Case Study
Patient Demographic: Client Age: 38 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual Presenting Problem: Marital Difficulties Diagnosis: Obsessive-Compulsive Personality Disorder 301.4 (F 60.5)
Mental Status Exam: Mental Status Exam: The client is meticulously dressed and immaculately groomed. He frequently checks his watch and states he has owned his watch since adolescence and it “still works like new.” His speech is even, and his affect is blunted. At times, he is defensive and attempts to talk over you. He exhibits poor insight into his marital problems and is excessively preoccupied with perfectionism, structure, and order. Fam
Presenting Problem: You are a counselor working in private practice and meeting your client for the first time today. The client is here at his wife’s insistence, who has threatened divorce if he does not seek and comply with therapy. The client explains that he is swamped at work and has already lost an hour of productivity traveling to your office. He discloses that he has been married just over four years and has a daughter who is 3½. The couple dated briefly and married when the client’s wife discovered she was pregnant. The client believes that if he didn’t leave his wife a schedule and checklist, “things would never get done.” He states that they would be in “so much debt” if it weren’t for his detailed household budget. In his estimation, conflict occurs each time his wife tried to do things “her way” because “it is never the right way.” You paraphrase and clarify the client’s concerns.
Other Contexts:    ily and Work History: The client works as a web designer and developer. He allows you to obtain collateral information from his wife. You reach his wife by phone, who explains that the client has “an explosive temper when I don’t do things exactly how he asks.” The client’s wife states he can be controlling, overly critical, and irrational at times\. This is the client’s first marriage\. The client’s wife wants to participate in couples counseling but says the client is adamant about her not joining

Question: Which diagnostic feature of OCPD tends to cause difficulties with close relationships?
(A): They must constantly adjust their expectations when perfectionistic standards are not met.
(B): They are oblivious to the fact that others are annoyed by their inflexibility and perfectionism.
(C): They possess ego-dystonic personality traits that are pervasive and less amenable to change.
(D): They disregard family activities and believe leisure time should be an individual pursuit.

Correct Answer: They are oblivious to the fact that others are annoyed by their inflexibility and perfectionism.
Explanation: According to the DSM-5-TR features include a preoccupation with rules and details, perfectionism that interferes with progress, excessive devotion to work, counterproductive rigidity about beliefs and morality, an inability to throw away old objects, reluctance to delegate authority to others, rigidity or stubbornness, and hoarding money without spending. Individuals with OCPD possess ego-syntonic traits rather than ego-dystonic traits. Individuals with ego-syntonic features are less amenable to change because there is little to no desire to change. Conversely, individuals with obsessive-compulsive disorder (OCD) have ego-dystonic traits, meaning they experience dissatisfaction with symptoms and desire change. Per the DSM-5, individuals with OCPD “are rigidly deferential to authority and rules and insist on quite literal compliance, with no rule bending for extenuating circumstances” Strict adherence to rules and authority persists despite personal distress while attempting to attain perfection. Leisurely activities are generally forfeited by prioritizing productivity and work. Solo vacations and vacations with others may be postponed, and when they do occur, they are highly structured in an effort to not waste time. Therefore, the correct answer is (A)
Competency: intake, assessment, and diagnosis