CHANGES IN THE DSM IV-TR TO DSM V

1.
2.
3.

Chapters reorganized
Reflects developmental lifespan
New Categories
a.
Obsessive-Compulsive and Related Disorders
b.
Trauma and Stress Related Disorders
4.
Discontinued the 5-axis system
5.
NOS replaced by Other Specified or Unspecified
6.
Another Medical Condition instead of General Medical Condition
7.
List Multiple Diagnoses in order attention or concern
8.
New Disorders
a.
Social (Pragmatic) Communication Disorder
b.
Disruptive Mood Dysregulation Disorder
c.
Premenstrual Dysphoric Disorder
d.
Hoarding Disorder
e.
Excoriation (Skin-Picking) Disorder
f.
Restless Legs Syndrome
g.
Caffeine Withdrawal
h.
Cannabis Withdrawal
i.
Major Cognitive Disorder with Lewy Body Disease (Dementia due to Other Medical Conditions)
j.
Mild Neurocognitive Disorder
9.
Eliminated
a.
Sexual Aversion Disorder
b.
Polysubstance-Related Disorder
10. Combined
a.
Language Disorder
b.
Autism Spectrum Disorder
c.
Specific Learning Disorder
d.
Delusional Disorder
e.
Panic Disorder
f.
Dissociative Amnesia
g.
Somatic Symptom Disorder
h.
Insomnia Disorder
i.
Hypersomnolence Disorder
j.
Non-REM Sleep Arousal Disorders
k.
Genito-Pelvic Pain/Penetration Disorder
l.
Alcohol Use Disorder
m. Cannabis Use Disorder
n.
Phencyclidine Use Disorder
o.
Other Hallucinogen Use Disorder
p.
Inhalant Use Disorder
q.
Opioid Use Disorder
r.
Sedative, Hypnotic, or Anxiolytic Use Disorder
s.
Stimulant Use Disorder
t.
Stimulant Intoxication
u.
Stimulant Withdrawal
v.
Substance/Medication-Induced Disorders
DSM-IV TR
(multiaxial System)
Axis
I: Clinical Synd
II: Personality Disorders
Retardation

and

Mental

III. Gen. Med. Con

DSM V
(non-axial approach)
Clinical syn and gen medical conditions

ICD-10
(multi-axial system)
Clinical disorders (mental and gen.)

Separate notations for important psychosocial

and contextual factors

Disabilities
(personal
care,
occupational
functioning, function with family, and broader
social functioning); ratings of WHO-DAS
Contextual factors (Interpersonal and other
psychosocial and environmental problems (Z
Codes)
Quality of life (Primarily reflecting patients
perceptions

Assess the functioning of the patient using the

Disability Assessment Schedule (WHO-DAS)

IV.
Psychosocial
and
Environmental
Problems
V. Global Assessment of Functioning

THEORETICAL PERSPECTIVES
1.
Psychodynamic
2.
Behavioral
3.
Cognitive
4.
Humanistic-Existential
5.
Socio-cultural
6.
Biological
1.

PSYCHODYNAMIC PERSPECTIVE
focuses on the motives (primarily unconscious)
the personality of individuals, and early childhood experiences in explaining disorders
psychological problems develop out of an inadequate resolution of conflicts that develop in one of stages of development

2.

BEHAVIORAL PERSPECTIVE
emphasizes the influence of environmental conditions (e.g. stimuli, consequences) in how individuals learn maladaptive behavior

3.

COGNITIVE PERSPECTIVE
Distorted thought patterns lead to maladaptive emotions and behaviour

4.

HUMANISTIC PERSPECTIVE

emphasizes the unique capacities of the individual and the fulfilment of potentials. Problematic behaviour develops as result of social and
cultural factors that impede the growth, selfactualisation and full expression of the personality

5.

HUMANISTIC PERSPECTIVE
Focuses on social and cultural factors that influence the development of maladaptive behaviour of individuals

6.

BIOLOGICAL PERSPECTIVE
Focuses on the role of biological factors in explaining disorders

Multidimensional Integrative Approach- look into the interaction of ALL relevant dimensions to explain the cause of psychological disorders.
Biological Etiology

genetic contributions to psychopathology

Diathesis-Stress Model individuals inherit predispositions or vulnerabilities that may be activated by a certain stressor

Gene-environment correlation model- individuals generic vulnerability toward a certain disorder may increase the probability that an
individual experience stressful life events that, in turn triggers the genetic vulnerability and thus the disorder
o
Caution: the environment can still mold and hold its own in the biological interactions that shape who we are

Epigenetics: the immediate effects of the environment influence cells that turn genes on or off
MAJOR NEUROTRANSMITTERS
AND THEIR EFFECTS
Generally excitatory
Conveys sensory info to the brain; affects arousal,
attention, memory, motivation, movement.

ACH
Acetylcholine

ADRENALINE
Epinehprine
NE
Norepinephrine
Noradrenaline
GABA
5-HT
Serotonin

Generally excitatory

ENDORPHINS
DA
Dopamine

Inhibitory
inhibitory

Generally
Excitatory
Most important inhibitory
Inhibitory

Too much: spasms

Too little: paralysis torpor
Affects arousal, wakefulness, learning, memory,
mood
Affects arousal, wakefulness, learning, memory,
mood
Serves as a brake against excitatory systems
Inhibits virtually all activities. Important for sleep
onset, learning, memory, mood, sexual activity,
eating behavior
Inhibits transmission of pain messages
Inhibits wide range of behaviour and emotions,
including pleasure

Psychosocial etiological factors

Schema and Selfschema

Early Deprivation or Trauma

Inadequate Parenting

Marital discord and Divorce

Maladaptive Peer

Relationships (Bullying)
Cognitive and Behavioral etiological concepts

Learned Helplessness

Modeling (Vicarious Learning)

Prepared Learning

Learn from your mistakes

Sociocultural etiological factors

Gender

Low SES

Social and Interpersonal factors on health and behaviour

Cultural Attitudes about Health and BEhavior

Social Change and Uncertainty

Biopsychosocial Model

interacting causal factors (biological, psychosocial, sociocultural)

The combination may be unique for an individual

Predisposing, precipitating, and reinforcing factors are identified to understand the individual

Predisposing:
Precipitating: make
Perpetuating:
makes an individual
an
action
happen
causes the problem
likely to behave in a
sooner or faster than
to continue
certain manner
expected; stressors
or the push over the
edge

A model of Chronic Insomnia

Biological traits
Medical Illness
Psychological traits
Psychiatric Illness
Social Factors
Stressful Live events

Excessive Time in Bed

Napping
Conditioning

Lifespan Development

Developmental Psychopathology: developmental processes that contribute to the formation of, or resistance to, psychopathology

I. NEURODEVELOPMENTAL DISORDERS

A group of conditions with onset in the DEVELOPMENTAL PERIOD typically manifest early in development (i.e. before the child enters grade
school)

characterized by developmental deficits that produce impairments of personal, social, academic, or occupational functioning

frequently co-occur (i.e. children ASD often have intellectual disability (IDD); ADHD and Learning Disorder)
1)
Intellectual Devtal Disorder
Onset: developmental period
First 2 years: delayed motor, language, and social milestones
School age: academic difficulty
Biological Etiology

Genetic Syndrome (i.e. Down Syndrome)

Behavioral Phenotypebehaviors are characteristic of a particular genetic disorder (i.e. Lesch-Nyhan Syndrome)

Lesch-Nyhan syndrome is a condition that occurs almost exclusively in males. It is characterized byneurological and behavioral
abnormalities and the overproduction of uric acid.

Acquired forms following an illness: i.e.

meningitis, encephalitis, or head trauma

DX of both IDD and neurocognitive disorder

Jack, a 6 year old boy, was enrolled in Ateneo Grade School. His Math teacher observed that he worked at a slower pace compared to his classmates and
that he often became disinterested in his work. During breaks, his teacher noticed he got along with some of his classmates but sometimes he would get
frustrated when he wasnt followed. He was referred for a psychological evaluation and Jack was immediately diagnosed with a Moderate Intellectual
Disability Disorder.
1.
What were possible markers for the said diagnosis?
2.
Was it right for Jack to be diagnosed immediately?
3.
What interventions can be given to help Jack?
4.
Is there still hope for Jacks severity level to change over time?
Risk and Prognostic Factors
Prenatal etiologies include:

genetic syndromes, inborn errors of metabolism, brain malformations, maternal disease

environmental influences (alcohol, drugs, toxins, teratogens)

Perinatal causes

labor and delivery-related events leading to encephalopathy

Postnatal causes:

hypoxic ischemic injury, traumatic brain injury, infections, demyelinating disorders, seizure disorders, severe and chronic deprivation, and
toxic metabolic syndroms and intoxications (lead, mercury)

NEURODEVELOPMENTAL DISORDERS
1.
2.
Intellectual Disabilities
Note: Conceptual, Social, and
Practical Domain

Intellectual Developmental Disorder- includes

(1) intellectual and (2) adaptive functioning deficits in: conceptual, social, and practical domain
Unspecified Intellectual Disability- over age 5 when assessment is difficult to obtain due to physical
impairments or severe problem behaviours or co-occurring mental disorder

RPF:
**Genetic: chromosomal disorders, errors of metabolism, brain malformations, maternal disease, exposure to
alcohol, drugs, teratogens, traumatic brain injury, infections, demyelinating disorders, seizure disorders, chronic
social deprivation, lead & mercury intoxications
3.
Global Developmental Delay- age 5 below; failing to meet developmental milestones in several areas
of intellectual functioning

Communication Disorder

4.

Language Disorder- difficulty in acquisition and use of language due to deficits in comprehension
(receptive ability), and production (expressive ability) due to:
(1) reduced vocabulary,
(2) limited sentence structure,
(3) impairments in discourse

Comorbidity: Neurodevelopmental Disorder (SLD, ADHD, ASD, Developmental Coordination Disorder); Social
Pragmatic Communication Disorder
5.
Speech-sound Disorder (phonological)- persistent difficulty with speech-sound production, interfering
with speech intelligibility or prevents verbal communication of messages; due to phonological and
articulation disorder

o
o
o
o
o

4 y/o Speech should be intelligible

7 y/o must be clearly and accurately pronounced
DDX:
Normal Regional Variations
Hearing/Sensory Impairment
Structural Deficits (cleft palate)
Dysarthria (cerebral palsy/motor D)
Selective Mutism
6.

Childhood-onset Fluency Disorder (stuttering)- disturbances in (1) normal fluency, and (2) time
patterning of speech which may include 1 or + of the ff: sound and syllable repetitions, broken words,

audible or silent blocking, circumlocutions, excess of physical tension, monosyllabic repetitions.

o
o

DDX:
Sensory deficits
Tourettes disorder
7.
(1)
(2)
(3)
(4)

ASD

8.

Social (Pragmatic) Communication Disorder- persistent difficulties in the social use of verbal and
nonverbal communication as manifested by difficulty/lacking in all of the ff:
communicating for social purposes
ability to change communication pattern to match context
following rules for conversation and storytelling
understanding what is explicitly stated
Autism Spectrum Disorder(1)Persistent deficits in social communication and social interaction;
(2) Restricted, Repetitive patterns of behaviour
a. stereotyped or repetitive motor movements
b. inflexibility
c. fixated interests with abnormal intensity of focus
d. Hyper/Hypoactivity that may set by 12-24 mos. of age.

ADHD

SLD

Motor Disorders

Tic Disorders
*Copropraxia-tic-like sexual
obscene gesture
*Echopraxia- imitation of
someone elses movts.
*Palilalia- repetition of ones
own sounds
*Echolalia- repeating last
heard words
*Coprolalia- uttering socially
unacceptable words

Typically recognized in 1-2 years of age

More often in males than females
9.
Attention Deficit/Hyperactivity Disorder- persistent pattern of:
(1) inattention
(2) Hyperactivity and
(3) Impulsivity, which were present prior to age 12 years in 2 or more settings.
**Irritability, low frustration tolerance, and mood lability
***Ritalin- lowers amount of aggressiveness in Children with ADHD
10. Specific Learning Disorder- difficulties learning and using keystone academic skills for 6 months.
(1)
inaccurate and slow effortful reading, (2)difficulty in comprehension, (3) spelling,(4) written
expression, (5) number sense, & (6) mathematical reasoning
11. Developmental Coordination Disorder- deficits in the acquisition and execution of coordinated motor
skills is inappropriate for chronological age (Clumsy Child Syndrome)
12. Stereotypic Movement Disorder- repetitive, seemingly driven, and apparently purposeless motor
behaviour: hand shaking, waving, body rocking, head banging, self-biting, hitting own body (may be selfinjurious) (onset before 3 yrs.)
*social isolation, environmental stress, fear
*Comorbidity:
Lesch-Nyhan syndrom
Rett Syndrome
Fragile X Syndrome
Cornelia de Lange Syndrome
Smith-Magenis Syndrome
13. Tourettes Disorder- both

multiple motor and

one or more vocal tics have been present

although not necessarily concurrent which may wax and wane but must have persisted for more
than 1 year since the first onset (below 18).
14. Persistent (Chronic) Motor or Vocal Tic Disorder
single or multiple motor or vocal tics have been present

but not both motor and vocal.

15. Provisional Tic Disorder
single or multiple motor and /or vocal tics, may be given if most criteria are met even if below 1 yr.

Simple motor tics

short duration (eye blinking, shoulder shrugging, throat clearning, sniffing, grunting)
Complex motor tics

longer duration; combination of simple tics (simultaneous head turning and shoulder shrugging)
copropraxia tic-like sexual or obscene gesture
echopraxiatic-like imitation of someone elses movements
palialia complex vocal tics include repeating ones own sounds or words
echolalia repeating the last-heard word or phrase
coprolalia uttering socially unacceptable words, including obscenities, or ethnic,
racial, or religious slurs

BIPOLAR AND RELATED DISORDERS

Manic Episode: (A)distinct period of abnormally and persistently elevated, expansive, or
irritable mood and increased goal-directed activity or energy, lasting

at least 1 week and present most of the day, nearly everyday

Hypomanic Episode:


for 4 consecutive days
Major Depressive Episode:
2 weeks of

(1) depressed mood and

(2) loss of interest and pleasure

Bipolar I Disorder
Bipolar II Disorder
Cyclothymic Disorder

Specifiers

Manic Episode
Hypomanic Episode and MDE (Never a manic Episode)
Chronic, fluctuating mood disturbance involving numerous periods of hypomanic symptoms and periods of
depressive symptoms
For atleast 2 yrs, numerous periods
with Hypomanic Symptoms (but not Hypomanic Episode)
and Major Depressive Symptoms (but not MDE)
For 2 years with no 2 mos. of its absence
Criteria for 1-4-2 are not met
With Anxious Distress: feeling keyed up or tense, restlessness, difficulty
concentrating due to worry and fear of losing control
With Mixed Features: prominent dysphoria, diminished interest or pleasure in
all activities, psychomotor retardation, fatigue, feelings of worthlessness, recurrent thoughts of death
Depressive Episode with Mixed Features: elevated, expansive mood, inflated
self-esteem, flight of ideas, increased goal-directed activities, decreased need for sleep
With Rapid Cycling: presence of 4 mood episodes in the previous 12 mos. that
meet criteria for 1-4-2.
With Melancholic Features: either lack of pleasure or reactivity to usually
Pleasurable stimuli with: emptiness, depression, early-morning wakening, significant weight loss,
excessive and inappropriate guilt.
With Atypical Features: Mood reactivity with significant weight gain,
hypersomnia, leaden paralysis, rejection sensitivity
With Psychotic Features, With Catatonia, With Peripartum Onset, With Seasonal Pattern

SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOTIC DISORDERS

4As by Bleuler:
Inappropriate Affect,
Loosening Associations,
Autistic Thoughts,
Ambivalence
Key Features:

(1)Delusions- fixed beliefs that are not amenable to change in light of conflicting evidence
Persecutory- one is going to be harmed/harassed
Referential- certain gestures, comments, environmental cues are directed at oneself
Grandiose - belief that he/she has exceptional abilities, wealth, or fame
Erotomanic- that another is in love with him/her
Nihilistic- conviction that a major catastrophe will occur
Somatic- preoccupations regarding health and organ fx
(2)Hallucination perception-like experiences that occur w/o external stimulus
(3)Disorganized Thinking or Speech formal thought disorder ; inferred from the individuals speech
Circumstantiality- excessive and irrelevant detail in descriptions with the person eventually making his/her point.
We went to a new restaurant. The waiter wore several earrings and seemed to walk with a limpyes we loved the
restaurant.

Concrete Thinking- unable to abstract and speaks concrete, literal terms. A rolling stone gathers no moss would
be interpreted literally.

Clang Association- association of words by sound rather than meaning. She cried till she died but could not hid
from the ride

Tangentiality switching from 1 topic to another

Derailment/Loose Associations - answers to questions may be obliquely related or completely unrelated
Incoherence or Word Salad- severely disorganized that it is nearly incomprehensible and resembles receptive
aphasia in its linguistic disorganization

Neologism- creation of a new word meaningful only to that person

(4)Grossly Disorganized or Abnormal Motor Behavior (Including Catatonia)

Childlike silliness to unpredictable agitation; any form of goal-directed behaviour leading to difficulties in performing
activities of daily living

Catatonic Behavior- marked decrease in reactivity to the environment

Negativism- resistance to instructions
Mutism and Stupor- maintaining a rigid, inappropriate or bizarre posture
Catatonic Excitement- purposeless and excessive motor activity without obvious cause
Other symptoms: repeated stereotyped movts, staring, grimacing, mutism, echoing of speech

(5)Negative SymptomsDelusional Disorder

alogia; affective blunting; anhedonia; asociality; avolition; apathy

1 month of delusions but no other psychotic symptoms

*Erotomanic, Grandiose, Jealous, Persecutory, Somatic, Mixed, Unspecified

Brief Psychotic Disorder

Schizophreniform

Schizophrenia

More than 1 day and remits by 1 month;

presence of one or more of the (1,2,3,4)
Symptomatic representation equivalent to that of Schizophrenia but only lasts
for atleast 1month but less than 6 months.
Disturbance for 6 months and includes
at least 1 mo. of active phase symptoms of schizophrenia occur together were preceded by or
are followed by

at least 2 weeks of delusions or hallucinations without prominent mood symptoms.

****dysfunction in glutamate receptor, and excess of dopamine

3rd brain ventricle is larger than normal
Frontal lobe decreased glucose use/smaller frontal lobe
Genetic familial; monozygotic twin
Virus
Schizoaffective Disorder

Uninterrupted period of illness during which there is a

(1) Major Mood Episode (Major Depressive/Manic)
(2) concurrent with criterion A of Schizophrenia
a. Delusions or hallucinations last for 2/+ weeks in the absence of a MME during the lifetime
duration of the illness

ANXIETY DISORDERS
Separation Anxiety

Selective Mutism
< Age 5
Specific Phobia
6 mos. for <18y.o.
Panic Disorder

Social Anxiety

Agoraphobia

Generalized Anxiety
Disorder

Excessive fear or anxiety concerning separation from home or attachment figures with: (1) recurrent ecessive
distress when separated, (2) worry about well-being or death of them, (3) worry for oneself, (4) reluctance to go
out (5) for 4weeks in children, and 6mos. or more in adults.
**social withdrawal, apathy, sadness, difficulty concentrating on work or play
High social anxiety which results to (1) consistent failure to speak in social situations in which there is an
expectation for speaking despite speaking in other situations for (2) atleast 1mo.
Marked and persistent fear that is unreasonable, cued by the presence or anticipation of a specifically avoided
object or situation which may be expressed through: tantrums, crying, freezing, or clinging (children)
Recurrent, unexpected panic attacks (abrupt surge of intense fear or discomfort which reaches peak within
minutes of: palpitation, sweating, trembling, smothering, choking, chest pain nausea, abdominal distress, lightheaded, chills/heat sensation, paresthesias, derealisation, fear of losing control, fear of dying
Followed by: 1mo. of persistent worry of another panic attack and (2) maladaptive change in behavior
Fear of being evaluated or scrutinized in front of others or in a social situation where there is high exposure to
interaction
**commonly due to childhood experiences of sexual and physical abuse and marked stressors a month before the
first panic attack
Anxiety triggered by the real or anticipated exposure to a wide range of situations where escape might be
difficult or help might not be available in the event of having panic-like symptoms.
**overprotective and reduced warmth type of family environment
Uncontrollable Apprehensive expectation about a number of events or activities with the ff symptoms:
restlessness, easily fatigued, mind going blank, irritability, muscle tension, sleep disturbance

DEPRESSIVE DISORDERS
Disruptive Mood
(1)Severe recurrent temper outbursts manifested verbally and/or behaviourally that are grossly out of proportion in
Dysregulation
intensity and duration to the situation or provocation for
(2) at least 2-3x a week with persistently angry and irritable mood between temper outbursts
Disorder
(3) for 12mos. or more months.
**6/10-18 y/o
onset must be before within 6-10 years old
Major Depressive
(1) depressed mood and (2) loss of interest/pleasure in almost all activities for
Disorder
2 weeks ; may experience 2mos. of remission
Cognitive symptoms: feelings of worthlessness/guilt
Behavioral symptoms: fatigue or physical agitation
Physical symptoms: changes in appetite and sleep
***high levels of cortisol
Premenstrual
A week before the onset of the menses, 1 or more of the ff may manifest: (1) affective lability, (2) marked
Dysphoric Disorder
irritability or anger (3) depressed mood, feelings of hopelessness, or self-deprecating thoughts, (4) marked anxiety,
tension, and/or feelings of being keyed up or on the edge
Persistent
2 years of depressed mood (1 year for children) with 2 or more of the ff: (1) poor appetite or overeating, (2) insomnia or
Depressive Disorder
hypersomnia, (3) low energy or fatigue, (4) low self-esteem, (5) poor concentration, (6) feelings of hopelessness
(Dysthymia)

OBSESSIVE-COMPULSIVE and RELATED DISORDERS

Obsessive-Compulsive
Disorder

Body Dysmorphic Disorder

Hoarding Disorder

Trichotillomania
Excoriation
Other Specified Obsessive
Compulsive Disorder

(1) Obsession- recurrent and persistent thoughts, urges, or images that are experienced at some time during
the disturbance, as intrusive and unwanted, causing marked anxiety and distress and attempts to reduce
anxiety through
(2) Compulsion- Repetitive behaviours or mental acts that the individual feels driven to perform in response to
an obsession which consumes most of their time
(1) Preoccupied with perceived defect or flaws in their physical appearance which appears slight or not
observable to others
(2) repetitive behaviours or mental acts in response to appearance concerns
**delusions of reference, high levels of anxiety, social avoidance, depressed mood, neuroticism, low
extroversion, and low self-esteem, perfectionism
*Shubo-kyofu (phobia of a deformed body)
(1) Persistent difficulty discarding or parting with possessions, regardless of their actual value which often leads
to excessive clutter
(2) perceived need to save the item and distress with regards to discarding them
**indecisiveness, perfectionism, avoidance, procrastination, difficulty planning and organizing tasks, and
distractibility
Hair-pulling disorder
Skin-picking disorder
1.
2.
3.

Body dysmorphic-like disorder with actual flaws

Dysmorphic-like disorder without repetitive behaviour
Body-focused repetitive behaviour disorder

4.
5.
6.
7.

Obsessional Jealousy- nondelusional preoccupation with a partners perceived infidelity

Shubo-Kyofu: excessive fear of having physical deformity
Koro; Similar to Dhat, an episode of sudden and intense anxiety that the penis will recede into the body
Jikoshu-Kyofu: fear of having an offensive body odor

TRAUMA and STRESSOR-RELATED DISORDERS

Reactive-Attachment
Disorder
Disinhibited Social
Engagement Disorder
*DSED
At least 9mos.
developmental age
Post-Traumatic Stress
Disorder

Acute Stress Disorder

Adjustment Disorder

Consistent pattern of inhibited, emotionally withdrawn behaviour toward adult caregivers (1) does not seek and
respond to comfort (2) limited positive affect and episodes of unexplained irritability, sadness, or fearfulness,
maybe due to (3) an experience of social neglect and deprivation, changes of primary caregivers
Pattern of behaviour in which a child actively approaches and interacts with unfamiliar adults and exhibits the ff:
reduced reticence, overly familiar verbal and physical behaviour, diminished checking back to caregiver,
willingness to go off with unfamiliar adult
**Persistent: when present for 12mos.
(1) Exposure to threatening stimuli
(2) Intrusion Symptoms: recurrent, involuntary, distressing memories and dreams
(3) Dissociative Reactions: flashbacks
(4) Persistent Avoidance of Stimuli
(5) Negative Alterations: selective amnesia, self-blame, depression
(6) 1mo. or more
***developmental regression, auditory pseudo-hallucinations
Similar to PTSD except 3 days-1mo. after (1) directly experiencing threat, (2) witnessing, (3) learning about the
event, (4) repeated exposure to aversive details
Developmental of emotional or behavioural symptoms in response to an identifiable stressor(s) occurring within
3mos. of the onset of the stressor(s)

DISSOCIATIVE DISORDERS
Disruption of and/or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation,
motor control, and behavior
Dissociative Identity
Frequently found in the aftermath of trauma, and many of the symptoms, including embarrassment and
confusion about the symptoms and the desire to conceal it
(1) presence of 2 or more distinct personality states or an experience of possession, and
(2) recurrent episodes of Amnesia
Dissociative Amnesia
Inability to recall autobiographical information usually of a traumatic or stressful nature: localized, selective,
generalized
**with Dissociative Fugue: apparently purposeful travel or bewildered wandering that is associated with amnesia
for identity or for other autobiographical information.

Localized: failure to recall events during a circumscribed period of time; most common

Selective Amnesia: only some

Generalized: complete loss of memory for ones life history (semantic/procedural)

Systematized Amnesia: loses memory for a specific category of information

Continuous: each new event as it occurs

Depersonalization/
Derealization

Other Specified Dissociative

Disorder

Presence of persistent recurrent experiences of depersonalization, derealisation, or both:

(1) Depersonalization: experiences of unreality, detachment, or being an outside observer with respect to
ones thoughts, feelings, sensations, body, or actions
(2) Derealization: experiences of unreality or detachment with respect to surroundings
But reality testing remains intact;
1.
Chronic and recurrent syndromes of mixed dissociative symptoms
2.
Identity disturbance due to prolonged and intense coercive persuasion
3.
Acute dissociative reactions to stressful events
4.
Dissociative Trance

SOMATIC SYMPTOM and RELATED DISORDERS

Somatic Symptom Disorder

Illness Anxiety Disorder

Conversion Disorder
(Functional Neurological
Symptom Disorder)
Factitious Disorder

(1)
(2)
a.
b.
c.
(3)
(1)
(2)
(1)
(2)
(1)

One or more somatic symptoms that are distressing or result in significant disruption of daily life
Excessive thoughts, feelings, or behaviours related to the somatic symptoms
disproportionate and persistent thoughts about the seriousness of ones symptoms
Persistent high level of anxiety
excessive time and energy devoted to these symptoms
more than 6mos.
preoccupation with having or acquiring a serious illness
somatic symptoms are mild or absent
**care-seeking type; care-avoidant type
one or more symptom of altered voluntary or motor sensory fx
clinical findings provide evidence of incompatibility
**
falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with

(2)
Other Specified Dissociative
Disorder

identified deception
deceptive behaviour is evident even in the absence of external reward
5.
Chronic and recurrent syndromes of mixed dissociative symptoms
6.
Identity disturbance due to prolonged and intense coercive persuasion
7.
Acute dissociative reactions to stressful events
8.
Dissociative Trance

FEEDING AND EATING DISORDERS

Pica
Min. of age 2 y/o
Rumination Disorder
3-12 mos.
Avoidant/Restrictive Food
Intake Disorder

Anorexia Nervosa

Bulimia Nervosa

Binge-Eating Disorder

ELIMINATION DISORDERS
Enuresis

Encopresis

SLEEP-WAKE DISORDERS
Insomnia Disorder

Hypersomnolence Disorder

Narcolepsy

Breathing-Related Sleep
Disorder

(1)

persistent eating of non-nutritive,non-food substances over a period of atleast 1mo.

Repeated regurgitation of food over a period of at least 1mo. :re-chewed, re-swallowed, or spit out
An eating or feeding disturbance as manifested by persistent failure to meet appropriate nutritional and/or
energy needs associated with the ff:
(1) significant weight loss;
(2) significant nutritional deficiency;
(3) dependence on enteral feeding or oral nutritional supplements;
(4) marked interference with psychosocial functioning
(1) Restriction of energy intake relative to requirements, leading to a significantly low body weight in the
context of age, sex, developmental trajectory, and physical health.
(2) Intense fear of gaining weight or of becoming fat
(3) undue evaluation of weight or body shape
**Restricting type: dieting, fasting, excessive exercise
**binge-eating/purging type: 3mos.
Recurrent episodes of binge eating in a (1) discrete period of time (2hrs) with an amount of food definitely larger
than normal, and (2) lack of control
(3) recurrent inappropriate compensatory behaviors to prevent weight gain (4) once a week in 3mos.

Same with bulimia nervosa but differs in the absence of compensatory behaviors.
Once a week for 3mos.

Repeated

voiding of urine into bed/clothes, whether involuntary/intentional

for atleast 2x a week for 3 consecutive mos.
atleast 5 years old.
SUBTYPES
o
Nocturnal-only (monosymptomatic)
o
Diurnal-only (urinary incontinence)

Urge incontinence

Voiding postponement
o
Both (nonmonosymptomatic)
Repeated passage of feces into inappropriate places 1x/mo. For atleast 3mos.

For atleast 1x a mo. For 3 mos

atleast 4 years old.

SUBTYPES
o
With Constipation and overflow incontinence
o
Without

Predominant complaint of dissatisfaction with sleep quantity or quality: difficulty initiating and maintaining sleep
with early-morning awakening
*3x a week (3mos.)
Excessive Sleepiness despite a main sleep period lasting atleast 7hrs.: lapses into sleep, prolonged main sleep
for 9hrs. which occurs
*3x a week (3mos.)
Recurrent periods of irrepressible need to sleep, lapsing into sleep, or napping occurring within the same day:
*Episodes of catalepsy(losing muscle tonus)
*Hypocretin deficiency
*(REM) sleep latency less than or equal to 15min.
1.
Obstructive Sleep Apnea Hypopnea: # of apneas plus hypopnea per hr of sleep
Based on polysomnography: nocturnal breathing disturbances (snoring, snorting/grasping,
breathing pauses during sleep); daytime sleepiness, fatigue, unrefreshing sleep, 5 or more
OSP per hour of sleep
*Apnea- total absence of airflow
*Hypopnea-reduction of airflow

*Cardinal
2.

3.
Circadian rhythm sleep-wake
disorders

Parasomnias

SEXUAL DYSFUNCTIONS
Delayed Ejaculation

Erectile Disorder
Female Orgasmic Disorder
Female Sexual Interest/Arousal
Disorder

Genito-Pelvic Pain/Penetration
Disorder

Male Hypoactive Sexual Disorder

Premature or Early Ejaculation

Gender Dysphoria
Gender Dysphoria

symptoms: snoring and daytime sleepiness

Central Sleep Apnea- evidence by 5 or more central apneas per hour of sleep
Idiopathic Central sleep Apnea: variability in respiratory effort
Cheyne-Strokes breathing: periodic crescendo decrescendo variation of tidal volume that results in
central apneas and hypopneas at a frequency of atleast five events per hour w/ frequent arousal
Central sleep apnea comorbid with opioid use: effects of opioids on the respiratory rhythm
generators in medulla and as well as the differential effects on hypoxic vs. hypercapnic respiratory
device
Sleep-related Hypoventilation- decreased respiration associated with elevated CO2 levels.

sleep disruption due to alteration of circadian system which could lead to Excessive Sleepiness, or Insomnia

*Delayed Sleep-phase Type: more than 2 hrs in relation to desired sleep and wake up time

*Advanced Sleep-phase type :

*Irregular sleep-Wake Type: sleep is fragmented into three periods

*Non-24 hr Sleep-Wale Type:

*Shift Work Type

**3mos. Or longer
1.
Non-Rapid Eye Movt. Sleep Arousal Disorders- incomplete awakening from sleep during the first
third major sleep episode without dream recall, but with*Sleep walking or *Sleep terrors*Amnesia
for Episodes
**Specify if
*Sleep walking Type
*Sleep-related eating
*Sexsomnia
2.
Nightmare Disorder- repeated occurrences of extended, extremely dysphoric, and well-remembered
dreams that usually involve efforts to avoid threats to survival, security, and occur during the 2nd half
of the major Sleep episode:
*Rapid waking, orientation, alertness
3.
Rapid-Eye Movt. Behavior Disorder- repeated episodes of arousal during sleep associated with
vocalization and/or complex motor behaviour usually occur 90 min. after sleep onset
*Completely awake alert, and not confused or disoriented
4.
Restless Legs Syndrome- urge to move the legs, in response to uncomfortable and unpleasant
sensation in the legs,
* crawling, creeping, tingling, burning, or itching
For atleast 3x/week for 3 mos.
*Periodic Leg Movt. in Sleep (PLMS)

Marked delay and infrequency or absence of ejaculation for 6mos.

*Specify if: Lifelong, acquired, generalized, situational, mild, moderate, severe
Factors: partner, relationship, individual vulnerability, cultural/religious factor, medical factors
*pharmacological agents: antidepressants, antipsychotics, alpha sympathetic drugs, opioid drugs
Marked difficulty in obtaining and/or maintaining an erection and marked decrease in erectile rigidity for 6mos.
*Alexithymia- deficits in cognitive processing of emotions
Marked delay in, marked infrequency of, or absence of orgasm;
Markedly reduced intensity of orgasmic sensations for 6mos.
Lack of, or significantly reduced, sexual interest/arousal, as manifested by atleast 3 of the ff for 6mos.:
1.
Absent/reduced interest in sexual activity
2.
Absent/reduced sexual/erotic thoughts or fantasies
3.
No/reduced initiation of sexual activity, and typically unreceptive to a partners attempt to initiate
4.
Absent/reduced sexual excitement/pleasure during sexual activity in almost all sexual encounters
5.
Absent/reduced sexual interest/arousal in response to any internal or external/erotic cues
6.
Absent/reduced genital or nongenital sensations during sexual activity
*cannot be diagnosed when with: nonsexual mental disorders, another medical condition, interpersonal factors,
asexual self-identity, inadequate or absent sexual stimuli
Persistent or recurrent difficulties with one or more of the ff:
1.
Vaginal penetrationpoacctive
2.
Pelvic pain
3.
Marked fear or anxiety
4.
Marked tensing or tightening of the pelvic floor muscles during attempted vaginal penetration
*maybe with another medical condition, somatic symptom, specific phobia
Persistently or recurrently deficient(or absent) sexual/erotic thoughts or fantasies and desire for sexual activity
for 6mos.
Cannot be made whenL: with sexual disorder, medical condition, interpersonal factors
60 second intravaginal ejaculatory latency time

Marked incongruence between ones experienced/expressed gender and assigned gender, of at least 6 mos.
6 for children, 2 for adults

Disruptive, Impulse-Control, and Conduct Disorders

Oppositional Defiant Disorder
A pattern of
(1)

angry/irritable mood(often loses temper, is often touchy or easily annoyed, often angry and

resentful);
argumentative/defiant behaviour (arguing with authority figures, deliberately annoys others,
blaming) or
(3) vindictive for atleast twice in the past 6mos.
*maybe confined to only one setting
(2)

Intermittent Explosive Disorder

Recurrent behavioural outbursts representing a failure to control aggressive impulses as manifested by either of
the ff:
1.
2.

verbal aggression 2x/week (3mos.)

three behavioural outbursts involving damage or destruction of property and/or physical assault
involving physical injury against or other individuals occurring within a 12mo. Period.
*Impulsive and anger-based
*Chronological age atleast 6y/o
Conduct Disorder

Repetitive and persistent pattern of behaviour in which the basic rights of others or major age-appropriate
societal norms or rules are violated for 3 for 12mos. , with one present for the past 6 mos.
1.
Aggression to People and Animals
2.
Destruction of Property
3.
Deceitfulness or Theft
4.
Serious Violations of Rules

Pyromania
Kleptomania

PERSONALITY DISORDERS-enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the
individuals culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, stable over time, and leads to
distress or impairment.
CLUSTER A
1.
Paranoid Personality Disorder- pattern of distrust and suspiciousness such that others motives are
(odd and eccentric)
misinterpreted (suspicious, hypersensitive, secretive)
2.
Schizoid Personality Disorder- seclusive, indifferent, passive
3.
Schizotypal- odd in thinking, with bizarre fantasy, w/peculiar language

CLUSTER B
(dramatic, emotional, and
erratic)

1.
2.
3.
4.

Histrionic- attention-seeker, flamboyant, provocative

Borderline-impulsive, self-mutilating, manipulative
Antisocial- rule breaker, aggressive, abusive
Narcissistic- excessive self-admiration, egocentric, grandiose

CLUSTER C
(anxious and fearful)

1.
2.
3.

Avoidant- fears criticism, overly serious, withdrawn

Dependent-clingy, submissive, indecisive
Obsessive-Compulsive- perfectionist, rigid, passive-aggressive

PARAPHILIC DISORDERS
Voyeuristic (18 years of age)
Exhibitionistic
Frotteuristic
Sexual Masochism
Sexual Sadism
Pedophilic Disorder
Fetishistic Disorder
Transvestic

For atleast 6mos. recurrent and intense sexual arousal from observing an unsespecting person who is naked, in
the process of disrobing, or engaging in sexual activity
Exposure of ones genitals to an unsuspecting person
Touching or rubbing against a nonconsenting person
Of being humiliated, beaten, bound, or made to suffer
Physical/psychological suffering of another person
13 years or younger
Use of nonliving objects or highly specific focus on nongenital body parts
Arousal In cross-dressing