Can someone help me diagnosis this abnormal patient using DSM IV. The patient is

Question

Can someone help me diagnosis this abnormal patient using DSM IV.

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.

Explanation / Answer

Given the patient's history, there is no mention of anxiety or hallucinations or delusions that the person may be having, rather an inculcated habit of perfectionism and inflexibility. A diagnosis made for the patient can be Obsessive Compulsive Personality disorder or Asperger's syndrome.

The symptoms of both the diseases are similar, but the differences lie in the affective behaviour as well as social skills of the patient. As per the symptoms:

1. The patient puts excessive notice on the details and this has led many secretaries leave his office.

2. He keeps doing or repeating everyone else's work as he is not satisfied with anyone else's work in his search for perfection.

3. He schedules every moment of his life and even his vacations.

4. He is inflexible and even plans activities for his family, wanting control

If these conditions are only considered, then the diagnosis would be OCPD. But then another dimension comes into play - the emotional coldness

1. His wife complains him to be unemotional and cold

2. He describes his children as "mechanical tools and his wife as suitable mate". This shows his emotional coldness

These symptoms point towards an emotional coldness along with compulsive personality. But, the patient's emotional coldness is not as prevalent as that if an autistic or pre autistic conditions.

Hence, it can be attributed to OCPD.

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