Most Important Flashcards

Question

Bipolar I Disorder Diagnostic Criteria

Answer 1

Must meet criteria for a manic episode, which may have been preceeded or be followed by hypomanic or major depressive episodes: A. A distinct period of abnormally and persistently elevated, exspansive, or irritable mood and abnormally/persistently elevated activity or energy, lasting ≥1 week most of the day, nearly every day (or until hospitalized). B. During that period, ≥3 if the following symptoms (≥4 if mood is irritable), and are a noticeable change from baseline: 1. Inflated self-esteem or grandiosity 2. Decreased need for sleep 3. More talkative than usual or pressure to keep talking 4. Flight of ideas or subjective experience that thoughts are racing. 5. Distractibility (reported or observed) 6. Increase in goal-directed activity (socially, at work/school, or sexually) or psychomotor agitation 7. Excessive involvement in highly risky/painful consequences activities C. Causes clinically significant functional impairment or requires hospitalization to prevent harm to self or others, or because there are psychotic features D. Not attributable to substances/medication/medical condition Note: Criteria A-B must be met, and at least one manic episode is not better explained by psychosis spectrum disorders.

Answer 2

Severity: * Mild * Moderate * Severe Other features: * With anxious distress * With mixed features * With rapid cycling * With melancholic features * With atypical features * With mood-congurent psychotic features * With mood incongruent psychotic features * With catatonia * With peripartum onset * With seasonal pattern Remission Status: * In partial remission * In full remission ## Footnote Note that specifiers depend on the current or most recent episode. Obviously "with melancholic features only applies to a depressive episode

Answer 3

A. A distinct period of abnormally/persistently elevated, expansive or irritable mood and abnormally/persistently increased energy, lasting ≥4 consecutive days, most of the day, nearly every day. B. During this period ≥3 of the following symptoms (≥4 if mood is irritable), and are a noticeable change from baseline 1. Inflated self-esteem or grandiosity 2. Decreased need for sleep 3. More talkative than usual or pressure to keep talking 4. Flight of ideas or subjective experience of racing thoughts 5. Distractibility 6. Increase in goal-directed activity or psychomotor agitation 7. Excessive involvement in highly risky/painful consequences activities C. Unequivocal change from baseline D. Changes are observable by others E. Not severe enough to cause marked functional impairment or result in hospitalization; no psychotic features. F. Not attributable to substances/medication/another medical condition

Answer 4

* In schizoaffective disorder, delusions/hallucinations occur for ≥ 2 weeks in the absence of a manic or major depressive episode * In Bipolar I, with psychotic features, the psychotic symptoms have occurred exclusively during manic or major depressive episodes

Answer 5

Mood lability and impulsivity are more episodic in bipolar (i.e., must represent a change from baseline to be considered a manic episode)

Answer 6

A. Must meet criteria for ≥1 past/current hypomanic episode *and* ≥1 past/current MDE B. There has never been a manic episode. C. ≥1 hypomanic episode and ≥1 MDE are not better explained by psychosis-spectrum disorders D. Symptoms of depression or unpredictability of changing/episodic mood states causes clinically significant distress/functional impairment

Answer 7

Current or most recent episode: * Hypomanic * Depressed If current/most recent episode = hypomanic: * Remission status: * In partial remission * In full remission * Additional features: * With anxious distress * With mixed features * With rapid cycling * With peripartum onset * With seasonal pattern If current/most recent episode = depressed: * Additional features: * With mixed features * With rapid cycling * With melancholic features * With atypical features * With mood-congruent psychotic features * With mood-incongruent psychotic features * With catatonia * With peripartum onset * With seasonal pattern * Remission status * In partial remission * In full remission * Severity * Mild * Moderate * Severe

Answer 8

A. For ≥2 years (≥1 year in children and teens), there have been numerous periods of hypomanic and depressive symptoms that do not meet criteria for hypomanic episodes or MDEs B. During that period, symptoms have been present for ≥1/2 the time, and the individual has not been without symptoms for ≥2 months at a time. C. Criteria for an MDE or manic/hypomanic episode have never been met. D. Symptoms not better explained by psychosis-spectrum disorders E. Not due to substances/medication/other medical condition. F. Causes clinically significant distress/functional impairment (either over the short or long term) Specify if: * With anxious distress

Answer 9

* Self-damaging behaviours occur in the context of hypomanic symtpoms in cyclothymic disorder * Mood instability in BPD occurs only with anxiety, irritability, and sadness * Mood instability in cyclothymic disorder can occur with the above, but also occurs with elation, euphoria, and/or increased energy (i.e., not seen in BPD) | Both diagnoses can be given if criteria for both are met.

Answer 10

A. Prominent/persistent change in mood that predominates the clinical picture, characterized by abnormally elevated/expanive or irritable mood and abnormally increased activity/energy. B. Evidence from history/examination/lab findings of both 1 and 2: 1. Symptoms develooped during or soon after substance/medication intoxication/exposure/withdrawal 2. The involved substance/medication is capable of producing the symptoms. C. Not better esplained by other bipolar disorders. D. Does not occur exclusively during delirium. E. Caused clinically significant distress/functional impairment.

Answer 11

Onset: * With onset during intoxication: If criteria are met for intoxication with the substance and symptoms develop during that time. * With onset during withdrawal: If criteria are met for substance withdrawal and symptoms develop during or shortly after that time. * With onset after medication use: If symptoms developed at initiation/change of use/withdrawal of medication.

Answer 12

A. Prominent/persistent change in mood that predominates the clinical picture, characterized by abnormally elevated/expanive or irritable mood and abnormally increased activity/energy. B. Evidence from history/physical examination/lab findings that the change is the direct pathophysiological result of another medical condition C. Not better esplained by other mental disorders. D. Does not occur exclusively during delirium. E. Caused clinically significant distress/functional impairment, *or necessitates hospitalization, or psychotic features are present* (i.e., these aren't present for substance/medication-induced bipolar).

Answer 13

Additional features: * With manic features: Full criteria for manic/hypomanic episode not met * With manic or hypomanic-like episode: Full criteria for manic/hypomanic episode met (except D and F, respectively) * With mixed features: Symptoms of depression are also present but to not predominate the clinical picture.

Answer 14

Additional features of current/most recent episode: * With anxious distress (specify if mild, moderate, moderate-severe, or severe) * With mixed features (applied only if current/most recent episode has mixed features; specify whether current/most recent episode is depressive or manic/hypomanic) * With rapid cycling * With melancholic features * With atypical features * With psychotic features (specify whether mood-congruent/incongruent) * With catatonia * With peripartum onset * With seasonal pattern Remission status: * In partial remission * In full remission Severity of current episode: * Mild * Moderate * Severe

Answer 15

A. Full criteria are met for a manic or hypomanic episode and ≥3 of the following are present most days during the current/most recent episode: * Prominent dysphoria or depressed mood (subjective of observed) * Diminisehd interest/pleasure in all or almost all activities (subjective or observed) * Psychomotor retardation nearly every day (observable by others) * Fatigue/loss of energy * Feelings of worthlessness or excessive/inappropriate guilt * Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, suicide attempt, or a specific plan to commit suicide B. Mixed symptoms observable by others and are a change from baseline C. If individuals meet criteria for mania and depression simultaneously, manic episode with mixed features should be given D. Not attributable to substances/medication. ## Footnote Note the "with mixed features" are the same as in the depressive disorders section if current/most recent episode is MDE

Answer 16

≥4 mood episodes in the last 12 months that meet criteria for manic/hypomanic episodes or MDE * Episodes demarcated by ≥2 months of remission or polarity switch * Manic/hypomanic episodes are considered to be on the same pole * Episodes should not be caused by substances

Answer 17

* With mood-congruent psychotic feautres: Content of hallucinations/delusions is consistent with themes of grandiosity, invulnerability, etc. but may also include suspiciousness, paranoia (esp about others' doubts about the individual's abilities) * With mood-incongruent psychotic feautres: Content of hallucinations/delusions does not involves the above themes, or is a mix of mood-congruent/incongruent themes ## Footnote Can also apply to current/most recent MDE in Bipolar II (see criteria in "Depressive Disorders" Section); Seemingly cannot apply to hypomanic eipsodes

Answer 18

Based on the number of symptoms, their severity, and degree of functional impairment * Mild: Minimum symptom criteria for manic episode are met * Moderate: Very significant increase in activity or impairment in judgement * Severe: Almost continual supervision required to prevent physical harm ## Footnote Severity specifiers are the same as in the depressive disorders section if current/most recent episode is MDE

Answer 19

A. The presence of ≥1 delusion(s) with a duration of ≥1 month(s). B. Criterion A for schizophrenia has never been met. C. Apart from the impact of the delusion(s) or its ramificaitons, functioning is not markedly impaired, behaviour is not obviously bizarre or odd. D. If manic episodes or MDEs have occurred, they are short compared to the periods of delusion. E. Not attributable to substances/medication/another medical condition.

Answer 20

Type of delusion: * Erotomanic type * Grandiose type * Jealous type * Persecutory type * Somatic type * Mixed type * Unspecified type Presence of bizarre content: * With bizarre content After 1-year duration of the disorder: * First episode, curently in acute episode * First episode, currently in partial remission: period after an episode in which criteria are only partially fulfilled * First episode, currently in full remission: period after an episode during which no disorder-specific symptoms are present * Multiple episodes, currently in acute episode * Multiple episodes, currently in partial remission * Multiple episodes, currently in full remission * Continuous: Diagnostic criteria have been met for the majority of illness course, with short periods of subthreshold symptoms present in between * Unspecified Severity: (based on Clinican-Rated Dimensions of Psychosis Symptom Severity)

Answer 21

* If an individual with OCD is completely convinced of their OCD belief, then OCD, with absent insight/delusional belief specifier should be given

Answer 22

* Delusional Disorder does not have characteristic symptoms of active phase of schizophrenia * In schizoprhenia, delusions show greater disorganization (less internally consistent) * In delusional disorder, there is greater conviction, greater extension (i.e., the delusion is more tied to areas of the individual's life) and greater pressure (i.e., preoccupation/concern)

Answer 23

* If delusions occur exclusively during a major mood episode, then it's likely not delusional disorder * Mood symptoms may be present, but only relatively briefly compared to the delusions for delusional disorder to be appropriate (otherwise it would be other specified/unspecified schizophrenia spectrum and other psychotic disorder, accomparnied by other specified/unspecified depressive/bipolar disorder)

Answer 24

A. Presence of ≥1 of the followning. ≥1 must be 1-3: 1. Delusions 2. Hallucinations 3. Disorganized speech 4. Grossly disorganized or catatonic behaviour B. Duration ≥1 day but <1 month, with eventual return to premorbid functioning. C. Not better explaind by MDD/bipolar with psychotic features and not attributable to substances/medication/other medical condition

Answer 25

Conditions at onset: * With marked stressor(s) (brief reactive psychosis) * Without marked stressor(s) * With peripartum onset: If onset is during pregnancy or ≤4 weeks postpartum Additional features: * With catatonia Severity (based on Clinician-Rated Dimensions of Psychosis Symptom Severity ## Footnote Diagnosis can be made without a severity specifier

Answer 26

* If symptoms persist ≥1 monthm diagnosis is either schizophreniform disorder, delusional disorder, MDD/bipolar with psychotic features, or other specified/unspecified schizophrenia spectrum and other psychotic disrder * Differentiation is challenging when symptoms have remitted in less than a month with successful treatment

Answer 27

A. ≥2 of hte following, present for a significant portion during a 1-month period (or less if successfully treated). ≥1 must be 1-3: 1. Delusions 2. Hallucinations 3. Disorganized speech 4. Grossly disorganized or catatonic behaviour 5. Negative symptoms B. An episode of the disorder lasts ≥1 month but < 6 months. When the diagnosis must be made without waiting for recovery, it should be qualified as "provisional". C. Schizoaffective disorder or depressive/bipolar disorder with psychotic features have been ruled out either because: 1. No MDE or manic episodes have occurred concurrently with active-phase symptoms 2. If mood episodes have occurred with active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of illness D. Not attributable to substances/medication/other medical condition.

Answer 28

Prognostic features: * With good prognostic features: Requires the presence or ≥2 of the following: 1. Onset of prominent psychotic symptoms within 4 weeks of first noticeable change in behaviour 2. Confusion or perplexity 3. Good premorbid functioning 4. Absence of blunted/flat affect * Without good prognostic features Other features: * With catatonia Severity ## Footnote Diagnosis can be made without severity specifier

Answer 29

A. ≥2 of the following, present for a significant portion during a 1-month period (or less if successfully treated). ≥1 must be 1-3: 1. Delusions 2. Hallucinations 3. Disorganized speech 4. Grossly disorganized or catatonic behaviour 5. Negative symptoms B. For a significant portion of time sine onset, functioning in ≥1 major areas is markedly below baseline C. Continuous signs of disturbance for >6 months; must include ≥1 month of symptoms (less if successfully treated) that meet criterion A and may include prodromal or residual symptoms (during this time, signs may only be manifested or attenuated versions of symptoms in A). D. Schizoaffective and mood disorders with psychotic features have been ruled out because either: 1. No mood episodes have occurred concurrently with active-phase symptoms 2. If mood episodes have occurred with active-phase symptoms, they have been presen for a minority of the total duration of the active and residual portions of the illness E. Not attributable to substances/medication/other medical condition F. If history of ASD or communication disorder with childhood onset, additional diagnosis of schizophrenia is made only if prominent hallucinations/delusions are present for ≥1 month (less if treated successfully)

Answer 30

After a 1-year duration: * First episode, currently in acute episode * First episode, currently in partial remission * First episode, currently in full remission * Multiple episodes, currently in acute episode * Multiple episodes, currently in partial remission * Multiple episodes, currently in full remission * Continuous * Unspecified Other features: * With catatonia Severity

Answer 31

* Delusional disorder lacks other psychotic symptoms * Brief psychotic and scchizophreniform disorder have different duration requirements * Schizoaffective disorder requires a concurrent mood episode with active-phase symptoms, and mood symptoms to be present for most of the total duration of active phase

Answer 32

A. Uninterrupted period of illness during which there is a major mood episode (depressed mood must be present if MDE) concurrent with Criterion A of schizophrenia B. Delusions/hallucinations for ≥2 weeks in the absence of a major mood episode C. Mood disorder episode symptoms are present for the majority of the active/residual portions of the illness D. Not attributable to substances/medication/other medical condition

Answer 33

Mood type: * Bipolar type: If a manic episode is part of the presentation * Depressive type Other features: * With catatonia After 1-year duration: * First episode, currently in acute episode * First episode, currently in partial remission * First episode, currently in full remission * Multiple episodes, currently in acute episode * Multiple episodes, currently in partial remission * Multiple episodes, currently in full remission * Continuous * Unspecified Severity

Answer 34

* Criterion B distinguishes from mood disorders: delusions/hallucinations are present for ≥2 weeks outside of mood episodes * Criterion C distinguishes from schizophrenia: mood episodes are present for most of the active/residual phases of the illness

Answer 35

A. The clinical picture is dominated by ≥3 of the following: 1. Stupour (i.e., no psychomotor activity; not actively relating to the environment) 2. Catalepsy (i.e., passive induction of a posture held against gravity) 3. Waxy flexibility (i.e., slight, even resistance to positioning by examiner) 4. Mutism (i.e., no, or very little, verbal response [excluce if known aphasia]) 5. Negativism (i.e., opposition or no response to instructions or external stimuli) 6. Posturing (i.e., spontaneous and active maintenance of a posture against gravity) 7. Mannerism (i.e., odd, circumstantial caricature of normal actions) 8. Stereotypy (i.e., repetitive, abnormally frequent, repetitive non-goal-directed movements) 9. Agitation, not influenced by external stimuli 10. Grimacing 11. Echolalia (i.e., mimicking another's speech) 12. Exchopraxia (i.e., mimicking another's movements)

Answer 36

A. Developmentally inappropriate and excessive fear/anxiety concerning separation from those to whom the individual is attached, as evidenced by ≥3 of the following: 1. Recurrent excessive distress when anticipating/experiencing separation from home or major attachement figures 2. Persistent and excessive worry about losing major attachment figures or about possible harm to them (e.g.m illness, injury, disasters, death) 3. Persistent and excessive worry about experiencing an untoward event (e.g., getting lost or kidnapped, having an accident, becoming ill) that causes separation from the major attachment figure 4. Persistent reulctance or refusal to go out, away from home, to school, to work, or elsewhere because of fear of separation 5. Persistent and excessive fear or reluctance about being alone without major attachment figrues at home or in other settings 6. Persistent reluctance or refusal to sleep away from home or to go to sleep without being near a major attachment figure 7. Repeated nightmares involving the theme of separation 8. Repeated complaints of physical symptoms (e.g., headaches, stomachaches, nausea, vomiting) when separation from major attachment figures occurs/is anticipated B. Fear/anxiety/avoidance is persistent, lasting ≥4 weeks in children/teens and ≥6 months in adults C. Causes clinically significant distress/functional impairment D. Not better explained by another disorder (e.g., excessive resistance to change in autism; delusions or hallucinations; agoraphobia; GAD; illness anxiety disorder)

Answer 37

A. Consistent failure to speak in specific social situations where there's an expectation for it (e.g., school), despite speaking in other situations B. Interferes with educational/occupational achievement or social communication C. Lasts ≥1 month (i.e., not jsut the first month of school) D. Not attributable to lack of knowledge of, or comfort with, the spoken language E. Not better explained by a communication disorder and does not occur exclusively in the context of ASD or psychotic disorders

Answer 38

A. Marked fear or anxiety about a specific object or situation (e.g., flying, heights, animals, injections, blood) B. The phobic object/situation almost always provokes fear/anxiety C. The phobic object/situation is actively avoided or endured with intense fear/anxiety D. Fear/anxiety is disproportionate to actual danger posed and/or to sociocultural context E. Fear/anxiety/avoidance is persistent, usually lasting ≥6 months F. Causes clinically significant distress/functional impairment G. Not better explained by symptoms of another mental disorder (e.g., fear of situations that could induce panic symptoms in agoraphobia/panic disorder; objects/situations relating to obsessions in OCD; reminders of traumatic events in PTSD; separation in separation anxiety disorder; social situations in social anxiety disorder)

Answer 39

Code based on the phobic situmulus: * Animal * Natural environment (e.g., heights, storms, water) * Blood-injection injury (e.g., needles, invasic procedures) * Situational (airplains, elevators, enclosed spaces) * Other (e.g., situations that may lead to choking/vomiting; loud sounds; clowns) ## Footnote If the fear/anxiety is the result of delusional thinking, specific phobia is not warranted as a diagnosis

Answer 40

A. Marked fear/anxiety about ≥1 social situations which may expose the individual to scrutiny by others (e.g., social interactions, being observed, performing in front of others; in children, must not occur only in front of adults) B. Individual fears that they will behave or show anxiety symptoms such that they will be negatively evaluated C. The social situations almost always provoke fear or anxiety D. Social situations are avoided or endured with intense fear or anxiety E. The fear or anxiety is dispropotionate to the actual threat posed and to sociocultural context F. The fear/anxiety/avoidance is persistent, typically lasting ≥6 months G. Causes clinically significant distress/functional impairment H. Not attributable to substances/medication/another medical condition I. Not better explained by another mental disorder J. If another medical condition is present, the fear/anxiety/avoidance is clearly unrelated or excessive Specify if: * Performance only: If the fear is restricted to public speaking/peforming

Answer 41

A. Recurrent unexpected panic attacks. A panic attack is an abrupt surge of intense fear/discomfort that reaches a peak within minutes, when ≥4 of the following occur: 1. Palpitations, pounding hear, accelerated HR 2. Sweating 3. Trembling/shaking 4. Shortness of breath/smothering sensation 5. Feelings of choking 6. Chest pain or discomfort 7. Nausea/abdominal distress 8. Feeling dizzy, unsteady, lightheaded, faint 9. Chills or heat sensation 10. Paresthesias (numbess/tingling) 11. Derealization (feelings of unreality) or depersonalization (being detached from oneself) 12. Fear of losing control or "going crazy" 13. Fear of dying B. ≥1 of the attacks has been followed by ≥1 month of one/both of the following: 1. Persistent concern/worry about additional panic attacks and their consequences (e.g., losing control, having a heart attack, going crazy) 2. A significant maladaptive change in behaviour related to the attacks (e.g., behaviours designed to avoid having panic attacks like avoiding exercise or unfamiliar situations) C.Not attributable to substances/medication/another medical condition D. Not better explained by another mental disorder

Answer 42

* If the panic attacks occur only in response to triggers related to an anxiety disorder (e.g., a phobic stimulus), then it's not panic disorder * Panic attacks in panic disorder are always unexpected

Answer 43

A. Marked fear/anxiety about ≥2 of the following 5: 1. Using public transport 2. Being in open spaces 3. Being in enclosed spaces 4. Standling in line or being in a crowd 5. Being outside of the home alone B. The individual fears or avoids these situations because of thoughts that escape might be difficult or help might not be available in the event of developing panic-like symptoms or other incapacitating/embarrassing symtpoms (e.g., fear of falling in older adults; fear of incontinence) C. Agoraphobic situations almost always provoke fear or anxiety D. Agoraphobic situations are actively avoided, require a companion, or are endured with intense fear/anxiety E. Fear/anxiety is disproportionate to actual danger posed by the situation and to sociocultural context F. Fear/anxiety is persistent, typically lasting ≥6 months G. Causes clinically significant distress/functional impairment H. If another medical condition is present, the fear/anxiety/avoidance is clearly excessive. I. Not better explained by another mental disorder ## Footnote Agoraphobia is diagnosed irrespective of the presence of panic disorder. If a person's presentation meets criteria for both, then both diagnoses should be given.

Answer 44

* Specific phobia should be diagnosed if fear/anxiety/avoidance is limited to one kind of agoraphobic situation (i.e., if ≥2 situations, it's likely agoraphobia) * Specific phobia fears have more to do with being harmed, rather than having panic-like or embarrassing/incapacitating symptoms in front of others

Answer 45

When criteria for panic disorder are met, agoraphobia should not be diagnosed if the avoidance behaviours associated with the panic attacks to not extent to avoidance of ≥2 agoraphobic situations. * Avoidance in panic disorder also seems to be motivated by the fear of having a panic attack at all, whereas in agoraphobia it's motivated by a lack of an escape route or help *in the event of* a panic attack

Answer 46

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not, for ≥6 months, about a number of events/activities B. The individual finds it difficult to control the worry. C. The anxiety/worry are associated with ≥3 of the following 6 (with at least some having been present for more days than not; only 1 is required in children): 1. Restlessness or feeling keyed up or on edge 2. Being easily fatigued 3. Difficulty concentrating or mind going blank 4. Irritability 5. Muscle tension 6. Sleep distubrance D. Causes clinically significant distress/functional impairment E. Not due to substances/medication/another medical condition F. Not better explained by another mental disorder

Answer 47

A. Presence of obsessions, compulsions or both: Obsessions are defined by 1-2: 1. Recurrent and persistent thoought/urges/images experienced as intrusive or unwanted and that cause the individual marked anxiety/distress 2. The individual attempts to ignore or suppress these through some other thought or action (i.e., compulsion) Compulsions are defined by 1-2: 1. Repetitive behaviours or mental acts that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly 2. The behaviour is aimed at preventing/reducing anxiety/distress or some dreaded event, but is not connected in a realistic way to that outcome or is clearly excessive B. The obsessions/compulsions are time-consuming (≥1 hour per day) or cause clinically significant distress/functional impairment C. Not attributable to substances/medication/anothewr medical condition D. Not better explained by another mental disorder

Answer 48

Insight: * With good or fair insight: Individual recognizes the OCD beliefs are definitely or porbably not true, or accepts that they may not be true * With poor insight: Individual thinks OCD beliefs are probably true * With absent insight/delusional beliefs: Individual is completely convinced Tics: * Tic-related: The individual has a current or history of tic disorder

Answer 49

A. Preoccupaion with ≥1 perceived defects or flaws in physical appearance that are not observable or only slight to others. B. Individual performs repetitive behaviours (e.g., mirror checking, skin picking, excessive grooming, reassurance seeking) or mental acts (e.g., comparing their appearance to others') in response to the concerns C. Causes clinically significant distress/functional impairment D. Not better eplained by conerns with body fat/weight in an individual who meets criteria for an ED

Answer 50

* With muscle dysmorphia: Individual is preoccuped with the idea that their body is too small/insufficiently muscular. This specifier can be used in conjunction with preoccupations with other body areas Insight * With good or fair insight * With poor insight * With absent insight/delusional beliefs

Answer 51

* Body dysmoprhic disorder involves repetitie and time-consuming behaviours which cause clinically significant distress/impairment

Answer 52

A. Persistent difficulty discarding or parting with possessions, regardless of true value B. Difficulty is due to a perceived need to save the items and distress associated with discarding them C. Difficulty results in accumulation of possessions that congest/clutter active living areas and substantially compromises their acitve use. If living areas are uncluttered, it is only because a third party intervened. D. Causes clinically significant distress/functional impairment E. Not attributable to another medical condition F. Not better explained by another mental disorder

Answer 53

* With excessive acquisition: If difficulty discarding is accompanied by excessive acquisition of unneeded items for which there is no available space Insight: * With good or fair insight * With poor insight * With absent insight/delusional belief

Answer 54

A. Recurrent pulling out of one's hair, resulting in hair loss B. Repeated attempts to decrease or stop hair pulling C. Causes clinically significant distress/functional impairment D. Not attributable to another medical condition E. Not better explained by another mental disorder (e.g., attempts to improve a perceived flaw in body dysmorphic disorder)

Answer 55

A. Recurrent skin picking resulting in skin lesions B. Repeated attempts to decrease or stop skin picking C. Causes clinically significant distress/functional impairment D. Not attributable to effects of a substance/medication/other medical condition E. Not better explained by another mental disorder (e.g., tactile hallucinations in psychotic disorder)

Answer 56

* With dissociative symptoms: Individual experiences either or both of the following: 1. Depersonalization 2. Derealization * With delayed expression: Full diagnostic criteria not met until ≥6 months after the event

Answer 57

A. Exposure to actual or threatened death, serious injury, secual violence in ≥1 of the following ways: 1. Direct experience 2. Witnessing as it occurred to others 3. Learning that it occurred to a close family member or friend. In these cases, even must have been violent or accidental 4. Experiencing extreme/repeated exposure to aversive details of the even (e.g., first responders collecting human remains; police officers who work on child abuse cases; Note: Not through media, unless it is work related) B. Presence if ≥1 of the following intrusion symptoms, following from the trauma: 1. Recurrent, involuntary, and intrusive distressing memories of the event 2. Recurrent distressing dreams in which the content and/or affect of the dream relates to the event 3. Dissociative reactions (e.g., flashbacks) in which the person feels or acts as if the event is recurring 4. Intense prolonged psychological distress at exposure to internal/external cues that resemble/symbolize an aspect of the event. 5. Marked physiological reactions to internal/external cues that symbolize/resemble an aspect of the event. C. Persistent avoidance of stimuli associated with the event, as evidenced by ≥1 of the following: 1. Avoidance or efforts to avoid distressing memoriees, thoughts, feelings about or closely associated with the event 2. Avoidance of efforts to avoid external reminders of the event D. Negative alterations in cognitions and mood associated with the event, as evidenced by ≥2 of the following: 1. Inability to remember an important aspect of the event (not better explained by e.g., head injury, substances) 2. Persistent and exaggerated negative beliefs about self, others, or the world 3. Persistent, disotrted cogntions about the cause/consequences of the event, leading to inappropriate blame of self or others 4. Persistent negative emotional states (e.g., fear, horror, anger, guilt, shame) 5. Marked diminished pleasure/participation in significant activities 6. Feelings of detachment or estrangement from others 7. Persistent inability to experience positive emotions (e.g., happiness, satisfaction, love) E. Marked alterations in arousal/reactivity, as evidenced by ≥2 of the following: 1. Irritable behaviour and angry outburts (with little/no provocation) 2. Reckless/self-destructive behaviour 3. Hypervigilance 4. Exaggerated startle response 5. Problems with concentration 6. Sleep disturbances F. Duration of B-E is ≥1 month G. Causes clinically significant distress/functional impairment H. Not attributable to substances/medication/medical condition.

Answer 58

* In adjustment, the stressors can be of any severity * If Criterion A is met, but others for PTSD are not, adjustment disorder may be appropriate, or if Criterion A is not met, but the rest of the PTSD symptom pattern does

Answer 59

Based on duration: 3 days-1 month for acute stress disorder, >1 month for PTSD

Answer 60

A. Exposure to actual or threatened death, serious injury, secual violence in ≥1 of the following ways: 1. Direct experience 2. Witnessing as it occurred to others 3. Learning that it occurred to a close family member or friend. In these cases, even must have been violent or accidental 4. Experiencing extreme/repeated exposure to aversive details of the even (e.g., first responders collecting human remains; police officers who work on child abuse cases; Note: Not through media, unless it is work related) B. Presence of ≥9 of the following from any 5 categories of intrusion, negative mood, dissociation, avoidance, and aroual * Intrusion Symptoms 1. Recurrent/involuntary/intrusive memories of the event 2. Recurrent distressing dreams in which content/affect relate to the event 3. Dissociative reactions in which the individual feels like the event is recurring 4. Intense/prolonges psychological distress or marked physiological reactions to internal/external cures of the event. * Negative Mood 1. Persistent inability to experience positive emotions * Dissociative symptoms 1. Altered sense of reality 2. Inability to remember important aspects of the event * Avoidance 1. Efforts to avoid distressing memories/thoughts/feelings of the event 2. Efforts to avoid external reminds of the event * Arousal symptoms 1. Sleep disturbance 2. Irritable behaviour and angry outbursts 3. Hypervigilance 4. Problems with concentrattion 5. Exaggerated startle response C. Duration is 3 days - 1 month after trauma exposure D. Causes clinically significant distress/functional impairment E. Not attributable to substances/medication/other medical condition or brief psychotic disorder

Answer 61

A. The development of emotional/behavioural symptoms in response to an identifiable stressor(s), occurring within 3 months of the onset of the stressor(s). B. Symptoms or behaviours are clinically significant, as evidenced by ≥1 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 cultural factors that might influence symptom severity and presentation. 2. Significant functional impairment C. Does not meet criteria for another mental disorder/is not an exacerbation of an existing mental disorder D. Not explained by normal bereavement or prolonged grief disorder E. Once the stressor/its consequences have terminate, symptoms do not persist longer than an additional 6 months

Answer 62

Presentation: * With depressed mood: low mood, tearfulness, feelings of hopelessness predominate * With anxiety: Nervousness, worry, jitteriness, separation anxiety predominate * With mixed anxiety and mood * With disturbance of conduct * With mixed disturbance of emotions and conuct: Mood symptoms and conduct disturbance are present * Unpsecified: Maladaptive reactions cannot cleanly be classified Course: * Acute: Symptoms persist for <6 months * Persistent (chronic): Symptoms persist ≥6 months (in total; symptoms cannot, by definition persist 6 months after stressor termination and still be adjustment disorder)

Answer 63

Both diagnoses cannot be given, if MDD criteria are met, then MDD wins out.

Answer 64

* Adjustment disorder is given if bereavement is judged to be out of proportion to what would be expected or significantly impairs self-care and interpersonal relations.

Answer 65

A. The death, ≥12 months ago (≥6 in children and teens), of a person who was close to the bereaved). B. Since the death, the development of a persistent grief response characterized by ≥1 of the following, to a clinical degree, nearly every day for the last month: 1. Intense yearning/longing for the deceased 2. Preoccupation with thooughts or memories of the deceased (may focus on circumstances of death in children and teens) C. Since the death, ≥3 of the following present most days, nearly every day of the last month, to a clinical degree: 1. Identity disruption (e.g., feeling that part of oneself has died) 2. Marked sense of disbelief about the death 3. Avoidance of reminders that the person is death 4. Intense emotional pain (e.g., anger/bitterness) 5. Difficulty reintegratng into one's relationships/activities (e.g., engaging with friends, pursuing interests, planning for the future) 6. Emotional numbness 7. Feeling that life is meaningless 8. Intense loneliness D. Causes clinically significant distress/functional impairment E. Bereavement has clearly exceeded social/cultural/religious norms F. Not better explained by another mental disorder (e.g., MDD, PTSD) and not attributable to substances/medication/another medical condition,

Answer 66

* Both can develop concurrently following the violent death of a loved one * PTSD intrusions have more to do with the traumatic event, whereas PGD intrusions have more to do with aspects of relationship with the deceased * Avoidance in PTSD is of reminders of the trauma, avoidance in PGD is of reminders that the loved one is no longer alive * Yearning for the deceased is not part of PTSD * PTSD re-experienncing is more vivid and perceptual.

Answer 67

Includes both intellectual and adaptive functioning deficits in conceptual, social, and practical domains. Following 3 criteria must be met: A. Deficits in intellectual functions (e.g., reasoning, problem-solving, plannign, abstract thinking, judgement, academic learning, learning from experience) confiemd by both clinical assessment and individualized, standardized intelligence testing. B. Deficits in adaptive functioning result in failure to meet developmental and sociocultural standards for personal independence/social responsibility. Without ongoing support, adaptive deficits limint functioning in ≥1 iADLs C. Onset of intellectual and adaptive deficits during development.

Answer 68

Evaluated based on domains (consult table in DSM-5-TR) * Mild: Some support needed/impairment in conceptual tasks; social immaturity; independence in simple iADLs (feeding, self-care, simple jobs) but support needed for very complex/abstract ones (e.g., legal decisions, raising a family) * Moderate: Marked delay in academic milestones/skills; marked differences in social behaviour and communication; similar iADL indepence to mild * Severe: Limited attainment of conceptual skills; little understanding of the written language, speech limited and confined to simple/gestural social communication; support needed in all iADLs * Profound: Abstraction/symobolic representation not comprehensible; limited understanding of symbolic communication; simple social communication; support needed in all aspects of daily care

Answer 69

A. Persistent deficits in social communication and interaction across multiple contexts, manifested by all of the following (currently or historically): 1. Deficits in social-emotional reciprocity (abnormal social approach, normal back-and-forth conversations, reduced sharing of interests/emotions/affect; failure to initiate or response to social interaction) 2. Deficits in nonverbal communicative behaviours for social interaction (e.g., maintaining eye contact, reading facial expressions) 3. Deficits in developing, maintaining, and understanding relationships (e.g., adjusting behaviour to suit contexts; lack of interest in peers) B. Restricted, repetitive patterns of behaviour, interests, or activities, manifested by ≥2 of the following (currently or historically) 1. Stereotyped/repetitive movements, use of obsject, or speech 2. Insistence on sameness, inflexible adherence to routines, ritualized patterns of verbal/nonverbal behaviour 3. Highly restriced, fixated interests that are abnormal in intensity or focus 4. Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment C. Symptoms must be present in the early developmental period (but may only become fully manifest later in life) D. Causes clinically significant distress/functional impairment E. Not better explained by intellectual developmetnal disorder (but may co-occur with it)

Answer 70

Severity: * Requiring very substantial support * Requiring substantial support * Requiring support Accompanying impairments: * With/without accompanying intellectual impairment * With/without accompanying language impairment Aetiology: * Associated with known genetic/medical condition or environmental factor * Associated with a neurodevelopmental, mental, or behavioural problem Other features: * With catatonia

Answer 71

A. Persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by ≥1 of: 1. Inattention: ≥6 of the following symptoms (≥5 if 17 or older) have persisted for ≥6 months to a degree that is incosistent with developmental level and negatively impacts directly on social and academic/occupational activities: * Often fails to give close attention to details or makes careless mistakes in schoowork, at work, or during other activities * Often has difficulty sustaining attention in tasks or play activities * Often does not seem to listen when spoken to directly, even in absence of an obvious distraction * Often does not follow through on instructions and failrs to finish schoolwork, chores, other duties (e.g., starts but loses focus/gets sidetrackede easily) * Avoids, dislikes, is reluctant to engage in tasks requiring sustained mental effort * Often has difficulty organizing tasks and activities * Often loses things necessary for activities * Is often easily distracted by extraneous stimuli * Is often forgetful in daily activities 2. Hyperactivity and impulsivity: ≥6 of the following thath ave persisted for ≥6 months to a degree that is inconsistent with developmental level and that negatively impacts social and academic/occupational activities: * Often fidgets or taps hands or feet or squirms in seat. * Often leaves seat in situations when remaining seated is expected * Often runs about or climbs in situations where it is inappropriate (may be only feelings of restlessness in teens/adults) * Often unable to play or engage in leisurely activities quietly * Is often "on the go" as if "driven by a motor" * Often talks excessively * Often blurts out an answer before a question has been completed * Often has difficulty waiting their turn * Often interrupts or intrudes on others B. Several symptoms were present before age 12 C. Several symptoms are present in ≥2 settings D. Clear evidence that symptoms interfere with or reduce quality of functioning in important domains E. Does not occur exclusively during schizophrenia or another psychotic disorder; not better explained by another mental disorder

Answer 72

Presentation: * Combined presentation: Criteria for inattention and hyperactivity are met * Predominantly inattentive presentation: Criteria met for inattention but not for hyperactivity for the past 6 months * Predominantly hyperactive presentation: Vice-versa Course: * In partial remission: Full criteria were previously met; now fewer than full criteria are met for the past 6 months, but still result in significant functional impairment Severity: * Mild: Few, if any, symptoms in excess of those needed for a dx. Results in some impairment but is manageable. * Moderate: Between mild and severe * Severe: Severe symptoms, well in excess of those needed for a dx. Result in severe functional impairment.

Answer 73

A. Difficulties learning and using academic skills, as indicated by the presence of ≥1 of the following symptoms that have persisted for ≥6 months, despite the provision of interventions targetting those abilities: 1. Inaccurate or slow, effortful word reading 2. Difficulty understanding the meaning of what is read (e.g., may read text accurately but not understand the sequence, relationships, inferences, or deeper meanings) 3. Difficulties with spelling (e.g., may add, omit, or substitute vowels or consonants) 4. Difficulties with written expression (e.g., makes multiple grammar or punctuation errors within sentences; employs poor paragraph organizationl written expression of ideas lacks clarity) 5. Difficulties mastering number sense, number facts, or calculation (e.g., has poor understanding of numbers, their magnitude, and relationships; counts on fingers to add single-digit numbers instead of recalling the math fact as peer so; gets lost in arithmetic computation and may switch procedures. 6. Difficulties with mathematical reasoning (e.g., has severe difficulty applying concepts, facts, or procedures to solve quantitative problems) B. The affected academic skills are substantially and quantifiably below those expected for the individual's age and cause significant interference with academic/occupational performance, or iADLs, as confirmed by individually administered standardized achievement measures and comprehensive clinical assessment (or hisgtory of impaired learning for individuals >17 years old) C. Difficulties begin in school-age years but may not become fully manifest until later in life. D. Not better accounted for by intellectual disabilities, uncorrected visual/auditory acuity, other mental/neurological disorders, psychosocial adversity, lack of proficiency in the language of instruction, or inadequate education

Answer 74

Specify all academic domains and subskills that are impaired: * With impairment in reading: * Word reading accuracy * Reading rate or fluency * Reading comprehension * With impairment in written expression: * Spelling accuracy * Grammar and punctuation accuracy * Clarity or organization of written expression * With impairment in mathematics * Number sense * Memorization of arithmetic facts * Accurate or fluent calculation * Accurate math reasoning Severity: * Mild: Some difficulties learning skills in 1-2 acadmic domains, but of mild enough severity that the individual may compensate or function well when provided with appropriate accommodations and support * Moderate: Marked difficulties learning skills in ≥1 academic domains so that the individual is unlikely to become proficient without intervals of intensive and specialized teaching during school years. Some accommodations/support needed at least part of the day at school, in the workplace, or at home to complete activities. * Severe: Severe difficulties learning skills, affecting several academic domains, so that the individual is unlikely to learn them without ongoing intensive individualized and specialized teaching for most of school years. Even an array of accommodations/support services at home/work/school may not allow the individual to complete all activities efficiently.

Answer 75

A. Persistent eating of nonnutritive, nonfood substances over a period of ≥1 month. B. Inappropriate for the developmental level of the individual. C. Not part of a culturally supported or socially normative practice. D. If the behaviour occurs in the context of another disorder (e.g., intellectual disability) or medcial condition, it is sufficiently severe to warrant additional clinical attention. Specify if: * In remission: After full criteria were previously met, the crtieria have not been for a sustained period of time.

Answer 76

A. Repeated regurgitation of food over a period of ≥1 month. May be re-chewed, re-swallowed, or spit out. B. Not attributable to an associated gastrointestinal or other medical condition. C. Does not occur exclusively during the course of anorexia nervose, bulimia nervosa, binge-eating disorder, or avoidant/restrictive food intake disorder. D. If symptoms occur in the context of another mental disorder, they are sufficiently sever to warrant additional clinical attention. Specify if: * In remission

Answer 77

A. An eating or feeding disturbance (e.g., apparent lack of interest in eating or food; avoidance based on sensory characteristics of food; concern about aversive consequences of eating) associated with ≥1 of the following: 1. Significant weight loss 2. Significant nutritional deficiency 3. Dependence on enteral feeding or oral nutritional supplements. 4. Marked interference with psychosocial functioning B. Not better explained by lack of available food or a culturally sanctioned practice. C. Does not occur exclusively during the course of AN or BN, and there is no evidence of a disturbance in the way in which one's body weight or shape is experienced. D. Not attributable to a concurrent medical condition; not better explained by another mental disorder. When it occurs in the context of another condition or disorder, the severity of the disturbance exceeds that routinely associated with the condition or disorder and warrants additional clinical attention Specify if: * In remission

Answer 78

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. B. Intense fear of gaining weight or becomign fat, or persistent behaviour 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.

Answer 79

Type: * Restricting Type: During the last 3 months, the individual has not engaged in recurrent episodes of binge-eating or purging behaviour (i.e., self-induced vomiting or misuse of laxatives, diuretics, or enemas). This subtype describes presentations in which weight loss is accomplished primarily through dieting, fasting, and/or excessive exercising. * Binge-eating/purging type: During the last 3 months, the individual has engaged in recurrent episode of binge-eating or purging behaviour Remission status: * In partial remission: After full criteria for AN were previously met, Criterion A (body weight) has not been met for a sustained period, but either Criterion B (intense fear of gaining weight/behaviour that interferes with weight gain) or Criterion C (disturbances in self-perception of weight and shape) is still met. * In full remission: None of the criteria are met for a sustained period of time. Severity: Based on BMI: * Mild: ≥17 * Moderate: 16-16.99 * Severe: 15-15.99 * Extreme: <15

Answer 80

* Both diagnoses can involve binge eating and inappropriate compensatory behaviours * In BN, body weight remains within the normal range

Answer 81

A. Recurrent episodes of binge eating, 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., feeling that one cannot stop or control it) B. Recurrent inappropriate compensatory behaviours in order to prevent weight gain, such as self-induced vomiting; misues of laxatives, etc. C. The binge eeating and inappropriate behaviours both occur, on average, ≥1/week for 3 months D. Self-evaluation is unduly influenced by body weight and shape. E. The disturbance does not occur exclusively duriung episodes of AN.

Answer 82

Remission status: * In partial remission: Some, but not all, of the criteria have been met for a sustained period of time. * In full remission Severity: Based on the frequency of the inappropriate compensatory behaviour. * Mild: Avg of 1-3 episodes/week * Moderate: Avg 4-7 episodes/week * Severe: Avg 8-13 episodes/week * Extreme: Avg ≥14 episodes/week

Answer 83

* Both diagnoses involve binges * Only BN involves compensatory behaviours

Answer 84

A. Recurrent episodes of binge eating, 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., feeling that one cannot stop or control it) B. Binges are associated with ≥3 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 bewcause of feeling embarrassed by the amount. 5. Feeling disgusted with oneself, dperessed, or very guilty afterwards. C. Marked distress regarding binge eating is present. D. The binge eating occurs, on average, ≥1/week for 3 months E. Not associated with recurrent use of inappropriate compensatory behaviours as in BN and doesn ot occur exclusively during the course of BN or AN.

Answer 85

Remission status: * In partial remission * In full remission Severity: Based on frequency of binges * Mild: 1-3/week * Moderate: 4-7/week * Severe: 8-13/week * Extreme: ≥14/week

Answer 86

A. ≥1 somatic symptoms that are distressing or result in significant disruption of daily life. B. Excessive thoughts, feelings, or behaviours related to the somatic symptoms or health concerns manifested by ≥1 of: 1. Disproportionate and persistent thoughts about the seriousness of symptoms 2. Persistently high level of anxiety about health symptoms. 3. Excessive time/energy devoted to these symptoms. C. Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically >6 months)

Answer 87

Specify if: * With predominant pain Specify if: * Persistent: Severe symptoms, marked impairment, and long duration (>6 months) Specify current severity: * Mild: Only 1 symptom in Criterion B. * Moderate: ≥2 symptoms in Criterion B. * Severe: ≥2 symptoms in Criterion B, plus there are multiple somatic complaints (or one very severe complaint)

Answer 88

If the individual has extensive worries about health but no or minimal somatic symptoms, it may be more appropriate to consider illness anxiety disorder.

Answer 89

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., family history), 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 behaviours (e.g., repeatedly checking for signs of the illness) or exhibits maladaptive avoidance (e.g., avoids doctors appointments/hospitals) E. Preoccupation present for >6 months, but the specific illness that is feared may change over that time period. F. Not better explained by another mental disorder

Answer 90

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.

Answer 91

A. ≥1 symptoms of altered voluntary motor or sensory function B. Clinical findings provide evidence of incompatibilty between the symptoms and the medical condition C. Not better explained by another medical or mental disorder. D. Causes clinically significant distress/functional impairment

Answer 92

Specify symptom type: * With weakness or paralysis * With abnormal movement (e.g., tremor, dystonia, myoclonus, gait disorder) * With swallowing symptoms * With speech symptoms * With attacks or seizures, * With anesthesia or sensory loss * With special snesory symptom (e.g., visual, olfactory, hearing) * With mixed symptoms Specify if: * Acute episode: Symptoms present <6 months * Persistent: ≥6 months Specify if: * With psychological stressor * Without psychological stressor

Answer 93

A. A pattern of angry/irritable mood, argumentative/defiant behaviour, or vindictiveness lasting ≥6 months as evidenced by ≥4 of the following, and exhibited during interaction with ≥1 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 Behaviour** 4. Often argues with authority figures 5. Often actively defies or refuses to comply with requests from authority figures or with rules 6. Often deliberately annoys others 7. Often blames other for their mistakes or misbehaivour **Vindictiveness** 8. Has been spiteful or vindictive ≥2 times in the last 6 months B. Causes distress in the individual or others in their immediate social context or causes functional impairment C. Does not occur exclusively during psychosis, substance use, mood disorders, and DMDD criteria not met.

Answer 94

Specify current severity: * Mild: Symptoms are confined to only one setting * Moderate: Symptoms present in 2 settings * Severe: Symptoms are present in ≥3 settings

Answer 95

* ODD behaviours are normally less severe in nature and do not include aggression toward people or animals, destruction of property, or a pattern of theft or deceit. * ODD includes problems of emotional dysregulation, which are not included in the CD definition

Answer 96

A. Recurrent behavioural 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 physical aggression towards property, animals, or other indeividuals, occuring 2/week on avg for 3 months. Aggression does NOT result in damage to property or physical injury. 2. 3 beahvioural outburts involving damage or destruction of property and/or physical assault involving injury occurring within a 12-month period. B. Magnitude of aggressiveness is grossly out of proportion to the trigger or precipitating psychosocial stressors C. Outburts are not premeditated and are not committed to achieve an objective. D. Causes either marked distress/functional impairment for the individual or is associated with financial/legal consequences E. Age is ≥6 years F. Not better explained by another mental disorder, other medical condition, substances, medication ## Footnote Dx can be made in addition to ADHD, CD, ODD, or ASD if outbursts are in excess of what is explained by those disorders

Answer 97

A. A repetitive/persistent pattern of behaviour in which the basic rights of others or major age-appropriate societal norms/rules are violated, as manifested by ≥3 of the following 15 crtieria, in the last 12 months, with ≥1 present in the past 6 months: **Aggression to People or Animals** 1. Often bullies, threatens, or intimidates others 2. Often initiates physical fights 3. Has used a weapen that can cause serious physical harm 4. Has been physically cruel to people 5. Has been physically cruel to animals 6. Has stolen while confronting a victim 7. Has forced someone into sexual activity **Destruction of Property** 8. Has deliberately set fires with the intention of causing serious damage 9. Has deliberately destroyed others' property (other than fire setting) **Deceitfulness or Theft** 10. Has broken into someone else's house, building, or car 11. Often lies to obtain goods or favors to avoid obligations 12. Has stolent items of nontrivial value without contronting a victim **Serious Violations of Rules** 13. Often stays out at night despite parental prohibitions (beginning before age 13) 14. Has run away from home overnight ≥2 times while living with caregivers or once w/o returning for a lengthy period 15. Is often truant from school (beginning before age 13) B. Causes clinically significant functional impairment C. If age ≥18, criteria for APD not met

Answer 98

Specify whether: * Childhood-onset type: ≥1 symptom before age 10 * Adolescent-onset type * Unspecified onset Specify if: * With limited prosocial emotions: ≥2 of the following characteristics persistently over last 12 months and in multiple settings. * Lack of remorse or guilt * Callous – lack of empathy * Unconcerned about performance * Shallow or deficient affect: Does not express feelings much except in ways that seem shallow or insincere or when emotional expressions are used for gain Specify current severity: * Mild: Few if any conduct problems in excess of those required to make disorder present. Causes relatively minor harm to others. * Moderate: Between mild and severe * Severe: Many conduct problems in excess of those required to make the diagnosis present and/or they cause considerable harm to others.

Answer 99

A. Deliberate and purposeful fire setting on >1 occasion B. Tension or affective arousal before the act C. Fascination with, interest in, curiosity about, or attraction to fire and its situational contexts D. Please, gratification, or relief when setting fires or when witness or participating in their aftermath E. Not done for monetary gain, political protest, to conceal criminal activity, anger or vengence, to improve one's living circumstances, in response to a delusion or hallucination, or as a result of impaired judgement. F. Not better explained by CD, manic episode, or APD

Answer 100

A. Recurrent failure to resist impulses to steal objects that are not needed for personal use or their monetary value. B. Increasing sense of tension immediately before committing the theft C. Pleasure, gratification, or relief when committing the theft. D. Not to express anger/vengence and not in response to a delusion or hallucination. E. Not better explained by CD, a manic episode, or APD

Answer 101

A. A problematic pattern of alcohol use leading to clinically significant impairment/distress, as manifested by ≥2 of the following within a 12-month period: 1. Alcohol is often taken in larger amounts or over a longer period than was intended. 2. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use. 3. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects. 4. Craving, or a strong desire/urge to use alcohol 5. Recurrent alcohol use resulting in failure to fulfill major role obligations at work, school, or home. 6. Continued alcohol sue despite having persistent or recurrent social/interpersonal problems caused/exacerbated by alcohol effects. 7. Important social/occupational/recreational activities are givne up or reduced because of alcohol use. 8. Recurrent alcohol use in situations in which it is physically hazardous. 9. Alcohol use is continued despite having a persistent/recurrent physical/psychological problem likely caused/exacerbated by alcohol. 10. Tolerance, as defined by either of the following: * A need for markedly increased amounts of alcohol to achieve intoxication or desired effect. * A markedly diminisehd effect wiht continued use of the same amount of alcohol. 11. Withdrawal, as manifested by either of the following: * The characteristic withdrawal syndrom for alcohol (i.e., Criterion A or B for alcohol withdrawal) * Alcohol (or a closely related substance, such as benzodiazipene) is taken to relieve or avoid withdrawal symptoms.

Answer 102

Specify if: * In early remission: None of the criteria have been met for >3 months but <12 months (with the exception of Criterion A4 [cravings]). * In sustained remission: None of the criteria have been met for ≥12 months (except Criterion A4) Specify if: * In a controlled environment: If the individual is in an environment where access to alcohol is restricted Specify current severity: * Mild: Presence of 2-3 symptoms * Moderate: 4-5 symptoms * Severe: ≥6 symptoms ## Footnote Specifiers are the same for other substances

Answer 103

A. Recent ingestion of alcohol B. Clinically significant problematic behavioural/psychological changes that developed in the course of alcohol ingestion C. ≥1 of the following signs/symptoms: 1. Slurred speech 2. Incoordination 3. Unsteady gait. 4. Nystagmus 5. Impairment in attention or memory 6. Stupour or coma D. Not attributable to another medical condition; not better explained by another mental disorder.

Answer 104

A. A cessation of (or reduction in) alcohol use that has been heavy and prolonged. B. ≥2 of the following, developing within several hours to a few days after cessation/reduction: 1. Autonomic hyperactivity (e.g., sweating or pulse greater than 100bpm) 2. Increased hand tremor 3. Insomnia 4. Nausea/vomiting 5. Transient visual/tactile/auditory hallucinations/illusions. 6. Psychomotor agitation 7. Anxiety 8. Generalized tonic-clonic seizures C. Causes clinically significant distress/functional impairment D. Not attributable to another medical condition; not better explained by another mental disorder.

Answer 105

Specify if: * With perceptual disturbances: Applies in rare instances where hallucinations occur with intact reality testing or illusions occur in the absence of a delirium.

Answer 106

A. A problematic pattern of [SUBSTANCE] use leading to clinically significant impairment/distress, as manifested by ≥2 of the following within a 12-month period: 1. [SUBSTANCE] is often taken in larger amounts or over a longer period than was intended. 2. There is a persistent desire or unsuccessful efforts to cut down or control [SUBSTANCE] use. 3. A great deal of time is spent in activities necessary to obtain [SUBSTANCE], use alcohol, or recover from its effects. 4. Craving, or a strong desire/urge to use [SUBSTANCE] 5. Recurrent [SUBSTANCE] use resulting in failure to fulfill major role obligations at work, school, or home. 6. Continued [SUBSTANCE] use despite having persistent or recurrent social/interpersonal problems caused/exacerbated by [SUBSTANCE] effects. 7. Important social/occupational/recreational activities are givne up or reduced because of [SUBSTANCE] use. 8. Recurrent [SUBSTANCE] use in situations in which it is physically hazardous. 9. [SUBSTANCE] use is continued despite having a persistent/recurrent physical/psychological problem likely caused/exacerbated by [SUBSTANCE]. 10. Tolerance, as defined by either of the following: * A need for markedly increased amounts of [SUBSTANCE] to achieve intoxication or desired effect. * A markedly diminisehd effect wiht continued use of the same amount of [SUBSTANCE]. 11. Withdrawal, as manifested by either of the following: * The characteristic withdrawal syndrom for [SUBSTANCE] (i.e., Criterion A or B for [SUBSTANCE] withdrawal) * [SUBSTANCE] (or a closely related substance) is taken to relieve or avoid withdrawal symptoms. ## Footnote Note that the withdrawal criterion is only present if it's a substance where withdrawal is possible (i.e., not for hallucinogens or inhalants)

Answer 107

A. Persistent and recurrent problematic gambling behaviour leading to clinically significant disress/functional impairment as indicated by ≥4 of the following within 12 months: 1. Needs to gamble with increasing amounts of money in order to achieve the desired excitement 2. Is restless/irritable when attempting to cut back or stop gambling 3. Has made repeared unsuccessful efforts to control, cut back, or stop gambling 4. Is often preoccupied with gambling (e.g., having persistent thoughts of reliving past gambling experiences, handicapping or planning the next venturem thinking of ways to get money to gamble) 5. Often gambles when feeling distressed 6. After losing money gambling, often returns on another day to get even ("chasing" losses) 7. Lies to conceal the extent of involvement with gambling 8. Has jeopardized or lost a significant relationship, job, or educational/career opportunity because of gambling 9. Relies on others to provide money to releive desperate financial situations caused by gambling. B. Not better explained by a manic episode.

Answer 108

Specify if: * Episodic: diagnostic criteria met at more than one time point, with symptoms subsiding in between for ≥several months * Persistent: Continuous symptoms meeting diagnostic criteria for multiple years Specify if: * In early remission: No criteria met for ≥3 months but <12 months * In sustained remission: No criteria met for ≥12 months Specify current severity: * Mild: 4-5 criteria met * Moderate: 6-7 criteria met * Severe: 8-9 criteria met

Answer 109

A. A disturbance in attention (i.e., reduced ability to direct, focus, sustain, and shift attention) accompanied by reduced awareness of the environment). B. The disturbance develops over a short period of time (hours to a few days), is a change from baseline, and tends to fluctuate in severity throughout the day. C. An additional disturbance in cognition (e.g., memory deficit, disorientation, language, visuospatial ability, or perception) D. A and C are not better explained by another neurocognitive disorder and do not occur in the context of severely reduced arousal, such as coma. E. Evidence from history, physical examination, or lab findings that the disturbance is a direct physiological consequence of another medical condition, substance intoxication or withdrawal, or exposure to a toxin, or is due to multiple etiologies.

Answer 110

Specify if: * Acute: Lasting a few hours or days * Persistent: Lasting weeks or months Specify if: * Hyperactive: Hyperactive level of psychomotor activity which may be accompanied by mood lability, agitation, and/or refusal to cooperate with medical care. * Hypoactive: Hypoactive level of psychomotor activity which may be accompanied by sluggishness and lethargy that approaches stupour. * Mixed level of activity: Normal level of psychomotor activity. Also includes individuals whose activity level rapidly fluctuates Specify whether: * Substance intoxication delirium * Medication-induced delirium * Delirium due to another medical condition * Delirium due to multiple etiologies

Answer 111

A. Evidence of significant cognitive decline from a previous level in ≥1 domains (complex attention, EF, learning and memory, language, perceptual-motor, or social cognition) based on: 1. Concern of the individual, a knowledgeable informant, or the clinican that there has been significant decline 2. A substantial impairment in cognitive performance, preferably documented by standardized neuropsychological testing or, in its absence, another quantified clinical assessment. B. The cognitive deficits interfere with independence in everyday activities (i.e., requiring, at minimum, assistance with complex iADLs) C. Does not occur exclusively in the context of delirium D. Not better explained by another mental disorder.

Answer 112

Specify whether due to: * Alzheimer's disease * Frontotemporal degeneration * Lewy body disease * Vascular disease * TBI * Substance/medication use * HIV infection * Prion disease * Parkinson's disease * Huntington's disease * Another medical condition * Multiple etiologies * Unspecified etiology Specify: * Without behavioural disturbance * With behavioural disturbance (e.g., psychotic sx, mood disturbance, agitation, apathy, other behavioural sx) (For Major only) Specify current severity: * Mild: Difficulties with iADLs * Moderate: Difficulties with basic ADLs (e.g., feeding, dressing) * Severe: Fully dependent

Answer 113

A. An enduring pattern of inner experience/behaviour that deviates markefly from expecations of the individual's culture. This is manifested in ≥2 of the following areas: 1. Cognition 2. Affectivity 3. Interpersonal functioning 4. Impulse control B. The pattern is inflexible and pervasive across a broad range of personal and social situations. C. Causes clinically significant distress/functional impairment. D. Pattern is stable and of long duration, and its onset can be traced back at least to adolescence or early adulthood. E. Not better explained by another mental disorder. F. Not attributable to substances or another medical condition.

Answer 114

A. A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts, as indicated by ≥4 of the following: 1. Suspects, without sufficient basis, that others are exploiting, harming, or deceiving them. 2. Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates. 3. Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against them. 4. Reads hidden demeaning or threathing meanings into benign remarks or events. 5. Persistently bears grudges 6. Perceives attacks on their character or reputation that are not apparent to others and is quick to react angrily or counterattack. 7. Has reuccrent suspicions, without justification, regarding the fideltiy of spouse or sexual partner. B. Does not occur exclusively during the course of schizophrenia/psychosis. Not attributable to another medical condition. ## Footnote If criteria are met prior to the onset of schizophrenia, add "premorbid", i.e., "paranoid personality disorder (premorbid)"

Answer 115

A. A pervasive pattern of detachment from social relationships and a restricted range of expresssion of emotions in interperosnal settings, beginning in early adulthood and present in a variety of contexts, as indicated by ≥4 of the following: 1. Neither desires, nor enjoys close relationships, including being part of a family. 2. Almost always chooses solitary activities. 3. Has little, if any, interest in having sexual experiences with another person. 4. Takes pleasure in few, if any, activities. 5. Lacks close friends or confidants other than first-degree relatives. 6. Appears indifferent to praise or criticism from others. 7. Shows emotional coldness, detachment, or flattened affectivity. B. Does not occur exclusives in the course of psychosis or ASD. Not attributable to another medical condition. ## Footnote If criteria are met prior to the onset of schizophrenia, add "premorbid", i.e., "schizoid personality disorder (premorbid)"

Answer 116

A. A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behaviour, beginning by early adulthood and present in a variety of contexts, as indicated by ≥5 of the following: 1. Ideas of reference (excluding delusions of reference) 2. Odd beliefs or magical thinking that influences behaviour and is inconsistent with subcultural norms 3. Unusual perceptual experiences, including bodily illusions 4. Odd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped) 5. Suspiciousness or paranoid ideation 6. Inappropriate or constricted affect 7. Behaviour or appearance that is odd, eccentric, or peculiar 8. Lack of close friends or confidants other than first-degree relatives 9. Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgements about self. B. Does not occur exclusively in the course of psychosis or ASD. ## Footnote If criteria are met prior to the onset of schizophrenia, add "premorbid", i.e., "Schizotypal personality disorder (premorbid)"

Answer 117

* Distinction is made based on whether there is a period of persistent psychotic symptoms * To give an additional PD dx, the disorder must have been present before onset of psychotic sx * When an individual has a persistent psychotic disorder that was preceded by a PD, the PD should be recorded as well, followed by "premorbid" in the dx)

Answer 118

A. A pervasive pattern of disregard for and violation of the rights of others, occurring since age 15, as indicated by ≥3 of the following: 1. Failure to conform to social norms wrt lawful behaviours, as indicated by repeated acts that are grounds for arrest. 2. Deceitfulness, as indicated by repeated lying, use of aliases, conning others for profit or pleasure. 3. Impulsivity or failure to plan ahead. 4. Irritability and aggressivenessm as indicated by repeated physical fights. 5. Reckless disregard for safety of self and others. 6. Consistent irresponsibility, as indicated by repeated failures to sustain consistent work behaviour or honour financial obligations. 7. Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from others. B. Individual is ≥18 years old. C. Evidence of conduct disorder with onset before age 15. D. Does not occur exclusively in the course of schizophrenia or bipolar. ## Footnote Also referred to as psychopathy/sociopathy, although some have argued they are different constructs.

Answer 119

* Dx of APD is given only to individuals ≥18 years old *and* only if there is evidence of CD before age 15 * For individuals over 18, CD dx is given *only* if APD criteria are not met.

Answer 120

* Both include tendencies to be tough-minded, glib, superficial, exploitative, and lacking empathy * Only APD involves impulsivity, aggression, and deceit * APD individuals are not as needy of admiration as people with narcissistic PD * Narcissistic PD usually lacks the presence of CD before age 15

Answer 121

A. A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by ≥5 of the following: 1. Frantic efforts to avoid real or imagined abandonmnent (excluding suicidal or self-mutilating behaviour covered in A5) 2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. 3. Identity disturbance: markedly and persistenyl unstable self-image or sense of self. 4. Impulsivity in ≥2 areas that are potentially self-damaging (e.g., spending, sex, substances, reckless driving, binge eating) 5. Recurrent suicidal behaviour, gestures, or threats, or self-mutilating behaviour 6. Affective instability due to marked reactivity in mood (e.g., intense episodic dysphoria, irritability, or anxiety, usually lasting a few hours and only rarely more than a few days) 7. Chronic feelings of emptiness 8. Inappropriate, intense anger or difficulty controllong anger (e.g., frequent displays of temper, constant anger, recurrent physical fights) 9. Transient stress-related paranoid ideation or severe dissociative sx

Answer 122

A. A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts, as indicated by ≥5 of the following: 1. Is uncomfortable in situations in which they are not the center of attention. 2. Interaction with others is often characterized by inappropriate sexually seductive or provocative behaviour. 3. Displays rapidly shifting and shallow expressions of emotions. 4. Consistently uses physical appearance to draw attention to self. 5. Has a style of speech that is excessively impressionistic and lacking in detail. 6. Shows self-dramatization, theatricality, and exaggerate expression of emotion 7. Is suggestible 8. Considers relationships to be more intimate than they actually are

Answer 123

A pervasive pattern of grandiosity (in fantasy or behaviour), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety on contexts, as indicated by ≥5 of the following: 1. Has grandiose self of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements) 2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love. 3. Believes that they are special and unique and can only be understood by, or should associate with, other special high-status people or institutions 4. Requires excessive admiration 5. Has a sense of entitlement 6. Is interpersonally exploitative 7. Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others 8. Is often envious of others or believes others are envious of them 9. Shows arrogant, haught behaviours or attitudes

Answer 124

A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood and present in a variety of contexts, as indicated by ≥4 of the following: 1. Avoids occupational activities that involve significant interpersonal contact because of fears of criticism, disapproval, or rejection 2. Is unwilling to get involved with people unless certain of being liked. 3. Shows restraint within intimate relationships because of the fear of being shamed or ridiculed. 4. Is preoccupied with being criticized or rejected in social situations. 5. Is inhibited in new interpersonal situations because of feelings of inadequacy. 6. Views self as socially inept, personally unappealing, or inferior to others 7. Is unusually reluctant to take personal risks or to engage in new activities because they may prove embarrassing.

Answer 125

A pervasive and excessive need to be taken care of that leads to submissive and clinging behaviour and fears of separation, beginning by early adulthood and present in a variety of contexts, as indicated by ≥5 of the following: 1. Has difficulty making everyday decisions without an excessive amount of advice and reassurance form others. 2. Needs others to assume responsibility for most major areas of their life. 3. Has difficulty expressing disagreement with others because of fear or loss of support or approval. 4. Has difficulty initiating projects or doing things on their own (because of lack of confidence in judgement or abilities) 5. Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant. 6. Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for themselves. 7. Urgently seeks another relationship as a source of care and support when a close relationship ends. 8. Is unrealistically preoccupied with fears of being left to take care of themselves.

Answer 126

A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts, as indicated by ≥4 of the following: 1. Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost. 2. Shows perfectionism that interferes with task completion. 3. Is excessively devoted to work and productivity to the exclusion of leisure activities and friendship 4. Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values 5. Is unable to discard worn-out or worthless objects even when they have no sentimental value. 6. Is reluctant to delegate tasks or to work with others unless they submit to exactly their way of doing things. 7. Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes. 8. Shows rigidity and stubbornness.

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