Obsessions, compulsions, or both
Obsessions- persistent, unwanted, intrusive, repetitive, mental events that arouse anxiety or distress
- Anxiety provoking thoughts, memories, wishes, urges, feelings, impulses, and images
- Excessive & inappropriate (often in head; not visible); patient knows but can't find ways to control; individual attempts to ignore/suppress/neutralize w/ some other thoughts/actions (ex. Performing compulsions)
Compulsions- repetitive behaviors or mental acts that OCD patients feel driven to do in order to reduce anxiety; aimed to neautralize anxiety; anxiety is prevented from doing said acts; most likely realize what's going on ; becomes uncomfortable if you stop them
- Repetitive behaviors (ex. Hand washing, rechecking) that person feels driven to perform in response to obsession or according to rules that must be applied
- Aimed at preventing/reducing anxiety; or preventing some dreaded act; excessive
Specifiers- specify how much insight
- Good/fair insight- individual recognizes that OCD beliefs are definitely/probably not true
- Poor insight- individual thinks OCD beliefs are probably true
- Absent insight/delusional beliefs- individual is completely convinced OCD beliefs are true
(Must be 18- doesn't count if issues arise b/c of substance use disorder); psychopath; disregard for rules/other's rights, liars, no empathy, lack of remorse, fail to conform to societal norms, most are incarcerated, aggressive; charming; able to manipulate
1) Failure to conform to social norms; performing acts that are grounds for arrest
2) Deceitfulness (lying, using aliases, conning) others for profit/pleasure
3) Impulsivity or failure to plan ahead
4) Irritability or aggressiveness as indicated by repeated physical fights/assaults
5) Reckless regard for safety of self/others
6) Consistent irresponsibility (repeated failure to sustain consistent work behavior/honor financial responsibilities)
7) Lack of remorse indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from others
Impulsive, emotionally intense, all good or all bad, thoughts determined by mood, cannot be alone, lacks stable sense of self, excessive anger
1) Frantic efforts to avoid real or imagined abandonment
2) Unstable/intense interpersonal relationships characterized by alternating idealization & devaluation
3) Identity disturbance characterized by markedly & persistently unstable self-image or sense of self
4) Impulsivity in at least 2 areas that is potentially self-damaging (spending, sexual behavior, substance abuse, reckless driving)
5) Recurrent suicidal behavior, gestures, threats, or self-mutilation
6) Affective instability due to marked reactivity of mood
7) Chronic feelings of emptiness
8) Inappropriate, intense anger or difficulty controlling anger
9) Transient, stress-related paranoid ideation or sever dissociative symptoms
Grandiose sense of self importance, unrealistic expecatations to be treated as special, arrogant, envy, lack of empathy, want to be worshipped, poor potential partner, hypersensitive about image (denial, devaluation, suicide- if ego is threatened)
1) Has a grandiose sense of self-importance (exaggerates achievements/talents)
2) Preoccupied w/ fantasies of unlimited power, success, brilliance, beauty
3) Believes he is special & unique
4) Requires excessive admiration
5) Has a sense of entitlement (favorable treatment)
6) Interpersonally exploitative (takes advantage of others to achieve own ends)
7) Lacks empathy
8) Envious of others/believes others are envious of him
9) Shows arrogance
Preoccupation w/ orderliness, perfectionism, & mental/interpersonal control, at the expense of inflexibility, openness & efficiency; Rules, lists, high standards, rigid thinking/morals, stubborn, stinginess 4/8
1) Preoccupied w/ details, rules, lists, order, organization, schedules to the extent that the major point of the activity is lost
2) Perfectionism that interferes w/ task completion
3) Excessively devoted to work to the exclusion of leisure activities/friendships
4) Over conscientious, scrupulous, & inflexible about matters of morality, ethics, values
5) Unable to discard worn-out worthless objects even when they have no sentimental value
6) Reluctant to delegate tasks or to work w/ others unless they submit exactly his way of doing things
7) Adopt a miserly spending style towards self/others; money is viewed as something to be hoarded for future catastrophes
8) Shows rigidity and stubbornness
During a 2 week period, the patient must report either depressed mood or loss of interest in pleasure which represents a change from previous functioning: 5/9 symptoms during a 2 week period:
1) Depressed mood most of the day nearly every day as indicated by subjective report
2) Markedly diminished interest or pleasure in all or most daily activities most of the day nearly every day
3) Significant weight loss or gain
4) Insomnia or hyper insomnia
5) Psychomotor retardation or agitation nearly every day
6) Fatigue or loss of energy almost every day
7) Feelings of worthlessness or excessive or inappropriate guilt
8) Diminished ability to think or concentrate
9) Recurrent thoughts of death or suicide; suicide attempt; or suicide plan
* Specify with...
- Anxious distress- keyed up, tense, restless, difficulty concentrating, fear of something happening, fear of loss of control
- Mixed features- manic/hypomanic symptoms; elevated mood, inflated self-esteem, talkative, decreased need for sleep
- Melancholic features- loss of pleasure in activities, lack of reactivity, despair, empty mood, guilt, anorexia
- Atypical features- mood reactivity, weight gain, impairment, leaden paralysis, etc.
- Mood-congruent psychotic features- content matches typical/expected feelings
- Mood-incongruent psychotic features- features are odd, bizarre, or not related to expected/typical feelings
- Catatonia- odd movements, still, or rigid, etc.
- Peripartum onset- during, before or after pregnancy
- Seasonal- occurs around specific season annually
* Specify if recurrent or single episode
A) Expression of mood lability, irritability, dysphoria, & anxiety symptoms that occur repeatedly during the premenstrual phase of the menstrual cycle & remit around the time of onset of menses, or shortly after 5/11 present in the week before onset of menses, start to improve w/in a few days of menses, & become minimal or absent in the week post menses:
One of the following:
1) Marked affective lability (mood swings, sad, sensitivity to rejection)
2) Marked irritability or anger, increased interpersonal conflicts
3) Marked depressed mood, feelings of hopelessness, or self-deprecating thoughts
4) Marked anxiety, tension, &/or feelings of being keyed up or on edge
One of more of the following:
5) Decreased interest in usual activities
6) Subjective difficulty in concentrating
7) Lethargy, easy fatigability, or lack of energy
8) Marked change in appetite, overeating, or specific food cravings
9) Hypersomnia or insomnia
10) A sense of being overwhelmed or out of control
11) Physical symptoms such as breast tenderness/swelling, joint/muscle pain, sensation of bloating/weight gain
Disturbance of attention, hallucinations, influenced thoughts, etc.; a thought disorder; low functioning
A:* 2 or more of the following, each present for a significant portion of time during a one-month period. At least 1 of these symptoms must be (1), (2), or (3).
1. Delusions (disorders of thought). This symptom is the purest form of illogical thought. Delusions are bizarre thoughts or beliefs, meaning that these beliefs are clearly implausible, and not understandable to same-culture peers, and do not derive from ordinary life experience. Delusions are fixed beliefs that are not amenable to change in the light of contradictory evidence.
2. Hallucinations (disorders of perception)- perceptual experiences that are not caused by any real sensory stimulus. (ex. hearing voices or sounds, when in reality there is no source of these sounds.) Hallucinations are perceptions that occur in the absence of any external stimulus. Auditory hallucinations are usually experienced as voices, either familiar or unfamiliar. (Sense organs)
3. Disorganized Speech. Incoherent, peculiar speech. One of the most classic presentations of schizophrenic language involves loose associations- when the schizophrenic patient's speech wanders far away from the topic (derailment). If the schizophrenic patient's thoughts are irrelevant to the topic being discussed (tangentiality), she is engaging in loose associations. For example, asked what movie she would like to see on a field trip, a schizophrenic patient might respond that, "the movie screen that has a silk screen T shirt is just the right one." Or "the theater of the absurd, that's the one."
4. Grossly Disorganized or Catatonic Behavior. This category of symptoms may be expressed in a variety of ways, ranging from childlike silliness to unpredictable agitation. Schizophrenic individuals may exhibit a wide array of aberrations in movement.
5. Negative symptoms- problems of omission/lack or loss of function. One example of negative symptoms is diminished emotional expression - reductions in facial cues associated with emotions, eye contact, intonation of speech (prosody), and hand movements that normally give emotional emphasis to speech. Another negative symptom, avolition, refers to a decrease in motivated self-initiated purposeful behavior. The avoilitional schizophrenic patient may sit for long periods of time showing little or no interest in participating in work or social activities. Additional negative symptoms include alogia, diminished speech output, and anhedonia, the decreased ability to experience pleasure previously experienced. Finally, most schizophrenics are socially withdrawn, emotionally detached from others. They withdraw from involvement with the interpersonal environment around them. This detachment is evidenced by avoidance of eye contact, not acknowledging others, not responding to others' attempts to connect with the patient, and retreating physically from others. Most schizophrenic individuals need greater than normal physical space between themselves and others. This apparent lack of interest in social interactions is sometimes referred to as asociality.
B. Social/Occupational Dysfunction: Marked loss of functioning in one or more of the following areas: work, self-care, interpersonal relationships.
C. Schizophrenic Symptoms continue for at least six months. This six month period must include one month of symptoms that meet criterion A (above). Periods of prodromal or residual symptoms may also occur, manifested by only negative symptoms, or two or more criterion A symptoms presented in an attenuated form.
A note about symptom organization and treatment: the most straightforward, and possible most practical way of categorizing symptoms of schizophrenia is to see them as fitting into one of two groups: *Positive or Type I symptoms, and Negative or Type II symptoms.
* Prodromal phase- odd behavior in teens; Active phase- prominent psychotic symptoms in early adulthood; Residual phase- day to day negative symptoms; Active phase my repeat again, followed by the residual phase
persistent or recurrent episodes of depersonalization, derealization, or both.
*Episodes of depersonalization are characterized by feelings of unreality, detachment from, or being an outside observer w/ respect to one's thoughts, feelings, sensations, body, or actions. The patient may describe unfamiliarity with one's self, or from aspects of the self. The patient may report experiences of feeling somehow detached from self, perhaps feeling like an outside observer watching herself in a dream or a movie. The individual may feel detached from the whole self ("I am no one/I have no self."); or the individual may feel subjectively detached from certain aspects of the self ("I know I have feelings, but I don't feel them."); thoughts ("My thoughts don't feel like my own.") The depersonalization patient may feel robotic, or feel like a "split self," with one part of the self-observing the other parts of the self. Depersonalization consists of several symptom factors: anomalous body experience (e.g. unreality of the self and perceptual alterations); emotional or physical numbing; and temporal distortions with anomalous subjective recall. At no time does the patient experience signs of a psychotic disorder. Instead, the patient may feel somewhat dreamy or unreal. The patient is distressed enough by these experiences that they interfere with her activities of daily living
*Derealization consists of experiences of unreality or detachment w/ respect to surroundings. Individuals/objects may seem unreal, dreamlike, foggy, & lifeless. Patient may describe feeling as if she were in a fog/dream/bubble/veil/glass wall btw them & the world. Derealization is often accompanied by visual distortions, such as blurriness, two-dimensionality or flatness. Auditory distortions are also possible in which voices may sound muted or heightened.
May have difficulty describing their symptoms and may think they are "going crazy." A commonly associated symptom is a distorted sense of time (i.e. too fast or too slow).
The essential feature of a substance use disorder is a cluster of behavioral, cognitive, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems. The diagnosis of substance use disorder is possible with all ten categories of substance, except caffeine. An important characteristic of substance use disorders is an underlying change in brain circuitry that may persist beyond detoxification.
Substance Use Disorders involve a maladaptive pattern of substance use which results in significant impairment in adjustment and/or distress as indicated by the following features:
1. Impaired Control - the individual may take the substance in larger amounts or over a longer period than was originally intended.
2. Impaired Control- the individual may express a persistent desire to cut down or regulate substance use, and may report multiple unsuccessful efforts to decrease or discontinue use.
3. Impaired Control- the individual may spend a great deal of time obtaining the substance, using the substance, or recovering from the effects of the substance. (In some severe substance use disorders, virtually all of the individual's daily activities revolve around the substance.
4. Impaired Control- Craving is present, manifested by an intense desire or urge for the drug.
5. Social Impairment - recurrent substance use may result in a failure to fulfill major role obligations at work, school, or home.
6. Social Impairment - The individual may continue using the substance despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance
7. Social Impairment - Important social, occupational, or recreational activities have been given up or reduced because of substance use. For example, he individual may withdraw from family activities or hobbies in order to use the substance.
8. Risky Use - The substance is recurrently used in situations in which it is physically hazardous.
9. Risky Use - The individual may continue substance use despite knowledge od having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
10. Pharmacological Criteria - Tolerance is signaled by requiring a markedly increased dose of the substance to achieve the desired effect, or a markedly reduced effect when the usual dose is consumed
11. Pharmacological Criteria - Withdrawal is a substance-specific syndrome that occurs when blood or tissue concentrations of a substance decline in an individual who had maintained prolonged heavy use of the substance. After developing withdrawal symptoms, the individual is likely to consume the substance to relieve the symptoms. Withdrawal symptoms vary greatly across drug classes. Significant withdrawal symptoms have not been documented in humans after repeated use of hallucinogens or inhalants, and so this criterion is not included in their symptom lists.
Intoxication involves the following symptoms:
1. Reversible, substance-specific symptoms or problematic behavioral or psychological changes caused by recent ingestion of or exposure to a substance. This symptom picture often involves disturbances in perception, wakefulness, attention, thinking, judgment, psychomotor behavior, and interpersonal behavior.
2. Substance specific, significant maladaptive behavioral or psychological changes caused by the effects of the substance on the central nervous system, including symptoms such as emotional lability, impaired judgment, and impaired motor control.
* Substance intoxication is common in individuals with Substance Use Disorders, but also frequently occurs in individuals without a substance use disorder.