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:

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DSM Practice: Depressive Disorders

DSM practiceHere's a section of the DSM that shows up in social work settings all the time and is just as likely to show up in diagnostic questions on the social work licensing exam: depressive disorders. Here's the complete list from DSM-5:

  • Disruptive Mood Dysregulation Disorder
  • Major Depressive Disorder
  • Persistent Depressive Disorder (Dysthymia)
  • Premenstrual Dysphoric Disorder
  • Substance/Medication-Induced Depressive Disorder
  • Depressive Disorder Due to Another Medical Condition
  • Other Specified Depressive Disorder
  • Unspecified Depressive Disorder

Do you have a general sense of what each of these involves? A quick browse through your DSM can get you up to speed. Better still, try out a practice question:

A social worker sees a 37-year-old client who reports several depressive symptoms: lack of appetite, difficulty sleeping, low energy, low self-esteem. The client says he's had the symptoms pretty much all the time since his marriage broke up, almost three years ago. Dating and work have both been negatively impacted. What is the MOST likely diagnosis for this client?

A) Major Depressive Disorder

B) Persistent Depressive Disorder

C) Adjustment Disorder with Depressed Mood

D) Disruptive Mood Dysregulation Disorder

Got the answer?

Here's how to narrow it down: disruptive mood dysregulation disorder involves outbursts of temper. Not what's described here. MDD is diagnosed for an episode of depression lasting at least two weeks. The client's symptoms have been continuing for almost three years. Adjustment disorder fits when symptoms arise within three months of the onset of a stressor (e.g., a divorce). So this timeline doesn't fit. That leaves B) Persistent depressive disorder (aka dysthymia). Persistent depressive disorder requires symptoms lasting at least two years in adults or one year in children and adolescents. Symptoms cause clinically significant distress and are present "most of the day, for more days than not." Check, check, and check. You have your answer!

For more about depressive disorders, try:

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DSM Practice: Paraphilic Disorders

DSM practiceAnother blog post, another free DSM practice question to help get you ready for the social work licensing exam. This one comes from the paraphilic disorders chapter. Do you know one from the other? Here's the complete DSM-5 list:

  • Voyeuristic Disorder
  • Exhibitionistic Disorder
  • Frotteuristic Disorder
  • Sexual Masochism Disorder
  • Sexual Sadism Disorder
  • Pedophilic Disorder
  • Fetishistic Disorder
  • Transvestic Disorder
  • Other Specified Paraphilic Disorder
  • Unspecified Paraphilic Disorder

We'll save some typing by referring you to the Desk Reference to the DSM for quickish summaries of each. Find more resources linked after the question. Here's the question:

A man comes to see a therapist after having been arrested for rubbing up against a woman in the subway. The man started the behavior a couple of years ago, when first moving to the city. What is the MOST likely diagnosis for this man?

A) Sexual Masochism Disorder

B) Fetishistic Disorder

C) Exhibitionistic Disorder

D) Frotteuristic Disorder

Have your answer?

Let's take A-D one at a time. Sexual masochism disorder involves sexual arousal from the act of being humiliated, beaten, bound, or otherwise made to suffer. (Not it.) Fetishistic disorder is diagnosed when arousal comes from nonliving objects or nongential body parts (e.g., shoes, feet). (Not it.) Sexual arousal in exhibitionistic disorder comes from exposing one's genitals to an unsuspecting person. (Not what's described.) That leaves one answer, the correct answer, D, frotteuristic disorder, which starts with this essential criterion:

Over a period of at least 6 months, recurrent and intense sexual arousal from touching or rubbing against a nonconsenting person, as manifested by fantasies, urges, or behaviors.

Also, as with all of these, symptoms "cause clinically significant distress or impairment in social, occupational, or other important areas of functioning."

Got it? Great.

Here are some places to read up on paraphilic disorders:

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DSM Practice: Eating Disorders

DSM practiceContinuing our occasional series of free practice questions based upon the DSM. Here's one that comes from the Feeding and Eating Disorders chapter. There are eight diagnoses included in the chapter (including Unspecified Feeding or Eating Disorder). How many of the other seven can you name? They're listed below, after the question. First, here the practice question:

A woman seeks help from a social worker for an eating disorder. She reports regularly eating large amounts of breakfast cereal right before bedtime, leaving her feeling uncomfortable and miserable. She often takes laxatives in order to flush out the unwanted food. What is the MOST likely diagnosis for this client?

A) Bulimia Nervosa

B) Binge-Eating Disorder

C) Night Eating Syndrome

D) Anorexia Nervosa Binge/Purging Type

What do you say?

In the DSM-5, binge-eating disorder has leapt from "for further study" to a full-fledged diagnosis. What is described here, however, is not binge-eating disorder. The woman's laxative use is what's called a "compensatory behavior" in the DSM-5 (like purging, fasting, or exercising excessively). In binge-eating disorder, there are no compensatory behaviors. Night eating syndrome is diagnosed when criteria for the other Feeding or Eating Disorders aren't met. Anorexia nervosa no longer includes a binge/purging type as it did in DSM-IV-TR. The best answer here is A) bulimia nervosa.

Here are those eight diagnoses from the Feeding and Eating Disorders chapter of DSM-5:

  • Pica (eating nonnutritive food, e.g., dirt)
  • Rumination Disorder (regurgitation of food)
  • Avoidant/Restrictive Food Intake Disorder (what it sounds like--avoiding and restricting food intake)
  • Anorexia Nervosa (restrictive energy intake that leads to low body weight)
  • Bulimia Nervosa (recurrent binge eating with compensatory behaviors, e.g., self-induced vomiting)
  • Binge-Eating Disorder (recurrent binge eating without compensatory behaviors)
  • Other Specified Feeding or Eating Disorder (e.g., purging disorder (purging without binge eating); night eating syndrome)
  • Unspecified Feeding or Eating Disorder (symptoms cause distress but don't meet full criteria of any of the above)

Read more about Feeding and Eating Disorder:

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DSM Practice

DSM practiceAs we've said here before, the majority of the DSM questions that show up on the social work licensing exam are likely to be about the diagnoses that most often show up in regular social work practice. You know the ones: anxiety disorders, depressive disorders, substance use disorders, psychotic disorders, personality disorders... That kind of stuff. But that doesn't mean you should just set aside your DSM once you've got those all under your belt. Here's a question that touches on a lesser-trafficked diagnosis. You may not encounter this question on the ASWB exam, but if you do, you'll sure be glad you took the time to read on!

A teacher refers an eight-year-old girl to a school social worker. On a museum field trip, the girl started talking to a museum-goer she didn't know and wandered off from the school group, holding the man's hand. The teacher says she can't reach the girl's parents to figure out what's going on. Which of the following diagnoses is the MOST likely to fit for the girl?

A) Reactive Attachment Disorder

B) Adjustment Disorder

C) Disinhibited Social Engagement Disorder

D) Conversion Disorder

Have your answer?

The possible answers all come from the Trauma- and Stressor-Related Disorders chapter of the DSM-5, except for conversion disorder, which has little to do with what's described. Since you aren't given much to go on in the vignette, it may be tricky to settle on an answer. But, if you look over DSM criteria, you'll see that disinhibited social engagement disorder is by far the best fit. Seen in that disorder, "a pattern of behavior in which a child actively approaches and interacts with unfamiliar adults."  Also, caretakers are neglectful (thus the attachment problems). Sounds more or less like what's described. Find the full criteria here.

As for the other answers: Reactive attachment disorder involves the opposite--"inhibited, emotionally withdrawn behavior." Adjustment disorder is diagnosed for "the development of emotional or behavioral symptoms in response to an identifiable stressor." The unrelated conversion disorder (aka functional neurological symptom disorder) is diagnosed when a client exhibits "altered voluntary motor or sensory function" (e.g., paralysis, sensory loss, abnormal movement) that cannot be attributed to a medical condition.

Now you have a better sense of not just one, but four diagnoses. That's how practice questions work. Find more DSM-5 questions, a lots more, in SWTP's full-length practice tests. Sign up to get started!

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