A 19-year-old man comes to the university health center after being referred by his professor. The patient says his professor "got annoyed" after he requested several extensions for his first writing assignment. He says, "I've gone through multiple rough drafts, but I need to make sure I submit something great. I don't want my name on just anything." The patient repeatedly mentions that he was valedictorian of his high school class because he was "the most diligent and dedicated student." He developed his own method of test preparation, which includes spending a few hours every morning planning out his daily study schedule. The patient studies alone in the library every evening after classes and on the weekends. He was invited to join a study group but declined because the other students refused to adopt his approach. The patient lives alone and denies having any hobbies because they are a "waste of time." Which of the following best explains this patient's behavior?

Question

A 19-year-old man comes to the university health center after being referred by his professor.  The patient says his professor "got annoyed" after he requested several extensions for his first writing assignment.  He says, "I've gone through multiple rough drafts, but I need to make sure I submit something great.  I don't want my name on just anything."  The patient repeatedly mentions that he was valedictorian of his high school class because he was "the most diligent and dedicated student."  He developed his own method of test preparation, which includes spending a few hours every morning planning out his daily study schedule.  The patient studies alone in the library every evening after classes and on the weekends.  He was invited to join a study group but declined because the other students refused to adopt his approach.  The patient lives alone and denies having any hobbies because they are a "waste of time."  Which of the following best explains this patient's behavior?

Quizplus · Accepted Answer

This patient's rigidity and perfectionism are characteristic of obsessive-compulsive personality disorder (OCPD). Individuals with OCPD are preoccupied with orderliness, details, scheduling, and rigid rules. Their perfectionism often interferes with efficiency and task completion, such as this patient's inability to finalize his paper due to his overly rigid standards. His reluctance to work with others unless they agree to his way of doing things is also characteristic. Other features of OCPD include stubbornness, excessive devotion to work, inability to delegate tasks, and a miserly spending style. Although this patient's OCPD traits might have helped him do well in high school, the increased demands and pace of college work have amplified his difficulties and now impair his functioning. As with other personality disorders, he has limited insight into the problematic nature of his behavior (eg, he believes that his study approach is superior). (Choice A) An adjustment disorder is characterized by emotional and/or behavioral disturbances in response to a stressor. It is not diagnosed when the symptoms are attributable to a preexisting disorder, such as OCPD in this patient. (Choice B) Individuals with narcissistic personality disorder may also be preoccupied with perfection and believe that others cannot do things as well as they can. However, they are motivated by a need for praise and admiration, whereas those with OCPD are driven by the need for orderliness and control. (Choice C) Obsessive-compulsive disorder (OCD) is marked by obsessions (ie, intrusive thoughts, images, or urges) that cause anxiety and result in compulsive, ritualistic behaviors performed to decrease them (eg, handwashing, counting, checking). Individuals with OCD typically experience their symptoms as intrusive and distressing. This patient, however, has a pervasive need for control and perfection rather than specific obsessions or compulsions. He is not distressed by his behavior, which he believes makes him a superior student. (Choice E) Schizoid personality disorder involves a lifelong pattern of detachment from social relationships and a restricted range of emotions. This patient's social isolation is better explained by his excessive devotion to work and insistence on doing things his way, rather than a fundamental lack of desire for relationships. Educational objective: Obsessive-compulsive personality disorder involves a pervasive pattern of preoccupation with orderliness, rigid rules, perfectionism, and control. It is differentiated from obsessive-compulsive disorder by the lack of clear obsessions and compulsions. References: Obsessive-compulsive personality disorder: a current review. (http://www.ncbi.nlm.nih.gov/pubmed/25617042)

A 19-Year-Old Man Comes to the University Health Center After