Question

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, “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. I’m as ugly as the Elephant Man! 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 abut 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 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, “I 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?” “That’s a hard question to answer,” Chris replies. “I’ve pretty much kept this preoccupation a secret because it’s so embarrassing. I’m afraid people with 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,” Chris adds. “It 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 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 awhile, 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 out 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. This is like an arrow through my heart.”

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, “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 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; Chris was so ashamed of his concern and thought it wouldn’t 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:

Answer 1

According to DSM IV, there are five dimensions or axis for assessing a patient's mental condition. They are as follows:

1. Clinical Diagnostic Disorders: He has depression, anxiety and Schizophrenia. He exhibits abnormal social behavior with false beliefs about his marks, unclear, deep thinker, reduced social engagement and lack of motivation. He is not happy with his present condition thats why tried to commit suicide. Disorganized thinking and speech, over concerned about his marks,
2. Personality Disorders & Mental retardation: He is asking same question whether I am looking good?" 50 times a day to his girlfriend. He keeps on staring the mirror for marks. And goes for all possible solutions like plastic surgery. He thinks himself as ugly like a moster or Elephant man. Tries to cover his face and hide his supposed marks.
3. General medical condition or Physical conditions: He is healthy with no physical illness.
4. Psycho-social or Environmental Factors contributing to the disorder: His girlfriend left him, he lost his job,has no friends. His loneliness gives him lot of time to think alone for hours with no professional business to mind. He stays at home most of the time.
5. Assessment Level of Fuctioning: It falls in category 31-40 because he has some impairment in reality testing. Impairment in thinking, mood and judgement.