- For 9 months, a person has excessive worry about many areas and muscle tension most days. Which disorder best matches?
Answer: Generalized anxiety disorder, because pervasive difficult-to-control worry with physical symptoms persists for at least six months across domains.
Generalized anxiety disorder (GAD) is defined by excessive anxiety and worry about multiple areas of life occurring more days than not for at least six months. The worry is difficult to control and associated with physical symptoms like muscle tension, restlessness, fatigue, concentration problems, irritability, or sleep disturbance. The 9-month duration and worry about 'many areas' with muscle tension perfectly match GAD criteria. Social anxiety disorder specifically involves fear of social evaluation, not general worries. OCD requires obsessions and compulsions, not just worry. Acute stress disorder lasts 3 days to 1 month after trauma exposure, not 9 months of general worry.
- After a serious accident, someone has nightmares, avoidance, and hypervigilance for 2 months. Which category applies?
Answer: Trauma- and stressor-related disorders, because PTSD includes intrusion, avoidance, negative mood/cognition changes, and arousal after trauma exposure.
The symptoms described - nightmares, avoidance, and hypervigilance following a serious accident lasting 2 months - are classic features of posttraumatic stress disorder (PTSD), which falls under trauma- and stressor-related disorders. PTSD requires exposure to actual or threatened death, serious injury, or sexual violence, followed by intrusion symptoms (nightmares), avoidance of trauma-related stimuli, negative alterations in mood/cognition, and alterations in arousal (hypervigilance). Symptoms must persist for more than one month. Anxiety disorders don't require a precipitating trauma. OCD involves obsessions and compulsions, not trauma-specific symptoms. Somatic symptom disorders focus on physical symptoms and health concerns, not trauma-related psychological symptoms.
- After a severe accident, someone has nightmares, avoidance, hypervigilance, and negative mood for over one month. Which diagnosis fits?
Answer: Posttraumatic Stress Disorder (PTSD), with trauma exposure plus intrusion, avoidance, negative mood/cognition, and arousal symptoms lasting over one month.
This scenario describes classic PTSD symptoms following trauma exposure. PTSD requires exposure to actual or threatened death, serious injury, or sexual violence, followed by four symptom clusters: intrusion symptoms (nightmares), avoidance, negative alterations in cognition and mood, and alterations in arousal and reactivity (hypervigilance). The duration criterion of over one month distinguishes PTSD from Acute Stress Disorder, which resolves within one month. The specific symptom constellation tied to trauma exposure differentiates it from Adjustment Disorder, which involves more general distress without the full PTSD symptom clusters. OCD involves obsessions and compulsions, not trauma-related intrusion and avoidance symptoms.
- A person reports hearing voices commenting on them and holds a fixed false belief for 3 months. Which disorder category is best?
Answer: Schizophrenia Spectrum and Other Psychotic Disorders, characterized by hallucinations and delusions with impaired reality testing.
The presence of auditory hallucinations (hearing voices) and fixed false beliefs (delusions) for 3 months clearly indicates a disorder from the Schizophrenia Spectrum and Other Psychotic Disorders category. These are the hallmark symptoms of psychotic disorders, representing a break from reality testing. The duration of 3 months suggests either Schizophreniform Disorder (1-6 months) or potentially Schizophrenia if symptoms persist beyond 6 months. Dissociative Identity Disorder involves distinct personality states and amnesia, not persistent psychotic symptoms. Depressive Disorders may occasionally include psychotic features, but psychosis is not the core defining feature. Obsessive-Compulsive Disorder involves intrusive thoughts that the person typically recognizes as excessive, unlike the fixed false beliefs (delusions) described here.
- A teen reports persistent inattention and hyperactivity across home and school for 8 months. Which disorder category fits best?
Answer: Neurodevelopmental disorders, because ADHD involves developmentally inappropriate inattention and/or hyperactivity-impulsivity across settings with functional impairment and persistence.
ADHD is classified under neurodevelopmental disorders in the DSM-5-TR because it involves developmentally inappropriate levels of inattention and/or hyperactivity-impulsivity that emerge during childhood. The key diagnostic criteria include symptoms present before age 12, persistence for at least 6 months, and impairment across multiple settings (home and school). The 8-month duration and cross-setting presentation described in the question clearly meet ADHD criteria. Depressive disorders may include concentration difficulties but don't require developmental onset or hyperactivity. Psychotic disorders involve hallucinations or delusions, not simple inattention. Dissociative disorders involve disruptions in consciousness or identity, not behavioral symptoms of ADHD.
- For 3 weeks, an adult needs little sleep, feels grandiose, and makes risky purchases. Which DSM-5-TR disorder is most likely?
Answer: Bipolar I disorder, because a distinct manic episode includes elevated or irritable mood with increased energy and impaired judgment or risky behavior.
The symptoms described - decreased need for sleep, grandiosity, and risky spending over 3 weeks - constitute a manic episode, which is the defining feature of Bipolar I disorder. A manic episode requires elevated, expansive, or irritable mood with increased energy lasting at least one week (or any duration if hospitalization is needed), plus three or more symptoms like decreased sleep need, grandiosity, and excessive involvement in risky activities. Major depressive disorder involves low mood and energy, not elevation. Generalized anxiety disorder involves chronic worry, not mood elevation or grandiosity. Schizoaffective disorder requires both psychotic symptoms and mood episodes, but the question describes only manic symptoms without psychosis.
- A 3-year-old has delayed language and poor social reciprocity, plus repetitive lining up of toys. Most likely diagnosis?
Answer: Autism Spectrum Disorder, because early social communication deficits plus restricted, repetitive behaviors like lining up toys fit core criteria.
This case describes Autism Spectrum Disorder, characterized by persistent deficits in social communication and social interaction across multiple contexts, plus restricted, repetitive patterns of behavior, interests, or activities, with symptoms present in the early developmental period. The combination of delayed language, poor social reciprocity, AND repetitive behaviors (lining up toys) meets both required symptom domains for ASD. Language Disorder would explain speech delays but not the restricted repetitive behaviors and social reciprocity difficulties. Reactive Attachment Disorder requires severe neglect and different attachment patterns. Social Communication Disorder involves pragmatic communication deficits but specifically excludes cases where restricted repetitive behaviors are present, which would indicate ASD instead.
- A person reports two distinct identity states with recurrent amnesia for everyday events. Which diagnosis best matches?
Answer: Dissociative Identity Disorder, characterized by identity disruption with distinct personality states and recurrent gaps in recall.
This describes Dissociative Identity Disorder (DID), characterized by disruption of identity with two or more distinct personality states and recurrent gaps in recall of everyday events, personal information, or traumatic events. The key diagnostic features include the presence of distinct identity states that take control of behavior and significant memory gaps that go beyond ordinary forgetfulness. Schizophrenia involves psychotic symptoms like hallucinations and delusions, not identity disruption with amnesia. Panic Disorder involves sudden fear surges with physical symptoms, not identity discontinuity. Somatic Symptom Disorder focuses on distressing physical symptoms, not identity fragmentation and memory gaps.
- A teen repeatedly pulls out hair, creating noticeable hair loss, and struggles to stop despite distress. Diagnosis?
Answer: Trichotillomania (Hair-Pulling Disorder), featuring recurrent hair pulling with hair loss and repeated attempts to decrease or stop.
This describes Trichotillomania (Hair-Pulling Disorder), characterized by recurrent pulling out of one's hair resulting in hair loss, despite repeated attempts to decrease or stop the behavior. The disorder causes clinically significant distress or impairment and the hair pulling is not better explained by symptoms of another mental disorder. Body Dysmorphic Disorder involves preoccupation with perceived appearance defects and repetitive checking behaviors, but not hair pulling specifically. Excoriation Disorder involves skin picking rather than hair pulling. Tic disorders involve sudden, rapid, recurrent movements or vocalizations, not the goal-directed pulling behavior seen in trichotillomania.
- A child has multiple motor and vocal tics for over one year, starting before age 18. Which diagnosis fits best?
Answer: Tourette's Disorder, defined by multiple motor tics and at least one vocal tic persisting over one year with onset before 18.
This describes Tourette's Disorder, which requires both multiple motor tics and one or more vocal tics present at some time during the illness, occurring many times a day nearly every day or intermittently for more than one year, with onset before age 18. Tics are sudden, rapid, recurrent, nonrhythmic motor movements or vocalizations. The combination of multiple motor tics AND vocal tics persisting over one year distinguishes Tourette's from other tic disorders. Persistent Motor Tic Disorder involves only motor tics without vocal tics. Stereotypic Movement Disorder involves repetitive nonfunctional movements that are more rhythmic and purposeless than tics. OCD involves obsessions and compulsions, not involuntary tics.
- A teen persistently restricts intake, fears weight gain, and has significantly low body weight. Which disorder is most likely?
Answer: Anorexia Nervosa, because restriction leads to significantly low weight with intense fear of gaining weight and body image disturbance.
The combination of persistent food restriction, intense fear of weight gain, and significantly low body weight are the three core features of Anorexia Nervosa. This disorder involves restriction of energy intake leading to significantly low weight, intense fear of gaining weight or becoming fat, and disturbance in body image or lack of recognition of the seriousness of low weight. Bulimia Nervosa involves binge eating with compensatory behaviors but typically without significantly low weight. Avoidant/Restrictive Food Intake Disorder involves food restriction but without the weight/shape concerns central to anorexia. Binge-Eating Disorder involves recurrent binges without the persistent restriction that leads to low weight.
- Fears abandonment, unstable relationships, mood swings within hours, self-harm. Category?
Answer: Personality disorders
These symptoms describe borderline personality disorder: fear of abandonment, unstable relationships, rapid mood swings, and self-harm. The mood shifts here are short-term and relationship-driven, not the longer episodes of bipolar disorder. That makes bipolar and related the tempting wrong answer, but its mood episodes last days to weeks rather than hours.
- A person has a week of elevated mood, decreased sleep, grandiosity, and risky spending causing hospitalization. Which disorder fits best?
Answer: Bipolar I Disorder, because a manic episode lasting at least one week or requiring hospitalization is sufficient for diagnosis.
This scenario describes a manic episode sufficient for Bipolar I Disorder diagnosis. A manic episode requires elevated, expansive, or irritable mood lasting at least one week (or requiring hospitalization) with at least three additional symptoms from a specified list (grandiosity, decreased sleep, increased goal-directed activity, risky behavior, etc.). The hospitalization requirement indicates severity sufficient for Bipolar I. Bipolar II requires hypomanic episodes, which are less severe and never require hospitalization; a full manic episode rules out Bipolar II. Major Depressive Disorder doesn't involve manic episodes. Schizoaffective Disorder requires psychotic symptoms occurring for at least two weeks in the absence of prominent mood symptoms, which isn't described here.
- Arm paralyzed after a stressful event; tests normal; he is distressed, not faking. Category?
Answer: Somatic symptom and related
Arm paralysis with normal test results, appearing after a stressful event and causing real distress, is conversion disorder, a somatic symptom and related disorder. Dissociative disorders are tempting because the trigger is stress, but they involve disrupted memory, identity, or consciousness, not physical paralysis.
- A child shows angry/irritable mood and vindictiveness toward adults for over six months, without severe rights violations. Diagnosis?
Answer: Oppositional Defiant Disorder, involving a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least six months.
This describes Oppositional Defiant Disorder (ODD), characterized by a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least six months with at least four symptoms from these categories, causing significant impairment. The behavior is exhibited during interaction with at least one individual who is not a sibling. Key features include angry/irritable mood, arguing with authority figures, and vindictiveness without the more severe rights violations seen in Conduct Disorder. Conduct Disorder involves more serious violations like aggression toward people/animals, property destruction, theft, or serious rule violations. ADHD involves inattention and hyperactivity. Disruptive Mood Dysregulation Disorder requires severe recurrent temper outbursts with persistent irritability and onset before age 10.
- Someone has recurrent unexpected panic attacks and avoids places fearing escape is difficult. Which disorder best fits?
Answer: Agoraphobia, because avoidance is driven by fear of being unable to escape or get help if panic-like symptoms occur.
While the person has panic attacks, the key feature here is avoiding places due to fear that escape might be difficult - this is the defining characteristic of Agoraphobia. Agoraphobia involves marked fear or anxiety about situations where escape might be difficult or help unavailable if panic-like symptoms occur, leading to avoidance of these situations. The diagnosis can occur with or without Panic Disorder. Social Anxiety Disorder focuses on fear of negative evaluation in social situations. Specific Phobia involves fear of a particular object or situation. OCD involves obsessions and compulsions rather than fear of panic symptoms in certain locations.
- A person reports hearing voices commenting and holds a fixed false belief despite evidence for six months. Which category applies?
Answer: Schizophrenia Spectrum and Other Psychotic Disorders, because persistent hallucinations and delusions indicate psychosis over time.
Hearing voices (auditory hallucinations) and holding fixed false beliefs (delusions) for six months clearly indicates a disorder in the Schizophrenia Spectrum and Other Psychotic Disorders category. The duration of six months meets criteria for Schizophrenia, which requires two or more psychotic symptoms (delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, or negative symptoms) for at least one month within a six-month period of significant functional decline. Dissociative Disorders involve disruptions in consciousness, memory, or identity but not true hallucinations. Somatic Symptom Disorders focus on physical symptoms and health anxiety. Neurocognitive Disorders primarily involve cognitive decline rather than psychotic symptoms as the core feature.
- An adult has intense fear of social scrutiny and avoids presentations, fearing embarrassment. Which diagnosis best fits?
Answer: Social Anxiety Disorder (Social Phobia), marked by fear of negative evaluation and avoidance of social or performance situations.
This describes Social Anxiety Disorder (Social Phobia), characterized by marked fear or anxiety about social or performance situations where the person might be scrutinized by others. The fear centers on negative evaluation, embarrassment, or humiliation. Key features include fear of scrutiny, avoidance of feared situations, and significant distress or impairment. Specific phobias involve fear of particular objects (like heights, needles) rather than social evaluation. Panic Disorder involves unexpected panic attacks and worry about future attacks, not primarily fear of social scrutiny. Avoidant Personality Disorder represents a pervasive pattern of social inhibition across contexts, typically with earlier onset and broader impairment than situational social anxiety.
- An adult has 3 weeks of elevated mood, decreased need for sleep, grandiosity, and risky spending causing hospitalization. Which diagnosis fits best?
Answer: Bipolar I Disorder, defined by at least one manic episode with marked impairment, possible hospitalization, and elevated or irritable mood.
This presentation clearly describes a manic episode characteristic of Bipolar I Disorder. The patient exhibits the classic triad of mania: elevated mood, decreased need for sleep, and grandiosity, along with risky behavior (excessive spending) severe enough to require hospitalization. A single manic episode lasting at least one week (or any duration if hospitalization is required) is sufficient for a Bipolar I diagnosis. Cyclothymic Disorder involves milder hypomanic symptoms without full manic episodes or hospitalization. Major Depressive Disorder involves depressed mood and anhedonia, not the elevated mood and grandiosity seen here. Schizoaffective Disorder requires both mood episodes and psychotic symptoms that occur independently of mood episodes, which is not described in this case.
- A person has chronic worry about many topics, restlessness, muscle tension, and sleep problems for over six months. Diagnosis?
Answer: Generalized Anxiety Disorder, defined by excessive anxiety and worry across domains with associated symptoms for at least six months.
This describes Generalized Anxiety Disorder (GAD), characterized by excessive anxiety and worry about multiple events or activities occurring more days than not for at least six months. The worry is difficult to control and associated with at least three additional symptoms (restlessness, fatigue, concentration problems, irritability, muscle tension, sleep disturbance). The key features are the generalized nature across multiple domains, chronicity (six months), and associated physical/cognitive symptoms. Panic Disorder involves discrete panic attacks and worry about future attacks. OCD involves specific obsessions and compulsions. PTSD requires trauma exposure and specific trauma-related symptom clusters including intrusion and avoidance symptoms.
