Paranoid Personality Disorder Symptoms, Causes

2034
Anthony Golden

The paranoid personality disorder it is characterized because the person who has it is excessively distrustful and suspicious of others without any justification. They tend not to trust other people and think they want to hurt them.

Although it may be adaptive to be a little cautious of others and their intentions, being overly suspicious can interfere with personal life or work. Even events that are not related to them are interpreted as personal attacks.

People with this disorder usually have a hard time getting along with others and often have trouble establishing close personal relationships. They are very sensitive to criticism and have a great need to be self-reliant and autonomous.

They also need to have a high level of control over those around them. They are often rigid, critical of others, and unable to collaborate.

Article index

  • 1 Symptoms
  • 2 Causes
  • 3 Diagnosis
    • 3.1 DSM-IV diagnostic criteria
    • 3.2 ICD-10 diagnostic criteria
  • 4 Differential diagnosis
  • 5 Comorbidity
  • 6 Treatment
    • 6.1 Psychotherapy
    • 6.2 Medication
  • 7 Epidemiology
  • 8 Prevention
  • 9 Complications
  • 10 References

Symptoms

Paranoid disorder usually begins in early adulthood and occurs in a variety of settings, with symptoms such as:

-Suspicion, without sufficient basis, that others are exploiting, harming or lying to you.

-Concern for unjustified doubts about the loyalty or mistrust of friends or close people.

-Reluctant to trust others out of unwarranted fear that the information will be used against him / her.

-Persistent grudge.

-You perceive attacks on your character or reputation.

-Impulsiveness when reacting.

-Recurring suspicions without justification, regarding the fidelity of the sexual partner.

Causes

Cognitive theorists believe that this disorder is the result of a belief that other people are liars or malevolent, in combination with a lack of self-esteem. This is a maladaptive way of seeing the world that dominates any aspect of the lives of these individuals.. 

Other possible causes have been proposed. For example, some therapists believe that behavior may have been learned from childhood experiences. Accordingly, children who are exposed to adult hatred and have no way to predict or escape develop paranoid thinking traits in an effort to cope with stress.

On the other hand, some research suggests that the disorder may be slightly more common among relatives of people with schizophrenia, although the association is not very strong..

Studies with monozygotic or dizygotic twins suggest that genetic factors may also play an important role. 

Cultural factors have also been related to this disorder; certain groups of people, such as prisoners, refugees, the hard of hearing, or the elderly are thought to be more susceptible to developing it.

Diagnosis

Because Paranoid Personality Disorder describes long-term behavior patterns, they are most often diagnosed in adulthood..

DSM-IV diagnostic criteria

A) General mistrust and suspicion from the beginning of adulthood, such that the intentions of others are interpreted as malicious, and that they appear in various contexts, as indicated by four (or more) of the following points:

  1. Suspect, without sufficient basis, that others are going to take advantage of them, harm them or deceive them.
  2. Worries about unwarranted doubts about the loyalty or fidelity of friends and associates.
  3. You are reluctant to trust others out of unwarranted fear that the information they share will be used against you.
  4. In the most innocent observations or facts, he glimpses hidden meanings that are degrading or threatening.
  5. Holds grudges for a long time, for example, I do not forget insults, insults or slights.
  6. You perceive attacks on yourself or your reputation that are not apparent to others and you are willing to react with anger or fight back.
  7. You repeatedly and unjustifiably suspect that your spouse or partner is unfaithful to you.

B) These characteristics do not appear exclusively in the course of schizophrenia, a mood disorder with psychotic symptoms, or other psychotic disorder, and are not due to the direct physiological effects of a general medical condition.. 

ICD-10 diagnostic criteria

It is characterized by at least three of the following:

  • Excessive sensitivity to setbacks or rejections.
  • Tendency to persistent resentment. Refusal to forgive insults or slights.
  • Suspicion and a general tendency to misinterpret the neutral or friendly actions of others.
  • Recurring suspicions, without justification, regarding the sexual fidelity of the spouse or sexual partner.
  • Tendency to experience excessive self-importance.
  • Unfounded concern about conspiracies at events.

Differential diagnosis

It is important that psychologists or psychiatrists do not confuse paranoid disorder with another personality or mental disorder that may have some symptoms in common..

For example, it is important to ensure that the patient is not a long-term amphetamine or cocaine user. Chronic abuse of these stimulants can lead to paranoid behavior.

Also, some drugs can produce paranoid as a side effect. If the patient has symptoms of schizophrenia, hallucinations, or a thought disorder, a diagnosis of paranoid disorder cannot be made..

Suspicion and other characteristics must be present in the patient for a long time.

The following pathologies must be ruled out before diagnosing PPD: paranoid schizophrenia, schizotypal personality disorder, schizoid personality disorder, mood disorders with psychotic characteristics, symptoms or personality changes caused by diseases, medical conditions or abuse of borderline, histrionic, avoidant, antisocial, or narcissistic drugs and personality disorders.

Comorbidity

Other disorders can occur frequently alongside this disorder:

  • Schizophrenia or psychotic disorders.
  • Major depression.
  • Agoraphobia.
  • Obsessive-compulsive disorder.
  • Substance abuse.
  • Personality disorders: avoidant, schizoid, avoidant, schizotypal, narcissistic, borderline.

Treatment

Treatment of paranoid personality disorder can be very effective in controlling paranoia but it is difficult because the person may be suspicious of the doctor.

Without treatment, this disorder can be chronic..

Psychotherapy

A trusting relationship with a therapist offers great benefit to people with this disorder, although it is extremely complicated by the skepticism of these people.

Building the patient-therapist relationship requires a lot of patience and is difficult to maintain even when trust has been established.

Group therapies that include family members or other psychiatric patients do not work for these people because of their lack of trust in others. 

To gain the trust of these patients, therapists must hide as little as possible. This transparency should include note taking, administrative details, tasks related to the patient, correspondence, medications ...

Any indication that the patient considers a “lie” can lead to the abandonment of treatment. 

On the other hand, paranoid patients do not have a developed sense of humor, so those who interact with them should think about whether to make jokes in their presence, since they can take them as ridiculous, since they feel easily threatened.

With some patients, the most important goal is to help them learn to relate appropriately to other people.. 

Medication

Medication is not recommended for patients with PPD, as they can contribute to a sense of suspicion.

If they can be used to treat specific conditions of the disorder such as severe anxiety or illusions.

An anxiolytic such as diazepam may be prescribed if the patient suffers from severe anxiety. An antipsychotic such as thioridazine or haloperidol if the patient has dangerous paranoid thoughts.

Medications should be used for the shortest time possible. 

The best use of medication may be for specific complaints, when the patient trusts the therapist enough to ask for help in reducing their symptoms..

epidemiology

TPP occurs in approximately 0.5% -2.5% of the general population and occurs more frequently in men.

A long-term study with Norwegian twins found that PPD is modestly heritable and shares a proportion of its genetic and environmental risk factors with schizoid and schizotypal personality disorders..

Like most personality disorders, PPD will decrease in intensity with age.

Prevention

Although prevention of PPD is not possible, treatment can allow the person prone to this condition to learn more productive ways of dealing with people and situations..

Complications

Individuals with paranoid disorder typically have difficulty getting along with other people and often have trouble establishing close personal relationships due to excessive suspicion and hostility..

They are usually unable to collaborate with others at work and may be against being close to others for fear of sharing information.

The combative and suspicious naturalization can elicit a hostile response in others, which serves to confirm their original expectations.

References

  1. American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision (DSM-IV-TR). Washington, DC: American Psychiatric Association.
  2. Kendler KS; Czajkowski N; Also K et al. (2006). "Dimensional representations of DSM-IV cluster A personality disorders in a population-based sample of Norwegian twins: a multivariate study". Psychological Medicine 36 (11): 1583-91. doi: 10.1017 / S0033291706008609. PMID 16893481.
  3. Millon, Théodore; Grossman, Seth (August 6, 2004). Personality disorders in modern life. Wiley. ISBN 978-0-471-23734-1.
  4. MacManus, Deirdre; Fahy, Tom (August 2008). "Personality disorders". Medicine 36 (8): 436-441. doi: 10.1016 / j.mpmed.2008.06.001.
  5. American Psychiatric Association (2012). DSM-V Development. dsm5.org .

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