ABNORMAL PSYCHOLOGY

CHAPTER 2: PART 2

Somatic Symptom Disorder

• one or more symptoms cause distress and disruption of daily life

• chronic, influenced by the number of symptoms, age, level of impairment, and any comorbidity

• ineffectiveness of analgesics, history of mental disorders, unclear palliative factors, persistence without cessation, and stress

• must be accompanied by excessive or disproportionate thoughts, feelings, or behavior

• focus is on the distress that particular symptoms cause

• individual's belief that somatic symptoms might reflect serious underlying physical illness are not held with delusional intensity

• with enhanced perceptual sensitivity to illness cues

⋆˚𝜗𝜚˚⋆Diagnostic Criteria⋆˚𝜗𝜚˚⋆

A. One or more somatic symptoms that are distressing and/or result in significant disruption of daily life.

B. Excessive thoughts, feelings, and behaviors related to the somatic symptoms or associated health concerns as manifested by at least one of the following:

1. Disproportionate and persistent thoughts about the serious-ness of one's symptoms.

2. High level of health-related anxiety.

3. Excessive time and energy devoted to these symptoms or health concerns.

C. Although any one symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months).

Specify if:

With predominant pain (previously pain disorder): This specifier is for individuals whose somatic complaints predominantly involve pain.

Specify current severity:

Mild: Only one of the symptoms in Criterion B is fulfilled.

Moderate: Two or more of the symptoms specified in Criterion B are fulfilled

Severe: Two or more of the symptoms specified in Criterion B are fulfilled, plus there are multiple somatic complaints (or one very severe somatic symptom).

Illness Anxiety Disorder

• preoccupation with having or acquiring serious illness

• usually minimal to no symptoms, mild intensity

• interpret ambiguous stimuli as threatening

• develop in the context of a stressful life

• People who develop these disorders tend to have a disproportionate incidence of disease in their family when they were children

⋆˚𝜗𝜚˚⋆Diagnostic Criteria ⋆˚𝜗𝜚˚⋆

A. Preoccupation with fears of having or acquiring a serious illness.

B. Somatic symptoms are not present or, if present, are only mild in intensity. If another medical condition is present or there is a high risk for developing a medical condition (eg, strong family history is present), the preoccupation is clearly excessive or disproportionate.

C. There is a high level of anxiety about health, and the individual is easily alarmed about personal health status.

D. The individual performs excessive health-related behaviors (eg. repeatedly checks his or her body for signs of illness) or exhibits maladaptive avoidance (e.g. avoids doctors' appointments and hospitals).

E. Illness preoccupation has been present for at least 6 months, but the specific illness that is feared may change over that period of time.

F. The illness-related preoccupation is not better explained by another mental disorder, such as somatic symptom disorder, generalized anxiety disorder, or obsessive-compulsive disorder

Specify whether:

Care-seeking type: Medical care, including physician visits or undergo-ing tests and procedures is frequently used

Care-avoidant type: Medical care is rarely used

Conversion Disorder (Functional Neurological Symptom Disorder)

• altered voluntary motor or sensory function

• incompatibility between the symptom and recognized neurological or medical conditions

• unexpected neurological disease cause for the symptoms is rarely found at follow-up

• too much use of denial

⋆˚𝜗𝜚˚⋆Diagnostic Criteria⋆˚𝜗𝜚˚⋆

A. One or more symptoms of altered voluntary motor or sensory function.

B. Clinical findings provide evidence of incompatibility between the symptom and recognized neurological or medical conditions.

C. The symptom or deficit is not better explained by another medical or mental disorder.

D. The symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation.

Psychological Factors affecting other Medical Conditions

• medical symptom is present psychological or behavioral factors affect medical condition

• psychological or behavioral factors are judged to affect the course of medical condition

• Psychological factors affecting other medical conditions are diagnosed when the psychological traits or behaviors do not meet criteria for a mental diagnosis

Factitious Disorder

• Imposed on Self: an individual presents himself or herself as ill

• Imposed on Another: presents another individual as ill in the absence of obvious rewards

• Malingering: false medical symptoms or exaggerating existing symptoms in hopes of being rewarded

⋆˚𝜗𝜚˚⋆Diagnostic Criteria⋆˚𝜗𝜚˚⋆

A. Falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception.

B. The individual presents himself or herself to others as ill, impaired or injured.

C. The deceptive behavior is evident even in the absence of obvious external rewards.

D. The behavior is not better accounted for by another mental disorder such as delusional belief system or acute psychosis.

Specify if:

Single episode

Recurrent episodes: Two or more events of falsification of illness and/or induction of injury.

Depersonalization-Derealization Disorder

• Depersonalization: your perception alters so that you temporarily lose the sense of your own reality, as if you are in a dream watching yourself

• Derealization: your sense of external world is lost; thing may seem to change shape or size; people may seem dead or mechanical

• characterized by the presence of constellation of typical depersonalization/derealization symptoms and the absence of manifestations of illness anxiety disorder

• must precede the onset of major depressive epi or clearly continues even after its resolution

• when symptoms occur ONLY during panic attacks, it must not be diagnosed with D/DD

⋆˚𝜗𝜚˚⋆Diagnostic Criteria⋆˚𝜗𝜚˚⋆

A. The presence of persistent or recurrent experiences of depersonalization, derealization, or both:

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

Derealization: Experiences of unreality or detachment with respect to surroundings (e.g. individuals or objects are experienced as unreal, dreamlike, foggy, lifeless, or visually distorted).

B. During the depersonalization or derealization experience, reality testing remains intact.

C. The symptoms cause clinically significant distress or impair-ment in social, occupational, or other important areas of functioning

D. The disturbance is not attributable to the physiological effects of a substance (e.g. a drug of abuse, medication) or another medical condition (e.g. seizures).

E. The disturbance is not better explained by another mental disorder, such as schizophrenia or panic disorder.

Dissociative Amnesia

• inability to recall important autobiographical information, usually of traumatic or stressful nature, that is inconsistent with ordinary forgetting

• usually localized or selective amnesia for specific events, then generalized, if entire life history

• Dissociative Fugue: memory loss revolves around specific incident, an unexpected trip; individuals just take off and later find themselves in a new place, unable to remember why or how you got there

• If a person experiencing PTSD cannot recall part or all of specific trauma event and that extends to beyond the immediate time of the trauma, comorbid diagnosis of DA may be warranted

• there must be no true neurocognitive deficits

• too much use of repression

⋆˚𝜗𝜚˚⋆Diagnostic Criteria⋆˚𝜗𝜚˚⋆

A. An inability to recall important autobiographical information, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting.

Note: Dissociative amnesia most often consists of localized or selective amnesia for a specific event or events; or generalized amnesia for identity and life history.

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

C. The disturbance is not attributable to the physiological effects of a substance (eg. alcohol or other drug of abuse, a medication) or a neurological or other medical condition (eg. partial com-plex seizures, transient global amnesia, sequelae of a closed head injury/traumatic brain injury, or other neurological condition).

D. The disturbance is not better explained by dissociative identity disorder, posttraumatic stress disorder, acute stress disorder, somatic symptom disorder, or major or mild neurocognitive disorder

Specify if:

With dissociative fugue: Apparently purposeful travel or bewildered wandering that is associated with amnesia for identity or for other important autobiographical information.

Dissociative Identity Disorder

• disruption of identity characterized by two or more distinct personality states

• host personality: the person who becomes the patient and asks for treatment; developed later

• switch: transition from one personality to another extreme subtype of PTSD

• Hypnotic Trance: tend to be focused on one aspect of their world and they become vulnerable to suggestions by the hypnotist

• does not have a classic bipolar sleep disturbance

• Individuals with schizophrenia have low hypnotic capacity, whilst, Individuals with DID have highest hypnotic capacity among all clinical groups

⋆˚𝜗𝜚˚⋆Diagnostic Criteria⋆˚𝜗𝜚˚⋆

A. Disruption of identity characterized by two or more distinct personality states, which may be described in some cultures as an experience of possession. The disruption of marked discon-tinuity in sense of self and sense of agency, accompanied by related alterations in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning. These signs and symptoms may be observed by others or reported by the individual.

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

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

D. The disturbance is not a normal part of a broadly accepted cul-tural or religious practice. Note: In children, the symptoms are not attributable to imaginary playmates or other fantasy play.

E. The symptoms are not attributable to the physiological effects of a substance (eg, blackouts or chaotic behavior during alco-hol intoxication) or another medical condition (eg. complex partial seizures)

Disruptive Mood Dysregulation Disorder

• Recurrent temper outbursts (verbally or behaviorally) that are grossly out of proportion

• 3 or more times/week - irritable or angry most of the day

• 12 or more months, at least 2 settings

• onset should be after 6 yrs-18 yrs

• do not occur exclusively during MDE

• bipolar episodic, DMD = persistent

• diagnosis cannot be assigned to a child who has ever experienced full-duration hypomanic or manic episode (irritable or euphoric) or who has ever had a manic or hypomanic episode lasting more than 1 day

• presence of severe and frequently recurrent outbursts and persistent disruption in mood between outbursts

• Severe in at least one setting and mild to moderate in a second setting

⋆˚𝜗𝜚˚⋆Diagnostic Criteria ⋆˚𝜗𝜚˚⋆

A. Severe recurrent temper outbursts manifested verbally (eg., verbal rages) and/or behaviorally (e.g, physical aggression toward people or property) that are grossly out of proportion in intensity or duration to the situation or provocation.

B. The temper outbursts are inconsistent with developmental level.

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

D. The mood between temper outbursts is persistently irritable or angry most of the day, nearly every day, and is observable by others (eg., parents, teachers, peers).

E. Criteria A-D have been present for 12 or more months. Throughout that time, the individual has not had a period lasting 3 or more consecutive months without all of the symptoms in Criteria A-D.

F. Criteria A and D are present in at least two of three settings (ie, at home, at school with peers) and are severe in at least one of these.

G. The diagnosis should not be made for the first time before age 6 years or after age 18 years.

H. By history or observation, the age at onset of Criteria A-E is before 10 years.

I. There has never been a distinct period lasting more than 1 day during which the full symptom criteria, except duration, for a manic or hypomanic episode have been met

Note: Developmentally appropriate mood elevation, such as occurs in the context of a highly positive event or its anticipation, should not be considered as a symptom of mania or hypomania.

J. The behaviors do not occur exclusively during an episode of major depressive disorder. They are not better explained by another mental disorder (eg, autism spectrum disorder, post-traumatic stress disorder, separation anxiety disorder, persistent depressive disorder [dysthymia]).

K. The symptoms are not attributable to the physiological effects of a substance or to another medical or neurological condition

Major Depressive Disorder

• at least 2 weeks of either anhedonia or depressed mood

• "other specified depressive disorder" can be made in addition to the diagnosis of psychotic disorder

• in schizoaffective, delusions or hallucinations occur exclusively for 2 weeks without MDE

• Seasonal, Catatonic, Melancholic

⋆˚𝜗𝜚˚⋆Diagnostic Criteria⋆˚𝜗𝜚˚⋆

A. At least one major depressive episode (DSM-5 Table 7.1 Criteria A-C).

B. The occurrence of the major depressive episode is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders.

C. There has never been a manic episode or hypomanic episode.

Note: This exclusion does not apply if all of the manic-like or hypomanic-like episodes are substance-induced or are attributable to the direct physiological effects of another medical condition.

Specify the clinical status and/or features of the current or most recent major depressive episode:

• Single episode or recurrent episode

• Mild, moderate, severe

• With anxious distress

• With melancholic features

• With atypical features

• With mood-congruent psychotic features

• With mood-incongruent psychotic features

• With catatonia

• With peripartum onset

• WIth seasonal pattern (recurrent episode only)

• In partial remission, in full remission

Persistent Depressive Disorder (Dysthymia)

• depressed mood for at least 2 years

• if full criteria for a MDE have been met at some point during the period of illness, a diagnosis of MDD would apply. Otherwise, a diagnosis of "other specified depressive disorder" or "unspecified depressive disorder" should be given

• a separate diagnosis of PDD is not made if the symptom occur only during the course of the psychotic disorder

• Double Depression: suffer from both MDE and PDD with fewer symptoms

⋆˚𝜗𝜚˚⋆Diagnostic Criteria⋆˚𝜗𝜚˚⋆

A. Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 years. Note in children and adolescents, mood can be irritable and duration must be at least 1 year.

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

1. Poor appetite or overeating

2. Insomnia or hypersomnia

3. Low energy or fatigue

4. Low self-esteem

5. Poor concentration or difficulty making decisions

6. Feelings of hopelessness

C. During the 2-year period (1 year for children or adolescents) of the disturbance, the person has never been without the symptoms in criteria A and 8 for more than 2 months at a time.

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

E. There has never been a manic episode or a hypomanic episode, and criteria have never been met for cyclothymic disorder.

F. The disturbance is not better explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder,

G. The symptoms are not attributable to the physiological effects of a substance (eg, a drug of abuse, a medication) or another medical condition (eg,hypothyroidism).

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

Specify if:

Current severity: Mild, moderate, severe

• With anxious distress

• With mbed features

• With melancholic features

• With atypical features

• With mood-congruent psychotic features

• With mood-incongruent psychotic features

• With peripartum onset

• Early onset: If onset is before age 21 years

• Late onset: If onset is at age 21 years or older

Specify (for most recent 2 years of dysthymic disorder):

• With pure dysthymic syndrome: if full criteria for a major depressive episode have not been met in at least the preceding 2 years

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

• With intermittent major depressive episodes, with current episode: if full criteria for a major depressive episode are currently met, but there have been periods of at least 8 weeks in at least the preceding 2 years with symptoms below the threshold for a full major depressive episode

• With intermittent major depressive episodes, without current episode: if full criteria for a major depressive episode are not currently met, but there as been one or more major depressive episodes in at least the preceding 2 years

• In partial remission, in full remission

Premenstrual Dysphoric Disorder

• majority of menstrual cycles, at least 5 symptoms must be present

Diagnostic Criteria

A. In the majority of menstrual cycles, at least five symptoms must be present in the first week before the onset of menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week postmenities

B. One (or more) of the following symptoms must be present:

1. Marked affective lability (ng, mood swings, feeling suddenly sad or tearful, or increased sensitivity to rejection)

2. Marked irritability or anger or increased interpersonal conflicts.

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

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

C. One (or more) of the following symptoms must additionally be present, to reach a total of five symptoms when combined with symptoms from Criterion B above:

1. Decreased interest in usual activities (eg, work, school, friends, hobbies)

2. Subjective difficulty in concentration.

3. Lethargy, easy fatigability, or marked lack of energy.

4. Marked change in appetites overeating, or specific food cravings.

5. Hypersomnia or insomnia.

6. A sense of being overwhelmed or out of control

7. Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of "bloating," or weight gain.

Note: The symptoms in Criteria A-C must have been met for most menstrual cycles that occurred in the preceding year.

D. The symptoms are associated with clinically significant dizziness or interference with work, school, usual social activities, or relationships with others (e.g, avoidance of social activities, decreased productivity and efficiency at work, school, or home).

E. The disturbance is not merely an exacerbation of the symptoms of another disorder, such as major depressive disorder, panic disorder, persistent depressive disorder (dysthymia), or a personality disorder (although it may co-occur with any of these disorders)

F. Criterion A should be confirmed by prospective daily ratings during at least two symptomatic cycles.

Note: The diagnosis may be made provisionally prior to this confirmation

G. The symptoms are not attributable to the physiological effects of a substance (eg, a drug of abuse, a medication) or another medical condition eg. hypothyroidism).

Seasonal Affective Disorder

episodes must have occurred for at least 2 yrs with no evidence of nonseasonal MDE during that period of time

Cabin fever

a state of restlessness, irritability, and claustrophobia that people feel when they stay inside an isolated place for a long time.

Integrated Grief

acute grief, the finality of death and its consequences are acknowledged and the individual adjusts to the loss

Complicated Grief

this reaction can develop without preexisting depressed state

bipolar disorder

may simply be a more severe variant of mood disorders

Bipolar I

• at least 1 manic episode

• children should be judged according to his or her own baseline in determining whether a particular behavior is normal or evidence of manic episode

• first ep usually MDE

• factors that should be considered: family history, onset, medical history, presence of psychotic symptoms, history of lack of response to antidepressant treatment or the emergence of manic episode during antidepressant treatment

• The diagnosis is “Bipolar I disorder, with psychotic features” if the psychotic symptoms have occurred EXCLUSIVELY during manic and major depressive episodes

• Symptoms of mania in BP1 occur in distinct episodes and typically begin in late adolescence or early adulthood

• When any child is being assessed for Mania, it is essential that the symptoms represent clear change from the child’s typical behavior

• Symptoms of mood lability and impulsivity must represent a distinct episode of illness, or there must be a noticeable increase in these symptoms over the individual’s baseline in order to justify an additional diagnosis of BP1

⋆˚𝜗𝜚˚⋆Criteria⋆˚𝜗𝜚˚⋆

A. A distinct period of abnormally and persistently devated, expansive. or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least I week and premt most of tne day, nearly every day (or any duration if hospitalization is necessary).

B. During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms (four if the mood is only irritable) are present to a significant degree and represent a noticeable change from usual behavior:

1. Inflated self-esteem or grandiosity

2. Decreased need for sleep (e.g., feels rested after only 3 hours of sleep)

3. More talkative than usual or pressure to keep talking

4. Flight of ideas or subjective experience that thoughts are racing

5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed

6. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (e.g., purposeless non-goal-directed activity)

7. Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained sprees, sexual indiscretions, or foolish business investments)

C. The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.

D. The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment) or to another general medical condition.

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

Bipolar II

• MDE + Hypomanic episodes

• often begins with depressive episodes

• highly recurrent

• once hypomanic episode has occurred, it never reverts back to MDD

• BP2 is distinguished from cyclothymic disorder by the presence of one or more hypomanic episodes and one or more MDE

⋆˚𝜗𝜚˚⋆Diagnostic Criteria ⋆˚𝜗𝜚˚⋆

A. Criteria have been met for at least one hypernanic episode and at least one major depressive episode. Criteria for a hypomanic episode are identical to those for a manic episode (see DSM-5 Table 7.2), with the following distinctions:

1) minimum duration is 4 days;

2) Although the episode represents a definite change in functioning, it is not severe enough to cause marked social or occupational impairment or hospitalization;

3) There are no psychotic features.

B. There has never been a manic episode.

C. The occurrence of the hypomanic episode(s) and and major depressive episode(s) is better explained by schizoaffective disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.

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

Specify current or most recent episode:

Hypomanic: If currently (or most recently) in a hypomanic episode

Depressed: If currently (or most recently) in a rnajor depressive episode

Specify if:

With anxious distress

With mixed features

With rapid cycling

With mood-congruent psychotic features

With mood-incongruent psychotic features

With catatonia

With peripartum onset

With seasonal pattern

Specify course if full criteria for a mood episode are not currently met:

In full remission, in partial remission

Specify severity if full criteria for a mood episode are currently met:

Mild, moderate, severe

Cyclothymic Disorder

• Milder but more chronic version of bipolar disorder

• do not meet the complete criteria for depressive symptoms and hypomanic symptoms

⋆˚𝜗𝜚˚⋆Diagnostic Criteria⋆˚𝜗𝜚˚⋆

A. For at least 2 years (at least 1 year in children and adolescents), there have been numerous periods with hypomanic symptoms that do not meet criteria for a hypomanic episode and numerous periods with depressive symptoms that do not meet criteria for a major depressive episode.

B. During the above 2-year period (1 year in children and adolescents), the hypomanic and depressive periods have been present for at least half the time, and the individual has not been without the symptoms for more than 2 months at a time.

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

D. The symptoms in criterion A are not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or specified or unspecified schizophrenia spectrum and other psychotic disorder.

E. The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

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

Specify if:

With anxious distress

Pica

• eating of non-nutritive, nonfood substances for at least 1 month

• inappropriate to the developmental age

Rumination Disorder

• repeated regurgitation of food for at least 1 month

• re-chewed, re-swallowed, or spit-out

• not attributable to gastrointestinal or other medical condition

• self-soothing or self-stimulating

Avoidant/Restrictive Food Intake Disorder

• eating or feeding disturbance

• lack of interest in eating food dependence on enteral feeding or nutritional supplements

• requires that the disturbance of intake is beyond that directly accounted for by physical symptoms consistent with medical condition; the eating disturbance may also persist after being triggered by medical condition and following resolution of the medical condition

• if eating problems is the focus, then A/RFID, if weight, then Anorexia Nervosa

• might precede the onset of Anorexia Nervosa

Anorexia Nervosa

• fear of gaining weight

• subtypes: binge-eating/purging type and restricting type

• associated with stressful life event

• BDD may be considered if the distortion is unrelated to body shape and size

• amenorrhea and cardiovascular problems

• very underweight

⋆˚𝜗𝜚˚⋆Diagnostic Criteria⋆˚𝜗𝜚˚⋆

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 of 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.

Specify type:

Restricting type: During the past 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 past 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).

Bulimia Nervosa

• recurrent episodes of binge-eating then purging to prevent weight gain

• binge-eating for at least once a week for 3 months

• normal weight

• chronic purging can result to enlargement of salivary gland caused by repeated vomiting, causing chubby face

• electrolyte imbalance that may lead to arrythmia, seizures, and renal failure

⋆˚𝜗𝜚˚⋆Diagnostic Criteria⋆˚𝜗𝜚˚⋆

A. Recurrent episodes 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 period), an amount of food that is definitely larger than most people would eat during a similar period of time and 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 behavior in order to prevent weight gain, such as 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.

Binge-Eating Disorder

• recurrent episodes of just binge eating

• do not show marked or sustained dietary restriction designed to influence body weight and shape between binge-eating episodes

• usually overweight

⋆˚𝜗𝜚˚⋆Diagnostic Criteria ⋆˚𝜗𝜚˚⋆

A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:

1. Eating, in a discrete period of time (eg, within any 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances

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

B. The binge-eating episodes are associated with three (or more) of the following:

1. Eating much more rapidly than normal.

2. Eating until feeling uncomfortably 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.

Enuresis

repeated voiding of urine in bed, voluntary or intentional

Encopresis

repeated passage of feces into inappropriate places

Insomnia

• difficulty initiating and maintaining sleep

• early-morning awakening with inability to return to sleep at least 3 nights/week, for at least 3 months

• Rebound Insomnia: sleep problems re-appearing, but sometimes worst

• situational, persistent, or recurrent, episodic

Hypersomnolence Disorder

• excessive sleepiness despite having at least 7 hours of main sleep

• recurrent periods of sleep or lapses into sleep within the same day

• take longer naps, have trouble waking from naps, and do not feel alert afterward

• at least 3x/week, for at least 3 months

Narcolepsy

• Recurrent episodes of irrepressible need to sleep, lapsing into sleep, or napping with cataplexy, hypocretin deficiency, and evidence from polysomnography showing REM sleep latency less than or equal to 15 mins

• 3x/week, for at least 3 months

Obstructive Sleep Apnea Hypopnea

• at least 4 obstructive apneas or hypopneas per hour of sleep or evidence from polysomnography of 15 or more obstructive apneas and/or hypopneas per hour of sleep

• Apnea: absence of airflow

• Hypopnea: reduction in airflow

Central Sleep Apnea

• evidence by polysomnography of 5 or more central apneas per hour of sleep

• Cheyne-Stokes Breathing: an abnormal pattern of breathing characterized by progressively deeper, and sometimes faster, breathing followed by a gradual decrease that results in a temporary stop in breathing called an apnea

Sleep-Related Hypoventilation

Polysomnography demonstrates episodes of decreased respiration associated with elevated CO2 levels

Circadian Rhythm Sleep-Wake Disorders

• persistent or recurrent pattern of sleep disruption due to alteration of the circadian system or misalignment between the endogenous circadian rhythm

• leads to excessive sleepiness or insomnia, or both

Non-REM Sleep Arousal Disorders

• incomplete awakening from sleep: sleepwalking or sleep terrors

• cannot remember anything when they woke up

• occur mostly in childhood and non-rem sleeps

• produce rapid and complete awakening

Nightmare Disorder

• repeated occurrences of extended, extremely dysphoric, and well-remembered dreams that usually involve efforts to avoid threats to survival, security, or physical integrity

• upon awakening, they become oriented and alert appear in children exposed to acute or chronic psychosocial stressors

• occur during REM Sleep

REM Sleep Behavior Disorder

• repeated episodes of arousal during sleep associated with vocalization and/or complex motor behaviors

• during REM sleep

• upon awakening, the individual is completely awake, alert, and not confused

Restless Legs Disorder

• urge to move the legs, usually accompanied or in response to uncomfortable and unpleasant sensations of the legs

• during rests

• sense of relief during the movement

• worse in evening

• 3x/week, for at least 3 months