Another day, another
free practice question! This one comes from the Sleep-Wake
Disorders chapter of the DSM. What's in that chapter? This is
what's in that chapter:
- Insomnia Disorder (dissatisfaction with sleep)
- Hypersomnolence Disorder (excessive sleepiness)
- Narcolepsy (recurrent, irrepressible need to sleep)
Then there are the Breathing-Related Sleep Disorders
(Obstructive Sleep Apnea Hypopnea, Central Sleep Apnea, and
Sleep-Related Hypoventilation). There're also Circadian Rhythm
Sleep-Wake Disorders. And then, Parasomnias (Non-Rapid Eye Movement
Sleep Arousal Disorders, Nightmare Disorder, Rapid Eye Movement
Sleep Behavior Disorder, Restless Leg Syndrome). Then all the
"others": Substance-induced this, unspecified that, other
It's enough to make you sleepy just reading through the list.
And it raises a lot of questions--possible questions for the social
work licensing exam. For instance, what's a parasomnia? Here's a
quick definition: "a disorder characterized by abnormal or unusual
behavior of the nervous system during sleep." Simple.
So, there are sleep problems that arise psych reasons, for
breathing reasons, for nervous system reasons, and for
other/unspecified reasons. There are a lot of ways to not get
sleep. But there's only one good way to answer the following
practice question. See you how you do:
A client tells a social worker that for the past several
weeks, ever since getting promoted, she has been getting
"terrible," dreamless sleep. She has a hard time falling asleep and
wakes up "way before the alarm rings," her mind racing with
thoughts about work. She reports difficulty focusing on the
job--"I'm so exhausted." What is the MOST likely diagnosis for this
B) Non-Rapid Eye Movement Sleep Arousal
D) Adjustment Disorder
What do you think?
Let's do the usual process of elimination:
--GAD requires "excessive anxiety and worry" for at least 6
months. That's not what's being reported here. Strike that
--Non-Rapid Eye Movement Sleep Arousal involves "recurrent
episodes of incomplete awakening from sleep" with either
sleepwalking or sleep terrors. With sleepwalking, some will engage
in sleep-related eating or sleep-related sexual behavior, known as
"sexsomnia." Not a fit here.
--Insomnia is an appealing answer. The client is
reporting symptoms of insomnia. However, the client's sleep
problems seem to be related to a recent stressor--a promotion.
There may be something else going on. Or maybe it is
insomnia, but that won't be diagnosable till the sleep problems
have persisted for three months. If three months haven't
passed yet, it's not insomnia disorder.
--That leaves adjustment disorder. Adjustment disorder is "the
development of emotional or behavioral symptoms in response to an
identifiable stressor occurring within three months of the onset of
the stressor." It's the best choice on the list.
A better diagnosis here might be no diagnosis at all.
The client is losing sleep over a new job. That's not necessarily a
disorder. But "No Diagnosis" isn't one of the choices offered, so
you're stuck with the least-bad of the bunch: D) Adjustment
To read up about sleep-wake disorders and adjustment disorders,
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