Examkin

Soru

Zorluk: OrtaPersonality Disorders

A 34-year-old man comes to the clinic seeking a second opinion regarding his "chronic fatigue and workplace stress." He brings a 5-page typed document detailing his symptoms, previous doctors' visits, and a list of medical literature he has reviewed. He states that he is constantly exhausted because he works 80 hours a week as a software developer. He explains, "I have to do everything myself because my colleagues are incompetent and careless. If I delegate, the code will be messy, and I refuse to release anything less than perfect." Because of this rigid standard, he frequently misses project deadlines, which recently led to a formal reprimand from his manager. The patient expresses anger at his manager's "inability to appreciate true quality." He denies any repetitive rituals or intrusive thoughts that cause him distress. He reports no periods of elevated mood, impulsivity, or decreased need for sleep. He has no close friends because he finds socializing to be "an inefficient use of time." Which of the following is the most likely diagnosis?

  1. Obsessive-compulsive personality disorderCevap
  2. B
    Obsessive-compulsive disorder
  3. C
    Narcissistic personality disorder
  4. D
    Schizoid personality disorder
  5. E
    Bipolar II disorder

Cevap

Obsessive-compulsive personality disorder
This patient exhibits classic features of obsessive-compulsive personality disorder (OCPD). OCPD is a Cluster C personality disorder defined by a pervasive pattern of preoccupation with orderliness, perfectionism, and control. Key features demonstrated by this patient include perfectionism that interferes with task completion (missing deadlines because the code must be perfect), an excessive devotion to work and productivity to the exclusion of leisure activities and friendships, and a reluctance to delegate tasks unless others submit exactly to his way of doing things. Crucially, his worldview is ego-syntonic; he does not see his perfectionism as a problem, but rather views others as 'incompetent'.

Adım Adım Çözüm

1
Analyze the core behavioral patterns described in the vignette.
The patient demonstrates extreme perfectionism, rigidity, reluctance to delegate, and excessive devotion to work to the point of missing deadlines.
Identifying the primary driving force behind the patient's impairment is necessary for an accurate psychiatric diagnosis.
2
Determine if the patient's symptoms are ego-syntonic or ego-dystonic.
The patient feels his behavior is justified and superior (ego-syntonic), and explicitly denies distressful intrusive thoughts or rituals.
This critically differentiates a personality disorder from an anxiety or obsessive-compulsive disorder.
3
Differentiate from other personality disorders with overlapping features.
The social isolation is driven by work devotion, not a lack of desire (ruling out Schizoid). The devaluation of others is based on their perceived incompetence regarding tasks, not a primary need for personal admiration (ruling out Narcissistic).
Cluster A, B, and C personality disorders can share superficial traits (e.g., social isolation, arrogance) but have entirely different underlying psychological motivations.

Anahtar Kavram

Obsessive-compulsive personality disorder (OCPD) is characterized by a pervasive pattern of preoccupation with orderliness, perfectionism, and mental/interpersonal control at the expense of flexibility, openness, and efficiency.
Bu soruyu puanla

Konular

Personality Disorders

Bu konudan daha fazla soru