Case 1: 

Donald reported feeling very depressed, but when he showed up for his 
consultation, stated that he had only done it to appease his parents. He was 
overdressed for his appointment, is very dramatic, and is hoping that a special 
person would be able to understand him. He talked about how he discovered several 
popular actors, compared himself to one of the actors, and talked about how he 
would have a future fan club. Based on this information, Donald likely has 
Narcissistic Personality Disorder. 
The diagnostic criteria for Narcissistic Personality Disorder requires the 
patient to meet at least five of nine criteria. From the information given, Donald 
meets six of the nine. Firstly, he demonstrates a grandiose sense of importance as 
he says that he is the “most incredible patient”. He never gives any type of 
evidence to explain why he believes so, and there is no real reasoning why he would 
be a better patient than others. Therefore, this is an example of grandiosity, as he 
sees himself superior over other patients. The second criteria that he meets is a 
belief that he is special and can only be understood by other special people. During 
his session, he stated that he hoped that there was a “someone very special who 
can understand” him. He thinks that he can only be understood by a “special” 
person, which fulfills that criteria. Next, he demonstrates that he has a sense of 
entitlement. When an actor came to his town, he showed up at the gala in a 
limousine as if he were the star. He was then upset when the actor’s agent was 
unhappy with his behavior. Donald had an unreasonable expectation that his “joke” 
would be treated lightly, and it wasn’t. This demonstrates his sense of entitlement. 
Additionally, he meets the criteria of interpersonally exploitative. He told his 
doctor that he had been feeling depressed and potentially suicidal, and then later 
told the psychiatrist that his doctor had been worried about him and the visit was 
merely to appease. His actions were exploitative of the doctor, as the doctor was 
used as a way for him to gain an additional platform to promote himself on and he 
misrepresented the doctor’s words. The next criteria that he meets is jealousy. He 
demonstrates jealousy when he stated that “​wasting my time promoting others, and 
that it was time for me to start promoting myself.” He was jealous of the fact that 
despite he and this famous actor both had similar backgrounds, the actor was 
famous and he was not. Finally, he shows an arrogant attitude when he had pictures 
of himself and a dollar bill with his face replacing George Washington’s. His 
inflated sense of himself makes him feel like he should be on the dollar bill instead 
of George Washington. As he meets six criteria out of nine, he qualifies for a 
Narcissistic Personality Disorder diagnosis.  
One of the differential diagnoses I considered in making this decision was 
Histrionic Personality Disorder. He showed theatricality when he initially entered 
the psychiatrist’s office. He also used his physical appearance to draw attention by 
wearing a white suit. However, these are only two of the eight criteria, and to 
qualify for Histrionic Personality Disorder, one must meet at least five of these 
criteria. For the other six criteria, either they were not met or the necessary 
information was not given. The other differential diagnosis that I considered was 
Major Depressive Disorder, Single Episode with Psychotic features. He stated that 
he had been feeling depressed which is why I initially considered this diagnosis. His 
evaluation showed signs of delusional behavior, as he showed delusions of 
grandiosity. However, beyond that initial statement, he showed no signs of 
depressed mood or lack of interest. Therefore, I eliminated this option.  
In order to form a more solid diagnosis, I would want to know his drug and 
alcohol history, whether he has had a depressed mood or loss of interest in 
activities, whether he is uncomfortable when he is not the center of attention, and 
to see how stable or unstable his emotions are. In doing so, I would eliminate 
substance abuse, a major depressive episode, and histrionic personality disorder.  
 
Case 2: 
As a child, Lyonel was very isolated, thought of as peculiar, and suspicious. 
He also showed strong interest and belief in magic and religion. When he was older, 
he began having hallucinations and disordered thinking which disrupted his life. 
Because of his symptoms, I believe that he has schizophrenia and schizotypal 
personality disorder (premorbid).  
Firstly, I will address his schizotypal personality disorder. In order to be 
diagnosed with schizotypal personality disorder, he must meet at least five of the 
eight criteria. The first criteria that he meets is ideas of reference. He felt that 
unrelated events were directly related to him. For example, he saw that his rear 
window defroster was labelled REAR DEF and decided that this meant that he was 
going deaf in his right ear. The next criteria that he meets is magical or odd 
beliefs which affect behavior. As a teenager, he read extensively about magic and 
later about the Bible and wanted to be a minister at one point. His magical 
thoughts affected his decisions and he spent a lot of time with them. The next 
criteria that he met is unusual perceptual experiences. Despite being described as 
a very thin individual, he thought that his muscles were flabby. He had an abnormal 
perception of his own body. The next criteria that he met is suspiciousness. He was 
described as “nervous” and it was stated that as a young child, he seemed 
suspicious if other children talked to him. Next, he meets the criteria for 
constricted affect. It was stated that as a child, he never smiled or showed much 
emotion. His emotional responses were limited. He also meets the criteria of odd or 
eccentric behavior. Many people who knew him thought that he seemed like a 
peculiar child, even his siblings. He also meets the criteria for lack of close 
friends. It was stated that he was isolated, even from his siblings, and that he did 
not seem at ease, even with others that he had known for a long time. Since he 
meets seven of the nine, he qualifies for the first criteria. The second criteria is 
that it doesn’t occur exclusively during the course of schizophrenia or other 
psychotic disorders, or autism spectrum disorder. His schizophrenic symptoms 
started after the onset of his schizotypal symptoms and because of his distorted 
views of reality, his behavior is better explained by schizotypal personality 
disorder rather than autism spectrum disorder. 
Next, he later developed schizophrenia with his hallucinations being at a 3 
and his delusions being at a 4. The first criteria is characteristic symptoms, of 
which he needs at least two of. The first he meets is delusions. He was delusional 
about Mary’s feelings towards him. He felt that Mary was thinking about him and 
that something was keeping them apart. The next he meets is hallucinations. He 
thought that his relatives were winking or tapping their fingers to let them know 
she was near and thought that people were nodding and winking at him to signal 
their approval. He also heard a woman’s voice speaking to him. This both lasted over 
a month as they continued from the summer through the winter. The next criteria 
is social or occupational dysfunction. He showed this by neglect to find a summer 
job. He did not make progress in his life and instead moved back to his parents 
house and rarely left his room. The next criteria is that it has to persist for at 
least 6 months. His symptoms were present for two and a half seasons, and with 
each season being about three months, his symptoms have been present for about 
7-8 months. The next criteria excludes schizoaffective and mood disorders. He 
does not have a mood disorder because he showed no sign of depressed mood or 
mood issues as a whole. The next criteria excludes substance abuse, and because 
he denied using any drugs, this can be concluded. Finally, as previously addressed, 
he does not meet the criteria for pervasive developmental disorders.  
One of the other diagnoses I considered was schizoid personality disorder 
because of his restricted affect, lack of friends, and little interest in sex. 
However, he only met three out of the four necessary criteria, so this diagnosis 
was rejected. I also considered paranoid personality disorder because he was 
suspicious and always ill-at-ease. However, he only met one of the four needed 
criteria, so this was also rejected. I also considered delusional disorder as his 
delusions were a large part of his symptoms. However, because of his 
hallucinations, this diagnosis was also rejected.  
Additional information which would solidify this diagnosis is further 
information on his childhood to ensure a rejection of autism spectrum disorder. 
This includes information regarding what his social interactions were like, whether 
he has any sensory sensitivities, and any repetitive movements or behaviors. 
Furthermore, in order to ensure that schizophrenia is the correct diagnosis, it is 
important to see how long his psychotic symptoms continue.