Case I. Diana Nodirt

Summary of the information about the patient taken from the case study which was used to determine the variants of diagnosis:
 14 years old, female
 She was tardy to school and grades became worse
 Reported feeling stupid and overwhelmed with her life
 Does stupid things, and while realized the absurdness of her actions, believes that something bad will happen if she stops
 Shakes her clothes to get the germs out
 Washes hands with alcohol to get rid of germs
 Everyday activities suffer because of these actions
 Hears words in her head that tell her what she should do with germs
 Denies that she has delusions or hallucinations
Diagnoses to consider
The symptoms that can be clearly outlined from the case are delusions or phobic behavior concerning the fixed idea of germs, and consequent impairment of everyday actions and of interaction with the outer world. According to DSM-IV classification, there can be suggested several diagnoses depending on the details of the disorders and time periods of different manifestation of the disorder.
The first diagnosis related to the fear of germs is 300.29 Specific Phobia. Indeed, Diana experiences persistent and unreasonable fear, she recognizes that her fear is unreasonable, and there is an immediate anxiety response when she is exposed to feared situations. Phobic situations are avoided, and this avoidance together with stress has negative consequences for normal routine of the patient. Since the length of the disorder and the strength of the manifestation are unknown (it is possible to suggest that it lasts at least 6 months), it is reasonable to state that the first diagnosis is the most probable one.
The second suggested variant is 300.7 Hypochondriasis; its symptoms are the preoccupation with fears of having a serious disease, which persists despite of normal medical conditions (American Psychiatric Association 2000). In Diana’s case, her fear of germs might also relate to this category; the belief of the patient should not be of delusional intensity. Since we haven’t information about length of disorder, we can equally suggest delusions and Hypochondriasis; again, the preoccupation with the idea causes significant impairment in everyday activities. In this case, the patient should not recognize that the concern is excessive (American Psychiatric Association 2000). Diana agrees that she does stupid things, but does not agree that she has delusions and that her concern is not linked with reality. Thus, the second diagnosis may also be true.
Finally, one of psychotic disorders, namely delusional disorder may take place. Diana’s visions do not include hallucinations; there were no mood episodes detected or there is no evidence about them. Diana’s case may be classified as 297.1 Delusional Disorder, somatic type. case
Multiaxial diagnoses
Axis I.
300.29 Specific Phobia
Axis II.
301.22 Schizotypal Personality Disorder; indeed, Diana has ideas of reference, odd behavior, social anxiety associated with her fears, unusual perceptual experiences, and shows inappropriate affect.
Axis III.
No general medical conditions influencing mental disorder diagnosed or mentioned.
Axis IV.
No additional data about psychosocial and environmental problems.
Axis V.
I would estimate Diana’s condition as 25, because her ideas or delusions influence her behavior and provide impairment for everyday actions, school etc.
Case II. Tiny Tim.
The information from the case used to suggest diagnoses:
 17 years old, male
 Does not have friends; quit spending time with them because considered them to be too dirty
 Lost 15 pounds
 Extremely concerned about his weight
 Is obsessed with losing weight (though he is growing taller) and cuts back on food if he does not lose weight
 Quit going out for track because he was afraid of dirty room and that someone’s sweat could be on him
 Gets up at least 3 hours before school, weighs 10 times, and follows his detailed plan concerning diet, exercise and hygiene
Diagnoses to consider
In my opinion, the symptoms of Tim’s behavior cannot be described by only one disorder and there are at least two types of disorders combined together. There is one obvious diagnosis: 307.1 Anorexia Nervosa. There are all the described signs of anorexia: refusal to maintain body weight and failure to make expected weight gain during period of growth (American Psychiatric Association 2000), fear of becoming fat (in my opinion, detailed exercise and diet plan is the indicator of this fear), Time denies the seriousness of his underweight state, and is constantly disturbed with the shape of his body. Tim’s disorder may be classified as restricting type since he did not have periods of binge-eating/purging (American Psychiatric Association 2000). However, this diagnosis does not explain Tim’s concerns about dirt, quitting friends due to this fact and quitting going out to track. These symptoms may indicate such diagnosis as 300.29 Specific Phobia: Tim is afraid of dirt and sweat (which can be also classified as dirt). Indeed, he has excessive fear of dirt, shows anxiety response when he is exposed to stimulus, and avoids phobic situations. For this to be a phobia, the duration has to be more than 6 months (American Psychiatric Association 2000). Since there is nothing said about length of the disorder, this diagnosis may be true.
Also, the dirt-related symptoms may indicate at 300.3 Obsessive-Compulsive Disorder. The criteria for this diagnosis also hold: Tim has recurrent thoughts about his weight and about contact with dirt; his obsessions are not just excessive worries, but present real threat to his well-being; Tim neutralizes these thoughts by appropriate actions – detailed plan of losing weight, end of contact with friends. Nothing is mentioned whether Tim realizes the excessiveness and absurdity of his actions; however, he has not reach 18 and this criteria may not work for him. Thus, both types of symptoms may be classified as 300.3 Obsessive-Compulsive Disorder. However, in my opinion, more correct diagnosis is the combination of 307.1 Anorexia Nervosa and 300.29 Specific Phobia.
Multiaxial diagnoses
Axis I.
307.1 Anorexia Nervosa and 300.29 Specific Phobia (phobia of dirt)
Axis II.
No additional informational available to detect Axis II disorder.
Axis III.
No special medical condition has been reported despite weight loss (induced by the disorder itself).
Axis IV.
No additional data about psychosocial and environmental problems.
Axis V.
I would rate Tim as 33 on the Axis V scale since there is a significant impairment in reality testing, he has completely changed his life due to obsessive ideas, quit friends and occupations he preferred, lost weight while growing etc.
Source
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR. American Psychiatric Association