Name: Penny

Name: Penny

Age: 53

Sex: Female

Family: Single

Occupation: Self-employed, carpentry

Presenting problem: Sister’s concern

Penny has lived a relatively isolated existence since she graduated from high school and moved out of her parents’ home. Prior to that time, she didn’t fit in with her family very well. Her brothers and sisters are all friendly and outgoing, while Penny prefers to be alone. These days, she barely maintains contact with her family. The only person she regularly talks with is her younger sister, Karen. Penny reports that the only reason she sought out a clinician was because she promised Karen that she would. Her family is distraught and angry over Penny’s reaction to the news of their father’s recent passing. When told about it, Penny flatly responded, “Well, everyone dies at some point.”

Penny reports that she doesn’t hate, or even dislike, her family. At the same time, it’s clear that she doesn’t feel any particular affinity for them, either. If it weren’t for her sister’s ongoing efforts to keep in touch, Penny would probably not be in contact with her family at all. This emotional indifference and distance extend to other parts of Penny’s life as well. She has a couple of acquaintances, but overall, seems rather disinterested in maintaining relationships with others. When people try to engage her in conversation, she can come across as cold or aloof, even though she’s never intentionally rude.

Penny has a steady job as a carpenter. She works by herself, and most of her business is generated through recommendations from former customers. Most of her online reviews are very similar, such as one which reads: “We needed some custom shelves built, and while Penny did great, high-quality work, she wasn’t very personable. She basically kept her nose to the grindstone and seemed kind of annoyed when we tried to talk to her. On the plus side, she finished the job earlier than expected! Would definitely recommend if you want someone to just come in and get it done right.” When asked about these reviews, she bluntly stated that it didn’t matter to her one way or another. She said that she always delivers exactly what the contract states, and if her clients don’t like it, it’s their problem. Her work ethic is very strong, and she rarely takes any time off. When asked why, she claims that she likes to stay busy and doesn’t have many interests outside of work.

On the whole, Penny is not very introspective, and her attitude is grounded in practicality and matter-of-factness. She shows no interest in pursuing romantic or sexual relationships. In fact, such things seem almost foreign to her. According to her sister, Penny is “cordial” toward her neighbors. She says that Penny does her thing, and they do theirs. Nevertheless, her bluntness can rub some people the wrong way.

1. Personality disorders often affect a patient’s behavior, interpersonal relations, thoughts, and emotions. Which of the following best describes Penny’s emotional state?

a. She is overtly expressive and clingy with others.
b. She is profoundly negative and has difficulty feeling good about anything.
c. Her emotional state is highly unstable and unpredictable.
d. Her emotions are flat and borders on being nonexistent.
2. Diagnostic criteria checklist

Some of the symptoms associated with various personality disorders are summarized as follows. Indicate which symptom is clearly present in Penny’s case.

a. Is exhibitionistic and impulsive in her social interactions and relationships
b. Fails or refuses to conform to social norms of lawful compliance
c. Avoids social interactions due to perceived sense of inadequacy
d. Shows no desire to form or maintain close interpersonal relationships
3. Potential diagnosis

Based on the full diagnostic criteria listed by the DSM-5 for personality disorders (not just the symptoms highlighted in the previous question), Penny appears to experience symptoms most consistent with a diagnosis of which of the following?

a. antisocial personality disorder
b. schizoid personality disorder
c. paranoid personality disorder
d. avoidant personality disorder
4. Potential treatment

Based on Penny’s symptoms, which of the following would be the most effective approach for her therapist to take?

a. Engage in role-playing focused on building social relationships.
b. Train her to be more assertive in social situations.
c. Challenge her to confront her fears of social relationships.
d. Explore her history of social standoffishness, possibly dating back to childhood.