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Paranoid Personality Disorder: Signs and Treatment


Paranoid personality disorder (PPD) is one of 10 recognized personality disorders (PDs) that falls under Cluster A, which are characterized by odd and eccentric behaviors. PPD, as suggested by its name, is a mental health condition involving marked and unreasonable suspicion of people, institutions, and groups along with a general pattern of distrust.

Signs and Symptoms

It’s common for people with PPD to severely limit their social lives and avoid novel situations due to the belief someone will harm, threaten, or demean them. An individual with PPD might exhibit one or several of the following behaviors and beliefs:

  • Expressing unreasonable and unjustified suspicion about the commitment, loyalty, or trustworthiness of others
    • A belief that friends and/or family are exploiting or deceiving them
    • A belief that spouses and/or romantic partners are being unfaithful
  • Extreme avoidance when asked to reveal personal information in an attempt to prevent information from being used against them
    • Choosing not to confide personal feelings, preferences, and secrets even to friends or family
    • Not giving out contact information, a description of their residence, etc.
  • Having a distorted interpretation of social interactions and situations
    • Finding hidden meanings (such as threats, criticism, hatred, etc.) in casual interactions with others
    • Perceiving attacks on their character or work/school performance that aren’t apparent to others
  • Having difficult personality traits
    • Holding grudges or being unforgiving
    • Intense hypersensitivity to criticism
    • Being stubborn and argumentative
    • Failing to see one’s own role in conflicts or problems
    • Believing one is always right

Triggers

Individuals suffering from PPD exhibit overly suspicious behaviors towards situations and others. Their social skills are affected by their constant searches for hidden meanings, which leads them to misinterpret social interactions, either positively (e.g., they are in love with me) or negatively (e.g., they are out to get me). These characteristics make them largely susceptible to change and any form of criticism, either real or perceived). Situations or life events such as the following are likely to trigger extreme PPD behaviors:

  • Change of social status, group, or place
    • A sense of being different than a particular social group, potentially because of gender, race, level of education, or a previous experience
    • Feelings of uncertainty regarding social status in a particular group such as when the group’s dynamic changes, new people enter the group, or they join a new group
    • Exposure to new situations and environments where previous social skills may not be useful or applicable (e.g. relocation, immigration, or imprisonment)
    • Sudden isolation from a particular group
    • Acute disruption of typical social networks
  • Criticism and evaluation
    • Feeling criticized by others
    • Feeling judged by people with more power (e.g. superiors in a professional setting)
  • Acute sensory deficits, which may lead to sensory deprivation
    • Powerlessness and victimization due to traumatic life events such as robbery, rape, abuse, or neglect

Prevalence and Treatment

Even though Cluster A personality disorders are the most severe and disruptive to an individual’s life, these conditions receive relatively little research attention. The prevalence measures and diagnostic criteria vary from study to study but, aside from the odd and eccentric disorders being recognized as most severe, they also seem to be among the most prevalent. Research suggests that the worldwide prevalence is around 2.3% and prevalence in the US varies between .5% and 4.5%.

PPD is a lifelong mental health condition and can be severely disruptive to an individual’s well-being and functioning if it’s left untreated. It is common for individuals with any personality disorder to not recognize disruptive thoughts, beliefs, or behaviors, so family members, friends, and coworkers may identify this disorder before the individual does. In severe cases, loved ones may refer the clinician to the person with PPD. The traits of PPD often manifest during the late teenage years or in early adulthood. If PPD is left untreated, it tends to get more severe and disruptive as someone ages.

If an individual with PPD or any PD is committed to treatment and therapy, this can greatly increase their functioning and well-being. Even though there are no specific medications for PPD, drugs such as anti-anxiolytics, antidepressants, or antipsychotics are commonly prescribed to treat the symptoms of PPD. The primary treatment for PPD is psychotherapy, including cognitive behavioral therapy (CBT), psychoanalysis, and others. Long-term treatment goals for PPD usually focus on:

  • Increasing feelings of self-worth
  • Increasing coping skills
  • Developing a more trusting view of others and the world
  • Recognizing and accepting feelings of vulnerability
  • Verbalizing and communicating feelings of distress instead of engaging in maladaptive strategies such as avoidance, shunning, or intimidating others

Unfortunately, ingrained mistrust and suspicion can inhibit a successful, long-term commitment to therapy, especially if the individual is referred to therapy by others since this fuels mistrust in all parties. A large amount of time must be dedicated to building rapport between the patient and the clinician. At the same time, progress tends to be slow, with some research suggesting that at least 12 months are required before any progress can be observed. In the cases of extreme stress, an individual suffering from PPD can express aggravated defensiveness and even aggression towards the clinician.

If you are close or living with someone who is suffering from PPD, it is important to encourage them toward therapy or treatment programs. In the event of distress, avoid confrontation and criticism. Speak in clear, short sentences to make communication easier, since this leaves little room for misinterpretation or suspicion. Notify the individual with PPD of changes (e.g. additional guests for family and friends dinner, changes in routines, time modifications, etc.) in advance to help build trust.

References:

Carroll, A. (2009). Are you looking at me? Understanding and managing paranoid personality disorder. Advances in psychiatric treatment, 15(1), 40-48.

Lewis, K. C., & Ridenour, J. M. (2020). Paranoid Personality Disorder. Encyclopedia of personality and individual differences, 3413-3421.

Vyas, A., & Khan, M. (2016). Paranoid personality disorder. American Journal of Psychiatry Residents' Journal, 11(01), 9-11.

Winsper, C., Bilgin, A., Thompson, A., Marwaha, S., Chanen, A. M., Singh, S. P., ... & Furtado, V. (2020). The prevalence of personality disorders in the community: a global systematic review and meta-analysis. The British Journal of Psychiatry, 216(2), 69-78.

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