Anxiety and OCD
What are 3 of the symptoms for Separation Anxiety Disorder under criterion A
What is 3 of
Recurrent excessive distress when anticipating or experiencing separation from home or from a major attachment figure.
Losing or harm to major attachment figures
Persistent worry about experiencing an untoward event that causes separation from attachment figures.
Persistent reluctance or refusal to go out, away from home due to fear of separation.
Reluctance about being alone or without attachment figures.
Reluctance to sleep away from home or to go to sleep w/o being near to a major attachment figure.
Repeated nightmares involving themes of separation.
8. Repeated complaints of physical symptoms.
What are the similarities and differences between Reactive Attachment Disorder and Disinhibited Social Engagement Disorder?
Similarities
Pattern of extremes of insufficient care
Social neglect or deprivation in the form of persistent lack of having basic needs for comfort, stimulation, and affect met by caregiving adults.
Repeated changes of primary caregivers that limit opportunities to form stable attachments.
Rearing in unusual settings that severely limit opportunities for selective attachments.
Differences
Reactive Attachment Disorder: pattern of inhibited, emotionally withdrawn behavior toward adult caregivers + a persistent social and emotional disturbance.
Disinhibited Social Engagement Disorder: pattern of behavior in which a child actively approaches and interacts with unfamiliar adults.
Describe Pica. (Definition, examples, Co-Morbidity)
Persistent eating of nonnutritive, nonfood substances over a period of at least 1 month inappropriate to the developmental level of the individual and not within the cultural norms for the person.
I.e., Paper, soap, dirt, crayons
Co-morbid: Autism Spectrum Disorder
What is an impulse?
A sudden, strong, and unreflective urge or desire to act.
Tendency to act without thinking - act first then deal with consequences
What can Marcus be diagnosed with?
Marcus J., a 12-year-old student in middle school, is referred to counseling after repeated reports of disruptive behavior at school and ongoing conflict at home. Over the past year, his teachers and caregivers have observed a persistent pattern of angry and defiant behavior occurring across multiple settings, including school, home, and after-school programs.
Marcus is often described as having a short temper. He frequently loses his temper over minor frustrations, such as being asked to complete assignments or follow classroom rules. He is easily annoyed by peers and adults and often appears chronically angry and resentful, especially when he feels “told what to do.”
In school, Marcus regularly argues with teachers and refuses to comply with instructions, even for routine tasks. He challenges rules openly, sometimes refusing to begin assignments or walking out of class when corrected. At home, he similarly resists parental requests, often stating that adults are “always trying to control him.” He frequently blames others for his mistakes, insisting that teachers are “unfair” or that classmates “start things on purpose.”
Peers report that Marcus sometimes deliberately annoys others, such as interrupting conversations, teasing, or provoking reactions, even after being asked to stop. Within the past six months, he has also engaged in at least two episodes of spiteful or vindictive behavior, including damaging a peer’s personal item after a disagreement and spreading rumors in retaliation for feeling excluded.
These behaviors have been present for more than six months and are not limited to interactions with siblings. They have caused significant distress in both his school and home environments, leading to disciplinary referrals and strained family relationships. His behavior is not occurring in the context of psychosis, substance use, or a mood disorder.
Severity: Moderate (symptoms present in at least two settings: school and home)
Rule-outs:
Oppositional Defiant Disorder
What are the rule outs pertaining to Specific Phobia?
Agnoraphobia: person needs 2+ situations, where phobias only require avoidance of one stimuli, and this dx is more about avoiding the REACTION to the stimuli, instead of just avoiding the stimuli in specific phobia.
Panic disorder: panic attacks can occur when confronting a feared object, but the phobia is about the specific object/situation and does not have to result in a panic attack.
PTSD: need to see more than just fear/avoidance of a specific object/situation.
What are the different types of amnesia? (6)
Localized amnesia: can’t recall events from a particular period of time (most common from trauma).
Selective amnesia: can recall some but not all events from a period of time.
Retrospective memory impairment: can’t recall events from past traumas and everyday events.
Systematized amnesia: a person can’t remember a specific category of important information.
Retrograde amnesia: can’t recall memories from the past.
Generalized dissociative amnesia: complete loss of memory for most of all of the individual’s life history.
What must you rule out to diagnose Avoidant/Restrictive Food Intake Disorder (ARFID)?
Anorexia Nervosa
What is the process of the brain when impulse control IS present
Impulse (driven toward pleasurable things)
No Considering the consequences
Acting on impulse
Domphanine for engaging in the behavior
Consequences to follow? A person connects to feeling rather than thought.
What are potential triggers for Bulimia Nervosa? (6)
Negative affect, interpersonal stressors, difficulty regulating emotions, dietary restraint, negative feelings related to body weight/shape, boredom.
What are the criterion for Social Anxiety Disorder
Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions, being observed, and performing in front of others.
In children, the anxiety must occur in peer settings.
Fears that they will act in a way or show anxiety symptoms that will be negatively evaluated (humiliation, embarrassment, rejection)
Social situations almost always provoke fear or anxiety.
In children, anxiety must be shown as crying, tantrums, freezing, shrinking., failing to speak
Social situations are avoided/endured with intense fear.
Fear is out of proportion to actual threat.
Persistent fear/anxiety, typically lasting for 6 months or more.
Causes impairment/distress
Not attributed to physiological effects of a substance.
Not better explained by symptoms of another disorder.
Unrelated to any other medical condition, if applicable.
What is Daniel presenting with?
Daniel R., a 29-year-old barista, is brought to therapy after repeated concerns from coworkers about “personality shifts” and unexplained absences during shifts. Daniel reports increasing confusion about his sense of self, stating, “Sometimes I feel like I’m watching someone else live my life.” He describes periods where his voice, posture, and preferences change abruptly—at times speaking in a childlike tone, at other times becoming unusually rigid and critical toward himself and others.
His roommate has observed these shifts as well, noting distinct patterns: a fearful, withdrawn “younger” state that hides in Daniel’s room; an impulsive, risk-taking state that spends money recklessly; and a harsh, judgmental state that berates Daniel for perceived failures. Daniel refers to his usual experience as his “waking self,” but reports feeling as though he “loses control” when these other states take over, followed by confusion and distress.
He also endorses frequent gaps in memory. For example, he has found unfamiliar clothing in his closet, discovered texts he does not remember sending, and once “came to” in a park across town with no recollection of how he got there. These lapses go beyond ordinary forgetfulness and have occurred consistently over the past year. Daniel denies substance use, and medical evaluation has not identified any neurological or other physiological causes.
The symptoms have significantly impaired his functioning—he has received warnings at work due to inconsistent behavior, struggles to maintain relationships, and feels distressed by his lack of control and fragmented identity. He reports no cultural or religious practices that would explain these experiences, and there is no history suggesting these symptoms are developmentally normative.
Rule-out:
Dissociative Identity Disorder
What are the A-F criterion for Illness Anxiety Disorder?
Preoccupation with having or acquiring a serious illness.
Somatic symptoms are NOT PRESENT (or only mild).
High level of anxiety about health & easily alarmed about personal health status.
Performs excessive health-related behaviors or maladaptive avoidance.
Present for 6 months or more.
Not better explained by SSS, PD, GAD, BDD, OCD, etc.
What is the age criterion for Intermittent Explosive Disorder?
At least 6 years old
What can Lena be diagnosed with
Lena H., a 30-year-old office coordinator, presents with longstanding difficulties related to decision-making and independence that have become increasingly impairing in her adult life. She describes a pervasive sense that she “can’t handle life on her own” and relies heavily on others for reassurance, guidance, and emotional support for even minor decisions, such as what to wear, what to eat, or how to respond to emails.
Lena reports that she often defers major life decisions to her partner, including financial planning, housing choices, and career decisions, stating that she feels “panicked” when expected to decide on her own. She expresses significant discomfort when she disagrees with others, particularly authority figures or close relationships, because she fears it may lead to rejection or loss of support. As a result, she tends to agree even when she has internal disagreement.
She also describes marked difficulty initiating tasks independently, often procrastinating or avoiding responsibilities unless someone else is present to guide or reassure her. At work, she frequently seeks confirmation from supervisors for tasks she has already been trained to complete. Lena reports that she will go to great lengths to maintain relationships, including volunteering for unpleasant or burdensome tasks to ensure others remain close to her.
When she is alone, Lena experiences intense discomfort and helplessness, accompanied by fears that she would be unable to take care of herself. After a recent breakup, she immediately sought out a new romantic relationship, stating she “can’t be without someone for long.” She also endorses persistent worry that she will be abandoned and left to manage life entirely on her own.
These patterns have been present across multiple adult relationships and contexts and have significantly impacted her occupational independence and self-confidence.
Rule-outs:
Dependent Personality Disorder
What can Maria be Diagnosed with?
Maria S., a 32-year-old graduate student, presents to the clinic reporting a “shrinking world” over the past eight months. She describes intense anxiety when attempting to ride the bus to campus, walking across the open quad, and standing in long lines at grocery stores. She also avoids going anywhere alone, including short walks around her neighborhood. Maria explains that in these situations she becomes overwhelmed by the thought that if she were to feel dizzy, nauseated, or panicked, she would not be able to escape or get help quickly, and others might notice and judge her.
Because of this, she has stopped using public transportation entirely, orders groceries online, and will only leave her apartment if accompanied by her roommate. When she does attempt to face these situations, she experiences immediate surges of fear, with a racing heart, sweating, and a sense of impending loss of control. She acknowledges that the level of fear she experiences is excessive compared to the actual risk, but feels unable to manage it. These patterns have persisted for over six months and have significantly interfered with her academic attendance, social life, and independence.
Maria denies a history of spontaneous, unexpected panic attacks occurring outside of these feared situations. She also reports no specific traumatic event tied to these fears and no underlying medical condition that would explain her symptoms. Her primary concern centers on the inability to escape or access help if she becomes incapacitated in these environments.
Rule outs:
Agoraphobia
What is the difference between depersonalization and derealization
Depersonalization: experiences of unreality, detachment, or being an outside observer with respect to one’s thoughts, feelings, sensations, body, or actions (perceptual alterations, distorted sense of time, unreal or absent self, emotional or physical numbing).
Derealization: experiences of unreality or detachment with respect to surroundings (individuals or objects are experienced as unreal, dreamlike, foggy, lifeless, or visually distorted).
What can Emily be diagnose with?
Emily T., a 41-year-old administrative assistant, presents with a two-year history of chronic lower back and diffuse joint pain. Despite multiple medical evaluations—including imaging, lab work, and consultations with specialists—no significant underlying pathology has been identified. Her physicians have reassured her that her symptoms are likely related to muscle tension and stress, but Emily remains convinced that “something serious is being missed.”
Emily reports that the pain is present daily and has become the central focus of her life. She spends several hours each day researching possible diagnoses online, frequently checks her body for new or worsening sensations, and has visited urgent care clinics multiple times in the past six months for reassurance. She describes her pain as “unbearable” and fears it may indicate a progressive, disabling condition, despite repeated normal findings.
Her anxiety about her health is persistent and overwhelming. She avoids physical activity out of fear of causing further “damage,” has reduced her work hours, and frequently cancels social plans due to concern about exacerbating her symptoms. Emily acknowledges that her worry may be excessive but feels unable to control it. She also reports heightened sensitivity to bodily sensations, often interpreting minor discomforts as signs of serious illness.
These symptoms have persisted well beyond six months and have resulted in significant impairment in her occupational functioning and relationships. While her pain is real and distressing, the degree of preoccupation, anxiety, and time devoted to her symptoms is disproportionate to the medical findings. She denies substance use, and there is no evidence of another medical condition that would fully explain the severity of her distress and functional impairment.
Somatic Symptom Disorder
What can Jordan be diagnosed with?
Jordan L., a 17-year-old high school student assigned female at birth, presents to a counseling clinic with persistent distress related to gender. Over the past year, Jordan has increasingly identified as male and reports a strong sense that his experienced gender does not align with his body. He describes significant discomfort with his chest and has begun wearing a binder daily, stating that seeing or feeling these physical characteristics causes intense distress. He has also expressed a strong desire to begin testosterone therapy and eventually pursue surgical options to align his body with his gender identity.
Jordan reports a strong desire to be treated as male by others and feels affirmed when peers and a few supportive teachers use his chosen name and he/him pronouns. He describes feeling “like myself for the first time” in those moments. He also expresses a firm conviction that his thoughts, emotional responses, and internal sense of self are consistent with being male.
This incongruence has been present for more than six months and has led to clinically significant distress. Jordan reports increasing anxiety and depressive symptoms, particularly at home where his family does not acknowledge his gender identity. He avoids situations such as changing for gym class and social events that might highlight his body, and his academic performance has declined due to emotional strain.
Jordan denies that these experiences are part of a cultural or religious practice and there is no evidence that his distress is better explained by another mental health condition.
Gender Dysphoria in Adolescents/Adults
What are the criteria for Antisocial Personality Disorder? A-D
A pervasive pattern of disregard for and violation of the rights of others, occurring since age 15, as indicated by 3 or more of the following:
Failure to conform to social norms with respect to lawful behaviors, repeatedly performing acts that are grounds for arrest.
Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure.
Impulsivity or failure to plan ahead.
Irritability and aggressiveness, including repeated physical fights or assaults.
Reckless disregard for the safety of others.
Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behaviors or honor financial obligations.
Lack of remorse, being indifferent to or rationalizing having hurt, mistreated, or stolen from another.
Individuals are at least 18 years old.
Evidence of conduct disorder with onset before age 15 years.
Occurrence of antisocial behavior does not exclusively occur during the course of schizophrenia or bipolar disorder.
What are the stages of the OCD cycle and describe them
Obsessions (Criterion A1, Criterion A2)
Anxiety (attempts to ignore, avoid, suppress)
Compulsions (preventing, reducing, checking)
Relief (temporary, intermediary between compulsions and return of intrusive thought)
What is the age criterion for Reactive Attachment and Disinhibited Social Engagement Disorders?
at least 9 months. (G and E respectively)
List A-D Criterion for Binge Eating Disorder
Recurrent episodes of binge eating. An episode of binge eating is characterized by both:
Eating in a discrete period of time, an amount of food that is larger than what most people would eat.
A sense of lack of control over eating during these episodes.
Binge-eating episodes are associated with 3 or more of the following:
Eating much more rapidly than normal.
Eating until feeling uncomfortably full.
Eating large amounts of food when not feeling physically hungry.
Eating alone because of feeling embarrassed by how much one is eating.
Feeling disgusted with oneself, depressed, or guilty.
Marked distress.
Occurs at least once a week for 3 months.
Not associated with the recurrent use of inappropriate compensatory behaviors as in bulimia nervosa and does not occur during Anorexia or Bulimia.
What is lacking in someone with poor impulse control?
*Hint* related to after action is taken
what is shame and embarrassment
What can Maddy be diagnose with?
Maddy R., a 24-year-old graduate student, presents with longstanding patterns of emotional and relational instability that began in late adolescence. She reports intense and rapidly shifting emotions, describing her internal experience as “all or nothing, all the time.” Maddy describes a pervasive fear of being abandoned, even in situations where no clear rejection is occurring, such as delayed text responses or a partner needing personal space. In these moments, she often engages in frantic efforts to prevent perceived abandonment, including repeated calling, pleading messages, or sudden accusations.
Her interpersonal relationships are highly unstable. She describes quickly becoming intensely attached to new friends or romantic partners, idealizing them as “the only person who understands me,” followed by abrupt shifts to anger or devaluation when she feels hurt or misunderstood. She states, “I either love them completely or I feel like they’re against me.”
Maddy reports a persistently unstable sense of self, noting that her identity, goals, and values change frequently depending on her current relationships or emotional state. She describes not knowing “who she really is” outside of how others see her. She also endorses impulsive behaviors in multiple domains, including risky sexual encounters, reckless spending sprees, and episodic substance use during emotional crises.
She has a history of recurrent suicidal gestures and self-injurious behavior, particularly during periods of perceived rejection or interpersonal conflict. Maddy describes chronic feelings of emptiness, stating that she often feels “hollow” or “like something is missing inside.” She also reports intense episodes of anger that are difficult to control, during which she may yell, break objects, or send highly charged messages she later regrets.
Occasionally, under extreme stress, she experiences transient paranoid thoughts such as believing others are “talking about her” or “planning to leave her,” though these resolve when her emotional state stabilizes. These symptoms have been present across multiple contexts since early adulthood and have significantly impaired her academic performance, occupational stability, and relationships.
Rule-outs:
Borderline Personality Disorder ;)