Psychopathology

sexual dysfunction

A disruption in the sexual response. Either persistent or recurrent psychophysiological impairment (generally, in 75-100% encounters). Occurring at least 6 months. Onset: lifelong type (primary; more difficult to treat); acquired type. Situation: generalized type; situational type. Factors related to sexual dysfunction: partner, relationship, individual, cultural/religious, medical.

obsessive-compulsive personality disorder

A. A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts, as indicated by 4 (or more) of the following: 1. Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost. 2. Shows perfectionism that interferes with task completion. 3. Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships. 4. Is overconscientious, scrupulous, and flexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification). 5. Is unable to discard worn-out or worthless objects even when they have no sentimental value. 6. Is reluctant to delegate tasks or to work with others unless they submit to exactly their way of doing things. 7. Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes. 8. Shows rigidity and stubbornness. Prevalence: one of the most prevalent personality disorders in the general population; 2.1-7.9%.

mild neurocognitive disorder

A. Evidence of modest cognitive decline from a previous level of performance in one or more cognitive domains based on: 1. Concern of the individual, a knowledgeable informant, or the clinician that there has been a mild decline in cognitive function; and 2. A modest impairment in cognitive performance, preferably documented by standardized neuropsychological testing or, in its absence, another quantified clinical assessment. B. The cognitive deficits do not interfere with the capacity for independence in everyday activities. C. The cognitive deficits do not occur exclusively in the context of a delirium. D. NBEBA another mental disorder. Specify whether due to: Alheimer's disease, frontotemporal lobar degeneration, Lewy body disease, Vascular disease, TBI, substance/medication use, HIV infection, Prion disease, Parkinson's disease, Huntington's disease, another medical condition, multiple etiologies, unspecified. Specify: without behavioral disturbance; with behavioral disturbance.

major neurocognitive disorder

A. Evidence of significant cognitive decline from a previous level of performance in one or more cognitive domains based on: 1. Concern of the individual, a knowledgeable informant, or the clinician that there has been a significant decline in cognitive function; and 2. A substantial impairment in cognitive performance, preferably documented by standardized neuropsychological testing or, in its absence, another quantified clinical assessment. B. The cognitive deficits interfere with independence in everyday activities. C. The cognitive deficits do not occur exclusively in the context of a delirium. D. NBEBA mental disorder Specify whether due to: Alheimer's disease, frontotemporal lobar degeneration, Lewy body disease, Vascular disease, TBI, substance/medication use, HIV infection, Prion disease, Parkinson's disease, Huntington's disease, another medical condition, multiple etiologies, unspecified. Specify: without behavioral disturbance; with behavioral disturbance. Specify current severity: mild, moderate, severe.

acute stress disorder

A. Exposure to actual or threatened death, serious injury, or sexual violation in one (or more) of the following ways: 1. Direct experience 2. Witnessing in person 3. Learning about violent or accidental death 4. Experiencing repeated or extreme exposure B. Presence of 9 or more: 1. Recurrent distressing intrusive recollections 2. Recurrent distressing dreams 3. Dissociative reactions (flashbacks) 4. Intense distress to external or internal cues 5. Inability to experience positive emotions 6. Altered sense of reality of one's surroundings or oneself 7. Inability to remember an important aspect of the traumatic event(s) 8. Efforts to avoid distressing memories, thoughts, feelings 9. Efforts to avoid external reminders 10. Sleep disturbance 11. Irritable behavior and angry outbursts 12. Hypervigilance 13. Problems with concentration 14. Exaggerated startle response C. Duration of the disturbance (symptoms in Criterion B) is 3 days to 1 month after trauma exposure. Prevalence: varies according to the nature of the events and the context in which it is assessed; anywhere 6-20% depending on situation.

gender dysphoria

A. Marked incongruence between experienced and assigned gender for at least 6 months. 1. At least 6 of the following in children: i. Desire or insistence that other gender. ii. Preference for cross-dressing, resistance of clothing of assigned gender. iii. Preference for cross-gender roles. iv. Preference for activity typical of other gender. v. Preference for other gender playmates. vi. Rejection of typical assigned gender activities. vii. Dislike of own anatomy. viii. Desire for sex characteristics that match experienced gender. 2. At least 2 of the following in adults/adolescents; i. Incongruence between experienced gender and sex characteristics. ii. Desire to be rid of sex characteristics. iii. Desire for sex characteristics of other gender. iv. Desire to be of other gender. v. Desire to be treated at the other gender. vi. Conviction that have the typical feelings/reactions of other gender. Specify if: with a disorder of sex development. Specify if: post-transition. Associated features: can experience androphilia or gynecophilia (sexual identity is independent of gender identity); social isolation (less for women than men); high levels of discrimination and violence; socioeconomic disadvantage; psychiatric distress (e.g., suicide attempts). Prevalence: relatively low (near 0%). Course: onset in childhood (differing signs), spontaneously remits frequently (desists to homosexual orientation, confuse gender and sexuality), lifelong course.

vascular neurocognitive disorder

Decline prominent in complex attention and executive function. Presence of cerebrovascular disease: o Large vessel changes: Ischemic: clot blocks blood flow to an area of the brain. Hemorrhagic: bleed out inside or around brain issue. o Small vessel changes: Subcortical ischemic changes: multiple little breakages; diffuse and all over the place. Associated features: o Large vessel changes: focal neurological signs (impairment in specific areas, but not others). o Small vessel changes: complex attention and executive function; looks like early Alzheimer's. Risk factors: hyper/hypotension, unmanaged diabetes, high cholesterol, heart disease, smoking. Course: o Large vessel: abrupt onset, stepwise/fluctuating course. o Small vessel: gradual onset, slow progression. o Death in 20%; 70% permanent disability.

Substance induced NCD

Deficits persist beyond the usual duration of intoxication and withdrawal; substance, duration, and extent of use capable of producing neurocognitive impairment. Substances include: alcohol, cocaine, opioids, amphetamines, cannabis, inhalants, sedatives/anxiolytics, anticonvulsants, heavy metals/industrial chemicals/insecticides, and carbon monoxide. Temporal course consistent with use and abstinence. Associated features: previous substance dependence; consistent exposure to toxins. Course: rare onset before 20 years; insidious/progressive; usually begins in addiction; common in withdrawal. Differential diagnosis: delirium; different types NCD; ID.

dissociative identity disorder

Diagnostic Criteria: A. Disruption of identity characterized by two or more distinct personality states (marked discontinuity in sense of self & agency; observed or self-reported). B. Recurrent gaps in recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting. C. Cause clinically significant distress or impairment in functioning. D. Disturbance is not a part of cultural practice or fantasy in children. Associated features: suggestibility; history of childhood trauma; presentation ---- multiple mannerisms, attitudes, emotional reactions; loss of time; reports of different abilities, attitudes, medical conditions; pansymptomatic; alters --average of 10, relationships among them. Prevalence: less than 1%. Course: complex trauma reaction, childhood-onset, diagnosed in adulthood, chronic course (subsiding in late adulthood).

Intellectual disability

Diagnostic criteria: A disorder with onset during the developmental period that includes both intellectual and adaptive functioning deficits in conceptual, social, and practical domains. The following 3 criteria must be met: A. Deficits in intellectual functions (e.g., reasoning, problem solving, planning, abstract thinking, etc.) confirmed by both clinical assessment and individualized, standardized intellectual testing. B. Deficits in adaptive functioning (activities of daily life) that result in failure to meet developmental and sociocultural standards for personal independence and social responsibility. Without ongoing support, the adaptive deficits limit functioning in 1 or more ADLs. C. Onset of intellectual and adaptive deficits during the developmental period. Mild - IQ - 50-55 to ~ 70 Moderate - IQ 35-40 to ~50-55 Severe - IQ 20-25 to 35-40 Prevalence: overall population prevalence of 1% and prevalence rates vary by age. Males are more likely than females to be diagnosed with both mild and severe forms of ID. Differential diagnosis: major/mild neurocognitive disorders, communication disorders and specific learning disorder, autism spectrum disorder. Etiology: genetic (e.g., Down syndrome), disease/injury, environmental factors (e.g., toxins); prenatal and postnatal factors.

Oppositional Defiant Disorder

Diagnostic criteria: A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months as evidenced by at least 4 symptoms from any of the following categories, and exhibited during interaction with at least one individual who is not a sibling. Angry/Irritable Mood 1. Often loses temper. 2. Is often touchy or easily annoyed. 3. Is often angry and resenƞul. Argumentative/Defiant Behavior 4. Often argues with authority figures, or for children and adolescents, with adults. rules. 6. Often deliberately annoys others. 7. Often blames others for their mistakes or misbehavior. Vindictiveness 8. Has been spiteful or vindictive at least twice within the past 6 months. B. Distress in individual or others or negative impact in functioning (severity is dependent on context OD displayed). Specify current severity: mild (one setting); moderate (at least 2 settings); severe (three or more settings). Associated features: poor emotion regulation; harsh, inconsistent parenting; disrupted caregiving; explain own behaviors as reactions to others' demands or unreasonableness; comorbidity with ADHD and conduct disorder. Prevalence: 5-6%; more prevalent in boys. Course: onset in early childhood; angry-irritable, anxiety or depression; defiant-argumentative- vindictive, conduct disorder.

Reactive Attachment Disorder

Diagnostic criteria: A. A consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers, manifested by both of the following: 1. The child rarely or minimally seeks comfort when distressed. 2. The child rarely or minimally responds to comfort when distressed. B. A persistent social and emotional disturbance characterized by at least 2 of the following: 1. Minimal social and emotional responsiveness to others. 2. Limited positive affect. 3. Episodes of unexplained irritability, sadness, or fearfulness that are evident even during nonthreatening interactions with adult caregivers. C. The child has experienced a pattern of extremes of insufficient care as evidenced by at least one of the following: 1. Social neglect or deprivation (persistent lack of having basic emotional needs met). 2. Repeated changes of primary caregivers that limited stable attachments. 3. Rearing in unusual setting that limited attachments. D. The care in Criterion C is presumed to be responsible for the disturbed behavior in Criterion A. E. Criteria not met for SD. F. Disturbance is evident before 5 years. G. The child has a developmental age of at least 9 months. Specify if: persistent (present for 12+ months). Specify current severity. Prevalence: unknown, seen relatively rarely in clinical settings. In population of severely neglected children, disorder uncommon in less than 10% of such children.

Delirium

Diagnostic criteria: A. A disturbance in attention and awareness. B. The disturbance develops over a short period of time (usually hours to a few days), represents a change from baseline attention and awareness, and tends to fluctuate in severity during the course of a day. C. An additional disturbance in cognition (e.g., memory deficit, disorientation, language, visuospatial ability, or perception). D. The disturbances in Criteria A and C NBEBA NCD or coma. E. Evidence that physiological (e.g., infections/fever, metabolic disorders, electrolyte imbalance, anesthesia/preoperative state, cardiopulmonary disorders, vitamin deficiency, head trauma, brain lesion or stroke) Specify whether: Substance intoxication delirium: in excess of effects of intoxication (prescribed medications, toxins, illicit drugs). Substance withdrawal delirium: especially with rapid withdrawal from short-acting medications (e.g., alcohol, benzos), delirium tremens. Medication-induced delirium: side effect of medication taken as prescribed. Specify if: acute (few hours or days); persistent (weeks or months). Specify if: hyperactive, hypoactive, mixed level of activity. Associated features: disturbances in sleep-wake cycle; psychomotor agitation or retardation (vocalizations); mood disturbance; inability to reason. Prevalence: 1% with all adults; increases with age (14% in 85+ years old); common in hospital setting. More often in males than females. Risk: older age, recent heart surgery, drug addiction and withdrawal. Age: children (fever/infection), young adults (drugs/accidents), adults (not common), older adults (metabolic problems, multiple health conditions, surgery, medications). Course: rapid onset, waxing/waning symptoms, generally resolves few hours to days when treating underlying condition; poorer prognosis -- brain not functioning.

Disinhibitied Social Engagement Disorder

Diagnostic criteria: A. A pattern of behavior in which a child actively approaches and interacts with unfamiliar adults and exhibits at least 2 of the following: 1. Reduced or absent reticence in approaching and interacting with unfamiliar adults. 2. Overly familiar verbal or physical behavior (that is not consistent with culturally sanctioned and with age-appropriate social boundaries). 3. Diminished or absent checking back with adult caregiver after venturing away, even in unfamiliar settings. 4. Willingness to go off with an unfamiliar adult with minimal or no hesitation. B. Behaviors in Criterion A are not limited to impulsivity (as in ADHD) but include socially disinhibited behavior. C. The child has experienced a pattern of extremes of insufficient care as evidenced by at least one of the following: 1. Social neglect or deprivation (persistent lack of having basic emotional needs met). 2. Repeated changes of primary caregivers that limited stable attachments. 3. Rearing in unusual setting that limited attachments. D. The care in Criterion C is resumed to be responsible for the disturbed behavior in Criterion A. E. The child has a developmental age of at least 9 months. Specify if: persistent (present for 12+ months). Specify current severity. Prevalence: unknown (appears to be rare); in high-risk populations, condition occurs in only about 20% of children. Seen rarely in other clinical settings.

ADHD

Diagnostic criteria: A. A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by (1) and/or (2): 1. Inattention: 6 (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupation activities. For older adolescents and adults (17+), at least 5 symptoms are required: a. Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities. b. Often has difficulty sustaining attention in tasks or play activities. c. Often does not seem to listen when spoken to directly. d. Often does not follow through on instruction and fails to finish schoolwork, chores, or duties in the workplace. e. Often has difficulty organizing tasks and activities. f. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort. g. Often loses things necessary for tasks or activities. h. Is often distracted by extraneous stimuli. i. Is often forgetful in daily activities. 2. Hyperactivity and impulsivity: 6 (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities. For older adolescents and adults (17+), at least 5 symptoms are required: a. Often fidgets with or taps hands or feet or squirms in seat. b. Often leaves seat in situations when remaining seated is expected. c. Often runs about or climbs in situations where it is inappropriate (in adolescents or adults, may be limited to feeling restless). d. Often unable to play or engage in leisure activities quietly. e. Is often "on the go," acting as if "driven by a motor." f. Often talks excessively. g. Often blurts out an answer before a question has been completed. h. Often has difficulty waiting their turn. i. Often interrupts or intrudes on others. B. Several inattentive or hyperactive-impulsive symptoms were present before age 12. C. Several inattentive or hyperactive-impulsive symptoms are present in 2+ settings. D. There is

dependent personality disorder

Diagnostic criteria: A. A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood and present in a variety of contexts, as indicated by 5 (or more) of the following: 1. Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others. 2. Needs others to assume responsibility for most major areas of their life. 3. Has difficulty expressing disagreement with others because of fear or loss of support or approval (note: do not include realistic fears of retribution). 4. Has difficulty initiating projects or doing things on their own. 5. Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant. 6. Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for themselves. 7. Urgently seeks another relationship as a source of care and support when a close relationship ends. 8. Is unrealistically preoccupied with fears of being left to take care of themselves. Prevalence: 0.49-0.6%.

paranoid personality disorder

Diagnostic criteria: A. A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts, as indicated by 4 (or more) of the following: 1. Suspects, without sufficient basis, that others are exploiting, harming, or deceiving them. 2. Is preoccupied with unjustified doubts about the loyalty or untrustworthiness of friends or associates. 3. Is reluctant to confide in others because of unwarranted fear that the information will be used against them. 4. Reads hidden demeaning or threatening meanings into benign remarks or events. 5. Persistently bears grudges (i.e., is unforgiving of insults, injuries, or slights). 6. Perceives attacks on their character or reputation that are not apparent to others and is quick to react angrily or to counterattack. 7. Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner. Prevalence: 2.3-4.4%.

schizoid personality disorder

Diagnostic criteria: A. A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal seƫngs, beginning by early adulthood and present in a variety of contexts, as indicated by 4 (or more) of the following: 1. Neither desires nor enjoys close relationships, including being part of a family. 2. Almost always chooses solitary activities. 3. Has little, if any, interest in having sexual experiences with another person. 4. Takes pleasure in few, if any, activities. 5. Lacks close friends or confidants other than first-degree relatives. 6. Appears indifferent to the praise or criticism of others. 7. Shows emotional coldness, detachment, or flattened affectivity. Prevalence: uncommon in clinical seƫngs; 3.1-4.9%.

antisocial personality disorder

Diagnostic criteria: A. A pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 years, as indicated by 3 (or more) of the following: 1. Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest. 2. Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure. 3. Impulsivity or failure to plan ahead. 4. Irritability and aggressiveness, as indicated by repeated physical fights or assaults. 5. Reckless disregard for safety of self or others. 6. Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations. 7. Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another. B. The individual is at least age 18 years. C. There is evidence of conduct disorder with onset before age 15 years. Prevalence: 12-month prevalence rates are between 0.2-3.3%; highest prevalence is among most severe samples of males with alcohol use disorder and from substance abuse clinics, prisons, or other forensic settings; prevalence is higher in samples affected by adverse socioeconomic or sociocultural factors.

histrionic personality disorder

Diagnostic criteria: A. A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts, as indicated by 5 (or more) of the following: 1. In uncomfortable in situations in which they are not the center of attention. 2. Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior. 3. Displays rapidly shifting and shallow expression of emotions. 4. Consistently uses physical appearance to draw attention to self. 5. Has a style of speech that is excessively impressionistic and lacking in detail. 6. Shows self-dramatization, theatricality, and exaggerated expression of emotion. 7. Is suggestible (i.e., easily influenced by others or circumstances). 8. Considers relationships to be more intimate than they actually are. Prevalence: 1.84%.

narcissistic personality disorder

Diagnostic criteria: A. A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by 5 (or more) of the following: 1. Has a grandiose sense of self-importance. 2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love. 3. Believes that they are "special" and unique and can only be understood by, or should associate with, other special or high-status people (or institutions). 4. Requires excessive admiration. 5. Has a sense of entitlement. 6. Is interpersonally exploitative. 7. Lacks empathy; is unwilling to recognize or identify with the feelings and needs of others. 8. Is often envious of others or believes that others are envious of them. 9. Shows arrogant, haughty behaviors, or aƫtudes. Prevalence: 0-6.2% in community samples.

borderline personality disorder

Diagnostic criteria: A. A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by 5 (or more) of the following: 1. Frantic efforts to avoid real or imagined abandonment. 2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. 3. Identity disturbance: markedly and persistently unstable self-image or sense of self. 4. Impulsivity in at least 2 areas that are potentially self-damaging. 5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior. 6. Affective instability due to a marked reactivity of mood. 7. Chronic feelings of emptiness. 8. Inappropriate, intense anger, or difficulty controlling anger. 9. Transient, stress-related paranoid ideation, or severe dissociative symptoms. Prevalence: 1.6-5.9%; higher prevalence in outpatient and psychiatric inpatient seƫngs.

Scizotypal Personality Disorder

Diagnostic criteria: A. A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior, beginning by early adulthood and present in a variety of contexts, as indicated by 5 (or more) of the following: 1. Ideas of reference (excluding delusions of reference). 2. Odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms. 3. Unusual perceptual experiences, including bodily illusions. 4. Odd thinking and speech. 5. Suspiciousness or paranoid ideation. 6. Inappropriate or constricted affect. 7. Behavior or appearance that is odd, eccentric, or peculiar. 8. Lack of close friends or confidants other than first-degree relatives. 9. Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self. Prevalence: 0.6-4.6%.

avoidant personality disorder

Diagnostic criteria: A. A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood and present in a variety of contexts, as indicated by 4 (or more) of the following: 1. Avoids occupational activities that involve significant interpersonal contact because of fears of criticism, disapproval, or rejection. 2. Is unwilling to get involved with people unless certain of being liked. 3. Shows restraint within intimate relationships because of the fear of being shamed or ridiculed. 4. Is preoccupied with being criticized or rejected in social situations. 5. Is inhibited in new interpersonal situations because of feelings of inadequacy. 6. Views self as socially inept, personally unappealing, or inferior to others. 7. Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing. Prevalence: 2.4%.

conduct disorder

Diagnostic criteria: A. A repetitve and persistent pattern of violating basic rights of others or major age-appropriate societal norms or rules. At least 3 behaviors in past year, with at least one present in the past 6 months: Aggression to People and Animals 1. Often bullies, threatens, or intimidates others. 2. Often initiates physical fights. 3. Has used a weapon that can cause serious physical harm to others. 4. Has been physically cruel to people. 5. Has been physically cruel to animals. 6. Has stolen while confronting a victim. 7. Has forced someone into sexual activity. Destruction of Property 8. Has deliberately engaged in fire setting with the intention of causing serious damage. 9. Has deliberately destroyed others' property (other than by fire setting). Deceitfulness or Theft 10. Has broken into someone else's house, building, or car. 11. Often lies to obtain goods or favors or to avoid obligations. 12. Has stolen items of nontrivial value without confronting a victim. Serious Violations of Rules 13. Often stays out at night despite parental prohibitions, beginning before age 13 years. 14. Has run away from home overnight at least twice while living in the parental or parental surrogate home, or once without returning for a lengthy period. 15. Is often truant from school, beginning before age 13 years. B. Causes clinically significant impairment. C. If the individuals is age 18 years or older, criteria are not met for antisocial personality disorder. Specify whether: childhood-onset type (before 10 y.o.); adolescent-onset type; unspecified onset (not enough information about when started). Specify if: With limited prosocial emotions (at least 2): o Lack of remorse or guilt o Callous—lack of empathy o Unconcerned about performance o Shallow or deficient affect Specify current severity: mild, moderate, severe. Prevalence: 5-6%, little difference by culture, more common in males than females. Course: no age limit, behaviors more disruptive with age, worse prognosis with earlier onset.

substance use disorder

Diagnostic criteria: A. Any problematic pattern of substance use leading to clinically significant impairment or distress. B. At least 2 symptoms in a 12-month period: a. Limit setting & breaking b. Social impairment c. Consequences d. Physiological dependence Specify if: mild, moderate, severe. Specify remission: In early remission: 3 consecutive months, no symptoms; cravings can be present. In full remission: 12 consecutive months, no symptoms; cravings can be present. Incidence: emerge before age 40; highest prevalence among young adults (negative correlation with age); short-acting substances have highest potential for addiction (quickest association with greater withdrawal effects). Prevalence: about 10% overall; alcohol most common; men tend to have more substance-use disorders in general (externalizing); highest among Native Americans; lowest among Asian Americans; there is also just problematic use. Treatment: most cases resolve without treatment; drug counseling most effective (12 step programs); CBT; assisted recovery for opioids.

Cylothymia

Diagnostic criteria: A. At least 2 years (1 year in children/adolescents) with numerous periods of hypomanic/depressive symptoms. B. Symptoms 50% of the time; not normal for more than 2 months. C. No mood episodes.

persistent depressive disorder

Diagnostic criteria: 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 (1 year for children/adolescents, can be irritable mood). B. At least 2 of the following while depressed: 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 C. For the 2 year (or 1 year children/adolescents) period of disturbance, the individual has never been without the symptoms in criteria A and B for more than 2 months at a time. D. Criteria for a major depressive disorder may be continuously present for 2 years (double depression). E. There has never been a manic or hypomanic episode. Specify course, onset, features, severity, whether major depressive episode. Associated features: more chronic impairment than MDD; separation or loss; poorer outcome; higher comorbidity (substance use, anxiety, personality disorder); symptom severity. Prevalence: 6% lifetime (2% point-prevalence). Course: 75% develop MDE in lifetime (gateway), 90% continue to have "depressive personality."

adjustment disorder

Diagnostic criteria: A. Development of emotional or behavioral symptoms in response to identifiable stressor(s) within 3 months of the onset of stressor(s). B. These symptoms or behaviors are clinically significant, as evidence by one or both of the following: 1. Marked distress that is out of proportion to the severity or intensity of the stressor, taking into account the external context and the cultural factors that might influence symptom severity and presentation. 2. Significant impairment in social, occupational, or other important areas of functioning. C. Does not meet criteria for, not related to another mental disorder. D. Not bereavement. E. Once the stressor (or its consequences) has terminated, the symptoms do not persist for more than an additional 6 months. Specify whether: with depressed mood; with anxiety; with mixed anxiety & depressed mood; with disturbance of conduct; with mixed conduct; unspecified. Associated features: younger age, more stressors, recent medical diagnosis/exacerbation, increased externalizing behaviors, suicidal behavior (given an inpatient discharge), less extensive psychiatric history (less need for treatment). Prevalence: 5-21% lifetime, higher among populations with stressors. Course: any time in the lifespan, cannot be for more than 6 months ------ then becomes "other specified" condition.

Separation Anxiety Disorder

Diagnostic criteria: A. Developmentally inappropriate and excessive fear or anxiety concerning separation to attached individual, at least 3 repetitive and excessive symptoms: 1. Distress anticipating or experiencing separation. 2. Worry about loss or harm to attachment figures. 3. Worry about event leading to separation. 4. Refusal to go out because of fear of separation. 5. Fear or refusal about being alone. 6. Refusal to sleep. 7. Nightmares about separation. 8. Complaints about somatic symptoms (headaches, stomachaches to stay home with attachment figure). B. Lasting 4 weeks in children, 6 months in adults. C. NBEB autism, psychotic symptoms, agoraphobia, other mental disorder. Associated features: separation protest (variations in amount, intensity); variety of negative emotion with separation; not always a direct expression of emotion (more indirect with adults); often related (or exacerbated by) stressor or separation; neediness, intrusiveness, clinginess in children (frequent accommodation by caregivers); school absences; homesickness; demandingness, overprotectiveness in adults (attached to other adults or children). Prevalence: 1.6% in children and similar in adults (most prevalent anxiety disorder under 12 years), prevalence decreases with age, develop something similar as an adult. Gender differences (boys more indirect). Course: onset in preschool/school age (less common for later ages), waxing/waning course, often "grow out of it," most adults with it had as children. Often when occurs later in life, shorter term due to an event. Culture: differences in value and timing of independence.

Specific Learning Disorder

Diagnostic criteria: A. Difficulties learning and using academic skills, as indicated by the presence of at least one of the following symptoms that have persisted for at least 6 months (despite intervention): 1. Inaccurate or slow and efforƞul word reading. 2. Difficulty understanding the meaning of what is read. 3. Difficulties with spelling. 4. Difficulties with written expression. 5. Difficulties mastering number sense, number facts, or calculation. 6. Difficulties with mathematical reasoning. B. The affected academic skills are substantially and quantifiably below those expected for the individual's chronological age, and cause significant interference. Confirmed by clinical assessment or individually administered standardized achievement measures. For older than 17 years, documented history of impairing learning difficulties may be substituted for standardized assessment. C. Learning difficulties began during school-age years, but may not become fully manifest until the demands for those affected academic skills exceed the individual's capacities. D. Not better accounted for by another dx. Specify if impairment in: reading, math, written expression. Prevalence: across reading, writing, and mathematics, 5-15% among school-age children across different language and cultures. Prevalence in adults is unknown but appears to be approximately 4%. Differential diagnosis: normal variation in academic attainment; ID; learning difficulties due to neurological or sensory disorders; neurocognitive disorders; ADHD; psychotic disorders.

generalized anxiety disorder

Diagnostic criteria: A. Excessive anxiety and worry, occurring more days than not for at least 6 months, about a number of events or activities. B. Individual finds it difficult to control the worry. C. The anxiety and worry are associated with 3 (or more) of the following 6 symptoms (with at least some symptoms having been present for more days than not for the past 6 months; only one symptom required in children): 1. Restlessness or feeling keyed up or on edge. 2. Being easily fatigued. 3. Difficulty concentrating or mind going blank. 4. Irritability. 5. Muscle tension. 6. Sleep disturbance. D. Causes clinically significant distress or impairment. E. Not attributable to physiological effects of a substance or another medical condition. F. NBEB another mental disorder. Associated features: always a "worrier;" interpersonal problems (reassurance seeking); stress-related physical conditions (not autonomic arousal); comorbid with depressive disorders, substance use. Prevalence: 9% lifetime, 3% 12-month prevalence. Women only slightly more prevalent compared to other anxiety disorders. In children, performance and events out of control (tend to overdiagnose). Course: median age of onset 31 years, high variability childhood to adulthood, early onset worse prognosis. Culture: ratio of expressed anxiety vs. somatic symptoms (more common in Western or developed nations).

specific phobia

Diagnostic criteria: A. Marked fear of object or situation. B. Always provokes immediate fear or anxiety. C. Avoided or endured with intense fear or anxiety. D. Out of proportion to actual danger. E. Lasting at least 6 months. Specify if: animal, natural environment, blood-injection-injury, situational, other. Associated features: fearful of stimuli threatening in evolutionary history (snakes, heights); autonomic arousal (except blood-injection-injury); comorbidity with other anxiety disorders; familiar pattern (tend to be for same subtype). Prevalence: common in population, but rare to meet for clinically significant distress or impairment; 10% lifetime. More common in women. Common/transitory in children, less common among older adults. Course: often appear in childhood; traumatic event. Culture: different cultural expressions; higher prevalence for lower SES (trauma).

social anxiety disorder

Diagnostic criteria: A. Marked fear of social situations with possible scrutiny (in children, must also be with peers). B. Fears that they will show anxiety (humiliation or embarrassment). C. Social situations almost always prove fear or anxiety. D. Social situations are avoided or endured with fear or anxiety. E. Out of proportion to the actual threat posed by social situation and to the sociocultural context. F. Persistent and lasting for at least 6 months. G. Causes clinically significant distress or impairment. H. NBEB another medical condition. I. If another medical condition, fear/anxiety/avoidance is excessive or unrelated. Specify if: performance only (i.e., fear is restricted to speaking or performing in public). Associated features: beliefs about how they appear (think appear much more nervous, that their anxiety is obvious); wish for interpersonal contact; unassertive, passive; in children, indirect expression (crying, refusing, hiding, mutism); modest familial pattern. Prevalence: common (especially public speaking), 12% lifetime, 7% 12-month prevalence. No sex-based difference in prevalence. Children cling to familiar adults, refuse to participate, speak in social activities; older adults concerns about functioning. Course: shyness as a child, onset in adolescence, continuous course, long time from onset to treatment. Culture: highly specific to cultural interactions (e.g., Asian cultures fear of offending others, fear of using public restrooms); collectivism ---- higher social anxiety but lower social phobia rates.

agoraphobia

Diagnostic criteria: A. Marked fear or anxiety about two (or more) of the following five situations: 1. Using public transportation 2. Being in open spaces 3. Being in enclosed spaces 4. Standing in line or being in a crowd 5. Being outside of the home alone B. Fears or avoids these situations because of thoughts that escape might be difficult or help might not be available in the event of developing panic-like symptoms or other incapacitating or embarrassing symptoms. C. Situations always provoke fear or anxiety. D. Situations avoided, require companion or endured with intense fear or anxiety. E. Out of proportion to the actual danger posed by the agoraphobic situations and to the sociocultural context. F. Persistent, lasting for 6 months or more. G. Causes clinical significant distress or impairment. H. If another medical condition present, fear/anxiety/avoidance is clearly excessive. I. NBEB social anxiety disorder, specific phobia, situational type, PTSD. Associated features: avoidance (active or passive—rituals, distraction, comfort zones); often to not report panic attacks (belief that avoidance prevents them); high comorbidity w/ anxiety precedes, depression and substance use follow, many have panic disorder beneath it. Prevalence: 2% 12-month prevalence. Children not show as agoraphobia (not a lot of volition), older adults worried about medical problems and falls. Course: onset in early adulthood, second common onset after 40, chronic disorder (often worsening course). Cultural impacts: few differences in prevalence; expression by race/ethnicity, family structure may influence detection.

somatic symptom disorder

Diagnostic criteria: A. One or more distressing or disruptive somatic symptoms. B. Excessive thoughts, feelings, or behaviors about symptoms, as manifested by at least one of the following: 1. Disproportionate and persistent seriousness. 2. Persistently high anxiety about symptoms. 3. Excessive time and energy devoted to symptoms. C. State of being symptomatic is persistent (typically more than 6 months). Specify if: with predominant pain (previously pain disorder). Specify if: persistent (severe symptoms, marked impairment, and long duration, i.e., 6+ months). Specify current severity: mild, moderate, severe. Associated features: genuine suffering from symptoms and distress; often non-specific, functional symptoms (sometimes normal variants of physiological complaints or discomforts, e.g., lower back pain); attention to negative attribution of physical sensations; multiple systems are affected; unusual diagnoses or circumstances of accrual; unusual relationship to diagnosis (appreciate the experience of being diagnosed; life circumstances around medical problems; treatment with multiple physicians; over-evaluation of medical diagnosis and under-evaluation psychological assistance. Risk factors: lower SES (less access medical care, more emphasis physical experiences, more work that involves physical body); trauma history; chronic illness, multiple medical illnesses; comorbid depression, anxiety disorders. Prevalence: 5-7%, slightly higher in females than males. Course: begins early in life, chronic/unremitting course (how they react to the world). Cultural Influences: "idioms of distress;" familial pattern of somatization and externalizing patterns in first degree relatives.

Conversion Disorder (Functional Neurological Symptom Disorder)

Diagnostic criteria: A. One or more symptoms altered voluntary motor or sensory function. B. Clinical findings provide evidence of incompatibility between the symptom and recognized neurological or medical conditions. Specify symptom type: with weakness or paralysis; with abnormal movement; with swallowing symptoms; with speech symptom; with attacks or seizures; with anesthesia or sensory loss; with special sensory symptom; with mixed symptoms. Specify if: acute episode (symptoms present for less than 6 mo.); persistent (symptoms occurring for 6+ mo.). Specify if: with psychological stressor (specify stressor); without psychological stressor. Associated features: la belle indifference (i.e., lack of concern about the nature or implications of the symptom) or histrionic features; suggestibility; psychosocial stressor; idiosyncratic symptom presentation; acute onset; more common in preindustrial cultures. Prevalence: precise prevalence unknown; incidence of symptoms 2-5/100,000 per year.

Autism Spectrum Disorder

Diagnostic criteria: A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by (all of) the following, currently or by hx.: 1. Deficits in social-emotional reciprocity. 2. Deficits in nonverbal communicative behaviors used for social interaction. 3. Deficits in developing, maintaining, and understanding relationships. B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history: 1. Stereotyped or repetitive motor movements, use of objects, or speech. 2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior. 3. Highly restricted, fixated interests that are abnormal in intensity or focus. 4. Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment. C. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life). D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning. E. Not better explained by another dx. Specify if: with or without accompanying intellectual impairment; with or without accompanying language impairment; associated with a known medical or genetic condition or environmental factor; associated with another neurodevelopmental, mental, or behavioral disorder; with catatonia. Prevalence: approached 1% of the population in the US. Often diagnosed more in boys than girls (4:1). Girls tend to show accompanying ID, suggesting girls without accompanying ID or language delays may go unrecognized. Differential Diagnosis: Retts syndrome, selective mutism, language disorders and social (pragmatic) communication disorder, ID without ASD, stereotypic movement disorder, ADHD, schizophrenia. Specify the level of supports needed - level 1,2, or 3.

Hoarding Disorder

Diagnostic criteria: A. Persistent difficulty discarding possessions (regardless of value or sentimentality). B. Perceived need to save, distress in discarding. C. Possessions contest and clutter living areas, compromise use. Specify if: with excessive acquisition. Specify if: with good or fair insight; with poor insight; with absent insight/delusional beliefs. Associated features: overvalue usefulness, importance, fate of objects (sentimentality, instrumental, or intrinsic values); procrastination, perfectionism, avoidance; unsanitary, unsightly, unsafe living spaces (embarrassed to have people over, significant compromises in lifestyle); animal hoarding; excessive acquisition (compulsive buying, acquisition free items,stealing); financial, legal, safety problems; memory, cognitive impairments specific to hoarding. Prevalence: 2-6% point prevalence. Harder to detect in children (tendency to collect, valuation of objects not on adult scale, caregivers control in discarding); 3x more likely in older adults than younger (lifetime of collection more impairing). Course: symptoms appear in childhood (e.g., collections), impairment in early adulthood, chronic.

illness anxiety disorder (hypochondriasis)

Diagnostic criteria: A. Preoccupation with having or acquiring a serious illness. B. Somatic symptoms are not present or not severe. C. High level of anxiety/alarm about health. D. Excessive engagement in or avoidance of health-related behaviors. E. Present for at least 6 months (feared illness can change). Specify whether: care-seeking type (medical care frequently used); care-avoidant type (medical care is rarely used). Associated features: afraid to have disease and believes they have it already; minor physiological alterations; fixation on particular illness; refuse to accept reassurance (not believe negative test results, deterioration in doctor-patient relationship); dependency in relationships; avoidance and preoccupation with medical information (cyberchondria, popularized illnesses, etc.). Prevalence: 1-10% lifetime, 2-7% in medical settings, similar in males and females. Course: onset in early adulthood, chronic, waxing/waning often in response to stress or interpersonal problems.

Body Dysmorphic Disorder (BDD)

Diagnostic criteria: A. Preoccupation with one or more perceived deficits or flaws in physical appearance that are not observable or appear slight to others. B. At some point during the course of the disorder, the individual has performed repetitive behaviors or mental acts in response to appearance concerns. C. Preoccupation causes clinically significant distress or impairment. D. NBEB eating disorder. Specify if: with muscle dysmorphia. Specify if: with good or fair insight; with poor insight; with absent insight/delusional beliefs. Associated features: excessive checking/reassurance seeking (often to exacerbation of any defect); generalizations about appearance; intrusive thoughts about defect (much of the day, little resistance to thoughts); poor insight (1/3 delusional beliefs); chronic low self-esteem (high overlap MDD); executive function and visual processing abnormalities (i.e., focus on details rather than the whole); focus on multiple defects or change in defect focus over time; want changes to appearance (frequent efforts to alter appearance, multiple visits to professionals); BDD by proxy. Prevalence: 2.4% lifetime, 6-15% in specialty clinics. Equally common in men and women (men more frequently concerned about muscle size). Course: onset in adolescence (early onset more severe), acute or gradual, chronic.

obessive-compulsive disorder

Diagnostic criteria: A. Presence of obsessions, compulsions, or both: Obsessions are defined by (1) and (2): 1. Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress. 2. The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion). Compulsions are defined by (1) and (2): 1. Repetitive behaviors or mental acts that the individual feels driven to perform in response to an obsession according to the rules that must be applied rigidly. 2. The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive. B. The obsessions or compulsions are time-consuming (e.g., 1 hour a day), or cause clinically significant distress or impairment. C. Not attributable to physiological effects of a substance or another medical condition. D. NBEB another medical condition. Specify if: with good or fair insight; with poor insight; with absent insight/delusional beliefs. Specify if: tic-related (individual has a current or past history of a tic disorder). Associated features: thought-action fusion (what they think is true/real); symptoms ego-syntonic; sometimes little insight into impairment of compulsions; familial pattern (tic disorders). Prevalence: 2% lifetime, equal for men and women, more common for boys than girls. Course: onset in early adolescence, 80% chronic/episodic (exacerbation with stress), persistent, 15% deteriorating course. Culture: no difference in prevalence across culture, expression varies/cultural content (e.g., scrupulosity and religious concepts).

bulimia nervosa

Diagnostic criteria: 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 overeating during the episode. B. Recurrent compensatory behaviors in order to prevent weight gain (e.g., self-induced vomiting, misuse of laxatives, fasting, excessive exercise). 1. Purging (92-94%): vomiting most common. 2. Nonpurging (6-8%): over-exercise, etc. C. Binge-eating/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. Disturbance does not occur exclusively during episodes of anorexia nervosa. Specify if: in partial remission; in full remission. Specify current severity: mild (1-3 episodes/week); moderate (4-7); severe (8-13); extreme (14+). Prevalence: 1-1.5% lifetime, higher in women than men. Course: adolescence onset, more likely to recover from than anorexia but still tends to persist.

binge eating disorder

Diagnostic criteria: 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 overeating during the episode. B. The binge-eating episodes are associate 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 feeling guilty afterward. C. Marked distress regarding binge eating. D. Occurs, on average, at least 1x a week for three months. E. Not associated with the recurrent use of inappropriate compensatory behavior; not occur exclusively during the course of bulimia or anorexia. Specify if: in partial remission; in full remission. Specify current severity: mild (1-3 binge eating episodes per week); moderate (4-7); severe (8-13); extreme (14+). Prevalence: 12-month prevalence among US adults is 1.6% females and 0.8% males. More prevalent among individuals seeking weight-loss treatment than in the general population.

Trichotillomania

Diagnostic criteria: A. Recurrent pulling out of one's hair, resulting in hair loss. B. Repeated attempts to decrease or stop hair pulling. Prevalence: 12-month prevalence 1-2%. Higher for females.

Excoriation (Skin-Picking) Disorder

Diagnostic criteria: A. Recurrent skin picking resulting in skin lesions. B. Repeated attempts to decrease or stop skin picking. Prevalence: lifetime prevalence 1.4% or higher. Higher for females.

panic disorder

Diagnostic criteria: A. Recurrent unexpected panic attacks. A panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four (or more) of the following symptoms occurs (can occur abruptly or while otherwise anxious): 1. Heart palpitations 2. Sweating 3. Trembling/shaking 4. Shortness of breath, smothering sensations 5. Choking 6. Chest pain or discomfort 7. Nausea or stomach aches 8. Dizziness, unsteady feelings, lightheadedness 9. Chills or heat sensations 10. Derealization (feelings of unreality) or depersonalization (being detached from oneself). 11. Numbness or tingling 12. Fear of losing control/going crazy 13. Fear of dying B. At least one of the attacks has been followed by 1 month (or more) of one or both of the following: 1. Persistent concern or worry about additional panic attacks or their consequences. 2. A significant maladaptive change in behavior related to the attacks. C. NBEB effects of a substance or another medical condition. D. NBEB another mental disorder. Associated features: emergency room/medical visits; anxiety sensitivity (fear of having anxiety symptoms, try to avoid ever feeling anxious); poor impressionistic memory for panic; interpersonal concomitants (separation, increase in responsibility); familial pattern; comorbidity with MDD, PTSD. Prevalence: 5% in lifetime (twice as common in women). Course: onset about 24 years, chronic (waxing/waning), agoraphobia usually develops in first year of panic—if it does, disorder tends to stick around.

anorexia nervosa

Diagnostic criteria: A. Restriction of intake leading to significantly low weight (typically 85% of expected weight, given age and height). B. Intense fear of gaining weight or interference in weight. C. Disturbance in body image only with self. Subtypes: 1. Restricting type: dieting, fasting, exercise. 2. Binge-eating/purging type: vomiting, laxatives, dietetics, enemas. Specify if: in partial remission; in full remission. Associated features: comorbidity with depression, OCD (thoughts, compensatory behaviors), OCPD; comorbid medical problems; physical changes; reinforcement and attention for dieting behaviors; lack of emotional attunement in family; conflicts around autonomy and control (obsessional traits in childhood); concerns about eating in public; amenorrhea (absence of menstrual periods); mortality from medical problems or suicide. Prevalence: less than 1%; women 9x more likely than men, often found in athletes/performers. Course: emergence in early adolescence, fluctuating/episodic course majority, half go on to develop bulimia.

Disruptive Mood Dysregulation Disorder

Diagnostic criteria: A. Severe recurrent temper outbursts manifested verbally and/or behaviorally that are grossly out of proportion in intensity or duration to the situation or provocation. B. Temper outbursts are inconsistent with developmental level. C. Temper outburst occurs, on average, 3+ times a 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. Criteria A-D have been present for 12+ months, no more than 3 months without. F. The diagnosis should not be made for the first time before age 6 years or after age 18 years. G. By history or observation, the age at onset of Criteria A-E is before 10 years. H. Never manic/hypomanic episode. I. Never ODD, intermittent explosive disorder, or bipolar disorder. Associated features: reactivity and poor affect regulation; distinguish from bipolar disorder in children (capture chronic reactivity and outbursts instead). Prevalence: 2-5%, higher in males, early childhood. Course: highest in childhood, decrease in adolescence, conversion into internalizing disorders.

delusional disorder

Diagnostic criteria: A. The presence of one (or more) delusions with a duration of 1 month or longer. B. Criterion A for Schizophrenia has never been met; no other positive or negative symptoms (except hallucinations in service of delusions). C. Functioning not otherwise impaired. D. If mood disorders have occurred, they have been brief relative to the duration of the delusional period. E. NBEBA substance use, medical condition, other mental disorder. Specify whether: erotomanic type, grandiose type, jealous type, persecutory type (most common), somatic type, mixed type, unspecified type. Specify if: with bizarre content. Specify if: first episode, currently in acute episode; first episode, currently in partial remission; first episode, currently in full remission; multiple episodes, currently in acute episode; multiple episodes, currently in partial remission; multiple episodes, currently in full remission; unspecified. Associated features: increased irritability, mood disturbance, aggressivity (related to the delusion). Prevalence: 0.3%. No difference in prevalence by sex. Consider cultural expressions.

Schizophrenia

Diagnostic criteria: A. Two or more of the following symptoms present for a significant portion of time during a 1-month period (less time if successfully treated). At least one must be (1), (2), or (3): 1. Delusions 2. Hallucinations 3. Disorganized speech 4. Disorganized behavior 5. Negative symptoms B. One or more major areas of functioning markedly below normal (e.g., work, interpersonal relations, self-care). C. Continuous signs of disturbance persist for at least 6 months. D. NBEBA schizoaffective, mood disorders. E. NBEBA substance use, another medical condition. F. NBEBA neurodevelopmental disorder. Specify if: first episode, currently in acute episode; first episode, currently in partial remission; first episode, currently in full remission; multiple episodes, currently in acute episode; multiple episodes, currently in partial remission; multiple episodes, currently in full remission; unspecified. Specify if: with catatonia. Specify current severity. Course: generally premorbid signs; negative symptoms progressively worsen over lifespan (positive symptoms variable). Associated features: childhood signs (language, motor delays, uneven motor development, poor social development, transient pervasive developmental disorder symptoms—developmental gain and loss); poor insight; suicidality; violence; substance use disorders; neurocognitive impairments (decreased verbal memory, decreased processing speed; decreased executive functioning); poor functioning; decreased fertility. Prevalence: consistently 1% (risk greater with first-degree relative). Culture: influences belief systems/experiences; higher prevalence among African Americans (bias with diagnosis); higher prevalence in developed countries. Age: onset late adolescence to early 30's; uncommon in children, late onset more likely in women. Gender: no difference in prevalence (difference in incidence); men more severe symptoms, women with more affective symptoms/paranoia/hallucinations.

schizoaffective disorder

Diagnostic criteria: A. Uninterrupted period of positive or negative symptoms with a major mood episode (major depressive episode with depressed mood or manic episode). B. At least 2 weeks during lifetime when delusions or hallucinations without mood disturbance. C. Mood episode present for the majority of active and residual period. D. NBEBA substance use or medical condition. Specify whether: bipolar type or depressive type. Specify if: with catatonia. Specify if: first episode, currently in acute episode; first episode, currently in partial remission; first episode, currently in full remission; multiple episodes, currently in acute episode; multiple episodes, currently in partial remission; multiple episodes, currently in full remission; unspecified. Specify current severity. Associated features: better prognosis than schizophrenia, but worse than bipolar or depressive disorders; negative symptoms less severe. Prevalence: 0.3% lifetime; more common in females than males.

posttraumatic stress disorder (PTSD)

Diagnostic criteria: applies to adults, adolescents, and children 6+ years. A. Exposure to actual or threatened death, serious injury, or sexual violence (at least 1): 1. Direct experience 2. Witnessing in person 3. Learning about violent or accidental death 4. Experiencing repeated or extreme exposure B. Reexperiencing (at least 1): 1. Recurrent distressing intrusive recollections 2. Recurrent distressing dreams 3. Dissociative reactions (flashbacks) 4. Intense distress to external or internal cues 5. Physiological reactivity to external or internal cues. C. Avoidance (at least 1): 1. Efforts to avoid thoughts, feelings. 2. Efforts to avoid activities, places, or people. D. Negative alterations in cognition and mood (at least 2): 1. Inability to recall important parts of trauma 2. Negative beliefs about self, other, world 3. Distorted cognitions about cases or consequences of trauma (e.g., individual blaming) 4. Negative emotional state (e.g., fear, depression) 5. Markedly diminished interest or participation 6. Detachment or estrangement feelings 7. Restricted range of affect E. Hyperarousal (at least 2): 1. Irritability 2. Self-destructive behavior 3. Hypervigilance 4. Easily startled 5. Problems concentrating 6. Sleep disturbance F. Disturbance lasting at least 1 month. Specify whether: with dissociative symptoms (depersonalization and/or derealization). Specify if: with delayed expression (if the full diagnostic criteria are not met until at least 6 months after the event). Criteria slightly different in children 6 years or younger: repetitive play trauma; nightmares not necessarily connected; developmental regressions (tantrums, outbursts); not any self- destruction (see DSM-V p. 272). Associated features: rigid or inflexible belief style; developmental regressions; likelihood of experiencing additional traumas; comorbidity -- children ODD and separation anxiety, adults mood disorders, substance; TBI common in service personnel; interpersonal trauma (chronic abuse), impaired affect regulation (hostility), defectiveness, shame, impaired relationships (attachment), dissociation, impulsivity, ineffectiveness, somatization; violent trauma and survivor's guilt. Prevalence: 20-50% following major t

major depressive disorder

Diagnostic criteria: must have had a major depressive episode(s), either single or recurrent (at least 2 months not meeting criteria in between), and never a had a manic or hypomanic episode. Code for episodic nature, severity. Associated features: psychosocial stressor more important for first episode than later episodes; interpersonal problems (reassurance seeking, hostility); double depression when with pre-existing dysthymia; 5-15% deaths by suicide; high comorbidity with other disorders (anxiety, substance use, borderline personality); medical problems (sleep disturbance, more experience of pain); disability. Prevalence: 20% lifetime women, 10% for men (point-prevalence 7% for women, 3% for men); more likely with first-degree relative. Culture moderates the experience: somatic features (weakness) in Asian cultures; "nerves" and headaches (increased emotionality) in Latin cultures. Course: onset in mid 20's, remission (partial symptoms vs. full), 60% more likely to have another major depressive episode; 10-15% experience a manic episode, chronic = dysthymia.

Bipolar II

Diagnostic criteria: must meet criteria for a current or past hypomanic episode and the criteria for a current or past major depressive episode. There has never been a manic episode. Specify hypomanic or depressed for most recent episode, course, and severity. Associated features: more mood episodes than bipolar I (less hypomanic symptoms than bipolar I); similar suicide attempts as bipolar I (more completed attempted); similar comorbidity to bipolar I (anxiety, substance/impulse). Prevalence: 1% in lifetime (women > men). Course: 5-15% will develop a manic episode (gateway to bipolar I).

Bipolar I

Diagnostic criteria: must meet criteria for a manic episode; the manic episode may have been preceded by and may be followed by hypomanic or major depressive episodes. Code for current or most recent episode, course, and severity. Associated features: abrupt onset/offset of manic episode (psychosocial stressor); low insight into mania as a problem (depression often viewed as the problem; regret from mania inducing depression); bipolar diathesis (i.e., will become manic if put on antidepressant treatments); interpersonal problems outside of mood episodes; comorbidity with anxiety disorder, substance use, or impulse control disorder; suicidality quite common; average life expectancy about 9 years less. Prevalence: 1% lifetime (equally common men and women); strong heritability coefficient; more common in higher SES (in terms of diagnosis, popular diagnosis now in psychiatry). No difference by race or ethnicity (African American individuals may be diagnosed with schizophrenia). More severe in childhood and adolescence (mixed episodes, psychotic featuresmore likely). Men often have first episode manic, women often major depressive episode first. Women more likely experience rapid cycling. Course: onset before age 20; 90% with a single manic episode have other manic episodes, possibility for rapid cycling.

factitious disorder

Factitious Disorder Imposed on Self: A. Falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception. B. The individual presents themselves to others as ill, impaired, or injured. C. Deceptive behavior is evident even in the absence of obvious external rewards. Specify: single episode; recurrent episodes (2+ events). Factitious Disorder Imposed on Another (previously factitious disorder by proxy): 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. Deceptive behavior is evident even in the absence of obvious external rewards. Specify: single episode; recurrent episodes (2+ events). Prevalence: unknown, likely because of the role of deception; estimated that 1% of patients in hospital settings meet criteria.

gambling disorder

Grouped with substance disorders due to similar reward pathways and behaviors. Diagnostic criteria: A. Problematic patterns of gambling, causing clinically significant distress or impairment. B. Four or more symptoms over a 12 month period: a. Gambles with more in order to achieve excitement (tolerance). b. Restless or irritable when attempting to cut down (withdrawal). c. Repeated unsuccessful attempts to cut back. d. Preoccupied with gambling. e. Gambles when distressed. f. After losing, returns to get even. g. Lies to conceal gambling. h. Jeopardized or lost relationship or opportunity. i. Relies on others to relieve finances. C. NBEB manic episode. Specify if: episodic (symptoms subside for several months) or persistent (continuous symptoms over years). Specify remission: early remission or full remission. Specify severity: mild (4-5 symptoms); moderate (6-7); or severe (8-9). Associated features: distortions (superstitious, grandiosity, denial); unusual relationship to money (believe to be the cause and solution to problems, extravagance); illicit activities common (unregulated games, stealing, lying); suicide attempts (shame/consequences); personality features (grandiosity, flashy). Prevalence: 1% lifetime; higher for males than females; males develop earlier and females later but more rapidly; 3x higher among Asian individuals (luck as a virtue/trait).

Schizophreniform Disorder

Impairment not necessary. Presumably better prognosis than schizophrenia. Diagnostic criteria: A. Two or more of the following symptoms present for a significant portion of time during a 1-month period (less time if successfully treated). At least one must be (1), (2), or (3): 1. Delusions 2. Hallucinations 3. Disorganized speech 4. Disorganized behavior 5. Negative symptoms B. An episode of the disorder lasts for at least 1 month but less than 6 months. When the diagnosis must be made without waiting for recovery, it should be qualified as "provisional." C. NBEBA schizoaffective or mood disorder. D. NBEBA substance use, another medical condition. Specify if: With good prognostic features: rapid onset of psychotic symptoms (4 weeks), confusion during psychosis, good premorbid functioning, absence of blunted/flattened affect. Without good prognostic features.

Alzheimer's disease

Insidious onset and gradual progression; typically unaware of cognitive deficits; onset of death typically 8-10 years. Three stages: 1. Problems for recent memory: forgetting (50% first symptom), repeating things. 2. Further cognitive declines: 3 A's, frontal release signs (regain early reflexes), personality changes, lose ability to live independently, delusions, hallucinations. 3. Final stages: lose vocabulary, lose self-care, unable to coordinate movement, death. Associated features: depressive symptoms, pronounced delusions. Brain changes (recognized in autopsy): amyloid plaques, neuronal tangles (cross wiring), enlarged ventricles, reduced ACh activity. Prevalence: early onset under age 50; age is a risk factor, earlier head injury, heredity. Course: progressive, degenerative, terminal. Medication can be used to manage symptoms in first two stages.

Malingering

Malingering: intentional production of symptoms; motivation for external incentives (e.g., money, time off work). Associated features: legal reasons for consult; discrepancy between findings vs. distress and impairment; antisocial personality; pressure to diagnose.

TBI NCD

One or more of: loss of consciousness; posttraumatic amnesia; disorientation and confusion; neurological signs (neuroimaging, seizures, change in functions). Presents immediately after injury and persists. Associated features: emotion regulation and personality changes; physical and neurological symptoms specific to injury location (headaches, sensory disorders, seizures, paralysis); orthopedic injuries. Prevalence: 2% lifetime (75% concussion or mild TBI). Risk: 0-4 years (falls); 15-19 years (risky, accidents); 65+; males >females across lifespan. Course: o Mild: usually reversed in weeks (longer for older individuals); repeated mild injuries lead to NCD. o Moderate to severe: persisting and more complex deficits and symptoms; greater comorbidity for other disorders (Alzheimer's).

transvestic fetishism

Over at least 6 months, recurrent & intense sexual arousal from cross-dressing Specify if: With fetishism: sexually aroused by fabrics, materials, or garments With autogynephilla: sexually aroused by thoughts or images of self as female

Fetishism

Over at least 6 months, recurrent & intense sexual arousal from either the use of nonliving objects or a highly specific focus on nongenital body parts The fetish objects are not limited to articles of clothing used in cross-dressing or devices specifically designed for tactile genital stimulation Specify if: Body parts, Nonliving objects, Other

Voyeurism

Over at least 6 months, recurrent & intense sexual arousal from observing an unsuspecting person who is naked, in the process of disrobing, or engaging in sexual activity, as manifested by fantasies, urges or behaviors. Has acted on these sexual urges with nonconsenting person, or the sexual urges or fantasies cause clinically significant distress At least 18 years old

sexual masochism

Over at least 6 months, recurrent & intense sexual arousal from the act of being humiliated, beaten, bound, or otherwise made to suffer Specify if: With asphyxiophillia: achieve sexual arousal through the restriction of breathing

Exhibitionism

Over at least 6 months, recurrent & intense sexual arousal from the exposure of one's genitals to an unsuspecting person, as manifested by fantasies, urges or behaviors. Has acted on these sexual urges with nonconsenting person, or the sexual urges or fantasies cause clinically significant distress Specify if: Sexually aroused by exposing genitals to prepubertal children, physically mature individuals, or both.

sexual sadism

Over at least 6 months, recurrent & intense sexual arousal from the physical or psychological suffering of another person Has acted on these sexual urges with nonconsenting person, or the sexual urges or fantasies cause clinically significant distress

Frotteurism

Over at least 6 months, recurrent & intense sexual arousal from touching or rubbing against a nonconsenting person Has acted on these sexual urges with nonconsenting person, or the sexual urges or fantasies cause clinically significant distress

Pedophilia

Over at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child or children (generally 13 or younger) Has acted on these sexual urges with nonconsenting person, or the sexual urges or fantasies cause clinically significant distress At least 16 years old and at least 5 years older than the child or children (do not include an individual in late adolescence involved in an ongoing sexual relationship with a 12 or 13 y/o) Specify if: Exclusive type (attracted only to children) Nonexclusive type Sexually attracted to males, females, or both Limited to incest

Mental Disorders due to a General Medical Condition

Presence of significant psychiatric symptoms. Evidence of direct physiological consequences of medical condition. NBEBA other mental disorder. Not exclusively during delirium.

Perception-distorting substances

Short-term effects: Bloodshot eyes (THC) Increased appetite (THC) Mood alterations Disorientation Hallucinations Synesthesia Impaired cognitive abilities Long-term effects: Flashbacks (LSD) Low motivation Decreased cognitive abilities Withdrawal: Sleep disturbance Loss of appetite Irritability Tremors Depression

Stimulants

Short-term effects: Euphoria Dilated pupils Feeling of energy Increased activity/speech Decreased appetite Wakefulness Long-term effects: Chronic sleep problems Poor appetite Rapid/irregular heartbeat Mood swings Withdrawal: Dysphoria Extreme fatigue Sleep disturbance Increased appetite/weight gain

Opioids

Short-term effects: Euphoria Drowsiness Apathy Impaired cognitive ability Reduced pain sensitivity Long-term effects: Mood instability Constipation Respiratory impairments Physical deterioration Withdrawal: Dysphoria Aches, pains Diarrhea/nausea/vomiting Pupil dilation Fever Insomnia

Depressants

Short-term effects: Relief from anxiety Euphoria Lowered inhibition Poor motor coordination Impaired concentration/judgment Slurred speech blurred vision Long-term effects: Depression Chronic fatigue Respiratory impairments Impaired sexual function Decreased attention span Poor memory/judgment Chronic sleep problems Withdrawal: Tremors Insomnia Irritability/restlessness Hallucinations Convulsions

criteria

Standards by which to evaluate or test membership (e.g., intensity, frequency, developmental status, duration, pervasiveness, external circumstances).

neurocognitive disorders (NCDs)

Substantial change in cognitive function from previous states, mostly due to medical cause, accident, or substance usage. Neurocognitive domains: Attention: orientation, sustained attention, divided attention, selective attention, processing speed. Executive functioning: planning, decision-making, working memory, feedback utilization, inhibition, flexibility. Learning and memory: sensory memory, short-term memory, long-term memory (declarative, semantic, episodic, procedural). Language: expressive, receptive, grammar/syntax. Perceptual-motor: visual perception, visuo-constructional, praxis, gnosis. Social cognition: emotion recognition, theory of mind, comprehension. Associated features: motor or gait disturbance; personality change (disinhibited behavior); mood changes and anxiety; sleep disturbance; delusions; poor insight into condition. Prevalence: 3% of adults with severe cognitive impairment (increases with age, 65+). More frequently observed in older and/or medically unwell individuals.

disorder

a disturbance or derangement that affects the function of mind/body.

syndrome

a group of symptoms that collectively indicate or characterize a disease, a psychological disorder, or another abnormal condition.

disease

a morbid entity originally characterized by two or more of the following criteria: recognized etiologic agent(s), identifiable group of signs and symptoms, and/or consistent anatomic alterations.

major depressive episode

at least 5 depressive episodes, present most of the day, nearly everyday for same 2 weeks: Gateway symptoms (must have at least 1): depressed mood; anhedonia (lack of interest). Other symptoms: appetite disturbance (hypophagia, hyperphagia), weight change, sleep disturbance (+/- 2 hours a night, cannot be making it up by sleeping later), insomnia, hypersomnia, psychomotor disturbance (agitation or retardation), low physical energy/fatigue, worthlessness, guilt, problems concentrating & indecisiveness, thoughts of death or suicide (passive vs. active). Clinically significant distress or impairment. NBEB substance use, another medical condition.

cultural idiom of distress

culture-specific way of indicating distress (e.g., fatigue in depression).

prototypical

description of a disease; way of defining a disorder (e.g., PDM description of BPD).

Polythetic

diagnosis is satisfaction of certain number of criteria; makes for qualitatively different experiences given same diagnosis (e.g., a DSM dx. that must meet 5 of 9 criteria).

Psychopathology

disorder of the mind

manic episode

elevated, expansive, or irritable mood AND increased goal-directed activity or energy lasting at least 1 week (or any duration if hospitalized). 3 or more symptoms (4 if only irritable): grandiosity, decreased need for sleep, pressured speech/more talkative, flight of ideas/racing thoughts, distractibility, increase in goal- directed activity or psychomotor agitation, risky behaviors. Causes marked impairment, hospitalization, or psychosis. NBEB substance use, another medical condition.

sexual arousal cycle

excitement, plateau, orgasm, resolution

dimensional

exists on a continuum (high or low); how psychologists view things.

categorical

have or have not

Incidence

how many people have x in a given time

Prevalence

how many people have x over a certain time (lifetime).

Apraxia

inability to coordinate motor movement (despite intact sensory ability).

Agnosia

inability to recognize objects (despite intact sensory ability).

abnormal psychology

incorporates all other areas of psychology (developmental, cognitive, etc.)

aphasia

language disturbance (speech vague, circumstantial, extensive, pronoun use, stereotyped phrases, cannot explain meaning common phrases).

provisional diagnosis

not enough information, but strong assumption.

Unspecified Disorder

not meeting full criteria but no reason given why.

other specified disorder

not meeting full criteria, but clinically significant; uncharacteristic presentation; reason given why not meeting criteria.

sign

objective indication of disorder (e.g., observed and interpreted by expert rather than patient/lay observer); may or may not be expressed by patient.

genito-pelvic pain/penetration disorder

persistent/recurrent difficulties with at least 1: vaginal penetration during intercourse, pain during penetration, fear or anxiety about pain, tensing or tightening of pelvic floor muscles during penetration; at least 6 months

course

progress of condition over time

Steroids

short-term effects: Euphoria Muscle growth long-term effects: Reversal of 2°sex characteristics Irritability Reduced energy Liver/heart disease Withdrawal: Mood swings Depression Weakness/fatigue Weight loss

symptom

subjective indication of a disorder (e.g., patient report); may or may not be directly observable.

Cultural syndrome

syndrome found uniquely in cultural group (e.g., Koro—genital retraction syndrome).

diagnosis

the art or act of identifying a disease from its signs and symptoms.

differential diagnosis

the process of differentiating between two or more conditions which share similar signs or symptoms.

cultural explanation or cause

understanding why a symptom occurs unique to a culture.