Personality disorder and DSM (IV)

The case of Tiffany is a psychiatric disorder and, in particular, a personality disorder from the knowledge given. DSM (IV) describes personality disorders as lasting patterns of inner actions and experience with others. If it meets the following criteria, a disorder is said to be a personality disorder: change in one's interaction with others, change in one's thinking, incapacity to regulate desires and emotions, and prolonged periods of intense feelings. Apart from most personality disorders, they typically occur throughout adulthood. Tiffany is 28 years old in our case study (In her early adulthood). No information is given about her childhood; hence this rules out there case being a childhood disorder. The fact that Tiffany leads a pretty decent life; with the exception being in particular instances where she becomes self-critical of herself due to her inability to meet her goals and expectations solidifies the claim that Tiffany is a victim of a personality disorder
The preliminary step in most psychological diagnosis is usually interviewing the patient. However, in Tiffany’s case, much information about her has been provided in the text. Her mental disturbance has been attributed to her inability to meet her previous high standards. Therefore, this rules out the suggestion that her disorder might have been caused by either substances abuse or bereavement. Consequently, I would subject her to a psychological testing. Psychological testing helps in the identification of personality disorders. The personal inventory, which is one of the methods of psychological testing, takes the form of yes or no answers; the answers obtained are then compared with those obtained from other patients of mental distortions (Baer, 2015). An example of such a test is the Millon Clinical Multiaxial Inventory (MCMI).Besides instead of administering one-word tests to her; I would subject her to a projective test. One example of a test I would administer to her is the Thematic Apperception Test (TAT). This would entail showing pictures to her and ask her to identify the themes of the images. This would help in discerning her condition.
From the information provided, Tiffany seems to be suffering from Borderline personality disorder. According to criteria set in DSM 5, a patient is said to exhibit BPD if she displays the following: excessive self-criticism, states of disassociation due to stress, change in self-direction, and emotional outbursts (Baer, 2015). First from the text, we read that Tiffany is often self-critical about herself when she is unable to meet her goals. In addition, she is portrayed as an outgoing and a friendly person, however, when stressed she tends to be reserved and withdrawn. Evidently, this is a case of mood swings. Again, her interpersonal relationships are impaired; unlike before she seems not to confide in her husband (“American Psychiatric Association” 2013). For instance, when her husband wants to know what her problem she does not inform him. Besides her sex, life is also affected by her emotional state. Again, she exhibits negativity effects in her pathological personality realm. In fact, we read, although she has never thought about suicide, she wishes she would have died earlier.DSM 5 in trying to identify personality disorders sets out three criteria that have to be met before a disorder is correctly identified and classified (Baer, 2015). These are changes in personal pathological traits, changes in interpersonal functioning and changes in individual functioning. As earlier mentioned Tiffany suffers from borderline personality disorder because she exhibits the emotional changes stipulated in the DSM 5 list.
The most effective method for managing BPD is through the use of psychotherapy. In particular dialectical behavior therapy (DBT) formulated by Marsha Linehan (Fusar-Poli et al., 2016). The DBT therapy has modules that help in cognitive restructuring, self-awareness, regulation of one’s emotion and stress tolerance. The cognitive restructuring would help her become more aware of events that happen around her (Fusar-Poli et al., 2017). This would ensure she can react to these events appropriately. The emotional regulation and stress management therapies would help her in teaching how to manage the instances of excessive self-criticism. Also, these would also assist in managing the thoughts that she would be better off if she had died. These if not controlled can escalate to suicidal thoughts.
Since Tiffany does not exhibit suicidal thoughts, I would not recommend medication for her case. Philip Long notes that during short periods of reactive psychoses, anti-psychotic drugs are needful; however, they are not important in the long run (2016). This is because their effects are only felt for short durations only. Besides, in the case of Tiffany, we note she has not had suicidal thoughts. In fact, it is mentioned she has never contemplated suicide. Evidently, her case is a minor one, which can be managed by the DBT therapy

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.
Baer, R. A. (Ed.). (2015). Mindfulness-based treatment approaches: Clinician's guide to evidence base and applications. Academic Press.
Fusar-Poli, P., Cappucciati, M., Bonoldi, I., Hui, L., Rutigliano, G., & Stahl, D. et al. (2016). Prognosis of Brief Psychotic Episodes. Retrieved 8 December 2017, from
Volkow, N. D., Gur, R. C., Wang, G. J., Fowler, J. S., Moberg, P. J., Ding, Y. S., ... & Logan, J. (1998). Association between decline in brain dopamine activity with age and cognitive and motor impairment in healthy individuals. American Journal of psychiatry, 155(3), 344-349.

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