Missed Questions from first practice test TDC

Question 1

A therapist on an inpatient unit conducts an intake with a 40-year-old man who was transported to the hospital by the police after an altercation in a park. He is unable to provide a medical or social history and reports having no memory before he arrived at the hospital. A police check reveals that he is an executive of a large company in a nearby city who was laid off a few days ago. At the end of his weeklong stay in the hospital, he has recovered his memory. The MOST likely diagnosis is:

A. Dissociative Amnesia with Dissociative Fugue
B. Factitious Disorder
C. Posttraumatic Stress Disorder (PTSD)
D. Acute Stress Disorder

Answer 1

A:

Rationale: Dissociative Fugue, is a rare disorder that occurs when a stressful event, in this case being laid off, triggers a memory lapse. Other symptoms may include impulsively wandering away from home, inability to recall past events, and confusion regarding one’s identity. B, is incorrect because this occurs when someone fakes a disorder in order to be a patient. In Factitious disorder this would be happening over and over again which is not occurring in this case. C and D are incorrect because we don’t see a life threatening trauma here that would indicate PTSD or ASD.

Question 2

A diagnosis of Enuresis is appropriate when:
A. The patient voids feces intentionally or unintentionally at last twice weekly.
B. Medications may be causing the problem.
Should have chosen
C. Urine is unintentionally voided at least twice weekly and the patient is at least five years old.
D. Urine is unintentionally voided at least twice weekly and the patient is at least six years old.

Answer 2

C

Rationale: C is the best answer because Enuresis can be diagnosed when an individual is at least five years old and is unintentionally urinating twice a week, generally for about 3 months. A and B are not symptoms of Enuresis and D is incorrect because the correct age for diagnosis is at least 5 years old, not 6.

Question 3

A 62-year-old woman presents for treatment five weeks after the death of her beloved cat. Prior to this incident, she worked full time and enjoyed many hobbies. Since then, she has stayed at home and isolated herself, stating that she cries all the time. What initial diagnosis should the therapist make?

A. Generalized Anxiety Disorder
B. Acute Stress Disorder
C. Major Depressive Disorder
D. Persistent Depressive Disorder

Answer 3

C

Rationale: The women is not describing any anxiety symptoms such as worry or restlessness, therefore A is incorrect. B is incorrect because while a traumatic event has occurred, this woman did not witness, experience, or confront a life or death situation which is required for Acute Stress Disorder. Additionally, D is incorrect because depressive symptoms must exist for at least two years for an adult to be diagnosed with Persistent Depressive Disorder. Therefore, C is correct because the woman is experiencing symptoms such as isolation and feeling tearful all the time for more than two weeks that are indicative of Major Depression.

Question 4

A 45-year-old married mother of two self-refers to a therapist in private practice. She reports a strong desire to return to the workforce now that her children are in high school but reports that she’s been cancelling her scheduled interviews due to panic and fear that she will embarrass herself during the interview. What is the MOST likely diagnosis?

A. Panic Disorder

B. Social Anxiety Disorder

C. Agoraphobia Without History of Panic disorder

D. Unspecified Anxiety Disorder

Answer 4

B

Rationale: A is incorrect because the client is not describing an actual panic attack which would be necessary in order to be diagnosed with Panic Disorder. C is incorrect because the client doesn’t report that she is afraid of leaving the house at all, which is what an individual with Agoraphobia would have trouble doing. D is incorrect because while the client does express anxieties, these anxieties are more related to the act of being around others and talking in front of other people. Therefore, B is the best answer here because the client is reporting that is specifically related to being self-conscious and anxious in front of others to the point that it gets in the way of doing things.

Question 5

A fifty-year-old comes to a community agency complaining of a general feeling of nervousness. The symptoms began 8 months ago and have occurred almost daily since then. He complains of feeling restless and is easily tired, though he is unable to sleep easily and wakes frequently during the night. The MOST likely initial diagnosis is:

A. Insomnia Disorder

B. Generalized Anxiety Disorder

C. Substance-Induced Anxiety Disorder

D. Somatic Symptom Disorder

Answer 5

B

Rationale: A is incorrect because Insomnia Disorder can’t be diagnosed without ruling out other mental disorders including Generalized Anxiety Disorder. Additionally, while the client is easily tired and unable to sleep easily these symptoms are most likely due to anxiety and the feelings of nervousness, therefore B is the most likely answer as an initial diagnosis. C is incorrect because the client does not indicate any substance use in the stem. Lastly, D is incorrect because the client is not complaining of any physical pain or physical manifestations in the body.

Question 6

All of the following are associated with a diagnosis of Illness Anxiety Disorder EXCEPT:

A. “Doctor shopping” behavior in which the client goes from provider to provider, believing he is not getting proper medical care.

B. A preoccupation with physical symptoms that is of delusional intensity.

C. Failure to have actual medical conditions diagnosed.

D. A willingness to consider the possibility that no serious disease actually exists.

Answer 6

B

Rationale: A, C, and D are all components of Illness Anxiety Disorder. B is the correct answer because while individuals with Illness Anxiety Disorder have a preoccupation with physical symptoms they are NOT of delusional intensity.

Question 7

A 22-year-old client is referred by his lawyer after being accused of burglary. The lawyer claims that the client is depressed. When the therapist meets with the client, the client states that he is depressed but cannot identify any specific symptoms. The MOST likely diagnosis is:

A. Major Depressive Disorder

B. Factitious Disorder

C. Malingering

D. Conversion Disorder

Answer 7

C

Rationale: Malingering is when an individual exaggerates symptoms of mental or physical disorders for secondary gain which could include motives such as financial compensation, a way to avoid school or work, to avoid a criminal sentence, or even to attract attention. Therefore, C is the correct answer because the client is reporting feeling depressed however is unable to state any symptoms. With this in mind, the client is most likely trying to get out of his sentence by reporting symptoms of depression. A is incorrect because the client is not actually reporting any symptoms of depression. B is incorrect because with Factitious Disorder the client would be deliberately producing or exaggerating symptoms, however, it is not done for secondary gain as is seen in this case. D is incorrect because Conversion Disorder is when an individual shows psychological stress in physical ways which is not indicated in the stem.

Question 8

According to the DSM-V, for Substance Use Disorder to be in Sustained Full Remission, the length of the absence of the symptoms must be:

A. One month

B. Two years

C. Six months

D. One year

Answer 8

D

Rationale: For an individual to be diagnosed with a Substance Use Disorder in Sustained Full Remission, all symptom must be absent for at least one year.

Question 9

According to the DSM-5-TR, for an individual to be diagnosed with Attention Deficit Hyperactivity Disorder, symptoms must be present before what age?

Answer 9

Rationale: According to the DSM-V, an individual can be diagnosed with ADHD if symptoms were present before age 12.

Question 10

Persistent Depressive Disorder

Answer 10

A child can be diagnosed with Persistent Depressive Disorder after they have been displaying symptoms for a year, whereas an adult can be diagnosed after they have been displaying symptoms for two years.

Question 11

A therapist at a community mental health clinic conducts an intake interview with a 20-year-old male who has been referred by his mother. He states that his mother is concerned about his lack of relationships and tendency to isolate himself in his room playing computer games. When prompted, he tells the therapist that he is lonely and wishes he could go out and meet people, but they would just be disappointed when they got to know him; he reports feeling comfortable interacting online because he knows the people “on there” will accept him. The therapist is MOST likely to treat him for:

A. Major Depressive Disorder

B. Avoidant Personality Disorder

C. Schizoid Personality Disorder

D. Panic Disorder With Agoraphobia

Answer 11

B

Rationale: B is the correct answer because the stem reports that the client has a lack of relationships and also fears being around others or interacting with them. Individuals with Avoidant Personality Disorder express a fear of being ridiculed, poor self-image, a preoccupation with being criticized, loneliness, and social isolation. Despite this, they have a strong desire for social relationships, but find it difficult to take that personal risk. The biggest differential here is C because while an individual with Schizoid Personality Disorder has a detachment from social relationships, they actually prefer to be alone.

Question 12

A school therapist receives a referral from one of the third grade teachers. The teacher complains that the child will not sit in his seat, interrupts his peers, does not finish assigned work, and has difficulty making friends. A developmental history from the parents indicates that the child has been impulsive since preschool and that he has difficulty following directions. According to the DSM-5-TR classification, the diagnosis will MOST likely be:

A. Oppositional Defiant Disorder

B. Conduct Disorder

C. Attention-Deficit/Hyperactivity Disorder

D. Autism Spectrum Disorder

Answer 12

C

Rationale: A and B are incorrect because the child is not displaying any disobedient, defiant, or violent behaviors. D is incorrect because while the child has difficulty making friends, this appears to be more related to his impulsivity. Therefore, C is correct because the child is displaying symptoms that are common with ADHD such as trouble sitting still, difficulty concentrating and impulsivities.

Question 13

Autism Spectrum Disorder

Answer 13

Rationale: Individuals with Autism Spectrum Disorder have trouble in three areas including social interaction, communication, and behaviors/interests. These individuals also many times will become heavily interested in knowledgeable in one particular subject. All of these symptoms are displayed in the stem, therefore B is correct.

Question 14

A client was physically attacked 2 weeks ago while walking home from work. The client states that since then she feels like she is in a daze and is afraid to leave her house at night. She reports difficulty sleeping and says that she keeps snapping at her boyfriend when he tries to comfort her. The client’s MOST likely diagnosis is:

A. Posttraumatic Stress Disorder

B. Acute Stress Disorder

C. Adjustment Disorder

D. Major Depressive Disorder

Answer 14

Rationale: B is the best answer because the client’s symptoms have been occurring for greater than 3 days and less than a month. The client also experienced a life threatening event and her symptoms are in reaction to that. A is incorrect because the client would need to experience these symptoms for over a month to be diagnosed with PTSD. C is incorrect because the event was a life threatening event and not a normal life stressors (such as divorce or losing a job). Lastly, D is incorrect because the client’s symptoms are related to the attack and therefore D cannot be diagnosed.

Question 15

A college counselor starts brief treatment with a senior who was referred by his honors thesis advisor. The student denies any need for treatment but engages in the intake, telling the therapist that he prefers to be alone and rarely goes home to see his family. He reports confusion around what his peers do on the weekends and denies any interest in romantic or sexual relationships. He tells the therapist that he’s had the same roommate since freshman year but does not really know much about him. What is the MOST likely diagnosis?

A. Schizotypal Personality Disorder

B. Antisocial Personality Disorder

C. Avoidant Personality Disorder

D. Schizoid Personality Disorder

Answer 15

D
Rationale: A is incorrect because an individual with Schizotypal Personality Disorder have more irrational beliefs, extreme social anxiety, paranoid ideation, and ideas of reference which is not all seen in the stem. B is incorrect because the client is not violating the rights of others in any way. C is incorrect because an individual with Avoidant Personality Disorder also has social inhibition, however, they have a greater fear of being ridiculed or rejected in social situations. Additionally, they have a desire for social relationships which isn’t displayed in the stem here. Therefore, D is correct because individuals with Schizoid Personality Disorder have a sense of detachment for social relationships, a lack of close relationships, and what sets this apart is that they don’t have a desire for relationships.

Question 16

The diagnostic category in which pathological behavior is MOST likely to be ego-syntonic is:

A. Personality Disorders

B. Anxiety Disorders, Phobic Attacks

C. Affective Disorder With Depressive Episode

D. Organic Mental Disorders

Answer 16

A
Rationale: Ego-syntonic means that an individual views their behaviors, values, and feelings as being acceptable and consistent with one’s personality and beliefs. Individuals with Personality Disorders are ego-syntonic because they believe their values and behaviors are acceptable and consistent with their self-concept, therefore A is correct.

Question 17

A 24-year-old woman calls a therapist at a community services agency for case management and therapy. She describes a variety of physical symptoms and reports difficulty in keeping all of her health care providers straight. When asked, she reports that she doesn’t have any formal medical diagnoses but was seen most recently by an allergy specialist for “puffy eyelids.” She’s been unable to maintain employment or friendships because of frequent appointments and bouts of “illness.” This client’s provisional diagnosis is MOST likely:

A. Somatic Symptom Disorder

B. Conversion Disorder

C. Illness Anxiety Disorder

D. Malingering

Answer 17

A
Rationale: B is incorrect because the client reports that she doesn’t have any formal medical diagnoses, yet complains about many physical symptoms. An individual with Conversion Disorder would have actual physical symptoms such as blindness or paralysis that have no medical explanation. C is incorrect because illness anxiety disorder, formerly hypochondriasis, would be more appropriate if the client believed that symptoms are sign of serious medical condition, which is not indicated here. D is incorrect because individuals with malingering fabricate or exaggerate mental or physical disorders for secondary gain. Secondary gain may include things such as financial compensation, avoiding school or work, or getting lighter criminal sentences. Therefore A is correct because the client is displaying physical symptoms however there is no medical cause to be found for these symptoms.

Question 18

A therapist in private practice receives a referral from a daycare for a 20-month-old girl. During the assessment, the therapist notices that the girl has no functional language, does not respond to prompts from her mother, and sits listlessly while wringing her hands. Her mother is very upset and reports that she doesn’t understand her daughter’s behavior. She states, “She used to talk, play and have fun. Now she can’t even feed herself.” What is the MOST likely diagnosis in this case?

A. Autism Spectrum Disorder

B. Intellectual Disability

C. Social (Pragmatic) Communication Disorder

D. Mixed Receptive-Expressive Language Disorder

Answer 18

A

Rationale: The correct answer is A, Autism Spectrum Disorder, because there is a language deficiency and repetitive movements.

Question 19

A therapist is completing a biopsychosocial with a new client. The client appears with a flat affect and when asked questions, he responds with tangential answers and very disorganized speech. The client states in a monotone voice that while riding the bus on the way to his appointment people were plotting against him and he believes he was followed here by one of them. The client’s MOST likely initial diagnosis is:

A. Schizoaffective Disorder

B. Schizophrenia

C. Bipolar I

D. Schizoid Personality Disorder

Answer 19

B

Rationale: A is incorrect because the client is not reporting symptoms of both a mood disorder (mania or depression) in addition to symptoms of schizophrenia. C is incorrect because the client is not reporting any manic episodes. D is incorrect because individuals with Schizoid Personality Disorder would not experience delusions or paranoia as is being seen in the stem. Therefore, B is the best answer because the client is presenting with disorganized speech patterns, a flat affect/monotone voice, and paranoid delusions.

Question 20

A man is referred to a therapist by his Employee Assistance Program for several incidents of falling asleep on the job. During the initial interview, the man confirms that he feels sleepy almost constantly and “just can’t seem to catch up” on rest. He reports that he often can’t get himself out of bed on the weekends and has been sneaking naps in at work but has been caught on several occasions. After ruling out substance abuse and a medical issue, the therapist will likely diagnose the client with:

A. Non-Rapid Eye Movement Sleep Disorder

B. Insomnia Disorder

C. Hypersomnolence Disorder

D. Major Depressive Disorder

Answer 20

C

Rationale: Hypersomnolence is the best answer here because the client is reporting excessive sleepiness during the day. Insomnia is incorrect because the client would need to report difficulties falling asleep, or staying asleep at night which is not stated in the stem. A and D are incorrect because the client is not reporting any symptoms that would coincide with these disorders.

Question 21

Parents seek the services of a therapist for their 5-year-old son; they explain that their son has been waking around 11 p.m. several nights a week for the last month, screaming hysterically and “staring into space.” They are frightened by the fact that they are often unable to rouse their son and report that he often falls back asleep without acknowledging their presence in the room. They have been unable to get him to tell them anything about his dreams and are confused by the fact that he seems to have no memory of the events the next morning. The MOST likely diagnosis in this case is:

A. Non-Rapid Eye Movement Sleep Disorder, Sleep Terror Subtype

B. Nightmare Disorder

C. Narcolepsy

D. Panic Disorder

Answer 21

A

Rationale: B is incorrect because the client reports that is has no memory of the events that are happening. Individuals with Nightmare Disorder are generally able to remember the nightmares they have, therefore B is incorrect. C is incorrect because the client is not having recurrent daytime naps. D is incorrect because Panic Disorder does not occur during sleep. Therefore, A is correct because the nightmares are occurring during the first ⅓ of sleep time and the boy has an incomplete waking and is difficult to comfort. Additionally, the client doesn’t remember the dreams that have occurred.
Incorrect

Question 22

A 30-year-old man presents for treatment on the advice of his mother, who is concerned that he has not yet found someone with whom he can “settle down.” The therapist notes during the assessment that the man fails to make eye contact and regards the therapist in a suspicious manner. When asked about his personal relationships, the man notes that he does not have any close friends because “no one likes a person who can read minds” and that he just doesn’t “fit in” with his co-workers. What is the MOST likely diagnosis in this case?

A. Paranoid Personality Disorder

B. Schizophrenia

C. Schizotypal Personality Disorder

D. Schizoid Personality Disorder

Answer 22

C
Rationale: A is incorrect because the client is not displaying any paranoid behaviors such as believing someone will sabotage him. B is incorrect because the client is not displaying a flat affect, or any hallucinations. D is incorrect because individuals with Schizoid Personality Disorder are viewed as being more of loners, whereas the client in this stem has a relationship with his mom. C is correct because the client is displaying odd behaviors, does not fit in with others, and the biggest defining factor in this stem is that the client reports magical thinking when stating that he can read minds.

Question 23

A college student seeks therapy for problems with schoolwork. She states that sometimes she is really productive and can go without much sleep for a few days straight. The problem is that she’ll end up crashing. She reports that she’ll feel bad about herself and not want to get out of bed for a few days because she is so unmotivated. What diagnosis is MOST likely?

A. Bipolar I Disorder

B. Bipolar II Disorder

C. Schizoaffective Disorder

D. Cyclothymic Disorder

Answer 23

D

Rationale: D is the best answer here because the client is displaying a milder form of Bipolar Disorder. The client reports hypomanic symptoms when she states that she can go for a few days straight without much sleep followed by depressive symptoms that do not fit the criteria for Major Depression. A and B are incorrect because the client is not experiencing full blown mania or Major Depression. C is incorrect because the client is not displaying any symptoms of psychosis.

Question 24

A client reports that despite going to bed at an early hour, he continues to struggle falling asleep, often laying in bed for 3 hours before he is able to fall asleep. The client reports that he is exhausted and has been happening more often than not throughout the week for the past 6 months. What is the client’s MOST likely diagnosis:

A. Insomnia Disorder

B. Hypersomnolence Disorder

C. Major Depressive Disorder

D. Non-REM Sleep Disorder

Answer 24

A

Rationale: Since the client reports that he is having trouble falling asleep and that this has been occurring for more than 3 months, the client’s most likely diagnosis is A. B is incorrect because the client does not report excessive sleepiness during the daytime. C is incorrect because the client is not reporting any symptoms of depression. Lastly, D is incorrect because the client is not reporting waking during the first ⅓ of sleep time with nightmares or night terrors.
Incorrect

Question 25

A mother brings in her young daughter to see a therapist. The mother reports that her daughter is very quiet and appears anxious when speaking. She also states that teachers have reported that she does not participate frequently in class. When the therapist asks the girl a question, the therapist notices that her words are often repeated while she speaks, and the syllables last longer than normal. The MOST likely diagnosis here is:

A. Language Disorder

B. Childhood-Onset Fluency Disorder

C. Autism Spectrum Disorder

D. Specific Learning Disorder

Answer 25

B

Rationale: B is the best answer here because the girl is struggling with the time patterning of her speech which is displayed by her repetition of words and prolonged syllables. A is incorrect because individuals with Language Disorder have trouble getting their meaning across to others, but they are able to produce sounds and their speech can be understood. C is incorrect because the child is not displaying deficits that indicate Autism Spectrum Disorder such as repetitive patterns of behavior, social interaction difficulties, or a disinterest in activities. D is incorrect because the stem does not indicate that the girl is having difficulties with academic learning.

Question 26

A 12-year-old child is displaying difficulties with reading comprehension and when asked to read out loud frequently makes mistakes in reading the words. The child’s MOST likely diagnosis is:

A. Specific Learning Disorder with Impaired Reading

B. Specific Learning Disorder with Impaired Written Expression

C. Childhood-Onset Fluency Disorder

D. Intellectual Disability

Answer 26

A

Rationale: A is the best answer here because the child is displaying difficulties with reading comprehension and fluency. B is incorrect because a child with Impaired Written Expression would experience difficulties with spelling accuracy, grammar and punctuation, and clarity or organization of written expression. C is incorrect because the child is not struggling with the sounds or syllables of the words but rather the accuracy of comprehending the words. Lastly, D is incorrect because the boy is not displaying symptoms that would be indicative of an Intellectual Disability.

Question 27

Kai, 15, was referred to therapy by their school counselor 7 months after their twin died of cardiovascular complications. Since the death, they report feeling numb and like they, too, have died. During an assessment, the therapist learns the child won’t enter their sibling’s room and no longer interacts with friends at school. Based on this information, what is the client’s MOST likely diagnosis?

A. Uncomplicated Bereavement

B. Major Depressive Disorder

C. Prolonged Grief Disorder

D. PTSD

Answer 27

C

Rationale: The most likely diagnosis, in this case, is (C) Prolonged Grief Disorder due to the duration and severity of grief after the death of a loved one. This diagnosis was added to the DSM-5-TR to describe maladaptive grief reactions that cause clinically significant distress or impairment in social, occupational, or other areas of functioning. For adults, it can only be diagnosed 12 months after someone close to the client has passed; for children and adolescents, it is six months after death. At the time of diagnosis, the client is seven months into grief and is still struggling with symptoms like identity disruption, avoidance of reminders, emotional numbness, and difficulty reintegrating into one’s relationships – all criteria for Prolonged Grief. This eliminates (A) Uncomplicated Bereavement, which is a Z Code to classify “typical” grief in the first few weeks or months of mourning. Answer (B) is a possible answer in the future. Answer (D) can be ruled out due to the lack of traumatic stressors or intrusion symptoms that are required. Answer (C) is more specific and appropriate to the client’s experience of grief at this time.

Question 28

Jalen works third shift as a security guard and admits using cocaine for the past few years to help him stay awake. He has difficulty sustaining attention in session and remembering what time he scheduled appointments. The therapist observes that the client often asks them to repeat questions and struggles with answering clearly and coherently. According to the DSM-5-TR criteria, the MOST likely diagnosis for the client is:

A. Stimulant-Induced Mild Neurocognitive Disorder

B. ADHD

C. Substance-Induced Mood Disorder

D. Major Neurocognitive Disorder

Answer 28

A

Rationale: Stimulant-Induced Mild Neurocognitive Disorder was added to the newest addition of the DSM to describe neurocognitive symptoms, such as difficulties with learning, memory, and executive function, associated with prolonged cocaine or methamphetamine use. Answer (B) and (D) are incorrect as they do not consider the possible long-term side effects of stimulants. Answer (C) is incorrect because there are no signs of a mood disorder at this time. Therefore, (A) is the most likely initial diagnosis because the client has admitted to repeated cocaine use over time and is exhibiting concordant neurocognitive issues, such as memory loss, decreased attention, and problems with processing and retaining information.

Question 29

During a 20-minute assessment with an intake specialist, Zuri, 27, reports that they can’t quite pinpoint what’s wrong. They just “don’t feel much of anything,” and they can’t remember when it started. The client denies any suicidal ideation. When they’re asked about their goals for therapy, the client states self-improvement and “feeling better.” What initial diagnosis should the intake therapist make?

A. Persistent Depressive Disorder

B. Unspecified Mood Disorder

C. Unspecified Depressive Disorder

D. Major Depressive Disorder

Answer 29

B

Rationale: Unspecified Mood Disorder was re-added to the DSM-5-TR to classify mood symptoms that do not meet the full criteria for any of the disorders in either the bipolar or depressive categories. In this case, there’s not enough clearly defined information, including estimated timeframes or multiple depressive symptoms (sadness, agitation, feelings of worthlessness, etc.) that cause clinically significant distress. At this point, the client is only possibly pointing to emotional numbness, so the most likely initial diagnosis is (B) Unspecified Mood Disorder until the therapist can find out more and update the diagnosis as new information is presented.
Incorrect

Question 30

Saarik, 17, is brought into therapy by his parents, who recently discovered self-inflicted wounds on their child’s forearms. Saarik shared that he does it “to blow off steam” when he is upset because it makes him feel better and admits that it can be hard to stop. The client reports that the last cutting incident was about 3 weeks ago. What is the MOST likely diagnosis at this time?

A. Unspecified Impulse Control Disorder

B. Obsessive-Compulsive Disorder

C. Malingering

D. Personal History of Non-Suicidal Self-Injury

Answer 30

D

Rationale: There is no indication of unreasonable obsessive thoughts, nor is there a time-consuming compulsion that is causing clinically significant distress or impairment, so (B) is incorrect. Malingering refers to an individual who fabricates or exaggerates a mental or physical disorder for personal gain, such as financial compensation or avoiding school. This makes (C) incorrect. (A) can be eliminated as it refers to issues in emotional and behavioral self-control with patterns of escalating problem behaviors leading to negative life consequences, often violating the rights of others. This diagnosis is often close to disorders like kleptomania or pyromania, but do not meet the full criteria. Therefore, (D) is the best answer since this is a Z Code that refers to a history of self-harm behavior that is not suicidal in nature.