What is Paranoid Personality Disorder?
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. As we get older in our sixth and seventh decade of life we become distrustful. We are not able to think as quick, react quickly and become overly cautious. Paranoid features are not uncommon. This is NOT paranoid personality disorder.
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.
What are the causes of Paranoid Personality Disorder?
Any severe life trauma at an early age can trigger some of these symptoms. Rape, sexual and physical abuse, observing a family tragedy, ie: seeing a family member murdered or losing a home due to natural disaster can trigger paranoia. In order to meet the criteria for this diagnosis the symptoms must be severe and debilitating.
Once again, the problems with labeling occur. Everyone who experiences life trauma and sever tragedy does not meet criteria to fit into a diagnostic category. Why is that? Health care providers continue to struggle with that question.
What is the 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.
