Objectives. The aim of the paper is to discuss diagnostic problems in patients presenting with symptoms that can be seen by clinicians as either psychotic, dissociative, or resulting from personality disorders. In an early deprivation of the child's psychological needs, a defense mechanism may be used: namely, the child may create an extensive fantasy world to satisfy the deprived needs. If such fantasies are still experienced and verbalized in adulthood, the individual may be diagnosed with psychotic disorders.
Case report. The patient, a woman whose psychological needs had not been satisfied in childhood, continued to verbalize her fantasies and manifest dysfunctional behaviors in adulthood. This resulted in her recurrent psychiatric hospitalization with the diagnoses of schizophrenia, borderline personality disorder, obsessive compulsive disorder and addictions. Her symptoms did not constitute any consistent clinical picture that would precisely fit a particular ICD-10 or DSM-IV diagnostic category.
Conclusion. In the psychiatric classification systems there is no diagnostic category that would univocally correspond to such cases.