Depression and Paranoid Personality Disorder

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Table of Contents

Introduction
Step 1: Diagnoses
Step 2: Decision Trees
Step3: Diagnostic Criteria
Step 4: Multiaxial Evaluation
Conclusion

Introduction

Mental health of a human being can be affected by a whole variety of both physical and mental factors. In the majority of cases, there is no single correct diagnosis because various disorders that characterize mental health usually come in combinations, and Ms. Bainbridge’s case is one of the examples of such a situation, because her symptoms reveal several possible diagnoses.

Step 1: Diagnoses

Probable Diagnosis

The probable diagnosis for Ms. Bainbridge is not limited to a single idea of, for instance, general depression. On the basis of the symptoms reported by Ms. Bainbridge, the probable diagnoses for her can also include the paranoid personality disorder and the posttraumatic stress disorder, as her paranoid symptoms seem to be conditioned by her childhood sexual abuse experiences associated with her father.

Possible Diagnosis

Possible diagnoses for Ms. Bainbridge are also three-fold. First, the patient can be diagnosed as the one having paranoia. Second, the symptoms of anxiety are also observed. Third, both above considered diagnoses might have been caused by substance abuse, as Ms. Bainbridge is reported to take cocaine for a rather long period of time. So, the diagnoses for Ms. Bainbridge include:

Probable Diagnosis	Possible Diagnosis	Not Probable Diagnosis
General Depression	Paranoia	Dissociative Disorder
Paranoid Personality Depression	Anxiety	Dementia
Posttraumatic Stress Disorder	Substance Abuse	Eating Disorder

Step 2: Decision Trees

The analysis of paranoia and anxiety caused by substance abuse (APA, 2000, pp. 191, 430) reveals that the diagnosis can be correct based on the symptoms, but the long-lasting nature of the symptoms rejects this diagnosis in favor of general depression mixed with paranoid personality disorder and posttraumatic stress disorder (APA, 2000, pp. 181, 429, 685). This diagnosis is correct because it has the matching symptoms, that are also listed in Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR in association with the mentioned disorders, and support for development in the patient’s background. The fact that numerous attempts of therapeutic treatment of the disorders brought to actual results is also an argument in support of the probable diagnoses presented above.

Step3: Diagnostic Criteria

The diagnostic criteria are the symptoms of the defined disorders. Thus, APA (2000) reveals that general depression is characterized by feelings of emptiness and worthlessness, loss of pleasure in common life activities, decrease of energy, suicidal thoughts and attempts (p. 181). All these symptoms were observed in Ms. Bainbridge as the case under analysis reveals.

Further on, the paranoid personality disorder is characterized by having doubts about people around the person, taking their actions as threatening or dangerous, displaying angry behavioral patterns, and being suspicious towards others (p. 429). Again, Ms. Bainbridge displayed all the listed symptoms of the paranoid personality disorder in her attitudes towards the male staff of the hospital, as well as her daughter and her boyfriend.

Finally, the posttraumatic stress disorder has three major symptoms: re-experiencing of the trauma through dreams and memories, trying to avoid places or situations reminding about the trauma, and permanent hyperarousal expressed in sleep problems and anger (pp. 685 – 686). Ms. Bainbridge displays all the above symptoms as well, which is expressed in her numerous flashbacks to the cases of sexual abuse she experienced being a child between 7 and 12 years. Accordingly, the case of Ms. Bainbridge proves that the patient displays all the symptoms of the three disorders found, and therefore the diagnosis is correct.

Step 4: Multiaxial Evaluation

Axis 1: General depression:

Posttraumatic stress disorder;
Substance abuse.

Axis 2: Paranoia:

Paranoid Personality Disorder.

Axis 3: None (the case under analysis gives no detail of illnesses related to this axis)

Axis 4: Sexual abuse in the early childhood:

Loss of employment and nursing license;
Living in a rather dangerous neighborhood where sexual abuse, drug trafficking, and mugging are common.

Axis 5: 20 – 11 on the GAF (Global Assessment of Functioning) scale

The patient has taken several suicide attempts; therefore, her behavior displays the danger of hurting herself;
The patient is aggressive towards male staff of the hospital, which evidences that she displays dangerous behavioral patterns towards others.

Conclusion

The symptoms of Ms. Bainbridge allow diagnosing her case as the one where a person faces a combination of general depression, paranoid personality disorder, and posttraumatic stress disorder. The correctness of the diagnosis is supported by the conformance of all the symptoms displayed by Ms. Bainbridge with the symptoms that are listed in Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR in relation to the mentioned disorders (APA, 2000).

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