Diagnosis is one of the following
1.Physical Disorders and Health Psychology
2. Anxiety, Trauma- and Stressor-Related
and Obsessive-Compulsive and Related Disorders
3. Somatic Symptom and Related Disorders and Dissociative Disorders
4. Eating and Sleep-Wake Disorders
5. Neurodevelopmental Disorders and Conduct Disorder
6. Mood Disorders and Suicide
Case
Car Salesman
A 29-year-old car salesman was referred by his current girlfriend, a psychiatric nurse, who suspected he had a mood disorder, even though the patient was reluctant to admit that he might be a moody person. According to him, since the age of 14, he has experienced repeated alternating cycles that he terms “good times and bad times.” During a bad period, usually lasting four to seven days, he oversleeps 10-14 hours daily, lacks energy, confidence, and motivation—“just vegetating,” as he puts it. Often he abruptly shifts, characteristically upon waking up in the morning, to a three-to-four day stretch of overconfidence, heightened social awareness, promiscuity, and sharpened thinking—“Things would flash in my mind.” At such times he indulges in alcohol to enhance the experience but also to help him sleep. Occasionally the good periods last seven to ten days, but culminate in irritable and hostile outbursts, which often herald the transition back to another period of bad days. He admits to frequent use of marijuana, which he claims helps him adjust to daily routines.
In school, As and Bs alternated with Cs and Ds, with the result that the patient was considered a bright student whose performance was mediocre overall because of unstable motivation. As a car salesman his performance has also been uneven, with good days canceling out the bad days; yet even during his good days, he is sometimes perilously argumentative with customers and loses sales that appeared sure. Although considered a charming man in many social circles, he alienates friends when he is hostile and irritable. He typically accumulates social obligations during the bad days and takes care of them all at once on the first day of a good period.
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