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 Stephen
The shy only child of
informally educated parents, Stephen was considered a “child genius” in his
early school years. Having always been pushed by his parents to succeed, he
received his doctorate in physics at 23 and was a celebrated student in his
department. Subsequently, however, things turned sour. He held several middle
level positions as a research physicist in a number of industrial firms, going
from one to another following a series of disputes, claiming that others were
trying to steal his ideas. (1)
Stephen’s father also
had considerable difficulty in his career. Although uneducated in a formal
sense, he understood a great deal of technical information, consulting with
several companies who sought someone with his detailed knowledge and inventive
mind. But these positions did not long endure. In less than a year, two at most,
Stephen’s father would alienate almost all of his colleagues, accusing them of
trying to steal his ideas and of not paying him what he was worth. Stephen
recalled quite vividly the dinner table conversations when his father would be
furious because he was being “fired again” because he was “too smart for the
fools around him.”
In a similar pattern,
Stephen’s own arrogance and egocentricity were now creating conflicts with his
supervisors, who felt Stephen spent too much time on his own “secret schemes”
and not enough on company work. (3) Anyone who commented on his
projects, even in a constructive manner, was subsequently greeted with
condescension. (4) Eventually, Stephen was assigned less important jobs
that made him feel that both his supervisors and subordinates were “making fun
of him” by not taking him seriously. (6)
Almost as revenge,
Stephen began to work on a scheme that would “revolutionize the industry,” a
new thermodynamic principle that, when applied to his company’s major product,
would prove extremely efficient and economical. He worked in private as long as
possible, refusing to share any of his ideas with his “turncoat colleagues.” (5)
After several months of what was
conceded by others as “brilliant thinking,” (2) he presented his plans
to the company president. Brilliant though it was, the plan overlooked certain
obvious simple facts of logic and economy.
Upon learning that his plan
had been rejected, Stephen withdrew to his home and established a habit of
drinking to excess. Thereafter, he became obsessed with “new ideas,” proposing
them in intricate schematics and formulas to a number of government officials
and industrialists. New rebuffs followed, which led to further efforts at self-inflation.
Not long thereafter, he lost all semblance of reality and control. For a brief
period, he convinced himself that he was Niels Bohr, a famous quantum
physicist. Whether such grandiose delusions could be attributed to his drinking
problem and personality problems, or were better conceived as an outgrowth of
his paranoid personality pattern alone, was a major question for clinical assessment.
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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