Can someone read this and tell me what issues this person has in the appropriate AXIS according to DSM IV?
Chris is a shy, anxious-looking, 31-year old carpenter who has been hospitalized after making suicide attempt by putting his head in a plastic bag. He asks to meet with the psychiatrist in a darkened room. He is wearing a baseball cap pulled down over his forehead and partially covering his eyes. Looking down at the floor, Chris says he has no friends, has just been fired from his job, and was recently rejected by his girlfriend. When the psychiatrist asks Chris to elaborate, he replies, âItâs really hard to talk about this, Doctor. I donât know if I can. Itâs too embarrassing. Well, I guess I should tell youâ¦after all, Iâm in the hospital because of it. Itâs my nose.â âYour nose?â the psychiatrist asks. âYes, these huge pockmarks on my nose. Theyâre grotesque! I look like a monster. Iâm as ugly as the Elephant Man! These marks on my nose are all I can think about. Iâve thought about them every day for the past 15 years. I even have nightmares abut them. And I think that everyone can see them and that they laugh at me because of them. Thatâs why I wear this hat all the time. And thatâs why I couldnât talk to you in a bright roomâ¦youâd see how ugly I am.â
The psychiatrist couldnât see the huge pockmarks that Chris was referring to, even when she later met him in a brightly lit room. Chris is, in fact, a handsome man with normal-appearing facial pores. The psychiatrist says, âI see no ugly pockmarks. Is it possible that your view of your appearance is distorted, that may be the pockmarks are just normal-looking facial pores?â âThatâs a hard question to answer,â Chris replies. âIâve pretty much kept this preoccupation a secret because itâs so embarrassing. Iâm afraid people with think Iâm vain. But Iâve told a few people about it, and theyâve tried to convince me that the pores really arenât visible. Sometimes I sort of believe them. I think I probably am distorting and that theyâre not so bad. Then I look in the mirror and see that theyâre huge and ugly, and Iâm convinced that people laugh at them. Then no one can talk me out of it. When people try to, I think they just feel sorry for me and that theyâre trying to make me feel better. This has affected me in a lot of ways, Doctor,â Chris adds. âIt may be hard for you to believe, but this problem has ruined my life. All I can think about is my face. I spend hours a day looking at the marks in the mirror. But I just canât resist. I started missing more and more work, and I stopped going out with my friends and my girlfriend. I got so anxious when people looked at me that I started staying in the house most of the time. Sometimes when I did go out, I went through red lights so I wouldnât have to sit at the light where people might be staring at me. The hat helped a little but it didnât cover all the marks. I tried covering them with makeup for awhile, but I thought people could see the makeup so that didnât really help. The only time I really felt comfortable was when I wore my nephewâs Batman mask on Halloween. Then no one could see the marks. I missed so much work that I was fired. My girlfriend stuck it out with me for a long time, but she finally couldnât take it anymore. One thing that was really hard for her was that I started asking her about 50 times a day whether I looked okay and whether she could see the marks. I think that was the last straw. If I had a choice, Iâd rather have cancer. It must be less painful. This is like an arrow through my heart.â
Chris went on to discuss the fact that he had seen a dermatologist to request a plastic surgery procedure, but was refused the procedure because, âthe dermatologist said there was nothing there.â He finally convinced another dermatologist to do the procedure but thought it did not help. Eventually he felt so desperate over the supposed marks that he made two suicide attempts. His most recent attempt occurred after he looked in the mirror and was horrified by what he saw. He told the psychiatrist, âI saw how awful I looked, and I thought, Iâm not sure itâs worth it to go on living if I have to look like this and think about this all the time.â His first suicide attempt had also led to hospitalization; Chris was so ashamed of his concern and thought it wouldnât be taken seriously, that he kept it secret and told the staff only that he was depressed.
List what you would diagnose for each of the 5 axes and a brief explanation of why:
Can someone read this and tell me what issues this person has in the appropriate AXIS according to DSM IV?
Chris is a shy, anxious-looking, 31-year old carpenter who has been hospitalized after making suicide attempt by putting his head in a plastic bag. He asks to meet with the psychiatrist in a darkened room. He is wearing a baseball cap pulled down over his forehead and partially covering his eyes. Looking down at the floor, Chris says he has no friends, has just been fired from his job, and was recently rejected by his girlfriend. When the psychiatrist asks Chris to elaborate, he replies, âItâs really hard to talk about this, Doctor. I donât know if I can. Itâs too embarrassing. Well, I guess I should tell youâ¦after all, Iâm in the hospital because of it. Itâs my nose.â âYour nose?â the psychiatrist asks. âYes, these huge pockmarks on my nose. Theyâre grotesque! I look like a monster. Iâm as ugly as the Elephant Man! These marks on my nose are all I can think about. Iâve thought about them every day for the past 15 years. I even have nightmares abut them. And I think that everyone can see them and that they laugh at me because of them. Thatâs why I wear this hat all the time. And thatâs why I couldnât talk to you in a bright roomâ¦youâd see how ugly I am.â
The psychiatrist couldnât see the huge pockmarks that Chris was referring to, even when she later met him in a brightly lit room. Chris is, in fact, a handsome man with normal-appearing facial pores. The psychiatrist says, âI see no ugly pockmarks. Is it possible that your view of your appearance is distorted, that may be the pockmarks are just normal-looking facial pores?â âThatâs a hard question to answer,â Chris replies. âIâve pretty much kept this preoccupation a secret because itâs so embarrassing. Iâm afraid people with think Iâm vain. But Iâve told a few people about it, and theyâve tried to convince me that the pores really arenât visible. Sometimes I sort of believe them. I think I probably am distorting and that theyâre not so bad. Then I look in the mirror and see that theyâre huge and ugly, and Iâm convinced that people laugh at them. Then no one can talk me out of it. When people try to, I think they just feel sorry for me and that theyâre trying to make me feel better. This has affected me in a lot of ways, Doctor,â Chris adds. âIt may be hard for you to believe, but this problem has ruined my life. All I can think about is my face. I spend hours a day looking at the marks in the mirror. But I just canât resist. I started missing more and more work, and I stopped going out with my friends and my girlfriend. I got so anxious when people looked at me that I started staying in the house most of the time. Sometimes when I did go out, I went through red lights so I wouldnât have to sit at the light where people might be staring at me. The hat helped a little but it didnât cover all the marks. I tried covering them with makeup for awhile, but I thought people could see the makeup so that didnât really help. The only time I really felt comfortable was when I wore my nephewâs Batman mask on Halloween. Then no one could see the marks. I missed so much work that I was fired. My girlfriend stuck it out with me for a long time, but she finally couldnât take it anymore. One thing that was really hard for her was that I started asking her about 50 times a day whether I looked okay and whether she could see the marks. I think that was the last straw. If I had a choice, Iâd rather have cancer. It must be less painful. This is like an arrow through my heart.â
Chris went on to discuss the fact that he had seen a dermatologist to request a plastic surgery procedure, but was refused the procedure because, âthe dermatologist said there was nothing there.â He finally convinced another dermatologist to do the procedure but thought it did not help. Eventually he felt so desperate over the supposed marks that he made two suicide attempts. His most recent attempt occurred after he looked in the mirror and was horrified by what he saw. He told the psychiatrist, âI saw how awful I looked, and I thought, Iâm not sure itâs worth it to go on living if I have to look like this and think about this all the time.â His first suicide attempt had also led to hospitalization; Chris was so ashamed of his concern and thought it wouldnât be taken seriously, that he kept it secret and told the staff only that he was depressed.
List what you would diagnose for each of the 5 axes and a brief explanation of why:
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