DSM-V criteria Flashcards
Emotional Disturbance
DSM-5 Disorders Associated with Emotional Disturbance
* Major Depressive Disorder (MDD)
* Generalized Anxiety Disorder (GAD)
* Social Anxiety Disorder
* Post-Traumatic Stress Disorder (PTSD)
* Obsessive-Compulsive Disorder (OCD)
* Bipolar Disorder
* Schizophrenia
* Oppositional Defiant Disorder (ODD)
* Conduct Disorder (CD)
Conduct Disorders
DSM-5-TR Criteria for Conduct Disorder (CD)
A. Repetitive and Persistent Pattern of Behavior
* Violates basic rights of others or societal norms/rules
* At least 3 of 15 criteria present in the past 12 months
* At least 1 criterion in the past 6 months
1. Aggression to People and Animals (At least 1 required)
○ Bullies, threatens, or intimidates others
○ Initiates physical fights
○ Uses a weapon (e.g., bat, knife, gun)
○ Physically cruel to people
○ Physically cruel to animals
○ Steals while confronting a victim (e.g., mugging)
○ Forces someone into sexual activity
2. Destruction of Property
○ Fire-setting with intent to cause serious damage
○ Deliberately destroys others’ property
3. Deceitfulness or Theft
○ Breaks into houses, buildings, or cars
○ Lies to obtain goods or favors (“cons” others)
○ Steals items without confronting a victim (e.g., shoplifting)
4. Serious Violations of Rules
○ Stays out at night despite parental prohibitions (before age 13)
○ Runs away from home at least twice
○ Is often truant from school (before age 13)
B. Significant Impairment
* Causes clinically significant impairment in social, academic, or occupational functioning.
C. Exclusion of Antisocial Personality Disorder
* If the individual is 18 years or older, the criteria for Antisocial Personality Disorder are not met.
Specifiers
1. Onset Type
○ Childhood-Onset: Before age 10
○ Adolescent-Onset: After age 10
○ Unspecified: Onset age unknown
2. Severity
○ Mild: Few conduct problems causing minimal harm (e.g., lying, truancy)
○ Moderate: Intermediate number and severity (e.g., vandalism)
○ Severe: Many conduct problems causing significant harm (e.g., physical cruelty)
3. With Limited Prosocial Emotions (At least 2 over 12 months):
○ Lack of remorse or guilt
○ Callous – lack of empathy
○ Unconcerned about performance (school, work, etc.)
○ Shallow or deficient affect
CD Prevalence Rates
* 2% to 10%
* More common in males
Oppositional Defiant Disorders
A. Pattern of Angry/Irritable Mood, Argumentative/Defiant Behavior, or Vindictiveness
* Must last at least 6 months and include at least 4 symptoms from the categories below, exhibited with at least one individual who is not a sibling:
1. Angry/Irritable Mood
○ Often loses temper
○ Is often touchy or easily annoyed
○ Is often angry and resentful
2. Argumentative/Defiant Behavior
○ Often argues with authority figures or adults
○ Often actively defies or refuses to comply with rules
○ Often deliberately annoys others
○ Often blames others for mistakes or misbehavior
3. Vindictiveness
○ Has been spiteful or vindictive at least twice in the past 6 months
B. Distress or Functional Impairment
* Behavior causes distress in the individual or others (e.g., family, peers) or significantly impairs social, educational, or occupational functioning.
C. Exclusion of Other Disorders
* Behavior is not exclusively due to psychotic, substance use, depressive, or bipolar disorders.
* Not disruptive mood dysregulation disorder.
Severity Specifiers
* Mild: Symptoms occur in one setting (e.g., home, school, peers)
* Moderate: Symptoms occur in two settings
* Severe: Symptoms occur in three or more settings
ODD Prevalence Rates
* Ranges from 1% to 11%
* Average prevalence: 3-4%
* More common in males before adolescence
* Consistent across different races and ethnicities
ODD Summary
* Characterized by angry, oppositional, and defiant behavior
* Persistent pattern of behavior for at least 6 months
* Considered a developmental precursor to Conduct Disorder (CD)
ADHD
A. Symptom Presentation
Inattention: At least 6 or more symptoms (for children under 17) or 5 or more symptoms (for adolescents/adults 17 and older), persisting for at least 6 months, to a degree inconsistent with developmental level and that negatively impacts social, academic, or occupational activities:
Often fails to give close attention to details or makes careless mistakes.
Often has difficulty sustaining attention in tasks or play activities.
Often does not seem to listen when spoken to directly.
Often does not follow through on instructions and fails to finish tasks.
Often has difficulty organizing tasks and activities.
Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort.
Often loses things necessary for tasks and activities.
Is often easily distracted by extraneous stimuli.
Is often forgetful in daily activities.
Hyperactivity and Impulsivity: At least 6 or more symptoms (for children under 17) or 5 or more symptoms (for adolescents/adults 17 and older), persisting for at least 6 months, to a degree inconsistent with developmental level and that negatively impacts social, academic, or occupational activities:
Often fidgets with or taps hands or feet or squirms in seat.
Often leaves seat in situations when remaining seated is expected.
Often runs about or climbs in inappropriate situations (in adolescents/adults, may be feelings of restlessness).
Often unable to play or engage in leisure activities quietly.
Is often “on the go,” acting as if “driven by a motor.”
Often talks excessively.
Often blurts out an answer before a question has been completed.
Often has difficulty waiting their turn.
Often interrupts or intrudes on others.
B. Symptom Onset
Several symptoms must have been present before age 12.
C. Symptom Occurrence
Symptoms must be present in two or more settings (e.g., home, school, work, social settings).
D. Functional Impairment
Clear evidence that symptoms interfere with or reduce the quality of social, academic, or occupational functioning.
E. Differential Diagnosis
Symptoms cannot be better explained by another mental disorder (e.g., mood disorder, anxiety disorder, personality disorder) or substance use.
ADHD Presentations (Subtypes)
Predominantly Inattentive Presentation: If inattention criteria are met but not hyperactivity-impulsivity.
Predominantly Hyperactive-Impulsive Presentation: If hyperactivity-impulsivity criteria are met but not inattention.
Combined Presentation: If both inattention and hyperactivity-impulsivity criteria are met.
ASD
A. Persistent Deficits in Social Communication and Social Interaction
Must include deficits in all three areas below, across multiple contexts:
Social-emotional reciprocity
Abnormal social approach or lack of normal back-and-forth conversation.
Reduced sharing of interests, emotions, or affect.
Failure to initiate or respond to social interactions.
Nonverbal communicative behaviors
Poorly integrated verbal and nonverbal communication.
Abnormalities in eye contact, body language, or deficits in understanding and using gestures.
Total lack of facial expressions or nonverbal communication.
Developing, maintaining, and understanding relationships
Difficulty adjusting behavior to suit various social contexts.
Trouble making friends or a lack of interest in peers.
Absence of imaginative play or sharing of experiences.
B. Restricted, Repetitive Patterns of Behavior, Interests, or Activities
Must include at least two of the following:
Stereotyped or repetitive motor movements, use of objects, or speech
Simple motor stereotypes (e.g., hand-flapping, rocking).
Echolalia (repeating others’ speech) or idiosyncratic phrases.
Insistence on sameness, inflexible adherence to routines, or ritualized behavior
Extreme distress at small changes.
Difficulty with transitions.
Rigid thinking patterns or ritualized verbal/nonverbal behaviors.
Highly restricted, fixated interests abnormal in intensity or focus
Strong attachment to unusual objects or topics.
Narrow interests that are abnormal in depth or intensity.
Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment
Over- or under-responsiveness to pain, sound, or light.
Unusual sensory exploration (e.g., fascination with lights, textures).
C. Symptoms Must Be Present in the Early Developmental Period
May not fully manifest until social demands exceed capacities or may be masked by learned strategies later in life.
D. Symptoms Cause Clinically Significant Impairment
There must be clear evidence that symptoms impair social, occupational, or other important areas of functioning.
E. Symptoms Are Not Better Explained by Another Diagnosis
Symptoms must not be better accounted for by intellectual disability or global developmental delay.
Specifiers
Clinicians may specify:
With or without intellectual impairment
With or without language impairment
Associated with a known medical/genetic condition or environmental factor
Associated with another neurodevelopmental, mental, or behavioral disorder
With catatonia (if present)
Severity Levels
ASD is classified by severity in both domains (A and B):
Level 1 (“Requiring Support”): Noticeable impairments without support.
Level 2 (“Requiring Substantial Support”): Marked deficits even with supports in place.
Level 3 (“Requiring Very Substantial Support”): Severe deficits causing significant interference in daily life.
ID
A. Deficits in Intellectual Functioning
Significant limitations in intellectual functioning confirmed by clinical assessment and standardized intelligence testing.
Areas of impairment include:
Reasoning
Problem-solving
Planning
Abstract thinking
Judgment
Academic learning (e.g., reading, writing, math)
Learning from experience
Intellectual functioning is typically measured using IQ tests, with scores approximately two standard deviations below the mean (IQ of 70 or below, accounting for testing margin of error).
B. Deficits in Adaptive Functioning
Significant impairment in adaptive functioning across at least one domain, affecting daily life and independence.
These deficits must limit functioning in multiple environments (e.g., home, school, work, community).
Three domains of adaptive functioning:
Conceptual – Academic and cognitive skills (e.g., language, reading, writing, math, problem-solving, memory).
Social – Communication, social judgment, ability to form relationships, and understanding social cues.
Practical – Personal care, money management, job responsibilities, organizational skills, and safety.
C. Onset During the Developmental Period
Symptoms must appear during childhood or adolescence (before age 18).
Intellectual disability is not diagnosed if deficits begin after this period (e.g., due to brain injury or illness).
Severity Levels of Intellectual Disability
Severity is based on adaptive functioning, not IQ score, because adaptive impairments determine the level of support required.
Mild:
May develop basic academic skills (up to 6th-grade level).
Can maintain personal care with some support.
Difficulty with complex social interactions and problem-solving.
Moderate:
Academic skills typically at an elementary level.
Requires supervision for daily life tasks.
Limited social judgment and communication skills.
Severe:
Limited understanding of written language and basic academic concepts.
Requires significant support for daily activities and decision-making.
Simple speech for communication with strong supervision needs.
Profound:
Severe limitations in all areas of functioning.
Often non-verbal or with very minimal communication.
Requires constant care and assistance for all personal and safety needs.
Exclusion Criteria
The deficits cannot be better explained by other mental health disorders (e.g., neurocognitive disorders).
Intellectual disability is distinct from specific learning disorders and other neurodevelopmental conditions.
