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

(A): It originates from future-oriented feelings of hopelessness and pessimism.
(B): It manifests in deceitfulness and impulsivity.
(C): It is marked by an inefficient persistence at tasks.
(D): It is characterized by separation and insecurity.

Correct Answer: It is marked by an inefficient persistence at tasks.
Explanation: In Section III of the DSM-5-TR, a trait-specific approach to personality disorders is discussed. In the Alternative DSM-5 Model for Personality Disorders, characteristics of pathological personality traits are presented, along with impairments in functioning. Pathological personality traits are grouped into five domains: negative affectivity, detachment, antagonism, disinhibition, and psychoticism. Negative affectivity is defined as “frequent and intense experiences of high levels of a wide range of negative emotions (eg, anxiety, depression, guilt/ shame, worry, and their behavioral (eg, self-harm) and interpersonal (eg, dependency) manifestations” (APA, 2022). The negative affectivity of OCPD is perseveration. The DSM-5-TR defines this as “persistence at tasks long after the behavior has ceased to be functional or effective; continuance of the same behavior despite repeated failures” Deceitfulness and impulsivity, an aspect of negative affectivity, is associated with narcissistic personality disorder. Pessimism and hopelessness characterize the negative affectivity of anxiousness, which is associated with avoidant personality disorder. Lastly, separation and insecurity are aspects of the negative affectivity domain for borderline personality disorder. Therefore, the correct answer is (C)
Competency: intake, assessment, and diagnosis