Learning Activity:

Diagnose the disorder described in each case and, link the specific fact/s of the case to its
different symptoms. (10 pts each)

1. JIM Ashamed to Be Seen

In his mid-20s, Jim was diagnosed with suspected social phobia; he was referred to our clinic by
another professional. Jim had just finished rabbinical school and had been offered a position at
a synagogue in a nearby city. However, he found himself unable to accept because of marked
social difficulties. Lately he had given up leaving his small apartment for fear of running into
people he knew and being forced to stop and interact with them. Jim was a good-looking young
man of about average height, with dark hair and eyes. Although he was somewhat depressed, a
mental status exam and a brief interview focusing on current functioning and past history did
not reveal any remarkable problems. There was no sign of a psychotic process (he was not out
of touch with reality). We then focused on Jim’s social difficulties. We expected the usual kinds
of anxiety about interacting with people or “doing something” (performing) in front of them.
But this was not Jim’s concern. Rather, he was convinced that everyone, even his good friends,
was staring at a part of his body that he found grotesque. He reported that strangers would
never mention his deformity and his friends felt too sorry for him to mention it. Jim thought his
head was square! Like the Beast in Beauty and the Beast who could not imagine people reacting
to him with anything less than revulsion, Jim could not imagine people getting past his square
head. To hide his condition as well as he could, Jim wore soft floppy hats and was most
comfortable in winter, when he could all but completely cover his head with a large stocking
cap. To everyone, Jim looked normal.

- Body Dysmorphic Disorder is the diagnosis. His mental status exam and a brief
interview focusing on current functioning and past history did not reveal any remarkable
problems. There was no sign that he is having a psychotic process. He doesn’t have problem at
interacting with other people but he have social difficulties because he thinks that people are
staring at him even his friends and that makes him feel uncomfortable because he has
deformity. In his mid-20s, he was diagnosed with suspected social phobia. But if he have a
social phobia he would have fear of interacting with people but he doesn’t. His deformity is his
problem so it makes him feel uncomfortable when someone is staring at him. He was most
comfortable when it is winter because he could cover his head with large stocking cap that
would make him looked normal. So he is having a Body Dismorphic Disorder because he is
conscious of himself. He has appearance concern.

2. ELOISE unlearning walking

Eloise sat on a chair with her legs under her, refusing to put her feet on the floor. Her mother
sat close by, ready to assist her if she needed to move or get up. Her mother had made the
appointment and, with the help of a friend, had all but carried Eloise into the office. Eloise was
a 20-year-old of borderline intelligence who was friendly and personable during the initial
interview and who readily answered all questions with a big smile. She obviously enjoyed the
social interaction. Eloise’s difficulty walking developed over 5 years. Her right leg had given way
and she began falling. Gradually, the condition worsened to the point that 6 months before her
admission to the hospital Eloise could move around only by crawling on the floor. Physical
examinations revealed no physical problems. Although she was not paralyzed, her specific
symptoms included weakness in her legs and difficulty keeping her balance, with the result that
she fell often. Eloise lived with her mother, who ran a gift shop in the front of her house in a
small rural town. Eloise had been schooled through special education programs until she was
about 15; after this, no further programs were available. When Eloise began staying home, her
walking began to deteriorate.

- Conversion Disorder is the diagnosis. Her difficulty in walking developed over 5 years.
Her condition gotten worse to the point that 6 months before admission to the hospital she
could move around but by crawling. Her physical examination revealed no physical problems.
Although she was not paralyzed, her specific symptoms included weakness in her legs and
difficulty keeping her balance, with the result that she fell often. When she began staying home,
her walking began to deteriorate. She is having a Conversion Disorder because she is having a
difficulty in walking, difficulty keeping her balance. Laboratory analysis of the condition typically
do not yield any findings either. The absence of any findings is a feature that may indicate that
Conversion Disorder is the actual source of the problem(s).