337 final criteria

Question 1

Social Anxiety (SAD) criteria

Answer 1

(A) marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others
(B) fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others)
(C) social situations almost always provoke fear or anxiety
(D) these situations are avoided or endured with great distress
(E) fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context
(F) fear or anxiety must have lasted for 6 months or more
(G) fear, anxiety, or avoidance must cause significant impairment in functioning
(H) not better explained by use of a substance
(I) not better explained by the symptoms of another mental disorder
(J) not better explained by a medical condition
Specify: performance only (public speaking, playing an instrument)

Question 2

Panic attack

Answer 2

(A) surge of intense fear or discomfort that rises and peaks within minutes (cognitive sx may last longer)
(B) at least 4 sx:
- increased heart rate or palpitations
- perspiration
- trembling
- shortness of breath
- choking sensation
- discomfort or pain in the chest
- nausea or abdominal upset
- dizziness or light-headedness
- feeling significantly chilled or hot
- parasthesia: tingling or numbness
- derealization (sense of unreality) or depersonalization (sense of separation from others)
- dread of losing control or going crazy
- dread of dying
Specify: full-blown (at least 4 sx) or limited-symptom (less than 4)

Question 3

Panic Disorder (PD)

Answer 3

(A) repeated and unexpected panic attacks (uncued)
(B) 1 month of worry about the persistent panic attacks or significant/maladaptive behavioural changes related to the attacks (like avoidance)
Specify: with/without agoraphobia

Question 4

Agoraphobia

Answer 4

(A) Pronounced, disproportionate, and repeated fear about being in at least 2 of the following situations
- public transportation
- parking lots, bridges, other open spaces
- shops, theatres, other confined spaces
- lines or crowds
- away from home unaccompanied
(B) fear of such agoraphobic situations derives from a concern that it would be hard to escape or get help if panic, embarrassment, or disabling symptoms were to occur
(C) Avoidance of the agoraphobic situations
(D) Symptoms usually continue for at least 6 months
(E) Significant distress or impairment

Question 5

Generalized Anxiety Disorder (GAD) criteria

Answer 5

(A) chronic and excessive worry about events, activities, topics occurring on more days than not (difficult to control the worry)
(B) Worry must persist for at least 6 months, and can involve a wide variety of topics such as work or school, finances, health, safety, and minor matters
(C) includes at least 3 physiological symptoms:
- feeling keyed up, restless, on edge
- difficulty concentrating or having one’s mind go blank due to worry
- disrupted sleep due to worry
- muscle tension
- irritability
- fatigue
(D) Not explainable by another disorder
(E) Excessive worry must predate another comorbid disorder and be present during remission of that disorder to be diagnosed (cannot only be present during a mood episode)

Question 6

Obsessive-Compulsive Disorder (OCD)

Answer 6

(A) presence of obsessions and/or compulsions that produce significant distress and cause noticeable interference with various aspects of role functioning
(B) obsessions or compulsions are time-consuming or cause significant distress or impairment in social, occupational, or other important areas of functioning
(C ) Symptoms are not attributable to the physiological effects of a substance or another medical condition
(D) Symptoms are not better explained by the symptoms of another mental disorder
Specify: with good/fair insight, poor insight, absent insight/delusional beliefs
Specidy: if tic-related (current or past history of a tic disorder)

Question 7

obsessions criteria

Answer 7

• persistent intrusive thoughts, ideas, images, impulses, or doubts that the person experiences as senseless and that evoke anxiety (unwanted, guilt-provoking, repugnant, ego-dystonic)
• Resisted; sense that they must be neutralized or avoided

Question 8

compulsions criteria

Answer 8

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

Question 9

most common obsessions

Answer 9

• contamination
• uncertainty
• aggression
• responsibility for harm and mistakes
• incompleteness (order/exactness, symmetry)
• unacceptable taboo violent, sexual, blasphemous thoughts
• somatic (fear that one has an illness)

Question 10

most common compulsions

Answer 10

• decontamination
• checking (including asking for reassurance)
• repeating routine activities
• ordering and arranging
• mental rituals

Question 11

Body Dysmorphic Disorder

Answer 11

(A) intrusive, distressing thoughts concerning one’s appearance, and repeated checking might be observed in both OCD and BDD

Question 12

Hoarding Disorder

Answer 12

(A) thoughts about acquiring and maintaining possessions
(B) thoughts that are not particularly intrusive or unwanted (generally emotionally positive or neutral and thus do not meet criteria for obsessions)
(C ) Excessive saving isn’t conceptualized as ritualistic, and this behaviour doesn’t neutralize obsessional anxiety

Question 13

Obsessive-Compulsive Personality Disorder (OCPD)

Answer 13

(A) presence of personality traits such as excessive perfectionism, inflexibility, and need for control that negatively impact interpersonal relationships, occupational functioning, or other important domains
(B) ego-syntonic: consider their behaviours and urges as rational and appropriate

Question 14

Post-Traumatic Stress Disorder (PTSD)

Answer 14

(A) experienced, witnessed, or learned about the traumatic event of a loved one, or have experienced repeated exposure to the aftermath of traumas
(B) at least 1 intrusion:
- persistent and distressing memories of the trauma
- recurrent distressing nightmares about the trauma
- dissociative reactions
- intense psychological or physiological responses to cues
(C) at least 1 avoidance:
- effortful avoidance of internal cues and efforts to avoid external reminders of the trauma like places, people, or situations
(D) at least 2 negative alterations in cognitions or mood:
- numbing and amnesia (and inability to have positive feelings)
- strong negative emotions like guilt, anger, fear
- distorted self-blame or erroneous blame of others who did not cause or intend the event
- negative beliefs about the self, others, and the world as a consequence of the trauma
(E) at least 2 alterations in arousal and reactivity:
- sleep difficulties
- impaired concentration
- exaggerated startle response and hypervigilance
- irritable or aggressive behaviours
- reckless or self-destructive bx
(F) all sx must have started/worsened after the trauma
(G) sx are present for at least 1 month, and perceived as causing distress or impairment

Question 15

PTSD specifiers

Answer 15

• “with delayed impairment”: diagnostic threshold is not met or exceeded until at least 6 months after the traumatic event
• for kids 6 or younger: kids usually don’t display negative alterations in mood/cognition, so required symptoms are reduced (more behavioural symptoms)
• with prominent dissociative sx: also experience either persistent or frequent experiences of depersonalization or derealization

Question 16

Major Depressive Disorder (MDD)

Answer 16

(A) at least 5 of the following symptoms present for most of the day, nearly every day for 2 weeks, 1 or 2 of which must be a cardinal symptom either (1) dysphoric mood (sad, empty, or tearful) and/or (2) anhedonia (the loss of interest or pleasure in almost all activities)
- significant weight gain/loss or change in appetite
- insomnia or hypersomnia
- psychomotor agitation or retardation
- fatigue or loss of energy
- feelings of worthlessness or excessive/inappropriate guilt
- decreased concentration or indecisiveness
- recurrent thoughts of death or suicidal ideation, plan, attempt
(B) distress or a decrease in functioning for at least 2 weeks
(C) not due to another illness or substance use

Question 17

MDD specifiers

Answer 17

• psychotic: loss of contact with reality
• recurrent: more than one episode
• melancholic
• chronic: unremitting for at least 2 years (meets full criteria for MDD constantly)
• atypical
• peripartum/postpartum: during pregnancy or within the 4 weeks following delivery
• with mixed features: some symptoms of a manic episode but don’t meet full bipolar criteria
• with anxious distress: considerable overlap between symptoms of depression and anxiety
• seasonal affective disorder: sx overlap with atypical/milder form

Question 18

melancholic specifier MDD

Answer 18

• profound anhedonia and lack of reactivity to pleasurable stimuli
• distinct quality of depressed mood: despondency, despair, empty
• regularly worse in the morning
• psychomotor agitation or retardation
• anorexia or weight loss
• excessive or inappropriate guilt

Question 19

atypical specifier MDD

Answer 19

• mood reactivity (no anhedonia)
• reverse vegetative: sleeping too much, increased appetite
• some psychomotor agitation (retardation isn’t common)
• “leadened paralysis” (limbs feel heavy)
• rejection sensitivity
• respond preferentially to MAOIs (but aren’t treated this way because of diet, so use ineffective SSRIs)
• more comorbidity with personality disorders (BPD), anxiety
• earlier onset

Question 20

Persistent Depressive Disorder/Dysthymic Disorder

Answer 20

(A) at least two symptoms accompanied by the occurrence of a depressed mood for most of the day, for more days than not, for at least 2 years
- poor appetite or overeating
- insomnia or hypersomnia
- low energy or fatigue
- low self-esteem
- poor concentration or difficulty making decisions
- feelings of hopelessness
(B) Must never have remitted for more than 2 months during the 2-year period

Question 21

PDD specifiers

Answer 21

• anxious distress
• mixed features
• pure dysthymic syndrome: full criteria for MDD have not been met in the previous 2 years
• persistent depressive episode: full criteria for major depressive episode have been ongoing in the preceding 2‐year period (same as chronic MDD)
• intermittent depressive episode, with current episode
• intermittent depressive episode, without current episode

Question 22

Bipolar I Disorder

Answer 22

• at least 1 manic episode
  (A) elated, expansive, or irritable mood and persistently goal-directed behavior or energy, lasting at least 1 week and present most of the day, nearly every day
  (B) at least 3 of the following (4 if only irritable mood)
• inflated self-esteem or grandiosity
• decreased need for sleep
• racing thoughts or flight of ideas
• rapid or pressured speech
• excessive involvement in activities that have a high potential for painful consequences
• increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
• distractability
• increased libido
  (C) symptoms last at least 1 weeks or require hospitalization or emergency treatment
  (D) produce functional impairment

Question 23

Bipolar II Disorder

Answer 23

• at least 1 hypomanic episode and one major depressive episode
  (A) noticeable changes in behaviour, mood, energy
  (B) at least 3 of the following (4 if only irritable mood)
• inflated self-esteem or grandiosity
• decreased need for sleep
• racing thoughts or flight of ideas
• rapid or pressured speech
• excessive involvement in activities that have a high potential for painful consequences
• increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
• distractability
  (C) symptoms last at least 4 days
  (D) not severe enough to cause marked impairment in social/occupational functioning or need hospitalization (no undue financial, emotional, or practical damage)
  *reality testing must be intact

Question 24

cyclothymia

Answer 24

• hypomania and short depressive episodes
• 2 years of switching between these milder states (doesn’t last for weeks at a time)
• not as impairing, often not seeking treatment

Question 25

Bipolar specifiers

Answer 25

• rapid cyclers: 4 or more episodes within a year (either type of episode), usually a phase people pass through, sometimes continuous presentation (shift between poles without a baseline in between)
• mood-congruent psychotic features: in mania (delusions of grandeur) and in depression (guilt and sin, nihilistic delusions)
• mood-incongruent psychotic features: in mania (thought-insertion and mind control) and in depression (anything happy)

Question 26

Specific Phobias

Answer 26

• marked, persistent, excessive fear of a dire outcome from interacting with an object, situation, activity
• avoided or endured with great distress + impairment in real life
• generalizes to images, related objects
• animal-type (rodents, reptiles, insects - most common, young age of onset)
• natural-environment type (storms, heights)
• blood/injection/injury type
• situational type (tunnels, bridges, elevators, flying)
• residual (choking, vomiting, illness, loud noises, falling down)

Question 27

alcohol use disorder

Answer 27

(A) problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least 2 of 11 specified symptoms, occurring within a 12‐month period
- symptoms are DSM-IV criteria for alcohol dependence and abuse + CRAVING - legal problems

Question 28

DSM-IV criteria for alcohol abuse

Answer 28

1. recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home
2. recurrent alcohol use in situations in which it is physically hazardous
3. continued use despite persistent/recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol

Question 29

DSM-IV criteria for alcohol dependence

Answer 29

1. tolerance (the need for greater amounts of alcohol to achieve the same intoxication level or desired effects) or a markedly diminished effect with continued use of the same amount of alcohol
2. withdrawal: physiological and cognitive maladaptive symptoms that occur when the blood concentration of alcohol declines after prolonged and heavy use of alcohol
3. alcohol is often taken in larger amounts and/or over longer periods of time than intended
4. persistent desire or unsuccessful efforts to stop or cut down alcohol use
5. increased amount of time is spent consuming, obtaining, or recovering from the effects of alcohol
6. important occupational, social, or recreational activities are given up or reduced because of alcohol use
7. alcohol consumption continues despite the knowledge of having persistent or recurring physiological or psychological difficulties

Question 30

severity ratings for AUD

Answer 30

• mild: 2-3 symptoms
• moderate: 4-5 symptoms
• severe: 6+ symptoms

Question 31

AUD specifiers

Answer 31

• in early remission: no criteria is met for at least 3 months, but less than 12 months
• sustained remission: no criteria is met for 12 months
• both specifiers exclude the craving criterion
• controlled environment: where access to alcohol is restricted

Question 32

borderline PD

Answer 32

(A) pervasive pattern of instability of interpersonal relationships, self-image and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by FIVE or more of the following:
1. Profound fears of abandonment (real or imagined). The person makes frantic and sometimes extreme efforts to avoid abandonment by others.
2. Interpersonal relationships that are both intense and unstable and that alternate between feelings of idealization and devaluation of the other person.
3. Identity disturbance characterized by a highly unstable sense of self or markedly disturbed self‐image.
4. Impulsive behavior in at least two areas that have the potential to be self‐damaging or to have harmful consequences (such as substance abuse, reckless driving, binge eating, unsafe sexual behavior, excessive spending).
5. Recurrent self-mutilating behavior or suicide threats, gestures, or suicidal behavior.
6. Highly reactive mood, leading to affective instability (e.g., intense negative affect such as depression, irritability, or anxiety that lasts a few hours or [rarely] a few days).
7. Persistent feelings of emptiness.
8. Intense or inappropriate anger that is difficult to control (e.g., constant feelings of anger, angry outbursts, or recurrent physical fights).
9. Brief periods of paranoid ideation or dissociative symptoms when under stress.

Question 33

antisocial PD

Answer 33

(A) pervasive pattern of disregard for and violation of the rights of others, occurring since AGE 15, as indicated by at least THREE of the following:
- failure to conform to social norms with respect to lawful behaviours (criminal behaviour)
- deceitfulness (lying, conning, aliases)
- impulsivity or failure to plan ahead
- irritability and aggressiveness
- reckless disregard for safety of self or others
- consistent irresponsibility (financial or work obligations)
- lack of remorse (indifferent to/rationalizing hurting others)
*need to be at least 18 years old
*antisocial behaviour can have psychological origins, which isn’t reflected here

Question 34

conduct disorder

Answer 34

• aggression to people or animals (bullies, using a weapon, physical cruelty to animals)
• destruction of property (fire setting)
• deceitfulness or theft (lying to obtain things)
• serious violations of rules (ignoring curfew, truancy)

Question 35

CD specifiers

Answer 35

• childhood-onset (before age 10)
• adolescent-onset
• with limited prosocial emotions (lack of remorse/guilt, callous lack of empathy, unconcerned about performance, shallow or deficient affect): egocentric, cold-hearted, violent, manipulative - tracking trajectory toward psychopathy

Question 36

CD epidemiology

Answer 36

• boys 4x more likely to be diagnosed
• girls diagnosed at a later age (different correlates and outcomes)
• assortative mating exacerbates CD problems (more negative behaviour, poorer parenting) which makes kids with higher genetic loading and more environmental risk factors

Question 37

schizophrenia

Answer 37

(A) At least TWO of the following: at least one of which is (1) delusions (2) hallucinations (3) disorganized speech or behaviour
- grossly disorganized or catatonic behaviour
- negative symptoms
(B) level of functioning is markedly lower than prior to onset
(C) symptoms present for 6 MONTHS with at least ONE MONTH of active symptoms
(D) unipolar, bipolar, schizoaffective disorders ruled out
(E) not attributable to substance

Question 38

schizoaffective disorder

Answer 38

• schizophrenic features + severe mood disorder
• mood disorder can be uni/bipolar, but must currently be depressed (with/without psychotic symptoms)
• delusions or hallucinations for at least 2 WEEKS in the ABSENCE of a mood episode
• symptoms of a mood episode must be present for the majority of the illness
• must have had mood episodes that included psychotic symptoms in the past/present

Question 39

delusional disorder

Answer 39

• psychotic symptoms are restricted to delusions
• can have nonprominent hallucinations related to the delusions
• less functional impairment than schizophrenia

Question 40

brief psychotic disorder

Answer 40

• psychotic symptoms occur for LESS than one month and resolve on their own
• once they resolve, the individual returns to normal level of functioning

Question 41

schizophreniform disorder

Answer 41

• symptoms of schizophrenia have lasted LONGER than one month, but LESS than 6 months
• if the symptoms do not resolve after 6 months, the diagnosis is changed to schizophrenia

Question 42

DDx schizoaffective disorder with schz and mood disorders

Answer 42

• differentiated from schizophrenia by the presence of mood episodes (distinct)
• differentiated from other mood disorders by the presence of psychotic Sx outside the mood episodes
• lots of overlap between BP1, MDD with psychotic features, schizophrenia, schizoaffective

Question 43

Anorexia Nervosa textbook

Answer 43

(A) low body weight from restricted energy intake relative to expenditure
(B) fear of weight gain OR behaviour that maintains low weight regardless of reason
(C) body-image disturbance OR overvaluation of weight/shape OR denial about being underweight
specify:
- restricting: no binge eating or purging, low weight is due to dieting and/or excessive exercise only
- binge-purge type: recurrent epsidoes in the past 3 months

Question 44

Bulimia Nervosa textbook

Answer 44

(A) repeated episodes of binge eating
- Distinct episode of eating an unusually large amount of food (usually, about 3x the portion for that food - 1900 calories)
- sense of loss of control over eating
(B) repeated episodes of behaviours intended to compensate for overeating and avoid weight gain, such as vomiting, laxatives, diuretics, fasting, excessive exercise
(C) binge eating and purging occur on average once a week for 3 months
(D) overvaluation of shape/weight
(E) criteria are not met for AN

Question 45

Binge Eating Disorder in textbook

Answer 45

(A) repeated episodes of binge eating
- distinct episode of eating an unusually large amount of food (usually 3x the portion for that food, about 1900 calories)
- sense of loss of control over eating
(B) episodes of binge eating are accompanied by at least THREE symptoms
- increased rate of eating
- eating beyond the point of fullness
- eating in the absence of physical hunger
- eating alone out of embarrassment
- feelings of disgust, depression, or guilt after episodes
(C) binge eating causes significant distress
(D) binge eating occurs at least once a week for 3 months
(E) criteria are not met for BN or AN