Differential Diagnosis
The spouse's behavior exhibits a complex array of symptoms that could be indicative of several psychiatric and personality disorders. Here's a differential diagnosis organized into categories:
Single Most Likely Diagnosis
- Borderline Personality Disorder (BPD): Characterized by a pervasive pattern of instability in interpersonal relationships, self-image, and affects, and marked impulsivity. The manipulative, controlling, and hysterical behavior, along with a lack of intimacy and excessive spending, are common traits seen in individuals with BPD.
Other Likely Diagnoses
- Narcissistic Personality Disorder (NPD): The controlling and manipulative behavior, along with a lack of intimacy and excessive spending, could also be indicative of NPD. Individuals with NPD often have an inflated sense of self-importance and a deep need for admiration, which might manifest as demanding behavior.
- Obsessive-Compulsive Personality Disorder (OCPD): The obsessive-compulsive traits mentioned could suggest OCPD, characterized by a preoccupation with orderliness, perfectionism, and control. However, the presence of other symptoms like hysteria and lack of intimacy might suggest a more complex diagnosis.
- Histrionic Personality Disorder (HPD): The hysterical behavior and excessive attention-seeking could be indicative of HPD. Individuals with HPD often exhibit rapidly shifting and shallow expressions of emotions and use their appearance to draw attention to themselves.
Do Not Miss Diagnoses
- Bipolar Disorder: The excessive spending and hysterical behavior could be indicative of a manic or hypomanic episode, suggesting bipolar disorder. It's crucial to assess for a history of mood episodes to rule out this diagnosis.
- Substance Use Disorder: The lack of intimacy, manipulative behavior, and excessive spending could be exacerbated or caused by substance use. It's essential to screen for substance use disorders.
- Post-Traumatic Stress Disorder (PTSD): Traumatic experiences could contribute to the development of manipulative and controlling behaviors as a coping mechanism. Assessing for a history of trauma is vital.
Rare Diagnoses
- Factitious Disorder: The spouse's behavior could be a fabrication or exaggeration of symptoms for attention and sympathy, suggesting factitious disorder. However, this would be less likely given the complexity and range of symptoms described.
- Munchausen Syndrome by Proxy: If the spouse is fabricating or inducing illness in another person (e.g., a child) to gain attention and sympathy, this could be considered. However, there's no direct indication of this in the provided information.