Psychopathology Exam 2

What is a personality disorder?

enduring pattern of inner experience and behavior that deviates markedly from the norms and expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment

Pattern of distrust and suspiciousness such that others’ motives are interpreted as malevolent describes…

Paranoid personality disorder

Pattern of detachment from social relationships and a restricted range of emotional expression describes…

Schizoid personality disorder

Pattern of acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behavior describes…

Schizotypal personality disorder

Pattern of disregard for, and violation of, the rights of others, criminality, impulsivity, and a failure to learn from experience describes…

Antisocial personality disorder

Pattern of instability in interpersonal relationships, self-image, and affects, and marked impulsivity describes…

Borderline personality disorder

Pattern of excessive emotionality and attention seeking describes…

Histrionic personality disorder

Pattern of grandiosity, need for admiration, and lack of empathy describes…

Narcissistic personality disorder

Pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation describes…

Avoidant personality disorder

Pattern of submissive and clinging behavior related to an excessive need to be taken care of describes…

Dependent personality disorder

Pattern of preoccupation with orderliness, perfectionism, and control describes…

Obsessive-compulsive personality disorder

Which personality cluster is described as “often appear odd and eccentric”?

Cluster A

Which personality disorders are included in Cluster A?

Paranoid, schizoid, and schizotypal

Which personality cluster is described as “often appear dramatic, emotional, or erratic”?

Cluster B

Which personality disorders are included in Cluster B?

Antisocial, borderline, histrionic, and narcissistic

Which personality cluster is described as “often appear anxious or fearful”?

Cluster C

Which personality disorders are included in Cluster C?

Avoidant, dependent, obsessive-compulsive

General Personality Disorder

• A - An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture. Manifested in two or more of the following areas:

  • Cognition (ways of perceiving and interpreting the self, other people, and events)

  • Affectivity (range, intensity, lability, and appropriateness of the emotional response)

  • Interpersonal functioning

  • Impulse control

• B - enduring pattern is inflexible and pervasive across a broad range of personal and social situations

• C - enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning

• D - a pattern is stable and of long duration, and its onset can be traced back at least to adolescence or early adulthood

• E - enduring pattern is not better explained as a manifestation or consequence of another mental disorder

• F - enduring pattern is not attributable to the physiological effects of a substance or another  medical condition

Paranoid Personality Disorder

• 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 four or more of the following:

  • Suspects, without sufficient basis, that others are exploiting, harming, or deceiving them

  • Preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates

  • Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against them

  • Reads hidden demeaning or threatening meanings into benign remarks or events

  • Persistently bears grudges (is unforgiving of insults, injuries, or slights)

  • Perceives attacks on their character or reputation that are not apparent to others and is quick to react angrily or to counterattack

  • Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner

• B - Does not occur exclusively during the course of schizophrenia, a bipolar or depressive disorder with psychotic features, or another psychotic disorder and is not attributable to the physiological effects of another medical condition

• NOTE - if criteria are met prior to schizophrenia onset, add “premorbid” to this diagnosis - paranoid personality disorder (premorbid)

Schizoid Personality Disorder

• A - A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts, as indicated by four or more of the following:

  • Neither desires nor enjoys close relationships, including being part of a family

  • Almost always chooses solitary activities

  • Has little, if any, interest in having sexual experiences with another person

  • Takes pleasure in few, if any, activities

  • Lacks close friends or confidants other than first-degree relatives

  • Appears indifferent to the praise or criticism of others

  • Shows emotional coldness, detachment, or flattened affectivity

• B - does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, another psychotic disorder, or ASD and is not attributable to the physiological effects of another medical condition

• NOTE - if criteria are met prior to the onset of schizophrenia, add “premorbid”

Schizotypal Personality Disorder

• 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 five or more of the following:

  • Ideas of reference (excluding delusions of reference)

  • Odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (superstitious beliefs in clairvoyance, telepathy, or sixth sense; in children or adolescents, bizarre fantasies or preoccupations)

  • Unusual perceptual experiences, including bodily illusions

  • Odd thinking and speech (vague, circumstantial, metaphorical, overelaborate, or stereotyped)

  • Suspiciousness or paranoid ideation

  • Inappropriate or constricted affect

  • Behavior or appearance that is odd, eccentric, or peculiar

  • Lack of close friends or confidants other than first-degree relatives

  • Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self

• B - Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, another psychotic disorder, or ASD

Antisocial Personality Disorder

• A - a pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 years, as indicated by three or more of the following:

  • Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest

  • Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure

  • Impulsivity or failure to plan ahead

  • Irritability and aggressiveness, as indicated by repeated physical fights or assaults

  • Reckless disregard for safety of self or others

  • Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations

  • Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another

• B - individual is at least 18 years of age

• C - there is evidence of conduct disorder with onset before age 15 years

• D - occurrence of antisocial behavior is not exclusively during the course of schizophrenia or bipolar disorder

Borderline Personality Disorder

• 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 five (or more) of the following:

  • Frantic efforts to avoid real or imagined abandonment (Do not include suicidal or self-mutilating behavior covered in pattern 5)

  • A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation

  • Identity disturbance: markedly and persistently unstable self-image or sense of self

  • Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating) (Don’t include suicidal or self-mutilating behavior)

  • Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior

  • Affective instability due to marked reactivity of mood (intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)

  • Chronic feelings of emptiness

  • Inappropriate intense anger or difficulty controlling anger (frequent displays of temper, constant anger, recurrent physical fights)

  • Transient, stress-related paranoid ideation or severe dissociative symptoms

Histrionic Personality Disorder

• A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

  • Is uncomfortable in situations in which they are not the center of attention

  • Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior

  • Displays rapidly shifting and shallow expression of emotions

  • Consistently uses physical appearance to draw attention to self

  • Has a style of speech that is excessively impressionistic and lacking in detail

  • Is suggestible (easily influenced by others or circumstances)

  • Considers relationships to be more intimate than they actually are

Narcissistic Personality Disorder

• 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 five (or more) of the following:

  • Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)

  • Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love

  • Believes they are “special” and unique and can only be understood by, or should associate with, other special or high-status people or institutions

  • Requires excessive admiration

  • Has a sense of entitlement (unreasonable expectations of others, especially favorable treatment or automatic compliance with their expectations)

  • Is interpersonally exploitative (takes advantage of others to achieve their own ends)

  • Lacks empathy, is unwilling to recognize or identify with the feelings and needs of others

  • Is often envious of others or believes that others are envious of them

  • Shows arrogant, haughty behaviors or attitudes

Avoidant Personality Disorder

• 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 four (or more) of the following:

  • Avoids occupational activities that involve significant interpersonal contact because of fears of criticism, disapproval, or rejection

  • Is unwilling to get involved with people unless certain of being liked

  • Shows restraint within intimate relationships because of the fear of being shamed or ridiculed

  • Is preoccupied with being criticised or rejected in social situations

  • Is inhibited in new interpersonal situations because of feelings of inadequacy

  • Views self as socially inept, personally unappealing, or inferior to others

  • Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing

Dependent Personality Disorder

• 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 five (or more) of the following:

  • Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others

  • Needs others to assume responsibility for major areas of their life

  • Has difficulty expressing disagreement with others because of fear of loss of support or approval (don’t include realistic fears of retribution)

  • Has difficulty initiating projects or doing things on their own (because of a lack of self-confidence in judgment or ability rather than a lack of motivation)

  • Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant

  • Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for themself

  • Urgently seeks another relationship as a source of care and support when a close relationship ends

  • Is unrealistically preoccupied with fears of being left to take care of themself

Obsessive-Compulsive Personality Disorder

• 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 four (or more) of the following:

  • Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost

  • Shows perfectionism that interferes with task completion (is unable to complete a project because their overly strict standards are not met)

  • Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity)

  • Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, and values (not accounted for by cultural or religious identification)

  • Is unable to discard worn-out or worthless objects even when they have no sentimental value

  • Is reluctant to delegate tasks or to work with others unless they submit to exactly their way of doing things

  • Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes

  • Shows rigidity and stubbornness

Negative affectivity (vs emotional stability)

Emotional lability, anxiousness, separation insecurity, submissiveness, hostility, perseveration, depressivity, suspiciousness

Detachment (vs extraversion)

Withdrawal, intimacy avoidance, anhedonia, depressivity, restricted affectivity, suspiciousness

Antagonism (vs agreeableness)

Manipulativeness, deceitfulness, grandiosity, attention seeking, callousness, hostility

Disinhibition (vs conscientiousness*)

irresponsibility, impulsivity, distractibility, risk taking, (lack of) rigid perfectionism

Psychoticism (vs lucidity)

Unusual beliefs and experiences, eccentricity, cognitive and perceptual dysregulation

The “self” component of Criterion A for the continuous model of personality disorders includes…

Identity, self-direction

Identity

unique, boundaries of self and others, stability of self-esteem  and accurate self-appraisal, regulation of emotion

Self-direction

pursue coherent and meaningful goals, prosocial internal standards of behavior, self reflect productively

The “interpersonal” component of Criterion A for the continuous model of personality disorders includes…

empathy, intimacy

Empathy

appreciate others and their experiences and motivation, tolerance of differing perspective, understand effect of behavior on others

Intimacy

connected to others, desire closeness, mutuality of regard

Continuous General Personality Disorder Criteria

A - moderate or greater impairment in personality (self/interpersonal) functioning

B - one or more pathological personality traits

C - the impairments in personality functioning and the individual’s personality trait expression are relatively inflexible and pervasive across a broad range of personal and social situations

D - impairment in personality functioning and the personality trait are relatively stable across time, with onsets that can be traced back to at least adolescence and early adulthood

E -the impairments in personality functioning and the individual’s personality trait expression are not better explained by another mental disorder

F - the impairments in personality functioning and the individual’s personality trait expression are not solely attributable to the physiological effects of a substance or another medical condition (severe head trauma)

G - the impairments in personality functioning and the individual’s personality trait expression are not better understood as normal for an individual’s developmental state and sociocultural environment

Schizotypal (Continuous Model)

• High end of detachment

  • Restricted affectivity

  • Withdrawal

  • suspiciousness

• High end of psychoticism

  • Cognitive and perceptual dysregulation

  • Unusual beliefs

  • Eccentricity

Antisocial (Continuous Model)

• High end of disinhibition

  • Risk taking

  • Impulsivity

  • irresponsibility

• High end of antagonism

  • Manipulativeness

  • Callousness

  • Deceitfulness

  • Hostility

Borderline (Continuous Model)

• High end of disinhibition

  • Risk taking*

  • impulsivity*

• High end of antagonism

  • hostility*

• High end of negative affectivity

  • Emotional lability

  • Anxiousness

  • Separation insecurity

    • Depressiveness

Narcissistic (Continuous Model)

• High end of antagonism

  • Grandiosity

    • Attention and admiration seeking

Avoidant (Continuous Model)

• High end of negative affectivity

  • anxiousness*

• High end of detachment

  • Withdrawal

  • Anhedonia

    • Intimacy avoidance

Obsessive-compulsive (Continuous model)

• High end of detachment

  • Intimacy avoidance

  • Restricted affectivity

• Low end of disinhibition (high conscientiousness)

  • Rigid perfectionism*

• High end of negative affectivity

  • Perseveration

According to Sharp et al. (2025), what are pros and cons of the personality disorders as dimensional?

Pros - greater empirical support, Diagnostic types can be translated into dimensions or a hybrid model, Better discriminant validity and psychometric properties, Clinical utility, Focus treatment on trait problems, Engenders greater compassionate understanding of PD and less stigma, We all have these personality traits

Cons - Limited consensus on number of dimensions or facets, More complex personality picture = more difficult to comprehend and communicate to other clinicians

According to Sharp et al. (2025), what are pros and cons of the personality disorders as categorical?

Pros - Familiar language, facilitates communication between professionals

Cons - Heterogeneity with criteria (4/8 criteria, potentially little symptom overlap), Comorbidity of PDs, PD U/O Specified

Which depressive disorders are new to the DSM-5?

Persistent depressive disorder and disruptive mood dysregulation disorder

DSM-IV diagnoses of chronic major depressive disorder and dysthymic disorder were combined in the DSM-5 to create….

Persistent depressive disorder

Disruptive mood dysregulation disorder

A - severe recurrent temper outburst manifested verbally (e.g., verbal rages) and/or behaviorally (e.g., physical aggression toward people or property) that are grossly out of proportion in intensity or duration to the situation or provocation

B - the temper outbursts are inconsistent with developmental level

C - the temper outbursts occur, on average, three or more times per week

D - 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 or more months. Throughout that time, the individual has not had a period lasting 3 or more consecutive months without all of the symptoms in Criteria A-D.

F - Criteria A and D are present in at least 2 of 3 settings (home, school, with peers), and are severe in at least one of these

G - the diagnosis should not be made for the first time before age 6 years or after age 18 years

H - by history or observation, the age of onset of Criteria A-E is before 10 years

I - there has never been a distinct period lasting more than 1 day during which the fully symptom criteria, except duration, for a manic or hypomanic episode have been met

• NOTE - developmentally appropriate mood elevation, such as occurs in the context of a highly positive event or its anticipation, should not be considered as a symptom of mania or hypomania.

J - behaviors don’t occur exclusively during an episode of MDD and are not better explained by another mental disorder (ASD, PTSD, separation anxiety disorder, persistent depressive disorder). 

• Cannot coexist with ODD, IED, or bipolar disorder

• Can coexist with MDD, ADHD, conduct disorder, and SUDs

K - the symptoms are not attributable to the physiological effects of a substance or another

Disruptive mood dysregulation requires outbursts that occur ____ or more times on average per week

3

In between outbursts in disruptive mood dysregulation disorder, ____ mood is present most of the day, nearly every day, and is observable by others.

Irritable or angry

In disruptive mood dysregulation disorder symptoms needs to be present for ___ months, in at least ____ setting(s), and are severe in at least ___ setting(s).

12, 2, 1

For disruptive mood dysregulation disorder, the diagnosis should not be made for the first time before ____ years or after age ____ years

6, 18

Disruptive mood dysregulation disorder cannot co-occur with which disorders?

oppositional defiant disorder, intermittent explosive disorder, bipolar disorder

Major depressive disorder

A - 5 or more of the following symptoms have been present during the same 2 week period and represent a change from previous functioning; at least one of the symptoms is either depressed mood or loss of interest or pleasure

• Depressed mood most of the day, nearly every day, as indicated by either subjective report or observation made by others (in children and adolescents, can be irritable mood)

• Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day

• Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day (In children, consider failure to make expected weight gain).

• Insomnia or hypersomnia nearly every day - sleeping too little or too much

• Psychomotor agitation or retardation nearly every day (observable by others)

• Fatigue or loss of energy nearly every day

• Feelings of worthlessness or excessive or inappropriate guilt nearly every day

• Diminished ability to think or concentrate, or indecisiveness, nearly every day

• Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

B - the symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

C - not attributable to the physiological effects of a substance or another medical condition

• NOTE - A-C represent a major depressive episode

• NOTE - responses to a significant loss (bereavement, financial ruin, loss from natural disaster, serious medical illness or disability) may include feelings in Criterion A, clinical judgment required to see if there is normal response to loss and episode of depression

D - at least one major depressive episode is not better explained by schizoaffective disorder and is not superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders

E - has never been a manic episode or hypomanic episode

• NOTE - does not apply for manic-like episodes that are substance induced or are from another medical condition

Major depressive disorder requires one or both of what symptoms?

depressed mood, loss of interest or pleasure

Major depressive disorder requires ____ symptoms or more that have been present during the same ____ week period and represent a change from previous functioning

5, 2

What are the symptoms of major depressive episodes?

Depressed mood, loss of interest of pleasure, weight loss or weight gain, insomnia or hypersomnia, psychomotor agitation, fatigue or loss of energy, feelings of worthlessness or excessive guilt, diminished ability to concentrate or make decisions, recurrent thoughts of death

Persistent depressive disorder

A - Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 years

• NOTE - in children and adolescents, mood can be irritable and duration must be at least 1 year

B - presence, while depressed, of two or more of the following:

• Poor appetite or overeating

• Insomnia or hypersomnia

• Low energy or fatigue

• Low self-esteem

• Poor concentration or difficulty making decisions

• Feelings of hopelessness

C - during the 2-year period (1 year for children or adolescents) of the disturbance, the individual has never been without the symptoms in Criteria A and B for more than 2 months at a time

D - criteria for MDD may be continuously present for 2 years

E - there has never been a manic episode or a hypomanic episode

G - the symptoms are not attributable to the physiological effects of a substance (drug of abuse, a medication) or another medical condition

H - the symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

In persistent depressive disorder, depressed mood occurs for at least ____ years in adults and ___ year for children and adolescents

2, 1

In persistent depressive disorder, ____ or more symptoms are required other than depressed mood

2

What are the criteria B symptoms for persistent depressive disorder?

Change in appetite, insomnia or hypersomnia, low energy or fatigue, low self-esteem, poor concentration and decision making, feelings of hopelessness

True or false - Major depressive episodes CANNOT co-occur with persistent depressive disorder

False

Premenstrual dysphoric disorder

A - in the majority of menstrual cycles, at least five symptoms must be present in the final week before the onset of menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week postmenses

B - one (or more) of the following symptoms must be present:

• Marked affective lability (mood swings, feeling suddenly sad or tearful, or increased sensitivity to rejection)

• Marked irritability or anger or increased interpersonal conflicts

• Marked depressed mood, feelings of hopelessness, or self-deprecating thoughts

• Marked anxiety, tension, and/or feelings of being keyed up or on edge

C - one (or more) of the following symptoms must additionally be present, to reach a total of five symptoms when combined with symptoms from Criterion B above

• Decreased interest in usual activities (e.g., work, school, friends, or hobbies)

• Subjective difficulty in concentration

• Lethargy, easy fatigability, or marked lack of energy

• Marked change in appetite, overeating, or specific food cravings

• Hypersomnia or insomnia

• A sense of being overwhelmed or out of control

• Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of “bloating,” or weight gain

• NOTE - criteria A-C must have been met for most menstrual cycles that occurred in the preceding year

D - the symptoms cause clinically significant distress or interference with work, school, usual social activities, or relationships with others (e.g., avoidance of social activities; decreased productivity and efficiency at work, school, or home).

E - the disturbance is not merely an exacerbation of the symptoms of another disorder, such as MDD, panic, PDD, or a PD (although it may co-occur with any of these disorders)

F - Criterion A should be confirmed by prospective daily ratings during at least 2 symptomatic cycles

G - the symptoms are not attributable to the physiological effects of a substance (drug of abuse, a medication, other treatment) or another medical condition

With anxious distress

• Presence of at least 2 of the following symptoms

  • Feeling keyed up or tense

  • Feeling unusually restless

  • Difficulty concentrating because of worry

  • Fear that something awful may happen

  • Feeling that the individual might lose control of themself

Depressive episode, with mixed features

• 3 or more following nearly everyday during MDE

  • Elevated or expansive mood

  • Decreased need for sleep

  • Increased or excessive involvement in activities with high potential painful consequences

  • Increased energy or goal directed behaviors

  • More talkative or pressured speech

  • Flight of ideas

  • Inflated self-esteem or grandiosity

With melancholic features

One of the following is present during the most severe period of the current major depressive episode (or most recent episode if they are in remission)

• Loss of pleasure in all, or almost all, activities

• Lack of reactivity to usually pleasurable stimuli (does not feel much better, even temporarily, when something good happens)

Three (or more) of the following:

• A distinct quality of depressed mood characterized by profound despondency, despair, and/or moroseness or by so-called empty mood

• Depression that is regularly worse in the morning

• Early-morning awakening (2 hours before usual awakening)

• Marked psychomotor agitation or retardation

• Significant anorexia or weight loss

• Excessive or inappropriate guilt

With atypical features

mood reactivity (mood brightens in response to actual or potential positive events)

Two or more of the following:

• Significant weight gain or increase in appetite

• Hypersomnia

• Leaden paralysis (heavy, leaden feelings in arms or legs)

• Long-standing pattern of interpersonal rejection sensitivity that results in significant social or occupational impairment

With mood-congruent psychotic features

content of all delusions and hallucinations is consistent with the typical depressive themes of personal inadequacy, guilt, disease, death, nihilism, or deserved punishment

With mood-incongruent psychotic features

the content of the delusions does not involve typical depressive themes of personal inadequacy, guilt, disease, death, nihilism, or deserved punishment, or the content is a mixture of mood incongruent and mood congruent

With Catatonia

• During most of the episode, three or more

  • Stupor

  • Catalepsy (muscular rigidity)

  • Waxy flexibility

  • Mannerism (odd or caricature)

  • Stereotypy

  • Agitation (independent of external stimulus)

  • Grimacing

  • Echolalia (mirror talking) or echopraxia (mirror movements)

  • Mutism

With peripartum onset

If onset occurs during pregnancy or in the 4 weeks following delivery

With seasonal pattern

For recurrent major depressive disorder

• Relapses and remissions occur at characteristic times of the year

• In last 2 years, 2 seasonal MDEs (and no non-seasonal MDEs during this period)

• Over lifetime, seasons episodes > non-seasonal episodes

  • Do not diagnose if it is not due to the seasons (Ex - don’t diagnose if they have MDE before the school year or unemployment season)

In partial remission (depressive specifier)

Symptoms of the immediately previous major depressive episode are present but full criteria are not met, or there is a period lasting less than 2 months without any significant symptoms of a major depressive episode following the end of such an episode

In full remission (depressive specifier)

During the past 2 months, no significant signs or symptoms of the disturbance were present

Mood

Predominant and sustained emotion, subjective description of feeling

Affect

Moment to moment emotion, observable manifestations of feeling and how it is conveyed

On the depression to mania continuum, what concept is in the middle?

Euthymia

What does SIGE CAPS stand for (MDE criteria)

Sleep, interest (anhedonia), guilt, energy, concentration, appetite, psychomotor, suicide

Endogenous

The nature of the etiology of the disorder is from within the person, for depression it may seem to come out of the blue

Exogenous

Nature of the etiology or factors causing the disorder, from outside of the person, external factors like a life stressor

When does having a major depressive episode (MDE) not equal a major depressive disorder (MDD)?

Hypomanic or manic episode

How do you distinguish MDD from grief or bereavement?

• MDD has a dominant affect of depressed mood

• Grief has dominant affect feelings of emptiness or loss

• MDD has persistent dysphoria with self-critical preoccupation and negative thoughts about the future

• Grief has dysphoria in waves, vacillates with exposure to reminders, and lessens with time

• MDD has a limited capacity for happiness or pleasure

• Grief has capacity for positive emotional experiences

• MDD has a worthlessness that clouds their esteem

• Grief has self-esteem preserved

  • Some critical evaluation with I should have done this, blame to self

• MDD has SI about escaping life rather than rejoining the lost one

• Grief more about being with the person they lost

Bipolar Disorder I

• A - criteria have been met for at least one manic episode

• B - at least one manic episode is not better explained by schizoaffective disorder and is not superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder

Bipolar Disorder II

• A - criteria have been met for at least one hypomanic episode and at least one major depressive episode

• B - there has never been a manic episode

• C - at least one hypomanic episode and at least one major depressive episode are not better explained by schizoaffective disorder and are not superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder

• D - the symptoms of depression or the unpredictability caused by frequent alternation between periods of depression and hypomania causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

Manic episode

• A - Distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 1 week and present most of the day, nearly every day (or any duration if hospitalization is necessary)

• B - During the period of mood disturbance and increased energy or activity, three or more of the following symptoms (four if irritable) are present to a significant degree and represent a noticeable change from usual behavior

  • Inflated self-esteem or grandiosity

  • Decreased need for sleep

  • More talkative than usual or pressure to keep talking

  • Flight of ideas or subjective experience that thoughts are racing

  • Distractibility

  • Increase in goal-directed activity (socially, at work or school, or sexually) or psychomotor agitation

  • Excessive involvement in activities that have a high potential for painful consequences (unrestrained buying sprees, sexual indiscretions, or foolish business investments)

• C - the mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features

• D - the episode is not attributable to the physiological effects of a substance or another medical condition

Hypomanic episode

• A - distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day

• B - during the period of mood disturbance and increased energy and activity, three or more of the following (four if the mood is only irritable) have persisted, represent a noticeable change from usual behavior, and have been present to significant degrees

  • Inflated self-esteem or grandiosity

  • Decreased need for sleep

  • More talkative than usual or pressure to keep talking

  • Flight of ideas or subjective experience that thoughts are racing

  • Distractibility

  • Increase in goal-directed activity (socially, at work or school, or sexually) or psychomotor agitation

  • Excessive involvement in activities that have a high potential for painful consequences (unrestrained buying sprees, sexual indiscretions, or foolish business investments)

• C - episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic

• D - the disturbance in mood and the change in functioning are observable by others

• E - the episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization. If there are psychotic features, the episode is, by definition, manic

• F - the episode is not from a substance or another medical condition

If psychotic features are present, it is considered a _______ episode.

Manic

If the individual is required to be hospitalized for their safety, it is considered a ______ episode.

Manic

What symptoms are in the classic triad of a manic episode?

Heightened self-esteem or grandiosity, pressured speech, increased psychomotor activity

What does DIG FAST stand for (mania/hypomania)?

• Distractibility

• Insomnia

• Grandiose

• Flight of ideas

• Activity - goal direct increased

• Sexual indiscretions or activities with greater potential for painful consequences

• Talkative - pressured speech

Rapid cycling

A specifier for a fast fluctuation of mood, need four or more major depressive, manic, or hypomanic episodes within a 12 month period

Cyclothymic disorder

• A - for at least 2 years (at least 1 year in children and adolescents) there have been numerous periods with hypomanic symptoms that do not meet criteria for a hypomanic episode and numerous periods with depressive symptoms that do not meet criteria for a major depressive episode

• B - during the above 2 year period, Criterion A symptoms have been present for at least half the time and the individual has not been without the symptoms for more than 2 months at a time

• C - criteria for a major depressive, manic, or hypomanic episode have never been met

• D - the symptoms in Criterion A are not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder

• E - the symptoms are not attributable to the physiological effects of a substance or another medical condition

Manic or hypomanic episode, with mixed features

Full criteria are met for a manic episode or hypomanic episode, and at least 3 of the following symptoms are present during the majority of days of the current or most recent episode of mania or hypomania:

• Prominent dysphoria or depressed mood

• Diminished interest or pleasure in all, or almost all, activities

• Psychomotor retardation nearly every day

• Fatigue or loss of energy

• Feelings of worthlessness or excessive or inappropriate guilt

• Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

Separation Anxiety Disorder

A - developmentally inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached, as evidenced by at least three of the following:

• Recurrent excessive distress when anticipating or experiencing separation from home or from major attachment figures

• Persistent and excessive worry about losing major attachment figures or about possible harm to them, such as illness, injury, disasters, or death

• Persistent and excessive worry about experiencing an untoward event (e.g., getting lost, being kidnapped, having an accident, becoming ill) that causes separation from a major attachment figure

• Persistent reluctance or refusal to go out, away from home, to school, to work, or elsewhere because of fear of separation

• Persistent and excessive fear of or reluctance about being alone or without major attachment figures at home or in other setting

• Persistent reluctance or refusal to sleep away from home or to go to sleep without being near a major attachment figure

• Repeated nightmares involving the theme of separation

• Repeated complaints of physical symptoms (e.g., headaches, stomachaches, nausea, vomiting) when separation from major attachment figures occurs or is anticipated

B - the fear, anxiety, or avoidance is persistent, lasting at least 4 weeks in children and adolescents and typically 6 months or more in adults

C - the disturbance causes clinically significant distress or impairment in social, academic, occupational, or other important areas of functioning

D - the disturbance is not better explained by another mental disorder, such as refusing to leave home because of excessive resistance to change is ASD; delusions or hallucinations concerning separation in psychotic disorders; refusal to go outside without a trusted companion in agoraphobia; worries about ill health or other harm in GAD; or concerns about having an illness in illness anxiety disorder

Selective Mutism

A - consistent failure to speak in specific social situations in which there is an expectation for speaking (e.g., at school) despite speaking in other situations

B - the disturbance interferes with educational or occupational achievement or with social communication

C - the duration of the disturbance is at least 1 month (not limited to the first month of school).

D - the failure to speak is not attributable to a lack of knowledge of, or comfort with, the spoken language required in the social situation.

E - the disturbance is not better explained by a communication disorder (e.g., childhood-onset fluency disorder) and does not occur exclusively during the course of ASD, schizophrenia, or another psychotic disorder

Specific Phobia

A - marked fear or anxiety about a specific object or situation (e.g., flying, height, animals, receiving an injection, seeing blood).

• NOTE - in children, the fear or anxiety may be expressed by crying, tantrums, freezing, or clinging

B - the phobia object or situation almost always provokes immediate fear or anxiety

C - the phobic object or situation is actively avoided or endured with intense fear or anxiety

D - the fear or anxiety is out of proportion to the actual danger posed by the specific and to the sociocultural context

E - the fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more

F - the fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

G - the disturbance is not better explained by the symptoms of another mental disorder, including fear, anxiety, or avoidance of situations associated with panic-like symptoms or other incapacitating symptoms (as in agoraphobia); objects or situations related to obsessions (as in obsessive-compulsive disorder); reminders of traumatic events (as in PTSD), separation from home or attachment figures (as in separation anxiety disorder); or social situations (as in social anxiety disorder)

Specific phobia specifiers

Animal (spider, insect, dog), natural environment (heights, storms, water), blood-injection-injury (needles, invasive medical procedures), situational (airplanes, elevators, enclosed places), other (lead to choking or vomiting)