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DSM5-TR: Prolonged Grief Disorder

dsm5trThe text revision for DSM5 is the now the diagnostic book of record for the APA…and for the ASWB. We've detailed some of the changes in earlier posts. The changes between regular 5 and 5-TR are many, but easy to miss. One big change stands out and it worth some extra time to get familiar with before stepping up to the the social work licensing exam: the reworking of extended grief into prolonged grief disorder. Here's the full criteria via Psychiatry Online.


Diagnostic Criteria for Prolonged Grief Disorder (F43.8)

  1. The death, at least 12 months ago, of a person who was close to the bereaved individual (for children and adolescents, at least 6 months ago).

  2. Since the death, the development of a persistent grief response characterized by one or both of the following symptoms, which have been present most days to a clinically significant degree. In addition, the symptom(s) has occurred nearly every day for at least the last month:

    1. Intense yearning/longing for the deceased person.

    2. Preoccupation with thoughts or memories of the deceased person (in children and adolescents, preoccupation may focus on the circumstances of the death).

  3. Since the death, at least three of the following symptoms have been present most days to a clinically significant degree. In addition, the symptoms have occurred nearly every day for at least the last month:

    1. Identity disruption (e.g., feeling as though part of oneself has died) since the death.

    2. Marked sense of disbelief about the death.

    3. Avoidance of reminders that the person is dead (in children and adolescents, may be characterized by efforts to avoid reminders).

    4. Intense emotional pain (e.g., anger, bitterness, sorrow) related to the death.

    5. Difficulty reintegrating into one's relationships and activities after the death (e.g., problems engaging with friends, pursuing interests, or planning for the future).

    6. Emotional numbness (absence or marked reduction of emotional experience) as a result of the death.

    7. Feeling that life is meaningless as a result of the death.

    8. Intense loneliness as a result of the death.

  4. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

  5. The duration and severity of the bereavement reaction clearly exceed expected social, cultural, or religious norms for the individual's culture and context.

  6. The symptoms are not better explained by another mental disorder, such as major depressive disorder or posttraumatic stress disorder, and are not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.

Remember, the social work licensing exam is meant for beginning social workers. You are being tested for starter knowledge, skills, and abilities-primarily the KSAs that might prevent you from doing harm as you put your license to use. Even for the clinical exam, you don't have to memorize every line of every diagnosis. But you should have a working familiarity with the diagnoses that come up most regularly (you know the ones).

A great way to get that knowledge locked in and get familiar with the test itself: practice tests. We've got lots of 'em. If you haven't already, create an account to get started.

Happy studying and good luck on the exam!

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DSM-5-TR Fact Sheets

detailsThe 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:

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.

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Free Practice Question: DSM-5-TR

grieving manIf 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!

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Welcome to DSM-5-TR

dsm-5-trWithout 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!

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Free Social Work Exam Question: Encopresis

mountain toilet

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!

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