Question

CASE STUDY:

“THE LAWYER”

The patient is a 45-year-old lawyer who seeks treatment at his wife’s insistence. She is fed up with their marriage; she can no longer tolerate his emotional coldness, rigid demands, bullying behavior, sexual disinterest, long work hours, and frequent business trips. The patient feels no particular distress in his marriage, and has agreed to the consultation only to humor his wife.

It soon develops, however, that the patient is troubled by problems at work. He is known as the hardest-driving member of a hard-driving law firm. He was the youngest full partner in the firm’s history, and is famous for being able to handle many cases at the same time. Lately, he finds himself increasingly unable to keep up. He is too proud to turn down a new case, and too much of a perfectionist to be satisfied with the quality of work performed by his assistants. Displeased by their writing style and sentence structure, he finds himself constantly correcting their briefs and therefore unable to stay abreast of his schedule. People at work complain that his attention to details and inability to delegate responsibility are reducing his efficiency. He has had two or three secretaries a year for 15 years. No one can tolerate working for him for very long because he is so critical of any mistakes made by others. When making schedules for himself and his staff, but then is unable to meet them and works 15 hours a day. He finds it difficult to be decisive now that his work has expanded beyond his own direct control.

The patient discusses his children as if they were mechanical dolls, but also with a clear underlying affection. He describes his wife as a “suitable mate” and has trouble understanding why she is dissatisfied. He is meticulous in his manners and dress and slow and ponderous in his speech, dry and humorless, with a stubborn determination to get his point across.

The patient is the son of two upwardly mobile, extremely hard-working parents. He grew up feeling that he was never working hard enough, that he had much to achieve and very little time. He was a superior student, a “bookworm,” awkward and unpopular in adolescent social pursuits. He has always been competitive and a high achiever. He has trouble relaxing on vacation, develops elaborate activities schedules for every family member, and becomes impatient and furious if they refuse to follow his plans. He likes sports, but has little time for them and refuses to play if he can’t be at the top of his form. He is a ferocious competitor on the tennis courts and a poor loser.

List what you would diagnose for each of the 5 axes and a brief explanation of why:

AXIS I: _________________________________

Explain your reason for this specific choice:

AXIS II: _________________________________

Explain your reason for this specific choice:

AXIS III: _________________________________

Explain your reason for this specific choice:

AXIS IV: _________________________________

Explain your reason for this specific choice:

AXIS V: _________________________________

DSM-5 Diagnosis (write diagnosis in format of DSM-5 as well):

Answer 1

Axis I: No Diagnosis of Axis I (this is because the client does not indicate any clinical disorders pertain to mental disorders, learning disorders or substance abuse disorders).
Axis II: Obsessive-compulsive personality disorder (this is because the client’s behaviours are meeting the criteria for this personality disorder; for instance his excessive preoccupation with perfectionism, need for control over his environment, rigidity in thought and behaviour, tendency towards orderliness and planning)
Axis III: None (this is because the client does not indicate any medical or physical disorders)
Axis IV: None (this is because there are no psychosocial or enviormental factors that are currently contributing to the client’s personality disorder)
Axis V: GAF = 55 (this is because the client seems to indicate moderate difficulties in difficulty in social and occupational functioning).

DSM 5 Diagnosis: The client presents with symptoms and behaviours that are consistent with a DSM 5 Diagnosis of an Obsessive-Compulsive Personality Disorder [301.4 (F60.5)].