an only child, is a 20-year-old receptionist in a wholesale dress house
who feels that she hasn't been discovered yet by the fashion world. She
has done some showroom modeling for customers and is always daydreaming
that she will be swept off her feet by the next wealthy man who comes
through the door. Eating in the local restaurants, she always takes the
opportunity to complain about the clumsy waiters, the inept service, or
the poor quality of the food. Frances engages in a rich fantasy life in
which she is adored and loved by crowds of onlookers and where she gets
even with all the people whom she perceives have been mean to her. She
would be diagnosed with:
B. Narcissistic Personality Disorder
Symptoms for this diagnosis include a grandiose sense of self-importance, preoccupied with fantasies of unlimited success, a belief of being special, a sense of entitlement, lacking in empathy, and an arrogant attitude toward others.
Matt is an active, physically strong, and exceptionally tall 18-year-old 12th
grader who stays out late at night with his friends, despite his
parents forbidding it. He ran away from home several times when he was
younger and is truant from school frequently. His grades are poor and
he has been left back and placed in special education classes. The
school psychologist gave him a diagnosis of Conduct Disorder when he
was 13. When he attends school now, he threatens and intimidates
students and teachers and seems to enjoy getting into fights. He has
attacked one student with a brick and boasts that he carries a knife
and has a gun hidden on school grounds. Matt has never expressed
feelings of remorse for his actions. A good talker, he often engages in
conning his teachers and enjoys the attention it seems to get from the
other kids. A favorite weekend activity in which Matt has been engaging
for the past several years is shoplifting. Your diagnosis would be:
C. Antisocial Personality Disorder
Conduct disorder is commonly a precursor to Antisocial Personality Disorder.
A diagnosis of Antisocial PD requires evidence of a Conduct Disorder before age 15. This patient meets all requirements of Antisocial PD including failure to conform to social norms relative to lawful behavior, repeated lying or conning other for personal profit or pleasure, impulsivity, aggressiveness around physical attacks, irresponsibility, and lack of remorse for hurting or mistreating others or stealing.
ADHD is not an appropriate diagnosis because the patient doesn't show any signs of inattention of hyperactivity-impulsivity, although there may be a learning disorder present.
Oppositional Defiant Disorder would not be the correct diagnosis either because this patient fails to meet the criteria for frequent loss of temper, arguing with adults, refusing to comply with requests, blaming, vindictiveness, and hostility.
He may have some of the symptoms from each category, but his prominent symptoms are shown in the way he conducts himself and violates the rights of others.
32-year-old Hispanic man comes to your general practice office for the
first time. In the course of taking his history, the man mentions
several times that he feels exploited by his employees and that he
doubts their loyalty to his company. "In fact," he says, "I have even
overheard them talking about how they would change the company if I
were no longer in charge." He says he is consequently reluctant to
confide in others, especially in his business partner, and he even
wonders if he should be telling you all this since you have just met.
Based on this information alone, you might suspect that his man is
suffering from which personality disorder?
A. Paranoid Personality Disorder
The correct choice is Paranoid PD, because the patient presents with at least four of the criterion symptoms, including suspicion without cause, preoccupation with the loyalty or trustworthiness of others, reluctance to confide in others, misinterpretation of benign events, or perception that remarks made to them are threatening.
The only other choice that is a similar disorder is Schizoid PD. The reason this is not the correct diagnosis is because individuals with Schizoid PD tend to tbe socially isolated, display restricted affect, and almost always prefer to be alone. These individuals do not do well in jobs that require social performance.
is the perfect homemaker. She loves to clean and spend much of her time
looking around her home for things which may require straightening or
dusting. Unable to relax, she has been accused of being a perfectionist
and, in fact, finds it hard to enjoy golf with her husband because she
finds he doesn't take it seriously enough. While her home is extremely
neat and clean, her attic contains boxes filled with old buttons,
magazines, food coupons, and bits of string and broken lamps because,
as she says, "you never know, you may need them". Extremely careful
with her money, she is overly concerned with being left with no money
and feels it is only right that people save as much as possible, even
if it means denying her family little things they would like, such as
an occasional movie. Her diagnosis would be:
C. Obsessive-Compulsive Personality Disorder
To make this diagnosis you have to differentiate between OCD and OCPD. Patients with OCD have obsessions, compulsions, and hoarding tendencies that are to the extreme that could present a danger to themselves and others. The OCPD patient, on the other hand, expresses a commitment to perfection, are self-critical, and has a discomfort with warm emotions. The OCPD patient is able to devote themselves to work and productivity, and exclude leisure activities. They are moral, inflexible, and preoccupied with making lists and organization. These patients are also unwilling to delegate duties to others and may be miserly because they fear the possibility of catastrophes.
therapy, such as might be used to treat a habitual sex offender, is
designed to change an individual's behavior by making the consequences
of a maladaptive behavior extremely unpleasant. This is an example of:
C. Behavioral Therapy
Behavioral therapy is similar to cognitive therapy in the sense that it does not account for the unconscious. Importance is placed on changing maladaptive patterns of behavior that are believed to result from learning the behaviors from others. Behaviors can be changed by reinforcing new behaviors or providing consequences to continuing maladaptive behaviors.
Violating the rights of others and being unable to conform to the norms of society is symptomatic of:
B. Antisocial Personality Disorder
Violating the rights of others and being unable to conform to the norms of society are key characteristics of Antisocial Personality Disorder. People with this disorder often exhibit a disregard for the rights and feelings of others, engage in impulsive and irresponsible behavior, and have a lack of remorse for their actions. They may also have a history of criminal behavior, deceitfulness, and manipulation. This behavior is not seen in the other listed disorders, making Antisocial Personality Disorder the most appropriate answer.
client is fearful of asking a woman out on a date because he has been
rejected in the past. While being hurt, he has decided that "all
relationships with women invariably hurt men." You begin exploring the
validity of this statement with your client by having him make a list
of his male friends, and then you give him an assignment to contact
each man and ask them if all women they have been involved with have
hurt them. This assignment best fits a model of:
B. Cognitive Therapy
Cognitive therapy disregards the unconscious in favor of helping a client understand how his or her thinking about things influences overall perceptions, consequently placing limitations on the individual's ability to work through problems. For example, if an individual thinks of the world as a dangerous place, he or she may be unwilling to take risks that might results in advancement at work or in a relationship. A cognitive therapist would challenge this pattern of thinking by proving with the client that thinking this way is flawed. Perhaps the world is sometimes dangerous, and in those cases risk-taking is ill-advised. However, in other situations, the therapist and client would discover risk-taking, and even failure, is okay and necessary for growth. (Mrs. DiBaise gave the example of a person who didn't ever want to go bowling because people would make fun of them. The therapist would urge the patient to go bowling sometime and see how many people actually say anything about the person's skills and then come back and talk about it).
Those with a phobic disorder tend to respond well to:
E. Behavior Therapy
Behavior therapy emphasizes current behaviors as opposed to psychoanalytic psychotherapy, which focuses on historical antecedents; therefore, it is most effective in bringing behavioral changes. Therapies, such as systematic desensitization, take patients through a series of progressive images (ie: imagining being in the room with a snake to imagining touching a snake) until the patient desensitizes to the feared object.
Family and group therapy are useful in treating the dynamics and structure of the family unit and with problems of interpersonal issues respectively.
Biofeedback has been shown to be helpful in relieving tension headaches, and in helping patients lower their stress levels by teaching them how to slow their heart rate and respirations.
40-year-old male comes to see you at the insistence of his wife. He
states that there is nothing wrong with him, but if seeing a
psychiatrist will shut his wife up, then he is willing to do it. The
client is a very successful businessman. He tells you that his wife
recommended he see a therapist, but he stated that if he was going to
receive counseling then he wanted to see a psychiatrist because they
have more education. The patient states that his wife is frustrated
because they have no friends, and that the client is too picky about
people. Upon further elaboration the client says that he is not going
to spend time with just anyone, and that spending time with people less
educated and intelligent then himself was a waste of time. When asked
about his job, the client states that it is okay, but he is under
appreciated. He says that without him the company would never make any
money, but that nobody ever recognizes how important he is to the
company. What DSM-IV diagnosis do you suspect for this client?
D. Narcissistic Personality Disorder
This client is experiencing an inflated sense of self, believes he has special abilities, will only associate with those of "high status," and he believes that he deserves special recognition.
Schizotypical Personality Disorder is best defined by which of the following?
B. A disturbance of interpersonal relationships due to discomfort with close interaction with others
Schizotypal Personality Disorder is marked by interpersonal deficits in one's ability and comfort in relating to others. Typically, an individual will display discomfort and reduced capacity for close relationships, which is the essential feature of the diagnosis. The diagnosis also features perceptual distortions and eccentricities of behavior, beginning in early adulthood and present in a variety of contexts.
Which of the following would be CONTRAINDICATED in the psychotherapy of the person with Borderline Personality Disorder?
A. Open therapist-patient boundaries
Borderline Personality Disorder is a pattern of impulsivity, and unstable relationships, affect, and self-image. The psychotherapy of such a person relies on a structured treatment with a clear delineation between patient and therapist, with the scrupulous avoidance of boundary violation on the part of the therapist. Medications are used as needed to treat particular symptoms, and stress interviews are not indicated.
is a 28-year old, single, high-school educated truck driver who has
been working for the same company for 10 years. He has had few raises
and puts in overtime whenever he is asked. Rarely dating, Tom lives
with his parents who handle his money, pay his bills, and purchase his
clothing for him. Tom got his job through an uncle who told his parents
it would be a good place for him to work. You diagnose him with:
A. Dependent Personality Disorder
People with Dependent PD allow others to make most of the decisions in their lives, both minor and major. Many adults depend on their parents or spouse to make decisions as to where to live, work, and with whom to socialize. They may not feel capable of functioning independently and will agree to things which they feel are wrong for them rather than risk losing the support of this individual. If involved in a marriage or relationship which ends, they will quickly seek another to provide them with the support they need.
woman brings her 25-year-old son to your office for evaluation. She
says that he never goes out and she complains that "it is high time he
finds himself a girlfriend." In discussing this with the man in
private, he reveals that he has never felt comfortable around other
people because he feels too much pressure to "perform." He fears
rejection. This man is probably suffering from which type of
E. Avoidant Personality Disorder
Avoidant personality disorder is characterized by social inhibition and feelings of inadequacy. Individuals who suffer from this disorder are extremely sensitive to negative feedback from others. They avoid social activities due to their fear of having to participate.
is a showroom model in New York City, where she models shoes. It is
extremely important that she not get any marks on her ankles or legs
and she takes very good care of her entire body. Twice a week, although
she can hardly afford it, she has a massage and goes to the
dermatologist to have hair removed on her legs and face. An attractive,
blonde-haired woman of 23, she has completed secretarial school, which
she refers to as "business college". Maryann is waiting to meet a rich
millionaire in the showroom and wants to get married and live in a
house in Connecticut with a full staff. Her boss tolerates her chronic
lateness and excessive demands because she is attractive and, although
she can be very condescending, his customers seem to find her amusing.
When asked about her work, she always tells people she is a model and
expects to be signed by a major agency very shortly. She is very
unhappy because she feels unrecognized and envys the models in the
magazines. You might diagnose her with
E. Narcissistic Personality Disorder
Narcissistic Personality Disorder individuals do not fear abandonment, engage in self-destructive behavior, or have a problem with self-image. They do, however, have a grandiose sense of self-importance, are preoccupied with fantasies of success, power, love, require excessive admiration, show a sense of entitlement, and envy others while showing an arrogant manner.
20-year-old male is referred by his school for behaviors that they feel
are about to cause him to be expelled from school. He has been in
trouble with the law for theft, bringing a weapon to school and his
mother reports that he hangs around with a gang of boys that have been
stealing cars and damaging property belonging to others. What would be
your provisional diagnosis?
D. Antisocial Personality Disorder
Persons with Antisocial Personality Disorder present with a history of theft, damaging property, physical cruelty to animals or people, forcing sex, using weapons to cause injury, starting fights, and threatening or stalking people.
Of the following Personality Disorders, a person with which disorder is likely to be most resistant to therapy?
E. Schizoid Personality Disorder
Essential features of Schizoid Personality Disorder is a detachment from social relationships, a restricted range of emotions, lack of warmth, and an indifference to others' opinions of them. Because of these traits, schizoids typically do not seek treatment and probably lack the motivation to benefit from psychotherapy.
A person with Borderline Personality Disorder is apt to regress if they perceive therapy is going well as a means of sabotaging a goal. Those with BPD may develop patterns of undermining successes just at the moment they may be realized.
Narcissistic Personality Disorder is marked by grandiose, egotistical, and arrogant behaviors. The narcissist would love therapy because it would allow him to be the center of attention!
A person with Dependent Personality Disorder would display dependent behaviors such as clinging, inability to make decisions without excessive advice seeking from others, and so on. This person would benefit a great deal from therapy, although the therapist's job would be very difficult.
Histrionics are typically over-dramatic and enjoy calling attention to themselves. They would not be interested in traditional psychoanalysis, but might benefit from confidence and esteem building.
have been hired to work at a mental health clinic. Your colleague
informs you that 60% of the patients have an axis II diagnosis and that
50% of the patients are female. He has been managing all of the male
patients and requests you manage all of the female patients. If you
agree, which of the following diagnoses are you both likely to see with
C. Avoidant Personality Disorder
Avoidant Personality Disorder involves a pervasive sense of inadequacy in social situations and hypersensitivity to negative evaluation. This diagnosis is made with equal frequency in males and females.
Currently, Antisocial Personality Disorder is more often a diagnosis given to males and Borderline Personality disorder is a diagnosis given primarily to females (75%).
The diagnosis of Obsessive-Compulsive Personality Disorder is made twice as often in males than in females.
Paranoid Personality Disorders are more common in males.
is a 35-year old single female, who is very concerned that she will be
abandoned by her boyfriend. She has always been very intense in her
relationships, many times alternating between idealization and
devaluation, often is highly impulsive, and engages in reckless driving
and casual sex. When left alone, her thoughts turn to suicide and she
has made several gestures in the past. Her mood ranges from intense
dysphoria to anger and she sometimes suffers from feelings of
dissociation. Your diagnosis would be
C. Borderline Personality Disorder
Borderline Personality Disorder is characterized by intense feelings with marked fluctuations from idealization to devaluation, concerns of abandonment, impulsivity in at least two areas which are self-damaging (ie: spending, sex, substance abuse, reckless driving, binge eating), suicidal behavior, gestures, threats, or self-mutilating behavior, chronic feelings of emptiness, and occasionally, dissociative symptoms.
The histrionic personality is similar, although this patient didn't present with any patterns of craving to be the center of attention, using her physical appearance to get attention, self-dramatization, or being easily influenced by others.
have been working with a 25-year-old male who states that he feels sad
all of the time. He states that he feels lonely, and that all of his
relationships seem to fail. His last relationship ended just a few
weeks ago and had only lasted about nine weeks. He says his
relationships always start out great. He and his love interest will
spend endless hours together discussing every detail of their lives. He
states that a few weeks into the relationship, things always change.
His girlfriends always pull away from him, and they stop respecting his
needs. He often tells his girlfriends that if they leave him, he will
kill himself. These threats are frequently followed by intense displays
of anger. He has been hospitalized three times, once for overdosing on
medication, and twice for superficial cuts to his arm. When asked about
his parents, the client states that he rarely speaks with them. They do
not seem to understand him or care about him as much as they do his
siblings. Although this patient has had some college, he never seems to
be able to settle on a major. He has a poor work history, frequently
jumping from one career to next. He states that sometimes the jobs seem
like more than he can handle, and he just wants something that does not
require so much concentration. He further explains that he does not
feel like getting up in the morning and has difficulty forcing himself
to go to work. He frequently has difficulty sleeping and often spends
hours tossing and turning in bed. He says he gets up in the morning
feeling just as tired as he was when he went to bed. In accordance with
the DSM-IV, what is the Axis II diagnosis for this patient?
E. Borderline Personality Disorder
Axis II diagnoses consist of personality disorders and mental retardation. This patient probably has an Axis I disorder such as dysthymic disorder or major depressive disorder. However, since the question asks for which Axis II diagnosis is appropriate, the best fitting would be Borderline Personality Disorder.
This client is experiencing unstable personal relationships, an unstable sense of self, unpredictable and unstable moods, and difficulty controlling his anger. He also expresses a sense of devaluation in his personal relationships. This case study shows that the client has made suicidal threats and attempts in order to manipulate others or make them feel guilty. Borderline Personality Disorder patients are different than Dependent Personality Disorder patients in their reaction to abandonment. BPD patients react to abandonment with an outward expression of anger, whereas DPD patients react with increased submissiveness. The fact that the patient is often self-destructive and displays angry disruptions in close relationships, differentiates him from a patient with a Histrionic Personality Disorder.
40-year-old male computer programmer comes to your office in a frantic
state. He states that he is stalking out one of his friends, has been
dangerously drinking and is under the influence of alcohol quite often,
has a history of picking up strangers, reports a series of suicidal
attempts, and seems to call in sick when he feels like it. He has no
medical history and does not appear depressed. From talking to another
therapist, this patient seems to have a history of self-damaging
behaviors. What would be your provisional diagnosis?
D. Borderline Personality Disorder
Borderline personality characteristics include: unstable impulse control, early adult life instability in interpersonal relationships, frantic attempts to prevent abandonment, identity disturbance, self damaging behavior, self mutilating behavior, severe reactivity to moods, chronic feelings of being no good, and anger and paranoid behavior which may last for short or long periods of time.
is common among those with Schizoid Personality Disorder or Avoidant
Personality Disorder. The distinction in this isolation between the two
types of personality disorders is that someone with Avoidant
B. Is unhappy with isolation
People with Avoidant Personality Disorder are afraid of rejection, and therefore, develop a lifestyle of isolation. They would like to have more friends, but feel inept to become socially involved.
Those with Schizoid Personality Disorder PREFER isolation and are unconcerned for others' opinions about them. They have a restricted range of emotions and lack warmth; thereby keeping others at bay.
The narcissist is a very social creature with egotistical and arrogant behaviors.
Managing a patient with a Dependent Personality Disorder would include:
A. Setting firm limits
Managing a Dependent Personality Disorder can be a wearying task. They tend to call the office incessantly seeking advice or to ask for more appointments. Setting FIRM LIMITS, up front, as to expectations can greatly relieve the practitioner and create a sense of security for the patient.
Attention to detail would be good for working with an Obsessive-Compulsive Personality Disorder patient, so they get the idea you are just like them, therefore creating a practitioner/patient alliance.
The Narcissist is best managed by a practitioner who acknowledges their "uniqueness." This will make it so the patient has a better perception of the practitioner being able to appreciate all their special problems.
Graded exposure to social situations is helpful in managing Schizoid Personality Disorder patients.
Those with Schizotypal Personality Disorders can benefit from low-dose antipsychotics to relieve their anxiety and unusual perceptions.
A woman in her mid-thirties has a history of difficulty in social relationships. She is highly demanding and hyperfocused on her appearance. When she wants a haircut she refuses to wait for an appointment demanding she receive immediate service regardless of others waiting ahead of her. She frequently ignores her boyfriend at social functions and is observed flirting with other men, even though he goes out of his way to try to please her. As a result of these behaviors, she has few if any close friends. This description is most indicative of which condition?
C. Narcissistic Personality Disorder
The patient's presentation is actually most consistent with Schizotypal Personality Disorder, characterized by a lifelong pattern of indifference to others as well as detachment and social isolation. Although isolated, patients are not usually unhappy with their lack of social contact. The personality traits of a Narcissist include an overblown sense of self-importance and self-centeredness with little concern for the needs of other people. As a result, people with NPD often antagonize people who try to befriend them and therefore have trouble maintaining long-term relationships. Irresponsible or erratic behavior is uncommon in patients with this condition.
Which of the following is consistent with Histrionic Personality Disorder?
A. Excessively expressionistic speech which is lacking in detail
Histrionic Personality Disorder is a pattern of excessive emotionality and attention seeking, which often includes a need to be the center of attention, sexually seductive behavior, rapidly shifting emotions, impressionistic speech, and an overestimation of the intimacy of personal relationships. All of the other choices are more consistent criteria for Borderline Personality Disorder.
have just come on duty at midnight in the emergency room and are being
told about the current patients. First is a 36-year-old male with a
deep laceration across his chest. The wound has been cleaned, and he is
waiting to be sutured by the on-call surgeon. He has been demanding
oxycodone (OxyContin) and has threatened several nurses for not
complying. When you go to check on him, he is rummaging through the
medical supplies in the cabinet in his room. He asks if you are going
to "fix him up" or are "just another flunkie." You remain professional
and ask him to give you some background information. He tells he is in
a hurry because he has some business to finish with some guys who are
after him. He is unkempt and has poor dental hygiene. While examining
his wound, he asks you if there are any police officers in the
emergency room and explains that they have been following him and
harassing him for the last year. As you leave to find the surgeon, you
inform him that threatening the staff will not be tolerated. He snorts
and mutters something under his breath. As you are walking away, he
calls after you to "get the surgeon in here." You suspect he may have
C. Antisocial Personality Disorder
The disregard for, and violation of, the rights of others characterize Antisocial Personality Disorder. It is associated with urban settings and low socioeconomic status. Criteria include repeated breaking of laws, impulsivity, lying, and other deceitful behaviors, irresponsibility in work and financial obligations, and lack of remorse. There must also be evidence of a conduct disorder before the age of 15. Antisocial personlities are more likely to die by violent means then the general population.
man in his mid-30s calls to make an appointment for counseling, stating
that his relationship of 5 years just broke off, at his partner's
insistence. He says that he is unsure what to do because he has not
been without a significant other for more than a week or so since high
school. You determine that the man is not suicidal or homicidal, but
from his responses to your questions you get the sense that this man's
sense of loss will persist long after a normal period of adjustment,
unless he enters into a new relationship. You think this because you
are guessing that this man has this type of personality disorder
D. Dependent Personality Disorder
Individuals with Dependent Personality Disorder tend to be clinging and submissive in their behaviors because their need to be taken care of is so pervasive. They have difficulty making everyday decisions without consulting others, they agree with others even if they believe the person to be wrong, due to their intense fear of rejection. They have difficulty doing things on their own and their most pervasive fear is that of being abandoned.
Which of the following signs and symptoms would RULE OUT the diagnosis of Schizotypal personality disorder?
B. Symptoms occurring only at home
Schizotypal Personality Disorder is a pervasive pattern of social deficits and cognitive and perceptual disturbances, which develops in early adulthood. (It therefore would not only be seen at home). Odd thinking, illusions, severe social anxiety, paranoid thoughts, and other disturbed thinking processes are evident, but not severe enough to warrant the diagnosis of schizophrenia.
45-year-old male comes to see you. He is a middle manager in a large
corporation. He states that he is feeling extremely stressed out. You
ask him what he means by stressed out. He states that he has too many
things to do and he cannot organize all of his tasks. He states that
even his lists are no longer working for him. He has so many tasks to
do that he spends half of his day writing and re-writing his lists
until they are perfect. He hasn't taken a vacation for almost five
years. His family complains that they never see him because he is
always at work. During the interview he keeps muttering to himself that
he cannot take time off because there is too much work to do. His boss
came in to talk to him the other day and he just blew up at him. He
says that he cannot handle the pressure anymore. He said he would
delegate tasks to his staff, but they do not pay attention to the
details the way he does and don't seem to put a high priority on the
tasks. When his boss hands him a task to do, he does not leave the
office until that task is perfectly done. The client is stiff as he
sits in your office and adjusts his tie several times to make sure it
is perfectly centered. What is the most likely diagnosis for this
B. Obsessive-Compulsive Personality Disorder
The client experiences a preoccupation with lists and organization, excessive devotion to work, an inability to delegate tasks, and a need for perfectionism. Those with generalized anxiety disorder do not necessarily experience the extreme attention to detail and perfectionist attitude of those with OCPD. A Narcissitic Personality Disorder person would believe they have already achieved perfection, and are not as self-critical as those with OCPD.
Which of the following criteria is consistent with Schizoid Personality Disorder?
B. Takes little pleasure in activities
Schizoid Personality Disorder consists of detachment from social relationships and a restricted range of emotional expression. Persons with this personality structure do not desire close relationships, have little interest in others, and enjoy very little. Schizotypal Personality Disorder, by contrast, consists of odd thoughts and behavior combined with a reduced CAPACITY for social relationships and an excessive social anxiety.
has always had a problem with her peers from childhood to the present.
She has never had a friend in whom she felt she could confide because
she suspects the motives of everyone. When any remark is made as a
joke, she takes it personally and has a tendency to carry a grudge.
Sarah feels that she is the constant butt of attacks on her reputation
and this has caused a great deal of difficulty in any on-going
relationship she has had with a man. She is always questioning their
fidelity without grounds to do so. It has resulted in most of the
relationships breaking up rather quickly and Sarah feels she's been
cheated by life. There is no history of psychotic illness, no mood
disorder, no familial history of psychosis, or serious medical illness
and Sarah is in good physical health for her age. You would say she is
A. Paranoid Personality Disorder
Although most prevalent in males, Paranoid Personality Disorder is found in 0.5 to 2.5% of the general population of the U.S. It's characteristics include an unknown etiology starting in childhood, but some evidence links it to chronic Schizophrenia and Delusional Disorder (Persecutory type). These individuals believe that others are constantly making unjust remarks about them, berating their reputation, attempting to exploit them, and they cannot trust their friends, mates, or sexual partners.
70-year-old woman is referred to you to be seen in a nursing facility.
She was recently evicted by an apartment building for odd and eccentric
behavior. The previous property manager reports that the patient would
wear winter clothing in the summer time, would stay off to herself and
never socialize with other peers in the building, and would not want
people to enter her apartment for any reason. At the nursing home, she
presents with the same behavior, and even talks of communicating with
aliens and going to another planet. She is alert and oriented, has no
history of serious medical problems, other than arthritis and
hypertension and scores perfectly on the mental status exam. What would
be your likely diagnosis?
C. Schizotypal Personality Disorder
Schizotypal Personality Disorder characteristics include: behavior that is influenced by magical thinking, telepathy, aliens, unusual perceptions or bodily delusions, odd behavior and appearance, extreme anxiety in social situations, and affect that is blunted or inappropriate to the topic at hand.
23-year-old female comes to see you for the first time. She states that
her mom thought she should see a doctor for "her problem." When asked
about "her problem" the client states that she just doesn't like being
around people and prefers to be alone. Her mom does not believe that
this is normal. When asked how long she has felt this way, the client
states that she progressively isolated herself from others more and
more, beginning about 6 years ago. She states that she has no hobbies,
and prefers to just sit in her room or maybe put together a puzzle. She
wishes that she could just disappear sometimes so that she does not
have to talk to anyone. This client has no history of alcohol or drug
use, and has never had sexual intercourse. She stated that she has no
desire to have intimacy with another person. She denies having any
delusions or hallucinations, nor has she ever experienced mania or
depression. She states that she really doesn't feel anything. The
client expresses very little emotion throughout the course of the
interview. What DSM-IV diagnosis is most appropriate for this client?
C. Schizoid Personality Disorder
This client expresses a lack of desire for social relationships, a preference for solitary activities, little interest in most activities or intimacy, and has demonstrated a flattened affect. The onset of symptoms is occurring in the beginning of adulthood (which rules out Autism), and she is not experiencing any psychotic symptoms or paranoid ideations. Since she avoids social situations due to a lack of DESIRE, this differentiates her from a diagnosis of Avoidant Personality Disorder, in which the person isolates themselves due to a FEAR of social situations.
woman in her early 50's is being seen at a behavioral health clinic.
She has been encouraged by her family and her employer to attend. The
primary reason is that "she has serious problems relating to other
people." Most people describe her as especially solitary, indifferent,
and emotionally cold. They feel that her quality of life suffers from
this lack of social inclination, and that problems with loneliness may
worsen as she gets older. She has always been single and has never had
any friends to speak of, even as a child. What is the most likely
provisional diagnosis from the DSM-IV based in this information?
C. Schizoid Personality Disorder
Schizoid Personality Disorder is characterized by detachment, indifference towards others, and marked coldness of emotion. These patients are often life-long loners.
female patient of yours is a dramatic actress. She is good at her work,
but it seems that one reason she is so good is that she is dramatic in
her life as well. All of her emotions are expressed to the extreme,
whether she is preparing dinner or reacting to stress. She is sexually
provocative as well, and you have no doubt that when she says "Darling,
my life is just the life of the party!," she is speaking the truth. If
a diagnosis were going to be made for this patient, you would probably
E. Histrionic Personality Disorder
People with Histrionic Personality Disorder are characterized by their excessive emotionality and attention-seeking. Five of the following criteria must be present: a need to be the center of attention, inappropriate sexual behavior such as seductiveness or provocativeness, shallow emotions which change quickly, excessively emotional speech, exaggerated emotional expression, and a history of believing that relationships with others are more intimate than they really are.
The Narcissist's grandiosity covers up his:
B. Lack of self-esteem
Narcissists tend to be oversensitive to criticisms and may fear being found undeserving of success. They lack self-esteem and their grandiose behavior seems to be an elaborate and intricate defense mechanism.
Lack of empathy and insight are still Narcissistic qualities, but do not explain their grandiose behaviors. They can be successful or not. They envy others' success and tend to exaggerate their own. They have a great deal of trouble aging gracefully and may become depressed over what they see in the mirror.
26-year-old female presents asking for a new employment physical. She
is a new patient to your office, having recently moved to the area. On
taking her social history, she reveals that she is quite sad because
she feels isolated and lonely. You ask whether she has attended any
local places of worship or tried any other things to foster new
relationships, but she has not, saying that she is afraid no one will
like her. She admits that she has always been shy and never had many
friends, which has been painful for her. In addition, she is afraid to
begin her new job because she fears that she will perform poorly and is
afraid that others will reject her. Which type of personality disorder
does this patient have?
B. Avoidant Personality Disorder
Avoidant Personality Disorder is common. These patients are exceedingly timid, shy, lonely, and hypersensitive to rejection. They have low self-esteem and often would rather avoid personal contact than face any potential social rejection. Additionally, they have a strong desire for acceptance and affection, and thus are very distressed by their isolation and inability to relate comfortably to others. Patients with this type of PD often have increased rates of anxiety and depression as well.
middle-aged woman comes to your office after missing her first
appointment. When she rescheduled she said that she was not able to get
to your office because she had no friends to ask for a ride. Today her
daughter was able to drive her. She is dressed in a very colorful
outfit with a very large hat that is pink with long ears. She says she
really does not like going out in public, but when she does, this hat
protects her from other people. You do not laugh, but you ask questions
to determine whether she has a form of schizophrenia, or perhaps which
of the following personality disorders?
C. Schizotypal Personality Disorder
Although superficially similar to Paranoid Personality Disorder, Schizotypal Personality Disorder is characterized more by pervasive social and interpersonal deficits that result in extreme discomfort with close relationships. Five or more of the following symptoms are present in the Schizotypal patient: ideas of reference (but not full blown delusions), odd beliefs or magical thinking, illusions or unusual perceptual experiences (but not classic hallucinations), odd thinking and speech, eccentric behavior or appearance, paranoid thinking or suspiciousness of others, no close friends, and social anxiety related to paranoid fears, rather than to negative feelings about oneself. Some of these symptoms are similar, but not nearly as severe as the symptoms of Schizophrenia.
43-year-old single female has been referred to you for psychiatric
evaluation from the employee assistance program at her job of 21 years.
She has been exhibiting some odd behaviors at work. Stressors she has
experienced over the last year include successful treatment of breast
cancer and the loss of both of her parents to illnesses. During several
interviews, in which she referred to herself in the third person, she
related that she had been close to her parents and had no one else in
her life that she trusted. She also expressed that she felt her
co-workers wanted her cancer to recur and that the fluorescent lights
at work made her "burn inside". She stated that she knew her cancer was
gone by the number of roses on her rose bush at home and that angels
have sent her messages through wind chimes since she was a little girl.
She denied any history of hallucinations. Her sleep and appetite were
normal. Her psychiatric history was significant only for taking an
antidepressant when she was 23 years old. Based on the information you
have, what is your provisional diagnosis?
E. Schizotypal Personality Disorder
This patient's disclosures are consistent with a diagnosis of Schizotypal Personality Disorder. She exhibits suspiciousness towards her co-workers, her relationships are limited to first-degree relatives, she has unusual perceptual experiences and ideas of reference, and she refers to herself in the third person.
Schizoid Personality Disorder is similar but does not include all of the eccentricities of this woman.
There is not a history of psychotic symptoms to suggest Schizophrenia.
Paranoid Personality Disorder would present with negativity and distrust of others with the expectation of exploitation and harm, and unusual perceptual experiences are not typical
Avoidant Personality Disorder may also lead to restricted social relationships, but they would be driven by a lack of confidence and fear of negative criticism.
A diagnosis of Schizoid Personality Disorder instead of Schizophrenia would be made in the absence of:
For a diagnosis of Schizophrenia, one must have an active case of bizarre delusions or hallucinations.
Social withdrawal goes along with Schizoid PD.
Flattened affect is true in both disorders.
Drug abuse is not associated with either disorder, and would therefore have to be rules out before making either diagnosis.
Active symptoms is a vague, made-up answer.
Emotional expressiveness is least likely to be present in which of the following personality disorders?
B. Schizoid Personality Disorder
Individuals with Schizoid Personality Disorder tend to be socially isolated, they display restricted affect (expression of mood),and they almost always prefer to be alone. These individuals tend to be introverted and preoccupied, and they do not do well in jobs that require social performance.
44-year-old male lives alone, in a rooming house, and has visited you
in a community clinic over many years. He is generally suspicious of
everyone's motives toward him, usually finding malevolence in even the
most ordinary comments and actions. He has never married because he has
yet to find a woman who could remain faithful to him for "even a month
or two, let alone a lifetime."The
male's older sister is also a patient of the clinic and has said that
he "has always been that way, since he was a kid. He thinks everyone is
mean to him, and he never forgets any wrongs done." Most of the time,
"he feels that he is being watched and followed," but is nonetheless
able to work consistently. Based on this information, what might be a
likely psychiatric diagnosis to consider?
B. Paranoid Personality Disorder
Within Cluster A, Paranoid Personality Disorder manifests as pervasive distrust of others and constant suspiciousness toward their motives. Interpretations of others' behavior made by these individuals will usually include maliciousness, hidden meanings, jealousy, and long-term grudges.
A distinguishing feature between Paranoid Personality Disorder and Schizotypal Personality Disorder is:
E. Perceptual distortions
Of all the symptoms, only perceptual distortions are not associated with BOTH personality disorder. Schizotypal Personality Disorder is marked by perceptual distortions (ie: hearing someone call their name) and magical thinking (ie: "If I wish hard enough, it will snow").
40-year-old female patient has been referred by a psychiatrist for a
general medical evaluation. While the nurse tries to locate the
referral information, you go and speak with the patient. She is lying
down on the examination table and tells you she was feeling
light-headed again. She is wearing a low cut blouse and spandex pants.
Before you can ask a question, she tells you she has had a difficult
year, and was very depressed after her lover left her without warning.
She begins crying, and says she has autoimmune problems from breast
implants she got "just to please John". When you ask if Dr. Smith, the
referring psychiatrist, treated her for depression, she smiles and
replies, "Oh, yes, Steven saved my life" and states she doesn't know
what she will do if he ever retires. When the nurse arrives with the
chart, you see that she has complaints of fatigue, recurrent ear
infections with bleeding, irritable bowel, and fibromyalgia. Dr. Smith
has made an Axis I diagnosis of recurrent major depression, in
remission and an Axis II diagnosis of
C. Histrionic Personality Disorder
Histrionic Personality Disorder is typified with attention seeking behavior and melodramatic emotional displays. Relationships are often exaggerated and characterized by attempts at emotional manipulation, and assuming a role, such as "martyr" or "princess." Suicidal gestures to gain attention or coerce a response place persons with this disorder at risk for completed suicide. Criteria include inappropriate seductive or provocative behavior, suggestibility, impressionistic speech, and shallow, shifting emotions. HPD is associated with higher rates of depression, somatization disorder, and conversion disorder.
Excessive emotionality and attention-seeking best characterizes which of the following personality disorders?
C. Histrionic Personality Disorder
The central component of Histrionic Personality Disorder is a pervasive display of emotions and attention-seeking behavior, starting in early adulthood. Generally, such an individual has a need to be the center of attention in social circles, may engage in seductive and/or provocative behavior, displays shallow expression of emotions, employs excessively expressionistic speech, is dramatic and self-dramatizing, uses physical appearance to obtain attention, is suggestible by others, and considers relationships to be closer than they actually are.
25-year-old male comes to see you after breaking up with his
girlfriend. He is in a panic. He tells you that he has never been on
his own and wants to know what you think he should do. He says he does
not understand why his girlfriend broke up with him. He always did
everything that she asked of him and never disagreed with her. "All I
wanted to do was make her happy," he told you. You asked him if his
ex-girlfriend gave him a reason for the break up. He stated that she
told him that she was tired of making all of the decisions in the
relationship such as where to go for dinner, which apartment they
should choose, etc. She told him that he never helped her make any of
the decisions that they should make together. The client tells you that
he must find a new girlfriend quick or his whole life will fall apart.
What is the most likely DSM-IV Axis II diagnosis for this patient?
D. Dependent Personality Disorder
This patient displays difficulty expressing disagreement with others; going to excessive lengths to please others; discomfort or helplessness when alone; an urgency in seeking another relationship; and difficulty making decisions without the advice of others.
This patient's symptoms are in reaction to his current situation and he does not report any symptoms of depression (suicidal ideation, depressed mood, or changes in sleep or appetite).
You can rule out Borderline Personality Disorder, because those patient's typically react to abandonment with anger, rage, and threatening behavior.
You can rule out Histrionic Personality Disorder because those patients are often flamboyant and demand attention from others.
You can rule out Narcissistic Personality Disorder because they typically have an inflated sense of self, seek to please themselves, and are arrogant. Whereas, Dependent Personality Disorder patients, such as the man in the above case study, seek to please others, have a deflated self of sense, and seek nurturance from others.
Narcissistic Personality Disorder is centrally characterized by which of the following features?
B. A pattern of grandiosity
These are ALL criteria of Narcissistic Personality Disorder, but a pervasive pattern of grandiosity is the CENTRAL feature of this diagnosis.
Submissive and clinging behavior is most closely associated with which of the following personality disorders?
C. Dependent Personality Disorder
Dependent Personality Disorder is featured by a pervasive need to be cared for that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood. It is generally marked by a need to urgently seek relationships as a source of comfort, preoccupation with fear of being left alone, and a tendency to go to excessive lengths in obtaining nurturance and support from others.
male goes to the clinic for follow-up treatment. He states that he
takes his medicine exactly every 8 hours and keeps a record of how many
pills he takes at what time and shows this to his doctor. He even wakes
up in the middle of the night worrying if he missed a time. He is
worried that maybe the medicine is not going to take effect because he
took one of the pills 15 minutes late. What kind of disorder does this
C. Obsessive-Compulsive Personality Disorder
Obsessive-Compulsive Personality Disorder is characterized by being perfectionistic, inflexible, and unable to express warm and tender feelings. Those suffering from this disorder are too concerned about trivial details and rules and do not appreciate changes in routine. They have a preoccupation with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost. Any illness is perceived as a threat to their control, and they may therefore struggle with their physician for control. In this case, the physician is handling the patient properly by allowing him to take part in the decisions and details of his medical care (like charting medication times).
An essential feature of Borderline Personality Disorder (BPD) is
A. Instability of relationships
Instability of social and interpersonal relationships is the cornerstone of Borderline Personality Disorder (BPD). Constantly fighting to avoid real or imagined abandonment, BPD's alternate between extremes of idealizing and devaluing those who attempt to get involved with them.
Long-term drug use is more related to a Substance Abuse Disorder.
Paranoia is an essential feature of Paranoid Personality Disorder.
Theatricality is central to a diagnosis of Histrionic Personality Disorder.
Lack of remorse may be present in Antisocial Personality Disorder.
impulsivity, patterns of instability in interpersonal relationships,
self-image, and affect together define which of the following
E. Borderline Personality Disorder
BPD is specifically marked by unstable relationships, self-image, affect, and impulsivity. It begins in early adulthood.