A quarter of the scored questions (25%) fall here, and this is where DSM-5-TR diagnosis is tested. On the exam the work starts from the provisional diagnosis printed in the case header. You show why it fits, which specifier applies, what else needs ruling out, how risky the client's situation is and what level of care follows.
Updated Oct 30, 2026 · Not affiliated with NBCC, CCE, AMFTRB, CRCC, ACA or AAMFT.
of scored questions25%
questions here19
short cases here2
What the domain covers
The October 2025 content outline lists 21 tasks for this domain. In plain terms:
Biopsychosocial, diagnostic and initial interviews, including the Cultural Formulation Interview.
The mental status exam: appearance, behavior, mood and affect, thought process and content, cognition, insight and judgment.
Confirming a diagnosis, its specifiers and any co-occurring condition.
Choosing and reading screening and outcome instruments, and using observation and self-report.
Trauma and substance use assessment.
Ongoing risk assessment: suicide, homicide, self-injury and partner violence.
Level of care and treatment modality.
Family and couple interaction patterns observed at intake.
Measuring change with the same instrument before and after treatment.
19 intake and diagnosis questions
Question 1 of 19 · Intake, Assessment, and Diagnosis · 25%
The GAD-7, PHQ-9, and PCL-5 are all examples of which type of instrument?
Clinician-rated interviews, such as the CAPS-5 for PTSD, are scored by the clinician; these three are self-report forms.
Projective techniques such as the Rorschach use ambiguous stimuli; these are structured symptom checklists with fixed items.
The GAD-7, PHQ-9 and PCL-5 are short questionnaires that clients complete about their own symptoms, which makes them patient-reported outcome measures.
Neuropsychological batteries measure cognitive functions such as memory and attention through performance tasks, not self-reported symptoms.
Question 2 of 19 · Intake, Assessment, and Diagnosis · 25%
A firefighter had some symptoms within days of a fatal fire 8 months ago, but first met full PTSD criteria last month. Which specifier applies?
Persistent (6 months or more) is also an adjustment disorder specifier, and it confuses how long symptoms have lasted with the delay before full criteria were met.
With delayed expression applies when full PTSD criteria are first met at least 6 months after the event, even if some symptoms began right away, as with this firefighter.
Acute (less than 6 months) is an adjustment disorder specifier; DSM-5 dropped the acute and chronic PTSD specifiers that DSM-IV used.
With dissociative symptoms requires persistent depersonalization or derealization, which nothing in the description suggests.
Question 3 of 19 · Intake, Assessment, and Diagnosis · 25%
A 19-year-old college student reports sudden intense fear, shortness of breath, and palpitations for 15 minutes in class. What information is most important to gather?
Exercise habits are not part of the diagnostic picture; a medical rule-out would ask about caffeine, substances and heart conditions instead.
Family relationships belong in the wider history, but they do not identify the pattern of the attacks.
Comparing grades with past semesters gauges the impact on school but cannot tell panic disorder from other anxiety disorders.
Whether the attacks come unexpectedly is the deciding fact: panic disorder requires recurrent unexpected attacks, while attacks cued by a situation point toward phobias or other disorders.
Question 4 of 19 · Intake, Assessment, and Diagnosis · 25%
A 29-year-old client assaulted 3 months ago reports nightmares and avoids parking garages. Which instrument would you use to measure the severity of her trauma symptoms?
The BDI-II measures depressive symptoms; it would miss the intrusion and avoidance symptoms that define her presentation.
The Mood Disorder Questionnaire screens for a history of manic or hypomanic symptoms, not trauma symptoms.
The Y-BOCS rates the severity of obsessions and compulsions, so it would measure OCD, not her nightmares and avoidance.
The PCL-5 is a 20-item self-report measure keyed to the DSM PTSD symptoms and the standard way to rate the severity of trauma symptoms and track change.
Question 5 of 19 · Intake, Assessment, and Diagnosis · 25%
A client reports a year of daily worry and 3 weeks of low mood and poor sleep. Which assessment plan best clarifies her presentation?
Using the PHQ-9 alone because the low mood is newest ignores a year of daily worry that points to an anxiety disorder.
Using the GAD-7 and PHQ-9 with a clinical interview measures both the year of worry and the recent low mood, and the interview sorts out how they relate.
A general distress screen cannot replace a diagnostic interview; screening scores support clinical judgment, they do not stand in for it.
Postponing measures leaves no baseline; intake scores are what later progress is compared against.
Question 6 of 19 · Intake, Assessment, and Diagnosis · 25%
A client with depression says, "Sometimes I think about hurting myself." Which tool would you use to structure the risk assessment?
SAD PERSONS is a mnemonic of demographic risk factors with poor ability to predict suicide; it does not structure questions about ideation, intent and plan.
The Mood Disorder Questionnaire screens for bipolar symptoms; it does not assess suicidal thinking or behavior.
The Columbia-Suicide Severity Rating Scale asks step by step about the presence and intensity of suicidal thoughts and about suicidal behavior, which is what structuring this assessment requires.
The BDI-II measures depression severity; its single suicide item cannot replace a structured suicide risk assessment.
Question 7 of 19 · Intake, Assessment, and Diagnosis · 25%
A 72-year-old client's daughter reports that 2 days after hip surgery, her mother became confused and inattentive, with symptoms that fluctuate during the day. Which condition must be ruled out first?
Depression in older adults can mimic cognitive decline, but it does not cause sudden confusion with attention that fluctuates during the day.
Dementia (major neurocognitive disorder) develops gradually over months or years; a sudden change two days after surgery with fluctuating attention points to delirium.
A primary psychotic disorder shows delusions or hallucinations with a clear sensorium; sudden confusion and inattention after surgery point to a medical cause first.
Acute onset after surgery, inattention and a course that fluctuates during the day are the core features of delirium, a medical emergency that is ruled out before any psychiatric diagnosis.
Question 8 of 19 · Intake, Assessment, and Diagnosis · 25%
A client's depressed mood began after 4 months of daily heavy drinking and lifted within 2 weeks of medically supervised detox. Which diagnosis best describes the depression?
Depression that develops during heavy use and clears within weeks of stopping fits alcohol-induced depressive disorder; an independent depression would be expected to persist about a month after withdrawal ends.
Persistent depressive disorder needs at least 2 years of depressed mood, far longer than this 4-month course.
Major depressive disorder is diagnosed only when the episode is not better explained by a substance, and remission within 2 weeks of detox argues against an independent episode.
Adjustment disorder follows a psychosocial stressor; here the mood tracks the drinking and lifts with detox, which points to a substance cause.
Question 9 of 19 · Intake, Assessment, and Diagnosis · 25%
Coworkers complain about a 45-year-old client's rigid perfectionism and insistence on rules. He believes his standards are correct and reports no intrusive thoughts or rituals. Which diagnosis should be considered?
A long-standing pattern of perfectionism, rule focus and rigidity that he sees as right, without obsessions or rituals, fits obsessive-compulsive personality disorder.
GAD centers on excessive worry about many areas; his problem is rigid standards he believes are correct, not uncontrollable worry.
Autism spectrum disorder requires deficits in social communication present from early development, not just rigid standards at work in midlife.
OCD requires obsessions or compulsions, which he denies; mistaking the rigid perfectionism of OCPD for OCD is a classic error.
Question 10 of 19 · Intake, Assessment, and Diagnosis · 25%
A client reports that her depression returns each winter and remits each spring. What would you assess to apply the seasonal pattern specifier?
Age of onset is not part of the seasonal pattern specifier; winter depression often begins in young adulthood.
Light-box use is a treatment for seasonal depression, not one of the criteria for the specifier.
Summer weight gain is irrelevant; the typical winter episode brings more appetite, carbohydrate craving and sleep.
DSM-5-TR applies the seasonal pattern specifier only when seasonal episodes substantially outnumber nonseasonal ones over her lifetime, with regular onset and remission and 2 years of seasonal episodes.
Question 11 of 19 · Intake, Assessment, and Diagnosis · 25%
A 24-year-old client reports frequent mood changes, chronic emptiness and an intense fear of abandonment. Which pattern would point to borderline personality disorder rather than bipolar disorder?
Distinct periods of elevated mood lasting a week describe a manic episode, which points toward bipolar I disorder, not BPD.
Depressive episodes of 2 weeks or more belong to mood disorders and do not point toward BPD over bipolar disorder.
Decreased need for sleep with more goal-directed activity is a core symptom of mania or hypomania, so it points toward bipolar disorder.
Mood shifts that last hours and are set off by interpersonal events such as perceived rejection reflect the affective instability of borderline personality disorder.
Case 1Intake · questions 12–14
Intake
Age: 24 · Gender: Nonbinary (they/them) · Sexuality: Queer Ethnicity: Vietnamese American · Relationship status: Single Setting: College counseling center · Counseling: Individual Provisional diagnosis: Panic disorder: F41.0; agoraphobia: F40.00
You are a counselor at a university counseling center. Riley, a 24-year-old engineering senior, had their first attack 6 months ago in a lecture hall: a racing heart, numb hands and a certainty they were dying, peaking within minutes. The emergency department found nothing wrong. Since then they have had two or three attacks a month that come "out of nowhere," some waking them from sleep, and they worry daily about the next one. They switched two classes to online sections and now avoid the campus bus, the crowded dining hall and the lecture hall. They go to the grocery store only with their roommate. They drink three energy drinks a day while studying. Last week an attack began as they walked into the crowded dining hall. Riley is casually dressed and fidgety, with an anxious affect; their mood is "scared all the time." They deny suicidal ideation and other substance use.
Case 1 · Question 1 of 3 · Intake, Assessment, and Diagnosis · 25%
Which information supports adding agoraphobia to the diagnosis of panic disorder?
Daily worry about the next attack is a criterion of panic disorder itself, not of agoraphobia.
Attacks that wake them from sleep are nocturnal panic attacks, part of panic disorder.
Where the first attack happened does not establish the avoidance pattern agoraphobia requires.
Fear and avoidance of two or more agoraphobic situations, such as public transportation and crowds, or needing a companion, meets the agoraphobia criteria.
Case 1 · Question 2 of 3 · Intake, Assessment, and Diagnosis · 25%
Which possibility should be ruled out before confirming the diagnosis?
Social anxiety is a differential, but their fear is of the attacks, not of being judged, and it is not the required rule-out.
Panic disorder requires that the attacks are not due to a substance or another medical condition, and three energy drinks a day is a realistic alternative.
A childhood trauma history is not a rule-out criterion for panic disorder.
Family history raises risk but does not need to be ruled out.
Case 1 · Question 3 of 3 · Intake, Assessment, and Diagnosis · 25%
How does the attack that began in the dining hall affect the diagnosis?
The diagnosis does not change: panic disorder needs recurrent unexpected attacks, which Riley also has, and expected attacks in feared places can occur alongside them.
Specific phobia would need fear limited to one situation, while Riley's attacks also come unexpectedly.
Limited-symptom attacks have fewer than four symptoms, which is not what was described.
Panic disorder does not require every attack to be unexpected, only recurrent unexpected ones.
Case 2Intake · questions 15–18
Intake
Age: 19 · Gender: Male · Sexuality: Heterosexual Ethnicity: Black (Nigerian American, Yoruba) · Relationship status: Single Setting: Community mental health center · Counseling: Individual, family present Provisional diagnosis: Schizophreniform disorder, provisional: F20.81
You are a counselor at a community mental health center. Olu, 19, moved to the United States from Nigeria at age 12 and is in his first year at a community college. His parents and uncle bring him in. For about 10 weeks he has heard a voice that comments on what he does when he is alone, and he believes classmates are putting thoughts into his head through their phones. He stopped attending classes 6 weeks ago, stays in his room and rarely showers. His parents believe it may be a spiritual attack and have taken him to their pastor for prayer. He used cannabis a few times in high school but none in the past 4 months, and a recent urine screen was negative. He and his family describe no depressive or manic episodes. He is disheveled and guarded, and he glances at a corner as if listening. His speech is tangential at times, his affect is flat and his insight is poor. He is oriented ×4 and denies suicidal or homicidal ideation.
Case 2 · Question 1 of 4 · Intake, Assessment, and Diagnosis · 25%
Why is schizophreniform disorder the provisional diagnosis rather than schizophrenia?
Hallucinations and delusions together meet the symptom criterion of both disorders.
Declining function is required for schizophrenia, not for schizophreniform, so it does not favor schizophreniform.
Symptoms lasting about 10 weeks so far fit schizophreniform disorder (1 to 6 months); schizophrenia requires at least 6 months of disturbance.
Past cannabis use with a negative screen and months of abstinence does not separate the two.
Case 2 · Question 2 of 4 · Intake, Assessment, and Diagnosis · 25%
Why does the diagnosis carry the specifier "provisional"?
Past cannabis use has already been ruled out as a cause by his history and a negative screen; it is not what "provisional" refers to.
"Provisional" is used when the diagnosis is made before recovery, because the episode may still pass 6 months and become schizophrenia.
A cultural formulation is valuable but is not what the specifier refers to.
Hospitalization is not part of the criteria or of the specifier.
Case 2 · Question 3 of 4 · Intake, Assessment, and Diagnosis · 25%
How should you address the family's belief that this is a spiritual attack?
The Cultural Formulation Interview asks about the family's explanation, help-seeking and expectations, which shapes engagement and the plan.
A belief shared by the family's cultural group is not a delusion.
Waiting until his symptoms improve delays cultural information that matters for diagnosis and engagement now.
Correcting the family's view before understanding it risks losing their trust and their help.
Case 2 · Question 4 of 4 · Intake, Assessment, and Diagnosis · 25%
Which level of care is the most appropriate next step?
Weekly counseling as his sole treatment leaves out the psychiatric care and team support a first episode needs.
Coordinated specialty care combines medication, therapy, family education and supported education or work, and is recommended for a first episode.
Waiting lengthens untreated psychosis, which worsens outcomes.
The family's pastor can be part of his support, but not the main source of help in place of psychiatric care.
Question 19 of 19 · Intake, Assessment, and Diagnosis · 25%
A client has had depressed mood, poor sleep and fatigue for 3 weeks with clear distress, but she denies the remaining depressive symptoms and any recent stressor. Which diagnosis is most appropriate?
Severity specifiers apply only once full criteria are met. Even mild major depressive disorder needs at least five symptoms over 2 weeks.
The client has clinically significant distress but only three of the five symptoms a major depressive episode requires, and no stressor. DSM-5-TR lists this as other specified depressive disorder (depressive episode with insufficient symptoms), which lets you record the reason.
Persistent depressive disorder requires depressed mood on most days for at least 2 years. Three weeks is far short of that.
Adjustment disorder requires symptoms that develop in response to an identifiable stressor, and the client reports none.
Answer every question to see your score
Durations that decide the diagnosis
Several diagnoses are told apart only by time. The thresholds worth knowing cold, from the DSM-5-TR:
Major depressive episode: at least 2 weeks, five of nine symptoms, one of them depressed mood or loss of interest.
Persistent depressive disorder: depressed mood most days for 2 years (1 year in children and adolescents).
Generalized anxiety disorder: excessive, hard-to-control worry for at least 6 months.
Acute stress disorder vs PTSD: 3 days to 1 month after the trauma is acute stress disorder; symptoms beyond a month point to PTSD.
Adjustment disorder: onset within 3 months of the stressor, resolving within 6 months after the stressor or its consequences end.
Prolonged grief disorder: at least 12 months after the death for adults, 6 months for children and adolescents.
Manic episode vs hypomania: mania lasts at least 7 days (any length if hospitalized); hypomania at least 4 consecutive days. One manic episode makes bipolar I.
Cyclothymic disorder: 2 years of subthreshold highs and lows (1 year in youth).
Substance use disorder severity: 2–3 of the 11 criteria is mild, 4–5 moderate, 6 or more severe.
Source: American Psychiatric Association, DSM-5-TR (2022).
Common traps
Mood is reported, affect is observed. An MSE question about affect wants what you saw (flat, constricted, labile, incongruent with the content), not the client's word for how they feel.
Thought process is not thought content. Tangential, circumstantial and loose describe how the client thinks; delusions, obsessions and suicidal thoughts are what they think.
Severity comes from symptom count and impairment, not from how upset the client sounds in session. NBCC's sample case asks exactly this about its severity specifier.
A screening score flags; the interview diagnoses. A high score is a reason to assess further, not a diagnosis on its own.
A passive wish to be dead still gets a structured assessment and a written safety plan. A no-suicide contract is not a substitute (Stanley and Brown's Safety Planning Intervention).
Partner violence is screened with the client alone. Asking in a couple session can put the client at risk.
Duration counts from onset, not from intake. Reread the history for when the symptoms began.
Sources: DSM-5-TR; NCMHCE state-licensure handbook, Appendix B; Stanley & Brown, Cognitive and Behavioral Practice, 2012.
The diagnosis is given
Since 2022 every case header carries a provisional diagnosis with its ICD-10-CM code. You will not be asked to name the disorder from scratch; you will be asked which detail supports it and whether something new should change it.
From July 1, 2027 this domain becomes Intake and Assessment. It also takes informed consent at intake from today's ethics domain and the research and statistics task from domain 1. Weights for every 2027 domain: the 2027 form.
No. The code comes with the provisional diagnosis in the case header. Read it for the specifiers it encodes, such as single or recurrent episode.
Which screening tools should I know?
The 2027 specifications name the PHQ, the C-SSRS, the PCL, the AUDIT, the ACEs questionnaire and the MSE among the tools most likely to appear. Know what each screens for and roughly what a high score means.