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Personality Disorder and Diagnosis

I need some help answering questions on this personality disorder case study:
Kevin, 44 year old ordained minister came to you at the insistence of his wife who complained he was showing "weak character" and was avoiding his responsibilities. For example, after opening a door, he performs ritualistic, odd behaviors.

When Kevin was 5 years old, the family moved to another town because his father had found a better job. His mother was quite unhappy about the move and badgered his father until he agreed to return to their hometown. At about the age 6, Kevin began wetting the bed and continued this behavior until he was 9. His mother criticized his laziness. She therefore did not seek treatment, and it was later accidentally discovered that Kevin had a weak urinary sphincter which had improved in time.

To avoid his mother criticisms of laziness and weakness, Kevin developed a strong work ethic and became quite successful in school. In spite of his efforts, his mother never complimented him or made comments of positive affection. Furthermore, critical messages from his mother were never countermanded by his father.
As a boy, because Kevin enjoyed baseball, he kept extensive statistics and records for his home team during each season. When Kevin expressed interest in joining the school baseball team, his mother told him that he should not play sports because he could get hurt.
When Kevin was a senior in high school, he applied for admission to a prestigious university. He mother who had previously called him lazy, then began to tell Kevin that he was not bright enough to be accepted by the university. Again, he looked to his father for some support only to see him defer to his mother. Somewhat defiantly, he went to the university with fierce determination and managed to succeed.
After college, Kevin attends a seminary, obtained excellent grades and was ordained. He married, settled in a parish in a large city. In time, his wife behavior duplicated that of his mother, and she accused him of being weak and incompetent. Several years after Kevin assumed his ministry, "odd behavior patterns began to impede his functioning. The first instance occurred when he decided to preach a liberal sermon, although he knew it would anger his supervising pastor. While preparing the sermon, he felt an intense surge of anxiety, which compared to a "breeze sweeping over me". He found himself reciting random numbers and turning in a circle several times before going out to deliver the sermon.
Shortly after this occurrence, one of his close friends died of a heart attack. When Kevin was taking a shower a few days later, he was thinking of the death and found himself rubbing soap on his cheat in a repetitive pattern, which tended to diminish his anxiety. Other patterns subsequently developed: he avoided stepping on cracks in the pavement, started adding license plate numbers and began developing several rituals with the Bible.
His wife is frustrated with him and see's these behaviors as "odd" and a weakness in his character. It has come to the point that they are thinking a divorce. This has increase Kevin's level of anxiety.

1. What you observe about the client behavior, appearance and impressions.
2. Describe the problem as the client has presented it,
3.(History of problem) Describe the course of the problem and his symptoms.
4. Describe the clients cognition, affect, behaviors and physiological functioning.
5. (Social History) Describe the clients present living situation and his family, school, health, and social history.
6. Describe assets that facilitate progress and change, such as motivation, intelligence, self-discipline, and willingness to utilize resources.
7. What is a good diagnosis for Kevin? What made you diagnosis him? What kind of personality disorder do he have?
8. What is a differential diagnoses? Rule in and out other possible diagnoses and why?
9.What is a good treatment plan for Kevin and why you think its a good treatment plan?
10. Discuss what therapeutic model you will utilize and provide literature to support?
11. Write up a one session SOAP notes-use information from case study Kevin
What are the differential diagnoses and what information and why rule-out other diagnoses.
use references/cite sources

Solution Preview

Case Study:

1. Observations about the client behavior, appearance and impressions:
-As this is a case study not a "real" clinical interview- I cannot comment on the appearance. If you saw the client or if the written case stated, the client enters the room with.... and omitted greeting you...eye contact was..., then you can comment on appearance. As it stands with this write up, I will leave that up to your discretion. Your professor is looking for first impressions based on superficial observations such as gait, manners, dress, eye contact, gestures ie. smiles, frown, flat expressions etc.

- Behaviors- again in a clinical write-up/report, comments on Behaviors generally begin with how you observe those behaviors at the moment of interview and your own observations. These observations are seen in context with the observations of other such as spouse, colleagues etc.
Therefore, based on his wife's observations, Kevin is demonstrating ritualistic behaviors that seem to be self-soothing. It seems that these ritual behaviors calm his anxiety and help him cope with negative thoughts and feedback from loved ones such as wife, his mother. It also seems that this pattern of behavior may have begun when he was a small child. Based on his wife's version of his childhood, it seems that strife in his family of origin caused much tension and anxiety for the ...

Solution Summary

This in-depth solution analyzes a case study of a couple having problems due to a husband having compulsive behaviors.