Lecture 3

Question 1

A group of psychiatric conditions where patients experience distressing physical symptoms that are not fully explained byother medical, neurologic, or psychiatric disorders, as well as abnormal thoughts, feelings, and behaviors in response to these
symptoms.

These disorders are characterized by the prominent focus on somatic concerns and their initial presentation is mainly in medical rather than mental health care settings.

Individuals with these disorders that have prominent somatic symptoms are commonly encountered in primary care and other medical settings but are less commonly encountered in psychiatric and other mental health settings.

Answer 1

SOMATIC SYMPTOM AND RELATED

DISORDERS

Question 2

Somatic symptom and related disorder characterized one or more somatic symptoms that are distressing or result in significant disruption of daily life.
1. Excessive thoughts, feelings, or behaviors related to the somatic symptoms or
associated health concerns as manifested by at least one of the following:
a. Disproportionate and persistent thoughts about the seriousness of one’s symptoms.
b. Persistently high level of anxiety about health or symptoms.
c. Excessive time and energy devoted to these symptoms or health concerns.
2. Although any one somatic symptom may not be continuously present, the state of
being symptomatic is persistent (typically more than 6 months)

Answer 2

Somatic Symptom Disorder:

Question 3

Somatic symptom and related disorder characterized by the preoccupation with having or
acquiring a serious illness.
1. Somatic symptoms are not present or, if present, are only mild in intensity. If another medical
condition is present or there is a high risk for developing a medical condition, the preoccupation is
clearly excessive or disproportionate.
2. There is a high level of anxiety about health, and the individual is easily alarmed about personal
health status.
3. The individual performs excessive health-related behaviors or exhibits maladaptive avoidance.
4. Illness preoccupation has been present for at least 6 months, but the specific illness that is feared
may change over that period of time.
5. The illness-related preoccupation is not better explained by another mental disorder, such as
somatic symptom disorder, panic disorder, generalized anxiety disorder, body dysmorphic
disorder, obsessive-compulsive disorder, or delusional disorder, somatic type.

Answer 3

Illness Anxiety Disorder

Question 4

Somatic symptom and related disorder characterized by one or more symptoms of altered voluntary motor or sensory function.
1. Clinical findings provide evidence of incompatibility between the
symptom and recognized neurological or medical conditions.
2. The symptom or deficit is not better explained by another medical or
mental disorder.
3. The symptom or deficit causes clinically significant distress or impairment
in social, occupational, or other important areas of functioning or
warrants medical evaluation.

Answer 4

Conversion Disorder (Functional Neurological Symptom Disorder)

Question 5

A medical symptom or condition (other than a mental disorder) is present.

Psychological or behavioral factors adversely affect the medical condition in one of the
following ways:
The factors have influenced the course of the medical condition as shown by a close temporal association between the psychological factors and the development or exacerbation of, or delayed recovery from, the medical condition.
1. The factors interfere with the treatment of the medical condition.
2. The factors constitute additional well-established health risks for the individual.
3. The factors influence the underlying pathophysiology, precipitating or exacerbating
symptoms or necessitating medical attention.

The psychological and behavioral factors in Criterion B are not better explained by
another mental disorder.

Answer 5

Psychological Factors Affecting Other Medical Conditions

Question 6

Somatic symptom and related disorder characterized by the falsification of physical or psychological signs or symptoms, or induction of injury or disease,
associated with identified deception.
1. The individual presents himself or herself to others as ill, impaired, or injured.
2. The deceptive behavior is evident even in the absence of obvious external rewards.
3. The behavior is not better explained by another mental disorder, such as delusional
disorder or another psychotic disorder.

Answer 6

Extreme Factitious Disorder

Question 7

These disorders are characterized by a persistent disturbance of eating or eating-related behavior that results in the altered consumption or absorption of food and that significantly impairs physical health or psychosocial functioning.

Answer 7

FEEDING AND EATING DISORDERS

Question 8

Feeding and eating disorder characterized by the persistent eating of nonnutritive, nonfood substances over a period of at least 1 month.
1. The eating of nonnutritive, nonfood substances is inappropriate to the
developmental level of the individual.
2. The eating behavior is not part of a culturally supported or socially
normative practice.
3. If the eating behavior occurs in the context of another mental disorder or medical condition, it is sufficiently severe to warrant additional clinical attention.

Answer 8

Pica

Question 9

Feeding and eating disorder characterized by the repeated
regurgitation of food over a period of at least 1 month.
1. Regurgitated food may be re-chewed, re-swallowed, or spit out.
2. The repeated regurgitation is not attributable to an associated
gastrointestinal or other medical condition.
3. The eating disturbance does not occur exclusively during the course of
anorexia nervosa, bulimia nervosa, binge-eating disorder,
or avoidant/restrictive food intake disorder.
4. If the symptoms occur in the context of another mental disorder, they
are sufficiently severe to warrant additional clinical attention.

Answer 9

Rumination Disorder

Question 10

Feeding and eating disorder characterized by an eating or feeding disturbance as
manifested by persistent failure to meet appropriate nutritional and/or energy
needs associated with one (or more) of the following:
a. Significant weight loss.
b. Significant nutritional deficiency.
c. Dependence on enteral feeding or oral nutritional supplements.
d. Marked interference with psychosocial functioning.
1. The disturbance is not better explained by lack of available food or by an associated culturally
sanctioned practice.
2. The eating disturbance does not occur exclusively during the course of anorexia nervosa or
bulimia nervosa, and there is no evidence of a disturbance in the way in which one’s body
weight or shape is experienced.
3. The eating disturbance is not attributable to a concurrent medical condition or not better
explained by another mental disorder. When the eating disturbance occurs in the context of
another condition or disorder, the severity of the eating disturbance exceeds that routinely
associated with the condition or disorder and warrants additional clinical attention.

Answer 10

Avoidant/Restrictive Food Intake Disorder

Question 11

Feeding and eating disorder characterized by the restriction of energy
intake relative to requirements, leading to a significantly low body
weight in the context of age, sex, developmental trajectory, and
physical health.
1. There is an intense fear of gaining weight or of becoming fat, or persistent
behavior that interferes with weight gain, even though at a significantly low
weight.
2. Significantly low weight is defined as a weight that is less than minimally
normal or, for children and adolescents, less than that minimally expected.
3. 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 the seriousness of the current low body weight.

Answer 11

Anorexia Nervosa

Question 12

Feeding and eating disorder characterized by recurrent episodes of binge eating.
An episode of binge eating is characterized by both of the following:
a. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that
is definitely larger than what most individuals would eat in a similar period of time under
similar circumstances.
b. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot
stop eating or control what or how much one is eating).
1. There are recurrent inappropriate compensatory behaviors in order to prevent
weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other
medications; fasting; or excessive exercise.
2. The binge eating and inappropriate compensatory behaviors both occur, on
average, at least once a week for 3 months.
3. Self-evaluation is unduly influenced by body shape and weight.
4. The disturbance does not occur exclusively during episodes of anorexia nervosa

Answer 12

Bulimia Nervosa:

Question 13

Feeding and eating disorder characterized by the characterized by recurrent episodes of binge eating.
1. An episode of binge eating is characterized by both of the following:
1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what
most people would eat in a similar period of time under similar circumstances.
2. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or
how much one is eating).
2. The binge-eating episodes are associated with three (or more) of the following:
1. Eating much more rapidly than normal.
2. Eating until feeling uncomfortably full.
3. Eating large amounts of food when not feeling physically hungry.
4. Eating alone because of feeling embarrassed by how much one is eating.
5. Feeling disgusted with oneself, depressed, or very guilty afterward.
3. Marked distress regarding binge eating is present.
4. The binge eating occurs, on average, at least once a week for 3 months.
5. The binge eating is not associated with the recurrent use of inappropriate compensatory behavior as in bulimia
nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.

Answer 13

Binge-Eating Disorder

Question 14

These disorder involve the inappropriate elimination of urine or
feces and are usually first diagnosed in childhood or
adolescence.

Answer 14

ELIMINATION DISORDERS

Question 15

Elimination disorder characterized by repeated voiding of urine into
bed or clothes, whether involuntary or intentional.
1. The behavior is clinically significant as manifested by either a frequency
of at least twice a week for at least 3 consecutive months or the
presence of clinically significant distress or impairment in social,
academic (occupational), or other important areas of functioning.
2. Chronological age is at least 5 years (or equivalent developmental
level).
3. The behavior is not attributable to the physiological effects of a
substance (e.g., a diuretic, an antipsychotic medication) or another
medical condition (e.g., diabetes, spina bifida, a seizure disorder).

Answer 15

Enuresis

Question 16

 Elimination disorder characterized by repeated passage of feces
into inappropriate places (e.g., clothing, floor), whether involuntary
or intentional.
1. At least one such event occurs each month for at least 3 months.
2. Chronological age is at least 4 years (or equivalent developmental
level).
3. The behavior is not attributable to the physiological effects of a
substance (e.g., laxatives) or another medical condition except through
a mechanism involving constipation.

Answer 16

Encopresis

Question 17

Individuals with these disorders typically present with sleep-wake
complaints of dissatisfaction regarding the quality, timing, and
amount of sleep.
 Resulting daytime distress and impairment are core features
shared by these disorders.

Answer 17

Sleep-wake disorders

Question 18

are a heterogeneous group of disorders that are typically
characterized by a clinically significant disturbance in a person’s
ability to respond sexually or to experience sexual pleasure.

Answer 18

Sexual Dysfunction

Question 19

As a general descriptive term refers to an individual’s
affective/cognitive discontent with the assigned gender but is more
specifically defined when used as a diagnostic category.

Answer 19

Gender Dysphoria

Question 20

Sexual dysfunction disorder characterized by either of the following symptoms
must be experienced on almost all or all occasions (approximately 75%–100%) of
partnered sexual activity (in identified situational contexts or, if generalized, in all
contexts), and without the individual desiring delay:
a. Marked delay in ejaculation.
b. Marked infrequency or absence of ejaculation.
1. Theses symptoms have persisted for a minimum duration of approximately 6
months.
2. These symptoms cause clinically significant distress in the individual.
3. The sexual dysfunction is not better explained by a nonsexual mental disorder or
as a consequence of severe relationship distress or other significant stressors and is
not attributable to the effects of a substance/medication or another medical
condition.

Answer 20

Delayed Ejaculation

Question 21

Sexual dysfunction disorder characterized by at least one of the three following
symptoms must be experienced on almost all or all (approximately 75%–100%)
occasions of sexual activity (in identified situational contexts or, if generalized, in
all contexts):
a. Marked difficulty in obtaining an erection during sexual activity.
b. Marked difficulty in maintaining an erection until the completion of sexual activity.
c. Marked decrease in erectile rigidity.
1. The symptoms in Criterion A have persisted for a minimum duration of
approximately 6 months.
2. The symptoms in Criterion A cause clinically significant distress in the individual.
3. The sexual dysfunction is not better explained by a nonsexual mental disorder or
as a consequence of severe relationship distress or other significant stressors and is
not attributable to the effects of a substance/medication or another medical
condition.

Answer 21

Erectile Disorder

Question 22

Sexual dysfunction disorder characterized by the presence of either of
the following symptoms and experienced on almost all or all
(approximately 75%–100%) occasions of sexual activity (in identified
situational contexts or, if generalized, in all contexts):
a. Marked delay in, marked infrequency of, or absence of orgasm.
b. Markedly reduced intensity of orgasmic sensations.
1. These symptoms have persisted for a minimum duration of approximately 6
months.
2. These symptoms cause clinically significant distress in the individual.
3. The sexual dysfunction is not better explained by a nonsexual mental
disorder or as a consequence of severe relationship distress or other
significant stressors and is not attributable to the effects of a
substance/medication or another medical condition.

Answer 22

Female Orgasmic Disorder

Question 23

Sexual dysfunction disorder characterized by lack of, or significantly reduced, sexual
interest/arousal, as manifested by at least three of the following:
a. Absent/reduced interest in sexual activity.
b. Absent/reduced sexual/erotic thoughts or fantasies.
c. No/reduced initiation of sexual activity, and typically unreceptive to a partner’s attempts to initiate.
d. Absent/reduced sexual excitement/pleasure during sexual activity in almost all or all sexual
encounters.
e. Absent/reduced sexual interest/arousal in response to any internal or external sexual/erotic cues.
f. Absent/reduced genital or nongenital sensations during sexual activity in almost all or all sexual
encounters.
1. These symptoms have persisted for a minimum duration of approximately 6 months.
2. These symptoms cause clinically significant distress in the individual.
3. The sexual dysfunction is not better explained by a nonsexual mental disorder or as a
consequence of severe relationship distress (e.g., partner violence) or other significant stressors
and is not attributable to the effects of a substance/medication or another medical condition.

Answer 23

Female Sexual Interest/Arousal Disorder

Question 24

Sexual dysfunction disorder characterized by persistent or recurrent difficulties with one
(or more) of the following:
a. Vaginal penetration during intercourse.
b. Marked vulvovaginal or pelvic pain during vaginal intercourse or penetration attempts.
c. Marked fear or anxiety about vulvovaginal or pelvic pain in anticipation of, during, or as a result of
vaginal penetration.
d. Marked tensing or tightening of the pelvic floor muscles during attempted vaginal penetration.
1. These symptoms have persisted for a minimum duration of approximately 6 months.
2. These symptoms cause clinically significant distress in the individual.
3. The sexual dysfunction is not better explained by a nonsexual mental disorder or as a
consequence of a severe relationship distress (e.g., partner violence) or other significant
stressors and is not attributable to the effects of a substance/medication or another medical
condition.

Answer 24

Genito-Pelvic Pain/Penetration Disorder

Question 25

Sexual dysfunction disorder characterized by persistently or recurrently
deficient (or absent) sexual/erotic thoughts or fantasies and desire for
sexual activity.
1. The judgment of deficiency is made by the clinician, taking into account
factors that affect sexual functioning, such as age and general and
sociocultural contexts of the individual’s life.
2. These symptoms have persisted for a minimum duration of approximately 6
months.
3. These symptoms cause clinically significant distress in the individual.
4. The sexual dysfunction is not better explained by a nonsexual mental
disorder or as a consequence of severe relationship distress or other
significant stressors and is not attributable to the effects of a
substance/medication or another medical condition

Answer 25

Male Hypoactive Sexual Desire Disorder:

Question 26

Sexual dysfunction disorder characterized by A persistent or recurrent pattern of
ejaculation occurring during partnered sexual activity within approximately 1
minute following vaginal penetration and before the individual wishes it.
a. Note: Although the diagnosis of premature (early) ejaculation may be applied to
individuals engaged in non-vaginal sexual activities, specific duration criteria have not
been established for these activities.
1. These symptoms must have been present for at least 6 months and must be
experienced on almost all or all occasions of sexual activity (in identified
situational contexts or, if generalized, in all contexts).
2. These symptoms cause clinically significant distress in the individual.
3. The sexual dysfunction is not better explained by a nonsexual mental disorder or
as a consequence of severe relationship distress or other significant stressors and is
not attributable to the effects of a substance/medication or another medical
condition.

Answer 26

Premature (Early) Ejaculation

Question 27

Characterized by marked incongruence between one’s experienced/expressed
gender and assigned gender, of at least 6 months’ duration, as manifested by at least six of the following (one
of which must be Criterion A1):
a. A strong desire to be of the other gender or an insistence that one is the other gender (or some alternative gender
different from one’s assigned gender).
b. In boys (assigned gender), a strong preference for cross-dressing or simulating female attire; or in girls (assigned gender), a
strong preference for wearing only typical masculine clothing and a strong resistance to the wearing of typical feminine
clothing.
c. A strong preference for cross-gender roles in make-believe play or fantasy play.
d. A strong preference for the toys, games, or activities stereotypically used or engaged in by the other gender.
e. A strong preference for playmates of the other gender.
f. In boys (assigned gender), a strong rejection of typically masculine toys, games, and activities and a strong avoidance of
rough-and-tumble play; or in girls (assigned gender), a strong rejection of typically feminine toys, games, and activities.
g. A strong dislike of one’s sexual anatomy.
h. A strong desire for the primary and/or secondary sex characteristics that match one’s experienced gender.
1. The condition is associated with clinically significant distress or impairment in social, school, or other important
areas of functioning

Answer 27

Gender Dysphoria

Question 28

Include conditions involving problems in the self-control of emotions and behaviors.

These disorders are unique in that these problems are manifested in
behaviors that violate the rights of others (e.g., aggression,
destruction of property) and/or that bring the individual into
significant conflict with societal norms or authority figures.

They tend to be more common in males than in females, although
the relative degree of male predominance may differ both across
disorders and within a disorder at different ages.

These disorders tend to have first onset in childhood or adolescence.
In fact, it is very rare for either conduct disorder or oppositional
defiant disorder to first emerge in adulthood.

Answer 28

DISRUPTIVE, IMPULSE-CONTROL, AND CONDUCT

DISORDERS

Question 29

Disruptive, impulse-control, and conduct disorder characterized by a pattern of
angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6
months as evidenced by at least four symptoms from any of the following categories,
and exhibited during interaction with at least one individual who is not a sibling.
a. Angry/Irritable Mood
b. Argumentative/Defiant Behavior
c. Vindictiveness
1. The disturbance in behavior is associated with distress in the individual or others in his or her
immediate social context (e.g., family, peer group, work colleagues), or it impacts negatively
on social, educational, occupational, or other important areas of functioning.
2. The behaviors do not occur exclusively during the course of a psychotic, substance use,
depressive, or bipolar disorder. Also, the criteria are not met for disruptive mood dysregulation
disorder.

Answer 29

Oppositional Defiant Disorder:

Question 30

Disruptive, impulse-control, and conduct disorder characterized by recurrent behavioral outbursts representing a
failure to control aggressive impulses as manifested by either of the following:
a. Verbal aggression or physical aggression toward property, animals, or other individuals, occurring twice weekly, on
average, for a period of 3 months. The physical aggression does not result in damage or destruction of property and does
not result in physical injury to animals or other individuals.
b. Three behavioral outbursts involving damage or destruction of property and/or physical assault involving physical injury
against animals or other individuals occurring within a 12-month period.
1. The magnitude of aggressiveness expressed during the recurrent outbursts is grossly out of proportion to the
provocation or to any precipitating psychosocial stressors.
2. The recurrent aggressive outbursts are not premeditated and are not committed to achieve some tangible
objective.
3. The recurrent aggressive outbursts cause either marked distress in the individual or impairment in occupational or
interpersonal functioning, or are associated with financial or legal consequences.
4. Chronological age is at least 6 years (or equivalent developmental level).
5. The recurrent aggressive outbursts are not better explained by another mental disorder and are not attributable to
another medical condition or to the physiological effects of a substance. For children ages 6–18 years, aggressive
behavior that occurs as part of an adjustment disorder should not be considered for this diagnosis.

Answer 30

Intermittent Explosive Disorder

Question 31

Disruptive, impulse-control, and conduct disorder characterized by repetitive and
persistent pattern of behavior in which the basic rights of others or major ageappropriate
societal norms or rules are violated, as manifested by the presence of
at least three of the following 15 criteria in the past 12 months from any of the
categories below, with at least one criterion present in the past 6 months:
a. Aggression to People and Animals
b. Destruction of Property
c. Deceitfulness or Theft
d. Serious Violations of Rules
1. The disturbance in behavior causes clinically significant impairment in social,
academic, or occupational functioning.
2. If the individual is age 18 years or older, criteria are not met for antisocial
personality disorder.

Answer 31

Conduct Disorder

Question 32

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

Answer 32

Antisocial Personality Disorder

Question 33

Disruptive, impulse-control, and conduct disorder characterized by deliberate
and purposeful fire setting on more than one occasion.
1. Tension or affective arousal before the act.
2. Fascination with, interest in, curiosity about, or attraction to fire and its situational
contexts (e.g., paraphernalia, uses, consequences).
3. Pleasure, gratification, or relief when setting fires or when witnessing or
participating in their aftermath.
4. The fire setting is not done for monetary gain, as an expression of sociopolitical
ideology, to conceal criminal activity, to express anger or vengeance, to improve
one’s living circumstances, in response to a delusion or hallucination, or as a result
of impaired judgment (e.g., in major neurocognitive disorder, intellectual disability
[intellectual developmental disorder], substance intoxication).
5. The fire setting is not better explained by conduct disorder, a manic episode, or
antisocial personality disorder.

Answer 33

Pyromania

Question 34

Disruptive, impulse-control, and conduct disorder characterized by
recurrent failure to resist impulses to steal objects that are not
needed for personal use or for their monetary value.
1. Increasing sense of tension immediately before committing the theft.
2. Pleasure, gratification, or relief at the time of committing the theft.
3. The stealing is not committed to express anger or vengeance and is not
in response to a delusion or a hallucination.
4. The stealing is not better explained by conduct disorder, a manic
episode, or antisocial personality disorder.

Answer 34

Kleptomania

Question 35

• A predominant complaint of dissatisfaction with sleep quantity or quality, associated with 1 or more of the following:
o Difficulty initiating sleep
o Difficulty maintain sleep, characterized by frequent awakenings or problems returning to sleep after awakenings
o Early-morning awakening with inability to return to sleep

Answer 35

Insomnia

Question 36

• Self-reported excessive sleepiness (hypersomnolence) despite a main sleep period lasting at least 7 hours, with at least 1 of the following:
o Recurrent periods of sleep or lapses into sleep within the same day
o A prolonged main sleep episode of more than 9 hours/day that is nonrestorative (unrefreshing)
o Difficulty being fully awake after abrupt awakening

Answer 36

 Hypersomnolence Disorder

Question 37

• Recurrent periods of an irrepressible need to sleep, lapsing into sleep, or napping occurring within the same day

Answer 37

Narcolepsy

Question 38

 Nocturnal breathing disturbances: snoring, gasping, or breathing pauses during sleep
 Daytime sleepiness, fatigue, or unrefreshing sleep despite sufficient opportunities to sleep

Answer 38

Obstructive Sleep Apnea

Question 39

• Polysomnography demonstrates episodes of decreased respiration associated with elevated CO2 levels

Answer 39

 Sleep-Related Hypoventilation

Question 40

• Evidence by polysomnography of 5 or more central apneas per hour of sleep

Answer 40

Central Sleep Apnea

Question 41

• A persistent or recurrent pattern of sleep disruption that is primarily due to an alteration of the circadian system or to a misalignment between the endogenous circadian rhythm and the sleep-wake schedule required by an individual’s physical environment or social or professional schedule

Answer 41

 Circadian Rhythm Sleep-Wake Circadian rhythm disorders

Question 42

o A pattern of delayed sleep onset and awakening times, with an inability to fall asleep and awaken at a desired or conventionally acceptable earlier time

Answer 42

• Delayed Sleep Phase Type

Question 43

o A pattern of advanced sleep onset and awakening times, with an inability to remain awake or asleep until the desired or conventionally acceptable later sleep or wake times

Answer 43

• Advanced Sleep Phase Type

Question 44

o A temporary disorganized sleep-wake pattern, such as the timing of sleep and wake periods is variable throughout the 24-hour period

Answer 44

• Irregular Sleep-Wake Type

Question 45

o A pattern of sleep-wake cycles that is not synchronized to the 24-hour environment, with a consistent daily drift of sleep onset and wake times

Answer 45

• Non-24-Hour Sleep-Wake Type

Question 46

o Insomnia during the major sleep period and/or excessive sleepiness during the major awake period associated with a shift work schedule

Answer 46

• Shift Work Type

Question 47

• Recurrent episodes of incomplete awakening from sleep, usually during the first 1/3 of the major sleep episode, accompanied by either one of the following:

Answer 47

 Non-REM Sleep Arousal Disorders

Question 48

 Repeated episodes of rising from bed during sleep and walking about. While sleepwalking, the individual has a blank, staring face; is relatively unresponsive to the efforts of others to communicate with him or her; and can be awakened only with great difficulty

Answer 48

Sleep walking

Question 49

 Recurrent episodes of abrupt terror arousals from sleep, usually beginning with a panicky scream. There is intense fear and signs of autonomic arousal, such as mydriasis, tachycardia, rapid breathing, and sweating, during each episode. There is relative unresponsiveness to efforts of others to comfort the individual during the episode

Answer 49

Sleep Terror

Question 50

• Repeated occurrences of extended, extremely dysmorphic, and well-remembered dreams that usually involve efforts to avoid threats to survival, security, or physical integrity and that generally occur during the second half of the major sleep episode
• On awakening, the patient rapidly becomes oriented and alert

Answer 50

Nightmare Disorder

Question 51

• Repeated episodes of arousal during sleep associated with vocalization and/or complex motor behaviors
• These arise during REM sleep and therefore usually occur within 90 minutes after sleep onset, are more frequent during the later portions of the sleep period, and uncommonly occur during daytime naps

Answer 51

 REM Sleep Behavior Disorder

Question 52

• An urge to move the legs, usually accompanied by or in response to uncomfortable and unpleasant sensations in the legs,

Answer 52

Restless Leg Syndrome