Unhappy Harry

Harry is a 19 year old who lives at home after a failed attempt at college last year (he hasn’t been in school for 12 months). During his first and only semester at college, Harry stopped going to class, kept ruminating on how much money college was costing his parents and fear he was putting them at risk for financial ruin, and would loudly state that he was ugly and unlovable. Just prior to his leaving school, Harry saw the family physician and was given a prescription to aid with his sleep problems. One night, he was consuming alcohol and “accidentally” took his prescription too. His roommate had to escort him to the emergency room. He was immediately taken off of the prescription. Currently (1 year later), Harry’s parents are concerned about his lack of productivity. He has maintained a minimum-wage job for the last year and even earned a raise recently; however, Harry sees the world as hopeless and occasionally gets irritable with anyone around him. His parents describe this current behavior as consistent since he was 13 years old (last fall was abnormally severe). This change in emotion does not appear to be connected to the concussion or broken wrist he experienced when he fell out of the tree house at age 11. Interestingly, his parents tried to keep him from going to a 4-year college and pressured him to attend a 2-year college first. In addition, they inform you that money is not a problem for them and this had no bearing on their decision. They just felt he is too negativistic and thought he might benefit from staying home for another year or so. Harry is in therapy, but the psychologist reports no change over the last year. In addition, anti-depressant drugs have been ineffective.

Click below for the answers: Notice the chronicity of the problem (back to age 13 with intensification last fall), but his ability to maintain a job and earn a raise. His symptoms are also non-responsive to therapy and medication. Thus his diagnosis would be:

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Axis V: