CA MFT Clinical DSM Quiz Flashcards Preview

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Flashcards in CA MFT Clinical DSM Quiz Deck (75):
1

A therapist on an inpatient unit conducts an intake with a 40-year-old man who was transported to the hospital by the police after an altercation in a park. He is unable to provide a medical or social history and reports having no memory before he arrived at the hospital. A police check reveals that he is an executive of a large company in a nearby city who was laid off a few days ago. At the end of his weeklong stay in the hospital, he has recovered his memory. The MOST likely diagnosis is:

A. Dissociative Amnesia with Dissociative Fugue

B. Factitious Disorder 

C. Posttraumatic Stress Disorder (PTSD)

D. Acute Stress Disorder

A therapist on an inpatient unit conducts an intake with a 40-year-old man who was transported to the hospital by the police after an altercation in a park. He is unable to provide a medical or social history and reports having no memory before he arrived at the hospital. A police check reveals that he is an executive of a large company in a nearby city who was laid off a few days ago. At the end of his weeklong stay in the hospital, he has recovered his memory. The MOST likely diagnosis is:

A. Dissociative Amnesia with Dissociative Fugue

B. Factitious Disorder 

C. Posttraumatic Stress Disorder (PTSD)

D. Acute Stress Disorder

Rationale: Dissociative Amnesia with Dissociative Fugue, is a rare disorder that occurs when a stressful event, in this case being laid off, triggers a memory lapse. Other symptoms may include impulsively wandering away from home, inability to recall past events, and confusion regarding one’s identity. B, is incorrect because this occurs when someone fakes a disorder in order to be a patient. In Factitious disorder this would be happening over and over again which is not occurring in this case. C and D are incorrect because we don’t see a life threatening trauma here that would indicate PTSD or ASD.

2

A school therapist receives a referral for a 13-year-old boy for inattention and poor grades. During observations and interactions with the student, the therapist experiences the boy as intelligent and highly verbal but notes that he has difficulty following instructions and reports that he avoids reading and writing activities. The initial diagnosis is MOST likely:

A. Conduct Disorder

B. Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Type

C. Autism Spectrum Disorder

D. Learning Disorder

A school therapist receives a referral for a 13-year-old boy for inattention and poor grades. During observations and interactions with the student, the therapist experiences the boy as intelligent and highly verbal but notes that he has difficulty following instructions and reports that he avoids reading and writing activities. The initial diagnosis is MOST likely:

A. Conduct Disorder

B. Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Type

C. Autism Spectrum Disorder

D. Learning Disorder

Rationale: Conduct disorder is incorrect because no where in the stem does it indicate aggressive, destructive, deceitful behavior or a violation of rules which are common symptoms of conduct disorder. ADHD is incorrect because according to the DSM-V, ADHD must be diagnosed before age 12 and in this case the boy is older than that. Autism Spectrum Disorder is incorrect because the child does not exhibit difficulties in language, both verbal and nonverbal, or with social interactions. Therefore, a learning disorder would be the most likely initial diagnoses because the boy is exhibiting symptoms such as difficulty following instructions and avoiding reading and writing.

3

A therapist evaluates a 6-year-old girl with moderately severe cerebral palsy. Among other symptoms, the parents report that their daughter is often observed attempting to chew and eat non-food items, including sand and houseplants. Sometimes they are able to intervene while she is chewing on the item, but she has been hospitalized on one occasion for ingesting leaves from a potentially harmful plant. What is the MOST likely diagnosis in this case?

A. Encopresis

B. Autism Spectrum Disorder

C. Rumination Disorder

D. Pica

 

A therapist evaluates a 6-year-old girl with moderately severe cerebral palsy. Among other symptoms, the parents report that their daughter is often observed attempting to chew and eat non-food items, including sand and houseplants. Sometimes they are able to intervene while she is chewing on the item, but she has been hospitalized on one occasion for ingesting leaves from a potentially harmful plant. What is the MOST likely diagnosis in this case?

A. Encopresis

B. Autism Spectrum Disorder

C. Rumination Disorder

D. Pica

Rationale: Encopresis incorrect because this occurs when an individual has bowel movements unexpectedly which is not indicated in the stem. Autism Spectrum Disorder would be incorrect because language or social interaction problems are not indicated in the stem. Rumination disorder is incorrect because this occurs when an individual involuntarily regurgitates food. In this case Pica is the best answer because symptoms of this include having an appetite for and eating foods that are non-nutritious or non-edible, in this case, sand and houseplants.

4

A therapist begins treatment with a child diagnosed with ADHD and intends to use cognitive behavioral treatment to help improve the child’s concentration. The therapist will MOST likely need to help the child in which additional area?

A. Expressive language

B. Social skills

C. Basic hygiene

D. Bladder control

A therapist begins treatment with a child diagnosed with ADHD and intends to use cognitive behavioral treatment to help improve the child’s concentration. The therapist will MOST likely need to help the child in which additional area?

A. Expressive language

B. Social skills

C. Basic hygiene

D. Bladder control

Rationale: Social skills is a common difficulty for children with ADHD because of impulsivity and difficulty focusing on one task. Therefore the child may have difficulty doing things with peers such as focusing on games, or interrupting conversation. A, C, and D are not issues with ADHD.

5

A couple enters treatment with a therapist due to increasing conflicts and distance after 2 years of marriage. The man reports feeling as if his wife needs his approval for everything and he’s exhausted with her constant worries and questions about what she should do. The woman endorses frequent worries about her husband leaving her or dying young and states that she only asks his opinion because she “trusts him more than I trust myself.” The man says that he feels more like a parent than a husband and that this can’t continue. The woman’s diagnosis is MOST likely:

A. Avoidant Personality Disorder

B. Histrionic Personality Disorder

C. Dependent Personality Disorder

D. Generalized Anxiety Disorder

A couple enters treatment with a therapist due to increasing conflicts and distance after 2 years of marriage. The man reports feeling as if his wife needs his approval for everything and he’s exhausted with her constant worries and questions about what she should do. The woman endorses frequent worries about her husband leaving her or dying young and states that she only asks his opinion because she “trusts him more than I trust myself.” The man says that he feels more like a parent than a husband and that this can’t continue. The woman’s diagnosis is MOST likely:

A. Avoidant Personality Disorder

B. Histrionic Personality Disorder

C. Dependent Personality Disorder

D. Generalized Anxiety Disorder

Rationale: A key factor in Dependent Personality Disorder is a need for constant approval regarding everything that someone does. The individual may also need others to take responsibility, lack self-confidence, and have difficulty doing things independently which are all indicated in the stem. Avoidant Personality Disorder is incorrect because symptoms include a preoccupation with being criticized or rejected in social situations, and a reluctance to take personal risks which is not stated in the stem. B is incorrect because symptoms of Histrionic Personality Disorder include sexual seductiveness, a constant need for approval/praise, and a use of physical appearance to draw attention. While approval/praise is indicated in the stem, the other symptoms are not. Lastly, Generalized Anxiety Disorder is incorrect because while the stem mentions worries, the constant dependency on her husband better fits the symptoms of Dependent Personality Disorder.

6

A therapist is asked to evaluate a 5-year-old boy whose parents are concerned about his inability to sit still periodically at school. During the interview, the boy makes multiple barking noises, blinks almost constantly, and jerks his right arm back and forth. His parents report that these symptoms started in preschool and are getting in the way of their son learning and making friends. What is the MOST likely diagnosis at this time?

A. Tourette’s Disorder

B. Attention-Deficit/Hyperactivity Disorder

C. Stereotypic Movement Disorder

D. Autism Spectrum Disorder

A therapist is asked to evaluate a 5-year-old boy whose parents are concerned about his inability to sit still periodically at school. During the interview, the boy makes multiple barking noises, blinks almost constantly, and jerks his right arm back and forth. His parents report that these symptoms started in preschool and are getting in the way of their son learning and making friends. What is the MOST likely diagnosis at this time?

A. Tourette’s Disorder

B. Attention-Deficit/Hyperactivity Disorder

C. Stereotypic Movement Disorder

D. Autism Spectrum Disorder

Rationale: Tourette’s syndrome is a disorder that involves repetitive, involuntary movements and vocalizations called tics which are seen in the stem through the barking noises, blinking, and jerking of arm. B is incorrect because involuntary movements such as these are not seen in ADHD. C is similar to Tourette’s, however, the main difference is that in Stereotypic Movement Disorder the repetitive movements generally start at a younger age and the movements last longer than tics would. D is incorrect because while the children has difficulty making friends and learning this is not due to difficulties with communication or language.

7

A school therapist is asked to evaluate an 8-year-old girl who has been crying frequently in class and complaining of stomach aches. When the therapist interviews the student, the student begs the therapist to let her go home and be with her mother and also expresses fears that something bad might happen to her mom. What is the MOST likely diagnosis in this case?

A. Posttraumatic Stress Disorder 

B. Separation Anxiety Disorder

C. School Phobia

D. Generalized Anxiety Disorder

A school therapist is asked to evaluate an 8-year-old girl who has been crying frequently in class and complaining of stomach aches. When the therapist interviews the student, the student begs the therapist to let her go home and be with her mother and also expresses fears that something bad might happen to her mom. What is the MOST likely diagnosis in this case?

A. Posttraumatic Stress Disorder 

B. Separation Anxiety Disorder

C. School Phobia

D. Generalized Anxiety Disorder

Rationale:  A is incorrect because there are no life threatening traumatic events described in the stem that would allow for a PTSD diagnosis to occur. C and D are incorrect because while the child is having difficulty staying in school and anxiety, her fears are more related to being away from her mother and having fear that something bad may happen to her mom. Therefore, B is the correct answer because common symptoms include worry that something may happen to a parent or guardian, a refusal to go to school or be away from the caregiver, and complaints of physical symptoms on school days.

8

A diagnosis of Enuresis is appropriate when:

A. The patient voids feces intentionally or unintentionally at last twice weekly. 

B. Medications may be causing the problem. 

C. Urine is unintentionally voided at least twice weekly and the patient is at least five years old.

D. Urine is unintentionally voided at least twice weekly and the patient is at least six years old.

A diagnosis of Enuresis is appropriate when:

A. The patient voids feces intentionally or unintentionally at last twice weekly. 

B. Medications may be causing the problem. 

C. Urine is unintentionally voided at least twice weekly and the patient is at least five years old.

D. Urine is unintentionally voided at least twice weekly and the patient is at least six years old.

Rationale: C is the best answer because Enuresis can be diagnosed when an individual is at least five years old and is unintentionally urinating twice a week, generally for about 3 months. A and B are not symptoms of Enuresis and D is incorrect because the correct age for diagnosis is at least 5 years old, not 6.

9

A mother brings her 5-year-old daughter for therapy. She is referred by the school. The mother tearfully reports that the teacher said that her daughter seems autistic because she doesn’t talk or interact with peers. The mother reports that the daughter plays with her older siblings and cousins and talks a lot at home and with their extended family. What differential diagnosis should be considered?

A. Separation Anxiety Disorder

B. Social Phobia 

C. Generalized Anxiety Disorder 

D. Selective Mutism

A mother brings her 5-year-old daughter for therapy. She is referred by the school. The mother tearfully reports that the teacher said that her daughter seems autistic because she doesn’t talk or interact with peers. The mother reports that the daughter plays with her older siblings and cousins and talks a lot at home and with their extended family. What differential diagnosis should be considered?

A. Separation Anxiety Disorder

B. Social Phobia 

C. Generalized Anxiety Disorder 

D. Selective Mutism

Rationale: A is incorrect because not talking or interacting with others is not a symptom of Separation Anxiety Disorder. B and C are incorrect because the stem doesn’t report that the girl has anxiety around talking or being in social situations which would be necessary for a social phobia or GAD diagnosis. Therefore, D is the best answer because symptoms of Selective Mutism include a consistent failure to speak in social situations despite speaking in other environments.

10

An 11-year-old boy is referred to the school therapist for excessive truancy. An assessment with the boy’s parents reveals several incarcerations at the juvenile detention center for selling drugs and the parents’ report a longstanding inability to enforce limits or consequences with him. His teacher describes him as quiet and disinterested in school, although the therapist knows the boy has a reputation as a bully. What diagnosis is MOST likely:

A. Oppositional Defiant Disorder 

B. Antisocial Personality Disorder 

C. Bipolar I Disorder

D. Conduct Disorder

An 11-year-old boy is referred to the school therapist for excessive truancy. An assessment with the boy’s parents reveals several incarcerations at the juvenile detention center for selling drugs and the parents’ report a longstanding inability to enforce limits or consequences with him. His teacher describes him as quiet and disinterested in school, although the therapist knows the boy has a reputation as a bully. What diagnosis is MOST likely:

A. Oppositional Defiant Disorder 

B. Antisocial Personality Disorder 

C. Bipolar I Disorder

D. Conduct Disorder

Rationale: A is incorrect because the boy is illustrating symptoms, such as truancy and selling drugs, that are beyond the disobedient or defiant behaviors that occur in oppositional defiant disorder. B is incorrect because an individual has to be 18 years old in order to be diagnosed with Antisocial Personality Disorder. C is incorrect because the boy isn’t illustrating manic or depressive behaviors. D is the best answer because with conduct disorder an individual displays symptoms that fall into four categories including: aggressive behavior, destructive behavior, deceitful behavior, and a violation of rules which are seen in the stem.

11

A client is referred to a therapist after being discharged from the psychiatric hospital. The records indicate that he has been hearing voices for the past four months and he believes he is being followed. According to the DSM-V criteria, the MOST likely diagnosis for the client is:

A. Brief Psychotic Disorder 

B. Schizophrenia 

C. Schizoaffective Disorder

D. Schizophreniform Disorder

A client is referred to a therapist after being discharged from the psychiatric hospital. The records indicate that he has been hearing voices for the past four months and he believes he is being followed. According to the DSM-V criteria, the MOST likely diagnosis for the client is:

A. Brief Psychotic Disorder 

B. Schizophrenia 

C. Schizoaffective Disorder

D. Schizophreniform Disorder

Rationale: The most likely diagnosis here is schizophreniform because the client has been experiencing psychotic symptoms for less than six months (in this case 4 months). An individual cannot be diagnosed with Schizophrenia unless they have been experiencing symptoms for more than 6 months, therefore B is incorrect. A is incorrect because symptoms of Brief Psychotic Disorder must last at least a day but not longer than a month. C is incorrect because the stem does not indicate that the client is experiencing depressive or manic symptoms which are required for a Schizoaffective Disorder diagnosis.

12

During an assessment, a therapist in a medical clinic finds that a patient has a decrease in libido, difficulty sleeping, and feelings of hopelessness for the last month. The MOST likely diagnosis in this case is:

A. Female Sexual Interest/Arousal Disorder

B. Persistent Depressive Disorder

C. Major Depressive Disorder

D. Adjustment Disorder

During an assessment, a therapist in a medical clinic finds that a patient has a decrease in libido, difficulty sleeping, and feelings of hopelessness for the last month. The MOST likely diagnosis in this case is:

A. Female Sexual Interest/Arousal Disorder

B. Persistent Depressive Disorder

C. Major Depressive Disorder

D. Adjustment Disorder

Rationale: A is incorrect because other mood disorders would need to be ruled out first before Female Sexual Interest/Arousal Disorder could be diagnosed. B is incorrect because an individual with Persistent Depressive Disorder has to be experiencing depressive symptoms more days than not for at least two years for an adult, and one year for a child. Since the individual has only been experiencing symptoms for a month B is incorrect. Adjustment Disorder is incorrect because the stem does not state that any identifiable stressors that would cause these symptoms to occur. Therefore, C is the best answer because the symptoms reported, including a decrease in libido, difficulty sleeping, and feelings of hopelessness are all indicative of Major Depression.

13

A 35-year-old woman enters treatment with a therapist; during the assessment, the therapist learns that she has been on Lithium for several years and was hospitalized after an episode in which she did not sleep for a week, sold her brother’s car, and used the money to go to Las Vegas. Based on this information, what is the client’s MOST likely diagnosis?

A. Unspecified Impulse Control Disorder

B. Bipolar II Disorder 

C. Bipolar I Disorder

D. Cyclothymic Disorder

A 35-year-old woman enters treatment with a therapist; during the assessment, the therapist learns that she has been on Lithium for several years and was hospitalized after an episode in which she did not sleep for a week, sold her brother’s car, and used the money to go to Las Vegas. Based on this information, what is the client’s MOST likely diagnosis?

A. Unspecified Impulse Control Disorder

B. Bipolar II Disorder 

C. Bipolar I Disorder

D. Cyclothymic Disorder

Rationale: Lithium is a key point here because it is commonly used for Bipolar Disorder therefore we would rule out A based on that information. Additionally, the individual is not reporting any depressive symptoms. For an individual to be diagnosed with Bipolar II they must experience a hypomanic episode as well as a depressive episode. In this question we are seeing a manic episode, and no depressive symptoms are illustrated in the stem, therefore B is ruled out. D is also ruled out because an individual with Cyclothymic Disorder would experience hypomanic symptoms and milder depressive symptoms. Again, no depressive symptoms are reported here therefore D is out. That leaves us with C being the correct answer. If we look at the stem, the client is describing a manic episode which is when the individual has increased energy, pressured speech, may go on excessive spending sprees, and an inflated self-image. A manic episode is necessary to diagnose a client with Bipolar I disorder.

14

A 62-year-old woman presents for treatment five weeks after the death of her beloved cat. Prior to this incident, she worked full time and enjoyed many hobbies. Since then, she has stayed at home and isolated herself, stating that she cries all the time. What initial diagnosis should the therapist make?

A. Generalized Anxiety Disorder

B. Acute Stress Disorder

C. Major Depressive Disorder

D. Persistent Depressive Disorder

A 62-year-old woman presents for treatment five weeks after the death of her beloved cat. Prior to this incident, she worked full time and enjoyed many hobbies. Since then, she has stayed at home and isolated herself, stating that she cries all the time. What initial diagnosis should the therapist make?

A. Generalized Anxiety Disorder

B. Acute Stress Disorder

C. Major Depressive Disorder

D. Persistent Depressive Disorder

Rationale: The women is not describing any anxiety symptoms such as worry or restlessness, therefore A is incorrect. B is incorrect because while a traumatic event has occurred, this woman did not witness, experience, or confront a life or death situation which is required for Acute Stress Disorder. Additionally, D is incorrect because depressive symptoms must exist for at least two years for an adult to be diagnosed with Persistent Depressive Disorder. Therefore, C is correct because the woman is experiencing symptoms such as isolation and feeling tearful all the time for more than two weeks that are indicative of Major Depression.

15

A 34-year-old man calls a therapist in a community clinic and inquires about the possibility of internet therapy or phone sessions. He reports that he’s unable to leave the house or use public transportation due to extreme anxiety.  The therapist will MOST likely diagnose the man with:

A. Generalized Anxiety Disorder

B. Agoraphobia

C. Panic Disorder

D. Social Phobia

A 34-year-old man calls a therapist in a community clinic and inquires about the possibility of internet therapy or phone sessions. He reports that he’s unable to leave the house or use public transportation due to extreme anxiety.  The therapist will MOST likely diagnose the man with:

A. Generalized Anxiety Disorder

B. Agoraphobia

C. Panic Disorder

D. Social Phobia

Rationale: In the stem the client reports that he is unable to leave the house because he due to anxiety. This inability to leave the house illustrates symptoms of Agoraphobia, where an individual avoids situations in public places or areas where an immediate escape might be difficult. Therefore, B is the best answer. A is incorrect because the client isn’t displaying general worries and anxiety. His fears are more specific. C is incorrect because the client does not report panic attack symptoms and D is incorrect because his phobia is not related to social situations.

16

A 45-year-old married mother of two self-refers to a therapist in private practice. She reports a strong desire to return to the workforce now that her children are in high school but reports that she’s been cancelling her scheduled interviews due to panic and fear that she will embarrass herself during the interview. What is the MOST likely diagnosis?

A. Panic Disorder

B. Social Anxiety Disorder

C. Agoraphobia Without History of Panic Disorder

D. Unspecified Anxiety Disorder

A 45-year-old married mother of two self-refers to a therapist in private practice. She reports a strong desire to return to the workforce now that her children are in high school but reports that she’s been cancelling her scheduled interviews due to panic and fear that she will embarrass herself during the interview. What is the MOST likely diagnosis?

A. Panic Disorder

B. Social Anxiety Disorder

C. Agoraphobia Without History of Panic Disorder

D. Unspecified Anxiety Disorder

Rationale: A is incorrect because the client is not describing an actual panic attack which would be necessary in order to be diagnosed with Panic Disorder. C is incorrect because the client doesn’t report that she is afraid of leaving the house at all, which is what an individual with Agoraphobia would have trouble doing. D is incorrect because while the client does express anxieties, these anxieties are more related to the act of being around others and talking in front of other people. Therefore, B is the best answer here because the client is reporting that is specifically related to being self-conscious and anxious in front of others to the point that it gets in the way of doing things.

17

A therapist in a community agency initiates an intake with a 19-year-old immigrant from Mexico who reports recurrent nightmares during which the death of her younger brother during their journey to the US is reenacted. She tells the therapist that she tried to start school when she arrived 2 months ago but was unable to concentrate and could only see her brother’s face in her mind. Her family does not hold her responsible for her brother’s death, but she reports feeling disconnected from them and does not know what to do. Her diagnosis is MOST likely:

A. Acute Stress Disorder 

B. Unspecified Anxiety Disorder 

C. Posttraumatic Stress Disorder

D. Major Depressive Disorder

A therapist in a community agency initiates an intake with a 19-year-old immigrant from Mexico who reports recurrent nightmares during which the death of her younger brother during their journey to the US is reenacted. She tells the therapist that she tried to start school when she arrived 2 months ago but was unable to concentrate and could only see her brother’s face in her mind. Her family does not hold her responsible for her brother’s death, but she reports feeling disconnected from them and does not know what to do. Her diagnosis is MOST likely:

A. Acute Stress Disorder 

B. Unspecified Anxiety Disorder 

C. Posttraumatic Stress Disorder

D. Major Depressive Disorder

Rationale: The client reports that the death of her brother occurred two months ago during their journey to the US. Acute Stress Disorder is incorrect because it can only be diagnosed if the symptoms occur within one month of the traumatic event. B and D are incorrect because the client does not describe symptoms of either such as constant worry or a feeling of hopelessness. The client is displaying symptoms of PTSD such as nightmares, difficulty concentrating, and seeing images of her brother’s face therefore this is the most likely diagnosis.

18

A fifty-year-old comes to a community agency complaining of a general feeling of nervousness. The symptoms began 8 months ago and have occurred almost daily since then. He complains of feeling restless and is easily tired, though he is unable to sleep easily and wakes frequently during the night. The MOST likely initial diagnosis is:

A. Primary Insomnia 

B. Generalized Anxiety Disorder

C. Substance-Induced Anxiety Disorder

D. Somatization Disorder

A fifty-year-old comes to a community agency complaining of a general feeling of nervousness. The symptoms began 8 months ago and have occurred almost daily since then. He complains of feeling restless and is easily tired, though he is unable to sleep easily and wakes frequently during the night. The MOST likely initial diagnosis is:

A. Primary Insomnia 

B. Generalized Anxiety Disorder

C. Substance-Induced Anxiety Disorder

D. Somatization Disorder

Rationale: A is incorrect because Primary Insomnia can’t be diagnosed without ruling out other mental disorders including Generalized Anxiety Disorder. Additionally, while the client is easily tired and unable to sleep easily these symptoms are most likely due to anxiety and the feelings of nervousness, therefore B is the most likely answer as an initial diagnosis. C is incorrect because the client does not indicate any substance use in the stem. Lastly, D is incorrect because the client is not complaining of any physical pain or physical manifestations in the body.

19

All of the following are associated with a diagnosis of Illness Anxiety Disorder EXCEPT:

A. “Doctor shopping” behavior in which the client goes from provider to provider, believing he is not getting proper medical care.

B. A preoccupation with physical symptoms that is of delusional intensity.

C. Failure to have actual medical conditions diagnosed.

D. A willingness to consider the possibility that no serious disease actually exists.

All of the following are associated with a diagnosis of Illness Anxiety Disorder EXCEPT:

A. “Doctor shopping” behavior in which the client goes from provider to provider, believing he is not getting proper medical care.

B. A preoccupation with physical symptoms that is of delusional intensity.

C. Failure to have actual medical conditions diagnosed.

D. A willingness to consider the possibility that no serious disease actually exists.

Rationale: A, C, and D are all components of Illness Anxiety Disorder. B is the correct answer because while individuals with Illness Anxiety Disorder have a preoccupation with physical symptoms they are NOT of delusional intensity.

20

A 22-year-old client is referred by his lawyer after being accused of burglary. The lawyer claims that the client is depressed. When the therapist meets with the client, the client states that he is depressed but cannot identify any specific symptoms. The MOST likely diagnosis is:

A. Major Depressive Disorder

B. Factitious Disorder

C. Malingering

D. Conversion Disorder

A 22-year-old client is referred by his lawyer after being accused of burglary. The lawyer claims that the client is depressed. When the therapist meets with the client, the client states that he is depressed but cannot identify any specific symptoms. The MOST likely diagnosis is:

A. Major Depressive Disorder

B. Factitious Disorder

C. Malingering

D. Conversion Disorder

Rationale: Malingering is when an individual exaggerates symptoms of mental or physical disorders for secondary gain which could include motives such as financial compensation, a way to avoid school or work, to avoid a criminal sentence, or even to attract attention. Therefore, C is the correct answer because the client is reporting feeling depressed however is unable to state any symptoms. With this in mind, the client is most likely trying to get out of his sentence by reporting symptoms of depression. A is incorrect because the client is not actually reporting any symptoms of depression. B is incorrect because with Factitious Disorder the client would be deliberately producing or exaggerating symptoms, however, it is not done for secondary gain as is seen in this case. D is incorrect because Conversion Disorder is when an individual shows psychological stress in physical ways which is not indicated in the stem.

21

A healthy-looking 16 year-old girl is referred to the school therapist after being found purposefully vomiting in the bathroom after lunch. The girl reports binge eating several times per week and then vomiting in order to avoid weight gain. She reports feeling that she will be called a “loser” if she gains weight. The most likely diagnosis is:

A. Bulimia Nervosa

B. Anorexia Nervosa

C. Unspecified Eating Disorder

D. Body Dysmorphic Disorder

A healthy-looking 16 year-old girl is referred to the school therapist after being found purposefully vomiting in the bathroom after lunch. The girl reports binge eating several times per week and then vomiting in order to avoid weight gain. She reports feeling that she will be called a “loser” if she gains weight. The most likely diagnosis is:

A. Bulimia Nervosa

B. Anorexia Nervosa

C. Unspecified Eating Disorder

D. Body Dysmorphic Disorder

Rationale: A is correct because the client is bingeing several times a day and then vomiting in order avoid gaining weight. B is incorrect because the client is not underweight and is not starving herself to lose weight which is the biggest indicator of Anorexia Nervosa. C is incorrect because the client has symptoms that are a better fit for Bulimia Nervosa which therefore rules out C. D is incorrect because the stem does not report that the client has intrusive or preoccupying thoughts regarding an imagined or slight defect on her body.

22

A school therapist begins treatment with a 16-year-old girl who was referred after being caught stealing from lockers after school. When the therapist asks about the theft, the girl guiltily says that it was just “stupid stuff” and that she gave it all to her friends. Later in the assessment, the girl’s parents report that they’ve found multiple items in the house that they know they did not buy. The girl's DSM-V diagnosis is MOST likely:

A. Antisocial Personality Disorder

B. Unspecified Impulse-Control Disorder

C. Kleptomania

D. Conduct Disorder

A school therapist begins treatment with a 16-year-old girl who was referred after being caught stealing from lockers after school. When the therapist asks about the theft, the girl guiltily says that it was just “stupid stuff” and that she gave it all to her friends. Later in the assessment, the girl’s parents report that they’ve found multiple items in the house that they know they did not buy. The girl's DSM-V diagnosis is MOST likely:

A. Antisocial Personality Disorder

B. Unspecified Impulse-Control Disorder

C. Kleptomania

D. Conduct Disorder

Rationale: Kleptomania is defined as an inability to refrain from stealing for reasons other than financial or personal gain which is what seen with the client in this case. The girl is stealing items, but does not have a financial or personal gain from doing so. A is incorrect because the client is not 18 years old and does not have an extreme disregard for others. B is incorrect because this would only be diagnosed if other diagnoses such as Kleptomania was ruled out. Conduct disorder is incorrect because the client does not have other symptoms that are necessary for this diagnosis such as aggression to people or animals, destruction of property, deceitfulness, lying, or stealing, and serious violations of rules. The client’s symptoms are much more minor than those needed for a Conduct Disorder diagnosis at this point. 

23

According to the DSM-V, for Substance Use Disorder to be in Sustained Full Remission, the length of the absence of the symptoms must be:

A. One month

B. Two years

C. Six months

D. One year

According to the DSM-V, for Substance Use Disorder to be in Sustained Full Remission, the length of the absence of the symptoms must be:

A. One month

B. Two years

C. Six months

D. One year

Rationale: For an individual to be diagnosed with a Substance Use Disorder in Sustained Full Remission, all symptom must be absent for at least one year.

24

A college student self-refers to the campus mental health center. She reports that for the last year, she’s been irritable and arguing more with her sorority sisters; plus, her grades have dropped dramatically. She also reports losing weight due to decreased appetite. The client is MOST likely exhibiting:

A. Substance-Induced Mood Disorder

B. Adjustment Disorder With Depressed Mood

C. Major Depressive Disorder

D. Persistent Depressive Disorder

A college student self-refers to the campus mental health center. She reports that for the last year, she’s been irritable and arguing more with her sorority sisters; plus, her grades have dropped dramatically. She also reports losing weight due to decreased appetite. The client is MOST likely exhibiting:

A. Substance-Induced Mood Disorder

B. Adjustment Disorder With Depressed Mood

C. Major Depressive Disorder

D. Persistent Depressive Disorder

Rationale: A is incorrect because the client does not report any substance use. B is incorrect because the stem does not state any recent events or stressors that the client would be reacting to. D is incorrect because the client’s symptoms have been going on for only a year, and for an adult they would need to exist for at least two years for D to be diagnosed. Therefore, C is correct because the client is reporting symptoms that go along with a diagnosis of Major Depression such as irritability, a drop in grades, and a decreased appetite.

25

A 32-year-old successful computer programmer seeks the services of a therapist in private practice. He tells the therapist that he believes he will soon be promoted and asked to advise the company board on strategic policy but is concerned that his supervisor will somehow sabotage his promotion. He goes on to say that his supervisor has even inserted mistakes into his programs in order to discredit him with management. He tells the therapist that he has important contributions to make for the company and desperately needs advice. He adds, “This kind of thing has been happening to me my whole life.” The client’s provisional diagnosis is MOST likely:

A. Narcissistic Personality Disorder 

B. Paranoid Personality Disorder

C. Delusional Disorder

D. Schizophrenia, Paranoid Type

A 32-year-old successful computer programmer seeks the services of a therapist in private practice. He tells the therapist that he believes he will soon be promoted and asked to advise the company board on strategic policy but is concerned that his supervisor will somehow sabotage his promotion. He goes on to say that his supervisor has even inserted mistakes into his programs in order to discredit him with management. He tells the therapist that he has important contributions to make for the company and desperately needs advice. He adds, “This kind of thing has been happening to me my whole life.” The client’s provisional diagnosis is MOST likely:

A. Narcissistic Personality Disorder 

B. Paranoid Personality Disorder

C. Delusional Disorder

D. Schizophrenia, Paranoid Type

Rationale: B is the best answer here because the client is reporting nondelusional paranoia and an expectation of being exploited when he states that he believes his supervisor will sabotage his promotion and that he is being discredited by his supervisor. A is incorrect because the client does not have a sense of entitlement, grandiosity, or a belief that he is special or unique which is needed for a Narcissistic Personality DIsorder diagnosis. C is incorrect because this cannot be diagnosed until a personality disorder has been ruled out first. D is incorrect because the client is not displaying other symptoms of schizophrenia.

26

A couple seeks therapy. The therapist notes that the husband reacts to criticism with rage, is interpersonally explosive, has a grandiose sense of self, and is preoccupied with thoughts of ideal love. What diagnosis should be considered?

A. Paranoid Personality Disorder

B. Antisocial Personality Disorder

C. Narcissistic Personality Disorder

D. Histrionic Personality Disorder

A couple seeks therapy. The therapist notes that the husband reacts to criticism with rage, is interpersonally explosive, has a grandiose sense of self, and is preoccupied with thoughts of ideal love. What diagnosis should be considered?

A. Paranoid Personality Disorder

B. Antisocial Personality Disorder

C. Narcissistic Personality Disorder

D. Histrionic Personality Disorder

Rationale: C is correct because the client is displaying symptoms that are all related to Narcissistic Personality Disorder. This includes having a grandiose sense of self, fantasies of love/arrogance, and a belief that he is special or unique which is why he responds to criticism with rage. A is incorrect because the client is not expressing any paranoid thoughts or beliefs. B is incorrect because the client does not have an extreme disregard for others and is not manipulative or displaying criminal behavior. D is incorrect because an individual with Histrionic Personality Disorder often constantly demands attention and has a need for approval or praise. Sometimes a sexual seductiveness is seen or a use of physical appearance to draw attention.

27

A 45-year-old woman is referred to a therapist through her company’s Employee Assistance Program; when she arrives at the initial appointment, the therapist notes that she is dressed dramatically. She reports a conflict at work and says, “My boss never notices my accomplishments or contributions, and she’s refused to accept my friend request on Facebook. Can you believe it? Everyone wants to be my friend on Facebook!” The therapist will MOST likely diagnose this client with:

A. Generalized Anxiety Disorder

B. Histrionic Personality Disorder

C. Persistent Depressive Disorder

D. Narcissistic Personality Disorder

A 45-year-old woman is referred to a therapist through her company’s Employee Assistance Program; when she arrives at the initial appointment, the therapist notes that she is dressed dramatically. She reports a conflict at work and says, “My boss never notices my accomplishments or contributions, and she’s refused to accept my friend request on Facebook. Can you believe it? Everyone wants to be my friend on Facebook!” The therapist will MOST likely diagnose this client with:

A. Generalized Anxiety Disorder

B. Histrionic Personality Disorder

C. Persistent Depressive Disorder

D. Narcissistic Personality Disorder

Rationale: B is correct because an individual with Histrionic Personality Disorder will often dress in a manner that is sexually seductive or draws attention to the individual which is noted in the stem. The client also displays an inflated sense of self as well as a need for approval from her boss, all of which are common with Histrionic Personality Disorder. A and C are incorrect because the client does not report feelings of anxiety or depression. D is incorrect because while the client does have an inflated sense of self that is seen with Narcissistic Personality Disorder, what sets Histrionic apart is that the client is dressing in a way that really draws attention to her and makes her the center of attention at all times.

28

A therapist is called to the emergency to room to evaluate an elderly client who has just been admitted. According to the client’s daughter, over the past few days, the client has become increasingly anxious, confused, and disoriented. The daughter goes on to state that she does not believe the client has been eating or drinking sufficiently. The client’s state is MOST likely due to:

A. Schizophrenia

B. Delirium

C. Neglect

D. Korsakoff Syndrome

A therapist is called to the emergency to room to evaluate an elderly client who has just been admitted. According to the client’s daughter, over the past few days, the client has become increasingly anxious, confused, and disoriented. The daughter goes on to state that she does not believe the client has been eating or drinking sufficiently. The client’s state is MOST likely due to:

A. Schizophrenia

B. Delirium

C. Neglect

D. Korsakoff Syndrome

Rationale: A is incorrect because the client is not displaying any psychotic symptoms. C is incorrect because the client at this point does not appear to be showing any symptoms of neglect. D is incorrect because Korsakoff Syndrome is generally the result of chronic alcohol abuse which is not reported in the stem. Therefore, B is the correct answer because a diagnosis of Delirium generally includes symptoms such as increasing confusion that occurs in the onset of hours or days, and a change in cognition and behaviors.

29

A client is admitted to an inpatient unit for symptoms including paranoid delusions, tangential thought process, and flat affect. The treatment team believes that this may be an initial psychotic break that will eventually lead to a diagnosis of Schizophrenia. What age range is the client MOST likely in?

A. 6-12 

B. 13-16

C. 17-45

D. 46-60

A client is admitted to an inpatient unit for symptoms including paranoid delusions, tangential thought process, and flat affect. The treatment team believes that this may be an initial psychotic break that will eventually lead to a diagnosis of Schizophrenia. What age range is the client MOST likely in?

A. 6-12 

B. 13-16

C. 17-45

D. 46-60

Rationale: Symptoms of Schizophrenia most commonly occur within the age range of 17-45.

30

According to the DSM-V, for an individual to be diagnosed with Attention Deficit Hyperactivity Disorder, symptoms must be present before what age?

A. 5

B. 7

C. 12

D. 18

According to the DSM-V, for an individual to be diagnosed with Attention Deficit Hyperactivity Disorder, symptoms must be present before what age?

A. 5

B. 7

C. 12

D. 18

Rationale: According to the DSM-V, an individual can be diagnosed with ADHD if symptoms were present before age 12.

31

A school therapist is asked to evaluate a 10-year-old female student who has been exhibiting irritability, low self-esteem, and distractibility for the last year. What is the MOST likely diagnosis in this case?

A. Oppositional Defiant Disorder

B. Separation Anxiety Disorder

C. Persistent Depressive Disorder

D. Anorexia Nervosa

A school therapist is asked to evaluate a 10-year-old female student who has been exhibiting irritability, low self-esteem, and distractibility for the last year. What is the MOST likely diagnosis in this case?

A. Oppositional Defiant Disorder

B. Separation Anxiety Disorder

C. Persistent Depressive Disorder

D. Anorexia Nervosa

Rationale: C is correct because the client has been displaying symptoms of depression such as irritability, low self-esteem, and distractibility for the last year. A child can be diagnosed with Persistent Depressive Disorder after they have been displaying symptoms for a year, whereas an adult can be diagnosed after they have been displaying symptoms for two years. Therefore C is correct.

32

A 66-year-old man is brought to therapy by his wife, who states that her husband has gotten lost several times in the past month and often appears to not know where he is. She notes that when she finds him, he tells her a story about where he's been, but she knows he isn't telling the truth because the details don't line up. She adds that he has also been crying a lot recently. What is the MOST likely diagnosis in this case?

A. Major Neurocognitive Disorder

B. Delirium

C. Major Depression

D. Substance Use Disorder

A 66-year-old man is brought to therapy by his wife, who states that her husband has gotten lost several times in the past month and often appears to not know where he is. She notes that when she finds him, he tells her a story about where he's been, but she knows he isn't telling the truth because the details don't line up. She adds that he has also been crying a lot recently. What is the MOST likely diagnosis in this case?

A. Major Neurocognitive Disorder

B. Delirium

C. Major Depression

D. Substance Use Disorder

Rationale: The symptoms point to a Neurocognitive Disorder. The therapist should refer the patient to a neurologist.

33

A therapist at a community mental health clinic conducts an intake interview with a 20-year-old male who has been referred by his mother. He states that his mother is concerned about his lack of relationships and tendency to isolate himself in his room playing computer games. When prompted, he tells the therapist that he is lonely and wishes he could go out and meet people, but they would just be disappointed when they got to know him; he reports feeling comfortable interacting online because he knows the people "on there" will accept him. The therapist is MOST likely to treat him for:

A. Major Depressive Disorder

B. Avoidant Personality Disorder

C. Schizoid Personality Disorder

D. Panic Disorder With Agoraphobia

A therapist at a community mental health clinic conducts an intake interview with a 20-year-old male who has been referred by his mother. He states that his mother is concerned about his lack of relationships and tendency to isolate himself in his room playing computer games. When prompted, he tells the therapist that he is lonely and wishes he could go out and meet people, but they would just be disappointed when they got to know him; he reports feeling comfortable interacting online because he knows the people "on there" will accept him. The therapist is MOST likely to treat him for:

A. Major Depressive Disorder

B. Avoidant Personality Disorder

C. Schizoid Personality Disorder

D. Panic Disorder With Agoraphobia

Rationale: B is the correct answer because the stem reports that the client has a lack of relationships and also fears being around others or interacting with them. Individuals with Avoidant Personality Disorder express a fear of being ridiculed, poor self-image, a preoccupation with being criticized, loneliness, and social isolation. Despite this, they have a strong desire for social relationships, but find it difficult to take that personal risk. The biggest differential here is C because while an individual with Schizoid Personality Disorder has a detachment from social relationships, they actually prefer to be alone.

34

A school therapist receives a referral from one of the third grade teachers. The teacher complains that the child will not sit in his seat, interrupts his peers, does not finish assigned work, and has difficulty making friends. A developmental history from the parents indicates that the child has been impulsive since preschool and that he has difficulty following directions. According to the DSM-V classification, the diagnosis will MOST likely be:

A. Oppositional Defiant Disorder

B. Conduct Disorder

C. Attention-Deficit/Hyperactivity Disorder

D. Autism Spectrum Disorder

A school therapist receives a referral from one of the third grade teachers. The teacher complains that the child will not sit in his seat, interrupts his peers, does not finish assigned work, and has difficulty making friends. A developmental history from the parents indicates that the child has been impulsive since preschool and that he has difficulty following directions. According to the DSM-V classification, the diagnosis will MOST likely be:

A. Oppositional Defiant Disorder

B. Conduct Disorder

C. Attention-Deficit/Hyperactivity Disorder

D. Autism Spectrum Disorder

Rationale: A and B are incorrect because the child is not displaying any disobedient, defiant, or violent behaviors. D is incorrect because while the child has difficulty making friends, this appears to be more related to his impulsivity. Therefore, C is correct because the child is displaying symptoms that are common with ADHD such as trouble sitting still, difficulty concentrating and impulsivities.

35

A therapist meets with a 19-year-old college student who reports that for the past year she has had trouble getting out of bed to go to class. She states that she doesn’t want to be around her friends anymore and overall feels very hopeless. When asked about her interests the client states that she recently dropped her extracurricular activities. The client’s MOST likely diagnosis is:

A. Adjustment Disorder

B. Major Depressive Disorder

C. Generalized Anxiety Disorder

D. Persistent Depressive Disorder

A therapist meets with a 19-year-old college student who reports that for the past year she has had trouble getting out of bed to go to class. She states that she doesn’t want to be around her friends anymore and overall feels very hopeless. When asked about her interests the client states that she recently dropped her extracurricular activities. The client’s MOST likely diagnosis is:

A. Adjustment Disorder

B. Major Depressive Disorder

C. Generalized Anxiety Disorder

D. Persistent Depressive Disorder

Rationale: A is incorrect because the client is not reporting a recent stressful event. C is incorrect because the stem does not state any symptoms such as worry or anxiety. D is incorrect because the client’s symptoms have only been going on for a year, whereas they would need to exist for two years for a Persistent Depressive Disorder diagnosis to be made. Therefore, B is the best answer because the client is reporting many symptoms that indicate depression including a loss of interest in activities that were once pleasurable, feelings of hopelessness, and fatigue.

36

A clinical therapist is evaluating a friendly, 5-year-old child who has difficulty making friends in school. He is very verbal but has a hard time answering questions about his feelings. He is eager to talk about all the different types of reptiles. What diagnosis is MOST likely?

A. Unspecified Anxiety Disorder

B. Autism Spectrum Disorder

C. Down Syndrome

D. Tourette’s Disorder

A clinical therapist is evaluating a friendly, 5-year-old child who has difficulty making friends in school. He is very verbal but has a hard time answering questions about his feelings. He is eager to talk about all the different types of reptiles. What diagnosis is MOST likely?

A. Unspecified Anxiety Disorder

B. Autism Spectrum Disorder

C. Down Syndrome

D. Tourette’s Disorder

Rationale: Individuals with Autism Spectrum Disorder have trouble in three areas including social interaction, communication, and behaviors/interests. These individuals also many times will become heavily interested in knowledgeable in one particular subject. All of these symptoms are displayed in the stem, therefore B is correct.

37

A client was physically attacked 2 weeks ago while walking home from work. The client states that since then she feels like she is in a daze and is afraid to leave her house at night. She reports difficulty sleeping and says that she keeps snapping at her boyfriend when he tries to comfort her. The client’s MOST likely diagnosis is:

A. Posttraumatic Stress Disorder

B. Acute Stress Disorder

C. Adjustment Disorder

D. Major Depressive Disorder

A client was physically attacked 2 weeks ago while walking home from work. The client states that since then she feels like she is in a daze and is afraid to leave her house at night. She reports difficulty sleeping and says that she keeps snapping at her boyfriend when he tries to comfort her. The client’s MOST likely diagnosis is:

A. Posttraumatic Stress Disorder

B. Acute Stress Disorder

C. Adjustment Disorder

D. Major Depressive Disorder

Rationale: B is the best answer because the client’s symptoms have been occurring for greater than 3 days and less than a month. The client also experienced a life threatening event and her symptoms are in reaction to that. A is incorrect because the client would need to experience these symptoms for over a month to be diagnosed with PTSD. C is incorrect because the event was a life threatening event and not a normal life stressors (such as divorce or losing a job). Lastly, D is incorrect because the client’s symptoms are related to the attack and therefore D cannot be diagnosed.

38

A college counselor starts brief treatment with a senior who was referred by his honors thesis advisor. The student denies any need for treatment but engages in the intake, telling the therapist that he prefers to be alone and rarely goes home to see his family. He reports confusion around what his peers do on the weekends and denies any interest in romantic or sexual relationships. He tells the therapist that he’s had the same roommate since freshman year but does not really know much about him. What is the MOST likely diagnosis?

A. Schizotypal Personality Disorder 

B. Antisocial Personality Disorder 

C. Avoidant Personality Disorder 

D. Schizoid Personality Disorder

A college counselor starts brief treatment with a senior who was referred by his honors thesis advisor. The student denies any need for treatment but engages in the intake, telling the therapist that he prefers to be alone and rarely goes home to see his family. He reports confusion around what his peers do on the weekends and denies any interest in romantic or sexual relationships. He tells the therapist that he’s had the same roommate since freshman year but does not really know much about him. What is the MOST likely diagnosis?

A. Schizotypal Personality Disorder 

B. Antisocial Personality Disorder 

C. Avoidant Personality Disorder 

D. Schizoid Personality Disorder

Rationale: A is incorrect because an individual with Schizotypal Personality Disorder have more irrational beliefs, extreme social anxiety, paranoid ideation, and ideas of reference which is not all seen in the stem. B is incorrect because the client is not violating the rights of others in any way. C is incorrect because an individual with Avoidant Personality Disorder also has social inhibition, however, they have a greater fear of being ridiculed or rejected in social situations. Additionally, they have a desire for social relationships which isn’t displayed in the stem here. Therefore, D is correct because individuals with Schizoid Personality Disorder have a sense of detachment for social relationships, a lack of close relationships, and what sets this apart is that they don’t have a desire for relationships.

39

A therapist meets with a client who was recently released from the hospital following a suicidal threat. The client reports she has been in a relationship on and off for the past year and is fearful that he is going to leave her soon. She states that the last time he told her he was going to leave she cut her arms and told him she was going to kill herself if he left. The client’s diagnosis is MOST likely:

A. Borderline Personality Disorder

B. Schizoid Personality Disorder

C. Antisocial Personality Disorder

D. Schizotypal Personality Disorder

A therapist meets with a client who was recently released from the hospital following a suicidal threat. The client reports she has been in a relationship on and off for the past year and is fearful that he is going to leave her soon. She states that the last time he told her he was going to leave she cut her arms and told him she was going to kill herself if he left. The client’s diagnosis is MOST likely:

A. Borderline Personality Disorder

B. Schizoid Personality Disorder

C. Antisocial Personality Disorder

D. Schizotypal Personality Disorder

Rationale: Individuals with Borderline Personality Disorder often have unstable relationships, are impulsive, and often fear abandonment. Self-mutilating behaviors and suicidal threats are also an aspect of this disorder, therefore A is correct. B is incorrect because the client is not illustrating a preference to be alone or an indifference to relationships. C is incorrect because the client is not violating the rights of others. Lastly, D is incorrect because the client is not displaying any ideas of reference or magical thinking.

40

The diagnostic category in which pathological behavior is MOST likely to be ego-syntonic is:

A. Personality Disorders

B. Anxiety Disorders, Phobic Attacks

C. Affective Disorder With Depressive Episode

D. Organic Mental Disorders

The diagnostic category in which pathological behavior is MOST likely to be ego-syntonic is:

A. Personality Disorders

B. Anxiety Disorders, Phobic Attacks

C. Affective Disorder With Depressive Episode

D. Organic Mental Disorders

Rationale: Ego-syntonic means that an individual views their behaviors, values, and feelings as being acceptable and consistent with one’s personality and beliefs. Individuals with Personality Disorders are ego-syntonic because they believe their values and behaviors are acceptable and consistent with their self-concept, therefore A is correct.

41

A 24-year-old woman calls a therapist at a community services agency for case management and therapy. She describes a variety of physical symptoms and reports difficulty in keeping all of her health care providers straight. When asked, she reports that she doesn’t have any formal medical diagnoses but was seen most recently by an allergy specialist for “puffy eyelids.” She’s been unable to maintain employment or friendships because of frequent appointments and bouts of “illness.” This client’s provisional diagnosis is MOST likely:

A. Somatic Symptom Disorder

B. Conversion Disorder

C. Pain Disorder

D. Malingering

A 24-year-old woman calls a therapist at a community services agency for case management and therapy. She describes a variety of physical symptoms and reports difficulty in keeping all of her health care providers straight. When asked, she reports that she doesn’t have any formal medical diagnoses but was seen most recently by an allergy specialist for “puffy eyelids.” She’s been unable to maintain employment or friendships because of frequent appointments and bouts of “illness.” This client’s provisional diagnosis is MOST likely:

A. Somatic Symptom Disorder

B. Conversion Disorder

C. Pain Disorder

D. Malingering

Rationale: B is incorrect because the client reports that she doesn’t have any formal medical diagnoses, yet complains about many physical symptoms. An individual with Conversion Disorder would have actual physical symptoms such as blindness or paralysis that have no medical explanation. C is incorrect because for a pain disorder to be diagnosed other disorders such as somatization or conversion disorder need to be ruled out first. D is incorrect because individuals with malingering fabricate or exaggerate mental or physical disorders for secondary gain. Secondary gain may include things such as financial compensation, avoiding school or work, or getting lighter criminal sentences. Therefore A is correct because the client is displaying physical symptoms however there is no medical cause to be found for these symptoms.

42

A 45-year-old man seeks the services of a therapist for work-related stress. He notes in the intake that he is a mail carrier and was recently assigned a new route but cannot get a solid grasp on where he is supposed to go; he has difficulty concentrating and has become lost on several occasions. The therapist notices that he is limping noticeably and appears to tire during the interview. The therapist should FIRST consider:

A. Medical or neurological problem

B. Mild/Major Neurocognitive Disorder

C. Catatonia Due to Another Medical Disorder

D. Conversion Disorder

A 45-year-old man seeks the services of a therapist for work-related stress. He notes in the intake that he is a mail carrier and was recently assigned a new route but cannot get a solid grasp on where he is supposed to go; he has difficulty concentrating and has become lost on several occasions. The therapist notices that he is limping noticeably and appears to tire during the interview. The therapist should FIRST consider:

A. Medical or neurological problem

B. Mild/Major Neurocognitive Disorder

C. Catatonia Due to Another Medical Disorder

D. Conversion Disorder

Rationale: A medical or neurological disorder should be considered FIRST in this question because the client is displaying a change in behavior that was not there previously. While B, C, and D may need to be considered at a later time we first need to make sure the client has a medical evaluation to see why these physical symptoms are occurring before he is treated psychologically.

43

A 15-year-old girl is brought to therapy by her stepmom who reports that the client obsessively pulls out her hair and eyebrows. What diagnosis is MOST likely?

A. Obsessive-Compulsive Disorder

B. Trichotillomania

C. Obsessive-Compulsive Personality Disorder

D. Generalized Anxiety Disorder

A 15-year-old girl is brought to therapy by her stepmom who reports that the client obsessively pulls out her hair and eyebrows. What diagnosis is MOST likely?

A. Obsessive-Compulsive Disorder

B. Trichotillomania

C. Obsessive-Compulsive Personality Disorder

D. Generalized Anxiety Disorder

Rationale: Trichotillomania is characterized by a compulsive urge to pull out one’s own hair, therefore B is the best answer in this case.

44

A therapist is called to the emergency room to evaluate a 25-year-old man who was brought in by police for public indecency. The therapist attempts to interview the man but has difficulty due to his rapid, tangential speech and his refusal to answer questions because he fears the therapist will “pass the info along to the wrong people.” The client adds that he has been awake for three days. The therapist notes that he is sweating profusely. A likely diagnosis is:

A. Opioid Intoxication 

B. Alcohol Intoxication 

C. Cocaine Intoxication 

D. Amphetamine Intoxication

A therapist is called to the emergency room to evaluate a 25-year-old man who was brought in by police for public indecency. The therapist attempts to interview the man but has difficulty due to his rapid, tangential speech and his refusal to answer questions because he fears the therapist will “pass the info along to the wrong people.” The client adds that he has been awake for three days. The therapist notes that he is sweating profusely. A likely diagnosis is:

A. Opioid Intoxication 

B. Alcohol Intoxication 

C. Cocaine Intoxication 

D. Amphetamine Intoxication

Rationale: Individuals with Amphetamine Intoxication may experience psychosis, particularly in individuals who are heavy users. This is seen in the stem by the man’s fear that the therapist will “pass the info to the wrong people.” These individuals may also experience palpitations, disorientation, and rapid/tangential speech. Therefore D is correct. While these symptoms may overlap with A, B, and C, the biggest difference is that a sense of paranoia or delusions would not be present.

45

A therapist in a skilled nursing facility receives a referral for a new resident, an 85-year-old wheelchair-confined woman. The referral states that the woman has refused to take meals in the dining room and has been isolating herself since she arrived 3 days ago. The woman’s behavior indicates:

A. Passive-Aggressive Personality Disorder

B. Major Depressive Disorder

C. Mild/Major Neurocognitive Disorder

D. Typical adjustment to a new situation

A therapist in a skilled nursing facility receives a referral for a new resident, an 85-year-old wheelchair-confined woman. The referral states that the woman has refused to take meals in the dining room and has been isolating herself since she arrived 3 days ago. The woman’s behavior indicates:

A. Passive-Aggressive Personality Disorder

B. Major Depressive Disorder

C. Mild/Major Neurocognitive Disorder

D. Typical adjustment to a new situation

Rationale: D is correct because the client is displaying normal behaviors, particularly because the client is a new referral and has only be in the skilled nursing facility for 3 days. If the woman continued to engaged in these behaviors for two weeks, we may then consider B at that point, however at this point her behaviors are typical for the situation.

46

A 34-year-old single female is referred to a therapist by her real estate company’s Employee Assistance Program. She has missed a significant amount of work since her mother’s death 6 months ago and has been unable to complete previously easy tasks. During the assessment, the woman reports that she spends hours every day preparing food and repeatedly cleaning her house. She adds that she can’t stop thinking that the house isn’t clean enough to meet her mother’s standards. What diagnosis should be considered?

A. Generalized Anxiety Disorder

B. Major Depression

C. Obsessive-Compulsive Disorder

D. Obsessive-Compulsive Personality Disorder

A 34-year-old single female is referred to a therapist by her real estate company’s Employee Assistance Program. She has missed a significant amount of work since her mother’s death 6 months ago and has been unable to complete previously easy tasks. During the assessment, the woman reports that she spends hours every day preparing food and repeatedly cleaning her house. She adds that she can’t stop thinking that the house isn’t clean enough to meet her mother’s standards. What diagnosis should be considered?

A. Generalized Anxiety Disorder

B. Major Depression

C. Obsessive-Compulsive Disorder

D. Obsessive-Compulsive Personality Disorder

Rationale: C is correct because the client is displaying compulsions such as spending hours every day preparing food, and repeatedly cleaning her house. These compulsions coincide with an Obsessive-Compulsive Disorder diagnosis. A and B are incorrect because the client is not displaying symptoms such as anxiety, worry, or a feeling of hopelessness. D is incorrect because individuals with Obsessive-Compulsive Personality Disorder do not display compulsions.

47

A therapist in private practice receives a referral from a daycare for a 20-month-old girl. During the assessment, the therapist notices that the girl has no functional language, does not respond to prompts from her mother, and sits listlessly while wringing her hands. Her mother is very upset and reports that she doesn't understand her daughter's behavior. She states, "She used to talk, play and have fun. Now she can't even feed herself." What is the MOST likely diagnosis in this case?

A. Autism Spectrum Disorder

B. Intellectual Disability

C. Social (Pragmatic) Communication Disorder

D. Mixed Receptive-Expressive Language Disorder

A therapist in private practice receives a referral from a daycare for a 20-month-old girl. During the assessment, the therapist notices that the girl has no functional language, does not respond to prompts from her mother, and sits listlessly while wringing her hands. Her mother is very upset and reports that she doesn't understand her daughter's behavior. She states, "She used to talk, play and have fun. Now she can't even feed herself." What is the MOST likely diagnosis in this case?

A. Autism Spectrum Disorder

B. Intellectual Disability

C. Social (Pragmatic) Communication Disorder

D. Mixed Receptive-Expressive Language Disorder

Rationale: The correct answer is A, Autism Spectrum Disorder, because there is a language deficiency and repetitive movements.

48

A 4-year-old child is brought to therapy by her foster parents. When the therapist enters the waiting room, the child runs up to her, wraps her arms around the therapist’s legs, and says, “Am I going home with you?” The foster parents are embarrassed by this behavior and say, “We’ve only had her for 2 weeks, but she does this with everyone!” What conclusion should the therapist draw from this behavior?

A. The child may have Reactive Attachment Disorder.

B. The child has had positive relationships with adults and is securely attached.

C. The child may have Disinhibited Social Engagement Disorder.

D. The child has most likely been abused.

A 4-year-old child is brought to therapy by her foster parents. When the therapist enters the waiting room, the child runs up to her, wraps her arms around the therapist’s legs, and says, “Am I going home with you?” The foster parents are embarrassed by this behavior and say, “We’ve only had her for 2 weeks, but she does this with everyone!” What conclusion should the therapist draw from this behavior?

A. The child may have Reactive Attachment Disorder.

B. The child has had positive relationships with adults and is securely attached.

C. The child may have Disinhibited Social Engagement Disorder.

D. The child has most likely been abused.

Rationale: A child with Disinhibited Social Engagement Disorder often forms attachments with strangers while disregarding the regular caregiver. This is generally the result of having multiple caregivers or abusive caregivers and onset occurs before age 5. Therefore C is the correct answer.

49

A therapist is completing a biopyschosocial with a new client. The client appears with a flat affect and when asked questions, he responds with tangential answers and very disorganized speech. The client states in a monotone voice that while riding the bus on the way to his appointment people were plotting against him and he believes he was followed here by one of them. The client’s MOST likely initial diagnosis is:

A. Schizoaffective Disorder

B. Schizophrenia

C. Bipolar I

D. Schizoid Personality Disorder

A therapist is completing a biopyschosocial with a new client. The client appears with a flat affect and when asked questions, he responds with tangential answers and very disorganized speech. The client states in a monotone voice that while riding the bus on the way to his appointment people were plotting against him and he believes he was followed here by one of them. The client’s MOST likely initial diagnosis is:

A. Schizoaffective Disorder

B. Schizophrenia

C. Bipolar I

D. Schizoid Personality Disorder

Rationale: A is incorrect because the client is not reporting symptoms of both a mood disorder (mania or depression) in addition to symptoms of schizophrenia. C is incorrect because the client is not reporting any manic episodes. D is incorrect because individuals with Schizoid Personality Disorder would not experience delusions or paranoia as is being seen in the stem. Therefore, B is the best answer because the client is presenting with disorganized speech patterns, a flat affect/monotone voice, and paranoid delusions.

50

A 36-year-old woman is referred to a therapist through her Employee Assistance Program due to ongoing difficulty in getting projects done in a timely manner and a refusal to delegate. In working to create treatment objectives, the woman states repeatedly that her slow production comes from her desire to “get it right,” and that she does and then re-does her work several times in order to ensure its perfection. She says, “I don’t see why my boss has a problem. Wouldn’t he rather it be done right?” The therapist’s initial diagnostic impression is MOST likely:

A. Obsessive-Compulsive Personality Disorder

B. Adjustment Disorder With Anxiety

C. Obsessive-Compulsive Disorder 

D. No diagnosis: Symptoms do not cause clinically significant disturbance.

A 36-year-old woman is referred to a therapist through her Employee Assistance Program due to ongoing difficulty in getting projects done in a timely manner and a refusal to delegate. In working to create treatment objectives, the woman states repeatedly that her slow production comes from her desire to “get it right,” and that she does and then re-does her work several times in order to ensure its perfection. She says, “I don’t see why my boss has a problem. Wouldn’t he rather it be done right?” The therapist’s initial diagnostic impression is MOST likely:

A. Obsessive-Compulsive Personality Disorder

B. Adjustment Disorder With Anxiety

C. Obsessive-Compulsive Disorder 

D. No diagnosis: Symptoms do not cause clinically significant disturbance.

Rationale: B is incorrect because there is no event or stressor that would allow for a diagnosis of Adjustment Disorder to be made. C is incorrect because the client is not displaying any compulsions (ex. excessive hand washing). Lastly, D is incorrect because the boss has noted that the client struggles in getting projects done in a timely manner, therefore her symptoms are impairing her ability to work effectively. A is correct because the client is preoccupied with the details of her work and is inflexible in regards to how she believes the work should be done.

51

A man seeks treatment from a therapist on the advice of his doctor, who is concerned about the man’s tendency to pick at his skin until it bleeds. The man reports that he only does this because of blemishes on his skin that embarrass him greatly. During the assessment, the therapist notes that the man appears to have only minor blemishes but observes him continually checking his appearance in the window glass. What is the MOST likely diagnosis in this case?

A. Narcissistic Personality Disorder 

B. Delusional Disorder 

C. Obsessive-Compulsive Disorder 

D. Body Dysmorphic Disorder

A man seeks treatment from a therapist on the advice of his doctor, who is concerned about the man’s tendency to pick at his skin until it bleeds. The man reports that he only does this because of blemishes on his skin that embarrass him greatly. During the assessment, the therapist notes that the man appears to have only minor blemishes but observes him continually checking his appearance in the window glass. What is the MOST likely diagnosis in this case?

A. Narcissistic Personality Disorder 

B. Delusional Disorder 

C. Obsessive-Compulsive Disorder 

D. Body Dysmorphic Disorder

Rationale: Body Dysmorphic Disorder is when an individual has persistent and intrusive preoccupations with an imagined or slight defect in their appearance. In this case, the man has minor blemishes, but believes that they are much greater, therefore D is the best answer. A is incorrect because the client does not have a grandiose sense of self. B is incorrect because Delusional Disorder can only be diagnosed as the primary disorder which is not seen in this case. C is incorrect because while the client is picking at his skin until it bleeds, he is not doing this compulsively which is needed for this diagnosis.

52

A 17-year-old girl is referred to the school therapist after her teacher observes her “completely zoning out” on several occasions in class. When the therapist asks the girl about this, she has difficulty describing the experience and says, “I think I’m going crazy.” The therapist tries to clarify the girl’s meaning, but the girl is only able to say, “It’s like I’m there, but I’m not, you know? I know I should be paying attention, but it’s like I can’t control my own body.” The therapist is MOST likely to diagnose the girl with:

A. Attention Deficit-Hyperactivity Disorder, Predominantly Inattentive Type 

B. Depersonalization Disorder

C. Schizophrenia 

D. Dissociative Amnesia

A 17-year-old girl is referred to the school therapist after her teacher observes her “completely zoning out” on several occasions in class. When the therapist asks the girl about this, she has difficulty describing the experience and says, “I think I’m going crazy.” The therapist tries to clarify the girl’s meaning, but the girl is only able to say, “It’s like I’m there, but I’m not, you know? I know I should be paying attention, but it’s like I can’t control my own body.” The therapist is MOST likely to diagnose the girl with:

A. Attention Deficit-Hyperactivity Disorder, Predominantly Inattentive Type 

B. Depersonalization Disorder

C. Schizophrenia 

D. Dissociative Amnesia

Rationale: Depersonalization Disorder is a Dissociative Disorder where an individual experiences persistent or recurrent feelings of depersonalization or derealization. Symptoms that are displayed in the stem such as zoning out, and feeling like she is not in her body are all indicative of Depersonalization Disorder, therefore B is correct.

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During an initial appointment, the therapist asks a husband and wife their reasons for seeking treatment. The wife hesitantly tells the therapist that it is because of "bedroom issues." Her husband cuts in and states that approximately a year ago, his wife seemed to lose interest in him sexually and that nothing he has done has been able to change this; he ends by saying, "I think she's having an affair." The wife insists, "I'm just feeling stressed with work and haven’t found sex pleasurable for a while. ” What is the MOST likely diagnosis in this case?

A. Female Sexual Interest/Arousal Disorder

B. Genito-Pelvic Pain/Penetration Disorder

C. Adjustment Disorder

D. Gender Dysphoria

During an initial appointment, the therapist asks a husband and wife their reasons for seeking treatment. The wife hesitantly tells the therapist that it is because of "bedroom issues." Her husband cuts in and states that approximately a year ago, his wife seemed to lose interest in him sexually and that nothing he has done has been able to change this; he ends by saying, "I think she's having an affair." The wife insists, "I'm just feeling stressed with work and haven’t found sex pleasurable for a while. ” What is the MOST likely diagnosis in this case?

A. Female Sexual Interest/Arousal Disorder

B. Genito-Pelvic Pain/Penetration Disorder

C. Adjustment Disorder

D. Gender Dysphoria

Rationale: B is incorrect because the client isn’t reporting any actual pain during sexual intercourse. C is incorrect because there is no identified stressor in the stem that would be required for an Adjustment Disorder diagnosis. D is incorrect because the client is not reporting any conflict between her physical gender and her her identified gender. Therefore, A is correct because the client is reporting an aversion to and lack of interest in sexual contact with her husband which as a result is causing conflict between the two of them.

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A man is referred to a therapist by his Employee Assistance Program for several incidents of falling asleep on the job. During the initial interview, the man confirms that he feels sleepy almost constantly and “just can’t seem to catch up” on rest. He reports that he often can’t get himself out of bed on the weekends and has been sneaking naps in at work but has been caught on several occasions. After ruling out substance abuse and a medical issue, the therapist will likely diagnose the client with:

A. Non-Rapid Eye Movement Sleep Disorder

B. Insomnia Disorder

C. Hypersomnolence Disorder

D. Major Depressive Disorder

A man is referred to a therapist by his Employee Assistance Program for several incidents of falling asleep on the job. During the initial interview, the man confirms that he feels sleepy almost constantly and “just can’t seem to catch up” on rest. He reports that he often can’t get himself out of bed on the weekends and has been sneaking naps in at work but has been caught on several occasions. After ruling out substance abuse and a medical issue, the therapist will likely diagnose the client with:

A. Non-Rapid Eye Movement Sleep Disorder

B. Insomnia Disorder

C. Hypersomnolence Disorder

D. Major Depressive Disorder

Rationale: Hypersomnolence is the best answer here because the client is reporting excessive sleepiness during the day. Insomnia is incorrect because the client would need to report difficulties falling asleep, or staying asleep at night which is not stated in the stem. A and D are incorrect because the client is not reporting any symptoms that would coincide with these disorders.

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Parents seek the services of a therapist for their 5-year-old son; they explain that their son has been waking around 11 p.m. several nights a week for the last month, screaming hysterically and “staring into space.” They are frightened by the fact that they are often unable to rouse their son and report that he often falls back asleep without acknowledging their presence in the room. They have been unable to get him to tell them anything about his dreams and are confused by the fact that he seems to have no memory of the events the next morning. The MOST likely diagnosis in this case is:

A. Non-Rapid Eye Movement Sleep Disorder, Sleep Terror Subtype

B. Nightmare Disorder

C. Narcolepsy

D. Panic Disorder

Parents seek the services of a therapist for their 5-year-old son; they explain that their son has been waking around 11 p.m. several nights a week for the last month, screaming hysterically and “staring into space.” They are frightened by the fact that they are often unable to rouse their son and report that he often falls back asleep without acknowledging their presence in the room. They have been unable to get him to tell them anything about his dreams and are confused by the fact that he seems to have no memory of the events the next morning. The MOST likely diagnosis in this case is:

A. Non-Rapid Eye Movement Sleep Disorder, Sleep Terror Subtype

B. Nightmare Disorder

C. Narcolepsy

D. Panic Disorder

Rationale: B is incorrect because the client reports that is has no memory of the events that are happening. Individuals with Nightmare Disorder are generally able to remember the nightmares they have, therefore B is incorrect. C is incorrect because the client is not having recurrent daytime naps. D is incorrect because Panic Disorder does not occur during sleep. Therefore, A is correct because the nightmares are occurring during the first ⅓ of sleep time and the boy has an incomplete waking and is difficult to comfort. Additionally, the client doesn’t remember the dreams that have occurred.

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All of the following are diagnostic criteria for Substance Use Disorder EXCEPT:

A. Failure to fulfill major role obligations at work, school, or home.

B. A need for markedly increased amounts of the substance to achieve intoxication or desired effect.

C. Legal problems related to substance use.

D. Cravings or a strong desire to for substance use.

All of the following are diagnostic criteria for Substance Use Disorder EXCEPT:

A. Failure to fulfill major role obligations at work, school, or home.

B. A need for markedly increased amounts of the substance to achieve intoxication or desired effect.

C. Legal problems related to substance use.

D. Cravings or a strong desire to for substance use.

Rationale: C is the only answer that is NOT part of the criteria for Substance Use Disorder.

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A 30-year-old man presents for treatment on the advice of his mother, who is concerned that he has not yet found someone with whom he can “settle down.” The therapist notes during the assessment that the man fails to make eye contact and regards the therapist in a suspicious manner. When asked about his personal relationships, the man notes that he does not have any close friends because “no one likes a person who can read minds” and that he just doesn’t “fit in” with his co-workers. What is the MOST likely diagnosis in this case?

A. Paranoid Personality Disorder 

B. Schizophrenia 

C. Schizotypal Personality Disorder

D. Schizoid Personality Disorder

A 30-year-old man presents for treatment on the advice of his mother, who is concerned that he has not yet found someone with whom he can “settle down.” The therapist notes during the assessment that the man fails to make eye contact and regards the therapist in a suspicious manner. When asked about his personal relationships, the man notes that he does not have any close friends because “no one likes a person who can read minds” and that he just doesn’t “fit in” with his co-workers. What is the MOST likely diagnosis in this case?

A. Paranoid Personality Disorder 

B. Schizophrenia 

C. Schizotypal Personality Disorder

D. Schizoid Personality Disorder

Rationale: A is incorrect because the client is not displaying any paranoid behaviors such as believing someone will sabotage him. B is incorrect because the client is not displaying a flat affect, or any hallucinations. D is incorrect because individuals with Schizoid Personality Disorder are viewed as being more of loners, whereas the client in this stem has a relationship with his mom. C is correct because the client is displaying odd behaviors, does not fit in with others, and the biggest defining factor in this stem is that the client reports magical thinking when stating that he can read minds.

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A therapist begins an assessment on a nine-year-old boy whose parents are reporting impulsive, aggressive, and argumentative behavior at home. The child refuses to follow directions and tries to hit and kick his parents when they intervene. Reports from the client’s teacher indicate the he often challenges her but has several friends. The parents state that this has been going on for over a year and has gotten progressively worse. What is the MOST likely diagnosis in this case?

A. Major Depressive Disorder, Childhood Onset 

B. ADHD 

C. Bipolar I Disorder 

D. Oppositional Defiant Disorder

A therapist begins an assessment on a nine-year-old boy whose parents are reporting impulsive, aggressive, and argumentative behavior at home. The child refuses to follow directions and tries to hit and kick his parents when they intervene. Reports from the client’s teacher indicate the he often challenges her but has several friends. The parents state that this has been going on for over a year and has gotten progressively worse. What is the MOST likely diagnosis in this case?

A. Major Depressive Disorder, Childhood Onset 

B. ADHD 

C. Bipolar I Disorder 

D. Oppositional Defiant Disorder

Rationale: A is incorrect because while the client is displaying anger, he is not showing any other signs of depression such as feelings of sadness or hopelessness. B is incorrect because children with ADHD would not be displaying the aggressive behaviors that are seen in the stem such as hitting and kicking his parents. C is incorrect because the client is not displaying any manic behaviors. Therefore, D is the best answer because the client is displaying hostile and disobedient behavior towards authority figures (parents and teachers).

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A college student seeks therapy for problems with schoolwork. She states that sometimes she is really productive and can go without much sleep for a few days straight. The problem is that she’ll end up crashing. She reports that she’ll feel bad about herself and not want to get out of bed for a few days because she is so unmotivated. What diagnosis is MOST likely?

A. Bipolar I Disorder

B. Bipolar II Disorder

C. Schizoaffective Disorder 

D. Cyclothymic Disorder

A college student seeks therapy for problems with schoolwork. She states that sometimes she is really productive and can go without much sleep for a few days straight. The problem is that she’ll end up crashing. She reports that she’ll feel bad about herself and not want to get out of bed for a few days because she is so unmotivated. What diagnosis is MOST likely?

A. Bipolar I Disorder

B. Bipolar II Disorder

C. Schizoaffective Disorder 

D. Cyclothymic Disorder

Rationale: D is the best answer here because the client is displaying a milder form of Bipolar Disorder. The client reports hypomanic symptoms when she states that she can go for a few days straight without much sleep followed by depressive symptoms that do not fit the criteria for Major Depression. A and B are incorrect because the client is not experiencing full blown mania or Major Depression. C is incorrect because the client is not displaying any symptoms of psychosis.

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A therapist meets with a client whose adult daughter encouraged her to get help due to her unhealthy living conditions. Upon inquiring further the client reports that she struggles to throw away anything in her house and states she feels extreme anxiety when trying to do so. The client states fear around throwing something away in case she will need it at a later time. Based on this information, the MOST likely diagnosis in this case is:

A. Hoarding Disorder

B. Obsessive Compulsive Disorder

C. Generalized Anxiety Disorder

D. Agoraphobia

A therapist meets with a client whose adult daughter encouraged her to get help due to her unhealthy living conditions. Upon inquiring further the client reports that she struggles to throw away anything in her house and states she feels extreme anxiety when trying to do so. The client states fear around throwing something away in case she will need it at a later time. Based on this information, the MOST likely diagnosis in this case is:

A. Hoarding Disorder

B. Obsessive Compulsive Disorder

C. Generalized Anxiety Disorder

D. Agoraphobia

Rationale: Individuals with Hoarding Disorder report extreme distress related to throwing items away despite the items having little or no value therefore A is correct. B is incorrect because the client is not reporting any compulsions. C is incorrect because while the client reports anxiety, her symptoms are better accounted for by A therefore C would not be diagnosed initially. D is incorrect because the client does not struggle in leaving her house or being in public places.

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A therapist meets with a client who tearfully reports that her “eating is out of control.” The client states that she has been eating large amounts of food in hiding even if she’s not even hungry. Upon further questioning the client reports that she doesn’t purge the food. The MOST likely diagnosis in this case is:

A. Bulimia Nervosa

B. Anorexia Nervosa

C. Binge Eating Disorder

D. Unspecified Eating Disorder

A therapist meets with a client who tearfully reports that her “eating is out of control.” The client states that she has been eating large amounts of food in hiding even if she’s not even hungry. Upon further questioning the client reports that she doesn’t purge the food. The MOST likely diagnosis in this case is:

A. Bulimia Nervosa

B. Anorexia Nervosa

C. Binge Eating Disorder

D. Unspecified Eating Disorder

Rationale: Individuals with Binge Eating Disorder will eat large amounts of food in the same period of time that someone else would eat a normal amount. C is correct because the client is also reporting that she does not purge the food. A is incorrect because the client is not purging and B is incorrect because the client is not restricting her intake in an effort to lose weight. D is incorrect because the client’s symptoms are better accounted for by Binge Eating Disorder, therefore D cannot be diagnosed at this time.

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A 22-year-old client reports that when he starts to feel anxious or stressed he picks at his skin to the point that it will bleed. The therapist notes multiple lesions on the clients arms and face. The MOST likely diagnosis is:

A. Excoriation Disorder

B. Obsessive-Compulsive Disorder

C. Generalized Anxiety Disorder

D. Trichotillomania

A 22-year-old client reports that when he starts to feel anxious or stressed he picks at his skin to the point that it will bleed. The therapist notes multiple lesions on the clients arms and face. The MOST likely diagnosis is:

A. Excoriation Disorder

B. Obsessive-Compulsive Disorder

C. Generalized Anxiety Disorder

D. Trichotillomania

Rationale: A is the best answer here because individuals with Excoriation (skin picking) Disorder will pick or scratch at their skin to the point where damage is caused. This is often done when the individual is feeling anxious or stressed. B is incorrect because his compulsion is better defined by Excoriation Disorder, therefore Obsessive-Compulsive Disorder cannot be diagnosed. C is incorrect because the client is not expressing enough symptoms to fit a GAD diagnosis. Lastly, D is incorrect because individuals with Trichotillomania will pull out their hair when stressed which is not indicated in the stem.

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A client reports that despite going to bed at an early hour, he continues to struggle falling asleep, often laying in bed for 3 hours before he is able to fall asleep. The client reports that he is exhausted and has been happening more often than not throughout the week for the past 6 months. What is the client’s MOST likely diagnosis:

A. Insomnia Disorder

B. Hypersomnolence Disorder

C. Major Depressive Disorder

D. Non-REM Sleep Disorder

A client reports that despite going to bed at an early hour, he continues to struggle falling asleep, often laying in bed for 3 hours before he is able to fall asleep. The client reports that he is exhausted and has been happening more often than not throughout the week for the past 6 months. What is the client’s MOST likely diagnosis:

A. Insomnia Disorder

B. Hypersomnolence Disorder

C. Major Depressive Disorder

D. Non-REM Sleep Disorder

Rationale: Since the client reports that he is having trouble falling asleep and that this has been occurring for more than 3 months, the client’s most likely diagnosis is A. B is incorrect because the client does not report excessive sleepiness during the daytime. C is incorrect because the client is not reporting any symptoms of depression. Lastly, D is incorrect because the client is not reporting waking during the first ⅓ of sleep time with nightmares or night terrors.

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A mother brings in her young daughter to see a therapist. The mother reports that her daughter is very quiet and appears anxious when speaking. She also states that teachers have reported that she does not participate frequently in class. When the therapist asks the girl a question, the therapist notices that her words are often repeated while she speaks, and the syllables last longer than normal. The MOST likely diagnosis here is:

A. Language Disorder

B. Childhood-Onset Fluency Disorder

C. Autism Spectrum Disorder

D. Specific Learning Disorder

A mother brings in her young daughter to see a therapist. The mother reports that her daughter is very quiet and appears anxious when speaking. She also states that teachers have reported that she does not participate frequently in class. When the therapist asks the girl a question, the therapist notices that her words are often repeated while she speaks, and the syllables last longer than normal. The MOST likely diagnosis here is:

A. Language Disorder

B. Childhood-Onset Fluency Disorder

C. Autism Spectrum Disorder

D. Specific Learning Disorder

Rationale: B is the best answer here because the girl is struggling with the time patterning of her speech which is displayed by her repetition of words and prolonged syllables. A is incorrect because individuals with Language Disorder have trouble getting their meaning across to others, but they are able to produce sounds and their speech can be understood. C is incorrect because the child is not displaying deficits that indicate Autism Spectrum Disorder such as repetitive patterns of behavior, social interaction difficulties, or a disinterest in activities. D is incorrect because the stem does not indicate that the girl is having difficulties with academic learning.

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A 25-year-old woman sees a therapist after complaining about feelings of hopelessness and anxiety. She states that the feelings are most severe within the week before she starts her menstrual cycle and go away once her cycle starts. She reports that during this time she loses interest in activities she usually enjoys and has trouble focusing. The client’s initial diagnosis is MOST likely:

A. Generalized Anxiety Disorder

B. Bipolar II

C. Premenstrual Dysphoric Disorder

D. Persistent Depressive Disorder

A 25-year-old woman sees a therapist after complaining about feelings of hopelessness and anxiety. She states that the feelings are most severe within the week before she starts her menstrual cycle and go away once her cycle starts. She reports that during this time she loses interest in activities she usually enjoys and has trouble focusing. The client’s initial diagnosis is MOST likely:

A. Generalized Anxiety Disorder

B. Bipolar II

C. Premenstrual Dysphoric Disorder

D. Persistent Depressive Disorder

Rationale: The best answer here is C because the client is reporting that these symptoms occur within the week before her menstrual cycle and then disappear. Individuals with Premenstrual Dysphoric Disorder experience depressive symptoms within 5-11 days before their menstrual cycle.  These symptoms then lessen or disappear completely once it has started.

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A mother brings her 9-year-old son in to see a therapist due to ongoing temper tantrums and outbursts at home and school. The mother reports that the tantrums have been going on for the past two years and that when he isn’t having a tantrum he appears very irritable and angry. The mother tearfully states that these outbursts occur more often than not and that this morning he started aggressively throwing books at the wall after learning that he couldn’t go to a friends house. What diagnosis should the therapist initially consider?

A. Major Depressive Disorder

B. Conduct Disorder

C. Disruptive Mood Dysregulation Disorder

D. Reactive Attachment Disorder

A mother brings her 9-year-old son in to see a therapist due to ongoing temper tantrums and outbursts at home and school. The mother reports that the tantrums have been going on for the past two years and that when he isn’t having a tantrum he appears very irritable and angry. The mother tearfully states that these outbursts occur more often than not and that this morning he started aggressively throwing books at the wall after learning that he couldn’t go to a friends house. What diagnosis should the therapist initially consider?

A. Major Depressive Disorder

B. Conduct Disorder

C. Disruptive Mood Dysregulation Disorder

D. Reactive Attachment Disorder

Rationale:  A is incorrect because individuals with Major Depression would not have the severe temper tantrums that are occurring here. B is incorrect because individuals with conduct disorder display behaviors that violate the rights of others, which isn’t occurring at this point with the child. D is incorrect because the boy’s symptoms started two years ago, whereas individuals with RAD must have an onset before age 5. Therefore, C is correct because the boy is displaying chronic irritability and severe temper tantrums that are not developmentally appropriate. Onset must occur between ages 6-10, but it can be diagnosed up to age 17.

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A 55-year-old client reports that for the past 6 months she has had trouble falling asleep. Upon further exploration the client states that she continually feels discomfort and sensations in her legs at night when she’s trying to sleep and has the urge to move them constantly, which only partially relieves the discomfort. She reports that due to the lack of sleep she’s having trouble concentrating at work and is falling behind. The client’s MOST likely diagnosis is:

A. Insomnia Disorder

B. Hypersomnolence Disorder

C. Central Sleep Apnea

D. Restless Leg Syndrome

A 55-year-old client reports that for the past 6 months she has had trouble falling asleep. Upon further exploration the client states that she continually feels discomfort and sensations in her legs at night when she’s trying to sleep and has the urge to move them constantly, which only partially relieves the discomfort. She reports that due to the lack of sleep she’s having trouble concentrating at work and is falling behind. The client’s MOST likely diagnosis is:

A. Insomnia Disorder

B. Hypersomnolence Disorder

C. Central Sleep Apnea

D. Restless Leg Syndrome

Rationale: D is the correct answer here because the client is reporting sensations and discomfort in her legs during times when she is trying to rest. Moving the legs helps for a little bit, but does not always fully relieve the discomfort. A is incorrect because while the client is having trouble falling asleep it is related to her restless legs, therefore Insomnia Disorder could not be diagnosed. B is incorrect because while the client is tired during the day, it’s because she’s not getting enough sleep at night. B could only be diagnosed if the client was still tired during the day despite a full night’s rest. C is incorrect because the client is not reporting that her breathing is stopping while sleeping.

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A 12-year-old child is displaying difficulties with reading comprehension and when asked to read out loud frequently makes mistakes in reading the words. The child’s MOST likely diagnosis is:

A. Specific Learning Disorder with Impaired Reading

B. Specific Learning Disorder with Impaired Written Expression

C. Childhood-Onset Fluency Disorder

D. Intellectual Disability

A 12-year-old child is displaying difficulties with reading comprehension and when asked to read out loud frequently makes mistakes in reading the words. The child’s MOST likely diagnosis is:

A. Specific Learning Disorder with Impaired Reading

B. Specific Learning Disorder with Impaired Written Expression

C. Childhood-Onset Fluency Disorder

D. Intellectual Disability

Rationale: A is the best answer here because the child is displaying difficulties with reading comprehension and fluency. B is incorrect because a child with Impaired Written Expression would experience difficulties with spelling accuracy, grammar and punctuation, and clarity or organization of written expression. C is incorrect because the child is not struggling with the sounds or syllables of the words but rather the accuracy of comprehending the words. Lastly, D is incorrect because the boy is not displaying symptoms that would be indicative of an Intellectual Disability.

69

A 21-year-old client sees a therapist in a private practice after friends expressed concerned at her constant isolation and lack of desire to be in social settings. She reports feelings of disgust when she looks in the mirror at herself and wishes that she could change her genitals. She states that recently she has considered dressing like a man, but wishes that she had just been born with a male body. What is the client’s MOST likely diagnosis?

A. Major Depressive Disorder

B. Gender Dysphoria

C. Social Phobia

D. Generalized Anxiety Disorder

A 21-year-old client sees a therapist in a private practice after friends expressed concerned at her constant isolation and lack of desire to be in social settings. She reports feelings of disgust when she looks in the mirror at herself and wishes that she could change her genitals. She states that recently she has considered dressing like a man, but wishes that she had just been born with a male body. What is the client’s MOST likely diagnosis?

A. Major Depressive Disorder

B. Gender Dysphoria

C. Social Phobia

D. Generalized Anxiety Disorder

Rationale: B is the best answer here because the client is reporting conflict between her physical gender and her identified gender. A is incorrect because while the client is reporting depressive symptoms the client’s symptoms are related to the disconnect between her physical and identified gender. C is incorrect because an individual with social phobia fears being out in public because they are afraid of being judged or embarrassed which is not the case here. D is incorrect because the client is not expressing anxiety.

70

A woman comes in to see a therapist with her partner. The women reports that within the past year she feels like their relationship has become more conflictual and states that she feels like a lot of it has to do to their lack of sex. The partner states that he has a desire for more sex and feels frustrated that she feels so anxious every time he starts to initiate sexual intercourse. The woman tearfully reports that she wants to have more sex but she experiences a lot of pain during intercourse because her pelvic muscles tense during penetration. The woman’s MOST likely diagnosis is:

A. Generalized Anxiety Disorder

B. Genito-Pelvic Pain/Penetration Disorder

C. Sexual Interest/Arousal Disorder

D. Female Orgasmic Disorder

A woman comes in to see a therapist with her partner. The women reports that within the past year she feels like their relationship has become more conflictual and states that she feels like a lot of it has to do to their lack of sex. The partner states that he has a desire for more sex and feels frustrated that she feels so anxious every time he starts to initiate sexual intercourse. The woman tearfully reports that she wants to have more sex but she experiences a lot of pain during intercourse because her pelvic muscles tense during penetration. The woman’s MOST likely diagnosis is:

A. Generalized Anxiety Disorder

B. Genito-Pelvic Pain/Penetration Disorder

C. Sexual Interest/Arousal Disorder

D. Female Orgasmic Disorder

Rationale: B is the best answer here because the woman is reporting pain during vaginal penetration and intercourse. As a result the woman is experiencing fear and anxiety around having sexual intercourse which as a result affects her relationship with her partner.

 

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