Blog

The changes that differentiate DSM-5 from the updated DSM-5-TR (TR for "Text Revision") are helpfully enumerated in Jonathan Singer's New Social Worker article (linked a few posts ago). For the spectacularly detail oriented, information omnivore, the APA has finer detail spelled out in a series of face sheets linked here at Psychiatry.org. If you insist upon knowing every adjustment made in the new DSM they're all there, and linked here:

• Attention-Deficit/Hyperactivity Disorder (ADHD)
• Autism Spectrum Disorder
• Conduct Disorder
• Disruptive Mood Dysregulation Disorder
• Eating Disorders
• Gender Dysphoria
• Intellectual Disability
• Internet Gaming Disorder
• Major Depressive Disorder and the Bereavement Exclusion
• Mild Neurocognitive Disorder
• Obsessive-Compulsive and Related Disorders
• Paraphilic Disorders
• Personality Disorder
• Posttraumatic Stress Disorder
• Schizophrenia
• Sleep-Wake Disorders
• Specific Learning Disorder
• Social Communication Disorder
• Somatic Symptom Disorder
• Substance-Related and Addictive Disorders

Let's drop in on one of those pdf face sheets, to see what's what. From the top of the list, ADHD. The new facts:

The definition of attention-deficit/hyperactivity disorder (ADHD) has been updated in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to more accurately characterize the experience of affected adults.

And:

DSM-5 includes no exclusion criteria for people with autism spectrum disorder, since symptoms of both disorders co-occur. However, ADHD symptoms must not occur exclusively during the course of schizophrenia or another psychotic disorder and must not be better explained by another mental disorder, such as a depressive or bipolar disorder, anxiety disorder, dissociative disorder, personality disorder, or substance intoxication or withdrawal.

So…they made some tweaks. Are these the kinds of details that show up on the social work licensing exam? They are, for the most part, definitively not. The ASWB exam is designed to ensure beginning social workers understand the fundamental, beginning knowledge, skills, and abilities of the social work field. It is not a DSM exam. It is not an exam filled with "gotchas" or tricks. It's about the basics: the NASW Code of Ethics, best practices in assessment, some essential DSM in the clinical exam…that sort of material.

If you've already studied everyting else and just want to chew on some extra information for kicks, then, sure, dig into the APA's DSM-5-TR fact sheets. Otherwise, stay the course. Take practice exams. Review where you went wrong. Repeat.

Then go and pass that exam!

Happy studying and good luck.

If you've been closely following additions to the DSM that came with the new text revision, you may have an easy time with this free practice question:

A client who's wife died a little over a year ago reports "constantly thinking" about her. He says he's still "in denial" about her death and struggles with a sense that "life has lost its meaning." Which is the DSM-5-TR diagnosis for the client's condition?

A) Adjustment disorder, depressed type

B) Major depressive disorder

C) Prolonged grief disorder

D) Bereavement

What do you think?

One quick way to answer, if you know your earlier versions of the DSM, is to pick the only answer on the list which is a DSM-5-TR addition (that is, wasn't in earlier versions of the DSM). That rules out adjustment disorder and MDD, right? Then you just have to take a best guess at what the man's symptoms might be labelled as in the DSM-5 Text Revision. Is it bereavement or prolonged grief disorder? And, you might ask, is a little over a year long enough to be considered "prolonged" grief? Well, the answer is prolonged grief disorder-C-and yes, 12+ months is enough time for PGD to be diagnosed.

Read up about the newly minted diagnosis-once a  at psychiatry.org. Key information from there:

Symptoms of prolonged grief disorder include:

• Identity disruption (e.g., feeling as though part of oneself has died).
• Marked sense of disbelief about the death.
• Avoidance of reminders that the person is dead.
• Intense emotional pain (e.g., anger, bitterness, sorrow) related to the death.
• Difficulty moving on with life (e.g., problems engaging with friends, pursuing interests, planning for the future).
• Emotional numbness.
• Feeling that life is meaningless.
• Intense loneliness (i.e., feeling alone or detached from others).

In the case of prolonged grief disorder, the duration of the person's bereavement exceeds expected social, cultural or religious norms and the symptoms are not better explained by another mental disorder.

Now you're that much more ready go take and pass the ASWB exam. Practice is the best way to get ready. We've got five complete, up-to-date practice tests, 170-questions each, with thorough rationales for each answer of each question. Sign  up to get a free study guide and get started.

Happy studying!

Without much fanfare, the American Psychiatric Association has launched an updated DSM. It's DSM-5-TR, which includes a hefty handful of changes, detailed here by Jonathan Singer (you may know him from the Social Work Podcast). Per Singer, text revisions include:

• updated descriptions of the prevalence, risk, and prognostic factors for each disorder based on new findings from research.
• one new disorder in the chapter Trauma and Related Stressors called prolonged grief disorder (F43.8). This is the only disorder that should be referred to as a DSM-5-TR disorder, because it is new to the text revision. All other disorders should be referred to as DSM-5 disorders.
• a change in terminology from intellectual disability (previously mental retardation) to intellectual developmental disorder [(F70) mild; (F71) moderate; (F72) severe; (F73) profound].
• a new category for Other Conditions That May Be a Focus of Clinical Attention - Suicidal behavior and nonsuicidal self-injury (NSSI).
• codes for the initial encounter of someone with suicidal ideation or attempt (T14.91A), subsequent encounters (T14.91D), and a history (but not current) suicidal behavior (Z91.51).
• codes for current NSSI (R45.88) and a history (not current) of NSSI (Z91.52).

Will this be on the exam? Eventually, yes. But look at the bullet pointed list. There's not much meaty material for exam question writers, except maybe for the new addition, prolonged grief disorder. We'll come up with a sample question or two on that in future posts.

The ASWB doesn't do trick questions, so a social work exam item aiming to catch you dozing on the difference between intellectual disability and intellectual development disorder is unlikely, but then again you never know. Give the article a read, and rest assured that we'll be integrating the new material into SWTP practice questions. We've got you covered.

So, back to it. Happy studying and good luck on the exam!

A mother and her twleve-year-old son meet with a social worker after the child was referred by his primary care physician, who has diagnosed the boy with encopresis. The boy makes it clear he doesn't want to talk about the condition and doesn't want to meet with the social worker. What treatment goal is likely to be MOST effective in reducing symptoms of encopresis?

A. The child will learn to identify and replace cognitive distortions that contribute to his feelings of shame.

B. The child's mother will establish a behavior plan that rewards him for using the toilet at regular intervals.

C. The child will learn to talk to his mother about his feelings about encopresis in family therapy.

D. The child will learn to talk openly about the encopresis to reduce his shame and embarrassment.

What do you think?

Let's take the answers one at a time. Remember you're looking for a treatment goal, not an intervention.

A. Identify cognitive distortions (intervention: CBT). Replacing cognitive distortions might be effective in reducing the child's shame but won't likely reduce his behavioral symptoms. So, no.

B. Behavior modification--rewarding the child for regular toilet habits--is likely to reduce the child's symptoms. This one's in the running. But always read through all answers. There may be a still better answer in the bunch.

C. Voice feelings. While there may be a psychodynamic route to symptom reduction in this case, having the child talk about his feelings about encopresis in family therapy isn't likely to reduce his symptoms.

D. More talking. Talking about his symptoms might help reduce this child's embarrassment but won't likely resolve his encopresis.

So, really only one contender this time. Which makes it easier than many questions on the ASWB exam, which often have two decent answers doing battle. This time, provided you aren't drawn to the CBT and talk-therapy options, you've got your answer without too much difficulty: B, behavior mod.

To read up about encopresis symtpoms and treatment, here's a good resource. To keep preparing for the social work licensing exam, you're already in the right place. Sign up to get started with full-length exams.

Happy studying, stay safe, and good luck on the exam!

You may travelling ahead. First, you have this free ASWB exam practice question about flying phobia:

A client seeks therapy to address his phobia about flying. Every time he gets near an airport, he breaks out in a sweat, and if he tries to board an airplane, he has a full-blown panic attack. The MOST effective treatment option is:

A. Exposure therapy

B. Cognitive behavioral therapy

C. Referring the client to a psychiatrist for anti-anxiety medication he can take when he has to fly.

D. Psychodynamic psychotherapy

How do you answer?

Let's take the answers one by one, from the bottom.

D. Psychodynamic psychotherapy involves looking into one's past experiences and conflicts to resolve a current situation. It's a long-term therapy and often not practical for the treatment of phobias. There's also little clinical research on its efficacy in cases of phobia.

C. Medication is a temporary solution at best. It may get the client through one or two instances when he has to fly, but over the long term, it makes more sense to work on extinguishing the irrational fear.

B. Cognitive behavioral therapy is evidence-based treatment for anxieties and phobias. It's a good answer. But is it the best offered answer here? The best answer is the more specific answer. It is...

D. Exposure therapy, in which the client is gradually exposed to more intense fear-inducing stimuli (discussion, pictures, a visit to an aiport, and, in time, a flying). Exposure therapy--which sits under the wide umbrella that makes up all CBT treatments--is the most effective of the treatments listed.

And you have your answer!

For LOTS more questions from the DSM and all corners of the ASWB exam outline, sign up for complete, 170-question SWTP practice.

Happy studying and good luck with the exam.