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Take five minutes to dive into this question drawn from the anxiety disorders chapter of the DSM.

A woman tells a social worker that she no longer goes to the movies. "Sitting on the aisle isn't enough," she says. "I keep thinking about trying to get out of there through the crowd." When she was younger, the woman used to go to movies and concerts regularly. "It's been years," she reports. "I wouldn't be able do it. Standing on line? Sitting in a crowd inside? I'll binge watch shows at home, thanks very much." What is the MOST likely diagnosis for this client?

Most DSM questions-most ASWB exam questions-involve a process of elimination, and this one's no different. See how you do. Then sign up at SWTP for full-length exams to really get you ready to pass the social work licensing exam. Good luck!

Here's a quick walk-through of a question that appeared on the blog once upon a time. A kindergartener is making life miserable for his mother and sister. How best to diagnose?

Watch the video here and be sure to subscribe to SWTP videos on YouTube or like SWTP on Facebook for the premiere (these start as Facebook Live videos).

Remember, the real exam doesn't read itself out loud to you-and it doesn't provide answers. Sign up to get started with full, 170-question ASWB exam practice tests here on SWTP.

What's the difference between schizophrenia, schizoaffective disorder, and schizophreniform disorder? When do you diagnose MDD with psychotic features? Here's a walk-through of a practice question from the blog that should help clear some of that up. Test your DSM knowledge and get ready to pass the ASWB exam. Enjoy.

They sound alike and look alike. They're not the same thing. Here's how to tell the difference between schizophrenia and schizoaffective disorder.

The DSM devotes a chapter to Schizophrenia Spectrum and Other Psychotic Disorders. Included there: delusional disorder (delusions without other schizophrenia symptoms), brief psychotic disorder (psychotic symptoms present less than one month), schizophreniform disorder (symptoms lasting for less than six months), catatonia, and substance/medication-induced and due-to-another-medical-condition psychotic disorder (describe themselves).

What's left: schizophrenia and schizoaffective disorder. Here are the criteria for schizophrenia:

A. Two or more present for bulk of a one-month period: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and/or negative symptoms.

B. Symptoms disturb level of functioning.

C. Signs of disturbance last for at least 6 months.

D. Schizoaffective and bipolar disorder ruled out.

E. Symptoms not due to the effects of a substance or medical condition.

Schizoaffective disorder is diagnosed when these criteria are met. Watch for the difference. It'll come up right away:

A. A major mood episode concurrent with criterion A of schizophrenia.

B. Delusions of hallucinations for two or more weeks without a major mood episode during the lifetime duration of the disorder.

C. A major mood episode is present for the majority of the illness.

D. Symptoms not due to the effects of a substance or medical condition.

Specifiers for schizoaffective disorder include bipolar type, depressive type, and with catatonia.

TL;DR? They're very similar. Both include some combination of delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and/or negative symptoms. But in schizoaffective disorder, a major mood episode is present most of the time (though not 100% of the time). Why not 100%? Because then you'd be looking at MDD or bipolar I with psychotic features. A topic for another blog post

So how do you boil this down into something simple and memorable? How about this: Schizoaffective disorder is like schizophrenia, but includes a big mood component generally occurring alongside psychotic symptoms.

ASWB exam preppers, see if the above helps you answer this question correctly:

A social worker sees a client who reports a lifetime of "seeing things all the time, shadows." He also reports hearing voices, "probably the NSA," which tell him he's "useless and stupid." The voices leave him feeling "pretty sad and really annoyed." Given the symptoms the client describes, what is the MOST likely of the following DSM diagnoses?

A. Major depression with psychotic features

B. Schizophrenia

C. Schizophreniform disorder

D. Schizoaffective disorder

What do you think?

The client appears to meet criteria for some psychotic disorder, given that he reports a lifetime of psychotic symptoms (hallucinations and delusions). The lifetime duration means schizophreniform disorder isn't the correct answer. Narrowing down between the three left standing depends upon your reading of "pretty sad and really annoyed." Sounds like the client gets in a bad mood due to his symptoms. Does that bad mood rise to the level of MDD? It does not. So scratch A. And while you're at it, since schizoaffective disorder requires MDD or bipolar disorder symptoms alongside schizophrenia symptoms, scratch that one as well. Now you're left with one answer, the correct answer as it happens: B, schizophrenia.

For more practice questions from the DSM, about psychotic disorder diagnosis, and other close-call social work situations, sign up with SWTP!

[Post by Will Baum, LCSW]

Given the similarities between bulimia nervosa and anorexia nervosa, binge-eating/purging type, there's room for confusion when making a diagnosis, whether on the ASWB exam or in real life. Let's take a look at what the DSM says about each.

What is anorexia nervosa?

Criteria for anorexia nervosa are as follows:

A. Restriction of energy intake leading to significantly low body weight.

B. Intense fear of gaining weight despite significantly low weight.

C. Disturbance in the way one's body weight or shape is experienced, undue influence of body weight shape on self-evaluation, or persistent lack of recognition of the seriousness of current low body weight.

What are the types of anorexia nervosa?

There are two subtypes in anorexia nervosa:

Restricting type. Weight loss accomplished primarily through dieting, fasting, and/or excessive exercise (not recurrent binging or purging).

Binge-eating/purging type. Recurrent episodes of binge eating or purging (self-induced vomiting or the misuse of laxatives, diuretics, or enemas).

What is bulimia nervosa?

Criteria for bulimia nervosa are as follows:

A. Recurrent episodes of binge eating (overeating in a discrete period of time with a sensed lack of control regarding the eating).

B. Recurrent inappropriate compensatory behaviors to prevent weight gain (e.g., self-induced vomiting, misuse of laxatives, diuretics, or other medications; fasting; excessive exercise).

C. Lasts once a week for three months.

D. Self-evaluation is unduly influenced by body shape and weight.

E. Does not occur exclusively during episodes of anorexia nervosa.

What's the difference between anorexia nervosa, binge/purging-type and bulimia nervosa?

Both anorexia nervosa and bulimia nervosa involve negative self-evaluation of body shape and weight. Both involve behaviors to avoid weight gain such as self-induced vomiting. However, in anorexia nervosa, the disorder leads to significantly low body weight, where bulimia nervosa does not.

The difference is the ways severity is coded for anorexia and bulimia helps highlight the essential difference between the two diagnoses.

For anorexia nervosa, severity is based on body mass index (BMI). For example, "mild" indicates a BMI less than or equal to 17 kilograms per square meter. "Extreme" indicates a BMI of less than fifteen kilograms per square meter.

For bulimia nervosa, severity is based on the frequency of behaviors. For 1-3 episodes per week, a specifier of "mild" is applied. "Extreme" is used for 14 or more episodes per week.

The difference is not the behavior itself, it's the result.

Free ASWB Exam Practice

The ASWB exam often tests to assess knowledge of differentials between commonly occurring DSM disorders like anorexia and bulimia. A sample question:

A 17-year-old client who appears noticeably underweight reports frequently forcing herself to vomit after meals in order to "stay skinny for cheerleading." The MOST likely DSM diagnosis for this client is a type of:

A. Bulimia nervosa

B. Body dysmorphic disorder

C. Rumination disorder

D. Anorexia nervosa

Unless you're caught by the distractors, body dysmorphic disorder (which is not diagnosed when an eating disorder is present) and rumination disorder (not described here), knowing the difference between anorexia and bulimia quickly gets you to the correct answer. The client is "noticeably underweight." You have your essential information. The phrase "a type of" at the end of the question stem is an additional clue. The client is most likely suffering from anorexia nervosa, binge/purging-type. The answer is D.

[Post by  Will Baum, LCSW]