anxiety, obsessive compulsive, somatic symptoms, trauma and stressor related disorders

Which of the following disorders is included in the “Anxiety Disorders” chapter of DSM-5?

A. Obsessive-compulsive disorder.

B. Posttraumatic stress disorder.

C. Acute stress disorder.

D. Panic disorder with agoraphobia.

E. Separation anxiety disorder

E. Separation anxiety disorder

A 9-year-old boy cannot go to sleep without having a parent in his room. While falling asleep, he frequently awakens to check that a parent is still there. One parent usually stays until the boy falls asleep. If he wakes up alone during the night, he starts to panic and gets up to find his parents. He also reports frequent nightmares in which he or his parents are harmed. He occasionally calls out that he saw a strange figure peering into his dark room. The parents usually wake in the morning to find the boy asleep on the floor of their room. They once tried to leave him with a relative so they could go on a vacation; however, he became so distressed in anticipation of this that they canceled their plans. What is the most likely diagnosis?

A. Specific phobia.

B. Nightmare disorder.

C. Delusional disorder.

D. Separation anxiety disorder.

E. Agoraphobia.

D. Separation anxiety disorder.

Which of the following is considered a culture-specific symptom of panic attacks?

A. Derealization.

B. Headaches.

C. Fear of going crazy.

D. Shortness of breath.

E. Heat sensations

B. Headaches.

Which of the following statements best describes how panic attacks differ from panic disorder?

A. Panic attacks require fewer symptoms for a definitive diagnosis.

B. Panic attacks are discrete, occur suddenly, and are usually less severe.

C. Panic attacks are invariably unexpected.

D. Panic attacks represent a syndrome that can occur with a variety of other disorders.

E. Panic attacks cannot be secondary to a medical condition.

D. Panic attacks represent a syndrome that can occur with a variety of other disorders.

The determination of whether a panic attack is expected or unexpected is ulti mately best made by which of the following?

A. Careful clinical judgment.

B. Whether the patient associates it with external stress.

C. The presence or absence of nocturnal panic attacks.

D. Ruling out possible culture-specific syndromes.

E. 24-Hour electroencephalographic monitoring.

A. Careful clinical judgment.

A 50-year-old man reports episodes in which he suddenly and unexpectedly awakens from sleep feeling a surge of intense fear that peaks within minutes. During this time, he feels short of breath and has heart palpitations, sweating, and nausea. His medical history is significant only for hypertension, which is well controlled with hydrochlorothiazide. As a result of these symptoms, he has begun to have anticipatory anxiety associated with going to sleep. What is the most likely explanation for his symptoms?

A. Anxiety disorder due to another medical condition (hypertension).

B. Substance/medication-induced anxiety disorder.

C. Panic disorder.

D. Sleep terrors.

E. Panic attacks.

C. Panic disorder.

A 32-year-old woman reports sudden, unexpected episodes of intense anxiety, accompanied by headaches, a rapid pulse, nausea, and shortness of breath. During the episodes she fears that she is dying, and she has presented several times to emergency departments. Each time she has been told that she is med ically healthy; she is usually reassured for a time, but on the occurrence of a new episode she again becomes concerned that she has some severe medical problem. She was given lorazepam once but disliked the sedating effect and has not taken it again. She abstains from all medications and alcohol in an at tempt to minimize potential causes for her attacks. What is the most likely ex planation for her symptoms?

A. Panic disorder.

B. Somatic symptom disorder.

C. Anxiety due to another medical condition.

D. Illness anxiety disorder.

E. Specific phobia.

A. Panic disorder.

A 65-year-old woman reports being housebound despite feeling physically healthy. Several years ago, she fell while shopping; although she sustained no injuries, the situation was so upsetting that she became extremely nervous when she had to leave her house unaccompanied. Because she has no children and few friends whom she can ask to accompany her, she is very distressed that she has few opportunities to venture outside her home. What is the most likely diagnosis?

A. Specific phobia, situational type.

B. Social anxiety disorder (social phobia).

C. Posttraumatic stress disorder.

D. Agoraphobia.

E. Adjustment disorder.

D. Agoraphobia

A 32-year-old man has regularly experienced panic attacks when out of his home alone and when on the bus. He now avoids leaving home for fear of experiencing these attacks. What is the most appropriate diagnosis?

A. Panic disorder with agoraphobia.

B. Agoraphobia with panic attacks.

C. Specific phobia, situational type.

D. Two separate disorders: panic disorder and agoraphobia.

E. Delusional disorder.

D. Two separate disorders: panic disorder and agoraphobia.

A 35-year-old man is in danger of losing his job because it requires frequent long-range traveling and for the past year he has avoided flying. Two years earlier he was on a particularly turbulent flight, and although he was not in any real danger, he was convinced that the pilot minimized the risk and that the plane almost crashed. He flew again 1 month later and, despite having a smooth flight, the anticipation of turbulence was so distressing that he experienced a panic attack during the flight; he has not flown since. What is the most appropriate diagnosis?

A. Agoraphobia.

B. Acute stress disorder.

C. Specific phobia, situational type.

D. Social anxiety disorder (social phobia).

E. Panic disorder.

C. Specific phobia, situational type

Which of the following types of specific phobia is most likely to be associated with vasovagal fainting?

A. Animal type.

B. Natural environment type.

C. Blood-injection-injury type.

D. Situational type.

E. Other (e.g.,. in children, loud sounds or costumed characters).

C. Blood-injection-injury type.

Which of the following most accurately describes people with specific phobias?

A. The average individual with a phobia has fears of only one object or situation.

B. The fear is usually quite mild in intensity.

C. Fewer than 10% of people fear more than one object or situation.

D. The fear occurs almost every time the person encounters the object or situation.

E. The fear is exactly the same in intensity each time the object or situation is encountered.

D. The fear occurs almost every time the person encounters the object or situation.

Although onset of a specific phobia can occur at any age, specific phobia most typically develops during which age period?

A. Childhood.

B. Late adolescence to early adulthood.

C. Middle age.

D. Old age.

E. Any age.

A. Childhood.

In social anxiety disorder (social phobia), the object of an individual’s fear is the potential for which of the following?

A. Social or occupational impairment.

B. Harm to self or others.

C. Embarrassment.

D. Separation from objects of attachment.

E. Incapacitating symptoms.

C. Embarrassment.

When called on at school, a 7-year-old boy will only nod or write in response. The family of the child is surprised to hear this from the teacher, because the boy speaks normally when at home with his parents. The child has achieved appropriate developmental milestones, and a medical evaluation indicates that he is healthy. The boy is unable to give any explanation for his behavior, but the parents are concerned that it will affect his school performance. What diagnosis best fits this child’s symptoms?

A. Separation anxiety disorder.

B. Autism spectrum disorder.

C. Agoraphobia.

D. Selective mutism.

E. Communication disorder.

D. Selective mutism

Social anxiety disorder (social phobia) differs from normative shyness in that the disorder leads to which of the following?

A. Social or occupational dysfunction.

B. Marked social reticence.

C. Avoidance of social situations.

D. Derealization or depersonalization.

E. Pervasive social deficits with poor insight.

A. Social or occupational dysfunction

In addition to feeling restless or “keyed up,” individuals with generalized anxiety disorder are most likely to experience which of the following symptoms?

A. Panic attacks.

B. Obsessions.

C. Muscle tension.

D. Multiple somatic complaints.

E. Social anxiety.

C. Muscle tension.

Which of the following characteristics of generalized anxiety disorder is espe cially common in children who have the disorder?

A. Complaining of physical aches and pains.

B. Excessively preparing for activities.

C. Avoiding activities that may provoke anxiety.

D. Seeking frequent reassurance from others.

E. Delaying or procrastinating before activities.

D. Seeking frequent reassurance from others.

What is the primary difference in the clinical expression of generalized anxiety disorder across age groups?

A. Content of worry.

B. Degree of worry.

C. Patterns of comorbidity.

D. Predominance of cognitive versus somatic symptoms.

E. Severity of impairment.

A. Content of worry.

In what aspect of generalized anxiety disorder do men and women most commonly differ?

A. Course.

B. Symptom profile.

C. Degree of impairment.

D. Patterns of comorbidity.

E. Age at onset.

D. Patterns of comorbidity.

Which of the following is more suggestive of anxiety that is not pathological than of anxiety that qualifies for a diagnosis of generalized anxiety disorder?

A. Anxiety and worry that interferes significantly with functioning.

B. Anxiety and worry that lasts for months to years.

C. Anxiety and worry in response to a clear precipitant.

D. Anxiety and worry focused on a wide range of life circumstances.

E. Anxiety and worry accompanied by physical symptoms.

C. Anxiety and worry in response to a clear precipitant.

A 26-year-old man is brought to the emergency department suffering from a sudden, severe surge of panic. He has no history of panic disorder, but he re ports taking several doses of an over-the-counter cold medication earlier that day. Which of the following clinical features, if present in this case, would help to confirm a diagnosis of substance/medication-induced anxiety disorder?

A. Symptoms that are mild and do not impair functioning.

B. Symptoms that persist for a long time after substance/medication use.

C. Symptoms that are in excess of what would be expected for the substance/ medication.

D. Presence of a delirium or gross confusion.

E. Lack of any history of anxiety disorder or panic symptoms.

E. Lack of any history of anxiety disorder or panic symptoms.

In which of the following circumstances would a diagnosis of substance/medication-induced anxiety disorder be appropriate for an individual who stopped taking benzodiazepines the previous day?

A. Significant anxiety symptoms are present.

B. Anxiety is present that is clearly related to the withdrawal state.

C. Anxiety is present that is sufficiently severe to warrant independent clinical attention.

D. Anxiety is present only during bouts of delirium.

E. Never: the diagnosis of substance withdrawal would supersede the anxiety disorder diagnosis.

C. Anxiety is present that is sufficiently severe to warrant independent clinical attention.

A 60-year-old man has just been diagnosed with congestive heart failure. He is intensely anxious and reports feeling as if he cannot breathe, which causes him to panic. Which of the following features, if present in this case, would tend to support a diagnosis of anxiety disorder due to another medical condition rather than adjustment disorder with anxiety?

A. The patient says that he is relieved to know his diagnosis.

B. The patient has no anxiety-associated physical symptoms.

C. The patient is focused on the reasons he has a cardiac disorder.

D. The patient is delirious.

E. The patient is extremely concerned that he will not be able to return to work

A. The patient says that he is relieved to know his diagnosis.

Which of the following statements about compulsive behaviors in obsessive compulsive disorder (OCD) is true?

A. Compulsions in OCD are best understood as a form of addictive behavior.

B. Compulsive behaviors in OCD are aimed at reducing the distress triggered by obsessions.

C. Examples of compulsive behaviors include paraphilias (sexual compul sions), gambling, and substance use.

D. Compulsions involve repetitive and persistent thoughts (e.g., of contamina tion), images (e.g., of violent or horrific scenes), or urges (e.g., to stab some one).

E. Compulsive behaviors in OCD are typically goal directed, fulfilling a real istic purpose.

B. Compulsive behaviors in OCD are aimed at reducing the distress triggered by obsessions.

A 52-year-old man with raw, chapped hands is referred to a psychiatrist by his primary care doctor. The man reports that he washes his hands repeatedly, spending up to 4 hours a day, using abrasive cleansers and scalding hot water. Although he admits that his hands are uncomfortable, he is entirely convinced that unless he washes in this manner he will become gravely ill. A medical workup is unrevealing, and the man takes no medications. What is the most appropriate diagnosis?

A. Delusional disorder, somatic type.

B. Illness anxiety disorder.

C. Obsessive-compulsive disorder, with absent insight.

D. Obsessive-compulsive personality disorder.

E. Generalized anxiety disorder.

C. Obsessive-compulsive disorder, with absent insight.

Men with obsessive-compulsive disorder (OCD) differ from women with the disorder in which of the following ways?

A. Men tend to get OCD later in life.

B. Men are more likely to have comorbid tics.

C. Men are more likely to be obsessed with cleaning.

D. Men are more likely to spontaneously recover.

E. Men have much higher rates of OCD.

B. Men are more likely to have comorbid tics

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?

A. Obsessive-compulsive disorder.

B. Hoarding disorder.

C. Delusional disorder.

D. Nonpathological collecting behavior.

E. Dementia (major neurocognitive disorder).

A. Obsessive-compulsive disorder.

Although gambling can seem compulsive, gambling disorder is not considered a type of obsessive-compulsive disorder (OCD) for which of the following rea sons?

A. A person with gambling disorder derives direct pleasure from the behavior.

B. Individuals with gambling disorder have poorer insight into their irrational behavior.

C. Gambling disorder is better conceived of as a personality trait.

D. The repetitive behavior associated with gambling is meant to avoid anxiety.

E. In gambling disorder, individuals have control over their repetitive behav iors.

A. A person with gambling disorder derives direct pleasure from the behavior

In addition to preoccupations with a perceived body flaw, which of the follow ing behaviors would be most suggestive of a diagnosis of body dysmorphic disorder (BDD)?

A. Repetitive mirror checking in response to the preoccupation.

B. Consulting a psychiatrist because of the distress caused by the preoccupation.

C. Losing an unhealthy amount of weight in order to improve one’s appearance.

D. Having a related preoccupation with having or acquiring a disfiguring ill ness.

E. Experiencing discomfort with one’s primary or secondary sex characteristics

A. Repetitive mirror checking in response to the preoccupation.

A 25-year-old man is concerned that he looks “weak” and “puny” despite the fact that to neutral observers he appears very muscular. When confronted about his belief he believes he is being humored and that people are in fact making fun of his small size behind his back. He has tried a number of strategies to increase muscle mass, including exercising excessively and using anabolic steroids; however, he remains dissatisfied with his appearance. What is the most likely diagnosis?

A. Delusional disorder, somatic type.

B. Narcissistic personality disorder.

C. Body identity integrity disorder.

D. Body dysmorphic disorder, with muscle dysmorphia.

E. Koro

D. Body dysmorphic disorder, with muscle dysmorphia.

A 19-year-old woman is referred to a psychiatrist by her internist after she ad mits to him that she recurrently pulls hair from her eyebrows to the point that she has scarring and there is little or no eyebrow hair left. She states that her natural eyebrows are “bushy” and “repulsive” and that she “looks like a cave man.” A photograph of the woman before she began pulling her eyebrow hair shows a normal-looking teenager. What is the most appropriate diagnosis?

A. Trichotillomania (hair-pulling disorder).

B. Body dysmorphic disorder.

C. Delusional disorder, somatic type.

D. Normal age-appropriate appearance concerns.

E. Obsessive-compulsive disorder.

B. Body dysmorphic disorder.

A 48-year-old man presents to a psychiatrist, stating that he was pressured by his wife to seek help. He explains that he likes to collect wine, and he does not see a problem with this; he claims that many of the wines are quite valuable and a potential investment. On further questioning, he admits that he rarely drinks the wines, because it “never seems the right time.” He has never sold or given away any wine because he finds it hard to part with the bottles. He has had to use increasing portions of his house for storage of the wine, which, along with the financial hardship, is his wife’s primary concern. He admits that many of the wine bottles have probably spoiled because he cannot afford to properly store the wine and the bottles have sat for years on shelves. What is the most appropriate diagnosis?

A. Normal collecting behavior.

B. Hoarding disorder, excessive acquisition type.

C. Obsessive-compulsive disorder.

D. Delusional disorder.

E. Narcissistic personality disorder.

B. Hoarding disorder, excessive acquisition type.

Which of the following statements about risk and prognostic factors in hoarding disorder is true?

A. About 10% of individuals who hoard report having a relative who also hoards.

B. Approximately half of the variability in hoarding behavior is due to genetic factors

C. Separation insecurity is a prominent temperamental feature of individuals with hoarding disorder and their first-degree relatives.

D. Hoarding disorder has been associated with high rates of childhood neglect and abuse.

E. Stressful or traumatic life events play no role in the onset or exacerbation of hoarding disorder

B. Approximately half of the variability in hoarding behavior is due to genetic factors.

Which of the following statements about the course of hoarding disorder is true?

A. Hoarding behavior tends to wax and wane in severity throughout an individual’s life.

B. Hoarding behavior peaks in young adulthood and subsequently lessens in severity.

C. Hoarding behavior tends to become more severe with increasing age.

D. Hoarding disorder begins in childhood, is chronic, and tends not to change in severity.

E. Hoarding disorder has a worse course when it begins in later adulthood or old age.

C. Hoarding behavior tends to become more severe with in creasing age.

What is the most common site of hair pulling in trichotillomania?

A. Scalp.

B. Axillary area.

C. Facial area.

D. Pubic area.

E. Perirectal area.

A. Scalp.

Although microscopic examination of hair can aid the diagnosis of trichotillo mania (hair-pulling disorder), such examination is rarely performed, for which of the following reasons?

A. Patients generally admit to the hair pulling.

B. The effects on hair are easily observed macroscopically.

C. Patients generally have a long medical history of the disorder.

D. Patients rarely consent to the examination.

E. Microscopic examination is prohibitively expensive.

A. Patients generally admit to the hair pulling.

A 25-year-old man is referred to a psychiatrist by his primary care doctor after mentioning to the doctor that he routinely spends a lot of time pulling out fa cial hair with tweezers, even after carefully shaving. On evaluation, he admits to frequent pulling of his facial hair, consuming significant amount of time; he explains that he becomes anxious when looking at himself because his mous tache, hairline, and sideburns are asymmetrical. He pulls out hairs in an effort to make them more symmetrical, but is rarely satisfied with the results. He finds this very upsetting but cannot resist the urge to try and “fix” his facial hair. What is the most appropriate diagnosis?

A. Trichotillomania (hair-pulling disorder).

B. Body dysmorphic disorder (BDD).

C. Delusional disorder, somatic type.

D. Normal age-appropriate appearance concerns.

E. Obsessive-compulsive disorder (OCD).

E. Obsessive-compulsive disorder (OCD)

To fulfill diagnostic criteria for excoriation (skin-picking) disorder, the picking must be severe enough to result in which of the following?

A. Itching.

B. Skin lesions.

C. An infection.

D. Medical attention.

E. Permanent deformity.

B. Skin lesions.

Which of the following statements about the course of excoriation (skin-picking) disorder is true?

A. Skin-picking behavior tends to wax and wane in severity throughout an individual’s life.

B. Skin-picking behavior peaks in young adulthood and subsequently lessens in severity.

C. Excoriation disorder tends to become more severe with increasing age.

D. Skin-picking behavior begins in childhood, is chronic, and tends not to change in severity.

E. Excoriation disorder has a worse course when it begins in later adulthood or old age.

A. Skin-picking behavior tends to wax and wane in severity throughout an individuals life.

In excoriation (skin-picking) disorder, which of the following is the most typical motivation for the skin-picking behavior?

A. Inflicting pain that brings relief by reaffirming one’s ability to feel.

B. Appearance concerns.

C. Symmetry concerns.

D. Boredom.

E. Fear of infection.

D. Boredom

A 55-year-old retail worker believes that he has “chronic halitosis” and fears that his bad breath is “scaring away shoppers.” He is in danger of losing his job because he so frequently absents himself from the sales floor to brush his teeth and use mouthwash. He constantly chews mint gum, even though his employer has asked him not to. His coworkers regularly reassure him that his breath is fine, but he is convinced that they are just being polite. Although the possibility of losing his job causes him concern, he finds his worries about his breath to be intolerable. He has seen his doctor and dentist, both of whom tell him that he is healthy and does not have malodorous breath. What is the most appropriate diagnosis?

A. Social anxiety disorder (social phobia).

B. Obsessive-compulsive disorder.

C. Body dysmorphic disorder.

D. Other specified obsessive-compulsive and related disorder.

E. Illness anxiety disorder.

D. Other specified obsessive-compulsive and related disorder.

Which of the following substances, when abused, is most likely to cause symptoms mimicking obsessive-compulsive disorder?

A. Heroin.

B. Cocaine.

C. Alprazolam.

D. Marijuana.

E. Lysergic acid diethylamide (LSD)

B. Cocaine.

Which of the following reactions to a traumatic event was required for the DSM-IV diagnosis of posttraumatic stress disorder (PTSD) but is not required for the DSM-5 diagnosis?

A. Intense fear, helplessness, or horror.

B. Insomnia or hypersomnia.

C. Avoidance.

D. A foreshortened sense of the future.

E. Flashbacks.

A. Intense fear, helplessness, or horror.

Which of the following statements about reactive attachment disorder (RAD) is true?

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

B. RAD occurs only in children who have secure attachments.

C. RAD occurs only in children who have impaired communication.

D. RAD occurs in children without a history of severe social neglect.

E. RAD is a common condition, with a prevalence of 25% of children seen in clinical settings

A. RAD occurs only in children who lack attachments.

A 4-year-old boy in day care often displays fear that does not seem to be related to any of his activities. Although frequently distressed, he does not seek con tact with any of the staff and does not respond when a staff member tries to comfort him. What additional caregiver-obtained information about this child would be important in deciding whether his symptoms represent reactive attachment disorder (RAD) or autism spectrum disorder (ASD)?

A. Age at first appearance of the behavior.

B. Family history about his siblings.

C. History of language delay.

D. Indications that he has experienced severe social neglect.

E. Presence of selective attachment behaviors

D. Indications that he has experienced severe social neglect.

For a child diagnosed with reactive attachment disorder, which of the following situations would qualify for a disorder specifier of “severe”?

A. The child has been in five foster homes.

B. The child never expresses positive emotions when interacting with caregivers.

C. The disorder has been present for 18 months.

D. The child meets all symptoms of the disorder, with each symptom manifesting at relatively high levels.

E. There is a documented history of physical abuse of the child.

D. The child meets all symptoms of the disorder, with each symptom manifesting at relatively high levels

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 his tory of being placed in several different foster homes over the past 3 years. Which diagnosis is suggested from this history?

A. Attention-deficit/hyperactivity disorder (ADHD).

B. Disinhibited social engagement disorder (DSED).

C. Autism spectrum disorder (ASD).

D. Bipolar I disorder.

E. Borderline personality disorder.

B. Disinhibited social engagement disorder (DSED).

A 25-year-old woman, new to your practice, tells you that a little more than 3 months ago she was accosted on her way home. The attacker told her he had a gun, was going to rape her, and would shoot her if she resisted. He walked her toward an alley. She was sure he would kill her afterward no matter what she did, and therefore she pushed away from him, aware that she might be shot. She was able to escape unharmed. She describes not being able to fall asleep for the first 2 nights after the attack and of avoiding that particular street in her neighborhood for 2 days following the event. She thinks that the attacker might have touched her breasts but cannot remember for sure. She has recently started feeling anxious all of the time and is tearful, and she has stopped going to work. She fears that something about her makes her “look like a victim.” What is the most likely diagnosis?

A. Posttraumatic stress disorder.

B. Acute stress disorder.

C. Adjustment disorder.

D. Dissociative amnesia.

E. Personality disorder.

C. Adjustment disorder.

After a routine chest X ray, a 53-year-old man with a history of heavy cigarette use is told that he has a suspicious lesion in his lung. A bronchoscopy confirms the diagnosis of adenocarcinoma. The man delays scheduling a follow-up ap pointment with the oncologist for more than 2 weeks, describes feeling as if “all of this is not real,” is having nightly dreams of seeing his own tombstone, and is experiencing intrusive flashbacks to the moment when he heard the physi cian saying, “The tests strongly suggest that you have cancer of the lung.” He is tearful and is convinced he will die. He also feels intense guilt that his smok ing caused the cancer and expresses the thought that he “deserves” to have cancer. What diagnosis best fits this clinical picture?

A. Acute stress disorder.

B. Posttraumatic stress disorder.

C. Adjustment disorder.

D. Major depressive disorder.

E. Generalized anxiety disorder.

C. Adjustment disorder.

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?

A. Intrusion.

B. Dissociation.

C. Confusion.

D. Avoidance.

E. Arousal.

C. Confusion.

Which of the following stressful situations would meet Criterion A for the diagnosis of acute stress disorder (ASD)?

A. Finding out that one’s spouse has been fired.

B. Failing an important final examination.

C. Receiving a serious medical diagnosis.

D. Being in the cross fire of a police shootout but not being harmed.

E. Being in a subway train that gets stuck between stations.

D. Being in the cross fire of a police shootout but not being harmed.

Following discharge from the hospital, a 22-year-old man describes vivid and intrusive memories of his stay in the intensive care unit (ICU), where he re ceived treatment for smoke inhalation. Now at home, he states that he has memories of people being tortured and hearing their screams. He dreams of this every night, waking from sleep in a terror. He talks about not feeling like himself after the experience, finding little pleasure in life after what happened to him, and being easily angered by his family; in addition, he avoids his physician out of fear that he will be told he needs to return to the ICU. What is the most likely explanation for this patient’s symptoms?

A. He has acute stress disorder because his life was in danger during the ICU stay.

B. He has posttraumatic stress disorder because his life was in danger during the ICU stay.

C. He has a delirium persisting from the ICU stay.

D. He had a delirium in the ICU and now has an adjustment disorder.

E. He has a psychotic disorder.

D. He had a delirium in the ICU and now has an adjustment disorder

Which of the following experiences would not qualify as exposure to a trau matic event (Criterion A) in the diagnosis of acute stress disorder or posttrau matic stress disorder?

A. Hearing that one’s brother was killed in combat.

B. Hearing that one’s close childhood friend survived a motor vehicle accident but is paralyzed.

C. Hearing that one’s child has been kidnapped.

D. Hearing that one’s company had suddenly closed.

E. Hearing that one’s spouse has been shot.

D. Hearing that ones company had suddenly closed.

A 31-year-old man narrowly escapes (without injury) from a house fire caused when he dropped the lighter while trying to light his crack pipe. Six weeks later, while smoking crack, he thinks he smells smoke and runs from the building in a panic, shouting, “It’s on fire!” Which of the following symptoms or circumstances would rule out a diagnosis of posttraumatic stress disorder (PTSD) for this patient?

A. Having difficulty falling asleep.

B. Being uninterested in going back to work.

C. Inappropriately getting angry at family members.

D. Experiencing symptoms only when smoking crack cocaine.

E. Concluding that “the world is completely dangerous.”

D. Experiencing symptoms only when smoking crack cocaine.

Criterion A4 of posttraumatic stress disorder requires “Experiencing repeated or extreme exposure to aversive details of the traumatic event.” Which of the following would not qualify as an experiencing trauma under this criterion?

A. A police officer reviewing surveillance videotapes of homicides to identify perpetrators.

B. A social worker interviewing children who have been sexually abused and obtaining the details of the abuse.

C. A soldier sifting through the rubble of a collapsed building to retrieve re mains of comrades.

D. A college student at a film festival watching a series of violent movies that contain graphic rape scenes.

E. A psychologist working with victims of torture who are seeking political asylum in the United States

D. A college student at a film festival watching a series of violent movies that contain graphic rape scenes.

Which of the following statements about gender differences in the risk of developing posttraumatic stress disorder (PTSD) is true?

A. The risk is lower in females in preschool-age populations.

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

C. The risk is higher in males in elderly populations.

D. The risk is lower in middle-aged females than in

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

A 5-year-old child was present when her babysitter was sexually assaulted. Which of the following symptoms would be most suggestive of posttraumatic stress disorder (PTSD) in this child?

A. Playing normally with toys.

B. Having dreams about princesses and castles.

C. Taking the clothing off her dolls while playing.

D. Expressing no fear when talking about the event.

E. Talking about the event with her parents

C. Taking the clothing off her dolls while playing.

Which of the following statements about risk factors for developing posttraumatic stress disorder (PTSD) is true?

A. Sustaining personal injury does not affect the risk of developing PTSD.

B. Severity of the trauma influences the risk of developing PTSD.

C. Dissociation has no impact on the risk of developing PTSD.

D. Perceived life threat is the only risk factor for developing PTSD.

E. Prior mental disorders have little influence on the risk of developing PTSD.

B. Severity of the trauma influences the risk of developing PTSD.

How does the 12-month prevalence of posttraumatic stress disorder (PTSD) in the United States compare with that in European and Latin American countries?

A. It is much lower than that in other countries.

B. It is much higher than that in other countries.

C. It is equal to that in other countries.

D. It is somewhat higher than that in other countries.

E. It is somewhat lower than that in other countries.

D. It is somewhat higher than that in other countries

A woman complains of sad mood and feeling hopeless 3 months after her hus band 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?

A. Adjustment disorder, with depressed mood.

B. Adjustment disorder, with disturbance of conduct.

C. Adjustment disorder, with anxiety.

D. Adjustment disorder, with mixed disturbance of emotions and conduct.

E. Adjustment disorder, unspecified.

A. Adjustment disorder, with depressed mood.

Six months after the death of her husband, a 70-year-old woman is seen for symptoms of overwhelming sadness, anger regarding her husband’s unex pected death from a heart attack, intense yearning for him to come back, and repeated unsuccessful attempts to begin moving out of her large home (which she can no longer afford) due to inability to sort through and dispose of her husband’s belongings. What is the most appropriate diagnosis?

A. Major depressive disorder.

B. Posttraumatic stress disorder.

C. Adjustment disorder, with depressed mood.

D. Other specified trauma- and stressor-related disorder (persistent complex bereavement disorder).

E. Normative stress reaction.

C. Adjustment disorder, with depressed mood.

A 25-year-old woman with asthma becomes extremely anxious when she gets an upper respiratory infection. She presents to the emergency department with complaints of being unable to breathe. While there, she begins to hyperventilate and then reports feeling extremely dizzy. Her hyperventilation causes her to become fatigued, and when the medical evaluation indicates that she is retaining carbon dioxide (CO2), it becomes necessary to admit her. The woman denies any other symptoms beyond anxiety. What is the most appropriate diagnosis?

A. Acute stress disorder.

B. Generalized anxiety disorder.

C. Adjustment disorder with anxiety.

D. Psychological factors affecting other medical conditions.

E. Factitious disorder.

D. Psychological factors affecting other medical conditions.

How many Criterion B symptoms are required to be present for the diagnosis of acute stress disorder?

A. One.

B. Three.

C. Five.

D. Seven.

E. Nine.

E. Nine

How do the diagnostic criteria for posttraumatic stress disorder (PTSD) in pre school children differ from those for PTSD in individuals older than 6 years?

A. The preschool criteria incorporate simpler language that can be understood by children 6 years or younger.

B. The preschool criteria require one or more intrusion symptoms, one symptom representing either avoidance or negative alterations in cognitions and mood, and two or more arousal/reactivity symptoms, whereas the criteria for older individuals require symptoms in all four categories.

C. The criteria for individuals older than 6 years require one or more intrusion symptoms, one symptom representing either avoidance or negative alterations in cognitions and mood, and two or more arousal/reactivity symptoms, whereas the preschool criteria require symptoms in all four categories.

D. The preschool criteria require that the child directly experience the trauma, whereas the criteria for older individuals do not have this requirement.

E. The preschool criteria include only one type of traumatic exposure—wit nessing of a traumatic event occurring to a parent or caregiving figure—as a qualifying traumatic event.

B. The preschool criteria require one or more intrusion symptoms, one symptom representing either avoidance or negative alterations in cognitions and mood, and two or more arousal/reactivity symptoms, whereas the criteria for older individuals require symptoms in all four categories

Eighteen months following the death of her son, a 49-year-old woman consults you for psychotherapy. She reports that her son died following a skiing accident on a trip that she gave him as a gift for his 17th birthday. She is preoccupied with the death and blames herself for providing the gift of the trip. Although she denies any overt suicidal plans, she describes longing for her son and an intense wish to be with him. She has not entered her son’s room since his death, has difficulty relating to her husband and feels anger toward him for agreeing to allow their son to go on the ski trip, and reports arguments between them regarding her social isolation and her lack of interest in maintaining their home and preparing meals for their other children. She was treated with a selective serotonin reuptake inhibitor at full dose for 6 months after her son’s death but reports that the medication had no impact on her symptoms. What is the most appropriate diagnosis?

A. Major depressive disorder.

B. Posttraumatic stress disorder.

C. Other specified trauma- and stressor-related disorder.

D. Normal grief.

E. Adjustment disorder

C. Other specified trauma- and stressor-related disorder.

Dissociative disorders involve disruptions or discontinuities in the operation and integration of many areas of psychological functioning. Which of the following is not a functional area affected in dissociative disorders?

A. Memory.

B. Consciousness.

C. Perception.

D. Delusional beliefs.

E. Emotional responses.

D. Delusional beliefs.

Which of the following statements correctly describes the meanings of the adjectives positive and negative when applied to dissociative symptoms?

A. When applied to dissociative disorder symptoms, the adjectives positive and negative have the same meanings as they do in schizophrenia.

B. “Positive” dissociative symptoms refer to those accompanied by euphoric moods.

C. “Negative” dissociative symptoms refer to inability to access mental con tent or to control mental functions in a normal fashion.

D. “Negative” dissociative symptoms refer to the belief that one has ceased to exist

E. The adjectives positive and negative are not appropriately applied to disso ciative symptoms because these symptoms are value neutral.

C. “Negative” dissociative symptoms refer to inability to access mental content or to control mental functions in a normal fashion.

Which of the following statements about depersonalization/derealization dis order is true?

A. Although transient symptoms of depersonalization/derealization are common in the general population, symptomatology that meets full criteria for depersonalization/derealization disorder is markedly less common.

B. Women are 1.5 times more likely than men to develop depersonalization/ derealization disorder.

C. Age at onset of the disorder is most commonly between 25 and 35 years.

D. During episodes of depersonalization/derealization, individuals may feel that they are “going crazy” and typically lose reality testing.

E. The most common childhood traumatic experience in persons with deper sonalization/derealization disorder is sexual abuse

A. Although transient symptoms of depersonalization/derealization are common in the general population, symptomatology that meets full criteria for depersonalization/derealization disorder is markedly less common.

Criterion A for the diagnosis of dissociative identity disorder (DID) requires the presence of two or more distinct personality states or an experience of pos session. Which of the following symptom presentations would not qualify as a manifestation of an alternate identity?

A. An intrusive but nonhallucinatory voice that is not recognized as being part of one’s own normal thought flow.

B. Suddenly emergent strong impulses or emotions.

C. Acute changes in personal preferences in areas such as food, clothing, or even political convictions.

D. An acute sense of being in a different body, such as an adult feeling like he or she is in a child’s body.

E. A religious experience of being reborn into a new spiritual state that affects multiple domains of the individual’s behavior.

E. A religious experience of being reborn into a new spiritual state that affects multiple domains of the individuals behavior.

Criterion B for the diagnosis of dissociative identity disorder (DID) requires re current gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting. Which of the following statements about Criterion B–qualifying amnesia is false?

A. Gaps in recall of remote life events do not meet Criterion B definitions for amnesia.

B. It is common for individuals with DID to minimize their amnesia symptoms.

C. Individuals with DID may discover evidence of their past actions or experiences, such as finding clothing in the closet they do not recall buying, or seeing a photo of a trip they don’t recall taking.

D. Forgetting of skills such as those involved in playing a musical instrument would count as amnesia for the purposes of Criterion B.

E. Dissociative fugues in which an individual finds him- or herself in a loca tion with no memory of having traveled there are common in DID and rep resent a form of amnesia

A. Gaps in recall of remote life events do not meet Criterion B definitions for amnesia.

Dissociative amnesia most often involves which of the following types of amnesia?

A. Continuous amnesia.

B. Permanent, irreversible amnesia.

C. Localized or selective amnesia for specific events.

D. Generalized amnesia similar to that seen in neurological toxicity.

E. Systematized amnesia

C. Localized or selective amnesia for specific events

Somatoform Disorders in DSM-IV are referred to as Somatic Symptom and Re lated Disorders in DSM-5. Which of the following features characterizes the major diagnosis in this class, somatic symptom disorder?

A. Medically unexplained somatic symptoms.

B. Underlying psychic conflict.

C. Masochism.

D. Distressing somatic symptoms and abnormal thoughts, feelings, and behaviors in response to these symptoms.

E. Comorbidity with anxiety and depressive disorders.

D. Distressing somatic symptoms and abnormal thoughts, feelings, and behaviors in response to these symptoms.

In DSM-IV, a patient with a high level of anxiety about having a disease and many associated somatic symptoms would have been given the diagnosis of hypochondriasis. What DSM-5 diagnosis would apply to this patient?

A. Hypochondriasis.

B. Illness anxiety disorder.

C. Somatic symptom disorder.

D. Generalized anxiety disorder.

E. Unspecified somatic symptom and related disorder

C. Somatic symptom disorder.

In DSM-III and DSM-IV, a large number of somatic symptoms were needed to qualify for the diagnosis of somatization disorder. How many somatic symptoms are needed to meet symptom criteria for the DSM-5 diagnosis of somatic symptom disorder?

A. Four: at least one pseudoneurological, one pain, one sexual, and one gastro intestinal symptom.

B. Fifteen, distributed across several organ systems.

C. One.

D. At least one that is medically unexplained.

E. None

C. One.

After an airplane flight, a 60-year-old woman with a history of chronic anxiety develops deep vein thrombophlebitis and a subsequent pulmonary embolism. Over the next year, she focuses relentlessly on sensations of pleuritic chest pain and repeatedly seeks medical attention for this symptom, which she worries is due to recurrent pulmonary emboli, despite negative test results. Review of systems reveals that she also has chronic back pain and that she has consulted many physicians for symptoms of culture-negative cystitis. What diagnosis best fits this clinical picture?

A. Post–pulmonary embolism syndrome.

B. Chest pain syndrome.

C. Hypochondriasis.

D. Pain disorder.

E. Somatic symptom disorder.

E. Somatic symptom disorder.

Which of the following is a descriptive specifier included in the diagnostic cri teria for somatic symptom disorder?

A. With predominant pain.

B. With hypochondriasis.

C. With psychological comorbidity.

D. Psychotic type.

E. Undifferentiated.

A. With predominant pain

A 60-year-old man has prostate cancer with bony metastases that cause persistent pain. He is treated with antiandrogen medications that result in hot flashes. He is unable to work because of his symptoms, but he is stoical, hopeful, and not anxious. What is the appropriate diagnosis?

A. Pain disorder.

B. Illness anxiety disorder.

C. Somatic symptom disorder.

D. Psychological factors affecting other medical conditions.

E. No diagnosis

E. No diagnosis

Illness anxiety disorder involves a preoccupation with having or acquiring a serious illness. How severe must the accompanying somatic symptoms be to meet criteria for the diagnosis of illness anxiety disorder?

A. Mild to moderate severity.

B. Moderate to high severity.

C. Any level of severity.

D. Mild severity at most, but there need not be any somatic symptoms.

E. None of the above; the presence of any somatic symptoms rules out the di agnosis of illness anxiety disorder.

D. Mild severity at most, but there need not be any somatic symptoms

Over a period of several years, a 50-year-old woman visits her dermatologist’s office every few weeks to be evaluated for skin cancer, showing the dermatologist various freckles, nevi, and patches of dry skin about which she has be come concerned. None of the skin findings have ever been abnormal, and the dermatologist has repeatedly reassured her. The woman does not have pain, itching, bleeding, or other somatic symptoms. She does have a history of occasional panic attacks. What is the most likely diagnosis?

A. Unspecified anxiety disorder.

B. Illness anxiety disorder.

C. Hypochondriasis.

D. Somatic symptom disorder.

E. Factitious disorder.

B. Illness anxiety disorder

A 45-year-old man with a family history of early-onset coronary artery disease avoids climbing stairs, eschews exercise, and abstains from sexual activity for fear of provoking a heart attack. He frequently checks his pulse, reads extensively about preventive cardiology, and tries many health food supplements alleged to be good for the heart. When he experiences an occasional twinge of chest discomfort, he rests in bed for 24 hours; however, he does not go to doc tors because he fears hearing bad news about his heart from them. What diagnosis best fits this clinical picture?

A. Persistent complex bereavement disorder.

B. Adjustment disorder.

C. Illness anxiety disorder.

D. Unspecified somatic symptom and related disorder.

E. Somatic symptom disorder

C. Illness anxiety disorder

A 25-year-old woman is hospitalized for evaluation of episodes in which she appears to lose consciousness, rocks her head from side to side, and moves her arms and legs in a nonsynchronous, bicycling pattern. The episodes occur a few times per day and last for 2–5 minutes. Electroencephalography during the episodes does not reveal any ictal activity. Immediately after a fit, her sensorium appears clear. What is the most likely diagnosis?

A. Epilepsy.

B. Malingering.

C. Somatic symptom disorder.

D. Conversion disorder (functional neurological symptom disorder), with attacks or seizures.

E. Factitious disorder.

D. Conversion disorder (functional neurological symptom disorder), with attacks or seizures.

Which of the following symptoms is incompatible with a diagnosis of conversion disorder (functional neurological symptom disorder)?

A. Light-headedness upon standing up.

B. Dystonic movements.

C. Tunnel vision.

D. Touch and temperature anesthesia with intact pinprick sensation over the left forearm.

E. Transient leg weakness in a patient with known multiple sclerosis.

A. Light-headedness upon standing up.

Why is la belle indiff rence (apparent lack of concern about the symptom) not in cluded as a diagnostic criterion for conversion disorder (functional neurologi cal symptom disorder)?

A. It has poor interrater reliability.

B. It has poor specificity.

C. It has poor sensitivity.

D. It pathologizes stoicism.

E. It has poor test-retest reliability.

C. It has poor sensitivity.

A 20-year-old man presents with the complaint of acute onset of decreased visual acuity in his left eye. Physical, neurological, and laboratory examinations are entirely normal, including stereopsis testing, fogging test, and brain magnetic resonance imaging. The remainder of the history is negative except for the patient’s report that since his midteens he has felt that his left cheekbone and eyebrow are too big. He spends a lot of time comparing the right and left sides of his face in the mirror. He is planning to have plastic surgery as soon as he graduates from college. Which of the following diagnoses are suggested?

A. Somatic symptom disorder and delusional disorder, somatic subtype.

B. Somatic symptom disorder and illness anxiety disorder.

C. Body dysmorphic disorder and conversion disorder (functional neurological symptom disorder).

D. Somatic symptom disorder, illness anxiety disorder, and body dysmorphic disorder.

E. Delusional disorder, somatic subtype

C. Body dysmorphic disorder and conversion disorder (functional neurological symptom disorder).

A 50-year-old man with hard-to-control hypertension acknowledges to his physician that he regularly “takes breaks” from his medication regimen be cause 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?

A. Nonadherence to medical treatment.

B. Unspecified anxiety disorder.

C. Denial of medical illness.

D. Adjustment disorder.

E. Psychological factors affecting other medical conditions.

E. Psychological factors affecting other medical conditions

A 60-year-old man has prostate cancer with bony metastases that cause persistent pain. He is being treated with antiandrogen medications that result in hot flashes. Although (by his own assessment) his pain is well controlled with an algesics, he states that he is unable to work because of his symptoms. Despite reassurance that his medications are controlling his metastatic disease, every instance of pain leads him to worry that he has new bony lesions and is about to die, and he continually expresses fears about his impending death to his wife and children. Which diagnosis best fits this patient’s presentation?

A. Panic disorder.

B. Illness anxiety disorder.

C. Somatic symptom disorder.

D. Psychological factors affecting other medical conditions.

E. Adjustment disorder with anxious mood.

C. Somatic symptom disorder.

A 60-year-old man with a history of coronary disease and emphysema continues to smoke one pack of cigarettes daily despite his doctor’s clear advice that abstinence is important for his survival. He says he’s tried to quit a dozen times but has always relapsed due to withdrawal symptoms or feelings of tension relieved by smoking. What is the most likely diagnosis?

A. Psychological factors affecting other medical conditions.

B. Tobacco use disorder.

C. Denial of illness.

D. Nonadherence to medical treatment.

E. Adjustment disorder

B. Tobacco use disorder.

What is the essential diagnostic feature of factitious disorder?

A. Somatic symptoms.

B. Conscious misrepresentation and deception.

C. External gain associated with illness.

D. Absence of another medical disorder that may cause the symptoms.

E. Normal physical examination and laboratory tests.

B. Conscious misrepresentation and deception.

A 19-year-old man is brought to the emergency department by his family with acute onset of hemoptysis. Although he denies any role in the genesis of the symptom, he is observed in the waiting area to be surreptitiously inhaling a solution that provokes violent coughing. On confrontation he eventually ac knowledges his action but explains that he heard an angel’s voice instructing him to purify himself for a divine mission for which he will receive a heavenly reward. He was therefore trying to expunge all “evil vapors” from his lungs but felt obliged to keep this a secret. Why would this patient not be considered to have factitious disorder?

A. Consequences of religious or culturally normative practices are exempt from consideration as fabricated illnesses.

B. Factitious disorder occurs almost exclusively in women.

C. Repeated instances of illness fabrication are necessary for a diagnosis of factitious disorder.

D. The patient expects to receive an external reward and therefore should be considered to be malingering.

E. The presence of a psychotic illness that better accounts for the symptoms precludes the diagnosis of factitious disorder.

E. The presence of a psychotic illness that better accounts for the symptoms precludes the diagnosis of factitious disorder

When a mother knowingly and deceptively reports signs and symptoms of ill ness in her preschool-aged child, resulting in the child’s hospitalization and subjection to numerous tests and procedures, what diagnosis would be re corded for the child?

A. Munchausen syndrome by proxy.

B. Factitious disorder by proxy.

C. No diagnosis.

D. Munchausen syndrome imposed on another.

E. Factitious disorder imposed on another.

C. No diagnosis

A 25-year-old woman with a history of intravenous heroin abuse is admitted to the hospital with infective endocarditis. Blood cultures are positive for several fungal species. Search of the patient’s belongings discloses hidden syringes and needles and a small bag of dirt, which, when cultured, yields the same fungal species. Which of the following diagnoses are likely to apply?
A. Infective endocarditis, opioid use disorder, malingering, factitious disorder, and antisocial personality disorder.

B. Opioid use disorder and malingering.

C. Infective endocarditis, opioid use disorder, and factitious disorder.

D. Malingering and antisocial personality disorder.

E. Malingering and factitious disorder.

C. Infective endocarditis, opioid use disorder, and factitious disorder

After finding a breast lump, a 50-year-old woman with a family history of breast cancer is overwhelmed by feelings of anxiety. Consultation with a breast surgeon, mammogram, and biopsy show the lump to be benign. The surgeon tells her that she requires no treatment; however, she continues to ruminate about the possibility of cancer and surgery that will result in disfigurement. Her sleep is restless, and she is having trouble concentrating at work. After 6 weeks of these symptoms, her primary physician refers her for psychiatric consultation. Her medical and psychiatric history is otherwise negative. Which diagnosis best fits this presentation?

A. Somatic symptom disorder.

B. Illness anxiety disorder.

C. Unspecified somatic symptom and related disorder.

D. Other specified somatic symptom and related disorder.

E. Adjustment disorder with anxious mood.

D. Other specified somatic symptom and related disorder.

After finding a breast lump, a 53-year-old woman with a family history of breast cancer is overwhelmed by feelings of anxiety. Consultation with a breast surgeon, mammogram, and biopsy show the lump to be benign. The surgeon indicates that she requires no treatment; however, she continues to ruminate about the possibility of cancer and surgery that will result in disfigurement. Her sleep is restless and she is having trouble concentrating at work. After 6 weeks in this state, her primary physician requests that she consult a psychiatrist. On initial evaluation the patient weeps throughout the interview, and is so distraught that the evaluator is unable to elicit details of her medical and psychiatric history beyond reviewing the current “crisis.” Which diagnosis best fits this presentation?

A. Somatic symptom disorder.

B. Illness anxiety disorder.

C. Unspecified somatic symptom and related disorder.

D. Other specified somatic symptom and related disorder.

E. Adjustment disorder with anxious mood

C. Unspecified somatic symptom and related disorder