Match each clinical vignette describing a psychiatric presentation to the most appropriate DSM-5 diagnostic category based on core clinical features, symptomatology, and timeframe.
- A 25-year-old mother experiences recurrent, distressing images of dropping her infant down the stairs. She knows these thoughts are irrational but feels compelled to repeatedly check the baby's crib locks to alleviate her intense anxiety.Obsessive-Compulsive Disorder (OCD)
- A 32-year-old accountant rigidly insists on categorizing all household expenses, becomes angry when his strict routines are interrupted, and views his extreme perfectionism as a necessary virtue for a successful life.Obsessive-Compulsive Personality Disorder (OCPD)
- A 45-year-old woman refuses to use public transportation or attend crowded concerts. She explains she is terrified she might experience sudden dizziness in these situations and would be completely unable to escape or get help.Agoraphobia
- A 19-year-old college student avoids eating in the cafeteria and attending dorm parties. He fears his hands will shake when holding a tray, leading others to judge him harshly as incompetent or weird.Social Anxiety Disorder (Social Phobia)
- A 28-year-old man presents with insomnia, restlessness, and anxiety that began 2 months after taking a new, highly demanding corporate job. He denies any life-threatening trauma. Symptoms cause distress but do not meet criteria for Generalized Anxiety Disorder.Adjustment Disorder with Anxiety
Answer
The correct matching aligns the mother with postpartum obsessions to Obsessive-Compulsive Disorder; the rigid, perfectionistic accountant to Obsessive-Compulsive Personality Disorder; the woman fearing inability to escape public places to Agoraphobia; the student fearing negative evaluation to Social Anxiety Disorder; and the man with job-related anxiety to Adjustment Disorder.
Each diagnosis is uniquely defined by specific DSM-5 criteria regarding the core cognition of the fear, the nature of the intrusive thoughts, and the relationship to a stressor. OCD requires ego-dystonic obsessions/compulsions. OCPD is characterized by ego-syntonic rigidity. Agoraphobia centers on the fear of being unable to escape. Social Anxiety Disorder centers on the fear of negative evaluation. Adjustment Disorder requires symptom onset within 3 months of an identifiable stressor without meeting criteria for another disorder.
Step-by-Step Solution
Key Concept
Differential diagnosis of anxiety and related disorders based on core fear cognitions and ego-syntonic versus ego-dystonic symptom presentation.