Final (DSM) Flashcards
Selective Mutism - Associated Features (6)
Shyness Fear of embarrassment
Social Isolation/Withdrawal
Clinging
Tantrums/Oppositional Behavior
Often comorbid with social anxiety
Occasionally comorbid with communication disorder
Specific Phobia Specifiers
Animal
Natural
Environment
Blood-Injection-Injury
Situational
Other
Selective Mutism Etiology, Risk and Prognostic Factors
Temperament
-Negative affectivity and behavioral inhibition
Environment
-Social inhibition, overprotective and controlling behavior among parents
Genetics
-Shared genetic factors with social anxiety disorder
MDD Prevalence
Lifetime 12-20%
12 month in US: 7%
Male to female 1:2
-but no difference in symptoms, course, treatment response, or functional consequences
Onset can occur at any age, with increased risk after puberty, and incidence peaking in the 20s
Obsessions (OCD)
recurrent or persistent thoughts, urges, or images that are experienced as intrusive and unwanted and caused marked anxiety and distress
Types: Taboo (aggressive/violent/sexual), Symmetry, Harm to self/others, Religious, Contamination, Doubt
Social Anxiety Disorder - Prevalence, Development, and Course
7% Prevalence
- lower for older adults
- more pronounced in adolescents/young adults
1. 5-2x more common in females - Females: comorbid with depressive, biopolar, and anxiety disorders
- Males: comorbid with ODD/CD and substance use
Majority (~75%) have onset between 8-15 years
-first onset in adulthood is rare
Onset may follow stressful/humiliating event
30% experience remission in 1 year
About half seek treatment
Trung gio
(“hit by the wind” or “to catch wind”)
Found among Vietnamese Panic attack (associated with headaches, feeling unwell) experienced after walking into a windy environment
- May attribute attack to exposure to wind
- May avoid atmospheric wind
MDD - Differential Diagnosis - ADHD
Distractibility and low frustration tolerance can occur in both attention-deficit/ hyperactivity disorder and a major depressive episode; if the criteria are met for both, attention-deficit/hyperactivity disorder may be diagnosed in addition to the mood disorder. However, the clinician must be cautious not to overdiagnose a major depressive episode in children with attention-deficit/hyperactivity disorder whose disturbance in mood is characterized by irritability rather than by sadness or loss of interest.
Separation Anxiety Disoder Criteria (4)
A. Developmentally inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached, as evidenced by at least three of the following:
- Recurrent excessive distress when anticipating or experiencing separation from home or from major attachment figures.
- Persistent and excessive worry about losing major attachment figures or about possible harm to them, such as illness, injury, disasters, or death.
- Persistent and excessive worry about experiencing an untoward event (e.g., getting lost, being kidnapped, having an accident, becoming ill) that causes separation from a major attachment figure.
- Persistent reluctance or refusal to go out, away from home, to school, to work, or elsewhere because of fear of separation.
- Persistent and excessive fear of or reluctance about being alone or without major attachment figures at home or in other settings.
- Persistent reluctance or refusal to sleep away from home or to go to sleep without being near a major attachment figure.
- Repeated nightmares involving the theme of separation.
- Repeated complaints of physical symptoms (e.g., headaches, stomachaches, nausea, vomiting) when separation from major attachment figures occurs or is anticipated.
B. The fear, anxiety, or avoidance is persistent, lasting at least 4 weeks in children and adolescents and typically 6 months or more in adults.
C. The disturbance causes clinically significant distress or impairment in social, academic, occupational, or other important areas of functioning.
D. The disturbance is not better explained by another mental disorder, such as refusing to leave home because of excessive resistance to change in autism spectrum disorder; delusions or hallucinations concerning separation in psychotic disorders; refusal to go outside without a trusted companion in agoraphobia; worries about ill health or other harm befalling significant others in generalized
Anxiety Disorders DSM-IV
Anxiety disorders in the DSM-IV were split into three categories in the DSM-5:
Anxiety Disorders
Obsessive Compulsive Disorder
PTSD & Acute Stress Disorder
Body Dysmorphic Disorder Criteria (4)
A. Preoccupation with one or more perceived defects or flaws in physical appearance that
are not observable or appear slight to others.
- often try to change how they look
- excessive fixation on defect
B. At some point during the course of the disorder, the individual has performed repetitive
behaviors (e.g., mirror checking, excessive grooming, skin picking, reassurance seeking)
or mental acts (e.g., comparing his or her appearance with that of others) in response
to the appearance concerns.
C. The preoccupation causes clinically significant distress or impairment in social, occupational,
or other important areas of functioning.
D. The 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.
Panic Disorder - Prevalence
Panic Attacks: 11.2% adults in US in last year
-30% had at least one PA in lifetime
Panic Disorder: 2-3% adults/adolescence
Panic Disorder Criteria (4)
A. Recurrent unexpected panic attacks. A panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four (or more) of the following symptoms occur;
Note: The abrupt surge can occur from a calm state or an anxious state.
- Palpitations, pounding heart, or accelerated heart rate.
- Sweating.
- Trembling or shaking.
- Sensations of shortness of breath or smothering.
- Feelings of choking.
- Chest pain or discomfort.
- Nausea or abdominal distress.
- Feeling dizzy, unsteady, light-headed, or faint.
- Chills or heat sensations.
- Paresthesias (numbness or tingling sensations).
- Derealization (feelings of unreality) or depersonalization (being detached from oneself).
- Fear of losing control or “going crazy.”
- Fear of dying. Note: Culture-specific symptoms (e.g., tinnitus, neck soreness, headache, uncontrollable screaming or crying) may be seen. Such symptoms should not count as one of the four required symptoms.
B. At least one of the attacks has been followed by 1 month (or more) of one or both of the following:
- Persistent concern or worry about additional panic attacks or their consequences (e.g., losing control, having a heart attack, “going crazy”).
- A significant maladaptive change in behavior related to the attacks (e.g., behaviors designed to avoid having panic attacks, such as avoidance of exercise or unfamiliar situations).
C. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism, cardiopulmonary disorders).
D. The disturbance is not better explained by another mental disorder (e.g., the panic attacks do not occur only in response to feared social situations, as in social anxiety disorder: in response to circumscribed phobic objects or situations, as in specific phobia: in response to obsessions, as in obsessive-compulsive disorder: in response to reminders of traumatic events, as in posttraumatic stress disorder: or in response to separation from attachment figures, as in separation anxiety disorder).
Severity specifiers - depressive disorders
Severity is based on the number of criterion symptoms, the severity of those symptoms, and the degree of functional disability.
Mild: Few, if any, symptoms in excess of those required to make the diagnosis are present, the intensity of the symptoms is distressing but manageable, and the symptoms result in minor impairment in social or occupational functioning.
Moderate: The number of symptoms, intensity of symptoms, and/or functional impairment are between those specified for “mild” and “severe.”
Severe: The number of symptoms is substantially in excess of that required to make the diagnosis, the intensity of the symptoms is seriously distressing and unmanageable, and the symptoms markedly interfere with social and occupational functioning.
Excoriation Disorder Criteria (5)
A. Recurrent skin picking resulting in skin lesions.
B. Repeated attempts to decrease or stop skin picking.
C. The skin picking causes clinically significant distress or impairment in social, occupational,
or other important areas of functioning.
D. The skin picking is not attributable to the physiological effects of a substance (e.g., cocaine)
or another medical condition (e.g., scabies).
E. The skin picking is not better explained by symptoms of another mental disorder (e.g.,
delusions or tactile hallucinations in a psychotic disorder, attempts to improve a perceived
defect or flaw in appearance in body dysmorphic disorder, stereotypies in stereotypic
movement disorder, or intention to harm oneself in nonsuicidal self-injury).
Disruptive Mood Dysregulation Disorder Criteria (11)
A. Severe recurrent temper outbursts manifested verbally (e.g., verbal rages) and/or behaviorally (e.g., physical aggression toward people or property) that are grossly out of proportion in intensity or duration to the situation or provocation.
B. The temper outbursts are inconsistent with developmental level.
C. The temper outbursts occur, on average, three or more times per week.
D. The mood between temper outbursts is persistently irritable or angry most of the day, nearly every day, and is observable by others (e.g., parents, teachers, peers).
E. Criteria A-D have been present for 12 or more months. Throughout that time, the individual has not had a period lasting 3 or more consecutive months without all of the symptoms in Criteria A-D.
F. Criteria A and D are present in at least two of three settings (i.e., at home, at school, with peers) and are severe in at least one of these.
G. The diagnosis should not be made for the first time before age 6 years or after age 18 years.
H. By history or observation, the age at onset of Criteria A-E is before 10 years.
I. There has never been a distinct period lasting more than 1 day during which the full symptom criteria, except duration, for a manic or hypomanic episode have been met.
Note: Developmentally appropriate mood elevation, such as occurs in the context of a highly positive event or its anticipation, should not be considered as a symptom of mania or hypomania.
J. The behaviors do not occur exclusively during an episode of major depressive disorder and are not better explained by another mental disorder (e.g., autism spectrum disorder, posttraumatic stress disorder, separation anxiety disorder, persistent depressive disorder [dysthymia]).
Note: This diagnosis cannot coexist with oppositional defiant disorder, intermittent explosive disorder, or bipolar disorder, though it can coexist with others, including major depressive disorder, attention-deficit/hyperactivity disorder, conduct disorder, and substance use disorders. Individuals whose symptoms meet criteria for both disruptive mood dysregulation disorder and oppositional defiant disorder should only be given the diagnosis of disruptive mood dysregulation disorder. If an individual has ever experienced a manic or hypomanic episode, the diagnosis of disruptive mood dysregulation disorder should not be assigned.
K. The symptoms are not attributable to the physiological effects of a substance or to another medical or neurological condition.
OCD Etiology and Risk Factors
Genetics
-First degree relatives have 6x risk of developing OCD
Biology
-Brain differences: the caudate nucleus and orbitofrontal cortex
Environment
-Child abuse/trauma, life stressors, family maintenance
Agoraphobia Prevalence
- 7% adults and adolescents
- less common in childhood and older adults
Major Depressive Disorder Specifiers
Severity/Course (based on number and severity of symptoms): Mild Moderate Severe
With psychotic features
In partial remission
In full remission
Unspecified
Other specifiers:
With anxious distress
With mixed features
WIth melancholic features
With atypical features
WIth mood-congruent psychotic features
With mood-incongruent psychotic features
With catatonia
With peripartum onset (aka postpartum depression)
With seasonal pattern
Major Depressive Disorder Criteria (5)
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 (1) depressed mood or (2) loss of interest or pleasure.
Note: Do not include symptoms that are clearly attributable to another medical condition.
- Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, can be irritable mood.)
- 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).
- 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.)
- Insomnia or hypersomnia nearly every day.
- Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
- Fatigue or loss of energy nearly every day.
- Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
- 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.
B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
C. The episode is not attributable to the physiological effects of a substance or to another medical condition.
Note: Criteria A-C represents a major depressive episode.
D. The occurrence of the major depressive episode is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders.
E. There has never been a manic episode or a hypomanic episode. Note: This exclusion does not apply if all of the manic-like or hypomanic-like episodes are substance-induced or are attributable to the physiological effects of another medical condition.
Note: Responses to a significant loss (e.g., bereavement, financial ruin, losses from a natural disaster, a serious medical illness or disability) may include the feelings of intense sadness, rumination about the loss, insomnia, poor appetite, and weight loss noted in Criterion A, which may resemble a depressive episode. Although such symptoms may be understandable or considered appropriate to the loss, the presence of a major depressive episode in addition to the normal response to a significant loss should also be carefully considered. This decision inevitably requires the exercise of clinical judgment based on the individual’s history and the cultural norms for the expression of distress in the context of loss.
Panic Disorder - Etiology, Risk, Prognostic Factors
Genetics/physiological
- Family history
- Respiratory problems (e.g. asthma)
- Amygdala response (activates sympathetic nervous system)
Temperament
- Negative affectivity, anxiety sensitivity
- History of limited-symptom attacks
Environment
- Childhood history of abuse
- Smoking
- Life stressors
Social Anxiety Disorder - Associated Features
Lack of assertiveness
Poor body language and nonverbal
Shy/withdrawn Blushing
Live at home longer
Limit employment opportunities
Substance use
Persistent Depressive Disorder - Criteria B Symptoms (6)
- Poor appetite or overeating.
- Insomnia or hypersomnia.
- Low energy or fatigue.
- Low self-esteem.
- Poor concentration or difficulty making decisions.
- Feelings of hopelessness.
Premenstruel Dysphoric Disorder - Criteria B Symptoms (4)
- Marked affective lability (e.g., mood swings: feeling suddenly sad or tearful, or increased sensitivity to rejection).
- Marked irritability or anger or increased interpersonal conflicts.
- Marked depressed mood, feelings of hopelessness, or self-deprecating thoughts.
- Marked anxiety, tension, and/or feelings of being keyed up or on edge.
Emotion and Physiology
Autonomic nervous system controls physiological arousal
Sympathetic division (arousing): dilates pupils, decreases salivation, creates perspiration, accelerates heart, inhibits digestion, secretes stress hormones
Parasympathetic division (calming): contracts pupils, increases salivation, dries skin, decreases respiration, slows heart, activates digestion, decreases secretion of stress hormones
Panic Loop
- Body Sensations: an unusual bodily sensation (e.g. pounding heart) makes you react with fear that something bad is about to happen
- Panic Attack: your continued overreaction to the bodily sensation triggers more fear and eventually leads to a full panic attack
- High Anxiety: once the panic attack subsides, you are left feeling anxious in a very sensitive state
- Fear of Fear: Your fear of having another panic attack keeps your anxiety levels high and this leads to further unusual bodily sensations. The panic loop is now established.
Trichotillomania Disorder (5)
A. Recurrent pulling out of one’s hair, resulting in hair loss.
B. Repeated attempts to decrease or stop hair pulling.
C. The hair pulling causes clinically significant distress or impairment in social, occupational,
or other important areas of functioning.
D. The hair pulling or hair loss is not attributable to another medical condition (e.g., a dermatological
condition).
E. The hair pulling is not better explained by the symptoms of another mental disorder
(e. g., attempts to improve a perceived defect or flaw in appearance in body dysmorphic
disorder) .
Hoarding Disorder DSM-IV Changes
Hoarding used to be diagnosed under OCD, OCPD, and Anxiety NOS but now it is its own disorder
Body Dysmorphic Disorder - Culture and Gender Considerations
Taijin Kyofusho
- Shubo-kyofu (fear of body deformity)
- Jikoshu-kyofu (fear of having offensive body odor)
Males: muscle dysmorphia and genital preoccupations
Females: comorbid eating disorders
Premenstrual Dysphoric Disorder - Onset and Course
Onset at any time
Symptoms peak in intensity around the time of menses onset
Premenstrual phase is a risk period for suicide
Symptoms seem to worsen approaching menopause, but cease thereafter
Hormone replacement can re-trigger symptoms
Use of oral contraceptives help
MDD - Differential Diagnosis - Sadness
periods of sadness are inherent aspects of the human experience. These periods should not be diagnosed as a major depressive episode unless criteria are met for severity (i.e., five out of nine symptoms), duration (i.e., most of the day, nearly every day for at least 2 weeks), and clinically significant distress or impairment.
The diagnosis other specified depressive disorder may be appropriate for presentations of depressed mood wiih clinically significant impairment that do not meet criteria for duration or severity.
Agoraphobia Etiology, Risk and Prognostic Factors
Genetics/physiological
- family history
- heritability = 61%
Temperament
-Negative affectivity, anxiety sensitivity
Environment
- Stressful life events
- Reduced family warmth and overprotectiveness
MDD Recovery
Recurrence is common
- 2 episodes = 70% recurrence
- 3 episodes = 90%
recurrence 20% recover within 3 months of onset
80% recover within 1 year
Selective Mutism Criteria (5)
A. Consistent failure to speak in specific social situations in which there is an expectation for speaking (e.g., at school) despite speaking in other situations.
B. The disturbance interferes with educational or occupational achievement or with social communication.
C. The duration of the disturbance is at least 1 month (not limited to the first month of school).
D. The failure to speak is not attributable to a lack of knowledge of, or comfort with, the spoken language required in the social situation.
E. The disturbance is not better explained by a communication disorder (e.g., childhood-onset fluency disorder) and does not occur exclusively during the course of autism spectrum disorder, schizophrenia, or another psychotic disorder.
Social Anxiety Disorder Criteria (10)
A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g., giving a speech).
Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.
B. The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing: will lead to rejection or offend others).
C. The social situations almost always provoke fear or anxiety. Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.
D. The social situations are avoided or endured with intense fear or anxiety.
E. The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.
F. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.
G. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
H. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.
I. The fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.
J. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from bums or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.
Specify if: performance only
Separation Anxiety Disorder Prevalence, Development, and Course
Most prevalent among children younger than 12
- Children 4%
- Adolescents 1.6%
- Adults .09% - 1.9%
Separation Anxiety is part of normal early development
Onset as early as preschool age, commonly during childhood, and rarely in adolescence and beyond
Majority of children grow out of it
Anxiety is manifested differently depending on age
HPA Axis
With mixed features - depressive specifier (4)
A. At least three of the following manic/hypomanic symptoms are present nearly every day during the majority of days of a major depressive episode:
- Elevated, expansive mood.
- Inflated self-esteem or grandiosity.
- More talkative than usual or pressure to keep talking.
- Flight of ideas or subjective experience that thoughts are racing.
- Increase in energy or goal-directed activity (either socially, at work or school, or sexually).
- Increased or excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, foolish business investments).
- Decreased need for sleep (feeling rested despite sleeping less than usual; to be contrasted with insomnia).
B. Mixed symptoms are observable by others and represent a change from the person’s usual behavior.
C. For individuals whose symptoms meet full criteria for either mania or hypomania, the diagnosis should be bipolar I or bipolar II disorder. D. The mixed symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication or other treatment).
Note: Mixed features associated with a major depressive episode have been found to be a significant risk factor for the development of bipolar I or bipolar II disorder. As a result, it is clinically useful to note the presence of this specifier for treatment planning and monitoring of response to treatment.
Agoraphobia Onset
Peaks in late adolescence to early adulthood
- mean age of onset is 17 years
- later onset if without panic attacks/disorder (25-29)
30-50% have preceding panic attacks/disorder
2:1 female to male ratio
Premenstruel Dysphoric Disorder - Criteria C Symptoms (7)
- Decreased interest in usual activities (e.g., work, school, friends, hobbies).
- Subjective difficulty in concentration.
- Lethargy, easy fatigability, or marked lack of energy.
- Marked change in appetite; overeating; or specific food cravings.
- Hypersomnia or insomnia.
- A sense of being ovenwhelmed or out of control.
- Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of “bloating,” or weight gain.
Obsessive-Compulsive Disorder Critieria (4)
A. Presence of obsessions, compulsions, or both:
Obsessions are defined by (1) and (2):
- Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress.
- The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion).
Compulsions are defined by (1) and (2):
- Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g.,praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.
- The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.
Note: Young children may not be able to articulate the aims of these behaviors or
mental acts.
B. The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per
day) or cause clinically significant distress or impairment in social, occupational, or
other important areas of functioning.
C. The obsessive-compulsive symptoms are not attributable to the physiological effects
of a substance (e.g., a drug of abuse, a medication) or another medical condition.
D. The disturbance is not better explained by the symptoms of another mental disorder
(e.g., excessive worries, as in generalized anxiety disorder; preoccupation with appearance,
as in body dysmorphic disorder; difficulty discarding or parting with possessions,
as in hoarding disorder; hair pulling, as in trichotillomania [hair-pulling disorder];
skin picking, as in excoriation [skin-picking] disorder; stereotypies, as in stereotypic
movement disorder; ritualized eating behavior, as in eating disorders; preoccupation
with substances or gambling, as in substance-related and addictive disorders; preoccupation
with having an illness, as in illness anxiety disorder; sexual urges or fantasies,
as in paraphilic disorders; impulses, as in disruptive, impulse-control, and conduct disorders;
guilty ruminations, as in major depressive disorder; thought insertion or delusional
preoccupations, as in schizophrenia spectrum and other psychotic disorders; or
repetitive patterns of behavior, as in autism spectrum disorder)
MDD Etiology
Diathesis-Stress Model Genetic
- Heritability = 40%
- Risk increased 2-4x with first degree relative with depression
- Neuroticism (negative affectivity)
Environmental
- adverse childhood experiences
- stressful life events
GAD Onset
Onset at any time, median age of onset is 30 -rare prior to adolescence
Early onset predicts comorbidity and impairment
Body Dysmorphic Disorder - Prevalence and Onset
- 4% prevalence rate in the U.S.
- Approx equal, perhaps slightly higher in females
Mean age of onset is 16-17 years
-2/3 have onset prior to age 18
Childhood onset (essentially severity) predicts suicidality, comorbidity
With anxious distress - depressive specifier
Anxious distress is defined as the presence of at least two of the following symptoms during the majority of days of a major depressive episode or persistent depressive disorder (dysthymia):
- Feeling keyed up or tense.
- Feeling unusually restless.
- Difficulty concentrating because of worry.
- Fear that something awful may happen.
- Feeling that the individual might lose control of himself or herself.
Specify current severity:
Mild: Two symptoms.
Moderate: Three symptoms.
Moderate-severe: Four or five symptoms.
Severe: Four or five symptoms and with motor agitation.
Note: Anxious distress has been noted as a prominent feature of both bipolar and major depressive disorder in both primary care and specialty mental health settings. High levels of anxiety have been associated with higher suicide risk, longer duration of illness, and greater likelihood of treatment nonresponse. As a result, it is clinically useful to specify accurately the presence and severity levels of anxious distress for treatment planning and monitoring of response to treatment.
Body Dysmorphic Disorder - Associated Features
Delusions of reference
Anxiety (especially social anxiety)
Social Avoidance
Depressed Mood
Low Self-Esteem
Perfectionism
Taijin Kyofusho
“Interpersonal fear disorder” in Japan and Korea Fear of making other people uncomfortable
One’s appearance and actions are inadequate or offensive
- facial blushing
- offensive body odor
- inappropriate gaze
- stiff/awkward facial expressions or movements
- body deformity
Broader construct than social anxiety
-may meet criteria for body dysmorphic disorder and delusional disorder
Related to interdependent self-construal
Premenstrual Dysphoric Disorder Criteria (6)
A. In the majority of menstrual cycles, at least five symptoms must be present in the final week before the onset of menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week postmenses.
B. One (or more) of the following symptoms must be present:
- Marked affective lability (e.g., mood swings: feeling suddenly sad or tearful, or increased sensitivity to rejection).
- Marked irritability or anger or increased interpersonal conflicts.
- Marked depressed mood, feelings of hopelessness, or self-deprecating thoughts.
- Marked anxiety, tension, and/or feelings of being keyed up or on edge.
C. One (or more) of the following symptoms must additionally be present, to reach a total of five symptoms when combined with symptoms from Criterion B above.
- Decreased interest in usual activities (e.g., work, school, friends, hobbies).
- Subjective difficulty in concentration.
- Lethargy, easy fatigability, or marked lack of energy.
- Marked change in appetite; overeating; or specific food cravings.
- Hypersomnia or insomnia.
- A sense of being ovenwhelmed or out of control.
- Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of “bloating,” or weight gain.
Note: The symptoms in Criteria A-C must have been met for most menstrual cycles that occurred in the preceding year.
D. The symptoms are associated with clinically significant distress or interference with work, school, usual social activities, or relationships with others (e.g., avoidance of social activities; decreased productivity and efficiency at work, school, or home).
E. The disturbance is not merely an exacerbation of the symptoms of another disorder, such as major depressive disorder, panic disorder, persistent depressive disorder (dysthymia), or a personality disorder (although it may co-occur with any of these disorders).
F. Criterion A should be confirmed by prospective daily ratings during at least two symptomatic cycles. (Note: The diagnosis may be made provisionally prior to this confirmation.)
G. The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment) or another medical condition (e.g., hyperthyroidism).
Course specifiers - depressive disorders
In partial remission:
Symptoms of the immediately previous major depressive episode are present, but full criteria are not met, or there is a period lasting less than 2 months without any significant symptoms of a major depressive episode following the end of such an episode.
In full remission:
During the past 2 months, no significant signs or symptoms of the disturbance were present.
OCD Specifiers
Specify if:
With good or fair insight: The individual recognizes that obsessive-compulsive disorder beliefs are definitely or probably not true or that they may or may not be true.
With poor insight: The individual thinks obsessive-compulsive disorder beliefs are
probably true.
With absent insight/delusional beliefs: The individual is completely convinced that
obsessive-compulsive disorder beliefs are true.
Specify if:
Tic-related: The individual has a current or past history of a tic disorder.
-typically males with OCD onset in childhood
MDD Presentation
Irritability instead of sadness among children/adolescents
Fatigue and insomnia are common
-may be presenting complaint
Psychomotor disturbances and psychosis are uncommon but indicate greater severity
Impairment
- Less efficiency, poorer performance
- Impaired cognition (memory, concentration)
- Missed work/school
- Social isolation
- Personal hygiene
Selective Mutism Prevalence, Development and Course
Rare (.3% - 1%)
Mostly diagnosed among young children
Usually manifests before age 5, but may not be noticed until the child enters school
Usually outgrown as child ages but social anxiety may remain `
Separation Anxiety Disorder Etiology, Risk, and Prognostic Factors
Genetic
-Heritability of 73% in twin study
Environmental
-Often develops after a life stressor (e.g. death, divorce, change of home/school, immigration, period of separation from loved ones)
DMDD - Differential Diagnosis - MDD and PDD
Can be comorbid BUT, if irritability present only in context of MDD or PDD, dx should only be MDD or PDD (no comorbid DMDD)
MDD - Bipolar Conversion
Bipolar transition more likely if:
Onset in adolescence
Psychotic features
Mixed features
Family history of bipolar
Panic Disorder changes from DSM-IV
Panic Disorder with Agoraphobia, Panic Disorder without Agoraphobia, and Agoraphobia without history of Panic Disorder became
Panic Disorder
Agoraphobia
Hoarding Disorder - Associated Features
Perfectionism
Indecisiveness
Avoidance
Procrastination
Difficulty planning/organizing
Distractibility
Animal Hoarding - can be defined as the accumulation of a large number
of animals and a failure to provide minimal standards of nutrition, sanitation, and veterinary
care and to act on the deteriorating condition of the animals (including disease, starvation,
or death) and the environment (e.g., severe overcrowding, extremely unsanitary
conditions).
Disruptive Mood Dysregulation Disorder - Prevalence, Development, and Course
Prevalence is unclear
-estimated at 2-5%
Predominantly diagnosed in males
Suicide risk, aggression, and hospitalization are common
Symptoms become less common over time into adulthood
Conversion from DMDD to Bipolar is low
More likely to convert MDD and/or anxiety in adulthood
Comorbidity is high
Specific Phobia Development and Course
Typically develops following a traumatic event
Onset at any age, but usually in early childhood
- Majority develop before age 10
- Situational type tends to develop later
Person often changes living circumstances/behaviors to avoid phobic object/situation
-impairment increase with number of feared objects/situations
Phobias persisting into adulthood are unlikely to remit
Hoarding Disorder Criteria (6)
A. Persistent difficulty discarding or parting with possessions, regardless of their actual value.
B. This difficulty is due to a perceived need to save the items and to distress associated
with discarding them.
C. The difficulty discarding possessions results in the 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).
D. The hoarding causes clinically significant distress or impairment in social, occupational,
or other important areas of functioning (including maintaining a safe environment
for self and others).
E. The hoarding is not attributable to another medical condition (e.g., brain injury, cerebrovascular
disease, Prader-Willi syndrome).
F. The hoarding is not better explained by the symptoms of another mental disorder (e.g.,
obsessions in obsessive-compulsive disorder, decreased energy in major depressive
disorder, delusions in schizophrenia or another psychotic disorder, cognitive deficits in
major neurocognitive disorder, restricted interests in autism spectrum disorder).
PDD Specifiers
Specify if: With anxious distress (p. 184)
With mixed features (pp. 184-185)
With melancholic features (p. 185)
With atypical features (pp. 185-186)
With mood-congruent psychotic features (p. 186)
With mood-incongruent psychotic features (p. 186)
With péripartum onset (pp. 186-187)
Specify if:
In partial remission (p. 188)
In full remission (p. 188)
Specify if:
Early onset: If onset is before age 21 years.
Late onset: If onset is at age 21 years or older.
Specify if (for most recent 2 years of persistent depressive disorder):
With pure dysthymic syndrome: Full criteria for a major depressive episode have not been met in at least the preceding 2 years.
With persistent major depressive episode: Full criteria for a major depressive episode have been met throughout the preceding 2-year period.
With intermittent major depressive episodes, with current episode: Full criteria for a major depressive episode are currently met, but there have been periods of at least 8 weeks in at least the preceding 2 years with symptoms below the threshold for a full major depressive episode. ‘
With intermittent major depressive episodes, without current episode: Full criteria for a major depressive episode are not currently met, but there has been one or more major depressive episodes in at least the preceding 2 years.
Specify current severity: Mild (p. 188) Moderate (p. 188) Severe (p. 188)
Compulsions (OCD)
Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g.,
praying, counting, repeating words silently) that the individual feels driven to perform
in response to an obsession or according to rules that must be applied rigidly.
Types: Ordering, Counting, Checking, Praying, Cleaning/Washing
Hoarding Disorder - Comorbidity
MDD
Social Anxiety
GAD
OCD
Premenstrual Dysphoric Disorder vs PMS
PMS has no minimum number of symptoms and no specific symptoms required
PMDD requires a minimum of five symptoms, one of which must be mood symptom
-PMDD is more severe than PMS
Confirmed by prevalence rates
- 20% meet PMS
- 1.8% - 5.8% meet PMDD
Panic Disorder - Onset and Development
Median age of onset for Panic Disorder is 20-24 years
- relatively rare in children
- lower prevalence in older adults
- believed to be due to the autonomic nervous system slowing in old age
More common among women than men
-2:1 female to male
Ataque de nervios
“attack of nerves”
Found among Latinos
Common symptoms
- intense anxiety, anger, grief
- trembling
- fainting/seizure episodes
- depersonalization/derealization
- uncontrollable screaming or crying
- heat in one’s chest and head
- verbal/physical aggression
- suicidal gestures
May experience longer than a few minutes
-Occur frequently as a result of stressful family event, may avoid family conflict
Used to indicate an episode of loss of control in response to a stressor
DMDD - Differential Diagnosis - ADHD
Unlike children diagnosed with bipolar disorder or oppositional defiant disorder, a child whose symptoms meet criteria for disruptive mood dysregulation disorder also can receive a comorbid diagnosis of ADHD, major depressive disorder, and/or anxiety disorder. However, children whose irritability is present only in the context of a major depressive episode or persistent depressive disorder (dysthymia) should receive one of those diagnoses rather than disruptive mood dysregulation disorder.
Children with disruptive mood dysregulation disorder may have symptoms that also meet criteria for an anxiety disorder and can receive both diagnoses, but children whose irritability is manifest only in the context of exacerbation of an anxiety disorder should receive the relevant anxiety disorder diagnosis rather than disruptive mood dysregulation disorder. In addition, children with autism spectrum disorders frequently present with temper outbursts when, for example, their routines are disturbed. In that instance, the temper outbursts would be considered secondary to the autism spectrum disorder, and the child should not receive the diagnosis of disruptive mood dysregulation disorder.
GAD - Criteria C Symptoms
3 or more symptoms (1 in children)
- Restlessness or feeling keyed up or on edge.
- Being easily fatigued.
- Difficulty concentrating or mind going blank.
- Irritability.
- Muscle tension.
- Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).
MDD vs Grief
MDD
Expression of mood: Despair and hopelessness
Time course: Steady or waning
Stability of mood: Persistent
Response to humor, distraction: Little or none
Content of thought: Largely unrelieved thoughts of own misery
Self-esteem: Guilt, blame, worthlessness
Passing of time: Time crawls
Death, dying: Wish for own death, suicidal plans
Clinical impairment: Yes
Grief
Expression of mood: loss or emptiness
Time course: decrease with time (weeks)
Stability of mood: surges and retreats
Response to humor, distraction: may bring relief
Content of thought: memories, thoughts of departed, but some positive thoughts regarding others
Self-esteem: “I’ve done my best”
Passing of time: time passes as before
Death, dying: Life is still worth living
Clinical impairment: No
GAD Course
Many report feeling anxious all their lives
Chronic course, waxes and wanes
-Full remission is low
Generalized Anxiety Disorder Criteria (6)
A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).
B. The individual finds it difficult to control the worry.
C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months);
Note: Only one item is required in children.
- Restlessness or feeling keyed up or on edge.
- Being easily fatigued.
- Difficulty concentrating or mind going blank.
- Irritability.
- Muscle tension.
- Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).
D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).
F. The disturbance is not better explained by another mental disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder [social phobia], contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).
OCD Feedback Loop
Prefrontal Cortex to Striatum (Caudate Nucleus - Brain Filter) to Thalamus (Brain Router) back to PFC
People w OCD have increased activity in PFC
Agoraphobia Criteria (9)
A. Marked fear or anxiety about two (or more) of the following five situations:
- Using public transportation (e.g., automobiles, buses, trains, ships, planes).
- Being in open spaces (e.g., parking lots, marketplaces, bridges).
- Being in enclosed places (e.g., shops, theaters, cinemas).
- Standing in line or being in a crowd.
- Being outside of the home alone.
B. The individual fears or avoids these situations because of thoughts that escape might be difficult or help might not be available in the event of developing panic-like symptoms or other incapacitating or embarrassing symptoms (e.g., fear of falling in the elderly; fear of incontinence).
C. The agoraphobic situations almost always provoke fear or anxiety.
D. The agoraphobic situations are actively avoided, require the presence of a companion, or are endured with intense fear or anxiety.
E. The fear or anxiety is out of proportion to the actual danger posed by the agoraphobic situations and to the sociocultural context.
F. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.
G. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
H. If another medical condition (e.g., inflammatory bowel disease, Parkinson’s disease) is present, the fear, anxiety, or avoidance is clearly excessive.
I. The fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder—for example, the symptoms are not confined to specific phobia, situational type; do not involve only social situations (as in social anxiety disorder): and are not related exclusively to obsessions (as in obsessive-compulsive disorder), perceived defects or flaws in physical appearance (as in body dysmorphic disorder), reminders of traumatic events (as in posttraumatic stress disorder), or fear of separation (as in separation anxiety disorder).
Note: Agoraphobia is diagnosed irrespective of the presence of panic disorder. If an individual’s presentation meets criteria for panic disorder and agoraphobia, both diagnoses should be assigned.
GAD Prevalence
12 month 0.9% adolescents and 2.9%
adults -lifetime: 9%
2:1 female to male ratio
Specific Phobia Prevalence
12-month prevalence: 7-9%
- 5% children
- 16% adolescents
- 3-5% adults
Typically development in childhood and adolescence
Common to have multiple specific phobias
- 75% has more than one specific phobia
- Average person fears 3 objects/situations
2: 1 female to male ratio - Fear of blood-injection-injury is equal across genders
Asian Americans and Latinos have a lower prevalence
Depression Stats
As measured by disability life years (DALY) By 2030 depression will be the top-ranking cause of potential life years lost due to premature mortality as well as years of productive life lost…
…costs include impaired quality of life, relationships, diminished work capacity, and increased mortality from comorbid depression interacts with poverty in a negative cycle because it is related to lower productivity, fewer work days, and lower educational attainment 18% increase in depression over last decade
Trichotillomania and Excoriation Disorder - Prevalence, Development and Course
1-2% Prevalence
Gender ratio:
- Trichotillomania - 10:1 (female to male)
- Excoriation 3:1 (female to male)
Onset usually during adolescence after puberty
Chronic if untreated
Persistent Depressive Disorder Criteria (7)
This disorder represents a consolidation of DSM-lV-defined chronic major depressive disorder and dysthymic disorder.
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 2 years.
Note: In children and adolescents, mood can be irritable and duration must be at least 1 year.
B. Presence, while depressed, of two (or more) of the following:
- Poor appetite or overeating.
- Insomnia or hypersomnia.
- Low energy or fatigue.
- Low self-esteem.
- Poor concentration or difficulty making decisions.
- Feelings of hopelessness.
C. During the 2-year period (1 year for children or adolescents) of the disturbance, the individual has never been without the symptoms in 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 episode or a hypomanic episode, and criteria have never been met for cyclothymic disorder.
F. The disturbance is not better explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.
G. The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g. hypothyroidism).
H. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Note: Because the criteria for a major depressive episode include four symptoms that are absent from the symptom list for persistent depressive disorder (dysthymia), a very limited number of individuals will have depressive symptoms that have persisted longer than 2 years but will not mee| criteria for persistent depressive disorder. If full criteria for a major depressive episode have been met at some point during the current episode of illness, they should be given a diagnosis of major depressive disorder. Othenwise, a diagnosis of other specified depressive disorder or unspecified depressive disorder is warranted.
OCD Development and Course
Onset typically in adolescence and young adulthood
- Mean age of onset is 19.5 years
- Onset typically earlier in males (1/4 males report onset before age 10)
- Onset after age 35 is unusual
Early onset and poor insight predicts poorer prognosis
Course is chronic if untreated
Panic Disorder - Associated Features
Many have intermittent or constant feelings of anxiety
-often comorbid with other anxiety disorders
Also comorbid with depression, bipolar disorder, and substance use
Approx 1/4 to 1/3 have nocturnal panic attacks -wakes up in a state of panic (not triggered by a nightmare) – considered unexpected
Predictors of lower recovery or high recurrence in MDD
- longer episode duration
- psychotic features
- anxiety
- personality disorder
- symptom severity
- early onset
- multiple episodes
- lower remission duration or partial remission
Hoarding Disorder - Prevalence, Development and Course
Estimated 2-5% in the US
Three times more prevalent among older adults
-Although onset tends to be in adolescence, with increasing severity as one ages
Mixed findings about gender rates
-more acquisition in females
Chronic course
Body Dysmorphic Disorder - Comorbidity and Differentials
Often comorbid with:
- Depression
- Social Anxiety
- OCD
Differentiate from:
- Eating Disorders
- OCD and related disorders
- Anxiety disorders
- Psychosis
Agoraphobia Course
Chronic if untreated
Course is dependent on severity and comorbidity
1/3 are homebound and are unable to work
Social Anxiety Disorder Differentials and Comorbidity
Differentials
- Normal shyness
- Agoraphobia
- Selective Mutism Often comorbid with
- MDD
- Other anxiety
- Substance use
- Body dysmorphic disorder
- Avoidant Personality Disorder
Specific Phobia Criteria (7)
A. Marked fear or anxiety about a specific object or situation (e.g., flying, heights, animals, receiving an injection, seeing blood). Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, or clinging.
B. The phobic object or situation almost always provokes immediate fear or anxiety.
C. The phobic object or situation is actively avoided or endured with intense fear or anxiety.
D. The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation and to the sociocultural context.
E. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.
F. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
G. The disturbance is not better explained by the symptoms of another mental disorder, including fear, anxiety, and avoidance of situations associated with panic-like symptoms or other incapacitating symptoms (as in agoraphobia): objects or situations related to obsessions (as in obsessive-compulsive disorder); reminders of traumatic events (as in posttraumatic stress disorder); separation from home or attachment figures (as in separation anxiety disorder); or social situations (as in social anxiety disorder).
Panic Attack Specifer
Not to be confused with Panic Disorder
Not part of the criteria, but a panic attack happens in the absence of real danger
Expected (specfic trigger or cue) and unexpected types
An abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four (or more) of the following symptoms occur:
Note: The abrupt surge can occur from a calm state or an anxious state.
- Palpitations, pounding heart, or accelerated heart rate.
- Sweating.
- Trembling or shaking.
- Sensations of shortness of breath or smothering.
- Feelings of choking.
- Chest pain or discomfort.
- Nausea or abdominal distress.
- Feeling dizzy, unsteady, light-headed, or faint.
- Chilis or heat sensations.
- Paresthesias (numbness or tingling sensations).
- Derealization (feelings of unreality) or depersonalization (being detached from oneself).
- Fear of losing control or “going crazy.”
- Fear of dying.
Note: Culture-specific symptoms (e.g., tinnitus, neck soreness, headache, uncontrollable screaming or crying) may be seen. Such symptoms should not count as one of the four required symptoms.
Note: Symptoms are presented for the purpose of identifying a panic attack
Hoarding Disorder - Specifiers
Specify if:
With excessive acquisition: If difficulty discarding possessions is accompanied by excessive
acquisition of items that are not needed or for which there is no available space.
Specify if:
With good or fair insight: The individual recognizes that hoarding-related beliefs and
behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition) are
problematic.
With poor insight: The individual is mostly convinced that hoarding-related beliefs
and behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition)
are not problematic despite evidence to the contrary.
With absent insight/delusional beliefs: The individual is completely convinced that
hoarding-related beliefs and behaviors (pertaining to difficulty discarding items, clutter,
or excessive acquisition) are not problematic despite evidence to the contrary.
With melancholic features - depressive specifier (2)
A. One of the following is present during the most severe period of the current episode:
- Loss of pleasure in all, or almost all, activities.
- Lack of reactivity to usually pleasurable stimuli (does not feel much better, even temporarily, when something good happens).
B. Three (or more) of the following;
- A distinct quality of depressed mood characterized by profound despondency, despair, and/or moroseness or by so-called empty mood.
- Depression that is regularly worse in the morning.
- Early-morning awakening (i.e., at least 2 hours before usual awakening).
- Marked psychomotor agitation or retardation.
- Significant anorexia or weight loss.
- Excessive or inappropriate guilt.
Note: The specifier “with melancholic features” is applied if these features are present at the most severe stage of the episode. There is a near-complete absence of the capacity for pleasure, not merely a diminution. A guideline for evaluating the lack of reactivity of mood is that even highly desired events are not associated with marked brightening of mood. Either mood does not brighten at all, or it brightens only partially (e.g., up to 20%-0% of normal for only minutes at a time). The “distinct quality” of mood that is characteristic of the “with melancholic features” specifier is experienced as qualitatively different from that during a nonmelancholic depressive episode.
A depressed mood that is described as merely more severe, longer lasting, or present without a reason is not considered distinct in quality. Psychomotor changes are nearly always present and are observable by others. Melancholic features exhibit only a modest tendency to repeat across episodes in the same individual. They are more frequent in inpatients, as opposed to outpatients; are less likely to occur in milder than in more severe major depressive episodes; and are more likely to occur in those with psychotic features.
PDD Prevalence and Course
Early onset - before 21
Late - 21 or older
Often has early onset
Early onset more likely to have comorbid substance use and personality disorders
Prevalence: .5% for dysthymia 1.5% for chronic depression
Course is chronic by definition
Khyal attacks (“wind attacks”)
Found among Cambodians
Common symptom
- dizziness
- palpations
- shortness of breath
- cold extremities
- tinnitus
- neck soreness
Concern that khyal (wind-like substance) will rise in the body
May avoid over-exertion of body
More about rising of wind in one’s body rather than external wind
Specific Phobia Diagnostic Considerations
must take into account sociocultural context and normal development
-children more fearful but it tends to be transient
overlap with agoraphobia
panic attacks may occur
overlap with PTSD
DMDD vs Bipolar
DMDD was added to distinguish children with persistent, irritable mood from children with bipolar disorder Some researchers view that nonepisodic irritability is indicative of bipolar disorder -may account for sharp increase in prevalence rates
How to distinguish?
- BD consists of distinct mood episodes
- DMDD is characterized by severe, nonepisodic irritability
- Elevated, expansive mood and grandiosity in BD
- Age of onset is during childhood for DMDD, whereas onset for BD prior to adolescence is uncommon
Panic Disorder - Course
If untreated, course tends to be chronic
The minority have full remission without relapse
-rarely goes away untreated
Lower in ethnic minority groups
