The Big Six 3 Abnormal Psychology

Question 1

Acupuncture

Answer 1

Acupuncture is a traditional Asian method for restoring health and involves stimulating specific anatomical points on the body, usually with a thin metallic needle. The traditional explanation for its effects is that illness is due to a blockage of qi (vital life energy) and that acupuncture unblocks the flow of qi along the pathways through which it circulates in the body. Research suggests that its benefits may be due to the release of pain–suppressing substances or to an alteration in blood flow in areas around the needle or in certain regions of the brain.

Question 2

Acute Stress Disorder

Answer 2

The diagnosis of Acute Stress Disorder requires the development of at least nine symptoms following exposure to actual or threatened death, severe injury, or sexual violation in at least one of four ways (direct experience of the event; witnessing the event in person as it happened to others; learning that the event occurred to a close family member or friend; repeated or extreme exposure to aversive details of the event). Symptoms can be from any of five categories (intrusion, negative mood, dissociative symptoms, avoidance symptoms, arousal symptoms), have a duration of three days to one month, and cause clinically significant distress or impaired functioning.

Question 3

Adjustment Disorder

Answer 3

The Adjustment Disorders involve the development of emotional or behavioral symptoms in response to one or more identifiable psychosocial stressors within three months of the onset of the stressor(s). Symptoms must be clinically significant as evidenced by the presence of marked distress that is not proportional to the severity of the stressor and/or significant impairment in functioning, and they must remit within six months after termination of the stressor or its consequences

Question 4

Agoraphobia

Answer 4

A diagnosis of Agoraphobia requires the presence of marked fear of or anxiety about at least two of five situations (using public transportation, being in open spaces, being in enclosed spaces, standing in line or being part of a crowd, and being outside the home alone). The individual fears or avoids these situations due to a concern that escape might be difficult or help will be unavailable in case he/she develops incapacitating or embarrassing symptoms; and the situations nearly always provoke fear or anxiety and are actively avoided, require the presence of a companion, or are endured with intense fear or anxiety. The fear or anxiety is persistent, is not proportional to the threat posed by the situations, and causes clinically significant distress or impaired functioning.

Question 5

Alcohol–Induced Disorders Korsakoff Syndrome,
Sleep Disorder)

Answer 5

Korsakoff Syndrome: The DSM–5 distinguishes between two types of Alcohol–Induced Major Neurocognitive Disorder – nonamnestic–confabulatory type and amnestic–confabulatory type. The amnestic–confabulatory type is also known as Korsakoff Syndrome, and it is characterized by anterograde and retrograde amnesia and confabulation and has been linked to a thiamine deficiency.

Alcohol–Induced Sleep Disorder is usually of the insomnia type and can be the result of either Intoxication or Withdrawal.

Question 6

Anorexia Nervosa

Answer 6

The essential features of Anorexia Nervosa are (a) a restriction of energy intake that leads to a significantly low body weight; (b) an intense fear of gaining weight or becoming fat or behavior that interferes with weight gain; and (c) a disturbance in the way the person experiences his or her body weight or shape or a persistent lack of recognition of the seriousness of his/her low body weight.

Question 7

Antisocial Personality Disorder

Answer 7

Antisocial Personality Disorder is characterized by a pattern of disregard for and violation of the rights of others that has occurred since age 15 and involves at least three characteristic symptoms – e.g., failure to conform to social norms with respect to lawful behavior; deceitfulness; impulsivity; reckless disregard for the safety of self and others; lack of remorse. The person must be at least 18 years old and have a history of Conduct Disorder before 15 years of age.

Question 8

Attention–Deficit/Hyperactivity Disorder

Answer 8

ADHD is the appropriate diagnosis when the individual has at least six symptoms of inattention and/or six symptoms of hyperactivity–impulsivity and symptoms had an onset prior to 12 years of age, are present in at least two settings (e.g., home and school), and interfere with social, academic, or occupational functioning. About 15% of children with ADHD continue to meet the full diagnostic criteria for the disorder as young adults and another 60% meet the criteria for ADHD in partial remission. In adults, inattention predominates the symptom profile.

Question 9

Autism Spectrum Disorder

Answer 9

For a diagnosis of Autism Spectrum Disorder, the individual must exhibit (a) persistent deficits in social communication and interaction across multiple contexts as manifested by deficits in social–emotional reciprocity, nonverbal communication, and the development, maintenance, and understanding of relationships; (b) restricted, repetitive patterns of behavior, interests, and activities as manifested by at least two characteristic symptoms (e.g., stereotyped or repetitive motor movements, use of objects, or speech; inflexible adherence to routines, or ritualized patterns of behavior); (c) the presence of symptoms during the early developmental period; and (d) impaired functioning as the result of symptoms. The best outcomes are associated with an ability to communicate by age 5 or 6, an IQ over 70, and a later onset of symptoms.

Question 10

Avoidant Personality Disorder

Answer 10

Avoidant Personality Disorder is characterized by a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, as indicated by at least four characteristic symptoms – e.g., avoids work activities involving interpersonal contact due to a fear of criticism, rejection, or disapproval; is unwilling to get involved with people unless certain of being liked; is preoccupied with concerns about being criticized or rejected; views self as socially inept, inferior, or unappealing to others.

Question 11

Behavioral Pediatrics
(Hospitalization, Compliance)

Answer 11

Hospitalized children are at increased risk for emotional and behavioral problems, and children ages one to four tend to have the most negative reactions to hospitalization. Children and adolescents with chronic medical conditions have higher rates of school–related problems (e.g., CNS irradiation and intrathecal chemotherapy for leukemia have been linked to impaired neurocognitive functioning and learning disabilities). Compliance with medical regimens is a particular problem for adolescents.

Question 12

Behavioral Theory Of Depression
(Lewinsohn)

Answer 12

Lewinsohn’s behavioral theory attributes depression to a low rate of response–contingent reinforcement.

Question 13

Bipolar I Disorder

Answer 13

A diagnosis of Bipolar I Disorder requires at least one manic episode that lasts for at least one week, is present most of the day nearly every day, and includes at least three characteristic symptoms – e.g., inflated self–esteem or grandiosity; decreased need for sleep; flight of ideas. Symptoms must cause marked impairment in social or occupational functioning, require hospitalization to avoid harm to self or others, or include psychotic features. This disorder may include one or more episodes of hypomania or major depression. Treatment usually includes lithium or an anti–seizure medication and cognitive–behavior therapy or other form of therapy.

Question 14

Bipolar II Disorder

Answer 14

A diagnosis of Bipolar II Disorder requires at least one hypomanic episode and at least one major depressive episode. A hypomanic episode lasts for at least four consecutive days and involves at least three symptoms that are also associated with a manic episode but are not severe enough to cause marked impairment in functioning or require hospitalization. A major depressive episode lasts for at least two weeks and involves at least five characteristic symptoms, at least one of which must be a depressed mood or a loss of interest or pleasure.

Question 15

Borderline Personality Disorder

Answer 15

The essential feature of Borderline Personality Disorder is a pervasive pattern of instability in interpersonal relationships, self–image, and affect, and marked impulsivity. At least five characteristic symptoms must be present – e.g., frantic efforts to avoid abandonment; pattern of unstable, intense interpersonal relationships that are marked by fluctuations between idealization and devaluation; an identity disturbance involving a persistent instability in self–image or sense of self; recurrent suicide threats or gestures; transient stress–related paranoid ideation ors evere dissociative symptoms.

Question 16

Brief Psychotic Disorder

Answer 16

Brief Psychotic Disorder is characterized by the presence of one or more of four characteristic symptoms (delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior) with at least one symptom being delusions, hallucinations, or disorganized speech. Symptoms are present for at least one day but less than one month with an eventual return to full premorbid functioning.

Question 17

Bulimia Nervosa

Answer 17

Bulimia Nervosa is characterized by (a) recurrent episodes of binge eating that are accompanied by a sense of a lack of control; (b) inappropriate compensatory behavior to prevent weight gain (e.g., self–induced vomiting, excessive exercise); and (c) self–evaluation that is unduly influenced by body shape and weight.

Question 18

Concordance Rates For Schizophrenia

Answer 18

The rates of Schizophrenia are higher among individuals with genetic similarity, and, the greater the similarity, the higher the concordance rates: For example, for biological siblings, the rate is 10%; and, for identical (monozygotic) twins, the rate is 48%.

Relationship to Person with Schizophrenia/Concordance Rate

Biological Sibling: 10%

Fraternal (dizygotic) twin: 17%

Identical (monogygotic) twin: 48%

Child of two parents with Schizophrenia: 46%

Question 19

Conduct Disorder

Answer 19

The diagnosis of Conduct Disorder requires a persistent pattern of behavior that violates the basic rights of others and/or age–appropriate social norms or rules as evidenced by the presence of at least three characteristic symptoms during the past 12 months and at least one symptom in the past six months. Symptoms are divided into four categories: aggression to people and animals; destruction of property; deceitfulness or theft; and serious violation of rules. Symptoms must cause significant impairment in functioning, and the disorder cannot be assigned to individuals over age 18 who meet the criteria for Antisocial Personality Disorder.

Question 20

Conversion Disorder

Answer 20

The symptoms of Conversion Disorder involve disturbances in voluntary motor or sensory functioning and suggest a serious neurological or other medical condition (e.g., paralysis, seizures, blindness, loss of pain sensation) with evidence of an incompatibility between the symptom and recognized neurological or medical conditions.

Question 21

Cyclothymic Disorder

Answer 21

Cyclothymic Disorder is characterized by multiple periods of hypomanic symptoms that do not meet the criteria for a hypomanic episode and multiple episodes of depressive symptoms that do not meet the criteria for a major depressive episode. Symptoms must last for at least two years in adults or one year in children and adolescents. Symptoms cause significant distress or impairment in functioning.

Question 22

Delirium

Answer 22

A diagnosis of Delirium requires (a) a disturbance in attention and awareness that develops over a short period of time, represents a change from baseline functioning, and tends to fluctuate in severity over the course of a day and (b) an additional disturbance in cognition (e.g., impaired memory, disorientation, impaired language, deficits in visuospatial ability, perceptual distortions). Symptoms must not be due to another Neurocognitive Disorder and must not occur during a severely reduced level of arousal (e.g., during a coma), and there must be evidence that symptoms are the direct physiological consequence of a medical condition, substance intoxication or withdrawal, and/or exposure to a toxin.

Question 23

Delusional Disorder

Answer 23

Delusional Disorder involves one or more delusions that last at least one month. Overall psychosocial functioning is not markedly impaired, and any impairment is directly related to the delusions. The DSM–5 distinguishes between the following subtypes: erotomanic, grandiose, jealous, persecutory, somatic, mixed, and unspecified.

Question 24

Dependent Personality Disorder

Answer 24

Dependent Personality Disorder involves a pervasive and excessive need to be taken care of, which leads to submissive, clinging behavior and a fear of separation as manifested by at least five symptoms – e.g., has difficulty making decisions without advice and reassurance from others; fears disagreeing with others because it might lead to a loss of support @has difficulty initiating projects on his/her own; goes to great lengths to gain nurturance and support from others; is unrealistically preoccupied with fears of being left to care for him/herself.

Question 25

Depressive Cognitive Triad

Answer 25

According to Beck, the cognitive profile for depression involves a cognitive triad – i.e., negative beliefs about oneself, the world (situation), and the future.

Question 26

Diagnostic Uncertainty

Answer 26

When using the DSM–5, diagnostic uncertainty about a client’s diagnosis is indicated by coding one of the following: Other specified disorder is coded when the clinician wants to indicate the reason why the client’s symptoms do not meet the criteria for a specific diagnosis, while unspecified disorder is coded when the clinician does not want to indicate the reason why the client’s symptoms do not meet the criteria for a specific diagnosis.

Question 27

Dialectical Behavior Therapy

Answer 27

Linehan’s (1987) Dialectical Behavior Therapy (DBT) was designed as a treatment for Borderline Personality Disorder and incorporates three strategies: (a) group skills training to help clients regulate their emotions and improve their social and coping skills; (b) individual outpatient therapy to strengthen clients’ motivation and newly–acquired skills; and (c) telephone consultations to provide additional support and between–sessions coaching. Research has confirmed that it reduces premature termination from therapy, psychiatric hospitalizations, and parasuicidal behaviors.

Question 28

Dissociative Amnesia

Answer 28

A diagnosis of Dissociative Amnesia requires an inability to recall important personal information that cannot be attributed to ordinary forgetfulness and causes clinically significant distress or impaired functioning. It is often related to exposure to one or more traumatic events. The most common forms of amnesia are localized and selective.

Question 29

Dopamine Hypothesis

Answer 29

The dopamine hypothesis attributes Schizophrenia to elevated levels of or oversensitivity to dopamine.

Question 30

DSM–5

Answer 30

The DSM–5 utilizes a categorical approach that divides the mental disorders into types that are defined by a set of diagnostic criteria and requires the clinician to determine whether or not a client meets the minimum criteria for a given diagnosis. To allow for individual differences, it includes a polythetic criteria set for most disorders that requires a client to present with only a subset of characteristics from a larger list. It provides a nonaxial assessment system in which all mental and medical diagnoses are listed together with the primary diagnosis listed first.

Question 31

Enuresis

Answer 31

Enuresis involves repeated voiding of urine into the bed or clothes at least twice a week for three or more consecutive months. Urination is usually involuntary but can be intentional and is not due to substance use or a medical condition. Enuresis is diagnosed only when the individual is at least five years old or the equivalent developmental level. The bell–and–pad (urine alarm) is the most common treatment.

Question 32

Erectile Disorder

Answer 32

A diagnosis of Erectile Disorder requires the presence of at least one of three symptoms (marked difficulty in obtaining an erection during sexual activity, marked difficulty in maintaining an erection until completion of sexual activity, marked decrease in erectile rigidity) on all or almost all occasions of sexual activity.

Question 33

Expressed Emotion And Schizophrenia

Answer 33

A high level of expressed emotion by family members toward the member with Schizophrenia is associated with a high risk for relapse and rehospitalization. High expressed emotion is characterized by open criticism and hostility toward the patient or, alternatively, overprotectiveness and emotional over involvement.

Question 34

Factitious Disorder

Answer 34

Individuals with Factitious Disorder Imposed on Self falsify physical or psychological symptoms that are associated with their deception, present themselves to others as being ill or impaired, and engage in the deceptive behavior even in the absence of an obvious external reward for doing so. Individuals with Factitious Disorder Imposed on Another falsify physical or psychological symptoms in another person, present that person to others as being ill or impaired, and engage in the deceptive behavior even in the absence of an external reward. For both types of Factitious Disorder, falsification of symptoms can involve feigning, exaggeration, simulation, or induction (e.g., by ingestion of a substance or self–injury).

Question 35

Gender Dysphoria

Answer 35

For Gender Dysphoria in Children, the diagnostic criteria are a marked incongruence between assigned gender at birth and experienced or expressed gender as evidenced by a strong desire to be the opposite sex and at least five symptoms – e.g., strong preference for wearing clothes of the other gender; strong preference for cross–gender roles during play; strong preference for toys and activities typically used or engaged in by the other gender; strong preference for playmates of the opposite gender; strong desire for primary and/or secondary sex characteristics of one’s experienced gender. For Gender Dysphoria in Adolescents and Adults, the marked incongruence between assigned gender and experienced or expressed gender must be manifested by at least two symptoms – e.g., marked incongruence between one’s primary and/or secondary sex characteristics and one’s experienced or expressed gender; strong desire for the primary and/or secondary sex characteristics of the opposite gender; strong desire to be of the opposite gender; strong conviction that one has the feelings and reactions that are characteristic of the opposite gender. For both disorders, symptoms must have a duration of at least six months and cause clinically significant distress or impaired functioning.

Question 36

Generalized Anxiety Disorder

Answer 36

GAD involves excessive anxiety and worry about multiple events or activities, which are relatively constant for at least six months, the person finds difficult to control, and cause clinically significant distress or impaired functioning. Anxiety and worry must include at least three characteristic symptoms (or at least one symptom for children) – restlessnes sor feeling keyed up or on edge; being easily fatigued; difficulty concentrating; irritability; muscle tension; sleep disturbance. Treatment usually involves cognitive–behavioral therapy or a combination of cognitive–behavioral therapy and pharmacotherapy.

Question 37

Genito–Pelvic Pain/Penetration Disorder

Answer 37

This disorder is diagnosed in the presence of persistent difficulties involving at least one of the following: vaginal penetration during intercourse; genito–pelvic pain during intercourse or penetration attempts; anxiety about genito–pelvic pain before, during, or as a result of vaginal penetration; tensing of pelvic floor muscles during attempted vaginal penetration.

Question 38

Histrionic Personality Disorder

Answer 38

Histrionic Personality Disorder is characterized by a pervasive pattern of emotionality and attention–seeking as manifested by at least five characteristic symptoms – e.g., discomfort when not the center of attention; inappropriately sexually seductive or provocative; rapidly shifting and shallow emotions; consistent use of physical appearance to gain attention; considers relationships to be more intimate than they are.

Question 39

Insomnia Disorder

Answer 39

Insomnia Disorder is characterized by dissatisfaction with sleep quality or quantity that is associated with at least one characteristic symptom– difficulty initiating sleep; difficulty maintaining sleep; early–morning awakening with an inability to return to sleep. The sleep disturbance occurs at least three nights each week, has been present for at least three months, occurs despite sufficient opportunities for sleep, and causes significant distress or impaired functioning.

Question 40

Intellectual Disability

Answer 40

Intellectual Disability is diagnosed in the presence of (a) deficits in intellectual functions (e.g., reasoning, problem solving, abstract thinking); (b) deficits in adaptive functioning that result in a failure to meet community standards of personal independence and social responsibility and impair functioning across multiple environments in one or more activities of daily life; and (c) an onset of intellectual and adaptive functioning deficits during the developmental period. Four degrees of severity (mild, moderate, severe, and profound) are based on adaptive functioning in conceptual, social, and practical domains.

Question 41

Learned Helplessness Model

Answer 41

Seligman’s learned helplessness model proposes that depression is due to exposure to uncontrollable negative events and internal, stable, and global attributions for those events. A reformulation of the theory by Abramson, Metalsky, and Alloy emphasizes the role of hopelessness.

Question 42

Major and Mild Neurocognitive Disorder

Answer 42

Major Neurocognitive Disorder (formerly Dementia) is diagnosed when there is evidence of significant decline from a previous level of functioning in one or more cognitive domains that interferes with the individual’s independence in everyday activities and does not occur only in the context of Delirium. Mild Neurocognitive Disorder (formerly Cognitive Disorder NOS) is the appropriate diagnosis when there is evidence of a modest decline from a previous level of functioning in one or more cognitive domains that does not interfere with the individual’s independence in everyday activities and does not occur only in the context of Delirium. Subtypes are based on etiology and include Major and Mild Neurocognitive Disorder Due to Alzheimer’s Disease, Vascular Disease, Traumatic Brain Injury, HIV infection, Parkinson’s Disease, and Huntington’s Disease.

Question 43

Major Depressive Disorder

Answer 43

A diagnosis of Major Depressive Disorder requires the presence of at least five symptoms of a major depressive episode nearly everyday for at least two weeks, with at least one symptom being depressed mood or loss of interest or pleasure. Symptoms are depressed mood (or, in children and adolescents, a depressed or irritable mood); markedly diminished interest or pleasure in most or all activities; significant weight loss when not dieting or weight gain or a decrease or increase in appetite; insomnia or hypersomnia; psychomotor agitation or retardation; fatigue or loss of energy; feelings of worthless or excessive guilt; diminished ability to think or concentrate; recurrent thoughts of death, recurrent suicidal ideation, or a suicide attempt. Symptoms cause clinically significant distress or impaired functioning. Treatment usually includes cognitive–behavioral therapy and an SSRI or other antidepressant.

Question 44

Major Depressive Disorder with Peripartum Onset

Answer 44

The peripartum onset specifieris applied to Major Depressive Disorder, Bipolar I Disorder, and Bipolar II Disorder when the onset of symptoms is during pregnancy or within four weeks postpartum. Symptoms may include anxiety and a preoccupation with the infant’s well–being or, in extreme cases, delusional thoughts about the infant.

Question 45

Major Depressive Disorder with Seasonal Pattern

Answer 45

The seasonal pattern specifier is applied to Major Depressive, Bipolar I disorder, and Bipolar II Disorder when there is a temporal relationship between the onset of a mood episode and a particular time of the year. This condition is also known as Seasonal Affective Disorder (SAD) and, in the Northern Hemisphere, most commonly occurs during the winter months. People with SAD usually experience hypersomnia, increased appetite and weight gain, and a craving for carbohydrates.

Question 46

Malingering

Answer 46

Malingering is included in the DSM–5 with Other Conditions that May Be a Focus of Clinical Attention. It involves the intentional production, faking, or gross exaggeration of physical or psychological symptoms to obtain an external reward (e.g., to avoid criminal prosecution or obtain financial compensation).

Question 47

Marlatt And Gordon /
Relapse Prevention Therapy

Answer 47

Marlatt and Gordon view addiction as an “overlearned maladaptive habit pattern,” and their relapse prevention therapy focuses on identifying circumstances that increase the risk for relapse and implementing cognitive and behavioral strategies that help the client prevent and cope effectively with lapses.

Question 48

Narcissistic Personality Disorder

Answer 48

Narcissistic Personality Disorder involves a pervasive pattern of grandiosity, need for admiration, and lack of empathy as indicated by at least five characteristic symptoms – e.g., has a grandiose sense of self–importance; is preoccupied with fantasies of unlimited success, power, beauty, love; believes he/she is unique and can be understood only by other high–status people; requires excessive admiration; has a sense of entitlement; lacks empathy; is often envious of others or believes others are envious of him/her.

Question 49

Narcolepsy

Answer 49

Narcolepsy is characterized by attacks of an irrepressible need to sleep with lapses into sleep or daytime naps that occur at least three times per week and have been present for at least three months. The diagnosis also requires episodes of cataplexy, a hypocretin deficiency, or a rapid eye movement latency less than or equal to 15 minutes.

Question 50

Neurocognitive Disorder Due To Alzheimer’s Disease

Answer 50

This disorder is diagnosed when the criteria for Major or Mild Neurocognitive Disorder are met, there is an insidious onset and gradual progression of impairment in one or more cognitive domains (or at least two domains for Major Neurocognitive Disorder), and the criteria for probable or possible Alzheimer’s disease are met. It involves a slow, progressive decline in cognitive functioning that can be described in terms of the following stages: Stage 1 (1 to 3 years) involves anterograde amnesia (especially for declarative memories); deficits in visuospatial skills (wandering); indifference, irritability, and sadness; and anomia. Stage 2 (2 to 10 years) is characterized by increasing retrograde amnesia; flat or labile mood; restlessness and agitation; delusions; fluent aphasia; acalculia; and ideomotor apraxia (inability to translate an idea into movement). Stage 3 (8 to 12 years) entails severely deteriorated intellectual functioning; apathy; limb rigidity; and urinary and fecal incontinence.

Question 51

Non–Rapid Eye Movement Sleep Arousal Disorders

Answer 51

This disorder involves recurrent episodes of incomplete awakening that usually occur during the first third of the major sleep episode and are accompanied by sleepwalking (getting out of bed during sleep and walking around) and/or sleep terror (an abrupt arousal from sleep that often begins with a panicky scream and is accompanied by intense fear and signs of autonomic arousal). The individual has limited or no recall of an episode upon awakening, and the disturbance causes significant distress or impaired functioning.

Question 52

Obsessive–Compulsive Disorder

Answer 52

OCD is characterized by recurrent obsessions and/or compulsions that are time–consuming or cause clinically significant distress or impairment in functioning: Obsessions are persistent thoughts, impulses, or images that the person experiences as intrusive and unwanted and that he/she attempts to ignore or suppress, and compulsions are repetitious and deliberate behaviors or mental acts that the person feels driven to perform either in response to an obsession or according to rigid rules. A combination of exposure with response prevention and the tricyclic clomipramine or an SSRI is usually the treatment–of–choice for OCD.

Question 53

Obsessive–Compulsive Personality Disorder

Answer 53

Obsessive–Compulsive Personality Disorder is characterized by a persistent preoccupation with orderliness, perfectionism, and mental and interpersonal control that severely limits the individual’s flexibility, openness, and efficiency. At least four characteristic symptoms must be present – e.g., exhibits perfectionism that interferes with task completion; is excessively devoted to work and productivity to the exclusion of leisure activities and friendships; is reluctant to delegate work to others unless they are willing to do it his/her way; adopts a miserly spending style toward self and others.

Question 54

Opioid Withdrawal

Answer 54

Opioid Withdrawal occurs following cessation or reduction in the use of an opioid following prolonged or heavy use or administration of an opioid antagonist following a period of opioid use. The diagnosis requires at least three characteristic symptoms: dysphoric mood; nausea or vomiting; muscle aches; lacrimation or rhinorrhea; pupillary dilation, piloerection, or sweating; diarrhea; yawning; fever; insomnia.

Question 55

Oppositional Defiant Disorder

Answer 55

Oppositional Defiant Disorder involves a recurrent pattern of an angry/irritable mood, argumentative/defiant behavior, or vindictiveness as evidenced by at least four characteristic symptoms that are exhibited during interactions with at least one person who is not a sibling – e.g., often loses temper; often argues with authority figures; often actively refuses to comply with requests from authority figures or with rules; often blames others for his/her mistakes.

Question 56

Outline for Cultural Formulation

Answer 56

The DSM–5’s Outline for Cultural Formulation provides guidelines for assessing four factors: the client’s cultural identity; the client’s cultural conceptualization of distress; the psychosocial stressors and cultural factors that impact the client’s vulnerability and resilience; and cultural factors relevant to the relationship between the client and therapist.

Question 57

Panic Disorder

Answer 57

Panic Disorder is characterized by recurrent unexpected panic attacks with at least one attack being followed by one month of persistent concern about having additional attacks or about their consequences and/or involving a significant maladaptive change in behavior related to the attack. Cognitive behavioral interventions that incorporate exposure are the treatment–of–choice for this disorder.

Question 58

Paranoid Personality Disorder

Answer 58

Paranoid Personality Disorder involves a pervasive pattern of distrust and suspiciousness that entails interpreting the motives of others as malevolent. The diagnosis requires the presence of at least four characteristic symptoms – e.g., suspects that others are exploiting, harming, or deceiving him/her without a sufficient basis for doing so; reads demeaning content into benign remarks or events; persistently bears grudges; is persistently suspicious about the fidelity of his/her spouse or sexual partner without justification.

Question 59

Paraphilic Disorders

Answer 59

The Paraphilic Disorders include Voyeuristic, Exhibitionistic, Frotteuristic, Sexual Sadism, Pedophilic, Fetishistic, and Transvestic Disorders. These disorders are characterized by an intense and persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypically normal, physically mature, consenting human partners …[that] is currently causing distress or impairment to the individual or … has entailed personal harm, or risk of harm, to others”

Question 60

Persistent Depressive Disorder

Answer 60

Persistent Depressive Disorder is characterized by a depressed mood (or in children and adolescents, a depressed or irritable mood) on most days for at least two years in adults or one year in children and adolescents as indicated by the presence of at least two characteristic symptoms – poor appetite or overeating; insomnia or hypersomnia; low energy or fatigue; low self–esteem; poor concentration or difficulty making decisions; feelings of hopelessness. During the two– or one–year period, the individual has not been symptom–free for more than two months, and symptoms cause clinically significant distress or impaired functioning.

Question 61

Posttraumatic Stress Disorder (PTSD)

Answer 61

The diagnosis of PTSD requires exposure to actual or threatened death, serious injury, or sexual violence; presence of at least one intrusion symptom related to the event; persistent avoidance of stimuli associated with the event; negative changes in cognition or mood associated with the event; and marked change in arousal and reactivity associated with the event. Symptoms must have a duration of more than one month and must cause clinically significant distress or impaired functioning. The treatment–of–choice is a comprehensive cognitive–behavioral intervention that incorporates exposure, cognitive restructuring, and anxiety management or similar techniques.

Question 62

Premature Ejaculation

Answer 62

Premature Ejaculation is diagnosed in the presence of a persistent or recurrent pattern of ejaculation during partnered sexual activity within about one minute of vaginal penetration or before the person desires it. The disturbance must have been present for at least six months, be experienced on all or almost all occasions of sexual activity, and cause clinically significant distress. Treatment often includes use of the start–stop or squeeze technique.

Question 63

Prognosis For Schizophrenia

Answer 63

A better prognosis for Schizophrenia is associated with good premorbid adjustment, an acute and late onset, female gender, the presence of a precipitating event, a brief duration of active–phase symptoms, insight into the illness, a family history of a mood disorder, and no family history of Schizophrenia.

Question 64

Reactive Attachment Disorder

Answer 64

Reactive Attachment Disorder is characterized by a pattern of inhibited and emotionally withdrawn behavior toward adult caregivers as manifested by a lack of seeking or responding to comfort when distressed and a persistent social and emotional disturbance. The diagnosis requires evidence that the child has experienced extreme insufficient care that is believed to be the cause of the disturbed behavior. Symptoms must be apparent before the child is five years of age, and the child must have a developmental age of at least nine months.

Question 65

Risk Factors for Suicide

Answer 65

High risk for suicide is associated with a warning; previous attempts; a plan (especially one involving a lethal weapon); male gender; being divorced, separate, or widowed; and feelings of hopelessness. For most age groups, the rates are highest for Whites; an exception is for American–Indian/Alaskan Native individuals ages 15 to 34 who have a rate 2.5 times higher than the national average for this age group. Of the mental disorders, the highest risk is associated with Major Depression and Bipolar Disorder. Suicide attempters (vs. completers) are most likely to be female.

Question 66

Schizoid Personality Disorder

Answer 66

Schizoid Personality Disorder involves a pervasive pattern of detachment from interpersonal relationships and a restricted range of emotional expression in social settings with at least four characteristic symptoms – doesn’t desire or enjoy close relationships; almost always chooses solitary activities; has little interest in sexual relationships; takes pleasure in few activities; lacks close friends or confidents other than first–degree relatives; seems indifferent to praise or criticism; exhibits emotional coldness or detachment.

Question 67

Schizophrenia

Answer 67

A diagnosis of Schizophrenia requires the presence of at least two active phase symptoms – i.e., delusions, hallucinations, disorganized speech, grossly disorganized behavior, negative symptoms – for at least one month with at least one symptom being delusions, hallucination, or disorganized speech. There must be continuous signs of the disorder for at least six months, and symptoms must cause significant impairment in functioning. Treatment usually includes an antipsychotic drug, cognitive–behavioral therapy, psychoeducation, social skills training, supported employment, and other interventions for the individual with Schizophrenia and psychosocial interventions for his/her family.

Question 68

Schizophreniform Disorder

Answer 68

The diagnostic criteria for Schizophreniform Disorder are identical to those for Schizophrenia except that the disturbance is present for at least one month but less than six months and impaired social or occupational functioning may occur but is not required.

Question 69

Schizotypal Personality Disorder

Answer 69

Schizotypal Personality Disorder is diagnosed in the presence of (a) pervasive social and interpersonal deficits involving acute discomfort with and reduced capacity for close relationships and (b) eccentricities in cognition, perception, and behavior as manifested by the presence of at least five symptoms – e.g., ideas of reference; odd beliefs or magical thinking that influence behavior; bodily illusions and other unusual perceptions; is suspicious or has paranoid ideation; inappropriate or constricted affect; lacks close friends or confidants other than first–degree relatives; excessive social anxiety.

Question 70

Separation Anxiety Disorder

Answer 70

Separation Anxiety Disorder involves developmentally inappropriate and excessive fear or anxiety related to separation from home or attachment figures as evidenced by at least three symptoms – e.g., recurrent excessive distress when anticipating or experiencing separation from home or major attachment figures; persistent excessive fear of being alone; repeated complaints of physical symptoms when separation from an attachment figure occurs or is anticipated. The disturbance must last at least four weeks in children and adolescents or six months in adults and must cause clinically significant distress or impaired functioning.

Question 71

Social Anxiety Disorder

Answer 71

Social Anxiety Disorder involves intense fear or anxiety about one or more social situations in which the individual may be exposed to scrutiny by others. The individual fears that he/she will exhibit anxiety symptoms in these situations that will be negatively evaluated; he/she avoids the situations or endures them with intense fear or anxiety; and his/her fear or anxiety is not proportional to the threat posed by the situations. The fear, anxiety, and avoidance are persistent and cause clinically significant distress or impaired functioning. Exposure with response prevention is an effective treatment, and its benefits may be enhanced when it is combined with social skills training or cognitive restructuring and other cognitive techniques.

Question 72

Specific Learning Disorder

Answer 72

Specific Learning Disorder is diagnosed when a person exhibits difficulties related to academic skills as indicated by the presence of at least one characteristic symptom that persists for at least six months despite the provision of interventions targeting those difficulties. The diagnosis requires that the individual’s academic skills are substantially below those expected for his/her age, interfere with academic or occupational performance or activities of daily living, began during the school–age years, and are not better accounted for by another condition or disorder or other factor such as uncorrected visual or auditory impairment or psychosocial adversity.

Question 73

Specific Phobia

Answer 73

Specific Phobia is characterized by intense fear of or anxiety about a specific object or situation, with the individual either avoiding the object or situation or enduring it with marked distress. The fear or anxiety is not proportional to the danger posed by the object or situation, is persistent (typically lasting for at least six months), and causes clinically significant distress or impaired functioning. The treatment–of–choice is exposure with response prevention (especially in vivo exposure).

Question 74

Substance Use Disorders

Answer 74

The Substance Use Disorders are characterized by “a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems” (APA, 2013, p. 483) as manifested by at least two symptoms during a 12-month period – e.g., substance used in larger amounts or for a longer period of time than intended; persistent desire or unsuccessful efforts to cut down or control use; craving for the substance; recurrent substance use despite persistent social problems caused or worsened by substance use; recurrent substance use in situations in which it is physically dangerous to do so; tolerance; withdrawal.

Question 75

Substance–Induced Disorders

Answer 75

The Substance-Induced Disorders include Substance Intoxication, Substance Withdrawal, and Substance/Medication-Induced Mental Disorders. The latter “are potentially severe, usually temporary, but sometimes persisting central nervous system (CNS) syndromes that develop in the context of the effects of substances of abuse, medications, or toxins” (APA, 2013, p. 487) and include Substance/Medication-Induced Psychotic Disorder, Substance/Medication-Induced Depressive Disorder, and Substance/Medication-Induced Neurocognitive Disorders.

Question 76

Tobacco Use Disorder / Smoking Cessation Interventions

Answer 76

Interventions for Tobacco Use Disorder are most likely to lead to long–term abstinence when they include three elements: (a) nicotine replacement therapy; (b) multicomponent behavioral therapy that includes, for example, skills training, relapse prevention, stimulus control, and/or rapid smoking; and (c) support and assistance from a clinician

Question 77

Tobacco Withdrawal

Answer 77

Tobacco Withdrawal is characterized by the development of at least four characteristic symptoms within 24 hours of abrupt cessation or reduction in the use of tobacco – i.e., irritability or anger, anxiety, impaired concentration, increased appetite, restlessness, depressed mood, insomnia.

Question 78

Tourette’s Disorder

Answer 78

Tourette’s Disorder is characterized by the presence of at least one vocal tic and multiple motor tics that may appear simultaneously or at different times, may wax and wane in frequency, have persisted for more than one year, and began prior to age 18.

Question 79

Uncomplicated Bereavement

Answer 79

Uncomplicated Bereavement is included in the DSM–5 with Other Conditions That May Be a Focus of Treatment and is described as a normal reaction to the death of a loved one.” Uncomplicated bereavement may include symptoms of a major depressive episode, but the individual usually experiences the symptoms as normal and may be seeking treatment for insomnia, anorexia, or other associated symptoms

Question 80

Vascular Neurocognitive Disorder

Answer 80

Vascular Neurocognitive Disorder is diagnosed when the criteria for Major or Mild Neurocognitive Disorder are met, the clinical features are consistent with a vascular etiology, and there is evidence of cerebrovascular disease from the individual’s history, a physical examination, and/or neuroimaging that is considered sufficient to account for his/her symptoms. This disorder often has a stepwise, fluctuating course with a patchy pattern of symptoms that is determined by the location of the brain damage.

Question 81

Withdrawal: Alcohol Withdrawal

Answer 81

Alcohol Withdrawal is diagnosed in the presence of at least two of the following symptoms within several hours to a few days following cessation or reduction of alcohol consumption: autonomic hyperactivity (e.g., sweating, tachycardia); hand tremor; insomnia; nausea or vomiting; transient illusions or hallucinations; anxiety; psychomotor agitation; generalized tonic-clonic seizures.

Question 82

Withdrawal: Opioid Withdrawal

Answer 82

Opioid Withdrawal: Opioid Withdrawal occurs following cessation or reduction in the use of an opioid following prolonged or heavy use or administration of an opioid antagonist following a period of opioid use. The diagnosis requires the presence of at least three of the following symptoms: dysphoric mood; nausea or vomiting; muscle aches; lacrimation or rhinorrhea; pupillary dilation, piloerection, or sweating; diarrhea; yawning; fever; insomnia.

Question 83

Withdrawal: Sedative, Hypnotic, or Anxiolytic Withdrawal

Answer 83

Sedative, Hypnotic, or Anxiolytic Withdrawal: A diagnosis of this disorder requires the development of at least two of the following symptoms within several hours to a few days following cessation or reduction in drug use: autonomic hyperactivity; hand tremor; insomnia; anxiety; nausea or vomiting; transient hallucinations or illusions; psychomotor agitation; anxiety; grand mal seizures.

Question 84

Withdrawal: Stimulant Withdrawal

Answer 84

Stimulant Withdrawal is diagnosed in the presence of at least two of five physiological changes that occur within a few hours to several days after cessation of or reduction in prolonged stimulant use: fatigue; vivid, unpleasant dreams; insomnia or hypersomnia; increased appetite; psychomotor agitation or retardation. Withdrawal after repetitive high-dose use can cause a “crash” that involves intense lethargy, depression, and increased appetite.

Question 85

Withdrawal: Tobacco Withdrawal

Answer 85

Tobacco Withdrawal is characterized by the development of at least four characteristic symptoms within 24 hours of abrupt cessation or reduction in the use of tobacco – i.e., irritability or anger, anxiety, impaired concentration, increased appetite, restlessness, depressed mood, insomnia.

Question 86

Withdrawal: Alcohol Withdrawal Delirium

Answer 86

Alcohol Withdrawal Delirium involves prominant disturbances in attention, awareness, and cognition following cessation or reduction of alcohol consumption that are sufficiently severe to warrant clinical attention. Common associated features include autonomic hyperactivity, vivid hallucinations, delusions, and agitation.