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tyfogleman
You MUST select THREE answers. During the course of a routine…
You MUST select THREE answers.
During the course of a routine physical examination, Nick, a 25-year-old single, African American man, suddenly started crying and blurted out that he was very depressed and was thinking about a suicide attempt he had made when he felt this way as a teenager. His doctor referred him for a psychiatric evaluation.
Nick is tall, bearded, muscular, and handsome. He is meticulously dressed in a white suit and has a rose in his lapel. He enters the psychiatrist’s office, pauses dramatically, and exclaims, “Aren’t roses wonderful this time of year?” When asked why he has come for an evaluation, he replies laughingly that he has done it to appease his family doctor, “who seemed worried about” him. He has also read a book on psychotherapy, and hopes that “maybe there is someone very special who can understand me. I’d make the most incredible patient.” He then takes control of the interview and begins to talk about himself, after first remarking, half jokingly, “I was hoping you would be as attractive as my family doctor.”
Nick pulls out of his briefcase a series of newspaper clippings, his resume, photographs of himself, including some of him with famous people, and a photocopied dollar bill with his face replacing George Washington’s. Using these as cues, he begins to tell his story.
He explains that in the last few years he has “discovered” some now-famous actors, one of whom he describes as a “physically perfect teenage heartthrob.” He volunteered to coordinate publicity for the actor, and as part of that, posed in a bathing suit in a scene that resembled a famous scene from the actor’s hit movie. Nick, imitating the actor’s voice, laughingly, and then seriously, describes how he and the actor had similar pasts. Both were rejected by their parents and peers, but overcame this to become popular. When the actor came to town, Nick rented a limousine and showed up at the gala “as a joke,” as though he were the star himself. The actor’s agent expressed annoyance at what he had done, causing Nick to fly into a rage. When Nick cooled down, he realized that he was “wasting my time promoting others, and that it was time for me to start promoting myself.” “Someday,” he said, pointing to the picture of the actor, “he will want to be president of my fan club.”
Nick has had little previous acting experience of a professional nature, but he is sure that success is “only a question of time.” He pulls out some promotional material he has written for his actors and says, “I should write letters to God-He’d love them!” When the psychiatrist is surprised that some materials are signed by a different name than the one Nick has given the receptionist, Nick pulls out a legal document explaining the name change. He has dropped his family name and taken as his new second name his own middle name.
When asked about his love life, Nick says he has no lover, and this is because people are just “superficial.” He then displays a newspaper clipping in which he had letterset his and his ex-lover’s names in headlines that read: “The relationship is over.” More recently he has dated and adored a man with the same first name as his own; but as he became disenchanted because he realized that the man was ugly and was an embarrassment because he dressed so poorly. Nick then explains that he owns over 100 neckties and about 30 suits, and is proud of how much he spends on “putting myself together.” He has no relationships with other homosexual men now, describing them as “only interested in sex.” He also stated that he would prefer to avoid relationships than to have one in which his partner might leave him – he reports that abandonment is his primary fear. Nick considers heterosexual men as “mindless and without aesthetic sense.” The only people who have understood him are older men who have suffered as much he has. “One day, the mindless, happy people who have ignored me will be lining up to see my movies.”
Nick’s alcoholic father was very critical of him, was rarely around, and had many affairs until he finally disappeared when Nick was a young teen. His mother was “like a friend.” She was chronically depressed about her husband’s affairs and turned to her son, often kissing him on the lips throughout adolescence. Eventually, she started an affair of her own and no longer spent time with Nick. He then felt abandoned again, and made two separate suicide attempts that were non-life-threatening. He described a tortured childhood, being picked on by his peers for looking odd until he began body building.
At the end of the interview, Nick is referred to an experienced clinician associated with the clinic, who charges a minimal fee (10 dollars), which he can afford. However, Nick requests a referral to someone who would offer him free treatment, seeing no reason for paying anyone as the therapist “would be getting as much out of it” as he would.
Select one or more:
a.Paranoid Schizophrenia
b.Schizotypal Personality Disorder
c.Narcissistic Personality Disorder
d.Dependent Personality Disorder
e.Schizoid Personality Disorder
f.Histrionic Personality Disorder
g.Borderline Personality Disorder
h.Antisocial Personality Disorder
