Test your diagnostic skills with this video. We’ll review the details of the case of Jules before you determine what you think the diagnosis will be. At the end, we’ll review the diagnosis for Jules.
The patient, Julian “Jules” Vane, is a 31-year-old male who presented to an outpatient clinic for a psychological evaluation. The evaluation was initiated following recent legal involvement. Jules arrived five minutes late to the appointment. He was dressed in high-end attire, which he reported was a gift from a business associate. Although, he stated later in the interview that he is currently unemployed. During the interview, he exhibited distinct compulsive behaviors, interrupting his narrative to manually arrange items on the clinician’s desk into a rigid, parallel alignment. He stated that this behavior mirrors a nightly ritual wherein his footwear must be perfectly aligned before he can sleep.
The clinician inquired about a variety of common mental symptoms, but this was largely unremarkable. Jules did report his compulsive behaviors at night, as well as difficulty sleeping. He noted that his sleep troubles were often the result of online gambling that he engaged in prior to bed, which he said is often exciting and can make it difficult to sleep after. He reports some elevation in anxiety at times, but struggled to identify any specific triggers for his anxiety symptoms. Jules reported having previously been diagnosed with ADHD in childhood, and continued to endorse symptoms consistent with this, such as difficulty sustaining attention, hyperactivity, impulsivity, often being late, making careless mistakes, and being forgetful.
When asked about his childhood, Jules commented that he was a troublemaker. He said that he was never in legal trouble until now, but was often scolded at home and in school because of his behaviors. He said that he would bully others, steal, and even started fires for the fun of it. He said he was a loner in school and was not liked by many other kids, but didn’t seem bothered by this. He notes that he continues to not have many friends. When asked what prevents him from having more friendships, he says that he doesn’t really desire much connection with others. He states that people often call him cold and uncaring, and that they tend to drift away out of his life. Jules was asked to share a story of a time a friend drifted away. To this he said that he had borrowed money for a friend, but they accused him of stealing it. With prompting, he elaborated that the friend had money sitting on their kitchen table, and Jules had taken the money with the intent to return it. He said was in a financial pinch and the friend just had the money sitting there like it was nothing, so they obviously didn’t need it too bad. He said he didn’t see any harm in borrowing the money because of that. He states that the friend became upset when they realized what occurred, and didn’t really talk to him after this. The clinician reiterated to Jules that he had said he had not previously been in legal trouble, and asked if he had committed crimes that he was not charged with. Jules then smirked and stated that laws are open to interpretation, but that he has maybe done a couple of things that could have got him in trouble.
The clinician asked Jules about his work history. He again says that he’s unemployed and that he has been for awhile. He goes on to explain that he doesn’t really see the point in working. When asked to expand on that, he says that there are always people that will help you out or forgive a debt, you just have to say the right thing. The clinician again asks for him to say more about what he means. Jules states that if you give people a sob story, it’s not too hard to find a person, a church, or some program that will help you pay for things. He remarks that it’s amazing how many people will give you money if you tell them you have cancer. When asked if he has cancer, he says that he doesn’t, unless he has a bill or two that needs to be paid. Jules states that he has been evicted once or twice, and that he did buy a house once when he was in his early twenties that he had taken away because he filed for bankruptcy.
Jules is asked about his family. He states that his family lives in another state and that he doesn’t really talk to them. He was asked what prompted him to move away from his family. To this, he says that he may have had a little legal charge in a different state, and that he couldn’t be bothered by going to court for something so dumb, so he decided to move away instead. He did not expand on what the charge was, instead he just said that it was so minor, he can’t believe it would even be a law.
During the session, Jules presented to session well-groomed in formal attire. He physical appearance presented as consistent with his chronological age. His behavior toward staff presented as cooperative. However, he contradicted himself and appeared to be dishonest in some of his responses. He appeared relaxed and calm, and had a demeanor that was even charming at times. He did not seem to struggle with maintaining his attention or being overly active, but he did say that he had taken his ADHD medication prior to the session. His mood was reported as being euthymic, and his affect was overall consistent with this. That said, there were brief moments during the interview that Jules appeared more irritated.
Based on what Jules reports, he meets criteria for a diagnosis of Antisocial Personality Disorder. Check out this diagnosis in your DSM to learn more about this diagnosis, or watch my video on the diagnosis.
Note: This case presentation is for entertainment and educational purposes. Any resemblance that this case has to a real situation is purely coincidence.
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