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According to the DSM IV, paranoid personality disorder
describes a pattern of continuous distrust and suspicion of others,
as well as their motives. The onset of this behavior is early adulthood.
These individuals believe that others will take advantage and deceive
them, with no foundation for this belief. These individuals also
believe their others are ignoring them and may harm them. The DSM
IV illustrates this well with an example of a store clerk who makes
an honest mistake, but the individual feels the clerk is purposely
trying to shortchange him.
These individuals may not view offers of help as help at all, but
rather as criticism. Grudges towards others are not uncommon. They
frequently engage in arguments, and constantly feel they are under
attack. They are frequently on the defensive, and counterattack.
They have extreme pathological jealousy, especially with close relationships
or partners, without sufficient justification. They also have an
extreme sense of individuality, and a strong need for self sufficiency.
These individuals feel they have to completely control others around
them. They do not admit to their shortcomings, but blame others,
quickly seeking out an attorney for advice.
It is important to note that these individuals may have psychotic
episodes, but only for brief periods; therefore, this disorder cannot
be grouped as a psychosis.
As individuals age, it is not uncommon for them to display what
appears to be paranoia from time to time, fearful of failing health
and deteriorating abilities. It is important to note that this does
not meet the criteria for paranoid personality disorder, as these
fears and frustrations are commonly found in all aging individuals.
Paranoia – Gender and culturally-related
Feelings of isolation are not uncommon for individuals who belong
to any gender or culturally-related minority group. This is especially
well illustrated with respect to individuals with Middle Eastern
backgrounds. Given our current political climate, it would not be
surprising to find these individuals hyper-vigilant, but this hyper-vigilance
would be incorrectly diagnosed as paranoia.
Treatment of Paranoid Personality Disorder
First and foremost, establishing trust is of critical importance.
It is also a most difficult task. If one is a true paranoid personality,
then establishing trust clearly becomes quite difficult. This examiner
usually begins by asking the patient his interpretation and definition
of the word trust, and what has to take place before someone can
be trusted. This is a good foundation on which to build trust. In
therapy, a few things have to occur before trust can be built:
- Time has to pass. There has to be time spent with the individual.
You cannot trust someone immediately. Usually the paranoid personality
very readily agrees with this premise, and length of time for
trust to occur is extremely variable.
- There has to be gift giving back and forth. This does not refer
to material gifts being offered and received; rather, it refers
to gifts of “disclosure” offered and received, a “quid
pro quo” of sorts.
- Consistency. In treating the paranoid personality disorder,
the therapist cannot miss a session, cannot be late to a session,
as this will be grossly misinterpreted. It is very, very important
to be consistent with these individuals, because you will take
5 steps backwards in sessions if you are not.
Therapy usually lasts a minimum of a year, but may be longer.
Medications have not prove to be particularly affective. However,
if the paranoid personality disorder shows degrees of anxiety which
is not uncommon, anti-anxiety medication such as Paxil can be helpful
in low doses. However, it should be noted that the severity of the
paranoia may impede the benefit of any medication.
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