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Vignette of Annie

 

Annie is a 47-year-old Chinese-American woman who has come to therapy because of difficulties she is having with her husband. Since her last child left home for college, Annie has felt increasingly lonely and has been asking her husband to spend more and more time with her. His response has been to become angry and critical, saying her expectations are unreasonable and that she needs to find other ways to fill up her time.

For over two years, Annie has felt sad most of the day. She has low energy, poor concentration, and often feels a sense of hopelessness. Annie is in good health and does not use alcohol or drugs. She has not felt this "low" before in her life.

Annie does admit that she has always felt a lack of confidence in herself, even as a child, and has relied on friends and family to provide guidance and direction. She remembers a reluctance, dating back to elementary school. to disagree or express a different opinion for fear of losing friends. She has looked to her son and husband to make all of the important decisions in the family, and has counted on her two daughters for continual reassurance.

Annie hates to be by herself and cannot imagine being able to face life on her own. She is terrified that her husband may leave her and has been clinging more to her friends, calling them frequently and asking them for advice. Lately her friends have been less available for her however, and suggested that she should really be talking to a therapist about these things. This has made Annie feel even more frightened and unhappy.

Based on the information presented, address the following questions:

  1. What diagnosis would you give this client? Provide the rationale for your choices, linking the client's symptoms to specific  DSM-5 criteria.
  2. How might age, gender, ethnicity, and relationship dynamics contribute to the symptoms and issues this client is presenting?
  3. How is neurocognitive functioning impacted by a personality disorder? How might a personality disorder be exacerbated by neurocognitive problems?
  4. What factors would you need to consider when developing a treatment plan for this client?
  5. How would a personality disorder diagnosis impact the client-counselor relationship, goals of therapy, and interventions you might choose?

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