Exam 3-PSY 320

Question 1

Female Sexual Interest/Arousal Disorder

Answer 1

Lack of, or significantly reduced, sexual interest/arousal, as manifested by at least three of the following:
A.
1. Absent/reduced interest in sexual activity
2. Absent/reduced sexual/erotic thoughts or fantasies
3. No-reduced initiation of sexual activity and typically unreceptive to a partner’s attempts to initiate
4.Absent/reduced sexual excitement/pleasure during sexual activity in almost all or all (approximately 75%-100%) sexual encounters (in identified situation contexts or, if generalized, in all contexts).
5. Absent/reduced sexual interest/arousal in reponse to any internal or external sexual/erotic cues (e.g., written, verbal, visual.
6. Absent/reduced genital or non-genital sensations during sexual activity in almost all or all sexual encounters (in identified situational contexts or if generalized, in all contexts
B. The symptoms in Criterion A have persisted for a minimum duration of approximately 6 months

Question 2

Male Hypoactive Sexual Desire Disorder

Answer 2

A. Persistently or recurrently deficient (or absent) sexual/erotic thoughts or fantasies and desire for sexual activity. The judgment of deficiency is made by the clinician, taking into account factors that affect sexual functioning, such as age and general and sociocultural contexts of the individual’s life.
B. The symptoms in Criterion A have persisted for a minimum duration of approximately 6 months.

Question 3

Erectile Disorder

Answer 3

A. At least one of the three following symptoms must be experienced on almost all or all(approximately 75%-100%) occasions of sexual activity (in identified situational contexts or, if generalized in all contexts):
1. Marked difficulty in obtaining an erection during sexual activity
2. Marked difficulty in maintaining an erection until the completion of sexual activity
3. Marked decreased in erectile rigidity.
B. The symptoms in Criterion A have persisted for a minimum duration of approximately 6 months.

Question 4

Female Orgasmic Disorder

Answer 4

A. Presence of either of the following symptoms and experienced on all or almost all (75-100%) occasions of sexual activity (in identified situational contexts or, if generalized, in all contexts):
1. Marked delay in, marked infrequency of, or absence of orgasm.
2. Marked reduced intensity of orgasmic sensations.
B. The symptoms in Criterion A have persisted for a minimum duration of approximately 6 months.

Question 5

Delayed Ejaculation

Answer 5

A. Either of the following symptoms must be experienced on almost all or all (75-100%) occasions of partnered sexual activity (in identified situational contexts or, if generalized, in all contexts), and without the individual desireing delay.
1. Marked delay in ejaculation
2. Marked infrequency or absence of ejaculation.
B. The symptoms in Criterion A have persisted for a minimum duration of approximately 6 months.

Question 6

Premature (early) ejaculation

Answer 6

A. A persistent or recurrent pattern of ejaculation occurring during partnered sexual activity within approximately 1 minute following vaginal penetration and before the individual wishes it.
NOTE: Although the diagnosis of premature (early) ejaculation may be applied to individuals engaged in nonvaginal sexual activities, specific duration criteria have not been established for these activities.
B The symptom in Criterion A must have been present for at least 6 months and must be experienced on almost all or all occasions of sexual activity

Question 7

Gentio-Pelvic pain/penetration disorder

Answer 7

A. Persistent or recurrent difficulties with one (or more) or the following:
1. Vaginal penetration during intercourse.
2. Marked vulvovaginal or pelvic pain during vaginal intercourse or penetration attempts.
3. Marked fear or anxiety about vulvovaginal or pelvic pain in anticipation of, during, or as a result of vaginal penetration.
B. The symptoms in Criterion A have persisted for a minimum during of approximately 6 months.

Question 8

Exhibitionistic Disorder

Answer 8

A. Over a period of at least 6 months, recurrent and intense sexual arousal from the exposure of one’s genitals to an unsuspecting person, as manifested by fantasies, urges, or behaviors.
B. The individual has acted on these sexual urges with a nonconsenting person, or the sexual urges or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Question 9

Fetishistic Disorder

Answer 9

A. Over a period of at least 6 months, recurrent and intense sexual arousal from either the use of nonliving objects or a highly specific focus on nongenital body part(s), as manifested by fantasies, urges, or behaviors.
B. The fantasies, sexual urges or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
C. The fetish objects are not limited to articles of clothing used in cross-dressing (as in transvestic disorder) or devices specifically designed for the purpose of tactile genital stimulation (e.g., vibrator)

Question 10

Frotteuristic Disorder

Answer 10

A. Over a period of at least 6 months, recurrent and intense sexual arousal from touching or rubbing against a nonconsenting person, as manifested by fantasies, urges, or behaviors.
B. The individual has acted on these sexual urges with a nonconsenting person, or the sexual urges or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Question 11

Pedophilic Disorder

Answer 11

A. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child or children (generally age 13 years or younger).
B. The individual has acted on these sexual urges, or the sexual urges or fantasies cause marked distress or interpersonal difficulty
C. The individual is at least age 16 years and at least 5 years older than the child or children in Criterion A.
NOTE: Do not include an individual in late adolescence involved in an ongoing sexual relationship with a 12- or 13-year-old.

Question 12

Sexual Masochism Disorder

Answer 12

A. Over a period of at least 6 months, recurrent and intense sexual arousal from the act of being humiliated, beaten, bound, or otherwise made to suffer, as manifested by fantasies, urges, or behaviors.
B. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of function.
Specify if:
With asphyxiophilia: If the individual engages in the practice of achieving sexual arousal related to restriction breathing.

Question 13

Sexual Sadism Disorder

Answer 13

A. Over a period of at least 6 months, recurrent and intense sexual arousal from the physical or psychological suffering of another person, as manifested by fantasies, urges, or behaviors.
The individual has acted on these sexual urges with a nonconsenting person, or the sexual urges or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Question 14

Transvestic Disorder

Answer 14

A. Over a period of at least 6 months, recurrent and intense sexual arousal from cross-dressing, as manifested by fantasies, urges, or behaviors.
B. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Specify with: With fetishism: if sexually aroused by fabrics, material, or garments
With Autogynephilia: if sexually aroused by thoughts or images of self as female.

Question 15

Voyeuristic Disorder

Answer 15

A. Over a period of at least 6 months, recurrent and intense sexual arousal from observing an unsuspecting person who is naked, in the process of disrobing, or engaging in sexual activity, as manifested by fantasies, urges, or behaviors.
B. The individual has acted on these sexual urges, or the sexual urges, or the sexual urges or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
C. The individual experiencing arousal and/or acting on the urges is at least 18 years of age.

Question 16

Gender Dysphoria In Children

Answer 16

A. A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months’ duration, as manifested by at least six of the following (one of which must be Criterion A I):
1. A strong desire to be of the other gender or an instance that one is the other gender ( or some alternative gender different from one’s assigned gender).
2. In boys (assigned gender), a strong preference for cross-dressing or stimulating female attire; or in girls (assigned gender), a strong preference for wearing only typical masculine clothing and a strong resistance to the wearing of typical feminine clothing.
3. A strong preference for cross-gender roles in make-believe play or fantasy play.
4. A strong preference for the toys, games, or activities stereotypically used or engaged in by the other gender.
5. A strong preference for playmates of the other gender.
6. In boys (assigned gender), a strong rejection of typically masculine toys, games, and activities and as strong avoidance of rough-and-tumble play; or in girls (assigned gender), a strong rejection of typically feminine toys, games, and activities.
7. A strong dislike of one’s sexual anatomy.
8. A strong desire for the primary and/or secondary sex characteristics that match one’s experienced gender.
B. The condition is associated with clinically significant distress or impairment in social, school, or other important areas of functioning.
Specify if:
With a disorder of sex development (e.g., a congenital adrenogenital disorder

Question 17

Gender Dysphoria in Adolescents and Adults:

Answer 17

A. A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months’ during, as manifested by at least two of the following:
1. A marked incongruence between ones’ experienced/expressed gender and primary and/or secondarysex characteristics (or in young adolescents, the anticipated secondary sex characterstics).
2. A Strong desire to be rid of one’s primary and/or secondary sex characteristics because of a marked incongruence between ones’ experienced/expressed gender and primary and/or secondary sex characterstics (or in young adolescents, the anticipated secondary sex characteristics).
3. A strong desire for the primary and/or secondary sex characteristic of the other gender.
4. A strong desire to be of the other gender (or some alternative gender different from one’s assigned gender).
5. A strong desire to be treated as the other gender (or some alternative gender different from one’s assigned gender).
6. A strong conviction that one has the typical feelings and reactions of the other gender (or some alternative gender different from one’s assigned gender).
B. The condition is associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Specify if:
With a disorder of sex development (e.g., a congenital adrenogenital disorder)
Specify if:
Posttransition: The individual has transitioned to full-time living in the desired gender (with or without legalization of gender change) and has undergone (or is preparing to have) at least one cross-sex medical procedure or treatment regimen - namely, regular cross-sex hormone treatment or gender reassignment surgery confirming the desried gender (e.g., penectomy, vaginoplasty in a natal male; mastectomy or phalloplasty in a natal female).

Question 18

Paranoid Personality Disorder

Answer 18

A. A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:
1. Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her.
2. Is preoccupied with unjustified doubts about the loyalty or trustworthieness of friends or associates.
3. Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her.
4. Reads hidden demeaning or threatening means into benign remarks or events.
5. Persistently bears grudges (i.e., is unforgiving of insults, injuries, or slights).
6. Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack.
7. Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner.
B. Does not occur exclusively during the course of schizophrenia, a bipolar or depressive disorder with psychotic features, or another psychotic disorder and is not attributable to the physiological effects of another medical condition.

Question 19

Schizoid Personality Disorder

Answer 19

A. A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts, as indicated by four ( or more) of the following:
1. Neither desires nor enjoys close relationships, including being part of a family.
2. Almost always chooses solitary activities.
3. Has little, if any interest in having sexual experiences with another person.
4. Takes pleasure in few, if any, activities.
5. Lack close friends or confidants other than first-degree relatives
6. Appears indifferent to the praise or criticism of others.
7. Shows emotional coldness, detachment, or flattened affectivity.
B. Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, or another psychotic disorder and is not attributable to the physiological effects of another medical condition.

Question 20

Schizotypal Personality Disorder

Answer 20

A. A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior, beginning by early adulthood and present in a variety of contexts as indicated by five (or more) of the following:
1. Ideas of reference (excluding delusions of reference).
2. Odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (e.g., superstitiousness belief in clairvoyance, telepathy, or “sixth sense”: in children and adolescents, bizzare fantasies or preccupations).
3. Unusual perceptual experiences, including bodily illusions.
4. Odd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped).
5. Suspiciousness or paranoid ideation.
6. Inappropriate or constricted affect
7. Behavior or appearance that is odd, eccentric, or peculiar.
8. Lack of close friends or confidants other than first degree relatives.
9. Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self.
B. Does not occur exclusively during the course of schizophrenia, a bipolar disorder, or depressive disorder with psychotic features, and another psychotic disorder, or autism spectrum disorder.

Question 21

Antisocial Personality Disorder

Answer 21

A. A pervasive pattern of disregard for and violation of the the right of other, occurring since age 15 years, as indicated by three (or more) of the following:
1. Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest.
2. Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure.
3.Impulsivity or failure to plan ahead.
4. Irritability and aggressiveness, as indicated by repeated physical fights or assaults.
5. Reckless disregard for safety of self or others.
6. Consistent irresponsibility, as indicate by repeated failure to sustain consistent work behavior or honor financial obligations.
7. Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.
B. The individual is at least 18 years.
C. There is evidence of conduct disorder with onset before age 15.
D. The occurrence of antisocial behavior is not exclusively during the course of schizophrenia or bipolar disorder.

Question 22

Borderline Personality Disorder

Answer 22

A pervasive pattern of instability in interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1. Frantic efforts to avoid real or imagined abandonment. (Note: do not include suicidal or self-mutilating behavior covered in Criterion 5).
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
3. Identity disturbance: markedly and persistently unstable self-image of sense of self.
4. Impulsivitity in at least two areas that are potentially self-damaging (e.g., spending sex, substance abuse, reckless driving, binge eating) (Note: do not include suicide or self-mutilating behavior covered in Criterion 5).
5. Recurrent suicidal behaviors, gestures, or threats, or self-mutilating behavior.
6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).
7. Chronic feelings of emptiness.
8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
9. Transient, stress-related paranoid ideation or severe dissociative symptoms.

Question 23

Histrionic Personality Disorder

Answer 23

A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1. Is uncomfortable in situations in which he or she is not the center of attention.
2. Interaction with others is often characterized by inappropriate sexually seductive or provocative behaviors.
3. Displays rapidly shifting and shallow expression of emotions.
4. Consistently uses physical appearance to draw attention to self.
5. Has a style of speech that is excessively impressionistic and lacking in detail.
6. Shows self-dramatization, theatricality, and exaggerated expression of emotion.
7. Is suggestible (i.e., easily influenced by others or circumstances).
8. Considers relationships to be more intimate than they actually are.

Question 24

Narcissitic Personality Disorder

Answer 24

A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1. Has grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior with commensurate achievements).
2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.
3. Believes that he she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions).
4. Requires excessive admiration.
5. Has a sense of entitlement (i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations).
6. Is interpersonally exploitive (i.e., takes advantage of others to achieve his or her own ends).
7. Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others.
8. Is often envious of others or believes that others are envious of him or her.
9. Shows arrogant, haughty behaviors or attitudes.

Question 25

Avoidant Personality Disorder

Answer 25

A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

1. Avoids occupational activities that involves significant interpersonal contact because of fears of criticism, disapproval, or rejection.
2. Is unwilling to get involved with people unless certain of being liked.
3. Shows restraint within intimate relationships because of the fear of being shamed or ridiculed.
4. Is preoccupied with being criticized or rejected in social situations.
5. Is inhibited in new interpersonal situations because of feelings of inadequacy.
6. Views self as socially inept, personally unappealing, or inferior to others.
7. Is unusually reluctant to take personal risks or to engage in any new activities because they prove embarrassing.

Question 26

Dependent Personality Disorder

Answer 26

A pervasive pattern and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1. Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others.
2. Needs others to assume responsibility for most major areas of his or her life.
3. Has difficulty expressing disagreement with others because of fear of loss of support or approval (NOTE: do not include realistic fears of retribution).
4. Has difficulty initiating projects or doing things on his or her own (because of lack of self-confidence in judgment or abilities rather than a lack of motivation or energy).
5. Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant.
6. Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself.
7. Urgently seeks another relationship as a source of care and support when a close relationship ends.
8. Is unrealistically preoccupied with fears of being left to take care of himself or herself.

Question 27

Obsessive-Compulsive Personality Disorder

Answer 27

A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

1. Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost.
2. Shows perfectionism that interferes with task completion (e.g., is unable to complete a project because his or her won overly strict standards are not met).
3. Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity).
4. Is overconcientious, scrupulous, and inflexicble about matters of mortality, ethics, or values (not accounted for by cultural or religious identification).
5. Is unable to discard worn-out or worthless objects even when they have no sentimental value.
6. Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things.
7. Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes.
8. Shows rigidity and stubbornness.

Question 28

Substance Use and Addictive Disorders (Chapter 14)

Answer 28

A substance use disorder (including: alcohol, stimulant, cannabis, phencyclidine, inhalant, tobacco, opioid, hallucinogen, and sedative, hypnotic, or anxiolytics) is indicated by:
A. A problematic pattern of use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:
1. The substance is often taken in larger amounts or over a longer period of time than was intended.
2. There is a persistent desire or unsuccessful efforts to cut down or control substance use.
3. A great deal of time is spent in activities necessary to obtain substance, use substance, or recover from its effects.
4. Craving, or a strong desire or urge to use the substance.
5. Recurrent substance use resulting in a failure to fulfilling major role obligations at work, school, or home.
6. Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance.
7. Important social, occupational, or recreational activities are given up or reduced because of substance use.
8. Recurrent substance use in situations in which it is physically hazardous.
9. Substance use is continued despite knowledge of having persistent ore recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
10. Tolerance, as defined by either of the following:
a. A need for markedly increased amounts of the substance to achieve intoxication or desired effect.
b. A markedly diminished effect with continued use of the same amount of the substance.
11. Withdrawal, as manifested by either of the following:
a. The characteristic withdrawal syndrome for the substance (refer to tables below for different withdrawal symptoms).
b. The substance is taken to relieve or avoid withdrawal symptoms.

Question 29

Alcohol Withdrawal

Answer 29

A. Cessation of (or reduction in) alcohol use that has been heavy and prolonged.
B. Two (or more) of the following, developing within several hours to a few days after the cessation of (or reduction in) alcohol use described in Criterion A.
1. Autonomic hyperactivity (e.g., sweating or pulse rate greater than 100 bpm).
2. Increased hand tremor.
3. Insomnia
4. Nausea or vomiting.
5. Transient visual, tacile, or auditory hallucinations or illusions
6. Psychomotor agitation
7. Anxiety
8. Generalized tonic-clonic seizures.

Question 30

Cannabis Withdrawal

Answer 30

A. Cessation of cannabis use that has been heavy and prolonged (i.e., usually daily or almost daily use over a period of at least a few months).
B. Three (or more) of the following signs and symptoms develop within approximately 1 week after Criterion A:
1. Irritability, anger, or aggression
2. Nervousness or anxiety
3. Sleep difficulty (e.g., insomnia, disturbing dreams).
4. Decreased appetite or weight loss.
5. Restlessness.
6. Depressed mood.
7. At least one of the following physical symptoms causing significant discomfort: abdominal pain, shakiness/tremors, sweating, fever, chills, or headache.

Question 31

Opoid Withdrawal

Answer 31

A. Presence of either of the following:
1. Cessation of (or reduction in) opioid use that has been heavy or prolonged (i.e., several weeks or longer).
2. Administration of an opioid antagonist after a period of opioid use.
B. Three or more of the following developing within minutes to several days after Criterion A:
1. Dysphoric mood
2. Nausea or vomiting.
3. Muscle aches.
4. Lacrimation or rhinorrhea
5. Pupillary dilation, piloerection or sweating.
6. Diarrhea.
7. Yawning
8. Fever.
9. Insomnia.

Question 32

Sedative, Hypnotic, or Anxiolytic Withdrawal

Answer 32

A. Cessation of (or reduction in sedative, hypnotic or anxiolytic use that has been prolonged.
B. Two (or more) of the following developing within several hours to a few days after the cessation of (or reduction in) sedative, hypnotic, or anxiolytic use described in Criterion A.
1. Autonomic hyperactivity (e.g., sweating or pulse rate greater than 100 bpm).
2. Hand tremor.
3. Insomnia
4. Nausea or vomiting.
5. Transient visual, tactile, or auditory hallucinations or illusions.
6. Psychomotor agitation.
7. Anxiety.
8. Grand mal seizures

Question 33

Major Depressive Disorder

Answer 33

A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the sumptoms is either (1) depressed mood or (2) loss of interest or pleasure.
Note: Do not include symptoms that are clearly attributable to another medical condition.
1. Depressed mood most of the day, nearly everyday, as indicated by either subjective report (e.g., feels sad, empty, and hopeless) or observation made by others (e.g., appears tearful) (NOTE: in children and adolescents can be irritable mood).
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation).
3. Significant weight loss when not dieting or weight gain (e.g., more than a 5% change of body weight in a month) or decrease or increase in appetite nearly every day. (NOTE: in Children, consider failure to make expected weight gain).
4. Insomnia or hypersomnia nearly every day
5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive or inappropriate guild (which may be delusional) nearly every day. Not merely self-reproach or guilt about being sick).
8. Dimished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
9. Recurrent thoughts of death (not just fear of ding), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

Question 34

Persistent Depressive Disorder

Answer 34

A. Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least two years.
Note: In children and adolscents, mood can be irritable and duration must be at least 1 year.
B. Presence while depressed, of two (or more) of the following:
1. Poor appetite or overeating
2. Insomnia or hypersomnia
3. Low energy or fatigue
4. Low self esteem
5. Poor concentration or difficulty making decisioins.
6. Feelings of hopelessness
C. During the 2-year period (1 year for children and adolescents) of the disturbance, the individual has never been without the symptoms of Criteria A and B for more than 2 months at a time.
D. Criteria for a major depressive disorder may be continuously present for 2 years.
E. There has never been a manic or hypomanic episode, and criteria have never been met for cyclothymic disorder.

Question 35

Bipolar 1 Disorder

Answer 35

For a diagnosis of bipolar I disorder it is necessary to meet the following criteria for a manic episode. The manic episode may have been preceded by and may be followed by hypomanic or major depressive episodes.

Question 36

Manic Episode

Answer 36

MANIC EPISODE
A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week and present most of the day, nearly every day (or any duration if hospitalization is necessary).
B. During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms (four if the mood is only irritable) are present to a significant degree and represent a noticeable change from usual behavior).
1. Inflated self-esteem or grandiosity
2. Decreased need for sleep (e.g., feels rested after only 2 hours of sleep).
3. More talkative than usual or pressure to keep talking.
4. Flight of ideas of subjective experience that thoughts are racing.
5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli) as reported or observed.
6. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (i.e., purposeless non-goal-directed activity).
7, Excessive involvement in activities that have a potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments

Question 37

Hypomanic Episode

Answer 37

A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day nearly every day.
B. During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms (four if the mood is only irritable) have persisted to a significant degree:
1. Inflated self-esteem or grandiosity
2. Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).
3. More talkative than usual or pressure to keep talking.
4. Flight of ideas of subjective experience that thoughts are racing.
5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed.
6. Increase in goal-directed activity (either socially, at work, or school or sexually) or psychomotor agitation (i.e., purposeless non-goal-directed activity).
7. Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).
C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual when no symptomatic
D. The disturbance in mood and the change in functioning are observable by others.
E. The episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization. If there are psychotic features, the episode is, by definition, manic.

Question 38

Major Depressive Episode

Answer 38

A. Five or (more of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (I) depressed mood or (2) loss of interest or pleasure.
NOTE: Do not include symptoms that are clearly attributable to another medical condition.
1. Depressed mood most of the day, nearly every day as indicated by either subjective report (e.g., feels sad, empty and hopeless) or observation made by others (e.g., appears tearful). (Note: in children and adolescents, can be irritable mood).
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation).
3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. (Note: in children, consider failure to make expected weight gain).
4. Insomnia or hypersomnia nearly every day.
5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive or inappropriate guild (which may be delusional nearly every day) not merely self-reproach or guilt about being sick).
8. Diminished ability to think or concentrate or indecisiveness, nearly every day (either by subjective account or as observed by others).
. Recurrent thoughts of death (not just fear of dying). recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

Question 39

Cyclothymic Disorder

Answer 39

A. For at least 2 years (at least 1 year in children and adolescents) there have been numerous periods with hypomanic symptoms that do not meet criteria for a hypomanic episode and numerous periods with depressive symptoms that do not meet criteria for a major depressive episode.
B. During the above 2-year period (1 year in children and adolescents), the hypomanic and depressive periods have been present for at least half the time and the individual has not been without the symptoms for more than 2 months at a time.
C. Criteria for a major depressive, manic, or hypomanic episode have never been met.