Thanks for the input! This setting was in the C/L setting for a patient with a well documented chart history of malingering with poor coping mechanisms, that would escalate while hospitalized around the time of discharge, which would end up being pursued for administrative reasons due to abuse of staff. The diagnosis in question was of antisocial personality disorder. I’m a resident, and assigned this diagnosis based on dsm-5 criteria, but my attending, while supportive felt that they would never feel comfortable assigning personality pathology in an acute setting when patients could be expected to be using less mature defense mechanisms, which made sense to me, but also is confusing for patients who seem to be only seen and evaluated in acute settings. Despite this pattern of behavior for many years with the exact same presentation (concerning for borderline intellectual functioning)c only one other provider diagnosed this patient with this diagnosis, and multiple other providers assigned diagnoses of adjustment disorder or malingering. Appreciate any thoughts on this! Thanks in advance.