Case Study: Tyler Background Information Tyler is a 15-year-old male who is currently living at home with his mother and younger sister. His mother describes Tyler as "always being an odd child" who had significant difficulty relating to his peers. As a child he would spend a great deal of time alone involved in role playing. She said that social situations always provoke great anxiety in Tyler and he is extremely socially inept. Currently Tyler rarely socializes, and when he is not in school he spends most of his time on his computer. Tyler spends several hours a day on the Internet playing on-line games and interacting with others in chat rooms. Tyler reports having one close real-life friend but it is not clear when he sees this person. However, he did list several "online friends", none of whom he has actually met in person. Tyler has a history of doing poorly in mainstream school and currently is attending a vocational school. He reports being very anxious at school because he "doesn't fit in". His mother suffers from depression and anxiety, and he has two maternal uncles diagnosed with schizophrenia. Odd Beliefs or Magical Thinking that Influences Behavior Since childhood Tyler has been interested in paranormal experiences. His mother reports that his interest goes beyond mere curiosity that would be "normal for someone of his age". Rather his preoccupations seem to dominate his life at the exclusion of other activities. For example, his mother expressed concern about Tyler's intense fascination with ghosts. Tyler is extremely preoccupied with websites that advertise paranormal research, and he continually asks his mother to purchase ghost hunting equipment from them. Tyler indicates that he has seen ghosts and he often attempts to photograph ghosts near abandoned houses. Tyler also reports that he is superstitious. For example, cats crossing his path, lack of a breeze and things falling are all "bad signs that negative energy" is in his area. Unusual Perceptual Experiences Tyler says that since the age of eight he has been hearing a voice that says his name at night. This happens a couple of times a year and Tyler said that he finds these experiences frightening. In January of this year Tyler saw his surroundings turn from color to black and white "as if all the color had drained away". This experience lasted for a couple of minutes and only happened on that one occasion. Occasionally Tyler reports "feeling the cold of spirits or ghosts" in his home. Inappropriate or Constricted Affect Tyler was highly animated and often inappropriate with smiling and laughing through much of the interview. He avoided eye contact with the interviewer. Odd Thinking and Speech Throughout the interview Tyler focused on trivial details, and matters of importance were often vague. When trying to explain himself he often inserted words that served to confuse rather than clarify the situation, yet made sense to him. His mother said that Tyler is unable to have an ongoing conversation, and this is particularly apparent when he is interacting with people other than close family. Behavior or Appearance that is Odd, Eccentric or Peculiar Tyler looked unkempt, he only dresses in black and despite the warm weather he wore a coat into the interview and did not take it off. Throughout the interview he repeatedly folded and unfolded a tissue and wiped at the table, his chair and his own legs. Lack of Close Friends or Confidants Other than First-Degree Relatives Tyler predominantly socializes with his mother and sister. Typically, they initiate the contact as he tends to prefer solitary activities. Tyler alleges to have one school friend, but his mother cannot substantiate this claim. The majority of Tyler's social interactions occur over the internet. Excessive Social Anxiety that Does Not Diminish with Familiarity and Tends to be Associated with Paranoid Fears Rather than Negative Judgments About Self Tyler is noticeably anxious in social situations, especially with those he is not familiar with. Even when Tyler is exposed to the same group of people over time - such as his classmates - his social anxiety does not lessen. His mother has noticed that since Tyler started high school his anxiety has actually increased and he presents as being suspicious of his peers. Tyler thinks his teachers and classmates have negative thoughts about him. He is now mistrustful of them as he worries that they will single him out. Critical Thinking 4. What are symptoms/behaviors that stand out for you? 5. Rule out possible diagnosis by explaining how the symptoms/behaviors do not match with the disorder. 6. Give your diagnosis and include your rational as it relates to the diagnostic criteria. 7. Using the integrative model, what are some possible causes to Tyler's behavior? 8. Using the integrative model, describe treatment that would benefit Tyler