LMSW Psychopathology and DSM Diagnostic Criteria — Questions and Answers
Question 1: A client presents with a 2-week period of depressed mood most of the day, loss of interest in previously enjoyed activities, hypersomnia, psychomotor retardation, and feelings of worthlessness. There is no history of manic or hypomanic episodes. Which diagnosis BEST fits this presentation?
- Bipolar I Disorder, depressive episode
- Persistent Depressive Disorder (Dysthymia)
- Major Depressive Disorder (Correct answer)
- Cyclothymic Disorder
Correct answer: Major Depressive Disorder
A discrete episode of at least 5 DSM symptoms (including depressed mood or anhedonia) lasting at least 2 weeks, without a history of mania or hypomania, meets criteria for Major Depressive Disorder. Persistent Depressive Disorder requires symptoms lasting at least 2 years. Bipolar diagnoses require a manic/hypomanic history.
Question 2: A client describes hearing voices that comment on his behavior and experiencing the belief that his thoughts are being broadcast on television. These symptoms have been present for 7 months. His mood is unremarkable. Which diagnosis is MOST consistent with this presentation?
- Brief Psychotic Disorder
- Schizophrenia (Correct answer)
- Schizoaffective Disorder
- Bipolar I Disorder with Psychotic Features
Correct answer: Schizophrenia
Schizophrenia requires at least two positive/negative symptoms (one must be hallucinations, delusions, or disorganized speech) for at least 1 month, with continuous signs of disturbance for 6 months. Thought broadcasting and third-person auditory hallucinations are classic positive symptoms. No mood episode rules out schizoaffective and bipolar with psychosis.
Question 3: A client has a pervasive pattern of instability in interpersonal relationships, self-image, and affect, along with impulsivity and recurrent self-harming behavior. She describes intense fear of abandonment and reports alternately idealizing and then devaluing her close relationships. These features BEST align with which personality disorder?
- Narcissistic Personality Disorder
- Histrionic Personality Disorder
- Borderline Personality Disorder (Correct answer)
- Antisocial Personality Disorder
Correct answer: Borderline Personality Disorder
Borderline Personality Disorder (BPD) is defined by unstable relationships, self-image, and affect, combined with impulsivity, self-harm, and frantic efforts to avoid abandonment. The hallmark features — splitting (idealization/devaluation), self-harm, and abandonment fears — distinguish it from other Cluster B disorders.
Question 4: According to the DSM-5-TR, which of the following is a criterion that distinguishes Posttraumatic Stress Disorder (PTSD) from Acute Stress Disorder (ASD)?
- PTSD requires exposure to actual or threatened death; ASD does not
- ASD symptoms must resolve within 3 days of the trauma; PTSD symptoms persist beyond 1 month (Correct answer)
- PTSD can only be diagnosed in adults; ASD applies to children and adolescents
- ASD requires the presence of dissociative symptoms; PTSD does not
Correct answer: ASD symptoms must resolve within 3 days of the trauma; PTSD symptoms persist beyond 1 month
The primary temporal distinction is duration: ASD is diagnosed when symptoms appear within 3 days to 1 month post-trauma. If symptoms persist beyond 1 month, the diagnosis becomes PTSD. Both disorders require the same trauma exposure criterion. Dissociative symptoms may appear in either disorder.
Question 5: A client meets criteria for both Alcohol Use Disorder and Major Depressive Disorder. To determine whether the depression is a separate diagnosis or substance-induced, the social worker should PRIMARILY consider:
- Whether the client has a family history of depression
- Whether depressive symptoms preceded alcohol use or persist after a period of sustained abstinence (Correct answer)
- The client's current BAC level at the time of assessment
- Whether the client acknowledges having a drinking problem
Correct answer: Whether depressive symptoms preceded alcohol use or persist after a period of sustained abstinence
Substance-induced depressive disorder is distinguished from an independent depressive disorder by temporal sequencing: if depressive symptoms substantially predate the substance use OR persist (typically 1 month or more) after cessation of the substance, an independent diagnosis is supported. The DSM-5-TR emphasizes this temporal criterion.
Question 6: Which of the following symptom clusters is required for a DSM-5-TR diagnosis of Generalized Anxiety Disorder (GAD)?
- Recurrent unexpected panic attacks with persistent concern about future attacks
- Excessive worry about multiple domains, difficult to control, plus at least 3 associated symptoms (e.g., fatigue, irritability, sleep disturbance) for at least 6 months (Correct answer)
- Marked fear of a specific object or situation with immediate anxiety response
- Anxiety related specifically to separation from major attachment figures
Correct answer: Excessive worry about multiple domains, difficult to control, plus at least 3 associated symptoms (e.g., fatigue, irritability, sleep disturbance) for at least 6 months
GAD requires excessive, difficult-to-control anxiety and worry occurring more days than not for at least 6 months across multiple areas, accompanied by at least 3 of 6 somatic/cognitive symptoms (adults): restlessness, fatigue, concentration difficulty, irritability, muscle tension, and sleep disturbance.
LMSW Psychopathology and DSM Diagnostic Criteria
A client presents with a 2-week period of depressed mood most of the day, loss of interest in previously enjoyed activities, hypersomnia, psychomotor retardation, and feelings of worthlessness.
There is no history of manic or hypomanic episodes.
Which diagnosis BEST fits this presentation?