Psychopathology Exam 3

Obsessive-compulsive disorder

A - presence of obsessions, compulsions, or both:

• Obsessions are defined by 1 and 2:

  • 1 - Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress

  • 2 - The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion)

• Compulsions are defined by 1 and 2:

  • 1 - Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly

  • 2 - the behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive

B - the obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

C - the obsessive-compulsive symptoms are not attributable to the physiological effects of a substance or another medical condition

D - The disturbance is not better explained by the symptoms of another mental disorder

Obsessions

Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress AND The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion)

Compulsions

Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly. AND the behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive

With good or fair insight (obsessive-compulsive and related disorders)

The individual recognizes that their beliefs are definitely or probably not true or that they may or may not be true

With poor insight (obsessive-compulsive and related disorders)

The individual thinks obsessive-compulsive disorder beliefs are probably true

With absent insight/delusional beliefs (obsessive-compulsive and related disorders)

The individual is completely convinced that obsessive-compulsive disorder beliefs are true

Tic-related (obsessive-compulsive disorder specifier)

The individual has a current or past history of a tic disorder

Body Dysmorphic Disorder

A - preoccupation with one or more perceived defects of flaws in physical appearance that are not observable or appear slight to others

B - at some point during the course of the disorder, the individual has performed repetitive behaviors (e.g., mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (e.g., comparing their appearance with that of others) in response to the appearance concerns

C - the preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

D - the appearance preoccupation is not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnostic criteria for an eating disorder

With muscle dysmorphia (body dysmorphic disorder specifier)

The individual is preoccupied with the idea that their body build is too small or insufficiently muscular. This specifier is used even if the individual is preoccupied with other body areas, which is often the case. Almost exclusively with boys and men.

Hoarding Disorder

A - persistent difficulty discarding or parting with possessions, regardless of their actual value

B - the difficulty is due to a perceived need to save the items and to distress associated with discarding them

C - the difficulty discarding possessions results in the accumulation of possessions that congest and clutter active living areas and substantially compromises their intended use. If living areas are uncluttered, it is only because of the interventions of third parties

D - the hoarding causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

E - the hoarding is not due to another medical condition

F - the hoarding is not better explained by the symptoms of another mental disorder

With excessive acquisition (hoarding disorder specifier)

If difficulty discarding possessions is accompanied by excessive acquisition of items that are not needed or for which there is no available space

Trichotillomania (Hair-Pulling Disorder)

A - recurrent pulling out of one’s hair, resulting in hair loss

B - repeated attempts to decrease or stop hair pulling

C - the hair pulling causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

D - the hair pulling or hair loss is not attributable to another medical condition

E - the hair pulling is not better explained by the symptoms of another mental disorder

Excoriation (Skin-Picking) Disorder

A - recurrent skin picking resulting in skin lesions

B - repeated attempts to decrease or stop skin picking

C - the skin picking causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

D - the skin picking is not attributable to the other physiological effects of a substance or another medical condition

E - the skin picking is not better explained by symptoms of another mental disorder

What are common types of OCD?

• Doubts/harms

  • Concerns with harm -> checking

    • Did I lock the door? Let me go check it, again and again

• Contamination

  • Concerns with dirt or germs -> washing, showering, cleaning

    • Time consuming or washing hands to the point that they are bleeding and cracked

• Symmetry

  • Concerns with symmetry -> ordering, straightening, counting

• Unacceptability

  • Concerns with intrusive, aggressive, sexual, religious thoughts -> counting and rituals

Obsessional jealousy

Other specified obsessive-compulsive and related disorder. This is characterized by nondelusional preoccupation with a partner’s perceived infidelity. The preoccupations may lead to repetitive behaviors or mental acts in response to the infidelity concerns; they cause clinically significant distress or impairment in social, occupational, or other important areas of functioning; and they are not better explained by another mental disorder such as delusional disorder, jealous type, or paranoid personality disorder

Olfactory reference disorder

Other specified obsessive-compulsive and related disorder. This is characterized by the individual’s persistent preoccupation with the belief that they emit a foul or offensive body odor that is unnoticeable or only slightly noticeable to others; in response to this preoccupation, these individuals often engage in repetitive and excessive behaviors such as repeatedly checking for body odor, excessive showering or seeking reassurance, as well as excessive attempts to camouflage the perceived odor.

Shubo-kyofu

Other specified obsessive-compulsive and related disorder. A variant of taijin kyofusho that is similar to body dysmorphic disorder and is characterized by excessive fear of having a bodily deformity

Koro

Other specified obsessive-compulsive and related disorder. Related to dhat syndrome, an episode of sudden and intense anxiety that the penis in males (or the vulva and nipples in females) will recede into the body, possibly leading to death

Reactive attachment disorder

A - a consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers, manifested by both of the following:

• The child rarely or minimally seeks comfort when distressed

• The child rarely or minimally responds to comfort when distressed

B - a persistent social and emotional disturbance characterized by at least two of the following:

• Minimal social and emotional responsiveness to others

• Limited positive affect

• Episodes of unexplained irritability, sadness, or fearfulness that are evident even during nonthreatening interactions with adult caregivers

C - the child has experienced a pattern of extremes of insufficient care as evidenced by at least one of the following:

• Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation, and affection met by caregiving adults

• Repeated changes of primary caregivers that limit opportunities to form stable attachments (e.g., frequent changes in foster care)

• Rearing in unusual settings that severely limit opportunities to form selective attachments (e.g., institutions with high child-to-caregiver ratios)

D - the care in Criterion C is presumed to be responsible for the disturbed behavior in Criterion A (e.g., the disturbances in Criterion A began following the lack of adequate care in Criterion C).

E - the criteria are not met for ASD

F - the disturbance is evident before age 5 years

G - the child has a developmental age of at least 9 months

In reactive attachment disorder, the disturbance is evident before age _____ and the child has a developmental age of at least _____ months

5, 9

Disinhibited social engagement disorder

A - a pattern of behavior in which a child actively approaches and interacts with unfamiliar adults and exhibits at least two of the following

• Reduced or absent reticence in approaching and interacting with unfamiliar adults

• Overly familiar verbal or physical behavior (that is not consistent with culturally sanctioned and with age-appropriate social boundaries).

• Diminished or absent checking back with adult caregiver after venturing away, even in unfamiliar settings

• Willingness to go off with unfamiliar adults with minimal or no hesitation

B - the behaviors in Criterion A are not limited to impulsivity (as in ADHD) but include socially disinhibited behavior

C - the child has experienced a pattern of extremes of insufficient care as evidenced by at least one of the following:

• Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation, and affection met by caregiving adults

• Repeated changes of primary caregivers that limit opportunities to form stable attachments (e.g., frequent changes in foster care).

• Rearing in unusual settings that severely limit opportunities to form selective attachments (e.g., institutions with high child-to-caregiver ratios).

D - the care in Criterion C is presumed to be responsible for the disturbed behavior in Criterion A (e.g., the disturbances in Criterion A began following the pathogenic care in Criterion C).

E - the child has a developmental age of at least 9 months

Reactive attachment disorder and disinhibited social engagement disorder specifiers include….

Persistent - the disorder has been present for more than 12 months

Severity - severe if all symptoms of the disorder are exhibited with each symptom manifesting at relatively high levels

In RAD and DSED, children have experienced patterns of extreme insufficient care such as….

social neglect or deprivation, repeated changes of primary caregivers and limited opportunities to form attachments (frequent changes in foster care), and rearing in unusual settings that limit opportunities to form attachments (institutions)

Posttraumatic stress disorder

A - exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:

• Directly experiencing the traumatic event(s)

• Witnessing, in person, the event(s) as it occurred to others

• Learning that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental

• Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse).

  • NOTE - Criterion A4 does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related

B - Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred:

• Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s)

  • NOTE - in children older than 6 years, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed

• Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s)

• Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring (such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings)

  • NOTE - in children, trauma-specific reenactment may occur in play

• Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s)

• Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s)

C - persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by one or both of the following:

• Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s)

• Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s)

D - negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:

• Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs)

• Persistent and exaggerated negative beliefs or expectations, about oneself, others, or the world (e.g., “I am bad,” “No one can be trusted,” “The world is completely dangerous”)

• Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame themself or others

• Persistent, negative emotional state (e.g., fear, horror, anger, guilt, shame)

• Markedly diminished interest or participation in significant activities

• Feelings of detachment or estrangement from others

• Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).

E - marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:

• Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects

• Reckless or self-destructive behavior

• Hypervigilance

• Exaggerated startle response

• Problems with concentration

• Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep)

F - duration of the disturbance (Criteria B, C, D, and E) is more than 1 month

G - the disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

H - the disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition

Criterion A traumas in PTSD are defined by actual or threatened death, serious injury, or sexual violence in one or more of the following ways:

Directly experiencing, witnessing, learning the event occurred to a close friend or family member (must have been violent or accidental), repeated exposure to details of traumatic events in occupation (firefighters, first responders)

Intrusive symptoms associated with traumatic events in PTSD (must have one or more) include…

Recurrent distressing memories or dreams, intense psychological distress or physiological reactions at exposure to internal or external cues that symbolize or resemble the event

Persistent avoidant symptoms associated with traumatic events in PTSD (must have one or more) include….

avoidance of distressing memories, thoughts, feelings about the event, or avoidance of external reminders that arouse memories, thoughts, or feelings that resemble the event

Negative alterations in cognitions and mood associated with traumatic events in PTSD (must have two or more) include….

Memory problems surrounding trauma, exaggerated negative beliefs or expectations about self/others/world (shattered world beliefs), blame of self or others, negative emotional state (horror, fear, anger), diminished interest or participation in activities, feelings of detachment from others, lack of experiencing positive emotions

Alterations in arousal and reactivity associated with traumatic events in PTSD (must have 2 or more) include….

Irritable behavior and angry outbursts, reckless or self-destructive behavior, hypervigilance, exaggerated startle response, concentration problems, sleep problems

In PTSD, symptoms must last more than _____ month

1

PTSD specifiers

With dissociative symptoms - the individual's symptoms meet PTSD criteria, and in addition, in response to the stressor, the individual experiences persistent or recurrent symptoms: depersonalization or derealization

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

PTSD has a greater prevalence in _____.

women

Acute Stress Disorder

A - exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:

• Directly witnessing the traumatic event(s)

• Witnessing, in person, the event(s) as it occurred to others

• Learning that the event(s) occurred to a close family member or friends (death must have been violent and accidental)

• Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse).

  • NOTE - Criterion A4 does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related

• B - presence of nine (or more) of the following symptoms from any of the five categories of intrusion, negative mood, dissociation, and arousal, beginning or worsening after the traumatic event

  • Intrusion symptoms

    • Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s)

    • Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s)

    • Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring (such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings)

      • NOTE - in children, trauma-specific reenactment may occur in play

    • Intense or prolonged psychological distress or marked physiological reactions at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s)

  • Negative mood

    • Persistent inability to experience positive emotions

  • Dissociative symptoms

    • An altered sense of reality of one’s surroundings or oneself (e.g., seeing oneself from another’s perspective, being in a daze, time slowing)

    • Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs)

  • Avoidance of symptoms

    • Efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s)

    • Efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s)

  • Arousal symptoms

    • Sleep disturbance

    • Irritable behavior and angry outbursts, typically expressed as verbal or physical aggression toward people or objects

    • Hypervigilance

    • Problems with concentration

    • Exaggerated startle response

C - duration of the disturbance (symptoms in Criterion B is 3 days to 1 month after trauma exposure

• NOTE - symptoms typically begin immediately after the trauma, but persistence for at least 3 days and up to a month is needed to meet disorder criteria

D - the disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

E - the disturbance is not attributable to the physiological effects of a substance or another medical condition and is not better explained by brief psychotic disorder

In acute stress disorder, symptom duration must be between ___ days to ___ month after trauma exposure

3, 1

Adjustment disorder

A - the development of emotional or behavioral symptoms in response to an identifiable stressor(s) occurring within 3 months of the onset of the stressor(s)

B - these symptoms or behaviors are clinically significant, as evidenced by one or both of the following:

• Marked distress that is out of proportion to the severity of intensity of the stressor, taking into account the external context and the cultural factors that might influence symptom severity and presentation

• Significant impairment in social, occupational, or other important areas of functioning

C - the stress-related disturbance does not meet the criteria for another mental disorder and is not merely an exacerbation of a preexisting mental disorder

D - the symptoms do not represent normal bereavement and are not better explained by prolonged grief disorder

E - once the stressor or its consequences have terminated, the symptoms do not persist for more than an additional 6 months

Adjustment disorder symptoms must be within ___ months of the onset of the stressor and cannot persist for more than an additional ___ months after the stressor or its consequences have terminated

3, 6

Adjustment Disorder specifiers

With depressed mood - low mood, tearfulness, or feelings of hopelessness are predominant

With anxiety - nervousness, worry, jitteriness, or separation anxiety are predominant

With mixed anxiety and depressed mood - a combination of depression and anxiety is predominant

With disturbance of conduct - disturbance of conduct is predominant

With mixed disturbance of emotions and conduct - both emotional symptoms (depression or anxiety) and a disturbance of conduct are predominant

Unspecified - for maladaptive reactions that are not classifiable as one of the specific subtypes of adjustment disorder

Acute - this specifier can be used to indicate persistence of symptoms for less than 6 months

Persistent (chronic) - this specifier can be used to indicate persistence of symptoms for 6 months or longer. Applies to a situation when the duration of disturbance is longer than 6 months in response to a  chronic stressor or to a stressor that has enduring consequences

Prolonged grief disorder

A - the death, at least 12 months ago, of a person who was close to the bereaved individual (for children and adolescents, at least 6 months ago).

B - since the death, the development of a persistent grief response characterized by one or both of the following symptoms, which have been present most days to a clinically significant degree. In addition, the symptom(s)

• Intense yearning/longing for the deceased person

  • Preoccupation with thoughts or memories of the deceased person (in children and adolescents, preoccupation may focus on the circumstances of the death)

C - since the death, at least three of the following symptoms have been present most days to a clinically significant degree. In addition, the symptoms have occurred nearly every day for at least the last month:

• Identity disruption (e.g., feeling as though part of oneself has died) since the death

• Marked sense of disbelief about the death

• Avoidance of reminders that the person is dead (in children and adolescents, may be characterized by efforts to avoid reminders)

• Intense emotional pain (e.g., bitterness, sorrow, anger)

• Difficulty reintegrating into one’s relationships and activities after death (e.g., problems engaging with friends, pursuing interests, or planning for the future)

• Emotional numbness (absence or marked reduction of emotional experience) as a result of the death

• Feeling that life is meaningless as a result of the death

• Intense loneliness as a result of the death

D - the disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

E - the duration and severity of the bereavement reaction clearly exceed expected social, cultural, or religious norms for the individual’s culture and context

F - the symptoms are not better explained by another mental disorder

In prolonged grief disorder, the death must be ___ months ago in adults and ___ months in children and adolescents.

12, 6

Dissociative identity disorder

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 in identity involves marked discontinuity in the sense of self and sense of agency, accompanied by related alteration 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, occupation, or other important areas of functioning

D - the disturbance is not a normal part of broadly accepted cultural or religious practice.

NOTE - in children, the symptoms are not better explained by imaginary playmates or other fantasy play

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

Dissociative amnesia

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

• NOTE - 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 or a neurological or other medical condition

D - the disturbance is not better explained by dissociative identity disorder, PTSD, acute stress disorder, somatic symptom disorder, or neurocognitive disorder

With dissociative fugue (dissociative amnesia specifier)

Apparently purposeful travel or bewildered wandering that is associated with amnesia for identity or other important autobiographical information

localized amnesia

Failure to recall events during a circumscribed period of time

Selective amnesia

the individual can recall some, but not all, of the events during a circumscribed period of time

Systematized amnesia

Individual fails to recall a specific category of important information (no recall of a violent older sibling, recall of home but not school)

Generalized dissociative amnesia

Complete loss of memory for most or all of the individual’s life history

Continuous amnesia (anterograde dissociative amnesia)

Individual forgets each new event as it occurs

Depersonalization/derealization disorder

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 (e.g., 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 experiences, reality testing remains intact

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

D - the disturbance is not attributable to the physiological effects of substance or another medical condition

E - the disturbance is not better explained by another mental disorder, such as schizophrenia, panic disorder, major depressive disorder, acute stress disorder, PTSD, or another dissociative disorder

Depersonalization

Experiences of unreality, detachment, or being an outside observer with respect to one’s thoughts, feelings, sensations, body, or actions (e.g., 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)

Somatic symptom disorder

A - one or more somatic symptoms that are distressing or result in significant disruption of daily life.

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

• Dispropriate and persistent thoughts about the seriousness of one’s symptoms

• Persistently high level of anxiety about health or symptoms

• Excessive time and energy devoted to these symptoms or health concerns

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

Somatic symptom disorder specifiers

• With predominant pain (previously pain disorder) - this specifier is for individuals whose somatic symptoms predominantly involve pain

• Persistent - a persistent course is characterized by severe symptoms, marked impairment, and long duration (more than 6 months)

• Mild - only one of the symptoms specified 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 in Criterion B are fulfilled, plus there are multiple somatic complaints (one very severe somatic symptom)

Illness Anxiety Disorder

A - preoccupation with 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, 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 (e.g., repeatedly checks their body for signs of illness) or exhibits maladaptive avoidance (e.g., avoids doctor 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, panic disorder, generalized anxiety disorder, body dysmorphic disorder, OCD, or delusional disorder, somatic type

Illness anxiety disorder specifiers

• Care-seeking type - medical care, including physician visits or undergoing tests and procedures, is frequently used

• Care-avoidant type - medical care is rarely used

Functional neurological symptom disorder (conversion disorder)

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 areas of functioning or warrants medical evaluation

Functional neurological symptom disorder specifiers

• With weakness or paralysis

• With abnormal movement (e.g., tremor, dystonia, myoclonus, gait disorder)

• With swallowing symptoms

• With speech symptom (e.g., dysphonia, slurred speech)

• With attacks or seizures

• With anesthesia or sensory loss

• With special sensory symptom (e.g., visual olfactory, or hearing disturbance)

• With mixed symptoms

• Acute episode - symptoms are present for less than 6 months

• Persistent - symptoms occur for 6 months or more

• With psychological stressor - specify stressor

  • Without psychological stressor

Psychological factors affecting other medical conditions

A - a medical symptom or condition (other than a mental disorder) is present

B - psychological or behavioral factors adversely affect the medical condition in one of the following ways:

• The factors have influenced the course of the medical condition as shown by a close temporal association between the psychological factors and the development or exacerbation of, or delayed recovery from, the medical condition

• The factors interfere with the treatment of the medical condition (e.g., poor adherence)

• The factors constitute additional well-established health risks for the individual

• The factors influence the underlying pathophysiology, precipitating or exacerbating symptoms or necessitating medical attention

C - the psychological and behavioral factors in Criterion B are not better explained by another mental disorder (e.g., panic disorder, MDD, PTSD)

Psychological factors affecting other medical conditions specifiers

• Mild - Increases medical risk (e.g., inconsistent adherence with antihypertensive treatment)

• Moderate - aggravates underlying medical condition (e.g., anxiety aggravating asthma)

• Severe - results in medical hospitalization or emergency room visit

• Extreme - results in severe, life threatening risk (e.g., ignoring heart attack symptoms)

Factitious Disorder (imposed on self)

A - falsification of physical or psychological symptoms or signs, or induction of injury or disease, associated with identified deception

B - the individual presents themself 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 explained by another mental disorder, such as delusional disorder or another psychotic disorder

Factitious Disorder (imposed on another)

A - falsification of physical or psychological symptoms or signs, or induction of injury or disease, associated with identified deception

B - the individual presents another individual (victim) 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 explained by another mental disorder, such as delusional disorder or another psychotic disorder

Factitious disorder specifiers

• Single episode

• Recurrent episode - two or more events

Pica

A - persistent eating of nonnutritive, nonfood substances over a period of at least 1 month

B - the eating of nonnutritive, nonfood substances is inappropriate to the developmental level of the individual

C - the eating behavior is not part of a culturally supported or socially normative practice

D - if the eating behavior occurs in the context of another mental disorder (ID, ASD, schizophrenia) or medical condition (pregnancy), it is sufficiently severe to warrant additional clinical attention

Rumination Disorder

A - repeated regurgitation of food over a period of at least 1 month. Regurgitated food may be re-chewed, re-swallowed, or spit out

B - the repeated regurgitation is not attributable to an associated gastrointestinal or other medical condition

C - the eating disturbance does not occur exclusively during the course of anorexia nervosa, bulimia nervosa, binge-eating disorder, or avoidant/restrictive food intake disorder

D - if the symptoms occur in the context of another mental disorder, they are sufficiently severe to warrant additional clinical attention

Avoidant/restrictive food intake disorder

A - an eating or feeding disturbance (e.g., apparent lack of interest in eating or food; avoidance based on sensory characteristics of food; concern about aversive consequences of eating) associated with one (or more) of the following:

• Significant weight loss (or failure to achieve expected weight gain or faltering growth in children)

• Significant nutritional deficiency

• Dependence on enteral feeding or oral nutritional supplements

• Marked interference with psychosocial functioning

B - the disturbance is not better explained by lack of available food or by an associated culturally sanctioned practice

C - the eating disturbance does not occur exclusively during the course of anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance in the way in which one’s body weight or shape is experienced

D - the eating disturbance is not attributable to a concurrent medical condition or not better explained by another mental disorder. When the eating disturbance occurs in the context of another condition or disorder, the severity of the eating disturbance exceeds that routinely associated with the condition or disorder and warrants additional clinical attention

In remission (Pica, rumination, and avoidant/restrictive food intake disorder specifier)

After full criteria for disorder were previously met, the criteria have not been met for a sustained period of time

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 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

Restricting type (anorexia specifier)

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 laxative, 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 (anorexia specifier)

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 laxative, diuretics, or enemas).

Anorexia severity specifiers

• Mild - BMI >/= 17

• Moderate - BMI 16-16.99

• Severe - BMI 15-15.99

• Extreme - BMI </= 15

A binge-eating episode requires what two features?

Large amount of food eaten in a discrete period of time (e.g., 2 hours) than what most individuals would eat in a similar amount of time AND sense of lack of control over eating during the episode

Bulimia Nervosa

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

• Eating, in a discrete period of time (e.g., within 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

• 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 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

A - recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following

• Eating, in a discrete period of time (e.g., 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

• A 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 - the binge-eating episodes are associated with three or more of the following

• Eating much more rapidly than normal

• Eating until feeling uncomfortably full

• Eating large amounts of food when not feeling physically hungry

• Eating alone because of feeling embarrassed by how much one is eating

• 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

Remission specifiers (AN, BN, BED)

• In partial remission - after full criteria were previously met, some, but not all, of the criteria have been met for a sustained period of time

  • In full remission - after criteria were previously met, none of the criteria have been met for a sustained period of time

Bulimia and binge-eating disorder severity specifiers

• Mild - average of 1-3 episodes of inappropriate compensatory behaviors (BN) or  binge-eating episodes (BED) per week

• Moderate - average of 4-7 episodes of inappropriate compensatory behaviors (BN) or binge-eating episodes (BED) per week

• Severe - average of 8-13 episodes of inappropriate compensatory behaviors (BN) or binge-eating episodes (BED) per week

• Extreme average of 14 or more episodes of inappropriate compensatory behaviors (BN) or binge-eating episodes (BED) per week

Atypical anorexia nervosa (OS eating disorder)

All criteria for anorexia are met, except that despite significant weight loss, the individual’s weight is within or above the normal range. Individuals with atypical anorexia nervosa may experience many of the physiological complications associated with anorexia

Purging disorder (OS eating disorder)

Recurrent purging behavior to influence weight or shape in the absence of binge eating

Night eating syndrome (OS eating disorder)

Recurrent episodes of night eating, as manifested by eating after awakening from sleep or by excessive food consumption after the evening meal. There is awareness and recall of the eating