Paranoid Personality Disorder and its Treatment - Case Study Example

A Case Study of Paranoid Personality Disorder and its Treatment In my paper, I will attempt to present an interesting and authentic study of a clinical case of paranoid personality disorder in an adult, educated, working woman. I will then show the current methodology and efforts of treatment through a classical approach with cognitive behavioral therapy. A thorough case report on the patient, the manifest symptoms, details of my treatment and a procedural analysis of the same are presented in the following sections. Case Report and Analysis Name: Amrita Desai Age: 38 years Presenting Information: The patient in question is an adult woman of Indian Origin living in the United States. She is thirty-eight years of age, working in a multinational company in a managerial position. She is recently divorced and a single mother of a ten-year old child. Mrs. Desai began to exhibit signs of hysteria and paranoia with delusional episodes. Presenting Problems and Clinical Symptoms: An Overview Mrs. Desai came for treatment about six months ago on court recommendation for anger management. She has been experiencing sudden fits of rage and manic episodes over one year, since her divorce. She had been short-listed for a recent promotion and this had given rise, by her account and in her words, “to dirty politics and a cutthroat rat race”. Her initial account of the episode in question was very incoherent and involved. It included sudden outbursts of rage and numerous digressions. Her inability to maintain focus seemed to stem from a subconscious effort to justify herself against, what she believed to the nefarious plots of her colleagues to push her out of the running for he aforementioned promotion. Mrs. Desai began showing traits of paranoia and persecution mania from early on during the session. It began with the account of her experience in the office. She stressed on the unfairness of her boss, of the work culture. She believed herself to be unjustly victimized by undue pressure, low recompense and the political “motives” of her colleagues. Her deliverance was often interrupted by her frequent denigration of her husband and even her child’ and She went as far as to call him a ‘hindrance” and accused him of being “one of them”. Her criminalization of what seemed to be past disputes with her husband and her believe in the complicity of her 10 year old child in her divorce was manifest proof of paranoia and delusional persecution mania. Mrs. Desai specifically emphasized on the fact that her husband wanted to take their son away and that he was out “to get her”. At an interesting point in the session, Mrs. Desai, on record, that since her divorce every time she entered the office cafeteria she could hear people lower their voices, point at her and whisper among each other. This particular instance is noteworthy because this parallels a case, of a woman named Donna who presented similar symptoms and almost an identical account, as recorded by Duane L. Dobbert in his introduction to personality disorders in his book Understanding Personality Disorders. (2007) Evidence Based Treatment Approach and Rationale The approach to the treatment of Mrs. Desai was directed towards an adapted clinical methodology of Cognitive Behavioral therapy. The treatment entailed the customary lines of treatment by employing strategic mildly negative and alternately positive reinforcements. Over the course of six months, the doctor continued to deliver several therapy sessions to Mrs. Desai, a fragment of whose record is present in the following section. For a cognitive therapist, the primary task was to rehabilitate my patient within the sphere of reality by constant emotional reinforcement, support and rapport. However, the course of the treatment required certain classical and highly rewarded methods of clinical application of psychology as well. The patient required the therapist to pull her out of the negative delusions. Her efforts to do the same by a constant reminder of the impossibility and improbability of her paranoid illogical thinking began with the targeting of the persecution mania. Karg and Alford, the pioneer authors on delusion and paranoia, had once stated that cognitive behavioral therapy is, in fact, “collaborative enterprise between the patient and the therapist” (Kantor, 2004) Psychologists believe, that the considerable success of the treatment lies in this very human fact. In accordance to the prescribed practice of the Cognitive Behavioral method as adopted by noted psychologists such as Karg, Alford, Millon and Davis, the aims was to, carefully and consciously, avoid any appearance of unsupportive nature and refrained from delivering direct negative strictures. Such direct negative association to the thought process of the patient can increase her propensity to resistance, or worse, a deterioration of her condition. Subtlety and patience are the first requirements of Cognitive therapy. The correction of cognitive errors involved in the patient’s paranoid cognition could be addressed directly or indirectly. The doctor alternated between the two modes of cognitive reorganization and thought reinforcement, as is the general practice among psychologists. Multicultural Issues: A General Note on the Socio-Cultural Aspects of Paranoia Paranoia has been identified as the third greatest affective factor in mental health problems. (Munro, 2004) Much of the patients on record come from well-educated backgrounds, and are themselves parts of the fast emerging and rapidly growing technical fields. Paranoia and its concomitant personality disorders like delusions and manic outbursts are becoming very common among the urban population. Paranoia/ delusional disorder, in fact, are among the most common forms of psychological complaints and form some of the most evident cases of psychoses. (Munro, 2004) Paranoia often becomes associated with delusions and a variety of hallucinations. Paranoia are accompanied with such delusions that often may vary to a great degree and cover an astonishing of psycho-social hallucinatory, behavioral and personality disorders. They may be socially/culturally determined, litigious erotomaniac, grandiose or persecutory and, in some most cases, both. (Kantor, 2004) In severe cases, these hallucinations may border on, or even become a particularly destructive form of schizophrenia. Early detection and regular therapy and medication are primary requirements for the patients. In the case of Mrs. Desai, the assimilative pressure of an immigrant, the interrelated pressure of a failed marriage (that can be attributed to an inability to maintain personal and social relations) and the tremendous anxiety of a competitive market in a foreign land were responsible for her deteriorating mental health. The cultural stigma and blame for her failures in both professional and personal life, was, in her mind, a direct consequence of her divorce. Fragment of a Transcript Dr. X: Today we will try to reorganize our perception of reality. Do you follow me, Amrita? Mrs. Desai: I don’t understand really. Dr. X: We will try to see your thoughts in a different way. Do you remember me telling you about cognitive behavioral method and positive reinforcement? Mrs. Desai: Yes, I do. Dr. X: Ok. I want you to imagine yourself as a “practical scientist” who doubts everything that does not make rational sense. Mrs. Desai: But I feel nervous. Dr. X: It is perfectly natural to be nervous. We are all nervous abut different things. But you are doing really well. Let us talk about the little things first… Conclusion: Following the prescribed mode of treatment, Mrs. Desai was repeatedly shown that her thoughts of persecution and delusions were “constructs of reality” rather than reality itself. (Dobbert, 2007) Without claiming to dispense of her thoughts as unreal or absurd, the therapist systematically and gently reinforced the contrary idea that eventually would diminish her rigidity of faith in her own delusions and mania. By slowly breaking down her defense system and persecution paranoia, she was brought into a moderately improved interpersonal identification of positive cognition. References Munro, Alistair. (2004). Delusional Disorder: Paranoia and Related Illnesses. Cambridge: Cambridge University Press. Kantor, Martin. (2004). Understanding Paranoia: A Guidebook for Professionals, Families and Sufferers. Westport, CT: Praeger Publishers. Dobbert. Duane L. (2007). Understanding Personality Disorders: An Introduction. Westport, CT: Praeger Publishers. Read More