The document provides information about preparing for the NCMHCE exam and differences between the DSM-IV and DSM-5. It notes that the exam framework and competencies did not change with the DSM-5 update, only diagnostic terminology. It highlights new and combined disorders in the DSM-5 and provides guidance on exam assumptions, rating scales, areas of the exam like information gathering and decision making, and approaches to case studies.

1. CounselingExam.Com
Preparation for
NCMHCE Exam
DSM-5
Preparation for
NCMHCE Exam
DSM-5
Dr. Linton Hutchinson

2. Assessment and Diagnosis
Counseling and Psychotherapy
Administration, Consultation and Supervision
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Exam Framework and Knowledge Base
Exam Framework and Knowledge Base

3. Difference Between
DSM-IV-TR
And
DSM-5
Exams
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4. NBCC is pleased to report that there were no
major structural changes to either the NCE or
the NCMHCE as a result of the DSM-5. There
were no changes to the framework or the
competencies of either examination. The
knowledge assessed is common to both
manuals. Modifications to the examination
content involved changes in diagnostic
terminology only.
From the NBCC
http://NBCC.ORG

5. While the number of items regarding the
DSM-5 will not increase, the new edition does
contain new diagnostic terminology, so
reviewing the differences between the two
editions may be helpful.
What Does That Mean?
What Does That Mean?
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6. 1. Social (Pragmatic) Communication Disorder
2. Disruptive Mood Dysregulation Disorder
3. Premenstrual Dysphoric Disorder (DSM IV appendix)
‐
4. Hoarding Disorder
5. Excoriation (Skin Picking) Disorder
‐
6. Disinhibited Social Engagement Disorder (split from Reactive
Attachment Disorder)
7. Binge Eating Disorder (DSM IV appendix)
‐
8. Central Sleep Apnea (split from Breathing Related Sleep Disorder)
‐
9. Sleep-Related Hypoventilation (split from Breathing Related Sleep
‐
Disorder)
10. Rapid Eye Movement Sleep Behavior Disorder (Parasomnia NOS)
11. Restless Legs Syndrome (Dyssomnia NOS)
12. Caffeine Withdrawal (DSM IV Appendix)
‐
13. Cannabis Withdrawal
14. Major Neurocognitive Disorder with Lewy Body Disease (Dementia Due
to Other Medical Conditions)
15. Mild Neurocognitive Disorder (DSM IV Appendix)
‐
New Disorders in the DSM-5

7. 1. Language Disorder
2. Autism Spectrum Disorder
3. Specific Learning Disorder
4. Delusional Disorder
5. Panic Disorder
6. Dissociative Amnesia
7. Somatic Symptom Disorder
8. Insomnia Disorder
9. Hypersomnolence Disorder
10. Non-Rapid Eye Movement Sleep Arousal Disorders
11. Genito Pelvic Pain/Penetration Disorder
‐
12. Alcohol Use Disorder
13. Cannabis Use Disorder
14. Phencyclidine Use Disorder
15. Other Hallucinogen Use Disorder
16. Inhalant Use Disorder
17. Opioid Use Disorder
18. Sedative, Hypnotic, or Anxiolytic Use Disorder
19. Stimulant Use Disorder
20. Stimulant Intoxication
21. Stimulant Withdrawal
22. Substance/Medication-Induced Disorders
Combined Specific Disorders in DSM-5
Combined Specific Disorders in DSM-5

8. 1. Language Disorder (Expressive Language Disorder & Mixed Receptive Expressive Language Disorder)
2. Autism Spectrum Disorder (Autistic Disorder, Asperger’s Disorder, Childhood Disintegrative Disorder, & Rett’s
disorder)
3. Specific Learning Disorder (Reading Disorder, Math Disorder, & Disorder of Written Expression)
4. Delusional Disorder (Shared Psychotic Disorder & Delusional Disorder)
5. Panic Disorder (Panic Disorder Without Agoraphobia & Panic Disorder With Agoraphobia)
6. Dissociative Amnesia (Dissociative Fugue & Dissociative Amnesia)
7. Somatic Symptom Disorder (Somatization Disorder, Undifferentiated Somatoform Disorder, & Pain Disorder)
8. Insomnia Disorder (Primary Insomnia & Insomnia Related to Another Mental Disorder)
9. Hypersomnolence Disorder (Primary Hypersomnia & Hypersomnia Related to Another Mental Disorder)
10. Non-Rapid Eye Movement Sleep Arousal Disorders (Sleepwalking Disorder & Sleep Terror Disorder)
11. Genito Pelvic Pain/Penetration Disorder (Vaginismus & Dyspareunia)
‐
12. Alcohol Use Disorder (Alcohol Abuse and Alcohol Dependence)
13. Cannabis Use Disorder (Cannabis Abuse and Cannabis Dependence)
14. Phencyclidine Use Disorder (Phencyclidine Abuse and Phencyclidine Dependence)
15. Other Hallucinogen Use Disorder (Hallucinogen Abuse and Hallucinogen Dependence)
16. Inhalant Use Disorder (Inhalant Abuse and Inhalant Dependence)
17. Opioid Use Disorder (Opioid Abuse and Opioid Dependence)
18. Sedative, Hypnotic, or Anxiolytic Use Disorder (Sedative, Hypnotic, or Anxiolytic Abuse and Sedative, Hypnotic,
or Anxiolytic Dependence)
19. Stimulant Use Disorder (Amphetamine Abuse; Amphetamine Dependence; Cocaine Abuse; Cocaine Dependence)
20. Stimulant Intoxication (Amphetamine Intoxication and Cocaine Intoxication)
21. Stimulant Withdrawal (Amphetamine Withdrawal and Cocaine Withdrawal)
22. Substance/Medication-Induced Disorders (aggregate of Mood, Anxiety, and Neurocognitive)
Combined Specific Disorders in DSM-5
Combined Specific Disorders in DSM-5

9. QUESTION:
I already have a copy of the DSM-IV-TR and that’s what
my agency is currently using. Do I really have to have
access to the DSM-5?
ANSWER:
Only if you want to pass the exam.
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10. • Assumptions of the Exam
• Rating Scale
• Information Gathering
• Decision Making
• DSM-5 (You’re on your own here)
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11. When taking the exam, consider yourself an
individual therapist in private practice, or working in an
agency, school setting, group home or even a prison.
You are a competent therapist and have a knowledge
base to treat ALL diagnoses in the DSM-5.
You can select assessment tools that are relevant to case
study. Assume you have been trained to give or do an
evaluation using ALL assessment tools.
Assumptions of the Exam
Assumptions of the Exam
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12. • You should not base your diagnosis on insurance concerns;
diagnose and treat the client as you would in a “perfect world”
• Once an option is selected it can not be unselected
• Diagnoses, Treatment items and Assessment instruments
presented in a simulation are "real" and do exist.
• Simulations can wander seemingly looking like a specific diagnosis
but along the way additional information is given that changes what
your final diagnosis is.
• On CHOOSE ONLY ONE options you have to continue selecting
until you get the correct answer. It will not let you go on until the
correct answer is selected.
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13. • There is no deception in the case study
Example:
Kelli's husband has just died and she claims that
she is not upset and she is doing fine
You need to take this as a true statement and
Kelli is not in denial.
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14. • This is the rating scale for each of the possible answers for every
question and they are based on the degree to which the client is
affected.
+3 Of central importance for good client care; omission would
result in serious damage to the client in terms of COST, TIME,
PAIN, and risk of MORBIDITY and/or MORTALITY
+2 Strongly Facilitative of good client care
+1 Mildly Facilitative of good client care
Option Uncovering Scale
Option Uncovering Scale
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15. 0: Does not contribute to client care, but
does not cause the client any harm in
terms of increased cost, pain, risk
of morbidity and/or mortality; and/or
may be a controversial option due to
regional differences.
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16. -1 Mildly detrimental to client care in terms of cost, time, risk
of morbidity and/or mortality.
-2 Seriously detrimental to client care in terms of cost, time,
pain, risk of morbidity and/or mortality.
-3 Gravely damaging to client care and very costly to the
client's welfare in terms of cost, time, pain, risk of morbidity
and/or mortality.
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17. Overlying Principles for Uncovering Items
Overlying Principles for Uncovering Items
• Everything uncovered should be directly linked in a logical
manner - try to think “Diagnosis” from the beginning
• Items uncovered should be linked back to the symptoms,
problems, and level of functioning presented in the case study
• Address and treat everything that is written in the case study
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18. If the case says the client has problems 1, 2, and 3, then you must
treat all three problems even if treating 1 would make 2 and 3 go
away
Example: Hamilton is a student in high school. He spends much of
his time smoking ‘weed’ with his buddies. Since this habit started,
his grades have dropped significantly and his parents have
threatened to disown him.
If during therapy, Hamilton stops smoking weed, his other
problems (bad grades, bad relationship with parents) will probably
go away. Even so, you must address these other problems
separately.
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19. 1. Information Gathering (IG)
2. Decision Making (DM)
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Areas of the Exam
Areas of the Exam

20. • Both Information Gathering and Decision Making
Areas have aggregate scores based on the total of
ten simulations. You must pass both the IG and
the DM areas
• You do not have to pass every simulation!
• Points are given for correct responses and
deducted for incorrect responses
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21. 1. Information Gathering (IG)
• How well can you gather appropriate
clinical information required to evaluate a
situation
• Do you ask appropriate questions of the
client
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22. 2. Decision Making (DM)
• How well can you utilize information in making
judgments and decisions?
• Can you make decisions that result in the best
treatment for the client?
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23. SPLAT
1. Symptom Identification
2. Problem Recognition
3. Level of Functioning
4. Assessment Tools
5. Treatment Progress
Information Gathering
Information Gathering
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24. TOASTED
1. Treatment Techniques
2. Objectives and Goals
3. Adjunct Services
4. Services during treatment
5. Termination and Referrals
6. Ethics
7. Diagnosis
Decision Making
Decision Making
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25. Developmental
Issues
Intake Family
Assessment
Tools
Presenting
Problem
Medical
Career
Personal
Pre-Diagnosis Flow
Chart
Preliminary
Diagnosis

26. Preliminary
Diagnosis
Adjusted
Diagnosis
Referrals
Client
Strengths
Interventions
TX Plan
Adjust
Treatments
Treatment
Goals
Treatment
Approach
Professional
Issues
Pre-Diagnosis Flow
Chart (cont.)

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