LMHC Psychopathology and Diagnosis 1 — Questions and Answers
Question 1: According to the DSM-5, which criterion differentiates Major Depressive Disorder (MDD) from Persistent Depressive Disorder (Dysthymia)?
- MDD requires at least 5 symptoms for 2+ weeks; Persistent Depressive Disorder requires at least 2 symptoms for 2+ years (Correct answer)
- MDD is caused by neurobiological factors only; Dysthymia is psychosocial
- MDD cannot occur in children; Dysthymia can
- MDD requires psychotic features; Dysthymia does not
Correct answer: MDD requires at least 5 symptoms for 2+ weeks; Persistent Depressive Disorder requires at least 2 symptoms for 2+ years
MDD requires at least 5 depressive symptoms for at least 2 weeks. Persistent Depressive Disorder requires depressed mood for at least 2 years with at least 2 additional symptoms.
DSM-5 distinguishes MDD (acute, severe episodes of at least 5 symptoms lasting 2+ weeks) from Persistent Depressive Disorder (chronic, lower-intensity depression lasting 2+ years in adults). The 'double depression' concept recognizes that a major depressive episode can be superimposed on PDD. Clinicians must carefully assess duration, symptom count, and functional impairment to differentiate these diagnoses and select appropriate treatment.
Question 2: A client presents with episodes of elevated mood, decreased need for sleep, grandiosity, and increased goal-directed activity lasting 4 days, without significant functional impairment. The MOST appropriate DSM-5 diagnosis to consider is:
- Bipolar I Disorder
- Cyclothymic Disorder
- Bipolar II Disorder (Correct answer)
- Major Depressive Disorder with mixed features
Correct answer: Bipolar II Disorder
Bipolar II Disorder requires at least one hypomanic episode (4+ days, not causing marked impairment) and at least one major depressive episode.
The key distinction between Bipolar I and Bipolar II is the severity of the elevated mood episodes. Mania (Bipolar I) lasts 7+ days and causes marked social or occupational impairment. Hypomania (Bipolar II) lasts 4+ days and does NOT cause marked impairment or require hospitalization. Bipolar II also requires at least one lifetime major depressive episode. This client's 4-day episode without significant impairment points to hypomania and Bipolar II.
Question 3: Which of the following is NOT a DSM-5 diagnostic criterion for Generalized Anxiety Disorder (GAD)?
- Difficulty controlling the worry
- Worry occurring more days than not for at least 6 months
- Presence of panic attacks with somatic symptoms (Correct answer)
- Fatigue, difficulty concentrating, or irritability
Correct answer: Presence of panic attacks with somatic symptoms
Panic attacks are characteristic of Panic Disorder, not GAD. GAD is characterized by pervasive, uncontrollable worry with somatic symptoms like fatigue and muscle tension.
DSM-5 criteria for GAD include: excessive anxiety and worry about multiple events/activities, occurring more days than not for 6+ months; difficulty controlling the worry; and at least 3 of 6 associated symptoms (restlessness, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance). Panic attacks are not a criterion for GAD — they are the hallmark of Panic Disorder. GAD and Panic Disorder can co-occur but are distinct diagnoses.
Question 4: The 'negative symptoms' of schizophrenia include all of the following EXCEPT:
- Avolition
- Alogia
- Auditory hallucinations (Correct answer)
- Flat affect
Correct answer: Auditory hallucinations
Auditory hallucinations are a 'positive' symptom of schizophrenia — an addition to normal experience. Negative symptoms reflect diminutions in normal functioning.
In schizophrenia, positive symptoms represent excesses added to normal experience: hallucinations, delusions, disorganized speech, and grossly disorganized behavior. Negative symptoms represent diminutions of normal function: avolition (lack of motivation), alogia (poverty of speech), anhedonia (lack of pleasure), flat affect, and asociality. Negative symptoms are often more refractory to treatment than positive symptoms and are strongly associated with functional impairment.
Question 5: A client reports a persistent, irrational fear of spiders that causes them to avoid outdoor activities. They recognize the fear is excessive. The MOST appropriate DSM-5 diagnosis is:
- Social Anxiety Disorder
- Agoraphobia
- Specific Phobia, animal type (Correct answer)
- Obsessive-Compulsive Disorder
Correct answer: Specific Phobia, animal type
Specific Phobia involves marked fear or anxiety about a specific object or situation — in this case, spiders (animal type) — leading to avoidance and distress.
Specific Phobia is characterized by marked fear or anxiety about a specific object or situation, immediate anxiety response upon exposure, active avoidance or endurance with intense distress, fear disproportionate to actual danger, persistence for 6+ months, and significant impairment. The animal specifier applies to fears of animals or insects. Insight (recognizing the fear is excessive) is common in adults and does not rule out the diagnosis. CBT with exposure is the first-line treatment.
Question 6: Which of the following best describes the 'diathesis-stress model' as it applies to mental health disorders?
- Mental health disorders are caused solely by genetic factors
- Disorders result from the interaction between a predisposition (vulnerability) and environmental stressors (Correct answer)
- Stress alone is sufficient to cause any mental health disorder
- Biological factors protect individuals from the effects of environmental stress
Correct answer: Disorders result from the interaction between a predisposition (vulnerability) and environmental stressors
The diathesis-stress model proposes that mental disorders develop from the interaction of a biological or psychological predisposition (diathesis) and environmental stressors.
The diathesis-stress model is a foundational framework in psychopathology explaining why not everyone who experiences stress develops a mental disorder. A 'diathesis' is a predisposing vulnerability — genetic, neurobiological, or psychological — that lowers the threshold for disorder development. When sufficient stress is added, the disorder emerges. This model supports both biological and psychosocial treatment approaches and explains the development of schizophrenia, depression, anxiety disorders, and many other conditions.
LMHC Psychopathology and Diagnosis 1
According to the DSM-5, which criterion differentiates Major Depressive Disorder (MDD) from Persistent Depressive Disorder (Dysthymia)?