LONG QUIZ [CHAPTER 6-8] Flashcards
1
Q
Individuals are pathologically concerned with the functioning of their bodies; have an excessive or maladaptive response to physical symptoms or to associated health concerns.
5 basic disorders:
(i) Somatic Symptom Disorder
(ii) Illness Anxiety Disorder
(iii) Psychological Factors Affecting Medical Condition
(iv) Functional Neurological Symptom Disorder (Conversion Disorder)
(v) Factitious Disorder
These disorders are sometimes grouped under the shorthand label of “medically unexplained physical symptoms”
A
Somatic Symptom and Related Disorders
2
Q
Individuals experience intense and extreme alterations, or detachments, in consciousness or identity (dissociation or dissociative experiences) that they lose their identity entirely and assume a new one, or they lose their memory or sense of reality and are unable to function.
Disorders:
(i) Depersonalization-Derealization Disorder
(ii) Dissociative Amnesia
(iii) Dissociative Identity Disorder
A
Dissociative Disorders
3
Q
Somatic symptom and dissociative disorders are strongly linked historically and used to be categorized under one general heading, _________ _________.
A
Hysterical Neurosis
4
Q
Soma means
A
Body
5
Q
Soma means body, and the problems preoccupying these people seem, initially, to be ________ ________
A
Physical Disorders
6
Q
A. One or more somatic symptoms that are distressing or result in significant disruption of daily life.
B. Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health
concerns as manifested by at least one of the following:
(1) Disproportionate and persistent thoughts about the seriousness of one’s symptoms.
(2) Persistently high level of anxiety about health or symptoms
(3) Excessive time and energy devoted to these symptoms or health concerns.
C. Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months).
- Formerly known as Briquet’s syndrome
- An important feature of these physical symptoms, such as pain, is that it is real and it
hurts whether there are clear physical reasons for pain or not
A
SOMATIC SYMPTOM DISORDER
7
Q
A. Preoccupation with having or acquiring a serious illness.
B. 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 (e.g., strong family history is present), the preoccupation is clearly excessive or disproportionate.
C. There is a high level of anxiety about health, and the individual is easily alarmed about personal
health status.
D. The individual performs excessive health-related behaviors (e.g., repeatedly checks his or her
body for signs of illness) or exhibits maladaptive avoidance (e.g., avoids doctor appointments
and hospitals).
- Formerly known as “hypochondriasis”
- Preoccupation with physical symptoms. Physical symptoms are either not experienced at
the present time or are very mild, but severe anxiety is focused on the possibility of having or developing a serious disease; the concern is primarily with the idea of being sick instead of the physical symptom itself; individual is preoccupied with bodily symptoms, misinterpreting them as indicative of illness or disease.
A
ILLNESS ANXIETY DISORDER
8
Q
A difficult to shake belief
A
Disease Conviction
9
Q
Requires the presence of medical conditions as well as psychological factors that adversely affect its course or interfere its treatment.
Example: Anxiety severe enough to clearly worsen an asthmatic condition.
Note: This diagnosis would need to be distinguished from the development of stress or anxiety in response to having a severe medical condition that would be more appropriately be diagnosed as an adjustment disorder.
A. A medical symptom or condition (other than a mental disorder) is present.
B. Psychological or behavioral factors adversely affect the medical condition in one of the following ways:
1. 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.
2. The factors interfere with the treatment of the medical condition (e.g., poor adherence).
3. The factors constitute additional well-established health risks for the individual.
4. The factors influence the underlying pathophysiology, precipitating or exacerbating symptoms or necessitating medical attention.
A
PSYCHOLOGICAL FACTORS AFFECTING MEDICAL CONDITION
10
Q
A. Falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception.
B. The individual presents himself or herself to others as ill, impaired, or injured.
C. The deceptive behavior is evident even in the absence of obvious external rewards.
D. The behavior is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder.
A
FACTITIOUS DISORDER IMPOSED ON SELF
11
Q
A. Falsification of physical or psychological signs or symptoms, or induction of injury or disease, in another, associated with identified deception.
B. The individual presents another individual (victim) to others as ill, impaired, or injured.
C. The deceptive behavior is evident even in the absence of obvious external rewards.
D. The behavior is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder.
A
FACTITIOUS DISORDER IMPOSED ON ANOTHER (FORMERLY FACTITIOUS DISORDER BY PROXY)
12
Q
A. One or more symptoms of altered voluntary motor or sensory function.
B. Clinical findings provide evidence of incompatibility between the symptom and recognized neurological or medical conditions.
C. The symptom or deficit is not better explained by another medical or mental disorder.
D. The symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation.
A
FUNCTIONAL NEUROLOGICAL SYMPTOM DISORDER (CONVERSION DISORDER)
13
Q
➢ Severe and frightening feeling of unreality that they dominate an individual’s life and prevent normal functioning
A. The presence of 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 (e.g., perceptual alterations, distorted sense of time, unreal or absent self, emotional and/or physical numbing).
- Derealization: Experiences of unreality or detachment with respect to surroundings (e.g., individuals or objects are experienced as unreal, dreamlike, foggy, lifeless, or visually distorted).
B. During the depersonalization or derealization experiences, reality testing remains intact.
A
DEPERSONALIZATION/DEREALIZATION DISORDER
14
Q
➢ Perception alters and temporarily loses the sense of one’s own reality, as if you were in a dream and you were watching yourself.
➢ A feeling of unreality or detachment from, or unfamiliarity with, the individual’s whole self or from aspects of the self
➢ The individual may feel detached from his or her:
- entire being (e.g., “I am no one,” “I have no self”)
- feelings (e.g., hypoemotionality: “I know I have feelings, but I don’t feel
them”)
- thoughts (e.g., “My thoughts don’t feel like my own,” “head filled with
cotton”)
- whole body or body parts, or sensations (e.g., touch, proprioception,
hunger, thirst, libido).
➢ There may also be a diminished sense of agency (e.g., feeling robotic, like an
automaton; lacking control of speech or movements).
➢ The unitary symptom of “_______________” consists of several symptom factors:
- anomalous body experiences (i.e., unreality of the self and perceptual alterations);
- emotional or physical numbing; and
- temporal distortions with anomalous subjective recall.
A
DEPERSONALIZATION
15
Q
➢ Sense of the reality of the external world is lost
➢ A feeling of unreality or detachment from, or unfamiliarity with, the world, be it individuals, inanimate objects, or all surroundings
➢ Feel as if he or she were in a fog, dream, or bubble, or as if there were a veil or a glass wall between the individual and the world around.
➢ Surroundings may be experienced as artificial, colorless, or lifeless.
➢ _____________ is commonly accompanied by subjective visual distortions, such as blurriness, heightened acuity, widened or narrowed visual field, two-dimensionality or flatness, exaggerated three-dimensionality, or altered distance or size of objects (i.e., macropsia or micropsia).
➢ Auditory distortions can also occur, whereby voices or sounds are muted or heightened.
A
DEREALIZATION
16
Q
● Characterized by an inability to recall autobiographical information that is inconsistent with normal forgetting.
● Memory deficits are primarily retrograde and often associated with traumatic experiences.
A
DISSOCIATIVE AMNESIA
17
Q
- characterized by apparently purposeful travel or bewildered wandering
- associated with amnesia for identity or other important autobiographical information.
- subtype of dissociative amnesia
- amnesia for travel
- commonly associated with generalized dissociative amnesia.
A
DISSOCIATIVE FUGUE
18
Q
An individual enters a trancelike state and suddenly, imbued with a mysterious source of energy, runs or flees for a long time.
A
RUNNING DISORDERS
19
Q
- Individuals in this trancelike state often brutally assault and sometimes kill people or animals.
- Apparently distinct dissociative state not found in Western cultures.
- Most people with this disorder are males.
A
AMOK
20
Q
Types of Dissociative Amnesia
A
Localized
Selective
Systematized
Generalized
21
Q
A failure to recall events during a circumscribed period of time.
A
LOCALIZED
22
Q
The individual can recall some, but not all, of the events during a circumscribed period of time.
A
SELECTIVE
23
Q
The individual fails to recall a specific category of important information.
A
SYSTEMATIZED
24
Q
Involves a complete loss of memory for most or all of the individual’s life history.
A
GENERALIZED
25
➢ Characterized by a) the presence of two or more distinct personality states or an experience of possession and b) recurrent episodes of dissociative amnesia.
➢ May adopt as many as 100 new identities, all simultaneously coexisting, although the average number is closer to 15.
➢ Individuals with _________ _________ __________ experience recurrent, inexplicable intrusions into their conscious functioning and sense of self; alterations of sense of self; odd changes of perception; and intermittent functional neurological symptoms
A. Disruption of identity characterized by two or more distinct personality states, which may be described in some cultures as an experience of possession. The disruption in identity involves marked discontinuity in sense of self and sense of agency, accompanied by related alterations in affect, behavior, consciousness, memory, perception, cognition,and/or sensory-motor functioning. These signs and symptoms may be observed by others or reported by the individual.
B. Recurrent gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgettin
DISSOCIATIVE IDENTITY DISORDER
26
The disorders described in this chapter used to be categorized under several general labels, such as “depressive disorders,” “affective disorders,” or even “depressive neuroses.” Beginning with the third edition of the Diagnostic and Statistical Manual (DSM-III), published by the American Psychiatric Association in 1980, these problems have been grouped under the heading _________ _____________ because they are characterized by gross deviations in mood.
MOOD DISORDERS
27
Individuals who experience either depression or mania are said to suffer from a ________ ________ _________, because their mood remains at one “pole” of the usual depression–mania continuum.
UNIPOLAR MOOD DISORDER
28
An individual can experience manic symptoms but feel somewhat depressed or anxious at the same time, or be depressed with a few symptoms of mania. This episode is characterized as having _______ ____________.
MIXED FEATURES
29
Include disruptive mood dysregulation disorder, major depressive disorder (including major depressive episode), persistent depressive disorder, and premenstrual dysphoric disorder.
- The common feature of all of these disorders is the presence of sad, empty, or irritable mood, accompanied by related changes that significantly affect the individual’s capacity to function
DEPRESSIVE DISORDERS
30
The most easily recognized mood disorder is ______ ___________ ___________, defined by the presence of depression and the absence of manic, or hypomanic episodes, before or during the disorder. An occurrence of just one isolated depressive episode in a lifetime is now known to be relatively rare.
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.
1. 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.)
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation).
3.
Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected weight gain.)
4. Insomnia or hypersomnia nearly every day.
5. Psychomotor agitation or retardation nearly every day
(observable by others, not merely subjective feelings of restlessness or being slowed down).
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
9. 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.
MAJOR DEPRESSIVE DISORDER
31
This disorder represents a consolidation of DSM-IV-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:
1. Poor appetite or overeating.
2. Insomnia or hypersomnia.
3. Low energy or fatigue.
4. Low self-esteem.
5. Poor concentration or difficulty making decisions.
6. Feelings of hopelessness.
PERSISTENT DEPRESSIVE DISORDER
32
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:
1. Marked affective lability (e.g., mood swings; feeling suddenly sad or tearful, or increased sensitivity to
rejection).
2. Marked irritability or anger or increased interpersonal
conflicts.
3. Marked depressed mood, feelings of hopelessness, or
self-deprecating thoughts.
4. Marked anxiety, tension, and/or feelings of being keyed up or on edge.
PREMENSTRUAL DYSPHORIC DISORDER
33
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.
DISRUPTIVE MOOD DYSREGULATION DISORDER
34
Are found between the chapters on schizophrenia spectrum and other psychotic disorders and depressive disorders in DSM-5-TR in recognition of their place as a bridge between those two diagnostic classes in terms of symptomatology, family history, and genetics.
This include bipolar I disorder, bipolar II disorder, cyclothymic disorder, substance/medication-induced bipolar and related disorder, bipolar and related disorder due to another medical condition, other specified bipolar and related disorder, and unspecified bipolar and related disorder.
BIPOLAR RELATED DISORDERS
35
For a diagnosis of _________ ____ ___________, it is necessary to meet the following criteria for a manic episode. The manic episode may have been preceded by and may be followed by hypomanic or major depressive episodes.
BIPOLAR I DISORDER
36
A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 1 week and present most of the day, nearly every day (or any duration if hospitalization is necessary).
B. During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms (four if the mood is only irritable) are present to
a significant degree and represent a noticeable change from usual behavior:
1. Inflated self-esteem or grandiosity.
2. Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).
3. More talkative than usual or pressure to keep talking.
4. Flight of ideas or subjective experience that thoughts are racing.
5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed.
6. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (i.e., purposeless non-goal-directed activity).
7. Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).
MANIC EPISODE
37
A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day.
B. During the period of mood disturbance and increased energy and activity, three (or more) of the following symptoms (four if the mood is only irritable) have persisted, represent a noticeable change from usual behavior, and have been present to a significant degree:
1. Inflated self-esteem or grandiosity.
2. Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).
3. More talkative than usual or pressure to keep talking.
4. Flight of ideas or subjective experience that thoughts are racing.
5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed.
6. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation.
7. Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).
HYPOMANIC EPISODE
38
For a diagnosis of __________ ___ ___________, it is necessary to meet the following criteria for a current or past hypomanic episode and the following criteria for a current or past major depressive episode.
BIPOLAR II DISORDER
39
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 a medical condition.
1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, or hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, can be irritable mood.)
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation).
3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected weight gain.)
4. Insomnia or hypersomnia nearly every day.
5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
9. 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.
MAJOR DEPRESSIVE EPISODE
40
A. For at least 2 years (at least 1 year in children and adolescents) there have been numerous periods with hypomanic symptoms that do not meet criteria for a hypomanic episode and numerous periods with depressive symptoms that do not meet criteria for a major depressive episode.
B. During the above 2-year period (1 year in children and adolescents), Criterion A symptoms have been present for at least half the time and the individual has not been without the symptoms for more than 2 months at a time.
C. Criteria for a major depressive, manic, or hypomanic episode have never been met.
D. The symptoms in Criterion A are not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.
E. 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., hyperthyroidism).
F. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
The essential feature of _____________ __________ is a chronic, fluctuating mood disturbance involving numerous periods of hypomanic symptoms and periods of depressive symptoms (Criterion A). The hypomanic symptoms are of insufficient number, severity, pervasiveness, and/or duration to meet full criteria for a hypomanic episode, and the depressive symptoms are of insufficient number, severity, pervasiveness, and/or duration to meet full criteria for a major depressive episode
CYCLOTHYMIC DISORDER
41
Death caused by injuring oneself with the intent to die.
SUICIDE
42
Important indicators of Suicide
Suicidal Ideation
Suicidal Plans
Suicidal Attempts
43
Thinking seriously about suicide
SUICIDAL IDEATION
44
The formulation of a specific method for killing oneself
SUICIDAL PLANS
45
The person survived
SUICIDAL ATTEMPTS
46
Emile Durkhein, a great sociologist, defines a number of suicide types based on the social or cultural conditions in which they occurred.
Altruistic Suicide
Egoistic Suicide
Anomic Suicide
Fatalistic Suicide
47
In Japan, an individual who brought dishonor to himself of his family was expected to impale himself on a sword.
ALTRUISTIC SUICIDE
48
Loss of social suppoort as an important provocation for suicide
EGOISTIC SUICIDE
49
Result of marked disruptions, such as sudden loss of high-prestige job.
ANOMIC SUICIDE
50
Result from a loss of control over one’s own destiny.
FATALISTIC SUICIDE
51
Ideation, hopelessness, burdensomeness, feeling trapped.
SUICIDAL DESIRE
52
Past attempts, high anxiety and/or rage, available means.
SUICIDAL CAPABILITY
53
Available plan, expressed intent to die, preparatory behavior.
SUICIDAL INTENT
54
A. Within the last 24 months, the individual has made a suicide attempt. Note: A suicide attempt is a self-initiated sequence of behaviors by an individual who, at the time of initiation, expected that the set of actions would lead to his or her own death. (The “time of initiation” is the time when a behavior took place that involved applying the method.)
B. The act does not meet criteria for nonsuicidal self-injury—that is, it does not involve self-injury directed to the surface of the body undertaken to induce relief from a negative feeling/cognitive state or to achieve a positive mood state.
C. The diagnosis is not applied to suicidal ideation or to preparatory acts.
D. The act was not initiated during a state of delirium or confusion.
E. The act was not undertaken solely for a political or religious objective.
Specify if:
Current: Not more than 12 months since the last attempt. In early remission: 12–24 months since the last attempt
SUICIDAL BEHAVIOR DISORDER
55
The essential manifestation of _________ ___________ ________ is a suicide attempt. The behavior might or might not lead to injury or serious medical consequences. Several factors can influence the medical consequences of the suicide attempt, including poor planning, lack of knowledge about the lethality of the method chosen, low intentionality or ambivalence, or chance intervention by others after the behavior has been initiated. These should not be considered in assigning the diagnosis.
SUICIDAL BEHAVIOR DISORDER
56
A. In the last year, the individual has, on 5 or more days, engaged in intentional self-inflicted damage to the surface of his or her body of a sort likely to induce bleeding, bruising, or pain (e.g., cutting, burning, stabbing, hitting, excessive rubbing), with the expectation that the injury will lead to only minor or moderate physical harm (i.e., there is no suicidal intent).
Note: The absence of suicidal intent has either been stated by the individual or can be inferred by the individual’s repeated engagement in a behavior that the individual knows, or has learned, is not likely to result in death.
B. The individual engages in the self-injurious behavior with one or more of the following expectations:
1. To obtain relief from a negative feeling or cognitive state.
2. To resolve an interpersonal difficulty.
3. To induce a positive feeling state. Note: The desired relief or response is experienced during or shortly after the self-injury, and the individual may display patterns of behavior suggesting a dependence on repeatedly engaging in it.
NONSUICIDAL SELF-INJURY DISORDER
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The essential feature of ____________ ______ ______ ____________ is that the individual repeatedly inflicts minor-to-moderate, often painful injuries to the surface of his or her body without suicidal intent. Most commonly, the purpose is to reduce negative emotions, such as tension, anxiety, sadness, or self-reproach, or less often to resolve an interpersonal difficulty. In some cases, the injury is conceived of as a deserved self-punishment. The individual will often report an immediate sensation of relief that occurs during the process. When the behavior occurs frequently, it might be associated with a sense of urgency and craving, the resultant behavioral pattern resembling an addiction. The inflicted wounds can become deeper and more numerous.
NONSUICIDAL SELF-INJURY DISORDER
58
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.
a. Pica
b. Rumination disorder
c. Avoidant/restrictive food intake disorder
d. Anorexia nervosa
e. Bulimia nervosa
f. Binge-eating disorder
g. Other Specified Feeding or Eating Disorder
h. Unspecified Feeding or Eating Disorder
FEEDING AND EATING DISORDER
59
A. Persistent eating of nonnutritive, nonfood substances over a period of at least 1 month.
B. The eating of nonnutritive, nonfood substances is inappropriate to the developmental level of the individual.
C. The eating behavior is not part of a culturally supported or socially normative practice.
D. If the eating behavior occurs in the context of another mental disorder (e.g., intellectual developmental disorder [intellectual disability], autism spectrum disorder, schizophrenia) or medical condition (including pregnancy), it is sufficiently severe to warrant additional clinical attention.
PICA
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A. Repeated regurgitation of food over a period of at least 1 month. Regurgitated food may be re-chewed, re-swallowed, or spit out.
B. The repeated regurgitation is not attributable to an associated gastrointestinal or other medical condition (e.g., gastroesophageal reflux, pyloric stenosis).
C. The eating disturbance does not occur exclusively during the course of anorexia nervosa, bulimia nervosa, binge-eating disorder, or avoidant/restrictive food intake disorder.
D. If the symptoms occur in the context of another mental disorder (e.g., intellectual developmental disorder [intellectual disability] or another neurodevelopmental disorder), they are sufficiently severe to warrant additional clinical attention.
RUMINATION DISORDER
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A. An eating or feeding disturbance (e.g., apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating) associated with one (or more) of the following:
1. Significant weight loss (or failure to achieve expected weight gain or faltering growth in children).
2. Significant nutritional deficiency.
3. Dependence on enteral feeding or oral nutritional supplements.
4. Marked interference with psychosocial functioning.
B. The disturbance is not better explained by lack of available food or by an associated culturally sanctioned practice.
C. 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.
AVOIDANT/RESTRICTIVE FOOD INTAKE DISORDER
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A. 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. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected.
B. Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though 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 the seriousness of the current low body weight.
- Persistent energy intake restriction; intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain; and a disturbance in self-perceived weight or shape. The individual maintains a body weight that is below a minimally normal level for age, sex, developmental trajectory, and physical health (Criterion A).
ANOREXIA NERVOSA
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A. Recurrent episodes of binge eating. 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 individuals 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).
B. 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.
C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months.
D. Self-evaluation is unduly influenced by body shape and weight.
E. The disturbance does not occur exclusively during episodes of anorexia nervosa.
- recurrent episodes of binge eating (Criterion A), recurrent inappropriate compensatory behaviors to prevent weight gain (Criterion B), and self-evaluation that is unduly influenced by body shape and weight (Criterion D). To qualify for the diagnosis, the binge eating and inappropriate compensatory behaviors must occur, on average, at least once per week for 3 months (Criterion C).
BULIMIA NERVOSA
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A. Recurrent episodes of binge eating. 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).
B. 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.
C. Marked distress regarding binge eating is present.
BINGE-EATING DISORDER
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All involve the inappropriate elimination of urine or feces and are usually first diagnosed in childhood or adolescence. This group of disorders includes
enuresis, the repeated voiding of urine into inappropriate places, and encopresis, the repeated passage of feces into inappropriate places.
ELIMINATION DISORDERS
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A. Repeated voiding of urine into bed or clothes, whether involuntary or intentional.
B. 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.
C. Chronological age is at least 5 years (or equivalent developmental level).
D. 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).
- Repeated voiding of urine during the day or at night into bed or clothes (Criterion A). Most often the voiding is involuntary, but occasionally it may be intentional.
ENURESIS
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A. Repeated passage of feces into inappropriate places (e.g., clothing, floor), whether involuntary or intentional.
B. At least one such event occurs each month for at least 3 months.
C. Chronological age is at least 4 years (or equivalent developmental level).
D. 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.
- Repeated passage of feces into inappropriate places (e.g., clothing or floor) (Criterion A). Most often the passage is involuntary but occasionally may be intentional.
ENCOPRESIS
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2 Categories of Sleep-Wake Disorders
Dyssomnias
Parasomnias
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Dyssomnias
● Insomnia Disorder
● Hypersomnolence Disorders
● Narcolepsy
● Breathing-related disorders
● Circadian Rhythm Sleep-wake
Disorder
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Parasomnias
● Disorder of Arousal
● Nightmare Disorder
● Rapid Eye Movement Sleep Behavior
Disorder
● Restless Legs Syndrome
● Substance-Induced Sleep Disorder
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A. A predominant complaint of dissatisfaction with sleep quantity or quality, associated with one (or more) of the following symptoms:
1. Difficulty initiating sleep. (In children, this may manifest as difficulty initiating sleep without caregiver intervention.)
2. Difficulty maintaining sleep, characterized by frequent awakenings or problems returning to sleep after awakenings. (In children, this may manifest as difficulty returning to sleep without caregiver intervention.)
3. Early-morning awakening with inability to return to sleep.
B. The sleep disturbance causes clinically significant distress or impairment in social, occupational, educational, academic, behavioral, or other important areas of functioning.
C. The sleep difficulty occurs at least 3 nights per week.
D. The sleep difficulty is present for at least 3 months.
E. The sleep difficulty occurs despite adequate opportunity for sleep.
- Dissatisfaction with sleep quantity or quality with complaints of difficulty initiating or maintaining sleep. The sleep complaints are accompanied by clinically significant distress or impairment in social, occupational, or other important areas of functioning. The sleep disturbance may occur during the course of another mental disorder or medical condition, or it may occur independentl
INSOMNIA DISORDER
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Different manifestations of insomnia.
Sleep-onset Insomnia
Sleep-maintenance Insomnia
Late Insomnia
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Difficulty initiating sleep at bedtime.
SLEEP-ONSET INSOMNIA
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Frequent or prolonged awakenings throughout the night.
SLEEP-MAINTENANCE INSOMNIA
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Early-morning awakening with an inability to return to sleep.
LATE INSOMNIA
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A. Self-reported excessive sleepiness (hypersomnolence) despite a main sleep period lasting at least 7 hours, with at least one of the following symptoms:
1. Recurrent periods of sleep or lapses into sleep within the same day.
2. A prolonged main sleep episode of more than 9 hours per day that is nonrestorative (i.e., unrefreshing).
3. Difficulty being fully awake after abrupt awakening.
- Includes symptoms of excessive quantity of sleep (e.g., extended nocturnal sleep or long naps), sleepiness, and sleep inertia (i.e., a period of impaired performance and reduced vigilance following awakening from the regular sleep episode or from a nap) (Criterion A). Individuals with this disorder generally fall asleep quickly and have a good sleep efficiency (> 90%).
HYPERSOMNOLENCE DISORDER
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A. Recurrent periods of an irrepressible need to sleep, lapsing into sleep, or napping occurring within the same day. These must have been occurring at least three times per week over the past 3 months.
B. The presence of at least one of the following:
1. Episodes of cataplexy, defined as either (a) or (b), occurring at least a few times per month:
a. In individuals with long-standing disease, brief (seconds to minutes) episodes of sudden bilateral loss of muscle tone with maintained consciousness that are precipitated by laughter or joking.
b. In children or in individuals within 6 months of onset, spontaneous grimaces or jaw-opening episodes with tongue thrusting or a global hypotonia, without any obvious emotional triggers.
2. Hypocretin deficiency, as measured using cerebrospinal fluid (CSF) hypocretin-1 immunoreactivity values (less than or equal to one-third of values obtained in healthy subjects tested using the same assay, or less than or equal to 110 pg/mL). Low CSF levels of hypocretin-1 must not be observed in the context of acute brain injury, inflammation, or infection.
3. Nocturnal sleep polysomnography showing rapid eye movement (REM) sleep latency less than or equal to 15 minutes, or a multiple sleep latency test showing a mean sleep latency less than or equal to 8 minutes and two or more sleep-onset REM periods.
- Are recurrent daytime naps or lapses into sleep that occur typically daily but that must occur at a minimum of three times a week for at least 3 months (Criterion A), and are accompanied by one or more of the following: cataplexy (Criterion B1), hypocretin deficiency (Criterion B2), or characteristic abnormalities on a nocturnal polysomnogram or on the MSLT (Criterion B3).
NARCOLEPSY
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A condition that brings on brief bouts of muscle weakness or paralysis.
CATAPLEXY
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(Also known as orexin) is a neuropeptide hormone produced in the hypothalamus that exerts important influences over sleep, arousal, appetite and energy expenditure.
HYPOCRETIN
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The breathing-related sleep disorders category encompasses three relatively distinct disorders:
● Obstructive sleep apnea hypopnea
● Central sleep apnea
● Sleep-related hypoventilation
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A. Either (1) or (2):
1. Evidence by polysomnography of at least five obstructive apneas or hypopneas per hour of sleep and either of the following sleep symptoms:
a. Nocturnal breathing disturbances: snoring, snorting/gasping, or breathing pauses during sleep.
b. Daytime sleepiness, fatigue, or unrefreshing sleep despite sufficient opportunities to sleep that is not better explained by another mental disorder (including a sleep disorder) and is not attributable to another medical condition.
2. Evidence by polysomnography of 15 or more obstructive apneas and/or hypopneas per hour of sleep regardless of accompanying symptoms.
- The most common breathing-related sleep disorder. It is characterized by repeated episodes of upper (pharyngeal) airway obstruction (apneas and hypopneas) during sleep. Each apnea or hypopnea represents a reduction in breathing of at least 10 seconds in duration in adults or two missed breaths in children and is typically associated with drops in oxygen saturation of ≥ 3% and/or an electroencephalographic arousal.
- Snoring and daytime sleepiness
OBSTRUCTIVE SLEEP APNEA HYPOPNEA
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A. Evidence by polysomnography of five or more central apneas per hour of sleep.
B. The disorder is not better explained by another current sleep disorder.
- Characterized by repeated episodes of apneas and hypopneas during sleep caused by variability in respiratory effort. These are disorders of ventilatory control in which respiratory events occur in a periodic or intermittent patte
CENTRAL SLEEP APNEA
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Characterized by repeated episodes of apneas and hypopneas during sleep caused by variability in respiratory effort but without evidence of airway obstruction.
IDIOPATHIC CENTRAL SLEEP APNEA
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A pattern of periodic crescendo-decrescendo variation in tidal volume that results in central apneas and hypopneas at a frequency of at least five events per hour, accompanied by frequent arousal.
CHEYNE-STROKES BREATHING
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Subtypes of Central Sleep Apnea
IDIOPATHIC CENTRAL SLEEP APNEA
CENTRAL SLEEP APNEA WITH CHEYNE-STROKES BREATHING
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A. Polysomnograpy demonstrates episodes of decreased respiration associated with elevated CO2 levels. (Note: In the absence of objective measurement of
CO2, persistent low levels of hemoglobin oxygen saturation unassociated with apneic/hypopneic events may indicate hypoventilation.)
B. The disturbance is not better explained by another current sleep disorder.
SLEEP-RELATED HYPOVENTILATION
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A. 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.
B. The sleep disruption leads to excessive sleepiness or insomnia, or both.
C. The sleep disturbance causes clinically significant distress or impairment in social, occupational, and other important areas of functioning.
- The delayed sleep phase type is based primarily on a history of a delay in the timing of the major sleep period (usually more than 2 hours) in relation to the desired sleep and wake-up time, resulting in symptoms of insomnia and excessive sleepiness. When allowed to set their own schedule, individuals with delayed sleep phase type exhibit normal sleep quality and duration for age. Symptoms of sleep-onset insomnia, difficulty waking in the morning, and excessive sleepiness early in the day are prominent.
CIRCADIAN RHYTHM SLEEP-WAKE DISORDER
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Disorders characterized by abnormal behavioral, experiential, or physiological events occurring in association with sleep, specific sleep stages, or sleep-wake transitions. The most common parasomnias are non–rapid eye movement (NREM) sleep arousal disorders and rapid eye movement (REM) sleep behavior disorder. These conditions each have distinct pathophysiology, clinical characteristics, and prognostic and therapeutic considerations discussed in the following sections specific to each disorder.
PARASOMNIAS
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A. Recurrent episodes of incomplete awakening from sleep, usually occurring during the first third of the major sleep episode, accompanied by either one of the following:
1. Sleepwalking: 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.
2. Sleep terrors: 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 episodes.
B. No or little (e.g., only a single visual scene) dream imagery is recalled.
C. Amnesia for the episodes is present.
- Repeated occurrence of incomplete arousals, usually beginning during the first third of the major sleep episode (Criterion A), that typically are brief, lasting 1–10 minutes, but may be protracted, lasting up to 1 hour. The maximum duration of an event is unknown. The eyes are typically open during these events.
NON RAPID EYE MOVEMENT SLEEP AROUSAL DISORDER
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A. Repeated occurrences of extended, extremely dysphoric, 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.
B. On awakening from the dysphoric dreams, the individual rapidly becomes oriented and alert.
C. The sleep disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
D. The nightmare symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication).
E. Coexisting mental disorders and medical conditions do not adequately explain the predominant complaint of dysphoric dreams.
NIGHTMARE DISORDER
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Typically lengthy, elaborate, story-like sequences of dream imagery that seem real and that incite anxiety, fear, or other dysphoric emotions
NIGHTMARES
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A. Repeated episodes of arousal during sleep associated with vocalization and/or complex motor behaviors.
B. These behaviors arise during rapid eye movement (REM) sleep and therefore usually occur more than 90 minutes after sleep onset, are more frequent during the later portions of the sleep period, and uncommonly occur during daytime naps.
C. Upon awakening from these episodes, the individual is completely awake, alert, and not confused or disoriented.
D. Either of the following:
1. REM sleep without atonia on polysomnographic recording.
2. A history suggestive of REM sleep behavior disorder and an established synucleinopathy diagnosis (e.g., Parkinson’s disease, multiple system atrophy).
- Repeated episodes of vocalizations and/or complex motor behaviors arising from REM sleep (Criterion A). These behaviors often reflect motor responses to the content of action-filled or violent dreams of being attacked or trying to escape from a threatening situation, which may be termed dream enacting behaviors. The vocalizations are often loud, emotion-filled, and profane.
RAPID EYE MOVEMENT SLEEP DISORDER
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A. An urge to move the legs, usually accompanied by or in response to uncomfortable and unpleasant sensations in the legs, characterized by all of the following:
1. The urge to move the legs begins or worsens during periods of rest or inactivity.
2. The urge to move the legs is partially or totally relieved by movement.
3. The urge to move the legs is worse in the evening or at night than during the day, or occurs only in the evening or at night.
B. The symptoms in Criterion A occur at least three times per week and have persisted for at least 3 months.
- Sensorimotor, neurological sleep disorder characterized by a desire to move the legs or arms, usually associated with uncomfortable sensations typically described as creeping, crawling, tingling, burning, or itching (Criterion A).
RESTLESS LEGS SYNDROME
