DSM VERSUS!!!

Question 1

Autism Spectrum Disorder vs Social (Pragmatic) Communication Disorder

Answer 1

Autism Spectrum Disorder
This was originally ASD, Aspergers, and Pervasive Development Disorder, but they were all merged into one in the DSM V which gives the clinician a bit more freedom and they are distinguished based on the severity.

• Shows up at a young age (often 0-5)
• Requires both deficiency in social communication and action as well as stereotyped repetitive behavior
• Deficiency in social communication:
o Lack of social reciprocity (unbalanced conversations)
o Lack of sustained eye contact (especially in babies)
o Lack of companion play as the child gets older
• Stereotyped repetitive behavior
o Speech patterns (especially repetition), hand flapping, chewing, etc
• Struggles with transitions
• Fixated on certain subjects (like snakes)
• Hyper or hyposensitivity (like hearing the ticking of a clock, or feeling the tag on a shirt)

Social Pragmatic Communication Disorder
This has impoverished social communication and just that – no stereotyped or repetitive behaviors. So if you see someone with bad social reciprocity, or eye contact, but not repetitive behaviors, this is Social Pragmatic Communication Disorder.

Question 2

Specific Learning Disorder vs Attention Deficit Hyperactivity Disorder

Answer 2

Learning disorder
Marked problems with learning basic academic skills that, based on their age and IQ they should be able to pick up, but can’t. In other words, they’re smart enough but can’t learn the way most people learn.

Learning disorders always need to be ruled out before diagnosing ADHD. Sometimes kids can present with ADHD symptoms because of an LD – for example a child with poor eyesight or dyslexia might be disruptive, fidgety, get bad grades etc, but its caused by the dyslexia. Once those things are fixed, the child can learn.

Attention Deficit Hyperactivity Disorder

• Again, be sure to rule out an LD first.
• Symptoms must be present before the age of 12, however, adults can still be diagnosed with ADHD, they just need to be able to trace the symptomology back to age 12 or prior.
• The person must have 2 or more environments where the individual is impaired (work, school, home, etc.)
• ADHD is marked by patterns of hyperactivity and problems with attention (sometimes girls only have problems with attention)
• Hyperactivity: fidgeting a lot, playing with things, sometimes annoying other people as a source of stimulation
• Inattention: trouble focusing, trouble sustaining attention, interruptions, struggles with tasks and getting organized.

Question 3

Pica vs Rumination Disorder

Answer 3

Pica
This is the persistent eating of non-food substances (like dirt, carpeting, etc). This is not likely to be tested on the exam, but you may well see it as a distraction answer which you can then quickly rule out.

Rumination Disorder
This is the repeated regurgitation of food that is not related to another disorder. The person will eat food and then regurgitate it.

Question 4

Language Disorder vs Child Onset Fluency Disorder

Answer 4

Both of these show up between the ages of 0-5

Language Disorder
This is when people, usually children, have a hard time building their vocabulary. So children should know a certain number of words at a certain age, and this is when they fall way below that.
• They use very simple sentences (“me go park” instead of “I want to go to the park”)
• They struggle with sentences of more than five words

Child Onset Fluency Disorder
This is stuttering. A repeated sound or syllable, or broken words “under [pause] stand”

Question 5

Tourette’s Disorder vs Persistent Motor / Vocal Tic Disorder

Answer 5

Tourette’s – the individual has both motor (jerking hand motions, for example) and vocal (shouting a curse word without intending to, for example) tics

Persistent Motor / Vocal Tic Disorder – the individual only has one. They either have vocal tics or motor tics, but they don’t have both. If they had both, they’d have Tourette’s.

Question 6

Encopresis vs Enuresis

Answer 6

Both must happen at the age of 5 or older (after we can expect they are potty trained)
Both must be a pattern over time, not a one-off event
Both can be signs of trauma or sexual abuse
Both can be intentional or unintentional

Encopresis – this is the shitting of pants or bed (word is kinda like constipated or crapping)
Enuresis – this is the pissing of the pants or bed (word is kinda like urine)

Question 7

Separation Anxiety Disorder vs Generalized Anxiety Disorder

Answer 7

Separation Anxiety Disorder – this is anxiety specific to being away from the caregiver. It can include anticipatory anxiety, being inconsolable when the separation occurs, worrying, etc.
• In adults, symptoms must be present for at least six months
• In children, symptoms must be present for at least four weeks

Generalized Anxiety Disorder - this is anxiety about many things, including potentially separation from spouse / caregiver, but would be seen across multiple domains (worrying about weather, performance, school, job, etc).
• Often has physical symptoms that you don’t see with separation anxiety disorder (like problems sleeping)
• For both children and adults symptoms must be present for at least 6 months
o Otherwise it is non-specific anxiety disorder

Question 8

Selective Mutism vs Social Anxiety Disorder / Social Phobia

Answer 8

Selective Mutism – this is when the individual fails to speak in a specific situation, but not others and it causes problems for them. For example the child speaks just fine at home, but at school they refuse to talk.

Social Anxiety Disorder – this is very specific to social situations and involves concerns about being judged, being seen, being rejected. These people only want to spend time with people they are comfortable around. The disorder can apply to people they know or people they don’t know. It refers specifically to groups of people.

Question 9

Reactive Attachment Disorder vs Disinhibited Social Engagement Disorder

Answer 9

Both:
• Onset between 9 months and 5 years old. You see this early.
• Result of persistent neglect, abuse, or constantly changing caregivers (like foster kids)

Reactive Attachment Disorder – Sometimes called failure to thrive
• Child is very withdrawn with a limited range of affect
• Child does not seek or respond to comfort
• You may see irritability but its directed at self
• These kids often just sit quietly in the corner
• Lots of sadness and fear of caregiver
• Minimal positive emotion or excitement
• These kids are easy to miss – they give up on people quickly, they keep to themselves, and they don’t act out

Disinhibited Social Engagement Disorder
• These kids stand out
• They have no boundaries and attach too quickly (ie they might meet someone and immediately say, “take me home with you!”)
• These kids have a willingness to go up to strangers and attach to them
• This children act out a good bit more

Question 10

Oppositional Defiant Disorder vs Conduct Disorder vs Disruptive Mood Dysregulation Disorder

Answer 10

These are commonly tested on the exam

Oppositional Defiant Disorder – this person is defiant, they have problems with authority, they are argumentative and refuse to follow directions. They don’t want other’s telling them what to do and this causes problems in their lives. The key here is the problem with authority.

Conduct Disorder – this involves violating the rights of others and problems with the law. Graffiti, initiating fights, vandalism, destruction of property, etc. The individual generally shows a lack of remorse. Conduct Disorder is a criteria for anti social personality disorder. The key here is they violate the rights of others.

Disruptive Mood Dysregulation Disorder – this used to be called bipolar in children and is generally diagnosed between the ages of 6-10 but can go up to 17 years old. These children are chronically moody and irritable, they have recurring tantrums (at least 3x / week), and even when they aren’t out bursting they often have negative moods. The key here is tantrums and negative moods.

Question 11

Brief Psychotic Disorder vs Schizophreniform Disorder vs Schizophrenia

Answer 11

All three disorders are similar and have 5 categories they can fall under with delusions and hallucinations being the most commonly tested:

1. Delusions – a belief that is obviously false (ie this movie star is in love with me)
   a. Bizarre delusions – things that can’t be true – I’m an alien
   b. Non-bizarre delusions – things that technically can be true, but aren’t – Britney Spears wants me to fuck her in the ass
2. Hallucinations – these can be visual or audio
3. Disorganized speech (often in response to a delusion / hallucination)
4. Disorganized behavior (often in response to a delusion / hallucination)
5. Negative symptoms (flat affect, doesn’t respond to discussion, stiffness, problems with movement)

Anyways:
Brief Psychotic - up to 30 days
Schizophreniform - 1-6 months
Schizophrenia - over 6 months

Question 12

Major Depressive Disorder vs Unspecified Depressive Disorder vs Persistent Depressive Disorder

Answer 12

Major Depressive Disorder:
• Symptoms present for at least 2 weeks
• Dark mood, lack of enjoyment in things (anhedonia)
• Can’t enjoy things they used to (this is a big tell)
• Lacking motivation
• Changes in biological functioning (sleeping too much or too little, eating too much or too little)
• Suicidal thoughts
• A sense of worthlessness or being a burden

Unspecified Depressive Disorder:
•	The person is functioning
•	Milder biological disturbances
•	No suicidal ideation
•	Decrease in mood
•	This can be difficult to identify on the exam as its like MDD but not as intense. Trainer suggests that if you see both and its not clear, go with MDD

Persistent Depressive Disorder (formerly dysthymia):
• Depressed for 2 or more years for adults, 1 or more year for children
• Not as deep a depression as MDD (almost like you have UDD for two years)
• Chronically mildly depressed
• So in the vignette the person would likely be struggling on and off for 2-3 years (they’d have a lack of energy, down mood, no changes in bio – something like that).

Question 13

Bipolar I Disorder vs Bipolar II Disorder vs Cyclothymic Disorder

Answer 13

Bipolar I Disorder:
• The only real criteria for Bipolar I is a manic phase. You do not need anything else (though BP 1 is often coupled with a depressive episode, it’s not needed)
• Manic phase:
o Goes on for at least 1 week
o Elevated mood that tend to have a significant impact
o Feelings of positivity or irritability
o Accompanied with feelings of grandiosity, risk taking (drugs, sex, gambling)
o Lack of a need for sleep and increased energy (and often increased exercise)
o Often experienced as euphoria with the client in denial of a problem during the manic phase

Bipolar II:
• A hypomanic phase that also has at least 1 episode of major depressive disorder
• Hypomania:
o 4 days of elevated mood, but not as impactful / damaging as mania

Cyclothymic Disorder
• Present for at least 2 years
• Hypomanic state alternating with a low level depressive episode
• Think alternating instances of Unspecified Depressive Disorder and hypomania

Question 14

Schizoaffective Disorder vs Mood Disorder with Psychotic Features (this includes Major Depressive Disorder with Psychotic Features ad Bipolar I Disorder with Psychotic Features)

Answer 14

All three of these are mood disorders with psychotic features, the difference is which is more persistent. You can actually just tell by the order of the words

Schizoaffective Disorder – in this instance psychotic features are present at all times. You can see it in the words Schizo (which is a psychotic disorder) then affective (which refers to affect, the mood)

Major Depressive Disorder with Psychotic Features – this is MDD first, with psychotic features that come in from time to time

Bipolar I with Psychotic Features – this is having Bipolar I all the time, and psychotic features coming in from time to time. Again, if they were always psychotic it would be Schizoaffective Disorder

Question 15

Bereavement vs Major Depressive Disorder vs Adjustment Disorder with Depressed Mood

Answer 15

Bereavement – someone is grieving the loss of a person or an animal that was important to them. They experience loss, anger, despair, self-blame. In the vignette, look for someone who is responding to the death of a loved one.

Major Depressive Disorder – this can present with bereavement if they are also experiencing a change in biological functioning along with a feeling of worthlessness, self-blame, and thoughts of self-harm.

In the vignette, look for someone not sleeping well, oversleeping, over or under eating, weight loss or gain, diet change. If there is a more serious impact with functioning this leans towards depression. Remember: bereavement can only be present if someone loses someone of importance.

Adjustment Disorder – this is not diagnosed with bereavement. This is a reaction to something happening in the environment (which can also have depression or anxiety associated with it). It comes with a recent life stressor like moving, getting or losing a job, divorce.

Note: symptoms must present within 3 months and cannot go beyond 6 months. If the symptoms have been present for more than 6 months, then the diagnosis is something else.

Question 16

Panic Disorder vs Agoraphobia

Answer 16

Panic disorder - this is a person who experiences recurrent and unexpected panic attacks and fears that they will happen again. The individual shapes their life around trying to avoid panic attacks
• Symptoms of panic attack: feel like you’re dying, room is spinning, heart palpitations, feels like you’re going crazy, disconnected from reality, very overwhelming

Agoraphobia – this is the fear of going out in public and must occur in at least 2 situations (fear of crowds, of standing in line, of open spaces, etc). This fear impacts the individual’s ability to function.

Question 17

Obsessive Compulsive Disorder vs Obsessive Compulsive Personality Disorder

Answer 17

These are often confused and therefor have a decent likelihood of being tested.

Obsessive Compulsive Disorder – this is what I think it is. OCD is a combination of obsessive thoughts and compulsive behavior. This is debilitating and needs to be treated.
• Obsessive thoughts: intrusive thoughts that run someone’s life (for example, they’re afraid of germs and always use napkins when they open the door)
• Compulsive behavior – these are compulsive actions (in the example of germs, you would see repeated handwashing again and again, or if they are worried the house will burn down, checking the oven many times to make sure its off).

Obsessive Compulsive Personality Disorder – this is when someone is a perfectionist. Things need to be exactly how they want them to be. Their drawers are perfectly organized, for example. They can be rigid and controlling, but they’re also functioning. They also have no awareness that this is really an issue.

Question 18

Post-Traumatic Stress Disorder vs Acute Stress Disorder vs Adjustment Disorder with Anxiety

Answer 18

Here’s the nitty gritty: Post-Traumatic Stress Disorder there must be at least one month between the incident and the symptoms, Acute Stress Disorder it must be one month or less. Both PTSD and ASD require either being in a life-threatening situation or witnessing one. Adjustment Disorder with Anxiety the person did not encounter a life-threatening incident (they moved or got fired or something).

Post-traumatic Stress Disorder and Acute Stress Disorder: Both PTSD and ASD require that the person endured or witnessed a life threatening (so if a child saw his mother beaten, he qualifies for these). Symptoms fall into four categories:
• Intrusive elements – the person is experiencing intrusive thoughts or memories or they’re having nightmares.
• Negative mood – the person is wrestling with depression, irritability, shame, grief, self-blame, survivors’ guilt
• Behavioral – they are avoiding situations that remind them of the event (for example, they avoid parks)
• Arousal – they have a hyper vigilance, a startle response, lots of tension, easily agitated

Post-Traumatic Stress Disorder – symptoms present for at least one month since the incident. If you see a combat vet on the exam, they almost certainly have PTSD and not ASD, unless you’re treating them in the field.

Acute Stress Disorder – this is when the patient is exhibiting symptoms but its within one month of the incident or less. So if you’re treating a soldier in the field, or working with a police officer shortly after an event, it’s like ASD.

Adjustment Disorder with Anxiety – this is different. The person still has anxiety linked to a particular event, but the event was not life threatening (divorce, moving, getting fired, etc). These people don’t have nightmares or flashbacks but they do have anxiety and worry.

Question 19

Generalized Anxiety Disorder vs Unspecified Anxiety Disorder

Answer 19

Once again, the key here is timeline. GAD is 6 months or more. UAD is 0-6 months. These distinctions are about timeline, not severity.

Generalized Anxiety Disorder – Symptoms present for at least six months. Look for impacts on biological functioning like sleeping and eating

Unspecified Anxiety Disorder – Symptoms present for less than 6 months, even if the symptoms are severe. You might see some elements of anxiety from different diagnoses without meeting the full criteria for a single diagnosis (like agoraphobia). In this case, the right diagnosis is Unspecified Anxiety Disorder.

Question 20

Delirium vs Major Neurocognitive Disorder vs Mild Neurocognitive Disorder

Answer 20

Delirium – this is most likely going to be a distractor on the exam, nothing more. Delirium comes on quickly and lasts for a few hours. Its most often seen in medical settings in response to a medication or drug or medical problem. The person experiences memory impairment, language impairment and executive functioning impairment. You may also see hallucinations and strange verbal patterns.

Mild Neurocognitive Disorder – with mild neurocognitive disorder the person has a noticeable decline in neurocognitive functioning, but they are still able to maintain independence. They can keep appointments and pay bills but are becoming more forgetful. They may need support, but it can be spousal support instead of a nursing home.

Major Neurocognitive Disorder – This is formerly called dementia. The person is having serious issues with attention, executive functioning, memory, language, cognition, and interaction. They have problems with perceptual motor skills and have a serious decline in functioning that requires accommodation (like a skilled care facility or nursing home).

Mild and Major are the continuums of the Neurocognitive disorders and on the exam we’re likely to see a family coming in and trying to determine the appropriate level of care.

Differential from Major Depressive Disorder in the Elderly – in the elderly MDD can appear similarly to a neurocognitive disorder, however there is a significant difference: with depression, the person is aware that their memory is declining. With the neurocognitive disorders, there is no awareness.

Question 21

Somatic Symptoms Disorder vs Illness Anxiety Disorder vs Conversion Disorder

Answer 21

The key difference between Somatic Symptoms Disorder and Illness Anxiety Disorder is that with Somatic Symptoms Disorder, there is an actual medical condition, whereas with Illness Anxiety Disorder, there is only the worry about one.

Somatic Symptoms Disorder – client has a real somatic issue that has been diagnosed by a medical professional, and then they have severe health related concerns and anxiety about the persistence of the symptoms. They dedicate a lot of time and energy to it and it impedes daily functioning. Symptoms must be present for at least 6 months.

Illness Anxiety Disorder – this is what we often call hypochondria. The person doesn’t actually have the disease, and they’ve been reassured by medical professionals that they’re fine, but they still spend huge amounts of time worrying about it. They may have vague physical symptoms, but there is not true somatic illness. Symptoms must be present for at least 6 months.

Conversion Disorder – this is when psychological issues present as physical symptoms. So “blind with rage” is when someone is so enraged that they actually can’t see. “Paralyzed with fear” is when someone experiences something so traumatic that their leg or arm actually stops working. This is fairly rare.

Question 22

Factitious Disorder vs Malingering vs Factitious Disorder by Proxy

Answer 22

The differential here is that factitious disorder is when the person just likes the attention of being sick and malingering is when the person is trying to gain or avoid something.

Factitious Disorder – this is when the individual likes the attention that comes with being sick, so they act like they’re sick and go to the doctor.

Factitious Disorder by Proxy – this is when someone, usually a caretaker, makes someone else appear sick because they like the attention (like they keep taking their child to the doctor). In rare occasions they’ll actually do something to make the child sick. This used to be called Munchausen syndrome by proxy.

Malingering - this is when someone is faking an illness in order to get out of something or to gain something (so they fake an illness to get on disability or they fake an illness to avoid appearing in court). They aren’t sick but they’re interested in the gain or avoidance.

Question 23

Anorexia Nervosa vs Bulimia Nervosa vs Binge Eating Disorder

Answer 23

These are what I think they are. These need to be coordinated with an MD and often require a fairly high level of care, like inpatient.

Anorexia Nervosa – the person restricts the intake of food to the point where it doesn’t meet their biological needs. They have an intense fear of gaining weight and are very thin. They dislike their body image. Oftentimes they will compensate with tons of exercise. They fear getting fat.

Bulimia Nervosa – this requires the presence of two things. First, the person must binge eat, which is eating way more than is appropriate in one sitting often accompanied by feelings of being out of control and shame, followed by some sort of purging (vomiting, laxatives, etc). This may also come with excessive exercise.

Binge Easting Disorder – this is when the person engages in binge eating but does not purge.

Question 24

Unspecified Eating Disorder vs Body Dysmorphia Disorder

Answer 24

Unspecified Eating Disorder – this is when the person has some sort of eating disorder but doesn’t meet the criteria for anorexia nervosa or bulimia nervosa. So for example, the person purges without binging (you need binging and purging for Bulimia) or they are a normal weight but they have an obsession and anxiety with their body image.

Body Dysmorphia Disorder – this is not about weight. The person has some sort of distinct displeasure with a specific part of their body (for example, they hate their nose). These people often get excessive plastic surgery on that part of their body (like Michael Jacksson with his nose). These people complain about a certain body party but its unrelated to weight.

Question 25

Depersonalization/Derealization Disorder vs Dissociative Amnesia vs Dissociative Identity Disorder

Answer 25

Depersonalization / Derealization Disorder – This is someone who is still in reality. They are present. You can talk to them. However, they feel like they are somehow out of reality, out of their body, or in a dream like state. They don’t feel connected to reality. The world feels surreal to them. Unlikely tested on the exam, but likely distractor.

Dissociative Amnesia – this is triggered after an event that caused extreme stress or shock. This is the sudden forgetting of pertinent personal information (SSN, phone number, address, etc).

Dissociative Identity Disorder – Commonly called multiple personality disorder. This is uncommon. It is when the person has two distinct personalities with different names and different character traits. For example, one is named Jess and she’s outgoing and confident, the other is named Erin and she’s anxious and shy. The different personalities are distinct states. One personality can’t remember the others. This often happens after extreme trauma at a young age.

Question 26

Genito-Pelvic Pain/Penetration Disorder vs Female Sexual Interest/Arousal Disorder

Answer 26

These are pretty much what they sound like.

Genito-Pelvic Pain/Penetration Disorder – this is when the woman reports pain, or fear of pain, around being penetrated during intercourse. They experience a tightening of the pelvic floor during penetration and express great displeasure at the thought of having sex. You see this in DV relationships and also with sexual abuse / rape victims.

Female Sexual Interest/Arousal Disorder – this is when the woman has a lack of interest in sex and arousal. They don’t have thoughts or fantasies about sex. This can be something that comes on or it can be something the person has experienced their entire lives. If you’re working with an individual or couple, it’s important to explore this.

Question 27

Insomnia Disorder vs Hypersomnolence Disorder

Answer 27

Insomnia – reports difficulty sleeping (technically it must be 3 nights / week for 3 months). They may report difficulty falling asleep, staying asleep, multiple awakenings during the night. Make sure to rule out Major Depressive Disorder, and Anxiety. Also people experiencing manic phases will often have something like insomnia, expect they don’t complain about it. People with insomnia complain.

Hypersomnolence – this is when someone experiences excessive sleepiness and it must exceed seven hours. They struggle to feel fully awake. They’re sluggish, tired, and excessively sleepy. You often see this with overweight people. Again, be sure to rule out Major Depressive Disorder and some sort of substance use.

Question 28

Nightmare Disorder vs Non-Rapid Eye Movement Sleep Disorder

Answer 28

Nightmare disorder – this is what it sounds like. The person wakes up from a nightmare, they remember the contents of their dream, and they are quickly oriented to where they really are.

Non-Rapid Eye Movement Sleep Disorder – This used to be called “night terrors.” This is recurrent episodes of incomplete waking, the person can’t recall what they were dreaming about, they sometimes wake up screaming. This can also include sleep walking / eating, and having no recollection of their adventures.

Question 29

Central Sleep Apnea vs Narcolepsy

Answer 29

These are what you think they are

Central Sleep Apnea – the person stops breathing while they are sleeping, often for up to 60 seconds, and this prevents them from getting REM sleep and feeling refreshed the next morning. They often have huge gasps of air when they do start breathing. This is very disruptive to sleep.

Narcolepsy – this is falling asleep randomly (like in the middle of a conversation). It is a sudden attack of sleep that is sometimes accompanied by loss of muscle tone, hallucinations right before or after, and daytime fatigue.

Question 30

Intermittent Explosive Disorder vs Kleptomania vs Trichotillomania

Answer 30

Intermittent Explosive Disorder – the person has problems controlling aggressive behaviors, they can be assaultive or destructive, verbally abusive or outbursts that are disproportionate. For this to be present it must not be accounted for by another disorder (Oppositional defiant disorder, Anti-social personality disorder, etc).

Kleptomania – compulsively stealing for its own sake (as opposed to need). Done for the rush. Winona Ryder has this – she was caught stealing from a department store.

Trichotillomania – this is the compulsion to pull your hair out (often eye lashes or eye brows or arm hair). This is most commonly seen in people who have experienced trauma or abuse.

Question 31

Substance Use Disorder vs Substance Induced Disorders (Substance Intoxication and Substance Withdrawal)

Answer 31

Substance Use Disorder – this is measured from mild to severe. It is marked by a failure to manage roles and obligations due to substance use. You’ll see it affecting people’s work, school, family, personal life, relationships, etc. The person is unable to stop. They often have an increased tolerance or dependence. They may need their fix in the morning to abate physical symptoms. They can become obsessed with the substance even though it is problematic for them.

Substance Induced Disorders – this is the overarching term that Substance Intoxication and Substance Withdrawal falls under

Substance Intoxication – this is when the person is actively intoxicated on the substance (see the quick study for how different substances affect people)

Substance Withdrawal – these are the effets that come with getting off the substance (and again, different substances have different symptoms – see quick study)

Question 32

Gambling Disorder

Answer 32

Compulsive gambling, even when it financially damages the person’s life. The person has a preoccupation with gambling, gambles when distressed, will lie about the issue, jeopardizes relationships, keep coming back even when losing. Be sure to rule out a manic episode.

Question 33

Ego syntonic vs Ego dystonic

Answer 33

Both of these terms refer to how the individual experiences their symptoms.

Ego syntonic – this is when the personality disorder is part of how the person views themselves, they don’t see their symptoms as much of a problem, it’s the norm for them. Narcisism is a common example.

Ego dystonic – this is when the person is aware of and dislikes about themselves (depression, anxiety, panic disorder, etc). If they are complaining about a symptom it’s ego dystonic. Think “d” for dislike.

Question 34

Paranoid Personality Disorder vs Delusional Disorder vs Schizophrenia

Answer 34

Paranoid Personality Disorder – this is characterized by irrational suspicion and distrust of others. It’s pervasive across domains. They believe that people are trying to hurt or exploit them and they are preoccupied with figuring out how loyal friends and associates are. They struggle to maintain friendships. They read into messages and remarks. They hold grudges. It feels like the world is hostile and out to get them.

Delusional Disorder – this is where the person experiences delusions (either bizarre or non-bizarre) but nothing else. It’s rare that they would test this.

Schizophrenia – as soon as you have delusions met by hallucinations, disorganized speech, flat affect, catatonia, then it becomes schizophrenia.

Question 35

Schizoid Personality Disorder vs Avoidant Personality Disorder vs Major Depressive Disorder

Answer 35

Schizoid personality is loner – they don’t want to be with people; avoidant personality disorder is lonely – they want to be with people but are afraid.

Schizoid Personality Disorder – these people lack interest in social relationships. They’re loners. They are withdrawn, they don’t see the point in interacting, they don’t long to connect. They’re just on their own. This is differentiated from Major Depressive Disorder because someone with MDD sees what’s going on and wants to be able to fix it. MDD is ego dystonic while Schizoid Personality is ego syntonic.

Avoidant Personality Disorder – these people are lonely. They want to be around other people and interact, but they’re afraid to do so. They are socially inhibited. They’re sensitive, they feel inferior, inadequate, they fear that people don’t like them, and they avoid social interactions out of fear. However they want to be connected.

Question 36

Schizotypal Personality Disorder vs Schizophrenia

Answer 36

The big x-factor here is a psychotic episode. Schizotypal have never had a psychotic episode.

Schizotypal Personality Disorder – think of it as sort of a precursor to schizophrenia. These people are oddballs. They believe in aliens, have delusions of reference, often have weird thinking patterns, believe they have a sixth sense, engaging in bizarre fantasies. They have odd ways of thinking and speaking. Some experience suspicion or paranoia. However, they’ve never had the psychotic episode that defines schizophrenia. They also sometimes dress oddly and struggle to make friends.

Question 37

Antisocial Personality Disorder vs Narcissistic Personality Disorder

Answer 37

Antisocial Personality Disorder – these people must be at least 18 and there needs to be evidence of conduct disorder when they were younger (that is misbehavior before the age of 15). Antisocial Personality Disorder is a pervasive pattern of disregarding and violating the rights of others. They break laws, they deceive, they lie for profit or impulse, they’re aggressive and have a reckless disregard for the safety of self and others. Marked by a lack of remorse.

Narcissistic Personality Disorder – these people experience a sense of grandiosity and superiority. They feel they are special. They have a strong need for admiration. They are marked by a lack of empathy (for example a husband demands a perfect dinner from his wife every night without any awareness of how that may affect her). They have fantasies of unlimited success and power, they feel special and entitled. This is a common diagnosis for perpetrators of Domestic Violence – they feel entitled to hit their partners and don’t have the empathy to stop.

Question 38

Borderline Personality Disorder vs Histrionic Personality Disorder

Answer 38

Borderline Personality Disorder – Known for their instability in relationships and black and white thinking about others (“I hate you” “I love you”). These people have a frantic fear – real or imagined – of being abandoned and will go to great lengths to avoid abandonment, especially things like suicidal gestures. In fact, someone with recurrent suicidal gestures / attempts is a great candidate for Borderline Personality Disorder. They will often idealize their therapists. They experience identity disturbance, especially in relationship to others. They experience mood instability and extremes. They often vacillate from emptiness to rage and struggle to control the rage. They struggle to maintain relationships and jobs. They are marked by instability in their relationships and suicidal gestures.

Histrionic Personality Disorder – this is pervasive attention seeking behavior. These people want to be the center of attention. They are known for their seductive behavior and dress (think of a woman dressed provocatively flirting with all of the boys at a party). They can experience rapid shifting of moods and shallow expression of emotions. They are vain and dramatic and need to be the center of attention.

Question 39

Obsessive Compulsive Personality Disorder vs Dependent Personality Disorder

Answer 39

Obsessive Compulsive Personality Disorder – these are the anal (sex) people. They require orderliness, they’re perfectionists, workaholics, and have strict rules and moral codes.

Dependent Personality Disorder – These people struggle to make decisions without the validation of others and need others to take responsibility for their lives. They struggle to disagree because they are afraid of the potential loss of support. They don’t argue or speak up and are very easy going. They don’t believe in themselves and will do unpleasant things to get others to like them. These people feel helpless on their own and think they can’t take care of themselves. These are people who lack the confidence to make decisions on their own and believe that they need other people to help them with this, even on basic things like what to eat or how to spend a day (sound familiar?). They latch onto others for support.