Which of the following is/are diagnostic criteria for primary insomnia?
A. The sleep disturbance is defined as difficulty initiating or maintaining sleep, or non-restorative sleep, for at least 1 month
B. The disturbance does not occur during the course of another mental disorder
C. The sleep disturbance or associated daytime fatigue causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
D. All of the above
ANS: D
Rationale: Insomnia has a multitude of causes, including age, menopause, chronic illness, pain, stress, anxiety, depression, poor sleep habits, endocrine disorders, or medications. The DSM-5 criteria for primary insomnia are as follows (American Psychiatric Association, 2013):
1. The sleep disturbance is defined as difficulty initiating or maintaining sleep, or non-restorative sleep, for at least 1 month.
2. The sleep disturbance (or associated daytime fatigue) causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
3. The sleep disturbance does not occur exclusively during the course of narcolepsy, breathing-related sleep disorder, circadian rhythm sleep disorder, or a parasomnia.
4. The disturbance does not occur exclusively during the course of another mental disorder (e.g., major depressive disorder, generalized anxiety disorder, a delirium).
5. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.
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