Category: cases

George moved to the city after completing his Communication studies in hopes to break into the fashion industry. He wanted to be an editor in a big-name fashion magazine or website. George had been involved in fashion his entire life, modeling since he was a teen and keeping a blog where he documented his outfits and purchases.

George soon learned that his background was far from unique and that, without good contacts in the industry, even finding an internship can be a difficult task. He could have tried applying to lesser known fashion media outlets but that was not for him. George would either work for an influential publication or he wouldn’t work in fashion at all.

When I met him, he had just joined the company I worked for and he was being trained to become an account manager. He was quick to tell us about his previous modeling career, his aspirations to become a fashion editor and how this job was only temporary for him.

Two months in, he was frustrated by everyone. He believed that, even as a junior manager, he was bringing more to the company than most people. Account management was the hardest and most vital part of the business and he wasn’t being recognized enough for it. He also disagreed about crucial matters with his superiors.

George told me this while we sat at the best table of a fancy restaurant during our lunch break. He had insisted on being placed there and had been offended by where the waiter wanted us to seat initially. It was then that I realized how much certain things mattered to George. He needed to have the best of everything: the best clothes, the newest phone, the ideally located apartment and the fanciest vacation. He also needed to be constantly recognized and reinforced for being exceptional.

After a while, I realized that George would only talk to me when he needed to vent and discuss his frustrations. He had no interest in my life, but that was his modus operandi when it came to friendships. George had an amateur photographer friend who he would only call up to get pictures for his blog, another friend he would only meet up with to go to certain clubs where she was guest-listed, an office buddy from IT he would only talk to if he needed a personal tutorial about how to use certain software but ignored otherwise…and the list goes on. The more I listened to his stories, the more I realized he never did anything for anyone in return. When complaining about co-workers, he lacked empathy for other people’s problems and circumstances.

Intensive networking produced results and George got a new job opportunity in the industry he loved. But after a year working for a fashion magazine, he was frustrated with his career not going the way he had expected. He decided to quite some time after and borrowing some money from his parents, started his own online shop selling up-and-coming fashion designer clothes.

I only spoke with him a couple of times after this. He told me his business was going very well and that a big fashion retailer would buy them out soon. He was wondering whether he should stay in the company or take the money and start something new.

In reality, the offer never materialized and George kept running his company with moderate success. His online store was profitable but he felt like a failure. He also felt that a lot of people have let him down. He started seeing a therapist that diagnosed him with depression and narcissistic personality disorder.

Nadia had a rich social life. She always had plans and seemed to be juggling several groups of friends. In reality, Nadia wasn’t able to establish healthy relationships with anyone. She would pursue someone’s friendship intensively only to distance herself from that person all of a sudden. She always claimed she had been wronged in some way or that people had stopped liking her.

Nadia had a good paying job with a permanent contract but -as I later found out- she had been “invited to leave” her previous one. The final straw had been Nadia’s emotional outburst in the presence of a patient. At the new clinic, she was experiencing the same issues that had gotten her fired. She, again, had a difficult relationship with her supervisor and disagreed with most of her decisions and assigned tasks.

The most worrying thing about Nadia was her dangerous and self-damaging behavior. It was common for her to go back home with a guy she had met that same night. Initially, we shrugged it off. After all, we all had a liberal mentality and we thought she was just enjoying her life and her freedom.

It was only when Nadia admitted she never practiced safe sex that we realized her behavior wasn’t just about being free spirited. She said she didn’t need to use condoms as she was already taking the pill to avoid getting pregnant and that the possibility of getting an STD made it all more exciting. She also said she would sometimes try drugs that were offered to her without knowing or caring for what it was.

We asked Nadia to at least let us when she was going home with a stranger but she refused to do so. She would disappear in the middle of the night and turn off her phone. This last point made people distance themselves from her as it was too much to handle.

In one of the rare instances in which Nadia seemed more calm and mellow, she confided that she sometimes felt like the ugly duckling and other times like the most attractive woman in the room. That was the reason why she acted the way she did, she claimed.

After some months during which I only saw Nadia occasionally, she called me to let me know she had decided to move to another city. She wanted to start from zero and leave her past behind. She said she would look for a psychologist there, as I had advised her. She did and she was eventually diagnosed with borderline personality disorder.

Prevalence in the general population: 0.7%– 1.6%*
Comorbid with: Schizotypal (15.2%), Paranoid (12.3%), Antisocial (9.5%)*
More common in females
Course: Symptoms actually improve once the person affected reaches their 30s

*Sources: Lenzenweger et al. (2007)
Torgersen, Kringlen, and Cramer (2001)
Zimmerman, M., Rothschild, L., & Chelminski, I. (2005)

I met Roy at a local bar. That Friday night, he had reluctantly joined his co-workers (my friends) for drinks. He wasn’t particularly interested in the conversations so I started talking to him.

Roy told me he had been working and living in the city for over two years. He said he didn’t know many people in here. On the weekends he would get in his car, drive for a couple of hours and hike at some remote location. He played guitar but he didn’t like going to concerts or playing with other people. I got the feeling he wasn’t enjoying our conversation so I left him alone.

I only saw Roy a handful of times the next year. Always at the same bar, with his co-workers but unwilling to socialize. He was a good-looking guy in his late twenties so he would attract some female attention. Roy however, was never responsive to those advances. He wasn’t shy or afraid to speak to girls, he just didn’t want to flirt and didn’t care for them.

My friends were convinced he was gay and afraid to come out to them, but speculations ended when he started dating a girl we all knew. The relationship was brief and not without troubles. Roy wasn’t very involved and kept going on solitary hikes every weekend.

The deal-breaker for the girl, she later confided, was the fact that they almost never had sex. She started believing that the rumors about his orientation were true but then found out that Roy had a big collection of heterosexual porn he watched regularly. When she finally broke things off with him, he didn’t seem relieved nor upset.

After the breakup, Roy had the perfect excuse to avoid the bar and us all together. He’d go to work every day and come home to himself. He wouldn’t even travel to his hometown for the holidays and had very little contact with his family.

The following year, Roy started drinking heavily. It was obvious for everyone in the company that he had a problem. His work started to suffer and HR recommended he seek ‘counseling’. He was reluctant to do so but he was also afraid to lose his job. He was eventually diagnosed with alcohol abuse and schizoid personality disorder. After two months of therapy, Roy quit his job and moved away. We never heard from him again.

Prevalence in the general population: 1.7%–4.9% *
Comorbid with: Schizotypal (19.2%), Avoidant (12.3%), Obsessive-compulsive (5.5%) *
More common in males
Course: Insufficient information

*Sources: Lenzenweger et al. (2007)
Torgersen, Kringlen, and Cramer (2001)
Zimmerman, M., Rothschild, L., & Chelminski, I. (2005)

Renée came from a close-knit family that had moved out of a small town in search of a better life. Her parents never fully embraced the city life. They were used to unlocked doors and familiarity. Their big apartment building with little neighborly interaction made them feel alienated.

Renée and her younger brother were constantly reminded about the potential dangers in every corner. They were also advised not to trust anyone outside of their small family. Sleepovers were not allowed and play dates in someone else’s home were a rare occurrence. They hardly interacted with people outside of school.

When Renée was 17 she was trying to get admitted to a top-ranked university. Unfortunately, her GPA had gone down in the last two years. She complained that her high school teachers were lowering her grades on purpose. She said they never liked her and did not want her to succeed.

Renée was finally accepted in another university. During her four years as a student, she didn’t make any friends. She was distrustful of everyone. She hid food in her dorm room and locked her drawers. She believed her roommates were trying to steal the nice things she had.

She moved out of campus as soon as she could. Her relationship with her classmates was also rocky. Renée refused to compare her notes with anyone. Group assignments with her were described as “a nightmare” by her peers. Renée would start arguments about how little credit her ideas received. She was also unable to accept any criticism.

After graduating, Renée started working a clerical position at a relative’s company. There she met and started dating Nick. After a short ‘honeymoon phase’, the relationship quickly soured. Renée claimed that Nick was cheating on her with another co-worker. She was convinced that everyone in the company knew about it. She also believed that some colleagues were covering up for them.

This suspicion led to several emotional outbursts in the office. She accused her co-workers of conspiring to destroy her relationship. She also brought up long-gone issues she has had with each of them. Nick decided to break up the relationship.

Renée’s parents were informed about her situation and it was recommended that she speak to a psychologist. After a psychological evaluation, she was diagnosed with a paranoid personality disorder.

Prevalence in the general population: 2.3%–2.4% *
Comorbid with: Schizotypal (37.3%), Borderline (12.3%), Narcissistic (8.7%) *
No gender differences
Course: Insufficient information

*Sources: Lenzenweger et al. (2007)
Torgersen, Kringlen, and Cramer (2001)
Zimmerman, M., Rothschild, L., & Chelminski, I. (2005)

When I first met Sonia, she struck me as the most extroverted and welcoming person in the office. She knew every person in the company, chatted with everyone and seemed to have a special type of relationship with most of our co-workers.

She soon complimented my skills and job experience in private. She also appointed herself as the unofficial leader of our small team. She enjoyed leading our meetings and having people report to her. However, she was not very interested in who was doing what or actual productivity.

Sonia spent most of her day in meeting rooms or hanging out in the breakroom. She also put a lot of effort into organizing get-togethers and parties outside of work.

After a couple of months, I grew tired of Sonia’s intense nature. Every little work issue was blown out of proportion, every matter was about her. I also started noticing how she insisted male co-workers join for after-work drinks while most female colleagues were deliberately left out of her plans.

It was only during our first meeting with some senior managers that I observed she was flirtatious in professional settings too. It took me some time to realize that Sonia was not trying to get ahead, she just yearned for the attention.

In reality, Sonia was quite a lonely person. She was about to turn forty and had lived in the same city for years, yet -who she considered- her closest friends, were people she had only recently met.

She had strong opinions about everyone. People Sonia liked were usually described as ‘the most loyal, good-hearted, amazing friend’ she could ask for. People she didn’t like -or paid her little attention- were considered ‘toxic, double-faced or insincere’.

After a series of organizational changes, we were left under the supervision of a boss she could not charm. He was more experienced and demanding than previous bosses. He also refused her advances quite clearly.

Sonia told everyone she was being bullied and decided to hand in her resignation. She claimed she already had several job offers lined up. The perks of having such good friends in the industry, she said.

Three months into unemployment she went to see a therapist who eventually diagnosed her with histrionic personality disorder.

Prevalence in the general population: >1%–2.0% *
Comorbid with: Narcissistic (13.2%), Dependent (9.5%), Schizotypal (9.4%) *
No gender differences
Course: Chronic

*Sources: Lenzenweger et al. (2007)
Torgersen, Kringlen, and Cramer (2001)
Zimmerman, M., Rothschild, L., & Chelminski, I. (2005)