DSM-V criteria

Question 1

What is the DSM-V criteria for Autism Spectrum Disorder (ASD)?

Answer 1

DSM-V criteria: child must have persistent deficits in each of 3 areas of social communication and interaction (see A.1. through A.3. below) plus at least 2/4 types of restricted, repetitive behaviours (see B.1. through B.4. below).
A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history:
A1. Deficits in social-emotional reciprocity (e.g. failure to respond to social interaction)
A2. Deficits in nonverbal communicative behaviours used for social interaction (e.g. poor eye contact)
A3. Deficits in developing, maintaining, and understand relationships (e.g. making friends)
B. Restricted, repetitive patterns of behaviour, interests, or activities, as manifested by at least two of the following:
B1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypes)
B2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behaviour (e.g., extreme distress at small changes)
B3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects)
B4. Hyper/hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (e.g. adverse response to differing textures)
C. Symptoms must be present in the early developmental period
D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.
E. These disturbances are not better explained by intellectual disability or global developmental delay. .

Question 2

Define ADHD?

Answer 2

DSM-V criteria:
A. Children must have at least 6 symptoms of either (or both) inattention or hyperactivity/impulsivity, while older adolescents and adults (>17yo) must have at least 5.
o Inattention symptoms: making careless mistakes, difficulty focusing one’s attention, often seeming not to listen, often failing to follow directions, difficulty organising tasks, avoiding tasks requiring sustained mental effort, often losing things, easily distracted by other stimuli, forgetful
o Hyperactivity symptoms: fidgeting/squirming, often leaving one’s seat, running/climbing excessively or inappropriately, difficulty playing quietly, often being “on the go”, talking excessively
o Impulsivity symptoms: blurting out an answer before the question is completed, difficulty waiting for one’s turn, often interrupting others
B. Evidence several of these symptoms were present <12yo
C. Impairment is present in two or more settings
D. Clinically significant impairment of functioning
E. Not better explained by another mental disorder

Question 3

Define bipolar disorder?

Answer 3

DSM-V criteria:
A. A distinct period of abnormally and persistently elevated, expansive or irritable mood AND persistent increased energy lasting at least 1 week (or any duration if hospitalised).
B. Three or more of the following symptoms during the period of mood disturbance and increased energy:
o Inflated self-esteem or grandiosity
o Decreased need for sleep
o Greater talkativeness than usual or pressure to keep talking
o Flight of ideas or subjective experience that thoughts are racing
o Distractibility
o Increase in goal-directed activity or psychomotor agitation
o Excessive involvement in pleasurable activities with a high potential for painful consequences (buying sprees, sexual activity, foolish investments)
C. Criteria for mixed episode are not met
D. Impairment must be severe enough to cause impaired functioning, hospitalisation OR psychotic features are present
E. Disturbance is severe enough to cause impairment in normal functioning
F. Symptoms are not caused by the effect of a substance or medical condition

Question 4

Define enuresis?

Answer 4

DSM-V criteria:
• Inappropriate elimination of urine into bed or clothes.
• Either frequency of at least 2/week for at least 3 months, OR clinically significant distress/impairment.
• Chronological or developmental age greater than 5yo.
• Not caused by a substance or medical condition.
• Specify if nocturnal, diurnal or both.

Question 5

Define gender dysphoria in adolescents/adults?

Answer 5

DSM-V criteria for adolescents and adults:
A. A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months duration. As manifested by at least 2 of the following:
1. A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics (or in young adolescents, anticipated secondary sex characteristics)
2. A strong desire to be rid of one’s primary and/or secondary sex characteristics because of marked incongruence with one’s experienced/expressed gender (or in young adolescents, the desire to prevent their development)
3. A strong desire for primary and/or secondary sex characteristics of the other gender
4. A strong desire to be one of the other gender (or some alternative different from that assigned)
5. A strong desire to be treated as the other gender (or some alternative different from that assigned)
6. A strong conviction one has the typical feelings and reactions of the other gender (or some alternative different from that assigned)
B. The condition is associated with clinically significant distress or impairment

Question 6

Define conduct disorder?

Answer 6

DSM-V criteria:
• Persistent, repetitive pattern of behaviour that infringes on the basis rights of others or violates major age-appropriate societal norms. This pattern is manifested by the presents of at least 3 of the following symptoms in the last 12 months (with at least one in the last 6 months):
• Symptom categories are:
o Aggression towards people or animals (7 symptoms in category)
o Destruction of property (2 symptoms in category)
o Deceitfulness or theft (3 symptoms in category)
o A serious rule violation (3 symptoms in category)
• The personal can have more than one symptom in a category.
• The disturbance causes clinically significant impairment.
• If the pt is older than 18, the criteria for antisocial personality disorder are not met.

Question 7

Define selective mutism?

Answer 7

DSM-V criteria:
A. The child shows consistent failure to speak in specific social situations in which there is an expectation for speaking (e.g., at school), despite speaking in other situations.
B. The disturbance interferes with educational or occupational achievement or with social communication.
C. The duration of the disturbance is at least 1 month (not limited to the first month of school).
D. The failure to speak is not attributable to a lack of knowledge of, or comfort with, the spoken language required in the social situation.
E. The disturbance is not better explained by a communication disorder (e.g., child-onset fluency disorder) and does not occur exclusively during the course of autism spectrum disorder, schizophrenia, or another psychotic disorder.

Question 8

Define intellectual disability (ID)?

Answer 8

DSM-V criteria:
A. Deficits in reasoning, problem solving, planning, abstract thinking, judgement, academic learning and experiential learning confirmed by clinical assessment and individual, standardised intelligence testing.
B. And concurrent deficits in adaptive functioning that limit functioning in key areas of daily life like communication, social participation and independent living, and result in the individual failing to meet developmental and societal standards for personal independence and social responsibility without social supports in multiple environments.
C. With onset during the developmental period.

Question 9

Define alcohol use disorder?

Answer 9

DSM-V criteria: (same general criteria for all substance abuse)
• Two or more of the following (within 12 months):
o Alcohol taken in larger amounts over a longer period of time than was intended
o Persistent desire or unsuccessful efforts to cut down or control alcohol use
o A great deal of time spent obtaining alcohol, using alcohol or recovering from the effects
o Craving or a strong desire to use alcohol
o Recurrent alcohol use resulting in failure to fulfill major obligations at work, school or home
o Continue alcohol use despite have persistent or recurrent social or interpersonal problems caused by alcohol
o Important social, occupational or recreational activities given up or reduced because of alcohol use
o Alcohol use continued despite the knowledge that it causes or worsens physical or psychological problems (e.g. ulcer disease, depression)
o Tolerance for alcohol
o Withdrawal symptoms (e.g. elevated vital signs, tremors, delirium tremens, seizures)

Question 10

Define stimulant intoxication?

Answer 10

DSM-V criteria for stimulant intoxication:
A. Recent use of a stimulant
B. Clinically significant maladaptive behaviour or psychological changes that developed during or shortly after use of substance
C. Two or more symptoms that develop during or shortly after use of the amphetamine or related substance, such as;
C1. Change in heart rate
C2. Pupil dilation
C3. BP change
C4. Perspiration or chills
C5. Nausea or vomiting
C6. Weight loss
C7. Psychomotor agitation or retardation
C8. Muscular weakness, respiratory depression, chest pain, arrhythmias
C9. Confusion, seizures, dyskinesia, dystonia, coma
D. The symptoms are NOT cause by another medical or psychiatric condition

Question 11

Define PCP intoxication?

Answer 11

DSM-V criteria:
A. Recent use of PCP or similar substance
B. Disturbed behaviour such as hostility, violence, impulsivity, psychomotor agitation after ingestion of PCP
C. Two or more of the following, within 1 hr of ingestion:
o Ataxia
o Dysarthria
o Hyperacusis (sensitive hearing)
o HTN or tachycardia
o Numbness
o Muscle rigidity
o Nystagmus; rhythmic, oscillating motion of the eyes, can be horizontal (most common), rotary (classic) or vertical
o Seizures or coma
D. The symptoms are NOT secondary to a medical condition or mental illness

Question 12

Define alcohol withdrawal?

Answer 12

DSM-V criteria:
A. Cessation or reduction in heavy, prolonged alcohol use.
B. Two or more of the following, developing within hours to days:
o Agitation
o Anxiety
o Autonomic hyperactivity (vital signs elevated)
o Hand tremor
o Insomnia
o Nausea/vomiting
o Seizures
o Transient hallucinations
C. The symptoms cause distress or impairment in functioning
D. The symptoms are not due to a general medical condition or another mental illness.

Question 13

Define anxiolytic withdrawal?

Answer 13

DSM-V criteria for anxiolytic withdrawal:
• Cessation or reduction in the use of an anxiolytic drug.
• Two or more of the following (occurring post cessation): autonomic hyperactivity, hand tremor, insomnia, N/V, hallucinations, psychomotor agitation, anxiety, grand mal seizures
• Symptoms should not be due to a general medical condition.

Question 14

Define cannabis intoxication?

Answer 14

DSM-V criteria for cannabis intoxication:
• Recent use of cannabis.
• Clinically significant problematic behavioural or psychological change(s) that developed during or shortly after cannabis use.
• Two or more of the following signs, developed within 2hrs of use:
1. Conjunctival injection
2. Dry mouth
3. Increased appetite
4. Tachycardia
• Symptoms are NOT due to a general medical condition, another mental disorder or another substance use.
• Specify: if with perceptual disturbances; hallucinations with intact reality testing.

Question 15

Define cannabis withdrawal?

Answer 15

DSM-V criteria for cannabis withdrawal:
• Cessation of heavy and prolonged cannabis use.
• Three or more of the following developed within 1 week of cessation:
• At least one of; abdo pain, shakiness/tremors, sweating, fever, chills, headache
1. Decreased appetite or weight-loss
2. Depressed mood
3. Irritability, anger or aggression
4. Nervousness or anxiety
5. Restlessness
6. Difficulty sleeping
• The symptoms cause clinically significant distress or impairment
• The symptoms are NOT attributable to another medical condition, mental disorder or substance

Question 16

Define Tourette’s disorder?

Answer 16

DSM-V criteria:
• Multiple motor and one or more vocal tics during the course of the illness but not necessarily at the same time.
• The frequency of the tics must be many times a day, nearly daily, for >1yr, with no period of remission lasting >2 months.
• Onset <18yo
• Must not be due to a substance or general medical condition

Question 17

Define delirium?

Answer 17

DSM-V criteria:
• Disturbance in baseline attention and awareness.
• The disturbance develops over a short period of time (hours to days) and fluctuates in severity throughout the day.
• A disturbance in cognition, such as memory deficit, language, visuo-spatial ability, perception
• The disturbances are not better explained by a neurocognitive disorder and do NOT occur in the context of a severely reduced level of arousal, such as a coma.
• There is evidence from the history, exam or labs that the disturbance is a direct physiologic consequence of another medical condition, substance intoxication/withdrawal, toxic exposure or multiple aetiologies.

Question 18

What are the signs of neuroepileptic malignant syndrome (NMS)?

Answer 18

1. hyperpyrexia
2. autonomic dysfunction (tachycardia, sweating, HTN, tremors)
3. muscle rigidity
4. mental confusion

Question 19

Define schizophrenia?

Answer 19

DSM-V criteria:
A. At least 2 of the following psychosis symptoms have been present for 1 month:
o Delusions: fixed, false beliefs that lack cultural sanctioning
o Hallucinations: false perceptions in any sensory modality without an external stimulus
o Disorganised speech: expression of thoughts lacking logical connections between ideas (loose associations) or between individual words (word salad).
o Disorganised or catatonic behaviour
-> Catatonia: 3 or more psychomotor symptoms; stupor, catalepsy, waxy flexibility, mutism, posturing, grimacing, mannerism, stereotyping, agitation, echopraxoia, echolalia
o Negative symptoms: lack of emotional responses and thoughts present in the general population; decreased emotional expression, flat affect, alogia (decreased spontaneous speech), avolition (decreased motivation)
B. Significant social and/or occupational dysfunction
C. Some symptoms are required for at least 6 months; must include at least 1 month of active phase symptoms, can include negative symptoms or less intense positive
D. Both schizoaffective and mood disorder with psychotic features need to be ruled out
E. A substance (abuse or medication) or another medical condition cannot be responsible.

Question 20

Define schizoaffective disorder?

Answer 20

DSM-V criteria:
• Patients must exhibit psychological symptoms consistent with the acute phase of schizophrenia.
• Psychotic symptoms must be accompanied by prominent mood symptoms (mania or depression) during part of the illness.
• At other points in the illness, psychotic symptoms must be unopposed; no mood symptoms present. Periods of illness where there are only psychotic symptoms alone must last >2 weeks.
• The disorder cannot be caused by a substance or by another medical condition.

Question 21

Define delusional disorder?

Answer 21

DSM-V criteria:
A. The presence of one (or more) delusions with a duration of 1 month or longer.
B. Criterion A for schizophrenia has never been met. Note: Hallucinations, if present, are not prominent and are related to the delusion theme (e.g., the sensation of being infested with insects associated with delusions of infestation.
C. Apart from the impact of the delusion(s) or its ramifications, functioning is not markedly impaired and behaviour is not obviously odd or bizarre.
D. If mood episodes have occurred concurrently with delusions, their total duration has been brief relative to the duration of the delusional periods.
E. The disturbance is not attributable to the physiological effects of a substance or another medical condition and is not better explained by another mental disorder, such as body dysmorphic disorder or obsessive-compulsive disorder.

Question 22

Define major depressive disorder?

Answer 22

DSM-V criteria:
A. Five or more of these symptoms have been present during the same 2 weeks (at least 1 must be depressed mood or anhedonia):
o Depressed mood
o Anhedonia
o Weight or appetite change
o Insomnia or hypersomnia
o Psychomotor agitation or retardation
o Fatigue or loss of energy
o Worthlessness, guilt
o Decreased concentration or indecisiveness
o Thoughts of death or suicidal ideation
B. Never been a manic, hypomanic or mixed episode
C. Symptoms cause distress or impaired functioning
D. Symptoms not caused by substance abuse, medication or medical condition
E. Symptoms not better accounted for by schizophrenia, schizoaffective disorder, delusional disorder, or other psychotic disorder

Question 23

Define cyclothymic disorder?

Answer 23

DSM-V criteria:
A. At least 2yrs of fluctuating hypomanic and depressive symptoms WITHOUT ever meeting full criteria for manic, hypomanic or major depressive episodes.
B. These symptoms have been present for at least half of the time and have not be absent for >2 months.
C. No hx of diagnosed mania, hypomania, depressive episode
D. Not better explained by another psychiatric illness.
E. Not induced by substances or a medical condition.
F. Symptoms lead to significant distress and/or impaired functioning.

Question 24

Define substance or medication-induced depression?

Answer 24

DSM-V criteria:
• A persistent, prominent disturbance in mood that is characterised by depressed mood or markedly diminished interest or pleasure
• The is evidence (hx, exam or labs) of both:
o The symptoms developed during or soon after substance intoxication or withdrawal or after exposure to a medication
o The involved substance/medication is capable of producing the symptoms
• The disturbance is not better explained by a depressive disorder that is NOT substance/medication induced
• The disturbance does not occur exclusively during the course of a delirium
• The disturbance causes clinically significant distress or impairment in functioning

Question 25

Define persistent depressive disorder?

Answer 25

DSM-V criteria:
• A subjective or objective depressed mood most of the day for more days than not, for at least 2yrs (can be 1yr for children/adolescents).
• The presence of two or more depressive symptoms (e.g. appetite changes, sleep changes, low energy, low self-esteem, poor concentration, hopelessness)
• During 2yr period, has never been without the depressive symptoms for >2 months.
• Criteria for major depression may be continually present for 2yrs.
• No manic, hypomanic or mixed episodes or cyclothymic disorders have ever been present.
• Symptoms not relative to psychotic disorder exclusively.
• Symptoms not caused by substance or due to another medical condition.
• Symptoms cause clinically significant distress or impaired functioning.

Question 26

Define premenstrual dysphoric disorder (PMDD)?

Answer 26

DSM-V criteria:
A. During the majority of menstrual cycles over the last year, multiple symptoms begin the week before menses, improve within days after the onset of menses and are minimal/absent during the post-menses week.
A. At least five symptoms total from both “mood” and “associated symptom” categories:
o Mood Symptoms:
- Depression, hopelessness, self-deprecation
- Affect instability, mood swings, rejection insensitivity
- Increased irritability, anger, interpersonal conflicts
- Significant anxiety and tension
o Associated symptoms:
- Decreased interest
- Concentration difficulty
- Insomnia or hypersomnia
- Fatigue or decreased energy
- Easily overwhelmed
- Change in appetite or specific cravings
- Weight gain, bloating, muscle/joint pain, breast tenderness or swelling
C. Symptoms cause significant distress or impaired functioning
D. Symptoms not caused by substance abuse, medication or medical condition

Question 27

Define adjustment disorder?

Answer 27

DSM-V criteria:
A. Development of an emotional response to a specific stressor within 3 months of the onset of that stressor.
B. Clinically significant symptoms (marked impact on functioning) developed as a response to the stressor.
C. The symptoms do not persist longer than 6 months after the stressor resolves.
Note: Six different subtypes of adjustment disorder:
1. With anxiety
2. With depressed mood
3. With disturbance of conduct
4. With mixed anxiety and depressed mood
5. With mixed disturbance of emotions and conduct
6. Unspecified

Question 28

Define GAD?

Answer 28

DSM-V criteria:
A. Persistent, excessive, uncontrollable anxiety/ worry for at least 6 months
B. The patient struggles to control the worry
C. At least three of:
o Disrupted sleep
o Fatigue
o Impaired concentration
o Irritability
o Muscle tension
o Restlessness
D. Symptoms are NOT better explained by another psychiatric disorder.
E. NOT caused by the direct effects of a substance or medication or medical illness.
F. Clinically significant distress or impairment of psychosocial functioning.

Question 29

Define panic attack?

Answer 29

DSM-V criteria for “Panic Attack”:
Panic attack consists of discrete episodes of intense fear or discomfort associated with at least 4 of:
•	Chest pain
•	Chills/ hot flashes
•	Derealization or depersonalisation 
•	Dizziness 
•	Fear of dying 
•	Fear of losing control or “going crazy”
•	Feelings of choking 
•	Nausea 
•	Numbness or tingling (paraesthesia’s) 
•	Palpitations
•	SOB 
•	Sweating 
•	Trembling

Question 30

Define panic disorder?

Answer 30

DSM-V criteria for “Panic Disorder”:
• Recurrent, unexplained panic attacks
• Attacks followed by 1 month of the following: concerns about having additional attacks or worry about the consequences of attacks, and/or maladaptive change in behaviour related to the attacks
• Attacks are not caused by the physiological effects of a substance, medication or medical condition
• Attacks are not better accounted for by another mental disorder

Question 31

Define agoraphobia?

Answer 31

Agoraphobia (differs from panic disorder): persistent marked or intense fear/anxiety triggered by real or anticipated exposure to a wide range (at least 2) of situations (e.g. public transport, crowds).

• Can be comorbid with panic disorder.

Question 32

Define specific phobia?

Answer 32

DSM-V criteria:
• Marked fear or anxiety about a specific object or situation (phobic stimulus).
• Phobic stimulus almost always provokes fear and anxiety.
• Phobic stimulus is avoided or endured with fear or anxiety.
• Fear or anxiety is out of proportion to actual danger.
• Symptoms last >6 months.
• Symptoms cause significant distress in impairment in social or occupational functioning.
• Symptoms are not better explained by another mental disorder.

Question 33

Define seperation anxiety disorder?

Answer 33

DSM-V criteria:
A. Developmentally inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached, as evidenced by at least three of the following:
A1. Recurrent excessive distress when anticipating or experiencing separation from home or from major attachment figures.
A2. Persistent and excessive worry about losing major attachment figures or about possible harm to them, such as illness, injury, disasters, or death.
A3. Persistent and excessive worry about experiencing an untoward event (e.g., getting lost, being kidnapped, having an accident, becoming ill) that causes separation from a major attachment figure.
A4. Persistent reluctance or refusal to go out, away from home, to school, to work, or elsewhere because of fear of separation.
A5. Persistent and excessive fear of or reluctance about being alone or without major attachment figures at home or in other settings.
A6. Persistent reluctance or refusal to sleep away from home or to go to sleep without being near a major attachment figure.
A7. Repeated nightmares involving the theme of separation
A8. Repeated complaints of physical symptoms (such as headaches, stomach-aches, nausea, or vomiting) when separation from major attachment figures occurs or is anticipated
B. The fear, anxiety, or avoidance is persistent, lasting at least 4 weeks in children and adolescents and typically 6 months or more in adults.
C. The disturbance causes clinically significant distress or impairment in social, academic (occupational), or other important areas of functioning.
D. The disturbance is not better explained by another mental disorder

Question 34

Define social anxiety disorder?

Answer 34

DSM-V criteria:
• A marked, persistent fear (at least 6 months duration) of at least one social or performance situation in which exposure to unfamiliar people or possible scrutiny of others occurs. The person fears they will act in a way to show anxiety symptoms that will be humiliating or embarrassing.
• Exposure to the feared situation(s) invariably provokes anxiety that can take the form of a panic attack.
• The person recognises the fear is unreasonable.
• The avoidance of, anxious anticipation of, or distress in the feared situation interferes with the person’s normal routine, or there is marked anxiety about having the phobia.
• Fear/avoidance is not related to a substance or another medication condition.
• If another medical condition is present, the fear is unrelated.

Question 35

Define OCD?

Answer 35

DSM-V criteria:
A. Recurrent and persistent thoughts, urges or images that are experienced, at some time during the disturbance, as intrusive, unwanted, and that in most individuals cause marked anxiety or distress.
B. The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some thought or action (i.e., by performing a compulsion).
C. 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.
D. 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.
E. The disturbance is not better explained by the symptoms of another mental disorder
F. The disturbance is not due to the direct physiological effects of a substance (e.g., drug of abuse, a medication) or a general medical condition.

Question 36

Define PTSD?

Answer 36

DSM-V criteria:
A. Exposure to actual or threatened, serious injury, or sexual violence in at least one of the following ways: directly experiencing or witnessing events, learning of events occurring to a close family member, or experiencing repeated exposure to aversive details of traumatic events.
B. Presence of at least one of:
• Recurrent, intrusive, distressing memories of the events
• Recurrent distressing dreams related to the events
• Dissociative reactions (e.g. flashbacks) of the events
• Psychological distress at exposure to cues symbolising/resembling events
• Marked physiological reactions to cues symbolising/resembling an aspect of the events
C. Persistent avoidance of associated stimuli:
• Efforts to avoid distressing memories/thoughts/feelings about the events
• Efforts to avoid external reminders that arouse distressing memories/thoughts/feelings about the events
D. At least two of the following negative alterations in thinking and mood related to the events;
• Inability to remember an important aspect of the events
• Persistent, exaggerated negative beliefs about oneself/others/world
• Inappropriately blaming oneself/others/world
• Persistent negative emotional state
• Anhedonia
• Feeling detachment from others
• Persistent inability to experience positive emotions
E. At least two alterations in arousal related to the event;
• Irritability or angry outbursts
• Reckless or self-destructive behaviour
• Hypervigilance
• Pronounced startle response
• Problems concentrating
• Sleep disturbance
F. Symptoms cause distress or impair functioning.
G. No other condition or substance explains symptoms.
H. Duration >1 month.

Question 37

Define acute stress disorder?

Answer 37

DSM-V criteria:
Diagnosis requires at least 9 of 14 symptoms in any of the five categories:
A. Intrusion symptoms
• Recurrent, involuntary and intrusive distressing memories of the traumatic event
• Recurrent distressing dreams related to the event
• Dissociative reactions in which the individual feels/acts as if the event were reoccurring
• Intense or prolonged psychological distress or marked physiologic reactions to internal or external cues that symbolize or resemble an aspect of the event
B. Negative mood
• Persistent inability to experience positive emotions
C. Dissociative symptoms
• An altered sense of reality of one’s surroundings
• Inability to remember an important aspect of the traumatic event
D. Avoidance symptoms
• Efforts to avoid distressing memories/thoughts/feelings associated with the event
• Efforts to avoid external reminders that arouse distressing memories/thoughts/feelings associated with the event
E. Arousal symptoms
• Sleep disturbance
• Irritable or angry outburst
• Hypervigilance
• Problems concentrating
• Exaggerated startle response
Note: Symptoms last 3 days to 4 weeks -> if lasting longer than 4 weeks, PTSD is diagnosed

Question 38

Define anorexia nervosa?

Answer 38

DSM-V criteria:
A. Restriction of energy intake relative to requirements, leading to a significant low body weight in the context of the age, sex, developmental trajectory, and physical health
B. Intense fear of gaining weight or becoming fat or persistent behaviour that interferes with weight gain.
C. Disturbed by one’s body weight or shape, self-worth influenced by body weight or shape, or persistent lack of recognition of seriousness of low bodyweight.
Specify if: restrictive type or binge/purge type

Question 39

Define bulimia nervosa?

Answer 39

DSM-V criteria:
A. Recurrent episodes of binge eating, as characterized by both:
• Eating, within any 2-hour period, an amount of food that is definitively larger than what most individuals would eat in a similar period of time under similar circumstances.
• A feeling that one cannot stop eating or control what or how much one is eating.
B. Recurrent inappropriate compensatory behaviours in order to prevent weight gain such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting or excessive exercise.
C. The binge eating and inappropriate compensatory behaviours occur, on average, at least once a week for 3 months.
D. Self-evaluation is unjustifiability influenced by body shape and weight.
E. The disturbance does not occur exclusively during episodes of anorexia nervosa.

Question 40

Define dissociative identity disorder (DID)?

Answer 40

DSM-V criteria:
A. Disruption of identity characterized by two or more distinct personality states, which may be described in some cultures as an experience of possession. The disruption of marked discontinuity in sense of self and sense of agency, accompanied by related alterations in affect, behaviour, consciousness, memory, perception, cognition, and/or sensory-motor functioning. These signs and symptoms may be observed by others or reported by the individual.
B. Recurrent gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting.
C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
D. The disturbance is not a normal part of a broadly accepted cultural or religious practice. Note: In children, the symptoms are not better explained by imaginary playmates or other fantasy play.
E. The symptoms are not attributable to the physiological effects of a substance (e.g., blackouts or chaotic behaviour during alcohol intoxication) or another medical condition (e.g. seizures)

Question 41

Define conversion disorder?

Answer 41

DSM-V criteria:
• One or more symptoms of altered voluntary motor or sensory function.
• Evidence of incompatibility between the symptoms and recognised neurologic or medical conditions.
• The symptoms or deficit is not better explained by another medical or mental disorder.
• The symptom or deficit causes significant distress or impairment in functioning or warrants medical evaluation.

Question 42

Define illness anxiety disorder?

Answer 42

DSM-V criteria:
A. Preoccupation with having or acquiring a serious illness.
B. Somatic symptoms are not present or, if present, are only mild in intensity. If another medical condition is present or there is a high risk for developing a medical condition (e.g., strong family history is present), the preoccupation is clearly excessive or disproportionate.
C. There is a high level of anxiety about health, and the individual is easily alarmed about personal health status.
D. The individual performs excessive health-related behaviors (e.g., repeatedly checks his or her body for signs of illness) or exhibits maladaptive avoidance (e.g., avoids doctor appointments and hospitals).
E. Illness preoccupation has been present for at least 6 months, but the specific illness that is feared may change over that period of time.
F. The illness-related preoccupation is not better explained by another mental disorder, such as somatic symptom disorder, panic disorder, generalized anxiety disorder, body dysmorphic disorder, obsessive-compulsive disorder, or delusional disorder, somatic type.

Question 43

Define somatic symptom disorder?

Answer 43

DSM-V criteria:
A. One or more somatic symptoms that are distressing or result in significant disruption of daily life.
o Specify if persistent (severe symptoms, marked impairment, long duration >6 months)
o Specify is mild/mod/severe
B. Excessive thoughts, feelings of behaviours related to the somatic symptoms or associated health concerns as manifested by at least one of the following:
o Disproportionate and persistent thoughts about the seriousness of one’s symptoms.
o Persistently high levels of anxiety about health or symptoms
o Excessive time and energy devoted to these symptoms or health concerns
C. Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically >6 months)
Note: “Predominant pain” is a specifier for individuals whose symptoms predominantly involve pain.

Question 44

Define factitious disorder?

Answer 44

DSM-V criteria:
• Falsification of physical or psychological signs or induction of injury or disease with identified deception
• The individual presents himself to others as ill, impaired or injured
• External incentives for the behaviour (as in malingering) are absent
• The behaviour is not better explained by another mental disorder, such as delusional or another psychotic disorder.

Question 45

Define malingering?

Answer 45

Definition: the intentional feigning, production or exaggeration of psychiatric or medical signs/symptoms to obtain secondary (external) gain, e.g. financial compensation, avoidance of work or criminal prosecution, to obtain drugs, to avoid military service).
• Not a psychiatric or medical diagnosis but is in the DSM-V listed as “another condition that may be the focus of clinical attention”.

Question 46

Define insomnia disorder?

Answer 46

DSM-V criteria:
• Predominant complaint of dissatisfaction with sleep quality or quantity, associated with one or more of the following:
o Difficulty initiating sleep, maintaining sleep, or early morning awakening with inability to return to sleep (in children, manifests without caregiver intervention).
• Sleep disturbances cause clinically significant distress or functional impairment.
• Sleep disturbance occurs at least 3 nights/week for at least 3 months.
• Sleep difficulty occurs despite adequate opportunity for sleep.
• The insomnia is not better explained by and doesn’t exclusively occur during the course of another sleep-wake disorder.
• Not due to substance or medication use.
• Not due to coexisting mental or medical conditions.

Question 47

Define NREM sleep arousal disorders?

Answer 47

DSM-V criteria for NREM sleep arousal disorders:
A. Recurrent episodes of incomplete wakening from sleep, usually occurring in the first 1/3 of the major sleep episode, accompanied by either one of the following:
a. Sleep walking; repeated episodes of rising from bed during sleep and walking about. Blank, staring face, unresponsive, no recollection.
b. Sleep terror; recurrent episodes of abrupt terror arousals. Intense fear, autonomic arousal (mydriasis, tachycardia, tachypnoea, diaphoresis). Unresponsive to comfort efforts.
B. No/little dream imagery recalled
C. Amnesia for episodes present
D. Episodes cause clinically significant distress or impairment
E. Disturbance not attributed to the physiological effects of substances
F. Coexisting mental or medical disorders do not explain the episode.
Specify form: sleep walking type (with sleep-related eating or sexual behaviour) OR sleep terror type

Question 48

Define personality disorders?

Answer 48

Personality Disorder definition: enduring patterns of perceiving, relating to and thinking about the environment and oneself that are inflexible, maladaptive and cause significant impairment in social or occupational functioning. Not due to another substance, medical condition or mental illness. They are present during the person’s stable functioning and not only during acute stress.

Question 49

Define borderline personality disorder?

Answer 49

DSM-V criteria:
A. Significant impairments in personality functioning manifest by:
1. Impairments in self-functioning (a or b):
a. Identity; impoverished/poorly developed/unstable self image, self-criticism, chronic feelings of emptiness, dissociative states under stress
b. Self direction; unstable goals/aspirations/values or career plans
AND
2. Impairments in interpersonal functioning (a or b):
a. Empathy; compromised ability to recognize feelings/needs of others associated with interpersonal hypersensitivity (perceptions of other selectively biased towards negative attributes)
b. Intimacy: intense, unstable and complicated close relationships, marked by mistrust and neediness, anxious pre-occupation with real or imagined abandonment, close relationships viewed in extremes of idealisation and devaluation alternating between overinvolvement and withdrawal
B. Pathologic personality traits in the following domains:
1. Negative affectivity; emotional lability, anxiety, separation insecurity, depression
2. Disinhibition; impulsivity, risk taking
3. Antagonism; hostility
C. Impairments are relatively stable across time and situations
D. Impairments are not better understood as normative for development of sociocultural environment
E. Impairments are not solely due to physiological effects of substance or general medical condition

Question 50

Define fetishistic disorder?

Answer 50

DSM-V criteria:
• Intense, recurring sexual arousal from either the use of non-living objects (e.g. shoes or female underwear) or a highly specific focus on non-genital body parts (e.g. the foot).
• This is manifested by fantasies, urges or behaviours; this must be present for at least 6 months.
• The sexual fantasies, desires of behaviours must cause clinically significant distress or impairment in social/occupational/other functioning.
• The fetish objects are not limited to articles of clothing use for cross-dressing (as in transvestic disorder) or devices specifically designed for genital stimulation (e.g. vibrator).