Paranoid personality disorder

Paranoia Personality Traits

What is Paranoid personality disorder?

Paranoid personality disorder is characterized as a longstanding suspiciousness and mistrust of people in general. Paranoid individuals are suspicious, resentful, hostile and often times irritable and angry. The essential picture of paranoid personality disorder is a pervasive and unwarranted tendency to interpret other people's actions as deliberately demeaning or threatening. Combined with this is the desire to remain free of close personal relationships in which there is a chance of losing power or self-control. Paranoid individuals frequently, without justification, question the loyalty or trustworthiness of friends, family and associates. In the workplace, they tend to be jealous of coworkers, guarded, and loners, often times isolating themselves from others. They react with anger even to constructive criticism and have a tendency to be quarrelsome, abrasive and would much rather work alone. It is commonplace for them to turn a small issue or problem into a catastrophic issue. They often times feel mistreated, overlooked and picked on by their superiors. Coworkers may become exasperated and angry toward them.

The disorder is more prevalent in men than women and occurs in about one-half to two and one-half percent of the population. It does not appear to run in families. The disorder is more common or has a higher prevalence in minority groups, immigrants, the deaf, or individuals who are related to someone diagnosed with schizophrenia. Overall, their demeanor tends to be cold, sullen, humorless and quick tempered. They tend to blame their problems on others and are unable to accept their own faults and weaknesses. They have a knack for pointing out other's subtle faults with great accuracy.

How is it diagnosed?

History: The diagnosis is based on the psychiatrist or mental health evaluator's history, which follows the diagnostic criteria from the DSM-IV. The paranoid personality has 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.

For the paranoid personality, there are seven categories of identifiable behaviors, called personality traits. Individuals must present four of the following seven behaviors to justify the diagnosis: 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; or has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner.

For a diagnosis of paranoid personality disorder to be made, these behaviors cannot occur exclusively during the course of schizophrenia, a mood disorder with psychotic features, or another psychotic disorder, nor can they be due to the direct physiological effects of a general medical condition. Inquiries as to drug and alcohol use are warranted, though this area must be broached carefully so as not to provoke hostility and jeopardize any rapport that may have been established.

Physical exam: There are no findings on the physical exam that contribute to this diagnosis.

Tests: Psychological tests such as the Minnesota Multiphasic Personality Inventory (MMPI) that can be used to help identify and classify personality disorders, however they are rarely needed by an experienced clinician. The interpretation of these tests can only be used in conjunction with the history and would not be used to make a final diagnosis of paranoid personality disorder alone.

How is paranoid personality disorder treated?

The two approaches to treating an individual with this disorder are psychotherapy and pharmacotherapy (medications).

  • The treatment of choice is psychotherapy. Individual psychotherapy requires a professional therapist. Behavioral therapy has been used to improve the individual's ability to socialize and diminish suspiciousness through role-playing. Paranoid individuals do not do well in group therapy sessions. Behavior therapy, if too intrusive, can become intolerable.
  • Pharmacotherapy (medication) is useful often times in dealing with the associated anxiety and agitation the individual often experiences. Antianxiety agents and antipsychotic drugs are used to control these symptoms, usually in small doses and for brief periods. If it has been determined that the individual has any associated drug or alcohol use, these medications should not be used unless they are part of the overall therapy directed at correcting the substance abuse.

Medications

Information Brand Generic Label Rating
order Venlafaxine Effexor Venlafaxine Off-Label
Lexapro 40mg Lexapro Escitalopram Off-Label
Generic Paroxetine Paxil Paroxetine Off-Label
Zoloft Zoloft Sertraline Off-Label

Celexa (Citalopram), Prozac (Fluoxetine)

What might complicate it?

Any change or increase in stress especially involving occupational, financial, legal problems or personal relationships can create complications. Even minimal perturbations will be exaggerated by the paranoid personality. Examples of stress involving the workplace are a change of supervisor, moving to another workspace, change in work hours, and/or a shift change. These could certainly complicate the condition. Substance abuse is often the individual's way of coping with the distress. Self- medication can lead to abuse and dependence. Substance abuse will complicate the picture of this disorder. There is a high incidence of alcoholism associated with this disorder. This leads to a vicious cycle of paranoid perceptions becoming reality, as the alcoholism leads to estrangement from family members, coworkers, and friends.

Predicted outcome

Currently, there are no adequate long-term studies to review for predicting systematic and reliable outcomes. In general, the disorder is life long and it may be the precursor to the larger picture of schizophrenia or other disorders. Occupational and marital problems are common among persons with paranoid personality disorder and, to a lesser degree, so are financial and legal problems.

Alternatives

Paranoid personality disorder can look like other personality disorders or a combination of traits such as paranoid-narcissistic, paranoid-antisocial, or paranoid-compulsive personality disorders.

Paranoid personality disorder may appear to be a form of the paranoid delusional disorder(s) or paranoid schizophrenia. Hallucinations and formal thought disorder are absent in paranoid personality disorder and thus can be differentiated from schizophrenia. In the paranoid delusional disorder, the individuals present themselves as completely normal, however they usually are focused on a single thought or belief that has no basis in fact. A severe mood disorder with psychotic features (including paranoia) is another example. Substance abuse, especially amphetamine and methamphetamine, can induce paranoia.

Appropriate specialists

Psychiatrist or psychologist.

Last updated 20 December 2011


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