DSM-5-TR Criteria Flashcards
1
Q
The four “D’s” of abnormality
(And related bullets)
A
- Deviant
- Distressing
- Dysfunctional
- Dangerous
- “Abnormal” considerations
- Frequency
- Intensity
- Duration
- Context
- Sequence
2
Q
GAD mnemonic
A
GAD
Energetic Dogs Tirelessly Run, Fetching Cicadas In Murky Swamps
3
Q
GAD flow
A
- Excesive anxiety and worry (apprehensive expectation) + 6 months + many events
- Difficult to control worry
- Three or more of following symptoms:
- Restlessness
- Fatigue
- Concentration issues
- Irritability
- Muscle tension
- Sleep disturbance
4
Q
GAD extras
A
- “Excessive anxiety and worry (apprehensive expectation)”
- Occurring more days than not for at least 6 months
- CHILDREN: Only one symptom required
- Mean age of onset = 35 in North America (later than other anxiety disorders)
Prevalence
- 12-month U.S. = 2.9% of adults in general community
- Lifetime morbid U.S. risk is 9.0%
5
Q
GAD - Comorbidity
A
- COMMON: Past or current anxiety disorders and unipolar depressive disorders
- OTHER, less common: substance use, conduct, psychotic, neurodevelopmental, and neurocognitive disorders
- “The negative affectivity (neuroticism) or emotional liability that underpins this pattern of comorbidity is associated with temperamental antecedents and genetic and environmental risk factors shared between these disorders, although independent pathways are also possible.
- Women: Comorbidity largely confined to anxiety disorders and unipolar depression
- Men: Comorbidity more likely to include SUDs
6
Q
GAD - demographic/cultural
A
GAD
- Considerable cultural variation in expression of GAD
- Greater expression of somatic vs. cognitive sxs, depending
- Need to consider social and cultural context to determine whether worries are excessive
- Example: higher GAD prevalence associated with racism and discrimination for U.S. minority groups
- GAD slightly more frequent in women than men
- Women: Comorbidity largely confined to anxiety disorders and unipolar depression
- Men: Comorbidity more likely to include SUDs
7
Q
GAD - etiology
A
Temperamental
- Behavioral inhibition
- negative affectivity (neuroticism)
- harm avoidance
- reward dependence
- and attentional bias to threat
Environmental
- Childhood adversities
- Parenting practices (e.g., overprotection)
Genetic and physiological
- 1/3 of risk = genetic
- Genetic factors overlap with risk of negative affectivity (neuroticism) –> shared with other anxiety and mood disorders (especially MDD)
8
Q
Social Anxiety Disorder mnemonic
A
Social Anxiety Disorder
Fearful Ninjas Always Avoid Open Spaces
9
Q
Social Anxiety Disorder flow
A
- Fear/Anxiety about social situations (e.g., interactions, observations, performance)
- Negative evaluation
- (Almost) Always provokes fear/anxiety
- Avoidance
- Out of proportion
- Six months
10
Q
Social Anxiety Disorder - Comorbidity
A
- COMMON-eh: Other anxiety disorders, MDD, SUDs, body dysmorphic disorder, avoidant personality disorder
- Onset of social anxiety disorder generally precedes other disorders (exception: specific phobia + separation anxiety disorder)
- Social isolation from social anxiety –> MDD
- Older adults: Comorbidity with depression is high
- Substances used to medicate social fears
- In children: comorbid with high-functioning ASD and selective mutism
11
Q
Social anxiety disorder - demographic/cultural
A
Social anxiety disorder
- Mean age of onset (U.S.) = 13
- Onset may be sudden or slow
- U.S. non-Latinx Whites –> earlier age of onset, but lesser impairment
- Immigrant status –> lower rates of SAD
- Women: report greater # of social fears and comorbid MDD and anxiety disorders
- Women also more likely to have social anxiety disorder
- Men: more likely to have paruresis (fear of peeing), fear of dating, have ODD/conduct/ASPD, or use drugs
12
Q
Social anxiety disorder: Etiology
A
Temperamental
- behavioral inhibition
- fear of negative evaluation
- harm avoidance
- personality: high negative affectivity (neuroticism) and low extraversion
Environmental
- Negative social experiences (e.g., bullying)
- African Americans + Caribbean Blacks U.S. –> discrimination and racism
Genetic
- Traits predisposing individuals to SAD, such as behavioral inhibition, are strongly genetically influenced
- Gene-environment interactions: “…children with high behavioral inhibition are more susceptible to environmental influences”
- Heritable: 1st-degree relatives = 2x–6x greater of having SAD
- Interplay of disorder-specific (e.g., fear of negative evaluation) and nonspecific (e.g., negative affectivity [neuroticism]) genetic factors
13
Q
Social anxiety disorder - extras
A
Prevalence:
- 12-month U.S. prevalence = 7%
- Lower 12-month prevalance worldwide (~0.5%—2.0%)
- Lower prevalence for non-Hispanic Whites in U.S.
- Lifetime U.S. prevalence is ~12% (non-DSM)
14
Q
Panic Disorder mnemonic (Jenna)
A
STUDENTS Fear C’s and they are a SURP-rise
SURP-rise!
- Sudden
- Unexpected
- Recurrent
- Panic attacks
STUDENTS
- Sweating
- Trembling
- Unsteadiness/dizziness
- Depersonalization/derealization
- Elevated heart rate
- Nausea
- Tingling
- Shortness of breath
Fear
- Dying
- Losing control or going crazy
C’s
- Chest pain
- Chills
- Choking
15
Q
Panic Disorder flow (core criteria, not symptoms)
A
- Recurrent unexpected panic attacks
- One month of WORRY and AVOIDANCE (i.e., maladaptive behavioral change) post-attack
16
Q
Panic attack symptoms
A
- Palpitations, pounding heart, or accelerated HR
- Sweating
- Shaking
- Shortness of breath or smothering
- (Feelings of) choking
- Chest pain or discomfort
- Nausea or abdominal distress
- Dizziness et al.,
- Chills or heat senstations
- Paresthesias (numbing or tingling)
- Derealization or depersonalization
- Fear of losing control or “going crazy”
- Fear of dying
17
Q
Panic Disorder - comorbidity
A
- Uncommon to only have panic disorder
- 80% have lifetime comorbid mental diagnosis
- NOTABLY: Other anxiety disorders (especially agoraphobia), MDD, bipolar I + II, SUDs
- Onset often occurs after comorbid disorder–can be seen as severity marker
- Comorbidity btwn MDD and panic disorder: 1/3 develop depression first, other 2/3 depression occurs coincident with or after onset of panic disorder
- Comorbid with medical symptoms and conditions (e.g., thyroid disease)
18
Q
Panic Disorder - demographic/cultural
A
- U.S. median age of onset = 20-24 yo, internationally = 32
- Childhood and older adult onset is uncommon
- African Americans –> more chronic panic disorder (e.g., racism, discrimination, stigma, lack of access)
- Culture influences interpretation of attacks/physical symptoms (e.g., ‘ataque de nervios’)
- Panic disorder associated with racism/discrimination in US
- Whites experience less impairment
- Fewer diagnoses among AA and Caribbean Blacks
- Women: almost 2x as high!
- Women: higher relapse rates too, greater impact –> may be attributable to greater anxiety sensitivity among women or greater comorbidity with agoraphobia and depression
19
Q
Panic disorder - etiology
A
Temperamental
- behavioral inhibition
- negative affectivity (neuroticism)
- harm avoidance
- anxiety sensitivity (i.e., disposition to believe that anxiety sxs are harmful)
- hx of “fearful spells” (subthreshold attacks)
Environmental
- Life stressors
- Trauma history + childhood adversity
- Parental overprotection and low emotional warmth
- Low SES
- Smoking
Genetic and physiological
- Genetics plays a role, but details are murky
- Parents with hx of mood and anxiety disorders –> increased risk for offspring
- Respiratory disturbance (e.g., asthma) may be associated
20
Q
Perillo extras - anxiety lecture
A
- When thinking about anxiety symptoms, important to consider whether they are adaptive or maladaptive
——Example: Is the anxiety anticipatory? (E.g., stressing about flight without even flight upcoming) - Anticipatory anxiety can be adaptive if it serves a purpose
- For GAD, even if the types of things people worry about evolve, their symptom presentations remains pretty consistent
- For GAD: We’re less focused on the specific things the person is worried about and more on the mechanisms and dysfunction caused by the worry
- When it comes to differential diagnosis of anxiety and depressive disorders (and related differential diagnossi), it is important to consider etiology, flow of symptoms, order of symptoms, etc.
- Ideally, we will be able to identify and prioritize treating core symptoms
- Differentiating example: Depressed person fears negative evaluation in terms of their core being–SAD fears evaluation more about the performance itself
- With agoraphobia, the fears are not necessarily specific, but more an uneasiness or sense of doom. When I go back home, I’m safe.
- Panic disorder: People with panic disorder pay special attention to physiological symptoms, especially interpretation of physiological symptoms as sxs of panic attacks or impending panic attacks
——Ex: Athlete interprets exercise physiological sxs as panic attack sxs
21
Q
Agoraphobia mnemonic
A
Fearful People Often Experience Stress Outdoors, Enduring Anxiety, Avoiding Open Spaces
22
Q
Agoraphobia flow
A
Fear/Anxiety of 2 or more situations:
- Public transportation
- Open spaces
- Enclosed spaces
- Standing in line/Crowds
- Outside of home alone
- Escape difficult, help unavailable in case of panic/embarrassing/incapacitating symptoms (which is one main reason these situations are feared)
- Almost always provoke fear
- Avoidance / Companion/ Endured
- Out of proportion
- Six months
23
Q
Agoraphobia - Comorbidity
A
- 90% have other mental disorders
- MOST COMMON: Anxiety disorders, depressive disorders, PTSD, and alcohol use disorder
- Other anxiety disorders often precede onset of agoraphobia
- HOWEVER, depressive disorders and SUDs typically occur secondary to agoraphobia (some experience SUD before)
24
Q
Major depressive disorder - mnemonic
A
Depressed Animals with Insomnia Prefer Fatty Foods, Constantly Sighing
