An old version of the diagnostic section of the exam

Does this behavior qualify for any of the diagnoses we've discussed? If it doesn't, why? Which diagnosis fits this case best? Briefly justify your diagnosis. (4 pts each.)

1. Hal and his partner Roberto have been more and more unhappy with their sex life. Roberto complains that the problem is that Hal has been drinking heavily more days than not and that, rather than making love as they used to, Hal falls asleep. In addition, Hal has been running into problems at work because he has missed 28 days so far this year.

2. For as long as Jayme can remember she's been drinking coffee. She now drinks 8 - 10 cups a day just to get the energy she used to get from one or two. One day last week she ran out of coffee after the local store closed -- she lives in a very small town -- and spent the next hour and a half looking for a store with her favorite brand of coffee. She eventually broke down and drank "sludge" from a McDonald's 45 minutes from home.

3. Brynn has been in a committed relationship for 10 years, has always had vivid and enjoyable fantasies about sex, but has had difficulties becoming lubricated -- even during the early part of their relationship. Marty has been more and more upset at how this is impacting the rest of their relationship and is contemplating leaving her.

4. Shmuel, 73, has been becoming more and more disoriented within recent months after an active and productive life as a plumber and scout leader. Problems were first noticed about three years ago. On some occasions he has gotten lost within blocks of his house. When asked about these incidents he says that he had been bird watching, a life time hobby, and simply forgot to watch where he was going. However, very clearly he was confused on these occasions. His dress, normally immaculate, has become erratic with clothes worn for a week or more at a time, cigarette burn on his sweater, his shirt misbuttoned. Last week he burned his dinner dry. His family is very supportive and report no other significant health problems or social stressors.

5. LaJohn, 81, a generally capable accountant before the death of his second wife, has been increasingly confused and disoriented since it. More days than not, he doesn't eat. His children have begun visiting at lunch time to get him out of bed and dressed in clean clothes, as well as prepare his lunch. Last week his children discovered that he hadn't paid more than a smattering of bills in the last three months. When asked, they added that he had behaved in a similar way when he was 35 and lost his job, also at 43 when his first wife left him.

   Diagnose the following case on all axes: (10 pts.)

   Rafaela, 36, has always been described as "shy," and frequently feels "inadequate" or "inept" -- even relative to activities such as baking where she is very accomplished. Even as a child it was common for her to react to relatively trivial teasing as though it was a major attack, and she has been known to stay in her room for days following normal mistakes. Although she would like to marry and have children, she has rarely entered situations where she could date, expecting rejection. When set up on a blind date, she is unusually quiet -- even for her -- and doesn't know what to say. She is only comfortable with her best friend, Laina.

   Things have gotten worse recently. Her employer is moving its office out of state and transferring some employees, laying off most. Her mother, with whom she has always lived, is ill and will probably require long-term care. Rafaela has also been experiencing "heart attacks" (sweating, shortness of breath, chest pains, flushing and chills, thoughts that she is dying or going crazy) at least twice a week over the last several months, often more. Since her attacks began occurring, she has restricted her travel severely. Laina must drive her to work and the store. Her physician says that Rafaela's heart and thyroid are healthy, although she did accidentally discover that Rafaela has cystic breasts.

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