DSM 5 Disoders with criteria and treatments

PSYCHOLOGICAL DISORDERS (DSM-5)
ANXIETY DISORDERS
DISORDER DIAGNOSTIC CRITERIA ETIOLOGY INTERVENTIONS
Generalized
Anxiety Disorder
(GAD)
Excessive worry
about everyday
issues & situations
✔At least 6 months
✔Anxiety & worry are associated with at least 3 (1 in
children) of the ff symptoms:
1.Restlessness/feeling keyed up/on edge
2.Easily fatigued
3.Difficulty concentrating/Mind going blank
4.Irritability
5.Muscle Tension
6.Sleep Disturbances
Biological
- Genetics
- Deficits in the functioning of the GABA
system
- High metabolic activity in frontal lobe
(involved in directing attention)
Behavioral
- Worry is reinforcing because it avoids people
from more powerful negative emotions (past
traumas)
Social/Environmental
- Abuse
•Pharmacotherapy
◦Anxiolytics (sedatives, minor tranquilizers)
- drugs that reduce anxiety
◦Benzodiazepines
- short-term relief & carry risks (impair both
cognitive & motor function)
- associated w/ falls in old adults = hip fractures
- produce both physical & psychological
dependence
◦Antidepressants (SSRIs)
- Paroxetine (Paxil), Escitalopram (Lexapro),
Duloxetine (Cymbalta), Venlafaxine (aka Effexor)
◦Serotonin-Norepinephrine Reuptake Inhibitors
(SNRIs)
•Psychotherapy
- Behavior, Cognitive & Psychodynamic Therapies
- Using images to feel (rather than avoid) anxious
- Relaxing deeply to combat tension
Panic Disorder
Frequent panic
attacks that are
unrelated to
specific situation
✔Recurrent unexpected panic attacks
✔At least 1 of the attacks has been followed by 1
month/more of 1 or both of the ff:
1.Persistent concern/worry about additional panic
attacks or their consequences
2.Significant maladaptive change in behavior related
to the attacks (avoidance of exercise/unfamiliar
situations)
Neurobiological
- Misfire of the fear circuit – Surge in activity
in SNS
- Locus Coeruleus – major source of
norepinephrine that plays a major role in
triggering SNS
Behavioral
- Classical Conditioning – panic attacks are
conditioned responses to either situations that
trigger anxiety or internal bodily sensations of
arousal (Interoceptive Conditioning) –
experiences of somatic signs of anxiety, which
are followed by the first panic attack)
Cognitive
- Panic attacks develop when a person
interprets bodily sensations as signs of
impending danger
•Gradual exposure exercises, combined with anxiety-
reducing coping mechanisms such as relaxation or
breathing retraining
•Panic Control Therapy (PCT)
- Exposing patients to the cluster of interoceptive
(physical) sensations that remind them of their panic
attacks
•Cognitive Behavioral Therapy (CBT)
◦Calm Tools for Living
- clinician and patient sit side-by-side as they both
view the program on screen
- Helps patient establish a fear hierarchy,
demonstrate breathing skills, or design exposure
assignments

Agoraphobia
Anxiety about
situations in which
it would be
embarrassing or
difficult to escape
if anxiety
symptoms occurred
(Karl Westphal)
✔Fear/anxiety about 2/more of the ff: public
transportation, open spaces, enclosed places,
standing in line/being in a crowd & being outside
the home alone
✔Fears/avoids these situations due to thoughts that
escape might be difficult/help might not be available
in the event of developing panic-like symptoms or
other incapacitating/embarrassing symptoms (ex.
fear of falling in the elderly)
✔The agoraphobic situation almost always provoke
fear/anxiety
✔The agoraphobic situation are actively avoided,
require the presence of a companion, or are endured
w/ intense fear/anxiety
✔Fear of anxiety is out of proportion to the actual
danger
✔Persistent & lasts for 6 months/more
Cognitive
- Fear-of-Fear Hypothesis – agoraphobia is
driven by negative thoughts about the
consequences of experiencing anxiety in public
•Psychotherapy
◦Supportive Psychotherapy
- use of psychodynamic concepts and a
therapeutic alliance to promote adaptive coping
◦Insight-Oriented Psychotherapy
◦Behavior therapy
- includes positive and negative reinforcement,
systematic desensitization, flooding, exposure,
relaxation, self- monitoring
◦Cognitive-Behavioral Therapy (CBT)
◦Virtual Therapy
Specific Phobia
Irrational fear of
a specific
object/situation that
interferes w/ an
individual’s ability
to function
✔Fear/anxiety about a specific object/situation
✔Phobic object/situation almost always provokes
immediate fear/anxiety.
(In children, anxiety may be expressed by crying, tantrums,
freezing or clinging)
✔Phobic object/situation is actively avoided/endured
w/ intense fear/anxiety
✔Fear/anxiety is out of proportion to the actual danger
✔Persistent & lasts for 6 months/more
Specific Type: Animal; Nature Environment; Blood-
injection-injury; Situational; Other
Biological
- Genetics
Behavioral
- Phobias could be conditioned by direct
trauma, modeling or verbal instruction
- Prepared Learning – out fear circuit may have
been “prepared” by evolution to learn fear of
certain stimuli
•Psychotherapy
◦Behavior Therapy – exposing serially to a
predetermined list of anxiety-provoking stimuli
graded in hierarchy from least to the most
frightening (systematic desensitization); intensive
exposure (flooding)
◦Insight-Oriented Therapy – enables patient to
understand the origin of the phobia, the
phenomenon of secondary gain, and the role of
resistance and enables them to seek healthy ways
of dealing with anxiety- provoking stimuli
◦Virtual Therapy – exposes patients on the
computer screen to interact with phobic object or
situation
◦Exposure Therapy
▪Systematic Desensitization
- client first taught of relaxation skills then
uses this skill to relax while undergoing
exposure to a list of feared situations
▪In-Vivo (real life) Exposure
- more effective than systematic
desensitization
◦Other therapeutic modalities
▪Hypnosis to enhance the therapist’s
suggestion that the phobic object is not
dangerous; self- hypnosis as a method of

relaxation in phobic situations; family
therapy to help the patient confront the
phobic object by supporting
Separation
Anxiety Disorder
Children’s
unrealistic &
persistent worry
that something will
happen to their
parents/important
people in their life
or to them that will
separate them from
their parents
✔Developmentally inappropriate & excessive
fear/anxiety concerning separation from those to
whom the individual is attached, as evidenced by at
least 3 of the ff:
1.Recurrent excessive distress when separating from
home/attachment figures
2.Worry about losing major attachment figures or
about possible harm to them
3.Worry about experiencing an untoward event that
causes separation from them
4.Persistent reluctance/refusal to go out
5.Fear of reluctance of being alone or without major
attachment figures
6.Reluctance/refusal to sleep away from home/sleep
without being near to them
7.Repeated nightmares about separation
8.Repeated complaints of physical symptoms when
separating
✔Persistent, lasting at least 4 weeks in children &
adolescents and 6 months or more in adults
Biological
- Genetics
- Imbalances of neurotransmitters (serotonin &
norepinephrine)
Environmental
- Abrupt change in the surroundings
- Over-protective caregivers
- Stress & trauma
- Major losses
•Psychotherapy
◦Cognitive Behavioral Therapy (CBT)
- to help understand and manage fears
◦Exposure Therapy
- by carefully exposing patients to separation
◦Relaxation Techniques
Social Anxiety
Disorder (Social
Phobia)
Fear of social
situations, being
watched or judged
by others
✔Fear/anxiety about 1/more social situations in which
the person is exposed to possible scrutiny by others
Ex: social interactions, being observed or
performing in front of others (Children: anxiety
must occur in peer settings & not just interactions
w/ adults)
✔Fears negative evaluation/rejection
✔Social situations almost always provoke
fear/anxiety. (Children: may be expressed by crying,
tantrums, freezing, clinging, shrinking, failing to
speak)
✔Social situations are avoided/endured w/ intense
fear/anxiety
✔Fear/anxiety is out of proportion to the actual threat
posed by the social situation
✔Persistent, lasting for 6 months/more
Specify if:
Performance only: Fears public speaking/performing but
not other situations
Biological
- Genetics
Behavioral
- A person could have a negative social
experience through modeling or verbal
instruction & become classically conditioned to
fear similar situations, which the person avoids
- Through operant conditioning, the avoidance
behavior is maintained because it reduces the
fear experiences
Cognitive
- They appear to have unrealistically negative
beliefs about the consequences of their social
behaviors
- They attend more to how they are doing in
social situations & their own internal sensations
than other do
•Pharmacotherapy
◦Paxil (SSRI) o Zoloft (SSRI)
◦Effexor (SSRI)
◦D-cycloserine (DCS) + CBT treatments =
enhanced effect of treatment
•Psychotherapy
◦Cognitive therapy program
- Emphasizes real-life experiences to disprove
automatic perceptions of danger
◦Interpersonal Psychotherapy (IPT)
◦Family-based treatment
- Better than individual treatment if parents also
have an anxiety disorder
◦Cognitive retraining, desensitization, rehearsal
during sessions and a range of homework
assignments
◦Role-playing
◦Social skills Training

Social/Environmental
- Inadequate social skills
- Controlling/overprotective caregivers
Cultural
- Growing up on a strong collectivist
orientation (Japan/Korea)
Selective Mutism
Lack of speech in
1/more settings
where speaking is
socially expected
✔Consistent failure to speak in specific social
situations in where speaking is socially expected
despite speaking in other situations
✔Disturbance interferes w/ educational/occupational
achievement or w/ social communication
✔At least 1 month (cannot be during 1
st
month of
school)
✔Not attributable to a lack of knowledge/comfort
with the spoken language required in the social
situation
Biological
- Genetics
- Sensory processing disorder
- Low excitability in amygdala, which senses
potential danger by processing signals from
SNS
Behavioral
- Negative Reinforcement – as the child
realizes if he keeps quiet, there are others who
will rescue him from the situation by talking
for him
Environmental
- Multilingual Family
- Lived in foreign country
•Psychotherapy
◦Behavior Therapy
- involves gradually exposing a child to
increasingly difficult speaking tasks in the context
of a supportive relationship
TRAUMA & STRESS-RELATED DISORDERS
DISORDER DIAGNOSTIC CRITERIA ETIOLOGY INTERVENTIONS
✔Exposure to actual/threatened death, serious injury or sexual violence
in 1/more of the ff:
1.Directly experiencing the traumatic event(s)
2.Witnessing, in person, the event(s) as they occurred to others
3.Learning that events occurred to a close relative/friend. (In
actual/threatened death of a family/friend, the event must been
violent/accidental)
4.Repeated/extreme exposure to aversive details of traumatic events (in
media/pictures, it should be work related)
✔Presence of 1/more of the ff intrusion symptoms beginning after the
traumatic events occurred:
1.Recurrent, involuntary & intrusive distressing memories of traumatic
events
(Children: repetitive play about the traumatic events may be
Neurobiological
- Genetics
- High levels of activity in
amygdala
- Diminished activation of the
medial prefrontal cortex
- Smaller hippocampus volume
Psychological
- History of another anxiety
disorder
•Pharmacotherapy
◦SSRIs: Prozac, Paxil
◦Hospitalization may be necessary when
symptoms are particularly severe or when a
risk of suicide or other violence exist
•Psychotherapy
◦Cognitive Processing Therapy (CPT)
- helps the patient consider all the things that
were beyond their control to be able to move
forward
◦Prolonged Exposure Therapy
- helps the patient confront the things that
remind them of the traumatic event
◦Stress management

Posttraumatic
Stress Disorder
(PTSD)
Develops on
people who
experienced
shocking, scary or
dangerous event
expressed)
2.Recurrent distressing dreams about the traumatic event (Children:
frightening dreams without recognizable content)
3.Dissociative reactions (flashbacks) where they feels/act as if the event
were recurring (occur in continuum, may have a complete loss of
awareness of present surroundings) (Children: trauma-specific
reenactment may occur in play)
4.Intense/prolonged psychological distress at exposure to
internal/external cues that symbolize/resembles an aspect of the
traumatic event
5.Physiological reactions to internal/external cues
✔Persistent avoidance of stimuli associated w/ the traumatic event,
beginning after the traumatic event occurred, as evidenced by 1 or
both of the ff:
1.Avoidance/efforts to avoid distressing memories, thoughts, feelings or
convos about the traumatic event
2.Avoidance/efforts to avoid external reminders that arouse distressing
memories, thoughts or feelings about the traumatic event
✔Negative alterations in cognitions & mood associated w/ the traumatic
event, beginning/worsening after that traumatic event, as evidenced by
2/more of the ff:
1.Inability to remember an important aspect of the traumatic event
(Dissociative)
2.Negative beliefs about self, others/world
3.Persistent distorted cognitions about the cause/consequence of the
traumatic event that lead to blaming himself/others
4.Persistent negative emotional state
5.Diminished interest/participation in significant activities
6.Feelings of detachment to others
7.Persistent irritability to experience positive emotions
✔Alterations in arousal & reactivity associated w/ the traumatic event,
beginning/worsening after the event occurred, as evidenced by 2/more
of theff:
1.Irritable behavior & angry outbursts expressed as verbal/physical
aggression to people or objects
2.Reckless/Self-destructive behavior
3.Hypervigilance
4.Exaggerated startle response
5.Problems w/ concentration
✔Sleep disturbance: More than 1 month
Specify if:
With delayed expression: criteria are not met until at least 6 months after the
event
Behavioral
- Classical conditioning
(conditioned fear)
- Operant Conditioning
(avoidance is reinforced by the
reduction of fear that comes from
not being in the presence of
conditioned stimulus)
Environmental
- Childhood trauma
- includes relaxation and coping strategies
◦Eye Movement Desensitization
&Reprocessing
- focuses on the lateral movement of the
clinician’s finger while maintaining a mental
image of the trauma experience
◦Group therapy
- includes sharing of traumatic experiences
and support from other group members
◦Family therapy
- helps sustain a marriage through periods of
exacerbated symptoms
◦Psychoanalytic therapy
▪Catharsis – reliving emotional trauma
▪Imaginal exposure – content of the
trauma and emotions associated with it
are worked through systematically

With Dissociative Symptoms: symptoms meet the criteria for PTSD and in
response to stressor, person experiences persistent/recurrent symptoms of either
depersonalization/derealization
Acute Stress
Disorder
Shorter duration of
PTSD
✔Symptoms similar to PTSD
✔Symptoms occur between 3 days – 1 month after a trauma
Adjustment
Disorder
Emotional/
behavioral reaction
to a stressful event
in a person’s life
✔Development of emotional/behavioral symptoms in response to an
identifiable stressors occurring within 3 months of the onset of the
stressors
✔Symptoms are clinically significant as evidenced by 1/both of the ff:
1.Distress that is out of proportion to the severity/intensity of the
stressor, taking into account the external context & the cultural factors
that might influence symptom severity & presentation
2.Significant impairment in social, occupational or other areas of
functioning
✔Symptoms do not represent normal bereavement
✔Once the stressor has removed, symptoms do not persist for more than
an additional 6 months (more than 6 months = chronic)
Specify whether:
With depressed mood: tearful/sad
With anxiety-related: nervous, tense or fearful of separation
With mixed-anxiety & depressed mood: both
With disturbance of conduct: behaves inappropriately
With mixed disturbance of emotions & conduct: both
Unspecified: other stress-related reactions
Specify if:
Acute: lasted less than 6 months
Persistent/Chronic: 6+ months but not more than 6 months after the stressor
has ended
•Psychotherapy
◦Group therapy
- useful for patients who have had similar
stress
◦Individual Psychotherapy
- explores the meaning of the stressor to the
patient so that earlier traumas can be worked
through
◦Short term treatments such as crisis
intervention and case management
- help patients resolve their situations by
supportive techniques, suggestion,
reassurance, environmental modification and
even hospitalization
Reactive
Attachment
Disorder (RAD)
✔Consistent pattern of inhibited, emotionally withdrawn behavior
toward adult caregivers, manifested by both of the ff:
1.Child rarely seeks comfort when distressed
2.Child rarely responds to comfort when distressed
✔Persistent social & emotional disturbance characterized by at least 2 of
the ff:
1.Minimal social & emotional responsiveness to others
2.Limited positive affect
3.Episodes of unexplained irritability, sadness or fearfulness that are
evident during nonthreatening interaction with adult caregivers
✔Child has experienced a pattern of insufficient care as evidenced by at
least 1 of the ff:
•Psychotherapy
◦Behavior Management Training (BMT)
- teaching caregivers about the psychology
behind RAD and providing them with tools
to improve problematic behaviors in their
children.
◦Attachment Therapy
- include parent education and skills training,
family-focused counseling, and child
education and training.
◦Holding Therapy
- caregiver holds the child across their lap,

Child doesn’t form
healthy emotional
bods with
caretakers
1.Social neglect/deprivation in the form of persistent lack of having
basic emotional needs for comfort, stimulation & affection met by
caregivers
2.Repeated changes of primary caregivers
3.Rearing in unusual settings that severely limit opportunities to form
selective attachments
✔Care in Criterion C is presumed to be responsible for the disturbed
behavior in Criterion A
✔Disturbance is evident before 5 years of age
✔Has a developmental age of at least 9 months
Specify if:
Persistent: Present for more than 12 months
Severe: All symptoms present at a high level of intensity
similar to how they would hold an infant
◦ Play Therapy
- to help children better understand some of
their attachment issues and to develop tools
for improving their behavior,
communication, and ultimately, attachment
style.
Disinhibited
Social
Engagement
Disorder (DSED)
Child shows no
inhibitions to
approaching adults.
✔Pattern of behavior in which a child actively approaches & interacts w/
unfamiliar adults & exhibits at least 2 of the ff:
1.Reduced/absent reticence in approaching & interacting w/ unfamiliar
adults
2.Overly familiar verbal/physical behavior
3.Diminished/absent checking back w/ caregivers after venturing away,
even in unfamiliar settings
4.Willingness to go off with an unfamiliar adult w/ minimal or no
hesitation
✔The behaviors in Criterion A are not limited to impulsivity (as in
ADHD) but include socially disinhibited behavior
✔Experienced a pattern of extremes of insufficient care as evidenced by
at least 1 of the ff:
1.Social neglect/deprivation in the form of persistent lack of having
basic emotional needs for comfort, stimulation & affection met by
caregivers
2.Repeated changes of primary caregivers
3.Rearing in unusual settings that severely limit opportunities to form
selective attachments
✔Care in Criterion C is presumed to be responsible for the disturbed
behavior in Criterion A
✔Has a developmental age of at least 9 months
Specify if:
Persistent: Present for more than 12 months
Severe: All symptoms present at a high level of intensity
•Psychotherapy
◦Talk Therapy
◦Play Therapy
- allow the young child to communicate their
experiences, struggles, and feelings without
the use of verbal disclosure.
◦Art Therapy
- because childhood trauma, such as sexual
abuse, can be a cause for DSED, art therapy
may be a suitable treatment to reduce the
symptoms associated with the condition.
◦Behavioral Management Training (BMT)
- helps give the caregiver skills to establish
reasonable expectations and boundaries for
the child
◦Parent-Child Interaction Therapy (PCIT)
- therapist helps the adult shift their
relationship with the child towards one based
on respect, trust, and support
◦Cognitive-Behavioral Therapy (CBT)
- focused on training the parent or guardian
to use behavior management skills.

OBSESSIVE-COMPULSIVE & RELATED DISORDERS
DISORDER DIAGNOSTIC CRITERIA ETIOLOGY INTERVENTIONS
Obsessive-
Compulsive
Disorder (OCD)
Uncontrollable,
reoccurring
thoughts and
behaviors that a
person feels the
urge to repeat over
& over
✔Presence of obsessions, compulsions or both.
Obsessions are defined by 1 & 2:
1.Recurrent & persistent thoughts, urges or images that are
experienced, at some time during the disturbance, as intrusive
& inappropriate & that in most individuals cause marked
anxiety/distress
2.Attempts to ignore/suppress or to neutralize them w/ some
other thought/action
Compulsions are defined by 1 & 2:
1.Repetitive behaviors/mental acts that the individual feels
driven to perform in response to an obsession or according
to rules that must be applied rigidly
2.Behaviors/mental acts are aimed at preventing/reducing
distress or some dreaded event/situation; however, these
behaviors/mental acts either are not connected in a realistic
way w/ what they are designed to neutralize/prevent or are
clearly excessive
✔Obsessions/compulsions are time-consuming (at least 1 hour
a day)
Specify if:
W/ good or fair insight: Recognized that OCD beliefs may/may not
be true
W/ poor insight: Thinks OCD beliefs are probably true
W/ absent insight/delusional: Completely convinced that OCD
beliefs are true
Specify if:
Tic-related: Has a current/past history of a tic disorder
Neurobiological
- Genetics
- Unusually active: Orbitofrontal
Cortex, Caudate Nucleus &
Anterior Cingulate
- when shown objects that
provoke symptoms, activity in
these 3 areas increases
Cognitive
- Deficit in Yedasentience
(subjective feeling of knowing)
Behavioral
- Operant Conditioning –
compulsions are reinforced
because they reduce anxiety
- Thought suppression
•Pharmacotherapy
◦Deep Brain Stimulation (DBS)
- Non ablative surgical technique
◦Clomipramine (aka Anafranil)
- Relapse occurs when discontinued
◦Antidepressants
▪Clomipramine
◦SSRIs
•Psychotherapy
◦Behavior therapy
◦Exposure and Ritual Prevention (ERP)
- Most effective approach
- Rituals are actively prevented and patient is
systematically and gradually exposed to the feared
thoughts or situations
◦Cognitive treatments
- Focus: overestimation of threat, importance and
control of intrusive thoughts, sense of inflated
responsibility, need for perfectionism and certainty
•Psychosurgery
◦Neurosurgery for a psychological disorder
Body Dysmorphic
Disorder (BDD)
Preoccupation w/
some imagined
defect in
appearance by
someone who
actually looks
reasonably normal
(Imagined
Ugliness)
✔Preoccupation with 1/more defects/flaws in physical
appearance that are not observable/appear slight to others
✔At some point, individual has performed repetitive
behaviors/mental acts in response to the appearance concerns
✔Not better explained by concerns w/ body fat/weight in an
individual whose symptoms meet the criteria for an eating
disorder
Specify if:
W/ muscle dysmorphia: Believes that his body is too
small/insufficiently muscular (this specifier is used even if individual
is preoccupied w/ other body areas, which is often the case)
Specify degree of insight:
W/ good/fair insight: Recognizes that the BDD beliefs may/may not
Neurobiological
- Hyperactivity of the orbifrontal
cortex & caudate nucleus
Cognitive
- Attuned to features that are
important to attractiveness &
facial symmetry
- Self-worth is dependent on their
appearance
•Pharmacotherapy
◦SSRI
▪Clomipramine (aka Anafranil)
▪Fluvoxamine
•Psychotherapy
◦Cognitive-Behavioral Therapy (CBT)
- Exposure and response prevention
- Produce better and longer lasting outcomes than
medication alone
•Dermatology (skin) treatment
- Most often received
•Plastic surgery
- Most common procedures: rhinoplasties (nose jobs),

be true
W/ poor insight: Thinks that BDD beliefs are probably true
W/ absent insight/delusional beliefs: Completely convinced that
BDD beliefs are true
facelifts, eyeshadow elevations, liposuction, breast
augmentation, surgery to alter the jawline
Hoarding
Disorder
Acquiring an
excessive number
of items & stores
them in a chaotic
manner
✔Persistently difficulty discarding/parting with possessions,
regardless of their actual value
✔Difficulty is due to a perceived need to save items & to the
distress associated with discarding them
✔Difficulty results in the accumulation of possessions that
congest & clutter active living areas & compromises their
intended use. If living areas are uncluttered, it is only because
of the interventions of 3
rd
parties (family, cleaners, etc)
Specify if:
W/ Excessive acquisition: Difficulty is accompanied by excessive
acquisition of items that are not needed or for which there is no
available space
Specify degree of insight:
W/ good/fair insight: Recognizes that Hoarding is problematic
W/ poor insight: Mostly convinced that Hoarding is not problematic
despite evidence
W/ absent insight/delusional beliefs: Completely convinced that
Hoarding is not problematic despite evidence
Cognitive
- Related to poor organizational
abilities, unusual beliefs about
possessions & avoidance
behaviors
- Difficulties with attention,
categorization & decision
•Psychotherapy
◦Exposure and Ritual Prevention (ERP)
- exposure on most feared situation: getting rid of their
objects
◦Cognitive Behavioral Therapy (CBT)
- to change beliefs about hoarding, practice in reducing
excessive acquisition, practice in discarding
possessions, skills training in organizing items and
staying focused on tasks
◦Motivational Interviewing
◦Teaching people to assign different values to objects
◦Reducing anxiety about throwing away items that are
somewhat less valued
Trichotillomania
(Hair Pulling
Disorder)
✔Recurrent pulling out of one’s hair, resulting in hair loss
✔Repeated attempts to decrease/stop hair pulling
•Stress/Anxiety
•Change in Hormone
Levels
•Pharmacotherapy
◦SSRIs
•Psychotherapy
◦Habit Reversal Training
- Patients are carefully taught to be more aware of their
repetitive behavior, particularly as it is just about to
begin, and to then substitute a different behavior
◦Behavior Therapy
- biofeedback, self- monitoring, desensitization, and
habit reversal
◦Hypnotherapy
Excoriation (Skin
Picking Disorder)
✔Recurrent skin picking resulting in skin lesions
✔Repeated attempts to decrease/stop skin picking
•Stress/Anxiety •Psychotherapy
◦Habit Reversal Training
- Patients are carefully taught to be more aware of their
repetitive behavior, particularly as it is just about to
begin, and to then substitute a different behavior
◦Behavior Therapy
- biofeedback, self- monitoring, desensitization, and
habit reversal
◦Hypnotherapy

SOMATIC SYMPTOM & RELATED DISORDERS
DISORDER DIAGNOSTIC CRITERIA ETIOLOGY INTERVENTIONS
Somatic Symptom
Disorder
Extreme focus on
physical symptoms
that causes
emotional distress
& impairment
✔1 or more somatic symptoms that are distressing & result in
significant disruption of daily life
✔Excessive thoughts, feelings & behaviors related to the
somatic symptoms or health concerns as manifested by at
least 1 of the ff:
1.Disproportionate & persistent thoughts about the seriousness
of one’s symptoms
2.High level of health-related anxiety
3.Excessive time & energy devoted to these symptoms/health
concerns
✔Although any 1 symptom may not be continuously present,
the state of being symptomatic is persistent (more than 6
months)
Specify if:
W/ predominant pain: Individuals whose somatic complaints
predominantly involve pain
Persistent: Marked by serious symptoms, lots of impairment &
duration more than 6 months
Specify current severity:
Mild: Only 1 symptom in Criterion B is fulfilled
Moderate: 2 or more symptoms in Criterion B are fulfilled
Severe: 2 or more of the symptoms in Criterion B are fulfilled, plus
there are multiple somatic complaints (or 1 very severe somatic
symptom)
Neurobiological
- Not heritable
- Increase activity in the Anterior
Insula & Anterior Cingulate
(Somatosensory Cortex – bodily
sensations)
Cognitive
- Attributional style that involves
interpreting physical symptoms in the
worst possible way
- Belief that symptoms are sign of an
underlying long-term disease
Environmental
- Early experiences of medical
symptoms
- Family attitudes to physical illness
Behavioral
- Attention and sympathy as
reinforcement
•Pharmacotherapy
◦Antidepressant (SSRI)
▪Paroxetine (aka Paxil)
◦Patients with this disorder usually resit
psychiatric treatment. The treatment takes place
in a medical setting and focuses on stress
reduction and education in coping with chronic
illness
◦Scheduled physical examination helps to reassure
patients that their physicians are not abandoning
them
•Psychotherapy
◦Group Psychotherapy
- provides the social support and social
interaction that seem to reduce their anxiety.
◦Cognitive-Behavioral Therapy (CBT)
◦Reassurance and education
◦Reducing the frequency of help-seeking
behaviors (e.g., assigning a gatekeeper physician
to each patient to screen all physical complaints)
◦Individual Insight-Oriented Psychotherapy,
Behavior Therapy, Cognitive Therapy, and
Hypnosis may be useful
Illness Anxiety
Disorder
Unrealistic fear
that they have/may
have serious
medical condition
✔Preoccupation w/ fears of having a serious illness
✔Somatic symptoms are not present or only mild in intensity.
If another medical condition is present or there is a high risk
for developing a medical condition, the preoccupation is
clearly excessive/disproportionate
✔High level of anxiety about health & is easily alarmed about
personal health status
✔Performs excessive health-related behaviors/exhibits
maladaptive avoidance
✔Preoccupation has been present for at least 6 months, but the
specific illness that is feared may change over that period of
time
Specify subtype:
Care-seeking type: Medical care is frequently used
Care-avoidant type: Medical care is rarely used

Psychological
Factor Affecting
Medical
Condition
A general medical
condition is
adversely affected
by
psychological/beha
vioral factors
✔A medical symptom/condition is present
✔Psychological/behavioral factors adversely affect the medical
condition in 1 of the ff:
1.Factors have influenced the course of the medical condition
as shown by a close temporal association between the
psychological factors & the development/exacerbation of, or
delayed recovery from, the medical condition
2.Factors interfere w/ the treatment of the medical condition
3.Factors constitute additional well-established health risks for
the individual
4.Factors influence the underlying pathophysiology,
precipitating or exacerbating symptoms or necessitating
medical attention
Specify if:
Mild: Increases medical risks (inconsistent adherence w/
antihypertension treatment)
Moderate: Aggravates underlying medical condition (anxiety-
aggravating asthma)
Severe: Results in medical hospitalization/emergency room visit
Extreme: Results in severe, life-threatening risk (ignoring heart attack
symptom)
•Anxiety
•Stressful Life Events
•Psychotherapy
◦The major goal is to mobilize the patient to
change behavior in ways that optimize the
process of healing. This may require a general
change in lifestyle of a more specific behavioral
change
◦Stress Management and Relaxation Therapy
◦Cognitive Behavioral Therapy (CBT)
- helps individuals better manage their responses
to stressful life events.
◦The 3 aims are (1) to help individuals become
more aware of their own cognitive appraisals of
stressful events; (2) to educate individuals about
how their appraisals of stressful events can
influence negative emotional and behavioral
responses and to help them reconceptualize their
abilities to alter these appraisals; (3) to teach
individuals how to develop and maintain the use
of a variety of effective cognitive and behavioral
stress management skills
◦Stress Management Training
- Self- observation, Cognitive restructuring,
Relaxation exercises, Time management,
Problem- solving
Conversion
Disorder
(Functional
Neurological
Symptom
Disorder)
Physical & sensory
problems with no
underlying
neurologic cause
✔1/more symptoms of altered voluntary motor/sensory
function
✔Clinical findings provide evidence of incompatibility
between the symptom & recognized neurological/medical
conditions
✔Symptom of deficit is not better explained by another
medical/mental disorder
Specify if:
Acute Episode: Symptoms lasted under 6 months
Persistent: Symptoms lasted more than 6 months
Specify if:
With or Without Psychological Disorder
Specify types of Symptoms:
With weakness/paralysis; abnormal movement; swallowing
symptoms; speech symptoms
With attacks/seizures
With anesthesia/sensory loss; with special sensory symptom
With mixed symptoms
Psychodynamic
- On an unconscious level, some
psychological factor is at work, making
the symptoms appear without any
physical cause
- People could be unconscious of
certain perceptions & be motivated to
have certain symptoms
Sociocultural
- More common among people from
rural areas & lower SES
•Psychotherapy
◦The most important feature of the therapy is a
relationship with a caring and confident therapist
◦Focus on issues of stress and coping. Telling
patients that their symptoms are imaginary often
makes them worse
◦Identify and attend to the traumatic or stressful
life event, if it is still present (either in real life or
memory)
◦Reduce any reinforcing or supportive
consequences of the conversion symptoms
(secondary gain)
◦Insight-oriented therapy and Psychoanalysis
- explore intrapsychic conflicts and the
symbolism of conversion disorder symptoms
◦Behavior Therapy
◦Hypnosis, anxiolytics, and behavioral
relaxation exercises are effective in some cases
◦Brief and direct forms of short-term

psychotherapy have also been used. The longer
the duration of these patients’ sick role and the
more they have regressed, the more difficult the
treatment
Factitious
Disorder Imposed
on Self
(Munchausen
Syndrome)
Falsification of
signs/symptoms w/
no reward
✔Falsification of physical/psychological signs/symptoms or
induction of injury/disease, associated w/ identified
deception
✔Presents self to others as ill, impaired, or injured
✔Deceptive behavior is evident even in the absence of obvious
external rewards
Specify if:
Single episode: 1 event
Recurrent episodes: 2 or more events
•Childhood trauma
•Serious illness during
childhood
•Loss
•Stress
•No specific treatment has been effective.
•Treatment is best focused on management rather than
on cure
◦To reduce the risk of morbidity and mortality
◦To address the underlying emotional needs or
psychiatric diagnosis underlying factitious illness
behavior
◦To be mindful of legal and ethical issues
•Clinicians who find themselves involved with
patients with factitious disorder may become angry at
patients for lying and deceiving them. Hence,
therapist must be mindful of countertransference
whenever they suspect factitious disorder
•Legal Intervention
- The senselessness of the disorder and the denial of
false action by parents are obstacles to successful
court action and often make conclusive proof
unobtainable
Factitious
Disorder Imposed
on Another
(Munchausen
Syndrome by
Proxy)
✔Falsification of physical/psychological signs/symptoms or
induction of injury/disease, associated w/ identified
deception
✔Presents another individual to others as ill, impaired, or
injured
✔Deceptive behavior is evident even in the absence of obvious
external rewards
Specify if:
Single episode: 1 event
Recurrent episodes: 2 or more events
•Childhood trauma
•Serious illness in childhood
DISSOCIATIVE DISORDERS
DISORDER DIAGNOSTIC CRITERIA ETIOLOGY INTERVENTIONS
Depersonalization
-Derealization
Disorder
Persistently/
repeatedly have the
feeling that you’re
observing yourself
from outside of
your body or things
aren’t real or both
✔The presence of persistent/recurrent experiences of
depersonalization, derealization or both
Depersonalization: experiences of unreality, detachment or being an
outside observer w/ respect to one’s thoughts, feelings, sensations,
body or actions
Derealization: Experiences of unreality/detachment with respect to
surroundings (individuals/objects are experienced as dreamlike, foggy,
lifeless or visually distorted)
✔During the depersonalization/derealization experience, reality
testing remains intact
•Childhood Trauma &
Abuse
•Stress
•Depression/Anxiety
•Psychotherapy
◦Psychological treatments similar to those for panic
disorder may be helpful
◦Stresses associated with onset of disorder should be
addressed
◦Pyschoanalytic Therapy
- to be able to resolve past trauma
◦Cognitive Therapy
- helps solve distortion but may result to slow progress
& may lead to additional dysphoria
◦Hypnosis
- can often alleviate self- destructive impulses or reduce
symptoms, like flashbacks, dissociative hallucinations
and passive-influence experiences

◦Movement Therapy
- may facilitate normalization of body sense and body
image
◦Occupational Therapy
- may help patient with grounding and symptom
management through structured activities
Dissoaciative
Amnesia
Inability to recall
important personal
information that
would not typically
be lost w/ ordinary
forgetting
✔Inability to recall important autobiographical information,
usually of a traumatic/stressful nature, that is inconsistent w/
ordinary forgetting (Dissociative Amnesia most often
consists of Localized or Selective Amnesia for a specific
event; or Generalized Amnesia for identity/life history)
Specify if:
W/ Dissociative Fugue: purposeful travel/bewildered wandering that
is associated w/ amnesia for identity or for other important
autobiographical information
•Stress
•Traumatic Events
•Pharmacotherapy
◦Benzodiazepines (minor tranquilizers)
•Psychotherapy
◦Recalling what happened during the amnesic/fugue
state, often with the help of friends & family who know
what happened, so the patient can confront the
information and integrate it into their conscious
experience
◦Pyschoanalytic Therapy
- to be able to resolve past trauma
◦Cognitive Therapy
- helps solve distortion but may result to slow progress
& may lead to additional dysphoria
◦Hypnosis
- can often alleviate self- destructive impulses or reduce
symptoms, like flashbacks, dissociative hallucinations
and passive-influence experiences
◦Electroconvulsive Therapy
- often successful and does not worsen dissociative
memory problems
Dissociative
Identity Disorder
(DID)
Multiple, distinct
personalities
✔Disruption of identity characterized by 2/more distinct
personality states, which may be described in some cultures
as an experience of possession. The disruption of marked
discontinuity in sense of self & sense of agency,
accompanied by related alterations in affect, behavior,
consciousness, memory, perception, cognition and/or
sensory-motor functioning. These signs & symptoms may be
observed by others or reported by the individual.
✔Recurrent gaps in the recall of everyday events, important
personal information, and traumatic events that are
inconsistent w/ everyday forgetting
✔Not a normal part of a broadly accepted cultural/religious
practice (Children: symptoms are not attributable to
imaginary playmates/fantasy plays)
Environmental
- Child abuse
Sociocognitive
- Alter appear in response to
suggestions by therapists,
exposure to media reports of
DID or other cultural influences
- When situation demands,
people can adopt personality
•Psychotherapy
◦Patient must identify cues or triggers that provoke
memories of trauma & dissociation
◦Patient must confront and relive the early trauma and
gain control over the horrible events
◦Therapist must help the patient visualize and relive
aspects of the trauma until it is simply a terrible memory
◦Hypnosis
- to access unconscious memories and bring various
alters into awareness
◦Pyschoanalytic Therapy
- to be able to resolve past trauma
◦Group Therapy
- elicits excess fascination or by frightening other
patients. It is more effective if all patients in a group
have dissociative identity disorder

◦Family Therapy
- important for long-term stabilization and to address
pathological family and marital processes that are
common in patients with DID and their family members
◦Expressive Therapy
- help with containment and structuring of severe DID
and PTSD symptoms; as to permit these patients safer
expression of thoughts, feelings, mental images and
conflicts
MOOD DISORDERS (DEPRESSIVE DISORDERS)
DISORDER DIAGNOSTIC CRITERIA ETIOLOGY INTERVENTIONS
Major
Depressive
Episode
Most commonly
diagnosed & most
severe depression
✔5 or more of the ff have been present during the same 2-week period
& represent a change from previous functioning; at least 1 of the
symptoms is either depressed mood or loss of interest/pleasure:
1.Depressed mood most of the day, nearly every day, as indicated by
either subjective report/observation made by others (Children &
Adolescents: Can be irritable mood)
2.Diminished interest/pleasure in all, or almost all, activities most of
the day, nearly every day
3.Significant weight loss when not dieting/weight gain, or
decrease/increase in appetite (Children: Failure to make expected
weight gains)
4.Insomnia/Hypersomnia
5.Psychomotor agitation/retardation
6.Fatigue/loss of energy
7.Feelings of worthlessness or excessive/inappropriate guilt
8.Diminished ability to think/concentrate or indecisiveness
9.Recurrent thoughts of death, suicidal ideation without a specific
plan, or a suicide attempt or a specific plan for committing suicide
• Pharmacotherapy
◦Antidepressants
▪SSRIs
•Fluoxetine (Prozac) – best known
▪Tricyclic antidepressants
•Most widely used treatment before
SSRI
•Imipramine (Tofranil) and
amitriptyline (Elavil) – best known
•Side effects: blurred vision, dry mouth,
constipation, difficulty urinating,
drowsiness, weight gain, sexual
dysfunction
•Lethal if taken in excessive doses
▪Monoamine oxidase (MOA) inhibitors
•Block the enzyme MAO that breaks
down such neurotransmitters as
norepinephrine and serotonin
•Used far less often because of two
potentially serious consequences:
hypertensive episodes or death, when
eating and drinking foods and beverages
containing tyramine
▪Mixed reuptake inhibitors
•Venlafaxine (Effexor) – best known
▪Lithium carbonate (Lithium)
•“Mood-stabilizing drug”
•Found in our drinking water
•Side effects: toxicity (poisoning),
Major
Depressive
Disorder (MDD)
Presence of
depression &
absence of
manic/hypomanic
episodes
✔At least 1 major depressive episode (Criteria A-C)
✔There has never been a manic/hypomanic episode (This exclusion
does not apply if all of the manic-like/hypomanic-like episodes are
substance-induced or attributable to the direct physiological effects
of another medical condition)
Specify the clinical status and features:
Single episode or recurrent
Mild (2-3), moderate (4+), severe
With: Anxious distress, mixed features, melancholic features, atypical
features, mood-congruent /incongruent psychotic features, catatonia,
peripartum onset (within 4 weeks), seasonal pattern
Neurobiological
- Genetics
- DRD4.2 – gene that influences
dopamine function
- low function of dopamine
- elevated activation of amygdala
& sugenual anterior cingulate
- diminished activation of the
hippocampus & dorsolateral
prefrontal cortex
- high cortisol levels

In partial remission: Previous symptoms present but full criteria not met or
a period of less than 2 months without symptoms following the end of such
an episode
In full remisision: No symptoms during past 2 months
lowered thyroid functioning, substantial
weight gain
•Major advantage: effective in
preventing and treating manic episodes
•Biological Treatments
◦Electroconvulsive Therapy (ECT)
- Most controversial treatment for psychological
disorders after psychosurgery
- Electric shock is administered directly through
the brain for less than 1 second, producing a
seizure and a series of brief convulsions that
usually lasts for several minutes
◦Transcranial Magnetic Stimulation
- Use of very short pulses of magnetic energy to
stimulate nerve cells in the brain for altering
electrical activity
◦Vagal Nerve Stimulation
- uses an electronic device that is implanted in
the skin, similar to cardiac pacemaker
•Psychosocial Therapy
◦Cognitive Therapy
- To alleviate depressive episodes and prevent
their recurrence by helping patients identify and
test negative cognitions; develop alternative,
flexible, and positive ways of thinking; and
rehearse new cognitive and behavioral responses
◦Cognitive Behavioral Therapy (CBT)
- Learn to replace negative depressive thoughts
and attributions with more positive ones
- Develop more effective coping behaviors and
skills
◦Interpersonal Psychotherapy (IPT)
- Consists of 12-16 weekly sessions and is
characterized by an active therapeutic approach
- Focus on the social and interpersonal triggers
for their depression (ex. loss of a loved one)
- Develop skills to resolve interpersonal conflicts
and build new relationships
◦BehaviorActivation (BA) Therapy
- Based on the idea that many of the risk factors
for depression can result in low levels of positive
reinforcement
- Goal is to increase participation in positively
Persistent
Depressive
Disorder
(Dysthymia)
Depressed mood
that occurs for
most of the day,
for more days
than not, for at
least 2 years
(1 year for
children &
adolescents)
✔Depressed mood for most of the day for at least 2 years (Children &
adolescents: mood can be irritable & duration must be at least 1
year)
✔Presence, while depressed, of 2 or more of the ff:
1.Poor appetite/Overeating
2.Insomnia/Hypersomnia
3.Low energy/Fatigue
4.Low self-esteem
5.Poor concentration/Difficulty in making decisions
6.Feelings of hopelessness
7.During the 2-year period (1 year for children & adolescents) of the
disturbance, the person has never been without the symptoms in
Criteria A & B for more than 2 months
✔Criteria for major depressive disorder may be continuously present
for 2 years
✔There’s never been a manic/hypomanic episode & criteria have
never met cyclothymic disorder
Specify if:
Current severity: Mild, moderate, severe
With: anxious distress, mixed features, melancholic features, atypical
faetures, mood-congruent/incongruent psychotic features, peripartum onset
Specify onset:
Early onset: before 21 years
Late onset: 21 years or older
Specify (for most recent 2 years of dysthymic disorder):
W/ Pure Dysthymic Syndrome: full criteria of a major depressive episode
have not been met in at least the preceding 2 years
W/ Persistent Major Depressive Episode: full criteria of a major depressive
episode have been met throughout the preceding 2 year period
W/ Intermittent Major Depressive Episodes, w/ current episode: full
criteria for major depressive episode are currently met; but there have been
periods of at least 8 weeks in the preceding 2 years w/ symptoms below the
threshold for a full major depressive episodes
W/ Intermittent Major Depressive Episodes, without current episode: full
criteria for major depressive episode are not currently met but there has been
1 or more major depressive episodes in at least the preceding 2 years
In full remission, In partial remission
•Stress
•Trauma
•Family History

reinforcing activities so as to disrupt the spiral of
depression, withdrawal & avoidance
◦Psychoanalytically Oriented Therapy
- Effects a change in a patient’s personality
structure or character, not simply to alleviate
symptoms, but improvements in interpersonal
trust, capacity for intimacy, coping mechanisms,
the capacity to grieve, and the ability to
experience a wide range of emotions are the aims
of this therapy
◦Family Therapy
- As a supplementary therapy, helps patient to
reduce and cope with stress, lessening the chance
of a relapse. It examines the well- being of the
whole family
◦Phototherapy
- patients typically experience depression as the
photoperiod of the day decreases with advancing
winter
◦Sleep Deprivation
- May precipitate mania in patients with Bipolar I
disorder and temporarily relieve depression in
those who have unipolar depression
Premenstrual
Dysphoric
Disorder
(PMDD)
Woman’s severe
depression,
irritability and
tension before
menstruation
✔In the majority of menstrual cycles, at least 5 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 & become
minimal/absent in the week postmenses
✔1/more of the ff must be present:
1.Affective lability (mood swings, sudden sadness)
2.Irritability/anger or increased interpersonal conflicts
3.Depressed mood, feelings of hopelessness/self-deprecating thoughts
4.Anxiety, tension and/or feelings of being keyed up or on edge
✔1/more of the ff must be present to reach the total of 5 symptoms
when combined:
1.Decreased interest in usual activities
2.Subjective difficulty in concentration
3.Lethargy, easy fatigability/lack of energy
4.Change in appetite; Overeating/Specified food cravings
5.Hypersomnia/Insomnia
6.Sense of being overwhelmed/Out of control
7.Physical symptoms (breast tenderness/swelling, joint/muscle pain,
bloating, weight gain)
✔Criterion A should be confirmed by prospective daily ratings during
•Hormone levels
•PMS
•Family history
•Personal history of
trauma or abuse
•Pharmacotherapy
◦Antidepressants (SSRIs/SNRI)
◦Hormone therapies/medications
•Behavior Interventions
◦Aerobic exercise
◦Consumption of complex carbohydrates and
frequent meals
◦Relaxation training
◦Light therapy
◦Seep deprivation
•Psychotherapy
◦Cognitive-Behavioral Therapy (CBT)

at least 2 symptomatic cycles
Disruptive Mood
Dysregulation
Disorder
(DMDD)
Children/
adolescents
experience
persistent
irritability, anger
& temper
outbursts
✔Severe recurrent temper outbursts manifested verbally/behaviorally
that are out of proportion in intensity/duration to the
situation/provocation
✔Outbursts are inconsistent w/ developmental level
✔Outbursts occur, on average, 3/more times per week
✔Mood between temper outbursts is persistently irritable/angry most
of the day, nearly every day, and is observable by others
✔Criteria A-D have been present for 12 months or more. Throughout
that time, the person has not had a period lasting 3 or more
consecutive months without all of the symptoms in Criteria A-D
✔Criteria A & D are present in at least 2 of 3 settings & are severe in
at least 1 of those
✔Diagnosis should not be made for the first time before 6 years or
after 18 years
✔By history/observation, age at onset of Criteria A-E is before 10
years
✔There has never been a distinct period lasting more than 1 day
during which the full symptom criteria, except duration, for a
manic/hypomanic episode have been met
✔Behaviors do not occur exclusively during an episode of major
depressive disorder or another mental disorder
•Family history
•Poor parental support
•Genetics
•Trauma
•Pharmacotherapy
◦Stimulants – decrease irritability
◦Antidepressants (SSRIs)
◦Atypical antipsychotic medications – to treat
irritability, outbursts or aggression
•Psychotherapy
◦Talk Therapy
◦Cognitive-Behavioral Therapy (CBT)
-includes exposing the child to situations that
make them anxious so that they can learn to
respond to those situations better
◦Dialectical behavior therapy for children
(DBT-C)
- may help children learn to regulate their
emotions and avoid extreme or prolonged
outbursts
- the clinician helps children learn skills that can
help with regulating their moods and emotions.
◦Computer Training
- teaches kids to have more happy judgments
about ambiguous expressions
◦Parent Training
MOOD DISORDERS (BIPOLAR DISORDERS)
DISORDER DIAGNOSTIC CRITERIA ETIOLOGY INTERVENTIONS
Manic Episode
High energy,
excitement and
euphoria over a
period of time
✔Distinct period of abnormally & persistently elevated, expansive or
irritable mood & abnormally & persistently increased goal-directed
activity/energy, lasting at least 1 week & present most of the day,
nearly every day
✔During the period of mood disturbance & increased energy/activity,
3/more of the ff symptoms (4 if the mood is only irritable) are
present:
1.Inflated self-esteem/grandiosity
2.Decreased need for sleep
3.More talkative than usual/pressure to keep talking
4.Flight of ideas or subjective experience that thoughts are racing
5.Distractability
6.Increase in goal-directed activity
7.Excessive involvement in activities that have a high potential for
painful consequences
Neurobiological
- During mania & not depression,
striatum (reactions to reward) is
overly active
•Pharmacotherapy
◦Lithium carbonate (Lithium)
- “Mood-stabilizing drug”
- Found in our drinking water
- Side effects: toxicity (poisoning), lowered
thyroid functioning, substantial weight gain
- Major advantage: effective in preventing and
treating manic episodes
◦Antipsychotic Medication
▪Olanzapine – immediate calming effect
•Psychotherapy
◦Interpersonal & Social Rhythm Therapy
(IPSRT)
- Regulates circadian rhythm by helping
patients regulate their eating and sleep cycles

✔Mood disturbance is sufficiently severe to cause marked impairment
or to necessitate hospitalization to prevent harm to self/others, or
there are psychotic features
Note: A full manic episode that emerges during antidepressant treatment but
persists at a fully syndromal level beyond the physiological effect of that
treatment is sufficient evidence of a manic episode & therefore a bipolar I
diagnosis
◦Increasing compliance with drug treatments,
as the “pleasures” of a manic state make
refusal to take lithium a major therapeutic
obstacle
◦Sleep Deprivation
- May precipitate mania in patients with
Bipolar I disorder and temporarily relieve
depression in those who have unipolar
depression Cyclothymic
Disorder
Milder form of
bipolar disorder
involving many
“mood swings”
✔For at least 2 years (Children & adolescents: 1 year) there have been
numerous periods w/ hypomanic symptoms that don’t meet criteria
for a hypomanic episode and numerous periods w/ depressive
symptoms that don’t meet criteria for major depressive episode
✔During the 2-year period, hypomanic & depressive periods have
been present for at least half the time & the individual has not been
w/o the symptoms for more than 2 months at a time
✔Criteria for a major depressive, manic or hypomanic episode have
never been met
Specify if:
With anxious distress
•Genetics
•Traumatic events
•Stress
Bipolar I
Disorder
Severe manic
episodes that last
for 7 days
✔At least 1 manic episode, which may have been preceded by & may
be followed by hypomanic/major depressive episodes
Note: Hypomanic & major depressive episodes are common in bipolar I
disorder but are not required for the diagnosis
Specify if:
With: anxious distress, mixed features, rapid cycling,
mood-congruent/incongruent features, catatonia, peripartum onset, seasonal
pattern
Specify: Remission status if full criteria are not currently met for a manic,
hypomanic or major depressive episode
Neurobiological
- Most heritable
- Dopamine receptors may be overly
sensitive
- Diminished sensitivity of the
serotonin receptors, hippocampus &
dorsolateral prefrontal cortex
- Elevated responsiveness in the
amygdala
- Increased activity of the anterior
cingulate
- Deficits in the membranes of
neurons
Bipolar II
Disorder
Pattern of
depressive &
hypomanic
episodes
✔At least 1 hypomanic episode & at least 1 major depressive episode.
Criteria for a hypomanic episode are identical to those for a manic
episode w/ the following distinctions:
1.Minimum duration is 4 days
2.Although the episode represents a definite change in functioning, it
is not severe enough to cause social/occupational
impairment/hospitalizations
3.No psychotic features
✔There has never been a manic episode
Specify current or most recent episode:
Hypomanic: Currently/most recently in a hypomanic episode
Neurobiological
- Most heritable
- Dopamine receptors may be overly
sensitive
- Diminished sensitivity of the
serotonin receptors, hippocampus &
dorsolateral prefrontal cortex
- Elevated responsiveness in the
amygdala
- Increased activity of anterior
cingulate

Depressed: Currently/most recently in a major depressive episode
Specify if:
With: anxious distress, mixed features, rapid cycling,
mood-congruent/incongruent features, catatonia, peripartum onset, seasonal
pattern
Full remission, partial remission
Mild, moderate, severe
- Deficits in the membranes of
neurons
EATING DISORDERS
DISORDER DIAGNOSTIC CRITERIA ETIOLOGY INTERVENTIONS
Bulimia Nervosa
Binge-eating
followed by
purging
✔Recurrent episodes of binge eating. An episode is characterized
by both of the ff:
1.Eating, in a discrete period of time, an amount of food that is
definitely larger than most people would eat during a similar
period of time & under similar circumstances
2.Lack of control over eating during the episode
✔Recurrent inappropriate compensatory behavior in order to
prevent weight gain (self-induced vomiting, misuse of laxatives,
diuretics or other medications; fasting or excessive exercise)
✔Binge eating & inappropriate compensatory behaviors both
occur, on average, at least once a week for 3 months
✔Self-evaluation is unduly influenced by body shape & weight
✔The disturbance does not occur exclusively during episodes of
anorexia nervosa
Specify if:
In Partial Remission: For “a sustained period”, patient meets some but
not all the criteria
In Full Remission: For “a sustained period”, no criteria have been met
Specify severity:
Mild: 1-3 episodes a week
Moderate: 4-7 episodes a week
Severe: 8-13 episodes a week
Extreme: 14+ episodes a week
Biological
- Genetics
- Starvation may increase levels of
endogenous opioids (suppress
appetite & enhances mood, released
during starvation), resulting in a
positively reinforcing euphoric state
- Binges result from a serotonin
deficit that causes them not to feel
satiated as they eat
Cognitive
- Self-worth = weight
- Low self-esteem
- Stress are relieved by purging
Sociocultural
- Societal standards
- Health consciousness
Environmental
- Child Abuse
•Pharmacotherapy
◦Fluoxetine (Prozac)
- Effective particularly during the binging and
purging cycle
◦Antidepressants
•Biological Intervention
◦Nutritional Rehabilitation
- helping clients eliminate their binge-purge
patterns and establish good eating habits
•Psychotherapy
◦Short-term cognitive-behavioral treatments
◦Cognitive-Behavioral Therapy-Enhanced
(CBT-E)
- Focus is on the distorted evaluation of body
shape and weight, and maladaptive attempts to
control weight
◦Exposure & Response Prevention
- require clients to eat particular kinds and
amounts of food and then prevent them from
vomiting to show that eating can be harmless
◦Interpersonal Psychotherapy (IPT)
-
✔Restriction of energy intake relative to requirements, leading to a
significantly low body weight in the context of age, sex,
developmental trajectory & physical health.
Significantly low weight: weight that is less than minimally normal
(Children & adolescents: less than minimally expected)
✔Intense fear of gaining weight/becoming fat, or persistent
behavior that interferes w/ weight gain, even though at a
Biological
- Genetics
- Abnormal level of hormones
regulated by the hypothalamus
(regulating hunger & eating), such
as cortisol
- These hormonal abnormalities
•Biological Intervention
◦Nutritional Rehabilitation
- help patients gain weight quickly and return to
health within weeks
◦Tube & Intravenous Feedings
- in life threatening cases on a patient who refuses
to eat

Anorexia
Nervosa
Restriction of
energy intake &
excessive
exercise due to
intense fear of
gaining weight &
distorted
perception of
weight
significantly low weight
✔Disturbance in which one’s body weight/shape is experienced,
undue influence of body weight/shape on self-evaluation, or
persistent lack of recognition of the seriousness of the current
low body weight.
Specify type:
Restricting type: during the past 3 months, the individual has not
engaged in recurrent episodes of binge-eating/purging behavior (This
subtype describes presentations in which weight loss is accomplished
primarily through dieting, fasting or excessive exercise)
Binge-eating/purging type: During the past 3 months, the individual has
engaged in recurrent episodes of binge eating/purging behavior
Specify severity: (adults)
Mild: BMI of 17 or more
Moderate: BMI of 16-17
Severe: BMI of 15-16
Extreme: BMI under 15
Specify if:
In Partial Remission: No longer underweight but still overly concerned/
has misconceptions with weight
In Full Remission: Has met no criteria
occur as a result of self-starvation &
returns to normal after weight gain
- Starvation may increase levels of
endogenous opioids (suppress
appetite & enhances mood, released
during starvation), resulting in a
positively reinforcing euphoric state
- Low levels of serotonin
- Greater activation in the ventral
striatum (dopamine & reward)
- Greater expression of dopamine
transporter gene DAT (release of
protein that regulates the reuptake of
dopamine back into synapse)
Cognitive
- Achieving thinness are negatively
reinforced by the reduction of
anxiety about becoming fat
- Perfectionism
- Fear of criticisms
◦Motivational Interviewing
- uses a mixture of empathy and inquiring review
to help motivate clients to recognize they have a
serious eating problem and commit to making
constructive choices and behavior changes
•Psychotherapy
◦Most important initial goal: restore the patient’s
weight to a point that is at least within the low
normal range
◦Cognitive-Behavioral Therapy (CBT)
- to help clients appreciate and change the
behaviors and thought processes that keep their
restrictive eating going
◦Cognitive-Behavioral Therapy-Enhanced
(CBTE)
◦Family-based Treatment (FBT)
- may try to help patient separate their feelings
and needs from those of other family members.
Binge-Eating
Disorder
Episodes of
consuming food
in a larger amount
than is normal in
a short time
✔Recurrent episodes of binge eating that is characterized by both
of the ff:
1.Eating an amount of food that is definitely larger than what most
people would eat in a similar period of time under similar
circumstance
2.Sense of lack of control over eating
✔Binge-eating episodes are associated with 3/more of the ff:
1.Eating much more rapidly than normal
2.Eating until feeling uncomfortably ill
3.Eating large amounts of food when not hungry
4.Eating alone because of feeling embarrassed by how much one is
eating
5.Feeling disgusted w/ oneself, depressed, or very guilty afterward
✔Binge-eating occurs, on average, at least once a week for 3
months
✔Not associated w/ the recurrent use of inappropriate
compensatory behavior as in bulimia nervosa & does not occur
exclusively during the course of bulimia nervosa or anorexia
nervosa
Specify if:
In Partial Remission: Binged-eat less often than once a week
In Full Remission: Has met no criteria
Cognitive
- Self-worth = weight
- Low self-esteem
- Stress are relieved by purging
•Pharmacotherapy
◦Antidepressants
•Psychotherapy
◦Cognitive-Behavioral Therapy (CBT)
◦For Obesity:
▪Bariatric surgery
- A surgical approach to extreme obesity

Specify Severity:
Mild: 1-3 binges a week
Moderate: 4-7 binges a week
Severe: 8-13 binges a week
Extreme: 14+ binges a week
Avoidant/
Restrictive Food
Intake Disorder
(ARFID)
Avoidance or
restriction of food
intake
✔An eating/feeding disturbance as manifested by persistent failure
to meet appropriate nutritional and/or energy needs associated
with at least 1 of the ff:
1.Significant weight loss (or failure to achieve expected weight
gain or faltering growth in children)
2.Significant nutritional deficiency
3.Dependence on enteral feeding or oral nutritional supplements
4.Marked interference with psychosocial functioning
✔The disturbance is not better explained by lack of available food
or by an associated culturally sanctioned practice
✔There is no evidence of a disturbance in the way in which one's
body weight or shape is experienced
Specify if:
In Remission: After full criteria were previously met, the criteria have
not been met for a sustained period of time
Biological
- Heredity
- History of gastrointestinal issues,
gastroesophageal reflux (GERD),
and vomiting
•Psychotherapy
◦CBT-AR (CBT for avoidant/restrictive disorder)
- patients are encouraged to eat large amounts of
their preferred foods, with the goal of weight
restoration, before introducing new foods.
◦Family Based Therapy (FBT)
- blame is removed from the patient and the
family, and the eating disorder is viewed as an
external force.
◦Occupational Therapy
- therapists complete a full assessment of a
person’s sensory, motor, developmental,
environmental, cultural, and behavioral factors
that could be impairing eating.
Pica Disorder
Eating of 1 or
more non-
nutritive, non-
food substances
✔Persistent eating of non-nutritive, non-food substances over a
period of at least 1 month
✔The eating of non-nutritive, non-food substances is inappropriate
to the developmental level of the individual
Specify if:
In remission: After full criteria were previously met, the criteria have not
been met for a sustained period of time
Psychological
- Intellectual Disability
Environmental
- Parental neglect, lack of
supervision
- Intellectual disability
•Behavioral Interventions
◦Nutrition Counseling
- educate the client & family about nutritional
deficits in the client’s diet, how to meet dietary
needs, and how to determine the difference
between edible and non-edible food items
◦Family Therapy
Rumination
Disorder
Repeated
regurgitation of
food occurring
after feeding or
eating
✔Repeated regurgitation of food over a period of at least 1 month.
Regurgitated food may be re-chewed, re-swallowed, or spit out
✔The repeated regurgitation is not attributable to an associated
gastrointestinal or other medical condition
Psychosocial
- Low stimulation, neglect
- Stress
- Difficulties in parent-child
relationship
•Behavioral Intervention
◦Behavior Modification
◦Habit Reversal Training (HRT)
- to create a competing behavior (or a distraction)
to reduce the regurgitation episodes.
◦Diaphragmatic Breathing Exercises
- uses a relaxation technique to inhale and exhale
by expanding the abdomen instead of the chest.

SLEEP-WAKE DISORDERS
DISORDER DIAGNOSTIC CRITERIA ETIOLOGY INTERVENTIONS
Insomnia
Disorder
Trouble falling
asleep, staying
asleep or getting
good quality sleep
✔Predominant complaint of dissatisfaction w/ sleep
quantity/quality associated with 1/more of the ff:
1.Difficulty initiating sleep (Children: difficulty initiating sleep
without caregiver intervention)
2.Difficulty maintaining sleep, characterized by frequent
awakenings/problems returning to sleep after awakenings
(Children: difficulty returning to sleep without caregiver
intervention)
3.Early-morning awakening w/ inability to return to sleep
✔Sleep difficulty occurs at least 3 nights per week
✔Sleep difficulty is present for at least 3 months
✔Sleep difficulty occurs despite adequate opportunity for sleep
Specify if:
Episodic: Symptoms last at least 1 month but less than 3 months
Persistent: Symptoms last 3 months or longer
Recurrent: 2 or more episodes within the space of 1 year
Specify if:
With non-sleep disorder mental comorbidity
With other medical comorbidity
With other sleep disorder
Biological
- Biological clock problems
- Delayed temperature rhythm (body
temp is high & don’t become
drowsy unlit later night)
- Family history
Environmental
- Light, noise, temperature
Psychological
- Stress & Anxiety
Behavioral
- Children learn to fall asleep only
with a parent present
•Pharmacotherapy
◦Benzodiazepine
◦Triazolam (Halcion)
◦Zaleplon (Sonata)
◦Zolpidem (Ambien)
◦Flurazepam (Dalmane)
•Psychotherapy
◦Cognitive Therapy
- Focus: changing the sleepers’ unrealistic
expectations & beliefs about sleep by providing
information on topics like normal amount of
sleeps & ability to compensate for lost sleep
◦Guided Imagery Relaxation
- Uses meditation/imagery to help with relaxation
at bedtime or after a night waking for people who
become anxious because of difficulty sleeping
◦Graduated Extinction
- Used for children who have tantrums at bedtime
or wake up crying by instructing the parent to
check on the child after longer periods until the
child falls asleep on his/her own
◦Paradoxical Intention
- Involves instructing individuals in the opposite
behavior from the desired outcome
◦Progressive Relaxation
- Involves relaxing the muscles of the body in an
effort to introduce drowsiness
Hypersomnolenc
e Disorder
Repeated feeling
of excessive
tiredness during
the day or
sleeping longer
than usual at
night
✔ Self-reported excessive sleepiness despite a main sleep period
lasting at least 7 hours, with at least 1 of the ff symptoms:
1.Recurrent periods of sleep/lapses into sleep within the same day
2.Prolonged main sleep episode of more than 9 hours per day that
is non-restorative
3.Difficulty being fully awake after abrupt awakening
✔Occurs at least 3x per week, for at least 3 months
Specify if:
Acute: less than 1 month
Subacute: 1-3 months
Persistent: more than 3 months
Specify current severity:
Mild: 1-2 days/week
Biological
- Genetics
- Exposure to viral infections
(Mononucleosis, hepatitis & viral
pneumonia)
•Pharmacotherapy
◦Stimulants
▪Amphetamine
▪Methylphenidate
▪Modafinil
◦Antidepressants
◦Monoamine Oxidase Inhibitors (MAOIs)

Moderate: 3-4 days/week
Severe: 5-7days/week
Specify if:
With mental disorder
With medical condition
With another sleep disorder
Narcolepsy
Sudden attacks of
deep sleep
because of the
brain’s inability to
control sleep-
wake cycles
✔Recurrent periods of irrepressible need to sleep, lapsing into
sleep or napping occurring within the same day. Must have been
occurring at least 3x per week over the past 3 months
✔Presence of at least 1 of the ff:
1.Episodes of cataplexy defined as either of the ff, occurring at
least a few times per month:
a)In individuals w/ long standing disease, brief episodes of
sudden bilateral loss of muscle tone w/ maintained
consciousness, precipitated by laughter/joking
b)In children or individuals within 6 months of onset,
spontaneous grimaces or jaw-opening episodes w/ tongue
thrusting or a global hypotonia, without any obvious
emotional triggers
2.Hypocretin deficiency, as measured using cerebrospinal fluid
(CSF) hypocretin-1 immunoreactivity values (less than/equal to
one third of values obtained in healthy subjects tested using the
same assay or less than or equal to 110pg/ml). Low CSF levels
of hypocretin-1 must not be observed in the context of acute
brain injury, inflammation or infection
3.Nocturnal sleep polysomnography showing REM sleep latency
less than or equal to 15 minutes, or a multiple sleep latency test
showing a mean sleep latency less than or equal to 8 minutes & 2
or more sleep onset REM periods
Specify current severity:
Mild: infrequent cataplexy (less than once per week), need for naps only
1-2x per day & less disturbed nocturnal sleep
Moderate: cataplexy once daily or every few days, disturbed nocturnal
sleep & need for multiple naps daily
Severe: drug-resistant cataplexy with multiple attacks daily, nearly
constant sleepiness & disturbed nocturnal sleep
Biological
- Associated with cluster of genes on
chromosome 6 (autosomal recessive
trait)
- Significant loss of hypocretin
neurons (nerve cell) – plays an
important role in wakefulness
•Pharmacotherapy
◦Stimulants
◦Amphetamines
◦Antidepressants (SNRIs, SSRIs)
◦Sodium Oxybate
- can help you sleep and also reduces how often
cataplexy happens
◦Histamine-affecting Drugs
Obstructive
Sleep Apnea
Hypopnea
✔Either:
1.Evidence by polysomnography of at least 5 obstructive
apneas/hypopneas per hour of sleep & either of the ff symptoms:
a)Nocturnal breathing disturbances: snoring, snorting/gasping,
or breathing pauses during sleep
b)Daytime sleepiness, fatigue or unrefreshing sleep despite
Biological
- Narrow or abnormal/damaged
airway
- Obesity & increasing age
- Use of MDMA (ecstasy)
•Polysomnography
- During this sleep study, you're hooked up to
equipment that monitors your heart, lung and brain
activity, breathing patterns, arm and leg movements,
and blood oxygen levels while you sleep.
•Home sleep apnea testing

Recurrent
episodes of upper
airway collapse
that causes
interruption of
breathing during
sleep
suffcient opportunities to sleep that is not better explained
by another disorder
2.Evidence by polysomnography of 15 or more obstructive apneas
and/or hypopneas per hour of sleep regardless of accompanying
symptoms
Specify current severity: (per hour)
Mild: Apnea hypopnea index is less than 15
Moderate: Apnea hypopnea index is 15-30
Severe: Apnea hypopnea index is greater than 30
- involves measurement of airflow, breathing patterns
and blood oxygen levels, and possibly limb
movements and snoring intensity.
Central Sleep
Apnea
Apnea episodes
alternating with
normal breathing
✔Evidence by polysomnography of 5/more central apneas per
hour of sleep
Specify current severity:
Severity is graded according to the frequency of the breathing
disturbances & the extent of associated oxygen desaturation & sleep
fragmentation that occur as a consequence of repetitive respiratory
disturbances
Biological
- CNS disorders (cerebral vascular
disease, head trauma & degenerative
disorders)
Sleep-Related
Hypoventilation
Blood oxygen
decrease below
90% for 5 mins &
elevated CO2
levels for 10 mins
during sleep
✔Polysomnography demonstrates episodes of decreased
respiration associated w/ elevated CO2 levels (In the absence of
objective measurement of CO2, persistent low levels of
hemoglobin oxygen saturation unassociated w/
apneic/hypoapneic events may indicate hypoventilation)
Specify current severity:
Severity is graded according to the degree of hypoxemia & hypercarbia
present during sleep & evidence of end organ impairment due to these
abnormalities. The presence of blood gas abnormalities during
wakefulness is an indicator of greater severity
•Damaged lungs
•Obstructed airways
•Positive Airway Pressure (PAP) therapy using
continuous positive airway pressure (CPAP)
•Non-Invasive Ventilation (NIV)
- both provide oxygen through a mask worn when a
person is asleep.
Circadian
Rhythm Sleep-
Wake Disorder
Internal clock is
out of sync with
the environment
✔Persistent/recurrent pattern of sleep disruption that due to an
alteration of the circadian system or to a misalignment between
the endogenous circadian rhythm & the sleep-wake schedule
required by an individual’s physical environment or
social/professional schedule
✔Sleep disruption leads to excessive sleepiness/insomnia, or both
Specify type:
Delayed sleep phase type: Trouble falling asleep & awakening on time
Advanced sleep phase type: Trouble remaining awake until bedtime &
awakens before time to arise
Irregular sleep-wake type: Irregular sleep-wake periods
Non-24 hour sleep-wake type: Not the usual 24-hour
Shift work type: Because of night-shift work
Unspecified type
Specify if:
Familial: Both delayed & advanced sleep phase types
Biological
- Biological clock is in the
suprachiasmatic nucleus in
hypothalamus, which is connected in
a pathway that comes from our eyes
- Melatonin (produced by the pineal
gland) is stimulated by darkness &
ceases in daylight
•Environmental Therapy
◦Phase delays (moving bedtime later)
- Going to bed several hours later each night until
bedtime is at the desired hour
◦Phototherapy
- Using bright light to trick the brain into
readjusting the biological clock
•Psychotherapy
◦Stimulus control
- Using the bed only for sleeping and for sex, not
for work or other anxietyprovoking activities
◦Progressive relaxation or sleep hygiene
- Changing daily habits that may interfere with
sleep
◦Cognitive-Behavioral Therapy (CBT)
◦Sleep restriction

Overlapping w/ non-24hr sleep-wake type: delayed type
Specify if:
Episodic: last at least 1 month but less than 3 months
Persistent: last 3 months or longer
Recurrent: 2 or more symptoms within 1 year
◦Confronting unrealistic expectations about how
much sleep is enough for a person
Non-Rapid Eye
Movement
(NREM) Sleep
Arousal
Disorder
Repeated
incomplete
awakening from
sleep
✔Recurrent episodes of incomplete awakening from sleep
occurring during the first third of the major sleep episode,
accompanied by either of the ff:
•Sleepwalking: Repeated episodes of rising from bed during
sleep & walking about. While sleepwalking, person has a blank,
staring face; is relatively unresponsive to the efforts of others to
communicate with him; and can be awakened only w/ great
difficulty
•Sleep terrors: Recurrent episodes of abrupt terror arousals from
sleep, usually beginning w/ a panicky scream. There’s intense
fear & signs of autonomic arousal, such as mydriasis,
tachycardia, rapid breathing & sweating, during each episode.
There is relative unresponsiveness to efforts of others to comfort
the person during the episode
✔No or little dream imagery is recalled
✔Amnesia for the episodes are present
Specify if:
Sleepwalking type
Sleep terror type
Specify if:
With sleep-related eating
With sleep-related sexual behavior (sexsomnia)
•Genetics
•Unhealthy sleeping
schedule
•Pharmacotherapy
◦Benzodiazepines
- for parasomnias that are long lasting or
potentially harmful
◦Tricyclic antidepressants
•Behavioral Intervention
◦Schedule awakenings
•Psychotherapy
◦Hypnosis
◦Relaxation Therapy
◦Cognitive-Behavioral Therapy
Rapid Eye
Movement
(REM) Sleep
Behavior
Disorder
Dream enactment
behaviors with
vocal sounds &
sudden
movements
✔Repeated episodes of arousal during sleep associated w/
vocalization and/or complex motor behaviors
✔Behaviors arise during REM sleep & therefore usually occur
greater than 90 minutes after sleep onset, are more frequent
during the later portions of the sleep period & uncommonly
occur during daytime naps
✔Upon awakening from these episodes, person is completely
awake, alert & not confused or disoriented
✔Either of the ff:
1.REM sleep without atonia on polysomnographic recording
2.History suggestive of REM sleep behavior disorder & an
established synucleinopathy diagnosis (ex. Parkinson’s disease)
•Alpha-synuclein
Neurodegeneration
•Pharmacotherapy
◦Melatonin
- may help reduce or eliminate your symptoms. It
may be as effective as clonazepam and is usually
well-tolerated with few side effects.
◦Clonazepam (Klonopin)
- often used to treat anxiety, is also the traditional
choice for treating REM sleep behavior disorder,
appearing to effectively reduce symptoms. It may
cause side effects such as daytime sleepiness,
decreased balance and worsening of sleep apnea.
✔Repeated occurrences of extended, extremely dysphoric & well-
remembered dreams that involve efforts to avoid threats to
survival, security/physical integrity & generally occur during the
•Stress
•Trauma
•Sleep deprivation
•Pharmacotherapy
◦Prazosin
•Behavioral Intervention

Nightmare
Disorder
Undesirable
experiences while
sleeping
2
nd
half of the major sleep episode
✔On awakening from the dysphoric dreams, the person rapidly
becomes oriented & alert
Specify if:
During sleep onset
Specify if:
With associated non-sleep-disorder
With associated other medical conditions
With associated other sleep disorder
Specify if:
Acute: lasted less than 1 month
Subacute: lasted 1-6 months
Persistent: lasted 6+ months
Specify current severity:
Mild: less than 1 episode per week on average
Moderate: 1 or more episodes per week but less than nightly
Severe: episodes nightly
•Substance misuse ◦Scheduled awakenings
•Psychotherapy
◦Cognitive-Behavioral Therapy (CBT)
◦Imagery Rehearsal Therapy (IRT)
- Often used with people who have nightmares as
a result of PTSD, imagery rehearsal therapy
involves changing the ending to your
remembered nightmare while awake so that it's no
longer threatening. You then rehearse the new
ending in your mind. This approach may reduce
the frequency of nightmares.
SEXUAL DYSFUNCTIONS
DISORDER DIAGNOSTIC CRITERIA ETIOLOGY INTERVENTIONS
Male Hypoactive
Sexual Desire
Disorder
Lack of interest in
sexual activity
✔Persistently/Recurrently deficient/absent sexual thoughts or
fantasies & desire for sexual activity.
✔Criterion A has persisted for at least 6 months
Specify whether:
Lifelong Type: Present since the patient became sexually active
Acquired Type: Began after a period of normal sex function
Specify whether:
Generalized Type: Not limited to certain types of stimulation,
situation or partners
Situational Type: Only occurs with certain types of stimulation,
situation or partners
Specify severity:
Mild: Mild distress
Moderate: Moderate distress
Severe: Severe distress
Biological
- Neurological diseases (diabetes &
kidney & vascular disease)
- Chronic illnesses
- Prescription medication (Anti-
hypertensive meds – beta-blockers)
- Anti-depressants (SSRIs, Prozac) – by
altering levels of serotonin in brain
- Alcohol (CNS suppresant)
- Nicotine
Psychological
- Anxiety --> Distractions
Sociocultural
- Erotophobia – learned early in
childhood from families, authorities
- Traumatic sexual events
- Poor interpersonal relationship
- Script Theory – following scripts that
guides our behavior
•Pharmacotherapy
◦Sildenafil (Viagra)
◦Levitra
◦Cialis
◦Injection of vasodilating drugs such as papaverine
or prostaglandin directly into the penis
◦Surgery
◦Vacuum Device Therapy
- Works by creating a vacuum in a cylinder
placed over the penis
•Psychotherapy
◦Providing basic education about sexual
functioning, altering deep-seated myths, and
increasing communication
◦Sensate focus
◦Nondemand pleasuring

Female Sexual
Interest/Arousal
Disorder
Lack of interest in
sexual activity in
females
✔Lack of/Reduced sexual interest/arousal, as manifest by at
least 3 of the ff:
1.Absent/reduced interest in sexual activity
2.Absent/reduced sexual/erotic thoughts/fantasies
3.No/reduced initiation of sexual activity & unreceptive to a
partner’s attempts to initiate
4.Absent/reduced sexual excitement/pleasure during sexual
activity in almost or all sexual encounters
5.Absent/reduced sexual interest/arousal in response to any
internal/external sexual/erotic cues
6.Absent/reduced genital/nongenital sensations during sexual
activity
✔Criterion A has persisted for at least 6 months
Specify whether:
Lifelong Type or Acquired Type
Generalized Type or Situational Type
Specify current severity:
Mild, Moderate, Severe
Biological
- Neurological diseases (diabetes &
kidney & vascular disease)
- Chronic illnesses
- Prescription medication (Anti-
hypertensive meds – beta-blockers)
- Anti-depressants (SSRIs, Prozac) – by
altering levels of serotonin in brain
- Alcohol (CNS suppresant)
- Nicotine
Psychological
- Anxiety --> Distractions
Sociocultural
- Erotophobia – learned early in
childhood from families, authorities
- Traumatic sexual events
- Poor interpersonal relationship
- Script Theory – following scripts that
guides our behavior
•Pharmacotherapy
◦Estrogen therapy
- Comes in the form of a vaginal ring, cream or
tablet. This therapy benefits sexual function by
improving vaginal tone and elasticity, increasing
vaginal blood flow and enhancing lubrication.
◦Androgen therapy
- Androgens include testosterone. It would only
be used in women whom there isn’t any other
cause for the low sexual desire
◦Flibanserin (Addyi)
- Originally developed as an antidepressant,
flibanserin may boost sex drive in women who
experience low sexual desire and find it
distressing.
◦Bremelanotide (Vyleesi)
- Injection just under the skin in the belly or thigh
before anticipated sexual activity.
•Psychotherapy
◦Mindfulness-Based Cognitive Therapy
(MBCT)
- used in small groups of women, can improve
arousal, orgasm& subsequent desire & motivation
Erectile Disorder
Difficulty getting
an erection
✔At least 1 of the ff symptoms:
1.Marked difficulty in obtaining an erection during sexual
activity
2.Marked difficulty in maintaining an erection until the
completion of sexual activity
3.Marked decrease in erectile rigidity
✔Criterion A has persisted for at least 6 months
Specify whether:
Lifelong Type or Acquired Type
Generalized Type or Situational Type
Specify current severity:
Mild, Moderate, Severe
Biological
- Heart disease, high cholesterol, high
blood pressure, diabetes
- Obesity
- Smoking
Psychological
- Anxiety
- Depression
- Stress
- Abuse/Trauma
•Pharmacotherapy
◦Sildenafil (Viagra) – increases blood flow to the
penis within 1 hour of ingestion; the increased
blood flow enables the user to attain an erection
during sexual activity
•Psychotherapy
◦Tease Technique – during sensate-focus
exercises: the partner keeps caressing the man,
but if the man gets an erection, the partner stops
caressing him until he loses it
Genito-Pelvic
Pain/Penetration
Disorder
Pain during
penetration
✔Persistenr/recurrent difficulties with 1/more of ff:
1.Vaginal penetration during intercourse
2.Marked vulvovaginal/pelvic pain during vaginal
intercourse/penetration attempts
3.Fear/anxiety about vulvovaginal/pelvic pain in anticipation
of or as a result of vaginal penetration
4.Marked tensing/tightening of the pelvic floor muscles
Biological
- Affects the pelvic floor muscles around
the vagina which causes the muscles to
contract/tighten during penetration
Psychological
- Trauma
•Practice tightening and relaxing vaginal muscles until
she gains more voluntary control over them.
•Gradual behavioral exposure treatment to help her
overcome her fear of penetration
•Botox – to help reduce spasms in those muscles

during attempted vaginal penetration
✔Criterion A has persisted for at least 6 months
Specify whether:
Lifelong Type or Acquired Type
Premature
(Early)
Ejaculation
Too quick
ejaculation of a
man
✔Consistently ejaculating within 1 minute/less of vaginal
penetration
✔Criterion A has persisted for at least 6 months & has been
experienced 75-100% of the time
Specify whether:
Lifelong Type or Acquired Type
Generalized Type or Situational Type
Specify current severity:
Mild, Moderate, Severe
Biological
- Excessive physiological arousal in SNS
may lead to rapid ejaculation
- Psychological factor of anxiety also
increases sympathetic arousal. Thus,
when a man becomes anxiously aroused
about ejaculating too quickly, his making
it worse
- Problem w/ oxytocin levels
- Low serotonin/dopamine levels
Psychological
- Performance anxiety-aggravating
- Stress
- Depression
•Pharmacotherapy
◦SSRIs – because these drugs often reduce sexual
arousal or orgasm
•Biological Therapy
◦Squeeze Technique
•Behavioral Therapy
◦Stop, Start or Pause Procedure
- penis is manually stimulated until the man is
highly aroused. The couple then pauses until this
arousal subsides, after which the stimulation is
resumed. This sequence is repeated several times,
so the man ultimately experiences much more
total time of stimulation than he has ever
experienced before.
Delayed
Ejaculation
(Orgasm)
Too slow
ejaculation of a
man
✔Marked delay/infrequency/absence of ejaculation
✔Criterion A has persisted for at least 6 months & has been
experienced 75-100% of the time
Specify whether:
Lifelong Type or Acquired Type
Generalized Type or Situational Type
Specify current severity:
Mild, Moderate, Severe
Biological
- Birth defects that affect the
reproductive system
- Injury to pelvic nerves (control orgasm)
- Low thyroid/tostesterone level
- Retrograde Ejaculation – semen goes
back in bladder rather than out of the
penis
•Include techniques to reduce performance anxiety and
increase stimulation
•When it is caused by physical factors such as
neurological damage or injury, treatment may include
a drug to increase arousal of the sympathetic nervous
system
Female
Orgasmic
Disorder
Delay or no
sexual climax for
women
✔Delayed/infrequent/absent orgasm or markedly decreased
intensity of orgasm after a normal sexual arousal phase on
all/almost all sexual activity
✔Criterion A has persisted for at least 6 months
Specify if:
Never experienced orgasm under any situation
Specify whether:
Lifelong Type or Acquired Type
Generalized Type or Situational Type
Specify current severity:
Mild, Moderate, Severe
Biological
- Damage to genital sensory/autonomic
nerves/pathways (due to diabetes or
multiple sclerosis)
- SSRIs
Psychological
- Stress, anxiety
- Lack of trust in partner
•Behavioral Therapy
◦Directed masturbation training
- a woman is taught step by step how to
masturbate effectively and eventually to reach
orgasm during sexual interactions.
- includes the use of diagrams and reading
material, private self-stimulation, erotic material
and fantasies, “orgasm triggers” such as holding
her breath or thrusting her pelvis, sensate focus
with her partner, and sexual positioning
✔Clinically significant disturbance in sexual function is
predominant in clinical picture
✔There’s evidence in history, physical exam or lab findings of
both:

Substance/
Medication-
Induced Sexual
Dysfunction
1.Symptoms in Criterion A developed during/soon after
substance intoxication/withdrawal or after exposure to a
medication
2.The involved substance/medication is capable of producing
the symptoms in Criterion A
Specify if:
With onset during intoxication/withdrawal: Tacked on at the end
of string of words
With onset after medication use: Can be used in addition to other
specifiers
Specify severity:
Mild: Dysfunction in 25-50% of sexual encounters
Moderate: 50-75% of encounters
Severe: 75% or more
PARAPHILIC DISORDERS
DISORDER DIAGNOSTIC CRITERIA ETIOLOGY INTERVENTIONS
Fetishistic
Disorder
Sexual arousal
from the use of
nonliving object
✔At least 6 months, recurrent & intense sexual arousal from the use of
nonliving objects or a highly specific focus on nongenital body parts, as
manifested by fantasies, urges/behaviors
✔The fetish objects are not limited to articles of clothing used in cross-dressing
(as in transvestic) or devices specifically designed fro the purpose of tactile
genital simulation
Specify type:
Body parts
Nonliving objects
Other (can be combination of the 2)
Specify if:
In remission
In a controlled environment
Biological
- Weak Behavioral Inhibition
System (BIS) in the brain that
might repress serotonergic
functioning
Psychosocial
- Inadequate social
relationships
Psychological
- Abuse
- Early sexual fantasies
Behavioral
- Operant Conditioning –
sexual arousal is reinforced
through association with
orgasm
•Pharmacotherapy
◦Cyproterone acetate
- An antiandrogen
- “Chemical castration” drug
- Eliminates sexual desire and fantasy by
reducing testosterone levels dramatically
◦Medroxyprogesterone (Depo-Provera
is the injectable form)
- A hormonal agent that reduces
testosterone
•Psychotherapy
◦Covert sensitization
- Carried out entirely in the imagination
of the patient
- Patients associate sexually arousing
images in their imagination with some
reasons why the behavior is harmful or
dangerous
◦Orgasmic reconditioning
- Patients are instructed to masturbate to
their usual fantasies but to substitute
more desirable ones just before
ejaculation
◦Relapse prevention
Voyeuristic
Disorder
Sexual arousal
from observing an
unsuspecting
person who is
naked
✔At least 6 months, recurrent & intense sexual arousal from observing an
unsuspecting person who is naked, in the process of disrobing or engaging in
sexual activity, as manifested by fantasies, urges/behaviors
✔Acted with a non-consenting person
✔Person experiencing the arousal or acting the urges is at least 18 years old
Specify if:
In full remission: no symptoms for 5+ years
In a controlled environment
Exhibitionistic
Disorder
✔At least 6 months, recurrent & intense sexual arousal from the exposure of
one’s genitals to an unsuspecting person, as manifested by fantasies,
urges/behaviors

Sexual arousal
from the exposure
of one’s genitals
to an
unsuspecting
person
✔Acted with a non-consenting person
Specify type: sexually aroused by exposing to:
Prepubertal children
Physicall mature individuals
Prepubertal children & physically mature individuals
Specify if:
In full remission: no symptoms for 5+ years
In a controlled environment
Frotteuristic
Disorder
Sexual arousal
from rubbing
against a non-
consenting person
✔At least 6 months, recurrent & intense sexual arousal from touching/rubbing
against a non-consenting person, as manifested by fantasies, urges/behaviors
Specify if:
In full remission: no symptoms for 5+ years
In a controlled environment
Transvestic
Disorder
Sexual arousal
from cross-
dressing
✔At least 6 months, recurrent & intense sexual arousal from cross-dressing as
manifested by fantasies, urges/behaviors
Specify if:
With fetishism: Sexual arousal by clothing/fabrics
With autogynephilia: Arousal by self-visualization as female
Specify if:
In full remission: no symptoms for 5+ years
In a controlled environment
Sexual Sadism
Disorder
Sexual arousal
from the suffering
of another person
✔At least 6 months, recurrent & intense sexual arousal from the
psychological/physical suffering of another person, as manifested by fantasies,
urges/behaviors
✔Acted with a non-consenting person
Specify if:
In full remission: no symptoms for 5+ years
In a controlled environment
Sexual
Masochism
Disorder
Sexual arousal
from the act of
being humiliated,
beaten/suffer
✔At least 6 months, recurrent & intense sexual arousal from the act of being
humiliated, beaten, bound or suffer, as manifested by fantasies, urges/behavior
Specify if:
With asphyxiophilia: Sexual arousal by oxygen deprivation
Specify if:
In full remission: no symptoms for 5+ years
In a controlled environment
Pedophilic
Disorder
Sexual arousal on
children
✔At least 6 months, recurrent, intense sexually arousing fantasies, sexual
urges/behaviors involving sexual activity w/ a prepubescent child/children (13
years or younger)
✔Person is at least 16 years & at least 5 years older than the child
Note: Don’t include an individual in late adolescence involved in an ongoing sexual
relationship with a 12 or 13 year old

Specify if:
In a controlled environment
Specify Type:
Exclusive Type: Aroused by children only
Non-exclusive Type:
Specify if:
Sexually attracted to: males, females, both
Limited to incest
GENDER DYSPHORIA
DISORDER DIAGNOSTIC CRITERIA ETIOLOGY INTERVENTIONS
Gender
Dysphoria
Person’s physical
sex is not
consistent w/ who
he/she really is
In Children:
✔Marked incongruence between one’s experienced/expressed
gender & assigned gender, of at least 6 months, as manifested by
at least 6 of the ff:
1.Strong desire to be of the other gender or an instance that one is
the other gender
2.Boys – strong preference for cross-dressing/stimulating female
attire; Girls – strong preference for wearing only typical
masculine clothing
3.Strong preference for cross-dressing roles in fantasy play
4.Strong preference for the toys, games or activities stereotypically
used by the other gender
5.Strong preference for playmates of other gender
6.Boys – strong rejection of typically masculine toys,
games/activities; Girls – strong rejection of typically feminine
toys, games/activities
7.Strong dislike of one’s sexual anatomy
8.Strong desire for the primary/secondary sex characteristics that
match one’s experienced gender
In Adolescents & Adults:
✔Marked incongruence between one’s experienced/expressed
gender & assigned gender, of at least 6 months, as manifested by
at least 2 of the ff:
1.Markedncongruence between one’s experienced/expressed
gender & primary/secondary sex characteristics
2.Strong desire to be rid of one’s primary/secondary sex
characteristics because of the incongruence (Young adolescents:
desire to prevent the development of the anticipated secondary
sex characteristics)
Biological
- Genetics
- Slightly higher levels of
testosterone/estrogen at certain
critical periods of development
- Structural differences in the area of
the brain
- Exposure to higher levels of fetal
testosterone was associated w/ more
masculine play behavior in both boy
& girls during childhood
Social
- Excessive attention & physical
contact
- Lack of male/female playmates
•Psychological evaluation and education
•Administration of gonadal hormones to bring
about desired secondary sex characteristics
- Partially reversible
•Sex Reassignment Surgery
- Non-reversible
•Alter anatomy physically to be consistent with gender
identity
•Must live in the desired gender for 1-2 years
•Must be stable psychologically, financially, and
socially
•Gynecomastia
- The growth of breasts (for transwomen)
Treatment of Gender Nonconformity in Children
•Work with the child and caregivers to lessen gender
dysphoria and decrease cross-gender behaviors on the
assumption that these behaviors are unlikely to persist
anyway and the negative consequences of social
rejection could be avoided, and that avoiding later
intrusive surgery would be desirable
•“Watchful waiting”
- Letting expressed gender unfold naturally
•Actively affirming and encouraging cross-gender
identification, but critics point out that gender
nonconformity usually does not persisted
Treatment of Disorders of Sex Development
(Intersexuality)
•Surgery

3.Strong desire for the primary/secondary sex characteristics of the
other gender
4.Strong desire to be of the other gender
5.Strong desire to be treated as the other gender
6.Strong conviction that one has the typical feelings & reactions of
the other gender
Specify if:
With a disorder of sex development
Posttransition: Living in the desired gender & has had at least 1 cross-
gender surgical procedure or medical treatment
•Hormonal Replacement Therapy (HRT)
•Psychological treatments to help individuals adapt to
their particular sexual anatomy or their emerging
gender experience
SUBSTANCE-USE & ADDICTIVE DISORDERS
DISORDER DIAGNOSTIC CRITERIA ETIOLOGY INTERVENTIONS
Alcohol-Use
Disorder
✔Problematic pattern of use as manifested by at least 2 of the
ff, occurring within 12 months:
1.Taken in larger amounts/longer period than was intended
2.Persistent desire/unsuccessful efforts to cut down/control the
use
3.Great deal of time is spent in activities necessary to obtain the
use or recover from its effects
4.Craving/strong desire/urge to use
5.Recurrent use resulting in failure to fulfill major role
obligations
6.Continued use despite having persistent/recurrent social
problems caused by the effects
7.Important activities are given up/reduced
8.Recurrent use in physically hazardous situations
9.Use is continued despite knowledge of having
physical/psychological problem that is likely to have been
caused by the use
10.Tolerance, as defined by either of the ff:
a)Need for increased amounts to achieve
intoxication/desired effect
b)Diminished effect w/ continued use of the same amount
11.Withdrawal, as manifested by either of the ff:
a)Characteristic withdrawal syndrome
b)Taken to relieve/avoid withdrawal symptoms
Specify if:
In early remission: Begins after 3 months sober & lasts until 1 year of
sobriety
Neurobiological
- Genetics
- Brain has a natural “pleasure
pathway” that mediates our
experience reward & all abused
substances affect this internal
reward center in the same way we
experience pleasure from foods or
sex
- psychoactive drugs has the
ability to activate this reward
center & provide pleasurable
experiences
- high = GABA neurons which
acts as the “brain police” of the
reward neurotransmitter system
Behavioral
- Positive Reinforcement
(pleasurable feelings)
- Negative Reinforcement (reduce
unpleasant feelings)
Cognitive
- Expectancy Effect – what people
expect to experience when they
use drugs influences how they
•First step: help someone through the withdrawal process
•Ultimate goal: abstinence
•Pharmacotherapy
◦Sedative drugs (benzodiazepines)
- Help minimize discomfort for people withdrawing
from other drugs, such as alcohol
◦Clonidine
- Given to people withdrawing from opiates
◦Nicotine Replacement Therapy (patch, gum, spray,
inhaler, lozenge)
•Agonist Substitution – providing the person with a safe
drug that has a chemical makeup similar to the addictive
drug (therefore the name agonist)
◦Methadone – an opiate agonist often given as a
heroine substitute; originally called “adolphine”
◦Buprenorphine – blocks the effects of opiate and
encourage better compliance
◦Nicotine – a cigarette substitute; provided to smokers
in the form of gum, patch, inhaler, or nasal spray,
which lack the carcinogens included in cigarette smoke
◦Bupropion (Zyban) – medical treatment for smoking;
also serves as an antidepressant under the trade name
Wellbutrin
•Antagonist Treatments – block/counteract the effects of
psychoactive drugs
◦Naltrexone – has limited success with individuals who
are not simultaneously participating in a structured
Sedative,
Hypnotic or
Anxiolytic-Use
Disorder
Stimulant-Use
Disorder
Tobacco-Use
Disorder
Caffeine-Use
Disorder
Opioid-Use
Disorder
Cannabis-Use
Disorder
Hallucinogen-
Use Disorder

In sustained remission: Begins after the first year of sobriety
In a controlled environment: Restricts access to substance
On maintenance therapy
Specify current severity:
Mild: 2-3 symptoms
Moderate: 4-5 symptoms
Severe: 6 or more symptoms
react to them
Social
- Exposure
treatment program
◦Acomprosate – decrease cravings in people dependent
on alcohol
•Aversive treatments
◦Disulfiram (Antabuse)
- For people who are alcohol-dependent
- Prevents the breakdown of acetaldehyde, a by-
product of alcohol, and the resulting build-up of
acetaldehyde causes feelings of illness
- Causes nausea, vomiting, elevated heart rate, and
respiration
◦Use of silver nitrate in lozenges or gum
- Combines with saliva to produce a bad taste in the
mouth
•Psychosocial treatments
◦Inpatient facilities
- Designed to help people get through the initial
withdrawal period and to provide supportive therapy
so they can go back to their communities
- Can be extremely expensive
◦Alcoholics Anonymous (AA) and its variations
▪Twelve Steps program – developed by AA; the
basis of its philosophy
▪Foundation of AA is the notion that alcoholism is
a disease and alcoholics must acknowledge their
addiction to alcohol and its destructive power over
them
•Component Treatments
◦Contingency Management
- Clinician and client together select the behaviors that
the client needs to change and decide on the
reinforcers that will reward reaching certain goals
◦Community Reinforcement Approach
- Several facets of the drug problem are addressed to
help identify and correct aspects of the person’s life
that might contribute to substance use or interfere with
efforts to abstain
◦Motivational Enhancement Therapy (MET)
- Intends to improve the individual’s beliefs that any
changes made (e.g., drinking less) will have positive
outcomes (e.g., more family time)
◦Cognitive-Behavioral Therapy (CBT)
- Addresses multiple aspects of the disorder, including

a person’s reactions to cues that lead to substance use
(e.g., being among certain friends)
- Addresses the problem of relapse
◦Aversion Therapy
- help clients identify and change the behaviors and
cognitions that keep contributing to their patterns of
substance misuse
Gambling
Disorder
Persistent and
recurrent
maladaptive
gambling
behavior that
disrupts personal,
family, and/or
vocational
pursuits.
✔Persistent & recurrent problematic gambling behavior as
indicated by 4/more of the ff in 12 months:
1.Needs to gamble w/ increasing amounts of money in order to
achieve the desired excitement
2.Restless/irritable when attempting to cut down/stop gambling
3.Made repeated unsuccessful efforts to control/stop gambling
4.Pre-occupied with gambling
5.Gambles when feeling distressed
6.After losing money gambling, returns another day to get even
7.Lies to conceal the extent of involvment w/ gambling
8.Jeopardized/lost significant relationship, job or opportunities
9.Relies on others to provide money to relieve desparate
financial situations caused by gambling
✔Not better explained by manic episode
Specify if:
Episodic or Persistent
Specify if:
In early remission: No criteria met for 3-12 months
In sustained remission: No criteria met for more than 1 year
Specify current severity:
Mild: 4-5 criteria met
Moderate: 6-7 criteria met
Severe: 8-9 criteria met
Biological
- Decreased activity on the
regions of the brain involved in
impulse regulation
- Ventromedial prefrontal cortex
& orbitofrontal cortex (executive
parts of the brain) do not function
normally
•Treatment is often similar to substance dependence
treatment
•Gambler’s Anonymous
- Incorporates the Twelve Step program
•Cognitive-behavioral interventions
◦Setting financial limits
◦Planning alternative activities
◦Preventing relapse
◦Imaginal desensitization
Caffeine
Intoxication
✔Recent consumption of caffeine (typically a high dose in
excess of 250 mg)
✔5/more of the ff developing during or shortly after caffeine
use: Restlessness, Nervousness, Excitement, Insomnia,
Flushed Face, Diuresis, Gastrointestinal Disturbance, Muscle
Twitching, Rambling flow of thought & speech, Tachycardia,
Periods of inexhaustibility, Psychomotor Agitation

DISRUPTIVE, IMPULSE-CONTROL & CONDUCT DISORDERS
DISORDER DIAGNOSTIC CRITERIA ETIOLOGY INTERVENTIONS
Intermittent
Explosive
Disorder (IED)
Aggressive
outbursts that has
a rapid onset & w/
little to no warning
✔Recurrent behavioral outburst representing a failure to control aggressive
impulses as manifested by either of the following:
1.Verbal aggression or physical aggression toward property, animals, or
other individuals, occurring twice weekly, on average, for a period of 3
months. The physical aggression does not result in damage or destruction
of property and does not result in physical injury to animals or other
individuals.
2.3 behavioral outbursts involving damage or destruction of property
and/or physical assault involving physical injury against animals or other
individuals occurring within a 12-month period.
✔The magnitude of aggressiveness expressed during the recurrent
outbursts is out of proportion to the provocation or to any precipitating
psychosocial stressors
✔The recurrent aggressive outbursts are not premeditated (i.e., they are
impulsive and/or anger-based) and are not committed to achieve some
tangible objective (e.g., money, power, intimidation)
✔Chronological age is at least 6 years (or equivalent developmental level)
Biological
- Disruption of the orbital
frontal cortex’s role in
inhibiting amygdala
activation combined w/
changes in serotonin system
•Psychotherapy
◦Psychotherapy with patients is difficult because
of their angry outbursts.
◦Cognitive-Behavioral Therapy (CBT)
- Helping the person identify and avoid
“triggers” for aggressive outbursts
◦Family & Group Therapy
- If the patient is an adolescent or a young adult
◦The goal is to have the patient recognize and
verbalize the thoughts or feeling that precede the
explosive outbursts instead of acting them out
Oppositional
Defiant Disorder
(ODD)
Frequent and
persistent pattern
of angry/irritable
mood,
argumentative
/defiant behavior
or vindictiveness
✔Pattern of angry/irritable mood, argumentative/defiant behavior, or
vindictiveness lasting at least 6 months as evidenced by at least 4
symptoms from any of the ff & exhibited during interaction with at least
1 individual who is not a sibling.
Argumentative/Defiant Behavior:
1.Often argues with authority figures or, for children and adolescents, with
adults.
2.Often actively defies or refuses to comply with requests from authority
figures or with rules.
3.Often deliberately annoys others.
4.Often blames others for his/her mistakes/misbehavior
Angry/Irritable Mood:
1.Often loses temper.
2.Often touchy or easily annoyed.
3.Often angry and resentful
Vindictiveness:
1.Has been spiteful or vindictive at least twice within the past 6 months.
✔The disturbance in behavior is associated with distress in the individual
or others in his/her immediate social context
Specify current severity:
Mild: Confined to only 1 setting
Moderate: At least 2 settings
Severe: 3 or more settings
Environmental
- Disrupted child care by the
presence of multiple
caregivers
- Harsh, inconsistent,
neglectful child-rearing
practices
•Psychotherapy
◦Family intervention
- To reinforce more prosocial behaviors and to
diminish undesired behaviors at the same time
◦Cognitive Behavioral Therapy (CBT)
- Emphasizes teaching parents how to alter their
behavior to discourage the child’s oppositional
behavior by diminishing attention to it, and
encourage appropriate therapy focused on
selectively reinforcing and praising appropriate
behavior and ignoring undesired behavior
◦Individual psychotherapy
- In which they role play and “practice” more
adaptive responses

Conduct
Disorder
Repetitive &
persistent pattern
of behavior in
which the basic
rights of
others/major age-
appropriate
societal
norms/rules are
violated
✔Repetitive & persistent pattern of behavior where the basic rights of
others/major age-appropriate societal norms/rules are violated, as
manifested by the presence of at least 3 of the ff in the past 12 months,
with at least 1 criterion present in the past 6 months:
Aggression to People & 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
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:
1.Has deliberately engaged in fire setting with the intention of causing
serious damage
2.Has deliberately destroyed others’ property
Deceitfulness/Theft:
1.Has broken into someone else’s house or car
2.Often lies to obtain goods or favors or to avoid obligations (“cons”
others)
3.Has stolen items of nontrivial value without confronting a victim
Serious Violations of Rules:
1.Often stays out at night despite parental prohibitions, beginning before
age 13 years
2.Has run away from home overnight at least twice while living in the
parental or parental surrogate home, or once without returning for a long
period
3.Is often truant from school, beginning before age 13 years
✔If the individual is age 18 year or older, criteria are not met for antisocial
personality disorder
Specify if:
Childhood-onset type: At least 1 symptom prior to age 10
Adolescent-onset type: No symptom prior to age 10
Unspecified onset: Criteria are met but not enough information available to
determine whether the onset of the first symptom was before or after age 10
years.
Specify severity:
Mild: Minor harm to others
Moderate: Intermediate effects
Severe: Considerable harm to others
Specify if:
With limited prosocial emotions /callous-unemotional traits (cold, uncaring, no
empathy)
Neurobiological
- frontotemporal-limbic
connections involving the
ventral prefrontal cortex and
amygdala are seen
- Heredity
Psychological
- Temperament
Cognitive
- Low IQ (verbal)
Environmental
- Adverse childhood events
- Peer rejection
•Psychosocial Therapy
◦Cognitive Behavioral Therapy (CBT)
Approaches
▪Kazdin’s Problem-Solving Skills Training
(PSST)
- in which a 12- week sequential program
helps children develop problem solving
solutions when faced with conflictual
situations
▪The Incredible Years
- targets young children, ages 3 to 8 years, is
administered over 22 weeks and delivers
sessions to the child and has a parent
training component and a teacher training
▪Anger Coping Program
- an 18-session intervention for school-aged
children in the grades 4-6 focused on a
child’s increased development of emotion
recognition and regulation, and managing
anger. It includes distraction, self-talk,
perspective taking, goal setting, and problem
solving

Kleptomania
Failure to resist
impulses to steal
items
✔Failure to resist impulses to steal objects that are not needed for personal
use/monetary value.
✔Increasing sense of tension immediately before committing the theft.
✔Pleasure, gratification, or relief at the time of committing the theft.
✔Not committed to express anger/vengeance and is not in response to a
delusion/hallucination.
Biological
- Damage in areas of the
brain associated w/ poor
decision making
•Pharmacotherapy
◦Antidepressants
▪Naltrexone – an opioid antagonist also used
in the treatment of alcoholism
•Psychotherapy
◦Insight-oriented psychotherapy and
psychoanalysis have been successful, but depend
on patients’ motivations
◦Those who feel guilt and shame may be helped
by insight-oriented psychotherapy because of
their increased motivation to change their
behavior
◦Behavior therapy
▪Systematic desensitization, aversive
conditioning, and combination of aversive
conditioning and altered social contingencies
Pyromania
Multiple episodes
of deliberate &
purposeful fire
setting
✔Deliberate and purposeful fire setting on more than 1 occasion.
✔Tension or affective arousal before the act.
✔Fascination with, interest in, curiosity about, or attraction to fire and its
situational contexts
✔Pleasure, gratification, or relief when setting fires, or when witnessing or
participating in their aftermath.
✔The fire setting is not done for monetary gain, expression of
sociopolitical ideology, conceal criminal activity, express
anger/vengeance, improve one's living circumstances, response to a
delusion/hallucination, result of impaired judgment
Social
- Family history
•Psychotherapy
◦Cognitive Behavioral Therapy (CBT)
▪Helping the person identify the signals that
initiate the urges
▪Teaching coping strategies to resist the
temptation to start fires
◦Family Therapy
PERSONALITY DISORDERS
DISORDER DIAGNOSTIC CRITERIA ETIOLOGY INTERVENTIONS
Paranoid PD
Pervasive distrust
& suspiciousness
of others without
adequate reasons
✔Pervasive distrust & suspiciousness of others such that their motives
are interpreted as malevolent, beginning by early adulthood & present
in a variety of contexts, as indicated by 4/more of the ff:
1.Suspects, without sufficient basis, that others are exploiting, harming or
deceiving him/her
2.Preoccupied w/ unjustified doubts about the loyalty/trustworthiness of
friends/associates
3.Reluctant to confide in others because of unwarranted fear that the
information will be used maliciously against him/her
4.Reads hidden demeaning/threatening meanings into benign events
5.Persistently bears grudges
Biological
- Genetics (Family history of
schizophrenia)
Psychological
- Early mistreatment or
childhood trauma
Cultural
- Unique experiences
(immigrant in new culture)
•Unlikely to seek professional help
•Therapists provide an atmosphere conducive to
developing a sense of trust
•Cognitive Therapy
◦To counter the person’s mistaken assumptions
about others, focusing on changing the person’s
beliefs that all people are malevolent and most
people cannot be trusted

6.Perceives attacks on his/her character/reputation that are not apparent
to others & is quick to react angrily or to counterattack
7.Has current suspicions, without justification, regarding fidelity of
spouse/sexual partner
Specify if:
Premorbid: If it precedes the onset of schizophrenia
Schizoid PD
Detachment from
social
relationships &
restricted range of
expression of
emotions
✔Pervasive pattern of detachment from social relationships & restricted
range of expression of emotions in interpersonal settings, beginning by
early adulthood & present in a variety of contexts, as indicatd by
4/more of the ff:
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 w/ others
4.Takes pleasure in few, if any, activities
5.Lacks close friends/confidants other than first degree relatives
6.Appears indifferent to the praise/criticism of others
7.Show emotional coldness, detachment or flattened affectivity
Specify if:
Premorbid: If it precedes the onset of schizophrenia
Neurobiological
- Biological dysfunction
found in autism combined w/
early problems w/
interpersonal relationships
Psychological
- Childhood shyness
- Childhood abuse & neglect
•Rare for a person with the disorder to seek treatment
•Therapists point out the value in social relationships
•May need to be taught the emotions felt by others to
learn empathy
•Receive social skills training
•Role-playing
◦Therapist takes the part of a friend or significant
other and help the patient practice establishing
and maintaining social relationships
Schizotypal PD
Social &
interpersonal
deficits marked by
acute discomfort
w/ reduced
capacity for close
relationships
✔Pervasive pattern of social & interpersonal deficits marked by acute
discomfort & reduced capacity for close relationships and
cognitive/perceptual distortions & eccentricities of behavior, beginning
by early adulthood & present in a variety of contexts, as indicated by
5/more of the ff:
1.Ideas of reference (excluding delusions of reference)
2.Odd beliefs/magical thinking that influences behavior & is inconsistent
w/ subcultural norms
3.Unusual perceptual experiences, including bodily illusions
4.Odd thinking & speech
5.Suspiciousness or paranoid ideation
6.Inappropriate or constricted affect
7.Behavior/appearance that is odd/eccentric
8.Lack of close friends/confidants other than first degree relatives
9.Excessive social anxiety that doesn’t diminish w/ familiarity & tends to
be associated w/ paranoid fears rather than negative judgments about
self
Specify if:
Premorbid: If it precedes the onset of schizophrenia
Biological
- Genetics
- Damage in the left
hemisphere
- Generalized brain
abnormalities
Psychological
- Childhood maltreatment
•Pharmacotherapy
◦Haloperidol
- To reduce ideas of reference, odd
communication, and isolation
◦Antipsychotic medication (younger persons)
•Psychotherapy
◦Treatment includes some of the medical and
psychological treatments for depression
◦Teaching social skills to reduce isolation and
suspicion
◦Cognitive Behavioral Therapy (CBT)
- For younger persons, in order to avoid the onset
of schizophrenia is proving to be a promising
prevention strategy
✔Pervasive pattern of disregard for & violation of the rights of others,
occurring since age 15, as indicated by 3/more of the ff:
1.Failure to conform to social norms w/ respect to lawful behaviors, as
Neurobiological
- Genetics
- Underarousal theories
•Rarely identify themselves as needing treatment
•Most clinicians are pessimistic about the outcome of
treatment for adults as they can be manipulative even

Antisocial PD
Disregard for &
violation of the
rights of others
indicated by repeatedly performing acts that are grounds for arrest
2.Deceitfulness, as indicated by repeated lying, use of aliases or conning
of others for personal profit/pleasure
3.Impulsivity/failure to plan ahead
4.Irritability & aggressiveness, as indicated by repeated physical
fights/assaults
5.Reckless disregard for safety of self/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
✔Individual is at least 18 years old
✔There is evidence of conduct disorder with onset before age 15 years
(psychopaths have low levels
of cortisol arousal)
- Fearlesness theories
(higher threshold for
experiencing fear than others)
- Imbalance between BIS
Behavioral Inhibition System
(ability to stop when we are
faced w/ impending
punishment) & reward
system may make the fear &
anxiety less apparent & the
positive feelings more
prominent
- Reduced activation in
frontal cortex
Behavioral
- Once they set their sights on
a reward goal, they are less
likely to be deterred despite
the signs that it is
unachievable
Social
- Coercive family process
- Less parental involvment
with their therapists
•In general, therapists agree with incarcerating
(imprisoning) these people to defer future antisocial
acts
•Clinicians encourage identification of high-risk
children so that treatment can be attempted before
they become adults
•Parent training for children
•Prevention through preschool programs
Borderline PD
Instability of
interpersonal
relationships, self-
image, affects &
control over
impulses
✔Pervasive pattern of instability of interpersonal relationships, self-
image & affects and marked impulsivity, beginning by early adulthood,
as indicated by 5/more of the ff:
1.Frantic efforts to avoid real/imagined abandonment (Don’t include
suicidal/self-mutilating behavior covered in Criterion 5)
2.Pattern of unstable & intense interpersonal relationships characterized
by alternating between extremes of idealization & devaluation
3.Identity disturbance: markedly & persistently unstable self-image/sense
of self
4.Impulsivity in at least 2 areas that are potentially self-damaging
(spending, sex, substance abuse, reckless driving, binge eating) (Not
suicidal/self-mutilating behavior)
5.Recurrent suicidal behavior, gestures or threats or self-mutilating
behavior
6.Affective instability due to a marked reactivity of mood (ex. Intense
episodic dysphoria, irritability, anxiety only lasting a few hours)
Neurobiological
- Genetics
- Low serotonergic activity is
involved w/ the regulation of
mood & impulsivity
Psychological
- Early trauma (sexual &
physical abuse)
- Temperament
Cultural
- Immigrant
•Pharmacotherapy
◦Mood stabilizers
▪Anticonvulsive and antipsychotic drugs
- effective for disturbances in affect (e.g.,
anger, sadness)
•Psychotherapy
◦Cognitive-Behavioral Therapy (CBT)
▪Dialectical Behavior Therapy (DBT)
- Involves helping people cope with the
stressors that seem to trigger suicidal
behaviors
◦Patients appear quite distressed and are more
likely to seek treatment
◦Symptomatic treatment

7.Chronic feelings of emptiness
8.Inappropriate, intense anger or difficulty controlling anger
9.Transient, stress-related paranoid ideation/severe dissociative
symptoms
Histrionic PD
Excessive emotion
& attention
seeking
✔Pervasive pattern of excessive emotionality & attention seeking,
beginning by early adulthood, as indicated by 5/more of the ff:
1.Uncomfortable in situations in which he/she is not the center of
attention
2.Interaction w/ others is often characterized by inappropriate sexually
seductive/provocative behavior
3.Displays rapidly shifting & shallow expression of emotions
4.Consistently uses physical appearance to draw attention to self
5.Has a style of speech that is excessively impressionistic & lacking in
detail
6.Shows self-dramatization, theatricality & exaggerated expression of
emotion
7.Is suggestible
8.Considers relationships to be more intimate than they actually are
Biological
- Co-occuring w/ antisocial
pd
- Genetics
Psychological
- Child abuse/trauma/neglect
•A large part of therapy focuses on the problematic
interpersonal relationships
•People with the disorder need to be shown how the
short-term gains derived from their various
interactional styles (e.g., emotional crises, using
charm, sex, seductiveness, or complaining) result in
long-term costs, and be taught more appropriate ways
of negotiating their wants and needs
Narcissistic PD
Grandiosity, need
for admiration &
lack of empathy
✔Pervasive pattern of grandiosity, need for admiration & lack of
empathy beginning by early adulthood, as indicated by 5/more of the
ff:
1.Grandiose sense of self-importance
2.Preoccupied w/ fantasies of unlimited success, power, brilliance,
beauty or ideal of love
3.Believes that he/she is special & unique and can only be understood by,
or should associate with, other special/high status people/institution
4.Requests excessive admiration
5.Has a sense of entitlement
6.Interpersonally exploitative
7.Lacks empathy
8.Often envious of others/believes that others are envious of him/her
9.Shows arrogant, haughty behaviors/attitudes
Environmental
- Failure by the parents of
modeling empathy
Cultural
- most Western societies with
large-scale social changes
- Baby boomers (“me”
generation)
•Psychotherapy
◦Therapy focuses on the person’s grandiosity,
their hypersensitivity to evaluation, and their
lack of empathy towards others
◦Cognitive therapy
- Strives to replace the person’s fantasies with a
focus on the day-to-day pleasurable experiences
that truly attainable
◦Coping strategies such as relaxation training to
help them face and accept criticism
◦Helping them focus on the feelings of others
Avoidant PD
Social inhibition,
feelings of
inadequacy &
hypersensitivity to
negative
evaluation
✔Pervasive pattern of social inhibition, feelings of inadequacy &
hypersensitivity to negative evaluation, beginning by early adulthood,
as indicated by 4 or more of the ff:
1.Avoids occupational activities that involve significant interpersonal
contact because of fears of criticism, disapproval/rejection
2.Unwilling to get involved w/ people unless certain of being liked
3.Shows restraint within intimate relationships because of the fear of
being shamed/ridiculed
4.Preoccupied w/ being criticized/rejected in social situations
5.Inhibited in new interpersonal situations because of feelings of
Biological
- Family history of
schizophrenia
Psychological
- Difficult temperament or
personality characteristics
- Low-self esteem
Environmental
•Behavioral Therapy
◦Behavioral intervention techniques for anxiety
and social skills problems
◦Systematic desensitization
◦Behavioral rehearsal
•Many of the same treatments used for social phobia
•Therapeutic alliance
- The collaborative connection between therapist and
client
- An important predictor for treatment success

inadequacy
6.Views self as socially inept, personally unappealing or inferior to others
7.Unusually reluctant to take personal risks or to engage in any new
activities because they may prove embarrassing
- Neglect of parents
- Childhood isolation,
rejection & conflict w/ others
Dependent PD
Excessive need to
be taken care of
✔Pervasive & excessive need to be taken care of that leads to submissive
& clinging behavior & fears of separation, beginning by early
adulthood as indicated by 5/more of the ff:
1.Difficulty making everyday decisions without an excessive amount of
advice & reassurance from others
2.Needs others to assume responsibility for most major areas of life
3.Difficulty expressing disagreement w/ others because of fear of loss of
support/approval (Do not include realistic fears of distribution)
4.Has difficulty initiating projects or doing things on his/her own (lack of
self-confidence/abilities rather than lack of motivation/energy)
5.Goes to excessive lengths to obtain nurturance & support from others,
to the point of volunteering to do things that are unpleasant
6.Feels uncomfortable/helpless when alone because of exaggerated fears
of being unable to take care of him/herself
7.Urgently seeks another relationship as a source of care & support when
a close relationship ends
8.Unrealistically preoccupied w/ fears of being left to take care of
himself
Behavioral
- Genetics
Environmental
- Early death of a parental
- Parental neglect/rejection
•People with the disorder can appear to be ideal
patients because of their attentiveness and eagerness
to give responsibility for their problems to the
therapist
•This submissiveness, however, negates one of the
major goals of therapy: make the person more
independent and personally responsible
•Therapy progresses gradually as the patient develops
confidence in their ability to make decisions
independently
Obsessive-
Compulsive PD
Preoccupation w/
orderliness,
perfectionism &
control
✔Pervasive pattern of preoccupation w/ orderliness, perfectionisim &
mental & interpersonal control, at the expense of flexibility, openness
& eficiency, beginning by early adulthood as indicated by 4 or more of
the ff:
1.Preoccupied w/ details, rules, lists, order, organization or schedules to
the extent that the major point of the activity is lost
2.Shows perfectionism that interferes w/ task completion
3.Excessively devoted to work & productivity to the exclusion of leisure
activities & friendships (not accounted for by obvious economic
necessity)
4.Overconscientious, scrupulous & inflexible about matters of morality,
ethics or values (not accounted for by cultural/religious identification)
5.Unable to discard worn-out/worthless objects even when they have no
sentimental value
6.Reluctant to delegate tasks or to work with others unless they submit to
exactly his/her way of doing things
7.Adopts a miserly spending style toward both self & other; money is
viewed as something to be hoarded for future catastrophes
8.Shows rigidity & stubbornness
Biological
- Family history of
personality disorders, anxiety
or depression
•Therapy often attacks the fears that seem to underlie
the need for orderliness
•Therapists help the individual relax or use distraction
techniques to redirect the compulsive thoughts

SCHIZOPHRENIA SPECTRUM & OTHER PSYCHOTIC DISORDERS
DISORDER DIAGNOSTIC CRITERIA ETIOLOGY INTERVENTIONS
Schizophrenia
Disorder
Characterized by
broad spectrum
of cognitive &
emotional
dysfunctions
including
hallucinations,
delusions,
disorganized
speech &
behavior and
inappropriate
emotions
✔2/more of the ff, each present for a significant portion of time during a 1
month period (less if treated), at least one of these must be 1, 2 or 3:
1.Delusions
2.Hallucinations
3.Disorganized speech
4.Grossly disorganized/catatonic behavior
5.Negative symptoms
✔For a significant portion of the time since the onset of the disturbance,
level of functioning in 1/more major areas (work, interpersonal relations
or self-care) is markedly below the level achieved prior to the onset (when
onset is in childhood/adolescence: there’s failure to achieve expected level
of interpersonal, academic or occupational functioning)
✔Continuous signs of the disturbance persist for at least 6 months. This 6-
month period must include at least 1 month of symptoms (less if treated)
that meet Criterion A & may include periods of prodomal/residual
symptoms. During these prodomal/residual periods, signs of the
disturbance may be manifested by only negative symptoms or by 2 or
more symptoms listed in Criterion A present in an attenuated form
✔Schizoaffective, depressive or bipolar disorder w/ psychotic features have
been ruled out because either a) no major depressive/manic episodes have
occurred concurrently w/ the active-phase symptoms (Criteria A) or b) if
mood episodes have occurred during active phase symptoms, they have
been present for a minority of the total duration of the active & residual
periods of the illness
✔If there’s a history of autism or communication disorder of childhood
onset, the additional diagnosis of schizophrenia is made only if prominent
delusions/hallucinations, in addition to other required symptoms, are also
present for at least 1 month (or less if treated)
Specify if: With catatonia
Biological
- Genetics
- Inherited
- Chromosome 8 (NRG1), 6
(DTNBPI1), 22 (COMT)
- COMT (dopamine metabolism)
- Eye-tracking deficit may be an
endophenotype
Neurobiological
- Excessive dopamine activity
- Excessive stimulation of
striatal dopamine D2 receptors
- Striatum (movement, balance
& relies on dopamine)
-Deficiency in stimulation of
prefrontal dopamine D1
receptors (thinking & reasoning)
- Alterations in prefrontal
activity involving glutamate
transmission
- N-methyl-aspartate (NMDA)
receptor of glutamate
- Phencyclidine & Ketamine can
result in psychotic-like behavior
(NMDA antagonist) – deficit in
glutamate/blocking of NMDA
sites may be involved in some
symptoms of schizophrenia
- Enlargement of lateral & 3
rd

ventricles
- Hypofrontality (frontal lobe is
less active) – particularly in
dorsolateral prefrontal cortex
(DLPFC)
- Hyperfrontality (too much
activity in frontal lobe) – for
some
Environmental
•Pharmacotherapy
◦Antipsychotic Medications
▪Neuroleptics
- Meaning “taking hold of the nerves”
- Provided the first real hope
- Help people think more clearly and
reduce hallucinations and delusions
- Dopamine antagonists
- Hadol and Thorazine – earliest
neuroleptics drugs; called
conventional or first-generation
antipsychotics
- Risperidone and Olanzapine –
newer medications; called atypical or
second-generation antipsychotics
•Biological Therapy
◦Insulin coma therapy
- Was thought for a time to be helpful, but
closer examination showed it carried great
risk of serious illness and death
◦Psychosurgery
◦Electroconvulsive Therapy (ECT)
◦Transcranial Magnetic Stimulation
- Treatment for hallucinations
- Uses wire coils to repeatedly generate
magnetic fields-up to 50 times per second-
that pass though the skull to the brain
•Psychosocial Therapy
◦Clinicians attempt to reattach social skills
such as basic conversation, assertiveness,
and relationship building
◦Therapists divide complex social skills
into their component parts, which clients
model
◦Clients do role-playing and ultimately
practice their new skills in the “real
world”
◦Programs teach a range of ways people
can adapt to their disorder yet live in the
community
Catatonia
Associated w/
Another Mental
Disorder
(Catatonia
Specifier)
✔The clinical picture is dominated by 3/more of ff:
1.Stupor (no psychomotor activity; not actively relating to environment)
2.Cataplexy (passive induction of a posture held against gravity)
3.Waxy flexibility (slight, even resistance to positioning by examiner)
4.Mutism (no or very little verbal response, exclude if aphasia)
5.Negativism (opposition/no response to instructions/external stimuli)
6.Posturing (spontaneous & active maintenance of posture against gravity)
7.Mannerism (odd, circumstantial caricature of normal actions)
8.Stereotypy (repetitive, abnormally frequent, non-goal-directed
movements)
9.Agitation, not influenced by external stimuli

10.Grimacing
11.Echolalia (mimicking another’s speech)
12.Echopraxia (mimicking another’s movements)
- Fetal exposure to viral
infection, preg complications
- Early use of marijuana
- Schizophrenogenic mother
(cold, dominant mother)
- Double bind communication
(conflicting messages)
- Expressed Emotion (EE) –
George Brown, high expression
of family = relapse
Psychological
- Stress
◦Virtual assessments and treatments
- Provide clinicians with controllable and
safer environments in which to study and
treat persons with schizophrenia
◦Behavioral family therapy
- Resembles classroom education
- Family members are informed about
schizophrenia and its treatment, relieved
of the myth that they caused the disorder
- Family members are taught practical
facts about antipsychotic medications and
their side effects
- Family members are helped with
communication skills & problem-solving
skills so that they can become more
empathic listeners
◦Vocational rehabilitation
- Supportive employment – involves
providing coaches who give on-the-job
training
◦Assertive Community Treatment (ACT)
Program
- Involves using a multidisciplinary team
of professionals to provide broad-ranging
treatment
◦Social Skills Training
- can be directly supportive and useful to
the patients
◦Case Management
- helps patient cope up with the treatment
whether pharmacological or
psychotherapy
◦Cognitive Behavioral Therapy (CBT)
- to improve cognitive distortion, reduce
distractibility, and correct errors in
judgment
◦Individual Psychotherapy
- helpful and that the effects are additive to
those of pharmacological treatment
◦Personal Therapy
- to enhance personal and social
adjustment and to forestall relapse
Schizophrenifor
m Disorder
Schizophrenia
that only lasts for
1 to 6 months &
can usually
resume normal
lives
✔2/more of the ff, each present for a significant portion of time during a 1-
month period (less if treated). At least one of these must be 1, 2, or 3:
1.Delusions
2.Hallucinations
3.Disorganized speech
4.Grossly disorganized/catatonic behavior
5.Negative symptoms
✔An episode lasts at least 1 month but less than 6 months. When the
diagnosis must be made without waiting for recovery, it should be
qualified as “provisional”
✔Schizoaffective, depressive or bipolar disorder w/ psychotic features have
been ruled out because either a) no major depressive/manic episodes have
occurred concurrently w/ the active-phase symptoms or b) if mood
episodes have occurred during active-phase symptoms, they have been
present for a minority of the total duration of the active & residual periods
of the illness
Specify if:
With good prognostic features: Presence of at least 2 of the ff: onset of prominent
psychotic symptoms within 4 weeks of the first noticeable change in usual
behavior/functioning; confusion/perplexity; good premorbid social & occupational
functioning; absence of blunted/flat affect
Without good prognostic features: 2 or more of the above features are not present
Specify if:
With catatonia
Provisional: Patient is still ill within 6 months
Schizophrenia or some other disorder: Ill after 6 months
Schizoaffective
Disorder
Experience of
both psychosis
and mood
symptoms
✔Uninterrupted period of illness during which there is a major episode
(major depressive/manic) concurrent w/ Criterion A of schizophrenia
(Major Depressive episode must include Criterion A1)
✔Delusions/hallucinations for 2 or more weeks in the absence of a major
mood episode (depressive/manic) during the lifetime duration of the
illness
✔Symptoms that meet criteria for a major mood episode are present for the
majority of the total durance of the active & residual portions of the illness
Specify whether:
Bipolar Type: If a manic episode is part of the presentation. Major depressive
episode may also occur.
Depressive Type: If only major depressive episodes are part of the presentation
Specify if: With catatonia

◦Dialectical Behavior Therapy
- improves interpersonal skills in the
presence of an active and emphatic
therapist
◦Art Therapy
- provides an outlet for their constant
bombardment of imagery
◦Cognitive Training/ Remediation
- utilizes computer generated exercises for
the cognition
•Across Cultures
◦Kenya
- Kisii tribal doctors listen to their
patients to find the location of the noises
in their heads (hallucinations), then get
them drunk, cut out a piece of scalp, and
scrape the skull in the area of the voices
◦Xhosa people of South Africa
- Report using traditional healers who
sometimes recommend the use of oral
treatments to induce vomiting, enemas,
and the slaughter of cattle to appease the
spirits
◦Hispanics
- Family support
◦British
- Use more biological, psychological, and
community treatments
◦Native Chinese
- Hold more religious beliefs about both
the causes and treatments of schizophrenia
Delusional
Disorder
Persistent belief
that is contrary to
reality in the
absence of
schizophrenia
✔The presence of 1/more delusions with a duration of 1 month or longer
✔Criterion A for schizophrenia has never been met
(Hallucinations are not prominent & are related to the delusional theme)
✔Apart from the impact of the delusion(s) or its ramifications, functioning
is not markedly impaired & behavior is not bizarre/odd
✔If manic/major depressive episode has occurred, these have been brief
relative to the duration of the delusional periods
Specify whether:
Erotomanic Type: Another person is in love w/ the individual
Grandiose Type: Conviction of having great talent/important discovery
Jealous Type: Spouse is unfaithful
Persecutory Type: Being cheated, spied on, harassed, followed, etc.
Somatic Type: Bodily functions/sensations
Mixed Type: No delusional predominated
Unspecified Type: Cannot be clearly determined
Specify if:
With bizarre content: improbable delusions
Brief Psychotic
Disorder
Presence of 1 or
more positive
symptoms that
lasts only for 1
month or less
✔Presence of 1/more of the ff. At least 1 of these must be 1, 2 or 3:
1.Delusions
2.Hallucinations
3.Disorganized Speech
4.Grossly disorganized/catatonic behavior
✔Duration of an episode is at least 1 day but less than 1 month, with
eventual full return to premorbid level of functioning
Specify if:
W/ marked stressors (brief reactive psychosis): Because of stressful events
Without marked stressors: Symptoms do not occur because of stressful events
W/ postpartum onset: Onset is during pregnancy or within 4 weeks portpartum
Specify if: With catatonia
Substance/
Medication-
Induced
Psychotic
Disorder
Psychosis due to
direct effect of
substance or
withdrawal from
a substance
without delirium
✔Presence of 1 or both of the ff:
1.Delusions
2.Hallucinations
✔Evidence from the history, physical examination or lab findings of both:
1.Symptoms in Criterion A developed during or soon after substance
intoxication/withdrawal or after exposure to a medication
2.Involved substance is capable of producing symptoms in Criterion A
✔Does not occur during the course of a delirium
(Diagnosis is made only when symptoms in Criterion A predominate in the clinical
picture & when they are sufficiently severe to warrant clinical attention)
Specify if:
With onset during intoxication/withdrawal
With onset after medication use

Psychotic
Disorder
Associated w/
Another Medical
Condition
✔Prominent hallucinations/delusions
✔Evidence from the history, physical examination/lab findings that
disturbance is the direct pathophysiological consequence of another
medical condition
✔Does not occur exclusively during the course of a delirium
NEURODEVELOPMENTAL DISORDERS
DISORDER DIAGNOSTIC CRITERIA ETIOLOGY INTERVENTIONS
Attention-
Deficit/
Hyperactivity
Disorder
(ADHD)
Characterized by
inattention,
impulsivity,
and/or
hyperactivity,
usually first
diagnosed in
childhood
✔Persistent pattern of inattention or hyperactivity-impulsivity as
characterized by 1 and/or 2:
1.Inattention: 6/more of the ff for at least 6 months: (17 & older: at
least 5 symptoms)
a)Fails to give close attention to details/makes careless mistakes
in works or any activities
b)Difficulty in sustaining attention/focus in tasks/play activities
c)Doesn’t seem to listen when spoken to directly
d)Doesn’t follow instructions & fails to finish works, chores or
duties
e)Difficulty organizing tasks & activities
f)Avoids, dislikes or reluctant to engage in tasks that require
sustained mental effort
g)Loses things needed for tasks/activities
h)Easily distracted by extraneous stimuli
i)Forgetful in daily activities
2.Hyperactivity & Impulsivity: 6/more of the ff for at least 6 months:
(17 & older: at least 5)
a)Fidgets with/taps hands/feet or squirms in seat
b)Leaves seat in situations when remaining seated is expected
c)Runs about/climbs in situations where it is inappropriate
d)Unable to play/engage in leisure activities quietly
e)“On the go” acting as if “driven by motor”
f)Talks excessively
g)Blurts out answer before a question has been completed
h)Difficulty waiting for his/her turn
i)Interrupts/intrudes on others
✔Several symptoms were present prior to age 12 years & are present
in 2 or more settings
Specify whether:
Combined Presentation: Both Criterion A1 & A2 are met for the past 6
months
Biological
- Genetics
- Having a specific dopamine
transporter (DAT1) & serotonin
transporter
- Copy number variants – extra
copies of a gene on 1
chromosome / deletion of genes
- Dopamine D4, receptor gene,
DAT1, Dopamine D5 receptor
gene
- Poor inhibitory control (ability
to stop responding to a task when
signaled)
- Slightly smaller brain
Environmental
- Unpopular & rejected by peers
- Prenatal smoking, stress &
alcohol use
Psychological
- Negative responses of parents
& peers
- Low self-esteem
•Pharmacotherapy
◦Stimulants
▪Methylphenidate (Ritalin, Adderall) and
other non-stimulant medications such as
Atomoxetine (Strattera), Guanfacine
(Tenex), and Clonidine
- have proved helpful in reducing the core
symptoms of hyperactivity and impulsivity,
and in improving concentration on tasks
•Psychotherapy
◦Goal: to help parents of children with ADHD
recognize and promote the notion he/she is still
capable of being responsible for meeting
reasonable expectations
◦Improving academic performance
◦Decreasing disruptive behavior
◦Social skills training
- Teaching the child how to interact appropriately
with peers
◦Reinforcement programs
- Rewarding the child for improvements
- Punishing misbehavior with loss of rewards
◦Parent education programs
- Teaching families how to respond
constructively to their child’s behaviors and how
to structure the child’s day to help prevent
difficulties
◦Cognitive-Behavioral Therapy (CBT)
- For adults with ADHD
- To reduce distractibility and improve
organizational skills

Predominantly Inattentive Presentation: Only Criterion A1 is met for the
past 6 months
Predominantly Hyperactive/Impulsive Presentation: Only Criterion A2
is met for the past 6 months
Specify if:
In partial remission: Criteria not met but impairment persists
Specify severity:
Mild: Few symptoms
Moderate: Intermediate
Severe: Many symptoms, more than required for diagnosis
Specific
Learning
Disorder
Affects 1 of 3
areas: reading,
writing and/or
math. that begins
during school-age
but may not be
recognized until
adulthood.
✔Difficulty learning & using academic skills, as indicated by at least
1 of the ff that have persisted for at least 6 months, despite the
provision of interventions that target those difficulties:
1.Inaccurate/slow & effortful word reading
2.Difficulty understanding the meaning of what is read
3.Difficulties with spelling
4.Difficulties with written expression
5.Difficulties mastering number sense, facts or calculation
6.Difficulties with mathematical reasoning
✔The affected academic skills are substantially below those
expected for the individual’s chronological age & cause significant
interference w/ academic/occupational performance as confirmed
by individually administered achievement measures &
comprehensive clinical assessment. (17 years & older: a
documented history of impairing learning difficulties may be
substituted)
✔Difficulties begin during school-age years but may not become
fully manifest until the demands for those affected academic skills
exceed the individual’s limited capacities
(Criteria are met based on clinical synthesis of the individual’s history,
school reports & psychoeducational assessment)
Specify if:
With Impairment in Reading: Word reading accuracy; Reading
rate/fluency; Reading comprehension
With Impairment in Expression: Spelling accuracy; Grammar &
Punctuation accuracy; Clarity/Organization of written expression
With Impairment in Mathematics: Number sense; Memorization of
arithmetic facts; Accurate calculations; Accurate math reasoning
Specify severity:
Mild: Patient can compensate some problems
Moderate: Requires considerable remediation for proficiency
Severe: Difficult to overcome without intensive remediation
Neurobiological
- Genetics
- Problems in dyslexia, Broca’s
area, area in the left
parietotemporal area & area in
the left occipitotemporal area
- Intraparietal Sulcus – critical
for the development of a sense of
numbers
- All people w/ reading disorders
has reduced activity in left
temporal lobe
Environmental
- Reading habits of families
•Pharmacotherapy
◦Methylphenidate (Ritalin, Adderall)
◦Restricted to individuals who may also have
comorbid ADHD
•Educational Intervention
◦Specific skills instruction
- Vocabulary
- Finding the main idea
- Finding facts in readings
◦Strategy instruction
- Includes efforts to improve cognitive skills
through decision making and critical thinking
◦Direct Instruction
- A program
- Components: systematic instruction (using
highly scripted lesson plans that place students
together in small groups based on their progress)
and teaching for mastery (teaching students until
they understand all concepts)
◦Remedial Treatment

Autism
Spectrum
Disorder (ASD)
Characterized by
persistent
impairments in
reciprocal social
communication &
social interaction,
and restricted,
repetitive patterns
of behavior,
interests, or
activities.
✔Persistent deficits in social communication & social interaction
across multiple contexts, as manifested by the ff, currently or
history:
1.Deficits in social-emotional reciprocity
2.Deficits in nonverbal communicative behaviors used for social
interaction
3.Deficits in developing, maintaining & understanding relationships
✔Restrictive, repetitive patterns of behavior, interests or activities, as
manifested by at least 2 of the ff:
1.Stereotyped/repetitive motor movements, use of objects/speech
2.Insistence on sameness, inflexible adherence to routines or
ritualized patterns of verbal/non-verbal behavior (ex. Extreme
distress at small changes, transitions)
3.Highly restricted, fixated interests that are abnormal in
intensity/focus (ex. Strong attachment w/ unusual objects)
4.Hyper or hypoactivity to sensory input or unusual interest in
sensory aspects of the environment (Ex. Indifference to
pain/temperature, adverse response to specific sounds/textures)
✔Symptoms must be present in the early developmental period but
may not be fully manifest until social demands exceed limited
capacities or may be masked by learning strategies in later life
Specify if:
With/Without accompanying intellectual impairment
With/Without accompanying language impairment
Associated w/ a known medical/genetic condition
Associated w/ another disorder
With catatonia
Specify severity:
- Social Communication
Level 1 (mild): Trouble starting conversations or less interested (Requiring
support)
Level 2 (moderate): Deficits in both verbal & nonverbal communication
(Requiring substantial support)
Level 3 (severe): Little response to others (Requiring very substantial
support)
- Restricted, Repetitive Behaviors
Level 1 (mild): Changes provokes some problems in at least 1 area of
activity (Requiring support)
Level 2 (moderate): Problems in coping w/ change are readily apparent &
interferes in various are of functioning (RSS)
Level 3 (severe): Change is exceptionally hard (RVSS)
Neurobiological
- Genetics
- Amygdala in children is
enlarged causing excessive
anxiety & fear. With continued
stress, the release of stress
hormone cortisol damages the
amygdala, causing the absence of
neurons in adulthood
- Low levels of oxytocin
Environmental
- Perfectionist, cold & aloof
parents
- Older parents (de novo
mutations)
Psychological
- Lack of self-awareness
(tendency to avoid first-person
pronouns)
Cultural
- High SES
•No completely effective treatment exists
•Pharmacotherapy
◦Major tranquilizers and SSRIs
- Most helpful in decreasing agitation
-Unlikely that one drug will work for everyone
•Psychotherapy
◦Behavioral approaches that focus on skill
building and behavioral treatment of problem
behaviors
◦Communication and socialization
◦Naturalistic teaching strategies
- Includes arranging the environment so that the
child initiates an interest (e.g., placing a favorite
toy just out of reach)
◦Incidental teaching
◦Pivotal response training
◦Milieu teaching
◦Behavior therapy combined pharmacologic
treatments
◦Cognitive Behavioral Therapy (CBT)
- to treat repetitive behavior in individuals
Early Intensive Behavioral and Developmental
Interventions
•UCLA/Lovaas- based Model
•Early Start Denver Model
•Parent Training Approaches
•Social Skills Approaches
◦Social Skills Training
Educational Interventions for children
•Treatment and education of autistic and
communication-related handicapped children
•Broad- based approaches
•Computer-based approaches and virtual reality
Intervention for comorbid symptoms
•Neurofeedback
•Management of insomnia
✔A disorder with onset during the developmental period that
includes both intellectual & adaptive functioning deficits in
Neurobiological
- Genetics (chromosomal, single
•Treatment parallels that of people with more severe
form of Autism Spectrum Disorder

Intellectual
Developmental
Disorder
(Intellectual
Disability)
Includes both
intellectual &
adaptive
functioning
deficits in
conceptual,
social, & practical
domains during
the developmental
period
conceptual, social & practical domains. The ff must be met:
1.Deficits in intellectual functions (reasoning, problem solving,
planning, abstract thinking, judgment, academic learning &
learning from experience) confirmed by both clinical assessment &
individualized, standardized intelligence testing
2.Deficits in adaptive functioning that result in failure to meet
developmental & sociocultural standards for personal
independence & social responsibility. Without ongoing support, the
adaptive deficits limit functioning in 1 or more activities of daily
life (communication, social participation & independent living
across multiple environments)
3.Onset of intellectual & adaptive deficits during the developmental
period
Specify severity:
Mild: IQ of 50-70
Moderate: IQ of high 30s – low 50s
Severe: IQ of low 20s – high 30s
Profound: IQ of low 20s downward
gene, mitochondrial disorders
and multiple genetic mutations
- Dominant gene, recessive gene
or an X-linked gene
- Infections & head injury
- De novo disorders (genetic
mutations in sperm/egg)
- Tuberuous Sclerosis (dominant
gene disorder) – 1 in every
30,000 births (about 60% have
ID)
- Phenylketonuria (PKU) –
recessive disorder
- Lesch-Nyhan Syndrome (X-
linked) – only males are affected
- Down Syndrome & Fragile X
Syndrome
Environmental
- Prenatal exposure to
disease/drugs
- Labor & delivery difficulties
- Abuse, neglect, social
deprivation
◦Teaching individuals the skills they need to
become more productive and independent
•For individuals with mild ID, intervention is similar
to that for people with learning disorders
◦Specific learning deficits are identified and
addressed to help the student improve such skills
are reading and writing
•Communication training
- Can be challenging for individuals with the most
severe disabilities because they may have multiple
physical or cognitive deficits that make spoken
communication difficult or impossible
◦Augmentative communication strategies
- alternative system; may use picture books,
teaching the person to make a request by
pointing to a picture (e.g., pointing to a picture of
a cup to request a drink)
•Teaching people how to communicate their
need/desire for such thing as attention as an
alternative to punishment that may be equally
effective in reducing behavior problems
•Psychotherapy
◦Behavioral Therapy
- to enhance social behaviors and to control and
minimize aggressive and destructive behavior
and benign punishment
◦Cognitive Therapy
- such as dispelling false beliefs and relaxation
exercises with self- instruction
◦Psychodynamic Therapy
- together with their families, to decrease
conflicts about expectations that result in
persistent anxiety, rage, and depression
◦Family Education
- educates the patients about ways to enhance
competence and self-esteem while maintaining
realistic expectations for the patients
◦Social Intervention
- to improve the quantity and quality of social
competence

NEURODEVELOPMENTAL DISORDERS (COMMUNICATION DISORDERS)
DISORDER DIAGNOSTIC CRITERIA ETIOLOGY INTERVENTIONS
Childhood-Onset
Fluency Disorder
(Stuttering)
Disturbance in the
normal fluency & time
patterning of speech
that is inappropriate
for an individual's age.
✔Disturbances in the normal fluency (dysfluencies) & time
patterning of speech that are inappropriate for the individual’s
age and language skills, persist over time, and are characterized
by frequent & marked occurrences of at least 1 of the ff:
1.Sound and syllable repetitions
2.Sound prolongations of consonants as well as vowels
3.Broken words (pauses within a word)
4.Audible or silent blocking (filled or unfilled pauses in speech)
5.Circumlocutions (word substitutions to avoid problematic
words)
6.Words produced with an excess of physical tension
7.Monosyllabic whole-word repetitions (“I-I-I am fine”)
✔The disturbance causes anxiety about speaking or limitations
ineffective communication, social participation, or academic or
occupational performance, individually or in any combination
✔The onset of symptoms is in the early developmental period.
(Adults are diagnosed as adult-onset fluency disorder)
Biological
- Heredity
•Behavioral Intervention
◦Regulated-breathing method
- Person is instructed to stop speaking when a
stuttering episode occurs and then to take a deep
breath (exhale, then inhale) before proceeding
◦Altered auditory feedback
- Electronically changing speech feedback to
people who stutter
- Can improve speech, as can using forms of
self-monitoring, in which people modify their
own speech for the words they stutter
•Psychosocial Therapy
◦Parents are counseled about how to talk to their
children
Language Disorder
Difficulties in the
acquisition & use of
language, due to
deficits in the
production or
comprehension of
vocabulary, discourse,
& sentence structure
✔Persistent difficulties in the acquisition and use of language
across modalities (spoken, written, sign language, or other) due
to deficits in comprehension or production that include the ff:
1.Reduced vocabulary (word knowledge/use)
2.Limited sentence structure (ability to put words and word
endings together to form sentences based on the rules of
grammar and morphology)
3.Impairments in discourse (ability to use vocabulary and
connect sentences to explain or describe a topic or series of
events or have a conversation).
✔Language abilities are substantially and quantifiably below
those expected for age, resulting in functional limitations
✔Onset of symptoms is in the early developmental period.
Environmental
- Family history of language
disorders
•May be self-correcting and may not require special
intervention
✔Persistent difficulties in the social use of verbal and nonverbal
communication as manifested by all of the following:
1.Deficits in using communication for social purposes (greeting
& sharing information) in a manner that is appropriate for the
social context.
2.Impairment of the ability to change communication to match
Neurobiological
- Right hemisphere is implicated
•Individualized social skills training (e.g., modeling,
role playing) with an emphasis on teaching
important rules necessary for carrying on
conversations with others (e.g., what is too much
and too little information)

Social (Pragmatic)
Communication
Disorder
Difficulty with
pragmatics, or the
social use of language
and communication
context/needs of the listener (speaking differently in a
classroom than on a playground, talking differently to a child
than to an adult, and avoiding use of overly formal language)
3.Difficulties following rules for conversation and storytelling
(taking turns in conversation, rephrasing when misunderstood
& knowing how to use verbal and nonverbal signals to regulate
interaction)
4.Difficulties understanding what is not explicitly stated &
nonliteral/ambiguous meanings of language (idioms, humor,
metaphors, multiple meanings)
✔The deficits result in functional limitations
✔The onset of the symptoms is in the early developmental period
(but deficits may not become fully manifest until social
communication demands exceed limited capacities)
✔Autism spectrum disorder must be ruled out before the
diagnosis
Speech Sound
(Phonological)
Disorder
Speech sound
production is not
consistent with what is
expected based on the
child's developmental
stage and age.
✔Persistent difficulty with speech sound production that
interferes with speech intelligibility or prevents verbal
communication of messages
✔The disturbance causes limitations in effective communication
✔Onset of symptoms is in the early developmental period.
✔The difficulties are not attributable to congenital (during fetal
development) or acquired conditions, such as cerebral palsy,
cleft palate, deafness or hearing loss, traumatic brain injury, or
other medical or neurological conditions. Hereditary and
genetic disorders (Down Syndrome) are excluded from this
criterion.
Biological
- Genetic Disorders: Down
syndrome, DiGeorge Syndrome
& FoxP2 gene mutation
NEURODEVELOPMENTAL DISORDERS (MOTOR DISORDERS)
DISORDER DIAGNOSTIC CRITERIA ETIOLOGY INTERVENTIONS
Persistent (Chronic)
Motor/Vocational Tic
Disorder
Single/multiple motor
or vocal tics, but not
both motor and vocal
for more than 1 year
✔Single/multiple motor or vocal tics have been present during
the illness, but not both motor and vocal.
✔The tics may wax and wane in frequency but have persisted for
more than 1 year since first tic onset
✔Onset is before 18 years old
Neurobiological
- Heredity & Genetics
- Changes in parts of the brain
that controls movement
- Specific gene mutations
- Dopamine, serotonin &
glutamate
Environmental
- Stress
•Psychotherapy
◦Self-monitoring
◦Relaxation training
◦Habit reversal
◦Sensory integration programs
◦Modified physical education
Provisional Tic
Disorder
Single/multiple motor
✔Single or multiple motor and/or vocal tics
✔The tics have been present for less than 1 year since first tic
onset

and/or vocal tics for
less than 1 year
✔Onset is before 18 years old - Sleep deprivation
Tourette’s Disorder
Multiple motor & at
least 1 or more vocal
tics for more than 1
year
✔Both multiple motor and 1/more vocal tics have been present at
sometime during the illness, although not necessarily
concurrently.
✔The tics may wax and wane in frequency but have persisted for
more than 1 year since first tic onset
✔Onset is before 18 years old
Developmental
Coordination
Disorder (DCD)
Lifelong condition that
makes it hard to learn
motor skills and
coordination.
✔The acquisition & execution of coordinated motor skills is
below the expected given the individual’s chronological age &
opportunity for skill learning & use. Difficulties are manifested
as clumsiness & slowness & inaccuracy of performance of
motor skills
✔The motor skills deficit in Criterion A significantly &
persistently interferes with activities of daily living appropriate
to chronological age
✔Onset of symptoms is in the early developmental period
Stereotypic
Movement Disorder
Repetitive, purposeless
movements
✔Repetitive, seemingly driven, & apparently purposeless motor
behavior (hand shaking/waving, body rocking, head banging,
self-biting, hitting own body)
✔Onset is in the early developmental period.
Specify if:
With self-injurious behavior
Without self-injurious behavior
Associated with a known medical/genetic condition,
neurodevelopmental disorder, or environmental factor
Specify severity:
Mild: Symptoms are readily managed behaviorally
Moderate: Require behavior modification & specific protective
measures
Severe: Require continuous watching
NEUROCOGNITIVE DISORDERS
DISORDER DIAGNOSTIC CRITERIA ETIOLOGY INTERVENTIONS
Delirium
Acute temporary
confusional state w/
global impairments in
attention & cognition
✔Disturbance in attention (reduced ability to direct, focus,
sustain, and shift attention) and awareness (reduced
orientation to the environment)
✔The disturbance develops over a short period of time (hours
to a few days), represents a change from baseline attention
& awareness & tends to fluctuate in severity during the
course of a day.
✔An additional disturbance in cognition (memory deficit,
Neurobiological
- Medications
- Age
- Disruption of connectivity
between dorsolateral prefrontal
cortex & posterior cingulate
cortex
- Reversible disruptions between
•Pharmacotherapy
◦Antipsychotic medications
▪Haloperidol
- Treatment for delirium brought on by
withdrawal from alcohol
- Can have a calming effect
•Psychotherapy
◦Recommended first line of treatment

disorientation, language, visuospatial ability)
✔There is evidence from the history, physical examination,
or laboratory 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
Specify if:
Hyperactive: Agitaion/increased level of activity
Hypoactive: Reduced level of activity
Mixed level of activity: Normal/fluctuating level
Specify duration:
Acute: Lasts hours to a few days
Persistent: Lasts weeks or longer
thalamus & reticular activating
system
Environmental
- Sleep deprivation
- Immobility
- Stress
◦Goal is to reassure the individual to help them
deal with the agitation, anxiety, and
hallucinations of delirium
◦Patient who is included in all treatment decisions
retains a sense of control
Mild Neurocognitive
Disorder/Mild
Cognitive Impairment
(MCI)
Cognitive impairment
with minimal
impairment of
instrumental activities
of daily living (IADLs)
✔Evidence of modest cognitive decline from a previous level
of performance in 1/more cognitive domains (complex
attention, executive function, learning and memory,
language, perceptual motor, or social cognition) based on:
1.Concern of the individual, a knowledgeable informant, or
the clinician that there has been a significant decline in
cognitive function
2.A substantial impairment in cognitive performance,
preferably documented by standardized neuropsychological
testing or, in its absence, another quantified clinical
assessment.
✔The cognitive deficits do not interfere with capacity for
independence in everyday activities (complex instrumental
activities of daily living like paying bills or managing
medications are preserved, but greater effort, compensatory
strategies, or accommodation may be required)
✔The cognitive deficits do not occur exclusively in the
context of a delirium
Specify if:
With/Without behavioral disturbance
Neurobiological
- Alzheimer’s Disease
- Damage in Neurofibrillary
Tangles & Amyloid Plaques
(Neuritic/Sensile Plaques)
- Amyloid Precursor Protein
(APP) produces the amyloid
protein found in amyloid plaques
- Brain atrophy (shrink)
- Chromosome 21, 14, 19, 12 and
1
- Deterministic Genes – if you
have these, 100% chance of
developing Alzheimer’s (Amyloid
Beta Peptides, Presenilin 1 & 2)
- Deposits of Amyloid Beta (Ab)
causes the cell death
- Apolipoprotein (Apo E4) causes
amyloid proteins to build up in the
neurons of people w/ Alzheimer’s
- Head trauma
Cultural
- Preindustrial rural societies
(insufficient vitamins)
- Occupational safety (head
injury)
✔Evidence of significant cognitive decline from a previous
level of performance in 1/more cognitive domains
(complex attention, executive function, learning and
memory, language, perceptual-motor, or social cognition)
based on:
1.Concern of the individual, a knowledgeable informant, or
the clinician that there has been a significant decline in

Major Neurocognitive
Disorder
Progressive condition
marked by gradual
deterioration of a range
of cognitive abilities
cognitive function
2.A substantial impairment in cognitive performance,
preferably documented by standardized neuropsychological
testing or another quantified clinical assessment.
✔The cognitive deficits interfere with independence in
everyday activities (at a minimum, requiring assistance
with complex instrumental activities of daily living like
paying bills or managing medications)
Specify if:
With/Without behavioral disturbance
Specify severity:
Mild: Requires help w/ daily activities
Moderate: Needs help even w/ basics
Severe: Fully dependent on others
Neurocognitive
Disorder Due To
Alzheimer’s
✔Criteria are met for major/mild neurocognitive disorder
✔There’s insiduous onset & gradual progression of
impairment in 1/more cognitive domains (for major ncd: 2
domains must be impaired)
✔Criteria are met for either possible Alzheimer’s Disease as
follows:
For Major Neurocognitive Disorder:
Probable Alzheimer’s: if either of the ff is present
Possible Alzheimer’s: if either of the ff is not present:
1.Evidence of a causative Alzheimer’s disease genetic
mutation from family history/genetic testing
2.All 3 of the ff are present:
a)Clear evidence of decline in memory & learning & at
least 1 other cognitive domain
b)Steadily progressive, gradual decline in cognition,
without extended plateaus
c)No evidence of mixed etiology (absence of other ncd
or another disease)
For Mild Neurocognitive Disorder:
Probable Alzheimer’s: evidence of a causative Alzheimer’s disease
genetic mutation from genetic testing/family history
Possible Alzheimer’s: no evidence of a causative Alzheimer’s
disease & all 3 of the ff are present:
1.Clear evidence of decline in memory & learning
2.Steadily progressive, gradual decline in cognition, without
extended plateaus
3.No evidence of mixed etiology
Neurobiological
- Presence of Beta Amyloid in
spinal fluid
Cultural
- Higher income countries (higher
number who seeks assistance)
•Pharmacotherapy
◦New medications that prevent acetylcholine
breakdown and vitamin therapy delay but do not
stop progression of decline
•No cure so far, but hope lies in genetic research and
amyloid protein
•Management may include lists, maps, and notes to
help maintain orientation

Vascular
Neurocognitive
Disorder
Disruptions in the
brain’s blood supply
that lead to impairment
of a person’s conscious
brain functions
✔Criteria are met for major/mild neurocognitve disorder
✔Clinical features are consistent w/ a vascular etiology as
suggested by either of the ff:
1.Onset of the cognitive deficits is temporarily related to 1 or
more cerobrovascular events
2.Evidence of decline is prominent in complex attention
(including processing speed) & frontal-exclusive functional
✔There is evidence of the presence of cerebrovascular
disease from history, physical exam and/or neuroimaging
considered sufficient to account for the neurocognitive
deficits
Specify if:
Probably due to Vascular Disease: Diagnosis is reinforced by
neuroimaging, proximity or clinical & genetic evidence
Possible due to Vascular Disease: none of the 3
Specify if:
With/Without Behavioral Disturbance
Environmental
- Lifestyle issues (diet, exercise,
stress) = cardiovascular disease
Substance/Medication-
Induced
Neurocognitive
Disorder
✔Criteria are met for major/mild neurocognitive disorder
✔The involved substance/medication, duration & extent of
use are capable of producing the neurocognitive
impairment
✔Temporal course of the deficit is consistent w/ the timing of
substance/medication use & abstinence
Specify if:
Persistent: Continue long past the time it should take to recover
with prolonged abstinence

ELIMINATION DISORDERS
DISORDER DIAGNOSTIC CRITERIA ETIOLOGY INTERVENTIONS
Encopresis (Fecal
Incontinence/Soiling)
Repeated passing of
stool (usually
involuntarily) into
clothing
✔Repeated passage of feces into inappropriate places
(clothing, floor), whether involuntary or intentional.
✔At least one event occurs each month for at least 3 months
✔Chronological age is at least 4 years (or equivalent
developmental level)
Specify whether:
With constipation & overflow incontinence: Evidence of
constipation on physical examination/history
Without constipation & overflow incontinence: No evidence of
constipation on physical examination/history
Enuresis (Urinary
Incontinence)
Loss of bladder control
✔Repeated voiding of urine into bed or clothes, whether
involuntary or intentional
✔Behavior is clinically significant as manifested by either a
frequency of at least twice a week for at least 3 consecutive
months
✔Chronological age is at least 5 years (or equivalent
developmental level)
Specify whether:
Nocturnal only: During nighttime sleep
Diurnal only: During waking hours
Nocturnal & Diurnal: Combination of 2

DSM 5 Disoders with criteria and treatments

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