2. Paranoid Personality Disorder

People with paranoid personality disorder are generally characterized by having a long-standing pattern of pervasive distrust and suspiciousness of others.  A person with paranoid personality disorder will nearly always believe that other people’s motives are suspect or even malevolent.
Individuals with this disorder assume that other people will exploit, harm, or deceive them, even if no evidence exists to support this expectation. While it is fairly normal for everyone to have some degree of paranoia about certain situations in their lives (such as worry about an impending set of layoffs at work), people with paranoid personality disorder take this to an extreme — it pervades virtually every professional and  personal relationship they have.
Individuals with Paranoid Personality Disorder are generally difficult to get along with and often have problems with close relationships. Their excessive suspiciousness and hostility may be expressed in overt argumentativeness, in recurrent complaining, or by quiet, apparently hostile aloofness. Because they are hypervigilant for potential threats, they may act in a guarded, secretive, or devious manner and appear to be “cold” and lacking in tender feelings. Although they may appear to be objective, rational, and unemotional, they more often display a labile range of affect, with hostile, stubborn, and sarcastic expressions predominating. Their combative and suspicious nature may elicit a hostile response in others, which then serves to confirm their original expectations.
Because individuals with Paranoid Personality Disorder lack trust in others, they have an excessive need to be self-sufficient and a strong sense of autonomy. They also need to have a high degree of control over those around them. They are often rigid, critical of others, and unable to collaborate, and they have great difficulty accepting criticism.
A personality disorder is an enduring pattern of inner experience and behavior that deviates from the norm of the individual’s culture. The pattern is seen in two or more of the following areas: cognition; affect; interpersonal functioning; or impulse control. The enduring pattern is inflexible and pervasive across a broad range of personal and social situations. It typically leads to significant distress or impairment in social, work or other areas of functioning. The pattern is stable and of long duration, and its onset can be traced back to early adulthood or adolescence.

Symptoms of Paranoid Personality Disorder

Paranoid personality disorder is characterized by a pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent. This usually begins in early adulthood and presents 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

Paranoid personality disorder generally isn’t diagnosed when another psychotic disorder, such as schizophrenia or a bipolar or depressive disorder with psychotic features, has already been diagnosed in the person.
Because personality disorders describe long-standing and enduring patterns of behavior, they are most often diagnosed in adulthood. It is uncommon for them to be diagnosed in childhood or adolescence, because a child or teen is under constant development, personality changes and maturation. However, if it is diagnosed in a child or teen, the features must have been present for at least 1 year.
Paranoid personality disorder is more prevalent in males than females, and occurs somewhere between 2.3 and 4.4 percent in the general population.
Like most personality disorders, paranoid personality disorder typically will decrease in intensity with age, with many people experiencing few of the most extreme symptoms by the time they are in the 40s or 50s.

How is Paranoid Personality Disorder Diagnosed?

Personality disorders such as  paranoid personality disorder are typically diagnosed by a trained mental health professional, such as a psychologist or  psychiatrist. Family physicians and general practitioners are generally not trained or well-equipped to make this type of psychological diagnosis. So while you can initially consult a family physician about this problem, they should refer you to a mental health professional for diagnosis and treatment. There are no laboratory, blood or genetic tests that are used to diagnose paranoid personality disorder.
Many people with paranoid personality disorder don’t seek out treatment. People with personality disorders, in general, do not often seek out treatment until the disorder starts to significantly interfere or otherwise impact a person’s life. This most often happens when a person’s coping resources are stretched too thin to deal with stress or other life events.
A diagnosis for  paranoid  personality disorder is made by a mental health professional comparing your symptoms and life history with those listed here. They will make a determination whether your symptoms meet the criteria necessary for a personality disorder diagnosis.

Causes of Paranoid Personality Disorder

Researchers today don’t know what causes paranoid personality disorder.  There are many theories, however, about the possible causes of paranoid   personality disorder.  Most professionals subscribe to a biopsychosocial model of causation — that is, the causes of  are likely due to biological and genetic factors, social factors (such as how a person interacts in their early development with their family and friends and other children), and psychological factors (the individual’s personality and temperament, shaped by their environment and learned coping skills to deal with stress). This suggests that no single factor is responsible — rather, it is the complex and likely intertwined nature of all three factors that are important. If a person has this personality disorder, research suggests that there is a slightly increased risk for this disorder to be “passed down” to their children.

Treatment of Paranoid Personality Disorder

Treatment of  paranoid personality disorder  typically involves long-term psychotherapy with a therapist that has experience in treating this kind of personality disorder. Medications may also be prescribed to help with specific troubling and debilitating symptoms. For more information about treatment, please see paranoid personality disorder treatment.

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Paranoid personality disorder (PPD) is one of a group of conditions called "Cluster A" personality disorders which involve odd or eccentric ways of thinking. People with PPD also suffer from paranoia, an unrelenting mistrust and suspicion of others, even when there is no reason to be suspicious.

This disorder usually begins by early adulthood and appears to be more common in men than in women.

What Are the Symptoms of Paranoid Personality Disorder?

People with PPD are always on guard, believing that others are constantly trying to demean, harm, or threaten them. These generally unfounded beliefs, as well as their habits of blame and distrust, might interfere with their ability to form close relationships. People with this disorder:

• Doubt the commitment, loyalty, or trustworthiness of others, believing others are using or deceiving them
• Are reluctant to confide in others or reveal personal information due to a fear that the information will be used against them
• Are unforgiving and hold grudges
• Are hypersensitive and take criticism poorly
• Read hidden meanings in the innocent remarks or casual looks of others
• Perceive attacks on their character that are not apparent to others; they generally react with anger and are quick to retaliate
• Have recurrent suspicions, without reason, that their spouses or lovers are being unfaithful
• Are generally cold and distant in their relationships with others, and might become controlling and jealous
• Cannot see their role in problems or conflicts and believe they are always right
• Have difficulty relaxing
• Are hostile, stubborn, and argumentative

What Causes Paranoid Personality Disorder?

The exact cause of PPD is not known, but it likely involves a combination of biological and psychological factors. The fact that PPD is more common in people who have close relatives with schizophreniasuggests a genetic link between the two disorders. Early childhood experiences, including physical or emotional trauma, are also suspected to play a role in the development of PPD.

How Is Paranoid Personality Disorder Diagnosed?

If physical symptoms are present, the doctor will begin an evaluation by performing a complete medical and psychiatric history and, if indicated, a physical exam. Although there are no laboratory tests to specifically diagnose personality disorders, the doctor might use various diagnostic tests to rule out physical illness as the cause of the symptoms.

If the doctor finds no physical reason for the symptoms, he or she might refer the person to a psychiatrist or psychologist, health care professionals who are specially trained to diagnose and treat mental illnesses. Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate a person for a personality disorder.

How Is Paranoid Personality Disorder Treated?

People with PPD often do not seek treatment on their own because they do not see themselves as having a problem. When treatment is sought, psychotherapy (a form of counseling) is the treatment of choice for PPD. Treatment likely will focus on increasing general coping skills, as well as on improving social interaction, communication, and self-esteem.

Because trust is an important factor of psychotherapy, treatment is challenging since people with PPD have such distrust of others. As a result, many people with PPD do not follow their treatment plan.

Medication generally is not a major focus of treatment for PPD. However, medications, such as anti-anxiety, antidepressant or anti-psychotic drugs, might be prescribed if the person's symptoms are extreme, or if he or she also suffers from an associated psychological problem, such as anxiety or depression.

What Complications Are Associated With Paranoid Personality Disorder?

The thinking and behaviors associated with PPD can interfere with a person's ability to maintain relationships, as well as their ability to function socially and in work situations. In many cases, people with PPD become involved in legal battles, suing people or companies they believe are "out to get them."

What Is the Outlook for People With Paranoid Personality Disorder?

The outlook for people with PPD varies. It is a chronic disorder, which means it tends to last throughout a person's life. Although some people can function fairly well with PPD and are able to marry and hold jobs, others are complete disabled by the disorder. Because people with PPD tend to resist treatment, the outcome often is poor.

Can Paranoid Personality Disorder Be Prevented?

Although prevention of PDD might not be possible, treatment can sometimes allow a person who is prone to this condition to learn more productive ways of dealing with situations.