Brief Report: Delusional Disorder in a Male Adolescent with High-Functioning PDDNOS

By Hiroshi Kurita, (1999) Journal of Autism and Developmental Disorders, Vol. 29, No. 5, 419-423.

At age 18.8. this male patient with PDDNOS visited this author, his primary doctor since he was 2.1 years old, with his mother for the treatment of his strong fear of people criticising him.

At age 17.7 when he was a third year student of an ordinary high school, he began to feel strangers in the street and in the train on his way to school spoke ill of him. Such strangers, however, did not make hostile remarks directly to him. When he saw strangers talking, he perceived that their topics were an insult him.

His delusion had not markedly impaired his functioning except for several months before his index when while his symptoms were most severe. The diagnostic team also agreed that he satisfied criteria not for schizophrenia but for delusional disorder of persecutory type in DSM-IV.

After the index visit, he started taking bromperidol (i.e., antipsycotic) 5mg and trihexphenydil 6 mg daily. Then, his persecution gradually abated.

Although the causation of his persecutory delusion is unknown, the following pathological understanding may be possible. Since infancy, he had displayed various compulsive (repetitive) behaviours common in children with PDD. In high school, he developed repetitive checking and hand washing, which are typical compulsions more common in patients with obsessive-compulsive disorder than autistic patients. Along with these compulsions he seems to have fostered an obsessive (i.e., repetitive)thought about people criticising him through a long suffering from bullying. During his 3rd year of high school, this obsessive ideas seems to have changed to a persecutory delusion via an unknown mechanism. This shift is theoretically possible, as it is suggested that an obsession could become a delusion when resistance is abandoned and insight is lost.