web viewflipping objects, echolalia [imitation of a heard word, phrase, or word fragment],...

Use this abridged version of the DSM-5 to make your diagnoses. Once your group has agreed on a diagnosis, type in the name of the case study under the name of the disorder. Then for each criterion, note the specific symptom the person described in the case study has that meets that criterion. For criteria that do not apply, write N/A. (See the sample at the end of this document for how to complete this portion.) Each group member must submit the completed document to turnitin when you are done.

of 31

Neurodevelopmental DisordersAutism Spectrum Disorder

A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following:

1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.

2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language, or deficits in understanding and use of gestures; to total lack of facial expression and nonverbal communication.

3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.

B. Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least two of the following:

1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypes, lining up toys or flipping objects, echolalia [imitation of a heard word, phrase, or word fragment], idiosyncratic phrases [language with private meanings or meaning that only makes sense to those familiar with the situation where the phrase originated]).

2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day).

3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed [restricted] or perseverated [repeated] interests).

4. Hyper- or hyporeactivity [reacting too much or too little] to sensory input or unusual interest in sensory aspects of environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).

C. Symptoms must be present in the early developmental period.

D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of functioning.

of 31

Neurodevelopmental DisordersAttention-Deficit/Hyperactivity Disorder

A. A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by (1) and/or (2):

Inattention: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities:

a. Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities (e.g., overlooks or misses details, work is inaccurate).

b. Often has trouble holding attention in tasks or play activities (e.g., has difficulty remaining focused during lectures, conversations, or lengthy readings).

c. Often does not seem to listen when spoken to directly.d. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in

the workplace (e.g., starts tasks but quickly loses focus and is easily sidetracked).e. Often has trouble organizing tasks and activities (e.g, difficulty managing sequential tasks,

difficulty keeping materials and belongings in order, messy and disorganized work, poor time management, fails to meet deadlines).

f. Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (e.g., schoolwork, homework, preparing reports, completing forms, reviewing lengthy papers).

g. Often loses things necessary for tasks and activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).

h. Is often easily distracted.i. Is often forgetful in daily activities (e.g., doing chores, running errands, returning calls, paying

bills, keeping appointments).

Hyperactivity and Impulsivity: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities:

a. Often fidgets with or taps hands or feet, or squirms in seat.b. Often leaves seat in situations when remaining seated is expected.c. Often runs about or climbs in situations where it is not appropriate.d. Often unable to play or take part in leisure activities quietly.e. Is often "on the go," acting as if "driven by a motor.”f. Often talks excessively.g. Often blurts out an answer before a question has been completed.h. Often has trouble waiting his or her turn.i. Often interrupts or intrudes on others (e.g., butts into conversations or games).

of 31

B. Several inattentive or hyperactive-impulsive symptoms were present before age 12 years.

C. Several symptoms are present in two or more setting, (e.g., at home, school or work, with friends or relatives, in other activities).

D. There is clear evidence that the symptoms interfere with, or reduce the quality of, social, academic, or occupational functioning.

of 31

Neurodevelopmental DisordersTourette’s DisorderA. Both multiple motor and one or more vocal tics have been present at some time during the illness,

although not necessarily concurrently.

B. The tics may wax and wane in frequency but have persisted for more than one year since first tic onset.

C. Onset is before age 18 years.

of 31

Schizophrenia Spectrum and Other Psychotic DisordersDelusional Disorder

A. The presence of one (or more) delusions [beliefs that are not true] with a duration of 1 month or longer.

C. Apart from the impact of the delusion(s) or its ramifications, functioning is not markedly impaired, and behavior is not obviously bizarre or odd.

of 31

Schizophrenia Spectrum and Other Psychotic DisordersSchizophrenia

A. Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least one of these must be (1), (2), or (3):

1. Delusions. [beliefs that are not true]2. Hallucinations. [something (such as an image, a sound, or a smell) that seems real but does

not really exist]3. Disorganized speech (e.g., frequent derailment [shifting train of thought] or incoherence

[unclear]).4. Grossly disorganized [silly, inappropriate, or bizarre] or catatonic [a state of apparent

unresponsiveness to external stimuli in a person who is apparently awake] behavior.5. Negative symptoms (i.e., diminished emotional expression or avolition [inability to initiate and

persist in goal-directed activities]).

B. For a significant portion of the time since the onset of the disturbance, level of functioning in one or more major areas, such as work, interpersonal relations, or self-care, is markedly below the level achieved prior to the onset.

C. Continuous signs of the disturbance persist for at least 6 months.

of 31

Bipolar and Related DisordersBipolar I Disorder

A. Criteria have been met for at least one manic episode.

Manic Episode

A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day.

B. During the period of mood disturbance and increased energy and activity, three (or more) of the following symptoms have persisted (four if the mood is only irritable), represent a noticeable change from usual behavior, and have been present to significant degree:

1. Inflated self-esteem or grandiosity [inflated self-esteem or self-worth].2. Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).3. More talkative then usual or pressure to keep talking.4. Flight of ideas or subjective experience that thoughts are racing. 5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as

reported or observed. 6. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor

agitation.7. Excessive involvement in activities that have a high potential for painful consequences (e.g.,

engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).

C. The episode is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.

of 31

Bipolar and Related Disorders Bipolar II Disorder

A. Criteria have been met for at least one hypomanic episode and at least one major depressive episode.

B. There has never been a manic episode.

C. The symptoms of depression or the unpredictability caused by frequent alternation between periods of depression and hypomania causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Hypomanic Episode

A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day.

B. During the period of mood disturbance and increased energy and activity, three (or more) of the following symptoms have persisted (four if the mood is only irritable), represent a noticeable change from usual behavior, and have been present to significant degree:

1. Inflated self-esteem or grandiosity [inflated self-esteem or self-worth].2. Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).3. More talkative then usual or pressure to keep talking.4. Flight of ideas or subjective experience that thoughts are racing. 5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as

reported or observed. 6. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor

agitation.7. Excessive involvement in activities that have a high potential for painful consequences (e.g.,

engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).

C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic.

D. The disturbance in mood and the change in functioning are observable by others.

E. The episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization. If there are psychotic features, the episode is, by definition, manic.

of 31

Major Depressive Episode

A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, or hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, can be irritable mood.)

2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.

3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected weight gain.)

4. Insomnia or hypersomnia nearly every day.5. Psychomotor agitation [excessive motor activity associated with feelings of inner tension; e.g.,

fidgeting, wringing of hands, pulling of clothes] or retardation [visible generalized slowing of movements and speech] nearly every day.

6. Fatigue or loss of energy nearly every day.7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly

every day (not merely self-reproach or guilt about being sick).8. Diminished ability to think or concentrate, or indecisiveness [inability to make decisions quickly

and easily], nearly every day.9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a

specific plan, a suicide attempt, or a specific plan for committing suicide.

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

of 31

Depressive DisordersMajor Depressive Disorder

A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, or hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, can be irritable mood.)

2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.

3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected weight gain.)

4. Insomnia or hypersomnia nearly every day. 5. Psychomotor agitation [excessive motor activity associated with feelings of inner tension; e.g.,

fidgeting, wringing of hands, pulling of clothes] or retardation [visible generalized slowing of movements and speech] nearly every day.

6. Fatigue or loss of energy nearly every day. 7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly

every day (not merely self-reproach or guilt about being sick). 8. Diminished ability to think or concentrate, or indecisiveness [inability to make decisions quickly

and easily], nearly every day. 9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a

specific plan, a suicide attempt, or a specific plan for committing suicide.

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

of 31

Depressive DisordersPremenstrual Dysphoric Disorder

A. In the majority of menstrual cycles, at least five symptoms must be present in the final week before the onset of menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week postmenses.

B. One (or more) of the following symptoms must be present:

1. Marked affective lability (e.g., mood swings; feeling suddenly sad or tearful, or increased sensitivity to rejection).

2. Marked irritability or anger or increased interpersonal conflicts. 3. Marked depressed mood, feelings or hopelessness, or self-deprecating [belittling, self-critical]

thoughts. 4. Marked anxiety, tension, and/or feelings of being keyed up or on edge.

C. One (or more) of the following symptoms must additionally be present, to reach a total of five symptoms when combined with symptoms from Criterion B above.

1. Decreased interest in usual activities (e.g., work, school, friends, or hobbies). 2. Subjective difficulty in concentration. 3. Lethargy, easy fatigability, or marked lack of energy. 4. Marked change in appetite; overeating; or specific food cravings. 5. Hypersomnia or insomnia. 6. A sense of being overwhelmed or out of control. 7. Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a physical

sensation of “bloating”, or weight gain.

D. The symptoms are associated with clinically significant distress or interference with work, school, usual social activities, or relationships with others (e.g., avoidance of social activities; decreased productivity and efficiency at work, school, or home).

of 31

Anxiety DisordersSpecific Phobia

A. Marked fear or anxiety about a specific object or situation (e.g., flying, heights, animals, receiving an injection, seeing blood).

B. The phobic object or situation almost always provokes immediate fear or anxiety.

C. The phobic object or situation is actively avoided or endured with intense fear or anxiety.

D. The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation and to the sociocultural context.

E. The fear, anxiety or avoidance is persistent, typically lasting for six months or more.

F. The fear, anxiety or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas or functioning.

of 31

Anxiety DisordersSocial Anxiety Disorder (Social Phobia)

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny [critical examination] by others. Examples include social interactions (e.g. having a conversation, meeting unfamiliar people), being observed (e.g. eating or drinking), and performing in front of others (e.g. giving a speech).Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.

B. The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e. will be humiliating or embarrassing; will lead to rejection or offend others).

C. The social situations almost always provoke fear or anxiety.Note: In children, the fear of anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.

D. The social situations are avoided or endured with intense fear or anxiety.

E. The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.

F. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

G. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

of 31

Anxiety DisordersPanic Disorder

A. Recurrent unexpected panic attacks. A panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four (or more) of the following symptoms occur:

1. Palpitations, pounding heart, or accelerated heart rate. 2. Sweating.3. Trembling or shaking.4. Sensations of shortness of breath or smothering.5. Feelings of choking. 6. Chest pain or discomfort. 7. Nausea or abdominal distress. 8. Feeling dizzy, unsteady, light-headed, or faint.9. Chills or heat sensations. 10.Paresthesias [numbness or tingling sensations].11.Derealization [feelings of unreality] or depersonalization [being detached from oneself].12.Fear of losing control or “going crazy.”13.Fear of dying.

B. At least one of the attacks has been followed by 1 month (or more) of one or both of the following:

1. Persistent concern or worry about additional panic attacks or their consequences (e.g., losing control, having a heart attack, “going crazy”).

2. A significant maladaptive change in behavior related to the attacks (e.g., behaviors designed to avoid having panic attacks, such as avoidance of exercise or unfamiliar situations).

of 31

Anxiety DisordersGeneralized Anxiety Disorder

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The individual finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):Note: Only one item 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 disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

of 31

Obsessive-Compulsive and Related DisordersObsessive-Compulsive Disorder

A. Presence of obsessions, compulsions, or both:

Obsessions are defined by (1) and (2):1. Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the

disturbance, as intrusive and unwanted and that in most individuals cause marked anxiety or distress.

2. The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (by performing a compulsion).

Compulsions are defined by (1) and (2):

1. Repetitive behavior (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.

2. The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.Note: Young children may not be able to articulate the aims of these behaviors or mental acts

B. The obsessions or compulsions are time-consuming (take more than 1 hour per day) or caused clinically significant distress or impairment in social, occupational, or other important areas of functioning.

of 31

Obsessive-Compulsive and Related DisordersBody Dysmorphic DisorderA. Preoccupation with one or more perceived defects or flaws in physical appearance that are not

observable or appear slight to others.

B. At some point during the course of the disorder, the individual has performed repetitive behaviors (e.g, mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (e.g., comparing his or her appearance with that of others) in response to the appearance concerns.

C. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The appearance preoccupation is not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnostic criteria for an eating disorder.

of 31

Obsessive-Compulsive and Related DisordersHoarding DisorderA. Persistent difficulty discarding or parting with possessions, regardless of their actual value.

B. This difficulty is due to a perceived need to save the items and to distress associated with discarding them.

C. The difficulty discarding possessions results in the accumulation of possessions that congest and clutter active living areas and substantially compromises their intended use. If living areas are uncluttered, it is only because of the interventions of third parties (e.g. family members, cleaners, authorities).

D. The hoarding causes clinically significant distress or impairment in social, occupational, or other important areas of functioning (including maintaining a safe environment for self and others).

of 31

Obsessive-Compulsive and Related DisordersTrichotillomania (Hair-Pulling Disorder)A. Recurrent pulling out of one’s hair, resulting in hair loss.

B. Repeated attempts to decrease or stop hair pulling.

C. The hair pulling causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

of 31

Trauma- and Stressor-Related DisordersPosttraumatic Stress Disorder

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 relative or close friend.4. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s).

Note: Criterion A4 does not apply through exposure through electronic media, television, movies, or pictures, unless this exposure is work-related.

B. Intrusion symptoms (1 or more)1. Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). 2. Recurrent, distressing dreams in which the content and/or affect [feeling or emotion] of the

dream are related to the traumatic event(s).3. Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic

event(s) were recurring.4. Psychological distress at exposure to reminders of the traumatic event(s).5. Marked physiologic [biological] reactions to exposure to reminders of the traumatic event(s).

C. Avoidance (1 or more)2. Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely

associated with the traumatic event(s).3. Avoidance of or efforts to avoid external reminders that arouse distressing memories,

thoughts, or feelings about or closely associated with the traumatic event(s).

D. Negative alterations in cognitions and mood (2 or more)1. Inability to remember an important aspect of the traumatic event(s).2. Persistent and exaggerated negative beliefs and expectations about oneself, others, or the

world.3. Persistent distorted blame of self or others for causing the traumatic event or for resulting

consequences.4. Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).5. Markedly diminished interest or participation in significant activities.6. Feeling alienated from others.7. Persistent inability to experience positive emotions.

E. Alterations in arousal and reactivity (2 or more)1. Irritable behavior and angry outbursts.2. Self-destructive or reckless behavior.3. Hypervigilance. [the experience of being constantly tense and “on guard”]4. Exaggerated startle response.

of 31

5. Problems with concentration.6. Sleep disturbance.

F. Duration of the disturbance is more than 1 month.

G. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

of 31

Somatic Symptom and Related DisordersIllness Anxiety Disorder

A. Preoccupation with having or acquiring a serious illness.

B. Somatic [bodily] 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 or 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.

of 31

Somatic Symptom and Related DisordersFactitious Disorder

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.

of 31

Gender Dysphoria (in children)

A. A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months’ duration, as manifested by at least six of the following (one of which must be Criterion A1):

1. A strong desire to be of the other gender or an insistence that one is the other gender (or some alternative gender different from one’s assigned gender).

2. In boys, a strong preference for cross-dressing or simulating female attire; or in girls, a strong preference for wearing only typical masculine clothing and a strong resistance to the wearing of typical feminine clothing.

3. A strong preference for cross-gender roles in make-believe play or fantasy play.4. A strong preference for the toys, games, or activities stereotypically used or engaged in by the

other gender.5. A strong preference for playmates of the other gender.6. In boys, a strong rejection of typically masculine toys, games, and activities and a strong

avoidance of rough-and-tumble play; or in girls, a strong rejection of typically feminine toys, games, and activities.

7. A strong dislike of one’s sexual anatomy.8. A strong desire for the primary and/or secondary sex characteristics [primary: features present

at birth; secondary: features that appear during puberty] of the other gender.B. The condition is associated with clinically significant distress or impairment in social, school, or

other important areas of functioning.

of 31

Disruptive, Impulse-Control, and Conduct Disorders Conduct Disorder

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 somebody into sexual activity.

Destruction of Property 3. Has deliberately engaged in fire setting with the intention of causing serious damage. 4. Has deliberately destroyed other’s property (other than by fire setting).

Deceitfulness or Theft 5. Has broken into someone else’s house, building or car. 6. Often lies to obtain goods or favors to avoid obligations (i.e., “cons” others). 7. Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without

breaking and entering; forgery).

Serious Violations of Rules 8. Often stays out at night despite parental prohibitions, beginning before age 13 years. 9. 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. 10. Is often truant [unauthorized absence] 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.

of 31

Personality Disorders Antisocial Personality Disorder

A. A pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 years, as indicated by three (or more) of the following:

1. Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest.

2. Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure.

3. Impulsivity or failure to plan ahead.

4. Irritability and aggressiveness, as indicated by repeated physical fights or assaults.

5. Reckless disregard for safety of self or others.

6. Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations.

7. Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.

B. The individual is at least age 18 years.

C. There is evidence of conduct order with onset before age 15 years.

of 31

Personality Disorders Borderline Personality Disorder

A pervasive pattern of instability of interpersonal relationships, self-image, and affects [emotions], and marked impulsivity, beginning by early adulthood and present in a variety of context, as indicated by five (or more) of the following:

1. Frantic efforts to avoid real or imagined abandonment (Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.)

2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. [they may idealize others at the first or second meeting, demand to spend a lot of time together, and share the most intimate details early in a relationship; however, they may switch quickly to devaluing them, feeling that the other person doesn’t care enough, doesn’t give enough, or is “not there’ enough]

3. Identity disturbance: markedly and persistently unstable self-image or sense of self.

4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). (Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.)

5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior

6. Affective [emotional] instability due to a marked reactivity of mood (e.g., intense episodic dysphoria [discontent], 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 controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical flights).

9. Transient, stress-related paranoid ideation or severe dissociative symptoms. [short periods of paranoia or feelings of being disconnected from one’s body or the world]

of 31

Personality Disorders Narcissistic Personality Disorder

A pervasive pattern of grandiosity [inflated self-esteem or self-worth] (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1. Has a grandiose sense 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 he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions).

4. Requires excessive admiration.

5. Has a sense of entitlement (i.e., unreasonable expectations or especially favorable treatment or automatic compliance with his or her expectations).

6. Is interpersonally exploitative (i.e., takes advantage of others to achieve his or her own ends).

7. Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others.

8. Is often envious of others or believes that others are envious of him or her.

9. Shows arrogant, haughty [arrogant] behaviors or attitudes.

of 31

Personality Disorders Obsessive-Compulsive Personality Disorder

A pervasive pattern of preoccupation with orderliness, perfectionism, and mental interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts as indicated by four or more 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 (e.g., is unable to complete a project because his or her own overly strict standards are not met.).

3. Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity).

4. Is overconscientious, scrupulous [very concerned to avoid doing wrong], and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification).

5. Is unable to discard worn-out or worthless objects, even when they have no sentimental value.

6. Is reluctant to delegate [entrust to another person] tasks or to work with others unless they submit to exactly his or her way of doing things.

7. Adopts a miserly [stingy] spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes.

8. Shows rigidity and stubbornness.

of 31

SAMPLE:

Major Depressive Disorder

Lost Interest in Life

A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure. She began to lose interest in life about four months ago.

1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, or hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, can be irritable mood.) For the past four months, she’s reported depression every day for most of the day.

2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day. She says she’s lost interest in life.

3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected weight gain.) She lost nine pounds without dieting because she didn’t feel like eating.

4. Insomnia or hypersomnia nearly every day. She has trouble falling asleep almost every night and wakes up 3 ½ hours earlier than normal several days a week.

5. Psychomotor agitation [excessive motor activity associated with feelings of inner tension; e.g., fidgeting, wringing of hands, pulling of clothes] or retardation [visible generalized slowing of movements and speech] nearly every day. She exhibited psychomotor agitation according to the therapist.

6. Fatigue or loss of energy nearly every day. She has diminished energy.7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly

every day (not merely self-reproach or guilt about being sick). She felt guilty about supposedly poisoning the dog food.

8. Diminished ability to think or concentrate, or indecisiveness [inability to make decisions quickly and easily], nearly every day. She has diminished concentration.

9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, a suicide attempt, or a specific plan for committing suicide. She said she felt like killing herself.

B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. See above; she is distressed and many facets of her life have been negatively affected by these symptoms.

of 31

web viewflipping objects, echolalia [imitation of a heard word, phrase, or word fragment],...

Documents