PSYCHOLOGICAL DISORDERS (DSM-5)

ANXIETY DISORDERS
DISORDER DIAGNOSTIC CRITERIA ETIOLOGY INTERVENTIONS
✔ At least 6 months Biological • Pharmacotherapy
✔ Anxiety & worry are associated with at least 3 (1 in - Genetics ◦ Anxiolytics (sedatives, minor tranquilizers)
children) of the ff symptoms: - Deficits in the functioning of the GABA - drugs that reduce anxiety
1. Restlessness/feeling keyed up/on edge system ◦ Benzodiazepines
Generalized 2. Easily fatigued - High metabolic activity in frontal lobe - short-term relief & carry risks (impair both
Anxiety Disorder 3. Difficulty concentrating/Mind going blank (involved in directing attention) cognitive & motor function)
(GAD) 4. Irritability - associated w/ falls in old adults = hip fractures
5. Muscle Tension Behavioral - produce both physical & psychological
Excessive worry 6. Sleep Disturbances - Worry is reinforcing because it avoids people dependence
about everyday from more powerful negative emotions (past ◦ Antidepressants (SSRIs)
issues & situations traumas) - Paroxetine (Paxil), Escitalopram (Lexapro),
Duloxetine (Cymbalta), Venlafaxine (aka Effexor)
Social/Environmental ◦ Serotonin-Norepinephrine Reuptake Inhibitors
- Abuse (SNRIs)
• Psychotherapy
- Behavior, Cognitive & Psychodynamic Therapies
- Using images to feel (rather than avoid) anxious
- Relaxing deeply to combat tension
✔ Recurrent unexpected panic attacks Neurobiological • Gradual exposure exercises, combined with anxiety-
✔ At least 1 of the attacks has been followed by 1 - Misfire of the fear circuit – Surge in activity reducing coping mechanisms such as relaxation or
month/more of 1 or both of the ff: in SNS breathing retraining
1. Persistent concern/worry about additional panic - Locus Coeruleus – major source of • Panic Control Therapy (PCT)
attacks or their consequences norepinephrine that plays a major role in - Exposing patients to the cluster of interoceptive
2. Significant maladaptive change in behavior related triggering SNS (physical) sensations that remind them of their panic
Panic Disorder to the attacks (avoidance of exercise/unfamiliar attacks
situations) Behavioral • Cognitive Behavioral Therapy (CBT)
Frequent panic - Classical Conditioning – panic attacks are ◦ Calm Tools for Living
attacks that are conditioned responses to either situations that - clinician and patient sit side-by-side as they both
unrelated to trigger anxiety or internal bodily sensations of view the program on screen
specific situation arousal (Interoceptive Conditioning) – - Helps patient establish a fear hierarchy,
experiences of somatic signs of anxiety, which demonstrate breathing skills, or design exposure
are followed by the first panic attack) assignments

Cognitive
- Panic attacks develop when a person
interprets bodily sensations as signs of
impending danger
✔ Fear/anxiety about 2/more of the ff: public Cognitive • Psychotherapy
Agoraphobia transportation, open spaces, enclosed places, - Fear-of-Fear Hypothesis – agoraphobia is ◦ Supportive Psychotherapy
standing in line/being in a crowd & being outside driven by negative thoughts about the - use of psychodynamic concepts and a
Anxiety about the home alone consequences of experiencing anxiety in public therapeutic alliance to promote adaptive coping
situations in which ✔ Fears/avoids these situations due to thoughts that ◦ Insight-Oriented Psychotherapy
it would be escape might be difficult/help might not be available ◦ Behavior therapy
embarrassing or in the event of developing panic-like symptoms or - includes positive and negative reinforcement,
difficult to escape other incapacitating/embarrassing symptoms (ex. systematic desensitization, flooding, exposure,
if anxiety fear of falling in the elderly) relaxation, self- monitoring
symptoms occurred ✔ The agoraphobic situation almost always provoke ◦ Cognitive-Behavioral Therapy (CBT)
fear/anxiety ◦ Virtual Therapy
(Karl Westphal) ✔ The agoraphobic situation are actively avoided,
require the presence of a companion, or are endured
w/ intense fear/anxiety
✔ Fear of anxiety is out of proportion to the actual
danger
✔ Persistent & lasts for 6 months/more
✔ Fear/anxiety about a specific object/situation Biological • Psychotherapy
✔ Phobic object/situation almost always provokes - Genetics ◦ Behavior Therapy – exposing serially to a
immediate fear/anxiety. predetermined list of anxiety-provoking stimuli
(In children, anxiety may be expressed by crying, tantrums, Behavioral graded in hierarchy from least to the most
freezing or clinging) - Phobias could be conditioned by direct frightening (systematic desensitization); intensive
✔ Phobic object/situation is actively avoided/endured trauma, modeling or verbal instruction exposure (flooding)
w/ intense fear/anxiety - Prepared Learning – out fear circuit may have ◦ Insight-Oriented Therapy – enables patient to
Specific Phobia ✔ Fear/anxiety is out of proportion to the actual danger been “prepared” by evolution to learn fear of understand the origin of the phobia, the
✔ Persistent & lasts for 6 months/more certain stimuli phenomenon of secondary gain, and the role of
Irrational fear of Specific Type: Animal; Nature Environment; Blood- resistance and enables them to seek healthy ways
a specific injection-injury; Situational; Other of dealing with anxiety- provoking stimuli
object/situation that ◦ Virtual Therapy – exposes patients on the
interferes w/ an computer screen to interact with phobic object or
individual’s ability situation
to function ◦ Exposure Therapy
▪ Systematic Desensitization
- client first taught of relaxation skills then
uses this skill to relax while undergoing
exposure to a list of feared situations
▪ In-Vivo (real life) Exposure
- more effective than systematic
desensitization
◦ Other therapeutic modalities
▪ Hypnosis to enhance the therapist’s
suggestion that the phobic object is not
dangerous; self- hypnosis as a method of
relaxation in phobic situations; family
therapy to help the patient confront the
phobic object by supporting
✔ Developmentally inappropriate & excessive Biological • Psychotherapy
fear/anxiety concerning separation from those to - Genetics ◦ Cognitive Behavioral Therapy (CBT)
Separation whom the individual is attached, as evidenced by at - Imbalances of neurotransmitters (serotonin & - to help understand and manage fears
Anxiety Disorder least 3 of the ff: norepinephrine) ◦ Exposure Therapy
1. Recurrent excessive distress when separating from - by carefully exposing patients to separation
Children’s home/attachment figures Environmental ◦ Relaxation Techniques
unrealistic & 2. Worry about losing major attachment figures or - Abrupt change in the surroundings
persistent worry about possible harm to them - Over-protective caregivers
that something will 3. Worry about experiencing an untoward event that - Stress & trauma
happen to their causes separation from them - Major losses
parents/important 4. Persistent reluctance/refusal to go out
people in their life 5. Fear of reluctance of being alone or without major
or to them that will attachment figures
separate them from 6. Reluctance/refusal to sleep away from home/sleep
their parents without being near to them
7. Repeated nightmares about separation
8. Repeated complaints of physical symptoms when
separating
✔ Persistent, lasting at least 4 weeks in children &
adolescents and 6 months or more in adults
✔ Fear/anxiety about 1/more social situations in which Biological • Pharmacotherapy
the person is exposed to possible scrutiny by others - Genetics ◦ Paxil (SSRI) o Zoloft (SSRI)
Ex: social interactions, being observed or ◦ Effexor (SSRI)
performing in front of others (Children: anxiety Behavioral ◦ D-cycloserine (DCS) + CBT treatments =
must occur in peer settings & not just interactions - A person could have a negative social enhanced effect of treatment
Social Anxiety w/ adults) experience through modeling or verbal • Psychotherapy
Disorder (Social ✔ Fears negative evaluation/rejection instruction & become classically conditioned to ◦ Cognitive therapy program
Phobia) ✔ Social situations almost always provoke fear similar situations, which the person avoids - Emphasizes real-life experiences to disprove
fear/anxiety. (Children: may be expressed by crying, - Through operant conditioning, the avoidance automatic perceptions of danger
Fear of social tantrums, freezing, clinging, shrinking, failing to behavior is maintained because it reduces the ◦ Interpersonal Psychotherapy (IPT)
situations, being speak) fear experiences ◦ Family-based treatment
watched or judged ✔ Social situations are avoided/endured w/ intense - Better than individual treatment if parents also
by others fear/anxiety Cognitive have an anxiety disorder
✔ Fear/anxiety is out of proportion to the actual threat - They appear to have unrealistically negative ◦ Cognitive retraining, desensitization, rehearsal
posed by the social situation beliefs about the consequences of their social during sessions and a range of homework
✔ Persistent, lasting for 6 months/more behaviors assignments
Specify if: - They attend more to how they are doing in ◦ Role-playing
Performance only: Fears public speaking/performing but social situations & their own internal sensations ◦ Social skills Training
not other situations than other do
Social/Environmental
- Inadequate social skills
- Controlling/overprotective caregivers

Cultural
- Growing up on a strong collectivist
orientation (Japan/Korea)
✔ Consistent failure to speak in specific social Biological • Psychotherapy
situations in where speaking is socially expected - Genetics ◦ Behavior Therapy
despite speaking in other situations - Sensory processing disorder - involves gradually exposing a child to
Selective Mutism ✔ Disturbance interferes w/ educational/occupational - Low excitability in amygdala, which senses increasingly difficult speaking tasks in the context
achievement or w/ social communication potential danger by processing signals from of a supportive relationship
Lack of speech in ✔ At least 1 month (cannot be during 1st month of SNS
1/more settings school)
where speaking is ✔ Not attributable to a lack of knowledge/comfort Behavioral
socially expected with the spoken language required in the social - Negative Reinforcement – as the child
situation realizes if he keeps quiet, there are others who
will rescue him from the situation by talking
for him

Environmental
- Multilingual Family
- Lived in foreign country

TRAUMA & STRESS-RELATED DISORDERS

DISORDER DIAGNOSTIC CRITERIA ETIOLOGY INTERVENTIONS
✔ Exposure to actual/threatened death, serious injury or sexual violence Neurobiological • Pharmacotherapy
in 1/more of the ff: - Genetics ◦ SSRIs: Prozac, Paxil
1. Directly experiencing the traumatic event(s) - High levels of activity in ◦ Hospitalization may be necessary when
2. Witnessing, in person, the event(s) as they occurred to others amygdala symptoms are particularly severe or when a
3. Learning that events occurred to a close relative/friend. (In - Diminished activation of the risk of suicide or other violence exist
actual/threatened death of a family/friend, the event must been medial prefrontal cortex • Psychotherapy
violent/accidental) - Smaller hippocampus volume ◦ Cognitive Processing Therapy (CPT)
4. Repeated/extreme exposure to aversive details of traumatic events (in - helps the patient consider all the things that
media/pictures, it should be work related) were beyond their control to be able to move
✔ Presence of 1/more of the ff intrusion symptoms beginning after the Psychological forward
traumatic events occurred: - History of another anxiety ◦ Prolonged Exposure Therapy
1. Recurrent, involuntary & intrusive distressing memories of traumatic disorder - helps the patient confront the things that
events remind them of the traumatic event
(Children: repetitive play about the traumatic events may be ◦ Stress management
expressed) Behavioral - includes relaxation and coping strategies
2. Recurrent distressing dreams about the traumatic event (Children: - Classical conditioning ◦ Eye Movement Desensitization
frightening dreams without recognizable content) (conditioned fear) &Reprocessing
Posttraumatic 3. Dissociative reactions (flashbacks) where they feels/act as if the event - Operant Conditioning - focuses on the lateral movement of the
Stress Disorder were recurring (occur in continuum, may have a complete loss of (avoidance is reinforced by the clinician’s finger while maintaining a mental
(PTSD) awareness of present surroundings) (Children: trauma-specific reduction of fear that comes from image of the trauma experience
reenactment may occur in play) not being in the presence of ◦ Group therapy
Develops on 4. Intense/prolonged psychological distress at exposure to conditioned stimulus) - includes sharing of traumatic experiences
people who internal/external cues that symbolize/resembles an aspect of the and support from other group members
experienced traumatic event Environmental ◦ Family therapy
shocking, scary or 5. Physiological reactions to internal/external cues - Childhood trauma - helps sustain a marriage through periods of
dangerous event ✔ Persistent avoidance of stimuli associated w/ the traumatic event, exacerbated symptoms
beginning after the traumatic event occurred, as evidenced by 1 or ◦ Psychoanalytic therapy
both of the ff: ▪ Catharsis – reliving emotional trauma
1. Avoidance/efforts to avoid distressing memories, thoughts, feelings or ▪ Imaginal exposure – content of the
convos about the traumatic event trauma and emotions associated with it
2. Avoidance/efforts to avoid external reminders that arouse distressing are worked through systematically
memories, thoughts or feelings about the traumatic event
✔ Negative alterations in cognitions & mood associated w/ the traumatic
event, beginning/worsening after that traumatic event, as evidenced by
2/more of the ff:
1. Inability to remember an important aspect of the traumatic event
(Dissociative)
2. Negative beliefs about self, others/world
3. Persistent distorted cognitions about the cause/consequence of the
traumatic event that lead to blaming himself/others
4. Persistent negative emotional state
5. Diminished interest/participation in significant activities
6. Feelings of detachment to others
7. Persistent irritability to experience positive emotions
✔ Alterations in arousal & reactivity associated w/ the traumatic event,
beginning/worsening after the event occurred, as evidenced by 2/more
of theff:
1. Irritable behavior & angry outbursts expressed as verbal/physical
aggression to people or objects
2. Reckless/Self-destructive behavior
3. Hypervigilance
4. Exaggerated startle response
5. Problems w/ concentration
✔ Sleep disturbance: More than 1 month
Specify if:
With delayed expression: criteria are not met until at least 6 months after the
event
With Dissociative Symptoms: symptoms meet the criteria for PTSD and in
response to stressor, person experiences persistent/recurrent symptoms of either
depersonalization/derealization
Acute Stress ✔ Symptoms similar to PTSD
Disorder ✔ Symptoms occur between 3 days – 1 month after a trauma
Shorter duration of
PTSD
Adjustment ✔ Development of emotional/behavioral symptoms in response to an • Psychotherapy
Disorder identifiable stressors occurring within 3 months of the onset of the ◦ Group therapy
stressors - useful for patients who have had similar
Emotional/ ✔ Symptoms are clinically significant as evidenced by 1/both of the ff: stress
behavioral reaction 1. Distress that is out of proportion to the severity/intensity of the ◦ Individual Psychotherapy
to a stressful event stressor, taking into account the external context & the cultural factors - explores the meaning of the stressor to the
in a person’s life that might influence symptom severity & presentation patient so that earlier traumas can be worked
2. Significant impairment in social, occupational or other areas of through
functioning ◦ Short term treatments such as crisis
✔ Symptoms do not represent normal bereavement intervention and case management
✔ Once the stressor has removed, symptoms do not persist for more than - help patients resolve their situations by
an additional 6 months (more than 6 months = chronic) supportive techniques, suggestion,
Specify whether: reassurance, environmental modification and
With depressed mood: tearful/sad even hospitalization
With anxiety-related: nervous, tense or fearful of separation
With mixed-anxiety & depressed mood: both
With disturbance of conduct: behaves inappropriately
With mixed disturbance of emotions & conduct: both
Unspecified: other stress-related reactions
Specify if:
Acute: lasted less than 6 months
Persistent/Chronic: 6+ months but not more than 6 months after the stressor
has ended
✔ Consistent pattern of inhibited, emotionally withdrawn behavior • Psychotherapy
toward adult caregivers, manifested by both of the ff: ◦ Behavior Management Training (BMT)
1. Child rarely seeks comfort when distressed - teaching caregivers about the psychology
2. Child rarely responds to comfort when distressed behind RAD and providing them with tools
✔ Persistent social & emotional disturbance characterized by at least 2 of to improve problematic behaviors in their
the ff: children.
1. Minimal social & emotional responsiveness to others ◦ Attachment Therapy
2. Limited positive affect - include parent education and skills training,
Reactive 3. Episodes of unexplained irritability, sadness or fearfulness that are family-focused counseling, and child
Attachment evident during nonthreatening interaction with adult caregivers education and training.
Disorder (RAD) ✔ Child has experienced a pattern of insufficient care as evidenced by at ◦ Holding Therapy
least 1 of the ff: - caregiver holds the child across their lap,
Child doesn’t form 1. Social neglect/deprivation in the form of persistent lack of having similar to how they would hold an infant
healthy emotional basic emotional needs for comfort, stimulation & affection met by ◦ Play Therapy
bods with caregivers - to help children better understand some of
caretakers 2. Repeated changes of primary caregivers their attachment issues and to develop tools
3. Rearing in unusual settings that severely limit opportunities to form for improving their behavior,
selective attachments communication, and ultimately, attachment
✔ Care in Criterion C is presumed to be responsible for the disturbed style.
behavior in Criterion A
✔ Disturbance is evident before 5 years of age
✔ Has a developmental age of at least 9 months
Specify if:
Persistent: Present for more than 12 months
Severe: All symptoms present at a high level of intensity
✔ Pattern of behavior in which a child actively approaches & interacts w/ • Psychotherapy
unfamiliar adults & exhibits at least 2 of the ff: ◦ Talk Therapy
1. Reduced/absent reticence in approaching & interacting w/ unfamiliar ◦ Play Therapy
adults - allow the young child to communicate their
2. Overly familiar verbal/physical behavior experiences, struggles, and feelings without
3. Diminished/absent checking back w/ caregivers after venturing away, the use of verbal disclosure.
even in unfamiliar settings ◦ Art Therapy
4. Willingness to go off with an unfamiliar adult w/ minimal or no - because childhood trauma, such as sexual
Disinhibited hesitation abuse, can be a cause for DSED, art therapy
Social ✔ The behaviors in Criterion A are not limited to impulsivity (as in may be a suitable treatment to reduce the
Engagement ADHD) but include socially disinhibited behavior symptoms associated with the condition.
Disorder (DSED) ✔ Experienced a pattern of extremes of insufficient care as evidenced by ◦ Behavioral Management Training (BMT)
at least 1 of the ff: - helps give the caregiver skills to establish
Child shows no 1. Social neglect/deprivation in the form of persistent lack of having reasonable expectations and boundaries for
inhibitions to basic emotional needs for comfort, stimulation & affection met by the child
approaching adults. caregivers ◦ Parent-Child Interaction Therapy (PCIT)
2. Repeated changes of primary caregivers - therapist helps the adult shift their
3. Rearing in unusual settings that severely limit opportunities to form relationship with the child towards one based
selective attachments on respect, trust, and support
✔ Care in Criterion C is presumed to be responsible for the disturbed ◦ Cognitive-Behavioral Therapy (CBT)
behavior in Criterion A - focused on training the parent or guardian
✔ Has a developmental age of at least 9 months to use behavior management skills.
Specify if:
Persistent: Present for more than 12 months
Severe: All symptoms present at a high level of intensity
OBSESSIVE-COMPULSIVE & RELATED DISORDERS
DISORDER DIAGNOSTIC CRITERIA ETIOLOGY INTERVENTIONS
✔ Presence of obsessions, compulsions or both. Neurobiological • Pharmacotherapy
Obsessions are defined by 1 & 2: - Genetics ◦ Deep Brain Stimulation (DBS)
1. Recurrent & persistent thoughts, urges or images that are - Unusually active: Orbitofrontal - Non ablative surgical technique
experienced, at some time during the disturbance, as intrusive Cortex, Caudate Nucleus & ◦ Clomipramine (aka Anafranil)
& inappropriate & that in most individuals cause marked Anterior Cingulate - Relapse occurs when discontinued
anxiety/distress - when shown objects that ◦ Antidepressants
2. Attempts to ignore/suppress or to neutralize them w/ some provoke symptoms, activity in ▪ Clomipramine
other thought/action these 3 areas increases ◦ SSRIs
Obsessive- Compulsions are defined by 1 & 2: • Psychotherapy
Compulsive 1. Repetitive behaviors/mental acts that the individual feels Cognitive ◦ Behavior therapy
Disorder (OCD) driven to perform in response to an obsession or according - Deficit in Yedasentience ◦ Exposure and Ritual Prevention (ERP)
to rules that must be applied rigidly (subjective feeling of knowing) - Most effective approach
Uncontrollable, 2. Behaviors/mental acts are aimed at preventing/reducing - Rituals are actively prevented and patient is
reoccurring distress or some dreaded event/situation; however, these Behavioral systematically and gradually exposed to the feared
thoughts and behaviors/mental acts either are not connected in a realistic - Operant Conditioning – thoughts or situations
behaviors that a way w/ what they are designed to neutralize/prevent or are compulsions are reinforced ◦ Cognitive treatments
person feels the clearly excessive because they reduce anxiety - Focus: overestimation of threat, importance and
urge to repeat over ✔ Obsessions/compulsions are time-consuming (at least 1 hour - Thought suppression control of intrusive thoughts, sense of inflated
& over a day) responsibility, need for perfectionism and certainty
Specify if: • Psychosurgery
W/ good or fair insight: Recognized that OCD beliefs may/may not ◦ Neurosurgery for a psychological disorder
be true
W/ poor insight: Thinks OCD beliefs are probably true
W/ absent insight/delusional: Completely convinced that OCD
beliefs are true
Specify if:
Tic-related: Has a current/past history of a tic disorder
✔ Preoccupation with 1/more defects/flaws in physical Neurobiological • Pharmacotherapy
Body Dysmorphic appearance that are not observable/appear slight to others - Hyperactivity of the orbifrontal ◦ SSRI
Disorder (BDD) ✔ At some point, individual has performed repetitive cortex & caudate nucleus ▪ Clomipramine (aka Anafranil)
behaviors/mental acts in response to the appearance concerns ▪ Fluvoxamine
Preoccupation w/ ✔ Not better explained by concerns w/ body fat/weight in an Cognitive • Psychotherapy
some imagined individual whose symptoms meet the criteria for an eating - Attuned to features that are ◦ Cognitive-Behavioral Therapy (CBT)
defect in disorder important to attractiveness & - Exposure and response prevention
appearance by Specify if: facial symmetry - Produce better and longer lasting outcomes than
someone who W/ muscle dysmorphia: Believes that his body is too - Self-worth is dependent on their medication alone
actually looks small/insufficiently muscular (this specifier is used even if individual appearance • Dermatology (skin) treatment
reasonably normal is preoccupied w/ other body areas, which is often the case) - Most often received
(Imagined Specify degree of insight: • Plastic surgery
Ugliness) W/ good/fair insight: Recognizes that the BDD beliefs may/may not - Most common procedures: rhinoplasties (nose jobs),
be true facelifts, eyeshadow elevations, liposuction, breast
W/ poor insight: Thinks that BDD beliefs are probably true augmentation, surgery to alter the jawline
W/ absent insight/delusional beliefs: Completely convinced that
BDD beliefs are true
✔ Persistently difficulty discarding/parting with possessions, Cognitive • Psychotherapy
regardless of their actual value - Related to poor organizational ◦ Exposure and Ritual Prevention (ERP)
✔ Difficulty is due to a perceived need to save items & to the abilities, unusual beliefs about - exposure on most feared situation: getting rid of their
distress associated with discarding them possessions & avoidance objects
✔ Difficulty results in the accumulation of possessions that behaviors ◦ Cognitive Behavioral Therapy (CBT)
congest & clutter active living areas & compromises their - Difficulties with attention, - to change beliefs about hoarding, practice in reducing
Hoarding intended use. If living areas are uncluttered, it is only because categorization & decision excessive acquisition, practice in discarding
Disorder of the interventions of 3rd parties (family, cleaners, etc) possessions, skills training in organizing items and
Specify if: staying focused on tasks
Acquiring an W/ Excessive acquisition: Difficulty is accompanied by excessive ◦ Motivational Interviewing
excessive number acquisition of items that are not needed or for which there is no ◦ Teaching people to assign different values to objects
of items & stores available space ◦ Reducing anxiety about throwing away items that are
them in a chaotic Specify degree of insight: somewhat less valued
manner W/ good/fair insight: Recognizes that Hoarding is problematic
W/ poor insight: Mostly convinced that Hoarding is not problematic
despite evidence
W/ absent insight/delusional beliefs: Completely convinced that
Hoarding is not problematic despite evidence
Trichotillomania ✔ Recurrent pulling out of one’s hair, resulting in hair loss • Stress/Anxiety • Pharmacotherapy
(Hair Pulling ✔ Repeated attempts to decrease/stop hair pulling • Change in Hormone ◦ SSRIs
Disorder) Levels • Psychotherapy
◦ Habit Reversal Training
- Patients are carefully taught to be more aware of their
repetitive behavior, particularly as it is just about to
begin, and to then substitute a different behavior
◦ Behavior Therapy
- biofeedback, self- monitoring, desensitization, and
habit reversal
◦ Hypnotherapy
Excoriation (Skin ✔ Recurrent skin picking resulting in skin lesions • Stress/Anxiety • Psychotherapy
Picking Disorder) ✔ Repeated attempts to decrease/stop skin picking ◦ Habit Reversal Training
- Patients are carefully taught to be more aware of their
repetitive behavior, particularly as it is just about to
begin, and to then substitute a different behavior
◦ Behavior Therapy
- biofeedback, self- monitoring, desensitization, and
habit reversal
◦ Hypnotherapy
SOMATIC SYMPTOM & RELATED DISORDERS
DISORDER DIAGNOSTIC CRITERIA ETIOLOGY INTERVENTIONS
✔ 1 or more somatic symptoms that are distressing & result in Neurobiological • Pharmacotherapy
significant disruption of daily life - Not heritable ◦ Antidepressant (SSRI)
✔ Excessive thoughts, feelings & behaviors related to the - Increase activity in the Anterior ▪ Paroxetine (aka Paxil)
somatic symptoms or health concerns as manifested by at Insula & Anterior Cingulate ◦ Patients with this disorder usually resit
least 1 of the ff: (Somatosensory Cortex – bodily psychiatric treatment. The treatment takes place
1. Disproportionate & persistent thoughts about the seriousness sensations) in a medical setting and focuses on stress
Somatic Symptom of one’s symptoms reduction and education in coping with chronic
Disorder 2. High level of health-related anxiety Cognitive illness
3. Excessive time & energy devoted to these symptoms/health - Attributional style that involves ◦ Scheduled physical examination helps to reassure
Extreme focus on concerns interpreting physical symptoms in the patients that their physicians are not abandoning
physical symptoms ✔ Although any 1 symptom may not be continuously present, worst possible way them
that causes the state of being symptomatic is persistent (more than 6 - Belief that symptoms are sign of an • Psychotherapy
emotional distress months) underlying long-term disease ◦ Group Psychotherapy
& impairment Specify if: - provides the social support and social
W/ predominant pain: Individuals whose somatic complaints Environmental interaction that seem to reduce their anxiety.
predominantly involve pain - Early experiences of medical ◦ Cognitive-Behavioral Therapy (CBT)
Persistent: Marked by serious symptoms, lots of impairment & symptoms ◦ Reassurance and education
duration more than 6 months - Family attitudes to physical illness ◦ Reducing the frequency of help-seeking
Specify current severity: behaviors (e.g., assigning a gatekeeper physician
Mild: Only 1 symptom in Criterion B is fulfilled Behavioral to each patient to screen all physical complaints)
Moderate: 2 or more symptoms in Criterion B are fulfilled - Attention and sympathy as ◦ Individual Insight-Oriented Psychotherapy,
Severe: 2 or more of the symptoms in Criterion B are fulfilled, plus reinforcement Behavior Therapy, Cognitive Therapy, and
there are multiple somatic complaints (or 1 very severe somatic Hypnosis may be useful
symptom)
✔ Preoccupation w/ fears of having a serious illness
✔ Somatic symptoms are not present or only mild in intensity.
If another medical condition is present or there is a high risk
for developing a medical condition, the preoccupation is
Illness Anxiety clearly excessive/disproportionate
Disorder ✔ High level of anxiety about health & is easily alarmed about
personal health status
Unrealistic fear ✔ Performs excessive health-related behaviors/exhibits
that they have/may maladaptive avoidance
have serious ✔ Preoccupation has been present for at least 6 months, but the
medical condition specific illness that is feared may change over that period of
time
Specify subtype:
Care-seeking type: Medical care is frequently used
Care-avoidant type: Medical care is rarely used
✔ A medical symptom/condition is present • Anxiety • Psychotherapy
✔ Psychological/behavioral factors adversely affect the medical • Stressful Life Events ◦ The major goal is to mobilize the patient to
condition in 1 of the ff: change behavior in ways that optimize the
1. Factors have influenced the course of the medical condition process of healing. This may require a general
as shown by a close temporal association between the change in lifestyle of a more specific behavioral
psychological factors & the development/exacerbation of, or change
delayed recovery from, the medical condition ◦ Stress Management and Relaxation Therapy
Psychological 2. Factors interfere w/ the treatment of the medical condition ◦ Cognitive Behavioral Therapy (CBT)
Factor Affecting 3. Factors constitute additional well-established health risks for - helps individuals better manage their responses
Medical the individual to stressful life events.
Condition 4. Factors influence the underlying pathophysiology, ◦ The 3 aims are (1) to help individuals become
precipitating or exacerbating symptoms or necessitating more aware of their own cognitive appraisals of
A general medical medical attention stressful events; (2) to educate individuals about
condition is Specify if: how their appraisals of stressful events can
adversely affected Mild: Increases medical risks (inconsistent adherence w/ influence negative emotional and behavioral
by antihypertension treatment) responses and to help them reconceptualize their
psychological/beha Moderate: Aggravates underlying medical condition (anxiety- abilities to alter these appraisals; (3) to teach
vioral factors aggravating asthma) individuals how to develop and maintain the use
Severe: Results in medical hospitalization/emergency room visit of a variety of effective cognitive and behavioral
Extreme: Results in severe, life-threatening risk (ignoring heart attack stress management skills
symptom) ◦ Stress Management Training
- Self- observation, Cognitive restructuring,
Relaxation exercises, Time management,
Problem- solving
Conversion ✔ 1/more symptoms of altered voluntary motor/sensory Psychodynamic • Psychotherapy
Disorder function - On an unconscious level, some ◦ The most important feature of the therapy is a
(Functional ✔ Clinical findings provide evidence of incompatibility psychological factor is at work, making relationship with a caring and confident therapist
Neurological between the symptom & recognized neurological/medical the symptoms appear without any ◦ Focus on issues of stress and coping. Telling
Symptom conditions physical cause patients that their symptoms are imaginary often
Disorder) ✔ Symptom of deficit is not better explained by another - People could be unconscious of makes them worse
medical/mental disorder certain perceptions & be motivated to ◦ Identify and attend to the traumatic or stressful
Physical & sensory Specify if: have certain symptoms life event, if it is still present (either in real life or
problems with no Acute Episode: Symptoms lasted under 6 months memory)
underlying Persistent: Symptoms lasted more than 6 months Sociocultural ◦ Reduce any reinforcing or supportive
neurologic cause Specify if: - More common among people from consequences of the conversion symptoms
With or Without Psychological Disorder rural areas & lower SES (secondary gain)
Specify types of Symptoms: ◦ Insight-oriented therapy and Psychoanalysis
With weakness/paralysis; abnormal movement; swallowing - explore intrapsychic conflicts and the
symptoms; speech symptoms symbolism of conversion disorder symptoms
With attacks/seizures ◦ Behavior Therapy
With anesthesia/sensory loss; with special sensory symptom ◦ Hypnosis, anxiolytics, and behavioral
With mixed symptoms relaxation exercises are effective in some cases
◦ Brief and direct forms of short-term
psychotherapy have also been used. The longer
the duration of these patients’ sick role and the
more they have regressed, the more difficult the
treatment
Factitious ✔ Falsification of physical/psychological signs/symptoms or • Childhood trauma • No specific treatment has been effective.
Disorder Imposed induction of injury/disease, associated w/ identified • Serious illness during • Treatment is best focused on management rather than
on Self deception childhood on cure
(Munchausen ✔ Presents self to others as ill, impaired, or injured • Loss ◦ To reduce the risk of morbidity and mortality
Syndrome) ✔ Deceptive behavior is evident even in the absence of obvious • Stress ◦ To address the underlying emotional needs or
Falsification of external rewards psychiatric diagnosis underlying factitious illness
signs/symptoms w/ Specify if: behavior
no reward Single episode: 1 event ◦ To be mindful of legal and ethical issues
Recurrent episodes: 2 or more events • Clinicians who find themselves involved with
✔ Falsification of physical/psychological signs/symptoms or • Childhood trauma patients with factitious disorder may become angry at
Factitious induction of injury/disease, associated w/ identified • Serious illness in childhood patients for lying and deceiving them. Hence,
Disorder Imposed deception therapist must be mindful of countertransference
on Another ✔ Presents another individual to others as ill, impaired, or whenever they suspect factitious disorder
(Munchausen injured • Legal Intervention
Syndrome by ✔ Deceptive behavior is evident even in the absence of obvious - The senselessness of the disorder and the denial of
Proxy) external rewards false action by parents are obstacles to successful
Specify if: court action and often make conclusive proof
Single episode: 1 event unobtainable
Recurrent episodes: 2 or more events

DISSOCIATIVE DISORDERS
DISORDER DIAGNOSTIC CRITERIA ETIOLOGY INTERVENTIONS
Depersonalization ✔ The presence of persistent/recurrent experiences of • Childhood Trauma & • Psychotherapy
-Derealization depersonalization, derealization or both Abuse ◦ Psychological treatments similar to those for panic
Disorder Depersonalization: experiences of unreality, detachment or being an • Stress disorder may be helpful
outside observer w/ respect to one’s thoughts, feelings, sensations, • Depression/Anxiety ◦ Stresses associated with onset of disorder should be
Persistently/ body or actions addressed
repeatedly have the Derealization: Experiences of unreality/detachment with respect to ◦ Pyschoanalytic Therapy
feeling that you’re surroundings (individuals/objects are experienced as dreamlike, foggy, - to be able to resolve past trauma
observing yourself lifeless or visually distorted) ◦ Cognitive Therapy
from outside of ✔ During the depersonalization/derealization experience, reality - helps solve distortion but may result to slow progress
your body or things testing remains intact & may lead to additional dysphoria
aren’t real or both ◦ Hypnosis
- can often alleviate self- destructive impulses or reduce
symptoms, like flashbacks, dissociative hallucinations
and passive-influence experiences
◦ Movement Therapy
- may facilitate normalization of body sense and body
image
◦ Occupational Therapy
- may help patient with grounding and symptom
management through structured activities
Dissoaciative ✔ Inability to recall important autobiographical information, • Stress • Pharmacotherapy
Amnesia usually of a traumatic/stressful nature, that is inconsistent w/ • Traumatic Events ◦ Benzodiazepines (minor tranquilizers)
ordinary forgetting (Dissociative Amnesia most often • Psychotherapy
Inability to recall consists of Localized or Selective Amnesia for a specific ◦ Recalling what happened during the amnesic/fugue
important personal event; or Generalized Amnesia for identity/life history) state, often with the help of friends & family who know
information that Specify if: what happened, so the patient can confront the
would not typically W/ Dissociative Fugue: purposeful travel/bewildered wandering that information and integrate it into their conscious
be lost w/ ordinary is associated w/ amnesia for identity or for other important experience
forgetting autobiographical information ◦ Pyschoanalytic Therapy
- to be able to resolve past trauma
◦ Cognitive Therapy
- helps solve distortion but may result to slow progress
& may lead to additional dysphoria
◦ Hypnosis
- can often alleviate self- destructive impulses or reduce
symptoms, like flashbacks, dissociative hallucinations
and passive-influence experiences
◦ Electroconvulsive Therapy
- often successful and does not worsen dissociative
memory problems
✔ Disruption of identity characterized by 2/more distinct Environmental • Psychotherapy
personality states, which may be described in some cultures - Child abuse ◦ Patient must identify cues or triggers that provoke
as an experience of possession. The disruption of marked memories of trauma & dissociation
discontinuity in sense of self & sense of agency, ◦ Patient must confront and relive the early trauma and
Dissociative accompanied by related alterations in affect, behavior, Sociocognitive gain control over the horrible events
Identity Disorder consciousness, memory, perception, cognition and/or - Alter appear in response to ◦ Therapist must help the patient visualize and relive
(DID) sensory-motor functioning. These signs & symptoms may be suggestions by therapists, aspects of the trauma until it is simply a terrible memory
observed by others or reported by the individual. exposure to media reports of ◦ Hypnosis
Multiple, distinct ✔ Recurrent gaps in the recall of everyday events, important DID or other cultural influences - to access unconscious memories and bring various
personalities personal information, and traumatic events that are - When situation demands, alters into awareness
inconsistent w/ everyday forgetting people can adopt personality ◦ Pyschoanalytic Therapy
✔ Not a normal part of a broadly accepted cultural/religious - to be able to resolve past trauma
practice (Children: symptoms are not attributable to ◦ Group Therapy
imaginary playmates/fantasy plays) - elicits excess fascination or by frightening other
patients. It is more effective if all patients in a group
have dissociative identity disorder
◦ Family Therapy
- important for long-term stabilization and to address
pathological family and marital processes that are
common in patients with DID and their family members
◦ Expressive Therapy
- help with containment and structuring of severe DID
and PTSD symptoms; as to permit these patients safer
expression of thoughts, feelings, mental images and
conflicts

MOOD DISORDERS (DEPRESSIVE DISORDERS)

DISORDER DIAGNOSTIC CRITERIA ETIOLOGY INTERVENTIONS
✔ 5 or more of the ff have been present during the same 2-week period • Pharmacotherapy
& represent a change from previous functioning; at least 1 of the ◦ Antidepressants
symptoms is either depressed mood or loss of interest/pleasure: ▪ SSRIs
1. Depressed mood most of the day, nearly every day, as indicated by • Fluoxetine (Prozac) – best known
either subjective report/observation made by others (Children & ▪ Tricyclic antidepressants
Major Adolescents: Can be irritable mood) • Most widely used treatment before
Depressive 2. Diminished interest/pleasure in all, or almost all, activities most of SSRI
Episode the day, nearly every day • Imipramine (Tofranil) and
3. Significant weight loss when not dieting/weight gain, or amitriptyline (Elavil) – best known
Most commonly decrease/increase in appetite (Children: Failure to make expected • Side effects: blurred vision, dry mouth,
diagnosed & most weight gains) constipation, difficulty urinating,
severe depression 4. Insomnia/Hypersomnia drowsiness, weight gain, sexual
5. Psychomotor agitation/retardation dysfunction
6. Fatigue/loss of energy • Lethal if taken in excessive doses
7. Feelings of worthlessness or excessive/inappropriate guilt ▪ Monoamine oxidase (MOA) inhibitors
8. Diminished ability to think/concentrate or indecisiveness • Block the enzyme MAO that breaks
9. Recurrent thoughts of death, suicidal ideation without a specific down such neurotransmitters as
plan, or a suicide attempt or a specific plan for committing suicide norepinephrine and serotonin
✔ At least 1 major depressive episode (Criteria A-C) Neurobiological • Used far less often because of two
✔ There has never been a manic/hypomanic episode (This exclusion - Genetics potentially serious consequences:
Major does not apply if all of the manic-like/hypomanic-like episodes are - DRD4.2 – gene that influences hypertensive episodes or death, when
Depressive substance-induced or attributable to the direct physiological effects dopamine function eating and drinking foods and beverages
Disorder (MDD) of another medical condition) - low function of dopamine containing tyramine
Specify the clinical status and features: - elevated activation of amygdala ▪ Mixed reuptake inhibitors
Presence of Single episode or recurrent & sugenual anterior cingulate • Venlafaxine (Effexor) – best known
depression & Mild (2-3), moderate (4+), severe - diminished activation of the ▪ Lithium carbonate (Lithium)
absence of With: Anxious distress, mixed features, melancholic features, atypical hippocampus & dorsolateral • “Mood-stabilizing drug”
manic/hypomanic features, mood-congruent /incongruent psychotic features, catatonia, prefrontal cortex • Found in our drinking water
episodes peripartum onset (within 4 weeks), seasonal pattern - high cortisol levels • Side effects: toxicity (poisoning),
In partial remission: Previous symptoms present but full criteria not met or lowered thyroid functioning, substantial
a period of less than 2 months without symptoms following the end of such weight gain
an episode • Major advantage: effective in
In full remisision: No symptoms during past 2 months preventing and treating manic episodes
✔ Depressed mood for most of the day for at least 2 years (Children & • Stress • Biological Treatments
adolescents: mood can be irritable & duration must be at least 1 • Trauma ◦ Electroconvulsive Therapy (ECT)
year) • Family History - Most controversial treatment for psychological
✔ Presence, while depressed, of 2 or more of the ff: disorders after psychosurgery
1. Poor appetite/Overeating - Electric shock is administered directly through
2. Insomnia/Hypersomnia the brain for less than 1 second, producing a
3. Low energy/Fatigue seizure and a series of brief convulsions that
4. Low self-esteem usually lasts for several minutes
5. Poor concentration/Difficulty in making decisions ◦ Transcranial Magnetic Stimulation
Persistent 6. Feelings of hopelessness - Use of very short pulses of magnetic energy to
Depressive 7. During the 2-year period (1 year for children & adolescents) of the stimulate nerve cells in the brain for altering
Disorder disturbance, the person has never been without the symptoms in electrical activity
(Dysthymia) Criteria A & B for more than 2 months ◦ Vagal Nerve Stimulation
✔ Criteria for major depressive disorder may be continuously present - uses an electronic device that is implanted in
Depressed mood for 2 years the skin, similar to cardiac pacemaker
that occurs for ✔ There’s never been a manic/hypomanic episode & criteria have • Psychosocial Therapy
most of the day, never met cyclothymic disorder ◦ Cognitive Therapy
for more days Specify if: - To alleviate depressive episodes and prevent
than not, for at Current severity: Mild, moderate, severe their recurrence by helping patients identify and
least 2 years With: anxious distress, mixed features, melancholic features, atypical test negative cognitions; develop alternative,
(1 year for faetures, mood-congruent/incongruent psychotic features, peripartum onset flexible, and positive ways of thinking; and
children & Specify onset: rehearse new cognitive and behavioral responses
adolescents) Early onset: before 21 years ◦ Cognitive Behavioral Therapy (CBT)
Late onset: 21 years or older - Learn to replace negative depressive thoughts
Specify (for most recent 2 years of dysthymic disorder): and attributions with more positive ones
W/ Pure Dysthymic Syndrome: full criteria of a major depressive episode - Develop more effective coping behaviors and
have not been met in at least the preceding 2 years skills
W/ Persistent Major Depressive Episode: full criteria of a major depressive ◦ Interpersonal Psychotherapy (IPT)
episode have been met throughout the preceding 2 year period - Consists of 12-16 weekly sessions and is
W/ Intermittent Major Depressive Episodes, w/ current episode: full characterized by an active therapeutic approach
criteria for major depressive episode are currently met; but there have been - Focus on the social and interpersonal triggers
periods of at least 8 weeks in the preceding 2 years w/ symptoms below the for their depression (ex. loss of a loved one)
threshold for a full major depressive episodes - Develop skills to resolve interpersonal conflicts
W/ Intermittent Major Depressive Episodes, without current episode: full and build new relationships
criteria for major depressive episode are not currently met but there has been ◦ BehaviorActivation (BA) Therapy
1 or more major depressive episodes in at least the preceding 2 years - Based on the idea that many of the risk factors
In full remission, In partial remission for depression can result in low levels of positive
reinforcement
- Goal is to increase participation in positively
reinforcing activities so as to disrupt the spiral of
depression, withdrawal & avoidance
◦ Psychoanalytically Oriented Therapy
- Effects a change in a patient’s personality
structure or character, not simply to alleviate
symptoms, but improvements in interpersonal
trust, capacity for intimacy, coping mechanisms,
the capacity to grieve, and the ability to
experience a wide range of emotions are the aims
of this therapy
◦ Family Therapy
- As a supplementary therapy, helps patient to
reduce and cope with stress, lessening the chance
of a relapse. It examines the well- being of the
whole family
◦ Phototherapy
- patients typically experience depression as the
photoperiod of the day decreases with advancing
winter
◦ Sleep Deprivation
- May precipitate mania in patients with Bipolar I
disorder and temporarily relieve depression in
those who have unipolar depression
✔ In the majority of menstrual cycles, at least 5 symptoms must be • Hormone levels • Pharmacotherapy
present in the final week before the onset of menses, start to improve • PMS ◦ Antidepressants (SSRIs/SNRI)
within a few days after the onset of menses & become • Family history ◦ Hormone therapies/medications
minimal/absent in the week postmenses • Personal history of • Behavior Interventions
✔ 1/more of the ff must be present: trauma or abuse ◦ Aerobic exercise
1. Affective lability (mood swings, sudden sadness) ◦ Consumption of complex carbohydrates and
2. Irritability/anger or increased interpersonal conflicts frequent meals
Premenstrual 3. Depressed mood, feelings of hopelessness/self-deprecating thoughts ◦ Relaxation training
Dysphoric 4. Anxiety, tension and/or feelings of being keyed up or on edge ◦ Light therapy
Disorder ✔ 1/more of the ff must be present to reach the total of 5 symptoms ◦ Seep deprivation
(PMDD) when combined: • Psychotherapy
1. Decreased interest in usual activities ◦ Cognitive-Behavioral Therapy (CBT)
Woman’s severe 2. Subjective difficulty in concentration
depression, 3. Lethargy, easy fatigability/lack of energy
irritability and 4. Change in appetite; Overeating/Specified food cravings
tension before 5. Hypersomnia/Insomnia
menstruation 6. Sense of being overwhelmed/Out of control
7. Physical symptoms (breast tenderness/swelling, joint/muscle pain,
bloating, weight gain)
✔ Criterion A should be confirmed by prospective daily ratings during
at least 2 symptomatic cycles
✔ Severe recurrent temper outbursts manifested verbally/behaviorally • Family history • Pharmacotherapy
that are out of proportion in intensity/duration to the • Poor parental support ◦ Stimulants – decrease irritability
Disruptive Mood situation/provocation • Genetics ◦ Antidepressants (SSRIs)
Dysregulation ✔ Outbursts are inconsistent w/ developmental level • Trauma ◦ Atypical antipsychotic medications – to treat
Disorder ✔ Outbursts occur, on average, 3/more times per week irritability, outbursts or aggression
(DMDD) ✔ Mood between temper outbursts is persistently irritable/angry most • Psychotherapy
of the day, nearly every day, and is observable by others ◦ Talk Therapy
Children/ ✔ Criteria A-D have been present for 12 months or more. Throughout ◦ Cognitive-Behavioral Therapy (CBT)
adolescents that time, the person has not had a period lasting 3 or more -includes exposing the child to situations that
experience consecutive months without all of the symptoms in Criteria A-D make them anxious so that they can learn to
persistent ✔ Criteria A & D are present in at least 2 of 3 settings & are severe in respond to those situations better
irritability, anger at least 1 of those ◦ Dialectical behavior therapy for children
& temper ✔ Diagnosis should not be made for the first time before 6 years or (DBT-C)
outbursts after 18 years - may help children learn to regulate their
✔ By history/observation, age at onset of Criteria A-E is before 10 emotions and avoid extreme or prolonged
years outbursts
✔ There has never been a distinct period lasting more than 1 day - the clinician helps children learn skills that can
during which the full symptom criteria, except duration, for a help with regulating their moods and emotions.
manic/hypomanic episode have been met ◦ Computer Training
✔ Behaviors do not occur exclusively during an episode of major - teaches kids to have more happy judgments
depressive disorder or another mental disorder about ambiguous expressions
◦ Parent Training

MOOD DISORDERS (BIPOLAR DISORDERS)

DISORDER DIAGNOSTIC CRITERIA ETIOLOGY INTERVENTIONS
✔ Distinct period of abnormally & persistently elevated, expansive or Neurobiological • Pharmacotherapy
irritable mood & abnormally & persistently increased goal-directed - During mania & not depression, ◦ Lithium carbonate (Lithium)
activity/energy, lasting at least 1 week & present most of the day, striatum (reactions to reward) is - “Mood-stabilizing drug”
Manic Episode nearly every day overly active - Found in our drinking water
✔ During the period of mood disturbance & increased energy/activity, - Side effects: toxicity (poisoning), lowered
High energy, 3/more of the ff symptoms (4 if the mood is only irritable) are thyroid functioning, substantial weight gain
excitement and present: - Major advantage: effective in preventing and
euphoria over a 1. Inflated self-esteem/grandiosity treating manic episodes
period of time 2. Decreased need for sleep ◦ Antipsychotic Medication
3. More talkative than usual/pressure to keep talking ▪ Olanzapine – immediate calming effect
4. Flight of ideas or subjective experience that thoughts are racing • Psychotherapy
5. Distractability ◦ Interpersonal & Social Rhythm Therapy
6. Increase in goal-directed activity (IPSRT)
7. Excessive involvement in activities that have a high potential for - Regulates circadian rhythm by helping
painful consequences patients regulate their eating and sleep cycles
✔ Mood disturbance is sufficiently severe to cause marked impairment ◦ Increasing compliance with drug treatments,
or to necessitate hospitalization to prevent harm to self/others, or as the “pleasures” of a manic state make
there are psychotic features refusal to take lithium a major therapeutic
Note: A full manic episode that emerges during antidepressant treatment but obstacle
persists at a fully syndromal level beyond the physiological effect of that ◦ Sleep Deprivation
treatment is sufficient evidence of a manic episode & therefore a bipolar I - May precipitate mania in patients with
diagnosis Bipolar I disorder and temporarily relieve
✔ For at least 2 years (Children & adolescents: 1 year) there have been • Genetics depression in those who have unipolar
Cyclothymic numerous periods w/ hypomanic symptoms that don’t meet criteria • Traumatic events depression
Disorder for a hypomanic episode and numerous periods w/ depressive • Stress
symptoms that don’t meet criteria for major depressive episode
Milder form of ✔ During the 2-year period, hypomanic & depressive periods have
bipolar disorder been present for at least half the time & the individual has not been
involving many w/o the symptoms for more than 2 months at a time
“mood swings” ✔ Criteria for a major depressive, manic or hypomanic episode have
never been met
Specify if:
With anxious distress
✔ At least 1 manic episode, which may have been preceded by & may Neurobiological
be followed by hypomanic/major depressive episodes - Most heritable
Note: Hypomanic & major depressive episodes are common in bipolar I - Dopamine receptors may be overly
Bipolar I disorder but are not required for the diagnosis sensitive
Disorder Specify if: - Diminished sensitivity of the
With: anxious distress, mixed features, rapid cycling, serotonin receptors, hippocampus &
Severe manic mood-congruent/incongruent features, catatonia, peripartum onset, seasonal dorsolateral prefrontal cortex
episodes that last pattern - Elevated responsiveness in the
for 7 days Specify: Remission status if full criteria are not currently met for a manic, amygdala
hypomanic or major depressive episode - Increased activity of the anterior
cingulate
- Deficits in the membranes of
neurons
✔ At least 1 hypomanic episode & at least 1 major depressive episode. Neurobiological
Criteria for a hypomanic episode are identical to those for a manic - Most heritable
Bipolar II episode w/ the following distinctions: - Dopamine receptors may be overly
Disorder 1. Minimum duration is 4 days sensitive
2. Although the episode represents a definite change in functioning, it - Diminished sensitivity of the
Pattern of is not severe enough to cause social/occupational serotonin receptors, hippocampus &
depressive & impairment/hospitalizations dorsolateral prefrontal cortex
hypomanic 3. No psychotic features - Elevated responsiveness in the
episodes ✔ There has never been a manic episode amygdala
Specify current or most recent episode: - Increased activity of anterior
Hypomanic: Currently/most recently in a hypomanic episode cingulate
Depressed: Currently/most recently in a major depressive episode - Deficits in the membranes of
Specify if: neurons
With: anxious distress, mixed features, rapid cycling,
mood-congruent/incongruent features, catatonia, peripartum onset, seasonal
pattern
Full remission, partial remission
Mild, moderate, severe

EATING DISORDERS
DISORDER DIAGNOSTIC CRITERIA ETIOLOGY INTERVENTIONS
✔ Recurrent episodes of binge eating. An episode is characterized Biological • Pharmacotherapy
by both of the ff: - Genetics ◦ Fluoxetine (Prozac)
1. Eating, in a discrete period of time, an amount of food that is - Starvation may increase levels of - Effective particularly during the binging and
definitely larger than most people would eat during a similar endogenous opioids (suppress purging cycle
period of time & under similar circumstances appetite & enhances mood, released ◦ Antidepressants
2. Lack of control over eating during the episode during starvation), resulting in a • Biological Intervention
✔ Recurrent inappropriate compensatory behavior in order to positively reinforcing euphoric state ◦ Nutritional Rehabilitation
prevent weight gain (self-induced vomiting, misuse of laxatives, - Binges result from a serotonin - helping clients eliminate their binge-purge
Bulimia Nervosa diuretics or other medications; fasting or excessive exercise) deficit that causes them not to feel patterns and establish good eating habits
✔ Binge eating & inappropriate compensatory behaviors both satiated as they eat • Psychotherapy
Binge-eating occur, on average, at least once a week for 3 months ◦ Short-term cognitive-behavioral treatments
followed by ✔ Self-evaluation is unduly influenced by body shape & weight Cognitive ◦ Cognitive-Behavioral Therapy-Enhanced
purging ✔ The disturbance does not occur exclusively during episodes of - Self-worth = weight (CBT-E)
anorexia nervosa - Low self-esteem - Focus is on the distorted evaluation of body
Specify if: - Stress are relieved by purging shape and weight, and maladaptive attempts to
In Partial Remission: For “a sustained period”, patient meets some but control weight
not all the criteria Sociocultural ◦ Exposure & Response Prevention
In Full Remission: For “a sustained period”, no criteria have been met - Societal standards - require clients to eat particular kinds and
Specify severity: - Health consciousness amounts of food and then prevent them from
Mild: 1-3 episodes a week vomiting to show that eating can be harmless
Moderate: 4-7 episodes a week Environmental ◦ Interpersonal Psychotherapy (IPT)
Severe: 8-13 episodes a week - Child Abuse -
Extreme: 14+ episodes a week
✔ Restriction of energy intake relative to requirements, leading to a Biological • Biological Intervention
significantly low body weight in the context of age, sex, - Genetics ◦ Nutritional Rehabilitation
developmental trajectory & physical health. - Abnormal level of hormones - help patients gain weight quickly and return to
Significantly low weight: weight that is less than minimally normal regulated by the hypothalamus health within weeks
(Children & adolescents: less than minimally expected) (regulating hunger & eating), such ◦ Tube & Intravenous Feedings
✔ Intense fear of gaining weight/becoming fat, or persistent as cortisol - in life threatening cases on a patient who refuses
behavior that interferes w/ weight gain, even though at a - These hormonal abnormalities to eat
significantly low weight occur as a result of self-starvation & ◦ Motivational Interviewing
✔ Disturbance in which one’s body weight/shape is experienced, returns to normal after weight gain - uses a mixture of empathy and inquiring review
Anorexia undue influence of body weight/shape on self-evaluation, or - Starvation may increase levels of to help motivate clients to recognize they have a
Nervosa persistent lack of recognition of the seriousness of the current endogenous opioids (suppress serious eating problem and commit to making
low body weight. appetite & enhances mood, released constructive choices and behavior changes
Restriction of Specify type: during starvation), resulting in a • Psychotherapy
energy intake & Restricting type: during the past 3 months, the individual has not positively reinforcing euphoric state ◦ Most important initial goal: restore the patient’s
excessive engaged in recurrent episodes of binge-eating/purging behavior (This - Low levels of serotonin weight to a point that is at least within the low
exercise due to subtype describes presentations in which weight loss is accomplished - Greater activation in the ventral normal range
intense fear of primarily through dieting, fasting or excessive exercise) striatum (dopamine & reward) ◦ Cognitive-Behavioral Therapy (CBT)
gaining weight & Binge-eating/purging type: During the past 3 months, the individual has - Greater expression of dopamine - to help clients appreciate and change the
distorted engaged in recurrent episodes of binge eating/purging behavior transporter gene DAT (release of behaviors and thought processes that keep their
perception of Specify severity: (adults) protein that regulates the reuptake of restrictive eating going
weight Mild: BMI of 17 or more dopamine back into synapse) ◦ Cognitive-Behavioral Therapy-Enhanced
Moderate: BMI of 16-17 Cognitive (CBTE)
Severe: BMI of 15-16 - Achieving thinness are negatively ◦ Family-based Treatment (FBT)
Extreme: BMI under 15 reinforced by the reduction of - may try to help patient separate their feelings
Specify if: anxiety about becoming fat and needs from those of other family members.
In Partial Remission: No longer underweight but still overly concerned/ - Perfectionism
has misconceptions with weight - Fear of criticisms
In Full Remission: Has met no criteria
✔ Recurrent episodes of binge eating that is characterized by both Cognitive • Pharmacotherapy
of the ff: - Self-worth = weight ◦ Antidepressants
1. Eating an amount of food that is definitely larger than what most - Low self-esteem • Psychotherapy
people would eat in a similar period of time under similar - Stress are relieved by purging ◦ Cognitive-Behavioral Therapy (CBT)
circumstance ◦ For Obesity:
Binge-Eating 2. Sense of lack of control over eating ▪ Bariatric surgery
Disorder ✔ Binge-eating episodes are associated with 3/more of the ff: - A surgical approach to extreme obesity
1. Eating much more rapidly than normal
Episodes of 2. Eating until feeling uncomfortably ill
consuming food 3. Eating large amounts of food when not hungry
in a larger amount 4. Eating alone because of feeling embarrassed by how much one is
than is normal in eating
a short time 5. Feeling disgusted w/ oneself, depressed, or very guilty afterward
✔ Binge-eating occurs, on average, at least once a week for 3
months
✔ Not associated w/ the recurrent use of inappropriate
compensatory behavior as in bulimia nervosa & does not occur
exclusively during the course of bulimia nervosa or anorexia
nervosa
Specify if:
In Partial Remission: Binged-eat less often than once a week
In Full Remission: Has met no criteria
Specify Severity:
Mild: 1-3 binges a week
Moderate: 4-7 binges a week
Severe: 8-13 binges a week
Extreme: 14+ binges a week
✔ An eating/feeding disturbance as manifested by persistent failure Biological • Psychotherapy
to meet appropriate nutritional and/or energy needs associated - Heredity ◦ CBT-AR (CBT for avoidant/restrictive disorder)
with at least 1 of the ff: - History of gastrointestinal issues, - patients are encouraged to eat large amounts of
Avoidant/ 1. Significant weight loss (or failure to achieve expected weight gastroesophageal reflux (GERD), their preferred foods, with the goal of weight
Restrictive Food gain or faltering growth in children) and vomiting restoration, before introducing new foods.
Intake Disorder 2. Significant nutritional deficiency ◦ Family Based Therapy (FBT)
(ARFID) - blame is removed from the patient and the
3. Dependence on enteral feeding or oral nutritional supplements
family, and the eating disorder is viewed as an
Avoidance or 4. Marked interference with psychosocial functioning external force.
restriction of food ✔ The disturbance is not better explained by lack of available food ◦ Occupational Therapy
intake or by an associated culturally sanctioned practice - therapists complete a full assessment of a
✔ There is no evidence of a disturbance in the way in which one's person’s sensory, motor, developmental,
body weight or shape is experienced environmental, cultural, and behavioral factors
Specify if: that could be impairing eating.
In Remission: After full criteria were previously met, the criteria have
not been met for a sustained period of time
Pica Disorder ✔ Persistent eating of non-nutritive, non-food substances over a Psychological • Behavioral Interventions
period of at least 1 month - Intellectual Disability ◦ Nutrition Counseling
Eating of 1 or ✔ The eating of non-nutritive, non-food substances is inappropriate - educate the client & family about nutritional
more non- to the developmental level of the individual Environmental deficits in the client’s diet, how to meet dietary
nutritive, non- Specify if: - Parental neglect, lack of needs, and how to determine the difference
food substances In remission: After full criteria were previously met, the criteria have not supervision between edible and non-edible food items
been met for a sustained period of time - Intellectual disability ◦ Family Therapy
Rumination ✔ Repeated regurgitation of food over a period of at least 1 month. Psychosocial • Behavioral Intervention
Disorder Regurgitated food may be re-chewed, re-swallowed, or spit out - Low stimulation, neglect ◦ Behavior Modification
Repeated ✔ The repeated regurgitation is not attributable to an associated - Stress ◦ Habit Reversal Training (HRT)
regurgitation of gastrointestinal or other medical condition - Difficulties in parent-child - to create a competing behavior (or a distraction)
food occurring relationship to reduce the regurgitation episodes.
after feeding or ◦ Diaphragmatic Breathing Exercises
eating - uses a relaxation technique to inhale and exhale
by expanding the abdomen instead of the chest.
SLEEP-WAKE DISORDERS
DISORDER DIAGNOSTIC CRITERIA ETIOLOGY INTERVENTIONS
✔ Predominant complaint of dissatisfaction w/ sleep Biological • Pharmacotherapy
quantity/quality associated with 1/more of the ff: - Biological clock problems ◦ Benzodiazepine
1. Difficulty initiating sleep (Children: difficulty initiating sleep - Delayed temperature rhythm (body ◦ Triazolam (Halcion)
without caregiver intervention) temp is high & don’t become ◦ Zaleplon (Sonata)
2. Difficulty maintaining sleep, characterized by frequent drowsy unlit later night) ◦ Zolpidem (Ambien)
awakenings/problems returning to sleep after awakenings - Family history ◦ Flurazepam (Dalmane)
(Children: difficulty returning to sleep without caregiver • Psychotherapy
intervention) Environmental ◦ Cognitive Therapy
3. Early-morning awakening w/ inability to return to sleep - Light, noise, temperature - Focus: changing the sleepers’ unrealistic
Insomnia ✔ Sleep difficulty occurs at least 3 nights per week expectations & beliefs about sleep by providing
Disorder ✔ Sleep difficulty is present for at least 3 months Psychological information on topics like normal amount of
✔ Sleep difficulty occurs despite adequate opportunity for sleep - Stress & Anxiety sleeps & ability to compensate for lost sleep
Trouble falling Specify if: ◦ Guided Imagery Relaxation
asleep, staying Episodic: Symptoms last at least 1 month but less than 3 months Behavioral - Uses meditation/imagery to help with relaxation
asleep or getting Persistent: Symptoms last 3 months or longer - Children learn to fall asleep only at bedtime or after a night waking for people who
good quality sleepRecurrent: 2 or more episodes within the space of 1 year with a parent present become anxious because of difficulty sleeping
Specify if: ◦ Graduated Extinction
With non-sleep disorder mental comorbidity - Used for children who have tantrums at bedtime
With other medical comorbidity or wake up crying by instructing the parent to
With other sleep disorder check on the child after longer periods until the
child falls asleep on his/her own
◦ Paradoxical Intention
- Involves instructing individuals in the opposite
behavior from the desired outcome
◦ Progressive Relaxation
- Involves relaxing the muscles of the body in an
effort to introduce drowsiness
✔ Self-reported excessive sleepiness despite a main sleep period Biological • Pharmacotherapy
Hypersomnolenc lasting at least 7 hours, with at least 1 of the ff symptoms: - Genetics ◦ Stimulants
e Disorder 1. Recurrent periods of sleep/lapses into sleep within the same day - Exposure to viral infections ▪ Amphetamine
2. Prolonged main sleep episode of more than 9 hours per day that (Mononucleosis, hepatitis & viral ▪ Methylphenidate
Repeated feeling is non-restorative pneumonia) ▪ Modafinil
of excessive 3. Difficulty being fully awake after abrupt awakening ◦ Antidepressants
tiredness during ✔ Occurs at least 3x per week, for at least 3 months ◦ Monoamine Oxidase Inhibitors (MAOIs)
the day or Specify if:
sleeping longer Acute: less than 1 month
than usual at Subacute: 1-3 months
night Persistent: more than 3 months
Specify current severity:
Mild: 1-2 days/week
Moderate: 3-4 days/week
Severe: 5-7days/week
Specify if:
With mental disorder
With medical condition
With another sleep disorder
✔ Recurrent periods of irrepressible need to sleep, lapsing into Biological • Pharmacotherapy
sleep or napping occurring within the same day. Must have been - Associated with cluster of genes on ◦ Stimulants
occurring at least 3x per week over the past 3 months chromosome 6 (autosomal recessive ◦ Amphetamines
✔ Presence of at least 1 of the ff: trait) ◦ Antidepressants (SNRIs, SSRIs)
1. Episodes of cataplexy defined as either of the ff, occurring at - Significant loss of hypocretin ◦ Sodium Oxybate
least a few times per month: neurons (nerve cell) – plays an - can help you sleep and also reduces how often
a) In individuals w/ long standing disease, brief episodes of important role in wakefulness cataplexy happens
sudden bilateral loss of muscle tone w/ maintained ◦ Histamine-affecting Drugs
consciousness, precipitated by laughter/joking
Narcolepsy b) In children or individuals within 6 months of onset,
spontaneous grimaces or jaw-opening episodes w/ tongue
Sudden attacks of thrusting or a global hypotonia, without any obvious
deep sleep emotional triggers
because of the 2. Hypocretin deficiency, as measured using cerebrospinal fluid
brain’s inability to (CSF) hypocretin-1 immunoreactivity values (less than/equal to
control sleep- one third of values obtained in healthy subjects tested using the
wake cycles same assay or less than or equal to 110pg/ml). Low CSF levels
of hypocretin-1 must not be observed in the context of acute
brain injury, inflammation or infection
3. Nocturnal sleep polysomnography showing REM sleep latency
less than or equal to 15 minutes, or a multiple sleep latency test
showing a mean sleep latency less than or equal to 8 minutes & 2
or more sleep onset REM periods
Specify current severity:
Mild: infrequent cataplexy (less than once per week), need for naps only
1-2x per day & less disturbed nocturnal sleep
Moderate: cataplexy once daily or every few days, disturbed nocturnal
sleep & need for multiple naps daily
Severe: drug-resistant cataplexy with multiple attacks daily, nearly
constant sleepiness & disturbed nocturnal sleep
✔ Either: Biological • Polysomnography
1. Evidence by polysomnography of at least 5 obstructive - Narrow or abnormal/damaged - During this sleep study, you're hooked up to
Obstructive apneas/hypopneas per hour of sleep & either of the ff symptoms: airway equipment that monitors your heart, lung and brain
Sleep Apnea a) Nocturnal breathing disturbances: snoring, snorting/gasping, - Obesity & increasing age activity, breathing patterns, arm and leg movements,
Hypopnea or breathing pauses during sleep - Use of MDMA (ecstasy) and blood oxygen levels while you sleep.
b) Daytime sleepiness, fatigue or unrefreshing sleep despite • Home sleep apnea testing
Recurrent suffcient opportunities to sleep that is not better explained - involves measurement of airflow, breathing patterns
episodes of upper by another disorder and blood oxygen levels, and possibly limb
airway collapse 2. Evidence by polysomnography of 15 or more obstructive apneas movements and snoring intensity.
that causes and/or hypopneas per hour of sleep regardless of accompanying
interruption of symptoms
breathing during Specify current severity: (per hour)
sleep Mild: Apnea hypopnea index is less than 15
Moderate: Apnea hypopnea index is 15-30
Severe: Apnea hypopnea index is greater than 30
Central Sleep ✔ Evidence by polysomnography of 5/more central apneas per Biological
Apnea hour of sleep - CNS disorders (cerebral vascular
Specify current severity: disease, head trauma & degenerative
Apnea episodes Severity is graded according to the frequency of the breathing disorders)
alternating with disturbances & the extent of associated oxygen desaturation & sleep
normal breathing fragmentation that occur as a consequence of repetitive respiratory
disturbances
Sleep-Related ✔ Polysomnography demonstrates episodes of decreased • Damaged lungs • Positive Airway Pressure (PAP) therapy using
Hypoventilation respiration associated w/ elevated CO2 levels (In the absence of • Obstructed airways continuous positive airway pressure (CPAP)
objective measurement of CO2, persistent low levels of • Non-Invasive Ventilation (NIV)
Blood oxygen hemoglobin oxygen saturation unassociated w/ - both provide oxygen through a mask worn when a
decrease below apneic/hypoapneic events may indicate hypoventilation) person is asleep.
90% for 5 mins & Specify current severity:
elevated CO2 Severity is graded according to the degree of hypoxemia & hypercarbia
levels for 10 mins present during sleep & evidence of end organ impairment due to these
during sleep abnormalities. The presence of blood gas abnormalities during
wakefulness is an indicator of greater severity
✔ Persistent/recurrent pattern of sleep disruption that due to an Biological • Environmental Therapy
alteration of the circadian system or to a misalignment between - Biological clock is in the ◦ Phase delays (moving bedtime later)
the endogenous circadian rhythm & the sleep-wake schedule suprachiasmatic nucleus in - Going to bed several hours later each night until
required by an individual’s physical environment or hypothalamus, which is connected in bedtime is at the desired hour
Circadian social/professional schedule a pathway that comes from our eyes ◦ Phototherapy
Rhythm Sleep- ✔ Sleep disruption leads to excessive sleepiness/insomnia, or both - Melatonin (produced by the pineal - Using bright light to trick the brain into
Wake Disorder Specify type: gland) is stimulated by darkness & readjusting the biological clock
Delayed sleep phase type: Trouble falling asleep & awakening on time ceases in daylight • Psychotherapy
Internal clock is Advanced sleep phase type: Trouble remaining awake until bedtime & ◦ Stimulus control
out of sync with awakens before time to arise - Using the bed only for sleeping and for sex, not
the environment Irregular sleep-wake type: Irregular sleep-wake periods for work or other anxietyprovoking activities
Non-24 hour sleep-wake type: Not the usual 24-hour ◦ Progressive relaxation or sleep hygiene
Shift work type: Because of night-shift work - Changing daily habits that may interfere with
Unspecified type sleep
Specify if: ◦ Cognitive-Behavioral Therapy (CBT)
Familial: Both delayed & advanced sleep phase types ◦ Sleep restriction
Overlapping w/ non-24hr sleep-wake type: delayed type ◦ Confronting unrealistic expectations about how
Specify if: much sleep is enough for a person
Episodic: last at least 1 month but less than 3 months
Persistent: last 3 months or longer
Recurrent: 2 or more symptoms within 1 year
✔ Recurrent episodes of incomplete awakening from sleep • Genetics • Pharmacotherapy
occurring during the first third of the major sleep episode, • Unhealthy sleeping ◦ Benzodiazepines
accompanied by either of the ff: schedule - for parasomnias that are long lasting or
• Sleepwalking: Repeated episodes of rising from bed during potentially harmful
Non-Rapid Eye sleep & walking about. While sleepwalking, person has a blank, ◦ Tricyclic antidepressants
Movement staring face; is relatively unresponsive to the efforts of others to • Behavioral Intervention
(NREM) Sleep communicate with him; and can be awakened only w/ great ◦ Schedule awakenings
Arousal difficulty • Psychotherapy
Disorder • Sleep terrors: Recurrent episodes of abrupt terror arousals from ◦ Hypnosis
sleep, usually beginning w/ a panicky scream. There’s intense ◦ Relaxation Therapy
Repeated fear & signs of autonomic arousal, such as mydriasis, ◦ Cognitive-Behavioral Therapy
incomplete tachycardia, rapid breathing & sweating, during each episode.
awakening from There is relative unresponsiveness to efforts of others to comfort
sleep the person during the episode
✔ No or little dream imagery is recalled
✔ Amnesia for the episodes are present
Specify if:
Sleepwalking type
Sleep terror type
Specify if:
With sleep-related eating
With sleep-related sexual behavior (sexsomnia)
Rapid Eye ✔ Repeated episodes of arousal during sleep associated w/ • Alpha-synuclein • Pharmacotherapy
Movement vocalization and/or complex motor behaviors Neurodegeneration ◦ Melatonin
(REM) Sleep ✔ Behaviors arise during REM sleep & therefore usually occur - may help reduce or eliminate your symptoms. It
Behavior greater than 90 minutes after sleep onset, are more frequent may be as effective as clonazepam and is usually
Disorder during the later portions of the sleep period & uncommonly well-tolerated with few side effects.
occur during daytime naps ◦ Clonazepam (Klonopin)
Dream enactment ✔ Upon awakening from these episodes, person is completely - often used to treat anxiety, is also the traditional
behaviors with awake, alert & not confused or disoriented choice for treating REM sleep behavior disorder,
vocal sounds & ✔ Either of the ff: appearing to effectively reduce symptoms. It may
sudden 1. REM sleep without atonia on polysomnographic recording cause side effects such as daytime sleepiness,
movements 2. History suggestive of REM sleep behavior disorder & an decreased balance and worsening of sleep apnea.
established synucleinopathy diagnosis (ex. Parkinson’s disease)
✔ Repeated occurrences of extended, extremely dysphoric & well- • Stress • Pharmacotherapy
remembered dreams that involve efforts to avoid threats to • Trauma ◦ Prazosin
survival, security/physical integrity & generally occur during the • Sleep deprivation • Behavioral Intervention
2nd half of the major sleep episode • Substance misuse ◦ Scheduled awakenings
✔ On awakening from the dysphoric dreams, the person rapidly • Psychotherapy
becomes oriented & alert ◦ Cognitive-Behavioral Therapy (CBT)
Nightmare Specify if: ◦ Imagery Rehearsal Therapy (IRT)
Disorder During sleep onset - Often used with people who have nightmares as
Specify if: a result of PTSD, imagery rehearsal therapy
Undesirable With associated non-sleep-disorder involves changing the ending to your
experiences while With associated other medical conditions remembered nightmare while awake so that it's no
sleeping With associated other sleep disorder longer threatening. You then rehearse the new
Specify if: ending in your mind. This approach may reduce
Acute: lasted less than 1 month the frequency of nightmares.
Subacute: lasted 1-6 months
Persistent: lasted 6+ months
Specify current severity:
Mild: less than 1 episode per week on average
Moderate: 1 or more episodes per week but less than nightly
Severe: episodes nightly

SEXUAL DYSFUNCTIONS
DISORDER DIAGNOSTIC CRITERIA ETIOLOGY INTERVENTIONS
✔ Persistently/Recurrently deficient/absent sexual thoughts or Biological • Pharmacotherapy
fantasies & desire for sexual activity. - Neurological diseases (diabetes & ◦ Sildenafil (Viagra)
✔ Criterion A has persisted for at least 6 months kidney & vascular disease) ◦ Levitra
Specify whether: - Chronic illnesses ◦ Cialis
Lifelong Type: Present since the patient became sexually active - Prescription medication (Anti- ◦ Injection of vasodilating drugs such as papaverine
Acquired Type: Began after a period of normal sex function hypertensive meds – beta-blockers) or prostaglandin directly into the penis
Male Hypoactive Specify whether: - Anti-depressants (SSRIs, Prozac) – by ◦ Surgery
Sexual Desire Generalized Type: Not limited to certain types of stimulation, altering levels of serotonin in brain ◦ Vacuum Device Therapy
Disorder situation or partners - Alcohol (CNS suppresant) - Works by creating a vacuum in a cylinder
Lack of interest in Situational Type: Only occurs with certain types of stimulation, - Nicotine placed over the penis
sexual activity situation or partners • Psychotherapy
Specify severity: Psychological ◦ Providing basic education about sexual
Mild: Mild distress - Anxiety --> Distractions functioning, altering deep-seated myths, and
Moderate: Moderate distress increasing communication
Severe: Severe distress Sociocultural ◦ Sensate focus
- Erotophobia – learned early in ◦ Nondemand pleasuring
childhood from families, authorities
- Traumatic sexual events
- Poor interpersonal relationship
- Script Theory – following scripts that
guides our behavior
✔ Lack of/Reduced sexual interest/arousal, as manifest by at Biological • Pharmacotherapy
least 3 of the ff: - Neurological diseases (diabetes & ◦ Estrogen therapy
1. Absent/reduced interest in sexual activity kidney & vascular disease) - Comes in the form of a vaginal ring, cream or
2. Absent/reduced sexual/erotic thoughts/fantasies - Chronic illnesses tablet. This therapy benefits sexual function by
3. No/reduced initiation of sexual activity & unreceptive to a - Prescription medication (Anti- improving vaginal tone and elasticity, increasing
Female Sexual partner’s attempts to initiate hypertensive meds – beta-blockers) vaginal blood flow and enhancing lubrication.
Interest/Arousal 4. Absent/reduced sexual excitement/pleasure during sexual - Anti-depressants (SSRIs, Prozac) – by ◦ Androgen therapy
Disorder activity in almost or all sexual encounters altering levels of serotonin in brain - Androgens include testosterone. It would only
5. Absent/reduced sexual interest/arousal in response to any - Alcohol (CNS suppresant) be used in women whom there isn’t any other
Lack of interest in internal/external sexual/erotic cues - Nicotine cause for the low sexual desire
sexual activity in 6. Absent/reduced genital/nongenital sensations during sexual ◦ Flibanserin (Addyi)
females activity Psychological - Originally developed as an antidepressant,
✔ Criterion A has persisted for at least 6 months - Anxiety --> Distractions flibanserin may boost sex drive in women who
Specify whether: experience low sexual desire and find it
Lifelong Type or Acquired Type Sociocultural distressing.
Generalized Type or Situational Type - Erotophobia – learned early in ◦ Bremelanotide (Vyleesi)
Specify current severity: childhood from families, authorities - Injection just under the skin in the belly or thigh
Mild, Moderate, Severe - Traumatic sexual events before anticipated sexual activity.
- Poor interpersonal relationship • Psychotherapy
- Script Theory – following scripts that ◦ Mindfulness-Based Cognitive Therapy
guides our behavior (MBCT)
- used in small groups of women, can improve
arousal, orgasm& subsequent desire & motivation
✔ At least 1 of the ff symptoms: Biological • Pharmacotherapy
1. Marked difficulty in obtaining an erection during sexual - Heart disease, high cholesterol, high ◦ Sildenafil (Viagra) – increases blood flow to the
activity blood pressure, diabetes penis within 1 hour of ingestion; the increased
Erectile Disorder 2. Marked difficulty in maintaining an erection until the - Obesity blood flow enables the user to attain an erection
completion of sexual activity - Smoking during sexual activity
Difficulty getting 3. Marked decrease in erectile rigidity • Psychotherapy
an erection ✔ Criterion A has persisted for at least 6 months Psychological ◦ Tease Technique – during sensate-focus
Specify whether: - Anxiety exercises: the partner keeps caressing the man,
Lifelong Type or Acquired Type - Depression but if the man gets an erection, the partner stops
Generalized Type or Situational Type - Stress caressing him until he loses it
Specify current severity: - Abuse/Trauma
Mild, Moderate, Severe
✔ Persistenr/recurrent difficulties with 1/more of ff: Biological • Practice tightening and relaxing vaginal muscles until
Genito-Pelvic 1. Vaginal penetration during intercourse - Affects the pelvic floor muscles around she gains more voluntary control over them.
Pain/Penetration 2. Marked vulvovaginal/pelvic pain during vaginal the vagina which causes the muscles to • Gradual behavioral exposure treatment to help her
Disorder intercourse/penetration attempts contract/tighten during penetration overcome her fear of penetration
3. Fear/anxiety about vulvovaginal/pelvic pain in anticipation • Botox – to help reduce spasms in those muscles
Pain during of or as a result of vaginal penetration Psychological
penetration 4. Marked tensing/tightening of the pelvic floor muscles - Trauma
during attempted vaginal penetration
✔ Criterion A has persisted for at least 6 months
Specify whether:
Lifelong Type or Acquired Type
✔ Consistently ejaculating within 1 minute/less of vaginal Biological • Pharmacotherapy
penetration - Excessive physiological arousal in SNS ◦ SSRIs – because these drugs often reduce sexual
Premature ✔ Criterion A has persisted for at least 6 months & has been may lead to rapid ejaculation arousal or orgasm
(Early) experienced 75-100% of the time - Psychological factor of anxiety also • Biological Therapy
Ejaculation Specify whether: increases sympathetic arousal. Thus, ◦ Squeeze Technique
Lifelong Type or Acquired Type when a man becomes anxiously aroused • Behavioral Therapy
Too quick Generalized Type or Situational Type about ejaculating too quickly, his making ◦ Stop, Start or Pause Procedure
ejaculation of a Specify current severity: it worse - penis is manually stimulated until the man is
man Mild, Moderate, Severe - Problem w/ oxytocin levels highly aroused. The couple then pauses until this
- Low serotonin/dopamine levels arousal subsides, after which the stimulation is
resumed. This sequence is repeated several times,
Psychological so the man ultimately experiences much more
- Performance anxiety-aggravating total time of stimulation than he has ever
- Stress experienced before.
- Depression
✔ Marked delay/infrequency/absence of ejaculation Biological • Include techniques to reduce performance anxiety and
Delayed ✔ Criterion A has persisted for at least 6 months & has been - Birth defects that affect the increase stimulation
Ejaculation experienced 75-100% of the time reproductive system • When it is caused by physical factors such as
(Orgasm) Specify whether: - Injury to pelvic nerves (control orgasm) neurological damage or injury, treatment may include
Lifelong Type or Acquired Type - Low thyroid/tostesterone level a drug to increase arousal of the sympathetic nervous
Too slow Generalized Type or Situational Type - Retrograde Ejaculation – semen goes system
ejaculation of a Specify current severity: back in bladder rather than out of the
man Mild, Moderate, Severe penis
✔ Delayed/infrequent/absent orgasm or markedly decreased Biological • Behavioral Therapy
Female intensity of orgasm after a normal sexual arousal phase on - Damage to genital sensory/autonomic ◦ Directed masturbation training
Orgasmic all/almost all sexual activity nerves/pathways (due to diabetes or - a woman is taught step by step how to
Disorder ✔ Criterion A has persisted for at least 6 months multiple sclerosis) masturbate effectively and eventually to reach
Specify if: - SSRIs orgasm during sexual interactions.
Delay or no Never experienced orgasm under any situation - includes the use of diagrams and reading
sexual climax for Specify whether: Psychological material, private self-stimulation, erotic material
women Lifelong Type or Acquired Type - Stress, anxiety and fantasies, “orgasm triggers” such as holding
Generalized Type or Situational Type - Lack of trust in partner her breath or thrusting her pelvis, sensate focus
Specify current severity: with her partner, and sexual positioning
Mild, Moderate, Severe
✔ Clinically significant disturbance in sexual function is
predominant in clinical picture
✔ There’s evidence in history, physical exam or lab findings of
both:
1. Symptoms in Criterion A developed during/soon after
substance intoxication/withdrawal or after exposure to a
medication
Substance/ 2. The involved substance/medication is capable of producing
Medication- the symptoms in Criterion A
Induced Sexual Specify if:
Dysfunction With onset during intoxication/withdrawal: Tacked on at the end
of string of words
With onset after medication use: Can be used in addition to other
specifiers
Specify severity:
Mild: Dysfunction in 25-50% of sexual encounters
Moderate: 50-75% of encounters
Severe: 75% or more

PARAPHILIC DISORDERS
DISORDER DIAGNOSTIC CRITERIA ETIOLOGY INTERVENTIONS
✔ At least 6 months, recurrent & intense sexual arousal from the use of Biological • Pharmacotherapy
nonliving objects or a highly specific focus on nongenital body parts, as - Weak Behavioral Inhibition ◦ Cyproterone acetate
manifested by fantasies, urges/behaviors System (BIS) in the brain that - An antiandrogen
Fetishistic ✔ The fetish objects are not limited to articles of clothing used in cross-dressing might repress serotonergic - “Chemical castration” drug
Disorder (as in transvestic) or devices specifically designed fro the purpose of tactile functioning - Eliminates sexual desire and fantasy by
Sexual arousal genital simulation reducing testosterone levels dramatically
from the use of Specify type: Psychosocial ◦ Medroxyprogesterone (Depo-Provera
nonliving object Body parts - Inadequate social is the injectable form)
Nonliving objects relationships - A hormonal agent that reduces
Other (can be combination of the 2) testosterone
Specify if: Psychological • Psychotherapy
In remission - Abuse ◦ Covert sensitization
In a controlled environment - Early sexual fantasies - Carried out entirely in the imagination
✔ At least 6 months, recurrent & intense sexual arousal from observing an of the patient
Voyeuristic unsuspecting person who is naked, in the process of disrobing or engaging in Behavioral - Patients associate sexually arousing
Disorder sexual activity, as manifested by fantasies, urges/behaviors - Operant Conditioning – images in their imagination with some
Sexual arousal ✔ Acted with a non-consenting person sexual arousal is reinforced reasons why the behavior is harmful or
from observing an ✔ Person experiencing the arousal or acting the urges is at least 18 years old through association with dangerous
unsuspecting Specify if: orgasm ◦ Orgasmic reconditioning
person who is In full remission: no symptoms for 5+ years - Patients are instructed to masturbate to
naked In a controlled environment their usual fantasies but to substitute
✔ At least 6 months, recurrent & intense sexual arousal from the exposure of more desirable ones just before
Exhibitionistic one’s genitals to an unsuspecting person, as manifested by fantasies, ejaculation
Disorder urges/behaviors ◦ Relapse prevention
Sexual arousal ✔ Acted with a non-consenting person
from the exposure Specify type: sexually aroused by exposing to:
of one’s genitals Prepubertal children
to an Physicall mature individuals
unsuspecting Prepubertal children & physically mature individuals
person Specify if:
In full remission: no symptoms for 5+ years
In a controlled environment
Frotteuristic ✔ At least 6 months, recurrent & intense sexual arousal from touching/rubbing
Disorder against a non-consenting person, as manifested by fantasies, urges/behaviors
Sexual arousal Specify if:
from rubbing In full remission: no symptoms for 5+ years
against a non- In a controlled environment
consenting person
✔ At least 6 months, recurrent & intense sexual arousal from cross-dressing as
Transvestic manifested by fantasies, urges/behaviors
Disorder Specify if:
Sexual arousal With fetishism: Sexual arousal by clothing/fabrics
from cross- With autogynephilia: Arousal by self-visualization as female
dressing Specify if:
In full remission: no symptoms for 5+ years
In a controlled environment
✔ At least 6 months, recurrent & intense sexual arousal from the
Sexual Sadism psychological/physical suffering of another person, as manifested by fantasies,
Disorder urges/behaviors
Sexual arousal ✔ Acted with a non-consenting person
from the suffering Specify if:
of another person In full remission: no symptoms for 5+ years
In a controlled environment
Sexual ✔ At least 6 months, recurrent & intense sexual arousal from the act of being
Masochism humiliated, beaten, bound or suffer, as manifested by fantasies, urges/behavior
Disorder Specify if:
Sexual arousal With asphyxiophilia: Sexual arousal by oxygen deprivation
from the act of Specify if:
being humiliated, In full remission: no symptoms for 5+ years
beaten/suffer In a controlled environment
Pedophilic ✔ At least 6 months, recurrent, intense sexually arousing fantasies, sexual
Disorder urges/behaviors involving sexual activity w/ a prepubescent child/children (13
Sexual arousal on years or younger)
children ✔ Person is at least 16 years & at least 5 years older than the child
Note: Don’t include an individual in late adolescence involved in an ongoing sexual
relationship with a 12 or 13 year old
Specify if:
In a controlled environment
Specify Type:
Exclusive Type: Aroused by children only
Non-exclusive Type:
Specify if:
Sexually attracted to: males, females, both
Limited to incest

GENDER DYSPHORIA
DISORDER DIAGNOSTIC CRITERIA ETIOLOGY INTERVENTIONS
In Children: Biological • Psychological evaluation and education
✔ Marked incongruence between one’s experienced/expressed - Genetics • Administration of gonadal hormones to bring
gender & assigned gender, of at least 6 months, as manifested by - Slightly higher levels of about desired secondary sex characteristics
at least 6 of the ff: testosterone/estrogen at certain - Partially reversible
1. Strong desire to be of the other gender or an instance that one is critical periods of development • Sex Reassignment Surgery
the other gender - Structural differences in the area of - Non-reversible
2. Boys – strong preference for cross-dressing/stimulating female the brain • Alter anatomy physically to be consistent with gender
attire; Girls – strong preference for wearing only typical - Exposure to higher levels of fetal identity
masculine clothing testosterone was associated w/ more • Must live in the desired gender for 1-2 years
Gender 3. Strong preference for cross-dressing roles in fantasy play masculine play behavior in both boy • Must be stable psychologically, financially, and
Dysphoria 4. Strong preference for the toys, games or activities stereotypically & girls during childhood socially
used by the other gender • Gynecomastia
Person’s physical 5. Strong preference for playmates of other gender Social - The growth of breasts (for transwomen)
sex is not 6. Boys – strong rejection of typically masculine toys, - Excessive attention & physical
consistent w/ who games/activities; Girls – strong rejection of typically feminine contact Treatment of Gender Nonconformity in Children
he/she really is toys, games/activities - Lack of male/female playmates • Work with the child and caregivers to lessen gender
7. Strong dislike of one’s sexual anatomy dysphoria and decrease cross-gender behaviors on the
8. Strong desire for the primary/secondary sex characteristics that assumption that these behaviors are unlikely to persist
match one’s experienced gender anyway and the negative consequences of social
rejection could be avoided, and that avoiding later
In Adolescents & Adults: intrusive surgery would be desirable
✔ Marked incongruence between one’s experienced/expressed • “Watchful waiting”
gender & assigned gender, of at least 6 months, as manifested by - Letting expressed gender unfold naturally
at least 2 of the ff: • Actively affirming and encouraging cross-gender
1. Markedncongruence between one’s experienced/expressed identification, but critics point out that gender
gender & primary/secondary sex characteristics nonconformity usually does not persisted
2. Strong desire to be rid of one’s primary/secondary sex
characteristics because of the incongruence (Young adolescents: Treatment of Disorders of Sex Development
desire to prevent the development of the anticipated secondary (Intersexuality)
sex characteristics) • Surgery
3. Strong desire for the primary/secondary sex characteristics of the • Hormonal Replacement Therapy (HRT)
other gender • Psychological treatments to help individuals adapt to
4. Strong desire to be of the other gender their particular sexual anatomy or their emerging
5. Strong desire to be treated as the other gender gender experience
6. Strong conviction that one has the typical feelings & reactions of
the other gender
Specify if:
With a disorder of sex development
Posttransition: Living in the desired gender & has had at least 1 cross-
gender surgical procedure or medical treatment

SUBSTANCE-USE & ADDICTIVE DISORDERS

DISORDER DIAGNOSTIC CRITERIA ETIOLOGY INTERVENTIONS
Alcohol-Use ✔ Problematic pattern of use as manifested by at least 2 of the Neurobiological • First step: help someone through the withdrawal process
Disorder ff, occurring within 12 months: - Genetics • Ultimate goal: abstinence
Sedative, 1. Taken in larger amounts/longer period than was intended - Brain has a natural “pleasure • Pharmacotherapy
Hypnotic or 2. Persistent desire/unsuccessful efforts to cut down/control the pathway” that mediates our ◦ Sedative drugs (benzodiazepines)
Anxiolytic-Use use experience reward & all abused - Help minimize discomfort for people withdrawing
Disorder 3. Great deal of time is spent in activities necessary to obtain the substances affect this internal from other drugs, such as alcohol
Stimulant-Use use or recover from its effects reward center in the same way we ◦ Clonidine
Disorder 4. Craving/strong desire/urge to use experience pleasure from foods or - Given to people withdrawing from opiates
Tobacco-Use 5. Recurrent use resulting in failure to fulfill major role sex ◦ Nicotine Replacement Therapy (patch, gum, spray,
Disorder obligations - psychoactive drugs has the inhaler, lozenge)
Caffeine-Use 6. Continued use despite having persistent/recurrent social ability to activate this reward • Agonist Substitution – providing the person with a safe
Disorder problems caused by the effects center & provide pleasurable drug that has a chemical makeup similar to the addictive
Opioid-Use 7. Important activities are given up/reduced experiences drug (therefore the name agonist)
Disorder 8. Recurrent use in physically hazardous situations - high = GABA neurons which ◦ Methadone – an opiate agonist often given as a
Cannabis-Use 9. Use is continued despite knowledge of having acts as the “brain police” of the heroine substitute; originally called “adolphine”
Disorder physical/psychological problem that is likely to have been reward neurotransmitter system ◦ Buprenorphine – blocks the effects of opiate and
caused by the use encourage better compliance
Hallucinogen- 10. Tolerance, as defined by either of the ff: Behavioral ◦ Nicotine – a cigarette substitute; provided to smokers
Use Disorder a) Need for increased amounts to achieve - Positive Reinforcement in the form of gum, patch, inhaler, or nasal spray,
intoxication/desired effect (pleasurable feelings) which lack the carcinogens included in cigarette smoke
b) Diminished effect w/ continued use of the same amount - Negative Reinforcement (reduce ◦ Bupropion (Zyban) – medical treatment for smoking;
11. Withdrawal, as manifested by either of the ff: unpleasant feelings) also serves as an antidepressant under the trade name
a) Characteristic withdrawal syndrome Wellbutrin
b) Taken to relieve/avoid withdrawal symptoms Cognitive • Antagonist Treatments – block/counteract the effects of
Specify if: - Expectancy Effect – what people psychoactive drugs
In early remission: Begins after 3 months sober & lasts until 1 year of expect to experience when they ◦ Naltrexone – has limited success with individuals who
sobriety use drugs influences how they are not simultaneously participating in a structured
In sustained remission: Begins after the first year of sobriety react to them treatment program
In a controlled environment: Restricts access to substance ◦ Acomprosate – decrease cravings in people dependent
On maintenance therapy Social on alcohol
Specify current severity: - Exposure • Aversive treatments
Mild: 2-3 symptoms ◦ Disulfiram (Antabuse)
Moderate: 4-5 symptoms - For people who are alcohol-dependent
Severe: 6 or more symptoms - Prevents the breakdown of acetaldehyde, a by-
product of alcohol, and the resulting build-up of
acetaldehyde causes feelings of illness
- Causes nausea, vomiting, elevated heart rate, and
respiration
◦ Use of silver nitrate in lozenges or gum
- Combines with saliva to produce a bad taste in the
mouth
• Psychosocial treatments
◦ Inpatient facilities
- Designed to help people get through the initial
withdrawal period and to provide supportive therapy
so they can go back to their communities
- Can be extremely expensive
◦ Alcoholics Anonymous (AA) and its variations
▪ Twelve Steps program – developed by AA; the
basis of its philosophy
▪ Foundation of AA is the notion that alcoholism is
a disease and alcoholics must acknowledge their
addiction to alcohol and its destructive power over
them
• Component Treatments
◦ Contingency Management
- Clinician and client together select the behaviors that
the client needs to change and decide on the
reinforcers that will reward reaching certain goals
◦ Community Reinforcement Approach
- Several facets of the drug problem are addressed to
help identify and correct aspects of the person’s life
that might contribute to substance use or interfere with
efforts to abstain
◦ Motivational Enhancement Therapy (MET)
- Intends to improve the individual’s beliefs that any
changes made (e.g., drinking less) will have positive
outcomes (e.g., more family time)
◦ Cognitive-Behavioral Therapy (CBT)
- Addresses multiple aspects of the disorder, including
a person’s reactions to cues that lead to substance use
(e.g., being among certain friends)
- Addresses the problem of relapse
◦ Aversion Therapy
- help clients identify and change the behaviors and
cognitions that keep contributing to their patterns of
substance misuse
✔ Persistent & recurrent problematic gambling behavior as Biological • Treatment is often similar to substance dependence
indicated by 4/more of the ff in 12 months: - Decreased activity on the treatment
1. Needs to gamble w/ increasing amounts of money in order to regions of the brain involved in • Gambler’s Anonymous
achieve the desired excitement impulse regulation - Incorporates the Twelve Step program
Gambling 2. Restless/irritable when attempting to cut down/stop gambling - Ventromedial prefrontal cortex • Cognitive-behavioral interventions
Disorder 3. Made repeated unsuccessful efforts to control/stop gambling & orbitofrontal cortex (executive ◦ Setting financial limits
4. Pre-occupied with gambling parts of the brain) do not function ◦ Planning alternative activities
Persistent and 5. Gambles when feeling distressed normally ◦ Preventing relapse
recurrent 6. After losing money gambling, returns another day to get even ◦ Imaginal desensitization
maladaptive 7. Lies to conceal the extent of involvment w/ gambling
gambling 8. Jeopardized/lost significant relationship, job or opportunities
behavior that 9. Relies on others to provide money to relieve desparate
disrupts personal, financial situations caused by gambling
family, and/or ✔ Not better explained by manic episode
vocational Specify if:
pursuits. Episodic or Persistent
Specify if:
In early remission: No criteria met for 3-12 months
In sustained remission: No criteria met for more than 1 year
Specify current severity:
Mild: 4-5 criteria met
Moderate: 6-7 criteria met
Severe: 8-9 criteria met
✔ Recent consumption of caffeine (typically a high dose in
excess of 250 mg)
Caffeine ✔ 5/more of the ff developing during or shortly after caffeine
Intoxication use: Restlessness, Nervousness, Excitement, Insomnia,
Flushed Face, Diuresis, Gastrointestinal Disturbance, Muscle
Twitching, Rambling flow of thought & speech, Tachycardia,
Periods of inexhaustibility, Psychomotor Agitation
DISRUPTIVE, IMPULSE-CONTROL & CONDUCT DISORDERS
DISORDER DIAGNOSTIC CRITERIA ETIOLOGY INTERVENTIONS
✔ Recurrent behavioral outburst representing a failure to control aggressive Biological • Psychotherapy
impulses as manifested by either of the following: - Disruption of the orbital ◦ Psychotherapy with patients is difficult because
1. Verbal aggression or physical aggression toward property, animals, or frontal cortex’s role in of their angry outbursts.
other individuals, occurring twice weekly, on average, for a period of 3 inhibiting amygdala ◦ Cognitive-Behavioral Therapy (CBT)
Intermittent months. The physical aggression does not result in damage or destructionactivation combined w/ - Helping the person identify and avoid
Explosive of property and does not result in physical injury to animals or other changes in serotonin system “triggers” for aggressive outbursts
Disorder (IED) individuals. ◦ Family & Group Therapy
2. 3 behavioral outbursts involving damage or destruction of property - If the patient is an adolescent or a young adult
Aggressive and/or physical assault involving physical injury against animals or other ◦ The goal is to have the patient recognize and
outbursts that has individuals occurring within a 12-month period. verbalize the thoughts or feeling that precede the
a rapid onset & w/ ✔ The magnitude of aggressiveness expressed during the recurrent explosive outbursts instead of acting them out
little to no warning outbursts is out of proportion to the provocation or to any precipitating
psychosocial stressors
✔ The recurrent aggressive outbursts are not premeditated (i.e., they are
impulsive and/or anger-based) and are not committed to achieve some
tangible objective (e.g., money, power, intimidation)
✔ Chronological age is at least 6 years (or equivalent developmental level)
✔ Pattern of angry/irritable mood, argumentative/defiant behavior, or Environmental • Psychotherapy
vindictiveness lasting at least 6 months as evidenced by at least 4 - Disrupted child care by the ◦ Family intervention
symptoms from any of the ff & exhibited during interaction with at least presence of multiple - To reinforce more prosocial behaviors and to
1 individual who is not a sibling. caregivers diminish undesired behaviors at the same time
Oppositional Argumentative/Defiant Behavior: - Harsh, inconsistent, ◦ Cognitive Behavioral Therapy (CBT)
Defiant Disorder 1. Often argues with authority figures or, for children and adolescents, with neglectful child-rearing - Emphasizes teaching parents how to alter their
(ODD) adults. practices behavior to discourage the child’s oppositional
2. Often actively defies or refuses to comply with requests from authority behavior by diminishing attention to it, and
Frequent and figures or with rules. encourage appropriate therapy focused on
persistent pattern 3. Often deliberately annoys others. selectively reinforcing and praising appropriate
of angry/irritable 4. Often blames others for his/her mistakes/misbehavior behavior and ignoring undesired behavior
mood, Angry/Irritable Mood: ◦ Individual psychotherapy
argumentative 1. Often loses temper. - In which they role play and “practice” more
/defiant behavior 2. Often touchy or easily annoyed. adaptive responses
or vindictiveness 3. Often angry and resentful
Vindictiveness:
1. Has been spiteful or vindictive at least twice within the past 6 months.
✔ The disturbance in behavior is associated with distress in the individual
or others in his/her immediate social context
Specify current severity:
Mild: Confined to only 1 setting
Moderate: At least 2 settings
Severe: 3 or more settings
✔ Repetitive & persistent pattern of behavior where the basic rights of Neurobiological • Psychosocial Therapy
others/major age-appropriate societal norms/rules are violated, as - frontotemporal-limbic ◦ Cognitive Behavioral Therapy (CBT)
manifested by the presence of at least 3 of the ff in the past 12 months, connections involving the Approaches
with at least 1 criterion present in the past 6 months: ventral prefrontal cortex and ▪ Kazdin’s Problem-Solving Skills Training
Aggression to People & Animals: amygdala are seen (PSST)
1. Often bullies, threatens, or intimidates others - Heredity - in which a 12- week sequential program
2. Often initiates physical fights helps children develop problem solving
3. Has used a weapon that can cause serious physical harm to others Psychological solutions when faced with conflictual
4. Has been physically cruel to people - Temperament situations
5. Has been physically cruel to animals ▪ The Incredible Years
6. Has stolen while confronting a victim Cognitive - targets young children, ages 3 to 8 years, is
7. Has forced someone into sexual activity - Low IQ (verbal) administered over 22 weeks and delivers
Destruction of Property: sessions to the child and has a parent
1. Has deliberately engaged in fire setting with the intention of causing Environmental training component and a teacher training
Conduct serious damage - Adverse childhood events ▪ Anger Coping Program
Disorder 2. Has deliberately destroyed others’ property - Peer rejection - an 18-session intervention for school-aged
Deceitfulness/Theft: children in the grades 4-6 focused on a
Repetitive & 1. Has broken into someone else’s house or car child’s increased development of emotion
persistent pattern 2. Often lies to obtain goods or favors or to avoid obligations (“cons” recognition and regulation, and managing
of behavior in others) anger. It includes distraction, self-talk,
which the basic 3. Has stolen items of nontrivial value without confronting a victim perspective taking, goal setting, and problem
rights of Serious Violations of Rules: solving
others/major age- 1. Often stays out at night despite parental prohibitions, beginning before
appropriate age 13 years
societal 2. Has run away from home overnight at least twice while living in the
norms/rules are parental or parental surrogate home, or once without returning for a long
violated period
3. Is often truant from school, beginning before age 13 years
✔ If the individual is age 18 year or older, criteria are not met for antisocial
personality disorder
Specify if:
Childhood-onset type: At least 1 symptom prior to age 10
Adolescent-onset type: No symptom prior to age 10
Unspecified onset: Criteria are met but not enough information available to
determine whether the onset of the first symptom was before or after age 10
years.
Specify severity:
Mild: Minor harm to others
Moderate: Intermediate effects
Severe: Considerable harm to others
Specify if:
With limited prosocial emotions /callous-unemotional traits (cold, uncaring, no
empathy)
✔ Failure to resist impulses to steal objects that are not needed for personal Biological • Pharmacotherapy
use/monetary value. - Damage in areas of the ◦ Antidepressants
✔ Increasing sense of tension immediately before committing the theft. brain associated w/ poor ▪ Naltrexone – an opioid antagonist also used
✔ Pleasure, gratification, or relief at the time of committing the theft. decision making in the treatment of alcoholism
Kleptomania ✔ Not committed to express anger/vengeance and is not in response to a • Psychotherapy
delusion/hallucination. ◦ Insight-oriented psychotherapy and
Failure to resist psychoanalysis have been successful, but depend
impulses to steal on patients’ motivations
items ◦ Those who feel guilt and shame may be helped
by insight-oriented psychotherapy because of
their increased motivation to change their
behavior
◦ Behavior therapy
▪ Systematic desensitization, aversive
conditioning, and combination of aversive
conditioning and altered social contingencies
✔ Deliberate and purposeful fire setting on more than 1 occasion. Social • Psychotherapy
✔ Tension or affective arousal before the act. - Family history ◦ Cognitive Behavioral Therapy (CBT)
Pyromania ✔ Fascination with, interest in, curiosity about, or attraction to fire and its ▪ Helping the person identify the signals that
initiate the urges
situational contexts
Multiple episodes ▪ Teaching coping strategies to resist the
of deliberate & ✔ Pleasure, gratification, or relief when setting fires, or when witnessing or temptation to start fires
purposeful fire participating in their aftermath. ◦ Family Therapy
setting ✔ The fire setting is not done for monetary gain, expression of
sociopolitical ideology, conceal criminal activity, express
anger/vengeance, improve one's living circumstances, response to a
delusion/hallucination, result of impaired judgment

PERSONALITY DISORDERS
DISORDER DIAGNOSTIC CRITERIA ETIOLOGY INTERVENTIONS
✔ Pervasive distrust & suspiciousness of others such that their motives Biological • Unlikely to seek professional help
are interpreted as malevolent, beginning by early adulthood & present - Genetics (Family history of • Therapists provide an atmosphere conducive to
in a variety of contexts, as indicated by 4/more of the ff: schizophrenia) developing a sense of trust
Paranoid PD 1. Suspects, without sufficient basis, that others are exploiting, harming or • Cognitive Therapy
deceiving him/her Psychological ◦ To counter the person’s mistaken assumptions
Pervasive distrust 2. Preoccupied w/ unjustified doubts about the loyalty/trustworthiness of - Early mistreatment or about others, focusing on changing the person’s
& suspiciousness friends/associates childhood trauma beliefs that all people are malevolent and most
of others without 3. Reluctant to confide in others because of unwarranted fear that the people cannot be trusted
adequate reasons information will be used maliciously against him/her Cultural
4. Reads hidden demeaning/threatening meanings into benign events - Unique experiences
5. Persistently bears grudges (immigrant in new culture)
6. Perceives attacks on his/her character/reputation that are not apparent
to others & is quick to react angrily or to counterattack
7. Has current suspicions, without justification, regarding fidelity of
spouse/sexual partner
Specify if:
Premorbid: If it precedes the onset of schizophrenia
✔ Pervasive pattern of detachment from social relationships & restricted Neurobiological • Rare for a person with the disorder to seek treatment
range of expression of emotions in interpersonal settings, beginning by - Biological dysfunction • Therapists point out the value in social relationships
early adulthood & present in a variety of contexts, as indicatd by found in autism combined w/ • May need to be taught the emotions felt by others to
Schizoid PD 4/more of the ff: early problems w/ learn empathy
1. Neither desires nor enjoys close relationships, including being part of a interpersonal relationships • Receive social skills training
Detachment from family • Role-playing
social 2. Almost always chooses solitary activities Psychological ◦ Therapist takes the part of a friend or significant
relationships & 3. Has little, if any, interest in having sexual experiences w/ others - Childhood shyness other and help the patient practice establishing
restricted range of 4. Takes pleasure in few, if any, activities - Childhood abuse & neglect and maintaining social relationships
expression of 5. Lacks close friends/confidants other than first degree relatives
emotions 6. Appears indifferent to the praise/criticism of others
7. Show emotional coldness, detachment or flattened affectivity
Specify if:
Premorbid: If it precedes the onset of schizophrenia
✔ Pervasive pattern of social & interpersonal deficits marked by acute Biological • Pharmacotherapy
discomfort & reduced capacity for close relationships and - Genetics ◦ Haloperidol
cognitive/perceptual distortions & eccentricities of behavior, beginning - Damage in the left - To reduce ideas of reference, odd
by early adulthood & present in a variety of contexts, as indicated by hemisphere communication, and isolation
Schizotypal PD 5/more of the ff: - Generalized brain ◦ Antipsychotic medication (younger persons)
1. Ideas of reference (excluding delusions of reference) abnormalities • Psychotherapy
Social & 2. Odd beliefs/magical thinking that influences behavior & is inconsistent ◦ Treatment includes some of the medical and
interpersonal w/ subcultural norms Psychological psychological treatments for depression
deficits marked by 3. Unusual perceptual experiences, including bodily illusions - Childhood maltreatment ◦ Teaching social skills to reduce isolation and
acute discomfort 4. Odd thinking & speech suspicion
w/ reduced 5. Suspiciousness or paranoid ideation ◦ Cognitive Behavioral Therapy (CBT)
capacity for close 6. Inappropriate or constricted affect - For younger persons, in order to avoid the onset
relationships 7. Behavior/appearance that is odd/eccentric of schizophrenia is proving to be a promising
8. Lack of close friends/confidants other than first degree relatives prevention strategy
9. Excessive social anxiety that doesn’t diminish w/ familiarity & tends to
be associated w/ paranoid fears rather than negative judgments about
self
Specify if:
Premorbid: If it precedes the onset of schizophrenia
✔ Pervasive pattern of disregard for & violation of the rights of others, Neurobiological • Rarely identify themselves as needing treatment
occurring since age 15, as indicated by 3/more of the ff: - Genetics • Most clinicians are pessimistic about the outcome of
1. Failure to conform to social norms w/ respect to lawful behaviors, as - Underarousal theories treatment for adults as they can be manipulative even
indicated by repeatedly performing acts that are grounds for arrest (psychopaths have low levels with their therapists
2. Deceitfulness, as indicated by repeated lying, use of aliases or conning of cortisol arousal) • In general, therapists agree with incarcerating
of others for personal profit/pleasure - Fearlesness theories (imprisoning) these people to defer future antisocial
3. Impulsivity/failure to plan ahead (higher threshold for acts
4. Irritability & aggressiveness, as indicated by repeated physical experiencing fear than others) • Clinicians encourage identification of high-risk
fights/assaults - Imbalance between BIS children so that treatment can be attempted before
5. Reckless disregard for safety of self/others Behavioral Inhibition System they become adults
Antisocial PD 6. Consistent irresponsibility, as indicated by repeated failure to sustain (ability to stop when we are • Parent training for children
consistent work behavior or honor financial obligations faced w/ impending • Prevention through preschool programs
Disregard for & 7. Lack of remorse, as indicated by being indifferent to or rationalizing punishment) & reward
violation of the having hurt, mistreated or stolen from another system may make the fear &
rights of others ✔ Individual is at least 18 years old anxiety less apparent & the
✔ There is evidence of conduct disorder with onset before age 15 years positive feelings more
prominent
- Reduced activation in
frontal cortex

Behavioral
- Once they set their sights on
a reward goal, they are less
likely to be deterred despite
the signs that it is
unachievable

Social
- Coercive family process
- Less parental involvment
✔ Pervasive pattern of instability of interpersonal relationships, self- Neurobiological • Pharmacotherapy
image & affects and marked impulsivity, beginning by early adulthood, - Genetics ◦ Mood stabilizers
as indicated by 5/more of the ff: - Low serotonergic activity is ▪ Anticonvulsive and antipsychotic drugs
1. Frantic efforts to avoid real/imagined abandonment (Don’t include involved w/ the regulation of - effective for disturbances in affect (e.g.,
Borderline PD suicidal/self-mutilating behavior covered in Criterion 5) mood & impulsivity anger, sadness)
2. Pattern of unstable & intense interpersonal relationships characterized • Psychotherapy
Instability of by alternating between extremes of idealization & devaluation ◦ Cognitive-Behavioral Therapy (CBT)
interpersonal 3. Identity disturbance: markedly & persistently unstable self-image/sense Psychological ▪ Dialectical Behavior Therapy (DBT)
relationships, self- of self - Early trauma (sexual & - Involves helping people cope with the
image, affects & 4. Impulsivity in at least 2 areas that are potentially self-damaging physical abuse) stressors that seem to trigger suicidal
control over (spending, sex, substance abuse, reckless driving, binge eating) (Not - Temperament behaviors
impulses suicidal/self-mutilating behavior) ◦ Patients appear quite distressed and are more
5. Recurrent suicidal behavior, gestures or threats or self-mutilating Cultural likely to seek treatment
behavior - Immigrant ◦ Symptomatic treatment
6. Affective instability due to a marked reactivity of mood (ex. Intense
episodic dysphoria, irritability, anxiety only lasting a few hours)
7. Chronic feelings of emptiness
8. Inappropriate, intense anger or difficulty controlling anger
9. Transient, stress-related paranoid ideation/severe dissociative
symptoms
✔ Pervasive pattern of excessive emotionality & attention seeking, Biological • A large part of therapy focuses on the problematic
beginning by early adulthood, as indicated by 5/more of the ff: - Co-occuring w/ antisocial interpersonal relationships
1. Uncomfortable in situations in which he/she is not the center of pd • People with the disorder need to be shown how the
attention - Genetics short-term gains derived from their various
Histrionic PD 2. Interaction w/ others is often characterized by inappropriate sexually interactional styles (e.g., emotional crises, using
seductive/provocative behavior Psychological charm, sex, seductiveness, or complaining) result in
Excessive emotion 3. Displays rapidly shifting & shallow expression of emotions - Child abuse/trauma/neglect long-term costs, and be taught more appropriate ways
& attention 4. Consistently uses physical appearance to draw attention to self of negotiating their wants and needs
seeking 5. Has a style of speech that is excessively impressionistic & lacking in
detail
6. Shows self-dramatization, theatricality & exaggerated expression of
emotion
7. Is suggestible
8. Considers relationships to be more intimate than they actually are
✔ Pervasive pattern of grandiosity, need for admiration & lack of Environmental • Psychotherapy
empathy beginning by early adulthood, as indicated by 5/more of the - Failure by the parents of ◦ Therapy focuses on the person’s grandiosity,
ff: modeling empathy their hypersensitivity to evaluation, and their
1. Grandiose sense of self-importance lack of empathy towards others
Narcissistic PD 2. Preoccupied w/ fantasies of unlimited success, power, brilliance, Cultural ◦ Cognitive therapy
beauty or ideal of love - most Western societies with - Strives to replace the person’s fantasies with a
Grandiosity, need 3. Believes that he/she is special & unique and can only be understood by, large-scale social changes focus on the day-to-day pleasurable experiences
for admiration & or should associate with, other special/high status people/institution - Baby boomers (“me” that truly attainable
lack of empathy 4. Requests excessive admiration generation) ◦ Coping strategies such as relaxation training to
5. Has a sense of entitlement help them face and accept criticism
6. Interpersonally exploitative ◦ Helping them focus on the feelings of others
7. Lacks empathy
8. Often envious of others/believes that others are envious of him/her
9. Shows arrogant, haughty behaviors/attitudes
✔ Pervasive pattern of social inhibition, feelings of inadequacy & Biological • Behavioral Therapy
hypersensitivity to negative evaluation, beginning by early adulthood, - Family history of ◦ Behavioral intervention techniques for anxiety
Avoidant PD as indicated by 4 or more of the ff: schizophrenia and social skills problems
1. Avoids occupational activities that involve significant interpersonal ◦ Systematic desensitization
Social inhibition, contact because of fears of criticism, disapproval/rejection Psychological ◦ Behavioral rehearsal
feelings of 2. Unwilling to get involved w/ people unless certain of being liked - Difficult temperament or • Many of the same treatments used for social phobia
inadequacy & 3. Shows restraint within intimate relationships because of the fear of personality characteristics • Therapeutic alliance
hypersensitivity to being shamed/ridiculed - Low-self esteem - The collaborative connection between therapist and
negative 4. Preoccupied w/ being criticized/rejected in social situations client
evaluation 5. Inhibited in new interpersonal situations because of feelings of Environmental - An important predictor for treatment success
inadequacy - Neglect of parents
6. Views self as socially inept, personally unappealing or inferior to others - Childhood isolation,
7. Unusually reluctant to take personal risks or to engage in any new rejection & conflict w/ others
activities because they may prove embarrassing
✔ Pervasive & excessive need to be taken care of that leads to submissive Behavioral • People with the disorder can appear to be ideal
& clinging behavior & fears of separation, beginning by early - Genetics patients because of their attentiveness and eagerness
adulthood as indicated by 5/more of the ff: to give responsibility for their problems to the
1. Difficulty making everyday decisions without an excessive amount of Environmental therapist
advice & reassurance from others - Early death of a parental • This submissiveness, however, negates one of the
Dependent PD 2. Needs others to assume responsibility for most major areas of life - Parental neglect/rejection major goals of therapy: make the person more
3. Difficulty expressing disagreement w/ others because of fear of loss of independent and personally responsible
Excessive need to support/approval (Do not include realistic fears of distribution) • Therapy progresses gradually as the patient develops
be taken care of 4. Has difficulty initiating projects or doing things on his/her own (lack of confidence in their ability to make decisions
self-confidence/abilities rather than lack of motivation/energy) independently
5. Goes to excessive lengths to obtain nurturance & support from others,
to the point of volunteering to do things that are unpleasant
6. Feels uncomfortable/helpless when alone because of exaggerated fears
of being unable to take care of him/herself
7. Urgently seeks another relationship as a source of care & support when
a close relationship ends
8. Unrealistically preoccupied w/ fears of being left to take care of
himself
✔ Pervasive pattern of preoccupation w/ orderliness, perfectionisim & Biological • Therapy often attacks the fears that seem to underlie
mental & interpersonal control, at the expense of flexibility, openness - Family history of the need for orderliness
& eficiency, beginning by early adulthood as indicated by 4 or more of personality disorders, anxiety • Therapists help the individual relax or use distraction
the ff: or depression techniques to redirect the compulsive thoughts
Obsessive- 1. Preoccupied w/ details, rules, lists, order, organization or schedules to
Compulsive PD the extent that the major point of the activity is lost
2. Shows perfectionism that interferes w/ task completion
Preoccupation w/ 3. Excessively devoted to work & productivity to the exclusion of leisure
orderliness, activities & friendships (not accounted for by obvious economic
perfectionism & necessity)
control 4. Overconscientious, scrupulous & inflexible about matters of morality,
ethics or values (not accounted for by cultural/religious identification)
5. Unable to discard worn-out/worthless objects even when they have no
sentimental value
6. Reluctant to delegate tasks or to work with others unless they submit to
exactly his/her way of doing things
7. Adopts a miserly spending style toward both self & other; money is
viewed as something to be hoarded for future catastrophes
8. Shows rigidity & stubbornness
SCHIZOPHRENIA SPECTRUM & OTHER PSYCHOTIC DISORDERS
DISORDER DIAGNOSTIC CRITERIA ETIOLOGY INTERVENTIONS
✔ 2/more of the ff, each present for a significant portion of time during a 1 Biological • Pharmacotherapy
month period (less if treated), at least one of these must be 1, 2 or 3: - Genetics ◦ Antipsychotic Medications
1. Delusions - Inherited ▪ Neuroleptics
2. Hallucinations - Chromosome 8 (NRG1), 6 - Meaning “taking hold of the nerves”
3. Disorganized speech (DTNBPI1), 22 (COMT) - Provided the first real hope
4. Grossly disorganized/catatonic behavior - COMT (dopamine metabolism) - Help people think more clearly and
5. Negative symptoms - Eye-tracking deficit may be an reduce hallucinations and delusions
✔ For a significant portion of the time since the onset of the disturbance, endophenotype - Dopamine antagonists
level of functioning in 1/more major areas (work, interpersonal relations - Hadol and Thorazine – earliest
Schizophrenia or self-care) is markedly below the level achieved prior to the onset (when Neurobiological neuroleptics drugs; called
Disorder onset is in childhood/adolescence: there’s failure to achieve expected level - Excessive dopamine activity conventional or first-generation
of interpersonal, academic or occupational functioning) - Excessive stimulation of antipsychotics
Characterized by ✔ Continuous signs of the disturbance persist for at least 6 months. This 6- striatal dopamine D2 receptors - Risperidone and Olanzapine –
broad spectrum month period must include at least 1 month of symptoms (less if treated) - Striatum (movement, balance newer medications; called atypical or
of cognitive & that meet Criterion A & may include periods of prodomal/residual & relies on dopamine) second-generation antipsychotics
emotional symptoms. During these prodomal/residual periods, signs of the -Deficiency in stimulation of • Biological Therapy
dysfunctions disturbance may be manifested by only negative symptoms or by 2 or prefrontal dopamine D1 ◦ Insulin coma therapy
including more symptoms listed in Criterion A present in an attenuated form receptors (thinking & reasoning) - Was thought for a time to be helpful, but
hallucinations, ✔ Schizoaffective, depressive or bipolar disorder w/ psychotic features have - Alterations in prefrontal closer examination showed it carried great
delusions, been ruled out because either a) no major depressive/manic episodes have activity involving glutamate risk of serious illness and death
disorganized occurred concurrently w/ the active-phase symptoms (Criteria A) or b) if transmission ◦ Psychosurgery
speech & mood episodes have occurred during active phase symptoms, they have - N-methyl-aspartate (NMDA) ◦ Electroconvulsive Therapy (ECT)
behavior and been present for a minority of the total duration of the active & residual receptor of glutamate ◦ Transcranial Magnetic Stimulation
inappropriate periods of the illness - Phencyclidine & Ketamine can - Treatment for hallucinations
emotions ✔ If there’s a history of autism or communication disorder of childhood result in psychotic-like behavior - Uses wire coils to repeatedly generate
onset, the additional diagnosis of schizophrenia is made only if prominent (NMDA antagonist) – deficit in magnetic fields-up to 50 times per second-
delusions/hallucinations, in addition to other required symptoms, are also glutamate/blocking of NMDA that pass though the skull to the brain
present for at least 1 month (or less if treated) sites may be involved in some • Psychosocial Therapy
Specify if: With catatonia symptoms of schizophrenia ◦ Clinicians attempt to reattach social skills
✔ The clinical picture is dominated by 3/more of ff: - Enlargement of lateral & 3rd such as basic conversation, assertiveness,
1. Stupor (no psychomotor activity; not actively relating to environment) ventricles and relationship building
2. Cataplexy (passive induction of a posture held against gravity) - Hypofrontality (frontal lobe is ◦ Therapists divide complex social skills
3. Waxy flexibility (slight, even resistance to positioning by examiner) less active) – particularly in into their component parts, which clients
Catatonia 4. Mutism (no or very little verbal response, exclude if aphasia) dorsolateral prefrontal cortex model
Associated w/ 5. Negativism (opposition/no response to instructions/external stimuli) (DLPFC) ◦ Clients do role-playing and ultimately
Another Mental 6. Posturing (spontaneous & active maintenance of posture against gravity) - Hyperfrontality (too much practice their new skills in the “real
Disorder 7. Mannerism (odd, circumstantial caricature of normal actions) activity in frontal lobe) – for world”
(Catatonia 8. Stereotypy (repetitive, abnormally frequent, non-goal-directed some ◦ Programs teach a range of ways people
Specifier) movements) can adapt to their disorder yet live in the
9. Agitation, not influenced by external stimuli Environmental community
10. Grimacing - Fetal exposure to viral ◦ Virtual assessments and treatments
11. Echolalia (mimicking another’s speech) infection, preg complications - Provide clinicians with controllable and
12. Echopraxia (mimicking another’s movements) - Early use of marijuana safer environments in which to study and
✔ 2/more of the ff, each present for a significant portion of time during a 1- - Schizophrenogenic mother treat persons with schizophrenia
month period (less if treated). At least one of these must be 1, 2, or 3: (cold, dominant mother) ◦ Behavioral family therapy
1. Delusions - Double bind communication - Resembles classroom education
2. Hallucinations (conflicting messages) - Family members are informed about
3. Disorganized speech - Expressed Emotion (EE) – schizophrenia and its treatment, relieved
4. Grossly disorganized/catatonic behavior George Brown, high expression of the myth that they caused the disorder
Schizophrenifor 5. Negative symptoms of family = relapse - Family members are taught practical
m Disorder ✔ An episode lasts at least 1 month but less than 6 months. When the facts about antipsychotic medications and
diagnosis must be made without waiting for recovery, it should be Psychological their side effects
Schizophrenia qualified as “provisional” - Stress - Family members are helped with
that only lasts for ✔ Schizoaffective, depressive or bipolar disorder w/ psychotic features have communication skills & problem-solving
1 to 6 months & been ruled out because either a) no major depressive/manic episodes have skills so that they can become more
can usually occurred concurrently w/ the active-phase symptoms or b) if mood empathic listeners
resume normal episodes have occurred during active-phase symptoms, they have been ◦ Vocational rehabilitation
lives present for a minority of the total duration of the active & residual periods - Supportive employment – involves
of the illness providing coaches who give on-the-job
Specify if: training
With good prognostic features: Presence of at least 2 of the ff: onset of prominent ◦ Assertive Community Treatment (ACT)
psychotic symptoms within 4 weeks of the first noticeable change in usual Program
behavior/functioning; confusion/perplexity; good premorbid social & occupational - Involves using a multidisciplinary team
functioning; absence of blunted/flat affect of professionals to provide broad-ranging
Without good prognostic features: 2 or more of the above features are not present treatment
Specify if: ◦ Social Skills Training
With catatonia - can be directly supportive and useful to
Provisional: Patient is still ill within 6 months the patients
Schizophrenia or some other disorder: Ill after 6 months ◦ Case Management
✔ Uninterrupted period of illness during which there is a major episode - helps patient cope up with the treatment
(major depressive/manic) concurrent w/ Criterion A of schizophrenia whether pharmacological or
(Major Depressive episode must include Criterion A1) psychotherapy
Schizoaffective ✔ Delusions/hallucinations for 2 or more weeks in the absence of a major ◦ Cognitive Behavioral Therapy (CBT)
Disorder mood episode (depressive/manic) during the lifetime duration of the - to improve cognitive distortion, reduce
illness distractibility, and correct errors in
Experience of ✔ Symptoms that meet criteria for a major mood episode are present for the judgment
both psychosis majority of the total durance of the active & residual portions of the illness ◦ Individual Psychotherapy
and mood Specify whether: - helpful and that the effects are additive to
symptoms Bipolar Type: If a manic episode is part of the presentation. Major depressive those of pharmacological treatment
episode may also occur. ◦ Personal Therapy
Depressive Type: If only major depressive episodes are part of the presentation - to enhance personal and social
Specify if: With catatonia adjustment and to forestall relapse
✔ The presence of 1/more delusions with a duration of 1 month or longer ◦ Dialectical Behavior Therapy
✔ Criterion A for schizophrenia has never been met - improves interpersonal skills in the
Delusional (Hallucinations are not prominent & are related to the delusional theme) presence of an active and emphatic
Disorder ✔ Apart from the impact of the delusion(s) or its ramifications, functioning therapist
is not markedly impaired & behavior is not bizarre/odd ◦ Art Therapy
Persistent belief ✔ If manic/major depressive episode has occurred, these have been brief - provides an outlet for their constant
that is contrary to relative to the duration of the delusional periods bombardment of imagery
reality in the Specify whether: ◦ Cognitive Training/ Remediation
absence of Erotomanic Type: Another person is in love w/ the individual - utilizes computer generated exercises for
schizophrenia Grandiose Type: Conviction of having great talent/important discovery the cognition
Jealous Type: Spouse is unfaithful • Across Cultures
Persecutory Type: Being cheated, spied on, harassed, followed, etc. ◦ Kenya
Somatic Type: Bodily functions/sensations - Kisii tribal doctors listen to their
Mixed Type: No delusional predominated patients to find the location of the noises
Unspecified Type: Cannot be clearly determined in their heads (hallucinations), then get
Specify if: them drunk, cut out a piece of scalp, and
With bizarre content: improbable delusions scrape the skull in the area of the voices
✔ Presence of 1/more of the ff. At least 1 of these must be 1, 2 or 3: ◦ Xhosa people of South Africa
Brief Psychotic 1. Delusions - Report using traditional healers who
Disorder 2. Hallucinations sometimes recommend the use of oral
3. Disorganized Speech treatments to induce vomiting, enemas,
Presence of 1 or 4. Grossly disorganized/catatonic behavior and the slaughter of cattle to appease the
more positive ✔ Duration of an episode is at least 1 day but less than 1 month, with spirits
symptoms that eventual full return to premorbid level of functioning ◦ Hispanics
lasts only for 1 Specify if: - Family support
month or less W/ marked stressors (brief reactive psychosis): Because of stressful events ◦ British
Without marked stressors: Symptoms do not occur because of stressful events - Use more biological, psychological, and
W/ postpartum onset: Onset is during pregnancy or within 4 weeks portpartum community treatments
Specify if: With catatonia ◦ Native Chinese
Substance/ ✔ Presence of 1 or both of the ff: - Hold more religious beliefs about both
Medication- 1. Delusions the causes and treatments of schizophrenia
Induced 2. Hallucinations
Psychotic ✔ Evidence from the history, physical examination or lab findings of both:
Disorder 1. Symptoms in Criterion A developed during or soon after substance
intoxication/withdrawal or after exposure to a medication
Psychosis due to 2. Involved substance is capable of producing symptoms in Criterion A
direct effect of ✔ Does not occur during the course of a delirium
substance or (Diagnosis is made only when symptoms in Criterion A predominate in the clinical
withdrawal from picture & when they are sufficiently severe to warrant clinical attention)
a substance Specify if:
without delirium With onset during intoxication/withdrawal
With onset after medication use
Psychotic ✔ Prominent hallucinations/delusions
Disorder ✔ Evidence from the history, physical examination/lab findings that
Associated w/ disturbance is the direct pathophysiological consequence of another
Another Medical medical condition
Condition ✔ Does not occur exclusively during the course of a delirium

NEURODEVELOPMENTAL DISORDERS
DISORDER DIAGNOSTIC CRITERIA ETIOLOGY INTERVENTIONS
✔ Persistent pattern of inattention or hyperactivity-impulsivity as Biological • Pharmacotherapy
characterized by 1 and/or 2: - Genetics ◦ Stimulants
1. Inattention: 6/more of the ff for at least 6 months: (17 & older: at - Having a specific dopamine ▪ Methylphenidate (Ritalin, Adderall) and
least 5 symptoms) transporter (DAT1) & serotonin other non-stimulant medications such as
a) Fails to give close attention to details/makes careless mistakes transporter Atomoxetine (Strattera), Guanfacine
in works or any activities - Copy number variants – extra (Tenex), and Clonidine
b) Difficulty in sustaining attention/focus in tasks/play activities copies of a gene on 1 - have proved helpful in reducing the core
Attention- c) Doesn’t seem to listen when spoken to directly chromosome / deletion of genes symptoms of hyperactivity and impulsivity,
Deficit/ d) Doesn’t follow instructions & fails to finish works, chores or - Dopamine D4, receptor gene, and in improving concentration on tasks
Hyperactivity duties DAT1, Dopamine D5 receptor • Psychotherapy
Disorder e) Difficulty organizing tasks & activities gene ◦ Goal: to help parents of children with ADHD
(ADHD) f) Avoids, dislikes or reluctant to engage in tasks that require - Poor inhibitory control (ability recognize and promote the notion he/she is still
sustained mental effort to stop responding to a task when capable of being responsible for meeting
Characterized by g) Loses things needed for tasks/activities signaled) reasonable expectations
inattention, h) Easily distracted by extraneous stimuli - Slightly smaller brain ◦ Improving academic performance
impulsivity, i) Forgetful in daily activities ◦ Decreasing disruptive behavior
and/or 2. Hyperactivity & Impulsivity: 6/more of the ff for at least 6 months: Environmental ◦ Social skills training
hyperactivity, (17 & older: at least 5) - Unpopular & rejected by peers - Teaching the child how to interact appropriately
usually first a) Fidgets with/taps hands/feet or squirms in seat - Prenatal smoking, stress & with peers
diagnosed in b) Leaves seat in situations when remaining seated is expected alcohol use ◦ Reinforcement programs
childhood c) Runs about/climbs in situations where it is inappropriate - Rewarding the child for improvements
d) Unable to play/engage in leisure activities quietly Psychological - Punishing misbehavior with loss of rewards
e) “On the go” acting as if “driven by motor” - Negative responses of parents ◦ Parent education programs
f) Talks excessively & peers - Teaching families how to respond
g) Blurts out answer before a question has been completed - Low self-esteem constructively to their child’s behaviors and how
h) Difficulty waiting for his/her turn to structure the child’s day to help prevent
i) Interrupts/intrudes on others difficulties
✔ Several symptoms were present prior to age 12 years & are present ◦ Cognitive-Behavioral Therapy (CBT)
in 2 or more settings - For adults with ADHD
Specify whether: - To reduce distractibility and improve
Combined Presentation: Both Criterion A1 & A2 are met for the past 6 organizational skills
months
Predominantly Inattentive Presentation: Only Criterion A1 is met for the
past 6 months
Predominantly Hyperactive/Impulsive Presentation: Only Criterion A2
is met for the past 6 months
Specify if:
In partial remission: Criteria not met but impairment persists
Specify severity:
Mild: Few symptoms
Moderate: Intermediate
Severe: Many symptoms, more than required for diagnosis
✔ Difficulty learning & using academic skills, as indicated by at least Neurobiological • Pharmacotherapy
1 of the ff that have persisted for at least 6 months, despite the - Genetics ◦ Methylphenidate (Ritalin, Adderall)
provision of interventions that target those difficulties: - Problems in dyslexia, Broca’s ◦ Restricted to individuals who may also have
1. Inaccurate/slow & effortful word reading area, area in the left comorbid ADHD
2. Difficulty understanding the meaning of what is read parietotemporal area & area in • Educational Intervention
3. Difficulties with spelling the left occipitotemporal area ◦ Specific skills instruction
4. Difficulties with written expression - Intraparietal Sulcus – critical - Vocabulary
5. Difficulties mastering number sense, facts or calculation for the development of a sense of - Finding the main idea
6. Difficulties with mathematical reasoning numbers - Finding facts in readings
Specific ✔ The affected academic skills are substantially below those - All people w/ reading disorders ◦ Strategy instruction
Learning expected for the individual’s chronological age & cause significant has reduced activity in left - Includes efforts to improve cognitive skills
Disorder interference w/ academic/occupational performance as confirmed temporal lobe through decision making and critical thinking
by individually administered achievement measures & ◦ Direct Instruction
Affects 1 of 3 comprehensive clinical assessment. (17 years & older: a Environmental - A program
areas: reading, documented history of impairing learning difficulties may be - Reading habits of families - Components: systematic instruction (using
writing and/or substituted) highly scripted lesson plans that place students
math. that begins ✔ Difficulties begin during school-age years but may not become together in small groups based on their progress)
during school-age fully manifest until the demands for those affected academic skills and teaching for mastery (teaching students until
but may not be exceed the individual’s limited capacities they understand all concepts)
recognized until (Criteria are met based on clinical synthesis of the individual’s history, ◦ Remedial Treatment
adulthood. school reports & psychoeducational assessment)
Specify if:
With Impairment in Reading: Word reading accuracy; Reading
rate/fluency; Reading comprehension
With Impairment in Expression: Spelling accuracy; Grammar &
Punctuation accuracy; Clarity/Organization of written expression
With Impairment in Mathematics: Number sense; Memorization of
arithmetic facts; Accurate calculations; Accurate math reasoning
Specify severity:
Mild: Patient can compensate some problems
Moderate: Requires considerable remediation for proficiency
Severe: Difficult to overcome without intensive remediation
✔ Persistent deficits in social communication & social interaction Neurobiological • No completely effective treatment exists
across multiple contexts, as manifested by the ff, currently or - Genetics • Pharmacotherapy
history: - Amygdala in children is ◦ Major tranquilizers and SSRIs
1. Deficits in social-emotional reciprocity enlarged causing excessive - Most helpful in decreasing agitation
2. Deficits in nonverbal communicative behaviors used for social anxiety & fear. With continued -Unlikely that one drug will work for everyone
interaction stress, the release of stress • Psychotherapy
3. Deficits in developing, maintaining & understanding relationships hormone cortisol damages the ◦ Behavioral approaches that focus on skill
✔ Restrictive, repetitive patterns of behavior, interests or activities, as amygdala, causing the absence of building and behavioral treatment of problem
manifested by at least 2 of the ff: neurons in adulthood behaviors
1. Stereotyped/repetitive motor movements, use of objects/speech - Low levels of oxytocin ◦ Communication and socialization
Autism 2. Insistence on sameness, inflexible adherence to routines or ◦ Naturalistic teaching strategies
Spectrum ritualized patterns of verbal/non-verbal behavior (ex. Extreme Environmental - Includes arranging the environment so that the
Disorder (ASD) distress at small changes, transitions) - Perfectionist, cold & aloof child initiates an interest (e.g., placing a favorite
3. Highly restricted, fixated interests that are abnormal in parents toy just out of reach)
Characterized by intensity/focus (ex. Strong attachment w/ unusual objects) - Older parents (de novo ◦ Incidental teaching
persistent 4. Hyper or hypoactivity to sensory input or unusual interest in mutations) ◦ Pivotal response training
impairments in sensory aspects of the environment (Ex. Indifference to ◦ Milieu teaching
reciprocal social pain/temperature, adverse response to specific sounds/textures) Psychological ◦ Behavior therapy combined pharmacologic
communication & ✔ Symptoms must be present in the early developmental period but - Lack of self-awareness treatments
social interaction, may not be fully manifest until social demands exceed limited (tendency to avoid first-person ◦ Cognitive Behavioral Therapy (CBT)
and restricted, capacities or may be masked by learning strategies in later life pronouns) - to treat repetitive behavior in individuals
repetitive patterns Specify if: Early Intensive Behavioral and Developmental
of behavior, With/Without accompanying intellectual impairment Cultural Interventions
interests, or With/Without accompanying language impairment - High SES • UCLA/Lovaas- based Model
activities. Associated w/ a known medical/genetic condition • Early Start Denver Model
Associated w/ another disorder • Parent Training Approaches
With catatonia • Social Skills Approaches
Specify severity: ◦ Social Skills Training
- Social Communication
Level 1 (mild): Trouble starting conversations or less interested (Requiring Educational Interventions for children
support) • Treatment and education of autistic and
Level 2 (moderate): Deficits in both verbal & nonverbal communication communication-related handicapped children
(Requiring substantial support) • Broad- based approaches
Level 3 (severe): Little response to others (Requiring very substantial • Computer-based approaches and virtual reality
support)
- Restricted, Repetitive Behaviors Intervention for comorbid symptoms
Level 1 (mild): Changes provokes some problems in at least 1 area of • Neurofeedback
activity (Requiring support) • Management of insomnia
Level 2 (moderate): Problems in coping w/ change are readily apparent &
interferes in various are of functioning (RSS)
Level 3 (severe): Change is exceptionally hard (RVSS)
✔ A disorder with onset during the developmental period that Neurobiological • Treatment parallels that of people with more severe
includes both intellectual & adaptive functioning deficits in - Genetics (chromosomal, single form of Autism Spectrum Disorder
conceptual, social & practical domains. The ff must be met: gene, mitochondrial disorders ◦ Teaching individuals the skills they need to
1. Deficits in intellectual functions (reasoning, problem solving, and multiple genetic mutations become more productive and independent
planning, abstract thinking, judgment, academic learning & - Dominant gene, recessive gene • For individuals with mild ID, intervention is similar
learning from experience) confirmed by both clinical assessment & or an X-linked gene to that for people with learning disorders
individualized, standardized intelligence testing - Infections & head injury ◦ Specific learning deficits are identified and
2. Deficits in adaptive functioning that result in failure to meet - De novo disorders (genetic addressed to help the student improve such skills
developmental & sociocultural standards for personal mutations in sperm/egg) are reading and writing
Intellectual independence & social responsibility. Without ongoing support, the - Tuberuous Sclerosis (dominant • Communication training
Developmental adaptive deficits limit functioning in 1 or more activities of daily gene disorder) – 1 in every - Can be challenging for individuals with the most
Disorder life (communication, social participation & independent living 30,000 births (about 60% have severe disabilities because they may have multiple
(Intellectual across multiple environments) ID) physical or cognitive deficits that make spoken
Disability) 3. Onset of intellectual & adaptive deficits during the developmental - Phenylketonuria (PKU) – communication difficult or impossible
period recessive disorder ◦ Augmentative communication strategies
Includes both Specify severity: - Lesch-Nyhan Syndrome (X- - alternative system; may use picture books,
intellectual & Mild: IQ of 50-70 linked) – only males are affected teaching the person to make a request by
adaptive Moderate: IQ of high 30s – low 50s - Down Syndrome & Fragile X pointing to a picture (e.g., pointing to a picture of
functioning Severe: IQ of low 20s – high 30s Syndrome a cup to request a drink)
deficits in Profound: IQ of low 20s downward • Teaching people how to communicate their
conceptual, Environmental need/desire for such thing as attention as an
social, & practical - Prenatal exposure to alternative to punishment that may be equally
domains during disease/drugs effective in reducing behavior problems
the developmental - Labor & delivery difficulties • Psychotherapy
period - Abuse, neglect, social ◦ Behavioral Therapy
deprivation - to enhance social behaviors and to control and
minimize aggressive and destructive behavior
and benign punishment
◦ Cognitive Therapy
- such as dispelling false beliefs and relaxation
exercises with self- instruction
◦ Psychodynamic Therapy
- together with their families, to decrease
conflicts about expectations that result in
persistent anxiety, rage, and depression
◦ Family Education
- educates the patients about ways to enhance
competence and self-esteem while maintaining
realistic expectations for the patients
◦ Social Intervention
- to improve the quantity and quality of social
competence
NEURODEVELOPMENTAL DISORDERS (COMMUNICATION DISORDERS)
DISORDER DIAGNOSTIC CRITERIA ETIOLOGY INTERVENTIONS
✔ Disturbances in the normal fluency (dysfluencies) & time Biological • Behavioral Intervention
patterning of speech that are inappropriate for the individual’s - Heredity ◦ Regulated-breathing method
age and language skills, persist over time, and are characterized - Person is instructed to stop speaking when a
Childhood-Onset by frequent & marked occurrences of at least 1 of the ff: stuttering episode occurs and then to take a deep
Fluency Disorder 1. Sound and syllable repetitions breath (exhale, then inhale) before proceeding
(Stuttering) 2. Sound prolongations of consonants as well as vowels ◦ Altered auditory feedback
3. Broken words (pauses within a word) - Electronically changing speech feedback to
Disturbance in the people who stutter
4. Audible or silent blocking (filled or unfilled pauses in speech)
normal fluency & time - Can improve speech, as can using forms of
patterning of speech 5. Circumlocutions (word substitutions to avoid problematic self-monitoring, in which people modify their
that is inappropriate words) own speech for the words they stutter
for an individual's age. 6. Words produced with an excess of physical tension • Psychosocial Therapy
7. Monosyllabic whole-word repetitions (“I-I-I am fine”) ◦ Parents are counseled about how to talk to their
✔ The disturbance causes anxiety about speaking or limitations children
ineffective communication, social participation, or academic or
occupational performance, individually or in any combination
✔ The onset of symptoms is in the early developmental period.
(Adults are diagnosed as adult-onset fluency disorder)
✔ Persistent difficulties in the acquisition and use of language Environmental • May be self-correcting and may not require special
across modalities (spoken, written, sign language, or other) due - Family history of language intervention
Language Disorder to deficits in comprehension or production that include the ff: disorders
1. Reduced vocabulary (word knowledge/use)
Difficulties in the 2. Limited sentence structure (ability to put words and word
acquisition & use of endings together to form sentences based on the rules of
language, due to
grammar and morphology)
deficits in the
production or 3. Impairments in discourse (ability to use vocabulary and
comprehension of connect sentences to explain or describe a topic or series of
vocabulary, discourse, events or have a conversation).
& sentence structure ✔ Language abilities are substantially and quantifiably below
those expected for age, resulting in functional limitations
✔ Onset of symptoms is in the early developmental period.
✔ Persistent difficulties in the social use of verbal and nonverbal Neurobiological • Individualized social skills training (e.g., modeling,
communication as manifested by all of the following: - Right hemisphere is implicated role playing) with an emphasis on teaching
1. Deficits in using communication for social purposes (greeting important rules necessary for carrying on
& sharing information) in a manner that is appropriate for the conversations with others (e.g., what is too much
social context. and too little information)
2. Impairment of the ability to change communication to match
context/needs of the listener (speaking differently in a
classroom than on a playground, talking differently to a child
than to an adult, and avoiding use of overly formal language)
3. Difficulties following rules for conversation and storytelling
Social (Pragmatic)
Communication (taking turns in conversation, rephrasing when misunderstood
Disorder & knowing how to use verbal and nonverbal signals to regulate
interaction)
Difficulty with 4. Difficulties understanding what is not explicitly stated &
pragmatics, or the nonliteral/ambiguous meanings of language (idioms, humor,
social use of language metaphors, multiple meanings)
and communication
✔ The deficits result in functional limitations
✔ The onset of the symptoms is in the early developmental period
(but deficits may not become fully manifest until social
communication demands exceed limited capacities)
✔ Autism spectrum disorder must be ruled out before the
diagnosis
Speech Sound ✔ Persistent difficulty with speech sound production that Biological
(Phonological) interferes with speech intelligibility or prevents verbal - Genetic Disorders: Down
Disorder communication of messages syndrome, DiGeorge Syndrome
✔ The disturbance causes limitations in effective communication & FoxP2 gene mutation
Speech sound ✔ Onset of symptoms is in the early developmental period.
production is not ✔ The difficulties are not attributable to congenital (during fetal
consistent with what is development) or acquired conditions, such as cerebral palsy,
expected based on the cleft palate, deafness or hearing loss, traumatic brain injury, or
child's developmental other medical or neurological conditions. Hereditary and
stage and age. genetic disorders (Down Syndrome) are excluded from this
criterion.

NEURODEVELOPMENTAL DISORDERS (MOTOR DISORDERS)

DISORDER DIAGNOSTIC CRITERIA ETIOLOGY INTERVENTIONS
Persistent (Chronic) ✔ Single/multiple motor or vocal tics have been present during Neurobiological • Psychotherapy
Motor/Vocational Tic the illness, but not both motor and vocal. - Heredity & Genetics ◦ Self-monitoring
Disorder ✔ The tics may wax and wane in frequency but have persisted for - Changes in parts of the brain ◦ Relaxation training
Single/multiple motor more than 1 year since first tic onset that controls movement ◦ Habit reversal
or vocal tics, but not ✔ Onset is before 18 years old - Specific gene mutations ◦ Sensory integration programs
both motor and vocal - Dopamine, serotonin & ◦ Modified physical education
for more than 1 year glutamate
Provisional Tic ✔ Single or multiple motor and/or vocal tics
Disorder ✔ The tics have been present for less than 1 year since first tic Environmental
Single/multiple motor onset - Stress
and/or vocal tics for ✔ Onset is before 18 years old - Sleep deprivation
less than 1 year
Tourette’s Disorder ✔ Both multiple motor and 1/more vocal tics have been present at
sometime during the illness, although not necessarily
Multiple motor & at concurrently.
least 1 or more vocal ✔ The tics may wax and wane in frequency but have persisted for
tics for more than 1 more than 1 year since first tic onset
year ✔ Onset is before 18 years old
Developmental ✔ The acquisition & execution of coordinated motor skills is
Coordination below the expected given the individual’s chronological age &
Disorder (DCD) opportunity for skill learning & use. Difficulties are manifested
as clumsiness & slowness & inaccuracy of performance of
Lifelong condition that motor skills
makes it hard to learn ✔ The motor skills deficit in Criterion A significantly &
motor skills and persistently interferes with activities of daily living appropriate
coordination. to chronological age
✔ Onset of symptoms is in the early developmental period
✔ Repetitive, seemingly driven, & apparently purposeless motor
behavior (hand shaking/waving, body rocking, head banging,
self-biting, hitting own body)
Stereotypic ✔ Onset is in the early developmental period.
Movement Disorder Specify if:
With self-injurious behavior
Repetitive, purposeless Without self-injurious behavior
movements Associated with a known medical/genetic condition,
neurodevelopmental disorder, or environmental factor
Specify severity:
Mild: Symptoms are readily managed behaviorally
Moderate: Require behavior modification & specific protective
measures
Severe: Require continuous watching

NEUROCOGNITIVE DISORDERS
DISORDER DIAGNOSTIC CRITERIA ETIOLOGY INTERVENTIONS
✔ Disturbance in attention (reduced ability to direct, focus, Neurobiological • Pharmacotherapy
Delirium sustain, and shift attention) and awareness (reduced - Medications ◦ Antipsychotic medications
orientation to the environment) - Age ▪ Haloperidol
Acute temporary ✔ The disturbance develops over a short period of time (hours - Disruption of connectivity - Treatment for delirium brought on by
confusional state w/ to a few days), represents a change from baseline attention between dorsolateral prefrontal withdrawal from alcohol
global impairments in & awareness & tends to fluctuate in severity during the cortex & posterior cingulate - Can have a calming effect
attention & cognition course of a day. cortex • Psychotherapy
✔ An additional disturbance in cognition (memory deficit, - Reversible disruptions between ◦ Recommended first line of treatment
disorientation, language, visuospatial ability) thalamus & reticular activating ◦ Goal is to reassure the individual to help them
✔ There is evidence from the history, physical examination, system deal with the agitation, anxiety, and
or laboratory findings that the disturbance is a direct hallucinations of delirium
physiological consequence of another medical condition, Environmental ◦ Patient who is included in all treatment decisions
substance intoxication or withdrawal or exposure to a toxin,- Sleep deprivation retains a sense of control
or is due to multiple etiologies - Immobility
Specify if: - Stress
Hyperactive: Agitaion/increased level of activity
Hypoactive: Reduced level of activity
Mixed level of activity: Normal/fluctuating level
Specify duration:
Acute: Lasts hours to a few days
Persistent: Lasts weeks or longer
✔ Evidence of modest cognitive decline from a previous level Neurobiological
of performance in 1/more cognitive domains (complex - Alzheimer’s Disease
attention, executive function, learning and memory, - Damage in Neurofibrillary
language, perceptual motor, or social cognition) based on: Tangles & Amyloid Plaques
Mild Neurocognitive 1. Concern of the individual, a knowledgeable informant, or (Neuritic/Sensile Plaques)
Disorder/Mild the clinician that there has been a significant decline in - Amyloid Precursor Protein
Cognitive Impairment cognitive function (APP) produces the amyloid
(MCI) protein found in amyloid plaques
2. A substantial impairment in cognitive performance,
- Brain atrophy (shrink)
Cognitive impairment preferably documented by standardized neuropsychological - Chromosome 21, 14, 19, 12 and
with minimal testing or, in its absence, another quantified clinical 1
impairment of assessment. - Deterministic Genes – if you
instrumental activities ✔ The cognitive deficits do not interfere with capacity for have these, 100% chance of
of daily living (IADLs) independence in everyday activities (complex instrumental developing Alzheimer’s (Amyloid
activities of daily living like paying bills or managing Beta Peptides, Presenilin 1 & 2)
- Deposits of Amyloid Beta (Ab)
medications are preserved, but greater effort, compensatory
causes the cell death
strategies, or accommodation may be required) - Apolipoprotein (Apo E4) causes
✔ The cognitive deficits do not occur exclusively in the amyloid proteins to build up in the
context of a delirium neurons of people w/ Alzheimer’s
Specify if: - Head trauma
With/Without behavioral disturbance
✔ Evidence of significant cognitive decline from a previous Cultural
level of performance in 1/more cognitive domains - Preindustrial rural societies
(complex attention, executive function, learning and (insufficient vitamins)
memory, language, perceptual-motor, or social cognition) - Occupational safety (head
based on: injury)
1. Concern of the individual, a knowledgeable informant, or
the clinician that there has been a significant decline in
cognitive function
2. A substantial impairment in cognitive performance,
Major Neurocognitive preferably documented by standardized neuropsychological
Disorder
testing or another quantified clinical assessment.
Progressive condition ✔ The cognitive deficits interfere with independence in
marked by gradual everyday activities (at a minimum, requiring assistance
deterioration of a range with complex instrumental activities of daily living like
of cognitive abilities paying bills or managing medications)
Specify if:
With/Without behavioral disturbance
Specify severity:
Mild: Requires help w/ daily activities
Moderate: Needs help even w/ basics
Severe: Fully dependent on others
✔ Criteria are met for major/mild neurocognitive disorder Neurobiological • Pharmacotherapy
✔ There’s insiduous onset & gradual progression of - Presence of Beta Amyloid in ◦ New medications that prevent acetylcholine
impairment in 1/more cognitive domains (for major ncd: 2 spinal fluid breakdown and vitamin therapy delay but do not
domains must be impaired) stop progression of decline
✔ Criteria are met for either possible Alzheimer’s Disease as Cultural • No cure so far, but hope lies in genetic research and
follows: - Higher income countries (higher amyloid protein
For Major Neurocognitive Disorder: number who seeks assistance) • Management may include lists, maps, and notes to
Neurocognitive Probable Alzheimer’s: if either of the ff is present help maintain orientation
Disorder Due To Possible Alzheimer’s: if either of the ff is not present:
Alzheimer’s 1. Evidence of a causative Alzheimer’s disease genetic
mutation from family history/genetic testing
2. All 3 of the ff are present:
a) Clear evidence of decline in memory & learning & at
least 1 other cognitive domain
b) Steadily progressive, gradual decline in cognition,
without extended plateaus
c) No evidence of mixed etiology (absence of other ncd
or another disease)
For Mild Neurocognitive Disorder:
Probable Alzheimer’s: evidence of a causative Alzheimer’s disease
genetic mutation from genetic testing/family history
Possible Alzheimer’s: no evidence of a causative Alzheimer’s
disease & all 3 of the ff are present:
1. Clear evidence of decline in memory & learning
2. Steadily progressive, gradual decline in cognition, without
extended plateaus
3. No evidence of mixed etiology
✔ Criteria are met for major/mild neurocognitve disorder Environmental
✔ Clinical features are consistent w/ a vascular etiology as - Lifestyle issues (diet, exercise,
Vascular suggested by either of the ff: stress) = cardiovascular disease
Neurocognitive 1. Onset of the cognitive deficits is temporarily related to 1 or
Disorder more cerobrovascular events
2. Evidence of decline is prominent in complex attention
Disruptions in the (including processing speed) & frontal-exclusive functional
brain’s blood supply ✔ There is evidence of the presence of cerebrovascular
that lead to impairment disease from history, physical exam and/or neuroimaging
of a person’s conscious considered sufficient to account for the neurocognitive
brain functions deficits
Specify if:
Probably due to Vascular Disease: Diagnosis is reinforced by
neuroimaging, proximity or clinical & genetic evidence
Possible due to Vascular Disease: none of the 3
Specify if:
With/Without Behavioral Disturbance
✔ Criteria are met for major/mild neurocognitive disorder
✔ The involved substance/medication, duration & extent of
Substance/Medication- use are capable of producing the neurocognitive
Induced impairment
Neurocognitive ✔ Temporal course of the deficit is consistent w/ the timing of
Disorder substance/medication use & abstinence
Specify if:
Persistent: Continue long past the time it should take to recover
with prolonged abstinence
ELIMINATION DISORDERS
DISORDER DIAGNOSTIC CRITERIA ETIOLOGY INTERVENTIONS
Encopresis (Fecal ✔ Repeated passage of feces into inappropriate places
Incontinence/Soiling) (clothing, floor), whether involuntary or intentional.
✔ At least one event occurs each month for at least 3 months
Repeated passing of
✔ Chronological age is at least 4 years (or equivalent
stool (usually
involuntarily) into developmental level)
clothing Specify whether:
With constipation & overflow incontinence: Evidence of
constipation on physical examination/history
Without constipation & overflow incontinence: No evidence of
constipation on physical examination/history
✔ Repeated voiding of urine into bed or clothes, whether
involuntary or intentional
Enuresis (Urinary ✔ Behavior is clinically significant as manifested by either a
Incontinence) frequency of at least twice a week for at least 3 consecutive
months
Loss of bladder control ✔ Chronological age is at least 5 years (or equivalent
developmental level)
Specify whether:
Nocturnal only: During nighttime sleep
Diurnal only: During waking hours
Nocturnal & Diurnal: Combination of 2