DSM 5

What's the difference

Autism Spectrum disorder vs Social (pragmatic) communication disorder

ASD: 0-5 yrs old

• Lack of eye contact

• Challenges in Play

• No receptive play

• Repetitive behaviors (e.g. hand flopping)

• Poor social relationships

• Communication & Relationships

Social Communication disorder

• Impaired social communication

• No repetitive behavior 

Specific learning disorder vs Attention Deficit Hyperactivity disorder

Specific learning disorder:

• Usually with certain classes

• Other needs e.g. needing glasses

• Hard learnings traditional ways

ADHD: Symptoms present before age of 12 and 2 or more locations of behaviors

• Can’t sustain attention on tasks

• Poor organization

• Fidgets (playing with pencils/difficulty focusing)

• Context for kids (school/home)/Adults (work/home)

PICA vs Rumination disorder

Pica:

• Persistent eating of non-food objects

Rumination disorder:

• repeated regurgitation of food (food comes back up not digested)

Language disorder vs Childhood-Onset fluency disorder

language disorder:

• Reduced vocabulary

• 5 word sentences 

• Simple sentences

Childhood-Onset Fluency disorder

• Broken sentences (stutters)

• Broken words

0-5 years old

Tourette Disorder bs Persistent Motor/Vocal Tic disorder

Tourettes:

• Have both motor/vocal tics

Persistent motor/vocal tic disorder

• Has motor or vocal tics

Encopresis Vs Enuresis

*Due to possible trauma or abuse

*Older than 4 years old

Encopresis:

• having pooping incidents (5 yrs or older)

Enuresis

• having pee incidents (5 years old)

Separation Anxiety disorder vs Generalized anxiety disorder

S.A.D:

• Anxiety to separation to care giver

• Worried about that person leaving

• Worry for the person

• More common in kids

• *Kids 4 months/Adults 6 months

GAD:

• Worried about other aspects of life

• *6 months for kids and adults

Selective Mutism vs Social Anxiety disorder

Selective mutism:

• Refuse to speak

Social Anxiety disorder:

• Fear & concerned/judged/observed in social events

• Avoids going to social events

• Tends to stay with “close people”

Reactive attachment vs Disinhibited Social Engagement disorder (DSED)

Reactive attachment disorder:

• Failure to thrive

• withdrawn/does not seek comfort/not attention seeking

• Lack of positive emotion

• Persistent after 2 months (9months - 5 years old for children/common in kids in foster care)

DSED:

• Kids easily attach themselves to different people

Oppositional Defiant disorder vs Conduct disorder vs Disruptive mood dysregulation disorder

O.D.D:

• Problem with authority

• Defiant

• Argumentative

• Does not follow instructions

Conduct disorder:

• law breaking activity 

• Aggressive

• lack of remorse

• Property destruction

• *Could lead to Anti-social personality disorder as an adult

DMDD:

• 6 year old up to 17 years old

• Chronically moody/irritable

• 3x per week having outbursts

• Negative mood even when having no outbursts

• Recurrent outbursts

Brief psychotic disorder vs Schizophreniform disorder vs Schizophrenia

*Timeline - negative symptoms : flat affect/don’t respond to discussions/lost in own word/can be still/Voices or delusions

Brief psychotic disorder:

• Flat affect

• negative emotions

• up to a month

• *delusions - false beliefs

Schizophreniform:

• 1 month - 6 months

• *hallucinations - visual/auditory

Schizophrenia:

• over 6 months

• disorganized

• rambling speech/behaviors and actions

Major depressive disorder vs Unspecified depressive disorder vs persistent depressive disorder

MDD

• 2 weeks

• lack of enjoyment in life - Possible SI

• lack of enjoyment in activities they used to enjoy - bio functioning

UDD

• Does not meet full criteria for MDD

PDD (Dysthymia)

• Adult 2 years/Kid 1 year

• Depressed mood

• no change in bio functioning

Bipolar 1 disorder vs Bipolar 2 disorder vs cyclothymic disorder

Bipolar 1:

• manic phase (lots of energy and ideas of grandiosity)

• Lack of need for sleep

• elevated mood for 1 week which can be positive

• risky behaviors that you wouldn’t normally due (such as gambling/ substance use etc.)

Bipolar 2:

• Hypomanic phase (4 days elevated mood/no impairment like manic episode)

• major depressive episode 

Cyclothymic disorder:

• Hypomanic state of mood

• alternate with mild depressive state

unspecified depressive disorder vs unspecified mood disorder vs unspecified bipolar disorder

unspecified depressive:

Unspecified mood:

• mood disorder

• does not meet criteria for full mood disorder

Unspecified bipolar:

• some symptoms of bipolar

• does not meet full criteria of bipolar

schizophrenia disorder vs bipolar 1 disorder vs psychotic features

Schizoaffective:

• psychotic features all the time

• mood symptoms happens sometimes

Bipolar 1:

• manic phase (lots of energy and ideas of grandiosity)

• Lack of need for sleep

• elevated mood for 1 week which can be positive

• risky behaviors

Psychotic features:

• mood is constant

• psychotic features in & out

Bereavement vs Major depressive disorder vs adjustment disorder with depressed mood

Bereavement:

• Grief

• Feelings of loss/depression

MDD

• worthlessness/hopelessness

• self-harm

• biological impairment (significant)

Adjustment disorder W/depressed mood:

• recent life stressors

• symptoms 3 months of stressors

• persistent adjustment 6 months or longer from stressor

bereavement vs prolonged grief disorder

Bereavement:

• Grief

• Feelings of loss/depression

• normal grief reaction

Prolonged grief disorder:

• adult 12 months or more/child/adolescent 6 months or more

• time frame/severity social/cultural norms for the individual

panic disorder vs agoraphobia

panic disorder:

• Fear that it will happen again

Agoraphobia:

• going out into the public (2 situations)

• crowded spaces/public transport etc.

• impacts ability to function in society

Obsessive-Compulsive disorder bs Obsessive-Compulsive personality disorder

OCD:

• Obsessive thoughts that controls their lives

• intrusive thoughts

• compulsive behaviors

• Impacts functioning

Obsessive compulsive personality disorder

• Perfectionist

• No awareness of it happening

• Functioning in society

PTSD vs Acute stress disorder vs adjustment disorder with anxiety

PTSD:

• Behavioral - Avoidant

• Hypervigilance

• Onset 1 months since incident (at least)

• Witnessed life threatening event

• Intrusive thoughts/memories

• Negative mood

Acute stress disorder: Present during life threatening situation

• Stressor that happens within 3days to a month

• Same symptoms as PTSD

• depression/irritability

• self-blame/survivors guilt

• avoidance of situations that reminds them of the situation

adjustment disorder with anxiety:

• not life threatening

• no hypervigilance/intrusive thoughts

• Symptoms occur within 3 months of the stressful event and lasts no longer than 6 months after the stressor has ended or the person has adapted.

Generalized anxiety disorder vs anxiety disorder unspecified

*KNOW TIMELINE

GAD:

• Onset symptoms of 6 months even if severe

• Impact on biological functioning (sleep diet, etc.)

• Unable to control the worry

Anxiety disorder unspecified:

• Less than 6 months of onset (severity does not matter)

Delirium vs major neurocognitive disorder vs mild neurocognitive disorder

Delirium:

• delusions or hallucinations

• language impairment

• memory impairment

• rapid onset (few hours yo to maybe a day)

• usually at hospitals (possible medical issue)

• Talks mumbo jumbo

• health crisis

Major neurocognitive:

• impaired executive functioning

• lack of language

• impaired bodily functioning

• Impaired individual functioning

Mild neurocognitive:

• *maintaining independence

• forgetfulness (names/observed forgetfulness by others)

• many need support

• *elderly with MDD could have memory loss/MDD elderly knows when they are forgetful

• Precursor to major neurocognitive disorder

With neurocognitive disorder vs depression: those who are depressed knows they are being forgetful.

Somatic symptom disorder vs illness anxiety disorder vs functional neurological symptoms disorder

Somatic symptom (somatoform disorder dsm4):

• health related issues (pain/illness/documented by health professional)

• persistent concern of medical issues

• impairs daily functioning 

illness anxiety disorder: timeline of 6 months.

• rarely or mild somatic issues

• fear of medical issues

• *documented health issues

• Shop around for doctors

functional neurological symptom disorder:

• blind rage

• psychological stressors

• Paralysis (unable to move arms)

• psychological stressors turns into somatic condition

Factitious disorder vs malingering vs factitious disorder be proxy

factitious (Munchausen syndrome):

• Acts like they are sick

• Likes attention being a patient

Malingering:

• faking illness to get out of something

• trying to seem sick to gain or avoid something

Factitious disorder by proxy:

• Making others feel sick

Anorexia Nervosa vs Bulimia nervosa vs binge eating disorder

Anorexia Nervosa: coordinate with medical Dr. (usually need higher level of care/inpatient)

• limits food intake

• fear of gaining weight/fat

• excessive exercise (usually skinnier people)

• Not meeting physical need (eating less than required)

• distorted body image

Bulimia nervosa:

• Binge eating (eating more than what a normal person would normally need)

• Recurrent purging by any means

Binge eating disorder:

• Only engages in binge eating/no purging of food

• Feeling of disgust after eating afer binge eating

Unspecified eating disorder vs body dysmorphic disorder

unspecified eating disorder:

• obsession with body image

• does not meet criteria for bulimia or anorexia

• purging without binging

• normal weight with anxiety of body image

Body dysmorphic 

• Not about weight

• all about how specific parts the body looks

Depersonalization/Derealization disorder vs dissociative amnesia vs dissociative identity disorder

Depersonalization/Derealization:

• experiences of reality (present and able to have convo)

• Dream like state

• don’t feel connected with reality

• world feels surreal

Dissociative amnesia

• sudden forgetting personal information (social security number etc.)

• extreme stress/shock

D.I.D:

• distinct personality disorder

• may have many names

• extreme trauma at a young age

• cant remember other states of personality

Genito - pelvic pain/Penetration disorder vs Female sexual interest/Arousal disorder

Genito-Pelvic pain:

• female feels pain during intercourse/fear of pain

• fear of sex

• Possibly due to trauma

Female sexual interest/arousal

• no desire for sex

• no thoughts or fantasies

• Not wanting intimacy

These can occur with those in DV relationship/raped/sexually abused

Insomnia disorder vs hypersomnolence disorder

Insomnia

• *confirm if manic

• Rule out manic phase (energized with lack of sleep), anxiety & depression

• 3 nights per week for 3 months difficulty sleeping

• Multiple waking during the evening/difficulty falling asleep/staying asleep/early morning waking

Hypersomnolence

• excessive sleepiness during the day despite getting 7 - 9+ hours

• sluggish/groggy

• overweight individual

• trouble being fully awake

• sleeping excessively

• rule out MDD/substances that could cause excessive sleep

• Excessive sleepiness has been present for at least 3 months.

nightmare disorder vs non-rapid eye movement sleep disorder

nightmare disorder:

• wakes up due to nightmare and remembers content of the dream

non-rapid eye movement sleep disorder (sleep terror disorder):

• cant remember dreams

• not fully awake/sleep walking

• don’t remember it happening

Central sleep Apnea vs Narcolepsy

Central sleep Apnea

• Stop breathing/Gasp for air can occur up to 1 min

• disrupts quality of sleep

• reports being tired in the morning due to lack of REM sleep due to breathing stopping

narcolepsy

• suddenly falls asleep

• sudden loss of muscle tone

• daytime fatigue

• hallucinations when going in and out of sleep

Intermittent explosive disorder vs kleptomania vs trichotillomania

IED

• trouble controlling aggressive outbursts/destructive/verbally abusive

• outbursts is disproportion of stressor

• easily triggered

• not ODD/Antisocial disorder/narcissistic 

kleptomania

• compulsive stealing

• not for need or purpose

Trichotillomania

• compulsion to pull out hair from any part of body

• possible due to trauma/abuse (possibly punishing self from “shame”)

substance use disorder vs substance induced disorder

substance use disorder

• failure to maintain/perform their duties due to substance use (home/work/social)

• dependence on substances (shaky/withdrawal)

• increased tolerance on the severe end

• interferes with functioning

• substance withdrawal (each substance can have different withdrawal symptoms)

Substance induced disorder

• intoxication

• different withdrawal symptoms

Substance intoxication vs substance withdrawal

Substance induced mild neurocognitive disorder (learning/memory/executive functioning

Prolonged meth/cocaine/amphetamine use - Learning/memory/executive functioning

gambling disorder

• Preoccupation to gambling

• increased gambling

• gamble to avoid troubles

• lies about gambling/could negatively impact social relationships

• even after losing will go back for more

• even when they are winning/losing they will continue

• use gambling as coping skill

• *rule out manic episode

Ego syntonic:

the disorder does not see the disorder/behaviors as a problem. Developed during young age (possible traumatic abusive upbringing).

Ego dystonic:

the disorder that the client is aware of and does not like/does not fit definition of themselves (depression/anxiety/panic disorder)

Paranoid Personality disorder vs delusional disorder vs schizophrenia

PPD

• rational suspicions of others

• others are trying to harm/deceive them

• hard time maintaining relationships

• remarks as persecutory against them

• often time hold grudges against as what they perceive as insult

• Place is hostile and out to get them

Delusional disorder

• bizarre/non-bizzare delusions

Schizophrenia

• hallucinations/delusions

• flat affect

• disorganized speech

• catatonia

Schizoid personality disorder vs avoidant personality vs major depressive disorder

Schizoid personality - egosyntonic

• LONERS

• lacks interest with social relationships

• withdrawn

• likes to be alone

• possible depression symptoms

Avoidant personality

• LONELY

• fear of rejection

• want to connect with others

• fears of being rejected/judged/evaluated

MDD - egodystonic

• someone who sees they have been withdrawn/self-isolated

Schizotypal personality disorder vs Schizophrenia

Schizotypal personality

• *not psychotic

• odd thinking behavior

• magical thinking

• ideas of reference (e.g. they think that the news is talking about them/aliens etc.

• lack of social relationships/lack close friends

• bizarre fantasies/dresses bizarrely

• PRECURSOR TO SCHIZOPHRENIA

Schizophrenia 

• psychotic episode

Antisocial personality disorder vs narcissistic personality disorder

Antisocial personality disorder

• *18 yr old to be DX

• *Evidence of conduct disorder prior to the age of 15

• Violation of rights to others

• impulsive

• safety of others/recklessness

• purposely hurting others

• lying for pleasure

• aggressive

• lack of remorse/indifference in mistreatment of others

Narcissistic personality disorder

• need for admiration

• lack of remorse/empathy

• grandiose of self achievement

• arrogant

• grandiose sense of self

• exaggerates achievements

• sense of entitlement

• enraged when challenges

• (Possibly with those who are perpetrator of DV)

Borderline personality disorder vs histrionic personality disorder

borderline personality

• *extreme in relationships/relationships instabilities

• *fear of being rejected/abandoned (can present with SH/SI recurrent gestures)

• fluctuating self image

• extreme moods/mood instability

• rage/difficulty controlling their rage

• maintaining jobs

• idealize therapist

• identity disturbances

Histrionic personality disorder

• *DRAMATIC/APPEARANCE

• *seductive dress/behaviors (not required)

• *center of attention

• attention seeking behaviors

• blind rage when challenged

• shallow expression of emotion/very vain/very dramatic

Obsessive compulsive personality disorder vs dependent personality disorder

obsessive compulsive personality disorder

• perfectionist

• excessive orderliness

• rules/morals

• lack of delegation

Dependent personality disorder

• assurance from others

• difficulty disagreeing with others

• fear of loss of support/fear of rejection

• trouble doing things on their own/initiating 

• doing things on their own

• helpless when alone

• very quick to move on when relationships end/need support to be co-pilot in their own lives/having to take care of themselves

T&Z CODES (no diagnoses/can use without other Dx)

T Code:

For those who have suicidal behaviors during first encounter a T code should be given/if working with a client and learn of suicidal behavior they get different T code

Z Code:

I client has history of suicidal behavior a specific Z code is necessary

2 codes for non-suicidal self-injury 1 is for current presentation and other is for history of clients lifetime.

Past suicide attempt to guess future attempts