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PARANOID PERSONALITY DISORDER
 


Prediction: Lasts For Decades

      Occupational-Economic:
  • Works poorly with others (highly critical of others, yet hypersensitive to criticism of self)
      Wisdom vs Irrationality: N/A
      Courage vs Negative Emotion:
  • Anger
      Helping Others vs Detachment:
  • Suspicious, bears grudges, feels victimized
      Self-Control vs Disinhibition: N/A
      Justice vs Antagonism: N/A
      Medical: N/A


SYNOPSIS

Paranoid Personality Disorder F60.0 - ICD10 Description, World Health Organization

Paranoid personality disorder is characterized by excessive sensitivity to setbacks, unforgiveness of insults; suspiciousness and a tendency to distort experience by misconstruing the neutral or friendly actions of others as hostile or contemptuous; recurrent suspicions, without justification, regarding the sexual fidelity of the spouse or sexual partner; and a combative and tenacious sense of personal rights. There may be excessive self-importance, and there is often excessive self-reference.
Paranoid Personality Disorder - Diagnostic Criteria, American Psychiatric Association

An individual diagnosed with paranoid personality disorder needs to show at least 4 of the following criteria:

  • Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her.

  • Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates.

  • Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her.

  • Reads hidden demeaning or threatening meanings into benign remarks or events.

  • Persistently bears grudges, i.e., is unforgiving of insults, injuries, or slights.

  • Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack.

  • Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner.
Like all personality disorders, paranoid personality disorder is a deeply ingrained and enduring behaviour pattern, manifesting as an inflexible response to a broad range of personal and social situations. This behavior represents an extreme or significant deviation from the way in which the average individual in a given culture relates to others. This behaviour pattern tends to be stable. It causes subjective distress and problems in social performance.

Core Features

Individuals with this disorder grow up having excessive distrust and suspiciousness. The core feature of this disorder is detachment (suspiciousness). This disorder is only diagnosed if: (1) it begins no later than early adulthood, (2) these behaviors occur at home, work, and in the community, and (3) these behaviors lead to clinically significant distress or impairment in social, occupational, or other important areas of functioning. This disorder should not be diagnosed if the suspiciousness occurs exclusively during the course of a psychotic disorder, or if it is attributable to the physiological effects of another medical condition (e.g., temporal lobe epilepsy).

Lack Of Social Skills And Personality Disorders

There are certain social skills that are essential for healthy social functioning. Individuals with paranoid personality disorder lack the essential social skills of trust, forgiveness, and gratitude.

    Social Skills That Are Lacking In Paranoid Personality Disorder

    SOCIAL SKILL LOW LEVEL HIGH LEVEL
    Trust Suspiciousness Trusting the loyalty and good intentions of significant others (e.g., family, friends)
    Forgiveness Bearing grudges Forgiving other peoplesí mistakes; not bearing grudges or seeking revenge
    Gratitude Feeling victimized Being thankful for the good things in life; expressing thanks to others

Paranoid, schizoid, and schizotypal personality disorder are so closely related that they are referred to as the "detached" cluster of personality disorders.

    Social Skills That Are Lacking In The "Detached" Cluster Of Personality Disorders

    PERSONALITY DISORDER LACKING LACKING LACKING
    Paranoid Personality Trust (instead has suspiciousness) Forgiveness (instead has bearing grudges) Gratitude (instead has feeling victimized)
    Schizoid Personality Intimacy (instead has intimacy avoidance) Sociability (instead has social withdrawal) Emotional expressiveness (instead has lack of emotional expression)
    Schizotypal Personality Normal Behavior (instead has eccentricity) Normal Beliefs (instead has odd beliefs) Normal Perception (instead has perceptual distortions)

Social Functioning

Individuals with paranoid personality disorder are generally difficult to get along with and often have problems with close relationships because of their excessive suspiciousness and hostility. They usually are unable to collaborate well with others at work. They may have a need to have a high degree of control over those around them. They are reluctant to confide in or become close to others because they fear that the information they share will be used against them.

Paranoid Traits

Individuals with paranoid personality disorder falsely believe that they are being victimized by others. They are highly critical of others, yet hypersensitive to criticism of themselves. They bear grudges and are unwilling to forgive the insults that they think they have received. Minor slights arouse major hostility, and the hostile feelings persist for a long time. Their combative and suspicious nature may elicit a hostile response in others, which then serves to confirm their original expectations. They may be pathologically jealous.

Ineffective Therapies

The effectiveness of treatment for paranoid personality disorder is unknown because there are no randomized controlled trials. Individuals with this disorder seldom voluntarily present for treatment. Most therapists believe that this disorder is very difficult to treat. Thus a trusting relationship with primary care physician is probably the best therapy.

Which Behavioral Dimension Is Involved?

The ancient Greek civilization lasted for 1,300 years (8th century BC to 6th century AD). The ancient Greek philosophers taught that the 5 pillars of their civilization were: wisdom, courage, helping others, self-control, and justice. Psychiatry named the opposite of each of these 5 ancient themes as being a major dimension of psychopathology (i.e., irrationality, negative emotion, detachment, disinhibition, and antagonism). (Psychology named these same factors the "Big 5 dimensions of personality": "intellect", "neuroticism", "extraversion", "conscientiousness", and "agreeableness")

    Paranoid Personality Disorder: Negative Emotion And Detachment
            Wisdom vs Irrationality: N/A
            Courage vs Negative Emotion:
      • Anger
            Helping Others vs Detachment:
      • Suspicious, bears grudges, feels victimized
            Self-Control vs Disinhibition: N/A
            Justice vs Antagonism: N/A

Prevalence

The prevalence of paranoid personality disorder is 2.3%-4.4% of the general population. It occurs more commonly in males.

Course

Paranoid personality disorder may be first apparent in childhood and adolescence with solitariness, poor peer relationships, social anxiety, underachievement in school, hypersensitivity, and peculiar thoughts and language. These children may appear to be odd or eccentric and attract teasing. The course of this disorder is chronic.

Familial Pattern

This disorder is more common among first-degree biological relatives of those with schizophrenia and delusional disorder, persecutory type.

Complications

Individuals with this disorder may be litigious and frequently become involved in legal disputes.

Comorbidity

Some other disorders frequently occur with this disorder:

    Non-Personality Disorders

            Schizophrenia Spectrum and Other Psychotic Disorders:
      • This disorder may be a premorbid antecendent of a psychotic disorder. In response to stress, individuals with this disorder may experience very brief psychotic episodes (lasting minutes to hours). If the psychotic episode lasts longer, this disorder may actually develop into delusional disorder or schizophrenia.
            Depressive Disorders:
      • Major depressive disorder
            Anxiety Disorders:
      • Agoraphobia
            Obsessive-Compulsive and Related Disorders:
      • Obsessive-compulsive disorder
            Substance-Related and Addictive Disorders:
      • Alcohol and other substance use disorder frequently occur

    Personality Disorders

            Negative Emotion Cluster:
      • Avoidant personality disorder
            Detachment Cluster:
      • Schizoid and schizotypal personality disorders
        Note: Paranoid, schizoid, and schizotypal personality disorders are all closely related since they all share the same core feature of detachment. If an individual has one of these detached personality disorders, they are very likely to have another.
            Antagonism Cluster:
      • Narcissistic, borderline personality disorders

Associated Laboratory Findings

No laboratory test has been found to be diagnostic of this disorder.

Primate Evolution

There appears to be three different ways in which primates have evolved socially:
  • The chimpanzees have evolved to be socially antagonistic, competitive, callous, and manipulative. Thus chimpanzee social behavior most closely mirrors the antagonistic behavior of the antisocial-narcissistic-borderline-histrionic cluster of personality disorders.

  • In contrast, the bonobos have evolved to be socially anxious, peaceful, cooperative, and loving. Thus bonobo social behavior most closely mirrors the negative emotion (anxious) behavior of the avoidant-dependent cluster of personality disorders.

  • Another separate evolutionary path was followed by the orangutans. They evolved to become solitary hermits. Thus orangutan social behavior most closely mirrors the detached behavior of the paranoid-schizoid-schizotypal cluster of personality disorders.

Core Behaviors Of The Detached Cluster Of Personality Disorders

Religious Hermit

History is filled with thousands of stories of religious hermits who withdrew to a solitary place for a life of religious seclusion.

The core feature of the paranoid-schizoid-schizotypal cluster of personality disorders is detachment. Individuals with these disorders are socially and emotionally withdrawn; thus prefer a solitary life.

    Detachment: The Core Feature Of The Detached Cluster Of Personality Disorders

    • suspiciousness:
      In the past week, did you suspect that people were exploiting, harming, or deceiving you?
    • social withdrawal:
      In the past week, did you mostly prefer to be alone?
    • intimacy avoidance:
      In the past week, did you avoid close friendships (outside of your family) or romantic relationships?
    • inability to feel pleasure:
      In the past week, did few things in life give you pleasure?
    • restricted emotional expression:
      In the past week, did you seldom smile or show much emotion?

Parental Behaviors Which Increase The Risk Of Developing A Personality Disorder

Research has shown that genetic, environmental, and prenatal factors all play important roles in the development of personality disorder. Recent research has also shown that low parental affection and harsh parenting increase the risk of a child later developing a personality disorder.

"Low affection" was defined as: low parental affection, low parental time spent with the child, poor parental communication with the child, poor home maintenance, low educational aspirations for the child, poor parental supervision, low paternal assistance to the child's mother, and poor paternal role fulfillment. "Harsh parenting" was defined as: harsh punishment, inconsistent maternal enforcement of rules, frequent loud arguments between the parents, difficulty controlling anger toward the child, possessiveness, use of guilt to control the child, and verbal abuse.

Setting Goals In Therapy

    Questions To Ask When Setting Goals

    In The Past Week:
    • WHO: was your problem?
    • EVENT: what did he/she do?
    • RESPONSE: how did you respond to that event?
    • OUTCOME: did your response help?
    • TRIGGER: what did you do that could have triggered this problem?
    • GOAL: what life skill(s) do you have to work on? (from checklist)

    Example Of Setting Goals In Interviewing A Person With Paranoid Personality Disorder

    In The Past Week:
    • WHO: was your problem?
      "My friend."

    • EVENT: what did he/she do?
      "My friend hasn't called me in weeks. I think she's mad at me."

    • RESPONSE: how did you respond to that event?
      "I decided that, if she didn't call me, I wouldn't call her."

    • OUTCOME: did your response help?
      "No. she still hasn't called."

    • TRIGGER: what did you do that could have triggered this problem?
      "We had an argument, and she said some things that really hurt me. Ever since then I stopped calling her."

    • GOAL: what life skill(s) do you have to work on? (from checklist)
      "I want to work on: (1) Forgiveness ("forgiving other peoplesí mistakes; not bearing grudges or seeking revenge"), and (2) Sociability ("being friendly; interested in social contacts and activities")."

Dictators Usually Have A Dangerous Combination of Personality Disorders

All of history's worst dictators had a combination of Paranoid + Narcissistic + Psychopathic Personality Disorders.

    Social Skills That Are Lacking In History's Worst Dictators

    PERSONALITY DISORDER LACKING LACKING LACKING
    Paranoid Personality Trust (had suspiciousness) Forgiveness (had bearing grudges) Gratitude (had feeling victimized)
    Narcissistic Personality Humility (had arrogance) Cooperation or generosity (had being manipulative or greedy) Kindness (had callousness)
    Sociopathic Personality Respect (had disrespect) Responsibility (had irresponsibility) Honesty (had dishonesty)

Given the amount of harm that these dictators created (e.g., Hitler, Mussolini, Stalin, Mao); it could be argued that the social skills that dictators lack are the most important of all the social skills. Thus it should come as no surprise that all of the world's religions emphasize the importance of these social skills (e.g., trust, forgiveness, gratitude, humility, cooperation, generosity, kindness, respect, responsibility, and honesty).

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