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Dissociative Identity Disorder
The existence of two or more distinct personality states or the experience of possession, with recurrent gaps in the recall of ordinary events, personal information, or traumatic events.
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Dissociative Amnesia
requires an inability to recall important personal information that cannot be attributed to ordinary forgetfulness. Often related to exposure to one or more traumatic events.
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Dissociative Amnesia - Localized amnesia
an inability to remember all events related to a circumscribed period of time
one of the most common
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Dissociative Amnesia - Selective amnesia
inability to recall some events related to a circumscribed period
one of the most common
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Dissociative Amnesia - Generalized amnesia
a loss of memory that encompasses the person's entire life
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Dissociative Amnesia - continuous amnesia
inability to recall events subsequent to a specific time through the present
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Dissociative Amnesia - Systematized amnesia
inability to recall memories related to a certain category of information - e.g., memories related to one's spouse
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Depersonalization/Derealization Disorder
Characterized by persistent or recurrent episodes of depersonalization (a sense of unreality, detachment, or being an outside observer of one's thoughts, feelings, etc.) or derealization (a sense of unreality or detachment involving one's surroundings)
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Somatic Symptom Disorder
The presence of one or more somatic symptoms that cause distress or a significant disruption in daily life accompanied by excessive thoughts, feelings, or behaviors related to the symptoms with at least one:
persistent or disproportionate thoughts about the seriousness of the symptoms; persistently high level of anxiety about one's health or symptoms; excessive time and energy devoted to health concerns or symptoms
at least six months
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Illness Anxiety Disorder
A preoccupation with having a serious illness, an absence of somatic symptoms or the presence of mild somatic symptoms, a high level of anxiety about one's health, and performance of excessive health-related behaviors or maladaptive avoidance of doctors, hospitals, etc.
at least six months
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Conversion Disorder
The presence of symptoms that involve disturbance in voluntary motor or sensory functioning and suggest a serious neurological or other medical condition (e.g., paralysis, seizures, blindness, loss of pain sensation) with evidence of an incompatibility between the symptom and recognized neurological or medical conditions.
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Factitious Disorder
2 types - Imposed on self and imposed on another
falsify physical or psychological symptoms that are associated with their deception (e.g., they falsify symptoms of depression following the death of a spouse even though the death did not occur); they present themselves to others as being ill or impaired; and they engage in the deceptive behavior even in the absence of an obvious external reward for doing so
Falsification can involve feigning, exaggeration, simulation, or induction (e.g., ingestion of a substance or self-injury)
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Pica
persistent eating of non-nutritive, bob-food substance for at least 1 month.
must be inappropriate for developmental age and not part of a culturally sanctioned practice.
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Anorexia Nervosa
Three feature:
a) a restriction of energy intake that leads to a significantly low body weight
b) intense fear of gaining weight or becoming fat or behavior that interferes with weight gain
c) disturbance in the way the person experiences his or her body weight or shape or a persistent lack of recognition of the seriousness of low body weight
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Anorexia and Bulimia Nervosa - Associated Features
excessive exercise, self-induced vomiting, use of laxatives and diuretics, preoccupied with thoughts of food and collect recipes, prepare elaborate meals for others, or hoard food.
common comorbid with anxiety and/or depression
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Anorexia Nervosa - Age/Gender
onset is mot common in adolescence or young adulthood
90% female
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Anorexia Nervosa - Treatment
first priority is always to gain weight
CBT is treatment of choice and emphasizes modifying the individual's dysfunctional beliefs about weight and food, including the value of being thin and the consequences of eating, and involves the following stages:
- 1) establishing a positive therapeutic alliance and enhancing motivation
- 2)normalizing eating patterns and body weight
- 3)identifying, evaluating, and modifying beliefs about weight and food using Socratic questioning, decatastrophizing, and other cognitive techniques.
- 4) preparing the client for termination and identifying ways to prevent relapse
can be restrictive or binge/purge
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Bulimia Nervosa
- a) recurrent episodes of binge eating that with a sense of a lack of control
- b) inappropriate compensatory behavior to prevent weight gain (vomiting, laxatives, excessive exercise, etc.)
- c) self-evaluation that is unduly influenced by body shape and weight.
binge eating and compensatory behaviors must occur, on average, at least once a week for three months.
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Bulimia Nervosa - Treatment
helping the individual gain control over eating and modifying dysfunctional beliefs about eating, shape, and weight.
Treatment usually incorporate nutritional counseling and cognitive-behavioral techniques such as self-monitoring, stimulus control, cognitive restructuring, problem-solving, and self-distraction during periods of high-risk for binge eating.
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Binge-Eating Disorder
requires recurrent episodes of binge eating that involves a sense of lack of control over eating, the presence of at least 3 characteristic symptoms (eating more rapidly than usual, eating until feeling uncomfortably full, eating alone due to feeling embarrassed about the amount of food consumed), and the presence of marked distress about binge eating.
binges occur at least once a week for 3 months
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Enuresis
repeated urination into the bed or clothes at least twice a week for 3 or more consecutive months.
must be at least 5 years old or equivalent developmental level.
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Enuresis - Treatment
most common is the bell-and-pad, which causes an alarm when urination begins
80% effective
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Encopresis
repeated involuntary or intentional passage of feces into inappropriate places.
At least once a month for 3 months
at least 4 years old
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Insomnia Disorder
dissatisfaction with sleep quality or quantity associated with at least one of: difficulty initiating sleep; difficulty maintaining sleep; early-morning awakening with an inability to return to sleep
at least 3 night per week for 3 months
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Hypersomnolence Disorder
excessive sleepiness despite at least 7 hours of sleep
one of the following: recurrent periods of sleep within the same day; a prolonged but nonrestorative sleep period of more than 9 hours each day; difficulty becoming fully awake after an abrupt awakening
3 times per week for 3 months
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Narcolepsy
attacks of an irrepressible need to sleep with lapses into sleep or daytime naps. Requires episodes of cataplexy (loss of muscle tone), hypocretin deficiency, or a rapid eye movement latency less than or equal to 15 minutes.
3 times per week for 3 months
many experience hypnogogic (hallucinations before sleep) or hypnopompic (hallucinations just after waking) hallucinations
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Nightmare Disorder
repeated occurrences of extended, extremely dysphoric, and well-remembered dreams that usually involve efforts to avoid threats to survival, security, or physical integrity
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________ involves an inability to recall important personal information that cannot be attributed to ordinary forgetfulness and most often takes the form of localized or ________ amnesia
Dissociative Amnesia
selective
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A diagnosis of Conversion Disorder requires the presence of symptoms involving disturbances in voluntary ________ functioning that suggests a serious neurological or other medical condition.
motor or sensory
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A person with Factitious Disorder falsifies physical or psychological symptoms associated with their deception in themself or another person in the absence of an _________ for doing so. Factitious Disorder must be distinguished from ________, which is characterized by the intentional production of symptoms for the purpose of obtaining an external reward
external reward
malingering
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The essential features of Anorexia Nervosa are a restriction of energy intake that leads to significantly low body weight; and intense __________; and a disturbance in the way the person experiences his/her body weight and shape. The onset of this disorder is most often in ____________. One theory of Anorexia is that it is due to a high-than-normal level of ________, which causes restlessness, anxiety, and obsessive thinking and that food restriction lowers the level of this neurotransmitter and thereby decreases unpleasant feelings. The first priority in treatment is to _________.
fear of gaining weight
adolescents or early adulthood
serotonin
gain weight
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Bulimia Nervosa is characterized by recurrent episodes of __________ that are accompanied by a sense of lack of control, inappropriate compensatory behaviors to prevent weight gain; and a self-image that is unduly influenced by body shape and weight. Medical complications include electrolyte imbalances that can, in some cases, result in _________. The onset of Bulimia is often during or after a period of __________.
binge eating
cardiac arrhythmias and arrest
dieting
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Enuresis is usually treated with the _________, which wakes the child up when he or she urinates in bed at night.
bell-and-pad
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The primary non-pharmacological treatment for Insomnia Disorder is a cognitive-behavioral approach that incorporates _________ education, stimulus __________, relaxation training, and cognitive therapy.
sleep hygiene
control
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Narcolepsy is characterized by attacks of an irrepressible need to sleep with lapses into sleep or daytime naps and ________ (loss of muscle tone), a hypocretin deficiency, or a rapid eye movement latency less that or equal to 15 minutes.
cataplexy
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Non-Rapid Eye Movement Sleep Arousal Disorders involve recurrent episodes of incomplete awakening that usually occur during stage ________ and are accompanied by sleepwalking or _________.
3 or 4 sleep
sleep terror
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For a diagnosis of ________, the behavior must be inappropriate for the individual’s developmental level and not part of a culturally sanctioned practice.
A.Tourette's Disorder
B.Rumination Disorder
C.Pica
D.Enuresis
C
For a diagnosis of pica, the behavior must be inappropriate for the individual’s developmental level and not part of a culturally sanctioned practice. If the behavior occurs in the context of another mental disorder or medical condition, it must be sufficiently severe to warrant additional clinical attention.
Answer A: Tourette’s Disorder is characterized by the presence of at least one vocal tic and multiple motor tics that may appear simultaneously or at different times, that may wax and wane in frequency but have persisted for more than one year, and that began prior to 18 years of age.
Answer B: Rumination Disorder is characterized by repeated regurgitation of food that is not attributable to a medical condition and does not occur exclusively during the course of another eating disorder.
Answer D: Enuresis is an Elimination Disorder. Urination is usually involuntary but can be intentional, and it is not due to use of a substance or a medical condition. This disorder is diagnosed only when the individual is at least five years old or the equivalent developmental level.
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Research evaluating the effects of imipramine as a treatment for Enuresis suggests that it is:
A.more effective than the bell-and-pad.
B.less effective than the bell-and-pad in terms of long-term effects.
C.about equally effective as the bell-and-pad in terms of both short- and long-term effects.
D.ineffective in terms of both short- and long-term effects.
B
Although imipramine has good short-term effects for Enuresis, it does not have good long-term effects.
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Dissociative Amnesia is most associated with:
A.a loss of memory for events from the distant past.
B.an inability to recall personal information.
C.an inability to form new sensory memories.
D.an inability to attach emotions to memories.
B
Dissociative Amnesia differs from amnesias that have a physiological cause in terms of the nature of the memory loss. Specifically, Dissociative Amnesia is characterized by a loss of memory for personal (biographical) information.
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The research suggests that a person with Anorexia Nervosa restricts his or her food intake to alleviate restlessness, anxiety, and obsessive thinking, which may be caused by:
A.higher-than-normal levels of serotonin.
B.lower-than-normal levels of serotonin.
C.higher-than-normal levels of dopamine.
D.lower-than-normal levels of dopamine.
A
Research on the contributors to Anorexia Nervosa suggests that food restriction reduces higher-than-normal serotonin levels and thereby alleviates anxiety and other unpleasant feelings.
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A hypnopompic hallucination is:
A.a sense of detachment from oneself.
B.a drug-induced sensory perception.
C.a vivid dream that occurs just before waking up.
D.a vivid dream that occurs just before falling asleep.
C
Hypnopompic hallucinations are vivid hallucinations that occur during the transition from sleep to wakefulness.
Answer D: Hypnagogic hallucinations are vivid dreams that occur during the transition from an awake to a sleep state.
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The intentional production of symptoms to obtain an external reward is characteristic of which of the following?
A.Factitious Disorder
B.Malingering
C.Somatic Symptom Disorder
D.Illness Anxiety Disorder
B
Malingering is characterized by an intentional production of physical or psychological symptoms to obtain an external reward such as avoiding work, receiving financial compensation, or obtaining drugs.
Answer A: Individuals diagnosed with Factitious Disorder Imposed on Self falsify physical or psychological symptoms that are associated with their deception, present themselves to others as being ill or impaired, and engage in the deceptive behavior even in the absence of an obvious external reward for doing so.
Answer C: The essential feature of Somatic Symptom Disorder is the presence of one or more somatic symptoms that cause distress or a significant disruption in daily life accompanied by excessive thoughts, feelings, or behaviors related to the symptoms. The DSM-5 does not require symptoms to be motivated by a desire to obtain an external reward.
Answer D: Illness Anxiety Disorder involves a preoccupation with having a serious illness, an absence of somatic symptoms or the presence of mild somatic symptoms, a high level of anxiety about one's health, and performance of excessive health-related behaviors or maladaptive avoidance of doctors and hospitals. For this diagnosis, there is no requirement for symptoms to be falsified to obtain an external reward.
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Two weeks ago, Amy A., age 17, suddenly began experiencing weakness in both legs and a loss of balance, which causes her to fall when she tries to walk. Amy has not been able to go to school because of her symptoms, and she says she thinks they started after she had argued with her best friend. A thorough physical examination has not found a medical explanation for her symptoms, and the symptoms are not compatible with any known neurological or medical condition. The most likely diagnosis for Amy is:
A.Conversion Disorder.
B.Somatic Symptom Disorder.
C.Body Dysmorphic Disorder.
D.Acute Stress Disorder.
A
Conversion Disorder involves one or more symptoms involving motor or sensory functioning that are incompatible with recognized neurological or medical conditions and cannot be better explained by a medical or other mental disorder.
Answer B: The incompatibility of Amy's symptoms with any known medical or neurological conditions is more characteristic of Conversion Disorder than Somatic Symptom Disorder. Additionally, no information is provided in the question indicating that Amy is having excessive thoughts and feelings about the symptoms, which is required for the diagnosis of Somatic Symptom Disorder.
Answer C: Body Dysmorphic Disorder is characterized by a preoccupation with a defect or flaw in appearance that appears minor or is unobservable to others.
Answer D: A diagnosis of Acute Stress Disorder requires exposure to actual or threatened death, severe injury, or sexual violation and at least nine symptoms from the following categories: intrusion, negative mood, dissociative symptoms, avoidance symptoms, or arousal symptoms.
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At least eight times in the past month, Mark has experienced sudden arousal from sleep that starts with a scream and is accompanied by signs of autonomic arousal. When his partner tries to comfort him during these episodes, Mark does not respond, and in the morning, he does not remember what happened. If Mark's episodes usually happen in the first third of the night during stage 3 of sleep, the most likely diagnosis is which of the following?
A.Narcolepsy
B.Nightmare Disorder
C.Non-REM Sleep Arousal Disorder
D.REM Sleep Behavior Disorde
C
Mark's symptoms (sudden arousal from sleep that starts with a scream and autonomic arousal) and the fact that his arousal from sleep occurs during stage 3 or 4 sleep are consistent with a diagnosis of Non-REM Sleep Arousal Disorder, sleep terror type.
Answer A: Narcolepsy involves recurrent episodes of an irrepressible need to sleep within the same day.
Answer B: Non-REM Sleep Arousal Disorder and Nightmare disorder both involve awakening during sleep with autonomic arousal, but episodes associated with Nightmare Disorder usually occur later in the night during REM sleep. Additionally, a person with Nightmare Disorder recalls having a dream that involved a threat to his or her survival or security.
Answer D: REM Sleep Behavior Disorder is characterized by repeated episodes of arousal during REM sleep that are often accompanied by complex motor behavior or vocalizations that are consistent with the content of a dream.
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