Paranoid Personality Disorder
What is paranoid personality disorder?
Paranoid personality disorder (PPD) is one of a group of conditions called Cluster A or eccentric personality disorders. People with these disorders often appear odd or peculiar. The essential characteristic of people with PPD is paranoia, a relentless mistrust and suspicion of others without adequate reason to be suspicious. This disorder often begins in childhood or early adolescence and appears to be more common in men than in women. Studies estimate that PPD affects between 2.3% and 4.4% of the general population.
Symptoms and Causes
What causes paranoid personality disorder?
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.
What are the symptoms of paranoid personality disorder?
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.
Diagnosis and Tests
How is paranoid personality disorder diagnosed?
If a person has symptoms, the doctor will begin an evaluation by performing a complete medical history and physical examination. Although there are no laboratory tests to specifically diagnose personality disorders, the doctor might use various diagnostic tests to rule out physical illness as the cause of the symptoms. For example, difficulty hearing or long-lasting substance abuse may be confused with PPD.
If the doctor finds no physical reason for the symptoms, he or she might refer the person to a psychiatrist or psychologist, health care professionals who are specially trained to diagnose and treat mental illnesses. PPD is different from psychotic disorders such as schizophrenia, paranoid type or delusional disorder, persecutory type, in that the person with PPD lacks the perceptual distortions (for example, hearing voices) or bizarre delusional thinking (for example, being followed everywhere by the FBI). Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate a person for a personality disorder.
Management and Treatment
How is paranoid personality disorder treated?
People with PPD often do not seek treatment on their own because they do not see themselves as having a problem. The distrust of others felt by people with PPD also poses a challenge for health care professionals because trust is an important factor of psychotherapy (a form of counseling). As a result, many people with PPD do not follow their treatment plan and may even question the motives of the therapist.
When a patient seeks treatment for PPD, psychotherapy is the treatment of choice. Treatment likely will focus on increasing general coping skills, especially trust and empathy, as well as on improving social interaction, communication, and self-esteem.
Medication generally is not used to treat PPD. However, medications—such as anti-anxiety, antidepressant, or anti-psychotic drugs—might be prescribed if the person’s symptoms are extreme, or if he or she also suffers from an associated psychological problem, such as anxiety or depression.
What are the complications of paranoid personality disorder?
The thinking and behaviors associated with PPD can interfere with a person’s ability to form and maintain relationships, as well as their ability to function socially and in work situations. In many cases, people with PPD become involved in legal battles, suing people or companies they believe are "out to get them."
Can paranoid personality disorder be prevented?
Although it might not be possible to prevent PPD, treatment can sometimes allow a person who is prone to this disorder to learn more productive ways of dealing with situations.
Outlook / Prognosis
What is the outlook for people with paranoid personality disorder?
The outlook for people with PPD varies. It is a chronic disorder, which means it tends to last throughout a person’s life. Although some people can function fairly well with PPD and are able to marry and hold jobs, others are completely disabled by the disorder. Because people with PPD tend to resist treatment, the prognosis often is poor.