Introduction

Levi is a thirty-year-old cisgender male. While he has no identified sexuality at this time, he is in a same-sex marriage with Raphael Everett and has had previous sexual relationships with women. Those previous relationships were a means to gathering information from the individuals, so Levi claims.

He was born to Cybil and Orion Blake. He was the oldest of two children, with his sister Seraph subsequently being born. His family has a long history of arranged marriages, including the one between his parents. They set Levi up with an arranged marriage to a woman named Julia, which was completed when he was sixteen years old. The wedding commenced when they were eighteen years old. Their marriage lasted five years, and was dissolved through divorce by claiming that she could not produce an heir. That was a technically accurate, but medically inaccurate, claim, as they agreed to not consummate the marriage because of being biological cousins.

While we will discuss his trauma more in-depth in the sections below, Levi has experienced multiple versions of physical, emotional, and sexual abuse. A variety of individuals inflicted them, including his grandfather and mother. His upbringing was formal, with his relationships strictly controlled by his parents. His education was supplied by private tutors in his family home rather than in a public, or even private, school environment.

Levi's personal relationships show a pattern of tension. His father and sister passed when he was young, but he reported having had close relationships with them. In comparison, the relationship with his mother and grandfather were strained because of reasons that will be listed in the sections below. Any relationships outside of these present as transactional, at best, in a vast majority of circumstances, with most of them developing as part of his plans for revolution rather than for personal fulfillment or enjoyment. This is a pattern that Levi himself acknowledges, and will be addressed more in-depth below.

The marriage between Levi and Raphael began as a means to an end. Initially, Levi lists the reason as a wish to "be free," though what that specifically meant to him was not mentioned until later, where he says thus: “My objective is quite direct: I desire to be disowned. My lineage has endured for centuries, and my parents insist upon the continuation of our noble heritage through my progeny. This, I assure you, is an impossibility for me.” That freedom could be categorized as a release from the restrictive rule sets imposed by his family and the other upper-class families around him, including around procreation and demeanor.

Diagnosis

To diagnose Levi Blake with any mental health or neurological condition, we must look at his behavior, choices, and words. While one stands out above all of them, it is important to consider how multiple possible conditions may interact and cause Levi to act in a way that perhaps goes against a primary diagnosis. We will provide justification for why each diagnosis might be rendered by a mental health practitioner for Levi, along with evidence that coincides with known symptoms of each condition.

Antisocial Personality Disorder

To touch on Antisocial Personality Disorder, or APD, we must first look at Levi's childhood. In general, adults with APD will first gain a diagnosis of Conduct Disorder during early to mid childhood. This is a condition in which a child shows patterns of disregarding the basic rights of others and/or a severe lack of age-appropriate societal norms in their behavior. It is difficult to glean whether this would have been the case for Levi, as there are conflicting reports regarding his behavior and conduct throughout his early childhood and adolescence.

Julia said the following about Levi in his early childhood: "He wasn't always like that. He was nice as a child, always taking care of his little sister. Then his sister died, then his father... I spent years believing and waiting for the sweet kid I grew up with to resurface." Despite Levi's insistence that he has always presented as void of most emotions and ability to connect with others, her words imply otherwise. It could imply that there was a time in his life when Levi could emotionally connect with and care about others beyond the transactional, though this could also be an assumption on her part and not necessarily a reflection of his reality. The death of his father and sister present as being a primary cause of the change in him from a "sweet kid" to the calculating man he ultimately ends up growing into.

Another point comes from Raphael, his husband, questioning whether Levi loved his father. His response was to say that it could be assumed, and Raphael took it as a chilling reminder of what Levi's emotions can cause, but this further points to an ability to emotionally bond with someone beyond what Levi admits to. While he may not any longer, this is strong evidence that any mental health discrepancies likely lay, not in his genetics or nature, as Levi assumes - but in nurture, or the experiences he had as a child and young adult.

Beyond childhood, however, Levi changed. In his adolescence, Levi used intimidation and threats to get information and start gaining power. While it is not necessarily explicitly reported, considering he is said to do so as an adult, it is likely safe to assume he would have deliberately destroyed others' property as an adolescent, another symptom of Conduct Disorder.

A third symptom, often lies to obtain goods or favors or to avoid obligations, is shown through his behavior toward the other nobles and his mother. Levi listed having to tell "polite lies" to staff at the Royal Academia to avoid being pushed into teaching; likewise, he used mistruths to indicate a relationship with Julia that did not truly exist in order to get favor while he built up his power structure.

Conduct Disorder only requires three out of the fifteen criteria that exists for the condition, of which Levi appears to meet at least three. Many other criteria, including use of a weapon that can cause serious harm, stolen while confronting a victim, breaking into someone else's belongings, staying out at night, and truancy, are ones that would be unsurprising to see in Levi's history, but are not presently mentioned. This may change as we learn more about his childhood and adolescence.

Further, we can look at specifiers of Conduct Disorder that may apply to Levi. One specifier is with limited prosocial emotions, which includes a lack of remorse or guilt, lack of empathy, and shallow affect. In other words, an individual with this specifier will present was a lack of concern for the consequences of their actions, including how it impacts others, as well as showing a superficial level of emotional expression. If you consider the development of the previously discussed traits, and the evolution of Levi's emotional landscape, it is likely safe to say that this specifier would apply. This would also collaborate with Levi having a childhood-onset type of Conduct Disorder, despite him not showing the more traditional tendencies toward violence expected of that onset type.

Like Conduct, we'll progress to the next step of Levi's primary diagnosis. While we do not guarantee that someone with Conduct Disorder in their youth will develop a personality disorder, Levi shows a distinct pattern of behavior that shows that it evolved into APD in his later adolescent and early adult years. APD is described as "a pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 years" in the DSM, and must be indicated by meeting at least three of the criteria of the condition.

The least concerning of the criteria is a "failure to conform to social norms with respect to lawful behaviors." If we were to take this out of context of law, Levi shows a pattern of disregard for social norms. His refusal to use swear words, speech that is more formal and/or outdated then is necessary for most occasions, as well as his behavior toward others both in public and private, show a lack of regard for social norms. While his noble upbringing could explain many of these away, Levi initially showed a lack of awareness of how these behaviors may impact those around him. In particular, Raphael has had to request that he use less formal speech with him in order for Levi to utilize more informal speech patterns around him.

As an adult, he has taken multiple actions, including arson, that would lead to arrest if he were caught, with little to no remorse in doing so. With both things taken into consideration, it is likely safe to say that Levi meets the first criteria of APD.

Deceitfulness is considered the second criteria of the condition. They describe this as repeated lying, use of aliases, or conning others for personal profit or pleasure. While perhaps most of the deceit Levi utilized was for a 'greater good,' that 'good' was driven by a personal need for freedom and belief system that caused the destruction of the nobility. Levi is reported to use deceit for personal amusement. This includes making underhanded comments that led his husband to believe he used a photo for pleasure, merely to see his reaction. If we look at both types of deceit, this criteria has been clinically met as well.

The third criteria, impulsivity or failure to plan ahead, is harder to pinpoint. While Levi stays three steps ahead in most situations, he shows impulsivity in other, more subtle ways. There are moments of impulsivity in his sugar seeking and quickness to anger, in particular. Raphael initiated sexual contact to see if he could at the beginning of their relationship, and Levi agreed with little consideration of the consequences. Likewise, he spent a good part of the beginning of their relationship agreeing to Raphael's whims immediately. We could argue this as impulsive acts that came from a place of wishing to make up for his inability to provide emotional stability or comfort. Levi argued he did so in order to feel better about their arrangement, rather than from any place of reason. As such, he has met criteria three.

Irritability and aggressiveness make up the fourth criteria. They specify this as often being indicated by physical fights or assaults, but we'll give creative liberty some credit and allow Levi's particular brand of aggressiveness to apply. While he does not outwardly show aggression toward others in the traditional sense, he does through more indirect means. His response to Cybil's behavior was to isolate her, and when faced with her ire regarding his marriage to Raphael, to politely and formally tell her to "take a trip to the back end of the island" - in other words, take her own life. Likewise, he has used arson to intimidate others when they threaten him or things he cares about, which could be another form of aggression.

Pertaining to irritability, Levi indicated he can often be quick to anger. While this rarely presents as outward bursts of rage, it can be seen in his responses to others in stressful situations and his demeanor when faced by people he views as below him. When speaking to "insects" or "vermin," his speech will contain signs of irritation or frustration. He finds these interactions boring at best, but usually is annoyed by the banality of it. This would show that Levi meets this criteria.

The fifth criteria is harder to discern. Reckless disregard for safety of self or others is yet another criteria for APD, and while Levi appears to consider all possible safety concerns toward himself and others, there are many instances that this is shown to go ignored. While Levi possesses the intelligence to look toward physical safety, he will disregard the emotional and mental safety of others around him. Levi admitted to being surprised by Raphael's response to his actions toward several government officials and how it emotionally impacted him. He also reported surprise and/or amusement at his husband's emotional responses to heavy or traumatizing information. Considering the type of trauma Levi has undergone throughout his childhood, this oversight appears ignorant and reckless. As such, we can consider this criteria met.

The final criteria, lack of remorse, was already touched on when we discussed Conduct Disorder, but could use more elaboration as we look at Levi's adult years. He reported no feelings of guilt, shame, or remorse regarding his actions, though he intellectually understands the concepts. When he does something that harms another - Raphael being a prime example - he will often justify the actions and words he used through what he considers sound judgment. Any harm caused to others is viewed through a lens of necessity, though he does not actively seek to harm others. Levi has also shown willingness to blame the individual for the harm they go through, whether or not they caused it.

Including lack of remorse, this would mean Levi meets six out of the seven criteria of Antisocial Personality Disorder. The seventh, consistent irresponsibility, was not included as criteria for Levi due to him showing a strong work ethic and history of honoring his obligations, even if grudgingly.

Of the associated features of APD, inflated self-appraisal would rate highly for Levi. He views most others as below him on an intellectual and physical level. Raphael noted Levi has a tiered system for the people around him - insects for those that are annoying or useless, vermin for those of some skill level, and swine for those that Levi perceives as greedy and worthless - that shapes how he interacts with those people and how he speaks of them.

While he can keep his views to himself when needed, he's proven to be excessively opinionated about the skills and abilities of those around him, particularly in the political fields. Another feature, utilization of advanced speech such as technical terminology to others unfamiliar with the subject, is a hallmark of Levi's speech patterns. He speaks in long, drawn out diatribes, with use of advanced terms that would require explanation to any that aren't familiar with the topic of conversation.

One complaint Levi has is of boredom, and he perceives everything as boring and bland. Levi reported having a moment of impulse where he screamed about being bored, indicating a lack of tolerance for that boredom. Following a near lethal car accident he was in with Raphael, he indicated using studies on the animal kingdom to keep his mind sufficiently entertained because of being incapacitated. Likewise, his substance use disorder seemed to be a means of also keeping this extreme boredom at bay.

With the evidence showing he likely had Conduct Disorder before he was fifteen, as well as no evidence of his antisocial behavior being caused by another disorder like schizophrenia or bipolar, this indicates him having APD, and would be considered a primary diagnosis. His family history of child abuse and neglect, as well as the method of parenting he underwent, could likely be considered the main cause for his development of this disorder.

Opioid Use Disorder

This disorder, which includes a problematic pattern of use of opioids that clinically impair or distress the client, is the second diagnosis to potentially fit Levi. Levi had been using Aether Bloom - the substance of which his entire pharmaceutical empire is built on - to address his mental and emotional health issues through pain relief. His grandfather asked to be overdosed on it, and Levi reportedly refused to assist him in doing so. In the marriage contract made between Raphael and Levi, a term in it was that Raphael was to not enter a locked room on the second floor of their home under any circumstances. This locked room referred to as Levi's study, is the place where he'd use the Aether Bloom as well as manage the details of his investigation into other upper-class individuals.

If we look at the clinical criteria of OUD, Levi would meet several of them. We'll disregard the first two, which are taking it in larger amounts then intended and persistent desire to cut down on use, as there are few or no indications that either of these were the case prior to Levi being forced to go into rehab. There were reported instances that Levi presented as sickly pale with glazed eyes, which could show that he had overused. However, he also presented with signs of anxiety because of the situation, so we cannot count this as a confirmed case of overdosing. So while they may be accurate, there is no strong supporting evidence of them, and as such we'll move on to the third.

The third criteria is for a great deal of time to be spent in obtaining the drug, using it, and/or recovering from its effects. While we don't know how much time Levi spent getting it, nor how long recovery from his usage was, we know approximately how much time he'd spend on its use. While not explicitly stated, Raphael noted Levi would immediately go to his locked room, spend "some time in there," and go right to bed immediately after every day when he returned from his work. This is a pattern that continued through most of their relationship until Raphael learned of his addiction, and could indicate an excessive amount of time using, and as we will count such as being met.

Cravings or urges to use opioids is the fourth criteria of the disorder. Levi reported previously considering breaking his own leg or pulling his fingernails off to gain painkillers, but decided not to when he realized staff would only give him ibuprofen instead. This would imply, on some level, that he had urges for it, though he views them through the lens of the other drugs not being sufficient to address his concerns. He later admitted to challenging himself to maintain full sobriety, including from alcohol, which further implies that he likely continues to have them even if he doesn’t mention it. As such, we can consider him as having this criteria.

With the fifth criteria, recurrent use resulting in failure to fulfill major role obligations, we must use some creative liberty. While his use does not appear to have hindered his abilities pertaining to work or home, sometimes it caused some undue stress. This primarily presented as him being late to certain functions because of his use, but did not reportedly cause any long-term consequences.

Another of the criteria, continued use despite persistent social or interpersonal problems caused by it, is one that could also be debatable. While there were no clear situations in which his use caused negative consequences in the long term, it caused disruption in his relationship with Raphael through the perception that the relationship was potentially falsified. Raphael questioned how much of their connection was through the drug use, rather than a genuine human bond between them. Likewise, the use of opioids caused Levi physical issues related to his sexual relationships, and in fact caused his hesitancy in beginning this facet of their relationship.

The seventh, reduction in important social, occupational, or recreational activities, would likely be considered not met. There is no evidence that Levi had reduced activities he would normally otherwise do because of his drug use, and as such would not meet this criteria.

While Levi rarely takes part in physically hazardous activities, he might qualify for the eighth criteria of recurrent use in situations if he used the aether bloom prior to situations or activities that require precision or clear headed-ness. As there is no reported evidence of this, we should assume he does not meet criteria.

Along the same lines of criteria six, seven includes use despite physical or psychological problems caused by or exacerbated by the substance. Levi was reported to be physically cold. Raphael noted he wore long-sleeved shirts at home constantly, and considered that Levi may be cold or hiding something. When Raphael touched him, he'd feel physically cool, and became more so after times Raphael assumes he possibly used. With Levi having skin callousing from needle use, particularly between his fingers and on his legs, the usage of long sleeves was another measure that he used to hide his substance use. These signs would point to criteria being met for physical issues related to the substance use.

With tolerance, the tenth criteria, it is difficult to find out whether Levi would meet this. It is hallmarked by needing increasing amounts of the substance to achieve the desired effect and diminished effect with continued use. While biologically and clinically, this is likely with how long Levi used the aether bloom for - approximately twelve years- nothing reported would show whether his tolerance had built up. Without knowing much about the drug itself, it can't be assumed what its impacts were and how its effects may differ from other opiates. As such, we should not count Levi as meeting the threshold for this criteria, but it is tentative.

Levi went through the eleventh criteria, withdrawal, during his time in rehab. He experienced vomiting, sweating, sleep disturbance, body tremors, migraine, and stomach aches - all symptoms of opioid withdrawal. Out of all the criteria, this is the simplest to apply. As such, we see he met several of the symptoms listed in the DSM for opioid withdrawal: dysphoric mood, nausea and vomiting, muscle aches, sweating, fever, and insomnia.

Post-rehab, we would consider Levi in early remission. He met full criteria for opioid use disorder by meeting six of the qualities of the disorder, and has since abstained from substance use for a minimum of three months but less than a full year. While he was in the rehab facility, he would have been considered in remission in a controlled environment because of his ability to use being cut off through being in a restrictive environment. Severity-wise, Levi would have been severe because of the presence of six or more symptoms.

With all the evidence considered, it would likely be safe to diagnose Levi with opioid use disorder, severe, in early remission.

Post-Traumatic Stress Disorder

As mentioned in Levi's history, he has a relatively extensive trauma history. Levi revealed his maternal grandfather forced him to consume the cooked remains of his pet rabbit at a young age. While he left the details vague, it was reported that Levi underwent an extensive amount of emotional neglect, physical and emotional abuse, and to some extent, parentification. On the Adverse Childhood Experiences questionnaire, it would be safe to say he experienced six of the ten criteria listed on it.

With that being the case, Levi meets the first requirement for a diagnosis of PTSD - exposure to actual or threatened harm. The DSM listed that this could be through direct experience, witnessing of the event,or repeated exposure to details of the trauma, all of which would apply to Levi. While he experienced his own traumas, he noticed the trauma of those around him - including the noblewomen that he conspired with as an adult. While his own direct abuses mostly ceased once he was in adulthood, Levi continued to experience exposure through witnessing of these events through his work with the nobility and his marriage to Julia.

That said, to attempt to diagnosis Levi with PTSD, we need to look at the symptoms. While most of the intrusive symptoms do not apply in his case, he reported having intense psychological distress and physiological reactions in the presence of his grandfather. Levi showed signs of a fight/flight/freeze response upon The Conqueror, the name he refers to his grandfather by, entering his domicile. This also occurred when there was an altercation between his grandfather and Raphael. In conversations about his grandfather, Levi voices the belief that he, as well as everyone, are better off without interacting with him because of those interactions.

This could point to persistent avoidance of stimuli related to the traumatic events he'd been through. Levi voiced a hatred of their back garden, related to it being connected to his grandfather's previous behaviors in his childhood. While he can go into those spaces, he avoids doing so outside of select circumstances.

Another aspect of PTSD are negative alterations in cognition and mood. For Levi, we can see most clearly this in the persistent state of rage that Levi showed throughout his childhood and early adolescence. While Levi attributes it to his other diagnosis's, his feelings of detachment or estrangement from others could have also resulted from the trauma he underwent by his family; likewise, the inability to experience positive emotions could also have resulted from the trauma he underwent since, effectively, birth.

PTSD presents with changes in arousal and reactivity. While Levi can present with a steady temper, there have been multiple instances that indicate that he often struggle with irritable and angry outbursts, sometimes with little to no provocation. This occurs when a trauma trigger is present, but also when Levi perceives being 'alone' in his experiences. These feelings of isolation ultimately led into self-destructive behaviors, including drug use and suicide attempts.

While his other diagnosis's likely cause the presentation of PTSD to be lessened compared to what would otherwise be expected, it appears safe to give Levi a positive diagnosis of PTSD.

Interaction of Diagnoses

The next thing to consider is how the variety of issues Levi presents with may interact or impact each other. At this time, we're running on the assumption that Levi has Antisocial Personality Disorder, Opioid Use Disorder, and Post-Traumatic Stress Disorder - a triad of mental health issues that present with a lot of overlap and interconnected symptomology.

For example, both PTSD and APD can cause an increase in negative emotional reactions and decrease of positive emotional experiences. In other words, an inability to experience the full array of emotional impulses that those without these conditions would. Likewise, both can lead to an increased risk of developing co-morbid conditions, such as the aforementioned Opioid Use Disorder.

When it comes to Levi, he comes with the question of which came first - the chicken or the egg? The APD - or Conduct Disorder, as it would have been in his childhood- or the PTSD? Levi has experienced a lack of emotional depth since a young age, with his first active perception of it being in his toddler years through the extreme levels of boredom he experienced. This would speak to the APD coming first, but with this being a known feature of PTSD as well, it complicates the ability to definitively say one way or another. With this being the case, we could likely chalk up the answer to 'Does it truly matter?' The introduction of both would have likely been close enough in time that the distinction, ultimately, impacts nothing in a meaningful way.

The introduction of the Opioid Use Disorder is a factor that could be directly attributed to both the APD and PTSD diagnosis. Had Levi not undergone the trauma that led to both conditions, perhaps he would have been less likely to fall into an addiction-based condition. Using substances was explained as a desire to feel 'normal' - in other terms, to experience life and emotions like other people, in whatever limited capacity the aether bloom could provide. If this is truly the case, then Levi may not have felt compelled to use it if he had the full array of emotions that his APD diagnosis prevents him from experiencing.

Due to the nature of Levi's conditions, and his general disposition, it is difficult to discern how each may interact with each other. A lot of assumptions need to be made in order to even theorize about them - for instance, his lack of emotional depth related to his APD could cause his PTSD to present in more subtle, nuanced ways compared to more typical presentations such as flashbacks. This could also be why it was difficult for most people in Levi's life to recognize the signs that he was undergoing a substance use disorder; while the effects on a neurotypical individual would have been more obvious through changes such as euphoria, for Levi the impacts were more like increased sensory experiences and increased tolerance for, as he put it, the 'vermin' around him.

Levi's responses to perceptions of isolation could directly result from PTSD. He divulged hopelessness regarding the ability of others to understand his unique brand of neurodiversity and lack of emotional breadth. When faced with the possibility that his beliefs were true, his responses were immediate and hallmarked with rage. We could view this anger as a defensive mechanism in the face of potential abandonment and further emotional abuse, or at least the perception of it on a subconscious level.

Treatment

While treating mental health is oftentimes viewed holistically, for this case study, we're going to separate each of the diagnosis's and discuss them individually.

For Antisocial Personality Disorder, there are no approved medications that can treat this condition. While medication can address other co-morbid conditions like anxiety and depression, the unique composition of APD means there is no easy means of addressing it via medication.

The primary means of treatment for APD is through talk, or psycho, therapy. While talk therapy cannot solve the underlying causes of ADP, they can use it to address the ongoing symptoms caused by it, including anger and violence management. In Levi's case, talk therapy would likely be ineffective because of his perception that the symptoms of his condition are, overall, a net positive for him, despite the isolation it causes. He would also struggle with participation in treatment because of his world view of most others being beneath him - this is illustrated in his limited experiences in rehab, where his view of the therapist was that of an annoying insect.

Treatment for Post-traumatic Stress Disorder can include aspects of exposure and cognitive therapy. That is, clients would undergo a gradual exposure to situations that trigger frightening memories in order to desensitize them and decrease negative reactions. Cognitive therapy involves finding new ways of thinking and perceiving the world around you in order to address negative beliefs about yourself and your environment.

Therapy would also focus on building stress management skills in order to address not just the reaction to trauma triggers, but general life stressors that can lead to increases in trauma responses.

Medication can effectively treat PTSD through management of depression-like symptoms; anti-anxiety medication can ease severe anxiety that result from PTSD and its variety of triggers, but often will be time limited in their use.

To address PTSD, Levi would first have to acknowledge the impact trauma has had on his childhood development and, furthermore, the impact it has had on his functioning as an adult. For similar reasons to ADP, it is likely that talk therapy would be rendered ineffective unless he could open himself to the idea that his innate views of the world and himself can change and that it could be beneficial for him to do so. Medication would likely not be used, as his symptoms are mild compared to what we would otherwise expect for someone with his trauma history.

In addressing addiction, the methods are much the same as other mental health conditions. Talk therapy, medication, therapy and self-help groups, and work on coping abilities are primary focuses in addiction treatment. Levi went through all the above as part of his experience during his stay in an inpatient rehab for opioid addiction, including the use of group and individual therapy.

Through reports of his experience, his usage of these kinds of treatment were ineffective in the traditional sense. His clear disdain for the other patients, as well as for the staff that attempted to work with him, made the likelihood of the treatment working positively fairly unlikely. With that being the case, a more creative treatment plan would need to be used that enables Levi to leverage his perceived higher intellect in order to address the emotional impacts of his conditions.

Prognosis and Conclusions

To reiterate, Levi Blake is a thirty-year-old cisgender man. He presents with the symptomology that indicates a diagnosis of Antisocial Personality Disorder, Opioid Use Disorder, and Posttraumatic Stress Disorder, with APD being the primary condition while OUD and PTSD would be secondary. The severity of each varies, with ADP being severe, OUD severe, and PTSD mild to moderate.

At this time. Levi does not present as willing to change these conditions. While he attained sobriety, he presented it as more of a challenge than because of any innate wish to be sober. Likewise, Levi showed hostility when faced with the possibility of differing from the way he perceives himself. In terms of the stages of change, Levi would likely be considered somewhere between precontemplation and contemplation; he has an awareness of the fact that he presents as neurodivergent, and that it can and previously caused harm, but does not see a need to change it or the way he addresses it.

Previous treatment has proven ineffective due to Levi maintaining the belief that others are less intelligent than him, and thus their professional knowledge is not sufficient to 'help' him. Levi often takes professional's efforts to assist as a fundamental misunderstanding of him as a person, and as such their suggestions should be disregarded.

That said, Levi has a small, but stable, support system. His husband, Raphael, is able and willing to work with Levi in ways that works most effectively with his form of neurodivergence, though it causes tension when their individual personalities clash. While he does not have 'friends,' per se, he has a handful of individuals that he will call on when he needs help in a professional capacity.

Despite the extensive amount of information available, it is difficult to glean how his conditions may progress and the treatments he may need in the future. Those with APD and OUD can sometimes experience a reduction in symptoms once they reach around forty years old, but whether that'll happen for Levi is unknown at this time because of the extensive nature of his trauma and unwillingness to address the underlying causes of his conditions.

With all the above considered, Levi's prognosis would be guarded.