Giving a patient diagnosis of personality disorder has high stakes in terms of accuracy. There is a lot of stigma surrounding this process chief among them being discrimination. Moreover, it is easy for some people to find insults in no help from diagnosis. In any case, it is important for a professional to offer a diagnosis as a reflection of understanding the emotional challenges that a person is facing so that proper remedies can be provided ( Jovev, et al., 2013). For patients experiencing chaotic lifestyles, chronic life interruptions, fractured support systems, and frayed identities, it is important to consider individual diagnosis for these cases as well as make a consideration of the DSM procedures.
In the case study, the patient is certainly in suffering from Borderline Personality Disorder. Based on DSM-IV-TR (American Psychiatric Association, 2000), this diagnosis has been done because there are indications of persistent instability in relationships, mood, and self-image besides distinct impulsive behavior from the patient. These indications have been generated right from childhood and are visible presently in a variety of ways.
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Explanation of Rationale
As seen from the interview, the patient is trying to show frantic efforts to get rid of all people in his life. The social aspect of his life is severely affected. He is building his environment where he feels and knows he is alone as he needs to be alone. Nothing seems to be related to anyone as the patient is completely clued towards self. His desires to value oneself are generated from experiences with the father. He is showing signs of unstable and intense interpersonal relationships. These relationships appear to change from being ideal and devaluation to being extremes. In any normal life, the patient seems healthy but such changes are worrying. The patient has a disturbance in elaborating his identity, especially how his father ruined his childhood. He is having intense and persistent self-image or self-sense. The patient is impulsive in many things. For instance, he is antisocial and thinks a way out in any case he is confronted with the same. Nonetheless, he is not including suicidal and self-harming behaviors in his repulsions. He has shown a great interest in creating fantasy world by playing his favorite Warcraft game. He seeks to find peace in self. He is feeling deeply empty. This is perceived with the manner in which he is answering questions. He says what makes him complete in some way. He is more into addressing his issues other than replying the questions directly asked. He does not want to involve anyone in his responses unless the father, who seems to be the cause of everything. This emptiness is in the feelings of this patient. In some way, the patient is trying to relay high levels of threats and possible self-containing behaviors. He is not concerned about people and does not want to be tangled with people.
The patient shows that he has hated many things right from his young age. No one can directly get to understand what he wants and what he does not want. He seems that everything he wants is what he misses as part of life. The fact that he did not finish his schooling does not warrant him to see the rest of the students as not wise enough like him. He sees more learning not by going to class but by missing them. He loves to work in his chosen environment. He is paranoid in his thinking but also sensitive towards interacting with other people. He demonstrates paranoia and excessive trust in his abilities resulting in excessive self-destruction. The gradual manifestation of the symptoms of being paranoid and sensitive to insensible things makes the patient have no direct or indirect way of understanding issues right at their basic levels.
He has some difficulty in controlling anger. He has intense anger that makes him want to do many things. He is transient. His ideas are paranoid and stress-related. He manifests enormous signs and symptoms of dissociative behavior. The patient is literally with dramatic behaviors that attract attention. He is swinging in moods in a rapidly and sensitive to the environment be it at home or in school and everywhere else. The patient is likely to be having quasi-psychotic symptoms in that he seems to be hearing voices in stress. He seems to be suffering from depersonalization. He is full of paranoid thinking. For instance, he says that he does not need friends to do anything, as he can be his best friend ( Paris, 2015 ).
Other Essential Information for Accurate Diagnosis
The worthiness of carrying out this DSM-IV-TR (American Psychiatric Association, 2000), diagnosis is supported by the manifested characteristics from the patient at hand. More of the deliberations with using these criteria are cited on the need to differentiate between true symptoms of personality disorder and other symptoms that might be attached to bipolar disorder. This criterion is also selected based on the knowledge that not every individual diagnosed with Borderline Personality Disorder will present in a similar manner (Crosby& Sprock, 2004). More than one hundred combinations of symptoms can be considered when for anyone to make an accurate diagnosis using DMSV. The diagnosis has to be done only when it is clear that such behaviors have been seen in a long time, as starting right from childhood and moving across a range of situations even up to adulthood. Thus, the choice of DSM as criteria is quite fundamental to the understanding of the varying symptoms leading to the diagnosis of Borderline Personality Disorder as seen with the patient in the case study ( Jovev, et al., 2013).
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (fifth Ed.). Arlington, VA: American Psychiatric Publishing.
Crosby, J. P., & Sprock, J. (2004). Effect of patient sex, clinician sex, and sex role on the diagnosis of antisocial personality disorder: Models of under-pathologizing and over-pathologizing biases. Journal of Clinical Psychology, 60(6), 583–604. Retrieved from the Walden Library databases.
Jovev, M., McKenzie, T., Whittle, S., Simmons, J. G., Allen, N. B., &Chanen, A. M. (2013). Temperament and maltreatment in the emergence of borderline and antisocial personality pathology during early adolescence. Journal of the Canadian Academy of Child & Adolescent Psychiatry , 22 (3), 220–229. Retrieved from the Walden Library databases.
Paris, J. (2015 ). The intelligent clinician’s guide to the DSM-5 (Second Ed.). New York, NY: Oxford University Press. Retrieved from the Walden Library.
