ED and the Social Work Exam

sexual dysfunctionLet's revisit the DSM for today's free practice question. Flipping randomly into the purple book, just as an exam item writer might, we land on the Sexual Dysfunctions chapter. Here are the disorders contained therein:

Delayed Ejaculation (what it sounds like)

Erectile Disorder (ditto--difficulty in obtaining or maintaining an erection during sexual activity)

Female Orgasmic Disorder (delay, infrequency, absence or reduced intensity of orgasm)

Female Sexual Interest/Arousal Disorder (what it sounds like)

Genito-Pelvic Pain/Penetration Disorder (persistent or recurrent difficulties with vaginal penetration)

Male Hypoactive Sexual Desire Disorder (More than six months of deficient or absent sexual/erotic thoughts and desire)

Premature (Early) Ejaculation (within 1 minute of penetration and before individual wishes it)

Substance/Medication-Induced Sexual Dysfunction (what it sounds like again)

Here's a sample question:

A client reports difficulty maintaining an erection when having sex with his wife ever since their honeymoon ended, a year ago. The problem occurs during what he describes as "vanilla" sex. As he reports details, the client seems fairly irritated, but not especially haunted by the issue. What set of specifiers is MOST appropriate to add to the diagnosis of erectile disorder:

A. Lifelong, situational, mild

B. Acquired, situational, mild

C. Lifelong, generalized, mild

D. Acquired, generalized, mild

What do you say?

This is one of those questions where you just need to know some definitions--or be able to suss them out with a little common sense. Here are the specifiers for erectile disorder:

Lifelong (present since the individual became sexually active)

Acquired (present after a period of relatively normal sexual function)

While we don't have details about the client's honeymoon or pre-marital sex life, we have to go with the contents of the question. Acquired is the better fit here. Hey, look, two answers already eliminated!

Generalized (not limited to certain types of stimulation, situations, or partners)

Situational (only occurs with certain types of stimulation, etc.)

The client's problems occur only during "vanilla" sex. We're quickly narrowed down to the answer. But we'll keep going. Mild, moderate, and severe are measures of the client's distress. Those specifiers don't describe symptoms, but the client's reaction to the symptoms. This client is irritated--a low level of distress. "Obsessed" or "unable to function" would be indicators of a more moderate or severe level of distress.

Also note, the problem has to have persisted for at least six months for a diagnosis of erectile disorder to be made.

TL;DR: Our answer is B, acquired, situational, mild.

For more reading about sexual dysfunctions in this chapter and beyond, take a look at:

And, of course, your DSM-5 is a friend as you prep DSM-5 questions--especially the desk reference edition.

For full-length practice tests covering the wide range of questions that can show up on the social work licensing exam (not just DSM!), sign up and create your exam bundle!

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Trauma- and Stressor-Related Disorders and the Social Work Exam

acute stressLet's all keep going. Here's another free practice question to help you get prepared to pass the ASWB exam.This time, we're digging into the Trauma- and Stressor-Related Disorders chapter of the DSM. The disorders included there are:

Reactive Attachment Disorder (inhibited, withdrawn behavior toward adult caregivers + emotional disturbance + history of neglect)

Disinhibited Social Engagement Disorder (child actively approaches and interacts with unfamiliar adults)

Posttraumatic Stress Disorder (Intrusion symptoms and avoidance following exposure to trauma)

Acute Stress Disorder (Symptoms following between three days to one month of exposure to trauma)

Adjustment Disorders (Emotional or behavioral symptoms in response to stressor, within 3 months of onset)

Got it? Here's a question:

A woman tells a social worker that she's been "a wreck" ever since being sexually assaulted a few weeks ago. She says she's been irritable, lashing out angrily for no apparent reason. She reports being hypervigilant and having difficulty concentrating. In which of the following categories do these symptoms belong?

A. Intrusion Symptoms

B. Negative Mood

C. Dissociative Symptoms

D. Arousal Symptoms

What do you say?

Not sure? Well, here are each of those categories spelled out.

Intrusion symptoms:  Recurrent, involuntary, and intrusive distressing memories; recurrent distressing dreams; flashbacks; distress in response to internal or external cues that symbolize or resemble an aspect of the traumatic event/s.

Negative Mood: Persistent inability to experience positive emotions.

Dissociative Symptoms: An altered sense of reality of one's surroundings and one's self; an inability to recall an important aspect of the traumatic event/s.

Arousal Symptoms: Sleep disturbance; Irritable behavior and angry outbursts; hypervigilance; problems with concentration; exaggerated startle response.

So, you have your answer! (It's D, right?)

One category of symptoms didn't make it into the A-D list. Avoidance Symptoms: Efforts to avoid distressing memories, thoughts, or feelings associated with the event/s; efforts to avoid external reminders of the event/s.

Another quick question:

The woman is reporting these symptoms within three months of the sexual assault, so the MOST likely diagnosis for her would be _________________.

PTSD or acute stress disorder?

Unless you skipped the info up top, you know the answer. Acute stress disorder is diagnosed between three days and one month since a trauma. For PTSD to be diagnosed, at least a month has to have passed since the trauma occurred. The best diagnosis for the woman is acute stress disorder.

There you have it. You're ever-more ready to pass the social work licensing exam. For more questions from the DSM and all parts of the content outline, sign up for SWTP's full-length practice tests. Each test has thorough rationales and links for additional study. Get started now! Good luck!

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Narcissistic Personality Disorder and the Social Work Exam

selfiePreparing for the ASWB exam? Here's a free practice question, this one from the Personality Disorders chapter of the DSM. But first, can you define all the personality disorders. Do you know which cluster each belongs in?

Here they all are:

Cluster A: Paranoid Personality Disorder, Schizoid Personality Disorder, Schizotypal Personality Disorder

Cluster B: Antisocial Personality Disorder, Borderline Personality Disorder, Histrionic Personality Disorder, Narcissistic Personality Disorder

Cluster C: Avoidant Personality Disorder, Dependent Personality Disorder, Obsessive-Compulsive Personality Disorder

Other Personality Disorders: Personality Change Due to Another Medical Condition, Other Specified Personality Disorder, Unspecified Personality Disorder

For details on all of these, take a look at PsychCentral's summaries. But first, let's zoom in on Cluster B and a recently much-discussed diagnosis: NPD.

A woman tells a social worker that she believes her husband, a successful businessman, is "a clinical narcissist." She says he's "completely obsessed with himself." Which of the following can the social worker tell the woman is a common symptom of narcissistic personality disorder?

A. Discomfort in situations in which he or she is not the center of attention.

B. Is unwilling to recognize or identify with the feelings or needs of others.

C. Inappropriate, intense anger or difficulty controlling anger.

D. Repeated lying, use of aliases, or conning others for personal profit or pleasure.

What do you say?

If you know the cluster B diagnoses in some detail, the answer comes much more easily. All but one of the listed symptoms come from other cluster B disorders. Let's take them one at a time:

A. sounds a lot like NPD. Needing to be the center of attention. But it's not. It's a criteria for histrionic personality disorder. Wait, really? Yep. Histrionic personality disorder is characterized by "a pervasive pattern of excessive emotionality and attention seeking..." It's attention-focused, not self-importance focused.

D., repeated lying for profit or pleasure, sounds like NPD too, but, this one is a criterion for antisocial personality disorder ("A pervasive pattern of disregard for and violation of the rights of others..."). NPD can include taking advantage of others, but not necessarily outright, repeated lying, conning, or using aliases.

C., anger problems, sounds a little like NPD too. But it's more indicative of BPD ("a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity")--and that's where that criterion comes form.

Which leaves...the correct answer! B., lack of empathy.  For diagnosis of NPD, five of nine possible criteria have to be exhibited. Here are the full nine:

1. Grandiose sense of self-importance.

2. Preoccupied with fantasies of success, power, brilliance...

3. Believes that he or she is "special" and can only be understood by other special/high-status people.

4. Requires excessive admiration.

5. Sense of entitlement.

6. Interpersonally exploitative.

7. Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others.

8. Often envious of others or believes others are envious of him or her.

9. Shows arrogant, haughty behaviors or attitudes.

That's NPD. You've no doubt encountered it at work and elsewhere. Maybe you'll encounter it on the social work licensing exam. If you do, you'll be ready. Congratulations in advance!

For more about narcissistic personality disorder, try:

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PTSD and the Social Work Exam

nightmareLet's hop to the Trauma- and Stressor-Related Disorders chapter of the DSM. It's stressful out there, so questions from this chapter may seem especially pertinent. Today's free social work licensing exam prep is about posttraumatic stress disorder (PTSD):

A client  reports intrusive distressing memories and recurring nightmares for the last month, ever since hearing about the sexual assault of a close friend. The client says she has had trouble talking to the friend since the reported events--"It's just too disturbing." When diagnosing the client, the social worker should keep in mind:

A. PTSD can only be diagnosed with three or more intrusion symptoms present (e.g., memories, dreams, flashbacks).

B. The diagnosis cannot be PTSD because the trauma was only reported, not experienced or witnessed.

C. PTSD can only be diagnosed when avoidance of trauma-associated stimuli is present (e.g., not talking to the friend).

D. PTSD can only be diagnosed after symptoms have been present for three months.

What do you say?

Items like this take a fair amount of focus and close reading (in addition to familiarity with PTSD criteria). But that's exactly what you're practicing for, right?

Let's eliminate the answers one by one.

A...isn't right. PTSD requires the presence of one or more intrusion symptoms, not three or more.

B...isn't right. PTSD can be diagnosed whether the trauma (exposure to actual or threatened death, serious injury, or sexual violence) was experienced, witnessed, or involved close family or a close friend. Repeated or extreme exposure to trauma (as experienced by EMTs, workers) also counts.

D...isn't right. PTSD symptoms need to be present for one month, not three.

That leaves one answer, the correct answer, answer C! PTSD can only be diagnosed when the avoidance of trauma-associated stimuli is present, and, in this vignette it's present. The client reports difficulty talking to the friend.

You may have had other diagnoses in mind, but since they weren't offered, they can't be the right answer, no matter how correct they are.

All make sense? If not, let us know!

With each practice question, you're more and more prepped for the real thing--the ASWB exam. Good luck!

For more details about PTSD criteria and symptoms, take a look at these sites:

For more questions about PTSD and lots, lots more, try SWTP's full-length, real-time practice tests!

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Free Practice Question: Schizoaffective Disorder

schizoaffective disorderLet's do one more free practice question from the psychotic disorders section of the DSM. We'll forego the usual vignette style of our practice questions. Not all questions on the ASWB exam are vignettes. Sometimes, they're in a simpler form, like this:

Which of the following BEST describes the criteria for schizoaffective disorder?

A. Hallucinations or delusions for two or more weeks in the absence of a major mood episode.

B. An uninterrupted period of illness during which there is a major mood episode concurrent with psychotic symptoms.

C. Psychotic symptoms concurrent with a mood disorder not attributable to the effects of a substance.

D. Depression concurrent with depressive mood along with two weeks of hallucinations or delusions without a major mood episode.

What's your answer?

This is really a (fairly irritating) reading question as much as it is a diagnostic one. You're tasked with remembering the criteria for schizoaffective disorder and then tracking all of this twisted language. You might consider simplifying the long answers in your mind (or on your scratch pad) to something like this:

A. 2 weeks psychotic sx; no mood

B. Psychotic + mood

C. Psychotic + mood, no substance

D. Mood + psychotic & 2 weeks psychotic no mood.

When you put it that way, the answer (assuming you know what schizoaffective disorder is) jumps right out at you. Schizoaffective disorder requires psychotic symptoms along with mood symptoms and independent of mood symptoms. Psychotic symptoms with no mood is something else (e.g., schizophrenia or delusional disorder). Psychotic symptoms that occur only during a mood episode is something else again (e.g., bipolar I disorder or MDD with psychotic features).

Even if you didn't know any of that, you could rule out answer A--schizoaffective disorder is going to have something to do with affect, aka mood. On to the other answers. Answers B and C are essentially the same, with one adding the substance rule-out. But neither fully describes schizoaffective disorder. That leaves one answer, which, though perhaps imperfect,  is the best we've got. The correct answer is D!

To save you some clicking around, here are the criteria for schizoaffective disorder for your quick review:

A. An uninterrupted period of illness during which there is a major mood episode (major depressive or manic) concurrent with Criterion A of schizophrenia.

B. Delusions or hallucinations for two or more weeks in the absence of a major mood episode (depressive or manic) during the lifetime duration of the illness.

C. Symptoms that meet criteria for major mood episode are present for the majority of the total duration of the active and residual portions of the illness.

D. The disturbance is not attributable to the effects of a substance or another medical condition.

Find lots more about schizoaffective disorder here:

And for more questions about schizoaffective disorder, the DSM, and lots, lots, lots, lots more, sign up for SWTP's full-length practice tests!

Good luck on the exam!

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