Lifespan Final Pt 1 (Disorders)

Bipolar I disorder (name 2 criteria)

A. Criteria have been met for at least one manic episode (Criteria A-D under 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 disorders

In lay terms:

- One manic episode must be met

- Cannot be because of schizophrenia or other psychotic disorder

Bipolar II Disorder (4 criteria)

• Criteria have been met for at least one ______ and one_______

• There has never been a ______

• Episodes not better explained by _______

• Causes…

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. These episodes are not better explained by Schizophrenia/ any schizophrenia related or psychotic disorder. 

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

Cyclothymic Disorder 

• For at least ____, ____ in children, there have been…

• Criterion A symptoms (above) have been present for ________ and the individual has not been without symptoms for more than ______ at a time.

• Criteria for _____, _____ and _____ have never been met.

• Symptoms not better explained by…

• Symptoms not attributable to…

• Symptoms cause…

A. For at least 2 years (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 this 2 year period (or 1 for kids and teens), Criterion A symptoms have been present for at least half the time, and the individual has not been without symptoms for more than 2 months at a time. 

C. Criteria for major depressive, manic, or hypomanic episode have never been met. 

D. Symptoms in criterion A are not better explained by schizophrenia/ schizophrenia related or psychotic disorder. 

E. Symptoms not attributable to a substance or other medical condition 

F. Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. 

Major Depressive Disorder 

• At least one _______, not better explained by…

• There has never been…

• At least one major depressive episode, not better explained by schizophrenia or related, or any psychotic disorder

• There has never been a manic episode or hypomanic episode (does not apply if these episodes were substance induced or attributable to another medical condition)

Persistent Depressive Disorder

• (A)_______ for most of the day, more days than not, for at least _____.

• (B) Presence of ___ or more of the following (list, 6)

• (C) During this ___ period, the individual has never been without criterion A or B for more than _____ at a time.

• (D). Criteria for ______ may be continuously present for _____ .

• There has never been a ____ or ____.

• Read note.

A. Depressed mood for most of the day, more days than not, for at least 2 years

B. Presence, while depressed, of two (or more) of the following :

1. Poor appetite or overeating

2. Insomnia or hypersomnia

3. Low energy/ fatigue

4. Low Self-esteem

5. Poor concentration/ difficulty making decisions

6. Feelings of hopelessness

C. During this 2 year period (1yr for children and adolescents) ,the individual has never been without the symptoms of Criteria A and B for more than 2 months at a time.

D. Criteria for major depressive disorder may be continuously present for 2 years

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

F. Not better explained by Schizophrenia, delusional, psychotic or related disorder.

NOTE: if criteria are sufficient for a diagnosis of major depressive episode at any time during the 2 year period, then a separate diagnosis of major depressive disorder should be made in addition to the diagnosis of persistent depressive disorder.

Specify if (for most recent 2 years)

• With pure dysthymic syndrome: full criteria for a major depressive episode have not been met for the past 2 years

• With persistent major depressive episode: full criteria for major depressive episode have been met throughout the preceding 2 year period.

Explanation

• Specifier = describes the pattern in the last 2 years of PDD.

• Separate diagnosis of MDD = whenever criteria for a major depressive episode are met.

• So, if they warrant the persistent major depressive episode specifier, they automatically also warrant a major depressive disorder diagnosis.

Premenstrual Dysphoric Disorder

(A) In the majority of _____, at least ____ symptoms must be present during ________, and must…

B. ____ or more of the following symptoms must be met (list 4)

C. ____ or more of the following symptoms must additionally be present (list 7)

Must have a total of ___ symptoms from B&C

NOTE: criterion A-C must have been met for…

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 met

1. marked affective lability (mood swings)

2. Marked irritability/ anger/ increased interpersonal conflicts

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

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

C. One or more of the following symptoms must additionally be present (total of 5 symptoms from both criteria)

1. Decreased interest in usual activity

2. Subjective difficulty in concentration

3. Lethargy

4. Marked change in appetite; overeating; specific food cravings

5. Hypersomnia or insomnia

6. A sense of being overwhelmed or out of control

7. Physical symptoms (breast tenderness, joint/ muscle pain, bloating)

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

Disruptive mood Dysregulation Disorder 

(A)

(B) Inconsistent with…

(C) ____ or more times a _____

(D)

(E) Criteria A-D have been present for ________. Within this period, the individual has not had a period lasting more than ______ without all symptoms in criteria A-D.

(F)Criteria A&D are present in at least ___ of ___ settings (name settings) and are ____ in at least one of these

(G) Diagnosis should not be made before the age of ____ or after ____

(H) Onset age is before ____

(I) There has never been a period lasting more than ____ during which full criteria have been met for _____ or _____

(J) Symptoms do not occur exclusively…

Note: This diagnosis cannot coexist with…(3)

A. Severe and recurrent temper outbursts manifested verbally and/or behaviorally that are grossly out of proportion in intensity or duration to the situation. 

B. Temper outbursts are inconsistent with the developmental level 

C. Temper outbursts occur, on average, three or more times per week 

D. The mood between 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. Within this period, the individual has not had a period lasting more than 3 consecutive months without all 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. Diagnosis should not be made before age 6 or after 18.

H. Onset age of criteria A-E is before 10 (by history or observation)

I. There has never been a distinct period lasting more than 1 day during which full criteria (other than duration) have been met for a manic or hypomanic episode 

J. Symptoms do not occur exclusively during an episode of Major depressive disorder, and are not better explained by another mental disorder (ASD, PTSD, Separation anxiety disorder, persistent depressive disorder). 

Note: This diagnosis cannot coexist with oppositional defiant disorder, intermittent explosive disorder, or bipolar disorder, though it can coexist with others, including major depressive disorder, attention-deficit/hyperactivity disorder, conduct disorder, and substance use disorders.

What are the criteria for a manic episode?

A

B (at least ___, ___if _______)

Duration? Shorter if?

At least ____ of the following symptoms (list)

Serious enough to…

Not caused by…

Read note.

A. There’s a period lasting at least one week (or shorter if hospitalization is needed) where a person feels extremely elevated, excited, or irritable, and has way more energy than usual.

B. During this time, the person shows at least 3 of these symptoms (4 if mostly irritable)

1. Feels unusually confident or superior (grandiosity)

2. Needs much less sleep but still feels rested

3. Talks way more or feels pressure to keep talking

4. Thoughts race or jump quickly from one to another

5. Easily distracted by things around them

6. Becomes much more active or restless, often with many goal-directed activities at once or unable to sit still

7. Engages in risky or impulsive activities (ex. overspending, risky sex, or reckless investments

C. Mood and behavior changes are serious enough to cause major problems at work, school, or in relationships or require hospitalization or include psychotic symptoms

D. The episode isn’t caused by drug, medication, or medical condition.

★ Note: A full manic episode that emerges during antidepressant treatment (e.g., medication, electroconvulsive therapy) but persists at a fully syndromal level beyond the physiological effect of that treatment is sufficient evidence for a manic episode and, therefore, a bipolar I diagnosis.

What constitutes a hypomanic episode?

Clear period of…

Lasting at least…

____ or ___ (If ____) of the following symptoms are clearly noticeable (list)

This is a clear…

Other people can…

This episode does NOT…

It is not caused by…

A. There’s a clear period of elevated, excited, or irritable mood, with more energy or activity than usual, lasting at least 4 days in a row, most of the day, nearly every day.

B. During this time, at least 3 (or 4 if irritable) of these symptoms are clearly noticeable:

• Feels unusually confident or powerful.

• Needs very little sleep but doesn’t feel tired.

• Talks much more or feels pressure to keep talking.

• Has racing thoughts.

• Is easily distracted.

• Is much more active or restless than usual.

• Does risky things (like overspending, reckless sex, or impulsive decisions).

C. This represents a clear change from the person’s normal behavior.

D. Other people can see the change.

E. The episode doesn’t cause major life problems or require hospitalization. (If it does, it’s mania, not hypomania.)

F. It’s not caused by drugs, medication, or a medical condition.

Summarize the differences between a manic and hypomanic episode.

Summary:
A manic episode is a severe, impairing, or psychotic version of mood elevation that usually requires clinical attention.
A hypomanic episode is a milder, shorter, and non-psychotic version that’s still abnormal and noticeable to others, but not severe enough to cause major dysfunction or hospitalization.

What constitutes a major depressive episode?

____ or more of the following symptoms (list) for at least _____.

At least one of the symptoms must be either …

Do not include symptoms that are clearly attributable to…

Symptoms cause…

All of the following criteria must be true

A. 5 or more of the following symptoms for at least two weeks, and this marks a clear change from your normal state

At least one of the symptoms must be either:

• Feeling sad or depressed or

• Losing interest or pleasure in things you usually enjoy

Note: do not include symptoms that are clearly attributable to a medical condition

Symptoms can include

1. Feeling sad, empty, hopeless, or tearful, most of the day, almost every day (in kids and teens, this may look like irritability)

2. Losing interest in almost everything you used to enjoy

3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day.
   (Note: In children, consider failure to make expected weight gain.)

4. Insomnia or hypersomnia nearly every day.

5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).

6. Fatigue or loss of energy nearly every day.

7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).

8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).

9. Recurrent thoughts of death (not just fear of dying); recurrent suicidal ideation without a specific plan; a specific suicide plan; or a suicide attempt.

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

C. The episode is not attributable to the physiological effects of a substance or another medical condition.

Summarize the differences between Bipolar I and Bipolar II Disorder 

In short:
👉 Bipolar I = at least one full manic episode (with or without depression).
👉 Bipolar II = at least one hypomanic episode and one major depressive episode — but no mania ever.

What are Criterion A, B, and C for PTSD?

Exposure to…

Presence of ___ or more of the following _____ symptoms.

Persistent _____ of…

A. Exposure to actual or threatened death, serious injury, or sexual violence in one or more of the following ways

1. Directly experiencing traumatic events

2. Witnessing, in person, the events that occurred to others

3. Learning that the traumatic events occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the events must have been violent or accidental.

4. Experiencing extreme or repeated exposure to aversive details of the traumatic events (ex. first responders collecting human remains). This does not apply if exposure is electronic, unless work-related.

B. Presence of one (or more) of the following intrusion symptoms associated with the event, beginning after the event occurred

1. Recurrent, involuntary, and intrusive distressing memories of the traumatic events (note: in children older than 6, repetitive play may occur in which the theme of the event is expressed) 

2. Recurrent, distressing dreams related to the event 

3. Dissociative reactions (ex. flashbacks) in which the individual feels or acts as if the traumatic event is recurring. 

4. Intense/ prolonged psychological distress at exposure to internal or external cues that remind of the event 

5. Marked physiological reactions to internal or external cues that symbolize/ remind of the event

C. Persistent avoidance of stimuli that remind of the event, after event occurred, as evidenced by one or both of the following

1. Efforts to avoid distressing memories, thoughts, or feelings about the event 

2. Avoidance of external reminders of the event (ex, people, places, conversations that arouse distressing memories, thoughts or feelings closely associated with the event) 

Reactive attachment disorder

Consistent pattern of ____ toward_____, manifested by BOTH of the following (list)

Persistent ________ characterized by at least ___ of the following. (list)

The child has experienced _____ as evidenced by at least __ of the following (list)

Criterion C is presumed to be responsible for behavior in A.

Criteria not met for ____

Disturbance is evident before the age of ____

Child has a developmental age of at least ____.

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. Persistent social and emotional disturbance characterized by at least two 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 non-threatening 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/ deprivation: persistent lack of having basic emotional needs for comfort, stimulation, and affection met by caregiving adults 

2. Repeated changes of primary caregivers that limit opportunities to form selective attachment (ex. frequent changes in foster care) 

3. Rearing in unusual settings that limits opportunity to form selective attachments (ex. institutions with high child-to-caregiver ratios) 

D. The care in criterion C is presumed to be responsible for the disturbed behavior in Criterion A  (ex. Criterion A symptoms followed Criterion C symptoms) 

E. The criteria are not met for ASD 

F. The disturbance is evident before the age of 5 years 

G. The child has a developmental age of at least 9 months. 

Acute stress disorder and PTSD are very similar. What are their differences?

Time frames?

Symptom cluster?

Acute Stress Disorder

• Trauma occurred 3 days–1 month ago

• Requires 9+ symptoms from ANY cluster

• Often includes dissociation (depersonalization/ derealization specifiers not included for ASD)

• If symptoms last >1 month → becomes PTSD

• Small ASD-specific emphasis:

  • DSM stresses immediate symptoms and rapid development after trauma.

PTSD

• Event had to occur at least 1 month ago

• Symptoms last >1 month

• Requires specific cluster minimums (1 intrusion, 1 avoidance, 2 mood, 2 arousal)

• Can be diagnosed later with delayed expression

Course and Prognosis Differences

Acute Stress Disorder

• Often resolves on its own.

• Many do not go on to develop PTSD.

• But ASD is a risk factor for later PTSD.

PTSD

• More chronic and persistent.

• May last months, years, or be lifelong without treatment.

If symptoms last more than 1 month → diagnosis changes to PTSD (if criteria met). If criteria not met, they are diagnosed with Other Specified Trauma and Stressor Related Disorder.

What are criterion D-H of PTSD?

Negative alterations in _____, evidenced by ___ or more of the following (list)

Marked alterations in _____ as evidenced by ___ or more of the following (list)

Duration of criteria BCD&E is more than 1 month.

Disturbance causes…

Not attributable to…

D. Negative alterations in cognitions and mood associated with the event, as evidenced by 2 or more of the following

1. Inability to remember an important aspect of the traumatic event (typically due to dissociative amnesia)

2. Persistent and exaggerated negative beliefs or expectations about ones self, others, or the world (ex. I am bad, no one is to be trusted, the world is a completely dangerous place)

3. Persistent, distorted cognitions about the cause/ consequences of the event that lead the person to believe it was their fault or the fault of others

4. Persistent negative emotional state (fear, horror, anger, guilt, or shame)

5. Diminished interest or participation in significant activities

6. Feeling detachment or estrangement from others

7. Inability to experience positive emotions

E. Marked alterations in arousal and reactivity evidenced by 2 or more of the following

1. Irritable behavior/ angry outbursts (with little or no provocation) typically expressed verbally or physically at other objects or people

2. Reckless or self-destructive behaviors

3. Hypervigilance

4. Exaggerated startle response

5. Problems with concentration

6. Sleep disturbance

F. Duration of criteria B,C,D, and E is more than 1 month

G. disturbance causes impairment or distress

H. Disturbance not attributable to substance or another medical condition

Describe the specifiers for PTSD. (3)

With dissociative symptoms: the individual meets PTSD criteria, and the person experiences persistent or recurrent symptoms of either of the following 

1. Depersonalization: feeling detached from mental processes or body (ex. feeling as if they are an observer of themselves) 

2. Derealization: Persistent or recurrent experiences of unreality of surroundings (the world feels dreamlike or distorted) 

Neither of these can be attributed to a substance or another medical condition 

Specify if: With Delayed Expression 

If the full diagnostic criteria are not met until at least 6 months after the event (although the onset and expression of some symptoms may be immediate) 

Describe PTSD in children 6 years and younger

A. In children 6 and under, exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways

1. Directly experiencing a traumatic event 

2. Witnessing in person the event as it occurred to others, especially primary caregivers

3. Learning that the event happened to a parent or caregiver

B. Presence of one or more of the following intrusion symptoms associated with the traumatic events, beginning after the event occurred 

1. Recurrent, involuntary, and intrusive distressing memories of the traumatic event 

   1. Note: these memories may not appear as distressing and may be expressed as play reenactment

2. Recurrent distressing dreams about the event

   1. Note: It may not be possible to ascertain that the frightening content is related to the traumatic event

3. Dissociative reactions (ex. flashbacks) in which the child feels or acts as if the event were recurring. May occur in play.

4. Intense or prolonged psychological distress at exposure to internal or external cues that remind of the traumatic event

5. Marked physiological reactions to reminders of the traumatic events

C. One or more of the following symptoms, representing either persistent avoidance of stimuli associated with the event or negative alterations in cognitions and mood associated with the event. Must be present beginning or worsening after the event

Persistent avoidance of stimuli

1. Avoidance of or efforts to avoid activities, places, or physical reminders that arouse recollections of traumatic events

2. Avoidance of people or conversations that remind of event

Negative Alterations in Cognition

3. increased frequency of negative emotional states

4. Diminished interest or participation in significant activities

5. Socially withdrawn

6. Reduction in expression of positive emotions

D. Alterations in arousal and reactivity associated with the event, evidenced by 2 or more of the following 

1. Irritable behavior and angry outbursts (typically expressed verbally or physically toward people or objects) 

2. Hyper vigilance 

3. Exaggerated startle response 

4. Problems with concentration 

5. sleep disturbance (difficulty falling or staying asleep)

E. Duration of disturbance is more than 1 month 

F. disturbance causes clinically significant distress or impairment in relationships with parents, siblings, peers, or school behavior

G. Not attributable to a substance or another medical condition.

Summarize the diagnostic differences between PTSD in people 6+ and PTSD in children 6 and under.

⭐ In Summary — Key Differences (Super Short Version)

1. Young children can meet avoidance OR negative mood criteria (don’t have to meet both).

2. Repetitive or trauma-themed play is a prominent symptom unique to children.

3. Dreams don’t need to contain recognizable trauma content.

4. Children cannot qualify based on repeated exposure to trauma details (e.g., first responders).

5. Impairment focuses on relationships, school, and behavior—not work.

6. Symptoms rely more on behavior than self-reported internal states.

What is dissociative identity disorder? 

Disruption in ____ marked by…

• accompanied by

Recurrent…

Clinically significant…

Disturbance is not…

In children, symptoms not better explained by…

Not attributable to…

A. Disruption in identity marked by two or more distinct personality states (may be described as possession in some cultures). Involves marked discontinuity in sense of self and sense of agency, accompanied by related alterations in affect, behavior, consciousness, memory, perception, cognition, and sensory motor function. May be observed by others or reported by the individual.

B. Recurrent gaps in recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting

C. Clinically significant distress or impairment

D. Disturbance is not part of broadly accepted cultural or religious practice

Note: In children, symptoms are not better explained by imaginary playmates or other fantasy play. 

E. Not attributable to a substance or other medical condition. 

What is depersonalization/ derealization disorder?

Presence of persistent/ recurrent experiences of… (1,2,or both. Name)

During these experiences, _______ remains… (key difference between this and ____)

Disturbance not better explained by…

A. Presence of persistent or recurrent experiences of depersonalization, derealization, or both 

1. Depersonalization: Experience of unreality, detachment, or being an outside observer with respect to one’s thoughts, feelings, sensations, body, or actions (ex. perceptual alterations, distorted sense of time, unreal or absent self, emotional/ physical numbing) 

2. Derealization: Unreality or detachment with respect to surroundings (ex. individuals or objects are experienced as unreal, dreamlike, foggy, lifeless, or visually distorted). 

B. During these experiences, reality testing remains intact: the ability to recognize that your experiences, thoughts, and perceptions are not literally true or actually happening outside of your mind. Key difference between this and psychosis

C. Clinically significant distress or impairment 

D. Not attributable to a substance or another medical condition

E. Disturbance not better explained by another mental disorder (schizophrenia, panic disorder, Major depressive disorder, acute stress disorder, PTSD, or another dissociative disorder)