Review Question - QID 108572

An 18-year-old patient is visiting the pediatrician with her mother for her annual exam before college starts. Her height and weight are appropriate for her age, and she is up to date on all her vaccinations and has no medical complaints. She is doing well in school and has a part-time job stocking shelves at a clothing store. She was offered a higher-paying job as a cashier at the store, but she declined. She is very shy and withdrawn with the physician. Afterwards, her mother asks to speak to the physician alone and expresses concern that her daughter is very socially isolated and feels lonely. She is also worried that her daughter is extremely sensitive to criticism, even from family. The daughter is interested in art and music, but hasn’t participated in any extracurriculars because she says that she is untalented and thinks nobody wants to hang out with her. When her mother has encouraged her to invite friends over, the daughter bursts into tears and says, “Nobody wants to be friends with me, I am too lame and ugly and I just know I’ll end up getting rejected.” Which of the following is the most likely explanation for the daughter’s behavior?