American Psychological Challenged Person Case Study

Case Study & Psychological Assessment

Kapiolani Browne

Southern New Hampshire University

PSY 215: Abnormal Psychology

Instructor: Jenny Chang

29 May 2016

Case Study & Psychological Assessment

        Many individuals suffer from a mental health issue or even a personality disorder. Patrick Bateman is one of those individuals. Bateman is a 27-year-old Caucasian male who works on Wall Street at Pierce & Pierce in Mergers and Acquisitions. Suffering from multiple disorders, his treatment must be carefully assessed to get the best results for the client.

Case Study

        Bateman seems to have a unique challenge to the psychology field. He shows signs of suffering from multiple disorders such as; Narcissistic Personality Disorder, Psychopathy, Obsessive Compulsive Personality Disorder, Antisocial Personality Disorder and Schizophrenia, to name a few. Bateman meets the Diagnostic & Statistical Manual -5, or DSM-5, criteria for most of the disorders listed above, though since he shows signs of Schizophrenia, Antisocial Personality Disorder is canceled out by DSM-5 301.7/F60.2 Criterion D.

        Graduated from Harvard and living in New York City and engaged to a woman named Evelyn, Bateman seems to have a good solid playing field over most people. Working in Mergers & Acquisitions for Pierce & Pierce on Wall Street he makes millions of dollars. This alone puts him above most people in the world. Bateman engages in no volunteer work in his community as he chooses not to associate with those of “lower standards” to him except for when he needs something from them, such as his indulgence in cocaine outside of work with some of his co-workers. This is where his Narcissistic Personality Disorder comes into play.

        Drawing more attention to his more severe condition, Schizophrenia, we can see this causes him the most problems as he shows signs of battling with it throughout the entire day. These problems are his main purpose of him seeking treatment. He presents symptomss of hallucinations. These hallucinations last most of the day and cause him to always show up late to work, meetings, and even personal occasions such as parties. These hallucinations are his biggest battles because he believes he has committed multiple crimes resulting in murders. One that stood out to show another presenting sign is the death of his co-worker by the name of Paul Allen. He believes he killed Allen and dumped his body somewhere. He admitted to this crime to his lawyer who states Allen is still alive and in London on a business trip. Bateman tries to emphasize that that is not true, and he really did murder him. This is considered a Delusion. This is his second sign as he still chooses to believe he killed all those people and cannot believe otherwise.

        His third sign is he cannot show any empathy towards others or “real” emotions. He cares for no-one other than himself, not even his fiancé which in his mind is a fake engagement he puts on for the public. Diagnostic & Statistical Manual -5 Code: 295.90/F20.9 lists this as a negative symptom, more directly as a diminished emotional expression. Most of his emotions are fake for him to “fit in” to normal society so no-one will know of his “second life” outside of work. His own fiancé knows nothing of his condition. There doesn’t seem to be any biological problems, and his social impairments seems to be the lack of attention to his mental state as it seems his condition is worsening as well as the occasional bursts of anger he shows towards others that upset him or makes him feel inferior. As for family, he speaks little of them. They fail to exist in his world so gaining information about his family to see if there is a family history of any of these symptoms will prove to be difficult.

Psychological Assessment

        Due to the client’s many disorders and overlapping symptoms, the symptoms must be separated to diagnose better and treat the client. The client shows a sense of superiority over others. He refuses to associate with people other than high class, as that is how he considers himself. He does not deal well with defeat or criticism. Requiring excessive amounts of admiration, he will find any way to receive it through lying or exaggerating his achievements. Throughout his day, he shows excessive amounts of arrogant behaviors while believing others are envious of him. He falsifies his empathy so he that he can take advantage of those around him. To achieve this, he believes he has an entitlement to whatever he wants and becomes aggravated when it is not given to him. These are signs of Narcissistic Personality Disorder, or NPD, and match the criteria listed in the Diagnostic & Statistical Manual -5, or DSM-5, Code: 301.81/F60.81. His symptoms fall in accordance to criterion 1-9 of the DSM-5 for NPD.

        In addition to NPD symptoms, the client also shows signs of Obsessions and Compulsions. The symptoms of Obsessions that present themselves are anxiety when an individual does an unwanted action. He tries to suppress himself from becoming distressed from these measures, but the attempt is failed and resulted in yelling for the actions to be corrected. The Obsessions symptoms are followed by Compulsion. These symptoms are followed every day at the same time religiously. He starts his mornings by doing sets of crunch exercises with a frozen eye mask. Following the exercises, he uses a deep pore cleansing lotion. He then proceeds to perform his shower session with a gel cleanser, exfoliating body scrub, a gel exfoliating face scrub. Afterward, he uses a herb-mint facial mask and leaves on for 10 minutes while performing the rest of his tasks which is: using an aftershave with little or no alcohol, moisturizer, eye balm, and a protective lotion. All of the tasks listed above is always performed in that exact order, going out of the order causes distress in the client. These symptoms fall in accordance to Obsessions Criteria 1 and 2 as well as Compulsions Criteria 1 and 2 listed in the Diagnostic & Statistical Manual -5 Code: 300.3/F42.

        The client has a sense of control when his Obsession Compulsion Disorder, or OCD, mixes with his NPD. When he commands something to be done a particular way, it provides the client with a sense of power. When not performed he lashes out in anger. This brings in his final set of symptoms. The client suffers from extreme hallucinations throughout the day. All hallucinations are of him committing gruesome murders of the individuals that cause him distress. Following the hallucinations is the delusion. The delusion is that these killings are real. His belief in the other life is active and when told otherwise shows signs of refusal. The client also shows signs of negative symptoms such as diminished emotional expression. He lacks the ability to show empathy or care for others. When he does show any type of expression or attachment it is faked. He uses this as an escape to avoid showing his “real self”.  The symptoms above affect his daily life, more specifically work and the relationship with his fiancé. He is unable to form a real intimate attachment to his fiancé and is always late for work and meetings. The use of Cocaine has been ruled out as a cause as he does not partake in the indulgence often enough to have an effect. These symptoms fall under Criterion A: 1,2, and 5 as well as Criterion B, and E for Schizophrenia. The client meets the requirement to be diagnosed with Schizophrenia under the DSM -5 Code: 295.90/F20.9 because the DSM-5 requires two or more symptoms present themselves.

        Meyer & MacCabe state “The syndrome of Schizophrenia can be divided broadly into positive or negative symptom dimensions. Additionally, a frank onset of illness is often preceded by a sub-clinical prodromal state, characterized by social and occupational withdrawal, loss of interest in activities, change in personality, altered mood and paranoid ideas” (Meyer & MacCabe, 2012). This matches with the DSM-5 criteria for Schizophrenia as stated previously, the client progressively begins to lose interest in work, showing up late every day as well as late to meetings and has no interest in social gatherings. He starts to become paranoid when he believes law enforcement are beginning to catch on to his secret life. Black states that “Antisocial Personality Disorder, or APD, is defined by symptoms including failure to conform to law, inability to sustain consistent employment, manipulation of others for personal gain, deception of others, and failure to develop stable interpersonal relationships” (Black, 2015). Since stated there are many similarities between APD, Schizophrenia and NPD. Black failed to mention that the DSM-5 Code: 301.7/F60.2 Criterion D cancels out the possibility of APD if Schizophrenia is present. If he did not show signs of Schizophrenia Bateman would meet the requirements to be treated for APD. Chemerinski & Colleagues state “Individuals with Schizotypal Personality Disorder, or SPD, are significantly less vulnerable to psychosis than patients with Schizophrenia” (Chemerinski, Triebwasser, Russos & Siever, 2013). This emphasizes the possibility of Bateman having Schizophrenia as it was already stated he suffers from psychosis due to his hallucinations and eliminates his possibility of being diagnosed with Schizotypal Personality Disorder.

        Using previous studies, it’s possible to eliminate disorders and support present disturbances. In addition to the cited statement previously stated, Chermerinski & Colleagues also informed that helped reduce the possibility of SPD “Individuals with SPD are protected from the severe cognitive deterioration and social deficits associated with chronic Schizophrenia” (Chemerinski & Colleagues, 2013). This not only supports the Schizophrenia diagnosis but also draws the attention to the deterioration occurring in the client’s brain. The two statements by Chemerinski & Colleagues help explain why the hallucinations and delusions and the inability to remember and distinguish reality and fantasy are present. This supports the American Psychological Association’s DSM -5 Code: 295.90/F20.9 Schizophrenia, under Criterion A sections 1,2 and 5 as well as Criterion B and E (APA, 2013).