Final

Question 1

Intellectual Disability

Answer 1

A. Deficits in intellectual functions, such as reasoning, problem solving, planning, abstract thinking, judgment, academic learning, and learning from experience, confirmed by both clinical assessment and individualized, standardized intelligence testing.
B. Deficits in adaptive functioning that result in failure to meet developmental and sociocultural standards for personal independence and social responsibility… Without ongoing support, the deficits limit functioning in one or more activities of daily life.
C. Onset of intellectual and adaptive deficits during the developmental
period.

Question 2

What do you need to identify in an intellectual disability?

Answer 2

Mild, Moderate, Severe, Profound

(Mild - Doesn’t read/write very well, Can’t keep calendar very well
Severe/profound - can’t tie shoes, need help turning on tv)

Question 3

Language Disorder

Answer 3

• Persistent difficulties in the acquisition and use of language across modalities (reduced vocabulary, limited sentence structure, impairments in discourse)
• Substantially and quantifiably below those expected for age, resulting in functional limitations in effective communication
• Onset occurs during developmental period

For the test, just know: Nothing else is going on, they are a child, they should be producing speech in a certain way and they are not.

Question 4

When is Language Disorder typically diagnosed?

Answer 4

As a young child

Question 5

Childhood-Onset Fluency Disorder (Stuttering)

Answer 5

A. Disturbances in the normal fluency and time patterning of speech that are inappropriate for the individual’s age and language skills, persist over time, and are characterized by frequent and marked occurrences of: (only need one)
a. Sound and syllable repetition (c-c-c-c-class)
b. Sound prolongations of consonants as well as vowels (hoooooomework)
c. Broken words
d. Audible or silent blocking
e. Circumlocutions
f. Words produced with an excess of physical tension
g. Monosyllabic whole-word repetitions
B. Disturbance causes anxiety about speaking or limitations in effective
communication
C. Onset during early developmental period
D. Symptoms not due to another condition (e.g. neurological harm,
sensory deficit)

Question 6

Social (Pragmatic) Communication Disorder

Answer 6

A. Persistent difficulties in social use of verbal and nonverbal communication as manifested by all of the following:
a. Deficits in using communication for social purposes, such as greeting and sharing information
b. Impairment of ability to change communication to match context
c. Difficulties following rules for conversation and storytelling, such as taking turns in conversation
d. Difficulties understanding what is not explicitly stated
((Child, oversharing, not adjusting to communication to context, inappropriate for level of development))

Question 7

What does “Pragmatic” refer to in Social Pragmatic Communication Disorder?

Answer 7

“Pragmatic” refers to our code switching. (How we talk to teachers in class vs to our niece vs to our partners vs to our boss etc etc) Kids with this disorder to not code switch

Question 8

Autism Spectrum Disorder

Answer 8

A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by:
a. Deficits in social-emotional reciprocity (SOCIAL)
b. Deficits in nonverbal communicative behaviors used for social interaction (BEHAVIOR)
c. Deficits in developing, maintaining, and understanding relationships
B. Restricted, repetitive patterns of behavior, interests, or activities, as manifest by:
a. Stereotyped or repetitive motor movements, use of objects, or speech (ex: flapping)
b. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (Ex: Don’t say ‘thanks’, say ‘thank you’)
c. Highly restricted, fixated interests that are abnormal in intensity or focus (Ex: someone who is fixated/obsessed with the movie Cars)
d. Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (Ex: hates the feeling of water, won’t take a bath) (Ex: loves lights)
C. Symptoms must be present in early developmental period
D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning
E. These disturbances are not better explained by intellectual disability or global developmental delay, though ASD and ID often co-occur

Question 9

Severity Levels for Autism Spectrum Disorder

Answer 9

Level 1 - Requiring support
Level 2 - Requiring substantial support
Level 3 - Requiring very substantial support

Question 10

Attention-Deficit/Hyperactivity Disorder

Answer 10

-A persistent pattern of inattention and/or hyperactivity/impulsivity that interferes with functioning or development, as characterized by:
Inattention criteria
and/or
Hyperactivity criteria
*Note that six or more of the criteria listed for either inattention or hyperactivity must be met For at least six months

Question 11

ADHD Specifiers

Answer 11

Predominantly inattentive presentation
Predominantly hyperactive/impulsive presentation
Combined presentation

Question 12

Specific Learning Disorder

Answer 12

A. Difficulties learning and using academic skills, as indicated by the presence of at least one of the following symptoms for 6 months, despite provision of interventions to target those difficulties
a. Inaccurate or slow and effortful word reading
b. Difficulty understanding the meaning of what is read
c. Difficulties with spelling
d. Difficulties with written expression
e. Difficulties mastering number sense, number facts, or calculation
f. Difficulties with mathematical reasoning
B. These skills are substantially and quantifiably below those expected for the individual’s chronological age

Question 13

Specific Learning Disorder Specifiers

Answer 13

With impairment in reading
With impairment in written expression
With impairment in mathematics

Question 14

Tourette’s Disorder

Answer 14

A. Both multiple motor and one or more vocal tics have been present at some time during the illness, although not necessarily concurrently
B. Tics may wax and wane in frequency, but have persisted for more than 1 year since first onset
C. Onset before age 18
D. Disturbance not attributable to physiological effects of a substance or other medical condition
(MULTIPLE (at least two) MOTOR AND ONE VOCAL TIC PRESENT FOR ONE YEAR+ BEFORE 18)

Question 15

Persistent (Chronic) Motor or Vocal Tic Disorder

Answer 15

-Shares exact criteria with Tourette’s, with condition that only “single or multiple motor or vocal tics have been present during the illness, but not both motor and vocal.”
-Specify if: Motor Tics Only, or Vocal Tics Only
(ONE TICK - MOTOR OR VOCAL, FOR ONE YEAR, UNDER 18)

Question 16

Provisional Tic Disorder

Answer 16

A. Single or multiple motor and/or vocal tics
B. The tics have been present for less than 1 year since first onset
C. Onset is before age 18
D. Disturbance not attributable to substance or medical condition
E. Criteria have never been met for Tourette’s or persistent motor or vocal tic disorder
(ANY TIC FOR LESS THAN A YEAR)

Question 17

Delirium

Answer 17

A. Disturbance in attention and awareness (Due to a medical condition or substance)
B. Disturbance develops over a short period of time, represents a change in baseline attention and awareness, and tends to fluctuate in severity during the course of a day
C. An additional disturbance in cognition
D. Disturbances in Criteria A and C are not better explained by another preexisting, established, or evolving neurocognitive disorder or in severely reduced level of arousal (e.g. coma)
E. Evidence that disturbance is a direct physiological consequence of another medical condition, substance intoxication or withdrawal, or exposure to a toxin, or due to multiple etiologies
CHANGE IN ATTENTION AND AWARENESS, NOT NORMALLY LIKE THIS, THEY’VE [TAKEN MEDICATION, ARE ON DRUGS, ALCOHOL, ETC]

Question 18

Major Neurocognitive Disorder

Answer 18

A. Evidence of significant cognitive decline from a previous level of performance in one or more cognitive domains, based on:
1. Concern of individual, knowledgeable informant, or clinician that there has been a significant decline in cognitive function, and
2. Substantial impairment in cognitive performance, preferably documented by standardized testing or quantified clinical analysis
B. Cognitive deficits interfere with independence in everyday activities
C. Deficits do not occur exclusively in context of delirium
D. Not better explained by another mental disorder
(For Major, the person cannot function independently anymore. Think: they need someone else to handle their money, handle their calendar, etc etc. Failing to perform ordinary things they used to be able to [using their phone])
LIKELY SOMEBODY OLDER

Question 19

Major Neurocognitive Disorder Specifier

Answer 19

Specify the cause or medical condition that has produced these effects

Question 20

Mild Neurocognitive Disorder

Answer 20

A. Evidence of modest cognitive decline from a previous level of performance in one or more cognitive domains, based on:
1. Concern of individual, knowledgeable informant, or clinician that
there has been a mild decline in cognitive function, and
2. Modest impairment in cognitive performance, preferably
documented by standardized testing or quantified clinical
analysis
B. Cognitive deficits do not interfere with independence in everyday activities
C. Deficits do not occur exclusively in context of delirium
D. Not better explained by another mental disorder
(They can function independently, which is different from major)

Question 21

Delusional Disorder

Answer 21

A. Presence of one (more more) delusion with a duration of 1 month or longer
B. Schizophrenia criteria have never been met
C. Delusion is only source of functional impairment, behavior is not markedly bizarre or odd
D. If manic or depressive symptoms have occurred, they are brief in comparison to delusional periods
E. Not due to another medical or substance-induced condition
-There are many specifiers, so be specific!

(Person does not just have a bizarre belief, they are acting bizarrely) (Delusion is highly disruptive)
(If it’s not disrupting someone’s life in a major way, maybe don’t diagnose it)

Question 22

Brief Psychotic Disorder

Answer 22

• Presence of one or more of the following: Delusions, Hallucinations, Disorganized Speech (very loose connections in speech), or Grossly disorganized or Catatonic behavior
• Time period is between 1 day and 1 month

Question 23

What do brief psychotic disorder, schizophreniform disorder, and schizophrenia have in common?

Answer 23

(Brief psychotic disorder, schizophreniform disorder, and schizophrenia are on the same timeline. They’re not that different, it’s about the length of time the symptoms have been around.)

Question 24

Schizophreniform Disorder

Answer 24

• TWO or more of the following: Delusions, Hallucinations, Disorganized Speech, Grossly disorganized or Catatonic behavior, or Negative Symptoms (Negative symptoms = something was there that is not there now [lack of motivation, not talking much])
• Significant presence for 1-month period, and at least one must be: Delusions, Hallucinations, Disorganized Speech
• Duration is between 1 month and 6 months

Question 25

Schizophrenia

Answer 25

A. Two (or more) of the following, each present for a significant amount of time during a 1-month period, and at least one must be (1), (2), or (3):
1. Delusions
2. Hallucinations
3. Disorganized Speech
4. Grossly disorganized or catatonic behavior
5. Negative symptoms
B. Level of functioning is markedly below the level achieved before onset of symptoms
C. Continuous signs of disturbance beyond 6 months
D. Schizoaffective and Bipolar have been ruled out
E. Not attributable to substance or medical condition
F. History of autism or communication disorder must be accounted for; only additionally diagnose schizophrenia if prominent hallucinations or delusions and presence of other schizophrenia symptoms are present for 1-month period

Question 26

Schizoaffective Disorder

Answer 26

A. Criterion (A) of schizophrenia, as well as a major mood episode
(depressive or manic)
B. Delusions or Hallucinations for 2 or more weeks in the absence of a
major mood episode during lifetime duration of illness
C. Symptoms of major mood episode are present for majority of total
duration of active and residual portions of illness
D. Not attributable to medical or substance-abuse condition

• Must specify: Bipolar or Depressive type
• Think Mood + Psychosis

Question 27

Substance/Medication-Induced Psychotic Disorder

Answer 27

A. Presence of Hallucinations, Delusions, or both
B. Evidence that symptoms developed soon after intoxication, and that
substance(s) can produce these symptoms
C. Not better explained by existing psychotic disorder
D. Disturbance does not occur exclusively during delirium
E. Disturbance causes clinically significant distress or impairment

Question 28

Delusion

Answer 28

Fixed belief that is not amenable to change in light of conflicting evidence.
-Content may include a variety of themes, including: persecutory, referential, somatic, religious, grandiose, etc.
(You hold this belief, despite evidence of the contrary.)
(not widely held beliefs by a population)

Question 29

Hallucination

Answer 29

Perception-like experience that occurs without an EXTERNAL STIMULUS.
-“They are vivid and clear, with the full force and impact of normal perceptions, and not under voluntary control.”
(Brain is telling you something is real. You feel like you’re really perceiving something [like you hear your name, when you don’t - light example])

Question 30

Positive symptoms in schizophrenia

Answer 30

Positive symptoms are usually outwardly observable, displaying an “added”
change in behavior (e.g. bizarre movement, delusions, hallucinations).
(POSITIVE = something was not there, not is IS THERE)

Question 31

Negative symptoms in schizophrenia

Answer 31

Negative symptoms “take away” from the behavior of a person, such as flat affect,
anhedonia, and catatonia. Although sometimes present in other psychotic disorders,
these symptoms are more common in schizophrenia.
(NEGATIVE = something was there, not is is NOT)

Question 32

Personality disorder clusters

Answer 32

CLUSTER A - “Odd & Eccentric”
CLUSTER B - “Dramatic, Emotional, or Erratic”
CLUSTER C - “Anxious or Fearful”

Question 33

Paranoid Personality Disorder

Answer 33

”Pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent”

-Consistent doubts about others’ trustworthiness; feeling persecuted, worried that information will be used against them; bears grudges and perceives attacks on their character without warrant

Question 34

Schizoid Personality Disorder

Answer 34

“A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings”

-Neither desires nor enjoys close relationships, including family; little interest in sexuality, close friends, or pleasurable activities; shows emotional “coldness” and flat affect; almost always chooses solitary activities; appears indifferent to praise or criticism

(Very withdrawn person. All the symptoms of depression, except they are not depressed)
(You don’t get a lot from this person. They don’t desire relationships, responsibility, etc)

Question 35

Schizotypal Personality Disorder

Answer 35

“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”
-Ideas of reference; magical thinking that is inconsistent with cultural norms (e.g. superstitiousness, telepathy, bizarre fantasies); unusual perceptual experiences or illusions (NOT hallucinations/delusions); odd thinking and speech; paranoia or suspiciousness; lack of close relationships; inappropriate or constricted affect

(Cousin of schizophrenia, it’s ALMOST schizophrenia without full blown hallucinations/delusions)

Question 36

Antisocial Personality Disorder

Answer 36

“A pervasive pattern of disregard for and violation of the rights of others, occurring since 15 years”
-Failure to conform to social norms with respect to lawful behavior; deceitfulness, lying, conning for profit or pleasure; impulsivity, irritability, and aggressiveness; reckless disregard for the safety of self or others; consistent irresponsibility and failure to honor obligations; lack of remorse (including rationalizing hurtful behavior)

-Individual must be at least 18 years old to receive the diagnosis, though the individual must have had symptoms of Conduct Disorder since before age 15

(No moral compass)
(Many violent people are antisocial. Not all antisocial people are violent.)

Question 37

Borderline Personality Disorder

Answer 37

marked impulsivity”
-Frantic efforts to avoid real or imagined abandonment; a pattern of unstable or intense relationships, alternating between extremes of idealization (you are the best thing that could have ever happened to me) and devaluation (you are satan, I wish I never met you); identity disturbance, unstable self-image or sense of self; recurrent suicidal behavior, gestures, threats, etc.; impulsivity in affect, safety, reactivity; chronic feelings of emptiness; inappropriate, intense anger, and transient, stress-related paranoia or dissociative symptoms

(They LOVE you then they HATE you)

Question 38

Histrionic Personality Disorder

Answer 38

“A pervasive pattern of excessive emotionality and attention seeking”
-Uncomfortable in situations in which he or she is not the center of attention; interactions with others often characterized by inappropriate sexually seductive or provocative behavior (including using physical appearance); rapidly shifting and shallow expression of emotions;
suggestible or easily-influenced; considers relationships more intimate than they actually are; style of speech which is excessively impressionistic and lacking in detail

(Attention seeking, very vain. Manipulative, but in a shallow way)

Question 39

Narcissistic Personality Disorder

Answer 39

“A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy”
-Grandiose sense of self-importance; preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love; believes he or she is “special” and unique, and can/should only be understood by others who are of high status; sense of entitlement (i.e. unreasonable expectations of especially favorable treatment or compliance); interpersonally exploitative; lacks empathy and is often envious, arrogant, or haughty
(They will come to you at the behest of somebody else, they’ll say they heard you were the best)
(They’re very fragile. Think an inflated balloon - it’s a huge ego, but with a pin prick it pops)

Question 40

Avoidant Personality Disorder

Answer 40

“A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation”
-Avoids activities that involve significant interpersonal contact for fear of disapproval, criticism, or rejection; unwilling to get involved with people unless certain of being liked; shows restraint in relationships due to preoccupation with acceptance or approval; views self as socially inept, personally unappealing, or inferior to others; unusually reluctant to take personal risks or engage in any new activities because they may prove embarrassing

(You are highly unlikely to see this in your practice. They will AVOID you)
(Different from social anxiety disorder/social phobia (where they are afraid of scrutiny, this is a mood disorder about anxiety) because there’s a deeper sense of worthlessness. This is much more pervasive, personality disorder, they don’t really get better. But consider social anxiety disorder very strongly before diagnosing this.)

Question 41

Dependent Personality Disorder

Answer 41

“A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation”
-Difficulty making everyday decisions without excessive advice and reassurance; needs others to assume responsibility for most major areas of life; difficulty initiating or expressing disagreement with others because of fear of loss or disapproval; goes to excessive lengths to obtain nurturance and support, even volunteering to do things that are unpleasant; feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for oneself; urgently seeks another relationship as source of care when one relationship ends
(Usually jump from family, to serious relationships)
(They are likely to attract authoritarian, exploitative partners) (It’s hard to be in a relationship with a dependent personality. You can’t rely on them because they rely on you so much)
(Beware of giving these people advice. Not having an opinion and not giving advice is the best thing you can do for them [often[, because then they can do it for themselves in the hour)

Question 42

Obsessive-Compulsive Personality Disorder

Answer 42

“A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency”
-Preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost; shows perfectionism that interferes with task completion; excessively devoted to work and productivity to the exclusion of leisure activities and friendships; is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values; unable to discard worn-out or worthless objects even with no sentimental value; reluctant to delegate tasks or work with others unless it is done their way; potential hoarding behavior to be ‘prepared’ for future catastrophes; rigidity and stubbornness

(Opposite of dependent personality disorder)
(Think: the middle manager who is very specific, tells you what to do, lectures you on how to do things “right” etc)
(Excessive rule follower, “hall monitor syndrome”)
(Different than and not related to OCD)

Question 43

Reactive Attachment Disorder

Answer 43

“A consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers”

• Child rarely or minimally seeks comfort or responds to comfort when distressed
• Child must also have a persistent social and emotional disturbance characterized by: minimal social and emotional responsiveness to others, limited positive affect, and episodes of unexplained irritability, sadness, or fearfulness even during nonthreatening interactions with adult caregivers
• Child has experienced pattern of extremes of insufficient care; e.g. Social neglect/deprivation, repeated changes of primary caregivers, rearing in unusual settings which limit opportunities to form selective attachments (THINK: FOSTER SYSTEM)
• Think: Unusually unattached and withdrawn* Onset before age 5, with developmental age at least 9 months

(They are inconsolable, not that they are always crying, but that no caregiver gives them that expected comfort)
(Attachment doesn’t form with anybody [usually due to not having a consistent caregiver])

Question 44

Disinhibited Social Engagement Disorder

Answer 44

“Pattern of behavior in which a child actively approaches and interacts with unfamiliar adults and exhibits at least two of the following: Reduced or absent reticence in approaching unfamiliar adults; overly familiar verbal or physical behavior; diminished or absent checking back with adult caregiver; willingness to go off with an unfamiliar adult.”

• Not limited to impulsivity
• Child has experienced pattern of extremes of insufficient care; e.g. Social neglect/deprivation, repeated changes of primary caregivers, rearing in unusual settings which limit opportunities to form selective attachments
• Developmental age at least 9 months (No necessity to be under age 5)
• Think: Unusual willingness to engage others, with unusually low attachment to any one caregiver*

(Disinhibited Social Engagement Disorder and Reactive Attachment Disorder are very SIMILAR, just with different presentations.)
(These children are unusually trusting. Going up to anyone being like ‘You can be my mom!’)
(Some experience of NEGLECT)

Question 45

Posttraumatic Stress Disorder (p 271)

Answer 45

Criteria apply to anyone over 6 years old– please see unique criteria for child under 6 (NOT BEING TESTED ON UNDER AGE 6)
Please read PTSD criteria carefully in DSM-5!

Broad overview of PTSD:

• Exposure to actual or threatened, death, serious injury, or sexual violence
• Presence of intrusion symptoms associated with the event, beginning after the event occurred (ex: memories, dreams, dissociative episodes like flashbacks, prolonged psychological stress to sensory cues [like a siren])
• Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the event occurred (ex: not getting into a car after a car accident)
• Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the event(s) occurred
• Marked alterations in arousal and reactivity associated with the event(s)
• Duration of disturbance more than 1 month

(For this diagnosis, something has to have happened)
(Exposure to event, presence of 1 or more intrusive system, avoidance of stimuli, negative alterations in cognitions and mood [depressive symptoms], alterations and arousals)

Question 46

Acute Stress Disorder

Answer 46

-To be diagnosed between 3 days and 1 month of stressful event; precursor to potential PTSD diagnosis

Basic overview of criteria:

• Exposure to actual or threatened death, serious injury, or sexual violation
• Presence of nine or more of listed symptoms: Please look at symptom list in DSM-5! (Similar to PTSD list)
• Categories of possible symptoms: Intrusion, Negative Mood, Dissociative, Avoidance, Arousal

(There has to be an activating event)
(This is the precursor to PTSD)
(You would diagnose this first, then if symptoms persist past 1 month, move on to PTSD)

Question 47

Adjustment Disorders

Answer 47

A. Development of emotional or behavioral symptoms in response to an identifiable stressor(s) occurring within 3 months of the onset of the stressor(s)
B. These symptoms or behaviors are clinically significant, as evidenced by one or both of the following:
a. Marked distress that is out of proportion to the severity or intensity of the stressor, taking into account the external context and cultural factors that might influence symptom severity and presentation
b. Significant impairment in social, occupational, or other important areas of functioning
C. Stress-related disturbance does not meet criteria for another mental
disorder and is not merely an exacerbation of a preexisting mental
disorder
D. Symptoms do not represent normal bereavement
E. Once stressor or its consequences have terminated, symptoms do
not persist for more than additional 6 months
Specify with: Depressed mood, anxiety, anxiety and depressed
mood, disturbance of conduct, mixed disturbance of emotions and
conduct, or unspecified

(This is vague and a gift for diagnosis)
(The client has three months to develop symptoms, then six months to have the systems)

Question 48

Obsession

Answer 48

A recurrent and persistent thought, urge, or image that is experienced as intrusive or unwanted (Refers to intrusive thoughts, they are intrusive and UNWANTED. Individual usually wants to get rid of them)

Question 49

Compulsion

Answer 49

A repetitive behavior or mental act that an individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly

Question 50

Obsessive-Compulsive Disorder

Answer 50

• Presence of obsessions, compulsions, or both
• Attempts to ignore or suppress them; and/or the compulsive behavior is an attempt to reduce or prevent the anxiety associated with the urges (The obsessions have to be something that aren’t realistic)
• The obsessions or compulsions are time-consuming (“e.g. take more than 1 hour per day”) or cause clinically significant distress or impairment
• Symptoms not attributable to substances or another condition
• Specify: level of insight and/or with tic disorder*
• Many differential diagnoses to be cautious of!

(We need both obsession and compulsion)
(The individual can have good or poor insight. Sometimes they know their actions are ‘ridiculous,’ and sometimes they really believe ‘the door won’t fully close unless I close it 3 times’)
(The person has to want to try to get rid of them, this is a criteria)

Question 51

Body Dysmorphic Disorder

Answer 51

A. Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others
B. At some point during the disorder, the individual has performed repetitive behaviors (e.g. mirror checking, excessive grooming, skin-picking, reassurance seeking)
C. Preoccupation causes clinically significant distress or impairment
D. Appearance preoccupation is not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnostic criteria for an eating disorder

(Not better explained by an eating disorder)
(People talk about very very small differences in appearances. [Ex: My chin is at 46 angle, I want it to be at 48]. It would be unobservable or undetectable to us, but they are obsessed with it) (Think: Michael Jackson)

Question 52

Hoarding Disorder

Answer 52

• Persistent difficulty discarding or parting with possessions, regardless of their actual value
• Perceived need to save the items and distress associated with discarding them
• Difficulty discarding possessions results in accumulation of possessions that congest and clutter active living areas and substantially compromises their intended use
• ”If living areas are uncluttered, it is only because of the interventions of third parties (e.g. family members, cleaners, authorities)
• Specify level of insight*

(This isn’t someone who is a collector, who may sell their collection. There is no intention to get rid of anything)
(Compulsively acquiring things, and obsessed with keeping things. They are very resistant to getting rid of things)
(A person with HD is NOT decluttering their space themselves. It’s done by a third party)
(Look for a history of trauma)

Question 53

Trichotillomania (Hair-Pulling) Disorder

Answer 53

A. Recurrent pulling out of one’s hair, resulting in hair loss
B. Repeated attempts to decrease or stop hair pulling (they have to want to stop and not be able to)
C. Hair pulling causes clinically significant distress or impairment
D. Not attributable to another medical condition
E. Hair pulling not better explained by another mental disorder (e.g. body dysmorphic disorder)

(Very common to have a co-occurring anxiety disorder or OCD)
(Mostly they pull out hair on their face and head)

Question 54

Excoriation (Skin-Picking) Disorder

Answer 54

A. Recurrent skin picking resulting in skin lesions
B. Repeated attempts to decrease or stop skin picking
C. Skin picking causes clinically significant distress or impairment
D. Not attributable to substance or medical condition
E. Not better explained by symptoms of other diagnosis

Please note (rule-out) Substance/Medication-induced, Due to another medical condition, and Other Specified Obsessive-Compulsive Disorders in DSM-5

Question 55

Oppositional Defiant Disorder

Answer 55

• At least 6 months of evidence of at least four symptoms of the following categories: angry/irritable mood, argumentative/defiant behavior, or vindictiveness
• See DSM for specific symptoms
• Sample symptoms: Temper, easily annoyed, angry, argumentative, deliberately annoys others, blames others, spiteful
• Not age appropriate, associated with individual’s distress, and not due to another disorder or condition
• Severity based on quantity of settings in which symptoms are present

(THINK: Difficult teen)
(ODD = Problem with authority)

Question 56

Intermittent Explosive Disorder

Answer 56

• Recurrent behavioral outbursts representing a failure to control aggressive impulses as manifested by:
• Damaging verbal or physical aggression twice weekly on average for 3 months
• Three behavioral outbursts involving damage or destruction of property and/or physical assault within a 12-month period (This is for truly dangerous occurences)
• Magnitude of aggressiveness is “grossly out of proportion” to the provocation or stressor
• Not premeditated; impulsive or anger-based outbursts

(Think: someone who is too old to be having temper tantrums)
(They have to be at least six [but this is so young! Probably don’t diagnose a 6 year old])
(These are not premeditated, it’s impulsive) (It’s aggressive, angry outbursts)

Question 57

Conduct Disorder

Answer 57

• Remember: symptoms are necessary precursor to Antisocial Personality Disorder
• Repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of at least 3 of 15 criteria in the past 12 months, with at least one criterion present in past 6 months (It’s a low number because these criteria are very extreme)
• Examples of this behavior: Aggression to people and animals (bullying, physical harm), Destruction of property, Deceitfulness or Theft, Serious Violations of Rules (defying prohibitions, truancy)
• Specifiers based on age, differentiation of guilt, empathy, and affect, as well as severity of conduct (SPECIFIERS ARE NOT ON THE TEST)

(This is one of the most pathological diagnoses you can give to a youth, outside of personality disorder)
(there’s malice involved. It’s not just something you disapprove of someone doing.)
(If they are over 18, make sure they don’t meet the criteria for antisocial. When you are considering this disorder, they are under 18)

Note: Pyromania and Kleptomania as separate, individual diagnoses listed in the DSM, though they are also symptoms of other diagnoses such as Antisocial Personality Disorder

Question 58

Dissociative Identity Disorder

Answer 58

(Previously Multiple Personality Disorder)

• Disruption of identity characterized by two or more distinct personality states (may be observed by others or the individual, who may not be aware of the distinct personalities)
• Recurrent gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting
• Not a part of a broadly accepted cultural or religious practice, or fantasy (e.g. children’s imaginary playmates)

(Usually brought on by heavy heavy trauma)

Question 59

Dissociative Amnesia

Answer 59

• Inability to recall important autobiographical information, usually of a traumatic or stressful nature, inconsistent with ordinary forgetting
• Not attributable to substances or other medical condition

(Usually brought on by trauma)

Question 60

Fugue

Answer 60

-A more rare and unique behavior which entails “apparently purposeful travel or bewildered wandering that is associated with amnesia for identity or for other important autobiographical information.”

(It’s unlikely to happen to someone randomly. This person would have a propensity to dissociate already)

Question 61

Depersonalization/Derealization Disorder

Answer 61

-Presence or persistent or recurrent experiences of depersonalization, derealization, or both.
Depersonalization: Experiences of unreality, detachment, or being an outside observer with respect to one’s thoughts, feelings, sensations, body, or actions
Derealization: Experiences of unreality or detachment with respect to surroundings

(This is not psychosis, someone really believing they are an alien from outer space. They know they feel detached from their body, and think it feels weird) (It feels like “I’m dead and this is purgatory // I’m in a dream // I’m looking at myself from someplace else”)

Question 62

Pica

Answer 62

• Persistent eating of nonnutritive, nonfood substances over a period of at least 1 month
• Inappropriate to individual’s developmental level
• Not part of a socially normative or culturally supported practice, or in context of other mental disorder

Question 63

Anorexia Nervosa

Answer 63

A. Restriction of energy intake relative to requirements, leading to a significant low body weight in context of age, sex, developement, and physical health
-Significantly low weight: Weight that is less than minimally normal (or expected, for children or adolescents)
B. Intense fear of gaining weight or becoming fat, or persistent behavior that interferes with weight gain, despite being at a significantly low weight
C. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of seriousness of the current low body weight
(SIGNIFICANTLY LOW BODY WEIGHT IS A REQUIREMENT)

Question 64

Anorexia Nervosa Restricting Type

Answer 64

During the last 3 months, individual has not engaged in recurrent episodes of binge eating or purging; weight loss is achieved through energy output and avoiding food intake

Question 65

Anorexia Nervosa Binge-eating/purging Type

Answer 65

During the last 3 months, individual has engaged in recurrent episodes of binge eating or purging behavior

Question 66

Bulimia Nervosa

Answer 66

A. Recurrent episodes of binge eating, which is characterized by:
a. Eating, in a discrete period of time (DSM uses 2-hour example), in which a larger-than-normal amount of food is ingested (This depends on the person. Obviously a sumo wrestler will normally eat more than a 16 year old girl, etc)
b. Sense of lack of control over eating during the episode (e.g. feeling that one cannot stop or control the eating)
B. Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives or medications, fasting, or excessive exercise.
C. Binge eating and inappropriate compensatory behaviors occur, on average, at least once a week for 3 months
D. Self-evaluation is unduly influenced by body shape and weight
E. Disturbance does not occur exclusively during episodes of anorexia nervosa
Specify: If in remission, and severity (listed in DSM)
(If someone meets criteria of anorexia, probably use that diagnosis, with binge/purge type)
(People with bulimia are often slightly overweight, not underweight)

Question 67

Binge-Eating Disorder

Answer 67

• Recurrent episodes of binge eating
• Episodes are associated with symptoms such as: Eating much more rapidly than normal, until uncomfortable, when not hungry, alone due to embarrassment, or feeling disgusted or guilty with oneself afterwards
• Marked distress, and occurring at least once per week on average for 3 months
• Not due to other eating disorder

Question 68

Gender Dysphoria in children

Answer 68

• Marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months’ duration, as manifested by six or more of the listed symptoms
• Some examples: Strong desire to be the other gender; preference for dressing like the other gender; preference for playmates of the other gender; dislike of one’s sexual anatomy

Question 69

Gender Dysphoria in adolescents and adults

Answer 69

• Marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months’ duration, as manifested by two or more of the listed symptoms
• Some examples: Aversion to one’s own sexual anatomy, and desire to change or be rid of one’s secondary sex characteristics; strong desire for primary and/or secondary sex characteristics of other gender; desire to be treated as other gender; strong conviction that one has typical feelings and reactions of other gender

Question 70

Gender Dysphoria

Answer 70

Refers to the (possible) distress that may accompany the incongruence between one’s experienced or expressed gender and one’s assigned gender

(This refers to the accompanying distress of assigned gender and identified gender)
(Not everyone with gender dysphoria is transgender, but everyone who is transgender probably/likely has gender dysphoria)
(The only diagnostic criteria that we have right now for transgender is self-identification) (So, it really is a feeling being expressed)