Examkin

Question

Difficulty: EasyPersonality Disorders

A 27-year-old man is referred to a psychiatrist for an evaluation requested by his employer. Over the past four years, his coworkers have complained that he behaves oddly, often wearing heavy winter clothing in the middle of summer and muttering to himself in the breakroom. During the interview, the patient makes poor eye contact and displays a constricted affect. He explains that he avoids social gatherings because he feels "out of sync" with others. When discussing his lack of friends, he utilizes fantasy as a defense mechanism, explaining that he does not need physical companions because he maintains strong telepathic connections with others on an "astral plane." He denies ever hearing external voices, seeing things that are not there, or feeling that his thoughts are being controlled by outside forces. His thought processes, while highly eccentric, remain logical. These traits have been stable since his late teens. Which of the following is the most likely diagnosis?

  1. Schizotypal personality disorderAnswer
  2. B
    Schizophrenia
  3. C
    Schizophreniform disorder
  4. D
    Schizoid personality disorder
  5. E
    Avoidant personality disorder

Answer

Schizotypal personality disorder
The correct diagnosis is schizotypal personality disorder. This condition is part of the Cluster A (odd/eccentric) personality disorders and is characterized by a pervasive pattern of social and interpersonal deficits, reduced capacity for close relationships, cognitive or perceptual distortions, and eccentricities of behavior. This patient's odd clothing, magical thinking (belief in telepathic connections on an 'astral plane'), and constricted affect, all present since adolescence without frank hallucinations or fixed delusions, perfectly fit this diagnosis.

Step-by-Step Solution

1
Analyze the chronological timeline of the patient's symptoms.
The patient has had stable, long-standing traits since his late teens, pointing toward a personality disorder rather than an acute psychotic episode.
Establishing the timeline helps rule out acute psychotic disorders like schizophrenia or schizophreniform disorder.
2
Evaluate the presence or absence of frank psychotic features.
The patient denies hearing voices or having visual hallucinations, and his thoughts are logical, ruling out schizophrenia-spectrum disorders.
Differentiating eccentric beliefs (magical thinking) from true, fixed delusions is critical in diagnosing Cluster A personality disorders.
3
Categorize the specific personality traits and defense mechanisms.
The combination of social anxiety, odd appearance, constricted affect, and the use of fantasy/magical thinking (telepathy) precisely aligns with the diagnostic criteria for schizotypal personality disorder.
This constellation differentiates the presentation from other personality disorders like schizoid (no magical thinking) and avoidant (desires relationships, lacks eccentricity).

Key Concept

Differentiation of Cluster A Personality Disorders from Psychotic Disorders
Rate this question

Topics

Personality Disorders

More questions from this topic