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What’s the Difference Between Anorexia Nervosa and Bulimia Nervosa?

signGiven the similarities between bulimia nervosa and anorexia nervosa, binge-eating/purging type, there's room for confusion when making a diagnosis, whether on the ASWB exam or in real life. Let's take a look at what the DSM says about each.

What is anorexia nervosa?

Criteria for anorexia nervosa are as follows:

A. Restriction of energy intake leading to significantly low body weight.

B. Intense fear of gaining weight despite significantly low weight.

C. Disturbance in the way one's body weight or shape is experienced, undue influence of body weight shape on self-evaluation, or persistent lack of recognition of the seriousness of current low body weight.

What are the types of anorexia nervosa?

There are two subtypes in anorexia nervosa:

Restricting type. Weight loss accomplished primarily through dieting, fasting, and/or excessive exercise (not recurrent binging or purging).

Binge-eating/purging type. Recurrent episodes of binge eating or purging (self-induced vomiting or the misuse of laxatives, diuretics, or enemas).

What is bulimia nervosa?

Criteria for bulimia nervosa are as follows:

A. Recurrent episodes of binge eating (overeating in a discrete period of time with a sensed lack of control regarding the eating).

B. Recurrent inappropriate compensatory behaviors to prevent weight gain (e.g., self-induced vomiting, misuse of laxatives, diuretics, or other medications; fasting; excessive exercise).

C. Lasts once a week for three months.

D. Self-evaluation is unduly influenced by body shape and weight.

E. Does not occur exclusively during episodes of anorexia nervosa.

What's the difference between anorexia nervosa, binge/purging-type and bulimia nervosa?

Both anorexia nervosa and bulimia nervosa involve negative self-evaluation of body shape and weight. Both involve behaviors to avoid weight gain such as self-induced vomiting. However, in anorexia nervosa, the disorder leads to significantly low body weight, where bulimia nervosa does not.

The difference is the ways severity is coded for anorexia and bulimia helps highlight the essential difference between the two diagnoses.

For anorexia nervosa, severity is based on body mass index (BMI). For example, "mild" indicates a BMI less than or equal to 17 kilograms per square meter. "Extreme" indicates a BMI of less than fifteen kilograms per square meter.

For bulimia nervosa, severity is based on the frequency of behaviors. For 1-3 episodes per week, a specifier of "mild" is applied. "Extreme" is used for 14 or more episodes per week.

The difference is not the behavior itself, it's the result.

Free ASWB Exam Practice

The ASWB exam often tests to assess knowledge of differentials between commonly occurring DSM disorders like anorexia and bulimia. A sample question:

A 17-year-old client who appears noticeably underweight reports frequently forcing herself to vomit after meals in order to "stay skinny for cheerleading." The MOST likely DSM diagnosis for this client is a type of:

A. Bulimia nervosa

B. Body dysmorphic disorder

C. Rumination disorder

D. Anorexia nervosa

Unless you're caught by the distractors, body dysmorphic disorder (which is not diagnosed when an eating disorder is present) and rumination disorder (not described here), knowing the difference between anorexia and bulimia quickly gets you to the correct answer. The client is "noticeably underweight." You have your essential information. The phrase "a type of" at the end of the question stem is an additional clue. The client is most likely suffering from anorexia nervosa, binge/purging-type. The answer is D.

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Diagnose This: Gradual Memory Loss and Occasional Confusion

boxerHere's another free ASWB exam practice question from our old bonus exam. The more practice you get, the better.

A man in his 40s comes to a mental health clinic complaining of gradual memory loss and occasional confusion, such as getting lost on the way to a job he has held for years. The man is a retired boxer who suffered multiple concussions during his career. The MOST likely diagnosis for this client is:


A. Post-traumatic stress disorder
B. Alzheimer's disease
C. Delirium
D. Chronic traumatic encephalopathy

What do you think?

Narrowing it down: With delirium, the onset of confusion is generally rapid; this client reports that his memory and confusion has been getting worse over time. The client does not mention any of the signs of post-traumatic stress disorder. Although Alzheimer's disease is the most common form of dementia, the patient's relatively young age, along with his history of head trauma, make him a more likely candidate for chronic traumatic encephalopathy. So you have  your answer: D.

This is tricky, which is why we left it off our full-length practice tests. To try out the questions that made the grade, sign up.

Happy studying and good luck on the exam!



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Free ASWB Exam Practice Question: Bipolar Disorder

bipolar disorder severity Hello ASWB exam preppers. Here's a free question--one that didn't make the cut to be included in our full-length practice, since it's a little too simple and info-based. See how you do.

The typical age of onset for bipolar disorder is:

A. Mid-40s.
B. Mid-20s.
C. The teenage years.
D. Early childhood.

What do you think? Experience may be a guide here. When did your clients first report bipolar symptoms? Is it a pervasive, lifelong disorder or something that can emerge later? If later, when do most late-emerging mental health disorders emerge? Early childhood's too early. Mid-40s? Too late. That leaves two best answers.  Teens or 20s.

So which is it?

The answer: Although bipolar disorder can be diagnosed in adolescence or even childhood, the average age of onset is 25. So B is the correct answer.

Did you get it right? If so, great. If not, you learned something by taking the time to click here. The more practice, the better. (So sign up!)

Happy studying and good luck on the exam!

Want more info? Find stats about bipolar disorder here.

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Social Work Exam Question: Psych Ward Social Worker

hospital Here's a quick, free exam-style question. A little practice, outside of our full-length practice tests, to get you ever-more prepared for the licensing exam.

A psychiatric hospital social worker tells her supervisor she's been feeling irritable, exhausted, restless at night, and unsure of her ability to do her job anymore. She's thinking of quitting. The supervisor suggests a new hobby, some exercise, and time with friends. How is the supervisor most likely conceptualizing the social worker's complaints?

A) As depression.

B) As adjustment disorder.

C) As compassion fatigue.

D) As acute stress disorder.

What do you think?

This one's pretty easily narrowed down. Does the supervisor think that the social worker has clinically significant, diagnosable symptoms? If so, you have three choices. Adjustment disorder is probably the best of those. But you're not given symptom duration or severity. So a diagnosis is pretty much not doable here.

That leaves one answer standing. The one that's not in the DSM. C, compassion fatigue.

Compassion fatigue is well-known to most front-line social workers. This article in Good Therapy outlines the most common causes, symptoms, and treatment.

Among the causes, encountering extremes at work (danger, suicide, death, trauma). A psych ward social worker is likely to be exposed to all of the above.

Symptoms of compassion fatigue look a lot like depression: low mood, sleep difficulty, weight loss, fatigue, self-doubt.

How do you remedy the symptoms? The first approach is the one not often available to social workers: reduce work stress. If that's not possible, everything you'd recommend to a depressive client is likely to be helpful. Sleep, meditate, eat better, take up a hobby, find social support.

For a social worker aiming to pass the social work licensing exam, all those helpful tools can get squeezed out. Please remember to breathe and take care of yourself as you're exam prepping. The work you do and will do is important. Take care of yourself!

And good luck on the exam!

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Free Practice Question: Kid Trouble and the Social Work Exam

angry kid Here's something to help you get prepared to pass the social work licensing exam. It's part of our ongoing, intermittent, free question series. Put yourself in this social worker's shoes and figure out what you would do?

A woman tells a social worker that her son has been misbehaving wildly ever since starting kindergarten, over a month ago. He's angry and irritable, throwing frequent tantrums. He's defiant and argumentative over small things. And he's been exhibiting a troubling vindictive streak, cruelly evening the score with his younger sister, escalating petty squabbles into full-blown battles. "He's turned into a little monster," the woman says. What diagnosis is the BEST fit for the son, given the limited information the mother has provided?

A. No diagnosis is indicated

B. Oppositional Defiant Disorder

C. Intermittent Explosive Disorder

D. Conduct Disorder

What do you think?

Let's look at DSM criteria for the offered diagnoses and narrow our way down to an answer.

Conduct disorder is characterized by theft, destruction of property, and other serious rules violations. Not what's being described here.

Intermittent explosive disorder involves tantrums and a failure to control aggressive impulses over a year-long period. Closer, but not the best fit.

Oppositional defiant disorder looks good for this. It involves everything mentioned--anger and irritability, defiance, and vindictiveness. That's your best bet...but read the find print. To diagnose ODD, behaviors have to be present for six months. This month-long onset of symptoms looks to be connected to the start of a new school year--something many have first-hand experience with.

That leaves one answer: A, no diagnosis.

How best to help the distressed client and her son? That's a question for another vignette. But normalizing and assessing stressors from school seem like good places to start.

For lots more vignette practice covering the wide range of material that can appear on the social work exam, try our full-length practice tests. Get started here.

Happy studying!

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