Anxiety, obsessive-compulsive and trauma- and stressor-related disorders
Last reviewed September 2026 by Dr. Andrew Wichterman · Aligned to the current NCE blueprint. Valid for exams through June 30, 2027.
AI-narrated overview made with Google NotebookLM. The written lesson below is by Dr. Andrew Wichterman.
These three DSM chapters produce more vignette items than any other. The exam gives you a symptom picture and a timeline and asks which diagnosis fits, then asks for the treatment with the best evidence.
Try to answer each from memory first, even if you have to guess. Guessing before reading makes the answer stick; reveal only after you have tried.
Anxiety disorders
Generalized anxiety disorder is excessive worry about multiple domains, more days than not, for at least six months, hard to control, with three or more of: restlessness, fatigue, poor concentration, irritability, muscle tension and sleep disturbance. Panic disorder is recurrent unexpected panic attacks followed by at least a month of worry about further attacks or behavior change to avoid them; a panic attack itself is a specifier, not a diagnosis. Agoraphobia is fear of two or more situations, public transport, open spaces, enclosed spaces, crowds, being outside the home alone, because escape might be hard. Specific phobia is marked fear of an object or situation for six months or more. Social anxiety disorder is fear of scrutiny in social situations for six months or more; the performance-only specifier exists. Separation anxiety disorder and selective mutism are the childhood-onset members of the chapter, and separation anxiety can be diagnosed in adults.
Obsessive-compulsive and related disorders
Obsessive-compulsive disorder is the presence of obsessions, intrusive unwanted thoughts, urges or images, or compulsions, repetitive behaviors or mental acts done to reduce distress, that are time-consuming, more than an hour a day, or impairing. Insight is specified as good, poor or absent. Body dysmorphic disorder is preoccupation with a perceived defect in appearance with repetitive behaviors such as mirror checking. Hoarding disorder is persistent difficulty discarding possessions. Trichotillomania is hair pulling and excoriation disorder is skin picking. The distinction from anxiety disorders is the compulsion: the ritual, not the worry, defines the chapter. Obsessive-compulsive personality disorder is a different thing, a pervasive pattern of perfectionism and control without true obsessions or compulsions.
Trauma- and stressor-related disorders
PTSD requires exposure to actual or threatened death, serious injury or sexual violence, directly, by witnessing, by learning it happened to someone close, or by repeated exposure to details in the course of work, followed by symptoms in four clusters: intrusion, avoidance, negative alterations in cognition and mood, and alterations in arousal and reactivity, lasting more than one month. Acute stress disorder is the same picture from three days to one month after the event. Adjustment disorder is emotional or behavioral symptoms within three months of an identifiable stressor, out of proportion or impairing, that do not meet criteria for another disorder and resolve within six months of the stressor ending; it is specified as with depressed mood, with anxiety, with mixed anxiety and depressed mood, with disturbance of conduct, or mixed. Prolonged grief disorder, new in DSM-5-TR, is intense yearning or preoccupation with the deceased at least twelve months after the death in adults, six months in children, with impairment. Reactive attachment disorder and disinhibited social engagement disorder are the childhood consequences of severe neglect.
Differential diagnosis
Timelines decide most items. Symptoms after trauma lasting under a month: acute stress disorder; over a month: PTSD. Distress after a non-traumatic stressor that does not meet other criteria: adjustment disorder. Worry across many domains for six months: GAD; unexpected attacks with a month of fear of more: panic disorder. Rituals that consume an hour a day: OCD. Grief that is still consuming at twelve months: prolonged grief disorder. Medical causes such as hyperthyroidism, caffeine and stimulant use, and withdrawal from alcohol or benzodiazepines mimic anxiety and are ruled out first. Dissociative symptoms after trauma point to the PTSD dissociative subtype or to a dissociative disorder; depersonalization and derealization are the terms.
Treatment the evidence supports
Exposure is the active ingredient across the anxiety disorders: graded in vivo exposure for phobias and agoraphobia, interoceptive exposure for panic, and cognitive behavioral therapy with exposure for social anxiety and GAD. Exposure and response prevention, exposure to the trigger while blocking the ritual, is the treatment for OCD, with SSRIs at higher doses as the medication of choice. For PTSD, trauma-focused therapies lead: prolonged exposure, cognitive processing therapy, trauma-focused CBT for children, and EMDR. Psychological debriefing right after trauma is not recommended; psychological first aid and watchful waiting are. Trauma-informed care, the principles of safety, trustworthiness, peer support, collaboration, empowerment and attention to culture, applies to every setting whether or not PTSD is diagnosed. Benzodiazepines are short-term at most; they impair exposure learning and carry dependence risk.
Without scrolling up, write everything you remember from this lesson. Then check yourself against the key terms. Recalling the whole lesson once, right after reading it, does more than reading it twice.
Ten questions from this domain, with an explanation after each answer.
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