LE 3 (2025)

Question 1

Which of the following statements about reactive attachment disorder (RAD) is true?
Select one:
a. RAD occurs only in children who have impaired communication.
b. RAD occurs only in children who have secure attachments.
c. RAD occurs only in children who lack healthy attachments.
d. RAD is a common condition, with a prevalence of 25% of children seen in clinical settings.

Answer 1

c. RAD occurs only in children who lack healthy attachments.

Rationale: RAD develops in children who do not form a healthy emotional attachment to their primary caregivers or parents. It typically emerges in children who have been neglected or abused and therefore lack the opportunity to form a close bond with a caregiver. The other options do not correctly describe the characteristics of children with RAD.

Question 2

A 6-year-old girl has repeatedly approached strangers while in the park with her class. The teacher requests an evaluation of the behavior. The girl has a history of being placed in several different foster homes over the past 3 years. Which diagnosis is suggested from this history?
Select one:
a. Disinhibited social engagement disorder (DSED).
b. Autism spectrum disorder (ASD).
c. Reactive attachment disorder
d. Acute stress disorder

Answer 2

a. Disinhibited social engagement disorder (DSED).

Rationale: DSED is characterized by a pattern of behavior where a child actively approaches and interacts with unfamiliar adults and exhibits a lack of normal reservations of approaching strangers. It is also linked to contexts of social neglect without forming selective attachments.

Question 3

Criterion B for acute stress disorder requires the presence of nine (or more) symptoms from any of five categories of response. Which of the following is not one of these five categories?
Select one:
a. intrusion
b. dissociation
c. avoidance
d. arousal
e. confusion

Answer 3

e. confusion

Rationale: Acute stress disorder (ASD) does not have “confusion” as one of its five categories of response. The five categories are intrusion, dissociation, avoidance, arousal, and mood.

Question 4

Which of the following statements about gender differences in the risk of developing posttraumatic stress disorder (PTSD) is true?
Select one:
a. The risk is higher in females across the life span.
b. The risk is lower in middle-aged females than in middle-aged males.
c. The risk is higher in males in elderly populations.
d. The risk is higher in males across the life span

Answer 4

a. The risk is higher in females across the life span.

Rationale: Research consistently shows that females have a higher risk of developing PTSD compared to males, even though males might be exposed to traumatic events more frequently.

Question 5

A woman complains of sad mood and feeling hopeless 3 months after her husband files for divorce. She finds it difficult to take care of her home or make meals for her family but has continued to fulfill her responsibilities. She denies suicidal ideation, feels she was a good wife who “has nothing to feel guilty about,” and wishes she could “forget about the whole thing.” She cannot stop thinking about her situation. Which diagnosis best fits this symptom picture?
Select one:
a. Adjustment disorder, with anxiety.
b. Adjustment disorder, with depressed mood.
c. Acute stress disorder
d. Unspecified trauma and stressor related disorder

Answer 5

b. Adjustment disorder, with depressed mood.

Rationale:
Adjustment disorders are stress-related conditions that arise after a person experiences a significant life change or stressor. The response to the stressor is maladaptive and causes significant impairment in social, occupational, or other areas of functioning. In the case of adjustment disorder with depressed mood, the predominant symptoms are feelings of sadness, tearfulness, or hopelessness. Given the timing (3 months after the triggering event) and the nature of the symptoms, this diagnosis is more fitting than the other options. Acute stress disorder typically occurs in response to trauma and involves a different set of symptoms. Unspecified trauma and stressor-related disorder is a broader category and would typically be used when the specific criteria for another trauma and stressor-related disorder are not met.

Question 6

Which of the following sleep disturbances or disorders occurs during rapid eye movement (REM) sleep?
Select one:
a. Central sleep apnea.
b. sleep terrors
c. Obstructive sleep apnea hypopnea.
d. Nightmare disorder.

Answer 6

d. Nightmare disorder.

Rationale: Nightmare disorder is characterized by recurrent nightmares that occur during REM sleep. Nightmares can cause significant distress and sleep disturbances.

Question 7

A woman complains of sad mood and feeling hopeless 3 months after her husband files for divorce. She finds it difficult to take care of her home or make meals for her family but has continued to fulfill her responsibilities. She denies suicidal ideation, feels she was a good wife who “has nothing to feel guilty about,” and wishes she could “forget about the whole thing.” She cannot stop thinking about her situation. Which diagnosis best fits this symptom picture?
Select one:
a. Acute stress disorder
b. Adjustment disorder, with anxiety.
c. Adjustment disorder, with depressed mood.
d. Unspecified trauma and stressor related disorder

Answer 7

c. Adjustment disorder, with depressed mood.

Rationale: This is a repeat question, and the rationale remains the same. The described symptoms are consistent with adjustment disorder, and the primary emotional response is a depressed mood.

Question 8

Match the criterion B of PTSD and its corresponding example:

I. Recurrent, involuntary, and intrusive distressing memories of the traumatic event/s
II. Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).
III. Efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
IV. An altered sense of the reality of one’s surroundings or oneself (e.g., seeing oneself from another’s perspective, being in a daze, time slowing).

A. dissociative symptoms
B. negative mood
C. avoidance
D. intrusion

Answer 8

I. Recurrent, involuntary, and intrusive distressing memories of the traumatic event/s
Answer: D. intrusion

II. Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).
Answer: B. negative mood

III. Efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
Answer: C. avoidance

IV. An altered sense of the reality of one’s surroundings or oneself (e.g., seeing oneself from another’s perspective, being in a daze, time slowing).
Answer: A. dissociative symptoms

Question 9

Men with obsessive-compulsive disorder (OCD) differ from women with the disorder in which of the following ways?
Select one:
a. Men tend to get OCD later in life.
b. Men have much higher rates of OCD.
c. Men are more likely to have comorbid tics.
d. Men are more likely to spontaneously recover.

Answer 9

c. Men are more likely to have comorbid tics.
Rationale: OCD can affect both men and women, but some studies suggest that men with OCD are more likely to also have a tic disorder compared to women with OCD.

Question 10

A 63-year-old woman has been saving financial documents and records for many years, placing papers in piles throughout her apartment to the point where it has become unsafe. She acknowledges that the piles are a concern; however, she says that the papers include important documents and she is afraid to throw them away. She recalls several instances in which her taxes were audited and she needed certain documents to avoid a penalty. She is concerned because her landlord is threatening to evict her unless she removes the piles of papers. What is the most likely diagnosis?
Select one:
A. other specified obsessive compulsive and related disorder
B. obsessive compulsive disorder
C. hoarding disorder
D. unspecified obsessive compulsive and related disorder

Answer 10

C. hoarding disorder
Rationale: Hoarding disorder is characterized by persistent difficulty discarding or parting with possessions because of a perceived need to save them. Individuals with this disorder experience distress at the thought of getting rid of the items, leading to excessive accumulation and clutter.

Question 11

These are recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted
Select one:
a. both
b. compulsions
c. obsessions
d. delusions

Answer 11

c. obsessions
Rationale: Obsessions are unwanted, intrusive thoughts, images, or urges that cause significant anxiety or distress.

Question 12

These are repetitive behaviors or mental acts that an individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.
Select one:
A. both
B. obsessions
C. compulsions
D. Delusions

Answer 12

C. compulsions
Rationale: Compulsions are behaviors or mental acts that an individual feels driven to perform, either in response to an obsession or based on rigid rules, with the aim of preventing or reducing distress.

Question 13

Which of the following is FALSE about body dysmorphic disorder?
Select one:
a.
Excessive repetitive behaviors or mental acts are performed in response to the preoccupation
b. The preoccupation causes clinically significant distress
c. Insight may range from good to absent
d. Preoccupation with one or more perceived defects or flaws in physical appearance that are observable to others

Answer 13

d. Preoccupation with one or more perceived defects or flaws in physical appearance that are observable to others.
Rationale: Body dysmorphic disorder (BDD) is characterized by a person’s preoccupation with imagined defects or flaws in their physical appearance that are not observable or appear minor to others. The core of BDD is that the perceived flaws are often not noticeable to others, making this option false.

Question 14

Which of the following is FALSE about hoarding disorder?
Select one:
a. Animal hoarding is a special manifestation
b. Quality of life of the person is considerably impaired
c. Some studies showed that it is more common among males
d. All are correct
e. Persistent difficulty discarding or parting with possessions that are invaluable because of the perceived need to save the items

Answer 14

e. Persistent difficulty discarding or parting with possessions that are invaluable because of the perceived need to save the items.
Rationale: The core of hoarding disorder is difficulty discarding possessions, regardless of their actual value. The term “invaluable” in the option is misleading. The perceived need to save items is not based on the intrinsic value of the items.

Question 15

Which of the following statements about the course of hoarding disorder is true?
Select one:
a. Hoarding behavior tends to become more severe with increasing age.
b. Hoarding behavior peaks in young adulthood and subsequently lessens in severity.
c. Hoarding disorder has a worse course when it begins in later adulthood or old age
d. Hoarding behavior tends to wax and wane in severity throughout an individual’s life.

Answer 15

a. Hoarding behavior tends to become more severe with increasing age.
Rationale: Hoarding symptoms often start in adolescence and become progressively worse with age.

Question 16

What is the most common site of hair pulling in trichotillomania?
Select one:
a. pubic area
b. axillary area
c. facial area
d. scalp

Answer 16

d. scalp
Rationale: The scalp is the most common site for hair pulling in trichotillomania, although other areas can also be affected.

Question 17

To fulfill diagnostic criteria for excoriation (skin-picking) disorder, the picking must be severe enough to result in which of the following?
Select one:
a. skin lesions
b. permanent deformity
c. itching
d. an infection

Answer 17

a. skin lesions
Rationale: The primary diagnostic criteria for excoriation disorder involves the repeated picking at one’s skin, leading to skin lesions.

Question 18

In excoriation (skin-picking) disorder, which of the following is the most typical motivation for the skin-picking behavior?
Select one:
a. boredom
b. inflicting pain that brings relief by reaffirming one’s ability to feel.
c. fear of infection
d. appearance concerns

Answer 18

a. boredom
Rationale: Individuals often pick their skin in response to feelings of boredom or anxiety.

Question 19

Which of the following is a core feature of insomnia disorder?
Select one:
A. abnormal behaviors during sleep
B. cognitive impairment
C. daytime fatigue
D. Dissatisfaction with sleep quantity or quality.

Answer 19

D. Dissatisfaction with sleep quantity or quality.
Rationale: A primary characteristic of insomnia disorder is dissatisfaction with sleep, either in terms of quantity or quality.

Question 20

In addition to requiring recurrent sleep attacks, the diagnostic criteria for narcolepsy require the presence of cataplexy, hypocretin deficiency, or characteristic abnormalities on sleep polysomnography or multiple sleep latency testing. Which of the following is a defining characteristic of cataplexy?
Select one:
a. It is sudden.
b. It is induced by suggestion.
c. It persists for hours.
d. It is accompanied by hypertonia.

Answer 20

a. It is sudden.
Rationale: Cataplexy is a sudden loss of muscle tone triggered often by strong emotions, particularly laughter.

Question 21

A 50-year-old emergency department nurse complains of sleepiness at work interfering with her ability to function. She recently switched from the 7 A.M.- 4 P.M. day shift to the 11 P.M.-8 A.M. night shift in order to have her afternoons free. Even with this schedule change, she finds it difficult to sleep in the mornings at home, has little energy for recreational activities or household chores in the afternoon, and feels exhausted by the middle of her overnight shift. What is the most likely diagnosis?
Select one:
a. Normal variation in sleep secondary to shift work.
b. Circadian rhythm sleep-wake disorder, shift work type.
c. Insomnia disorder
d. Hypersomnolence disorder.

Answer 21

b. Circadian rhythm sleep-wake disorder, shift work type.
Rationale: Circadian rhythm sleep-wake disorders are disruptions in a person’s circadian rhythm, the internal clock that regulates the 24-hour cycle of biological processes. A shift in work hours, especially night shifts, can disrupt this internal clock, leading to symptoms like those described.

Question 22

A 14-year-old girl frequently wakes in the morning with clear recollection of very frightening dreams. Once she awakens, she is normally alert and oriented, but the dreams are a persistent source of distress. Her mother reports that the girl sometimes murmurs or groans but does not talk or move during the period before waking.
Her history is otherwise notable for having been homeless and living with her mother in a series of temporary shelter accommodations for 1 year when she was 10 years old. What is the most likely diagnosis?
Select one:
a. REM sleep behavior disorder
b. Posttraumatic stress disorder
c. nightmare disorder
d. non-REM sleep arousal disorder

Answer 22

c. nightmare disorder
Rationale: Nightmare disorder is characterized by recurrent, distressing dreams that usually involve threats to survival or security. The person wakes from the dream and becomes quickly alert.

Question 23

Which of the following is a type of non-rapid eye movement (REM) sleep arousal disorder in DSM-5?
Select one:
a. nightmare disorder
b. obstructive sleep apnea hypopnea
c. sleep terrors
d. REM sleep behavior disorder

Answer 23

c. sleep terrors
Rationale: Sleep terrors (also known as night terrors) are a type of non-REM sleep arousal disorder. They are episodes of intense fear during sleep that lead to arousal from deep sleep.

Question 24

Which of the following is a specific subtype of non-rapid eye movement sleep arousal disorder, sleepwalking type?
Select one:
a. Sleep-related sexual behavior (sexsomnia).
b. Complex motor behavior during alcoholic blackout.
c. Sleep-related seizure disorder.
d. Rapid eye movement (REM) sleep behavior disorder.

Answer 24

c. Sleep-related sexual behavior (sexsomnia).
Rationale: Sleep-related sexual behavior, or sexsomnia, is considered a type of sleepwalking behavior and is a subtype of non-REM sleep arousal disorder.

Question 25

Which of the following is a specific subtype of non-rapid eye movement sleep arousal disorder, sleepwalking type?
Select one:
a. Sleep-related sexual behavior (sexsomnia).
b. Complex motor behavior during alcoholic blackout.
c. Sleep-related seizure disorder.
d. Rapid eye movement (REM) sleep behavior disorder.

Answer 25

a. Sleep-related sexual behavior (sexsomnia).
Rationale: Sleep-related sexual behavior, or sexsomnia, is considered a type of sleepwalking behavior and is a subtype of non-REM sleep arousal disorder.

Question 26

What is the key abnormality in sleep physiology in rapid eye movement (REM) sleep behavior disorder?
Select one:
a. There is more REM sleep than normal.
b. Skeletal muscle tone is preserved during REM sleep.
c. Delta wave activity is increased.
d. REM starts earlier than normal in the sleep cycle.

Answer 26

b. Skeletal muscle tone is preserved during REM sleep.
Rationale: In REM sleep behavior disorder, the normal paralysis (atonia) that accompanies REM sleep is lost, so the person may act out their dreams.

Question 27

Which of the following substances is associated with parasomnias?
Select one:
A. cocaine
B. zolpidem
C. cannabis
D. methadone

Answer 27

B. zolpidem
Rationale: Zolpidem, a sedative-hypnotic medication, has been associated with various parasomnias, including sleepwalking, sleep-related eating, and other complex sleep behaviors.

Question 28

Somatic Disorder commonly coexists with a __or___ disorder
Select one:
a. sleep or obsessive compulsive
b. Bipolar or somatoform
c. depressive or anxiety
d. psychotic or manic

Answer 28

c. depressive or anxiety
Rationale: Somatic Symptom Disorder frequently coexists with depressive or anxiety disorders.

Question 29

In Somatic Symptom Disorder the false belief that they have a serious disease must last at least
__, despite the absence of pathological findings on medical and neurological examinations.
Select one:
A. 1 month
B. 3 months
C. 12 months
D. 6 months

Answer 29

B. 6 months
Rationale: This duration is a characteristic of Illness Anxiety Disorder (previously called Hypochondriasis). The individual is preoccupied with having or acquiring a serious illness for at least 6 months.

Question 30

Which of the following is FALSE about somatic symptom disorder.
Select one:
a.
The symptoms may or may not be associated with another medical condition.
b. Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated with health concerns
c. Preoccupation with having or acquiring serious illness
d. All are correct

Answer 30

c. Preoccupation with having or acquiring serious illness
Rationale: Preoccupation with having or acquiring a serious illness without significant somatic symptoms is characteristic of Illness Anxiety Disorder, not Somatic Symptom Disorder.

Question 31

The following are conversion disorder symptoms or specifiers, except:
Select one:
a. seizures
b. hallucinations
c. abnormal movement
d. weakness or paralysis
e. no exception, all are correct

Answer 31

b. hallucinations
Rationale: Conversion disorder (Functional Neurological Symptom Disorder) involves symptoms that affect motor or sensory function, and the most common symptoms include weakness or paralysis, abnormal movement, and seizures. Hallucinations are not a typical symptom of conversion disorder.

Question 32

Which of the following is FALSE about illness anxiety disorder.
Select one:
a. also called hypochondriasis
b. somatic symptoms are always present in severe intensity and the preoccupation is disproportionate
c. the individual performs excessive health related behaviors or exhibits maladaptive avoidance
d. all are correct
e. there is a high level of anxiety about health and the individual is easily alarmed about personal health status

Answer 32

b. somatic symptoms are always present in severe intensity and the preoccupation is disproportionate
Rationale: Illness Anxiety Disorder does not necessarily involve the presence of somatic symptoms. Instead, the primary feature is a high level of anxiety about having a serious illness, even when no (or only mild) symptoms are present.

Question 33

Which of the following is FALSE in the diagnosis of factitious disorder imposed on self?
Select one:
a. Falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception
It can occur as single episode or recurrent
b. The deceptive behavior is evident in the presence of external rewards
c. The individual presents himself or herself to others as ill, impaired, or injured
d. All are correct

Answer 33

b. The deceptive behavior is evident in the presence of external rewards
Rationale: Factitious Disorder is characterized by intentional production of symptoms in the absence of external rewards, meaning the motivation is not for financial gain, legal avoidance, or other tangible benefits.

Question 34

Methods of illness falsification include the following, except:
Select one:
a. fabrication
a. stimulation
b. exaggeration
c. all are correct
d. induction

Answer 34

c. all are correct
Rationale: Methods of illness falsification in factitious disorders can include fabrication, exaggeration, induction, and stimulation.

Question 35

A false belief of being pregnant that is associated with objective signs and reported symptoms of pregnancy
Select one:
a. delusional disorder
b. pseudocyesis
c. psychotic pregnancy
d. pseudosynthesis

Answer 35

b. pseudocyesis
Rationale: Pseudocyesis refers to the false belief of being pregnant, coupled with objective signs and symptoms of pregnancy, but where no actual pregnancy exists.

Question 36

Which of the following is a descriptive specifier included in the diagnostic criteria for somatic symptom disorder?
Select one:
a. undifferentiated
b. psychotic type
c. with hypochondriasis
d. with predominant pain

Answer 36

d. with predominant pain
Rationale: In DSM-5, “with predominant pain” is a specifier for Somatic Symptom Disorder.

Question 37

A 50-year-old man with hard-to-control hypertension acknowledges to his physician that he regularly “takes breaks” from his medication regimen because he was brought up with the belief that pills are bad and natural remedies are better. He is well aware that his blood pressure becomes dangerously high when he does not follow the regimen. Which diagnosis best fits this case?
Select one:
a. Unspecified somatic symptom and related disorder
b. Adjustment disorder
c. Non-adherence to medical treatment
d. Psychological factors affecting other medical conditions.

Answer 37

d. Psychological factors affecting other medical conditions.
Rationale: The diagnosis of “Psychological Factors Affecting Other Medical Conditions” is used when psychological or behavioral factors adversely affect a medical condition, including affecting the course of the medical condition, the treatment, or increasing the risks associated with the medical condition. This man’s belief, leading him to take breaks from medication, is negatively impacting his hypertension.