This is the question:
Based on the information provided, how would you diagnose the patient using the DSM-IV-TR?
Axis I
Axis II
Axis III
Axis IV
Axis V
The is the case study:
Kevin is a 19-year-old white male who, until admission, was working in a mailroom and planning to apply to college. The onset of his illness is not clear. According to him, he has not been "the same" since his mother died of a cerebral hemorrhage 9 months before his admission. According to his father, however, he exhibited a normal mourning response to his mother's death and changed only 3 months earlier.
At that time, shortly after his girlfriend had rejected him for another man, he began to think that male co-workers were mak-ing homosexual advances toward him. He began to fear that he was homosexual and that his friends believed he was homosexual. He finally developed the conviction that he had a disorder of the reproductive system, that he had one normal testicle that produced sperm and that his other testicle was actually an ovary that produced eggs. He thought that this was evidence that a "woman's body resides inside my man's body." He began to gamble, and was convinced that he had won $400,000 and was not paid by his bookie and that he was sought after by talk show hosts to be a guest on their shows and tell his unusual story (all not true). He claimed that he had a heightened awareness, an "extra sense," and that sounds were unusually loud. He had difficulty sleeping at night, but no appetite disturbance.
On admission, Kevin's speech was somewhat rapid, and he jumped from topic to topic. His affect was neither irritable, euphoric, nor expansive. He said he was now seeking treatment because "there is a war between my testicles, and I prefer to be male.
When he was 10, his pediatrician became concerned that he had an undersized penis. This led to a complete endocrine workup and examinations of his genitals every 4 months for the next 4 years. At that time it was concluded that there were no significant abnormalities.
During high school Kevin had been a poor student with poor attendance. He claims always to have had many friends. He has never received psychiatric treatment. He admits to occasional marijuana and cocaine use in the past, but denies any use of hallucinogens.
Kevin is the oldest child in a family of six children. His parents met when they were both patients in a psychiatric hospital.