2.4 Eating, Psychotic, and Neurodevelopmental Disorders
Key Takeaways
- Schizophrenia requires a total duration of at least 6 months, including at least 1 month of active-phase psychotic symptoms.
- Schizoaffective Disorder is distinguished by delusions or hallucinations for at least 2 weeks in the absence of a major mood episode.
- ADHD requires several symptoms of inattention and/or hyperactivity-impulsivity to be present in 2+ settings and starting before age 12.
- Autism Spectrum Disorder is marked by early-onset deficits in social communication and restricted, repetitive patterns of behavior.
- Anorexia Nervosa is characterized by energy restriction and significantly low body weight, while Bulimia Nervosa involves a binge-purge cycle with normal or overweight status.
This section covers critical diagnoses that span the lifespan, from early developmental stages to adulthood. Social workers must understand the duration requirements for psychotic disorders, the behavioral and setting criteria for neurodevelopmental disorders, and the physiological distinctions essential for diagnosing eating disorders.
Psychotic Disorders
Psychotic disorders are characterized by abnormalities in one or more of five domains: delusions, hallucinations, disorganized thinking (speech), grossly disorganized or abnormal motor behavior (including catatonia), and negative symptoms.
Schizophrenia requires that symptoms must persist for at least six months. This six-month period must include at least one month of active-phase symptoms (or less if successfully treated). The active-phase symptoms must include at least two of the following, and at least one must be from the first three:
- Delusions
- Hallucinations
- Disorganized speech
- Grossly disorganized or catatonic behavior
- Negative symptoms (e.g., diminished emotional expression or avolition)
If the disturbance has lasted more than one month but less than six months, the appropriate diagnosis is Schizophreniform Disorder. If the active symptoms last less than one month and resolve completely, the diagnosis is Brief Psychotic Disorder.
Schizoaffective Disorder is characterized by an uninterrupted period of illness during which there is a major mood episode (either a major depressive or manic episode) concurrent with active-phase symptoms of Schizophrenia. To differentiate Schizoaffective Disorder from a Depressive or Bipolar Disorder with Psychotic Features, the diagnostic criteria require that delusions or hallucinations must be present for at least two consecutive weeks in the absence of a major mood episode at some point during the lifetime course of the illness.
Neurodevelopmental Disorders
Neurodevelopmental disorders manifest early in development, often before the child enters grade school, and produce impairments of personal, social, academic, or occupational functioning.
Attention-Deficit/Hyperactivity Disorder (ADHD) involves a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development. For the exam, remember these two critical criteria:
- Several inattentive or hyperactive-impulsive symptoms must have been present prior to age 12.
- Several symptoms must be present in two or more settings (such as at home, school, work, or in social situations).
Autism Spectrum Disorder (ASD) is characterized by persistent deficits in social communication and social interaction across multiple contexts, alongside restricted, repetitive patterns of behavior, interests, or activities. These patterns can include stereotyped motor movements, insistence on sameness, highly restricted fixated interests, or hyper- or hypo-reactivity to sensory input. Symptoms must be present in the early developmental period, though they may not fully manifest until social demands exceed limited capacities.
Eating Disorders
Eating disorders represent severe disturbances in eating behavior and are associated with significant physical health risks.
Anorexia Nervosa is defined by three core criteria:
- Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.
- Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain.
- Disturbance in the way in which one’s body weight or shape is experienced, or persistent lack of recognition of the seriousness of the current low body weight.
Bulimia Nervosa is characterized by recurrent episodes of binge eating (eating an abnormally large amount of food in a discrete period with a sense of lack of control) followed by recurrent inappropriate compensatory behaviors (such as self-induced vomiting, misuse of laxatives, diuretics, fasting, or excessive exercise) to prevent weight gain. The binge eating and compensatory behaviors must both occur, on average, at least once a week for three months.
A critical clinical distinction for the exam is body weight:
- Individuals with Anorexia Nervosa have a significantly low body weight (underweight, BMI typically < 18.5).
- Individuals with Bulimia Nervosa typically maintain a body weight that is within the normal or overweight range (BMI ≥ 18.5). If a client meets all criteria for bulimia but has a significantly low body weight, the correct diagnosis is Anorexia Nervosa, Binge-eating/Purging type.
| Disorder | Duration / Age Threshold | Key Distinguishing Feature |
|---|---|---|
| Schizophrenia | 6+ Months (including 1 month active phase) | Delusions, hallucinations, disorganized speech, negative symptoms |
| Schizoaffective Disorder | Concurrent mood + psychotic; 2+ weeks psychosis alone | Psychotic symptoms exist independently of major mood episodes |
| ADHD | Onset before age 12; present in 2+ settings | Inattention and/or hyperactivity-impulsivity impairing functioning |
| Autism Spectrum Disorder | Early developmental onset | Deficits in social communication; restricted, repetitive behaviors |
| Anorexia Nervosa | Ongoing energy restriction | Significantly low body weight; intense fear of weight gain |
| Bulimia Nervosa | 1x per week for 3 months | Binge/purge cycle; body weight is normal or overweight |
Clinical Vignette
A school social worker is assessing a 9-year-old child whose teacher reports he is constantly out of his seat, interrupts classmate conversations, and struggles to complete his classwork. The parents report similar behaviors at home, stating he has always been "hyper" and cannot sit still for meals since he was a toddler.
Clinical Analysis: The child displays symptoms of inattention and hyperactivity-impulsivity. These symptoms are present in two distinct settings (school and home) and have been present since early childhood (well before the age 12 threshold). This clinical picture indicates Attention-Deficit/Hyperactivity Disorder (ADHD).
A client has experienced auditory hallucinations and persecutory delusions for the last two years. During this period, the client also experienced a major depressive episode that lasted for four months, during which the psychotic symptoms persisted. For the past six months, the client's mood has returned to normal, but the hallucinations and delusions continue. What is the most appropriate diagnosis?
A 20-year-old college student is referred to a clinical social worker. The client reports that twice a week for the past five months, they consume massive quantities of food in their room until they feel physically ill, followed by self-induced vomiting to prevent weight gain. The client is highly preoccupied with their body shape. Upon reviewing the client's medical records, the social worker notes that the client's body mass index (BMI) is 21.5, which is in the normal range. What is the most appropriate diagnosis?
A social worker is assessing an 8-year-old child for Attention-Deficit/Hyperactivity Disorder (ADHD) at the request of the school. The child exhibits significant hyperactivity and impulsivity in the classroom, leading to disruption. To confirm the diagnosis under the DSM-5-TR, which of the following criteria must also be met?