disruptive, impulse control, conduct, paraphilic disorders

An 11-year-old boy has shown extreme stubbornness and defiance since early childhood. This behavior is seen primarily at home and does not typically in volve significant mood instability or anger, although he occasionally can be spiteful and vindictive. These symptoms have affected his sibling relationships in an extremely negative fashion, and more recently this behavior has been seen with peers and has begun to affect his friendships. His parents demon strate a somewhat hostile parenting style. Which of the following statements correctly summarizes the appropriateness of a diagnosis of oppositional defi ant disorder (ODD) for this patient?

A. The boy does not qualify for a diagnosis of ODD because his symptoms lack a significant mood component and seem to be confined primarily to the home setting.

B. Although the boy does not have a persistently negative mood, he may nevertheless qualify for a diagnosis of ODD if he meets the other symptom criteria.

C. If as a preschooler the boy had demonstrated temper outbursts that oc curred on a weekly basis on most days during a 6-week period, he might have received a diagnosis of ODD at that point, as long as he had four or more of the required symptoms for 6 months.

D. The boy does not qualify for a diagnosis of ODD; the hostile parenting style is probably the cause of his oppositional behavior.

E. If the boy meets criteria for ODD, then he probably has begun to acknowl edge his own role in overreacting to reasonable demands.

B. Although the boy does not have a persistently negative mood, he may nevertheless qualify for a diagnosis of ODD if he meets the other symptom criteria.

A 3-year-old boy has rather severe temper tantrums that have occurred at least weekly for a 6-week period. Although the tantrums can sometimes be associ ated with defiant behavior, they often result from a change in routine, fatigue, or hunger, and he only rarely does anything destructive. He is generally well behaved in nursery school and during periods between his tantrums. Which of the following conclusions best fits this child’s presentation?

A. The boy does not meet criteria for oppositional defiant disorder (ODD).

B. The boy meets criteria for ODD because of the presence of tantrums and de fiant behavior.

C. The boy could be diagnosed with ODD as long as it does not appear that his home environment is harsh, neglectful, or inconsistent.

D. The boy’s symptoms more likely represent intermittent explosive disorder than ODD.

E. The boy’s symptoms more likely represent disruptive mood dysregulation disorder than ODD.

A. The boy does not meet criteria for oppositional defiant disorder (ODD).

The diagnostic criteria for oppositional defiant disorder (ODD) include speci fiers for indicating severity of the disorder as manifested by pervasiveness of symptoms across settings and relationships. Which of the following specifiers would be appropriate for an 11-year-old boy who meets Criterion A symptoms in two settings?

A. Mild.

B. Moderate.

C. Severe.

D. Extreme.

E. There is not enough information to code the specifier.

B. Moderate.

A previously well-behaved 13-year-old girl begins to display extremely defiant and oppositional behavior, with vindictiveness. She is angry, argumentative, and refuses to accept responsibility for her behavior, which is affecting both her home life and school life in a significant way. What is the least likely diagnosis?

A. Major depressive disorder.

B. Bipolar disorder.

C. Oppositional defiant disorder.

D. Adjustment disorder.

E. Substance use disorder

C. Oppositional defiant disorder.

Which of the following statements about prevalence/course of and risk factors for oppositional defiant disorder (ODD) is false?

A. ODD is more prevalent in boys than in girls by a ratio of 1.4:1.

B. Harsh, inconsistent, or neglectful child-rearing practices are common in the families of individuals with ODD.

C. ODD tends to be moderately stable across childhood and adolescence.

D. Individuals with ODD as children or adolescents are at higher risk as adults for difficulties with antisocial behavior, impulse-control problems, anxiety, substance abuse, and depression.

E. Biological factors such as lower heart rate and skin conductance reactivity, reduced basal cortisol reactivity, and abnormalities in the prefrontal cortex and the amygdala have been associated with ODD and can be used diag nostically.

E. Biological factors such as lower heart rate and skin conductance reactivity, reduced basal cortisol reactivity, and abnormalities in the prefrontal cortex and the amygdala have been associated with ODD and can be used diag nostically.

A 16-year-old boy with a long history of defiant behavior toward authority fig ures also has a history of aggression toward peers (gets into fights at school), toward his parents, and toward objects (punching holes in walls, breaking doors). He frequently lies, and he has recently begun to steal merchandise from stores and money and jewelry from his parents. He does not seem pervasively irritable or depressed, and he has no sleep disturbance or psychotic symptoms. What is the most likely diagnosis?

A. Oppositional defiant disorder (ODD).

B. Conduct disorder.

C. Attention-deficit/hyperactivity disorder (ADHD).

D. Major depressive disorder.

E. Disruptive mood dysregulation disorder.

B. Conduct disorder.

A 15-year-old boy has a history of episodic violent behavior that is out of pro portion to the precipitant. During a typical episode, which will escalate rapidly, he will become extremely angry, punching holes in walls or destroying furni ture in the home. There seems to be no specific purpose or gain associated with the outbursts, and within 30 minutes he is calm and “back to himself,” a state that is not associated with any predominant mood disturbance. What diagno sis best fits this clinical picture?

A. Bipolar disorder.

B. Disruptive mood dysregulation disorder (DMDD).

C. Intermittent explosive disorder (IED).

D. Conduct disorder.

E. Attention-deficit/hyperactivity disorder (ADHD).

C. Intermittent explosive disorder (IED).

Which of the following statements about the risk and prognostic factors in in termittent explosive disorder (IED) is true?

A. First-degree relatives of individuals with IED show no increased risk of having IED themselves.

B. The etiology for the disorder is thought to be predominantly environmen tally determined, and twin studies have not demonstrated a significant ge netic influence for the impulsive aggression.

C. Individuals with antisocial personality disorder or borderline personality disorder and those who have a history of disorders with disruptive behav iors (e.g., attention-deficit/hyperactivity disorder [ADHD], conduct disorder, oppositional defiant disorder) are at greater risk of comorbid IED behaviors

D. The course of IED is usually not chronic and persistent.

E. The prevalence in males versus females across cultures and studies is con sistently about 4:1

C. Individuals with antisocial personality disorder or borderline personality disorder and those who have a history of disorders with disruptive behaviors (e.g., attention-deficit/hyperactivity disorder [ADHD], conduct disorder, oppositional defiant disorder) are at greater risk of comorbid IED.

Which of the following biological markers is associated with intermittent ex plosive disorder (IED)?

A. Serotonergic abnormalities globally and in the limbic system and orbito frontal cortex.

B. Reduced amygdala responses to anger stimuli during functional magnetic resonance imaging (fMRI) scanning.

C. Atrophy of the cerebral cortex.

D. Abnormalities in adrenal function.

E. Increased urinary catecholamines.

A. Serotonergic abnormalities globally and in the limbic system and orbitofrontal cortex.

Which of the following statements about the differential diagnosis of intermit tent explosive disorder (IED) is false?

A. The diagnosis of IED can be made even if the impulsive aggressive out bursts occur in the context of an adjustment disorder.

B. In contrast to IED, disruptive mood dysregulation disorder is characterized by a persistently negative mood state (i.e., irritability, anger) most of the day, nearly every day, between impulsive aggressive outbursts.

C. The level of impulsive aggression in individuals with antisocial personality disorder or borderline personality disorder is lower than that in individuals with IED.

D. A diagnosis of IED should not be made when aggressive outbursts are judged to result from the physiological effects of another diagnosable med ical condition.

E. Aggression in oppositional defiant disorder is typically characterized by temper tantrums and verbal arguments with authority figures, whereas im pulsive aggressive outbursts in IED are in response to a broader array of provocation and include physical assault.

A. The diagnosis of IED can be made even if the impulsive aggressive out bursts occur in the context of an adjustment disorder.

A 17-year-old boy with a history of bullying and initiating fights using bats and knives has also stolen from others, set fires, destroyed property, broken into homes, and “conned” others. This pattern of disturbed conduct covers all of the Criterion A behavior categories except

A. Aggression to people and animals.

B. Destruction of property.

C. Deceitfulness or theft.

D. Serious violations of rules.

E. Malevolent intent.

D. Serious violations of rules.

A 15-year-old girl with a history of cruelty to animals, stealing, school truancy, and running away from home shows no remorse when caught, or when she is confronted with how her behavior is affecting the rest of her family. She disre gards the feelings of others and seems to not care that her conduct is compro mising her school performance. The behavior has been present for over a year and in multiple relationships and settings. Which of the following components of the “With limited prosocial emotions” specifier is absent in this clinical pic ture?

A. Lack of remorse or guilt.

B. Callous—lack of empathy.

C. Lack of concern about performance.

D. Shallow or deficient affect.

E. The required time duration.

D. Shallow or deficient affect.

Which of the following does not qualify as aggressive behavior under Criterion A definitions for the diagnosis of conduct disorder?

A. Cyberbullying.

B. Forcing someone into sexual activity.

C. Stealing while confronting a victim.

D. Being physically cruel to people.

E. Aggression in the context of a mood disorder.

E. Aggression in the context of a mood disorder.

In order to be considered a symptom of conduct disorder, running away must have occurred with what frequency?

A. At least three times.

B. At least five times.

C. Only once if the individual did not return for a lengthy period.

D. Twice, in response to physical or sexual abuse.

E. Six times over a 3-month period

C. Only once if the individual did not return for a lengthy period.

Which of the following statements about childhood versus adolescent onset of conduct disorder (CD) is true?

A. Compared with individuals with adolescent-onset CD, those with child hood-onset CD are more often female and tend to get along better with peers.

B. Compared with individuals with adolescent-onset CD, those with childhood-onset CD are less aggressive and less likely to have oppositional defi ant disorder (ODD) or attention-deficit/hyperactivity disorder (ADHD).

C. Compared with individuals with childhood-onset CD, those with adolescent-onset CD are more likely to have CD that persists into adulthood.

D. Compared with individuals with childhood-onset CD, those with adolescent-onset CD are more likely to display aggressive behaviors and to have disturbed peer relationships.

E. Compared with individuals with childhood-onset CD, those with adolescent-onset CD are less likely to have CD that persists into adulthood.

E. Compared with individuals with childhood-onset CD, those with adolescent-onset CD are less likely to have CD that persists into adulthood.

Which of the following statements about individuals who qualify for the “With limited prosocial emotions” specifier for conduct disorder is true?

A. These individuals generally display personality features such as risk avoid ance, fearfulness, and extreme sensitivity to punishment.

B. These individuals are less likely than other individuals with conduct disor der to engage in aggression that is planned for instrumental gain.

C. These individuals generally exert more effort in their activities compared with other individuals with conduct disorder, and consequently are more successful.

D. These individuals are more likely to have a severity specifier rating of mild.

E. These individuals are more likely to have the childhood-onset type of con duct disorder

E. These individuals are more likely to have the childhood-onset type of con duct disorder

Which of the following statements about the prevalence of conduct disorder is true?

A. One-year prevalence rates range from 5% to 15%, with a median of 7%.

B. The prevalence varies widely across countries that differ in race and ethnicity.

C. Prevalence rates are higher among males than among females.

D. Callous unemotional traits are present in more than half of individuals with conduct disorder.

E. Prevalence rates remain fairly constant from childhood to adolescence

C. Prevalence rates are higher among males than among females.

Which of the following statements about the onset and developmental course of conduct disorder is true?

A. Onset may occur as early as the preschool years and is rare after age 16 years.

B. Onset typically occurs in adolescence.

C. Age at onset has no bearing on the developmental course of the disorder.

D. Oppositional defiant disorder is generally not a precursor to the childhood onset type of conduct disorder.

E. Those with the adolescent-onset type of conduct disorder are less likely to adjust successfully as adults.

A. Onset may occur as early as the preschool years and is rare after age 16 years.

Which of the following statements about risk factors in conduct disorder is false?

A. A difficult undercontrolled infant temperament and lower-than-average verbal IQ are risk factors for conduct disorder.

B. Family-based risk factors include parental rejection and neglect, inconsis tent child-rearing practices, harsh discipline, physical or sexual abuse, lack of supervision, early institutional living, frequent changes of caregivers, large family size, and substance-related disorders.

C. Community-level risk factors include association with a delinquent peer group and neighborhood exposure to violence.

D. The risk of conduct disorder is increased in children who have a biological or adoptive parent or sibling with conduct disorder.

E. Parental history of attention-deficit/hyperactivity disorder (ADHD) does not constitute a risk factor for conduct disorder in offspring.

E. Parental history of attention-deficit/hyperactivity disorder (ADHD) does not constitute a risk factor for conduct disorder in offspring.

Which of the following statements about risk and prognostic factors in conduct disorder (CD) is false?

A. Individuals with CD are at risk of later depressive and bipolar disorders, anxiety disorders, posttraumatic stress disorder, impulse control disorders, somatic symptom disorders, and substance-related disorders as adults.

B. Temperamental risk factors for CD include a difficult undercontrolled in fant temperament and lower-than-average intelligence, particularly in re gard to verbal IQ.

C. Structural and functional differences in brain areas associated with affect regulation and affect processing have been consistently noted in individu als with CD.

D. The risk that CD will persist into adulthood is increased by co-occurring at tention-deficit/hyperactivity disorder and by substance abuse.

E. Increased autonomic fear conditioning, particularly high skin conductance, is well documented and diagnostic of CD.

E. Increased autonomic fear conditioning, particularly high skin conductance, is well documented and diagnostic of CD.

Which of the following statements about the differential diagnosis of conduct disorder (CD) and oppositional defiant disorder (ODD) is true?

A. In both diagnoses, individuals tend to have conflict with authority figures.

B. In both diagnoses, individuals display significant emotional dysregulation.

C. In both diagnoses, individuals display aggression toward people or ani mals.

D. In both diagnoses, individuals destroy property, steal, or lie.

E. If criteria for CD are met, then an individual cannot also receive a diagnosis of ODD.

A. In both diagnoses, individuals tend to have conflict with authority figures.

Which of the following comorbid disorders is associated with pyromania?

A. Antisocial personality disorder.

B. Substance use disorders.

C. Mood disorders.

D. Gambling disorder.

E. All of the above.

E. All of the above.

A 15-year-old male student in private school, without known psychiatric his tory, has been caught stealing other students’ laptops and cell phones, even though he comes from a wealthy family and his parents continue to purchase the newest electronics for him in an effort to deter him from stealing. Which of the following would raise your clinical suspicion that he may have kleptomania?

A. He demonstrates recurrent failure to resist impulses to steal objects that are not needed for personal use or for their monetary value.

B. He demonstrates recurrent failure to resist impulses to steal objects during periods of detachment or boredom.

C. He experiences increased tension before committing the theft but does not experience relief, pleasure, or gratification while committing the theft.

D. He has a strong family history for antisocial personality disorder and con duct disorder.

E. He has a strong family history for bipolar disorder.

A. He demonstrates recurrent failure to resist impulses to steal objects that are not needed for personal use or for their monetary value.

Which of the following statements about kleptomania is false?

A. The prevalence of kleptomania in the general population is generally very low, and the disorder more frequent among females.

B. First-degree relatives of individuals with kleptomania may have higher rates of obsessive-compulsive disorder and/or substance use disorders than the general population.

C. Kleptomania is similar to ordinary theft in that the act of shoplifting, whether planned or impulsive, is deliberate and often motivated by the usefulness of the object.

D. The age at onset is variable, but the disorder often begins in adolescence.

E. Individuals with kleptomania generally do not preplan their thefts

C. Kleptomania is similar to ordinary theft in that the act of shoplifting, whether planned or impulsive, is deliberate and often motivated by the usefulness of the object.

What changes were made to the diagnosis of paraphilias and paraphilic disor ders in DSM-5?

A. A distinction has been made between paraphilias and paraphilic disorders.

B. Three specifiers have been added to paraphilic disorders: “in a controlled environment,” in remission,” and “benign.”

C. Transvestic disorder has been eliminated.

D. To be diagnosed as a paraphilic disorder, a paraphilia must go beyond fan tasy or urge to include behavior.

E. Paraphilic disorders are grouped in a chapter with sexual disorders.

A. A distinction has been made between paraphilias and paraphilic disorders.

Which of the following statements about paraphilias is false?

A. The presence of a paraphilia does not always justify clinical intervention.

B. Most paraphilias can be divided into those that involve an unusual activity and those that involve an unusual target.

C. Paraphilias may coexist with normophilic sexual interests.

D. It is rare for an individual to manifest more than one paraphilia.

E. The propensity to act on a paraphilia is difficult to assess “in a controlled environment.”

D. It is rare for an individual to manifest more than one paraphilia.

Which of the following is not a paraphilic disorder?

A. Sexual masochism disorder.

B. Transvestic disorder.

C. Transsexual disorder.

D. Voyeuristic disorder.

E. Fetishistic disorder.

C. Transsexual disorder.

Which of the following statements about pedophilic disorder is true?

A. Pedophilic disorder is found in 10%–12% of the male population.

B. There is no evidence that neurodevelopmental perturbation in utero in creases the probability of development of a pedophilic orientation.

C. Adult males with pedophilia often report that they were sexually abused as children.

D. To meet criteria for the diagnosis, the individual must experience sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with children age 8 years or younger.

E. To meet criteria for the diagnosis, the individual must be at least 8 years older than the victim(s).

C. Adult males with pedophilia often report that they were sexually abused as children.

Which of the following statements about pedophilic disorder is true?

A. The extensive use of pornography depicting prepubescent or early pubes cent children is not a useful diagnostic indicator of pedophilic disorder.

B. Pedophilic disorder is stable over the course of a lifetime.

C. There is an association between pedophilic disorder and antisocial personality disorder.

D. Although normophilic sexual interest declines with age, pedophilic sexual interest remains constant.

E. Vaginal plethysmography is a more reliable diagnostic instrument for pe dophilia in women than is penile plethysmography for pedophilia in men

C. There is an association between pedophilic disorder and antisocial personality disorder.

A 35-year-old woman tells her therapist that she has recently become intensely aroused while watching movies in which people are tortured and that she reg ularly fantasizes about torturing people while masturbating. She is not dis tressed by these thoughts and denies ever having acted on these new fantasies, though she fantasizes about these activities several times a day. Which of the following best summarizes the diagnostic implications of this patient’s presen tation?

A. She meets all of the criteria for sexual sadism disorder.

B. She does not meet the criteria for sexual sadism disorder because the fanta sies are not sexual in nature.

C. She does not meet the criteria for sexual sadism disorder because she has never acted on the fantasies.

D. She does not meet the criteria for sexual sadism disorder because the interest and arousal began after age 35.

E. She does not meet the criteria for sexual sadism disorder as the diagnosis is only made in men

C. She does not meet the criteria for sexual sadism disorder because she has never acted on the fantasies.

While intoxicated at a Mardi Gras celebration, a 19-year-old woman lifts her blouse and bra as a float goes by to get beads. The event appears on a cable news program watched by friends of her parents, who inform her parents. They insist that she get a psychiatric evaluation. She denies any other similar events in her life but admits that the experience was “sort of sexy.” She is cur rently extremely anxious and distressed—to the point of being unable to focus on her work at college—about her parents’ anger at her and their refusal to al low her to attend parties or go away on vacation. What is the most appropriate diagnosis?

A. Exhibitionistic disorder.

B. Frotteuristic disorder.

C. Voyeuristic disorder.

D. Adjustment disorder.

E. Antisocial personality disorder.

D. Adjustment disorder.