Midterm

Question 1

Positive Symptoms of Dissociation

Answer 1

Intrusions into awareness and behavior with loss of continuity in subjective experience

• Fragmented identity
• Depersonalization
• Derealization

Question 2

Restless Legs Syndrome (5)

Answer 2

A. An urge to move the legs, usually accompanied by or in response to uncomfortable and
unpleasant sensations in the legs, characterized by all of the following:
1. The urge to move the legs begins or worsens during periods of rest or inactivity.
2. The urge to move the legs is partially or totally relieved by movement.
3. The urge to move the legs is worse in the evening or at night than during the day,
or occurs only in the evening or at night.

B. The symptoms in Criterion A occur at least three times per week and have persisted
for at least 3 months.

C. The symptoms in Criterion A are accompanied by significant distress or impairment in
social, occupational, educational, academic, behavioral, or other important areas of
functioning.

D. The symptoms in Criterion A are not attributable to another mental disorder or medical
condition (e.g., arthritis, leg edema, peripheral ischemia, leg cramps) and are not better
explained by a behavioral condition (e.g., positional discomfort, habitual foot tapping).

E. The symptoms are not attributable to the physiological effects of a drug of abuse or
medication (e.g., akathisia).

Question 3

Dissociative Amnesia - Prevalence, Development and Course

Answer 3

12 month: 1.8%

2:1 female to male ratio

Multiple episodes of amnesia can occur
-predispose to future episodes

Distress can increase as amnesia remits

May need collateral information, especially for children

Question 4

Narcolepsy (2)

Answer 4

A. Recurrent periods of an irrepressible need to sleep, lapsing into sleep, or napping occurring
within the same day. These must have been occurring at least three times per
week over the past 3 months.

B. The presence of at least one of the following:

1. Episodes of cataplexy, defined as either (a) or (b), occurring at least a few times
   per month:
   a. In individuals with long-standing disease, brief (seconds to minutes) episodes
   of sudden bilateral loss of muscle tone with maintained consciousness that are
   precipitated by laughter or joking.
   b. In children or in individuals within 6 months of onset, spontaneous grimaces or
   jaw-opening episodes with tongue thrusting or a global hypotonia, without any
   obvious emotional triggers.
2. Hypocretin deficiency, as measured using cerebrospinal fluid (CSF) hypocretin-1
   immunoreactivity values (less than or equal to one-third of values obtained in
   healthy subjects tested using the same assay, or less than or equal to 110 pg/mL).
   Low CSF levels of hypocretin-1 must not be observed in the context of acute brain
   injury, inflammation, or infection.
3. Nocturnal sleep polysomnography showing rapid eye movement (REM) sleep latency
   less than or equal to 15 minutes, or a multiple sleep latency test showing a
   mean sleep latency less than or equal to 8 minutes and two or more sleep-onset
   REM periods.

Question 5

Somatic Symptom Disorder (3)

Answer 5

A. One or more somatic symptoms that are distressing or result in significant disruption
of daily life.

B. Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated
health concerns as manifested by at least one of the following:
1. Disproportionate and persistent thoughts about the seriousness of one’s symptoms.
2. Persistently high level of anxiety about health or symptoms.
3. 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 more than 6 months).

Specify if:
With predominant pain (previously pain disorder): This specifier is for individuals
whose somatic symptoms predominantly involve pain.

Specify if:
Persistent: A persistent course is characterized by severe symptoms, marked impairment,
and long duration (more than 6 months).

Specify current severity:
Mild: Only one of the symptoms specified in Criterion B is fulfilled.
Moderate: Two or more of the symptoms specified in Criterion B are fulfilled.
Severe: Two or more of the symptoms specified in Criterion B are fulfilled, plus there
are multiple somatic complaints (or one very severe somatic symptom).

Question 6

Hypopnea

Answer 6

Shallow or infrequent breathing (like a mini apnea)

Question 7

Apnea

Answer 7

Absence of breathing

Question 8

Obstructive Sleep Apnea Hypopnea

Answer 8

Obstructive sleep apnea hypopnea is the most common breathing-related sleep disorder.

It is characterized by repeated episodes of upper (pharyngeal) airway obstruction (apneas
and hypopneas) during sleep.

Apnea refers to the total absence of airflow, and hypopnea refers
to a reduction in airflow.

Question 9

Disinhibited Social Engagement Disorder (5)

Answer 9

A. A pattern of behavior in which a child actively approaches and interacts with unfamiliar
adults and exhibits at least two of the following:
1. Reduced or absent reticence in approaching and interacting with unfamiliar adults.
2. Overly familiar verbal or physical behavior (that is not consistent with culturally
sanctioned and with age-appropriate social boundaries).
3. Diminished or absent checking back with adult caregiver after venturing away, even
in unfamiliar settings.
4. Willingness to go off with an unfamiliar adult with minimal or no hesitation.

B. The behaviors in Criterion A are not limited to impulsivity (as in attention-deficit/hyperactivity
disorder) but include socially disinhiblted behavior.

C. The child has experienced a pattern of extremes of insufficient care as evidenced by
at least one of the following:
1. Social neglect or deprivation in the form of persistent lack of having basic emotional
needs for comfort, stimulation, and affection met by caregiving adults.
2. Repeated changes of primary caregivers that limit opportunities to form stable attachments
(e.g., frequent changes in foster care).
3. Rearing in unusual settings that severely limit opportunities to form selective attachments
(e.g., institutions with high child-to-caregiver ratios).

D. The care in Criterion C is presumed to be responsible for the disturbed behavior in Criterion A (e.g:, the disturbances in Criterion A began following the pathogenic care in Criterion C).

E. The child has a developmental age of at least 9 months.

Question 10

PTSD Criteria A

Answer 10

A. Exposure to actual or threatened death, serious injury, or sexual violence in one (or
more) of the following ways:
1. Directly experiencing the traumatic event(s).
2. Witnessing, in person, the event(s) as it occurred to others.
3. Learning that the traumatic event(s) occurred to a close family member or close
friend. In cases of actual or threatened death of a family member or friend, the
event(s) must have been violent or accidental.
4. Experiencing repeated or extreme exposure to aversive details of the traumatic
event(s) (e.g., first responders collecting human remains: police officers repeatedly
exposed to details of child abuse).
Note: Criterion A4 does not apply to exposure through electronic media, television,
movies, or pictures, unless this exposure is work related.

Question 11

Kleptomania (5)

Answer 11

A. Recurrent failure to resist impulses to steal objects tliat are not needed for personal
use or for their monetary value.

B. Increasing sense of tension immediately before committing the theft.

C. Pleasure, gratification, or relief at the time of committing the theft.

D. The stealing is not committed to express anger or vengeance and is not in response
to a delusion or a hallucination.

E. The stealing is not better explained by conduct disorder, a manic episode, or antisocial
personality disorder.

Question 12

Oppositional Defiant Disorder - ODD (3)

Answer 12

A. A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting
at least 6 months as evidenced by at least four symptoms from any of the following categories,
and exhibited during interaction with at least one individual who is not a sibling.
Angry/Irritable Mood
1. Often loses temper.
2. Is often touchy or easily annoyed.
3. Is often angry and resentful.
Argumentative/Defiant Behavior
4. Often argues with authority figures or, for children and adolescents, with adults.
5. Often actively defies or refuses to comply with requests from authority figures or
with rules.
6. Often deliberately annoys others.
7. Often blames others for his or her mistakes or misbehavior.
Vindictiveness
8. Has been spiteful or vindictive at least twice within the past 6 months.

Note: The persistence and frequency of these behaviors should be used to distinguish
a behavior that is within normal limits from a behavior that is symptomatic. For children
younger than 5 years, the behavior should occur on most days for a period of at least
6 months unless otherwise noted (Criterion A8). For individuals 5 years or older, the
behavior should occur at least once per week for at least 6 months, unless othenwise
noted (Criterion AS). While these frequency criteria provide guidance on a minimal level
of frequency to define symptoms, other factors should also be considered, such as
whether the frequency and intensity of the behaviors are outside a range that is normative
for the individual’s developmental level, gender, and culture.

B. The disturbance in behavior is associated with distress in the individual or others in his or
her immediate social context (e.g., family, peer group, work colleagues), or it impacts negatively
on social, educational, occupational, or other important areas of functioning.

C. The behaviors do not occur exclusively during the course of a psychotic, substance
use, depressive, or bipolar disorder. Also, the criteria are not met for disruptive mood
dysregulation disorder.

Specify current severity:
iUliid: Symptoms are confined to only one setting (e.g., at home, at school, at work, with
peers).
Moderate: Some symptoms are present in at least two settings.
Severe: Son\e symptoms are present in three or more settings.

Question 13

Pica (4)

Answer 13

A. Persistent eating of nonnutritive, nonfood substances over a period of at least 1 month.

B. The eating of nonnutritive, nonfood substances is inappropriate to the developmental level of the individual.

C. The eating behavior is not part of a culturally supported or socially normative practice.

D. If the eating behavior occurs in the context of another mental disorder (e.g., intellectual
disability [intellectual developmental disorder], autism spectrum disorder, schizophrenia)
or medical condition (including pregnancy), it is sufficiently severe to warrant additional
clinical attention.

Question 14

Anorexia Nervosa - Prevalence, Course, risk Factors

Answer 14

12 month: .4% among females

10:1 Female to male ratio

Onset typically during adolesence/young adulthood

Typically triggered by a stressful life event

Most (2/3) remit within 5 years
-Hospitalization and binge/purge type predicts poorer prognosis

Question 15

Central sleep apnea

Answer 15

Due to diaphragm taking a break

Question 16

Systemized amnesia

Answer 16

Type of dissociative amnesia

Loss of memory for a category of info (e.g. family)

Question 17

Generalized amnesia

Answer 17

Type of dissociative amnesia

Uncommon

Complete loss of memory of one’s life history

Can include loss of semantic knowledge (e.g. about the world) or procedural knowledge (e.g. well learned skills)

Question 18

Intermittent Explosive Disorder - Prevalence, Course

Answer 18

12 month: 2.7%

More prevalent in males

Onset most common in late childhood/adolesence, rare in mid-late adulthood

Chronic and persistent course over many years

Question 19

Dissociative Amnesia

Answer 19

A. An inability to recall important autobiographical information, usually of a traumatic or
stressful nature, that is inconsistent with ordinary forgetting.
Note: Dissociative amnesia most often consists of localized or selective amnesia for a
specific event or events; or generalized amnesia for identity and life history.

B. The symptoms cause clinically significant distress or impairment in social, occupational,
or other important areas of functioning.

C. The disturbance is not attributable to the physiological effects of a substance (e.g., alcohol
or other drug of abuse, a medication) or a neurological or other medical condition
(e.g., partial complex seizures, transient global amnesia, sequelae of a closed head injury/
traumatic brain injury, other neurological condition).

D. The disturbance is not better explained by dissociative identity disorder, posttraumatic
stress disorder, acute stress disorder, somatic symptom disorder, or major or mild neurocognitive
disorder.

Specify if ;
300.13 (F44.1) With dissociative fugue: Apparently purposeful travel or bewildered
wandering that is associated with amnesia for identity or for other important autobiographical
information.

Question 20

Culture and Attachment

Answer 20

Attachment theory is not universal in the way it manifests

Consider the following: what is valued - fostering autonomy vs dependency?
-how is competence defined

Question 21

Anorexia Specifiers

Answer 21

Restricting type: During the last 3 months, the individual has not engaged in recurrent
episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse
of laxatives, diuretics, or enemas). This subtype describes presentations in which
weight loss is accomplished primarily through dieting, fasting, and/or excessive exercise.

Binge-eating/purging type: During the last 3 months, the individual has engaged
in recurrent episodes of binge eating or purging behavior (i.e., self-induced
vomiting or the misuse of laxatives, diuretics, or enemas).

Specify if:

In partial remission: After full criteria for anorexia nervosa were previously met. Criterion
A (low body weight) has not been met for a sustained period, but either Criterion
B (intense fear of gaining weight or becoming fat or behavior that interferes with weight
gain) or Criterion C (disturbances in self-perception of weight and shape) is still met.

In full remission: After full criteria for anorexia nervosa were previously met, none of
the criteria have been met for a sustained period of time.

Specify current severity:

Mild: BMI>17kg/m2
Moderate: BM116-16.99 kg/m^
Severe: BM115-15.99 kg/

Question 22

Parasomnias

Answer 22

something abnormal is happening during some cycle of sleep

Question 23

Intermittent Explosive Disorder (6)

Answer 23

A. Recurrent behavioral outbursts representing a failure to control aggressive impulses
as manifested by either of the following;
1. Verbal aggression (e.g., temper tantrums, tirades, verbal arguments or fights) or
physical aggression toward property, animals, or other individuals, occurring twice
weekly, on average, for a period of 3 months. The physical aggression does not result
in damage or destruction of property and does not result in physical injury to
animals or other individuals.
2. Three behavioral outbursts involving damage or destruction of property and/or
physical assault involving physical injury against animals or other individuals occurring
within a 12-month period.

B. The magnitude of aggressiveness expressed during the recurrent outbursts is grossly
out of proportion to the provocation or to any precipitating psychosocial stressors.

C. The recurrent aggressive outbursts are not premeditated (i.e., they are impulsive and/
or anger-based) and are not committed to achieve some tangible objective (e.g.,
money, power, intimidation).

D. The recurrent aggressive outbursts cause either marked distress in the individual or
impairment in occupational or interpersonal functioning, or are associated with financial
or legal consequences.

E. Chronological age is at least 6 years (or equivalent developmental level).

F. The recurrent aggressive outbursts are not better explained by another mental disorder
(e.g., major depressive disorder, bipolar disorder, disruptive mood dysregulation
disorder, a psychotic disorder, antisocial personality disorder, borderline personality
disorder) and are not attributable to another medical condition (e.g., head trauma, Alzheimer’s
disease) or to the physiological effects of a substance (e.g., a drug of abuse,
a medication). For children ages 6-18 years, aggressive behavior that occurs as part
of an adjustment disorder should not be considered for this diagnosis.

Note: This diagnosis can be made in addition to the diagnosis of attention-deficit/hyperactivity
disorder, conduct disorder, oppositional defiant disorder, or autism spectrum disorder
when recurrent impulsive aggressive outbursts are in excess of those usually seen
in these disorders and warrant independent clinical attention.

Question 24

Pica Onset

Answer 24

Commonly in childhood

Question 25

Factitious Disorder Imposed on Another (4)

Answer 25

A. Falsification of physical or psychological signs or symptoms, or induction of injury or disease, in another, associated with identified deception. B. The individual presents another individual (victim) to others as ill, impaired, or injured. C. The deceptive behavior is evident even in the absence of obvious external rewards. D. The behavior is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder. Note: The perpetrator, not the victim, receives this diagnosis. Specify. Single episode Recurrent episodes (two or more events of falsification of illness and/or induction of injury)

Question 26

Posttraumatic Stress Disorder Criteria (8)

Answer 26

A. Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways ``` B. Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred ``` C. Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by one or both of the following D. Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following E. Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: F. Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month. G. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. H. The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.

Question 27

Continuous amnesia

Answer 27

Type of dissociative amnesia Forgetting each new event as it occurs

Question 28

Anorexia Nervosa (3)

Answer 28

A. Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected. B. Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight. C. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.

Question 29

What is the natural course of PTSD?

Answer 29

Many recover without treatment within months/years of the event (50% natural remission by 2 years) Treatment means 20% more people with PTSD recover 33% remain symptomatic for 3 years or longer with greater risk of secondary problems

Question 30

Illness Anxiety Disorder (6)

Answer 30

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. Specify whether: Care-seeking type: Medical care, including physician visits or undergoing tests and procedures, is frequently used. Care-avoidant type: Medical care is rarely used.

Question 31

Avoidant/Restrictive Food Intake Disorder Prevalence etc.

Answer 31

Prevalence unknown May be due to sensitivity to food's smell, taste, texture, appearance May be due to past aversive experiene ("conditioned response") - choking, vomiting - negative parent-child interaction Associated with a lack of interest in eating or food Most commonly dveelops in infancy or childhood -may persist into adulthood Health impact - anemia, bradycardia, hypothermia - Malnutrition and fatality in children and infants

Question 32

Bulimia - Prevalence, Course, Risk Factors

Answer 32

12 month: 1-1.5% among females (more common than anorexia) 10:1 female to male ratio Onset peaks in late adolescence/young adulthood Course is chronic or intermittent 10-15% cross to anoerexia nervosa

Question 33

Factitious Disorder (Munchausen Syndrome) Imposed on Self (4)

Answer 33

A. Falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception. B. The individual presents himself or herself to others as ill, impaired, or injured. C. The deceptive behavior is evident even in the absence of obvious external rewards. D. The behavior is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder. Specify: Single episode Recurrent episodes (two or more events of falsification of illness and/or induction of injury)

Question 34

Kleptomania - Prevalence and Course

Answer 34

4-24% of shoplifters 3:1 Female to male Onset tpically in adolescence

Question 35

PTSD Prevalence, Development and Course

Answer 35

Lifetime: 8.7% 12-month 3.5% Rates differ by race/ethnicity - higher rates among US Latinos, African Americans and American Indians compared to non-latino. - lower rates among Asian Americans compared to non-Latino Whites More prevalent among females Can occur at any age -lower rates in children and elderly (may be due to old criteria and thresholds) Clinical presentation varies Duration varies

Question 36

PTSD Changes from DSM IV

Answer 36

Definitions of "traumatic" event Number of symptom clusters and new symptoms Diagnostic thresholds for children Criteria added for children 6 years or younger

Question 37

Localized (Circumscribed) Amnesia

Answer 37

Type of dissociative amnesia Most common type Can't recall events within specific time frame

Question 38

Avoidant/Restrictive Food Intake Disorder

Answer 38

A. An eating or feeding disturbance (e.g., apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating) as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following: 1. Significant weight loss (or failure to achieve expected weight gain or faltering growth in children). 2. Significant nutritional deficiency. 3. Dependence on enteral feeding or oral nutritional supplements. 4. Marked interference with psychosocial functioning. B. The disturbance is not better explained by lack of available food or by an associated culturally sanctioned practice. C. The eating disturbance does not occur exclusively during the course of anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance in the way in which one’s body weight or shape is experienced. D. The eating disturbance is not attributable to a concurrent medical condition or not better explained by another mental disorder. When the eating disturbance occurs in the context of another condition or disorder, the severity of the eating disturbance exceeds that routinely associated with the condition or disorder and warrants additional clinical attention.

Question 39

Circadian Rhythm Sleep-Wake Disorder (3)

Answer 39

A. A persistent or recurrent pattern of sleep disruption that is primarily due to an alteration of the circadian system or to a misalignment between the endogenous circadian rhythm and the sleep-wake schedule required by an individual’s physical environment or social or professional schedule. B. The sleep disruption leads to excessive sleepiness or insomnia, or both. C. The sleep disturbance causes clinically significant distress or impairment in social, occupational, and other important areas of functioning.

Question 40

Hypersomnolence Disorder

Answer 40

A. Self-reported excessive sleepiness (hypersomnolence) despite a main sleep period lasting at least 7 hours, with at least one of the following symptoms: 1. Recurrent periods of sleep or lapses into sleep within the same day. 2. A prolonged main sleep episode of more than 9 hours per day that is nonrestorative (i.e., unrefreshing). 3. Difficulty being fully awake after abrupt awakening. B. The hypersomnolence occurs at least three times per week, for at least 3 months. C. The hypersomnolence is accompanied by significant distress or impairment in cognitive, social, occupational, or other important areas of functioning. D. The hypersomnolence is not better explained by and does not occur exclusively during the course of another sleep disorder (e.g., narcolepsy, breathing-related sleep disorder, circadian rhythm sleep-wake disorder, or a parasomnia). E. The hypersomnolence is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication). F. Coexisting mental and medical disorders do not adequately explain the predominant complaint of hypersomnolence. Specify if: With mental disorder, including substance use disorders With medicai condition With another sleep disorder Acute: Duration of less than 1 month. Subacute: Duration of 1-3 months. Persistent: Duration of more than 3 months. Specify severity Mild: Difficulty maintaining daytime alertness 1-2 days/week. Moderate: Difficulty maintaining daytime alertness 3-4 days/week. Severe: Difficulty maintaining daytime alertness 5-7 days/week.

Question 41

Dissociative Identity Disorder (DID) - Prevalence, development and course

Answer 41

12-month = 1.5% Can manifest at any age In children, primarily discontinuity of experience and mental states rather than "identity" changes Associated with trauma and child abuse Identity changes or disturbance may be triggered by cues related to previous traumas or later experiences of truama - removal from trauma situation - One's children reaching age of original abuse - later traumatic experiences - death or fatal illness of abuser(s)

Question 42

Bulimia Nervosa (5)

Answer 42

A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: 1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances. 2. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating). B. Recurrent inappropriate compensatory behaviors 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 behaviors both occur, on average, at least once a week for 3 months. D. Self-evaluation is unduly influenced by body shape and weight. E. The disturbance does not occur exclusively during episodes of anorexia nervosa.

Question 43

Psychological Factors Affecting Other Medical Conditions (3)

Answer 43

A. A medical symptom or condition (other than a mental disorder) is present. B. Psychological or behavioral factors adversely affect the medical condition in one of the following ways: 1. The factors have influenced the course of the medical condition as shown by a close temporal association between the psychological factors and the development or exacerbation of, or delayed recovery from, the medical condition. 2. The factors interfere with the treatment of the medical condition (e.g., poor adherence). 3. The factors constitute additional well-established health risks for the individual. 4. The factors influence the underlying pathophysiology, precipitating or exacerbating symptoms or necessitating medical attention. C. The psychological and behavioral factors in Criterion B are not better explained by another mental disorder (e.g., panic disorder, major depressive disorder, posttraumatic stress disorder). Specify current severity: Mild: Increases medical risk (e.g., inconsistent adherence with antihypertension treatment). Moderate: Aggravates underlying medical condition (e.g., anxiety aggravating asthma). Severe: Results in medical hospitalization or emergency room visit. Extreme: Results in severe, life-threatening risk (e.g., ignoring heart attack symptoms

Question 44

Reactive Attachment Disorder (7)

Answer 44

A. A consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers, manifested by both of the following: 1. The child rarely or minimally seeks comfort when distressed. 2. The child rarely or minimally responds to comfort when distressed. B. A persistent social and emotional disturbance characterized by at least two of the following: 1. Minimal social and emotional responsiveness to others. 2. Limited positive affect. 3. Episodes of unexplained irritability, sadness, or fearfulness that are evident even during non-threatening interactions with adult caregivers. C. The child has experienced a pattern of extremes of insufficient care as evidenced by at least one of the following: 1. Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation, and affection met by caregiving adults. 2. Repeated changes of primary caregivers that limit opportunities to form stable attachments (e.g., frequent changes in foster care). 3. Rearing in unusual settings that severely limit opportunities to form selective attachments (e.g., institutions with high child-to-caregiver ratios). D. The care in Criterion C is presumed to be responsible for the disturbed behavior in Criterion A (e.g., the disturbances in Criterion A began following the lack of adequate care in Criterion C). E. The criteria are not met for autism spectrum disorder. F. The disturbance is evident before age 5 years. G. The child has a developmental age of at least 9 months. Specify if: Persistent: The disorder has been present for more than 12 months. Specify current severity: Reactive attachment disorder is specified as severe when a child exhibits all symptoms of the disorder, with each symptom manifesting at relatively high levels.

Question 45

Insomnia Disorder - Prevalence, Course

Answer 45

6-10% - most prevalent of all sleep disorders -1/3 of adults report insomnia symptoms More common in women and elderly Often comorbid with another mental disorder Onset anytime, but often in young adulthood

Question 46

Dyssomnias

Answer 46

quality, quantity, and timing of sleep

Question 47

Acute Stress Disorder Criteria (5)

Answer 47

A. Exposure to actual or threatened death, serious injury, or sexual violation in one (or more) of the following ways: 1. Directly experiencing the traumatic event(s). 2. Witnessing, in person, the event(s) as it occurred to others. 3. Learning that the event(s) occurred to a close family member or close friend. Note: In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental. 4. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains, police officers repeatedly exposed to details of child abuse). Note: This does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related. B. Presence of nine (or more) of the following symptoms from any of the five categories of intrusion, negative mood, dissociation, avoidance, and arousal, beginning or worsening after the traumatic event(s) occurred: Intrusion Symptoms 1. Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). Note: In children, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed. 2. Recurrent distressing dreams in which the content and/or affect of the dream are related to the event(s). Note: In children, there may be frightening dreams without recognizable content. 3. Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.) Note: In children, trauma-specific reenactment may occur in play. 4. Intense or prolonged psychological distress or marked physiological reactions in response to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). Negative Mood 5. Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings). Dissociative Symptoms 6. An altered sense of the reality of one’s surroundings or oneself (e.g., seeing oneself from another’s perspective, being in a daze, time slowing). 7. Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs). Avoidance Symptoms 8. Efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). 9. Efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). Arousal Symptoms 10. Sleep disturbance (e.g., difficulty falling or staying asleep, restless sleep). 11. Irritable behavior and angry outbursts (with little or no provocation), typically expressed as verbal or physical aggression toward people or objects. 12. Hypervigilance. 13. Problems with concentration. 14. Exaggerated startle response. C. Duration of the disturbance (symptoms in Criterion B) is 3 days to 1 month after trauma exposure. Note: Symptoms typically begin immediately after the trauma, but persistence for at least 3 days and up to a month is needed to meet disorder criteria. D. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. E. The disturbance is not attributable to the physiological effects of a substance (e.g., medication or alcohol) or another medical condition (e.g., mild traumatic brain injury) and is not better explained by brief psychotic disorder._________________________

Question 48

PTSD Criteria D

Answer 48

D. Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: 1. Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs). 2. Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., “I am bad,” “No one can be trusted,” ‘The world is completely dangerous,” “My whole nervous system is permanently ruined”). 3. Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others. 4. Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame). 5. Markedly diminished interest or participation in significant activities. 6. Feelings of detachment or estrangement from others. 7. Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).

Question 49

Conversion Disorder - Prevalence, Course, and Risk Factors

Answer 49

Prevalence unknown -5% of neurology clinic referrals 2-3x more common in females Onset anytime Can be transient or persistent -prognosis seems better for children Associated with dissociative symptoms Risk Factors - personality disorders - stressful life events (including child abuse) - comorbid neurological conditions and physical disease - longer duration of symptoms

Question 50

Depersonalization/derealization prevalence, development, and course

Answer 50

Lifetime prevalence = 2% Mean age of onset is 16 Becomes more rare as one ages, very rare after age 40 Duration varies Course is typically persistent but varies - 1/3 continous symptoms - 1/3 discrete episodes - 1/3 initially episodic then becomes continuous Can be exacerbated by stress, poor mood, new or overstimulating settings, and lack of sleep

Question 51

Rumination Disorder (4)

Answer 51

A. Repeated regurgitation of food over a period of at least 1 month. Regurgitated food may be re-chewed, re-swallowed, or spit out. ``` B. The repeated regurgitation is not attributable to an associated gastrointestinal or other medical condition (e.g., gastroesophageal reflux, pyloric stenosis). ``` C. The eating disturbance does not occur exclusively during the course of anorexia nervosa, bulimia nervosa, binge-eating disorder, or avoidant/restrictive food intal

Question 52

Sleep related hypoventilation

Answer 52

periods of reduced breathing and high CO2 levels

Question 53

PTSD Criteria E

Answer 53

E. Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: 1. Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects. 2. Reckless or self-destructive behavior. 3. Hypervigilance. 4. Exaggerated startle response. 5. Problems with concentration. 6. Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep).

Question 54

ODD - Prevalence, Course

Answer 54

Range of 1-11% 1.4:1 male to female in school age children Onset tends to be early childhoood and rarely later than early adolescence Can precede CD but majority do not cross over

Question 55

Dissociative Identity Disorder (4)

Answer 55

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 in identity involves marked discontinuity in sense of self and sense of agency, accompanied by related alterations in affect, behavior, 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., blacl

Question 56

Does trauma/stressor cause disorders?

Answer 56

yes and no There are no symptoms before trauma/stressor but not all people when experience they trauma/stressor have the symptoms

Question 57

Factitious Disorder - Prevalence, Course, Risk Factors

Answer 57

Prevalence unknown, estimated 1% of hospital patients Onset typically in early adulthood, often after hospitalization for medical condition or mental disorder

Question 58

Rapid Eye Movement (REM) Sleep Behavior Disorder (7)

Answer 58

A. Repeated episodes of arousal during sleep associated with vocalization and/or complex motor behaviors. B. These behaviors arise during rapid eye movement (REM) sleep and therefore usually occur more than 90 minutes after sleep onset, are more frequent during the later portions of the sleep period, and uncommonly occur during daytime naps. C. Upon awakening from these episodes, the individual is completely awake, alert, and not confused or disoriented. D. Either of the following: 1. REM sleep without atonia on polysomnographic recording. 2. A history suggestive of REM sleep behavior disorder and an established synucleinopathy diagnosis (e.g., Parkinson’s disease, multiple system atrophy). E. The behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (which may include injury to self or the bed partner). F. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition. G. Coexisting mental and medical disorders do not explain the episodes. *People often don't realize they have it

Question 59

Conduct Disorder - CD (

Answer 59

A. A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of at least three of the following 15 criteria in the past 12 months from any of the categories below, with at least one criterion present in the past 6 months: Aggression to People and Animals 1. Often bullies, threatens, or intimidates others. 2. Often initiates physical fights. 3. Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun). 4. Has been physically cruel to people. 5. Has been physically cruel to animals. 6. Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery). 7. Has forced someone into sexual activity. Destruction of Property 8. Has deliberately engaged in fire setting with the intention of causing serious damage. 9. Has deliberately destroyed others’ property (other than by fire setting). Deceitful ness or Theft 10. Has broken into someone else’s house, building, or car. 11. Often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others). 12. Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering: forgery). Serious Violations of Rules 13. Often stays out at night despite parental prohibitions, beginning before age 13 years. 14. Has run away from home overnight at least twice while living in the parental or parental surrogate home, or once without returning for a lengthy period. 15. Is often truant from school, beginning before age 13 years. B. The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning. C. If the individual is age 18 years or older, criteria are not met for antisocial personality disorder. Specify whether: 312.81 (F91.1) Childhood-onset type: Individuals show at least one symptom characteristic of conduct disorder prior to age 10 years. 312.82 (F91.2) Adolescent-onset type: Individuals show no symptom characteristic of conduct disorder prior to age 10 years. 312.89 (F91.9) Unspecified onset: Criteria for a diagnosis of conduct disorder are met, but there is not enough information available to determine whether the onset of the first symptom was before or after age 10 years.

Question 60

Hypersomnolence Disorder - Course

Answer 60

~1% of population Onset is gradual and progressive, typically in late adolescence/early adulthood -tho most aren't diagnosed unti 10-15 years after first symptoms Course is persistent and can become increasingly severe

Question 61

Enuresis (4)

Answer 61

A. Repeated voiding of urine into bed or clothes, whether involuntary or intentional. B. The behavior is clinically significant as manifested by either a frequency of at least twice a week for at least 3 consecutive months or the presence of clinically significant distress or impairment in social, academic (occupational), or other important areas of functioning. C. Chronological age is at least 5 years (or equivalent developmental level). D. The behavior is not attributable to the physiological effects of a substance (e.g., a diuretic, an antipsychotic medication) or another medical condition (e.g., diabetes, spina bifida, a seizure disorder). Specify whether: Nocturnal only: Passage of urine only during nighttime sleep. Diurnal only: Passage of urine during waking hours. Nocturnal and diurnal: A combination of the two subtypes above

Question 62

Illness Anxiety Disorder - prevalence, course, and risk factors

Answer 62

1-2 year prevalence: 1-10% Onset typically in eraly-middle adulthood -rare in children Typically chronic and relapsing condition -transient in 33-50% of individuals In older individuals, health-related anxiety focuses on memory loss Sometimes precipitated by stressful life event, which may be health related Severity and comorbid mental disorders predict worse prognosis

Question 63

Disinhibited Social Engagement Disorder - Prevalence, Etiology, Course

Answer 63

Prevalence is rare, even amongst high-risk populations RAD<10% of severely neglected DSED ~20% of severely neglected Social neglect in first few months of life Symptoms may persist for several years, even after neglect ends, especially if untreated Co-occurs w/ developmental delays, stereotypies and other signs of severe neglect RAD is rarely, if ever, diagnosed in children older than 5 -prognosis depends on caregiving environment DSED not identified in children who are neglected after age 2 - can occur for children with or without secure attachment to caregivers - Disinhibited behavior manifests differently developmentally - attention-seeking behaviors during preschool age - overfamiliarity and inauthenticity of emotions in middle childhood - indiscriminate behavior, superficial relationships, and peer conflicts in adolescence

Question 64

Trauma and Stressor DSM IV

Answer 64

Neurodevelopmental: Reactive Attachment Disorder Disinhibited Social Engagement Disorder Anxiety: PTSD Acute Stress Disorder Adjustment Disorder

Question 65

Nightmare Disorder

Answer 65

A. Repeated occurrences of extended, extremely dysphoric, and well-remembered dreams that usually involve efforts to avoid threats to survival, security, or physical integrity and that generally occur during the second half of the major sleep episode. B. On awakening from the dysphoric dreams, the individual rapidly becomes oriented and alert. C. The sleep disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. D. The nightmare symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication). E. Coexisting mental and medical disorders do not adequately explain the predominant complaint of dysphoric dreams.

Question 66

Negative Symptoms of Dissociation

Answer 66

Inability to access information or control mental functions | -Amnesia

Question 67

CD prevalence, course & associated features

Answer 67

12-month: 4% avg more common among males, especially children Childhood onset is common and predicts worse prognosis -rare after 16 Diagnosis remits by adulthood for majority

Question 68

PTSD Criteria C

Answer 68

C. Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by one or both of the following: 1. Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). 2. Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).

Question 69

Selective Amnesia

Answer 69

Type of dissociative amnesia Close second most common Can't recall some parts of circumscribed events

Question 70

Adjustment Disorder (5)

Answer 70

A. The development of emotional or behavioral symptoms in response to an identifiable stressor(s) occurring within 3 months of the onset of the stressor(s). B. These symptoms or behaviors are clinically significant, as evidenced by one or both of the following: 1. Marked distress that is out of proportion to the severity or intensity of the stressor, taking into account the external context and the cultural factors that might influence symptom severity and presentation. 2. Significant impairment in social, occupational, or other important areas of functioning. C. The stress-related disturbance does not meet the criteria for another mental disorder and is not merely an exacerbation of a preexisting mental disorder. D. The symptoms do not represent normal bereavement. E. Once the stressor or its consequences have terminated, the symptoms do not persist for more than an additional 6 months.

Question 71

Developmental of Attachment

Answer 71

Schaffer & Emerson (1964) Asocial/preattachment (0-6 weeks) -infants respond to both social and non-social stimuli ``` Indiscriminate Attachment (6 weeks - 7 months) -most babies respond equally to any caregiver, distinguish and smile more at familiar faces ``` ``` Discriminate Attachment (7 - 9 months) -special preference for a single attachment figure ``` ``` Multiple Attachments (10 months onward) -many by 10 months and majority by 18 months from multiple attachments, especially to those with "sensitive responsiveness" ```

Question 72

Dissociative Amnesia risk factors

Answer 72

Trauma - Childhood adversity - interpersonal violence - high severity, frequency, violence Repeated or continuous exposure to truamatic circumstances

Question 73

Depersonalization/derealization disorder (5)

Answer 73

A. The presence of persistent or recurrent experiences of depersonalization, derealization, or both: 1. Depersonalization: Experiences of unreality, detachment, or being an outside observer with respect to one’s thoughts, feelings, sensations, body, or actions (e.g., perceptual alterations, distorted sense of time, unreal or absent self, emotional and/ or physical numbing). 2. Derealization: Experiences of unreality or detachment with respect to surroundings (e.g., individuals or objects are experienced as unreal, dreamlike, foggy, lifeless, or visually distorted). B. During the depersonalization or derealization experiences, reality testing remains intact. C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. D. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, medication) or another medical condition (e.g., seizures). E. The disturbance is not better explained by another mental disorder, such as schizophrenia, panic disorder, major depressive disorder, acute stress disorder, posttraumatic stress disorder, or another dissociative disorder. *This is different from psychosis in that you know it's just your perception and you are aware

Question 74

Non-Rapid Eye Movement (REM) Sleep Arousal Disorders (6)

Answer 74

A. Recurrent episodes of incomplete awakening from sleep, usually occurring during the first third of the major sleep episode, accompanied by either one of the following: 1. Sleepwalking: Repeated episodes of rising from bed during sleep and walking about. While sleepwalking, the individual has a blank, staring face; is relatively unresponsive to the efforts of others to communicate with him or her; and can be awakened only with great difficulty. 2. Sleep terrors: Recurrent episodes of abrupt terror arousals from sleep, usually beginning with a panicky scream. There is intense fear and signs of autonomic arousal, such as mydriasis, tachycardia, rapid breathing, and sweating, during each episode. There is relative unresponsiveness to efforts of others to comfort the individual during the episodes. B. No or little (e.g., only a single visual scene) dream imagery is recalled. C. Amnesia for the episodes is present. D. The episodes cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication). F. Coexisting mental and medical disorders do not explain the episodes of sleepwalking or sleep terrors.

Question 75

Insomnia Disorder (8)

Answer 75

``` A. A predominant complaint of dissatisfaction witli sleep quantity or quality, associated with one (or more) of the following symptoms: 1. Difficulty initiating sleep. (In children, this may manifest as difficulty initiating sleep without caregiver intervention.) 2. Difficulty maintaining sleep, characterized by frequent awakenings or problems returning to sleep after awakenings. (In children, this may manifest as difficulty returning to sleep without caregiver intervention.) 3. Early-morning awakening with inability to return to sleep. ``` B. The sleep disturbance causes clinically significant distress or impairment in social, occupational, educational, academic, behavioral, or other important areas of functioning. C. The sleep difficulty occurs at least 3 nights per week. D. The sleep difficulty is present for at least 3 months. E. The sleep difficulty occurs despite adequate opportunity for sleep. F. The insomnia is not better explained by and does not occur exclusively during the course of another sleep-wake disorder (e.g., narcolepsy, a breathing-related sleep disorder, a circadian rhythm sleep-wake disorder, a parasomnia). G. The insomnia is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication). H. Coexisting mental disorders and medical conditions do not adequately explain the predominant complaint of insomnia. Specify if: With non-sleep disorder mental comorbidity, including substance use disorders With other medical comorbidity With other sleep disorder Specify if: Episodic: Sy(nptoms last at least 1 month but less than 3 months. Persistent: Symptoms last 3 months or longer. Recurrent: Two (or more) episodes within the space of 1 year.

Question 76

Encopresis (4)

Answer 76

A. Repeated passage of feces into inappropriate places (e.g., clothing, floor), whether involuntary or intentional. B. At least one such event occurs each month for at least 3 months. C. Chronological age is at least 4 years (or equivalent developmental level). D. The behavior is not attributable to the physiological effects of a substance (e.g., laxatives) or another medical condition except through a mechanism involving constipation. Specify whether: With constipation and overflow incontinence: There is evidence of constipation on physical examination or by history. Without constipation and overflow incontinence: There is no evidence of constipation on physical examination or by history.

Question 77

PTSD Criteria B

Answer 77

B. Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred: 1. Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). Note: In children older than 6 years, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed. 2. Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). Note: In children, there may be frightening dreams without recognizable content. 3. Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.) Note: In children, trauma-specific reenactment may occur in play. 4. Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). 5. Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).

Question 78

PTSD Mneumonic

Answer 78

RAv CAr (1, 1 2, 2)

Question 79

Enuresis - Prevalence & Course

Answer 79

5-10% among 5 y.o. Diurnal is more common in females and nocturnal in males Primary course: continence never established since age 5 Secondary course: continence establisehd then diminshed (often 5-8 y.o.)

Question 80

Somatic Symptom Disorder - Prevalence and Risk Factors

Answer 80

Prevalence is unknown; estimated at 5-7% Likely to be higher in females Onset is typically in adolescence/young adulthood -believed to be underdiagnosed in elderly Risk factors include: - neuroticism - comorbid anxiety/depression - low SES and education - Stressful life events (including child abuse) - Concurrent physical illness - Cognitive factors (e.g. attribution style, sensitivity/attention)

Question 81

Conversion Disorder (Functionanl Neurological Symptom Disorder) (4)

Answer 81

A. One or more symptoms of altered voluntary motor or sensory function. B. Clinical findings provide evidence of incompatibility between the symptom and recognized neurological or medical conditions. C. The symptom or deficit is not better explained by another medical or mental disorder. D. The symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation. Specify symptom type: With weakness or paralysis With abnormal movement (e.g., tremor, dystonie movement, myoclonus, gait disorder) With swallowing symptoms With speech symptom (e.g., dysphonia, slurred speech) With attacks or seizures With anesthesia or sensory loss With special sensory symptom (e.g., visual, olfactory, or hearing disturbance) With mixed symptoms Specify if: Acute episode; Symptoms present for less than 6 months. Persistent: Symptoms occurring for 6 months or more. Specify if: With psyctiological stressor (specify stressor) Without psychoiogicai stressor

Question 82

Pyromania (6)

Answer 82

A. Deliberate and purposeful fire setting on more than one occasion. B. Tension or affective arousal before the act. C. Fascination with, interest in, curiosity about, or attraction to fire and its situational contexts (e.g., paraphernalia, uses, consequences). D. Pleasure, gratification, or relief when setting fires or when witnessing or participating in their aftermath. E. The fire setting is not done for monetary gain, as an expression of sociopolitical ideology, to conceal criminal activity, to express anger or vengeance, to improve one’s living circumstances, in response to a delusion or hallucination, or as a result of impaired judgment (e.g., in major neurocognitive disorder, intellectual disability [intellectual developmental disorder], substance intoxication). F. The fire setting is not better explained by conduct disorder, a manic episode, or antisocial personality disorder.

Question 83

Binge-Eating Disorder (5)

Answer 83

A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: 1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances. 2. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating). B. The binge-eating episodes are associated with three (or more) of the following: 1. Eating much more rapidly than normal. 2. Eating until feeling uncomfortably full. 3. Eating large amounts of food when not feeling physically hungry. 4. Eating alone because of feeling embarrassed by how much one is eating. 5. Feeling disgusted with oneself, depressed, or very guilty afterward. C. Marked distress regarding binge eating is present. D. The binge eating occurs, on average, at least once a week for 3 months. E. The binge eating is not associated with the recurrent use of inappropriate compensatory behavior as in bulimia nen/osa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.