Bob Case:
Clinical Case
Bob
Bob, a 50-year-old college professor, sought treatment only after urging from his wife. During the interview, Bob’s wife noted that he seemed so focused on himself and his own advancement that he often belittled others. Bob was dismissive of these concerns, stating that he had never been the sort of person to tolerate idiots, and he could see no reason why he should begin offering such tolerance now—in rapid fire, he described his supervisor, his students, his parents, and a set of former friends as lacking the intelligence to merit his friendship. He willingly acknowledged working long hours but stated that his research had the potential to change people’s lives and that other activities could not be allowed to interfere with his success. The therapist’s gentle questioning of whether his expressions of superiority might provoke some interpersonal tension was met with a scathing rebuke.
DSM-5 Criteria for Narcissistic Personality Disorder
Presence of five or more of the following signs of grandiosity, need for admiration, and lack of empathy from early adulthood across many contexts:
Grandiose view of one’s importance
Preoccupation with one’s success, brilliance, beauty
Belief that one is special and can be understood only by other high-status people
Extreme need for admiration
Strong sense of entitlement
Tendency to exploit others, lack of empathy, envious of others and arrogant behavior or attitudes
Leon Case:
Clinical Case
Leon
Leon, a 45-year-old man, sought treatment for depression. During the interview, Leon described feeling depressed and uncomfortable socially for as long as he could remember. By age 5, he would experience intense anxiety when he was with other children, and his mind would “go blank” if he had to speak in front of others. He grew up dreading birthday parties, teachers’ classroom questions, and meeting new children. Although he was able to play with some of the children in his neighborhood, he had never asked a woman out on a date or developed a “best friend.” He took a job at the post office after graduation because it involved little social interaction. (Adapted from Spitzer, Gibbon, et al., 1994.)
DSM-5 Criteria for Dependent Personality Disorder
An excessive need to be taken care of, as shown by the presence of at least five of the following from early adulthood across many contexts:
Difficulty making decisions without excessive advice and reassurance from others
Need for others to take responsibility for most major areas of life
Difficulty disagreeing with others for fear of losing their support
Difficulty doing things on own or starting projects because of lack of self-confidence
Doing unpleasant things to obtain the approval and support of others
Feelings of helplessness when alone because of fears of being unable to care for self
Urgently seeking new relationship when one ends
Preoccupation with fears of having to take care of self
Assignment 1:
Clinical Case Bob (p. 473)
In discussing Bob’s history of behaviors and thought patterns, what would be the most likely diagnosis? What behavior(s) would be best to target for therapeutic intervention in order to help Bob develop better interactions with others? What treatment would you recommend?
Clinical Case Leon (p. 477)
In reviewing the case on Leon, what would be the most likely personality disorder diagnosis? What would be the most beneficial treatment targets for Leo? What treatment would you recommend?
