LMHC Psychopathology and Diagnosis 2 — Questions and Answers
Question 1: According to the DSM-5, a diagnosis of Alcohol Use Disorder (AUD) is based on:
- The specific amount of alcohol consumed per week
- The presence of at least 2 of 11 criteria within a 12-month period (Correct answer)
- A positive blood alcohol level test at the time of assessment
- A history of at least one alcohol-related hospitalization
Correct answer: The presence of at least 2 of 11 criteria within a 12-month period
AUD is diagnosed dimensionally by the presence of at least 2 of 11 criteria over 12 months: mild (2-3), moderate (4-5), severe (6+).
DSM-5 consolidated alcohol abuse and alcohol dependence into a single diagnosis — Alcohol Use Disorder — assessed dimensionally by severity. The 11 criteria include: taking more than intended, unsuccessful efforts to cut down, significant time spent, craving, failure to fulfill obligations, social/occupational problems, continued use despite problems, tolerance, and withdrawal. Severity specifiers (mild/moderate/severe) replace the former abuse/dependence distinction.
Question 2: Which of the following diagnoses requires that symptoms be present for at least 6 months to meet DSM-5 diagnostic criteria?
- Acute Stress Disorder
- Adjustment Disorder
- Generalized Anxiety Disorder (Correct answer)
- Major Depressive Disorder
Correct answer: Generalized Anxiety Disorder
GAD requires excessive worry occurring more days than not for at least 6 months. Acute Stress Disorder is 3 days to 1 month; MDD requires only 2 weeks.
Duration criteria are critical in differential diagnosis. GAD requires at least 6 months of excessive, difficult-to-control worry. Acute Stress Disorder requires symptoms 3 days to 1 month post-trauma. PTSD requires symptoms 1+ month post-trauma. MDD requires symptoms for at least 2 weeks. Adjustment Disorder requires onset within 3 months of a stressor and resolution within 6 months of stressor removal.
Question 3: A client has been experiencing recurrent, intrusive thoughts about contamination that cause significant distress. They perform handwashing rituals for several hours per day, which temporarily reduces anxiety. This presentation is MOST consistent with:
- Generalized Anxiety Disorder
- Panic Disorder
- Obsessive-Compulsive Disorder (Correct answer)
- Illness Anxiety Disorder
Correct answer: Obsessive-Compulsive Disorder
OCD is characterized by intrusive obsessions (contamination fears) and compulsive rituals (excessive handwashing) that temporarily reduce anxiety but are time-consuming and impairing.
DSM-5 defines OCD as the presence of obsessions, compulsions, or both. Obsessions are recurrent, intrusive, distressing thoughts/images/urges. Compulsions are repetitive behaviors performed to reduce anxiety or prevent a feared outcome. The cycle (obsession → anxiety → compulsion → temporary relief → recurrence) is characteristic. Contamination obsessions with washing compulsions are among the most common OCD presentations. First-line treatment is ERP (Exposure and Response Prevention) with or without SSRI medication.
Question 4: In the DSM-5, which of the following represents a significant change from the DSM-IV regarding ADHD diagnosis?
- ADHD can no longer be diagnosed in adults
- The symptom onset criterion changed from 'before age 7' to 'before age 12' (Correct answer)
- The hyperactive-impulsive subtype was eliminated
- ADHD now requires a neurological evaluation for diagnosis
Correct answer: The symptom onset criterion changed from 'before age 7' to 'before age 12'
DSM-5 raised the age of symptom onset from 'before age 7' (DSM-IV) to 'before age 12,' acknowledging that ADHD may not be impairing until school demands increase.
DSM-5 made several changes to ADHD criteria: the onset criterion changed from 'impairment before age 7' to 'several symptoms present before age 12'; the subtypes were replaced with 'presentations'; the comorbidity exclusion for autism spectrum disorder was removed; and the symptom threshold for adults was reduced to 5 of 9 symptoms per domain. These changes improved diagnostic accuracy for older adolescents and adults.
Question 5: To meet the DSM-5 Criterion A for schizophrenia, at least one of the two required symptoms must be from which group?
- Negative symptoms such as flat affect or avolition
- Catatonia or grossly disorganized behavior
- Delusions, hallucinations, or disorganized speech (Correct answer)
- A period of elevated mood or grandiosity
Correct answer: Delusions, hallucinations, or disorganized speech
DSM-5 requires that at least one of the two Criterion A symptoms be delusions, hallucinations, or disorganized speech — negative symptoms alone are insufficient.
Schizophrenia Criterion A requires 2+ symptoms from: delusions, hallucinations, disorganized speech, grossly disorganized/catatonic behavior, and negative symptoms. Crucially, DSM-5 requires that at least one symptom be from the first three (delusions, hallucinations, or disorganized speech). This ensures that the diagnosis is not made solely on negative symptoms, which are less specific to schizophrenia.
Question 6: Which DSM-5 personality disorder is characterized by a pervasive pattern of instability in interpersonal relationships, self-image, affect, and marked impulsivity?
- Narcissistic Personality Disorder
- Histrionic Personality Disorder
- Borderline Personality Disorder (Correct answer)
- Antisocial Personality Disorder
Correct answer: Borderline Personality Disorder
Borderline Personality Disorder is defined by instability in relationships, self-image, and affect combined with marked impulsivity, beginning in early adulthood.
Borderline Personality Disorder (BPD) is characterized by 9 criteria including: frantic efforts to avoid abandonment; unstable and intense relationships; identity disturbance; impulsivity; recurrent suicidal/self-injurious behavior; affective instability; chronic feelings of emptiness; intense, inappropriate anger; and transient paranoid ideation or dissociation. Five of 9 criteria are required. DBT was specifically developed for BPD and is the most evidence-based treatment.
LMHC Psychopathology and Diagnosis 2
According to the DSM-5, a diagnosis of Alcohol Use Disorder (AUD) is based on: