A 22-year-old man comes to the office for a psychiatric evaluation at his mother's insistence. She is worried that her son has no close friends, does not date, and shows no interest in activities popular with young adults. His mother describes normal developmental milestones but says, "I thought he would outgrow his shyness, but he seems more isolated than ever." The patient attends a local university where he studies engineering and performs well academically. After class, he returns home and enjoys playing computer games or reading comic books. When interviewed alone, the patient makes limited eye contact. He gives brief responses and appears somewhat anxious and uncomfortable at times, but his affect is predominantly flat. In response to questioning about reasons for avoiding social activities, he replies, "I'm just not comfortable around people. I don't like it when people try to get too personal and would rather keep to myself." This patient's behavior is most consistent with which of the following?

Question

A 22-year-old man comes to the office for a psychiatric evaluation at his mother's insistence.  She is worried that her son has no close friends, does not date, and shows no interest in activities popular with young adults.  His mother describes normal developmental milestones but says, "I thought he would outgrow his shyness, but he seems more isolated than ever."  The patient attends a local university where he studies engineering and performs well academically.  After class, he returns home and enjoys playing computer games or reading comic books.  When interviewed alone, the patient makes limited eye contact.  He gives brief responses and appears somewhat anxious and uncomfortable at times, but his affect is predominantly flat.  In response to questioning about reasons for avoiding social activities, he replies, "I'm just not comfortable around people.  I don't like it when people try to get too personal and would rather keep to myself."  This patient's behavior is most consistent with which of the following?

Quizplus · Accepted Answer

11ec25c8_d7e4_b6cf_bc81_6d469d8eabdc_MD0003_00 This patient's pattern of lack of desire for close relationships and preference for solitary activities is characteristic of schizoid personality disorder. Individuals with this disorder typically have few friends by choice and show little interest in intimacy or sexual experiences. They tend to be emotionally detached, with flat affect and apparent indifference to praise or criticism. Individuals with schizoid personality disorder are often considered loners who tend toward introverted behaviors. (Choice A) Antisocial personality disorder involves a pattern of violation of the rights of others and a lack of remorse. (Choice B) Differentiating schizoid personality disorder from mild forms of autism spectrum disorder (ASD) can be difficult. However, a diagnosis of ASD requires both social communication deficits and repetitive/restrictive behaviors with early childhood onset. This patient's normal developmental milestones and lack of stereotyped behaviors are more consistent with schizoid personality disorder. (Choices C and G) In contrast to those with schizoid personality disorder, individuals with avoidant personality disorder or social anxiety disorder desire relationships but avoid them due to fears of rejection or being embarrassed. (Choices D and F) Social isolation is also seen in schizotypal and paranoid personality disorders. However, this patient lacks the eccentric behavior, odd beliefs, and perceptual distortions typical in schizotypal personality disorder. He does not demonstrate the pervasive suspiciousness and mistrust characteristic of paranoid personality disorder. Educational objective: Individuals with schizoid personality disorder are socially detached and prefer to be alone. They can be differentiated from individuals with avoidant personality disorder, who desire relationships but avoid them due to fears of rejection. They lack the eccentric cognitions and perceptual distortions characteristic of schizotypal personality disorder. References: Personality disorders. (http://www.ncbi.nlm.nih.gov/pubmed/26039856)

A 22-Year-Old Man Comes to the Office for a Psychiatric