychological difficulties (ex: blackouts, depression, worsening of an ulcer)
  ○ Craving or strong desire to use alcohol (new DSM-5 criterion)

Question 25

DSM-5 Criteria for BPD

Answer 25

• 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 or more of the following:
  1. Profound fears of abandonment (real or imagined). Frantic efforts to avoid real or imagined abandonment.
  2. A pattern of unstable and intense interpersonal relationships that alternate between feelings of idealization and devaluation of the other person
  3. Identity disturbance characterized by a highly unstable sense of self or markedly disturbed self‐image
  4. Impulsivity in at least 2 areas that are potentially self-damaging or have harmful consequences (ex: substance abuse, reckless driving, binge eating, unsafe sexual behavior, excessive spending)
  5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
  6. Affective instability due to a marked reactivity of mood
  7. Chronic/persistent feelings of emptiness
  8. Inappropriate, intense anger, or difficulty controlling anger (ex: constant feelings of anger, angry outbursts, or recurrent physical fights)
  9. Brief periods of stress-related paranoid ideation or severe dissociative symptoms

Question 26

What are Cleckley’s Criteria for Psychopathy?

Answer 26

○ Superficial charm and good “intelligence.”
○ Absence of delusions and other signs of irrational thinking.
○ Absence of “nervousness” or psychoneurotic manifestations.
○ Unreliability.
○ Untruthfulness and insincerity.
○ Lack of remorse or shame.
○ Inadequately motivated antisocial behavior.
○ Poor judgment and failure to learn by experience.
○ Pathological egocentricity and incapacity for love.
○ General poverty in major affective reactions.
○ Specific loss of insight.
○ Unresponsiveness in general interpersonal relations.
○ Fantastic and uninviting behavior with drink and sometimes without.
○ Suicide rarely carried out.
○ Sex life impersonal, trivial, and poorly integrated.
○ Failure to follow any life plan

Question 27

DSM-5 Criteria for ASPD

Answer 27

A. A pervasive pattern of disregard for and violation of the rights of others, occurring since age 15, as indicated by 3 (or more) of the following:
1. Failure to conform to social norms with respect to lawful behaviors
2. Deceitfulness
3. Impulsivity or failure to plan ahead
4. Irritability and aggressiveness
5. Reckless disregard for safety of self or others.
6. Consistent irresponsibility
7. Lack of remorse

Question 28

Criteria for Conduct Disorder

Answer 28

• Aggression to People and Animals (ex: often bullies, has used a weapon to intimidate others, has been physically cruel to animals)
• Destruction of Property (ex: deliberately engaged in fire setting, deliberately destroyed property)
• Deceitfulness or Theft (ex: stealing non-trivial items, lies to obtain things)
• Serious Violations of rules
  (ex: ignores curfew (before the age of 13), often truant from school (before 13))

Question 29

What constitutes the “With limited prosocial emotions” specifier of Conduct Disorder?

Answer 29

• Lack of remorse or guilt
• Callous- lack of empathy
• Unconcerned about performance
• Shallow or deficient affect

Question 30

Conduct Disorder Specifiers

Answer 30

Specify Onset Type
* Childhood-onset type (prior to age 10)
* Adolescent-onset type (no symptoms prior to 10)

Specify if: “With limited prosocial emotions”

Question 31

DSM-5 Criteria for Schizophrenia

Answer 31

• Need at least 2 of first 3:
• Delusions
• Hallucinations
• Disorganized speech and behavior
• Grossly disorganized or catatonic behavior
• Negative symptoms
• Level of functioning markedly lower than prior to onset
• Symptoms present for 6 months and include at least one month of active symptoms
• Unipolar, bipolar depression, schizoaffective disorder ruled out
• Not attributable to substance

Question 32

Criteria for Schizoaffective Disorder

Answer 32

• People with schizophrenic features (psychotic symptoms) and severe mood disorder
• Mood disorders can be unipolar or bipolar; must currently meet criteria for depressed mood
• Delusions or hallucinations for 2 or more weeks in the absence of a mood episode during lifetime duration of illness
• Symptoms of major mood episode present for the majority of illness
• Not attributable to effects of a substance

Question 33

DSM-5 Criteria for OCD

Answer 33

A. Presence of obsessions, compulsions, or both
B. Obsessions or compulsions are time-consuming (ex: more than 1 hr per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
C. Symptoms are not attributable to the physiological effects of a substance (ex: a drug of abuse, a medication) or another medical condition
D. The disturbance is not better explained by the symptoms of another mental disorder

Question 34

OCD Specifiers

Answer 34

Specify if:
- Good/fair insight (recognition that beliefs probably not true)
- Poor insight (believed to be probably true)
- Absent insight/delusional (believed to be definitely true)

Specify if:
- Tic‐related (current or past history of a tic disorder)