You suspect enduring personality change after a catastrophic experience in a patient. Before revealing the answer, decide how you would assess for this.

Take a careful history establishing that no personality disorder was present before the specific catastrophic experience or severe episode of psychiatric illness in question, since this absence is required by definition. Ask about the specific pattern present: following a catastrophic experience, look for social withdrawal, a hostile or mistrustful attitude to the world, feelings of hopelessness and estrangement, and a chronic sense of being constantly on edge; following a severe psychiatric illness instead, look for dependency, a demanding attitude toward others, reduced interests, passivity, and persistent claims of being ill. Confirm that the change has persisted for more than two years, since this duration is required before the diagnosis is made. Consider and carefully differentiate chronic post-traumatic stress disorder, which can be difficult to separate from this picture and may itself precede and evolve into it.