Agoraphobia and the Social Work Exam

waiting for elevatorHere comes another section in the anxiety disorders chapter of DSM-5. It's agoraphobia. (Memorization clue: Agora is Greek for a public open space. Fear of that, more or less.) Agoraphobia is a new dx in DSM-5. Criteria look like this:

A. Marked fear or anxiety about two or more of these:

   1. Public transportation

   2. Open spaces (e.g., parking lots, bridges)

   3. Enclosed places (e.g., shops, theaters)

   4. Standing in line or being in a crowd

   5. Being outside of the home alone

B. These situations are feared or avoided due to thoughts of being unable to escape when and if panic-like symptoms (or other incapacitating or embarrassing symptoms) develop.

C. These situations almost always provoke fear/anxiety.

D. These situations are actively avoided, require the presence of a companion, or are endured with intense fear/anxiety.

E. Reaction is out of proportion to actual danger.

F. Symptoms present for 6 months or more

G. Symptoms cause clinically significant distress

H. If another medical condition (e.g., IBS) is present, fear/anxiety/avoidance are clearly excessive.

I. Symptoms not better explained by another disorder.

The list of other disorders that agoraphobia might be better explained by is useful, especially for narrowing down answers on the ASWB exam. On that list: specific phobia, social anxiety disorder, OCD, body dysmorphic disorder, PTSD, and separation anxiety disorder.

The most difficult distinctions there may be the first two. Imagine a question like this:

A client tells a social worker she hates leaving her apartment on her own. She says she's terrified of having a panic attack and not being able to escape from wherever she is when it hits.  "I had to quit my job because the elevators in the building freaked me out so much," she says. She hasn't worked in over six months. What is the MOST likely diagnosis for this client?

A. Specific Phobia, Situational

B. Social Anxiety Disorder

C. Panic Disorder with Agoraphobia

D. Agoraphobia

You know the answer because it's the subject of the blog post. But on a test, without that giant clue, do you think you might've been tempted by the other possibilities?  Specific phobia doesn't really fit. The client's anxiety is situational, but the situation isn't just elevator or just shopping--it's more widespread. She's afraid to leave the apartment. Social anxiety isn't a great fit either--it's places and her own panic the client seems to fear, not other people and their judgment.  How about panic disorder with agoraphobia? The client may meet criteria for panic disorder--she reports recurrent, unpredictable panic attacks. But there's this: panic disorder with agoraphobia is a DSM-IV-TR diagnosis. It doesn't appear in DSM-5. DSM-5 separates panic disorder and agoraphobia; clients can be diagnosed with either or both. So, narrowed down thusly, you have your answer: D) Agoraphobia.

If this comes up on the exam, consider yourself ready for it.

To read up on agoraphobia, try:

Now that you're prepped for an agoraphobia-related question on the big test, get more practice on the topic and others  by signing up with SWTP.

Good luck on the exam!

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More Exams, More Savings

Just a quick post to alert you to SWTP's new exam pricing. A la carte exams have ducked just a dollar to $39 each. It's the pricing for bundles that has undergone the biggest change. See our pricing page for details.

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Happy studying and good luck with the exam!

Separation Anxiety Disorder and the Social Work Exam

separation anxiety (38465245_s)Let's continue our journey through the DSM-5 anxiety disorders chapter by taking a look at separation anxiety.

What's separation anxiety disorder? The DSM definition is simple:

Developmentally inappropriate and excessive fear or anxiety concerning separation concerning separation from those to whom the individual is attached.

Three of eight symptoms are needed to diagnose the disorder. The eight:

1. Anticipatory distress

2. Fear of losing attachment figures (e.g., due to illness or injury)

3. Fear of event that may cause separation (e.g., getting lost or being kidnapped)

4. Persistent reluctance or refusal to go out d/t fear of separation

5. Fear of being alone without attachment figure

6. Persistent reluctance or refusal to sleep away from attachment figures

7. Repeated separation-themed nightmares

8. Repeated complaints of physical symptoms when a separation occurs or is anticipated (e.g., headaches, stomachaches, nausea)

Symptoms need to be present for at least four weeks in children or six months in adults for a diagnosis to be made.

Adults, you ask? Yes, adults. Once upon a time (that is, in DSM-IV-TR), separation anxiety was a disorder that had to have its onset during childhood. No longer. DSM-5 recognizes separation anxiety as a condition that begin at any age. That distinction suggests a simple question:

A 34-year-old man tells a social worker that in the last few years he has been afraid to be be apart from his wife. He fears she might be injured or killed and he would never see her again. His nightmares often include that exact scenario. What is the MOST likely diagnosis for this client?

A) Reactive attachment disorder

B) Dependent personality disorder

C) Separation anxiety disorder

D) Specific phobia

Yes, the man meets criteria for separation anxiety disorder. If you see something like this on the ASWB exam you'll now be more than ready to answer it. Try not to yell at the screen. "Come on! Ask me something hard!" Try to remain calm and move on to the next question.

Here's hoping that the majority of questions you encounter on the social work licensing exam are comfortably familiar and answerable. The more practice questions you do, the better chance you have of that happening. (Get started with SWTP practice tests by signing up!)

For more about separation anxiety disorder, try:

Good luck on the exam!

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The SWTP DSM Booster is Here!

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DSM Booster Beta Testers Wanted

Dear Exam Prepper,

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We only need a handful of beta testers, so it's first come, first serve.  Thanks in advance for your help!