Paranoid Personality Disorder

Paranoid Personality Disorder

Paranoid Personality Disorder

Paranoid personality disorder (PPD) is characterized by a persistent, long-lasting suspiciousness and general distrust of others, and paranoid delusions. Those with PPD believe everyone is out to exploit or hurt them, no matter what is presented as factually true.

Prevalence

PPD affects between 2% to 4% of the general population and is more common in males than it is in females. Symptoms begin in early childhood or adolescence

Symptoms of Paranoid Personality Disorder:

Those with PPD:

  • Often, for unfounded reasons, feel that their lives are in danger and constantly search for evidence to support their suspicions. They can have a preoccupation with unsubstantiated “conspiratorial”” explanations of events — both immediate to them and in the world at large.
  • Individuals with PPD frequently get involved in legal battles and sue people or companies they believe are “out to get them.”
  • Are highly sensitive to criticism and easily offended
  • Can be stubborn, believing they are always right. Indeed, they can have a tendency to be self-aggrandizing and have a persistent self-referential attitude.
  • Refuse to acknowledge the role they play in problems or conflicts
  • Tend to develop negative stereotypes of others, especially those from different cultural groups
  • Have very limited social and emotional lives by choice, detached
  • Believe everyone has hidden motives and is out to harm or exploit them
  • Reads negativity into every comment, be it kind, neutral, or factual
  • Unable to work with others, hostile, bears grudges

Risk Factors for Paranoid Personality Disorder:

PPD can have a profound effect on romantic relationships and can cause severe impairment in social, academic, relational, and occupational settings. Those with PPD tend to be guarded and avoid intimacy with others, interpreting their motives as malevolent.

They can be withdrawn and isolate themselves from society. Those with PPD can also be hostile, argumentative, callous, and aloof, leading to substantial interpersonal difficulties.

Causes of Paranoid Personality Disorder?

The causes of PPD remain unknown; however, biological, psychological, and social factors have all been implicated.


  • Genetic – There appears to be a genetic link between PPD and schizophrenia. Having family members with a persecutory type of delusional disorder can increase the risk of developing it oneself.
  • Psychological factors – that contribute to the development of PPD are lack of self-awareness and holding the underlying belief that humans are generally unfriendly. Children likely to develop PPD are seen as solitary, underachieving children with social anxiety and hypersensitivity.
  • Environmental factors – A person from any people group generally treated as “lesser than” by local or national culture might display symptoms of PPD, but this behavior should not be confused with PPD, and their behavior might be based on a lack of understanding of the new culture the person is entering. This includes the perspectives of immigrants and refugees.

Diagnosis of Paranoid Personality Disorder:

Diagnosis is made after other causes are ruled out, such as other medical conditions, physical handicaps, or substance abuse disorders. Paranoid personality disorder should only be diagnosed when symptoms are unchanging and persistent, impair daily function considerably, and cause distress.

According to the DSM-5, for a diagnosis of PPD to be made, symptoms must be present from an early adult age and occur in a range of situations.

  1. 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, as indicated by four (or more) of the following:
    1. Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her.
    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 him or her.
    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 his or her 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.
  2. Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, or another psychotic disorder and is not attributable to the physiological effects of another medical condition.

People with PPD often also have other coexisting personality disorders.

Treatment of Paranoid Personality Disorder:

Because of the pervasive distrust and suspiciousness that characterizes PPD, it is a notoriously difficult condition to treat.

  • Psychotherapy can help, but improvement depends on the willingness of the person to continue with the therapy long term, which is unlikely.
  • Talk therapy – can help the individual understand the source of their paranoid beliefs and hopefully learn how to examine them in a factual way and accept different perspectives. Thought patterns then need to be retrained to consider the positive side of others’ behavior and comments and respond in a healthy way. Stress management skills are also taught.
  • Practical help – can be given in the form of finding work that doesn’t require much interpersonal skill, but if the effects of the disorder are too great, the person can be helped with disability income and housing.

Medication

Antidepressants, antipsychotics, and anti-anxiety medications can all play a role in the treatment of PPD, with antipsychotics such as risperidone or quetiapine being the first choice.

Symptoms of Paranoid Personality Disorder:

Those with PPD:

  • Often, for unfounded reasons, feel that their lives are in danger and constantly search for evidence to support their suspicions. They can have a preoccupation with unsubstantiated “conspiratorial”” explanations of events — both immediate to them and in the world at large.
  • Individuals with PPD frequently get involved in legal battles and sue people or companies they believe are “out to get them.”
  • Are highly sensitive to criticism and easily offended
  • Can be stubborn, believing they are always right. Indeed, they can have a tendency to be self-aggrandizing and have a persistent self-referential attitude.
  • Refuse to acknowledge the role they play in problems or conflicts
  • Tend to develop negative stereotypes of others, especially those from different cultural groups
  • Have very limited social and emotional lives by choice, detached
  • Believe everyone has hidden motives and is out to harm or exploit them
  • Reads negativity into every comment, be it kind, neutral, or factual
  • Unable to work with others, hostile, bears grudges

Risk factors for Paranoid Personality Disorder:

PPD can have a profound effect on romantic relationships and can cause severe impairment in social, academic, relational, and occupational settings. Those with PPD tend to be guarded and avoid intimacy with others, interpreting their motives as malevolent.

They can be withdrawn and isolate themselves from society. Those with PPD can also be hostile, argumentative, callous, and aloof, leading to substantial interpersonal difficulties.

Causes of Paranoid Personality Disorder:

The causes of PPD remain unknown; however, biological, psychological, and social factors have all been implicated.


  • Genetic – There appears to be a genetic link between PPD and schizophrenia. Having family members with a persecutory type of delusional disorder can increase the risk of developing it oneself.
  • Psychological factors – that contribute to the development of PPD are lack of self-awareness and holding the underlying belief that humans are generally unfriendly. Children likely to develop PPD are seen as solitary, underachieving children with social anxiety and hypersensitivity.
  • Environmental factors – A person from any people group generally treated as “lesser than” by local or national culture might display symptoms of PPD, but this behavior should not be confused with PPD, and their behavior might be based on a lack of understanding of the new culture the person is entering. This includes the perspectives of immigrants and refugees.

Diagnosis of Paranoid Personality Disorder?

Diagnosis is made after other causes are ruled out, such as other medical conditions, physical handicaps, or substance abuse disorders. Paranoid personality disorder should only be diagnosed when symptoms are unchanging and persistent, impair daily function considerably, and cause distress.

According to the DSM-5, for a diagnosis of PPD to be made, symptoms must be present from an early adult age and occur in a range of situations.

  1. 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, as indicated by four (or more) of the following:
    1. Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her.
    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 him or her.
    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 his or her 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.
  2. Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, or another psychotic disorder and is not attributable to the physiological effects of another medical condition.

People with PPD often also have other coexisting personality disorders.

Treatment of Paranoid Personality Disorder:

Because of the pervasive distrust and suspiciousness that characterizes PPD, it is a notoriously difficult condition to treat.

  • Psychotherapy can help, but improvement depends on the willingness of the person to continue with the therapy long term, which is unlikely.
  • Talk therapy – can help the individual understand the source of their paranoid beliefs and hopefully learn how to examine them in a factual way and accept different perspectives. Thought patterns then need to be retrained to consider the positive side of others’ behavior and comments and respond in a healthy way. Stress management skills are also taught.
  • Practical help – can be given in the form of finding work that doesn’t require much interpersonal skill, but if the effects of the disorder are too great, the person can be helped with disability income and housing.

Medication

Antidepressants, antipsychotics, and anti-anxiety medications can all play a role in the treatment of PPD, with antipsychotics such as risperidone or quetiapine being the first choice.

Sources DRUGS.com – Paranoid Disorder | Psychiatry for Medical Students – Paranoid Personality Disorder | HARVARD MEDICAL – National Comorbidity Survey Replication | NIH – National Epidemiologic Survey on Alcohol and Related Conditions | DSM-5 – Diagnostic Criteria