Classroom 11332016_sWe're overdue for a practice question here on the SWTP blog. Today, let's take a look at the DSM chapter covering anxiety disorders. Here's the complete list of disorders covered in the chapter:

  • Separation Anxiety Disorder
  • Selective Mutism
  • Specific Phobia
  • Social Anxiety Disorder (Social Phobia)
  • Panic Disorder
  • Agoraphobia
  • Generalized Anxiety Disorder

Those are the basics. Then there're also the usual extras:

  • Substance/Medication-Induced Anxiety Disorder
  • Anxiety Disorder Due to Another Medical Condition
  • Other Specified Anxiety Disorder
  • Unspecified Anxiety Disorder

Your task on the social work exam will usually be to sort through the differences in the first group, not the second. How well do you know the differences and similarities between the types of anxiety disorders? Here's a exam-style question to test you out:

A social worker sees a client, an MSW student, who reports feeling anxious in social situations, especially in classes. She says she gets clammy hands, shortness of breath, and can't bring herself to speak at all when called upon. Her participation grade has already been affected. She has a presentation to make soon and instead of going through with it, she's thinking of dropping the class. Friends are encouraging her to stick with it. What is the MOST likely primary diagnosis for this client?

A) Selective Mutism

B) Specific Phobia

C) Social Anxiety Disorder

D) Panic Disorder

What do you think? The clammy hands and shortness of breath sound like panic symptoms. The fear of classroom interaction sounds sort of like a phobia. The reported worry in social situations sounds like social anxiety disorder. But the inability to speak during class? That sounds like this:

Consistent failure to speak in specific social situations in which there is an expectation for speaking (e.g., at school) despite speaking in other situations.

That's the first of the criteria for, you guessed it, selective mutism. For a diagnosis of selective mutism, symptoms have to have been present for at least one month (which seems to be the case here); they have to be interfering with achievement (check); they cannot be attributable to a lack of knowledge; plus the disturbance cannot be better explained by a communication disorder, ASD, schizophrenia, or another psychotic disorder. It's a brief vignette, and entirely too little information to make a decisive diagnosis is given. But the most likely of the offered diagnoses in this case is selective mutism.

It's tempting to answer social anxiety disorder. But remember that social anxiety disorder is characterized almost entirely by anxiety itself--fear and worry about social situations and judgment by others. While she begins by describing what sounds like social anxiety, the client's inability to speak in class is something else entirely. That symptom makes the better choice for primary diagnosis selective mutism.


For more about DSM-5 anxiety disorders including selective mutism, read on here:

For more questions about anxiety disorders and much more, sign up for SWTP's full-length practice tests.

March 31, 2016
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