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Difficulty: MediumPersonality Disorders

Match each of the following patient clinical vignettes with the most likely personality disorder diagnosis.

  • During a routine medical evaluation, a 42-year-old accountant repeatedly questions the clinic staff about how his medical records will be secured. He firmly believes his wife is unfaithful despite her constant reassurances and a lack of evidence. He refuses to disclose basic social history to the physician, stating that the information will 'undoubtedly be used against him' by his employer.Paranoid Personality Disorder
  • An elegantly but flamboyantly dressed 31-year-old actress presents to a new primary care physician and immediately attempts to hug the doctor. She describes a recent minor disagreement with a colleague as a 'catastrophic betrayal that destroyed her soul,' yet her explanation of the event is vague and lacks specific details.Histrionic Personality Disorder
  • A court-ordered psychiatric evaluation is performed on a 28-year-old man who was recently convicted of defrauding his business partners. He expresses absolutely no remorse, stating they were 'foolish enough to be taken advantage of.' His past medical records reveal a childhood history of frequent truancy and animal cruelty.Antisocial Personality Disorder
  • A 35-year-old administrative assistant seeks help for chronic anxiety. She remains in a highly critical and emotionally abusive marriage, stating she is utterly incapable of managing life on her own. At work, she frequently calls her mother to decide what she should wear and volunteers for demeaning tasks just to ensure her coworkers will not abandon her.Dependent Personality Disorder

Answer

The correct matches align the guarded, suspicious accountant with Paranoid Personality Disorder; the attention-seeking, dramatic actress with Histrionic Personality Disorder; the remorseless, deceitful man with Antisocial Personality Disorder; and the submissive, excessively clinging administrative assistant with Dependent Personality Disorder.
Each vignette provides classic diagnostic criteria for specific personality disorders as outlined in the DSM-5. The first patient matches Paranoid Personality Disorder (Cluster A) due to pervasive distrust. The second matches Histrionic Personality Disorder (Cluster B) due to excessive attention-seeking and emotionality. The third matches Antisocial Personality Disorder (Cluster B) due to a history of conduct disorder and lack of remorse for exploiting others. The fourth matches Dependent Personality Disorder (Cluster C) due to an excessive need to be cared for and submissive behavior.

Step-by-Step Solution

1
Analyze the first vignette to identify core maladaptive traits.
The patient shows pervasive distrust, suspicion of infidelity without evidence, and fear that information will be used against him maliciously.
Identifying these specific paranoid traits differentiates this from other Cluster A disorders like schizoid (which involves social detachment) or schizotypal (which involves magical thinking).
2
Evaluate the second vignette for predominant behavioral patterns.
The patient exhibits excessive emotionality, attention-seeking behavior, inappropriate familiarity, and impressionistic speech lacking detail.
These are the diagnostic criteria for Histrionic Personality Disorder, differentiating it from Borderline Personality Disorder, which would typically feature chronic feelings of emptiness, self-harm, or intense anger.
3
Assess the third vignette focusing on interpersonal conduct and history.
The patient demonstrates exploitation of others, lack of remorse, and a childhood history of conduct disorder.
A history of conduct disorder before age 15 and current disregard for the rights of others are required for the diagnosis of Antisocial Personality Disorder, distinguishing it from Narcissistic Personality Disorder, which centers on grandiosity rather than pervasive law-breaking or physical aggression.
4
Review the fourth vignette for defining interpersonal dependencies.
The patient shows an excessive need to be taken care of, relies on others for minor decisions, and tolerates abuse or volunteers for unpleasant tasks to maintain relationships.
This submissive and clinging behavior is the core of Dependent Personality Disorder, which can be distinguished from Avoidant Personality Disorder, where the primary driver is fear of rejection and feelings of inadequacy rather than fear of losing support.

Key Concept

The ability to distinguish between different personality disorders based on core pervasive, maladaptive traits and behaviors across various interpersonal contexts.
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Topics

Personality Disorders

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