The Politicized Practitioner
Differential Diagnosis Lab
Interactive cases for learning how to build, test, and document a differential diagnosis—one symptom, decision tree, comparison table, and provisional formulation at a time.
Start with the method. These simulations do not ask you to guess a diagnosis. They ask you to show how you ruled possibilities in, ruled them out, or retained them as uncertain.
The seven-step trees-and-tables method
1Broad rule-outs
2Key symptoms
3Tree matching
4Tree walks
5Candidate list
6Table comparison
7Provisional formulation
How to use each pair: complete the A case first for guided coaching. Then complete the B case with fewer prompts and compare your reasoning with the expert debrief.
Depression and low mood
01A · Guided practice
Use lifetime course, activation, and safety information before settling on unipolar depression.
Open simulation →01B · Independent application
Differentiate grief-related experience, adjustment disorder, and a depressive disorder without pathologizing attachment or overlooking risk.
Open simulation →Possible mania and mood instability
02A · Guided practice
Use chronology to distinguish intoxication or substance-induced symptoms from a primary bipolar episode while responding to acute risk.
Open simulation →02B · Independent application
Distinguish sustained mood episodes from rapid, cue-linked affective reactivity without reducing the person to a personality label.
Open simulation →Hearing voices unusual beliefs and psychosis
03A · Guided practice
Use the temporal relationship between psychosis and mood symptoms to distinguish mood, schizoaffective, schizophrenia-spectrum, substance, and medical explanations.
Open simulation →03B · Independent application
Assess voice-hearing phenomenology, trauma, culture, function, and risk without assuming that an unusual experience equals a psychotic disorder.
Open simulation →Anxiety and excessive worry
04A · Guided practice
Recognize panic phenomenology without using a psychiatric explanation to bypass medical red flags.
Open simulation →04B · Independent application
Differentiate generalized anxiety, social anxiety, obsessive doubt, trauma-related vigilance, and realistic stress by examining the object and function of worry.
Open simulation →Intrusive thoughts
05A · Guided practice
Distinguish ego-dystonic obsessions from intent while conducting a real safety assessment.
Open simulation →05B · Independent application
Differentiate trauma intrusions from obsessions, rumination, and psychosis through trigger, sensory quality, orientation, meaning, and associated symptoms.
Open simulation →Trauma-related symptoms
06A · Guided practice
Use timing and symptom pattern to distinguish acute stress responses, acute stress disorder, PTSD, and other conditions without minimizing distress.
Open simulation →06B · Independent application
Differentiate prolonged grief, PTSD, depression, and culturally situated mourning while allowing comorbidity.
Open simulation →Attention and concentration problems
07A · Guided practice
Use developmental onset, cross-setting persistence, functional history, mood, sleep, and substances to evaluate adult attention complaints.
Open simulation →07B · Independent application
Differentiate neurodevelopmental symptoms from trauma, anxiety, learning needs, sleep problems, and context while avoiding discipline-driven diagnosis.
Open simulation →Emotional instability and relationship crises
08A · Guided practice
Compare episodic mood course with pervasive relational and self-function patterns while avoiding diagnostic stigma.
Open simulation →08B · Independent application
Distinguish enduring personality pathology from trauma adaptation, realistic threat appraisal, institutional inconsistency, and clinician-system dynamics.
Open simulation →Dissociation and feeling unreal
09A · Guided practice
Distinguish depersonalization/derealization, panic, psychosis, substance effects, and neurologic conditions.
Open simulation →09B · Independent application
Keep dissociative disorders, seizures, sleep, substances, and medical causes open while avoiding suggestive interviewing.
Open simulation →Eating and food restriction
10A · Guided practice
Differentiate restriction driven by weight/shape concerns from sensory sensitivity, feared consequences, low interest, and medical causes.
Open simulation →10B · Independent application
Identify binge episodes and compensatory behaviors without relying on body size, gender, or vomiting stereotypes.
Open simulation →Confusion and cognitive change
11A · Guided practice
Recognize acute fluctuating inattention as a medical emergency and avoid attributing it to age or presumed dementia.
Open simulation →11B · Independent application
Differentiate depression-related cognitive impairment from neurocognitive disorder while avoiding the misleading assumption that one excludes the other.
Open simulation →Physical symptoms without clear explanation
12A · Guided practice
Understand that functional neurologic disorder is diagnosed through positive clinical features, not merely normal tests or presumed psychological conflict.
Open simulation →12B · Independent application
Differentiate illness anxiety from somatic symptom disorder and avoid equating either with “symptoms are imaginary.”
Open simulation →Substance use and psychiatric symptoms
13A · Guided practice
Use exposure, abstinence course, prior symptoms, collateral, and functional change without assuming that substance use settles the diagnosis.
Open simulation →13B · Independent application
Recognize alcohol withdrawal as a potentially life-threatening medical condition rather than treating the presentation as uncomplicated anxiety.
Open simulation →Clinical boundary. The lab is educational. Use current diagnostic criteria, supervision, scope-of-practice requirements, medical evaluation, and local emergency procedures in real practice.