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Psychiatric Diagnosis

Blow are ten cases of people with psychiatric symptoms. You are to pick the correct diagnosis form the pull-down list of twenty diagnosis. Each of the ten cases has a different diagnosis.

Click here for a list of the disorders as well as a link to the diagnostic criteria for some of the diagnosis. Many but not all of these are described in Chapter 16 of our textbook You can resize the window so that you can refer to it as you complete the questions below.

You can print this page, search for the answers, then come back, select the answers and submit the project.

Sources of case studies:

David Barlow and Mark Durand (2001). Abnormal Psychology: An Integrative Approach (2nd ed.). Belmont, CA: Wadsworth/Thompson Learning.

Spitzer, Gibbon et. al. (Eds.), (1994). DSM - IV Case Book: A Learning Companion to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, DC: American Psychiatric Press.

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#1 - Irene

Irene was a 20-year-old college student, with an engaging personality but not many friends. She came to the clinic complaining of excessive anxiety and general difficulties in controlling her life. Everything was a catastrophe for Irene. Although she carried a 3.7 grade point average she was convinced that she would flunk every test she took. As a result, she repeatedly threatened to drop courses after only several weeks of classes because she feared that she would not understand the material

Irene worried until she dropped out of the first college she attended after 1 month. She felt depressed for a while, then decided to take a couple of courses at a local junior college, believing she could handle the work there better. After achieving straight As at the junior college for 2 years, she enrolled once again in a 4-year college as a junior. After a short time she began calling the clinic in a state of extreme agitation, saying that she had to drop this or that course because she couldn't handle it. With great difficulty, her therapist and parents persuaded her to stay in the courses and to seek further help. In any course Irene completed, her grade was between an A and a B-minus, but she still worried about every test and every paper, afraid that she would fall apart and be unable to understand and complete the work.

Irene did not worry only about school. She was also concerned about relationships with her friends, and whenever she was with her new boyfriend she feared making a fool of herself and losing his interest. In fact, she reported that each date went extremely well, but she knew the next one would probably be a disaster. As the relationship progressed and some sexual contact seemed natural, Irene was worried sick that her inexperience would make her boyfriend consider her naive and stupid. Nevertheless, she reported enjoying the early sexual contact and admitted that he seemed to enjoy it also, but she was convinced that the next time a catastrophe would happen.

Irene was also concerned about her health. She had minor hypertension, probably because she was somewhat overweight. She then approached every meal as if death itself might result if she ate the wrong types or amounts of food. She became reluctant to have her blood pressure checked for fear that it would be very high, or to weigh herself for fear that she was not losing weight. She severely restricted her eating, and as a result had an occasional episode of binge eating, although not often enough to warrant concern.

In addition, Irene worried about her religious faith and about her relationships with her family, particularly her mother and sister. Although Irene had an occasional panic attack, this was not a major issue to her. As soon as the panic subsided she focused on the next possible catastrophe. In addition to high blood pressure, Irene had tension headaches and a "nervous stomach," with a lot of gas, occasional diarrhea, and some abdominal pain.

Irene's life was a series of impending catastrophes. Her mother reported that she dreaded a phone call from Irene, let alone a visit, because she knew that she would have to see her daughter through a crisis. For the same reason, Irene had very few friends. Even so, when she temporarily gave up her anxiety she was really fun to be with.

Diagnosis:

#2 - Ryan

I first met Ryan on his 17th birthday. Unfortunately, he was celebrating the event in a psychiatric hospital. He had been truant from school for several months and had gotten into some trouble; the local judge who heard his case had recommended psychiatric evaluation one more time, though Ryan had been hospitalized six previous times, all for problems related to drug use and truancy. He was a veteran of the system and already knew most of the staff. I interviewed him to assess why he was admitted this time, and to recommend treatment.

My first impression was that Ryan was cooperative and pleasant. He pointed out a tattoo on his arm that he had made himself, saying that it was a "stupid" thing to have done, and that he now regretted it. In fact, he regretted many things and was looking forward to moving on with his life. I later found out that he was never truly remorseful for anything. Our second interview was quite different. During those 48 hours, Ryan had done a number of things that showed why he needed a great deal of help. The most serious incident involved a 15-year-old girl named Ann who attended class with Ryan in the hospital school. Ryan had told her that he was going to get himself discharged, get in trouble, and be sent to the same prison Ann's father was in, where he would rape her father. Ryan's threat so upset Ann that she hit her teacher and several of the staff. When I spoke to Ryan about this, he smiled slightly and said he was bored and that it was fun to upset Ann. When I asked whether it bothered him that his behavior might extend her stay in the hospital, he looked puzzled and said, "Why should it bother me? She's the one who'll have to stay in this hell hole!"

Just before Ryan's admittance, a teenager in his town was murdered. A group of teens went to the local cemetery at night to perform satanic rituals and a young man was stabbed to death, apparently over a drug purchase. Ryan was in the group, although he did not stab the boy. He told me that they occasionally dug up graves to get skulls for their parties; not because they really believed in the devil, but because it was fun and it scared the younger kids. I asked, "What if this were the grave of someone you knew, a relative or a friend? Would it bother you that strangers were digging up the remains?" He shook his head, "They're dead, man; they don't care. Why should I?"

Ryan told me he loved PCP, or "angel dust," and that he would rather be dusted than anything else. He routinely made the 2-hour trip to New York City to buy drugs in a particularly dangerous neighborhood. He denied that he was ever nervous. This wasn't machismo; he really seemed unconcerned.

Ryan made little progress. I discussed his future in family therapy sessions and we talked about his pattern of showing supposed regret and remorse, and then stealing money from his parents and going back onto the street. In fact, most of our discussions centered on trying to give his parents the courage to say no to him and not to believe his lies. One evening, after many sessions, Ryan said that he had seen the "error of his ways" and that he felt bad that he had hurt his parents. If they would only take him home this one last time, he would be the son that he should have been all these years. His speech moved his parents to tears, and they looked at me gratefully as if to thank me for curing their son. When Ryan finished talking, I smiled, applauded, told him it was the best performance I had ever seen. His parents turned on me in anger. Ryan paused for a second, then he too smiled and said, "It was worth a shot!" Ryan's parents were astounded that he had once again tricked them into believing him; he hadn't meant a word of what he had just said.

Ryan was eventually discharged to a drug rehabilitation program. Within 4 weeks, he had convinced his parents to take him home, and within 2 days he had stolen all their cash and disappeared; he apparently went back to his friends and to drugs.

Diagnosis:

#3 - Cheryl

Cheryl is 42 years old and had been employed as a part-time accountant for the past ten years. Cheryl describes her childhood as unhappy, and says, "Things just got worse as I grew up." Until recently, Cheryl was able to function normally in her job and in her family responsibilities. But over the past year her family has become increasingly concerned about disturbances in her behavior. For at least a month she has withdrawn from family life, staying in bed for days at a time, refusing to cook or eat or go to work. She lost 15 pounds without trying to lose weight, and claims to have no energy or desire to do anything. She weeps frequently and for no apparent reason. She went through a similar episode about seven months ago, but she snapped out of it after a few weeks. Although her employer was supportive during that first episode, after several weeks of this latest display of erratic behavior, the company fired Cheryl four days ago. She has not bathed since that time, and she rarely leaves her room or talks to family members, and when she does, she walks and talks very slowly.

Diagnosis:

#4 - Mr. Simpson

Mr. Simpson is a 44-year-old, single, unemployed, white man brought to the emergency room by the police for striking an elderly woman in his apartment building. His chief complaint is, "That damn bitch. She and the rest of them deserved more than that for what they put me though."

The patient has been continuously ill since age 22. During his first year of law school, he gradually became more and more convinced that his classmates were making fun of him. He noticed that they would snort and sneeze whenever he entered the classroom. When a girl he was dating broke off the relationship with him, he believed that she had been "replaced" by a look-alike. He called the police and asked for their help to solve the "kindapping." His academic perormance in school delcined dramatically, and he was asked to leave and seek psychiatric care.

Mr. Simpson got a job as an investment counselor at a bank, which he held for 7 months. However, he was getting an increasing number of distracting "signals" from co-workers, and he became more and more suspicious and withdrawn. It was at this time that he first reporated hearing voices. He was eventually fired, and soon thereafter was hospitalized for the first time, at age 24. He has not worked since.

Mr. Simpson has been hospitalized 12 times, the longest stay being 8 months. However, in the last 5 years he has been hospitalized only once, for 3 weeks. During the hospitalizations he has received various antipsychotic drugs. Although optpatient medication has been prescribed, he usuallys stops taking it shortly after leaving the hospital. Aside form twice-yearly lunch meetings with his uncle and his contacts with mental health workers, he is totally isolated socially. He lives on his own and manages his own financial affairs, including a modest inheritance. He read the Wall Street Journal daily. He cooks and cleans for hmself.

Mr. Simpson maintains that his apartment is the center of a large communication system that involves all the major television networks, his neighbors, and apparently hundreds of "actors" in his neighborhood. Thre are secret cameras in his apartment that carefully monitor all his activities. When he is watching TV, many of his minor actions (e.g., going to the bathroom) are soon direclty commented on by the announcer. Whenever he goes outside, the "actors" have all been warned to keep him under surveillance. Everyone on the street watches him. His neighbors operate two different "machines"; one is responsible for all of his voices, except the "joker." He is not certain who controls this voice, which "visits" him only occasionally and is very funny. The other voices, which he hears many tmes each day, are generated by this machine, which he sometimes thinks is directly run by the neighbor whom he attacked. For example, when he is going over his investments, these "harassing" voices constantly tell him which stocks to buy. The other machines he calls "the dream machine." This machine puts erotic dreams into his head, usually of "black women."

Mr. Simpson describes other unusual experiences. For example, he recently went to a shoe store 30 miles from this house in the hope of getting some shoes that wouldn't be "altered." However, he soon found out that, like the rest of the shoes he buys, special nails had been put into the bottom of the shoes to annoy him. He was amazed that his decision concerning which shoe store to go to must have been known to his "harassers" before he himself knew it, so that they had time to get the altered shoes made up especially for him. He realized that great effort and "millions of dollars" are inovlved in keeping him under survelliance. He sometimes thinks this is all part of a large experiment to discover the secret of his "superior intelligence."

At the interview, Mr. Simpson is well-groomed and his speech is coherent and goal-directed. His affect is, at most, only mildly blunted. He was initially very angry at being brought in by the police. After several psychotic symptoms, he was transferred to a long-stay facility with a plan to arrange a structured living situation for him.

Diagnosis:

#5 - Claire

I have known Claire for over 25 years and have watched her through the good but mostly bad times of her often shaky and erratic life. Claire and I went to school together from the eighth grade through high school, and we've kept in touch periodically. My earliest memory of her is of her hair, which was cut short and rather unevenly. She told me that when things were not going well she cut her own hair severely, which helped to "fill the void." I later found out that the long sleeves she usually wore hid scars and cuts that she had made herself. Claire was the first of our friends to smoke. What was unusual about this and her later drug use was not that they occurred (this was in the 1960s when "If it feels good, do it!" hadn't been replaced by "Just say no!") or that they began early; it was that she didn't seem to use them to get attention, like everyone else. Claire was also one of the first whose parents divorced, and both of them seemed to abandon her emotionally. She later told me that her father was an alcoholic who had regularly beaten her and her mother. She did poorly in school and had very low self-esteem. She frequently said she was stupid and ugly, yet she was obviously neither.

Throughout our school years, Claire left town periodically, without any explanation. I learned many years later that she was in psychiatric facilities to get help with her suicidal depression. She often threatened to kill herself, although we didn't guess that she was serious.

In our later teens we all drifted away from Claire. She had become more and more unpredictable, sometimes berating us for a perceived slight ("You're walking too fast. You don't want to be seen with me!"), and at other times desperate to be around us. We were obviously confused by her behavior. With some people, emotional outbursts can bring you closer together. Unfortunately for Claire, these incidents and her overall demeanor made us feel that we didn't know her at all. As we all grew older, the "void" she described in herself became overwhelming and eventually shut us all out. Claire married twice, and both times had very passionate but stormy relationships interrupted by hospitalizations. She tried to stab her first husband during a particularly violent rage. She tried a number of drugs, but mainly used alcohol to "deaden the pain."

Now, in her mid-40s, things have calmed down some. Although she says she is rarely happy, Claire does feel a little better about herself and is doing well as a travel agent. Although she is seeing someone, she is reluctant to become very involved because of her personal history.

Diagnosis:

#6 - Emillio

Emilio is a 40-year-old man who looks 10 years younger. He is brought to the hospital, his twelfth hospitalization, by his mother because she is afraid of him. He is dressed in a ragged overcoat, bedroom slippers, and a basebnall cap, and wears several medals around hi s neck. His affect ranges from anger at his mother ("She feeds me shit ... what comes out of other people's rectums") to a giggling, obsequious seductiveness toward the interveiwer. His speech and manner have a childlike quality, and he walks with a mincing step and exaggerated hip movements. His mother reports that he stopped taking his medication about a month ago, and has since begun to hear voices and to look and act more bizarrely. When asked what he has been doing, he says, "Eating wires and lighting fires." His spontaneous speech is often incoherent and marked by frequent rhyming and clang associations (speech in which sounds, rather than meaningful relationships, govern word choice).

Emilio's first hospitalization occurred after he dropped out of school at age 16, and since that time he has never been able to attend school or hold a job. He has been treated with neuroleptics during his hospitalizations, but doesn't continue to take medication when he leaves, so he quickly becomes disorganized again. He lives with his elderly mother, but sometimes disappears for several months at a time, and is eventually picked up by the police as he wanders in the streets. There is no known history of drug or alcohol abuse.

Diagnosis:

#7 Richard

Richard, a 19-year-old college freshman majoring in philosophy, withdrew from school because of incapacitating ritualistic behavior. He abandoned personal hygiene because the compulsive rituals that he had to carry out during washing or cleaning were so time-consuming that he could do nothing else. Almost continual showering gave way to no showering. He stopped cutting and washing his hair and beard, brushing his teeth, and changing his clothes. He left his room infrequently and, to avoid rituals associated with the toilet, defecated on paper towels, urinated in paper cups, and stored the waste in the closet. He ate only late at night when his family was asleep. To be able to eat he had to exhale completely, making a lot of hissing noises, coughs, and hacks, and then fill his mouth with as much food as he could while no air was in his lungs. He would eat only a mixture of peanut butter, sugar, cocoa, milk, and mayonnaise. All other foods he considered contaminants. When he walked he took very small steps on his toes while continually looking back, checking and rechecking. On occasion he ran quickly in place. He withdrew his left arm completely from his shirt sleeve as if he were crippled and his shirt was a sling.

Diagnosis:

#8 - Gail

Gail was married at 21 and looked forward to a new life. As one of many children in a lower-middle-class household, she felt weak and somewhat neglected and suffered from low self-esteem. An older stepbrother berated and belittled her when he was drunk. Her mother and stepfather refused to listen to her or believe her complaints. But she believed that marriage would solve everything; she was finally someone special. Unfortunately, it didn't work out that way. She soon discovered her husband was continuing an affair with an old girlfriend.

Three years after her wedding Gail came to our clinic complaining of anxiety and stress. She was working part-time as a waitress and found her job extremely stressful. Although to the best of her knowledge her husband had stopped seeing his former girlfriend, she had trouble getting the affair out of her mind.

Although Gail complained initially of anxiety and stress, it soon became clear that her major concerns were about her health. Any time she experienced minor physical symptoms such as breathlessness or a headache, she was afraid that she had a serious illness. A headache indicated a brain tumor. Breathlessness was an impending heart attack. Other sensations were quickly elaborated into the possibility of AIDS or cancer. Gail was afraid to go to sleep at night for fear that she would stop breathing. She avoided exercise, drinking, and even laughing because the resulting sensations upset her. Public restrooms and, on occasion, public telephones were feared as sources of infection.

The major trigger of uncontrollable anxiety and fear was the news in the newspaper and on television. Each time an article or show appeared on the "disease of the month," Gail found herself irresistibly drawn into it, intently noting symptoms that were part of the disease. For days afterward she was vigilant, looking for the symptoms in herself and others. She even watched her dog closely to see whether he was coming down with the dreaded disease. Only with great effort could she dismiss these thoughts after several days. Real illness in a friend or relative would incapacitate her for days at a time.

Gail's fears developed during the first year of her marriage, around the time she learned of her husband's affair. At first, she spent a great deal of time and more money than they could afford going to doctors. Over the years she heard the same thing during each visit: "There's nothing wrong with you; you're perfectly healthy." Finally, she stopped going, as she became convinced that her concerns were excessive, but her fears did not go away and she was chronically miserable.

Diagnosis:

#9 - Khalil

Khalil is a 29-year-old mechanic who has been a pessimist all his life. He once owned and operated his own auto repair shop, but it turned into a financial disaster; he had to close the shop and take a temporary job as a janitor. He reports that he now feels like a failure and is ashamed to be seen in public. For the past several years he has had persistent feelings of worthlessness and inferiority, and doesn't see any hope for the future. He has broken off his engagement because of his financial problems and his pessimism about his future prospects. However, he still frequently goes over to the home of his younger brother, and seems to be able to enjoy himself in the company of a small group of family members and friends who accept him. When he is alone, his feelings of failure well up inside him again. He reports that he spends most of his free time in his basement, cleaning his tools and staring aimlessly at the walls, wondering what he can do to avoid bringing further shame upon his family.

Diagnosis:

#10 - Jonah

Jonah, 27 years old and black, suffered from severe headaches that were unbearably painful and lasted for longer and longer periods of time. Furthermore, he couldn't remember things that happened while he had a headache, except that sometimes a great deal of time passed. Finally, after a particularly bad night, when he could stand it no longer, he arranged for admission to the local hospital. What really prompted Jonah to come to the hospital, however, was that other people told him what he did during his severe headaches. For example, he was told that the night before he had a violent fight with another man and attempted to stab him. He fled the scene and was shot at during a high-speed chase by the police. His wife told him that during a previous headache he chased her and his 3-year-old daughter out of the house, threatening them with a butcher knife. During his headaches, and while he was violent, he called himself "Usoffa Abdulla, son of Omega." Once he attempted to drown a man in a river. The man survived and Jonah escaped by swimming a quarter of a mile upstream. He woke up the next morning in his own bed, soaking wet, with no memory of the incident.

Diagnosis: