Learning Objectives
Show
Cluster A DisordersParanoid personality disorder (PPD) is a Cluster A personality disorder. Paranoid personality disorder is a clinically well-recognized disorder that has not been the object of a great deal of investigation. Although noted in the writings of psychiatrists since the late 1800s, the condition was first called paranoid personality by Kraepelin in 1921 (Akhtar, 1990). The hallmark criteria regarding paranoid personality disorder (PPD) are distrust and suspicion of others such that others are seen as purposefully attempting to harm one in some way without any evidence to suggest this is the case. Individuals with paranoid personality disorder also may be very critical of others, argumentative, and rigid in beliefs, again stemming from harboring unwarranted suspicions about people around them. This behavior often leads to problems with relationships, both personal and in the workplace.
Diagnosing Paranoid Personality Disorder Figure 1. A person with paranoid personality disorder is suspicious and mistrustful of others but does not experience delusions or hallucinations consistent with schizophrenia. Paranoid personality disorder (PPD) is characterized by a general suspicion and distrust of others that presents with at least four or more of the following:
Paranoid personality disorder must be diagnosed to the exclusion of schizophrenia, or any other psychotic disorder including psychosis in the context of a mood disorder. ComorbidityIndividuals with paranoid personality disorder appear to have an increased likelihood of developing depression, agoraphobia, obsessive-compulsive disorder, and alcohol or substance abuse or dependence. With regard to comorbid personality disorders, there is some variation in the literature. Generally though, it has been suggested that in clinically based samples, over 75% of patients who met paranoid personality disorder criteria also met criteria for other personality disorders: the most common were found to be schizotypal and narcissistic. One area of research is the possible relationship of post-traumatic stress disorder (PTSD) with personality disorders, with the strongest association with paranoid personality disorder, specifically paranoid personality disorder.[2] This suggests a possible link between trauma during early events in life and subsequent paranoid behavior and mistrust. Another area that has received some attention is the relationship of violence to paranoid personality disorder. Paranoid cognitive personality style was found to increase the risk of violence in subjects with personality disorders, particularly schizophrenia spectrum disorders (Nestor, 2002). Estimates of the prevalence of paranoid personality disorder range from 2.3% to 4.4% in the United States.[3] EtiologyThere is no known cause of PPD, but researchers believe it is caused by a combination of biological, psychological, and social factors. Genetics play a role in contributing to paranoid traits and there is also a possible genetic link between PPD and schizophrenia. Using data from the Roscommon family study, an epidemiologic study conducted in Ireland, it was discovered that biological relatives of those with schizophrenia had a significantly higher amount of paranoid personality disorder compared with relatives of controls (Kendler et al. 1993). Figure 2. Some theories argue that PPD stems from negative parental modeling. A large, long-term Norwegian twin study found paranoid personality disorder to be modestly heritable and to share a portion of its genetic and environmental risk factors with the other Cluster A personality disorders, schizoid and schizotypal.[4] Psychosocial theories argue that the disorder stems from early trauma or childhood abuse, possibly coming from the projection of negative internal feelings or parental modeling. Cognitive theorists believe the disorder to be a result of an underlying belief that other people are unfriendly in combination with a lack of self-awareness. As with other disorders, cultural factors must be taken into account in diagnosing this disorder. There are some groups that might, for reasons of maltreatment, language barriers, and unfamiliarity to the mainstream society, display what could be labeled paranoid traits. In an epidemiologic study recently completed on personality disorders, Black, Hispanic, and Native American people were at greater risk for having paranoid personality disorder than White people (Grant et al. 2004). Also, according to the same study, paranoid personality disorder was more common among younger people (ages 18–29), those with lower incomes, and those who were divorced or never married. Some of these findings are not surprising, taking into account the nature of paranoid personality disorder. However, this does bring up the question of which came first: are some paranoid traits the result of maltreatment by others due to socioeconomic status (SES), race, etc., or does the disorder contribute to, for example, the inability to succeed professionally or remain in a relationship? There appears to be a combination of both, which can contribute to complications in diagnosing the disorder. Course and PrognosisPPD can be noted first in childhood; symptoms observed include solitariness, social anxiety, and odd thoughts and language. Kids who are bullied, socially unaccepted, or even abused, may be more prone to PPD. There is not a lot of data regarding the course and prognosis of the disorder. This is likely due to the fact that as it is a personality disorder, it tends to be stable over adult life and although it can cause interpersonal problems, does not often require treatment. It has been observed that the course of the disorder rarely worsens or goes into remission (Akhtar, 1990). TreatmentThere is no specific treatment or medication for PPD. When existing in conjunction with other personality disorders, i.e., borderline personality disorder, treatment may be sought, but that is primarily due to symptoms experienced in other personality disorders. There is some data on the effectiveness of day treatments for patients with personality disorders in general (Karterud et al. 2003). Treatment results, although effective for some personality disorders (i.e., borderline), were the poorest for those with paranoid, schizoid, and schizotypal personality disorders. Case Study: Paranoid Personality DisorderA 36-year-old divorced worker, Nathan, developed severe depression after he was fired from his job and subsequently had severe alcohol problems. He presented himself to a general practitioner with somatic complaints, anxiety, compulsively washing his hands, fatigue, and disturbing inner feelings of hatred towards other people. Nathan’s troubles started during his childhood. He reported that he was very aggressive towards other children and was involved in recurrent conflicts. At home he was constantly on guard. In his work relations, he was involved in severe interpersonal conflicts, reacting with aggressive attacks at the slightest offences. The last years he spent working, he was continuously involved in conflicts with his colleagues. The only person he stayed friends with was his brother-in-law who lived a hundred miles away. Nathan’s case study illustrates important issues and characteristic features of the paranoid personality. First, they typically do not seek treatment unless they are in a crisis (fired from job) or because of additional pathology (depression). Second, when decompensated, or triggered, they most often get depression, panic attacks, OCD, or somatoform disorder (as in this case) or in other cases, an increase in alcohol abuse. His personality pathology is excessive aggression and mistrust. Key Takeaways: Paranoid personality Disorder
WAtCh ItThis video spells out the diagnostic characteristics of paranoid personality disorder. You can view the transcript for “Paranoid Personality Disorder in a Minute” here (opens in new window). Try ItGlossaryparanoid personality disorder: characterized by distrust and suspicion of others; others are seen as purposefully attempting to harm one in some way without any evidence to suggest this is the case What are the diagnostic criteria for paranoid personality disorder?DSM-5 Diagnostic Criteria
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)
What are some of the diagnostic criteria for personality disorders?Diagnosis of a personality disorder requires the following: A persistent, inflexible, pervasive pattern of maladaptive traits involving ≥ 2 of the following: cognition (ways or perceiving and interpreting self, others, and events), affectivity, interpersonal functioning, and impulse control.
What are the 3 clusters of personality disorders?Personality disorders are characterized by unhealthy thoughts and actions, which interrupt one's day-to-day living. These disorders can be further divided into three clusters: A, the odd and eccentric; B, the dramatic or erratic; and C, the anxious or fearful.
What is the DSMParanoid Personality Disorder: Causes, Symptoms, Treatment DSM-5 301.0 (F60. 0) Individuals with Paranoid Personality Disorder (PPD) usually have prevalent distrust and suspicion of other people that has lasted for a long time.
|
