Lesson 4: Personality Disorders

Description

Garry, an outwardly charming 21 year-old man, reluctantly agreed to see a psychiatrist as suggested by his college counsellor. Upon arrival at the first session, however, Garry announced that he had no problems and that he only came to the session to get his parents “off his back.” He said that he relied on his parents for money but not for emotional support. His parents were present at the session.

The college counsellor recommended psychiatric help for Garry because Garry was spreading malicious rumours about teachers. Specifically, Garry spread rumours about teachers in classes in which he performed poorly. He implied that the teachers were having homosexual affairs with students. These false rumours, coupled with the fact that Garry had inconsistent attendance following his separation from his girlfriend, prompted the recommendation for psychiatric counselling by his college counsellor.

Garry did not think his poor school performance was a problem. He did think, however, that his theatrical successes were being overlooked and that everything was, in his view, “all right.” Garry admitted that the rumours were false, but he did not appear remorseful or concerned in any way. Garry was a distant man who liked having intellectual conversations. However, he was cynical and patronizing during the psychiatric interview and had an “air of superiority” about himself.

Garry’s mother was stylishly dressed, nervous, and outspoken. She said that Garry had been a good baby and an extremely gifted child. She also noted that both she and his father doted on him – especially after her miscarriage of a sibling a year after Garry was born. The father was a quiet yet successful man. He admitted to confiding in Garry when Garry was young, but after the birth of his two siblings, Garry had become distant and resentful. Garry’s father commented that Garry would have liked to have been an only child. Garry showed a dislike for both his siblings and authority figures.

In elementary school, Garry did not interact with other children often. After a change in teachers, when he was ten, Garry became increasingly arrogant and withdrawn. In fact, Garry refused to participate in class despite maintaining good grades. In high school Garry had also spread rumours about a fellow student. He and the other student were both competing for the same role in the school play. Other students often considered Garry a “loner” even though he claimed he never felt lonely. Garry distanced himself from his parents who thought that he was, because of his demeanour, a sad and lonely person.

His relationship with classmates was one of admiration on their part more than friendship. Other students did not socialize with him, but rather came to him for help with academic work. Garry understood that others thought him cold and insensitive, but he did not care. In fact, Garry thought that not needing friends was a measure of strength and that, when others complained about his demeanour, he believed it was because they were weak. He believed that others were jealous of him and wanted attention from him.

Garry dated occasionally, but it was his last relationship that was linked to his erratic school attendance and performance. His most recent girlfriend was the first person with whom he had had a sexual association. The relationship ended after she expressed a desire to spend more time with her friends and go to more school functions – something he was reluctant to do so.

Diagnosis

It is evident that Garry believed himself to be better than others. He was insensitive to other people (lack of empathy) and, from his school records, did not believe that school rules applied to him. With respect to the spreading of rumors, his actions show that he was interpersonally exploitative. This information, coupled with his jealousy of his siblings, his belief that others were jealous of him, and his need for admiration and attention resulted in the Axis II diagnosis of narcissistic personality disorder.