DSM VERSUS!!! Flashcards
(39 cards)
Autism Spectrum Disorder vs Social (Pragmatic) Communication Disorder
Autism Spectrum Disorder
This was originally ASD, Aspergers, and Pervasive Development Disorder, but they were all merged into one in the DSM V which gives the clinician a bit more freedom and they are distinguished based on the severity.
• Shows up at a young age (often 0-5)
• Requires both deficiency in social communication and action as well as stereotyped repetitive behavior
• Deficiency in social communication:
o Lack of social reciprocity (unbalanced conversations)
o Lack of sustained eye contact (especially in babies)
o Lack of companion play as the child gets older
• Stereotyped repetitive behavior
o Speech patterns (especially repetition), hand flapping, chewing, etc
• Struggles with transitions
• Fixated on certain subjects (like snakes)
• Hyper or hyposensitivity (like hearing the ticking of a clock, or feeling the tag on a shirt)
Social Pragmatic Communication Disorder
This has impoverished social communication and just that – no stereotyped or repetitive behaviors. So if you see someone with bad social reciprocity, or eye contact, but not repetitive behaviors, this is Social Pragmatic Communication Disorder.
Specific Learning Disorder vs Attention Deficit Hyperactivity Disorder
Learning disorder
Marked problems with learning basic academic skills that, based on their age and IQ they should be able to pick up, but can’t. In other words, they’re smart enough but can’t learn the way most people learn.
Learning disorders always need to be ruled out before diagnosing ADHD. Sometimes kids can present with ADHD symptoms because of an LD – for example a child with poor eyesight or dyslexia might be disruptive, fidgety, get bad grades etc, but its caused by the dyslexia. Once those things are fixed, the child can learn.
Attention Deficit Hyperactivity Disorder
- Again, be sure to rule out an LD first.
- Symptoms must be present before the age of 12, however, adults can still be diagnosed with ADHD, they just need to be able to trace the symptomology back to age 12 or prior.
- The person must have 2 or more environments where the individual is impaired (work, school, home, etc.)
- ADHD is marked by patterns of hyperactivity and problems with attention (sometimes girls only have problems with attention)
- Hyperactivity: fidgeting a lot, playing with things, sometimes annoying other people as a source of stimulation
- Inattention: trouble focusing, trouble sustaining attention, interruptions, struggles with tasks and getting organized.
Pica vs Rumination Disorder
Pica
This is the persistent eating of non-food substances (like dirt, carpeting, etc). This is not likely to be tested on the exam, but you may well see it as a distraction answer which you can then quickly rule out.
Rumination Disorder
This is the repeated regurgitation of food that is not related to another disorder. The person will eat food and then regurgitate it.
Language Disorder vs Child Onset Fluency Disorder
Both of these show up between the ages of 0-5
Language Disorder
This is when people, usually children, have a hard time building their vocabulary. So children should know a certain number of words at a certain age, and this is when they fall way below that.
• They use very simple sentences (“me go park” instead of “I want to go to the park”)
• They struggle with sentences of more than five words
Child Onset Fluency Disorder
This is stuttering. A repeated sound or syllable, or broken words “under [pause] stand”
Tourette’s Disorder vs Persistent Motor / Vocal Tic Disorder
Tourette’s – the individual has both motor (jerking hand motions, for example) and vocal (shouting a curse word without intending to, for example) tics
Persistent Motor / Vocal Tic Disorder – the individual only has one. They either have vocal tics or motor tics, but they don’t have both. If they had both, they’d have Tourette’s.
Encopresis vs Enuresis
Both must happen at the age of 5 or older (after we can expect they are potty trained)
Both must be a pattern over time, not a one-off event
Both can be signs of trauma or sexual abuse
Both can be intentional or unintentional
Encopresis – this is the shitting of pants or bed (word is kinda like constipated or crapping)
Enuresis – this is the pissing of the pants or bed (word is kinda like urine)
Separation Anxiety Disorder vs Generalized Anxiety Disorder
Separation Anxiety Disorder – this is anxiety specific to being away from the caregiver. It can include anticipatory anxiety, being inconsolable when the separation occurs, worrying, etc.
• In adults, symptoms must be present for at least six months
• In children, symptoms must be present for at least four weeks
Generalized Anxiety Disorder - this is anxiety about many things, including potentially separation from spouse / caregiver, but would be seen across multiple domains (worrying about weather, performance, school, job, etc).
• Often has physical symptoms that you don’t see with separation anxiety disorder (like problems sleeping)
• For both children and adults symptoms must be present for at least 6 months
o Otherwise it is non-specific anxiety disorder
Selective Mutism vs Social Anxiety Disorder / Social Phobia
Selective Mutism – this is when the individual fails to speak in a specific situation, but not others and it causes problems for them. For example the child speaks just fine at home, but at school they refuse to talk.
Social Anxiety Disorder – this is very specific to social situations and involves concerns about being judged, being seen, being rejected. These people only want to spend time with people they are comfortable around. The disorder can apply to people they know or people they don’t know. It refers specifically to groups of people.
Reactive Attachment Disorder vs Disinhibited Social Engagement Disorder
Both:
• Onset between 9 months and 5 years old. You see this early.
• Result of persistent neglect, abuse, or constantly changing caregivers (like foster kids)
Reactive Attachment Disorder – Sometimes called failure to thrive
• Child is very withdrawn with a limited range of affect
• Child does not seek or respond to comfort
• You may see irritability but its directed at self
• These kids often just sit quietly in the corner
• Lots of sadness and fear of caregiver
• Minimal positive emotion or excitement
• These kids are easy to miss – they give up on people quickly, they keep to themselves, and they don’t act out
Disinhibited Social Engagement Disorder
• These kids stand out
• They have no boundaries and attach too quickly (ie they might meet someone and immediately say, “take me home with you!”)
• These kids have a willingness to go up to strangers and attach to them
• This children act out a good bit more
Oppositional Defiant Disorder vs Conduct Disorder vs Disruptive Mood Dysregulation Disorder
These are commonly tested on the exam
Oppositional Defiant Disorder – this person is defiant, they have problems with authority, they are argumentative and refuse to follow directions. They don’t want other’s telling them what to do and this causes problems in their lives. The key here is the problem with authority.
Conduct Disorder – this involves violating the rights of others and problems with the law. Graffiti, initiating fights, vandalism, destruction of property, etc. The individual generally shows a lack of remorse. Conduct Disorder is a criteria for anti social personality disorder. The key here is they violate the rights of others.
Disruptive Mood Dysregulation Disorder – this used to be called bipolar in children and is generally diagnosed between the ages of 6-10 but can go up to 17 years old. These children are chronically moody and irritable, they have recurring tantrums (at least 3x / week), and even when they aren’t out bursting they often have negative moods. The key here is tantrums and negative moods.
Brief Psychotic Disorder vs Schizophreniform Disorder vs Schizophrenia
All three disorders are similar and have 5 categories they can fall under with delusions and hallucinations being the most commonly tested:
- Delusions – a belief that is obviously false (ie this movie star is in love with me)
a. Bizarre delusions – things that can’t be true – I’m an alien
b. Non-bizarre delusions – things that technically can be true, but aren’t – Britney Spears wants me to fuck her in the ass - Hallucinations – these can be visual or audio
- Disorganized speech (often in response to a delusion / hallucination)
- Disorganized behavior (often in response to a delusion / hallucination)
- Negative symptoms (flat affect, doesn’t respond to discussion, stiffness, problems with movement)
Anyways:
Brief Psychotic - up to 30 days
Schizophreniform - 1-6 months
Schizophrenia - over 6 months
Major Depressive Disorder vs Unspecified Depressive Disorder vs Persistent Depressive Disorder
Major Depressive Disorder:
• Symptoms present for at least 2 weeks
• Dark mood, lack of enjoyment in things (anhedonia)
• Can’t enjoy things they used to (this is a big tell)
• Lacking motivation
• Changes in biological functioning (sleeping too much or too little, eating too much or too little)
• Suicidal thoughts
• A sense of worthlessness or being a burden
Unspecified Depressive Disorder: • The person is functioning • Milder biological disturbances • No suicidal ideation • Decrease in mood • This can be difficult to identify on the exam as its like MDD but not as intense. Trainer suggests that if you see both and its not clear, go with MDD
Persistent Depressive Disorder (formerly dysthymia):
• Depressed for 2 or more years for adults, 1 or more year for children
• Not as deep a depression as MDD (almost like you have UDD for two years)
• Chronically mildly depressed
• So in the vignette the person would likely be struggling on and off for 2-3 years (they’d have a lack of energy, down mood, no changes in bio – something like that).
Bipolar I Disorder vs Bipolar II Disorder vs Cyclothymic Disorder
Bipolar I Disorder:
• The only real criteria for Bipolar I is a manic phase. You do not need anything else (though BP 1 is often coupled with a depressive episode, it’s not needed)
• Manic phase:
o Goes on for at least 1 week
o Elevated mood that tend to have a significant impact
o Feelings of positivity or irritability
o Accompanied with feelings of grandiosity, risk taking (drugs, sex, gambling)
o Lack of a need for sleep and increased energy (and often increased exercise)
o Often experienced as euphoria with the client in denial of a problem during the manic phase
Bipolar II:
• A hypomanic phase that also has at least 1 episode of major depressive disorder
• Hypomania:
o 4 days of elevated mood, but not as impactful / damaging as mania
Cyclothymic Disorder
• Present for at least 2 years
• Hypomanic state alternating with a low level depressive episode
• Think alternating instances of Unspecified Depressive Disorder and hypomania
Schizoaffective Disorder vs Mood Disorder with Psychotic Features (this includes Major Depressive Disorder with Psychotic Features ad Bipolar I Disorder with Psychotic Features)
All three of these are mood disorders with psychotic features, the difference is which is more persistent. You can actually just tell by the order of the words
Schizoaffective Disorder – in this instance psychotic features are present at all times. You can see it in the words Schizo (which is a psychotic disorder) then affective (which refers to affect, the mood)
Major Depressive Disorder with Psychotic Features – this is MDD first, with psychotic features that come in from time to time
Bipolar I with Psychotic Features – this is having Bipolar I all the time, and psychotic features coming in from time to time. Again, if they were always psychotic it would be Schizoaffective Disorder
Bereavement vs Major Depressive Disorder vs Adjustment Disorder with Depressed Mood
Bereavement – someone is grieving the loss of a person or an animal that was important to them. They experience loss, anger, despair, self-blame. In the vignette, look for someone who is responding to the death of a loved one.
Major Depressive Disorder – this can present with bereavement if they are also experiencing a change in biological functioning along with a feeling of worthlessness, self-blame, and thoughts of self-harm.
In the vignette, look for someone not sleeping well, oversleeping, over or under eating, weight loss or gain, diet change. If there is a more serious impact with functioning this leans towards depression. Remember: bereavement can only be present if someone loses someone of importance.
Adjustment Disorder – this is not diagnosed with bereavement. This is a reaction to something happening in the environment (which can also have depression or anxiety associated with it). It comes with a recent life stressor like moving, getting or losing a job, divorce.
Note: symptoms must present within 3 months and cannot go beyond 6 months. If the symptoms have been present for more than 6 months, then the diagnosis is something else.
Panic Disorder vs Agoraphobia
Panic disorder - this is a person who experiences recurrent and unexpected panic attacks and fears that they will happen again. The individual shapes their life around trying to avoid panic attacks
• Symptoms of panic attack: feel like you’re dying, room is spinning, heart palpitations, feels like you’re going crazy, disconnected from reality, very overwhelming
Agoraphobia – this is the fear of going out in public and must occur in at least 2 situations (fear of crowds, of standing in line, of open spaces, etc). This fear impacts the individual’s ability to function.
Obsessive Compulsive Disorder vs Obsessive Compulsive Personality Disorder
These are often confused and therefor have a decent likelihood of being tested.
Obsessive Compulsive Disorder – this is what I think it is. OCD is a combination of obsessive thoughts and compulsive behavior. This is debilitating and needs to be treated.
• Obsessive thoughts: intrusive thoughts that run someone’s life (for example, they’re afraid of germs and always use napkins when they open the door)
• Compulsive behavior – these are compulsive actions (in the example of germs, you would see repeated handwashing again and again, or if they are worried the house will burn down, checking the oven many times to make sure its off).
Obsessive Compulsive Personality Disorder – this is when someone is a perfectionist. Things need to be exactly how they want them to be. Their drawers are perfectly organized, for example. They can be rigid and controlling, but they’re also functioning. They also have no awareness that this is really an issue.
Post-Traumatic Stress Disorder vs Acute Stress Disorder vs Adjustment Disorder with Anxiety
Here’s the nitty gritty: Post-Traumatic Stress Disorder there must be at least one month between the incident and the symptoms, Acute Stress Disorder it must be one month or less. Both PTSD and ASD require either being in a life-threatening situation or witnessing one. Adjustment Disorder with Anxiety the person did not encounter a life-threatening incident (they moved or got fired or something).
Post-traumatic Stress Disorder and Acute Stress Disorder: Both PTSD and ASD require that the person endured or witnessed a life threatening (so if a child saw his mother beaten, he qualifies for these). Symptoms fall into four categories:
• Intrusive elements – the person is experiencing intrusive thoughts or memories or they’re having nightmares.
• Negative mood – the person is wrestling with depression, irritability, shame, grief, self-blame, survivors’ guilt
• Behavioral – they are avoiding situations that remind them of the event (for example, they avoid parks)
• Arousal – they have a hyper vigilance, a startle response, lots of tension, easily agitated
Post-Traumatic Stress Disorder – symptoms present for at least one month since the incident. If you see a combat vet on the exam, they almost certainly have PTSD and not ASD, unless you’re treating them in the field.
Acute Stress Disorder – this is when the patient is exhibiting symptoms but its within one month of the incident or less. So if you’re treating a soldier in the field, or working with a police officer shortly after an event, it’s like ASD.
Adjustment Disorder with Anxiety – this is different. The person still has anxiety linked to a particular event, but the event was not life threatening (divorce, moving, getting fired, etc). These people don’t have nightmares or flashbacks but they do have anxiety and worry.
Generalized Anxiety Disorder vs Unspecified Anxiety Disorder
Once again, the key here is timeline. GAD is 6 months or more. UAD is 0-6 months. These distinctions are about timeline, not severity.
Generalized Anxiety Disorder – Symptoms present for at least six months. Look for impacts on biological functioning like sleeping and eating
Unspecified Anxiety Disorder – Symptoms present for less than 6 months, even if the symptoms are severe. You might see some elements of anxiety from different diagnoses without meeting the full criteria for a single diagnosis (like agoraphobia). In this case, the right diagnosis is Unspecified Anxiety Disorder.
Delirium vs Major Neurocognitive Disorder vs Mild Neurocognitive Disorder
Delirium – this is most likely going to be a distractor on the exam, nothing more. Delirium comes on quickly and lasts for a few hours. Its most often seen in medical settings in response to a medication or drug or medical problem. The person experiences memory impairment, language impairment and executive functioning impairment. You may also see hallucinations and strange verbal patterns.
Mild Neurocognitive Disorder – with mild neurocognitive disorder the person has a noticeable decline in neurocognitive functioning, but they are still able to maintain independence. They can keep appointments and pay bills but are becoming more forgetful. They may need support, but it can be spousal support instead of a nursing home.
Major Neurocognitive Disorder – This is formerly called dementia. The person is having serious issues with attention, executive functioning, memory, language, cognition, and interaction. They have problems with perceptual motor skills and have a serious decline in functioning that requires accommodation (like a skilled care facility or nursing home).
Mild and Major are the continuums of the Neurocognitive disorders and on the exam we’re likely to see a family coming in and trying to determine the appropriate level of care.
Differential from Major Depressive Disorder in the Elderly – in the elderly MDD can appear similarly to a neurocognitive disorder, however there is a significant difference: with depression, the person is aware that their memory is declining. With the neurocognitive disorders, there is no awareness.
Somatic Symptoms Disorder vs Illness Anxiety Disorder vs Conversion Disorder
The key difference between Somatic Symptoms Disorder and Illness Anxiety Disorder is that with Somatic Symptoms Disorder, there is an actual medical condition, whereas with Illness Anxiety Disorder, there is only the worry about one.
Somatic Symptoms Disorder – client has a real somatic issue that has been diagnosed by a medical professional, and then they have severe health related concerns and anxiety about the persistence of the symptoms. They dedicate a lot of time and energy to it and it impedes daily functioning. Symptoms must be present for at least 6 months.
Illness Anxiety Disorder – this is what we often call hypochondria. The person doesn’t actually have the disease, and they’ve been reassured by medical professionals that they’re fine, but they still spend huge amounts of time worrying about it. They may have vague physical symptoms, but there is not true somatic illness. Symptoms must be present for at least 6 months.
Conversion Disorder – this is when psychological issues present as physical symptoms. So “blind with rage” is when someone is so enraged that they actually can’t see. “Paralyzed with fear” is when someone experiences something so traumatic that their leg or arm actually stops working. This is fairly rare.
Factitious Disorder vs Malingering vs Factitious Disorder by Proxy
The differential here is that factitious disorder is when the person just likes the attention of being sick and malingering is when the person is trying to gain or avoid something.
Factitious Disorder – this is when the individual likes the attention that comes with being sick, so they act like they’re sick and go to the doctor.
Factitious Disorder by Proxy – this is when someone, usually a caretaker, makes someone else appear sick because they like the attention (like they keep taking their child to the doctor). In rare occasions they’ll actually do something to make the child sick. This used to be called Munchausen syndrome by proxy.
Malingering - this is when someone is faking an illness in order to get out of something or to gain something (so they fake an illness to get on disability or they fake an illness to avoid appearing in court). They aren’t sick but they’re interested in the gain or avoidance.
Anorexia Nervosa vs Bulimia Nervosa vs Binge Eating Disorder
These are what I think they are. These need to be coordinated with an MD and often require a fairly high level of care, like inpatient.
Anorexia Nervosa – the person restricts the intake of food to the point where it doesn’t meet their biological needs. They have an intense fear of gaining weight and are very thin. They dislike their body image. Oftentimes they will compensate with tons of exercise. They fear getting fat.
Bulimia Nervosa – this requires the presence of two things. First, the person must binge eat, which is eating way more than is appropriate in one sitting often accompanied by feelings of being out of control and shame, followed by some sort of purging (vomiting, laxatives, etc). This may also come with excessive exercise.
Binge Easting Disorder – this is when the person engages in binge eating but does not purge.
Unspecified Eating Disorder vs Body Dysmorphia Disorder
Unspecified Eating Disorder – this is when the person has some sort of eating disorder but doesn’t meet the criteria for anorexia nervosa or bulimia nervosa. So for example, the person purges without binging (you need binging and purging for Bulimia) or they are a normal weight but they have an obsession and anxiety with their body image.
Body Dysmorphia Disorder – this is not about weight. The person has some sort of distinct displeasure with a specific part of their body (for example, they hate their nose). These people often get excessive plastic surgery on that part of their body (like Michael Jacksson with his nose). These people complain about a certain body party but its unrelated to weight.
