Research Related to Paranoid Personality Disorders

Key Issues

Mr. Boyle, a fifty-five-year-old high school principal, presented himself for assessment. Mr. Boyle is encountering difficulties in getting along with his coworkers, the school board, and his family, which, as a result, has placed his job and marriage at risk. Mr. Boyle firmly believes that the school board and certain disgruntled parents are conspiring to have him removed from his position as principal. He also reports that his coworkers are jealous and complain about his overly structured manner, which drives them "nuts.

" Furthermore, he believes that he is being mistreated by the school board, which he feels has caused him to underperform and work below the standards he believes he could meet. Mr. Boyle reports he has been drinking more often than he would like as a mechanism to cope with all the stress he has been undergoing. However, he does not see this as a problem, but instead feels he needs to cut back. There is no other substance use listed in the case study.

According to reports from Mr. Boyle’s wife, he has always struggled with making friends and trusting others. She also reported that, since the denial of his pay raise, he has become more irritable and argumentative with faculty members and his friends. His children have reported that Mr. Boyle's strict and controlling behaviors are overbearing. His daughter thinks he is a “penny-pincher.” While he takes pride in not being easily intimidated or mistreated, he does acknowledge some responsibility for his tendency to overreact.

The following are the key issues presented in the case study:

• Has increased suspicion of others.

Believes that the school and parents are conspiring to have him removed from his position.

Argumentative and irritable with others at work.

Difficulty getting along with my wife and others.

Marriage and job in jeopardy.

Decreased interest in things.

A structured demeanor is causing issues.

Paranoid that others want his position,

• Issues making friends.

He feels he is being mistreated.

• Does not take responsibility but feels he is the victim.

Feels hopeless and helpless.

He's drinking more wine than he wants to.

Rationale.

Mr. Boyle's suspicious behavior is excessive and overbearing on the people around him, impacting his personal and professional life negatively. His suspicion is causing him to act paranoidly, which is mainly affecting his wife and daughter. This behavior also seems to be having a profound effect on his professional relationships, putting his job at risk. Mr. Boyle’s behavior is also affecting his standard of work, placing him even more at risk of losing his job.

Due to his paranoia and trust issues, his current mood instability is causing him to act out and drink more than he would like.

Diagnostic Impression

After analyzing Mr. Boyle’s symptoms, he best fit the Paranoid personality disorder (301.0-F60.0) under the Personality Disorder category. According to the American Psychiatric Association (2013), "Personality disorder is an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture, is pervasive and inflexible, and has an onset in adolescence or early adulthood." The American Psychiatric Association also lists Paranoid personality disorder as "a pattern of distrust and suspiciousness such that others' motives are interpreted as malevolent." Mr. Boyle's symptoms criteria fits 4 out of the 7 symptoms for paranoid personality disorder.

Suspicious of others without sufficient basis, Mr. Boyle finds himself intensely suspicious of the people around him. He feels they are conspiring against him, not to physically harm him, but to have him removed from his job. This fear aligns with his suspicion of others attempting to deceive him.

Being preoccupied with unjust doubt, Mr. Boyle has found himself feeling doubtful of his coworkers, the school board, and parents. Mr. Boyle believes he is mistreated by his peers and questions their motives.

Reluctant to confide in others, Mr. Boyle has found himself struggling to trust those around him. This lack of trust has increased due to information about others not approving of his structured demeanor. In fact, his wife reports that this has been an ongoing issue.

Mr. Boyle's recurring suspicion has led him to continuously monitor his daughter's every move, including her car's gas usage.

Possible Treatment.

Due to Mr. Boyle’s need to be in control and his presence for assessment because of his wife, initial treatment may be rejected. The hyper-vigilance associated with individuals suffering from paranoid personality disorder, along with their guarded and secretive ways, may make treatment challenging. Mr. Boyle's suspicious and argumentative behaviour could make it difficult to build trust in the treatment process with his counselor. Consequently, treatment would need to center on communication and building a trusting environment that is comfortable enough to initiate the trust-building process. Psychotherapy would be the recommended first line of treatment. Often, people with paranoid personality disorder do not believe they need treatment. Hence, this treatment would focus on developing coping skills and empathy. Cognitive behavior therapy could also be beneficial in restructuring Mr. Boyle's rigid and critical thoughts about others, and in improving social interaction. This approach could also aid his relationship with his daughter. The counselor should also address Mr. Boyle’s paranoia to ensure it does not progress to any other disorder. It is crucial to understand that treatment for this disorder may be more long-term than anticipated (Kring, Johnson, Davison, & Neale, 2014). The reason being that the treatment is more cognitively based, requiring more time for processing and application of new skills. After building a trusting relationship and working on cognitive therapy, Mr. Boyle could benefit from family therapy. This would address the needs for parental boundaries, trust, and communication.

Differential Diagnosis.

The differential diagnosis of paranoid personality disorders includes:

"Other mental disorders with psychotic symptoms: no mention in the case study."

Personality change due to another medical condition: no mention in case study.

• Substance use disorders, mentioned in the case study, were deemed to be minor.

Paranoid traits associated with physical handicaps were not mentioned in the case study, as no physical impairments were discussed.

"Other personality disorders and personality traits." (American Psychiatric Association, 2014).

Mr. Boyles could be considered for schizoid personality disorder and schizotypal personality disorder. These two disorders are in the same A cluster of personality disorders; however, they differ in that Mr. Boyle does not exhibit a willing desire to avoid social relationships; rather, he has difficulties forming and maintaining them. He also exhibits symptoms of obsessive-compulsive personality disorder in his need for control over his daughter’s constant whereabouts. He further manifests this symptom by monitoring her car gas usage to ensure she does not go where she is not permitted.

Spiritual, biological, and psychological impression.

Research on the causes of paranoid personality disorder is limited to the biological tendencies of paranoid personality disorders. Nonetheless, there seems to be some relation to families with schizophrenia and delusional disorder through genetic lineage (Hoermann, Zupanick & Dombeck). Generally, medication is not needed for this disorder. However, anti-anxiety, anti-depressant, and anti-psychotic medications can be prescribed for persons with extreme symptoms. The psychological aspect of this would be to address the client using a client-centered approach to develop a trusting atmosphere. This would also allow for cognitive therapy and family therapy.

Spirituality also plays a key role in this treatment. Of course, this would be explored after the initial treatments have been implemented and have taken some effect. Mr. Boyle struggles with trust, which could affect the healing process from a spiritual standpoint. He may feel anger and resentment towards God. In this case, the counselor would need to exercise caution when introducing faith-based therapy into the sessions.

References

American Psychiatric Association. (2014). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: Author.
Hoermann, S., Zupanick, C. E., & Dombeck, M. Biological Factors Related to the Development of Personality Disorders.
Kring, A. M., & Johnson, S. L. (2018). Abnormal Psychology. Danvers, MA: John Wiley & Sons.

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