This week, we are sharing another USMLE® Step 1-style practice question to test your knowledge of medical topics. Today’s case focuses on a 25-year-old man presents to the office due to a suspicion of being poisoned. The patient is suspicious that his neighbors have been tampering with his food lately and that they may have poisoned him. When the physician states that there are no signs or symptoms of poisoning, the patient becomes suspicious of the physician, asking if they are secretly working with his neighbors. Can you figure it out?
A 25-year-old man presents to the office due to a suspicion of being poisoned. The patient states that when he left for work this morning, he was certain that he had closed the door of the refrigerator. However, upon returning home, he saw that the refrigerator was slightly open. The patient is suspicious that his neighbors have been tampering with his food lately and that they may have poisoned him. He states that he suspects that his neighbors have been trying to break into his house and steal things ever since he moved here. He has tried multiple times to get them evicted from the building and expresses concern that “Now they’re trying to get their revenge.” When the physician states that there are no signs or symptoms of poisoning, the patient becomes suspicious of the physician, asking if they are secretly working with his neighbors. Which of the following is the most likely diagnosis in this patient?
A. Schizoid personality disorder
B. Paranoid personality disorder
C. Schizotypal personality disorder
D. Borderline personality disorder
E. Obsessive-compulsive personality disorder
Scroll down for the correct answer!
The correct answer to today’s USMLE® Step 1 Question is…
B. Paranoid personality disorder
Before we get to the Main Explanation, let’s look at the incorrect answer explanations. Skip to the bottom if you want to see the correct answer right away!
Incorrect answer explanations
A. Schizoid personality disorder
Incorrect: Individuals with schizoid personality disorder typically present with voluntary social withdrawal and limited emotional expression. This patient’s pattern of distrust and suspiciousness of others is consistent with a different diagnosis.
C. Schizotypal personality disorder
Incorrect: Schizotypal personality disorder is characterized by eccentric appearances, interpersonal awkwardness, as well as odd/magical thinking. This patient’s pattern of distrust and suspiciousness of others is consistent with a different diagnosis.
D. Borderline personality disorder
Incorrect: Individuals with borderline personality disorder typically have a history of instability with interpersonal relationships, self-image, and impulse control. This patient’s pattern of distrust and suspiciousness of others is consistent with a different diagnosis.
E. Obsessive-compulsive personality disorder
Incorrect: Obsessive-compulsive personality disorder is characterized by a consistent pattern of preoccupation with orderliness, perfectionism, and control. This patient’s distrust and suspiciousness of others is consistent with a different diagnosis.
Main Explanation
This patient demonstrates a chronic and pervasive pattern of distrust and suspiciousness; these symptoms are characteristic of paranoid personality disorder (PPD). PPD is a cluster A personality disorder that is characterized by generalized distrust and suspiciousness. Individuals with PPD tend to view others’ actions as hostile and will often bear grudges. Patients with PPD often lead guarded lives, which can be associated with other disorders such as schizoid personality disorder. There appears to be an epidemiological link between the cluster A personality disorders (paranoid, schizoid, and schizotypal) and schizophrenia. However, patients with cluster A disorders do not have persistent psychotic symptoms – though during periods of stress, patients with PPD may develop brief psychotic episodes.
Major Takeaway
Paranoid personality disorder (PPD) is a cluster A personality disorder that is characterized by generalized distrust and suspiciousness. Individuals with PPD tend to view others’ actions as hostile and will often bear grudges.
References
Geringer ES, Stern TA. Coping with medical illness: the impact of personality types. Psychosomatics 1986;27:251–261.
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