A 42-year-old man comes to the office because his wife told him that he™d better help or she will divorce him. The patient™s wife describes the patient as œcompletely inflexible. He always demands that simple tasks in the couple™s house be done to his exact specifications. He also makes his wife give detailed accounts of exactly how she spends the household™s money. Additionally, he is so particular about details of how their house is taken care of that entire weekends are lost to housework. The patient, in his own defense, states that he wants things done œthe right way, what™s wrong with that? Which of the following is the most likely diagnosis?
A. Borderline personality disorder
B. Histrionic personality disorder
C. Major depressive disorder
D. Obsessive-compulsive disorder
E. Obsessive-compulsive personality disorder
The correct answer is E. Patients with obsessive-compulsive personality disorder are self-described œperfectionists. This level of attention to detail results in inflexibility in personal interactions, however, and an overall loss of efficiency. Additional features of this disorder include a miserly attitude toward money and a lack of understanding regarding why others do not share one™s view.
Patients with borderline personality disorder (choice A) manifest unpredictable and unstable self and object relationships. This patient seems completely stable in his opinion of himself and is firm on his opinion that others should accede to his wishes. A diagnosis of borderline personality disorder is therefore incorrect.
Patients with histrionic personality disorder (choice B) crave attention and attribute more significance to superficial relationships than is warranted. This patient in no way seems motivated by attention from others. This patient in no way seems depressed and there is no evidence from the narrative to suggest a depressed mood or neurovegetative symptoms of depression. A diagnosis of major depressive disorder (choice C) is therefore incorrect.
Patients with obsessive-compulsive disorder (choice D) demonstrate repeated, unpleasant thoughts or images (obsessions) or compulsive rituals that they acknowledge are not grounded in necessity. Unlike patients with obsessive-compulsive personality disorder, patients with obsessive-compulsive disorder do not see their obsessions or compulsive rituals as sensible or to be emulated by others.
great question..where did you get it?