Psychopathology Quiz 1

Assessments, Mood Disorders (Bipolar & Related, Depressive), Personality Disorders & Alternative Model, Anxiety Disorders, Obsessive-Compulsive Disorders, & Trauma and Stressor Related Disorders

manic episode

7+ days of mania: abnormal, persistent, elevated, expansive, or irritable mood; 3 or more of the following:

• Decreased need for sleep 

• Inflated self-esteem or grandiosity 

• More talkative / pressured speech 

• Flight of ideas / mind racing 

• Distractibility 

• Increased goal-directed activity / psychomotor agitation 

• High-risk behaviors 

• Severe impairment and/or psychosis 

hypomanic episode

Milder form of mania lasting 4-7 days; elevated, expansive, or irritable mood lasting at least 4 days; 3 or more of the following symptoms over the course of 4+ days:

• Inflated self-esteem or grandiosity 

• Decreased need for sleep 

• More talkative/pressured speech 

• Flight of ideas / mind racing 

• Distractibility 

• Increased goal-directed activity / psychomotor agitation 

• High risk behaviors 

• Impairment not severe / no psychosis 

bipolar 1 disorder

• Manic episode (ALWAYS – MUST BE PRESENT FOR this)

• Lasting 7 or more days or if the mania requires hospitalization 

• Major depressive episode can be associated, but not required for  

• More commonly understood form of bipolar 

• Subtypes: Mild / Moderate / Severe

• Specify if: psychotic features, partial remission, full remission, or unspecified 

• With: Mixed features / Melancholic features / Atypical features / Mood-congruent psychotic features / Mood-incongruent psychotic features / Catatonia / Peripartum onset /Seasonal pattern 

bipolar 2 disorder

• Presence (or history) of one or more major depressive episodes (ALWAYS required) 

• Presence (or history) of one hypomanic episode ALWAYS 

Specify: 

• Hypomanic – if currently in a hypomanic episode 

• Depressed – If currently in a major depressive episode 

cyclothymic disorder

• 2 or more years hypomanic and depressive symptoms (1 yr for children/adolescents) 

• Symptom free intervals last no longer than 2 months 

• Chronic (current, persistent) symptoms, but not major depressive, manic, or mixed episode 

substance / medication induced, other, and unspecified

• Bipolar and related symptoms expressions, but with medical or substance-related (or other unspecified) basis 

• Indicates predisposition toward bipolar and related symptoms and that medical and/or substance-related issues are essentially pushing the person over the edge 

Disruptive Mood Dysregulation Disorder (Childhood/Adolescents) 

• Recurrent temper outbursts (verbal and/or physical) 

• Inconsistent with developmental level 

• 3+ times per week 

• Persistent irritability between outbursts 

• Temper outbursts and persistent irritability present in at least 2 of 3 settings (home, school, with peers) 

• Criteria 1-4 present for at least 12 months with no more than 3 months recovery period 

• Between ages 6-18 with onset of symptoms before 10 years old 

• No evident mania or hypomania for 1+ day (excluding excitement) 

• Not depression or other (ODD, ADHD) 

• Not substance or medical related 

• Differentiate from ODD 

• Cannot exist with ODD, intermittent explosive disorder, or BPD 

• CAN coexist with major depressive disorder, ADHD, conduct disorder, and substance use disorders 

Major Depressive Disorder

• Diagnose episode first (MDE) 

• 5+ symptoms for 2+ weeks 

• Depressed mood most of day, nearly every day 

• Markedly diminished interest nearly every day 

• Weight / appetite disturbance 

• Insomnia or hypersomnia nearly every day 

• Psychomotor agitation / retardation (slowing down of physical movements or cognitive processes) 

• Fatigue/loss of energy 

• Worthlessness/excessive guilt (not about being sick) 

• Difficulty concentrating or indecisive 

• Recurrent thoughts of death or suicide 

• With or without suicidal intent 

• May include psychotic, delusional symptoms 

Major Depressive Episode

• 5 or more following symptoms during a two-week period: 

  • Depressed mood or loss of interest / pleasure 

  • Depressed mood most of the day, nearly every day  

  • Markedly diminished interest nearly every day 

  • Weight / appetite disturbance  

  • Insomnia or hypersomnia nearly every day

    • “I desire to fall asleep and I cannot” (insomnia) 

    • “I desire to get up / awake and I cannot” (hypersomnia) 

  • Psychomotor agitation / retardation most days 

  • Fatigue / loss of energy 

  • Worthlessness / excessive guilt (not about being sick) 

  • Difficulty concentrating or indecisive 

  • Recurrent thoughts of death or suicide 

  • With or without suicidal intent 

  • May include psychotic, delusional symptoms 

Persistent Depressive Disorder (Dysthymia)

Depressed mood for most of the day, for more days than not, for at least 2 years (children, 1 year) 

2 or more: 

• Poor appetite or overeating 

• Insomnia or hypersomnia 

• Low energy or fatigue 

• Low self-esteem 

• Poor concentration or indecisive 

• Feelings of hopelessness 

No more than 2-month gap between symptoms 

Premenstrual Dysphoric Disorder

In majority of menstrual cycles, 5+  

• Affective lability (mood swings) 

• Irritability / anger 

• Depressed mood, feelings of hopelessness 

• Anxiety, tension  

• Decreased interest 

• Difficulty concentrating 

• Lethargy 

• Appetite disturbance 

• Hypersomnia / insomnia 

• Overwhelmed or out of control 

• Physical symptoms (e.g., breast swelling, joint pain, etc.) 

Cluster A

PD: Odd, eccentric

• Paranoid 

• Schizoid 

• Schizotypal

Cluster B

PD: emotional, dramatic, erratic

• Antisocial 

• Histrionic 

• Borderline 

• Narcissistic  

Cluster C

PD: anxious, fearful

• Avoidant 

• Dependent 

• Obsessive-Compulsive PD 

DSM-5 Alternative Model for Personality Disorders

• Moderate or greater impairment in personality functioning 

• One or more pathological personality traits 

• Inflexible and pervasive 

• Relatively stable patterns across time (childhood) 

• Not another mental disorder (better explained) 

• Not substance/medical 

• Not normal for developmental or sociocultural context 

Disorders included in the Alternative Model

• Schizotypal (A) 

• Antisocial (B) 

• Borderline (B) 

• Narcissistic (B) 

• Avoidant (C) 

• Obsessive-Compulsive PD (C) 

trait domains

• negative affectivity v. emotional stability

• detachment v. extraversion

• antagonism v. agreeableness

• disinhibition v. conscientiousness

• psychoticism v. lucidity

facets of negative affectivity

• emotional lability

• anxiousness

• separation insecurity

• submissiveness

• hostility

• perseveration

• depressivity

• suspiciousness

• restricted affectivity

facets of detachment

• withdrawal

• intimacy avoidance

• anhedonia

• depressivity

• restricted affectivity

• suspiciousness

facets of antagonism

• manipulativeness

• deceitfulness

• grandiosity

• attention-seeking

• callousness

• hostility

facets of disinhibition

• irresponsibility

• impulsivity

• distractibility

• risk-taking

• rigid perfectionism (lack of)

facets of psychoticism

• unusual beliefs and experiences

• eccentricity

• cognitive and perceptual dysregulation

Schizoid Personality Disorder

Pattern of detachment from social relationships – restricted range of emotional expression (4 or more) 

• Does not enjoy close relationships, family 

• Solitary activities 

• Little sexual interest 

• Few, if any, pleasurable activities 

• Lacks close friends, confidants 

• Indifferent to praise or criticism (motiveless) 

• Emotional coldness, detachment, flat affect 

Paranoid Personality Disorder

Pervasive distrust and suspiciousness / interpret motives as malicious (4 or more)  

• Unsubstantiated suspicion of harm 

• Preoccupied with unjustified doubts about loyalty 

• Reluctance to confide based in unwarranted fear 

• Read hidden, demeaning into benign events 

• Persistent grudge bearing (i.e., unforgiving on insults) 

• Perceived character attacks  

• Recurrent unjustified suspicions regarding fidelity 

Dropped from alternative model of DSM-5 

Schizotypal Personality Disorder

• Social and interpersonal deficits and discomfort caused by: 

• Cognitive or perceptual distortions and behavioral eccentricities (5 or more)

  • ideas of reference (misinterpret, not delusions)

  • superstitious / odd perceptual (bodily illusions)

  • inappropriate paranoid fear-based that does not diminish

• Personality Functioning:

  • Self: Identity

    • confused boundaries

    • distorted self-concept

    • incongruent emotional expression

  • Self: Self-Direction

    • unrealistic

    • incoherent goals

    • not clear internal standards

  • Interpersonal: Empathy

    • pronounced difficulty understanding others

    • frequent misinterpretation of others’ motives/behaviors

  • Interperson: Intimacy

    • impaired development of close relationships

    • mistrust / anxiety

• Domains and Facets

  • Psychoticism (eccentricity, cognitive/perceptual dysregulation, unusual beliefs) 

  • Detachment (restricted affect, withdrawal) 

  • Negative affect (suspiciousness) 

Antisocial Personality Disorder

• Pattern of disregard for and violation of the rights of others occurring since age 15 (3+) 

• Failure to conform, deceitful, impulsive, aggressive, reckless disregard, lack of remorse 

• Evidence of Conduct Disorder before age 15 

• Personality functioning: 

  • Self: Identity

    • Ego-centric 

    • Self-esteem from personal gain, power, or pleasure 

  • Self: Self-Direction

    • Goal-setting = personal gratification 

    • Absence of prosocial internal standards 

    • Failed conform to lawful / culturally normal ethical behavior 

  • Interpersonal: Empathy

    • Lack of concern for feelings, needs, or suffering of others 

    • Lack of remorse after hurting or mistreating another 

  • Interpersonal: Intimacy

    • No mutual intimate relationships 

    • Exploitation is a means of relating 

    • Deceit, coercion, dominance, intimidation to control other 

• Domains and Facets

  • Antagonism: Manipulativeness, deceitfulness, callousness, hostility 

  • Disinhibition: irresponsibility, impulsivity, risk-taking 

Borderline Personality Disorder

• Unstable interpersonal, self-image with impulsivity 

  • Frantic avoidance of abandonment 

    • Feels like life or death with this diagnosis 

  • Unstable, intense relations 

  • 2+ self-damaging impulses 

  • Inappropriate, intense, uncontrolled 

  • Transient, stress-related paranoid ideation (dissociation) 

• Personality functioning 

  • Self: Identity

    • poorly developed, unstable self-image 

    • Excessive self-criticism 

    • Chronic emptiness 

    • Dissociative states under stress 

  • Self: Self-Direction

    • Instability in goals, aspirations, values, or career plans 

  • Interpersonal: Empathy

    • Compromised ability to recognize feelings / needs of others 

    • Hypersensitivity to others (i.e., feels slighted/insulted) 

  • Interpersonal: Intimacy

    • Intense, unstable, conflicted close relationships 

    • Mistrust, neediness, anxious preoccupation with real or imagined abandonment 

    • Relationships viewed in extremes 

• Domains and Facets

  • Negative affectivity 

    • Emotional lability 

    • Anxiousness 

    • Separation anxiety 

    • Depressivity 

  • Disinhibition 

    • Impulsivity 

    • Risk-taking 

  • Antagonism 

    • Hostility

Histrionic Personality Disorder

• Pattern of excessive emotionality and attention-seeking beginning by early adulthood (5 or more)

  • Uncomfortable when not the center of attention 

  • Inappropriate sexual, seductive, provocative behavior 

  • Rapid shifting & shallow expression of emotion 

  • Attention-seeking through physical appearance 

  • Speech is impressionistic and lack in detail 

  • Self-dramatization, theatrical expression of emotion 

  • Suggestible (easily influenced by others) 

  • Considers relationships to be more intimate than they are 

Narcissistic Personality Disorder

• Grandiosity, needs admiration, lack of empathy 

• Preoccupied with unlimited success, power 

• Must associate with elite 

• Requires excessive admiration 

• Entitled, interpersonally exploitative 

• Very sensitive to injury or criticism 

• Personality Functioning 

  • Self: Identity

    • Excessive reference to other for self-definition / esteem 

    • Exaggerated self-appraisal 

    • Vacillate between extremes 

  • Self: Self-Direction

    • Goal=approval; unreasonable standards (high or low) 

  • Interpersonal: Empathy

    • Impaired recognition of others 

    • Excessively attuned to reactions of others 

  • Interpersonal: Intimacy

    • Superficial 

    • Others exist to serve self-esteem 

    • Constrained to mutuality due to predominance / need for personal gain 

• Domains and Facets

  • Antagonism - Grandiosity, attention-seeking

Avoidant Personality Disorder

• Criteria

  • Social inhibition, inadequate, hypersensitive 

  • Avoids interpersonal (social, occupational) 

  • Restrained intimate 

  • Preoccupied with criticism, rejection 

  • “Socially inept” self-image, reluctant engagement 

• Personality Functioning

  • Self: Identity

    • Low self-esteem 

    • Self-appraisal 

    • Socially inept 

    • Personally unappealing 

    • Inferior 

    • Excessive feelings of shame or inadequacy 

  • Self: Self-Direction

    • Unrealistic standards with reluctance to pursue goals 

    • Take personal risks 

    • Engage in new interpersonal activities 

  • Interpersonal: Empathy

    • Preoccupation / sensitivity to criticism or rejection 

    • Distorted inference of others as negative 

  • Interpersonal: Intimacy

    • Reluctance involvement unless certain

    • Diminished mutuality within intimate relationships because of fear of being shamed/ridiculed

• Domains and Facets

  • Detachment

    • Withdrawal

    • Intimacy avoidance

    • anhedonia

  • Negative Affectivity

    • anxiousness

Dependent Personality Disorder

• Excessive need to be cared for 

• Submissive and clinging behavior and fears of separation (5 or more)

  • Requires excessive advice, reassurance 

  • Needs others to assume responsibility 

  • Difficulty expressing disagreement (fear of disapproval) 

  • Difficulty initiating projects / doing things on own 

  • Excessive lengths to obtain approval (volunteer for unpleasant duties) 

  • Uncomfortable or helpless when alone 

  • Urgently seeking of relationships (esp. when losing one) 

  • Unrealistically preoccupied with fears of being left to care for self 

Obsessive-Compulsive Personality Disorder

• Criteria

  • Preoccupied with order, perfection, w/interpersonal control 

  • Details and rules, loses point of activity 

  • Excessive devotion to work 

  • Morally inflexible (overconscientious) 

  • Unable to discard (hoarding?) 

  • Reluctant to delegate, rigid, stubborn 

• Personality Functioning

  • Self: Identity

    • Self-derived from work/productivity 

    • Constricted emotions 

  • Self: Self-Direction

    • Difficulty completing tasks 

    • Rigid 

    • Unreasonable goals (internal standards) 

    • Overly conscientious and moralistic 

  • Interpersonal: Empathy

    • Difficulty appreciating ideas, feelings, behavior of others 

  • Interpersonal: Intimacy

    • Relationships secondary 

    • Rigidity has negative impact on relationships 

• Domains and Facets

  • Extreme conscientiousness (opposite of detachment) 

  • Rigid perfectionism 

  • Negative affectivity – perseveration 

  • Detachment – intimacy avoidance, restricted affect 

• person believes their rules/high standards are completely logical (ego-syntonic - aligning with personal values); doesn’t recognize an issue

Separation Anxiety Disorder

• Developmentally inappropriate/excessive fear of separation (3 or more symptoms) 

  • Recurrent, excessive distress anticipating separation 

  • Worry about losing “attachment figures” (death, injury) 

  • Worry about untoward event (getting lost) 

  • Reluctance / refusal to go out 

  • Reluctance / refusal to be alone 

  • Reluctance / refusal to sleep away from home 

  • Repeated complaints of physical symptoms (worried sick?) 

• Duration: 4 weeks (children); 6 months (adults)

Selective Mutism

• Consistent failure to speak in social situations 

• Interferes with education / occupation / social life 

• 1+ month (not just the first month of school) 

• Not attributable to lack of knowledge of language 

• Not a communication or other disorder (e.g., autism) 

Specific Phobia

• Marked and persistent fear that is excessive or unreasonable 

• Phobic stimulus almost invariably provokes an immediate anxiety response 

• Recognition that the fear is excessive / unreasonable 

• The phobic situation is avoided or endured with distress 

• The avoidance, anxious anticipation, or distress interferes significantly with social/occupational functioning 

• In individuals under 18 years, duration is at least 6 months 

• Specifiers:

  • animal type

  • natural environment type (heights, storms)

  • Blood-injection - injury type

  • situational type (airplanes, elevators)

  • others

Social Anxiety Disorder

• Marked and persistent fear of one/more social situations (unfamiliar people, scrutiny) 

• Afraid of being humiliated or embarrassed 

• Exposure to the feared social situation almost invariably provokes anxiety  

• Recognition that fear is excessive or unreasonable 

• Avoidance of situation 

• Significant impairment 

Panic Disorder and Panic Attacks

• must first diagnose attacks before disorder diagnosis

• Discrete period of intense fear (10 minutes, 4+ symptoms) 

  • Palpitations, pounding heart 

  • Sweating 

  • Trembling or shaking 

  • Short breath / smothering 

  • Feeling of choking 

  • Chest pain or discomfort 

  • Nausea or abdominal distress 

  • Dizzy, unsteady, faint 

  • Derealization / depersonalization  

  • Fear of losing control / going crazy 

  • Fear of dying 

  • Paresthesia (numb/tingling) 

  • Cold or hot flashes 

• Disorder

  • Recurrent unexpected attacks 

  • At least one attack has been followed by 1 month of the following: 

    • Persistent concern about having additional attacks 

    • Worry about the implications of the attack or its consequences 

    • Significant change in behavior related to the attacks 

Agoraphobia

• Marked fear or anxiety about 2+ following situations: 

  • Using public transport 

  • Open spaces 

  • Enclosed spaces 

  • Standing in line or crowd 

  • Being outside of home 

• Fears / avoids situations because “escape” might be difficult or not available 

  • Very preoccupied with the need to escape / inability to escape 

• Consistent fear provocation 

• Out of proportion with actual danger 

• With or without panic 

Generalized Anxiety Disorder

• Excessive, uncontrollable anxiety and worry (more days than not for 6+ months) 

• 3 or more symptoms of anxiety/worry: 

  • Restlessness / keyed up / on edge 

  • Easily fatigued 

  • Difficulty concentrating / mind going blank 

  • Irritability 

  • Muscle tension 

  • Sleep disturbance 

Obsessive-Compulsive Disorder

• Obsessions:

  • Recurrent or persistent intrusive thoughts, impulses, or images that cause distress 

  • Not excessive worries about real-life problems 

  • Attempts to ignore or suppress obsessions 

  • Recognition that obsessions are product of mind - individual recognizes cognitions as irrational (ego-dystonic - does not align with self-concept and thoughts are deeply distressing)

• Compulsions

  • Repetitive behaviors / mental acts (response to obsession) 

  • Behaviors / mental acts aimed at reducing distress 

• Specify:

  • With good or fair insight 

  • With poor insight 

  • With absent insight / delusional beliefs 

• With absent insight, can mimic OCPD

  • distinguish OCD as very intrusive, unwelcome cognitions v. moral, rigid, perfectionist cognitions of OCPD

Body Dysmorphic Disorder

• Preoccupation w/ perceived defects (not observable/appear slight to others) 

• Repetitive behaviors (i.e., checking, grooming, picking) 

• Not concern with body fat or eating disorder 

• Causes clinically significant distress or impairment – social, occupational, other important areas of functioning 

• Specify

  • With muscle dysmorphia (insufficient) 

  • With good or fair insight 

  • With poor insight 

  • With absent insight / delusional beliefs (completely convinced) 

Hoarding Disorder

• Persistent difficulty discarding possessions (regardless of actual value) 

• Perceived need to save items; distress discarding 

• Result: accumulation substantially compromises living areas 

• Clinical distress / impairment 

• Not “other” 

• Specify with: 

  • Excessive acquisition 

  • Good or fair insight (cecil: OCD) 

  • Poor insight (cecil: OCPD) 

  • Absent insight / delusional beliefs (cecil: OCPD) 

Trichotillomania and Excoriation Disorders

• Recurrent hair pulling or skin picking, resulting in hair loss or sores 

• Repeated attempts to stop 

• Clinical distress / impairment 

Reactive Attachment Disorder

• Consistent inhibition (emotionally withdrawn) 

  • Rare/minimal comfort seeking (even in distress) 

  • Rare / minimal response to comfort 

• Persistent social / emotional disturbance 

  • Minimal social / emotional responsiveness 

  • Limited positive affect 

  • Unexplained irritability, sadness, fearfulness (nonthreatened) 

• Experienced extremes of insufficient care 

  • Social neglect / deprivation 

  • Repeated change of primary caregivers 

  • Rearing in unusual setting that limit opportunities for attachment 

• Specify

  • persistent

  • severe (all symptoms)

• Disturbance evident before 5 years old; child’s developmental age at least 9 months at time of diagnosis

Disinhibited Social Engagement Disorder

• Active approach to strangers 

  • Reduced / absent reticence 

  • Overly familiar verbal / physical 

  • Diminished / absent “checking back with adult” 

  • Willing to go off with unfamiliar adult 

• Not impulsivity; disinhibition 

• Experienced extremes of insufficient care 

  • Social neglect / deprivation 

  • Repeated change of primary caregivers 

  • Rearing in unusual setting that limit opportunities for attachment 

Posttraumatic Stress Disorder

• Criteria

  • Exposure to threat, injury, death, sexual violence 

    • Directly experienced 

    • Witnessing 

    • Learning about a close family member / friend (violent or accidental) 

    • Repeated extreme exposure to aversive details (not media, unless work related) 

  • Intrusion symptoms (1 or more) 

    • Recurrent, involuntary, intrusive memories 

    • Recurrent, intrusive dreams 

    • Dissociative reactions (e.g., flashbacks) 

    • Intense psychological distress at exposure to internal or external cues 

    • Physiological reactions 

  • Avoidance (1 or more)

    • Avoid distressing stimuli 

    • Avoid external reminders (people, places, conversations) 

  • Altered Cognitions

    • Memory impairment (blocking) 

    • Exaggerated negative beliefs and expectations (i.e., trust) 

    • Distorted views of causes / consequences (i.e., blame) 

    • Negative emotions 

    • Diminished interest / participation 

    • Detachment / estrangement 

    • Inability to experience positive emotions 

  • Arousal / Reactivity (2 ore more)

    • Irritable / angry outbursts 

    • Reckless / self-destructive 

    • Hypervigilance 

    • Exaggerated startle response 

    • Problems concentrating 

    • Sleep disturbance 

• Specify:

  • Dissociative 

  • Depersonalized 

  • Derealized 

  • Delayed expression (6+ months post-trauma symptoms) 

Acute Stress Disorder

• Exposure to trauma (same as PTSD)

• 9+ symptoms

  • Intrusion 

  • Negative mood 

  • Dissociative 

  • Avoidance 

  • Arousal  

• Duration: 3 days to 1 month

• Essentially, this person meets the criteria for PTSD, except it has not been 1 month yet 

Adjustment Disorders

• Emotional / behavioral symptoms resulting from identifiable stressors (within 3 months of stressor) 

• Clinically significant impairment 

  • Marked distress is out of proportion to the severity or intensity of the stressor, taking into account the context 

• Clearly disproportionate to situation 

• Not “other” 

• Not normal bereavement 

• Stressor relief = stability in 6 months (person can find resolution) 

• Specify: 

  • Depressed mood 

  • Anxiety 

  • Mixed anxiety and depressed mood 

  • Disturbance of conduct  

  • Disturbance of emotions and conduct 

  • Unspecified