morning coffeeAnother day, another free practice question! This one comes from the Sleep-Wake Disorders chapter of the DSM. What's in that chapter? This is what's in that chapter:

  • Insomnia Disorder (dissatisfaction with sleep)
  • Hypersomnolence Disorder (excessive sleepiness)
  • Narcolepsy (recurrent, irrepressible need to sleep)

Then there are the Breathing-Related Sleep Disorders (Obstructive Sleep Apnea Hypopnea, Central Sleep Apnea, and Sleep-Related Hypoventilation). There're also Circadian Rhythm Sleep-Wake Disorders. And then, Parasomnias (Non-Rapid Eye Movement Sleep Arousal Disorders, Nightmare Disorder, Rapid Eye Movement Sleep Behavior Disorder, Restless Leg Syndrome). Then all the "others": Substance-induced this, unspecified that, other other.

It's enough to make you sleepy just reading through the list. And it raises a lot of questions--possible questions for the social work licensing exam. For instance, what's a parasomnia? Here's a quick definition: "a disorder characterized by abnormal or unusual behavior of the nervous system during sleep." Simple.

So, there are sleep problems that arise psych reasons, for breathing reasons, for nervous system reasons, and for other/unspecified reasons. There are a lot of ways to not get sleep. But there's only one good way to answer the following practice question. See you how you do:

A client tells a social worker that for the past several weeks, ever since getting promoted, she has been getting "terrible," dreamless sleep. She has a hard time falling asleep and wakes up "way before the alarm rings," her mind racing with thoughts about work. She reports difficulty focusing on the job--"I'm so exhausted." What is the MOST likely diagnosis for this client?


B) Non-Rapid Eye Movement Sleep Arousal Disorder

C) Insomnia

D) Adjustment Disorder

What do you think?

Let's do the usual process of elimination:

--GAD requires "excessive anxiety and worry" for at least 6 months. That's not what's being reported here. Strike that answer.

--Non-Rapid Eye Movement Sleep Arousal involves "recurrent episodes of incomplete awakening from sleep" with either sleepwalking or sleep terrors. With sleepwalking, some will engage in sleep-related eating or sleep-related sexual behavior, known as "sexsomnia." Not a fit here.

--Insomnia is an appealing answer. The client is reporting symptoms of insomnia. However, the client's sleep problems seem to be related to a recent stressor--a promotion. There may be something else going on. Or maybe it is insomnia, but that won't be diagnosable till the sleep problems have persisted for three months. If three months haven't passed  yet, it's not insomnia disorder.

--That leaves adjustment disorder. Adjustment disorder is "the development of emotional or behavioral symptoms in response to an identifiable stressor occurring within three months of the onset of the stressor." It's the best choice on the list.

A better diagnosis here might be no diagnosis at all. The client is losing sleep over a new job. That's not necessarily a disorder. But "No Diagnosis" isn't one of the choices offered, so you're stuck with the least-bad of the bunch: D) Adjustment Disorder.

To read up about sleep-wake disorders and adjustment disorders, try:

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August 19, 2016
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