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The SWTP DSM Booster is Here!

dsm boosterWe're very excited to announce the arrival of a new SWTP practice test, our DSM Booster. The 56-question, DSM-only exam is a great way to work out your DSM-5 test-prepping muscles. The more questions you experience before the exam, the more ready you'll be come exam day.

The test is just $20. Right now, use coupon code DSM5 to save an additional five percent on the DSM Booster or any other test or bundle in the SWTP library!

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Generalized Anxiety Disorder and the Social Work Exam

coffee (38861808_s)The theme lately has been anxiety disorders. Let's continue now with generalized anxiety disorder (GAD). Criteria for GAD are pretty straightforward:

A. Excessive anxiety and worry occurring more days than not for at least six months, about a number of events or activities.

B. The worry is difficult to control.

C. The worry comes with three or more of these (or just one in children):

   1. Restlessness, feeling keyed up or on edge.

   2. Being easily fatigued.

   3. Difficulty concentrating or mind going blank.

   4. Irritability.

   5. Muscle tension.

   6. Sleep problems.

Plus the usual...

D. Symptoms cause clinically significant distress or impairment.

E. Not substance induced

F. Not better explained by another condition (e.g., panic, OCD, PTSD, anorexia, somatic symptom disorder, body dysmorphic disorder, illness anxiety disorder, schizophrenia, or delusional disorder).

That is, lots of anxiety, lots of the time. Which is simple enough as far as the social work licensing exam goes, until you get to the "e.g." in letter F. All those rule outs. To be able to identify GAD, you have to be able to identify what it isn't. That means you have to have a pretty good idea what all of those other anxiety and related disorders look like. Suddenly, learning GAD for the exam becomes a little more complicated than expected.

On the test, you might see GAD as a frequent distractor (an appealing answer that isn't the correct answer). It's a catch-all for anxiety-related symptoms. How to ready yourself to tell when GAD's a distractor and when it's the answer? Piecing together your own practice question might help. It could go something like this:

A client tells a social worker he's been an "anxious mess" ever since dropping out of college, worrying about a variety of things "all of the time." He reports difficulty falling asleep even though he's usually exhausted early in the day. He has trouble with self-care like reading or meditating--"my mind just keeps going."

If you leave it there, you've got GAD. Worry for more days than not, significant distress, three of the six offered symptoms. But here's a quiz. Imagine there's an added line. What's the MOST likely diagnosis then?

The client reports everything is easier when he drinks fewer than four cups of coffee in a day.

...or...

The client reports he is "obsessed" with how much he weighs. His MD wants him to put on 20 additional pounds--"but he's a quack."

...or...

The client reports he witnessed a suicide in his college dorm room--"I've never been the same since."

Etc. Now you're into something that may not be GAD. Four cups of coffee--sounds like the symptoms may be "attributable to the physiological effects of a substance." Weigh obsession and weight loss--sounds like anorexia nervosa. Witnessed a suicide--sounds like the client's symptoms might be better explained by PTSD.

And so on. You get the idea.

For more reading about generalized anxiety disorder, check out:

For exam-style questions about GAD, anxiety disorders, and lots more, sign up for SWTP full-length practice tests!

 

[Post by Will Baum, LCSW]

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Panic Disorder and the Social Work Exam

panic (3633778_s)Your client reports occasional "freak outs" during which she experiences:

1. Palpitations

2. Sweating

3. Trembling

4. Shortness of breath

5. Choking feelings

6. Chest pain

7. Nausea

8. Dizziness

9. Chills

10. Numbness

11. Feelings of unreality

12. Fear of going crazy

13. Fear of dying

What's she experiencing? That's a panic attack. What's the diagnosis? It's very likely panic disorder. This imaginary client is symptoms in every one of the thirteen categories of symptoms that make up a panic attack. (She only needed to have four to meet initial criteria for a panic disorder diagnosis.) It's as if she entered your office to help you prepare for the ASWB exam. Thanks, client!

In order to fully meet panic disorder criteria, a panic attack needs to be follow by a month or more of either 1) persistent worry about additional panic attacks or 2) significant maladaptive change in behavior related to the attacks (avoidance bx, that is). Also, as with every last diagnosis, panic disorder can only be diagnosed if it's not better explained by substance use or a medical condition. So watch out for an exam question like this:

A client reports a series of panic attacks during which he experiences an accelerated heart rate, shaking, a sensation of being smothered, and heat sensations. He worries "all the time" about future panic attacks and has stopped dating for fear of a panic attack occurring in the middle of a date. What should the social worker do FIRST to help this client?

Before looking at the answers, think of what yours would be. That's generally a good approach to studying, unless you're pressed for time (e.g., in timed mode on a practice exam). What answers might you expect to see as A-D? Maybe these:

A) Diagnose the client with panic disorder

B) Provide psychoeducation about panic attacks

C) Refer client for a medical evaluation

D) Introduce cognitive behavioral techniques for reducing panic.

What do you say? We're in a diagnostic blog post, so the diagnostic answer is tempting. But it's premature to diagnose the client. First things first: rule out an underlying medical condition that may be causing the client's panic-attacky symptoms (the client's symptoms are just about all the ones left of the DSM list of thirteen above) . The client saying he's having panic attacks doesn't mean that's necessarily what's really going on. He should get a clean bill of health, then receive the diagnosis, then the psychoed and CBT. This simple order of operations--rule outs first!--will help get you through many a social work exam item.

Before moving on to helpful links, there's one more thing to note for the diagnosis: Culture-specific symptoms are sometimes seen. The DSM-5 lists tinnitus, headaches, and "uncontrollable screaming or crying" among them. They count too.

Okay, now some helpful links:

For more exam prep re panic disorder and lots more, try SWTP's full-length practice tests. Sign up to get started!

 

[Post by Will Baum, LCSW]

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Social Anxiety Disorder and the Social Work Exam

judgement (34043230_s)Social anxiety disorder aka SAD aka social phobia is one of those diagnoses, like OCD or PTSD, that many people use casually to describe non-clinical symptoms (eg, "I really don't want to go to that party, my social phobia's kicking in.") But having some anxiety about party-going or spending time in groups of people isn't a disorder. It's just, for many, life--normal, non-clinical worry. Take a look at these (abridged) criteria for SAD:

A. Fear of scrutiny in social situations.

B. Fear of anxiety showing and being negatively evaluated.

C. The social situations almost always provoke anxiety.

D. The social situations are avoided and endured with intense fear or anxiety.

E. The fear or anxiety is out of proportion to the actual threat posed.

F. Symptoms are persistent, lasting for 6 months or more.

G. Symptoms cause clinically significant distress or impairment.

H Symptoms are not attributable to the effects of a substance or

I. ...another disorder or...

J. ...a medical condition.

The focus in social anxiety disorder is a fear of scrutiny and negative evaluation. What will people say about me? On the social work licensing exam, look for phrases like that. As soon as you see,  people think I'm a loser, start thinking social anxiety disorder. Then look for the six month duration, intensity, impairment, lack of exceptions, and the absence of other explanations, and you've got your dx!

SAD was by far the most popular choice for the last free practice question. And why not? "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." That sounds a lot like social anxiety disorder. The trick there was the client's inability to speak. That's not a SAD symptom. That's selective mutism. Selective mutism was the best primary diagnosis in that case. The client in the vignette may qualify for both diagnoses. So it's sort of a trick question--the kind that will probably not be used for scoring--a tester which will be discarded before appearing as a scored item on the ASWB exam.

Hope this clears things up some. For additional reading about social anxiety disorder, try these:

For more questions about social anxiety disorder, anxiety disorders in general, and lots more, sign up now for SWTP's full-length practice exams.

 

[Post by Will Baum, LCSW]

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DSM Practice: Anxiety Disorders

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.

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