Examkin

Question

Difficulty: HardPersonality Disorders

A 31-year-old man visits the outpatient psychiatry clinic seeking help for career stagnation. Despite receiving excellent performance reviews as an independent data analyst, he recently declined a lucrative promotion that required him to oversee a small team. He admits, "I am terrified they will criticize my management style and realize I am inadequate." He expresses a deep desire for close friendships and a romantic partner but spends his weekends entirely alone, stating, "I can't interact with people unless I am 100% sure they already like me." He denies any history of hallucinations, delusions, or manic episodes. He occasionally feels depressed about his isolation but does not meet the criteria for a major depressive episode. Which of the following is the most accurate statement regarding this patient's presentation and management?

  1. Cognitive-behavioral therapy is the preferred first-line management for his underlying personality disorder.Answer
  2. B
    His profound lack of interpersonal relationships establishes a diagnosis of schizoid personality disorder.
  3. C
    The duration of his social withdrawal for over six months meets the criteria for schizophrenia.
  4. D
    The physician is ethically obligated to contact his employer to arrange workplace accommodations.
  5. E
    Selective serotonin reuptake inhibitor monotherapy is indicated to address his episodic sadness as a manifestation of bipolar depression.

Answer

The most accurate statement is that cognitive-behavioral therapy is the preferred first-line management for his underlying personality disorder.
The patient's presentation of avoiding occupational activities that involve significant interpersonal contact, restraint in intimate relationships due to fear of being shamed, and a pervasive feeling of inadequacy are diagnostic of avoidant personality disorder (Cluster C). The primary and most effective treatment for personality disorders, particularly avoidant personality disorder, is psychotherapy. Cognitive-behavioral therapy (CBT) helps these patients challenge their deep-seated beliefs of inadequacy and gradually exposes them to feared social situations. While SSRIs may be used as an adjunct if comorbid generalized social anxiety disorder is present, CBT remains the foundational treatment.

Step-by-Step Solution

1
Analyze the patient's pattern of social withdrawal and interpersonal behavior.
The patient experiences profound social isolation but explicitly expresses a deep desire for relationships, coupled with a paralyzing fear of criticism and rejection.
This differentiates Avoidant Personality Disorder from Schizoid Personality Disorder, where patients have no desire for social intimacy.
2
Rule out psychotic spectrum disorders.
The patient has no history of hallucinations, delusions, or disorganized thought processes.
Schizophrenia and related psychotic disorders require positive symptoms, not merely negative symptoms like social withdrawal.
3
Determine the appropriate management for Avoidant Personality Disorder.
Cognitive-behavioral therapy (CBT), focusing on social skills training and graded exposure, is identified as the first-line treatment.
CBT directly addresses the core cognitive distortions (fear of inadequacy and rejection) driving the avoidant behavior.

Key Concept

Diagnosis and management of Avoidant Personality Disorder, including differentiation from Cluster A personality disorders and psychotic disorders.
Estimated Time:1m 30s
Rate this question

Topics

Personality Disorders

More questions from this topic