Alex, age 32, has been a "hermit" all his life. He lives with his family, spends most of his time
alone in his room listening to music, and says he never feels particularly happy or unhappy.
Six months ago, Alex was diagnosed with Brief Psychotic Disorder. Alex has never had a close
relationship and says he does not mind. His symptoms are most suggestive of which of the
following?
Select one:
a. Schizophreniform Disorder.
b. Major Depressive Disorder.
c. Schizoaffective Disorder.
d. Schizoid Personality Disorder.
ANSWER
Alex's symptoms are not explained by Brief Psychotic Disorder or other psychotic disorder
and suggest that another diagnosis is appropriate.Answer D is correct: Alex's life-long isola-
tion, indifference to social relationships, and lack of strong emotions are consistent with a
diagnosis of Schizoid Personality Disorder.Answer A is incorrect: Schizophreniform Disorder
is characterized by symptoms similar to those associated with Schizophrenia except that
their duration is one month to less than six months. Because Alex was diagnosed with Brief
Psychotic Disorder, we know that the duration of his psychotic symptoms did not exceed one
month. Moreover, he is not currently experiencing psychotic symptoms.Answer B is incor-
rect: You can rule out Major Depressive Disorder since there are no obvious symptoms of a
major depressive episode. In addition, Alex's symptoms have been life-long.Answer C is in-
correct: Schizoaffective Disorder requires a combination of psychotic symptoms and mood
episodes.
The correct answer is: Schizoid Personality Disorder.
Your client is an 11-year-old boy who has a history of behavioral problems. At school, the
boy disturbs his classmates whenever the teacher asks the students to work independently
on assignments in the classroom. He talks, makes noises, and throws paper wads and pencils
to disrupt the other students and avoid doing his own work. He is easily annoyed and often
loses his temper. The most likely DSM-5 diagnosis for this boy is which of the following?
1
,Select one:
a. Oppositional Defiant Disorder
b. ADHD
c. Conduct Disorder
d. Intermittent Explosive Disorder
ANSWER
Answer A is correct: Although the information provided is too limited to make a firm diagno-
sis (e.g., you don't know the duration of the boy's symptoms or how he behaves at home
and in other settings), Oppositional Defiant Disorder (ODD) is the most likely diagnosis. The
boy has a history of behavioral problems and appears to be deliberately annoying others and
resisting or defying his teacher's requests, and he is easily annoyed and often loses his tem-
per. As described in the DSM-5, ODD is characterized by a pattern of angry/irritable mood,
argumentative/defiant behavior, or vindictiveness. The boy's symptoms do not meet the cri-
teria for inattention or hyperactivity-impulsivity required for a diagnosis of ADHD and aren't
sufficiently severe for a diagnosis of Conduct Disorder or Intermittent Explosive Disorder.
The correct answer is: Oppositional Defiant Disorder
The symptoms of Oppositional Defiant Disorder are categorized in three groups in the DSM-
5. These groups are:
Select one:
a. destruction of property, deceitfulness or theft, and serious violations of rules.
b. negativistic, defiant, and hostile behavior.
c. deceitfulness or dishonesty, irritability or aggressiveness, and failure to conform to social
norms.
d. angry or irritable mood, argumentative or defiant behavior, and vindictiveness.
ANSWER
Answer D is correct: Angry/irritable mood, argumentative/defiant behavior, and vindictive-
ness are the three categories of symptoms included in the DSM-5 for Oppositional Defiant
Disorder.
Answer A is incorrect: These are three of the four categories of symptoms included in the
DSM-5 for Conduct Disorder (the fourth is aggression to people and animals).
2
,The correct answer is: angry or irritable mood, argumentative or defiant behavior, and vin-
dictiveness.
Marissa is 23 and has come to you because she is finding it difficult to care about her gradu-
ate work in accounting, her job, or her hobbies of tennis and sailing. In addition, she com-
plains that she is feeling real despair for the first time in her life. She is irritable with friends
and is having trouble sleeping. She does state, however, that she is happy she has lost her
appetite. She has felt this way for three weeks. Your first action with the client would be
which of the following?
Select one:
a. consultation with a physician
b. assessment of her potential for suicide
c. contacting her family
d. behavioral therapy to relieve her depression
ANSWER
You were asked to identify your first action.
Answer B is correct: The client's feelings of despair suggest that the first intervention should
be an assessment of potential for suicide.
Answer A is incorrect: Note that this suggests "consultation" with a physician. Had this sug-
gested referral for a medical evaluation, it would also have been an important first step.
Answer C is incorrect: If you assessed that Marissa's potential for suicide was high, you could
contact her family to enlist their help in protecting her from a suicide attempt, and you could
do this without Marissa's permission if necessary. Before you have performed a suicide as-
sessment, however, this action, without prior written permission from Marissa, would repre-
sent an unethical breach of her confidentiality. (You might, alternatively, have interpreted
"contacting her family" as suggesting a means of collecting collateral information for your
assessment; here too, however you would need to get Marissa's written permission before-
hand in order to avoid an unethical breach of confidentiality.)
Answer D is incorrect: This might be effective later but it certainly isn't the best first step, as
it ignores the possibility that this client might be suicidal.
The correct answer is: assessment of her potential for suicide
Which of the following is not a DSM-5 diagnostic criterion for Conversion Disorder?
3
, Select one:
a. one or more symptoms that involve an alteration in sensory or motor functioning
b. evidence of incompatibility between the symptoms and known medical conditions
c. symptoms are not better explained by a medical condition or other mental disorder
d. evidence that the symptoms are related to a psychological need or conflict.
ANSWER
Answer D is correct: The DSM-IV-TR requirement for evidence that symptoms are associated
with psychological factors has been removed as a diagnostic criterion for Conversion Disor-
der in the DSM-5.
Answers A, B, and C: These answers describe the DSM-5's diagnostic criteria for Conversion
Disorder.
The correct answer is: evidence that the symptoms are related to a psychological need or
conflict.
Your new client, a college freshman, says she sometimes has an "out of body" experience in
which she is watching what she is doing from outside herself. She describes a recent experi-
ence in which she was in her dorm room writing a paper when she realized she couldn't feel
her fingers on the computer keyboard or her feet on the floor and then suddenly felt like she
was watching herself from the ceiling. The client says that these episodes make her feel like
she's "going crazy" and are interfering with her ability to attend class and complete course
assignments. The client's symptoms are most suggestive of a DSM-5 diagnosis of:
Select one:
a. Delusional Disorder
b. Dissociative Fugue
c. Depersonalization or Derealization Disorder
d. Depersonalization Disorder
ANSWER
Answer C is correct: Depersonalization/Derealization Disorder is characterized by recurrent
episodes of depersonalization (a sense of unreality, detachment, or being an outside ob-
server of one's thoughts, feelings, etc.) and/or derealization (a sense of unreality or detach-
ment involving one's surroundings) that cause clinically significant distress or impaired func-
tioning.
4
alone in his room listening to music, and says he never feels particularly happy or unhappy.
Six months ago, Alex was diagnosed with Brief Psychotic Disorder. Alex has never had a close
relationship and says he does not mind. His symptoms are most suggestive of which of the
following?
Select one:
a. Schizophreniform Disorder.
b. Major Depressive Disorder.
c. Schizoaffective Disorder.
d. Schizoid Personality Disorder.
ANSWER
Alex's symptoms are not explained by Brief Psychotic Disorder or other psychotic disorder
and suggest that another diagnosis is appropriate.Answer D is correct: Alex's life-long isola-
tion, indifference to social relationships, and lack of strong emotions are consistent with a
diagnosis of Schizoid Personality Disorder.Answer A is incorrect: Schizophreniform Disorder
is characterized by symptoms similar to those associated with Schizophrenia except that
their duration is one month to less than six months. Because Alex was diagnosed with Brief
Psychotic Disorder, we know that the duration of his psychotic symptoms did not exceed one
month. Moreover, he is not currently experiencing psychotic symptoms.Answer B is incor-
rect: You can rule out Major Depressive Disorder since there are no obvious symptoms of a
major depressive episode. In addition, Alex's symptoms have been life-long.Answer C is in-
correct: Schizoaffective Disorder requires a combination of psychotic symptoms and mood
episodes.
The correct answer is: Schizoid Personality Disorder.
Your client is an 11-year-old boy who has a history of behavioral problems. At school, the
boy disturbs his classmates whenever the teacher asks the students to work independently
on assignments in the classroom. He talks, makes noises, and throws paper wads and pencils
to disrupt the other students and avoid doing his own work. He is easily annoyed and often
loses his temper. The most likely DSM-5 diagnosis for this boy is which of the following?
1
,Select one:
a. Oppositional Defiant Disorder
b. ADHD
c. Conduct Disorder
d. Intermittent Explosive Disorder
ANSWER
Answer A is correct: Although the information provided is too limited to make a firm diagno-
sis (e.g., you don't know the duration of the boy's symptoms or how he behaves at home
and in other settings), Oppositional Defiant Disorder (ODD) is the most likely diagnosis. The
boy has a history of behavioral problems and appears to be deliberately annoying others and
resisting or defying his teacher's requests, and he is easily annoyed and often loses his tem-
per. As described in the DSM-5, ODD is characterized by a pattern of angry/irritable mood,
argumentative/defiant behavior, or vindictiveness. The boy's symptoms do not meet the cri-
teria for inattention or hyperactivity-impulsivity required for a diagnosis of ADHD and aren't
sufficiently severe for a diagnosis of Conduct Disorder or Intermittent Explosive Disorder.
The correct answer is: Oppositional Defiant Disorder
The symptoms of Oppositional Defiant Disorder are categorized in three groups in the DSM-
5. These groups are:
Select one:
a. destruction of property, deceitfulness or theft, and serious violations of rules.
b. negativistic, defiant, and hostile behavior.
c. deceitfulness or dishonesty, irritability or aggressiveness, and failure to conform to social
norms.
d. angry or irritable mood, argumentative or defiant behavior, and vindictiveness.
ANSWER
Answer D is correct: Angry/irritable mood, argumentative/defiant behavior, and vindictive-
ness are the three categories of symptoms included in the DSM-5 for Oppositional Defiant
Disorder.
Answer A is incorrect: These are three of the four categories of symptoms included in the
DSM-5 for Conduct Disorder (the fourth is aggression to people and animals).
2
,The correct answer is: angry or irritable mood, argumentative or defiant behavior, and vin-
dictiveness.
Marissa is 23 and has come to you because she is finding it difficult to care about her gradu-
ate work in accounting, her job, or her hobbies of tennis and sailing. In addition, she com-
plains that she is feeling real despair for the first time in her life. She is irritable with friends
and is having trouble sleeping. She does state, however, that she is happy she has lost her
appetite. She has felt this way for three weeks. Your first action with the client would be
which of the following?
Select one:
a. consultation with a physician
b. assessment of her potential for suicide
c. contacting her family
d. behavioral therapy to relieve her depression
ANSWER
You were asked to identify your first action.
Answer B is correct: The client's feelings of despair suggest that the first intervention should
be an assessment of potential for suicide.
Answer A is incorrect: Note that this suggests "consultation" with a physician. Had this sug-
gested referral for a medical evaluation, it would also have been an important first step.
Answer C is incorrect: If you assessed that Marissa's potential for suicide was high, you could
contact her family to enlist their help in protecting her from a suicide attempt, and you could
do this without Marissa's permission if necessary. Before you have performed a suicide as-
sessment, however, this action, without prior written permission from Marissa, would repre-
sent an unethical breach of her confidentiality. (You might, alternatively, have interpreted
"contacting her family" as suggesting a means of collecting collateral information for your
assessment; here too, however you would need to get Marissa's written permission before-
hand in order to avoid an unethical breach of confidentiality.)
Answer D is incorrect: This might be effective later but it certainly isn't the best first step, as
it ignores the possibility that this client might be suicidal.
The correct answer is: assessment of her potential for suicide
Which of the following is not a DSM-5 diagnostic criterion for Conversion Disorder?
3
, Select one:
a. one or more symptoms that involve an alteration in sensory or motor functioning
b. evidence of incompatibility between the symptoms and known medical conditions
c. symptoms are not better explained by a medical condition or other mental disorder
d. evidence that the symptoms are related to a psychological need or conflict.
ANSWER
Answer D is correct: The DSM-IV-TR requirement for evidence that symptoms are associated
with psychological factors has been removed as a diagnostic criterion for Conversion Disor-
der in the DSM-5.
Answers A, B, and C: These answers describe the DSM-5's diagnostic criteria for Conversion
Disorder.
The correct answer is: evidence that the symptoms are related to a psychological need or
conflict.
Your new client, a college freshman, says she sometimes has an "out of body" experience in
which she is watching what she is doing from outside herself. She describes a recent experi-
ence in which she was in her dorm room writing a paper when she realized she couldn't feel
her fingers on the computer keyboard or her feet on the floor and then suddenly felt like she
was watching herself from the ceiling. The client says that these episodes make her feel like
she's "going crazy" and are interfering with her ability to attend class and complete course
assignments. The client's symptoms are most suggestive of a DSM-5 diagnosis of:
Select one:
a. Delusional Disorder
b. Dissociative Fugue
c. Depersonalization or Derealization Disorder
d. Depersonalization Disorder
ANSWER
Answer C is correct: Depersonalization/Derealization Disorder is characterized by recurrent
episodes of depersonalization (a sense of unreality, detachment, or being an outside ob-
server of one's thoughts, feelings, etc.) and/or derealization (a sense of unreality or detach-
ment involving one's surroundings) that cause clinically significant distress or impaired func-
tioning.
4
