LMSW LMSW Clinical Assessment and Diagnosis Questions and Answers 4 — Questions and Answers
Question 1: Which of the following is a key distinguishing feature between Borderline Personality Disorder and Bipolar II Disorder during clinical assessment?
- Presence of impulsivity in BPD only
- Mood shifts in BPD are typically triggered by interpersonal events and last hours rather than days (Correct answer)
- Bipolar II involves no depressive episodes
- BPD includes hypomanic episodes by definition
Correct answer: Mood shifts in BPD are typically triggered by interpersonal events and last hours rather than days
In BPD, mood instability is typically reactive to interpersonal stressors and resolves within hours, whereas Bipolar II mood episodes last days to weeks.
Question 2: A client scores 22 on the PHQ-9. What severity level does this indicate and what clinical action is most warranted?
- Mild depression; psychoeducation only
- Moderate depression; watchful waiting
- Moderately severe depression; initiate treatment
- Severe depression; immediate safety assessment and intensive intervention (Correct answer)
Correct answer: Severe depression; immediate safety assessment and intensive intervention
A PHQ-9 score of 20–27 indicates severe depression, warranting immediate safety assessment and likely intensive treatment including medication consultation.
Question 3: When assessing for Somatic Symptom Disorder, which feature is required by DSM-5 that was NOT required under DSM-IV Somatization Disorder?
- Multiple unexplained physical symptoms across four symptom groups
- Symptoms unexplained by a medical condition
- Excessive thoughts, feelings, or behaviors related to somatic symptoms (Correct answer)
- Onset before age 30
Correct answer: Excessive thoughts, feelings, or behaviors related to somatic symptoms
DSM-5 Somatic Symptom Disorder requires excessive psychological distress or behaviors related to somatic symptoms, even if a medical cause is present, shifting focus from medically unexplained to psychological impact.
Question 4: A social worker notices a client's affect is restricted, mood-incongruent, and shifts rapidly without apparent environmental cause. Which term best describes this affective presentation?
- Blunted affect
- Labile affect (Correct answer)
- Flat affect
- Expansive affect
Correct answer: Labile affect
Labile affect refers to rapid, unpredictable shifts in emotional expression that are excessive or disproportionate to the situation.
Question 5: Under the DSM-5, a child who shows symptoms of ADHD only in the home environment but not at school or other settings would most likely:
- Still meet criteria if symptoms cause impairment at home
- Not meet criteria because DSM-5 requires symptoms in two or more settings (Correct answer)
- Meet criteria if parent-reported symptoms are severe
- Automatically qualify if onset was before age 12
Correct answer: Not meet criteria because DSM-5 requires symptoms in two or more settings
DSM-5 requires ADHD symptoms to be present in two or more settings (e.g., home and school) to meet diagnostic criteria, ruling out a single-setting presentation.
Question 6: Which assessment approach is MOST culturally responsive when evaluating a client from a collectivist culture who minimizes personal distress?
- Relying solely on standardized Western self-report measures
- Exploring idioms of distress and culturally specific symptom expressions (Correct answer)
- Diagnosing based on behavioral observation only
- Postponing assessment until a cultural broker is identified
Correct answer: Exploring idioms of distress and culturally specific symptom expressions
Culturally responsive assessment includes exploring idioms of distress—culturally specific ways of expressing suffering—which may not align with DSM symptom language.
Question 7: A client discloses having uncontrollable urges to set fires and a sense of tension before the act, followed by relief afterward, with no material motive. Which diagnosis fits best?
- Antisocial Personality Disorder
- Pyromania (Correct answer)
- Conduct Disorder
- Intermittent Explosive Disorder
Correct answer: Pyromania
Pyromania involves deliberate fire-setting accompanied by tension before the act, fascination with fire, and relief or gratification afterward, with no financial or other motive.
LMSW LMSW Clinical Assessment and Diagnosis Questions and Answers 4
Which of the following is a key distinguishing feature between Borderline Personality Disorder and Bipolar II Disorder during clinical assessment?