Diagnosis and Treatment
Axis II of the DSM covers personality disorders extensively, illuminating the criteria by which personality disorders can be diagnosed, and allowing clinicians to effectively distinguish between them in order to provide the most accurate diagnosis and treatment plan for the client. As a multi-model model, the DSM also allows clients like Mary to be treated for additional clinical conditions and accounts for comorbidity. Alternative models of personality disorder assessment and diagnosis can also be used alone or in conjunction with the DSM (Oldham, 2015). Using any model of assessment, the clinician is advised to take into account the client’s health history with a long range view of behavioral and other presenting symptoms. Clinicians can also take into account what prior treatments Mary has received and the assessments given by her former therapists.
In Mary’s case, personality disorder symptoms are diverse, including self-harm behaviors, suicidal ideation, substance abuse, and troubles maintaining interpersonal relationships. In fact, a superficial overview of Mary’s symptoms would indicate the possibility of paranoid, antisocial, or avoidant personality disorders. A closer look at Mary’s presentation would indicate that borderline personality disorder would also be likely given Mary’s impulsivity, her self-harming behaviors, her difficulties...
1). The latter symptom, Mary’s relationship issues and her inability to form the social connections that would improve her sense of self as well as her coping mechanisms, is central to the diagnosis. Mary’s overall symptom picture includes potential red herrings for clinicians who have not spent as much time with the client, including her history with truancy and her most recent expressions of paranoia related to her coworkers. Feeling “vibrations” from others and feeling persecuted or disliked in the office is not necessarily indicative of a psychotic disorder or paranoid personality disorder, particularly given these are recent, rather than consistent, symptom manifestations. Furthermore, it is possible that Mary’s coworkers indeed do not like her given that Mary might be consciously or unconsciously putting up barriers that prevent her from achieving intimacy.
Treatment approaches for Mary would depend on the recent evidence on borderline personality disorder, which is notoriously “difficult to treat,” (National Institute of Mental Health, 2017, p. 1). Being difficult…
