Family Constellation: Married, no children

Living Situation: Upscale apartment in the city

History of present illness:

Characteristics of Personality Disorder

The characteristics of a personality disorder are impairments in self and interpersonal functioning and the presence of pathological personality traits. To diagnose a personality disorder, the following criteria must be met:

•Substantial impairments in self (identity or self-direction) and interpersonal (empathy or intimacy) functioning

•One or more pathological personality trait domains or trait features

•These impairments in personality functioning and the individual’s personality traits are relatively stable across time and situation

•These impairments in personality functioning and personality trait expression are not considered normal for the individual’s developmental stage or socio-cultural environment

•These impairments in personality function and trait expression are not due to the physiological effects of a medical condition or substance (APA, 2013).

Patterns of behavior (self-harm, alcohol, drug use, Addiction (shopping, gambling, pornography, video, gaming, etc.):

Shoplifting:

Legal issues:

Interpersonal functioning and relatedness:

Alterations in cognition:

Current and recent stressors:

Current coping skills:

Spirituality and/or religion:

Client and family’s perception of the problem:

–Conflicts at work: There is a higher likelihood that MR’s narcissistic tendencies are to blame for the never-ending conflicts and tensions that he has with his colleagues at work. As a result, his overall performance at work and job satisfaction are in jeopardy.

–Marital problems:  Multiple regions of the brain are responsible for regulating compassion. These regions influence positive emotions such as empathy towards others. Some individuals may have unusual patterns in some brain regions, which affects how they perceive interactions with others. This can result in difficulties with understanding social cues and empathy. For instance, this holds true for individuals who exhibit narcissistic traits and have narcissistic personality disorder (NPD). Neuropsychologist Ronda Freeman states that narcissists exhibit a brain pattern characterized by heightened sensitivity towards themselves and a lack of sensitivity towards others (Day et al., 2024). This elucidates their egocentric isolation towards others, the maltreatment stemming from their narcissistic tendencies, and their acute susceptibility to any perceived harm or disapproval. This provides a thorough explanation for the troubled relationship between MR and his spouse. This could be due to his lack of empathy and his craving for approval, which leads to difficulties in communication and emotional detachment.

Summary: The above complaints are common among individuals with NPD. The unending desire for approval from others is often driven by a sense of emptiness. Conflicts in the workplace occur when people have trouble working together and taking criticism positively. When a spouse exhibits narcissistic traits, such as being emotionally distant and self-absorbed, marital issues are likely to take place (Bird & Caligor, 2024).

Symptoms first emerged in early adulthood: As is common for people with personality disorders, MR’s narcissistic tendencies and associated problems did not manifest until he was in his early twenties. The onset of a personality disorder is often experienced during early adult years although the main causes of it is still unknown (Bird & Caligor, 2024). Nevertheless, factors including genetics and childhood traumas probably contribute.

Leaving multiple jobs due to conflicts:

Individuals suffering from personality disorders barely take criticism positively, even if it is justified. This may lead to lawsuits or even physical altercations. Their inability to accept the possibility that they may be mistaken causes them to become fixated on exacting revenge. Furthermore, they often engage in behaviors that hurt them since they fail to consider the broader implications of their choices for their professional or personal standing in the future. For MR, it’s business as usual, switching jobs every two to three years on average. He often quits jobs because of conflicts with coworkers, which are probably a result of his narcissistic traits.

Second marriage, first ended in divorce:

A person living with personality disorders such as NPD may exhibit intense jealousy due to their insatiable need for attention. Such individuals can also have covert feelings of insecurity, which may intensify a want for excessive admiration (Dimaggio & Valentino, 2023). MR is in his second marriage after dissolution of his first marriage which indicates a persistent trend of challenges in his relationships, possibly stemming from his narcissistic personality disorder (NPD).

Impairments in self-functioning:

-Identity: Overreliance on external sources to establish one’s own identity. MR’s self-esteem has an unrealistic tendency to be excessively high or low and keeps on changing.

-Self-direction: Goal-setting driven by the need for external validation. MR’s standards are too stringent, leading him to see himself as unique.

Impairments in interpersonal functioning:

-Empathy: Diminished capacity to perceive or empathize with the emotions and needs of others. MR is very sensitive to the reactions of others, particularly if they are essential to him.

-Intimacy: Relationships that are designed to help regulate self-esteem tend to be superficial. It’s clear that MR is more concerned with his own interests than with that of others.

Pathological personality traits

-Seeking attention: Attention-seeking conduct involves a deliberate or unintentional effort to attract the attention of others, sometimes to receive validation or appreciation. It might be motivated by feelings of jealousy or isolation (Littlebear et al., 2023).

-Grandiosity: Considering oneself to be better than everybody else.

Self-functioning impairments:

-Identity: Overreliance on others to define oneself and manage one’s self-esteem. Can also encompass emotionally regulating oneself based on others’ reaction.

-Self-direction:

Encompasses setting goals based on gaining approval from others.

MR barely recognizes that his actions contribute to workplace conflicts.

Interpersonal functioning impairments:

-Empathy:

Lack of empathy hinders one’s capacity to understand and meet the needs of others (Weinberg, 2023).

-Intimacy:

Most relationships are shallow and just exist to help people regulate their self-esteem.

A history of broken marriages and several work changes attest to MR’s difficulty in sustaining personal relationships over the long term.

-Entitlement:  Entitlement is portrayed through the belief that others are envious of MR’s achievements and the tendency to downplay his success while attributing blame to others.

-MR seems to have a consistent pattern of behavior throughout all of his workplaces, even though he has left each one because of workplace disputes.

– As seen, MR is in his second marriage after divorcing his first wife, which indicates that he struggles in his relationships with others.

-Social context: His narcissistic conduct is considered abnormal in his community, where individuals are educated and are mainly middle-class.

-Age and occupation: Being a 35 years old individual who works as a marketing executive, MR is an adult whose conduct is not normal for his age and occupation.

-Medication: MR is currently not under any medication

-He occasionally takes over-the-counter drugs

-According to MR’s medical history, he had an appendectomy at age 12, but no major condition is reported.

-Excessively spending on luxury items which can be considered as an addiction to shopping.

-MR is addicted to social media

No issue reported

None Reported

-MR lacks empathy towards others

-MR always wants to be the center of attention

– MR struggles in his relationships with others

-MR constantly fantasizes about being successful and powerful

-Grandiose sense of self-importance

-Marital conflict

-Potential job loss due to workplace conflict

Seeking attention through excessive use of social media

-Spending many hours working

-Constantly criticizing others and, especially co-workers

No religious activities are observed by MR, who identifies as an agnostic.

-Barely trusts others and believes they are jealous of his success

-MR often blames others for his mistakes. Barely takes responsibility for his actions.

Family medical history:

Medications (side effects, adverse side effects, and treatment response) INCLUDE BELIEFS about medications

-MR has never been hospitalized or suffered from any severe illness.

-MR’s father suffered from hypertension, type 2 diabetes

-MR’s mother is a breast cancer survivor

Currently none. MR briefly used antidepressant medication in the past but decided to quit their use, claiming that they were “unnecessary” and that he was capable of managing his condition without medication.

Legal, psychosocial, physical, interpersonal, and occupational consequences.

Smoking history:

Alcohol use:

Marijuana use:

Illicit drugs:

Alcohol:

Type- Social drinking

Duration: Since college

Frequency: Occasionally, sometimes indulging in excessive consumption during work-related events.

Last use: Not specified

No reported cases of blackouts, withdrawal seizures, or drug-related psychosis

Marijuana use: MR does not smoke

Illicit drugs: No reported cases

MR does not smoke

Since his college days, MR has occasionally participated in social drinking, sometimes indulging in excessive consumption during work-related events.

No reported case

There are no reported cases of illicit drug use.

Complementary treatments:

MR has a gym membership, which he rarely uses.

Psychotropic medications, side effects, adverse side effects, and treatment response:

-Psychotropic meds: A brief trial of escitalopram two years ago, MR voluntarily stopped using the meds after just one month.

-Brief use of escitalopram two years ago.

– MR voluntarily stopped using the meds after just one month. They are mainly prescribed for depression and anxiety.

– Although the case study does not mention any negative side effects that MR may have encountered, it is crucial to watch out for any serious allergic reactions when MR begins taking a new psychotropic drug.

-The self-discontinuation of escitalopram by MR shows either ineffectiveness or intolerance to adverse effects. He may have stopped the drug too soon due to negative effects or his dismissive attitude.

Family psychiatric history and/or substance use history:

Sociocultural history (family and social history, work history, current employment, volunteer work, legal history, active and past, current support system, marital status, and children):

Trauma history:

Trauma exposure (childhood abuse or neglect, rape or sexual assault, emotional abuse, domestic violence, military/combat service, and natural disasters, historical/political trauma):

History of head injury, loss of consciousness, seizures:

MR did pay a visit to a therapist two years ago since his wife strongly encouraged him to do so. The patient failed to attend the follow-up session, claiming that the therapist failed to “understand” him.

-MR’s maternal grandmother suffered from depression

-MR’s father was suspected of having narcissistic traits.

-MR comes from an upper-middle-class background

-He is well educated and works as a marketing executive

-He is in his second marriage of 3 years

-Has a history of changing jobs after 2-3 years

-Has few friends

No reported case of significant trauma

No case reported

INCLUDE EVIDENCED- BASED THERAPEUTIC MODALITIES FOR THE IDENTIFIED PERSONALITY DISORDER

(Cluster B Personality Disorder)

Psychodynamic Psychotherapy:

-It is a kind of therapy that examines the relationship between a patient’s previous experiences, generally during childhood, and their present mental state (Day et al., 2024).

– MR should attend individual weekly sessions to increase self-awareness.

Cognitive behavioral therapy:

-Is a type of psychotherapy that aims to modify undesirable behavior patterns or address mood disorders like depression by challenging negative thinking patterns related to oneself and the environment (Littlebear et al., 2023).

-Attending this type of therapy will help MR to address maladaptive thought patterns.

– He will be in a position to develop more realistic self-appraisal.