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Dr. Z
Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 10643
Experience:  Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
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What is a possible diagnosis of an middle aged woman who seems

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What is a possible diagnosis of an middle aged woman who seems to have the mental capacity of a 14 year girl. She seems somewhat high-functioning (drives, pays attention to physical appearance, can hold a basic superficial conversation), but when you speak with her she is just off. Some people even think that her girlish behavior is an act. It's impossible to have a real discussion beyond basic pleasantries and she does ask the same question or repeat the same phrase more than once in a conversation. She has never been able to hold a job and lives in a "dream world" that doesn't include any sort of long-term reality - no concern or planning for her future. Everything is about right now, later doesn't exist. Is this just someone with a low IQ or is the a possible mental disorder?

Dr. Z :

Hello I believe I can help you with your concern

Dr. Z :

I would like to ask a few questions to get some information to determine if this an intelligence issue or a possible personality disorder, if you do not mind.

Customer:

sure

Dr. Z :

Has this women demonstrated this behavior for a very long time (e.g. years)?

Customer:

Yes, all her life. The family knows there has always been a problem, but no one will accept it so they pretend there is no problem.

Dr. Z :

Does she shift emotional states rapidly very often, but do these emotional states seem shallow like she is over exaggerating them?

Dr. Z :

And does she blame others for her failures frequently?

Customer:

Sometimes shifts rapidly. Her emotional states are always shallow and do seem to be exaggerated. I've had people ask me if her behavior is an act.

Customer:

I don't have experience with her blaming others for her failures.

Dr. Z :

So you mentioned that she does pay attention to her physical appearance, do you think she overly pays attention to this?

Customer:

I'm not sure if she has the capacity to blame. Again, everything seems shallow. I can say that she always appears to be happy and positive. I've never seen her as aggressive or negative.

Customer:

Yes, but her mother is the same way and she's as sharp as a tack. They are very much into clothes and make-up. The difference is that her mother is very sophisticated and the daughter dresses like she's 13 years old and she's really 50.

Customer:

She thinks that it's normal. Not sure if she sees herself as a young girl or as a woman.

Dr. Z :

So by dressing as a 13 year old I am guessing she does not dress seductively at all?

Customer:

Never seductive. Always girlish - feathered earrings, heavy make-up, flowers, ruffles, cats on t-shirts. Never any low cut tops or indecently short skirts.

Customer:

Doesn't flirt or try to attract the attention of men. I've heard she had a boyfriend years ago and it lasted a year or so. Don't know the details of the relationship.

Dr. Z :

Okay, well I do not believe that she has a personality disorder or another mental disorder. But I do believe based on what you have described she may have something called Borderline Intellectual Functioning which is a low IQ (70-85). This is the level of functioning between mental retardation and average IQ.

Dr. Z :

When she was in school, this term was not very well accepted, so she may have slipped through the cracks of the system regarding testing when she was younger

Dr. Z :

Now a days a simple IQ test (WAIS-IV) can pick this up and properly diagnose her

Customer:

Would someone like this be able to make decisions regarding their future? She's all alone and there is concern that she can't care for herself over the long term.

Dr. Z :

It depends on high her IQ is. If she was in the high 70's and low 80's then yes it is possible she may be able to make quality decisions about her future, although she may be impulsive with some decisions and not factor in everything. If her IQ is in the low 70's then it would be hard for her to make long term plans concerning her future and she would be more impulsive. But with proper therapy and guidance to teach her basic cognitive skills and social skills, she would be able to overcome this.

Customer:

Since no one has ever addressed this issue within the family and I don't believe that she may understand there is a problem, how do you go about approaching her regarding therapy and guidance? What resources can you recommend?

Dr. Z :

It is a difficult subject to bring up, but Adult Protective Services in her area could be helpful and provide resources for her regarding support and assistance. But if you can convince someone close to her to explain the issues it would be better to help her cope with it and get the help and assistance she needs.

Customer:

I just read online that people with BIF are not disable enough to qualify for specialized services or benefits - say financial or mental health/medical support. Is that correct?

Customer:

Regarding your previous comment, no one close to her admits there is an issue so no one can explain it to her. The Adult Protective Services is an excellent suggestion. I'll check with them. Any books or websites you can recommend for further assistance/research?

Dr. Z :

In some jurisdictions that is true and in some not so much. Some social workers are very kind and if she is close to the cutoff they will fudge the paperwork a little bit to help her qualify for services or they will tack on another mental health disorder to help her qualify for benefits. Social workers want to help individuals like her and they do not like when people fall through the cracks

Dr. Z :

There are not many website or books that I know of for BIF unfortunately because it does not happen that often where someone is first diagnosed later in life, but this looks like a good website for you

Customer:

That's good to know. Thanks so much for your help - you were extremely professional and fast!

Customer:

Have a great night.

Dr. Z :

Anytime I am always happy to help. I hope this lady gets the treatment that she needs. My goal is to provide you with excellent service, so if you ever have any further questions or concerns please do not hesitate to contact me at anytime.

Customer:

Again, thank you.

Dr. Z and other Mental Health Specialists are ready to help you

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