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:
Suspects, without sufficient basis, that others are exploiting,
harming, or deceiving him or her.
Is preoccupied with unjustified doubts about the loyalty or
trustworthiness of friends or associates.
Is reluctant to confide in others because of unwarranted fear
that the information will be used maliciously against him or
her.
Reads hidden demeaning or threatening meanings into benign remarks
or events persistently bears grudges, i.e., is unforgiving of
insults, injuries, or slights.
Perceives attacks on his or her character or reputation that
are not apparent to others and is quick to react angrily or
to counterattack.
Has recurrent suspicions, without justification, regarding fidelity
of spouse or sexual partner
DSM-IV Code: 301.0.
Does not
occur exclusively during the course of Schizophrenia, a Mood
Disorder With Psychotic Features, or another Psychotic Disorder
and is not due to the direct physiological effects of a general
medical condition.
Note: If
criteria are met prior to the onset of Schizophrenia, add "Premorbid,"
e.g., "Paranoid Personality Disorder (Premorbid)."
Associated Features:
Odd
or Eccentric or Suspicious Personality
Dramatic or Erratic or
Antisocial Personality
Differential
Diagnosis:
Some disorders
have similar or even the same symptoms. The clinician, therefore,
in his/her diagnostic attempt has to differentiate against the
following disorders which need to be ruled out to establish
a precise diagnosis.
Delusional
Disorder, Persecutory Type.
Schizophrenia,
Paranoid Type.
Mood Disorder
With Psychotic Features.
Schizotypal
Personality Disorder.
Schizoid
Personality Disorder.
Borderline
and Histrionic Personality Disorders.
Avoidant Personality
Disorder.
Antisocial
Personality Disorder
Narcissistic
Personality Disorder
Personality
Change Due to a General Medical Condition.
Symptoms
that may develop in association with chronic substance use.
Paranoid traits
associated with the development of physical handicaps.
Cause:
The
specific cause of this disorder is unknown, but the incidence
appears increased in families with a schizophrenic member. Paranoid
personality disorder can result from negative childhood experiences
fostered by a threatening domestic atmosphere. It is prompted
by extreme and unfounded parental rage and/or condescending
parental influence that cultivate profound child insecurities.
Treatment:
Treatment
of paranoid personality disorder can be very effective in controlling
the paranoia but is difficult because the person may be suspicious
of the doctor. Without treatment this disorder will be chronic.
Medications and therapy are common and effective approaches
to alleviating the disorder.
The social
consequences of serious mental disorders—family disruption,
loss of employment and housing—can be calamitous. Comprehensive
treatment, which includes services that exist outside the formal
treatment system, is crucial to ameliorate symptoms, assist
recovery, and, to the extent that these efforts are successful,
redress stigma. Consumer self-help programs, family self-help,
advocacy, and services for housing and vocational assistance
complement and supplement the formal treatment system. Consumers,
that is, people who use mental health services themselves, operate
many of these services. The logic behind their leadership in
delivery of these services is that consumers are thought to
be capable of engaging others with mental disorders, serving
as role models, and increasing the sensitivity of service systems
to the needs of people with mental disorder.
Counseling
and Psychotherapy [ See
Therapy Section ]:
Psychotherapy
is the most promising method of treatment for Paranoid Personality
Disorder. People afflicted with this disorder have deep foundational
problems that necessitate intense therapy. A confident therapist-client
relationship offers the most benefit to people with the disorder,
yet is extremely difficult to establish due to the dramatic
skepticism of patients with this condition. People with paranoid
personality disorder rarely initiate treatment and often terminate
it prematurely. Likewise, building therapist-client trust requires
great care and is complicated to maintain even after a confidence
level has been founded.
The long-term
projection for people with paranoid personality disorder is
bleak. Most patients experience predominant symptoms of the
disorder for the duration of their lifetime and require consistent
therapy.
Pharmacotherapy
[ See
Psychopharmacology Section ] :
An anti-anxiety
agent, such as diazepam, is appropriate to prescribe if the
client suffers from severe anxiety or agitation where it begins
to interfere with normal, daily functioning. An anti-psychotic
medication, such as thioridazine or haloperidol, may be appropriate
if a patient decompensates into severe agitation or delusionsal
thinking which may result in self-harm or harm to others.
