What’s Causing This College Freshman’s Anxiety?

Session 52

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[02:37] Question of the Week

An 18-year-old college freshman presents with increased anxiety. He reports trouble making friends in college which is causing him great distress. He was hoping to have a “fresh start at college” as he did not make friends in high school because he was too worried about being rejected.

The patient has always felt isolated because he thinks he is not as smart as his peers and he is afraid he will be rejected being dumb. He had planned to join the intramural sports league at his college but backed out because he “wasn’t good enough” to play sports and he thought he would only embarrass himself.

Additionally, the patient attempted to go to a meet-and-greet at his dorm, but was so anxious that people would not like him that he sat in his chair and did not interact with anyone.

Which of the following diagnosis is consistent with his presentation?

(A) antisocial personality disorder

(B) schizotypal personality disorder

(D) avoidant personality disorder.

[03:34] Thought Process Behind the Correct Answer

The correct answer here is D.

The schizoid stuff is complicated. There are three flavors to this.

Schizophrenia is not a personality disorder. It’s a medical condition that deals with dopamine dysregulation and so on.

The schizoid is like the guy who wants to live in the lighthouse all by himself and he’s very content to do. He doesn’t have anxiety about being around other people. He just doesn’t prefer to. He wants to sit alone and hang out and play with his puzzles, like extreme introvert, but is not anxious or wanting for connections. He just doesn’t have any close connections. And that’s how he prefers it.

Schizotypal is also somewhat socially ostracized and isolated. But the thing about them is they have this kind of weird, magical thinking. For instance, they think crystals will give them powers and they think this or that. There’s some kind of weird stuff going on. They tend to dress very eccentric and they’re just a very kind of an oddball. It’s like Kramer from Seinfeld.

Avoidant personality disorder is someone who’s trying to avoid these types of social interactions because it gives him anxiety, but he has this desire to be accepted. That’s where this idea of rejection comes into play and causes him a great deal of anxiety.

Antisocial personalities are those mean people that you do not want to be around. They’re people haters. And this guy is not exhibiting, or at least from the stem, not exhibiting that personality.