Lesson 1: Clinical Disorders - Part A

Description

A 34 year-old woman came for counselling regarding problems in her marriage. She was wealthy and she had married a successful businessman. She felt her husband was demanding and insensitive; he accused her of being a self-centred compulsive liar. During their marriage, each partner had numerous affairs, which each confessed to, and both partners resolved to stop. The affairs, however, would eventually begin again, on and off, for most of their ten-year marriage. The woman also described a special problem that caused her much concern. She had urges to go to expensive clothing stores and steal an item of clothing. Without her husband’s knowledge, she had over the last few years stolen several items. Although she had more than enough money to buy the items, she rarely stole expensive items. Some stolen items she did not even wear. She realized that her behaviour was irrational.

The patient would become aware of a craving to steal several days before she went “shopping.” Gradually, the desire built in her mind until, impulsively, she walked into a store and stuffed an item of clothing under her coat or in a bag. Once she was safely out of the store, she experienced a great sense of relief and contentment. When she arrived home, however, she felt tense and guilty.

She also told the doctor about how successful and accomplished she was – that she was superior, beautiful, and talented.

She also noted that her husband was handsome, aggressive, and successful – a perfect match for her. Because their marriage was not trouble-free, she decided that it was due to her husband’s unreasonable expectations of her and his not spending enough time with her. She did, however, confess to telling “white lies” to her husband instead of admitting that she had done something “stupid.”

Diagnosis

While the reason for seeking treatment was marital difficulties, the information makes obvious that the woman was a kleptomaniac. She could not resist the urge to steal items (most of which she didn’t like or need) and felt both relief and remorse after doing so. The acts of theft were not due to revenge or anger. Her kleptomania did not seem related to her marital difficulties. She did display some narcissistic personality traits (such as exaggerated sense of superiority, lack of empathy, lying) that also linked to her need for admiration and attention from various lovers through her numerous affairs. Her lack of other traits (such as indifference, rage, preoccupation with envy), however, did not warrant a narcissistic personality disorder diagnosis.

Because the patient’s main concern is her marital difficulties, not kleptomania, marital problems are noted first on the DSM diagnosis below.

Axis I: Marital Problem
          Kleptomania

Axis II: Narcissistic personality traits