A CASE OF Paranoid Personality Disorder
By: THEODORE MILLON
et al.
Notes:
(1) Numbers mark aspects of the case most consistent with DSM
criteria as follow, and
do not necessarily indicate that the case
“meets” diagnostic criteria in this respect.
(2) Patient's name has been changed in respect to
confidentiality, and names mentioned are not of a real existent person.
Case of Ron
Forced to seek counseling by the court, Ron was resistant from the
very start, even though assured that confidentiality is an important part of
the therapeutic relationship. He postures himself defensively, crosses his arms tightly across
his chest, taps his foot furiously in endless circles, and glares at the
interviewer, never breaking eye contact. An aggressive stance is firmly in
place. (3)
For almost a year now, Ron has refused to pay child support to his
former wife. Although he states openly that his position is “deplorable,” he
nevertheless answers specific questions only reluctantly. Sometimes, he
challenges the therapist by asking, “Why would you need to know that? I just
don’t see the relevance.” Otherwise, he deflects questions or gives only marginally
useful information. When asked why he is evasive, he pauses, makes piercing eye
contact, and says, “Because you never know when something might come back to
haunt you.” Obviously, he suspects that the therapist and the court have
ulterior motives. What he does answer paints him in the role of the victim. (3)
Eventually, he states that his wife has been unfaithful to him,
and that he suspects even his children, ages 7 and 12, are not his own. He
becomes more defensive when asked why he believes his wife has been unfaithful.
He offers no direct substantiation, but believes that she and his former best friend
have been carrying on an affair. “I can see it in their eyes when we’re
together,” he says. Apparently, the belief itself suffices for proof. Although
he admits his children do resemble him, he also asserts indignantly that both
his children and his friend have brown hair. The fact that his wife has brown
hair is unimportant. He maintains that he should not be ordered to support a
woman who has betrayed him and made his life intolerable. (7)
Ron is also having trouble at work. He notes that his coworkers have
been manipulating the time clock so that he is cheated out of pay, while adding
it to their own checks. “I can’t prove it yet, but I know they’ll slip up. I’m
keeping my eyes wide open for them. (2) They’re trying to humiliate me
in front of society by making it impossible for me to provide for a family.
They want to tarnish my good name before the community.” He admits that the
family is having problems with money, which he attributes to his coworkers. (6)
When asked why he believes these things, Ron becomes very
agitated, interpreting a simple request for information as blatant and insulting
skepticism. Each subsequent gesture and inflection is viewed with suspicion. (4)
He continues with a fusillade of remarks that malign his wife, and now, the motivations
of the therapist and the court. He states that he believes that he is the
victim of a well-conceived plan. Even his putative children are perhaps
coconspirators with all those involved. (1)
Moreover, he asserts, “I’ll
never forgive the injustices that have been done to me, and I’ll never forget them,
either. My memory is long, and I’ll see that those who have wronged me are made
to pay. You can count on that.” He glares at the interviewer one last time
before leaving. (5)
DSM-IV
Criteria
A. A pervasive distrust and suspiciousness of others such that their
motives are interpreted as malevolent, beginning by early adulthood and present
in a variety of contexts, as indicated by four (or more) of the following:(1) suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her
(2) is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates
(3) is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her
(4) reads hidden demeaning or threatening meanings into benign remarks or events
(5) persistently bears grudges, i.e., is unforgiving of insults, injuries, or slights
(6) perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack
(7) has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner
B. Does not occur exclusively during the course of Schizophrenia, a Mood Disorder with Psychotic Features, or another Psychotic Disorder and is not due to the direct physiological effects of a general medical condition. Note: If criteria are met prior to the onset of Schizophrenia, add “Premorbid,” e.g. “Paranoid Personality Disorder (Premorbid).”
References
(1) Personality Disorders in Modern Life, second edition,
2000, 2004 by John Wiley & Sons, Inc.
(2)Diagnostic and Statistical Manual of Mental Disorders,
Fourth Edition. Copyright
1994 American Psychiatric Association.
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