Depressive Dx
This disorder requires 5 or more symptoms for at least 2 weeks, with at least one being depressed mood or loss of interest.
What is Major Depressive Disorder (MDD)?
GAD's hallmark worry symptom must be present for at least this long, occurring more days than not.
What is 6 months?
PTSD symptoms must persist for more than this duration to be distinguished from Acute Stress Disorder.
What is 1 month?
This is the core distinction between OCD and Obsessive-Compulsive Personality Disorder.
What is OCD is ego-dystonic (the obsessions/compulsions feel unwanted and distressing) while OCPD is ego-syntonic (the rigidity and perfectionism feel consistent with the person's identity)?
Before diagnosing any anxiety or depressive disorder, DSM-5-TR requires ruling out these two general causes first.
What are substance/medication-induced effects and another medical condition?
The key feature that distinguishes Persistent Depressive Disorder from MDD is this.
What is duration (PDD requires at least 2 years in adults, vs. 2 weeks for MDD)?
This is the key distinction between panic disorder and agoraphobia — one can exist without the other.
What is panic disorder involves recurrent unexpected panic attacks with persistent concern, while agoraphobia involves fear/avoidance of specific situations due to escape being difficult — neither requires the other to be present?
These are the four symptom clusters required for a PTSD diagnosis in DSM-5-TR.
What are intrusion, avoidance, negative alterations in cognition and mood, and alterations in arousal and reactivity?
In OCD, compulsions are defined as repetitive behaviors aimed at doing this — not at providing pleasure.
What is reducing anxiety or distress, or preventing a dreaded event (not connected in a realistic way to what they're meant to neutralize)?
A patient reports low energy, hypersomnia, and difficulty concentrating for 8 months. She does not report sad mood but says she feels "empty." Which two disorders should be at the top of your differential?
What are PDD (Persistent Depressive Disorder) and MDD with atypical features (or MDD — depressed mood can manifest as emptiness per DSM-5-TR)?
This MDD specifier applies when a full depressive episode begins during pregnancy or within 4 weeks of delivery.
What is "with peripartum onset"?
Unlike in children, adults with separation anxiety disorder must have symptoms lasting at least this long.
What is 6 months?
This PTSD specifier describes patients who present primarily with depersonalization or derealization rather than hyperarousal.
What is the dissociative subtype?
DSM-5-TR requires OCD symptoms to be time-consuming or cause significant distress. Specifically, this is the time threshold used as a general clinical benchmark.
What is more than 1 hour per day?
This is the key feature that distinguishes Illness Anxiety Disorder from Somatic Symptom Disorder.
What is in Illness Anxiety Disorder, somatic symptoms are absent or mild — the distress is about feared illness, not about the physical symptoms themselves (which are prominent in Somatic Symptom Disorder)?
In MDD with this specifier, the patient has at least 3 of: mood reactivity, leaden paralysis, hypersomnia, hyperphagia, interpersonal rejection sensitivity, or a heavy feeling in the limbs.
What is the atypical features specifier?
This anxiety disorder is the only one in DSM-5-TR that explicitly requires the fear to be out of proportion to the actual danger posed by the object or situation, taking cultural context into account.
What is Specific Phobia (also accepted: Social Anxiety Disorder shares this criterion)?
Adjustment Disorder differs from PTSD in this critical way regarding the stressor.
What is Adjustment Disorder can follow any identifiable stressor (not just traumatic ones), and symptoms must begin within 3 months of the stressor — there is no requirement that the stressor involve threatened death, serious injury, or sexual violence?
This OCD-related disorder involves recurrent pulling out of one's own hair, resulting in hair loss, and is classified in the obsessive-compulsive and related disorders chapter.
What is Trichotillomania (Hair-Pulling Disorder)?
A patient has intrusive, unwanted thoughts that something bad will happen if she doesn't tap her desk 4 times before leaving a room. She has good insight that this is irrational. Give the full DSM-5-TR diagnosis including the appropriate specifier.
What is Obsessive-Compulsive Disorder, with good insight?
This is the minimum number of depressive episodes and the minimum symptom-free period between them required to diagnose Disruptive Mood Dysregulation Disorder's comorbidity exclusion with Bipolar I.
What is DMDD cannot be diagnosed if the symptoms occur exclusively during a manic or hypomanic episode- DMDD and Bipolar I/II are mutually exclusive diagnoses?
A patient worries excessively about multiple domains, has muscle tension and poor sleep, but denies feeling restless or having difficulty concentrating. How many of the 6 GAD associated symptoms does she meet, and does she qualify for the diagnosis?
What is 2 of 6 (muscle tension + sleep disturbance) — adults require 3 or more, so she does NOT meet criteria for GAD?
A first responder who witnesses traumatic events repeatedly as part of their job meets criterion A for PTSD via this specific exposure route listed in DSM-5-TR.
What is repeated or extreme indirect exposure to aversive details of traumatic events (Criterion A4) — which applies to first responders but NOT to media/screen exposure?
A patient with BDD spends 3 hours daily preoccupied with a slight asymmetry in her nose, performs repetitive mirror-checking, and believes her nose is severely disfigured when others see nothing abnormal. Which DSM-5-TR specifier and which additional specifier must you assign, and why?
What is "with poor insight" or "with absent insight/delusional beliefs" (depending on degree), AND "with repetitive behaviors" — BDD requires specifying insight level AND noting the presence of repetitive behaviors (mirror checking counts)?
A patient meets full criteria for GAD and MDD simultaneously. Per DSM-5-TR comorbidity rules, what should you do, and what is the clinical reasoning?
What is diagnose both — DSM-5-TR explicitly states GAD and MDD are frequently comorbid and both should be diagnosed when criteria are independently met; the "with anxious distress" specifier on MDD does not preclude a separate GAD diagnosis if full GAD criteria are met?