Paranoid Personality Disorder Case- Dr. Schatzky

Paranoid Personality Disorder Case- Dr. Schatzky

Paranoid Personality Disorder Case- Dr. Schatzky

A professor of dermatology at University Hospital, Dr. Schatzky had never consulted a mental health professional. But he was well known to the staff at the medical center and notorious among his colleagues. One of them, Dr. Cohen, provided most of the information for this vignette.

Dr. Schatzky had been around for several years. He was known as a solid researcher and an excellent clinician. A hard worker, he supervised fellows working on two grants and carried more than his share of the teaching load.

One of the trainees working in his lab was a physician named Masters. He was a bright, capable young man whose career in academic dermatology seemed destined to soar. When Dr. Masters got an offer from Boston of an assistant professorship and his own lab space, he told Dr. Schatzky that he was sorry, but he would leave at the end of the semester. Furthermore, he wanted to use some of their data.

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Dr. Schatzky was more than upset. He responded by telling Dr. Masters that “what happened in the lab stayed in the lab.” He wouldn’t allow anyone to “rip him off,” and he told Dr. Masters that he would be blackballed if he tried to publish papers based on their findings. Furthermore, Dr. Schatzky told him to keep away from the students until he left. This outraged the other dermatologists. Dr. Masters was one of the most popular young teachers in the department, and the notion that he shouldn’t have any contact with the students seemed punitive to all and little short of an assault on academic freedom.

The other dermatologists discussed the situation in a department meeting when Dr. Schatzky was out of town. One of the older professors had volunteered to try to persuade him to let Dr. Masters teach anyway. Subsequently, Dr. Schatzky refused with the response, “What have I done to you?” He now seemed to think that the other professor had it in for him.

This professor told Dr. Cohen that he wasn’t really surprised. He’d known Dr. Schatzky since college, and he’d always been a suspicious type. “He won’t confide in anyone without a signed loyalty oath,” was how the other professor put it. Dr. Schatzky seemed to think that if he said anything nice, it would somehow be turned against him. The only person he seemed to trust completely was his wife, a rabbity little creature who had probably never disagreed with him in her life.

At the meeting, someone else suggested that the department chairman should talk to him and try to “jolly him along a bit.” But Dr. Schatzky had little sense of humor and “the longest memory for a grudge of anyone on the face of the planet.”

In the collective memory of all the staff, Dr. Schatzky had never had mood swings or psychosis, and at department dinners, he didn’t drink. “Never out of touch with reality, only nasty,” said Dr. Cohen.

Evaluation of Dr. Schatzky

I begin with a disclaimer: From the information available in this vignette, it would appear that Dr. Schatzky had never been interviewed by a mental health professional. Any conclusions must therefore be tentative. Clinicians simply have no right to make definitive diagnoses of patients—or just plain people—for whom they haven’t gathered adequate information.

That said, Dr. Schatzky’s symptoms had apparently been quite constant and present throughout his entire adult life (at least since college). His problems involved both his thinking and his interpersonal functioning, which in turn led to problems with his work and personal life.

What symptoms of PPD did Dr. Schatzky have? Without cause, he suspected young Dr. Masters of planning to “rip off’ his data (criterion A1). His colleagues noted his long-standing concerns about the loyalty of associates (A2). He would never confide in others (A3), and he refused to let Dr. Masters teach, which sounds a lot like holding a grudge (A5). (However, he had apparently never questioned the loyalty of his wife, which would be another common symptom of this PD.) So we can find a total of four symptoms, which is what’s required for a diagnosis of PPD.

Could a non-PD diagnosis explain Dr. Schatzky’s behavior as described? Although the information is incomplete, drug or alcohol use appears unlikely. (It also seems unlikely that anyone of middle age could have been taking a medication long enough to produce character disturbance that had lasted his entire adult life.) The vignette provides no evidence of another medical condition. According to the information provided, Dr. Schatzky had never had frank psychosis, such as delusional disorder or schizophrenia, and he had no mood disorder (B).

What about other PDs? Patients with schizoid PD are cold and aloof, and as a result may appear distrustful, but they do not have the prominent suspiciousness characteristic of patients with PPD. Patients with schizotypal PD may have paranoid ideation, but they also appear peculiar or odd (not the case here). And Dr. Schatzky didn’t appear to prefer solitude. Those with antisocial PD are often cold and unfeeling, may be suspicious, and have trouble forming interpersonal relationships. However, they rarely have the perseverance to complete professional school, and Dr. Schatzky had no history of criminal behavior or reckless disregard for the safety of others.

With a GAF score of 70, Dr. Schatzky’s tentative diagnosis would be as follows: