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 Marcus
Marcus, a professor at
the university, has taught chemistry for over 20 years. Never an overly
friendly man, in recent years he has become increasingly alienated from his
colleagues. Students now regularly complain about his rude behavior during
office hours. He has been known to pause during lectures, look at the class,
and say, “I know what you’re doing.” (1) After gentle suggestions from
the department chair that he seek therapy were ignored, a firmer recommendation
was made in writing. Several appointments were made and then cancelled, until
Marcus finally learned that he would otherwise be taken off the teaching
schedule.
Marcus refers to himself
as a “military brat.” His family moved 11 times by his eighteenth year. His
parents are now deceased, and he has little contact with his older brother. He
describes his early years as an extension of military life. He and his brother
were expected to follow the rules of the home without discussion or emotion. As a slight, thin
child, Marcus was an easy target for bullies at each new school. He learned to
fend off attacks by keeping his distance, excelling in school, and becoming
vigilant.
At the beginning of the
session, Marcus maintains that there is nothing wrong with him. “The system
allows mediocrity,” he states, “but I will not allow it in my classroom. The students think they
can just breeze through my classes without working. By the end of the first
week, they know they are mistaken.” At this, Marcus pauses and seems to smile
to himself. (1)
As the interview
continues, Marcus maintains that the student’s complaints are part of a larger
plot involving other instructors and even the department chair. To upset their
plans, he has resolved to rule his classes “with an iron fist.” (2) He
lays traps for the cheaters, and states that several have now been caught and
brought up on charges of academic dishonesty. “I have no use for the
other faculty,” he states boldly. “They are jealous of my intelligence. They want
me out of the department because I make them look bad. (1) They had
their chance, and now, we are at an impasse, and I will never give in or trust
them again.” (5) He concedes that it is possible that he is wrong, but
“highly unlikely.” “The faculty make sure that every semester I get the bad
students,” he continues. “That way, when they complain about their low grades,
it looks like I’m a lousy teacher.” (6)
Marcus is firm in his
beliefs. He states that he has always done things his way, and that he has
always been right in the past. He has known for some time that he would need to
fight for his position at the university. In anticipation of a court battle, he
has kept careful records of all his activities as an educator. He seems to
relish the coming battle. “There is not a single blemish on my record,” he says
proudly. (1) “I have followed the rules to the letter, and I have the
goods on those who haven’t.” He concludes by saying that he will comply with
the order to continue therapy, because he knows that he was referred because
the department is looking for an excuse for his dismissal. (4)
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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