MEDizzy - A 45-year-old teacher is having difficulty at work. He

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Personality Disorders

A 45-year-old teacher is having difficulty at work. He believes his colleagues are plotting against him and that they wish to force him to leave his job. He has had confrontations with several colleagues in which he has cited human rights law, and has threatened to use a solicitor. When one colleague asked him about his weekend plans, he was convinced this meant she was suggesting that he clear out his desk. He believes that it is right that he be promoted to vice-principal as he is clearly the best teacher in the school. He has left or been asked to leave four previous schools because of similar problems. What is the likely diagnosis?

ExplanationParanoid personality disorder is characterised by suspiciousness and a pervasive tendency to distort experience by misconstruing the neutral or friendly actions of others as hostile, a tendency to bear grudges persistently, a combative and tenacious sense of personal rights out of keeping with the actual situation, a tendency to experience excessive self-importance, and a preoccupation with unsubstantiated ‘conspiratorial’ explanations of events both immediate to the patient and in the world at large. Such individuals are highly querulous and often cause serious disruption in the workplace or the community. Their reduced capacity for meaningful emotional involvement and the general pattern of isolation overlaps with the other DSM-5 Cluster A personality disorders. A recent review pointed out that there is comparatively little published evidence for the reliability and validity of paranoid personality disorder and called for its exclusion from future diagnostic manuals. It has been excluded from Section III of DSM-5, which identifies disorders for further research. See Triebwasser et al (2013) and WHO (1992) and, for further reading, Harper (2010)