DSM-IV Application

Question 0

Published in 1994, the DSM-IV is the most widely used classification system in the United States. It adopts a descriptive approach and fundamental disorders in terms of their behavioral signs and symptoms. It is theoretical with regard to etiology. It defines a mental disorder as:

A clinically significant behavioral syndrome or pattern that occurs in an individual and is associated with present distress… disability… Or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom. This syndrome or pattern must not be merely an expectable response to a particular event.

Answer 0

The classification of mental disorders

Question 1

The Multiaxial classification system

The DSM-IV describes a person’s condition in terms of the following five axes:

Answer 1

Axis I= Clinical disorders and other conditions that may be a focus of clinical attention. The following would be coded on this axis: disorders usually first diagnosed in Infancy, childhood or adolescence (excluding mental retardation), delirium, dementia and other cognitive disorders; mental disorders due to a general medical condition; substance related disorders; mood disorders; anxiety disorder; somatoform disorders; factitious disorders; disassociative disorder; sexual and gender identity disorders; eating disorders; sleep disorders; impulse–control disorders not elsewhere classified; adjustment disorders; other conditions that may be a focus of clinical attention
Axis II-Personality disorders and mental retardation
Axis III-Gen. medical conditions like (blindness, deafness etc.)
Axis IV-Psychosocial and environmental problems (like unemployment etc.)
Axis V-Global assessment of functioning

Question 2

The Multiaxial classification system

Answer 2

2) The DSM-IV emphasizes the importance of culture, age, and gender. The description of various culture – bound syndromes is included.
3) There are 16 diagnostic categories for mental disorders in the DSM-IV.
4) A principal diagnosis describes the primary symptoms that currently necessitate treatment.
5) A provisional diagnosis is used when there is reason to believe that the full criteria will ultimately be met.

Question 3

Review of DSM-IV clinical diagnoses

Answer 3

This review corresponds to the structure and content of the DSM-IV. Although the DSM-IV is atheoretical in regard to etiology, discussions of etiology have been included here to help you prepare for the exam. These explanations are merely cursory. Please refer to the DSM-IV for more in-depth discussion of symptoms etc.

Question 4

1) Disorders usually first diagnosed in infancy, childhood, or adolescence. These disorders may also first-come to clinical attention in adulthood. The following disorders are included in this section:

Answer 4

A) Mental retardation= An individual must have significantly sub average intellectual functioning (IQ of 70 or below), concurrent deficits or impairments and adaptive functioning in at least two areas (like work, health, safety, self-care etc.), and onset prior to age 18.

• Mild retardation exhibits an IQ of 50-55 to 70 and is the largest category of individuals with this disorder. Academic skills of about the six grade equivalent can usually be achieved. Vocational abilities may also be developed, and many of these individuals can support themselves with guidance and supervision.
• Moderate retardation exhibits an IQ of 35-40 to 50–55. Communication skills and academic skills up to an average of the equivalent of the second or third grade may be achieved. skilled and semi-skilled vocation is sometimes possible.
• Severe retardation exhibits an IQ of 20 – 25 to 35 – 40. They may learn to talk and to read simple words. Basic skills for self – care are usually achievable. They may perform some simple task under close supervision.
• Profound retardation exhibits an IQ of below 20 – 25. Etiology is generally neurological. Extensive training is required to foster minimal self – care skills, communication, and performance of simple – task. If an individual exhibits an IQ in the 71 – 84 range, this may be considered borderline intellectual functioning as a differential diagnosis. Mental retardation is not static and need not be lifelong in some cases. Education and training can improve IQ scores. In 30% – 40% of cases, etiology of MR is not known. However, biological, psychosocial, or a combination of these two factors may be the calls of some MR.

Question 5

1)Disorders usually first diagnosed in infancy, childhood, or adolescence. These disorders may also first-come to clinical attention in adulthood. The following disorders are included in this section:

Answer 5

B) Learning disorders= And individuals achievement on a standardized test in reading, math, or written expression is substantially below that expected of his/her age, schooling, and level of intelligence (Generally 2 or more standard deviations below). In terms of a differential diagnosis, MR is characterized by severe impairments in several areas of development. LD is accompanied by impairments in general intellectual and adaptive functioning. Also, LD must be distinguished from normal variations and academic achievement that maybe due to lack of opportunity or to cultural factors. Prognosis for LD is improved with early identification and intervention. However, LD is a lifespan diagnosis. Genetic, neurological and injury factors have all been associated with the etiology of LD.

Question 6

1)Disorders usually first diagnosed in infancy, childhood, or adolescence. These disorders may also first-come to clinical attention in adulthood. The following disorders are included in this section:

Answer 6

C) Developmental coordination disorder= A significant impairment in the development of motor coordination. Depending on the age of the individual, different symptoms may exist. Etiology can be a GMC or a pervasive developmental disorder.

Question 7

1)Disorders usually first diagnosed in infancy, childhood, or adolescence. These disorders may also first-come to clinical attention in adulthood. The following disorders are included in this section:

Answer 7

D) Communication disorders= Expressive, mixed receptive – expressive, and language disorders as well as stuttering are all included here. These are all self–explanatory. Etiologies vary. The onset of stuttering is usually between two – seven years of age.

Question 8

1)Disorders usually first diagnosed in infancy, childhood, or adolescence. These disorders may also first-come to clinical attention in adulthood. The following disorders are included in this section:

Answer 8

E) Pervasive developmental disorders= All involve severe impairments in communication and social interaction and the presence of stereotyped behaviors and activities. They include autistic disorder, aspergers disorder, rett’s disorder, childhood disintegrative disorder, and pervasive developmental disorder not other wise specified.
-Autism= Individuals with this disorder seem oblivious to others. They often do not make eye contact and seem unaware of the feeling states of others. Stereotyped behaviors are common. About 75% of autistic individuals are also mentally retarded. Autism is four – five times more common in males. Prognosis for autism is poor. However, best outcome is associated with individuals who possess an ability to speak by age 5, and IQ of over 70, and a late onset of symptoms. Neurological and genetic factors are most often cited as etiological.

Question 9

1)Disorders usually first diagnosed in infancy, childhood, or adolescence. These disorders may also first-come to clinical attention in adulthood. The following disorders are included in this section:

Answer 9

E) Attention deficit and disruptive behavior disorders including ADHD, conduct disorder, and oppositional defiant disorder. Please understand the differences between conduct disorder and oppositional defiant disorder/this is usually the basis of more than one question on the exam.

Question 10

1)Disorders usually first diagnosed in infancy, childhood, or adolescence. These disorders may also first-come to clinical attention in adulthood. The following disorders are included in this section:

Answer 10

F) Feeding and eating disorders of infancy or early childhood= Pica (eating non-nutritive substances); Rumination disorder(Regurgitating and rechewing food); And feeding disorder (failure to eat and gain weight).

Question 11

1)Disorders usually first diagnosed in infancy, childhood, or adolescence. These disorders may also first-come to clinical attention in adulthood. The following disorders are included in this section:

Answer 11

G) tic disorders= can be motor or vocal. Tourette’s disorder, chronic motor or vocal tic disorder, and transient tic disorder are included here.

Question 12

1)Disorders usually first diagnosed in infancy, childhood, or adolescence. These disorders may also first-come to clinical attention in adulthood. The following disorders are included in this section:

Answer 12

H) Elimination disorders= Encopresis and enuresis

Question 13

1)Disorders usually first diagnosed in infancy, childhood, or adolescence. These disorders may also first-come to clinical attention in adulthood. The following disorders are included in this section:

Answer 13

I) Other disorders of infancy, childhood or adolescence= Separation anxiety disorder; reactive attachment disorder of infancy or early childhood; stereotypic movement disorder (Often associated with MR it includes rocking, headbanging etc.)

Question 14

2) Delirium, dementia, amnestic, and other cognitive disorder

Disturbance in consciousness with a change in cognition or the development of perceptual abnormalities.

Answer 14

Delirium

Question 15

2) Delirium, dementia, amnestic, and other cognitive disorder

An impairment in the ability to learn new information or to recall previously learned information or past events, with the impairment representing a significant decline from a previous level of functioning.

Answer 15

Amnestic disorder

Question 16

2) Delirium, dementia, amnestic, and other cognitive disorder

Multiple cognitive deficits that include some degree of memory impairment and at least one of the following disturbances in cognition: aphasia, apraxia, agnosia and disturbance in executive function.

Answer 16

Dementia

Question 17

3) Mental disorders due to a general medical condition (GMC)

The following three criteria must be met if a mental disorder is due to a GMC:

Answer 17

• There is evidence from the history, physical exam, and/or laboratory findings that the condition is the direct physiological consequence of the GMC.
• The disturbance is not better explained by another mental disorder.
• The disturbance does not occur only during the course of an episode of delirium.

Question 18

4) Substance related disorders

These disorders are related to drugs of abuse, side effects of medications, and exposure to toxins. Two categories are delineated: substance–use disorders and substance–induced disorders. There are 11 classes of substances covered by the DSM-IV:

Answer 18

Alcohol, cocaine, amphetamines, hallucinogens, caffeine, cannabis, inhalants, nicotine, opioids, hypnotics and anxiolytics, phencyclidine and sedatives

Question 19

5) Schizophrenia and other psychotic disorders- Must know; The narrowest definition of “psychotic” is restricted to delusions or prominent hallucinations, with the hallucinations occurring in the absence of insight into their pathological nature. Conceptually, it is a loss of ego boundaries or a gross impairment in reality
testing. There is no universally accepted definition of this term, however.

*** Mood symptoms are brief relative to the duration of the full disorder. Mood symptoms do not occur during the active phase of the disorder and do not meet criteria for a mood disorder.

Answer 19

A) Schizophrenia= A disturbance that last for six months and includes at least one month of active–phase symptoms (two or more of the following positive symptoms: delusions, hallucinations, disorganized speech, grossly disorganized catatonic behavior, OR negative symptoms which involve a restriction in the range and intensity of emotions like affective flattening, alogia, and avolition). Common associated features include but are not limited to: inappropriate affect, anhedonia, dysphoric mood, abnormalities in motor behavior, and somatic complaints. There may be accompanying confusion, memory impairment, lack of insight, and depersonalization. This disorder typically onsets in the late teens to early 30s. Complete remission is rare. There are five subtypes:

• Paranoid= Preoccupation with one or more delusions and/or frequent auditory hallucinations within the context of relatively intact cognition and affect. Usually, the delusions are organized around a coherent theme.
• Disorganized= Fragmentary delusions, not organized into a theme. Speech and behavior may also be disorganized. Affect may be inappropriate or flat.
• Catatonic= Predominant symptoms include at least two of the following: moderate immobility, excessive motor activity, extreme negativism, mutism, peculiarities in voluntary movement, echolalia, echopraxia.
• Undifferentiated= The symptoms do not meet the criteria for specific subtype
• Residual= Person is not currently exhibiting delusions, hallucinations, or other positive symptoms. The person has had these symptoms in the past and continues to display negative symptoms and/or attenuated positive symptoms.

Question 20

5) Schizophrenia and other psychotic disorders

The criteria are identical to those of schizophrenia EXCEPT that the disturbance is present for at least one month but less than six months. Furthermore, impaired social and occupational functioning is not required to make this diagnosis (although they may be ).

*** The symptoms last one month but less than six months.

Answer 20

Schizophreniform disorder

Question 21

5) Schizophrenia and other psychotic disorders

An uninterrupted period of disturbance in which there are concurrent symptoms of a mood disorder and the psychotic, active–phase symptoms of schizophrenia and during which hallucinations or delusions are present without a mood disturbance for at least two weeks.

*** Prominent mood symptoms occur concurrently with the
active–phase symptoms of schizophrenia and there’s also a period of at least two weeks during which only psychotic symptoms are present.

Answer 21

Schizoaffective disorder

Question 22

5) Schizophrenia and other psychotic disorders

The presence of one or more non-bizarre delusions that last at least one month.

*** Delusions must be non bizarre and overall functioning must not be impaired.

Answer 22

Delusional disorder

Question 23

5) Schizophrenia and other psychotic disorders

Delusions, hallucinations, disorganized speech, and/or grossly catatonic behavior that is present for at least one day but less than one month (with an eventual return to full functioning).

*** Symptoms are present for at least one day but less than month.

Answer 23

Brief psychotic disorder

Question 24

5) Schizophrenia and other psychotic disorders

A delusional system that develops in a person as a consequence of a close relationship with someone who already had an established delusion.

Answer 24

Shared psychotic disorder

Question 25

5) Schizophrenia and other psychotic disorders

Prominent delusions or hallucinations are believed to be the direct physiological effects of a GMC

Answer 25

Psychotic disorder due to a GMC

Question 26

5) Schizophrenia and other psychotic disorders

Prominent delusions or hallucinations are believed to be caused by the direct physiological effects of a drug of abuse, medication, or toxin.

Answer 26

Substance–induced psychotic disorder

Question 27

5) Schizophrenia and other psychotic disorders

When psychotic symptoms occur only during episodes of a mood disturbance.

Answer 27

Mood disorder with psychotic features

Question 28

6) Mood Disorders

A) Mood episodes

Depressed mood and/or a loss of interest or enjoyment in customary activities that represents a change from previous functioning and that persists for at least two weeks. The following five symptoms must be present (with one being either depressed mood OR loss of interest in activities): 1) Depressed mood most of the day nearly every day; 2) Diminished interest or pleasure in almost all activities; 3) Feelings of worthlessness or inappropriate guilt; 4) Psychomotor agitation or retardation; 5) Loss of or increase in appetite, significant weight loss or gain, fatigue or loss of energy, insomnia or hypersomnia, reduced ability to think or concentrate, indecisiveness, suicidal ideation.

Answer 28

Major depressive episode

Question 29

6) Mood Disorders

A) Mood episodes

A period of one week or longer in which the prevailing mood is abnormally and persistently elevated, expansive, or irritable and during which at least three of the following symptoms are present (four if the mood is only Irritable): 1) increased goal-directed activity or psychomotor agitation; 2) Flight of ideas; 3) Decreased need for sleep; 4) Grandiosity; 5) Restlessness; 6) Distractibility; 7) Involvement in pleasurable activities that have the potential for negative consequences. A significant impairment in occupational functioning, or the need to be hospitalized to prevent harm to self and others, or the presence of psychotic features must be present for a diagnosis of this episode.

Answer 29

Manic episode

Question 30

6) Mood Disorders

A) Mood episodes

A distinct period of persistently and abnormally elevated, expansive, or irritable mood that last for at least four days and is accompanied by at least three of the symptoms associated with a manic episode ( if the mood is irritable). The episode represents a clear change in mood and functioning but is not sufficiently severe to cause marked impairment or require hospitalization, and there is an absence of psychotic symptoms.

Answer 30

Hypomanic episode

Question 31

6) Mood Disorders

A) Mood episodes

Lasts for at least one week and involves rapidly alternating symptoms of manic and major depressive episodes. It causes marked impairment, may require hospitalization, and may include psychotic symptoms.

Answer 31

Mixed episode

Question 32

6) Mood Disorders

B)Depressive disorders

Diagnosed in the presence of one or more major depressive episodes without a history of manic, hypomanic, or mixed episode. When there has been only one major depressive episode, the appropriate diagnosis is major depressive disorder, single episode. When there have been two or more major depressive episodes, the appropriate diagnosis is major depressive disorder, recurrent. In terms of differential diagnosis, in major depressive disorder, the psychotic symptoms occur exclusively during periods of a mood disturbance. This will distinguish major depressive disorder (with delusions, hallucinations, catatonia etc.) from schizophrenia or other psychotic disorders. In other disorders with psychotic features, psychotic features occur in the absence of mood symptoms.

Answer 32

Major depressive disorder

Question 33

6) Mood Disorders

B)Depressive disorders

A chronically depressed mood that is present most of the time for at least two years. During this time there must never be a period of more than two months in which the person is symptom–free, and depressive symptoms must not be severe enough to meet the criteria for major depressive episode. (In children and adolescents the mood can be irritable or depressed and the disturbance need only last a year).

Answer 33

Dysthymic disorder

Question 34

6) Mood Disorders

C) Bipolar disorders

The occurrence of one or more manic episodes or mixed episodes with or without a history of one or more major depressive episodes. There are six types of bipolar I disorder’s (please refer to the DSM-IV for an explanation)

Answer 34

Bipolar I disorder

Question 35

6) Mood Disorders

C) Bipolar disorders

At least one major depressive episode and one hypomanic episode. The individual has never had a manic or mixed episode.

Answer 35

Bipolar II disorder

Question 36

6) Mood Disorders

C) Bipolar disorders

The presence of fluctuating hypomanic symptoms and numerous periods of depressive symptoms. The symptoms cannot be severe enough to meet the criteria for major depressive or manic disorders. The duration of the symptoms must be at least two years for adults and one year for children or adolescents.

Answer 36

Cyclothymic disorder

Question 37

7) Anxiety disorders

Sudden onset of intense fear and anxiety. These attacks develop abruptly and usually peak in about 10 minutes.

Answer 37

Panic attack

Question 38

7) Anxiety disorders

An irrational and persistent fear of being in unfamiliar places or of leaving one’s home. Environments in which escape might be difficult or embarrassing are avoided by these people.

Answer 38

Agoraphobia

Question 39

7) Anxiety disorders

Are characterized by two or more unexpected panic attacks, with at least one of the attacks being followed by a persistent concern about having another attack, worry about the implications of the attack, or a significant change in behavior related to the attack.

Answer 39

Panic disorders with and without a agoraphobia

Question 40

7) Anxiety disorders

Agoraphobia is present without a history of panic attacks

Answer 40

Agoraphobia without a history of panic disorder

Question 41

7) Anxiety disorders

A marked and persistent fear of social performance situations that may cause embarrassment or humiliation as a result of scrutiny or evaluation by others.

Answer 41

Social phobia

Question 42

7) Anxiety disorders

Recurrent obsessions or compulsions that are severe enough to cause significant distress, to be time-consuming, or to markedly interfere with the persons routine, occupational or academic functioning, or social activities and relationships. (For adults the individual must be aware at some time during the disorder that the obsessions/compulsions are excessive or irrational.)

Answer 42

Obsessive compulsive disorder (OCD)

Question 43

7) Anxiety disorders

The development of characteristic symptoms after exposure to an extreme trauma. It is characterized by reexperiencing the trauma and is accompanied by increased arousal and by avoidance of stimuli associated with the trauma.

Answer 43

Post traumatic stress disorder

Question 44

7) Anxiety disorders

Similar to PTSD except the symptoms must have an onset within four weeks of the trauma and must last for at least two days but no longer than four weeks. While or after experiencing the event, the person must have at least three or more disassociative symptoms and must exhibit persistent reexperiencing of the trauma, marked avoidance of stimuli that cause recollection of the trauma, and symptoms of marked anxiety or increased arousal.

Answer 44

Acute stress disorder

Question 45

7) Anxiety disorders

Excessive anxiety and worry about multiple events or activities. The anxiety and worry are relatively constant for at least six months, and the person finds them difficult to control. The anxiety and worry must entail at least three of the following symptoms: restlessness or feeling keyed up or on edge; being easily fatigued; difficulty concentrating; irritability, muscle tension; sleep disturbance.

Answer 45

Generalized anxiety disorder

Question 46

8) Somatoform, factitious, and disassociative disorders

A) Somatoform

Recurrent multiple somatic complaints that began prior to age 30 and persist for several years and for which medical attention has been sought but no physical explanation has been found. Complaints must include at least four pain symptoms, two gastrointestinal symptoms, one sexual symptom, and one pseudo neurological symptom (like double vision, seizures, blindness etc.)

Answer 46

Somatization disorder

Question 47

8) Somatoform, factitious, and disassociative disorders

A) Somatoform

Characterized by symptoms that involve voluntary motor or sensory functioning and that suggests a serious neurological or other medical condition. Symptoms are judged to be due to psychological factors because there is initiation or exacerbation was preceded by conflicts or other stressors and because they do not conform to physiological mechanisms. Both primary gain (the symptoms keep an internal conflict or need out of concious awareness) and secondary gain (the symptom helps the Individual avoid an unpleasant activity or obtain support from the environment).

Answer 47

Conversion disorder

Question 48

8) Somatoform, factitious, and disassociative disorders

A) Somatoform

Pain that is sufficiently severe to warrant clinical attention and that cannot be fully accounted for by medical condition.

Answer 48

Pain disorder

Question 49

8) Somatoform, factitious, and disassociative disorders

A) Somatoform

Unrealistic preoccupation with the fear of having, or the belief that one has a serious illness based on misinterpretation of bodily symptoms.

Answer 49

Hypochondriasis

Question 50

8) Somatoform, factitious, and disassociative disorders

A) Somatoform

Preoccupation with a defect in appearance such as spots on the skin or facial hair. The defect is either unimagined or very slight.

Answer 50

Body dysmorphic disorder

Question 51

8) Somatoform, factitious, and disassociative disorders

B) Factitious

The presence of physical or psychological symptoms that are intentionally produced or feigned for the purpose of fulfilling an intrapsychic need to adopt a sick role.

Answer 51

Factitious disorder

Question 52

8) Somatoform, factitious, and disassociative disorders

C) Dissociative

One or more episodes of an inability to recall important personal information that cannot be attributed to ordinary forgetfulness.

Answer 52

Dissociative amnesia

Question 53

8) Somatoform, factitious, and disassociative disorders

C) Dissociative

Abrupt, unexpected travel away from home or work with an inability to recall some or all of one’s past.

Answer 53

Dissociative fugue

Question 54

8) Somatoform, factitious, and disassociative disorders

C) Dissociative

The existence in one individual of two or more distinct identities or personality states that each has its on pattern of perceiving, relating, and thinking about the environment and self. At least two of the personalities take full control of the person’s behavior in sequence, and there are gaps in recent and past memories for personal information.

Answer 54

Dissociative identity disorder

Question 55

8) Somatoform, factitious, and disassociative disorders

C) Dissociative

One or more episodes of depersonalization (a feeling of detachment or estrangemant from oneself).

Answer 55

Depersonalization disorder

Question 56

9) Sexual and gender identity disorders and sleep disorders

A) Sexual dysfunctions

Deficient or absent sexual fantasies or desires.

Answer 56

Hypoactive sexual desire disorder

Question 57

9) Sexual and gender identity disorders and sleep disorders

A) Sexual dysfunctions

Extreme aversion to and avoidance of genital sexual contact with a sexual partner

Answer 57

Sexual aversion disorder

Question 58

9) Sexual and gender identity disorders and sleep disorders

A) Sexual dysfunctions

Inability to attain or maintain an adequate lubrication swelling response of sexual excitement

Answer 58

Female sexual arousal disorder

Question 59

9) Sexual and gender identity disorders and sleep disorders

A) Sexual dysfunctions

Inability to attain or maintain an adequate erection

Answer 59

Male erectile disorder

Question 60

9) Sexual and gender identity disorders and sleep disorders

A) Sexual dysfunctions

Delay in our absence of orgasm following a normal excitement phase.

Answer 60

Female orgasmic disorder/male orgasmic disorder

Question 61

9) Sexual and gender identity disorders and sleep disorders

A) Sexual dysfunctions

Orgasm and ejaculation with minimal sexual stimulation, before, or shortly after penetration and before the person desires it.

Answer 61

Premature ejaculation

Question 62

9) Sexual and gender identity disorders and sleep disorders

A) Sexual dysfunctions

Genital pain associated with sexual intercourse

Answer 62

Dyspareunia

Question 63

9) Sexual and gender identity disorders and sleep disorders

A) Sexual dysfunctions

Involuntary spasms of the pubococygeus muscle in the outer third of the vagina, which interfere with sexual intercourse

Answer 63

Vaginismus

Question 64

9) Sexual and gender identity disorders and sleep disorders

A) Sexual dysfunctions

Intense recurrent sexual urges, fantasies, or behaviors involving either nonhuman objects, the suffering or humiliation of oneself or one’s partner, or children or other nonconsenting partners. The paraphilia’s include: fetishism, tranvistic fetishism, pedophilia, exhibitionism, voyeurism, sexual masochism, sexual sadism, frotteurism

Answer 64

Paraphilias

Question 65

9) Sexual and gender identity disorders and sleep disorders

B) Gender identity disorder

a strong persistent cross gender identification and discomfort with one sex or a sense of inappropriateness and the gender role of that sex

Answer 65

Gender identity disorder

Question 66

9) Sexual and gender identity disorders and sleep disorders

C) Sleep disorders

Difficulty in initiating sleep or the presence of non-restorative sleep for at least one month

Answer 66

Primary insomnia

Question 67

9) Sexual and gender identity disorders and sleep disorders

C) Sleep disorders

Excessive sleepiness for at least one month as evidenced by prolonged or daytime sleep

Answer 67

Primary hypersomnia

Question 68

9) Sexual and gender identity disorders and sleep disorders

C) Sleep disorders

Irresistible attacks of restorative sleep accompanied by cataplexy or an intrusion of REM sleep during the transition between sleep and wakefulness.

Answer 68

Narcolepsy

Question 69

9) Sexual and gender identity disorders and sleep disorders

C) Sleep disorders

Sleep disruption due to sleep apnea or central alveolar hyperventilation.

Answer 69

Breathing–related sleep disorder

Question 70

9) Sexual and gender identity disorders and sleep disorders

C) Sleep disorders

A pattern sleep disruption involving excessive sleep or insomnia due to a mismatch between individuals natural sleep–wake cycle and the requirements of his/her schedule.

Answer 70

Circadian rhythm sleep disorder

Question 71

9) Sexual and gender identity disorders and sleep disorders

C) Sleep disorders

Disturbances in the amount, quality, and timing

Answer 71

Dyssomnias

Question 72

9) Sexual and gender identity disorders and sleep disorders

C) Sleep disorders

Behavioral or physiological abnormalities during sleep or in the sleep wakefulness transition

Answer 72

Parasomnias

Question 73

9) Sexual and gender identity disorders and sleep disorders

C) Sleep disorders

Repeated awakenings from sleep with detailed recollection of extremely frightening dreams

Answer 73

Nightmare disorder

Question 74

9) Sexual and gender identity disorders and sleep disorders

C) Sleep disorders

Characterized by repeated episodes of abrupt awakening from sleep usually beginning with a panicky scream or cry and accompanied by intense autonomic arousal and behavioral signs of fear

Answer 74

Sleep terror disorder

Question 75

9) Sexual and gender identity disorders and sleep disorders

C) Sleep disorders

Repeated episodes of complex motor behaviors during sleep that involve rising from bed and walking about

Answer 75

Sleepwalking disorder

Question 76

10) Eating disorders
1) a refusal to maintain minimally normal bodyweight; 2) intense fear of gaining weight; 3) significant disturbance in the perception of the shape or size of one’s body; and 4) in females, amenorrhea

Answer 76

Anorexia nervosa

Question 77

10) Eating disorders
1) Recurrent episodes of binge eating that is accompanied by a sense of lack of control; 2) inappropriate compensatory behavior to prevent the weight gain; 3) self–evaluation that is unduly influenced by body shape and weight. *Must have an average of at least two binge episodes per week for three months or more for a diagnosis

Answer 77

Bulimia nervosa

Question 78

11) Adjustment disorders and impulse control disorders not elsewhere classified

Maladaptive reaction to one or more identifiable psychosocial stressors. The onset of symptoms must be within three months of the stressor and there must be evidence of impairment in social, occupational, or academic functioning and or distress that is in excess of what would be expected given the nature of the stressor. The subtypes are: depressed mood; anxiety; mixed anxiety and depressed mood; Disturbance of conduct; mixed disturbance of emotions and conduct. Normally, the symptoms remit in six months. However, a chronic specifier may be used if the stressor is chronic or has enduring consequences.

Answer 78

Adjustment disorders

Question 79

11) Adjustment disorders and impulse control disorders not elsewhere classified

Failure to resist an impulse, drive, or temptation to perform an act that it’s harmful to self or others. These include: intermittent explosive disorder; kleptomania; pyromania; pathological gambling; trichotillomania.

Answer 79

Impulse control disorders (not elsewhere classified)

Question 80

12) Personality disorders

Cluster A personality disorders (odd or eccentric behaviors)

A pervasive pattern of mistrust and suspiciousness that entails interpreting the motives of others as malevolent. Diagnosis cannot be made unless the individual exhibits at least 4 characteristic symptoms: suspects that others are exploiting, harming, or deceiving her/him; preoccupied with unjustified doubts about the trustworthiness of others; reluctant to confide in others; reads demeaning content into benign remarks or events; persistently bears grudges; persistently suspicious without justification about the fidelity of spouse or sexual partner.

Answer 80

Paranoid personality disorder

Question 81

12) Personality disorders

Cluster A personality disorders (odd or eccentric behaviors)

A pervasive pattern of indifference to interpersonal relationships and a restricted range of emotional expression in social settings. At least 4 characteristic symptoms must be present for diagnosis: doesn’t desire or enjoy close relationships; almost always chooses solitary activities; has little interest in sexual relationships; takes pleasure in a few activities; seems indifferent to praise or criticism; Exhibits emotional coldness or detachment

Answer 81

Schizoid personality disorder

Question 82

12) Personality disorders

Cluster A personality disorders (odd or eccentric behaviors)

Presence of pervasive the deficit in interpersonal relationships; acute discomfort with, and restricted capacity for, close relationships; and eccentricities in cognition, perception, and behavior. Five or more characteristic symptoms must be present for diagnosis: ideas of reference; odd beliefs or magical thinking; body illusions and other unusual perceptions; Odd thinking ans speech; suspiciousness; inappropriate or constricted affect; peculiarities in behavior and appearance; social anxiety.

Answer 82

Schizotypal personality disorder

Question 83

12) Personality disorders

Cluster B personality disorders (Dramatic, emotional, or erratic behaviors)

A pattern of disregard for, in violation of, the rights of others. For this diagnosis, the person must be at least 18 years of age and have a history of conduct disorder before age 15.

Answer 83

Antisocial personality disorder

Question 84

12) Personality disorders

Cluster B personality disorders (Dramatic, emotional, or erratic behaviors)

A pervasive pattern of instability in interpersonal relationships, self image, and affect and marked impulsivity. At least five characteristic symptoms must be present for this diagnosis: frantic efforts to avoid abandonment; pattern of unstable, intense interpersonal relationships that are marked by fluctuations between ideallization and devaluation; persistent instability and self image or Sense of self; Impulsivity in 2 areas that are potentially self damaging (suicide threats, suicidal gestures, affective instability, chronic feelings of emptiness)

Answer 84

Borderline personality disorder

Question 85

12) Personality disorders

Cluster B personality disorders (Dramatic, emotional, or erratic behaviors)

Pervasive pattern of emotionality and attention seeking. Five characteristic symptoms must be present: discomfort when not the center of attention; interactions with others that are often sexually seductive or provocative; rapidly shifting and shallow emotions; excessively impressionistic speech that is lacking in detail; exaggerated expression of emotion; easily influenced by others; considers relationships to be more intimate than they are.

Answer 85

Histrionic personality disorder

Question 86

12) Personality disorders

Cluster B personality disorders (Dramatic, emotional, or erratic behaviors)

A pervasive pattern of grandiosity, need for admiration, and a lack of empathy. At least five characteristic symptoms must be present: grandiose sense of self importance; preoccupied with fantasies of unlimited success, power, beauty, love; believes he/she is unique; acquires excessive admiration; sense of entitlement; interpersonally exploitative; lacks empathy.

Answer 86

Narcissistic personality disorder

Question 87

12) Personality disorders

Cluster C personality disorders (anxiety or fearfulness).

A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. Must have 4 characteristic symptoms: avoid work or school activities involving interpersonal contact due to a fear of criticism, rejection, or disapproval; Unwilling to become involved with people and less certain of being liked; preoccupied with concerns about being criticized or rejected; views self as socially inept; usually reluctant to take risk.

Answer 87

Avoidant personality disorder

Question 88

12) Personality disorders

Cluster C personality disorders (anxiety or fearfulness).

A pervasive and excessive need to be taking care of, which leads to submissive, clinging behavior and fear of separation. 5 symptoms must be present: has difficulty making decisions without advice and reassurances from others; needs others to assume responsibility for most aspects of his/her life; fears disagreeing with others because it might lead to a loss of support; has difficulty initiating project project; goes to great lengths to gain nurturance and support; feels helpless when alone.

Answer 88

Dependent personality disorder

Question 89

12) Personality disorders

Cluster C personality disorders (anxiety or fearfulness).

A persistent preoccupation with orderliness, perfectionism, and mental and interpersonal control, which have the effect of severely limiting flexibility, openness, and efficiency. Five symptoms must be present: preoccupied with details; perfection that interferes with task completion; excessive devotion to work and productivity to the exclusion of leisure activities; Over conscientious and in flexible about morality, ethics, and values; unable to discard worn–out or worthless objects; reluctant to delegate.

Answer 89

Obsessive compulsive personality disorder