A 35-year-old woman comes to the office for evaluation of anxiety. The patient works as a mechanical engineer and recently declined a promotion to be a project manager. Although her salary would have increased significantly, she felt that overseeing other employees and leading team meetings would be too stressful. She says, "If something were to go wrong, everyone would blame me. I don't even know why they offered me this position." The patient enjoys her job but tends to eat lunch by herself because she feels that her coworkers do not like her appearance or sense of humor. She has never had a long-term romantic partner but fantasizes about getting married someday. The patient lives alone, rarely socializes with friends, and is close with her mother, whom she describes as "the person I can always rely on no matter what." Which of the following is the most likely diagnosis?

Question

A 35-year-old woman comes to the office for evaluation of anxiety.  The patient works as a mechanical engineer and recently declined a promotion to be a project manager.  Although her salary would have increased significantly, she felt that overseeing other employees and leading team meetings would be too stressful.  She says, "If something were to go wrong, everyone would blame me.  I don't even know why they offered me this position."  The patient enjoys her job but tends to eat lunch by herself because she feels that her coworkers do not like her appearance or sense of humor.  She has never had a long-term romantic partner but fantasizes about getting married someday.  The patient lives alone, rarely socializes with friends, and is close with her mother, whom she describes as "the person I can always rely on no matter what."  Which of the following is the most likely diagnosis?

Quizplus · Accepted Answer

11ec160b_3637_7c58_9249_0f6087ad8627_MD0001_00 This patient's pattern of avoiding social interactions and hypersensitivity to criticism is characteristic of avoidant personality disorder. Patients with this disorder typically have very limited social relationships due to the fear of being judged, embarrassed, or rejected. They desire social acceptance and may fantasize about having relationships, as in this patient; however, they struggle with feelings of inadequacy and pursue relationships only if certain of absolute acceptance by others. Occupational dysfunction due to difficulties interacting with coworkers or turning down promotions due to fear of criticism is common. (Choice A) Acute stress disorder involves exposure to a life-threatening event with resulting flashbacks, intrusive memories, avoidance, negative mood, hyperarousal, and dissociation from reality. (Choice B) In adjustment disorder with anxiety, a disproportionate level of worry develops within 3 months of onset of an identifiable stressor. This patient's chronic anxiety symptoms appear to be related to a longstanding fear of rejection in social situations and low self-esteem, which is more consistent with avoidant personality disorder. (Choice C) Antisocial personality disorder is marked by persistent disregard for and violation of the rights of others. Individuals with this disorder are often risk-takers who exhibit criminal behavior. (Choice E) Generalized anxiety disorder is characterized by excessive worry about multiple issues and is associated with irritability, restlessness, muscle tension, fatigue, sleep disturbance, and difficulty concentrating. This patient's anxiety is more consistent with avoidant personality disorder because it revolves around a fear of judgment by others and feelings of inadequacy, resulting in a pattern of social avoidance. (Choice F) Paranoid personality disorder involves a pattern of distrust and suspiciousness of others' motives. Patients with this disorder also avoid relationships and socialization, but do so because they are concerned about personal information being used to exploit them. (Choice G) Individuals with schizoid personality disorder are also socially avoidant, but they tend to be content with their social isolation. Patients with this disorder are emotionally detached, have a limited range of affect, do not desire social acceptance, and prefer to be alone. Educational objective: Avoidant personality disorder is a maladaptive pattern of behavior characterized by social inhibition, feelings of inadequacy, and fear of embarrassment and rejection. __________ References: Avoidant personality disorder: current insights. (http://www.ncbi.nlm.nih.gov/pubmed/29563846) Personality functioning in patients with avoidant personality disorder and social phobia. (http://www.ncbi.nlm.nih.gov/pubmed/23786266)

A 35-Year-Old Woman Comes to the Office for Evaluation of Anxiety