🧠 Name That Diagnosis
A 34-year-old reports excessive worry about work, finances, family, and health on most days for the past eight months. They find the worry difficult to control and report restlessness, fatigue, muscle tension, and poor sleep.
What is the most likely diagnosis?
A. Panic Disorder
B. Generalized Anxiety Disorder
C. Adjustment Disorder with Anxiety
D. OCD
Answer: B. Generalized Anxiety Disorder
Why: The worry involves multiple areas, is difficult to control, has persisted longer than six months, and is accompanied by associated anxiety symptoms.
A client fears social situations because they believe others will judge or embarrass them. They avoid parties, presentations, and meeting unfamiliar people.
What is the best differential pair?
A. Social Anxiety Disorder vs. Specific Phobia
B. OCD vs. PTSD
C. MDD vs. Bipolar I Disorder
D. GAD vs. Panic Disorder
Answer: A
Key distinction: Social anxiety centers on possible scrutiny or negative evaluation by others.
A client says, “I feel anxious all the time.”
What information is most important next?
A. Favorite coping strategy
B. Duration, triggers, symptoms, severity, and functional impact
C. Relationship status
D. Whether their parents have anxiety
Answer: B
Duration, triggers, symptoms, severity, and functional impact
A client reports feeling depressed. During assessment they state, “Sometimes I wonder if everyone would be better off without me.”
What is the best next step?
A. Diagnose MDD
B. Change the subject to avoid increasing suicidal thoughts
C. Conduct a suicide risk assessment
D. Immediately terminate treatment
Answer: C
Conduct a suicide risk assessment
Initial case: A client reports anxiety, insomnia, difficulty concentrating, and irritability.
Most likely?
A. GAD
B. Adjustment Disorder with Anxiety
C. Panic Disorder
D. More information needed
PLOT TWIST: Symptoms began three weeks ago immediately after the client was unexpectedly laid off.
Initial best answer: D
PLOT TWIST: Symptoms began three weeks ago immediately after the client was unexpectedly laid off.
Now?
Answer: B may become more likely, assuming the full criteria and clinically significant distress/impairment are established and another disorder does not better explain the presentation.
A client has experienced recurrent, unexpected panic attacks for several months. They now spend significant time worrying about having another attack and avoid places where they fear an attack could occur.
A. Generalized Anxiety Disorder
B. Specific Phobia
C. Panic Disorder
D. OCD
Answer: C. Panic Disorder
Why: Recurrent unexpected panic attacks followed by persistent concern or maladaptive behavioral changes point toward Panic Disorder.
A client has been depressed since their spouse died three weeks ago. They cry frequently, miss their spouse, experience waves of sadness triggered by reminders, but continue to experience moments of positive emotion and connection with family.
Which requires the most careful differentiation?
A. Bipolar I Disorder vs. Cyclothymia
B. Acute Stress Disorder vs. PTSD
C. Acute grief vs. Major Depressive Disorder
D. OCD vs. GAD
Answer: C
Why: Bereavement can involve significant distress without automatically indicating MDD. The clinician should assess the entire depressive syndrome, functioning, safety, and the nature and persistence of symptoms.
A client reports depressed mood and fatigue for the past week.
What prevents you from confidently diagnosing MDD?
A. They haven't started therapy
B. The therapist hasn't spoken with their family
C. Duration and the presence of sufficient depressive symptoms have not been established
D. Nothing; depressed mood indicates MDD
Answer: C
Duration and the presence of sufficient depressive symptoms have not been established
A client presents with panic-like symptoms including chest pain, shortness of breath, dizziness, and a racing heart. They have never received medical evaluation for these symptoms.
What should the therapist consider?
A. Panic Disorder is confirmed
B. Possible medical explanations should be assessed and appropriate medical evaluation considered
C. The symptoms are definitely psychological
D. Exposure therapy should begin immediately
Answer: B
Possible medical explanations should be assessed and appropriate medical evaluation considered
Initial case: A client reports depressed mood, fatigue, poor concentration, and social withdrawal.
A. MDD
B. Adjustment Disorder
C. Persistent Depressive Disorder
D. More information needed
PLOT TWIST: The symptoms have been present nearly every day for three years.
Answer initially: D
PLOT TWIST: The symptoms have been present nearly every day for three years.
Now what becomes important?
Answer: Persistent Depressive Disorder should enter the differential, but duration alone is insufficient; assess the full symptom pattern and whether major depressive episodes occurred.
A client reports depressed mood, loss of interest, fatigue, difficulty concentrating, insomnia, feelings of worthlessness, and decreased appetite nearly every day for the past month. The symptoms are affecting work and relationships.
A. Major Depressive Disorder
B. Persistent Depressive Disorder
C. Adjustment Disorder with Depressed Mood
D. Cyclothymic Disorder
Answer: A. Major Depressive Disorder
Why: The client presents with a depressive syndrome lasting longer than two weeks with significant impairment.
A client reports difficulty concentrating, restlessness, procrastination, and trouble completing tasks. They believe they have ADHD after watching videos online. They also report sleeping four hours per night and experiencing significant anxiety.
What is the best response?
A. Diagnose ADHD
B. Diagnose GAD
C. Rule out ADHD because anxiety is present
D. Assess developmental history, symptom onset, functioning, anxiety, sleep, substances, and other possible explanations
Answer: D
Why: Concentration and executive-function difficulties are nonspecific. ADHD requires a developmental pattern, and other causes need consideration.
A 30-year-old reports difficulty concentrating, disorganization, losing things, and procrastination.
Before diagnosing ADHD, what information is especially important?
A. Whether they like their job
B. Evidence of symptoms beginning during childhood and occurring across settings, along with differential assessment
C. Whether their parents have ADHD
D. Their IQ
Answer: B
Evidence of symptoms beginning during childhood and occurring across settings, along with differential assessment
A client reports depression but also describes periods of decreased need for sleep, elevated mood, impulsivity, and increased energy.
Before conceptualizing the presentation as unipolar depression, the therapist should:
A. Assess for past manic and hypomanic episodes
B. Diagnose MDD
C. Diagnose ADHD
D. Focus only on current depressive symptoms
Answer: A
Assess for past manic and hypomanic episodes
Initial case: A client reports anxiety, racing thoughts, insomnia, and difficulty concentrating.
A. GAD
B. ADHD
C. Bipolar Disorder
D. More assessment needed
PLOT TWIST: They started a stimulant medication shortly before the symptoms began.
Answer: D
PLOT TWIST: They started a stimulant medication shortly before the symptoms began.
What changes?
Answer: Medication/substance-induced symptoms become an important differential.
Teaching point: Always consider whether symptoms began after a medication or substance change.
A client reports intrusive thoughts that their hands are contaminated after touching everyday objects. They recognize the fear is excessive but wash their hands repeatedly, sometimes for several hours per day, to decrease their anxiety.
A. Illness Anxiety Disorder
B. Specific Phobia
C. Generalized Anxiety Disorder
D. Obsessive-Compulsive Disorder
Answer: D. Obsessive-Compulsive Disorder
Why: Intrusive contamination obsessions accompanied by repetitive compulsions intended to reduce distress strongly support OCD.
A client repeatedly checks that the stove is off because they experience intrusive thoughts that their house will burn down. Another client checks the stove because they frequently forget whether they turned it off and want reassurance.
What is particularly important for distinguishing OCD?
A. Whether the client owns a stove
B. The function of the checking and presence of obsessions/compulsions
C. Whether checking occurs at night
D. Whether the client has anxiety
Answer: B
Why: Similar behaviors can serve different functions. OCD involves obsessions and/or compulsions rather than checking alone.
A client reports hearing a voice when nobody is around.
What should the therapist do?
A. Diagnose schizophrenia
B. Immediately diagnose a psychotic disorder
C. Conduct further assessment of the experience and relevant differential factors
D. Ignore it unless it happens again
Answer: C
Ask about: content, frequency, onset, distress, command content, safety, substance use, medications, sleep, medical conditions, trauma, mood symptoms, cultural context, and other psychotic symptoms.
A client presents with anxiety, insomnia, irritability, and difficulty concentrating. They report drinking several energy drinks daily, using cannabis nightly, and recently increasing another substance.
What should happen before finalizing the diagnosis?
A. Diagnose GAD
B. Ignore substance use because anxiety is psychological
C. Assess the timing and relationship between substances and symptoms
D. Diagnose Substance Use Disorder
Answer: C
Assess the timing and relationship between substances and symptoms
Initial case: A client presents with depression, hopelessness, insomnia, and low motivation.
A. MDD
B. Bipolar II Disorder
C. Adjustment Disorder
D. Persistent Depressive Disorder
PLOT TWIST: The client then reports a previous period of elevated mood, decreased need for sleep, rapid speech, increased goal-directed activity, and impulsive behavior.
The team chooses.
PLOT TWIST: The client then reports a previous period of elevated mood, decreased need for sleep, rapid speech, increased goal-directed activity, and impulsive behavior.
What should the therapist do?
Answer: Assess carefully for a history of mania or hypomania before diagnosing unipolar depression.
A client reports recurrent depressive episodes. During assessment, they describe a previous four-day period of unusually elevated mood, increased confidence, decreased need for sleep, rapid speech, increased goal-directed activity, and impulsive spending. The episode was noticeable to others but did not cause marked impairment or require hospitalization.
A. Major Depressive Disorder
B. Bipolar I Disorder
C. Bipolar II Disorder
D. Cyclothymic Disorder
Answer: C. Bipolar II Disorder
Why: The history suggests a hypomanic episode plus major depressive episodes, without evidence of a manic episode.
After a serious car accident two months ago, a client reports nightmares, intrusive memories, avoiding driving, hypervigilance, exaggerated startle, and difficulty sleeping.
Which diagnosis should be strongly considered?
A. Adjustment Disorder with Anxiety
B. PTSD
C. Acute Stress Disorder
D. GAD
Answer: B. PTSD
Why: There is trauma exposure followed by intrusion, avoidance, arousal symptoms, and duration beyond one month. Full criteria would still need assessment.
A client reports sleeping three hours per night, feeling unusually energetic, talking rapidly, starting several businesses, and spending $8,000 unexpectedly.
What piece of information is particularly important for differentiating mania from hypomania?
A. Whether they enjoy being productive
B. Whether they drink coffee
C. Severity/functional impairment, hospitalization, or psychotic features, along with duration
D. Whether they have previously been diagnosed with depression
Answer: C
Severity/functional impairment, hospitalization, or psychotic features, along with duration
A client reports periods of lost time, feeling detached from their body, nightmares, panic symptoms, and a significant trauma history.
What is the best approach?
A. Immediately diagnose Dissociative Identity Disorder
B. Diagnose PTSD because trauma is present
C. Conduct a broader trauma and dissociation assessment while considering other explanations
D. Diagnose Panic Disorder
Answer: C
Teaching point: Complex presentations often require additional assessment rather than immediate diagnostic certainty.
A 38-year-old presents with irritability, insomnia, difficulty concentrating, hypervigilance, avoidance of social activities, and increased alcohol use. Symptoms began several months ago.
Which diagnosis best explains the presentation?
A. GAD
B. PTSD
C. MDD
D. Adjustment Disorder
PLOT TWIST: Six months ago, the client witnessed a coworker die in a workplace accident. They experience unwanted memories of the event, nightmares, avoid the location where it occurred, feel detached from others, and remain constantly alert for danger.
DOUBLE PLOT TWIST: The client reports: “I drink six or seven drinks every night because it's the only way I can sleep.”
PLOT TWIST: B. PTSD, assuming the full diagnostic criteria are established.
Does this change the PTSD diagnosis?
DOUBLE PLOT TWIST: Not necessarily. It creates an additional area requiring assessment. The therapist should evaluate the alcohol use, its function, consequences, pattern, and whether a co-occurring Alcohol Use Disorder may be present rather than assuming one diagnosis explains everything.