Psychopathology Final

Murray's findings on trauma and etiology

o Said we wasted too much time and money trying to find biological basis for disorders and we ignored trauma. Since then, trauma accounts for more variance in psychosis than genetics does.

Miklowitz on family factors

o Peole who are diagnosed with psychosis often come from families where there is a lot of complaining, perfectionism, basically negative expressed emotions.

-Negative Expressed emotional (EE): high levels of criticism, hostility, or emotional over involvement by a key relative likely contribute to exacerbation and maintenance of psychotic symptoms. In families where there is more at risk for psychosis, there is more negative expressed emotion.

-Negative affective style (AS): negative AS is characterized by at least one relative making at least one personal criticism or guilt-inducing statement or six or more intrusive (mind-reading: I assume you know what youre thinking and chastise you for it) statements to the patient during a 10-minute problem-solving discussion. At least one influential individual in the person's life who conveys and establishes a negative affective style. You do this to try and change the person's behavior.

Mystification: when someone does something, and an emotion happens that you think is indicative of the behavior but it isn't. for example, you yawn and someone goes "why are you mad?". Occurs in negative affective style.

-Double bind hypothesis: damned if you do, damned if you don't. You get in trouble for acting one way and get in trouble for fixing it.

Stice's "dual pathway" model of bulimia and binge eating

o Sociocultural pressure/ideal body internalization body dissatisfaction negative affect OR restrained eating eating disorders

o The two pathways are key. Personal and societal pressure. Talks about external and internal factors

o Body internalization is a specific instance of a human behavior of wanting to imitate.

o Peter burger and looknow, social construction of reality

o What happens for us is that we are in social settings and experience a socially determined order we internalize and see it as the nature of reality, we lose touch as it becomes personalized

Cognitive model of substance use

o not a stand alone treatment, works best with psychopharmacology and group intervention

o be sensitive to stages of change model to gauge current stage of patient when beginning a session (ex: asking about usage since last session)

o -7 psychological factors that contribute to risk of substance use:

1) high risk situations: internal and external. Identify people places and things they associate with substance use; physiological and mood states are internal high risk (ex: low distress/discomfort tolerance)

2) dysfunctional beliefs: challenging faulty beliefs (ex: that one is fundamentally bad and doesn't deserve to recover)

3) automatic thoughts increase sympathetic arousal and increase craving; prepare rational responses to reduce reflexive drug use (ex: mental image of children)

4) physiological cravings: delay and distract technique; make a list of activities to do instead of acting on urge

5) permission giving beliefs: "its ok to use this time"; develop rational, well rehearsed responses, like " there is no such thing as using a little" have emotional valance to them; have rise in emotional moments

6) rituals: restructure routine so it is more difficult to access drugs, focusing on improving communication and problem solving skills

7) adverse psychological reactions: to a lapse/relapse; challenge erroneous thinking around failure, study lapse and learn from it

how personality disorders differ from other diagnoses

· OCPD and hoarding: 5 and 7 criteria for OCPD match hoarding diagnosis. OCPD is egosyntonic

· Avoidant personality disorder is different than social anxiety is that someone with avoidant disorder does not think there is a chance of social success. Someone with social anxiety wants to fix their social anxiety. They do not want to be afraid

· Schizotypal is included in the psychotic disorders, but schizoid is not.

hayes and hoffman chapter 6

o Human suffering is shaped by our own capacity for language, symbolic cognition, and relational framing

§ Relational frame theory (RFT): how humans use language to relate stimuli, and how those relations transform the functions of behaviors

o We may develop core beliefs and relational webs that will shape our behavior and emotions (how do we develop "rule-governed behaviors")

o Shift from "what disorder does someone have" to "what relational learning processes are maintaining this person's suffering?"

o Challenges the idea that psychological distress is captured by certain symptom clusters

o Need to understand how an individual processes relations and how they respond

o We use language to create understanding

hayes and hoffman chapter 11

o Researchers and practitioners are moving away from "protocols for syndromes."

§ Unexplained comorbidity, unreliable, increased stigma, and no treatment specificity because it is based on the medical model

o Processes-based therapy (PBT)

§ Build on ACT universalism, process-focused, and idographic methods

§ Emphasis of an evolutionary approach (function, history development, proximal mechanisms)

§ Main question: what core biopsychosocial processes should be targeted with this client, for this goal, in this situation, and how can they change effectively

§ Therapeutic processes of change, set of theory based, dynamic, progressive, context-dependent, and multilevel change processes that occur in sequences toward the goal

§ EEMM is one of these

o Extended evolutionary meta model (EEMM)

§ Dimensions are all the things psychotherapists concern themselves with (affect, cognition, attention, self, motivation, overt behavior, biophysiological, and sociocultural)

§ The levels are biophysiological and sociocultural (old model separates these from other dimensions

§ The variations across the top (variation, selection, retention, and context) effect how the domains present; they select the particular variation of any of the dimensions

§ Ex: at home your mood is depressed, but you go out and see your friends and your mood is lifted

§ Context ultimately determines whether what was retained in adaptive or maladaptive (the old model). The new model does not have maladaptive or adaptive, just context

§ As a therapist, you have to see the pattern of variation and retention of chrematistics of disorders.

§ Ex: one fo the main symptoms can be low mood that you have most days but there are still days where there is no low mood and there is another variation. Motivation changes too.

delayed ejaculation

A.Either of the following symptoms must be experienced on almost all or all occasions (approximately 75%-100%) of partnered sexual activity (in identified situational contexts or, if generalized, in all contexts), and without the individual desiring delay:

1. Marked delay in ejaculation.

2. Marked infrequency or absence of ejaculation.

B.The symptoms in Criterion A have persisted for a minimum duration of approximately 6 months.

C.The symptoms in Criterion A cause clinically significant distress in the individual.

D.The sexual dysfunction is not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress or other significant stressors and is not attributable to the effects of a substance/medication or another medical condition.

premature ejaculation

A.A persistent or recurrent pattern of ejaculation occurring during partnered sexual activity within approximately 1 minute following vaginal penetration and before the individual wishes it.

B.The symptom in Criterion A must have been present for at least 6 months and must be experienced on almost all or all (approximately 75%-100%) occasions of sexual activity (in identified situational contexts or, if generalized, in all contexts).

C.The symptom in Criterion A causes clinically significant distress in the individual.

D.The sexual dysfunction is not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress or other significant stressors and is not attributable to the effects of a substance/medication or another medical condition.

erectile disorder

A.At least one of the three following symptoms must be experienced on almost all or all (approximately 75%-100%) occasions of sexual activity (in identified situational contexts or, if generalized, in all contexts):

1.Marked difficulty in obtaining an erection during sexual activity.

2.Marked difficulty in maintaining an erection until the completion of sexual activity.

3.Marked decrease in erectile rigidity.

B.The symptoms in Criterion A have persisted for a minimum duration of approximately 6 months.

C.The symptoms in Criterion A cause clinically significant distress in the individual.

D.The sexual dysfunction is not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress or other significant stressors and is not attributable to the effects of a substance/medication or another medical condition.

male hypoactive sexual desire disorder

A.Persistently or recurrently deficient (or absent) sexual/erotic thoughts or fantasies and desire for sexual activity. The judgment of deficiency is made by the clinician, taking into account factors that affect sexual functioning, such as age and general and sociocultural contexts of the individual's life.

B.The symptoms in Criterion A have persisted for a minimum duration of approximately 6 months.

C.The symptoms in Criterion A cause clinically significant distress in the individual.

The sexual dysfunction is not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress or other significant stressors and is not attributable to the effects of a substance/medication or another medical condition

female orgasmic disorder

A.Presence of either of the following symptoms and experienced on almost all or all (approximately 75%-100%) occasions of sexual activity (in identified situational contexts or, if generalized, in all contexts):

1.Marked delay, marked infrequency of, or absence of orgasm.

2.Markedly reduced intensity of orgasmic sensations.

B.The symptoms in Criterion A have persisted for a minimum duration of approximately 6 months.

C.The symptoms in Criterion A cause clinically significant distress in the individual.

D.The sexual dysfunction is not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress or other significant stressors and is not attributable to the effects of a substance/medication or another medical condition.

female sexual interest/arousal disorder

A.Lack of, or significantly reduced, sexual interest/arousal, as manifested by at least three of the following:

1.Absent/reduced interest in sexual activity.

2.Absent/reduced sexual/erotic thoughts or fantasies.

3.No/reduced initiation of sexual activity, and typically unreceptive to a partner's attempts to initiate.

4.Absent/reduced sexual excitement/pleasure during sexual activity in almost all or all (approximately 75%-100%) sexual encounters (in identified situational contexts or, if generalized, in all contexts).

5.Absent/reduced sexual interest/arousal in response to any internal or external sexual/erotic cues (e.g., written, verbal, visual).

6.Absent/reduced genital or nongenital sensations during sexual activity in almost all or all (approximately 75%-100%) sexual encounters (in identified situational contexts or, if generalized, in all contexts).

B.The symptoms in Criterion A have persisted for a minimum duration of approximately 6 months.

C.The symptoms in Criterion A cause clinically significant distress in the individual.

D.The sexual dysfunction is not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress or other significant stressors and is not attributable to the effects of a substance/medication or another medical condition.

Genito-Pelvic Pain/Penetration Disorder

A.Persistent or recurrent difficulties with one (or more) of the following:

1.Vaginal penetration during intercourse.

2.Marked vulvovaginal or pelvic pain during vaginal intercourse or penetration attempts.

3.Marked fear or anxiety about vulvovaginal or pelvic pain in anticipation of, during, or as a result of vaginal penetration.

4.Marked tensing or tightening of the pelvic floor muscles during attempted vaginal penetration.

B.The symptoms in Criterion A have persisted for a minimum duration of approximately 6 months.

C.The symptoms in Criterion A cause clinically significant distress in the individual.

D.The sexual dysfunction is not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress or other significant stressors and is not attributable to the effects of a substance/medication or another medical condition.

gender dysphoria (adults and adolescents)

A.A marked incongruence between one's experienced/expressed gender and assigned gender, of at least 6 months' duration, as manifested by at least two of the following:

1.A marked incongruence between one's experienced/expressed gender and primary and/or secondary sex characteristics (or in young adolescents, the anticipated secondary sex characteristics).

2.A strong desire to be rid of one's primary and/or secondary sex characteristics because of a marked incongruence with one's experienced/expressed gender (or in young adolescents, a desire to prevent the development of the anticipated secondary sex characteristics).

3.A strong desire for the primary and/or secondary sex characteristics of the other gender.

4.A strong desire to be of the other gender (or some alternative gender different from one's assigned gender).

5.A strong desire to be treated as the other gender (or some alternative gender different from one's assigned gender).

6.A strong conviction that one has the typical feelings and reactions of the other gender (or some alternative gender different from one's assigned gender).

B.The condition is associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning.

gender dysphoria specifiers

•With a disorder/difference of sex development (e.g., congenital adrenogenital disorder)

Specify :

•Posttransition (i.e., living in the experienced gender and has had or is preparing to have gender-affirming medical procedure)

voyeuristic disorder

A.Over a period of at least 6 months, recurrent and intense sexual arousal from observing an unsuspecting person who is naked, in the process of disrobing, or engaging in sexual activity, as manifested by fantasies, urges, or behaviors.

B.The individual has acted on these sexual urges with a nonconsenting person, or the sexual urges or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

The individual experiencing the arousal and/or acting on the urges is at least 18 years of age

voyeuristic disorder specifer

•In a controlled environment

In full remission (5 years)

Exhibitionistic Disorder

A.Over a period of at least 6 months, recurrent and intense sexual arousal from the exposure of one's genitals to an unsuspecting person, as manifested by fantasies, urges, or behaviors.

The individual has acted on these sexual urges with a nonconsenting person, or the sexual urges or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

exhibitionistic disorder specifier

•Exposing to prepubertal children

•Exposing to physically mature individuals

•Exposing to both

Specify if:

•In a controlled environment

•In full remission (5 years)

Frotteuristic Disorder

A.Over a period of at least 6 months, recurrent and intense sexual arousal from touching or rubbing against a nonconsenting person, as manifested by fantasies, urges, or behaviors.

B.The individual has acted on these sexual urges with a nonconsenting person, or the sexual urges or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

frotteuristic disorder

Specify if:

•In a controlled environment

•In full remission (5 years)

sexual masochism disorder

A.Over a period of at least 6 months, recurrent and intense sexual arousal from the act of being humiliated, beaten, bound, or otherwise made to suffer, as manifested by fantasies, urges, or behaviors.

B.The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

sexual machismo disorder specifier

Specify if:

•With asphyxiophilia

Specify if:

•In a controlled environment

•In full remission (5 years)

sexual sadism disorder

A.Over a period of at least 6 months, recurrent and intense sexual arousal from the physical or psychological suffering of another person, as manifested by fantasies, urges, or behaviors.

B.The individual has acted on these sexual urges with a nonconsenting person, or the sexual urges or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Pedophilic Disorder

A.Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child or children (generally age 13 years or younger).

B.The individual has acted on these sexual urges, or the sexual urges or fantasies cause marked distress or interpersonal difficulty.

C.The individual is at least age 16 years and at least 5 years older than the child or children in Criterion A.

Note: Do not include an individual in late adolescence involved in an ongoing sexual relationship with a 12- or 13-year-old

pedophilic disorder specifiers

•Exclusive type (attracted only to children)

•Nonexclusive type

Specify if:

•Sexually attracted to males

•Sexually attracted to females

•Sexually attracted to both

Specify if:

•Limited to incest

fetishistic disorder

Specify:

•Body part or parts

•Nonliving objects

•Other

Specify if:

•In a controlled environment

•In full remission (5 years)

Transvestic Disorder

A.Over a period of at least 6 months, recurrent and intense sexual arousal from cross-dressing, as manifested by fantasies, urges, or behaviors.

B.The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

tranvestic disorder specifier

Specify if:

•With fetishism

•With autogynephilia

Specify if:

•In a controlled environment

In full remission (5 years)

General Personality Disorder

A. An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture. This pattern is manifested in two (or more) of the following areas:

1 . Cognition (i.e., ways of perceiving and interpreting self, other people, and events).

2. Affectivity (i.e., the range, intensity, lability, and appropriateness of emotional response).

3 .Interpersonal functioning.

4. Impulse control.

B.The enduring pattern is inflexible and pervasive across a broad range of personal and social situations.

C.The enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D.The pattern is stable and of long duration, and its onset can be traced back at least to adolescence or early adulthood.

E.The enduring pattern is not better explained as a manifestation or consequence of another mental disorder.

F.The enduring pattern is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., head trauma).

Paranoid Personality Disorder

A.A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

1.Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her.

2.Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates.

3.Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her.

4.Reads hidden demeaning or threatening meanings into benign remarks or events.

5.Persistently bears grudges (i.e., is unforgiving of insults, injuries, or slights).

6.Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack.

7.Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner.

B.Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, or another psychotic disorder and is not attributable to the physiological effects of another medical condition.

Note: If criteria are met prior to the onset of schizophrenia, add "premorbid," i.e., "paranoid personality disorder (premorbid)."

Schizoid Personality Disorder

A.A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

1.Neither desires nor enjoys close relationships, including being part of a family.

2.Almost always chooses solitary activities.

3.Has little, if any, interest in having sexual experiences with another person.

4.Takes pleasure in few, if any, activities.

5.Lacks close friends or confidants other than first-degree relatives.

6.Appears indifferent to the praise or criticism of others.

7.Shows emotional coldness, detachment, or flattened affectivity.

B.Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, or another psychotic disorder and is not attributable to the physiological effects of another medical condition.

Note: If criteria are met prior to the onset of schizophrenia, add "premorbid," i.e., "schizoid personality disorder (premorbid)."

Schizotypal Personality Disorder

A.A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1.Ideas of reference (excluding delusions of reference).

2.Odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (e.g., superstitiousness, belief in clairvoyance, telepathy, or "sixth sense"; in children and adolescents, bizarre fantasies or preoccupations).

3.Unusual perceptual experiences, including bodily illusions.

4.Odd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped).

5.Suspiciousness or paranoid ideation.

6.Inappropriate or constricted affect.

7.Behavior or appearance that is odd, eccentric, or peculiar.

8.Lack of close friends or confidants other than first-degree relatives.

9.Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self.

B.Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, or another psychotic disorder and is not attributable to the physiological effects of another medical condition.

Note: If criteria are met prior to the onset of schizophrenia, add "premorbid," i.e., "schizotypal personality disorder (premorbid)."

antisocial personality disorder

A.A pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 years, as indicated by three (or more) of the following:

1.Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest.

2.Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure.

3.Impulsivity or failure to plan ahead.

4.Irritability and aggressiveness, as indicated by repeated physical fights or assaults.

5.Reckless disregard for safety of self or others.

6.Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations.

7.Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.

B.The individual is at least age 18 years.

C.There is evidence of conduct disorder with onset before age 15 years.

D.The occurrence of antisocial behavior is not exclusively during the course of schizophrenia or bipolar disorder.

Histrionic Personality Disorder

A.A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1.Is uncomfortable in situations in which he or she is not the center of attention.

2.Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior.

3.Displays rapidly shifting and shallow expression of emotions.

4.Consistently uses physical appearance to draw attention to self.

5.Has a style of speech that is excessively impressionistic and lacking in detail.

6.Shows self-dramatization, theatricality, and exaggerated expression of emotion.

7.Is suggestible (i.e., easily influenced by others or circumstances).

8.Considers relationships to be more intimate than they actually are.

Narcissistic Personality Disorder

A.A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1.Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements).

2.Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.

3.Believes that he or she is "special" and unique and can only be understood by, or should associate with, other special or high-status people (or institutions).

4.Requires excessive admiration.

5.Has a sense of entitlement (i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations).

6.Is interpersonally exploitative (i.e., takes advantage of others to achieve his or her own ends).

7.Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others.

8.Is often envious of others or believes that others are envious of him or her.

Shows arrogant, haughty behaviors or attitudes.

Borderline Personality Disorder

A.A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1.Frantic efforts to avoid real or imagined abandonment. (Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.)

2.A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.

3.Identity disturbance: markedly and persistently unstable self-image or sense of self.

4.Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). (Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.)

5.Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.

6.Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).

7.Chronic feelings of emptiness.

8.Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).

9.Transient, stress-related paranoid ideation or severe dissociative symptoms.

Avoidant Personality Disorder

A.A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

1.Avoids occupational activities that involve significant interpersonal contact because of fears of criticism, disapproval, or rejection.

2.Is unwilling to get involved with people unless certain of being liked.

3.Shows restraint within intimate relationships because of the fear of being shamed or ridiculed.

4.Is preoccupied with being criticized or rejected in social situations.

5.Is inhibited in new interpersonal situations because of feelings of inadequacy.

6.Views self as socially inept, personally unappealing, or inferior to others.

7.Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing.

Dependent Personality Disorder

A.A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1.Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others.

2.Needs others to assume responsibility for most major areas of his or her life.

3.Has difficulty expressing disagreement with others because of fear of loss of support or approval. (Note: Do not include realistic fears of retribution.)

4.Has difficulty initiating projects or doing things on his or her own (because of a lack of self-confidence in judgment or abilities rather than a lack of motivation or energy).

5.Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant.

6.Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself.

7.Urgently seeks another relationship as a source of care and support when a close relationship ends.

8.Is unrealistically preoccupied with fears of being left to take care of himself or herself.

Obsessive-Compulsive Personality Disorder

A.A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

1.Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost.

2.Shows perfectionism that interferes with task completion (e.g., is unable to complete a project because his or her own overly strict standards are not met).

3.Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity).

4.Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification).

5.Is unable to discard worn-out or worthless objects even when they have no sentimental value.

6.Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things.

7.Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes.

8.Shows rigidity and stubbornness.

personality change due to another medical condition

A.A persistent personality disturbance that represents a change from the individual's previous characteristic personality pattern.Note: In children, the disturbance involves a marked deviation from normal development or a significant change in the child's usual behavior patterns, lasting at least 1 year.

B.There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condition.

C.The disturbance is not better explained by another mental disorder (including another mental disorder due to another medical condition).

D.The disturbance does not occur exclusively during the course of a delirium.

E.The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

personality change due to another medical condition- specifiers

Labile type: If the predominant feature is affective lability.

Disinhibited type: If the predominant feature is poor impulse control as evidenced by sexual indiscretions, etc.

Aggressive type: If the predominant feature is aggressive behavior.

Apathetic type: If the predominant feature is marked apathy and indifference.

Paranoid type: If the predominant feature is suspiciousness or paranoid ideation.

Other type: If the presentation is not characterized by any of the above subtypes.

Combined type: If more than one feature predominates in the clinical picture.

Unspecified type

Cluster A Personality Disorders

the "odd" personalities: paranoid, schizoid, schizotypal

Cluster B personality disorders

the "dramatic-erractic" personalities: antisocial, histrionic, narcissistic, borderline

Cluster C Personality Disorders

the "anxious-fearful" personalities: avoidant, dependent, obsessive-compulsive

alcohol use disorder

a. a problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12 month period:

1. alcohol is often taken in larger amounts or over a longer period than was intended

2. there is a peristent desire or unsuccessful to cut down or control alcohol use

3. great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects

4. craving or a strong desire or urge to use alcohol

5. recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home

6. continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol

7. Important social, occupational, or recreational activities are given up or reduced because of alcohol use

8. recurrent alcohol use in situations in which it is physically hazardous

9. alcohol use in continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol

10. tolerance, as defined by either of the following:

a. a need for markedly increased amounts of alcohol to achieve intoxication or desired effect

b. a markedly diminished effect with continued use of the same amount of alcohol

11. Withdrawal as manifested by either of the following:

a. the characteristic withdrawal syndrome for alcohol (refer to criteria A and B of the criteria set for alcohol withdrawl)

b. alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms

alcohol use disorder specifier

-in early remission: after full criteria was previously met, none of the criteria for alcohol use disorder have been met for at least 3 months, but for less than 12 months (with the exception that criteria A4, "craving, or a strong desire or urge to use alcohol," may be met)

-in sustained remission: after full criteria for alcohol use disorder were previously met, none of the criteria for alcohol use disorder have been met at any time during a period of 12 months or longer (with the exception that criterion A4, "craving, or a strong desire or urge to use alcohol" may be met)

-in a controlled envrionment: this additional specifier is used if the individual is in an environment where access to alcohol is restrcited.

alcohol intoxication

a. recent ingestion of alcohol

b. clinically significant problematic behavior or psychological changes (e.g., inappropriate sexual or aggressive behavior, mood lability, impaired judgment) that developed during, or shortly after, alcohol ingestion.

c. one (or more) of the following signs or symptoms developing during, or shortly after, alcohol use:

1. slurred speech

2. incoordination

3. unsteady gait

4. nystagmus

5. impairment in attention or memory

6. stupor or coma

d. the signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication with another substance

alcohol withdrawl

a. cessation of (or reduction in) alcohol use that has been heavy and prolonged

b. 2 or more of the following, developing within several hours to a few days after the cessation of (or reduction in) alcohol use described in criterion A:

1. automatic hyperactivity (e.g., sweating or pulse rate greater than 100 bpm)

2. increased hand tremor

3. insomnia

4. nausea or vomiting

5. transient visual, tactile, or auditory hallucinations or illusions

6. psychomotor agitation

7. anxiety

8. Generalization tonic-clonic seizures

c. the signs or symptoms in criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

d. the signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication or withdrawal from another substance

opioid use disorder

a. a problematic pattern of opioid use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12 month period:

1. opioids are often taken in larger amounts or e=over a longer period than was intended

2. there is a persistent desire or unsuccedddul efforts to cut down or control opioid use

3. a great deal of time is spent i activities necessary to obtain the opioid, use the opioid, or recover from its effects

4. craving, or a strong desire or urge to use opioids

5. recurrent opioid use resulting in failure to fulfill major role obligations at work, school, or home

6. continued opioid use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of opioids

7. Important social, occupational, or recreational activities are given up or reduced because of opioid use

8. recurrent opioid use in situations in which it is physically hazardous

9. continued opioid use despite knowledge of having a persistent or recurrent physical or psychological problem that likely to have been caused or exacerbated by the substance

10. tolerance, as defined by either of the following:

a. a need for markedly increased amounts of opioids to achieve intoxication or desired effect

b. a markedly diminished effect with continued use of the same amount of an opioid

11. withdrawal, as manifested by either of the following:

a. the characteristic opioid withdrawal syndrome (refer to criteria A and B of the criteria set for opioid withdrawal)

b. opioids (or closely related substances) are taken to relieve or avoid withdrawal symptoms

opioid use disorder specifier

-in early remission: after full criteria for opiod use disorder were previously met, none of the criteria for opioid use disorder have been met for at least 3 months but for less than 12 months (with the exception that criterion A4, "craving, or a strong desire or urge to use opioids" may be met)

-in previously sustained remission: after full criteria for opioid use disorder were previously met, none of the criteria for opioid use disorder have been met at any time during a period of 12 months or longer (with the exception that criterion A4, "craving or a strong desire or urge to use opioids" may be met)

-on maintenance therapy: this addition specifier is used if the individual is taking a prescribed agonist medication such as methadone or buprenorphine and none of the criteria for opioid use disorder have been met for that class of medication (except tolerance to or withdrawal from the agonist). This category also applies to those individuals being maintained on a partial agonist, an agonist/antagonist, or full antagonist, such as an oral naltrexone or depot naltrexone.

-in a controlled environment: this additional specifier is used if the individual is in an environment where access to opioids is restricted

opioid intoxication

A) Recent use of an opioid.

B) Clinically significant problematic behavioral or psychological changes (e.g., initial euphoria followed by apathy, dysphoria, psychomotor agitation or retardation, impaired judgment) that developed during, or shortly after, opioid use.

C) Pupillary constriction (or pupillary dilation due to anoxia from severe overdose) and one (or more) of the following signs or symptoms developing during, or shortly after, opioid use:

1) Drowsiness or coma.

2) Slurred speech.

3) Impairment in attention or memory.

D) The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication with another substance.

opioid withdrawal

A) Presence of either of the following:

1) Cessation of (or reduction in) opioid use that has been heavy and prolonged (i.e., several weeks or longer).

2) Administration of an opioid antagonist after a period of opioid use.

B) Three (or more) of the following developing within minutes to several days after Criterion A:

1) Dysphoric mood.

2) Nausea or vomiting.

3) Muscle aches.

4) Lacrimation or rhinorrhea.

5) Pupillary dilation, piloerection, or sweating.

6) Diarrhea.

7) Yawning.

8) Fever.

9) Insomnia.

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

D) The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication or withdrawal from another substance.

tobacco use disorder

a. a problematic pattern of tobacco use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within 12 12-month period:

1. Tobacco is often taken in larger amounts or over time a longer period than was intended

2. there is a persistent desire or unsuccessful efforts to cut down or control tobacco use

3. a great deal of time is spent on activities necessary to obtain or use tobacco

4. craving, or a strong desire or urge to use tobacco

5. recurrent tobacco use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., interference with work)

6. continued tobacco use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of tobacco (e.g., arguments with others about tobacco use)

7. important social, occupational, or recreational activities are given up or reduced because of tobacco use

8. recurrent tobacco use in situations in which it is physically hazardous (e.g., smoking in bed)

9. Tobacco use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by tobacco

10. tolerance as defined by wither of the following:

a. a need for markedly increased amounts or tobacco to achieve the desired effect

b. a markedly diminished effect with continued use of the same amount of tobacco

11. withdrawal as manifested by either of the following:

a. the characteristic withdrawal syndrome for tobacco (refer to criteria A and B of the criteria set for tobacco withdrawal)

b. tobacco (or a closely related substance such as nicotine) is taken to relieve or avoid withdrawal symptoms

tobacco use disorder specifier

-in early remission: after full criteria for tobacco use disorder were previously met, none of the criteria for tobacco use disorder have been met for at least 3 months but for less than 12 months (with the exception that criterion A4 "craving or a strong desire or urge to use tobacco" may be met)

-in sustained remission: after full criteria for tobacco use disorder were previously met, none of the criteria for tobacco use disorder have been met at any time during a period of 12 months or longer (with the exception that criterion A4 "craving or a strong desire or urge to use tobacco" may be met)

-on maintenance therapy: the individual is taking a long term maintenance medication such as nicotine replacement medication, and no criteria for tobacco use disorder have been met for the class of medication (except tolerance to or withdrawal from the nicotine replacement medication)

-in a controlled environment: this additional specifier is used if the individual is in an environment where access to tobacco is restricted

tobacco withdrawl

a. daily use of tobacco for at least several weeks

b. abrupt cessation of tobacco use, or reduction in the amount of tobacco used, followed within 24 hours by 4 (or more) of the following signs or symptoms:

1. irritability, frustration, or anger

2. anxiety

3. difficulty concentrating

4. increased appetite

5. restlessness

6. depressed mood

7. insomnia

c. the signs or symptoms in criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

d. the signs or symptoms are not attributed to another medical condition and are not better explained by another mental disorder, including intoxication or withdrawal from another substance

gambling disorder

a. persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress, as indicated by the individual exhibiting 4 (or more) of the following in a 12 month period:

1. needs to gamble with increasing amounts of money in order to achieve the desired excitement

2. is restless or irritable when attempting to cut down or stop gambling

3. has made repeated unsuccessful efforts to control, cut back, or stop gambling

4. is often preoccupied with gambling (e.g., having persistent thoughts or reliving past gambling experiences, handicapping or planning the next venture, thinking of ways to get money with which to gamble)

5. often gambles when feeling depressed (e.g., helpless, guilty, anxious, depressed)

6. after losing money gambling, often returns another day to get even ("chasing" one's losses)

7. lies to conceal the extent of involvement with gambling

8. has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling

9. relies on others to provide money to relieve desperate financial situations caused by gambling

b. the gambling behaviors is not better explained by a manic episode

gambling disorder specifiers

Mild: 4-5 criteria

Moderate: 6-7 criteria

Severe: 8-9 criteria

Optional specifiers:

Episodic: criteria met at more than one point in time, with symptoms subsiding for several months in between

Persistent: Continuous symptoms for several years

In early remission: 3-12 months of 0 symptoms

In sustained remission: more than 12 months of 0 symptoms

cannabis use disorder

a. a problematic pattern of cannabis use leading to clinically significant impairment or distress as manifested by at least two of the following occurring within a 12 month period:

1. cannabis if often taken in larger amounts or over a longer period than was intended

2. there is a persistent desire or unsuccessful efforts to cut down or control cannabis use

3. a great deal of time is spent in activities necessary to obtain cannabis, use cannabis, or recover from its effects

4. craving, or a strong desire or urge to use cannabis

5. recurrent cannabis use resulting in a failure to fulfill major role obligations at work, school, or home

6. continued cannabis use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects or cannabis

7. Important social, occupational or recreational activities are given up or reduced because of cannabis use

8. recurrent cannabis use in situations in which it is physically hazardous

9. cannabis use is continues despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by cannabis

10. tolerance as defined by either of the following;

a. a need for markedly increased amounts of cannabis to achieve intoxication or desired effect

b. markedly diminished effect with continued use of the same amount of cannabis

11. withdrawal as manifested by either of the following:

a. the characteristic withdrawal syndrome for cannabis (refer to criteria a and b of the criteria set for cannabis withdrawal)

b. cannabis (or closely related substance) is taken to relieve or avoid withdrawal symptoms)

cannabis use disorder specifier:

-in early remission: after full criteria for cannabis use disorder were previously met, none of the criteria for cannabis use disorder have been met for at least 3 months but for less than 12 months (with the exception that criterion A4 "craving or a strong desire or urge to use cannabis" may be met)

-in sustained remission: after full criteria for cannabis use disorder were previously met, none of the criteria for cannabis use disorder have been met at any time during a period of 12 months or longer (with the exception that criterion A4 "craving or a strong desire or urge to use cannabis" may be present)

-in a controlled environment: this additional specifier is used if the individual is in an environment where access to cannabis is restricted

cannabis intoxication

a. recent use of cannabis

b. clinically significant problematic behavior or psychological changes (e.g., impaired motor coordination, euphoric anxiety, sensation of slowed time, impaired judgement, social withdrawal) that developed during or shortly after cannabis use

c. two or more of the following signs or symptoms developing within 2 hours of cannabis use:

1. conjunctival injection

2. increased appetite

3. dry mouth

4. tachycardia

d. the signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication with another substance

cannabis withdrawal

a. cessation of cannabis use that has been heavy and prolonged (i.e., usually daily or almost daily use over a period of at least a few months)

b. three or more of the following signs and symptoms develop within approximately 1 week after criterion A:

1. irritability, anger, or aggression

2. nervousness or anxiety

3. sleep difficulty (e.g., insomnia, disturbing dreams)

4. decreased appetite or weight loss

5. restlessness

6. depressed mood

7. at least one of the following symptoms causing significant discomfort: abdominal pain, shakiness/tremor, sweating, fever, chills, or headaches

c. the sign or symptoms in criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

d. the signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication or withdrawal from another substance

stimulant use disorder(including cocaine use)

a. a pattern of amphetamine-type substance, cocaine or other stimulant by at least two of the following occurring within a 12 month period:

1. The stimulant is often taken in larger amounts or over a longer period than was intended

2. there is a persistent desire in unsuccessful efforts to cut down or control stimulant use

3. a great deal of time is spent in activities necessary to obtain the stimulant, use the stimulant, or recover its effects

4. craving, or a strong desire or urge to use the stimulant

5. recurrent stimulant use resulting in a failure to fulfill major role obligations at work, school, or home

6. continued stimulant use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the stimulant

7. Important social, occupational, or recreational activities are given up or reduced because of stimulant use

8. recurrent stimulant use in situations in which it is physically hazardous

9. stimulant use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the stimulant

10. tolerance as defined by either of the following:

a. a need for markedly increased amounts of the stimulant to achieve intoxication or the desired effect

b. a markedly diminished effect with continued use of the same amount of the stimulant

11. withdrawal, as manifested by either of the following:

a. the characteristic withdrawal syndrome for the stimulant (refer to criteria and B of the criteria set for stimulant withdrawal)

b. the stimulant is taken to relieve or avoid withdrawal symptoms

stimulant use disorder (including cocaine use) specifier

-in early remission: after full criteria is met, none of the criteria have been met for at least 3 months, but less than 12 months

-in sustained remission: after full criteria was previously met, none of the criteria have been met for 12 months

-in a controlled environment: if the individual is in an environment where access to stimulants is restricted

-mild: 2-3 symptoms

-mild, in early remission:

-mild, in sustained remission

-moderate: 4-5 symptoms

-moderate in early remission

-moderate in sustained remission

-severe: 6 or more symptoms

-severe in early remission

-severe in sustained remission

stimulant intoxication

A) Recent use of an amphetamine-type substance, cocaine, or other stimulant.

B) Clinically significant problematic behavioral or psychological changes (e.g., euphoria or affective blunting; changes in sociability; hypervigilance; interpersonal sensitivity; anxiety, tension, or anger; stereotyped behaviors; impaired judgment) that developed during, or shortly after, use of a stimulant.

C) Two (or more) of the following signs or symptoms, developing during, or shortly after, stimulant use:

1) Tachycardia or bradycardia.

2) Pupillary dilation.

3) Elevated or lowered blood pressure.

4) Perspiration or chills.

5) Nausea or vomiting.

6) Evidence of weight loss.

7) Psychomotor agitation or retardation.

8) Muscular weakness, respiratory depression, chest pain, or cardiac arrhythmias.

9) Confusion, seizures, dyskinesias, dystonias, or coma.

D) The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication with another substance.

stimulant withdrawal

A) Cessation of (or reduction in) prolonged amphetamine-type substance, cocaine, or other stimulant use.

B) Dysphoric mood and two (or more) of the following physiological changes, developing within a few hours to several days after Criterion A:

1) Fatigue.

2) Vivid, unpleasant dreams.

3) Insomnia or hypersomnia.

4) Increased appetite.

5) Psychomotor retardation or agitation.

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

D) The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication or withdrawal from another substance.

anorexia nervosa

a. restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected.

b. intense fear of gaining weight or becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight.

c.Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.

anorexia nervosa specifiers

Specify whether:

●Restricting type: During the last 3 months, the individual has not engaged in recurrent episodes of binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas). This subtype describes presentations in which weight loss is accomplished primarily through dieting, fasting, and/or excessive exercise.

●Binge-eating/purging type: During the last 3 months, the individual has engaged in recurrent episodes of binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas).

Remission:

●In partial remission: After full criteria for anorexia nervosa were previously met, Criterion A (low body weight) has not been met for a sustained period, but either Criterion B (intense fear of gaining weight or becoming fat or behavior that interferes with weight gain) or Criterion C (disturbances in self-perception of weight and shape) is still met.

●In full remission: After full criteria for anorexia nervosa were previously met, none of the criteria have been met for a sustained period of time.

bulimia nervosa

a. recurrent episodes of binge eating. an episode of binge eating is characterized by both of the following:

1. eating, in a descrete period of time (e.g., withi any 2 hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances.

2. a sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating)

b. recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as a self induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise.

c.The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months. d.Self-evaluation is unduly influenced by body shape and weight.

e.The disturbance does not occur exclusively during episodes of anorexia nervosa.

bulimia nervosa specificers

remission:

-in partial remission: some but not all criteria have been met

-in full remission: no criteria have been met

severity:

-mild: 1-3 episodes of inappropriate behavior per week

-moderate: 4-7 of inappropriate behavior per week

-severe: 8-13 episodes of inappropriate behavior per week

-extreme: 14 or more episodes of inappropriate behavior per week

binge-eating disorder

a. recurrent epsiodes of binge eating. an episode of binge eating is characterized by both of the following:

1. eating, in a discrete period of time (e.g., within any 2 hour periods), an amount of food that is defitntily larger than what most people would eat in a simailr period of tine under simialr circumstances.

2. a sense of lack of control over eating during the episodes (e.g., a feeling that one cannot stop eating or control what or hwo much one is eating)

b. the binge eating epsiodes are associated with 3 (or more) of the following:

1. eating much more rapidly than normal

2. eating until feeling uncofortably full

3. eating large amounts of food when not feeling physically hungry

4. eating alone because of feeling embarrassed by how much one is eating

5. feeling disgusted with oneself, depressed, or very guilty afterward. c. Marked distress regarding binge eating is present.

d.The binge eating occurs, on average, at least once a week for 3 months.

e.The binge eating is not associated with the recurrent use of inappropriate compensatory behavior as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.

binge eating disorder specifiers

remission:

-in partial remission: After full criteria for binge-eating disorder were previously met, binge eating occurs at an average frequency of less than one episode per week for a sustained period of time.

-in full remission: After full criteria for binge-eating disorder were previously met, none of the criteria have been met for a sustained period of time

severity:

-mild: 1-3 binge-eating episodes per week.

-moderate: 4-7 binge-eating episodes per week

-severe: 8-13 binge-eating episodes per week

-extreme: 14 or more binge-eating episodes per week

notable "other specified" feeding or eating disorders

-atypical anorexia nervosa: meets all criteria for anorexia nervosa but remains in the normal weight range, sometimes even overweight

-bulimia nervosa of low frequency or duration: compensatory behaviors occuring less frequently than once per week or for duration of less than 3 months

-purging disorder: recurrent purging behavior (e.g., vomiting, laxative use) without binge eating

-night eating syndrome: recurrent episodes of eating excessively upon waking or following one's evening meal (not better explained as binge-eating disorder)

substance-related remission

what is the time period for early remission (3 months), sustained remission (12 months)

- Something can be sustained full remission, can still have 1 criteria met for all substance use disorder (craving), you don’t discount their sobriety

craving is the one thing you have have in remission

alcohol withdrawal

the most dangerous as there is a risk for seizures

opioid withdrawal

flu like symptoms

ACT on thoughts vs traditional CBT

- Im so stressed, I need a drink and I deserve one, (cog diffusion, ACT, seeing thoughts as thoughts, space between thought and experience, freedom for choice, if I don’t see it as a permission granting thought I am more likely to do it. Can we see them as thoughts, can we live to not be governed by that) Trad CBT, warning thought