Adam is a 25-year-old, single, white man who is referred after dropping out of college subsequent to being arrested for making fake college IDs. In addition to this, his parents report that he has taken money from them for college when, in fact, he was not attending classes.
Adam moved back home with his parents 1 year ago; since then, he has had angry outbursts and has destroyed some household property. His parents report that he has written bad checks, has a history of chronic lying, has years of substance abuse, and has severe mood swings with violent outbursts. The psychiatrist interviews Adam privately, and then speaks with Adam's mother for historical confirmation. His father is interviewed at a later session for corroborating information.
A clinician's initial reaction to this presentation may be one of trepidation. The parents complain about and the patient acknowledges substantial substance abuse, antisocial behavior, academic delinquency, and violent mood swings. It is incumbent upon the clinician to avoid premature conclusions and follow a thoughtful structured diagnostic interview in order to parse out symptoms and diagnostic disorders according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria, longitudinal course, and family psychiatric history.
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