Personality Disorders:

Case Study: Dave is a middle-aged, successful self-identified male who comes to your office to inquire about counseling because he “has trouble getting along with me.” He has noticed this for many years but has not felt he really needed treatment until his most recent divorce from his third wife. Since childhood, Dave has been “obsessed” with money and power. When he was younger he got into trouble for some crimes such as breaking and entering and theft. He spent some time in jail and was on probation; however, he has not committed any crimes since he was in his early 20s. Dave reports that his success has come easily to him because “everyone else is weak or incompetent so I just step in and take over.” He also states “everyone wishes they were me.” He expects others to appreciate his brilliance and success. “I don’t understand why my wife and kids aren’t grateful. I’m not trying to brag, but my success makes the whole town treat us with respect.” Dave comments that he is not a particularly warm person, he does not appear to understand the needs or feelings of others, and appears to show no remorse for his prior actions or how he treats others. He states his prior wives were both “idiots.”
Based on the information above, what diagnosis (or diagnoses) would you consider and why? Are there any co-occurring diagnoses to rule out? What are some hypotheses you have as to how the potential diagnosis/diagnoses developed? What other cultural considerations or outside factors should we consider when conceptualizing this case?