AB_Psych_Module_4

• This lecture on the DSM-5/-TR is not endorsed by the American Psychiatric Association. No copyright infringement is intended for providing the diagnostic criteria from DSM-5/-TR under fair use for education purposes. The speaker does not receive any royalty for using or mentioning the APA and the DSM; as well as in the case of WHO and ICD-11.
• This lecture will not discuss the entire section of the DSM-5/-TR sections. Students are advised to read the sections of each disorder's section for their clinical case formulation.
• Reference


  Nolen-Hoeksema's Chapter 5 (pp. 102-145), APA's (2022) Anxiety Disorders (pp. 215-262), and Obsessive-Compulsive and Related Disorders (pp. 263-294)

  
• Learning Objectives: LO2


  • Recognize the diagnostic symptoms of these disorders based on the DSM-5-TR and compare with ICD-11
  • Distinguish normal and pathological variants of anxiety and obsessions-compulsions
  • Distinguish differential diagnosis and co-occurring mental disorders with these disorders
  • Explain why individuals experience these disorders from a biopsychosocial spiritual framework and identify appropriate therapeutic interventions
  • Develop one's interviewing skills in diagnosing these disorders
• Rules on Diagnosis for Disorders Related to Anxiety and Fear, Obsessions-Compulsions, and Stress/Trauma


  Reviewing the Rule Out Conditions prior diagnosing any specific mental disorder
• Rule No. 1


  A clinician must determine whether the MH condition is due to: 1. Malingering (Z76.5): intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives, 2. Factitious Disorder (F68.10: Imposed on Self; F68.A: Imposed on Another): the falsification of medical or psychological signs and symptoms in the individual or others that are associated with the identified deception.
• Rule No. 2


  Prior to giving a specific full disorder diagnosis, a clinician must ask: A. does my client's mental health condition induced by any substance or medication? B. does my client's mental health condition due to another medical condition?
• Rule No. 3


  Identify problems that warrants clinical attention: What was the stress event that caused your client to experience such distressful condition?
• General Categories Based on the DSM-5-TR


  • Suicidal behavior and Nonsuicidal Injury
  • Abuse and Neglect (focused on children or childhood)
  • Adult Maltreatment and Neglect Problems
  • Relational Problems
  • Educational Problems
  • Occupational Problems
  • Housing Problems
  • Economic Problems
  • Problems Related to the Social Environment
  • Problems Related to Interaction with the Legal System
  • Problems Related to Other Psychosocial, Personal, and Environmental Circumstances
  • Problems Related to Access to Medical and Other Health Care
  • Circumstances of Personal History
  • Other Health Service Encounters for Counseling and Medical Advice
  • Additional Conditions or Problems that May Be a Focus of Clinical Attention (e.g., uncomplicated bereavement)
• Rule No. 4


  Distinguish your diagnosis from other disorders or is there another mental disorder? Differential Diagnosis, Comorbidity (co-occurring mental disorders)
• Rule No. 5

  Is the disorder due to Mood (Bipolar or Depressive), Neurodevelopmental Disorders, or Schizophrenia and other Psychotic Disorders? If No, continue examining the specific disorders under anxiety and or obsessions-compulsions. If Yes, refer to disorders mentioned in Module 3 (for Mood Disorders), Module 6 (for Schizophrenia and other Psychotic Disorders), and DSM-5-TR for Neurodevelopmental Disorders.
• An Overview of Disorders Related to Anxiety and Obsessions-Compulsions: Diagnostic groupings based on DSM-5-TR and ICD-11. Take note that the DSM-5-TR uses the ICD-10-CM codes and is different from the ICD-11 codes.

  
• Anxiety Disorders (APA, 2022, March 18)

  • Separation Anxiety Disorder*
  • Selective Mutism*
  • Specific Phobia*
  • Social Anxiety Disorder*
  • Panic Disorder
  • Agoraphobia*
  • Generalized Anxiety Disorder*
  • Substance/Medication-Induced Anxiety Disorder
  • Anxiety Disorder Due to Another Medical Condition
  • Other Specified Anxiety Disorder
  • Unspecified Anxiety Disorder

  
• Anxiety and Fear-Related Disorders (World Health Organization, 2018)


  • Separation Anxiety Disorder*
  • Selective Mutism*
  • Specific Phobia*
  • Social Anxiety Disorder*
  • Panic Disorder
  • Agoraphobia*
  • Generalized Anxiety Disorder*
  • Substance-Induced Anxiety Disorder
  • Secondary Anxiety Syndrome*
  • Other Specified Anxiety or Fear-Related Disorder*
  • Anxiety or Fear-Related Disorder, Unspecified*
  • Hypochondriasis*

  
• Obsessive-Compulsive and Related Disorders (APA, 2022, March 18)


  • Obsessive-Compulsive Disorder*
  • Body Dysmorphic Disorder
  • Hoarding Disorder
  • Trichotillomania
  • Excoriation
  • Substance/Medication-Induced Obsessive-Compulsive and Related Disorder
  • Obsessive-Compulsive Disorder Due to Another Medical Condition
  • Other Specified Obsessive-Compulsive and Related Disorder
  • Unspecified Obsessive-Compulsive and Related Disorder
• Obsessive-Compulsive or Related Disorders (World Health Organization, 2018)

  • Obsessive-Compulsive Disorder*
  • Body Dysmorphic Disorder*
  • Hoarding Disorder*
  • Body Focused Repetitive Behaviour Disorders
  • Substance/Medication-Induced Obsessive-Compulsive or Related Disorder
  • Secondary Obsessive-Compulsive or Related Disorders
  • Other Specified Obsessive-Compulsive or Related Disorder
  • Olfactory Reference Disorder*
  • Hypochondriasis*
  • Obsessive-Compulsive or Related Disorder, Unspecified
• Trauma- and Stressor-Related Disorders (APA, 2022, March 18)


  • Reactive Attachment Disorder
  • Disinhibited Social Engagement Disorder
  • Posttraumatic Stress Disorder
  • Acute Stress Disorder
  • Adjustment Disorder
  • Other Specified Trauma- and Stressor-Related Disorder
  • Unspecified Trauma- and Stressor-Related Disorder
  • Prolonged Grief Disorder
• Disorders Specifically Associated with Stress (World Health Organization, 2018)

  • Reactive Attachment Disorder
  • Disinhibited Social Engagement Disorder
  • Posttraumatic Stress Disorder
  • Acute Stress Reaction
  • Adjustment Disorder
  • Other Specified Disorders Specifically Associated with Stress
  • Disorders Specifically Associated with Stress, unspecified
  • Prolonged Grief Disorder
  • Complex PTSD
• The Disorders Related to Trauma and or Stress grouping will not be discussed in this course subject. It will be discussed in the PSYEL06 Disaster and Mental Health course subject.
• Of the trauma and stress-related disorders in DSM-5-TR, the only applicable disorder if the client has no history of trauma or has lost a loved one, we examine our clients with Adjustment Disorder unless the disorders in anxiety and obsessions-compulsions requires a differential diagnosis of PTSD or Acute Stress Disorder.
• Generalized Anxiety Disorder


  A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance). B. The individual finds it difficult to control the worry. C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months): 1. Restlessness or feeling keyed up or on edge, 2. Being easily fatigued, 3. Difficulty concentrating or mind going blank, 4. Irritability, 5. Muscle tension, 6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep). D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism). F. The disturbance is not better explained by another mental disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder, contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder).

  
• D


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

  
• E


  The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism)
• F

  The disturbance is not better explained by another mental disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder, contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder)

  
• Mnemonic Criteria for Generalized Anxiety Disorder

  • W - Worry
  • A - Anxiety
  • T - Tension in muscles
  • C - Concentration difficulty
  • H - Hyperarousal (or irritability)
  • E - Energy loss
  • R - Restlessness
  • S - Sleep disturbance

  
• A

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

  
• Panic Attack Symptoms


  • Palpitations, pounding heart, or accelerated heart rate
  • Sweating
  • Trembling or shaking
  • Sensations of shortness of breath or smothering
  • Feelings of choking
  • Chest pain or discomfort
  • Nausea or abdominal distress
  • Feeling dizzy, unsteady, light-headed, or faint
  • Chills or heat sensations
  • Paresthesias (numbness or tingling sensations)
  • Derealization (feelings of unreality) or depersonalization (being detached from oneself)
  • Fear of losing control or "going crazy"
  • Fear of dying

  
• B


  At least one of the attacks has been followed by 1 month (or more) of one or both of the following: 1) Persistent concern or worry about additional panic attacks or their consequences, 2) A significant maladaptive change in behavior related to the attacks (e.g., behaviors designed to avoid having panic attacks, such as avoidance of exercise or unfamiliar situations)
• C


  The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism, cardiopulmonary disorders)
• D

  The disturbance is not better explained by another mental disorder (e.g., the panic attacks do not occur only in response to feared social situations, as in social anxiety disorder; in response to circumscribed phobic objects or situations, as in specific phobia; in response to obsessions, as in obsessive-compulsive disorder; in response to reminders of traumatic events, as in posttraumatic stress disorder; or in response to separation from attachment figures, as in separation anxiety disorder)

  
• Mnemonic for Panic Attack Symptoms


  • STUDENTS FEAR 3 C's
• Mnemonic for Panic Disorder Criteria

  • ABCD

  
• A

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

  
• B


  The phobic object or situation almost always provokes immediate fear or anxiety
• C


  The phobic object or situation is actively avoided or endured with intense fear or anxiety
• D


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

  
• E


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

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

  
• G


  The disturbance is not better explained by the symptoms of another mental disorder, including fear, anxiety, and avoidance of situations associated with panic-like symptoms or other incapacitating symptoms (as in agoraphobia); objects or situations related to obsessions (as in obsessive-compulsive disorder); reminders of traumatic events (as in posttraumatic stress disorder); separation from home or attachment figures (as in separation anxiety disorder); or social situations (as in social anxiety disorder)

  
• Specific Phobia Types


  • Animal (e.g., spiders, insects, dogs)
  • Natural environment (e.g., heights, storms, water)
  • Blood-injection-injury (e.g., needles, invasive medical procedures)
  • Situational (e.g., airplanes, elevators, enclosed places)
  • Other (e.g., situations that may lead to choking or vomiting; in children, e.g., loud sounds or costumed characters)