Rocky Mowntin was born and raised in New Fountain, Idaho. His father, who died w

Question

Rocky Mowntin was born and raised in New Fountain, Idaho. His father, who died when Rocky was 6-years-old, was a custodian at a local grocery store. His mother worked out of their home. Neither parent graduated from high school and subsequently gave birth to Rocky when they were just 16 years old Rocky is now 49-years-old and has been working for United Parcel Services for the past 25 years. He reports that he finds his job to be enjoyable as he interacts with others. Rocky was a single child and notes that he was the center of attention while growing up. He reports that that he felt much love from his parents despite their odd behaviors. Rocky notes, "They were very similar to me." He then makes reference to his great aunt, grandfather and cousin who were all institutionalized at some point in their lives. This middle aged man has remained unmarried his entire life. Rocky makes reference to the fact that he enjoys being around girls but follows by stating that he was never able to develop a long term relationship. He further points out that he has felt anxiety when around girls and has chosen to avoid making any social contacts with them. Rocky reports that he also redirected any sexual energies into regularly scheduled workouts. Each morning, he will go for a walk often lasting several hours. Then, he will come home and do 100 sit-ups, followed by 50 push-ups, followed by 20 minutes of running in place. Rocky is involved in several activities that are offered through his community but chooses to stay to himself while in attendance During the past year, Rocky has worked at a dairy farm where coworkers have noticed a gradual decline in his behavior. While he always seemed a bit odd, during the past year, his social countenance has seemed inappropriate. He often smiles when he is agitated, and occasionally seems irritated when everyone else is chuckling. A colleague wonders if Rocky has been taking drugs - a point that Rocky has strongly denied. Although his colleaques have noted a marked deterioration in his functioning, one

Explanation / Answer

1. Based on the case, we can diagnose rocky with the following two :
(a) Delusional Disorder
(b) Avoidant personality disorder

2. Observarions from the case : Rocky has to be diagnosed with the following due to the following ovservations from the case:

(a) Delusional disorder :Somatic type : A person with this type of delusional disorder believes that he or she has a physical defect or medical problem. As in case with rocky, he believed that he had a disease in his stomach even thoigh his physisian rules it out.

observation:
When rocky handed over the parcel to the individual on the street and said “This is a gift from god---please keep it for eternity”

Second observation : When rocky believes that he has been suffering from gangrene of stomach , even though his physist ruled out the case.

The patient , Rocky, expresses an idea or belief with unusual persistence or force, even when evidence suggests the contradictory in our second observation.
That idea appears to have an undue influence on the patient's life, and the way of life is often altered to an inexplicable extent , his strong beliefs that some ‘bad’ guys may call him or his recurrent checking of the locks in his house.

Despite his profound conviction, there is often a quality of secretiveness or suspicion when the patient is questioned about it.

Symptoms of Delusional Disorder:

The presence of non-bizarre delusions is the obvious symptom of this disorder. Other symptoms that mighty appear include:

An irritable, angry, or low mood
There are various causes of this disorder:

Genetic:

delusional disorder is more common in people who have family members with delusional disorder or schizophrenia, a tendency to develop delusional disorder can be passed on from parents to their children.

Environmental/psychological:

Evidence suggests that delusional disorder can be triggered by stress.

. People who tend to be isolated, such as immigrants or those with poor sight and hearing, appear to be more vulnerable to developing delusional disorder. In our case rocky tend to be isolated mostly due to his avoidant personality disorder . people with this disorder can eventually become alienated from others, especially.
Research suggest that people develop delusions as a way to manage extreme stress or deal with a history of trauma.

Genetics may also contribute to the development of a delusional disorder. These people are more likely to be diagnosed with delusional disorder especially if they have family members with schizophrenia or schizotypal personality disorder etc. In our case, rockys parents and relatives had a history of being institutioned.

(b) Avoidant personality disorder : Rocky can be diagnosed with this disorder due to the following :
Avoidant personality disorder (APD) first noticed in early adulthood and tends to be present in a variety of situations.

People with APD have many of the same characteristics as those with social anxiety disorder (SAD); however, the severity of the symptoms is greater.

Rocky tends to have low self-esteem, strong feelings of inadequacy and a sensitivity to rejection.

People with APD have many of the same characteristics as those with social anxiety disorder (SAD); however, the severity of the symptoms is greater.

In new social settings, Rocky will become extremely self-conscious, shy or inhibited and will be preoccupied with being criticized or rejected.

He tends view himself as socially inept, personally unappealing or inferior to others.
In interpersonal relationships, he will show restraint.
He will not tend to trust others and he avoids relationships. Often, people with APD become socially isolated as a result of this avoidance.

Avoidant personality disorder tends to interfere with occupational functioning. People with the disorder avoid work . The work that requires interpersonal contact and are also reluctant to take risks or engage in new activities. people who have been diagnosed with personality disorders are diagnosed when there is impairment in personality functioning (self and interpersonal), and the impairment is quiet stable across time and situations.

People with APD display relationship detachment can be characterized by the following:

# withdrawal (being reticent in social situations, avoiding social contact,

#Failing to initiate social contact),

# avoidance of intimacy (avoidance of close or romantic relationships,

# interpersonal attachment, or intimate sexual relations),
and anhedonia (lack of enjoyment or failure to engage in life's experiences; trouble experiencing pleasure or taking an interest in things).

From rockys case we have observed that he has anxiety when girls are around him and he avoids being into relationships, and has failed to have a long term relationship. But he sublimates his sexual energy through exercising and has avoided marriage. He is quiet isolated at workplace and his co-wprkers have also noticed a pattern of behavior where he tends to get lonely and on his own. And doesnt indulge in social activities.
Inorder to avoid the relationships and marriage he tends to adopt such a life style of staying lonely and this has inturn affected his comorbidity with delusional disorder.

4.(a) OCD (obsessive compulsive disorder)

A diagnosis that would be fit for rocky would be anxiety disorder for the following reasons :

His habit of rechecking the locks on the door for the fear of burglars, However some evidence withing this case suggests that he was able to live normally without these either of the compulsions deterioting his quality of life. And his symptoms didnt persist for diagnosing OCD
Eventhough he has been having thoughts about the locking of the locks, he has no episodes of being obsessed with the acts of doing so which affects his quality of life.

OCD can characterized by repeated behaviors which tend to be sparked by anxious feelings or obsessions . These may include contamination by dirt or germs, imagined harm to loved ones, runaway sexual urges, and devastating moral guilt.

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