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The "face" of paranoid personality disorder

  • Published on:
    15/05/2018
The "face" of paranoid personality disorder

From the psychologist of the Rehabilitation Unit "Thalpos Kalamata" Evi Tsikrikikou.

Paranoid Personality Disorder (PPD) is a mental disorder characterized by paranoia, diffuse and long-term suspicion and generalized distrust of others1. People suffering from this disorder tend to protect themselves from everything, be suspicious, while their emotional life is very limited. People with PPD may show grudges, suspicion and characterize the actions of others as hostile. They also have a persistent self-reporting tendency, or a persistent sense of personal right2.

World Health Organization ICD-10 quotes Paranoid Personality Disorder as F60.03.

PPD is characterized by at least three of the following symptoms:

  • excessive sensitivity to failures and denials
  • tendency to keep hard feelings (for example, refuse to forgive insults or skirmishes)
  • the existence of suspicion and the diffuse tendency to distort reality, misinterpreting the neutral or friendly actions of others as hostile or contemptuous
  • a militant and aggressive sense of complacency, which deviates from the real situation
  • recurring, unjustified suspicions about partner's sexual loyalty
  • tendency to experience excessive self-restraint, manifesting a persistent self-reporting attitude
  • employment with unproved "conspiratorial" explanations of events, directly related either to themselves or to the world at large.

PPD includes widespread paranoia, fanaticism, embarrassing and sensitive paranoid personality disorder, but excluding delusional disorder and schizophrenia.

It is very important to separate paranoid schizophrenia from paranoid personality disorder. As the first is psychosis, which means that the patient "loses" contact with reality, while in the second the patient has a relatively good perception of reality.

Patients with this disorder are likely to have morbidity with other personality disorders. The exact cause of PPD is not known but may involve a combination of biological and psychological factors. A possible genetic relationship has been observed between this personality disorder and schizophrenia.

However, it is believed that early childhood experiences, including physical or emotional trauma, play a role in developing it4. Cognitive theorists believe that this disorder is the result of an underlying belief that other people are hostile, coupled with a lack of self-awareness5.

As with all personality disorders, diagnosis depends on the proof that the dysfunctional features of the person last over time. Therefore, additional information is needed to show that the features are not limited to specific situations (such as clinical encounters) and that they are proven by puberty or early adulthood6.

None of the possible treatments for paranoid personality disorder has been subjected to randomized controlled trials. However, this disorder should not be considered that it cannot be solved, and there is a degree of consensus on general principles as well as the effort to manage it safely (Gabbard 2000; Fagin 2004).

Appropriate long-term treatment goals (Bernstein 2007) include helping the patient to:

  • recognize and accept the feelings of vulnerability
  • increase the sense of self-worth
  • develop more trust in others
  • verbally expressing anxiety instead of using counterproductive methods such as evasion or intimidation.

As with all personality disorders, progress is likely to be slow, and some suggest that at least 12 months may be required to determine if treatment is effective (Bateman 2004).

Sources:

  1. Waldinger, Robert J. (1 August 1997). Psychiatry for Medical Students. American Psychiatric. ISBN 978-0-88048-789-4. 
  2. MacManus, Deirdre; Fahy, Tom (August 2008). "Personality disorders". Medicine. 36 (8): 436–441. doi:10.1016/j.mpmed.2008.06.001.
  3. Paranoid personality disorder — International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10)
  4. https://my.clevelandclinic.org/health/diseases/9784-paranoid-personality...
  5. Beck, AT, & Freeman, AM. (1990). Cognitive therapy of personality disorders. New York: Guilford Press.
  6. http://apt.rcpsych.org/content/15/1/40
  7. Fagin L (2004) Management of personality disorders in acute in-patient settings. Part 2: Less-common personality disorders. Advances in Psychiatric Treatment; 10: 100–6.
  8. Bernstein DP, Useda JD (2007) paranoid personality disorder. In Personality Disorders: Toward the DSM–V (eds W O’Donohue, KA Fowler, SO Lilienfield). Sage Publications.
  9. Bateman AW, Tyrer P (2004) Psychological treatment for personality disorders. Advances in Psychiatric Treatment; 10: 378–88.