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Jeremiah is a 57-year-old single, unemployed, white male. He still lives with his 83-year-old mother and is embarrassed about this living arrangement.

Read the following vignette for this discussion, making note of any diagnostic criteria that are clearly met:

Jeremiah is a 57-year-old single, unemployed, white male. He still lives with his 83-year-old mother and is embarrassed about this living arrangement. He was previously diagnosed with dysthymia and has undergone psychotherapy treatment for the past two years. He changes counselors often and claims that most were “no good” because he felt he knew more than they did. This counseling appointment was made as a last effort to find someone competent enough to appreciate his problems.  Jeremiah previously worked as an insurance broker. He explained, “It’s ridiculous. I was the best broker they had ever seen, but they won’t rehire me. I think the problem is that the profession is filled with big egos, and they don’t know excellence when it’s right in front of them.”  Despite encouragement from several therapists, Jeremiah has not pursued employment or volunteer work. He views positions with lower salaries as beneath him. He reports that any truly worthy opportunities would easily find him.

Address the following:

The client does not meet all criteria for narcissistic personality disorder (NPD), therefore he cannot be diagnosed with the disorder. However, he does meet most of the required criteria. Describe the criteria that are clearly met for NPD. ◦What further information would help you assess if he meets this diagnosis or another? ◦What would be some assessment strategies that could help to fill the gaps?

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