DSM Stuff Flashcards
- Substance use
a. Rule Out Substance Use
i. After ruling out medical conditions
b. Models of Recovery
i. AA: disease and abstinence model
ii. Harm Reduction: any positive change that reduces use or user becomes safer
iii. there are different options for different clients
c. Referrals
i. detox: requires MD to oversee care (monitoring biological functioning)
1. it’s time for detox when there is heavy regular use and dependency (need to use to function)
a. heroine
b. pills (pain killers)
c. alcohol
ii. inpatient (not as severe as detox)
1. lots of issues being responsible about use
2. recently got in trouble
3. a lot of support
4. usually person has lots of friends that are using and little social support to stop using
iii. outpatient
1. maybe once a week
2. people have social supports to help reduce or stop use
iv. AA
1. know they have a problem
2. relapse prevention
d. Motivational Interviewing
i. stages of change (different willingness to change)
1. pre-contemplation (don’t even think they have problem)
2. contemplation (maybe think they have an issue)
3. planning
4. action
5. relapse
e. Active Use
i. check quantity
ii. check frequency
f. History of use
i. find out if currently using
ii. address their past use and help maintain sobriety (what has worked to keep you sober - coping skills)
iii. ask about any urges
iv. may not be active focus of treatment
v. watch for relapse
g. Client Under the Influence
i. don’t engage in therapy with them (would be condoning)
ii. find safe way home
iii. call police if they are driving drunk (duty to warn, but don’t necessarily need to disclose that they are a client)
- Disorder Usually Diagnosed in Childhood
a. ADD
i. problem in at least two setting (at school or work, in addition to home)
1. if problem just at school = learning disability
b. ADHD
i. consider medication
ii. maybe consider natural homeopath
iii. there is biological component
iv. treatment plan should include things in conjunction with therapy
v. need structure and support
vi. caregivers need to be firm but patient
vii. parents need a lot of help
viii. you’re doing parent support
ix. parent support groups
x. psychiatrist
xi. social skills groups are good
c. learning Disabilities
i. need psych test to be done
ii. may come across as depression anxiety and acting out, because child is having trouble learning and not paying attention, possibly board
d. Autism Spectrum Disorder
i. autism = issues with social interactions
1. no eye-contact
2. stop speaking
3. hand flapping
4. some kids can have social activity but usually limited to a single topic
5. if client is not engaging in normal social interaction, should have them assessed
ii. effect on parents
1. help parents process and grieve (denial, anger, depression)
2. high rate of divorce
3. support groups helpful
e. Attachment Disorders
i. Reactive Attachment Disorder
1. disengaged from the world
2. withdraw
3. don’t seek out caregivers
4. when working with reactive attachment…
a. play by themselves
b. flat affect
c. don’t get upset or happy
d. result of dramatic change in caregivers at a young age
e. play therapy
f. psycho education to caregiver
ii. Disinhibited Social Disorder
1. result of dramatic change in caregivers at a young age
2. extremely friendly
3. will crawl into everyone lap
4. superficial attachments to complete strangers
5. multiple caregivers
6. when working with disinhibited…
a. play therapy
b. build trust
c. psycho education to caregiver
f. Anxiety Disorders
i. separation anxiety (unique to kids)
1. upset when separation happens
2. worried about leaving caregiver
3. just thinking about separation
4. doesn’t normally happen to adults
ii. adjustment disorder in kids
1. kids exhibit anxiety when adjusting to a stressor
g. Conduct Disorder vs. Oppositional Defiant Disorder vs. Disruptive Mood Regulation disorder
i. Disruptive Mood Regulation
1. New diagnosis
2. created cuz over diagnosing Bi-polar in kids
3. child who is irritable and has tantrums outside of normal age development
4. constant state of irritability
5. angry outburst
6. multiple times a week
7. hard to sooth
8. beyond normal for a developmental issue
ii. Oppositional Defiant Disorder
1. problem with authority
2. argumentative
3. push limits
4. don’t want to be told what to do
5. don’t follow direction
iii. Conduct Disorder
1. breaking the law
2. vandalism
3. assault
4. robbery
- Psychotic Disorders
a. Timeline
i. Brief Psychotic = under a month
ii. Schizophreniform = 1 to 6 months
iii. Schizophrenia = over 6 months
iv. TEST: if psychotic symptoms but no timeline, they could all be right – the additional info needed is the timeline to differentiate
b. Medication Management
i. can’t engage if person’s psychosis is not managed
ii. can’t force them to take meds, but won’t engage in therapy
c. Coordination of Care
i. get release in advance
ii. if client goes into psychotic state, you already have the release
d. Referrals
i. if no psychiatrist, refer them to one
e. Treatment Planning
i. first thing is to always stabilize symptoms – address active psychosis
ii. when stabilized- respond to needs (may be relationship building, depends on functioning)
iii. once symptoms are stabilized, address treatment to whatever the capacities of the individual (if homeless, keep goals simple; if well-off, goals may be higher and utilize more supports)
iv. coordinate with treatment team, psychiatrist, and family members (family should be aware of challenges; don’t be overbearing, don’t be distant)
v. when stabilized, family treatment is common
f. TEST: Actively Hearing Voices
i. find out content of voices (if benign or non-persecutory get in touch with psychiatrist, but if directing to do harmful things to self or others, person is gravely disabled, and you should initiate 5150)
g. social skills groups are good because psychosis may negatively impact social skills
- Depressive and Bi-Polar Related Disorders (both affect mood)
a. Major Depression or Bi-polar
i. medication should be discussed, especially with bi-polar
ii. for sake of the exam, include medication as treatment options
b. Collaborate with Psychiatrist or MD for Medications
i. if they go off meds, right answer would be to encourage person to talk with psychiatrist about decision to go off meds
ii. these meds (anti-anxiety, anti-depression) have severe withdrawal effects
1. black outs
2. vertigo
3. headaches
4. insomnia
iii. if client reports that they have stopped their meds, first pick answer that says client calls psychiatrist before you do
c. Treatment Planning
i. goals are first to stabilize and get them to pre-morbid standard
1. when stabilized, develop additional coping skills, identify awareness of triggers, self-soothing techniques, accessing supports (groups, family, loved ones)
d. Life Span
i. young children
1. irritability when depressed
2. aggression when depressed
3. negative self-talk
4. “I’m always a loser”
5. Disruptive Mood Regulation Disorder falls under depressive disorders
e. Adults and Teens
i. irritability (particularly with men)
ii. culturally, men are more permitted to be irritable and women are tearful
f. Elderly
i. memory loss
ii. person is aware of memory loss
iii. social isolation
- Anxiety Disorders
a. Common Reason People Seek Therapy
i. big topic on test
b. Differentials/Diagnosis
i. Timelines
1. Adjustment Disorder
2. GAD = at least 6 months
3. Anxiety disorder unspecified = under 6 months
c. Medication
i. affectively treated with meds for some, so you may include in treatment plan, coordinate with MD or psychiatrist
d. Treatment Planning
i. if they report that the anxiety is around a specific future issue (college, final, whatever), want to address interventions around that pressing thing first
ii. once the thing is gone, treatment may be over
iii. if anxiety stays after pressing issue is gone, the client’s anxiety may be more pervasive
iv. this may be an anxiety disorder that is more pervasive (worried about different things and areas in their life), but address whatever issue they led with and build skills
v. steps of treatment planning:
1. first help stabilize symptoms of anxiety that are interfering with their functioning (e.g. focus on alleviating trouble sleeping, physical sensations, obsessive thoughts)
2. work towards helping person develop coping skills, increase awareness of triggers, and help people identify physical nature of symptoms (help find where it is happening in their body)
3. help look at having anxiety without judgment (reduce snowball effect)
4. catch early, help treat with positive self-talk, deep breathing, self-care
- Bereavement and grieving
a. Bereavement
i. diagnosis if family pet, friend, partner, or relative dies
ii. can be co-diagnosed with major depression
b. Grief
i. response to loss of a person, relationship
ii. also, grief around child being diagnosed with autism (child they didn’t get to have)
iii. also, grief around realizing didn’t get mothering that you needed (loss that something didn’t take place)
iv. grief = any kind of loss (also can be moving from another country)
v. TEST: if an intervention says process grief, ask yourself has there been any kind of loss (life they can no longer pursue after leg amputation)
c. Expression Across Life Span
i. children act out
ii. become clingy (separation anxiety)
d. Grief Varies Across Cultures
i. TEST: if they mention someone of a specific culture and bereavement/grieving, look for answers related to exploring if it is a cultural norm
ii. need even more enhanced sensitivity around culture, grief, and dying
e. Referrals
i. support groups are important referrals
ii. source of social support
iii. talk to others with similar experience
iv. also shows that grief and bereavement are expressed in different ways:
1. angry
2. cry
3. denial
4. overcompensate by overwork
5. different individual in family react different ways and these expressions collide
f. Intervention
i. psychoeducation about different expressions
ii. normalize grief reactions
- Eating Disorders and Somatic Symptom Disorders
a. Anorexia and Bulimia
i. should include coordination with MD
ii. with eating disorder, especially anyone who purges, can experience sever medical difficulties
iii. stabilize the persons health (involve MD)
iv. be in touch with a nutritionist (outside of our scope)
v. mental health treatment
1. CBT
a. Start here
b. identify thoughts and feelings relating to behavior
2. family therapy at some point
a. build support system
vi. medications do not really work with anorexia
b. Somatic Symptom Disorders
i. when a person has symptoms related to a health issue
ii. may or may not have physical symptoms
iii. they may report physical symptoms, but MD has ruled out medical condition OR may have a condition, but doesn’t explain severity of symptoms
iv. also have excessive worry about the disorder
v. illness anxiety disorder (used to be called hypochondriac), fear they have something
vi. you DO want to have them checked by a doctor
vii. TEST: usually get a question that says they were referred by their doctor to rule out something
c. Fictitious Disorder
i. make up symptom, like being patient and attention
d. Fictitious Disorder by Proxy
i. make their own child sick for attention they receive
1. TEST: if husband says wife may be making child sick, file a child abuse report cuz there is reasonable suspicion
- Sexual Disorders
a. Assessing Couples Sexuality
i. important
ii. getting an idea of each client’s sexual satisfaction is important
iii. assess desire
iv. get idea of sexual health
b. Intervention
i. referring to sex therapy is good if there is a sex problem going on
c. Sensate Focus
i. for working with people with sexual issues
ii. take active intercourse is off the table
iii. focus on clients communicating to each other what is pleasurable
iv. open intimacy
v. creates meaningful sexual relationships
vi. communicate your needs and meet someone else’s needs
- Personality Disorders
a. Life Time
i. all personality disorders are pervasive over the life time of the individuals
ii. doesn’t just pop up at age 35
iii. attachment disorder stuff can lead to personality disorders
iv. deeper personality issue
v. CBT has some success, but long term psychodynamic is good (relationship between therapist and client)
b. Therapeutic Relationship
i. if client says they have relationship issues and notices client is critical of therapist, person may be always doing this with people (therapist would then confront/bring up and empathize)
ii. may be afraid of being rejected, so they are mean to prove their belief (makes them right)
c. Ego Syntonic
i. personality disorders are ego syntonic (part of the person and person doesn’t identify it as a problem)
1. NOTE: Ego Dystonic means they don’t like the issue they have
a. they know they have an issue (anxiety and depression) and they are aware, and they don’t like that they have the issue
b. narrative therapy is good because it separates/externalizes the person from that issue/problem
ii. Ego Syntonic means the personality disorder is just the person’s worlds view, who they are; person doesn’t think that they have the issue; how they see the world; complain of others
1. developed in response to caregiving they received or didn’t receive; coping
2. don’t look at them as pathologies
3. their behavior has at some point served a purpose, but client no longer has flexibility to adapt to situation; unable to develop new coping skills and resources
4. also, maybe the child didn’t learn coping skills due to NO conflict in the home, didn’t see their parents stressed
5. person doesn’t see the problem as being in themselves, but rather come in complaining of other people
d. Borderline Personality Disorder
i. challenging kind of client
ii. need to pay attention to the signs
iii. there are issues of boundaries (want to encroach on time, push clinical boundaries)
iv. splitting (all good view and all bad view); they can’t hold the idea that people have both good and bad qualities (psychodynamic can maybe help with this)
v. must establish and maintain good boundaries
vi. frequent suicide attempt - use DBT (developed for Borderline)
- Trauma Related Disorders
a. PTSD or Acute Stress Disorder (differential = timeline)
i. Acute= under a month
ii. PTSD = over a month
b. Symptoms
i. this is the “stress” part
ii. startle response
iii. hypervigilance
iv. difficult sleep
v. anxiety
vi. reliving events
vii. intrusive thought
viii. flash backs
ix. experience of powerlessness
c. Event Exposure
i. this is the “post” part of the event
ii. life threating to the person themself
iii. life threating to somebody else
iv. witness person beat up
d. Treatments
i. Acute
1. crises management (within the first month)
2. mobilize coping
ii. PTSD
1. Exposure Therapy
a. NOTE: for some people exposure therapy not good, but for a lot of others it is good
b. haven’t processed a traumatic event and its wreaking havoc inside – different things may trigger (noise, place, smell)
c. therapist starts to identify how person experiences their traumatic reaction and becomes aware of physical symptoms
d. first step is to help them develop coping strategies (deep breathing, mindful of experience of here and now)
e. help develop skills before talking about trauma or exposure
f. with PTSD there are feelings of powerlessness and this strategy reduces feelings of powerlessness (therapist gives people coping skills and helps regulate when trauma is reexperienced)
2. EMDR (eye movement desensitization and reprocessing)
a. manualized approach to treating trauma
b. like controlled exposure
c. person will talk about event over and over with stimulus (tapping, or eye movement, or buzzer)
d. therapist is present, talking person through, checking in on arousal and person starts to take power back over experiences
3. Desensitization
a. gets exposed to the memories and thoughts in a controlled way, thus controlling reactions
4. Trauma Informed Care
a. came from DV field
b. coming from world view that a lot of people experience trauma at some point
c. when working with people, be on the lookout for trauma history or a reaction
d. create system of supports that doesn’t re-traumatize victims (powerlessness)
e. Trauma Informed Care values collaborative approach with client – client has strengths (symptoms are way people survive, serving a purpose, nothing “wrong” with the person, but symptoms are now causing problems for the client
f. talk about pros and cons of symptoms
g. de-pathologizes
• DSM 5: What’s The Difference, Part I
o AUTISM SPECTRUM DISORDER (ASD) VS. SOCIAL PRAGMATIC COMMUNICATION DISORDER (SPCD)
these are new
Autism spectrum Disorder
• used to be what was autistic disorder, pervasive developmental disorder NOS, and Asperger’s
• ASD now is all 3 in one, with different degrees of functioning
o Shows up at a young development age (0 to 5)
o Screenings are better
o show different levels of impairment
• ASD requires 2 categories need to be met (difficulty communicating and repetitive behaviors)
o persistent deficiency in social commination and interaction impacts social reciprocity; (abnormal social communication, lack of eye contact, unable to understand emotions and affect, impact ability to play with friends); poor non-verbal communication (not accepting a toy, or no back and forth play); older kids have no companion play or limited companion play; leads to poor relationships
o Stereotyped restricted repetitive patterns of behavior, interests, or activities (clapping, echolalia, very inflexible functioning (distressed when transitioning, rituals, nothing out of order, ridged fixated view of the world; hypo or hyper reactivity to sensory input) repetitive speech; oral stimulation; have a hard time with transitions; fixed interest (ex: loves snakes)
Social Pragmatic Communication Disorder
• (what Asperger’s would have been)
• only deficit in communication aspects
• usually not as prominent as ASD
• no reparative behaviors
• persistent difficulty in use of social verbal cues and communication
o deficit for social purposes don’t greet or share appropriate info in social context
o impairment in ability to change commination to match the context of the listener (can’t consider settings – yell in a classroom)
o hard time following rules and storytelling (can’t take turns or rephrase; don’t get moral of story)
o pragmatic in SPCD means that there is difficulty getting by day-to-day
• this diagnosis DOES NOT have the repetitive behaviors
SPCD not as compromised as ASD
for both the onset is early on
o SPECIFIC LEARNING DISORDER (SLD) VS. ADHD VS. OTHER SPECIFIED ADHD
Specific Learning Disorder
• used to be learning disorder
• Could be related to math, reading, writing
• Difficulty learning basic academic skills
• Stuff should be able to be learned based on age and IQ
• Smart kid may be unable to learn the same way other people learn
• Related to Dyslexia and processing disorder (need to get info in a different way (auditory, repetition, etc.)
• If you have a problem child with symptoms and behaviors, rule out a learning disorder (if they can’t learn, they may be disruptive)
• if there are problems in school, first thing should be to refer to psych testing and rule out learning disorder before diagnose ADHD
• unable to learn in typical manner (usually processing issue)
• reading disability (phonics awareness)
ADHD
• Symptoms need to be present before the age of 12
• Need two or more context where there is impairment (school, home, work, etc.)
• commonly misdiagnosed
• problems with inattention
• hyperactivity
• inattention sometimes can be dominant features (more for girls)
o hard time sustaining activity
o can’t sit and read a book
o can’t focus
o can’t sit and do test
o frequently interrupt people
o hard time getting organized
• hyperactivity can be the dominant feature
o hyperactivity has a lot of fidgetiness,
o excessive talking
o move a lot
o impulsivity (blurt answers, butting into games)
• refer to psychiatrist to rule out, then find out if they have problem with attention or hyperactivity
o PICA VS. RUMINATION DISORDER
Pica
• Pica is the persistent eating of nonfood substances
• Eating dirt, eating carpeting
Rumination disorder
• Repeated regurgitation of food that is not related to any other kind of disorder
• Like a reflux disorder
• Eat food then regurgitate it
o LANGUAGE DISORDER (LD) VS. SPEECH SOUND DISORDER (SSD) VS. CHILD ONSET FLUENCY DISORDER (COFD)
all new names for what used to be expressive language disorder, phonological disorder and stuttering
LD is when persistent difficulty with acquisition and use of language
• Hard time building vocab
• reduced vocab
• limited sentence structure (about 5 words)
• leads to impairment in discourse
• shows up 0 to 5yo
SSD deals with production of speech (articulation)
• can’t form the words
• words run together
• pronunciation limited
COFD going to be like stuttering
• Sound or syllable repeated
• Prolongations (I, I, I, understand)
• broken words (I under…stand what you’re saying)
• shows up 0 to 5yo
o TOURETTE’S VS. PERSISTENT MOTOR/VOCAL TIC DISORDER
Tourette’s
• multiple motor tics AND at least one or more vocal tic
• Motor tics show up as physical hand movement or gesture that they can’t control or facial tic
• Vocal tics (shout out word uncontrollably, often bad word)
• present multiple times day
• must be present for a year
Persistent Motor/Vocal Tic Disorder
• doesn’t require vocal tic
• difference is that Tourette’s has motor and vocal at same time
• Persistent Motor/Vocal Tic Disorder has one or the other
o ENCOPRESIS VS. ENURESIS
Encopresis = poop
• inappropriate place
• must be older than 4 years old
• these can be warning sign that child was sexually abused
Enuresis = urine
• Urination on bed or close
• Involuntary
• Must be 5 or older
• these can be warning sign that child was sexually abused
o SEPARATION ANXIETY DISORDER (SAD) VS. GENERALIZED ANXIETY DISORDER (GAD)
SAD
• developmentally inappropriate and excessive anxiety when separated from home or person of attachment (caregiver; if an adult, could be a spouse)
• For children, symptoms must be present for 4 weeks
• For adults, symptoms must be present for 6 months
• Anxiety is focused around caregiver about being separated (anticipatory, inconsolable, constant worry about the caregiver)
• distress when separated or thought of being separated
• fear of being kidnapped
• fear something will happen to attachment object
• nightmares about separation
• complaints about physical symptoms to stay with caregiver
GAD
• anxiety is more pervasive
• worry about several different things (caregiver, test, school, game day)
• will also have symptoms like trouble sleeping, attention, problems sleeping, problems concentrating
• symptoms must be present for 6 months
• less than 6 moths = unspecified anxiety disorder
o SELECTIVE MUTISM (SM) VS. SOCIAL ANXIETY DISORDER (SOCIAL PHOBIA)
SM
• rare
• failure to speak in specific special situations (school)
• but will be fine at home
• refuse to speak were speaking is expected
Social Anxiety Disorder (Social Phobia)
• groups of people
• Specific context, fear of going into a social setting
• Fear of being observed, judged, or rejected
• Will decline invites
• Will be withdrawn
• Keep to people they are comfortable with
• Can have social anxiety around people they know or don’t know
• more broad and pervasive
o REACTIVE ATTACHMENT DISORDER VS. DISINHIBITED SOCIAL ENGAGEMENT DISORDER
diagnose early on, between 9 months to 5
both require a history of disruptions in caregiving (loss, changes, multiple caregiver, persistent neglect, persistent abuse, foster care)
Reactive Attachment Disorder
• Failure to thrive
• Very withdrawn
• Don’t seek comfort and don’t respond to comfort
• Limited affect
• Little positive affect
• Irritability
• Sit in corner
• Don’t look for attention
• Sadness and fear with caregivers
• Difficult engaging
• child who has a lack of connection with other people, particularly with caregivers
• no help seeking behaviors
• lack initiative to reach out to caregivers
• flat affect
• inhibited behavior
• under the radar cuz they don’t seek help or attention
• they have given up that anyone would care about them
• moves into depression
Disinhibited Social Engagement Disorder
• Stand out
• No boundaries
• attach to anybody
• little kid will sit anyone’s lap
• comfortable with strangers
• attention seeking behaviors
• child stands out and be problematic would not leave teachers side
• moves into ADD, conduct and borderline
o OPPOSITIONAL DEFIANT DISORDER VS. CONDUCT DISORDER VS. DISRUPTIVE MOOD DISREGULATION DISORDER
Oppositional Defiant Disorder
• Defiant
• Problems with authority
• Refuse to comply with directives
• Don’t want to do things that people tell them to do
• defiant disobedient and hostility towards authority
• arguing
• defying
• annoying others
• blaming others
• irritable
• true to rule out depression
• with ODD its very specific with problems with authority
• argumentative
Conduct Disorder
• violations with the basic rights of others
• law breaking
• start fights
• causes or threatens physical harm to others or animals
• property loss/damage
• stealing
• lying
• lack of remorse
• violation of rules
• vandalizing
• laws being broken
• feeds into antisocial personality disorder (must be 18)
Disruptive Mood Disregulation Disorder
• Chronically irritable and moody
• Mood negative even when they aren’t having the outburst
• came from over diagnosing of bi-polar in kids
• need to have sever temper outbursts 3 or more times a week
• child is also consistently angry and irritable
• diagnose between 6 and to 10, up to 17
• if tantrums went on for hours or even days, could mean manic
• can be diagnosed with other disorders
• TEST: severe temper outbursts
o BRIEF PSYCHOTIC DISORDER VS. SCHIZOPHRENIFORM DISORDER VS. SCHIZOPHRENIA VS SCHIZOAFFECTIVE (positive symptoms = delusions, hallucinations, disorganized thinking and agitation; negative symptoms = poor eye contact, reduced body language, poverty of speech, avolition – inability to initiate and participate in goal directed behaviors)
Brief Psychotic Disorder
• symptoms present for up to a month
Schizophreniform Disorder
• symptoms present from 1 month to 6 months
Schizophrenia
• symptoms present for over 6 months
Schizoaffective
• psychotic disorder with a mood disorder that comes in and out
o depression
o mania
5 categories of things you would see
• 1) delusion: belief that is false (non-bizarre = you think a movie star is in love with you; bizarre = you think movie star is an alien)
• 2) hallucination
• 3) disorganized speech (rambling, non-coherent)
• 4) disorganized behaviors (gestures that don’t make sense, acting in ways that don’t make sense ex: moving chairs around room) these can be result of hallucinations
• 5) negative symptoms (flat affect, don’t respond to discussion, lost in own world, stiff, problems with movement)
Note: main thing you will see is that people report they hear voices or having delusions
o MAJOR DEPRESSIVE DISORDER VS. UNSPECIFIED DEPRESSIVE DISORDER VS. PERSISTENT DEPRESSIVE DISORDER
Major Depressive Disorder
• symptoms present for at least 2 weeks
• anhedonia
• can’t enjoy things they used to
• lack motivation
• feelings of sadness
• hopelessness
• withdraw
• changes in appetite (more or less)
• changes in sleep (more or less)
• change in biological functioning
• difficulty concentrating
• reduced functioning
• day-to-day functioning affected
• irritability
• anger
• thoughts of death or suicide
• worthlessness
• feeling like a burden
Unspecified Depressive Disorder
• when don’t meet full criteria for MDD
• they do function, but have mild disturbance in functioning
Persistent Depressive Disorder
• need a time line
o 2 years of mild depression for adults
o 1 year of mild depression for children
• Not as deep as MDD
• Almost like UDD that has gone on for a long time
• people usually don’t report anything change in their biological functioning
o BIPOLAR I DISORDER VS. BIPOLAR II DISORDER VS. CYCLOTHYMIC DISORDER
Bipolar I Disorder
• one of the most commonly misdiagnosed
• need one full manic episode – that’s it
o elevated mood that leads to significant impairment of at least one week
o extreme happiness
o hyperactive mood = feelings of positive or irritability, usually grandiose thoughts
o acting risky
o high risk sex
o gambling
o goes on for min of 7 days
o don’t need sleep/excessive energy
o experienced as euphoria
o substance use
o little sleep
o racing thoughts
o rapid speech
o maybe psychotic
o lots of exercise during this time
o in denial they are in a manic phase
o frequently followed by a depressive episode, but you don’t need this to diagnose
Bipolar II Disorder
• need 1 hypomania (similar to a manic phase)
o elevated mood not as severe as full manic phase
o no psychotic feature
o 4 days
o No sever problems in their relationships
• need 1 depressive episode
o hopeless
o sleeping
o tearful
o problems functioning
Cyclothymic Disorder
• need hypomania
• need mild depressive phase
• mild up and down, but noticeable
• need to be present for 2 years
o SCHIZOAFFECTIVE DISORDER VS. BIPOLAR I DISORDER WITH PSYCHOTIC FEATURES VS. MDD WITH PSYCHOTIC FEATURES (have mood disturbance and psychotic features)
Schizoaffective Disorder
• predominant symptoms are psychotic features (constant)
• mood disorders come in and out
Bipolar I Disorder with psychotic features or MDD with Psychotic Features
• predominant symptoms are mood disorders (constant)
• psychotic features come in and out
o BEREAVEMENT VS. MAJOR DEPRESSIVE DISORDER VS. ADJUSTMENT DISORDER
Bereavement
• Grieving after a death (mourning) person or animal
• Feelings of loss
• Anger
• Despair
• Depression
• Self-blame
• Responding to death of someone or animal
• can now diagnose MDD with this (don’t have to wait 2 months)
Major Depressive Disorder
• This can be present with bereavement
• Must have problem with biological functioning
• Worthlessness and
• Self-blame
• Self-harm
• Bereavement can trigger depression
• Not sleeping well
• Diet change
• Sever loss and gain
• If more impairment to functioning, lean toward MDD
Adjustment Disorder with Depressed Mood
• don’t get after a death
• but, happens after something happens to person
• can get with depressed mood
• can get with anxiety
• recent life stressor (new job, loss of job, moving, divorce)
• must come up within 3 months and can’t go beyond 6 months
• if meet full criteria of MDD, give MDD
• specifier: depressed mood, conduct etc.
o PANIC DISORDER VS. AGORAPHOBIA (can have both at same time)
Panic Disorder
• Recurrent unexpected panic attacks
• experience panic attack
• ongoing fear of panic attack happening again
• 1 month of fear of another attack
• avoid situations to avoid panic attack
• underlying fear of having attack
• feel like your gunna die
• heart palpitations
Agoraphobia
• fear of going out into public
• fear of at least 2 situations
o avoid crowd
o bus
o open space
o shopping
o in line
o avoid leaving house alone
• excessive beyond what’s normal
• be around for at least 6 months
• fear of spaces
o OBSESSIVE-COMPULSIVE DISORDER VS. OBSESSIVE-COMPULSIVE PERSONALITY DISORDER
Obsessive-Compulsive Disorder
• when a person has obsessive thoughts and compulsive behaviors
o obsessive thoughts
intrusive thoughts that run a person’s life (I’m dirty, germs, ex: scans a room, uses napkins to open door)
impulses
images
disturbing or inappropriate that can cause anxiety or distress
not real-life problems
try to ignore
recognizes that they are obsessive
o compulsive actions: repetitive behaviors or mental acts that a person feels they must do as a result of the obsession
excessive hand washing hands
ordering things
counting
checking
aimed at preventing or reducing stress of situation or obsession
these behaviors are debilitating and noticeable and impairs ability to function in society
Obsessive-Compulsive Personality Disorder
• pervasive pattern preoccupation with orderliness, perfection, and control
• perfectionist
• detail oriented
• organized
• workaholic
• hard time delegating tasks
• inflexible
• however, don’t do things repeatedly
• no awareness or problematic behaviors
• impact on social life
• these are functioning normal people in society
o POSTTRAUMATIC STRESS DISORDER (PTSD) VS. ACUTE STRESS DISORDER VS. ADJUSTMENT DISORDER WITH ANXIETY
Posttraumatic Stress Disorder (PTSD)
• life threating event or witness life threating event or witnessed death
• re-experience a traumatic event in an intrusive manner
• experience or exposure to a life-threatening event
• reliving the event
o nightmares
o hypervigilance
o startle response
o intrusive thoughts and memories
o feeling as if its reoccurring
o startle response
o numbing
o attached avoidance
o difficulty concentrating
o irritability
o negative mood
o shame
o survivors’ guilt
o avoiding situations that remind them of incident
o outbursts
o difficulty falling/staying asleep
o reckless and destructive behavior
o persistent and distorted blame of self or other
• timeline = over a month
Acute Stress Disorder
• same symptoms as PTSD
• timeline = more than 3 days and up to a month
Adjustment Disorder with Anxiety
• stressor not life threating
• symptoms are not nutty
o no nightmares
o no reliving
o no nightmares
• but still a stressful event
o moving
o loss of a job
o divorce
• some anxiety
o GENERALIZED ANXIETY DISORDER VS. UNSPECIFIED ANXIETY DISORDER (both have excessive anxiety and worry, occurring more days than not, several activities, hard to control worry, restless, fatigued, mind going blank, irritability, muscle tension, problems sleeping)
Generalized Anxiety Disorder
• timeline = at least 6 moths
• symptoms
o problems with biological functioning
o sleep issues
o diet issues
Unspecified Anxiety Disorder
• timeline = less than 6 months
• severity may not be as intense
• some elements of anxiety (separation, agora, etc.)
• DSM 5: What’s The Difference, Part II
o DELIRIUM VS. MAJOR NEUROCOGNITIVE DISORDER VS. MILD NEUROCOGNITIVE DISORDER
Delirium
• mainly seen in a hospital setting
o Liver cancer, illness, medical condition, medication, drugs, etc.
• Biochemical change
• marked shift in memory, awareness, executive functioning, language, perceptual problems
• rapid onset
• last few hours to a day (not sustained)
• delusions or hallucinations
• specifier
o medical condition
o medication
Major Neurocognitive Disorder (used to be dementia)
• on a continuum
• elderly
• difficulty with attention
• difficulty with executive functioning
• difficulty with language
• difficulty with memory
• difficulty with cognition
• difficulty with words
• hard remembering people
• perceptual motor skills
• person loses ability to function independently in their own
• serious decline in level of functioning
• can’t pay bills or make appointment
• usually need nursing home
Mild Neurocognitive Disorder
• on a continuum
• precursor to major neuro cognitive disorder
• noticeable decline in functioning, but can maintain independence (will require added system/support)
• has awareness they need support
• people may report that they are becoming more forgetful
• Note: is an elderly person is just experiencing MDD, they may EXPERIENCE MEMORY DIFFICULTY, HOWEVER, THEY ARE AWARE OF THIS DIFFICULTY
o SOMATIC SYMPTOM DISORDER VS. ILLNESS ANXIETY DISORDER VS. CONVERSION DISORDER
Somatic Symptom Disorder (used to be somatization disorder)
• Client does have a somatic/health-related issue (pain, illness, can be documented)
• The issue on top of this is that they must have a lot anxiety related to the symptoms
• devote a lot of time and energy to symptoms
• one or more somatic symptoms
• symptoms need to be present for 6 months
Illness Anxiety Disorder (hypochondriasis)
• symptoms are mild (not serious), symptoms are not delusional
• but, they have intense fear that they have serious disease, even after doctor says they are okay
• no medical condition diagnosed
• symptoms need to be present for 6 months
• excessive checking of body, research, and doctor shopping
• avoid hospital and places with germs
• willingness to consider the possibility that no serious disease actually exists
Conversion Disorder
• no formal medical diagnosis
• psychological issue converts to a somatic one
• ACTUAL PHYSICAL SYMPTOMES
• no medical explanation
• ex: bind rage (so angry they actually go blind)
• ex: trauma situation, lose use of an arm (paralyzed by trauma)
o FACTITIOUS DISORDER VS. MALINGERING VS. FACTITIOUS DISORDER BY PROXY
Factitious Disorder
• Likes attention of being sick
• Act like they are sick
• Go to doctor to get the attention of being a patient
• somebody makes up they are sick to get attention
Factitious Disorder by Proxy (formally known as Münchausen Syndrome by Proxy
• Make somebody else appear sick
• Parent continually takes child to the doctor
• More severe cases are when parent give child something to make child sick
• parent induces child to get sick, because they like to take care of a sick child
• person likes the attention
Malingering
• fakes a disorder or fakes illness to get out of something or get an alternative benefit
• ex: fake insanity plea, claim mental illness to get SSI
• isn’t sick
• secondary gain
o ANOREXIA NERVOSA VS. BULIMIA NERVOSA VS. BINGE EATING DISORDER
Anorexia Nervosa
• somebody restricts dietary intake to point where doesn’t meet physical needs
• significantly low weight
• less than minimally normal weight for age and growth
• very thin
• Distorted body image (think they are fat
• Excessive exercise
• intense fear of gaging weight or getting fat
• medical monitoring in addition to psychotherapy is a MUST
• high level of care
• could be inpatient
• family sessions have been shown to be particularly effective with anorexics because the root of the problem often starts in the family relationships
• anorexics tend to be perfectionistic, so making a journal of accomplishments would only reinforce that tendency, however, Sherri could benefit from learning how to be imperfect
• helping Sherri to identify her fears of failure may help change her obsessions with perfection
• explore her dysfunctional beliefs about food would be positive interventions for her
• contracting with Sherri to gain weight would be fine as long as she is motivated to adhere to this
Bulimia Nervosa
• NEED to have binge eating (consumes a much larger portion of food then what a normal person would eat during same period)
• lack of control over eating
• feel out of control
• eat alone
• eat fast
• eat until uncomfortable
• feel shame and depression embarrassment, disgusted, guilt
• NEED recurrent purging/compensation to prevent weight gin
o vomiting
o laxative
o meds
o diuretics
o over exercising
o fasting
• need both binging and purging
Binge Eating Disorder
• have binge eating, no purging
• much more than what people would eat over the same time period
• lack of control over eating
• eat alone
• eat fast
• eat until uncomfortable
• feel shame and depression embarrassment, disgusted, guilt
o UNSPECIFIED EATING DISORDER VS. BODY DYSMORPHIC DISORDER
Unspecified Eating Disorder
• hasn’t met criteria for other disorders
o ex: just purging, but no binging (eats normal)
o normal body weight but obsessed about being overweight (not below minimal body weight)
Body Dysmorphic Disorder
• can’t be related to somebody’s weight
• somebody has displeasure in some part of their body
o maybe don’t like nose
o do behaviors to hide that part of their body
o check a lot
o preoccupation with body part
o usually something normal or slightly different, but it is imagined as significantly abnormal
o some get a lot of plastic surgery
o DEPERSONALIZATION/DEREALIZATION DISORDER VS. DISSOCIATIVE AMNESIA VS. DISSOCIATIVE IDENTITY DISORDER
Depersonalization/Derealization Disorder
• Depersonalization
o person’s reality testing is intact, but feel outside of their own body
o don’t feel connected to reality
o time moves slowly
o out of body
• Derealization
o person feels surrounding are unreal
o dream lie state
o world is dream like
Dissociative Amnesia
• sudden forgetting of pertinent personal information (SS#, address)
• occurs in extreme stress or shock (war, natural disaster)
• Dissociative Fugue falls under this category
o forget who they are
o end up far away
• could possibly have this with acute stress disorder
Dissociative Identity Disorder (aka multiple personality disorder)
• Uncommon
• 2 or more distinct personality states
• Different names
• Can’t remember other state
• Usually happens to people who have extreme trauma
• possession/taken over by personality
• unable to recall important personal information and they can’t remember what other personality knew
• sometimes confused with schizophrenia
o GENITO-PELVIC PAIN/PENETRATION DISORDER VS. FEMALE SEXUAL INTEREST/AROUSAL DISORDER
Genito-Pelvic Pain/Penetration Disorder
• pain during intercourse or fear about pain of intercourse
• tightening of pelvic muscles
• unable to have intercourse because they become so tense
• displeasure during act or idea of sex
• common in DV relationships
• possible sexual abuse or rape
Female Sexual Interest/Arousal
• lack of sexual interest or arousal
• no sexual thoughts or fantasies
• decline or lack of intimacy
• can be permanent or not
• needs to be around for at least six months
• lack/decline in initiation
• would not diagnose if they were not in a relationship, unless they themselves reported that there has been a decline
• noticeable decline in their level of activity
o INSOMNIA DISORDER VS. HYPERSOMNOLENCE DISORDER
Insomnia Disorder
• complains of difficulty sleeping
• 3 nights a week for three months
• difficulty falling asleep, maintain sleep, can’t go back to sleep, multiple waking up
• person is complaining of low quality/quantity of sleep
• rule out manic phase (these people usually don’t complain)
• rule out MDD and anxiety dis (they impact sleep)
Hypersomnolence Disorder
• self-report of excessive sleepiness
• must exceed 7 hours (could be up to 9 hours)
• difficult being fully awake
• groggy and sluggish
• often people are over weight
• rule out MDD
• may be result of substance abuse (es: pain killers)
• person must complain about it
o NIGHTMARE DISORDER VS. NON-RAPID EYE MOVEMENT SLEEP DISORDER
Nightmare Disorder
• somebody wakes up during second cycle with a nightmare
• quickly oriented and can recall dream
• distress over nightmare and lack of sleep
Non-Rapid Eye Movement Sleep Disorder (aka sleep terror)
• recurrent episodes of incomplete awaking of sleep
• can’t remember dream
• don’t fully wake up
• sleepwalking
o CENTRAL SLEEP APNEA VS. NARCOLEPSY
Central Sleep Apnea
• when stops breathing up to a minute
• when breathe again it’s with a snort
• disrupts quality of sleep
• report being really tired in the morning (can’t enter REM sleep)
Narcolepsy
• Sudden attack of sleep
• Loss of muscle tone
• Hallucinations when going in and out of sleep
• Report daytime fatigue
• falls asleep during the day unexpectedly
o INTERMITTENT EXPLOSIVE DISORDER VS. KLEPTOMANIA VS. TRICHOTILLOMANIA
Intermittent Explosive Disorder
• person has problems with failure to resist aggressive impulses
• serious assaultive acts or destructive to property
• disproportioned verbal abuse and outbursts
• aggressive episodes can’t be accounted for by another disorder (ex: ODD, antisocial personality disorder)
• can’t be accounted for by substance use, medication, or head trauma
• uncommon
Kleptomania
• recurrent failure to resist impulse to steal objects
• compulsive not for monetary value or survival
• no need to steal
• get a rush
• does it out of a weird fetish
Trichotillomania
• Compulsive hair picking/pulling
• When stressed
• Anywhere in body
• Often do to abuse
• May be a self-punishment
• anxiety disorder
• done excessively
• hair is thinned out
o SUBSTANCE USE DISORDER VS. SUBSTANCE INDUCED DISORDERS
Substance Use Disorder
• continuum of mild to severe (depends on how much criteria they meet)
• must have recurrent symptoms that result in a failure to fulfill major role obligations at work school home or in situations that can be dangerous
• impacts social interactions
• made effort to stop
• have had interventions to try and stop
• use when physically dangerous
• lots of hours spent using recovering and obtaining
• cut back on social stuff
• cravings
• tolerance
• withdraw/dependence/shakes
• use become excessive and problematic
• NOTE: legal issue are not a criterion
Substance Induced
• Substance intoxication = under the influence of the substance
o when actively using
• Subscene withdrawal = getting off substance
o get back to normal state
o GAMBLING DISORDER
Gambling Disorder
• Compulsive gambling if when it I damaging to their life financially
• Increase amounts they use
• Preoccupation
• Gamblers fallacy
o I’m losing, so I should win soon
o I’m winning, so I will continue wining
• When they feel distressed
• think about it excessively
• interferes with life
• jeopardizes relationship and job and livelihood
• lying to conceal
• keep going back after losing
• failure to control or cut back
• can be co-occurring
• rule out manic episode
• DSM 5: What’s the Difference, Part III
o EGO DYSTONIC OR EGO SYNTONIC: HOW AN INDIVIDUAL EXPERIENCE THEIR DISORDER
Ego Dystonic
• something client aware of
• doesn’t like
• doesn’t fit in perception of self
• ex: depression, anxiety, panic disorder
• D in dystonic = doesn’t like
Ego Syntonic
• part of view of self
• don’t see as issue
• behavior is not a problem
• characteralogical processes that people develop early on in life
• usually due to neglect and trauma
• becomes norm
o PARANOID PERSONALITY DISORDER VS. DELUSIONAL DISORDER VS. SCHIZOPHRENIA
Paranoid Personality Disorder
• is characterized by irrational suspension and mistrust of others
• pervasive across all domains
• think people are trying to hurt, exploit, or deceive them with not enough basis
• preoccupied with doubts of loyalty
• hard time maintaining relationships
• read into messages and remarks as being persecutory
• hold grudges
• world is a hostile place
Delusional Disorder
• bizarre (aliens abducting) or non-bizarre (being followed)
• this is the only thing you have, just delusions
• once you have other schizophrenia symptoms, it is no longer delusional disorder
Schizophrenia
• No longer just delusions, but now hallucinations, disorganized speech, flat affect, catatonia, etc.
o SCHIZOID PERSONALITY DISORDER VS. AVOIDANT PERSONALITY DISORDER VS. MAJOR DEPRESSIVE DISORDER
Schizoid Personality Disorder
• Ego syntonic
• lack interest in social relationship (loaners)
• no point in sharing time with others
• withdrawn
• no longing to connect
• no belief that connecting will help them
• kind of depressed
• isolated
• hard to feel happy
• pervasive over course of life
• pattern of behavior
• no urgency to connect with others
Avoidant Personality Disorder
• Ego syntonic
• Lonely
• Want to connect with others
• these individuals are lonely
• they want to connect
• feel inadequate
• feel sensitive
• feel people don’t like them
• fear of being rejected or judged negatively
• avoid social situations, but want to be connected to other people
Major Depressive Disorder
• Ego dystonic
• marked change that people notice
• people notice they have been withdrawn and isolated
o SCHIZOTYPAL PERSONALITY DISORDER VS. SCHIZOPHRENIA
Schizotypal Personality Disorder
• pre-curser to schizophrenia
• odd behavior of thinking
• little off
• may believe in aliens
• read a mag, think mag is talking to them
• think news is directed specifically to them
• magical thinking (sixth sense)
• bazar fantasies maybe paranoid
• some suspiciousness or paranoid ideation
• people with prodromal form of schizophrenia will look like a schizotypal
• haven’t crossed over to psychotic episode
• lack close friends
• dress bizarrely
• odd behavior or thinking
o ANTISOCIAL PERSONALITY DISORDER VS. NARCISSISTIC PERSONALITY DISORDER
Antisocial Personality Disorder
• must be 18
• needs to have conduct disorder before age 15
• pervasive pattern of disregard for rights of others from 15
• law breaking
• deception repeated lying for personal profit and pleasure
• impulsive
• aggressive
• reckless for self and others
• irresponsible
• lack of remorse (do something bad and don’t care)
• indifference
• rationalizations of mistreating others
Narcissistic Personality Disorder
• Pervasive pattern of grandiosity of self-importance
• need for admiration
• lack of empathy (have no idea how they are impacting others, ex: rude, snotty, have wife make perfect meal every night and not realize how stressful that is)
• exaggerate achievement
• expect to be recognized as superior
• unlimited success and power and brilliance
• think they are special and unique
• sense of entitlement (be treated better than others)
• envious of others
• arrogant of others
• can fly into a rage if challenged or put down
• common for DV perpetrators
o BORDERLINE PERSONALITY DISORDER VS. HISTRIONIC PERSONALITY DISORDER
Borderline Personality Disorder
• known for instability in relationship
• black and white thinking (like you then hate you, back and forth)
• frantic feelings of abandonment (real or imagined)
• don’t want to be rejected
• if rejected or fear of being rejected, can go to extreme (SI)
• recurrent suicidal jesters
• multiple suicide attempts = maybe borderline personality disorder
• may idealize therapist at first
• identity disturbances (sense of self fluctuates)
• mood instability
• feelings of emptiness
• feelings of rage
• instability in relationships
• hard to keep jobs
• feelings of emptiness and rage
Histrionic Personality Disorder
• pervasive attention seeking behavior
• wants to be center of attention
• known for seductive behavior/dress (although its not required)
• need to be recognized constantly
• shallow expression of emotion
• appearance is very important to them
• dramatic
• dramatic story tellers
o OBSESSIVE-COMPULSIVE PERSONALITY DISORDER VS. DEPENDENT PERSONALITY DISORDER
Obsessive-Compulsive Personality Disorder
• rigid conformity to the rules, moral codes, and orderliness
• hard time delegating
• workaholic
• obsessive orderliness
• must be done a certain way
• anal
Dependent Personality Disorder
• difficulty making decisions without advice or reassurance from other people
• defer their life/decision making to others
• need others to take responsibility for their life
• difficulty disagreeing with others out of fear of loss of support or approval
• fear rejection linked to loss of support
• very easy going (don’t speak up, don’t argue, just go along in relationships)
• hard time initiating problems or doing things on their own
• lack confidence in their own judgment
• don’t believe they can make decisions and do things
• go to excessive lengths to try and get nurturance from others
• take on tasks that are unpleasant in order to get people to like them and want to be with them
• when alone they feel uncomfortable and helpless cuz they have exaggerated fears of being unable to care for themselves
• really see relationships as a support
• when one relationship ends, they are quick to move into another relationship cuz they really need other person to be their main pilot they are the copilot in their own life
• preoccupation with unrealistic fears of being by themselves = latch on to someone else
• no confidence in their ability to take care of themselves
• Other person makes decisions for them (what they should eat, do with day, etc.)
o OTHER DIAGNOSES
Excoriation Disorder
• skin picking
• pick or scratch at their skin to the point where damage is caused
• individual is feeling anxious or stressed
• V Codes
o Other Conditions that May Be a Focus of Clinical Attention
V codes show up on the exam when there are multiple diagnoses in the answer set
o 1. Parent-Child Relational Problem – Possible on test
issue between primary caregiver
“brat”
child acting out
o 2. Sibling Relational Problem
o 3. Upbringing Away From Parents
o 4. Child Affected by Parental Relationship Distress
o 5. Child Physical Abuse
o 6. Child Sexual Abuse
o 7. Child Neglect
o 8. Child Psychological Abuse
o 9. Relationship Distress with Spouse or Intimate Partner – Possible on test
commonly diagnosis
mention when the argue a lot with spouse
o 10. Disruption of Family by Separation or Divorce
o 11. High Expressed Emotion Level Within Family
o 12. Uncomplicated Bereavement – Possible on test
client reports that someone of significance dies
o 13. Spouse or Partner Physical Abuse
o 14. Spouse or Partner Sexual Abuse
o 15. Spouse or Partner, Neglect
o 16. Spouse or Partner Psychological Abuse
o 17. Adult Abuse by Non-spouse or Non-partner
o 18. Academic or Educational Problem – Possible on test
this can show up on exam, but usually not right answer
o 19. Occupational Problem/Other Problem Related to Employment – Possible on test
when referred by employee assistance program (EAP)
get productive at work again
o 20. Problem Related to Current Military Deployment Status
o 21. Homelessness
o 22. Inadequate housing
o 23. Discord With Neighbor, Lodger, and Landlord
o 24. Problem Related to Living in a Residential Institution
o 25. Lack of Adequate Food or Safe Drinking Water
o 26. Extreme Poverty
o 27. Low Income
o 28. Insufficient Social Insurance or Welfare Support
o 29. Phase of Life Problem – Possible on test
when working with older adult
retired
adjustment to life
someone died
o 30. Problem Related to Living Alone
o 31. Acculturation Difficulty – Possible on test
client from different country
dealing with conflict between us culture and country of origin
also, when parents are immigrants
o 32. Social Exclusion or Rejection
o 33. Target of (Perceived) Adverse Discrimination or Persecution
o 34. Unspecified Problem Related to Social Environment
o 35. Victim of Crime
o 36. Conviction in Civil or Criminal Proceedings Without Imprisonment
o 37. Imprisonment or Other Incarceration
o 38. Problems Related to Release from Prison
o 39. Problems Related to Other Legal Circumstances
o 40. Religious or Spiritual Problems – Possible on test
any indication that client is struggling about believes (spouse dies and question if god exists)
o 41. Problems Related to Unwanted Pregnancy
o 42. Problems Related to Multiparity (Someone pregnant with multiples such as twins, triplets, etc. Not likely to be tested.)
o 43. Discord with Social Service Provider, Probation Officer, Case Manager,
o Social Services Worker
o 44. Victim of Terrorism or Torture
o 45. Exposure to Disaster, War, or Other Hostilities
o 46. Other Personal History of Psychological Trauma
o 47. Personal History of Self-Harm – Possible on test
cutter
history of cutting
may be part of answer
o 48. Personal History of Military Deployment
o 49. Problem Related to Lifestyle
o 50. Adult Antisocial Behavior – Possible on test
if someone is doing something illegal, not related to their diagnosis (ex: not a conduct issue)
diagnose when occasionally stealing
was a drug dealer
wouldn’t have conduct disorder and this in same answer
o 51. Child or Adolescent Antisocial Behavior – Possible on test
if someone is doing something illegal, not related to their diagnosis (ex: not a conduct issue)
diagnose when occasionally stealing
was a drug dealer
wouldn’t have conduct disorder and this in same answer
o 52. Nonadherence/Noncompliance to Medical Treatment – Possible on test
when someone has a medical condition, they are not taking care of
like someone who is not addressing their diabetes
figure out how to make them more compliant
o 53. Unavailability or Inaccessibility of Health Care Facilities
o 54. Unavailability or Inaccessibility of Other Helping Agencies
o 55. Overweight or Obesity
o 56. Malingering – Possible on test
when somebody fakes being sick in order to avoid a responsibility or benefit in some way
o 57. Wandering Associated with a Mental Disorder
o 58. Borderline Intellectual Functioning
