Diagnostic Foundations

Substance-Related and Addictive Disorders

Psychopathology in Practice (Disorders & Treatment)

Symptom Presentations and Disorder Features

Neurodevelopment and Cognitive Disorders

100

Which of the following is most true regarding the diagnosis of a client?

A. If the diagnosis is accurate, it should remain stable throughout treatment

B. It is crucial to establish a formal diagnosis to create the most effective treatment plan

C. It can change during an episode of care as more information emerges

D. It is advised to create a working diagnosis before the formal assessment and then update this diagnosis as needed


Correct answer: C. It can change during an episode of care as more information emerges 

The diagnosis of a client is a clinical matter of great importance, as it has implications that reach far beyond a single episode of care. A diagnosis can be a stigmatizing label or a helpful shorthand to capture the presenting issues of a client. In most cases, but not all, it is consistent with a formal system such as the DSM-5. Diagnoses can be fluid, and it is not uncommon for diagnoses to change if and when new information emerges.

If treatment is successful, the diagnosis may be eliminated altogether.

It is not always necessary to establish a formal diagnosis when creating a treatment plan, especially if you need more information or the client does not meet the criteria for any diagnosis.

The working diagnosis is generally made after the formal assessment - not before.

Reference:

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision (DSM-5-TR) (ISBN: 978-0890425763). Pg 5, 21, 23.

National Counselor Examination and CPCE Study Guide (ISBN: 978-0964837799). Pg 45.


100

What would be the least common diagnostic factor found among those diagnosed with a substance use issue?

A. Suicidal impulses

B. Anxiety

C. Social isolation

D. Psychosis


Correct answer: D. Psychosis 

People diagnosed with substance use issues come from all backgrounds, cultures, and comorbidities. Many common factors are seen among those diagnosed with substance use issues, such as a tendency toward social isolation, suicidal impulses, and anxiety.

Psychosis is less diagnostic of substance use itself, although psychosis can be a result of use and is present in those with a comorbid thought disorder.

Reference:

National Counselor Examination and CPCE Study Guide, 9th Edition. Pg 125.

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision (DSM-5-TR) (ISBN: 978-0890425763). Pg 127, 129.

100

Which of the following is not part of the schizophrenia spectrum?

A. Brief psychotic disorder

B. Schizophrenia

C. Schizoaffective disorder

D. Dissociative identity disorder

Correct answer: D. Dissociative identity disorder 

The section on the schizophrenia spectrum and other disorders in the DSM-5 includes disorders that are mainly characterized by psychotic symptoms, although the nature, duration, and frequency of these behaviors are variable. Brief psychotic disorder, schizophrenia, and schizoaffective disorder are all part of this category.

Dissociative identity disorder is classified with dissociative disorders in the DSM-5; as opposed to schizophrenia, these conditions are more trauma-inflicted than psychotic.

Reference:

National Counselor Examination and CPCE Study Guide, 9th Edition. Pg 54.

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision (DSM-5-TR) (ISBN: 978-0890425763). Pg 329-330, 336.

100

Which of the following is characteristic of somatic symptom disorders?

A. Physical complaints with little to no demonstrable physical evidence that they exist

B. Physical complaints that seem to arise from traumatic memory

C. Physical complaints with abundant physical evidence that they exist

D. Physical complaints that result in a psychotic presentation


Correct answer: A. Physical complaints with little to no demonstrable physical evidence that they exist 

A section in the DSM-5 is devoted to somatic symptoms and other disorders. These disorders involve physical complaints with little to no demonstrable physical evidence that they exist. To avoid stigma, hypochondriasis as a diagnosis has been eliminated, but the interventions for these disorders will most likely not be medical.

In these cases, the physical complaint may or may not be tied to traumatic memory and would likely not represent a break from reality.

Reference:

National Counselor Examination and CPCE Study Guide, 9th Edition. Pg 55-56.

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision (DSM-5-TR) (ISBN: 978-0890425763). Pg 349, 351, 360.

100

Which of the following is true about the difference between neurodevelopmental and neurocognitive disorders?

A. Neurodevelopmental disorders typically are diagnosed by physicians, while neurocognitive disorders are typically diagnosed by counselors

B. Neurodevelopmental disorders typically begin in childhood, while neurocognitive disorders can be more prevalent later

C. Neurodevelopmental disorders typically begin in later life, while neurocognitive disorders can be more prevalent in childhood

D. Neurodevelopmental disorders typically are diagnosed by counselors, while neurocognitive disorders are typically diagnosed by physicians

Correct answer: B. Neurodevelopmental disorders typically begin in childhood, while neurocognitive disorders can be more prevalent later

Neurodevelopmental and neurocognitive disorders have in common that they may be diagnosed by a physician, and the formal diagnosis will most likely call for a medical professional. Neurodevelopmental disorders typically begin and are diagnosed in childhood, while neurocognitive disorders can be more observable and more prevalent later in life.

Reference:

National Counselor Examination and CPCE Study Guide, 9th Edition. Pg 54.

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision (DSM-5-TR) (ISBN: 978-0890425763). Pg 35-36, 687.

200

Which of the following is the purpose of a V Code in the DSM-5?

A. Social factors related to a client's presentation

B. Comorbid conditions a client has

C. Differential aspects of the primary diagnosis

D. Contextual factors related to a client's presentation


Correct answer: D. Contextual factors related to a client's presentation 

The diagnostic structure in the DSM-5 is lacking in some respects. In many cases, the diagnosis given by the criteria in the DSM is not sufficiently descriptive of the contextual factors of a client's life, such as a client's worldview, social arrangements, and so on. These issues may also warrant clinical attention and are documented using V Codes.

A V Code is not specifically about social factors but can include other contextual issues. V Codes are not descriptive of comorbid conditions or differential aspects of a primary diagnosis, both of which would be captured in the diagnosis proper.

Reference:

National Counselor Examination and CPCE Study Guide, 9th Edition. Pg 47.

200

Which of the following is correct about substance-related and addictive disorders in the DSM-5?

A. The DSM-5 excludes a gambling disorder from the category of addictive disorders

B. Substance-related disorders are categorized separately from behavioral addictions without any overlap

C. Only substance intoxication and withdrawal are included; addictive behaviors are excluded

D. The DSM-5 combines substance abuse and substance dependence into a single disorder called substance-use disorder, with varying levels of severity


Correct answer: D. The DSM-5 combines substance abuse and substance dependence into a single disorder called substance-use disorder with varying levels of severity 

The DSM-5 merged substance abuse and dependence into one diagnosis called substance-use disorder, which is rated by severity (mild, moderate, severe).

Behavioral addictions, such as a gambling disorder, are included alongside substance-use disorders, reflecting recognition of addictive behaviors beyond substances.

Substance intoxication and withdrawal are part of the overall classification but not the entirety of substance-related disorders.

Gambling disorder is included under addictive disorders, so excluding it is inaccurate.

Reference:

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision (DSM-5-TR) (ISBN: 978-0890425763). Pg 543-544, 556.

National Counselor Examination and CPCE Study Guide (ISBN: 978-0964837799). Pg 51.

200

Which of the following medications would be most likely used to address psychosis?

A. Xanax

B. Abilify

C. Lithium

D. Paxil

Correct answer: B. Abilify

Ability (aripiprazole) is an antipsychotic often used to address psychosis and treat schizophrenia

Paxil would more likely be used to treat panic. Lithium is a standard frontline medication for bipolar disorder. Xanax is often used to treat anxiety.

Reference:

Encyclopedia of Counseling: Master Review and Tutorial for the National Counselor Examination, State Counseling Exams, and the Counselor Preparation Comprehensive Examination, 4th Edition. Pg 680.

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision (DSM-5-TR) (ISBN: 978-0890425763). Pg 121, 124, 134.

200

Which of the following is meant by an ego-dystonic symptom?

A. A symptom that the client is not aware of

B. A symptom that the client is aware of

C. A symptom that is not desired by the client

D. A symptom that the client can tolerate


Correct answer: C. A symptom that is not desired by the client 

In general, symptoms of mental illness can be divided into two areas based on the desire or lack of a desire on the part of the patient for the symptom. In other words, there are some symptoms that are tolerable for a client and some that are not. An ego-dystonic symptom is one that the client does not desire and cannot tolerate; an ego-syntonic symptom is one that the client can tolerate and may actually desire.

The term does not involve awareness of a symptom.

Reference:

National Counselor Examination and CPCE Study Guide, 9th Edition. Pg 42-43.

200

How is delirium classified in the DSM-5?

A. As a neurocognitive disorder

B. As a dissociative disorder

C. As a psychotic disorder

D. As a neurodevelopmental disorder

Correct answer: D. As a neurocognitive disorder

Delirium, a state of confusion and changed mental ability, is classified in the DSM-5 under neurocognitive disorders, alongside Alzheimer's disease and Parkinson's disease.

Reference:

National Counselor Examination and CPCE Study Guide, 9th Edition. Pg 54.

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision (DSM-5-TR) (ISBN: 978-0890425763). Pg 667, 672, 674.

300

Can a counselor refuse to make a diagnosis?

A. It depends on state law

B. No, under no circumstances

C. Yes, if the client is a minor

D. Yes, if they believe it will cause harm

Correct answer: D. Yes, if they believe it will cause harm

The ethical standard of diagnosis established by the ACA suggests that a counselor can choose not to make a diagnosis if they believe that it will cause harm to the client or someone else. This is not a matter of state law, although state law might have directives of its own. It is a professional standard. The client's age may or may not be a factor in a case.

Reference:

Encyclopedia of Counseling: Master Review and Tutorial for the National Counselor Examination, State Counseling Exams, and the Counselor Preparation Comprehensive Examination, 4th Edition. Pg 616.

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision (DSM-5-TR) (ISBN: 978-0890425763). Pg 22.

300

How are substance use disorders ranked for severity in the DSM-5?

A. Recurring, novel, mediated

B. Acute, pervasive, remission

C. Beginning, middle, end-stage

D. Mild, moderate, severe

Correct answer: D. Mild, moderate, severe 

The diagnostic category of substance-related and addictive disorders contains the 10 substance-specific disorders that have chiefly warranted clinical attention, from inhalant-related disorders to cannabis-related disorders, and so on. These diagnoses share a ranked severity based on the number of symptoms present, so a person's substance use problem is ranked as either mild, moderate, or severe.

The other choices do not represent the severity ranks of these disorders found in the DSM-5.

Reference:

National Counselor Examination and CPCE Study Guide, 9th Edition. Pg 51.

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision (DSM-5-TR) (ISBN: 978-0890425763). Pg 547, 550, 554.

300

About how many people diagnosed with anorexia and bulimia are female?

A. 50%

B. 90%

C. 75%

D. 35%

Correct answer: B. 90% 

Eating disorders such as anorexia and bulimia are diagnosed in women more than in men. In fact, about 90% of those who are diagnosed with these disorders are female. Although neurological explanations are being researched, many believe the reason for this disparity is a greater societal focus on the body shape of females, as well as females receiving more cues from their families about weight.

Reference:

Encyclopedia of Counseling: Master Review and Tutorial for the National Counselor Examination, State Counseling Exams, and the Counselor Preparation Comprehensive Examination, 4th Edition. Pg 605.

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision (DSM-5-TR) (ISBN: 978-0890425763). Pg 371, 389-390.

300

Which of the following is the least likely symptom of binge eating disorder?

A. A lack of established meal times

B. Stockpiling food to eat in secret

C. Purging of excessive food immediately after eating

D. A difference in eating behaviors when alone as opposed to being in a group

Correct answer: C. Purging of excessive food immediately after eating 

Binge eating disorder (BED) is characterized by behaviors and emotions related to excessive food intake. Its emotional symptoms are clustered around a person's feelings, such as shame or guilt, surrounding their eating habits. Its behavioral symptoms include different feeding behaviors while alone as opposed to being in a group setting, a lack of established meal times with continuous feeding throughout the day, and the stockpiling of food to eat in secret.

Generally, purging as a means of weight control (particularly after eating excessively) is not characteristic of BED.

Reference:

Encyclopedia of Counseling: Master Review and Tutorial for the National Counselor Examination, State Counseling Exams, and the Counselor Preparation Comprehensive Examination, 4th Edition. Pg 606.

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision (DSM-5-TR) (ISBN: 978-0890425763). Pg 388, 393, 395.

300

Which of the following would most likely not result in dissociative symptoms?

A. Developmental trauma

B. Chronic drug use

C. Traumatic brain injury

D. Developmental disability

Correct answer: D. Developmental disability

There is no specific research supporting a relationship between developmental disabilities and dissociation.

Dissociative disorders are classified in their own section in the DSM-5 and are characterized by the disconnection of typical connections, such as memory, self-concept, behavior, and motor control. Many factors, including trauma, traumatic brain injuries, and drug use, are associated with dissociation.

Reference:

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision (DSM-5-TR) (ISBN: 978-0890425763). Pg 313, 329, 335.

National Counselor Examination and CPCE Study Guide (ISBN: 978-0964837799). Pg 55.

400

Which of the following is the best definition of differential diagnosis?

A. A diagnosis that is presented at the end of an episode of care

B. A second diagnosis that is in the same diagnostic category as the first

C. A diagnosis arrived at from a clinical presentation that could indicate more than one diagnosis

D. A diagnosis that is different from the primary diagnosis of the client

Correct answer: C. A diagnosis arrived at from a clinical presentation that could indicate more than one diagnosis 

Differential diagnosis is the practice of carefully deciding which of several potentially appropriate diagnoses should be chosen and assigned to the client. The DSM-5 has a section in most diagnostic descriptions that is geared toward helping diagnosticians filter through competing diagnostic conclusions.

Differential diagnosis does not refer to a diagnosis in addition to or different from a primary diagnosis, nor is it necessarily in the same diagnostic category as a primary diagnosis.

Reference:

National Counselor Examination and CPCE Study Guide, 9th Edition. Pg 47.

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision (DSM-5-TR) (ISBN: 978-0890425763). Pg 5, 21-22.

400

In addition to themselves, about how many people on average are affected by a person with a substance use problem?

A. Ten

B. Two

C. Six

D. Four

Correct answer: D. Four 

Substance use issues are prevalent, difficult to isolate in individuals as opposed to families, and widespread in the culture. One fact that complicates the diagnosis of a substance use issue is that the clinical literature does not pay close attention to those outside the individual who manifests the main substance use issue.

People with substance use issues affect a constellation of people around them who are forced to deal with the use and its consequences. Research suggests that up to four people are affected by an individual's substance use.

Reference:

National Counselor Examination and CPCE Study Guide, 9th Edition. Pg 124.

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision (DSM-5-TR) (ISBN: 978-0890425763). Pg 547, 557.

400

Most antidepressants directly address which chemical?

A. Potassium

B. Dopamine

C. Sodium

D. Serotonin

Correct answer: D. Serotonin 

Serotonin, a neurotransmitter implicated in mood issues, is directly addressed by most frontline medications meant to treat depression. These are referred to as SSRIs (selective serotonin reuptake inhibitors), as their action is to keep more serotonin available.

These antidepressants do not directly address dopamine, sodium, or potassium.

Reference:

Encyclopedia of Counseling: Master Review and Tutorial for the National Counselor Examination, State Counseling Exams, and the Counselor Preparation Comprehensive Examination, 4th Edition. Pg 679.

400

Which of the following is diagnostic of somatic symptom disorder (SSD)?

A. Believing that spirits are causing neck pain

B. Seeking back pain medication

C. Excessive thoughts about shortness of breath

D. Manufacturing symptoms of a heart attack

Correct answer: C. Excessive thoughts about shortness of breath 

The main diagnostic feature of somatic symptom disorder (SSD) is not the symptom that is being reported or the one that causes the client the most concern. Rather, it is the excessive focus and thoughts about that symptom that form SSD. Thus, a person who is obsessed with their symptom of shortness of breath would appear to be suffering from SSD.

Seeking back pain medication is more likely to be characteristic of a substance use disorder. Manufacturing symptoms may indicate malingering, and a belief that spirits are causing neck pain may or may not be pathological, depending on the patient's culture and other considerations.

Reference:

Encyclopedia of Counseling: Master Review and Tutorial for the National Counselor Examination, State Counseling Exams, and the Counselor Preparation Comprehensive Examination, 4th Edition. Pg 603.

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision (DSM-5-TR) (ISBN: 978-0890425763). Pg 349-351.

400

Which of the following is not a type of dissociation?

A. Depersonalization

B. Delirium

C. Identity alteration

D. Derealization

Correct answer: B. Delirium 

The five types of dissociation are depersonalization, derealization, amnesia, identity confusion, and identity alteration. These are all classified under the dissociative disorders section of the DSM-5

Delirium is classified as a neurocognitive disorder.

Reference:

National Counselor Examination and CPCE Study Guide, 9th Edition. Pg 55.

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision (DSM-5-TR) (ISBN: 978-0890425763). Pg 329-330, 676.

500

To form a diagnosis of depression, which of the following must be considered first?

A. Potential mania

B. Potential physical causes

C. Potential long-term cyclothymia

D. Potential psychosis

Correct answer: B. Potential physical causes 

When forming any diagnosis, providers must rule out physical causes first and/or identify them as possible contributors to or exacerbators of the existing problem. This is especially true in depression, which can take many forms and have many causes that are temporary and long-standing in character.

It would be important to rule out psychosis and mania diagnostically, but this would happen after a physical cause is ruled out. Cyclothymia of any duration is a form of depressive disorder.

Reference:

National Counselor Examination and CPCE Study Guide, 9th Edition. Pg 48.

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision (DSM-5-TR) (ISBN: 978-0890425763). Pg 177, 205.

500

Which statement best captures the nature of comorbidities commonly seen in Obsessive-Compulsive Disorder (OCD)?

A. OCD frequently co-occurs with anxiety and mood disorders, affecting clinical presentation and treatment outcomes

B. Comorbid personality disorders are more predictive of functional impairment in OCD than mood disorders

C. Substance-use disorders are equally prevalent and central to managing OCD symptoms

D. OCD often co-occurs with anxiety and mood disorders but usually does not significantly affect treatment

Correct answer: A. OCD frequently co-occurs with anxiety and mood disorders, affecting clinical presentation and treatment outcomes 

Obsessive-Compulsive Disorder (OCD) commonly presents alongside anxiety and depressive disorders, which can complicate symptoms and influence the effectiveness of treatment.

While substance-use disorders can occur, they are less common and not usually the primary focus in OCD management.

Personality disorders may contribute to functional difficulties but are not as frequently observed or as impactful on treatment outcomes as mood and anxiety disorders

Although OCD often co-occurs with these disorders, the presence of comorbidities typically does affect treatment planning and prognosis, making the notion that it does not significantly impact treatment inaccurate.

Reference:

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision (DSM-5-TR) (ISBN: 978-0890425763). Pg 263-264, 271.

National Counselor Examination and CPCE Study Guide (ISBN: 978-0964837799). Pg 49.


500

When assessing anxiety disorders, which of the following best describes the role of physical symptoms in diagnosis?

A. Physical symptoms are often present but must be evaluated alongside psychological and behavioral symptoms for diagnosis

B. Physical symptoms can sometimes be related to anxiety, but often require further medical evaluation to rule out other causes

C. Physical symptoms are secondary to psychological symptoms and typically diminish with clinical intervention

D. If severe enough, physical symptoms alone are sufficient to diagnose an anxiety disorder

Correct answer: A. Physical symptoms are often present but must be evaluated alongside psychological and behavioral symptoms for diagnosis

Physical symptoms commonly accompany anxiety disorders, but they do not independently confirm a diagnosis. Evaluating these symptoms alongside emotional and behavioral signs ensures accuracy.

Physical symptoms may overlap with other medical conditions, so medical evaluations can be important to exclude other causes.

While physical symptoms often improve with treatment targeting anxiety, they do not simply diminish on their own with or without clinical intervention.

A balanced, comprehensive assessment is essential for correct diagnosis and effective treatment planning.

Reference:

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision (DSM-5-TR) (ISBN: 978-0890425763). Pg 216, 234, 242.

National Counselor Examination and CPCE Study Guide (ISBN: 978-0964837799). Pg 48-49.

500

What is the difference between hypochondriasis and somatic symptom disorder?

A. Somatic symptom disorder is more severe

B. They are the same disorder

C. Hypochondriasis is more severe

D. Somatic symptom disorder is outdated terminology

Correct answer: B. They are the same disorder 

The Diagnostic and Statistical Manual of Mental Disorders (DSM), now in its fifth edition, has historically made attempts to be responsive to how treatment language is used and perceived by both clinicians and the community. One example is the term hypochondriasis, which was discarded in the latest edition of the diagnostic manual largely due to the stigma and negativity associated with it. This category of disorders is now referred to under the umbrella of somatic symptom disorder.

Reference:

Encyclopedia of Counseling: Master Review and Tutorial for the National Counselor Examination, State Counseling Exams, and the Counselor Preparation Comprehensive Examination, 4th Edition. Pg 538.

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision (DSM-5-TR) (ISBN: 978-0890425763). Pg 351-353.

500

Meredith

Site: Footprints to Recovery. Population: Adults, Substance Use Disorders, General Mental Health, OP, IOP, & PC for SUD

Clients present with a wide range of diagnoses coming into treatment. Once they have met with their whole team, if needed, more diagnoses will be added to the client's chart, and treatment planning will begin. Many clients who come in only for substance use discover an underlying secondary diagnosis throughout their treatment. Weekly staff meetings are held to discuss clients' progress or changes within the program to keep everyone aware. Structurally, the site separates clients into groups based on whether their primary concern is substance use or mental health. While this supports targeted care, the majority of substance use clients also carry mental health concerns. This overlap shows why integrated treatment is so important. Connecting the study of psychopathology at my site shows the importance of recognizing symptoms to help guide treatment, build trust, and support relapse prevention.

Zala

Site: Creative Change Counseling. Population: Adults with substance use disorders and mental health conditions.

Most of the clients are diagnosed by an APN or an outside professional to confirm their diagnosis. However, once I am fully licensed, I will be able to contribute to diagnosing clients. Currently, being aware of specific symptoms and treatment options for clients is essential. As clinicians at my site, we review clients' charts periodically and create treatment plans according to their specific substance use diagnosis. IOP groups and individual sessions are offered at my site that require an understanding of each condition and how the symptoms that you may encounter in either of these settings. Co-occurring conditions that include mental health conditions and substance use disorders are a common theme when treating clients at my internship. We use the DSM-5-TR when creating treatment plans, discussing symptoms with clients, and in group supervision weekly when we discuss clients’ progress. The connection with psychopathology appears when reviewing symptoms and treatments based on the client’s primary and secondary diagnoses. Typically, each client has a substance-related diagnosis that is primary, followed by a secondary diagnosis such as depression, anxiety, bipolar disorder, etc.

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