Case Study 19.1 Oscar, a 46-year-old man who has worked for over 20 years as a government contractor for the Department of the Army, was well known to all of his colleagues for his forceful negotiating skills and his ability to stay calm under pressure. Oscar had been an only child, raised by a doting mother who was in her 40s when he was born. She was delighted to have a child and always praised him and catered to his needs. He was 7 when his father died, and from that point on his mother started cooking his favorite meals every night for dinner. Even after he was married, his mother took dinner to his house every night so he would have a home-cooked meal. His wife Lexi, was instructed not to eat the food because “it was for Oscar” Both Oscar and his mother viewed themselves as superior to other people. When she was around them his wife was often the brunt of their irritability and annoyance that she did not wipe the kitchen sink dry after each use. Oscar and his mother were certain this was necessary to prevent ants, and that Lexi was “lackadaisical” about this important detail. It had been a bad year for Oscar. His mother had died at the age of 88, and he missed her constant praise, but mostly he missed her ziti and meatballs. The stress at home increased after his mother died, and Oscar was often irritable. In addition to his mother’s death, Oscar was being investigated at work for possible fraud in negotiating contracts. Over a million dollars was unaccounted for. His coworkers were starting to criticize him and Oscar came home from work every night grumbling about his “jealous inferiors” as he tried to keep the full extent of the investigation a secret from his wife. But his company’s annual Fourth of July party was only a month away and Oscar was sure he would be a main focus of conversation. His insouciant veneer was starting to crack. One night, after his wife made his favorite food, fried chicken, based on his mother’s recipe, Oscar took one bite and threw the plate of food across the room. “You are not Southern!” he screamed at her “and you never will be able to cook like my mother! Do I have to do everything myself?” The next day his wife called a therapist to make an initial appointment She expressed concern that her husband might not come to the appointment because he had not liked a previous therapist years earlier “No one is good enough for Oscar” she said. “He will ask you where you went to school, so I hope you have your diploma, license, and other certificates displayed on the wall in your office. He will be looking for them.” Indeed, on the day of their first session, Oscar shook hands with the therapist and asked where she had gone to grad school, while he scanned her credentials on the wall. After the first appointment, the therapist diagnosed Oscar with narcissistic personality disorder.
List the signs and symptoms that point to a mental health diagnosis in the case.
Describe the other case details you would need to know for treatment planning and explain your reasoning.
List and describe the treatment interventions you would use for this case and explain your reasoning.