What is the DSM-5-TR Diagnosis for Clinical Case below?

Clinical Case:

Frazier Archer was a 34-year-old single white man who called a mood and personality disorders research program because an ex-friend had once said he was "borderline," and Mr. Archer wanted to learn more about his personality conflicts.

During his diagnostic research interviews, Mr. Archer reported regular, almost daily situations in which he was sure he was being lied to or deceived. He was particularly wary of people in leadership positions and people who had studied psychology and, therefore, had "training to understand the human mind," which they used to manipulate people. Unlike those around him, Mr. Archer believed he did not "drink the Kool-Aid" and was able to detect manipulation and deceit.

Mr. Archer was extremely detail oriented at work, and had trouble delegating and completing tasks. Numerous employers had told him that he focused excessively on rules, lists, and small details, and that he needed to be more friendly. He had held numerous jobs over the years, but he was quick to add, "I've quit as often as I've been fired." During the interview, he defended his behavior, asserting that unlike many people, he understood the value of quality over productivity. Mr. Archer's wariness had contributed to his "bad temper" and emotional "ups and downs." He socialized only "superficially" with a handful of acquaintances and could recall the exact moments when previous "so-called friends and lovers" had betrayed him. He spent most of his time alone.

Mr. Archer denied any significant history of trauma, any current or past problems with substance use, and any history of head trauma or loss of consciousness. He also denied any history of mental health diagnosis or treatment, but reported that he felt he might have a mental health condition that had not yet been diagnosed.

On mental status examination, Mr. Archer appeared well groomed, cooperative, and oriented. His speech varied; at times he would pause thoughtfully prior to answering questions, causing his rate of speech to be somewhat slow. His tone also changed significantly when he discussed situations that had made him angry, and many of his responses were lengthy, digressive, and vague. However, he seemed generally coherent and did not evidence perceptual disorder. His affect was occasionally inappropriate (e.g., smiling while crying) but generally constricted. He reported apathy as to whether he lived or died but did not report any active suicidal ideation or homicidal ideation.

Notably, Mr. Archer became irritated and argumentative with research staff when he was told that although he could receive verbal feedback on his interviews, he could not receive a copy of completed questionnaires and diagnostic tools. He commented that he would document in his personal records that research staff were refusing him the forms.

by: Larry J. Siever, M.D., Lauren C. Zaluda, B.A. in Clinical Cases (2013) by the American Psychiatric Association.