Paranoid Personality Disorder

Paranoid Personality Disorder

Paranoid Personality Disorder is a pattern of distrust and suspiciousness such that others' motives are interpreted as malevolent. It is one of a group of conditions called "Cluster A" personality disorders which involve odd or eccentric ways of thinking. People with PPD also suffer from paranoia, an unrelenting mistrust and suspicion of others, even when there is no reason to be suspicious. This disorder usually begins by early adulthood and appears to be more common in men than in women.

Features

 

Primary features of PPD according to DSM-5 are:

1.     Individuals with this disorder assume that other people will exploit, harm, or deceive them, even if no evidence exists to support this expectation

2.     They are preoccupied with unjustified doubts about the loyalty or trustworthiness of their friends and associates, whose actions are minutely scrutinized for evidence of hostile intentions

3.     Individuals with paranoid personality disorder are reluctant to confide in or become close to others because they fear that the information they share will be used against them

4.     They read hidden meanings that are demeaning and threatening into benign remarks or events

5.     Individuals with this disorder persistently bear grudges and are unwilling to forgive the insults, injuries, or slights that they think they have received

6.     They are quick to counterattack and react with anger to perceived insults

7.     Individuals with this disorder may be pathologically jealous, often suspecting that their spouse or sexual partner is unfaithful without any adequate justification

8.     Individuals with paranoid personality disorder are generally difficult to get along with and often have problems with close relationships.

Symptoms

People with PPD are always on guard, believing that others are constantly trying to demean, harm, or threaten them. These generally unfounded beliefs, as well as their habits of blame and distrust, interfere with their ability to form close or even workable relationships. People with this disorder:

• Doubt the commitment, loyalty, or trustworthiness of others, believing others are exploiting or deceiving them.
• Are reluctant to confide in others or reveal personal information because they are afraid the information will be used against them.
• Are unforgiving and hold grudges.
• Are hypersensitive and take criticism poorly.
• Read hidden meanings in the innocent remarks or casual looks of others.
• Perceive attacks on their character that are not apparent to others; they generally react with anger and are quick to retaliate.
• Have persistent suspicions, without reason, that their spouses or lovers are being unfaithful.
• Are generally cold and distant in their relationships with others, and might become controlling and jealous to avoid being betrayed.
• Cannot see their role in problems or conflicts, believing they are always right.
• Have difficulty relaxing.
• Are hostile, stubborn, and argumentative.
• Tend to develop negative stereotypes of others, especially those from different cultural groups.

Causes

The exact cause of PPD is not known, but it likely involves a combination of biological and psychological factors. The fact that PPD is more common in people who have close relatives with schizophrenia and delusional disorder suggests a genetic link between the two disorders (may run in the family). It is also believed that early childhood experiences, including physical or emotional trauma, play a role in the development of PPD.

Diagnosis

PPD is characterized by a pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts. To qualify for a diagnoses, the patient must meet at least four out of the following criteria:

1. Suspects, without sufficient basis, that others are exploiting, harming, or deceiving them.
2. Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates.
3. Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against them.
4. Reads hidden demeaning or threatening meanings into benign remarks or events.
5. Persistently bears grudges (i.e., is unforgiving of insults, injuries, or slights).
6. Perceives attacks on their character or reputation that are not apparent to others and is quick to react angrily or to counterattack.
7. Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner.

 Treatment

Because of reduced levels of trust, there can be challenges in treating PPD. However, psychotherapy, antidepressants, antipsychotics and anti-anxiety medications can play a role when a person is receptive to intervention.