Assignment task: Tony is a shy, anxious-looking, 31 year old carpenter who has been hospitalized after making a 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, Tony says he has no friends, has just been fired from his job, and was recently rejected by his girlfriend. When the psychiatrist asks Tony to elaborate he replies, "It's really hard to talk about this, Doctor. I don't know if I can. It's too embarrassing. Well, I guess I should tell you...after all, I'm in the hospital because of it. It's my nose." "Your nose?" the psychiatrist asks. "Yes, these huge pockmarks on my nose. They're grotesque! I look like a monster. These marks on my nose are all I can think about. I've thought about them every day for the past 15 years. I even have nightmares about them. And I think that everyone can see them and that they laugh at me because of them. That's why I wear this hat all the time. And that's why I couldn't talk to you in a bright room...you'd see how ugly I am." The psychiatrist couldn't see the huge pockmarks that Tony was referring to, even when she later met him in a brightly like room. Tony is, in fact, a handsome man with normal-appearing facial pores. The psychiatrist says, "I see no ugly pockmarks. Is it possible that your view of your appearance is distorted, that maybe the pockmarks are just normal looking facial pores?" "That's a hard question to answer," Tony replies. "I've pretty kept this preoccupation a secret because it's so embarrassing. I'm afraid people will think I'm vain. But I've told a few people about it, and they've tried to convince me that the pores really aren't visible. Sometimes I sort of believe them. I think I probably am distorting and that they're not so bad. Then I look in the mirror and see that they're huge and ugly, and I'm 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 they're trying to make me feel better. This has affected me in a lot of ways, Doctor," Tony adds. "It may be hard for you to believe, but this problem has ruined my life. All I can think of is my face. I spend hours a day looking at the marks in the mirror. I just can't 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 wouldn't have to sit at the light where people might be staring at me. The hat helped a little, but it didn't cover all the marks. I tried covering them with makeup for a while, but I thought people could see the makeup so that didn't really help. The only time I really felt comfortable was when I wore my nephew's Batman mask on Halloween. Then no one could see the marks. I missed so much work that I was fired. My girlfriend stuck it with me for a long time, but she finally couldn't 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, I'd rather have cancer. It must be less painful." Tony went on to discuss the fact that he had seen a dermatologist to request dermabrasion, but was refused the procedure because "the dermatologist said there was nothing there." 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, "I saw how awful I looked, and I thought, I'm not so sure it's worth it to go on living if I have to look like this and think about this all the time." His first suicide attempt had also led to hospitalization; but, because Tony was so ashamed of his concern and thought it wouldn't be taken seriously, he had kept it a secret and told the staff only that he was depressed.
1. Identify (list) the specific symptoms each patient is exhibiting,
2. Identify when the symptoms onset (began), and what etiology (cause/s) is evident (when applicable).
3. Compare the symptoms you've identified in the case study to the various disorders described in the textbook. Use the DSM-V and/or the text to give a diagnosis for each case study.
4. Explain your choice by defining the disorder (using the DSM-V or the textbook).