“I'm Having Trouble Digesting”

This chapter presents the case of “Pekka,” a 48-year-old man referred for a comprehensive psychiatric assessment due to unexplained somatic complaints and functional difficulties. A six-week multi-method evaluation in a psychiatric day hospital setting—including interviews, behavioral observations, cognitive testing, the Minnesota Multiphasic Personality Inventory, Thematic Apperception Test, and Rorschach (scored according to Exner's Comprehensive System)—revealed a pattern of concrete thinking, poor emotional awareness, and rigid interpersonal behavior. Despite earlier suspicion of psychosis, no evidence of a psychotic disorder was found. Instead, the Rorschach helped highlight a severe emotional shutdown, a fragmented and very simplistic processing style, and low stress tolerance. Findings supported a diagnosis of autism spectrum disorder (Asperger's disorder), alongside hypochondriasis and atypical anorexia, with the death of Pekka's mother likely triggering a maladaptive, somaticized grief reaction. The Rorschach was instrumental in identifying elements of affective, cognitive, and social functioning not captured by self-report or other tests. The case illustrates how performance-based assessment can aid differential diagnosis and guide individualized treatment planning in presentations complicated by neurodevelopmental vulnerability and unresolved loss.