Personality Disorders

Question 1

66-year-old man who moves to Thailand alone after retirement, has no desire to remain in contact with his family, and is very distant in his interactions. He stays in his remote accommodations without unnecessary travel and does not crave interaction with the locals.

Dx?

Answer 1

Schizoid
فصامي

Isolated, detached “loners” who prefer to be alone
Restricted emotional expression

cluster A-weird

Question 2

35-year-old man with very strange ideas regarding the importance of crystals and their effect on health. He meticulously mines and collects crystals, feeling that they will one day prevent him from acquiring cancer

Dx?

Answer 2

Schizotypal

Odd behavior, perceptions, and appearance
Magical thinking; ideas of reference

Note: Remember, in contrast to OCD, these patients do not feel their behavior is problematic (ego syntonic). They also do not have true obsessions and compulsions.

cluster A-weird

Question 3

59-year-old man who lives alone constantly feels that his neighbor’s children are spying on him and plotting to break into his home. He has installed security cameras all around his property to obtain proof. He feels he cannot trust the police to do a good job because they will probably take the side of his neighbors.

Dx?

Answer 3

Paranoid

Distrustful, suspicious; interpret others’ motives as malevolent
Note: These patients will use projection as a defense mechanism

cluster A-weird

Question 4

28-year-old woman presents to clinic after having praised her new clinician as better than all the others. She reveals that she fired her last therapist, as he was not really helping. You notice she has fresh cuts in a row on her forearm

Dx?

Answer 4

Borderline

• Unstable mood, relationships, and self-image; feelings of emptiness
• ((( Impulsive )))
• History of suicidal ideation or (((self-harm)))

Note: These patients often employ (((splitting))) as a defense mechanism (splitting is believing that people are either all bad or all good)

Question 5

22-year-old man who was in juvenile detention for theft as a teenager and presents to your office now via court order after a brutal assault. He says that he does not need to be seen by a shrink and that the victim offended him and deserved the assault

Dx?

Answer 5

Antisocial

• Violate rights of others, social norms, and laws; ((( impulsive ))); lack remorse
• Must be > 18 years of age
• Evidence of conduct disorder before 15 years of age

cluster B-wild

Question 6

35-year-old woman presents to clinic wearing a very low-cut blouse, adjusting her position to draw attention to herself. When she does not get attention, she breaks into tears, saying that no one notices her, not even her friends

Answer 6

Histrionic

• Excessively emotional and ((( attention seeking )))
• Sexually provocative; theatrical مسرحي

Question 7

45-year-old man sits impatiently tapping his foot in the waiting room of your office. He approaches the receptionist, demands to know where the doctor is, and tells her that he will have her fired and the doctor reported if he is not seen shortly. You are all wasting his time

Dx?

Answer 7

Narcissistic

• Grandiose فخم غالي; need admiration; have sense of entitlement
• Lack empathy

Question 8

35-year-old woman presents to your office at the request of her boss, who feels she is too focused on minute details on team projects and does not allow others to participate for fear of unwanted errors. She does not see anything wrong with this style of work, as she believes her coworkers cannot be trusted to pay adequate attention to detail

Dx?

Answer 8

Obsessive compulsive

• Preoccupied with ((( perfectionism ))), order, and control at the expense of efficiency
• ((( Inflexible ))) morals and values

Question 9

33-year-old man stays at home to avoid an office party, as he fears having to make small talk. He wants to go, though he is more afraid that he will be inadequate or rejected by others

Dx?

Answer 9

Avoidant

• Socially inhibited; ((( rejection sensitive )))
• “Fear of being disliked” or ridiculed, yet desires to have friends and social interactions

Question 10

30-year-old woman presents to your office in crisis, saying that her parents just kicked her out of their house and she is struggling to survive on her own. She says she cannot make her own choices at the grocery store, as her mother would always care for her, and now these decisions are overwhelming. She has been sitting outside of their house daily, hoping they will let her live there again.

Dx?

Answer 10

Dependent

• Submissive, clingy; feel a need to be taken care of
• Have difficulty making decisions
• Feel helpless

Regression is defense mechanism (Involuntarily reverting to an earlier developmental stage)

Question 11

A middle-aged woman asks for help after splitting up with her partner, who apparently felt she was too ‘needy’. She describes him as ‘my world’ and thinks she won’t be able to cope by herself and wants your advice on how to find a new partner quickly

Dx?

Answer 11

dependent personality disorder

Question 12

A middle-aged male manager comes in for review after having trouble at work. His colleagues find him arrogant, ‘cut-throat’ and lacking empathy. He seems to exaggerate his own importance to the company and seems preoccupied with success

Dx?

Answer 12

narcissistic personality disorder