PSYCHIATRY 2

A middle-aged divorced woman brings Rebecca, her 19-year-old daughter to your office and says, “Rebecca seems abnormal to me”. She’s concerned that she hardly has any friends and does not indulge in any activities that girls her age normally do, i.e. dating or going out with friends. She always keeps to herself, stays locked in her room for most of the day, or goes out hiking in the woods by herself. Other than that, she attends college regularly and is good in her academics. You notice that she makes minimal eye contact when you speak to her. Her thought process seems devoid of any delusions or hallucinations. On directly questioning her about the reason for her preference for keeping aloof, she says, “I just don’t enjoy being in the company of others. People don’t interest me much and I’d rather be to myself”. From the above information you come to the conclusion that she belongs to which one of the following personality types?
A. Schizotypal
B. Dependent
C. Schizoid
D. Avoidant
E. Borderline

Explanation:
Schizoid personality disorder is characterized by detachment from relationships and inability to express emotions. These patients do not enjoy close relationships and prefer keeping aloof and isolated. They rarely indulge in any pleasurable activities and appear indifferent to praise or criticism from others. They always choose solitary activities.

Choice A. Patients with Schizotypal personality disorder show a pattern of odd and eccentric behavior and reduced capacity for close relationships. These patients usually exhibit “magical thinking” like bizarre fantasies, belief in sixth sense, telepathy, superstitions or clairvoyance. They often have paranoid ideation and unusual perceptual experiences.

Choice B. Patients with Dependant personality disorder have an excessive need to be taken care of and tend to be clinging and submissive with their close ones. They tend to be extremely indecisive and avoid taking initiative with any new activities, due to feelings of inadequacy. They have difficulty expressing disagreement with others, for fear of losing support. They fear being "left alone" to take care of themselves.

Choice D. Avoidant personality disorder is characterized by a pattern of hypersensitivity to criticism, social inhibition, and feelings of inadequacy. These individuals AVOID (as the name suggests) intimate relations in an attempt to escape from being ridiculed. They also view themselves as inferior to others and are reluctant to engage in new activities or take any risk, due to fear of being embarrassed.

Choice E. As per DSM IV criteria, patients with Borderline personality disorder show a pattern of instability of interpersonal relationships and marked impulsivity. They swing wildly between devaluing and idealizing people (people are either "all good or all bad", popularly known as “splitting”). These patients often demonstrate suicidal or self- mutilating behavior. They also exhibit instability of mood and often find it difficult to control their anger. They tend to have chronic feelings of emptiness.