The predominant symptom associated with dysthymic disorder is:
Correct Answer D:
The predominant symptom associated with dysthymic disorder is depressed mood. Other names commonly used for this disorder are depressive neurosis, characterological depression, and minor depression. The depression associated with dysthymic disorder lacks the severity of major depression is sustained over a 2-year period. Delusions, loosening of associations, and incoherence are not associated with dysthymic disorder.
The most common symptoms of dysthymia include the following:
The criteria for diagnosis of a Munchausen syndrome include all of the following, except:
Correct Answer C:
Munchausen syndrome, a severe and chronic form of factitious disorder, consists of repeated production of feigned physical symptoms without an external incentive; the motivation for this behavior is to assume the sick role. Symptoms are usually acute, dramatic, and convincing and are accompanied by a tendency to wander from one physician or hospital to another for treatment. The exact cause is unknown, although stress and borderline personality disorder are often implicated.
Munchausen syndrome is distinguished from other factitious diseases by the lack of secondary gain. The patient's reason for engaging in deception is not to escape some consequence in life. Instead, the patient suffers from an apparent deep seated need to be sick; a need which can impel the sufferer to injure or poison themselves in an effort to sustain the illusion of organic illness.
In transvestism disorder all of the following are true, except:
In transvestic fetishism, heterosexual males dress in women's clothing. They generally begin such behavior in late childhood. This behavior is associated, at least initially, with sexual arousal.
Cross-dressing per se is not a disorder. Personality profiles of cross-dressing men are generally similar to age- and race matched norms. When their partners are cooperative, these men have intercourse in partial or full feminine attire. When their partners are not cooperative, they may feel anxiety, depression, guilt, and shame associated with the desire to cross-dress.
Most transvestites do not present for treatment. Those who do are brought in by unhappy spouses, are referred by courts, or are self-referred out of concern about experiencing negative social and employment consequences. Some cross dressers present for treatment of comorbid gender dysphoria, substance abuse, or depression. Social and support groups for cross-dressers are generally helpful.
Patients with disorders of gender identity often have a history of:
Correct Answer B:
Gender identity disorder is a strong, persistent cross-gender identification condition in which people believe they are victims of a biologic accident and are cruelly imprisoned in a body incompatible with their subjective gender identity. Those with the most extreme form of gender identity disorder are called transsexuals.
Childhood gender identity problems are usually present by age 2. For some people, however, gender identity disorder does not manifest until adulthood. Children experiencing difficulty with gender identity commonly prefer cross dressing, insist that they are of the other sex, intensely and persistently desire to participate in the stereotypical games and activities of the other sex, and have negative feelings toward their genitals.
A 20 year old white male states that he was physically abused by his natural parents, and as a result of running away from home on several occasions was placed in a series of foster homes. His schooling was sporadic, and he was frequently in trouble for truancy, vandalism, initiating fights, and stealing. He dropped out of school at the age of 16, and during that year he was arrested for car theft and driving while intoxicated. He has not worked at any job for more than 6 months, and has had frequent changes of address due to failure to pay rent and other financial obligations. He brags that he has fathered three children by three different women, but has not provided any support of many any contact with any of them since their pregnancies. IQ testing is normal and there is no history of a psychotic break.
The most accurate diagnosis of this patient’s condition is:
This patient meets the criteria for antisocial personality disorder, including age over 18, evidence of conduct disorder in childhood; a pattern of irresponsible and antisocial behavior since age 15, and absence of schizophrenia or manic episodes. Although the patient has some features of borderline personality disorder, such as unstable relationships, the persistently aggressive nature and lack of remorse are much more typical of antisocial personality. Although the boasting quality of the patient might appear somewhat grandiose, there are no other features to suggest mania. Abused child reaction formation is not a recognized diagnosis in the Diagnostic and Statistical Manual of Mental Disorders. Schizotypal personality disorder is not usually associated with such pervasive antisocial behavior and violence.
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