Download DSM-IV-TR

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KBK Psikologi Klinis
14 Februari 2014
Henny Wirawan
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Going for a walk in a Thunderstorm.
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Checking the door is locked three times before leaving
the house.
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Having five baths every day.
Betting Rp. 5,000,000 on a horse.
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Having hair dyed pink with green stripes.
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Living in isolation without interacting with people.
Getting pregnant without being married.
Being scared of spiders.
Getting anxious before an examination.
Writing an extra statement because 13 is an unlucky
number.
something undesirable and requiring change
*Therefore, we must be careful how we use the term
*Psychologists need methods for distinguishing ‘normal’
from ‘abnormal’
*
www.psychlotron.org.uk
*Defining a person or behavior as ‘abnormal’ implies
* Deviation from social norms
* Statistical infrequency
* Failure to function adequately
* Deviation from ideal mental health
*
www.psychlotron.org.uk
* Four definitions of abnormality are:
There is a difficulty in distinguishing normal from
abnormal behavior.
The following are the definitions:
Deviation from the average
Deviation from the ideal
Abnormality as a sense of subjective discomfort
Abnormality as the inability to function effectively
Legal definitions of abnormality
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*Social norms are a set of rules for
behaviour based on a set of moral and
conventional standards within society.
*They are judged by the dominant culture
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* John Maguire and Laurence Scott-Mackay were the first couple to exchange vows in
a civil partnership ceremony in Scotland, with a ceremony in Edinburgh
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*social norms vary from one time to
another
Wilde and Lord Alfred Douglas in 1893
On 25 May 1895 Wilde was convicted of gross indecency
and sentenced to two years' hard labour.
classified as abnormal if it is rare or statistically unusual.
* With this definition it is necessary to be clear about how rare a
trait or behaviour needs to be before we class it as abnormal
*
www.psychlotron.org.uk
* Under this definition, a person’s trait, thinking or behaviour is
frequency
The further from 100
you look, the fewer
people you find
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70
100
IQ Scores
130
www.psychlotron.org.uk
Average IQ in the
population is 100pts.
frequency
www.psychlotron.org.uk
A very small subset of
the population (<2.2%)
have an IQ below 70pts.
Such people are
statistically rare. We
regard them as having
abnormally low IQs
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70
100
IQ Scores
130
L2
A very unusual behaviour
or trait will be more than
2 standard deviations
from the mean. i.e. over
130 or under 70 IQ score.
This statistically ‘rare’
behaviour or trait is likely
to be seen as being
abnormal.
20
*From an individual’s point of view
abnormality can be judged in terms of
not being able to cope with day to day
living.
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are unable to cope with the demands of everyday life.
* They may be unable to perform the behaviours necessary for
day-to-day living e.g. self-care, hold down a job, interact
meaningfully with others, make themselves understood etc.
*
www.psychlotron.org.uk
* Under this definition, a person is considered abnormal if they
*
It may be the case that
apparently dysfunctional
behaviour is actually
adaptive and functional for
the specific individual.
*This definition may be biased by who judges ‘failure
to function adequately’ as in the opinion of the
individual they may believe that they are functioning
adequately even if others do not agree.
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* http://nobelprize.org/nobel_prizes/economics/laureates/1994/nashautobio.html
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characteristics:
*Suffering
*Maladaptiveness (danger to self)
*Vividness & unconventionality (stands out)
*Unpredictability & loss of control
*Irrationality/incomprehensibility
*Causes observer discomfort
*Violates moral/social standards
*
www.psychlotron.org.uk
*Rosenhan & Seligman (1989) suggest the following
* Suffering
* Maladaptiveness (danger to self)
* Vividness & unconventionality (stands out)
* Unpredictability & loss of control
* Irrationality/incomprehensibility
* Causes observer discomfort
* Violates moral/social standards
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define what is normal/ideal and anything that deviates from this
is regarded as abnormal
* This requires us to decide on the characteristics we consider
necessary to mental health
*
www.psychlotron.org.uk
* Under this definition, rather than defining what is abnormal, we
*
Jahoda states that we identified 6 categories that people
need in order to be MENTALLY HEALTHY
*1/ Self attitudes = high self esteem
*2/ Personal growth (Self actualization) = achieve their
full potential
*3/ Integration = being able to cope with stressful
situations
*4/ Autonomy = making own decisions, being in control
*5/ Accurate perception of reality
*6/ Adaptation to environment = ability to love and solve
problems
* Positive view of the self
* Capability for growth and development
* Autonomy and independence
* Accurate perception of reality
* Positive friendships and relationships
* Environmental mastery – able to meet the varying demands of
day-to-day situations
*
www.psychlotron.org.uk
* Psychologists vary, but usual characteristics include:
*Marie Jahoda (1958) states that we define physical
illness by looking at what is different from ideal
physical health. I.e. correct temperature, correct
blood pressure
*SO WHY NOT DO THE SAME FOR MENTAL
ILLNESS
*SEE IT AS A DOCTOR APPROACH TO
DEFINING ABNORMALITY!
*
Mental illness is a complex area,
difficult to define, and definitions of
normal and abnormal behavior vary
over time, from society to society,
and in different contexts.
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Are you always worrying?
Are you unable to concentrate because of
unrecognized reasons?
Are you continually unhappy without
justified causes?
Do you loose your temper easily and often?
Do you have wide fluctuations in your mood
from depression to elation, back to
depression, which incapacitate you?
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Do you continually dislike to be with people?
Are you upset if the routine of your life is
disturbed?
Do your children/parents consistently get on
your nerves?
Are you ‘browned off’and constantly bitter?
Are you afraid without real cause?
*Are
you always right and the other person is
always wrong?
*Do
you have numerous aches and pains for
which no doctor can find a physical cause?
*if the answer is definitely ‘yes’ for any one question
it indicates poor mental health)
GRADATIONS OF ABNORMAL AND NORMAL BEHAVIOUR:
DRAWING THE LINE ON ABNORMALITY
*It is better to view abnormal and normal behavior
as marking two ends of a continuum rather than as
absolute state.
*As such behavior should be evaluated in terms of
gradations, ranging from completely normal
functioning to extreme abnormal behavior.
Obviously, behavior typically falls somewhere
between the two extremes.
MODELS OF ABNORMALITY: From Superstition to
Science
*For much of the past, abnormal behavior
was linked to superstition and witchcraft.
*People displaying abnormal behavior were
accused of being possessed by the devil or
some sort of demonic god.
*This typically involved whipping, immersion
in hot water, starvation, or other forms of
torture in which the cure was often worse
than affliction.
Contemporary approaches take a more
enlightened view, and six major perspectives on
abnormal behavior predominate.
They are:
* the Medical Model
* the Psychoanalytic Model
* the Behavioral Model
* the Cognitive Model
* the Humanistic Model
* the Socio-cultural Model
MODELS OF PSYCHOLOGICAL DISORDERS
* Medical model – Suggests that physiological causes are at the
root of abnormal behavior ( for ex. a brain tumor or chemical
imbalance in the brain or disease)
* Psychoanalytic Model – Abnormal behavior stems from
childhood conflicts over opposing wishes regarding sex and
aggression.
* Behavioral Model – Abnormal behavior is a learned response –
Its emphasis is on here and now.
Both Medical and Psychoanalytic Models look at abnormal
behavior as symptoms of some underlying problem.
*
*
Cognitive Model – The model suggests that
people’s thoughts and beliefs are central to
abnormal behavior. ( the primary goal of
treatment using the cognitive model is to
explicitly teach new and more adaptive ways
of thinking)
Humanistic Model – It suggests that
individuals can, by and large, set their own
limits of what is acceptable behavior.
It focuses on the relationship of the
individual to society, considering the ways in
which people view themselves in relation to
others and see their place in the society.
•Socio-cultural Model – The model suggests that
people’s behavior – both normal and abnormal –
is shaped by family, society and cultural
influences.
Social phenomena such as homelessness
have been associated with psychological
disorders – People from lower classes may be
less likely than those from higher classes to seek
help until their symptoms become relatively
severe and warrant a more serious diagnosis
*
ABNORMAL BEHAVIOUR
*‘Abnormal’ literally means ‘away from the
normal’. It implies deviation from some
clearly defined norm.
*In the case of physical illness, the norm is the
structural and functional integrity of the body.
*The concepts of ‘normal’ and ‘abnormal’
are meaningful only with reference to a given
culture.
*Normal behavior conforms to social
expectations where abnormal behavior does
not.
NORMAL AND ABNORMAL
I) Psychiatric signs and symptoms are patterns of
disturbed human behavior.
Such patterns are also labeled with such terms
‘maladaptive’, ‘disordered’, ‘deviant’,
‘inappropriate’ and ‘abnormal’.
II) Although grossly deviant behavior patterns are readily
recognized as abnormal, the distinction between
‘normal’ and ‘abnormal’ can be difficult.
III) A rough definition is ‘Behavior is abnormal if it
causes trouble either for the patient or for others’.
Behavior may cause trouble because of its intensity, its
frequency, its lack of appropriateness to a given
situation.
MENTAL DISORDERS
The term ‘mental’ springs from a dualistic
interpretation of human behavior
The dualistic interpretation holds that
the human organism consists of two separate
components:
*The body or soma
*The mind or psyche
These two components have impact upon one another – they
are viewed as essentially separate.
MENTAL DISORDERS ARE SIMPLY
DISTURBANCES OF BEHAVIOUR
POPULAR MISCONCEPTIONS
Mental Disorders have been generally characterized by
superstition, ignorance and fear.
Although successive advances in the scientific
understanding of abnormal behavior have dispelled
many false ideas, there remain a number of popular
misconceptions.
They are
* The belief that abnormal behavior is always bizarre.
* The idea that ‘normal’ and ‘abnormal’ are sharply
differentiated.
* The view of mental disorders as a hereditary stigma.
* The view of genius as ‘akin to insanity’
* The view of mentally ill persons as incurable and dangerous.
* The belief that mental disorder is a disgrace.
* An exaggerated fear of one’s own susceptibility to mental
disorder.
General reaction of public to mentally ill
persons
The following emotional reactions which directly
or indirectly determine our approach to mentally
ill are
*Fear and suspicion…..that the mentally ill person
may be harmful.
*Disgust and Dislike….because the mentally ill
person is not clean
*Anger and Rejection…..because the mentally ill
person annoys others.
*Sympathy and Pity
*Amusement and laughter
*Distrust
*Indifference
CAUSES OF MENTAL ILLNESSES
Mental illnesses are caused by variety of factors viz.
* Changes in the structure and functioning of the brain.
* Heredity factors.
* Childhood experiences.
* Home/family atmosphere
* Other factors viz. Bad peer-group influence,
unemployment, poverty, insecurity, exposure to stressful
situations etc.
* Provides a common understanding of a
condition and how it is commonly treated
* Aids in treatment planning and medical
management
* Aids in patient education
* Fundamental to medical record keeping
* Facilitates data collection, retrieval, and analysis
* Necessary for reimbursement
*
*DSM-IV published in 1994 was the last major revision of
the DSM.
* the culmination of a six-year effort that involved over
1000 individuals and numerous professional
organizations.
* Much of the effort involved conducting a comprehensive
review of the literature to establish a firm empirical basis
for making modifications.
* Numerous changes were made to the classification
(i.e., disorders were added, deleted, and reorganized), to
the diagnostic criteria sets, and to the descriptive text
based on a careful consideration of the available research
about the various mental disorders.
* In anticipation of the fact that the next major revision of
the DSM (i.e., DSM-V) will not appear until 2010 or later
(i.e., at least 16 years after DSM-IV), a text revision of
the DSM-IV called DSM-IV-TR was published in July 2000.
* The primary goal of the DSM-IV-TR was to maintain the
currency of the DSM-IV text, which reflected the
empirical literature up to 1992. Thus, most of the major
changes in DSM-IV-TR were confined to the
descriptive text. Changes were made to a handful of
criteria sets in order to correct errors identified in
DSM-IV. In addition, some of the diagnostic codes
were changed to reflect updates to the ICD-9-CM
coding system adopted by the US Government.
*
* Subtypes define mutually exclusive and
jointly exhaustive phenomenological
subgroupings within a diagnosis
* Specifiers are not intended to be mutually
exclusive or jointly exhaustive
* Both subtypes and specifiers increase
specificity in diagnosis
*
* Mild, Moderate, Severe
* Partial Remission, Full Remission
* PriorHistory, Recurrence
* Principal Diagnosis, Reason for Visit
* Provisional Diagnosis
* Disorder–Not Otherwise Specified
*
* DiagnosticFeatures
* Subtypesand/orSpecifiers
* Associated Features and Disorders –
Associated descriptive features and mental
disorders
* Associated laboratory findings
* Associated physical examination findings and
general medical condition
*
* Specific Culture, Age, and Gender Features
* Prevalence
* Course
* Familial Pattern
* Differential Diagnosis
*
* Disorders Usually First Diagnosed in Infancy,
Childhood, or Adolescence
* Delirium, Dementia, and Amnestic and Other
Cognitive Disorders
* Mental Disorders Due to
aGeneral Medical
Condition
* Substance-Related Disorders
* Schizophrenia and other psychotic disorders
*
* Mood Disorders
* Anxiety Disorders
* Somatoform Disorders
* Factitious Disorders
* Dissociative Disorders
* Sexual and Gender Identity Disorders
* Eating Disorders
* Sleep Disorders
* Impulse-Control Disorders Not Elsewhere
Classified
* Adjustment Disorders
* Personality Disorders
* Additionally, there is a section on other
conditions that may be a focus of clinical
attention
* AXIS I: Clinical Disorders, Other Conditions that
my be a focus of attention
* AXIS II: Personality Disorders, Mental Retardation
* AXIS III: General Medical Conditions
* AXIS IV: Psychosocial/Environmental Problems
* AXIS V: Global Assessment of
Functioning/Children’s Global Assessment of
Functioning
*
* Adult GAF
* Children’s Global Assessment Scale (CGAS)
– For ages 4-16
* GAF and CGAS both assign a specific
numerical rating of the person’s overall
functioning
* Scales are in 10 point increments with a
general description of the level of functioning
within the range
*
* Assigns a numerical rating on a scale from 0100
* Evaluator to use clinical judgment based upon
his/her total experience with the population
* Consider psychological, social, and
occupational functioning on a hypothetical
continuum of mental health-illness
* GAF/CGAF used to track clinical progress over
time
* For adults, a GAF score of 50 or less along with
a qualifying SMI diagnosis triggers an SMI
Determination.
* (See SMI Determination Addendum of the
Assessment)
 Mental Retardation (Axis II)
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1-2 % of the Population
Significantly Below Average Intellectual Functioning
Intellectual Quotient (IQ) below 70 on standardized testing
WISC-R, WAIS III, WPPSI, Stanford-Binet
Concurrent Deficits or Impairments in Adaptive
Functioning
Communication, Self-care, Home Living, Social
Interpersonal Skills, Use of Community Resources, Self
Direction, Functional Academic Skills, Work, Leisure, Health
and Safety
Onset Before Age 18 years
*
* INTELLECTUAL FUNCTIONING
* Borderline Intellectual Functioning – IQ ~70-85
* Normal Intelligence – IQ ~85-115
* Superior intelligence – IQ ~115 or Higher
MENTAL RETARDATION
 Mild Mental Retardation
 IQ~55-69
 85% of MR cases
 Moderate Mental Retardation
 IQ~40-55
 10% of MR cases
 Severe Mental Retardation
 IQ~25-40
 <5% of MR cases
 Profound Mental Retardation
 IQ~25or Below
 <3% of MR cases
* Reading Disorder
* Mathematics Disorder
* Disorder of Written Expression
* Learning Disorder NOS
*
* Developmental Coordination Disorder
*
* Expressive Language Disorder
* Mixed Receptive-Expressive
* Language Disorder
* Phonological Disorder
* Stuttering
*
 Delays or abnormal functioning in:
 Social Interactions
 Communication
 Restrictive Repetitive and Stereotyped Patterns
of Behavior, Interests and Activities
 Autistic Disorder
 Rett’s Disorder
 Childhood Disintegrative Disorder
 Asperger’s Disorder
 Pervasive Developmental Disorder NOS
*
* DISTINGUISHING ASPERGER’S
SYNDROME FROM AUTISM
* Autistic Disorder and Asperger’s Syndrome:
* 10-15 / 10,000 population
* Early cognitive and language skills not delayed
* Evidence of disorder has later onset
* Greater motivation for engaging others, but
done in an eccentric, one-sided, insensitive
manner
* Attention-Deficit/Hyperactivity Disorder
* Attention-Deficit/Hyperactivity Disorder NOS
* Conduct Disorder
* Oppositional Defiant Disorder
* Disruptive Behavior Disorder
*
* ATTENTION-DEFICIT / HYPERACTIVITY
DISORDER
* 3–10%ofPopulation
* 3:1 Male to Female Ratio
* Clinical Management: Combination of Somatic
(Medication) Therapy and Behavioral
Management
* DISRUPTIVE BEHAVIOR DISORDERS
* Conduct Disorders:
* Repetitive and Persistent Pattern of Behavior That
Violate Rights of Others or Age-Appropriate Social
Norms
* Aggression to People and Animals
* Destruction of Property
* Deceitfulness and Theft
* Serious Violations of Rules
* 10 % of Boys, 2 % of Girls: Often Develops into Adult
Antisocial Personality
* Oppositional Defiant Disorder:
* Persistent and Totally Negative, Hostile, and
Defiant Behavior
* DELIRIUM
* Disturbance of Consciousness
* Change in Cognition
* Develops Over a Short Period of Time
* Fluctuates
* Look For Underlying Medical Causes
*
* DELIRIUM, due to…
* Substance Intoxication Delirium
* Substance Withdrawal Delirium
* Delirium Due to Multiple Etiologies
* Delirium NOS
DEMENTIA
 Alzheimer’s Dementia:
 Risks: Up to 50 % of First-Degree
 Relatives by Age 90 Years
 Memory Impairment
 Cognitive Disturbances
 Aphasia, Apraxia, Agnosia
 Executive Functioning: Planning, Organizing,
Sequencing,
 Gradual Onset and Continuing Cognitive Decline

Pre-Senile (<65 yo) or Senile (>65 yo) Onset
* Vascular Dementia: Multi-Infarct Dementia
* Dementia Due to General Medical Conditions:
* HIV Infection
* Head Injury
* Parkinson’s, Huntington’s, Pick’s, CreutzfeldJacob’s Disease
* Brain Tumors, Hydrocephalus
* Substance-Induced Persisting Dementias
*
* AMNESTIC DISORDERS
* Amnestic Disorder Due to . . .
* Substance-Induced Persisting Amnestic
Disorder
• Amnestic Disorder NOS
Substance Dependence:
 Tolerance Develops
 Characteristic Withdrawal Syndromes
 Taking Substance in Larger Amounts or Over
Longer Time Than Intended
 Persistent Desire or Unsuccessful Efforts to
Cut Down or Control Use
 Spending a Great Deal of Time
Obtaining/Using/Recovering
 Use Despite Knowledge of
Persistent/Recurrent Physical /Psychological
Problems
*
* Substance Abuse:
* Maladaptive Pattern of Substance use:
* Recurrent Use Results in Failure in Role
Obligations (Work/School/Home)
* Use in Hazardous Situations: Driving Under
Influence
* Recurrent use-Related Legal Problems
(Arrests/Assaults/ Disorderly Conduct)
* Continued Use Despite Persistent/Recurrent
Social/Interpersonal Problems
* Multitude of Classifications:
* See pages 16 – 19 of DSM-IV-TR Classification
* Over 100 pages in DSM-IV-TR are substancerelated disorder descriptions
* Specific presentation is related to drug(s) of
abuse
* Use Core Assessment Substance Abuse section,
pages to assist in classification
* • Schizophrenia:
– 1 % of Population
– Peak Onset: Late Teens, Early 20’s
*
* Characteristic Symptoms:
* Delusions
* Hallucinations
* Disorganized Speech
* Grossly disorganized or Catatonic Behavior
* Negative Symptoms: Flat/Blunted Affect, Alogia,
Avolition, Apathy, Anhedonia
* Social/Occupational Dysfunction:
* Markedly Below Pre-Morbid Functioning in:
* School or Work
* Interpersonal Relationships
* Self Care
* • Duration: Continuous Signs Persist >6
Months
* Subtypes:
* Paranoid Type
* Disorganized type
* Catatonic Type
* Undifferentiated
* Residual Type
* PARANOID TYPE
* Preoccupation with One or More Delusions or
Frequent Auditory Hallucinations
* None of the following is Prominent:
* Disorganized Speech, Disorganized or Catatonic
Behavior, or Flat or Inappropriate Affect
* DISORGANIZED TYPE
* All of the Following are Prominent:
* Disorganized Speech
* Disorganized Behavior
* Flat of Inappropriate Affect
* The Criteria Are Not Met for Catatonic Type
 CATATONIC TYPE
 The Clinical Picture Is Dominated by at Least Two of the
Following:
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
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

Motoric Immobility as Evidenced by Catalepsy or Stupor
Excessive Motor Activity
Extreme Negativism (Apparently Motiveless Resistance to All
instructions or Maintenance of a Rigid Posture Against Attempts to
Be Moved) and Mutism
Peculiarities of Voluntary Movement as Evidenced by Posturing
(Inappropriate or Bizarre Postures), Stereotyped Movements,
Prominent Mannerisms, or Prominent Grimacing
Echolalia or Echopraxia
* UNDIFFERENTIATED TYPE
* A Type of Schizophrenia in Which Symptoms
That Meet Criterion A Are Present,
but The Criteria Are Not Met for The Paranoid,
Disorganized, or Catatonic Type
* RESIDUAL TYPE
* Absence of ProminentDelusions,
Hallucinations, Disorganized Speech, and
Grossly Disorganized or Catatonic Behavior
* Continuing Evidence of a Disturbance, as
Indicated by The Presence of Negative
Symptoms or 2 or More Symptoms Listed in
Criterion A for Schizophrenia
* SCHIZOPHRENIFORM DISORDER
* Criteria for Schizophrenia Are Met An Episode
of the Disorder Lasts at Least 1 Month but Less
Than 6 Months
* Good Prognostic Features:
* Onset of Psychotic Symptoms Within 4 Weeks of
1st Notable Change in Usual Behavior or Function
* Confusion or Perplexity
* Good Pre-morbid Social and Occupational
Functioning
* Absence of Blunted or Flat Affect
* SCHIZOAFFECTIVE DISORDER
* During the Same Period of Illness, There Have
Been Delusions or Hallucinations for At Least 2
Weeks in the Absence of Prominent Mood
Symptoms
* Symptoms of a Mood Episode are Present for a
Substantial Portion of the Total Duration of
illness
* DELUSIONAL DISORDERS
* Non-bizarre Delusions of at Least 1 Month
Duration
* Criterion for Schizophrenia Has Never Been Met
* Apart From the Impact of Delusion(s),
Functioning is Not Markedly Impaired/Behavior
is Not Obviously Odd or Bizarre
* Concurrent Mood Symptoms are Relatively
Brief in Duration
* Erotomanic Type
* Delusions That Another Person, Usually of
Higher Status, Is In Love With The Individual
* Grandiose Type
* Delusions of Inflated Worth, Power,
Knowledge, Identity, or Special Relationship to
a Deity or Famous Person
* Jealous Type
* Delusions That The Individual’s Sexual Partner
Is Unfaithful
* PersecutoryType
* Delusions That The Peron (Or Someone Close)
Is Being Malevolently Treated In Some Way
* SomaticType
* Delusions That The Person Has Some Physical
Defect or General Medical Condition
* BRIEF PSYCHOTIC DISORDER
* Presence of One or More of the Following
* Delusions
* Hallucinations
* Disorganized Speech
* Grossly disorganized or Catatonic Behavior
* Duration of an Episode of the Disturbance is at
least 1 day but less that 1Month, and full return
to Pre- morbid Functioning
* SHARED PSYCHOTIC DISORDER
* A Delusion Develops In An Individual In The
Context of a Close Relationship With Another
Person(s), Who Has An Already Established
Delusion
* The Delusion Is Similar In Content To That of
The Person Who Already Has The Established
Delusion
* Depressive disorders
* 4.3 % of Population At Any Given Time
* 8 – 20% Lifetime Prevalence
* 2:1FemaletoMale
* Bipolar Disorder:
* O.5 – 1 % Lifetime Prevalence
* 3:2 Female to Male
* Dysthymic Disorder
* 3 % Lifetime Prevalence
*
* RED FLAGS: SUICIDE
* 10-15 % of All Hospitalized with Depression
* 10-15 % of Persons with Bipolar Disorder
* Epidemic of Suicide Among Adolescents and
the Elderly
* Highest Risks for Those With Prior History Of
Suicide Attempt; Family History of Suicide;
Divorced, Widowed, Separated, or Living Alone;
and Currently Abusing Substances
* DEPRESSIVE DISORDERS
* Major Depressive Disorder
* Single episode
* Recurrent
* Dysthymic Disorder
* Depressive Disorder NOS
*
* MAJOR DEPRESSION SYMPTOMS
* Depressed Mood Most of the Day, Nearly Every
Day
* For a Child – Can Be Irritable Mood
* Markedly Diminished Interest or Pleasure in
All, or Almost All, Activities Most of the Day,
Nearly Every Day
* Significant Weight Loss or Weight Gain (5% or
more of Body Weight), or Decrease or Increase
In Appetite
* Insomnia or Hypersomnia
* Psychomotor Agitation or Retardation
* Fatigue or Loss of Energy
* • Feelings of Guilt or Worthlessness or
Excessive or Inappropriate Guilt (Delusional
Guilt)
* Diminished Ability to Think or Concentrate, or
Indecisiveness
* Recurrent Thoughts of Death, Recurrent
Suicidal Ideation Without a Specific Plan, or a
Suicide Attempt, or a Specific Plan for
Committing Suicide
* Symptoms Cause Significant Distress or
Impairment In Functioning
* ManicEpisode:
* Distinct Period of Abnormally and Persistently
Elevated , Expansive, or Irritable Mood, Lasting
At Least 1 Week
* During the Period, 3 or More Are Present:
* Inflated Self-esteem or Grandiosity
* Decreased Need for Sleep (Feels Rested After Only
3 Hrs.)
* Hyper-talkative or Pressured Speech
* Flight of Ideas or Subjective Experience of
Racing Thoughts
* Distractibility
* Increase in Goal-Directed Activities
* Excessive Involvement in Pleasurable Activities
That Have a High Potential for Painful
Consequences (Spending Sprees, Sexual
Indiscretions, Foolish Business Investments)
* Manic episodes:
* Mood Disturbance Is Sufficiently Severe to
Cause Marked impairment in Occupational
Functioning or in Usual Social Activities or
Relationships with Others, or to Necessitate
Hospitalization to Prevent Harm to Self or
Others or There Are Psychotic Features.
* PSYCHOTIC FEATURES MIXED EPISODE
* Criteria Are Met for Both a Manic Episode and
for a Major Depressive Episode Nearly Every
Day During At Least 1 week
* Mood disturbance Is Sufficiently Severe to
Cause Marked Impairment
* MAJOR DEPRESSIVE DISORDER
* Single Episode or Recurrent
* With or Without Psychotic Features
* With Catatonic Features
* With Melancholic Features
* With Atypical Features
* With Postpartum Onset
* DYSTHYMIC DISORDER
* Depressed Mood for Most of the Day, for
More days Than Not, for At Least 2 Years
* What is the difference between Major
Depression and Dysthymic Disorder?
* BIPOLAR DISORDERS
* Bipolar I Disorder:
* Must have had at least One Episode of illness
meeting the full criteria for Mania
* Bipolar II Disorder:
* Never has had a Manic Episode
* May have had episode of Hypomania
* • Bipolar Disorder NOS
* CYCLOTHYMIC DISORDER
* For at least 2 Yrs, the presence of numerous
periods with Hypomania and Depression
* During the 2 Yr Period, the person has not been
without symptoms for more than 2 months
* No episodes of Major Depression, Mania, or
Mixed Episodes
* ANXIETY DISORDERS
* Panic Disorder
* Agoraphobia
* Specific Phobia
* Social Phobia
* Obsessive-Compulsive Disorder
* Posttraumatic Stress Disorder
* Generalized Anxiety Disorder
* PANIC ATTACKS/DISORDER
* Discrete Periods of the following:
* Palpitations
* Sweating
* Trembling or Shaking
* Sensation of Shortness of Breath
* Feeling of Choking
* Nausea or Abdominal Distress
* Feeling Dizzy, Unsteady, Lightheaded/Fain
* Derealization (Unreality) or Depersonalization
(Detached)
* Fear of Losing Control or Going Crazy
* Fear of Dying
* Paresthesias (Numbness, Tingling)
* Chills or Hot Flushes
* AGORAPHOBIA
* Anxiety about being in Places or Situations from
which escape might be difficult or embarrassing,
or in which help may not be available in an
unexpected situation or situation that may lead
to panic
* The Situations are avoided or are endured with
marked distress, or require the presence of a
companion
* SPECIFIC PHOBIA
* Marked or Persistent Fear That Is Excessive or
Unreasonable, Cued By the Presence or
Anticipation of a Specific Object or Situation:
* Flying
* Heights
* Animals
* Receiving An Injection or Seeing Blood
* SOCIAL PHOBIAS
* A marked or Persistent Fear of One or More
Social or Performance Situations In Which the
Person Is Exposed to Unfamiliar People or to
Possible Scrutiny By Others. The Individual
Fears That He or She Will Act In a Way (Or
Show Anxiety Symptoms) That Will Be
Humiliating or Embarrassing
* Exposure to the Feared Social Situation Almost
Invariably Provokes Anxiety or Panic Attack
* The Person Recognizes That the Fear is
Excessive or Unreasonable
* Feared Social or Performance Situations Are
Avoided or Endured With Intense Anxiety or
Distress
* The Avoidance, Anxious Anticipation, or
Distress Interferes Significantly With Normal
Activities
* Generalized Social Phobia
 OBSESSIVE-COMPULSIVE DISORDER (OCD)
 Obsessions:
 Recurrent and Persistent Thoughts, Impulses,
or Images That Are Experienced As Intrusive
and Inappropriate, and That Cause Marked
Anxiety or Distress
 The Thoughts, Impulses, or Images Are Not
Simply Excessive Worries About Real-Life
Problems
 The Person Attempts to Ignore or Suppress
Them With Some Other Thought or Action
 The Person Recognizes That the Obsessions Are
From His/Her Own Mind
 Compulsions:
 Repetitive Behaviors (Hand Washing, Ordering,
Checking) or Mental Acts (Praying, Counting,
Repeating Words Silently) That the Person Feels
Driven to Perform In Response to an Obsession,
or According to Rules That Must Be Applied
Rigidly
 Are Aimed At Preventing or Reducing Distress or
Preventing Some Dreaded Event or Situation,
But Are Not Connected In a Realistic Way With
What They are Designed to Neutralize or
Prevent, or Are Clearly Excessive
* At Some Point The Person Recognizes That
The Obsessions or Compulsions Are Excessive
or Unreasonable
* Obsessions or Compulsions Cause Marked
Distress
* Some Persons May Have Poor Insight or
Recognition That The
Obsessions/Compulsions Are Excessive or
Unreasonable
* POST-TRAUMATIC STRESS DISORDER (PTSD)
* The Person Has Been Exposed to a Traumatic Event
In Which Both of The Following Are Present:
* The Person Experienced, Witnessed, or Was
Confronted With an Event(s) That Involved Actual
or Threatened Death or Serious Injury, or a Threat
to the Physical Integrity of Self or Others
* The Person’s Response Involved Intense Fear,
Helplessness, or Horror
 The Traumatic Eventis Persistently Re-
experienced In One or More of the Following
Ways:
 Recurrent and Intrusive Distressing
Recollections of the Event
 Recurrent Distressing Dreams of the Event
 Acting or Feeling As If the Traumatic Event
Were Recurring
 Intense Psychological Distress at Exposure to
Internal or External Cues That Symbolize or
Resemble Aspects of the Event
 Physiological Reactivity on Exposure to Internal
or External Cues
* Persistent Avoidance or Numbing
* Persistent Symptoms of Increased Arousal
* Course:
* Acute: <3 Months
* Chronic: >3 Months
* Delayed Onset: Onset of Symptoms >6 Months
After the Trauma
 GENERALIZAED ANXIETY DISORDER
 Excessive Anxiety and Worry
 The Person Finds It Difficult to Control the
Worry
 The Anxiety and Worry Are Associated With 3 or
More of the Following:

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
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Restlessness or Feeling Keyed Up or On Edge
Being Easily Fatigued
Difficulty Concentrating or Mind Going Blank
Irritability
Muscle Tension
Sleep Disturbance (Falling Asleep, Staying Asleep, or
Restless Sleep)
* Somatization Disorder
* Conversion Disorder
* Pain Disorder
* Hypochondriasis
* Body Dysmorphic Disorder
*
* DISSOCIATIVE DISORDERS
* Dissociative Amnesia
* Dissociative Fugue
* Dissociative Identity Disorder
* Multiple Personality Disorder
* Intense Sexually Arousing Fantasies, Urges, or
Behaviors / Perversions
* The Person Acts On These With Resulting
Significant Distress or Impairment in Social,
Occupational, or Other Important Areas of
Functioning
*
 PARAPHILIAS
 Exhibitionism: Exposing
 Fetishism: Use of Non-Living Objects
 Frotteurism: Touching, Groping
 Pedophilia: Involving Children (Often 13 y.o. or
Younger)
 Sexual Masochism: Made to Suffer (Beating,
Bondage, or Humiliation)
 Sexual Sadism: Inflicting Suffering
 Transvestic Fetishism: Involving Cross-Dressing
 Voyeurism: Observing Unsuspecting Person’s
Nudity
* Anorexia Nervosa
* Bulimia Nervosa
*
* ANOREXIA NERVOSA
* Refusal to Maintain Body Weight At or Above
Minimally Normal Weight For Age and Height
(<85% of Expected)
* Intense Fear of Gaining Weight or Becoming Fat,
Even Though Underweight
* Disturbance In Perception of Body Weight or
Shape, or Denial of the Seriousness of Current
Low Weight
* Amenorrhea (No Menses for 3 or More
Consecutive Months)
* Restricting Type:
* No Binge-Eating or Purging Behaviors
* Binge-Eating/Purging Type:
* Regularly Engages in Self-Induced Vomiting or
the Misuse of Laxatives, Diuretics, or Enemas
* Death Rate 10-20%: One of the Most Lethal
Disorders
 BULIMIA NERVOSA
 Recurrent Episodes of Binge Eating;
 Within a Discrete Period (e.g., <2 hours), Eating
Food in Larger Amounts Than Most People
Would Eat
 Sense of Lack of Control Over Eating –
Recurrent Inappropriate Compensatory
 Behavior In Order to Prevent Weight Gain:
 Self-Induced Vomiting;
 Misuse of Laxatives, Diuretics, Enemas, or
Other Medications;
 Fasting; or Excessive Exercise
* IntermittentExplosiveDisorder:
* Sudden Violent Aggression
* Kleptomania:
* Impulsive Stealing
* Pyromania
* Fire Setting
* PathologicalGambling:
* Trichotillomania
* Hair pulling/May Eat Hair
*
* Enduring Pattern of inner experience and
Behavior That Deviates From the Expectations
of the Individual’s Culture Manifested In:
* Cognition (Perceiving and Interpreting Self,
Others, and Events
* Affectivity (Range, Intensity, Lability, and
Appropriateness of Emotional Response
* Interpersonal Functioning
* Impulse Control
*
* Enduring Pattern of Personality Is Inflexible
and Pervasive Across a Broad Range of
Personal and Social Situations
* Enduring Pattern Leads to Significant Distress
or Impairment In Social, Occupational, or
Other Important Areas of Functioning
* Enduring Pattern Is Stable and Of Long
Duration, and Its Onset Can Be Traced Back
At Least To Adolescence or Early Adulthood
 Cluster A:
 Paranoid
 Schizoid
 Schizotypal
 Cluster B:
 Antisocial
 Borderline
 Histrionic
Narcissistic
* Cluster C:
* Avoidant
* Dependent
* Obsessive-Compulsive