DSM Master Differential Comparison

Schizophrenia Spectrum and Other Psychotic Disorders

Schizoaffective vs Bipolar I or MDD with psychotic features

Schizoaffective requires at least 2 weeks of psychosis WITHOUT a mood episode. In Bipolar I or MDD with psychotic features, psychosis occurs only during the mood episode.

Schizophrenia Spectrum and Other Psychotic Disorders

Delusional Disorder vs Schizophrenia

Delusional Disorder: delusions are primary/only psychotic symptom, 1+ month, with relatively preserved functioning. Schizophrenia: broader psychotic/disorganized/negative symptom pattern and 6+ month disturbance.

Bipolar and Related Disorders

Bipolar I vs Bipolar II

Bipolar I requires one full manic episode and does NOT require depression. Bipolar II requires hypomania plus a major depressive episode and no history of mania.

Bipolar and Related Disorders

Mania vs Hypomania

Mania: 1+ week or any duration if hospitalized; marked impairment, hospitalization, or psychosis. Hypomania: 4+ days; observable change but no marked impairment, hospitalization, or psychosis.

Bipolar and Related Disorders

Cyclothymia vs Bipolar II

Cyclothymia is 2+ years of subthreshold hypomanic and depressive symptoms, never full hypomania or MDE. Bipolar II has a full hypomanic episode plus a full MDE.

Depressive Disorders

MDD vs Persistent Depressive Disorder

MDD: major depressive episode lasting 2+ weeks. Persistent Depressive Disorder: chronic depressed mood for 2+ years in adults or 1+ year in youth, without >2 months symptom-free.

Depressive Disorders

DMDD vs Pediatric Bipolar Disorder

DMDD: chronic irritability with frequent outbursts, 12+ months, ages 6-18, onset before 10. Bipolar: distinct episodic mania/hypomania.

Anxiety Disorders

Panic Disorder vs GAD

Panic Disorder: recurrent unexpected panic attacks plus 1+ month fear/behavior change. GAD: broad, difficult-to-control worry more days than not for 6+ months.

Anxiety Disorders

Specific Phobia vs Agoraphobia

Specific Phobia: one specific object/situation. Agoraphobia: fear of at least two situation categories because escape/help may be difficult.

Obsessive-Compulsive and Related Disorders

OCD vs OCPD

OCD: intrusive obsessions and/or compulsions, often ego-dystonic. OCPD: enduring ego-syntonic perfectionism, order, rigidity, and control.

Trauma- and Stressor-Related Disorders

PTSD vs Acute Stress Disorder

Acute Stress Disorder: 3 days to 1 month after trauma. PTSD: symptoms continue longer than 1 month.

Trauma- and Stressor-Related Disorders

PTSD vs Adjustment Disorder

PTSD requires qualifying trauma and trauma-specific clusters. Adjustment Disorder follows an identifiable stressor, begins within 3 months, and does not meet criteria for another disorder.

Trauma- and Stressor-Related Disorders

RAD vs DSED

RAD: emotionally withdrawn, rarely seeks/responds to comfort. DSED: overly familiar and indiscriminate approach to unfamiliar adults. Both are linked to severe insufficient care.

Dissociative Disorders

Depersonalization/Derealization vs Psychosis

In depersonalization/derealization, reality testing remains intact: the person knows the unreality/detachment is an experience. In psychosis, reality testing is impaired.

Disruptive, Impulse-Control, and Conduct Disorders

ODD vs Conduct Disorder

ODD: angry/irritable, argumentative, defiant, vindictive behavior. Conduct Disorder: serious rights violations such as aggression, destruction, theft/deceit, or major rule violations.

Personality Disorders

Conduct Disorder vs Antisocial Personality Disorder

Conduct Disorder occurs before age 18. Antisocial Personality Disorder requires age 18+ and evidence of conduct disorder symptoms before age 15.

Personality Disorders

Borderline Personality Disorder vs Bipolar Disorder

BPD: rapid, reactive mood shifts linked to relationships/abandonment and an enduring pattern. Bipolar: sustained episodic mania/hypomania lasting days or longer.

Personality Disorders

Schizoid vs Avoidant Personality Disorder

Schizoid: little desire for close relationships. Avoidant: desires relationships but avoids them because of inadequacy and fear of rejection.

Somatic Symptom and Related Disorders

Somatic Symptom Disorder vs Illness Anxiety Disorder

Somatic Symptom Disorder: prominent distressing physical symptoms plus excessive response. Illness Anxiety Disorder: minimal/no symptoms but strong fear of serious illness.

Somatic Symptom and Related Disorders

Conversion Disorder vs Factitious Disorder

Conversion symptoms are not intentionally produced. Factitious Disorder involves intentional falsification/induction of symptoms to assume the sick role, without obvious external reward.

Feeding, Eating, and Elimination Disorders

Anorexia vs ARFID

Anorexia includes fear of weight gain/body-image disturbance and significantly low weight. ARFID involves restriction from sensory issues, low interest, or feared consequences without weight/shape disturbance.

Feeding, Eating, and Elimination Disorders

Bulimia vs Binge-Eating Disorder

Both involve recurrent binges. Bulimia includes compensatory behaviors; Binge-Eating Disorder does not.

Sleep-Wake Disorders

Insomnia vs Circadian Rhythm Sleep-Wake Disorder

Insomnia persists despite adequate opportunity and timing. Circadian disorder reflects a mismatch between internal clock and required schedule; sleep may be normal on the preferred schedule.

Neurocognitive Disorders

Delirium vs Major Neurocognitive Disorder

Delirium: acute, fluctuating disturbance in attention/awareness over hours to days. Major NCD: acquired cognitive decline that interferes with independence, usually more persistent.

Neurocognitive Disorders

Major vs Mild Neurocognitive Disorder

Major NCD interferes with independent daily functioning. Mild NCD does not, although extra effort or compensatory strategies may be needed.

Universal DSM Exam Rules- Core Rule

What two conditions should you mentally add to every DSM diagnosis on the exam?

1. Clinically significant distress or impairment.

2. The symptoms are not better explained by another mental disorder, medical condition, substance/medication, developmental level, or culturally expected response.

Universal DSM Exam Rules- Core Rule

What is the main way diagnosis questions are tested on the National MFT Exam?

Differential diagnosis: identify the distinguishing feature, timeline, age/onset, and the best explanation for the vignette rather than memorizing every symptom count.