Master the board step 3

Psychiatry
FEATURES
EXAMPLES
Borderline PD:
A 30-year-old woman presents to the clinic. She reports
• Unstable affect, mood swings, marked impulsivity,
that she has been to many doctors, she said they were
unstable relationships, recurrent suicidal behaviors, all wonderful until they started ignoring her or cutting
chronic feelings of emptiness, identity disturbance, and her visits short, then she realized what terrible doctors
inappropriate anger. Become intensely angered if they they were. She starts the visit saying that the assistant
feel abandoned.
at the front desk is the “worst she’s ever seen”
because she didn’t smile at her. The other assistant
• Main defense mechanism is splitting.
was just wonderful according to her.
Antisocial PD:
A 26-year-old man is caught lighting forest fires during a
• Usually characterized by continuous antisocial or
recent spate. He has a history of legal problems since
criminal acts, inability to conform to social rules,
childhood. He reports that his mother is to blame. He
impulsivity, disregard for the rights of others,
denies feeling regret. He has no friends and is found
aggressiveness, lack of remorse, and deceitfulness.
to be hostile to everyone at the police station.
Narcissistic PD:
A patient is in the hospital for chest pain and becomes
• Usually characterized by a sense of self-importance, very agitated because he feels he is not getting
grandiosity, and preoccupation with fantasies of
enough attention. He reports that he is an important
success. This person believes he is special, requires CEO and demands a special VIP room and more
excessive admiration, reacts with rage when
consideration and a dedicated nurse to attend his
criticized, lacks empathy, is envious of others, and is needs.
interpersonally exploitative.
Cluster C: Anxiety, preoccupation with criticism or rigidity
Avoidant PD:
A 45-year-old single man fears an upcoming social
party being hosted by his parents. He dreads having
to meet other people and doesn’t feel comfortable
speaking with others. He is planning on staying at
home to avoid speaking to others.
• Individuals have social inhibition, feelings of
inadequacy, and hypersensitivity to criticism. They shy
away from starting anything new or attending social
gatherings for fear of failure or rejection. They desire
affection and acceptance and are open about their
isolation and inability to interact with others.
Dependent PD:
• Submissive and clinging behavior related to a need
to be taken care of. Individuals are consumed with
the need to be taken care of. They are clingy and
worry about abandonment. They feel inadequate and
helpless and avoid disagreements with others. They
usually focus dependency on a family member or
spouse.
Obsessive-Compulsive PD:
• Individuals are preoccupied with orderliness,
perfectionism, and control. They are often consumed
by the details of everything and lose their sense
of overall goals. They are strict and perfectionistic,
overconscientious, and inflexible. Associated with
difficult interpersonal relationships.
• Differentiated from obsessive-compulsive disorder.
A 28-year-old woman seeks counseling because of a
recent relationship breakup. They were dating for 6
months. She continues to call her ex 15–20 times a
day even though he does not pick up. She says she
can’t understand why they broke up because she
never disagreed with him. She never left the house
without him, and she always asked for his opinion,
even for little decisions. She cannot imagine a life
without him.
A 38-year-old man presents with his wife for marital
counseling. The wife reports that he is inflexible
and has unrealistic demands of orderliness and an
inflexible schedule. Both partners agree that his
demands are causing marital problems.
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