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Paranoid Personality Disorder

Disorders Paranoid

Paranoid personality disorder (PPD), is a mental condition characterized by prolonged pattern of mistrust and suspicion towards other individuals.


Presentation

People with PPD are always under the belief that others are constantly trying to harm, exploit and demean them. Their habit of mistrust and doubt hampers them from forming close relationships with others. In addition to these, other common symptoms include [5]:

  • Feeling of disbelief
  • Unable to take criticism 
  • They do not forgive others and hold grudges against people
  • Feeling of jealous and ruthless behavior exhibited
  • Social isolation accompanied by detachment is evident
  • Inability to realize and judge one’s own problem
Vomiting
  • These paranoid personality disorder medications have several side effects like nausea, vomiting, headache, disrupted metabolism, and are not recommended for people with heart or lung diseases and kidney diseases.[newsmax.com]
Fear
  • Paranoid personality disorder typically manifests as an irrational fear or paranoia that someone is planning to harm you.[news-medical.net]
  • They have very poor judgment in matters relating to their specific fears. Often their judgment is not so impaired in other areas and so can be quite misleading.[ptypes.com]
  • Symptoms Paranoid Personality Disorder Diagnosis Paranoid Personality Disorder Treatment Paranoid Personality Disorder Research Paranoid Personality Disorder Statistics Paranoid Personality Disorder Suggestions Anxiety Disorder NOS – Excessive Worry, Fear[ietherapy.com]
  • It was this fear which caused him to order the Watergate break-in even though he was all but certain to win the 1972 election, and it was this fear which made him record everything in the White House – records which would eventually lead to his downfall[lifehack.org]
Anger
  • Please answer … Read More Anger Test This test will help find your anger level. Answer below questions honestly and the anger test will check if your … Read More Psychopath Test Here is an online version of a psychopathic personality test.[illnessquiz.com]
  • Quick anger at perceived attack. Holding grudges, often about imagined slights. Discussion Everyone has a ' theory of mind ' in the way we try to guess what others are thinking.[changingminds.org]
  • […] 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[web.archive.org]
  • Perceive attacks on their character that are not apparent to others; they generally react with anger and are quick to retaliate. Have persistent suspicions, without reason, that their spouses or lovers are being unfaithful.[my.clevelandclinic.org]
  • Anger - People who suffer from personality disorders often feel a sense of unresolved anger and a heightened or exaggerated perception that they have been wronged, invalidated, neglected or abused.[outofthefog.website]
Social Isolation
  • Complications may include: Extreme social isolation Problems with school or work See a health care provider or mental health professional if suspicions are interfering with your relationships or work.[medlineplus.gov]
  • Symptoms of / Reasons for Paranoid Personality Disorder Detachment Hostility Concern about hidden motives Expectations of exploitation Inability to work well with others Poor self-image Social isolation[gomentor.com]
  • Paranoid personality disorder symptoms include social isolation, hostility, aggression, lack of a sense of humor, feeling of certainty without proof, and questioning hidden motives of even close friends and family members.[newsmax.com]
Delusion
  • Buchanan , A , Reed , A , Wessely , S et al ( 1993 ) Acting on delusions: II. The phenomenological correlates of acting on delusions . British Journal of Psychiatry ; 163 : 77 – 81 .[cambridge.org]
  • Buchanan, A, Reed, A, Wessely, S et al ( 1993 ) Acting on delusions: II. The phenomenological correlates of acting on delusions. British Journal of Psychiatry ; 163 : 77 – 81.[apt.rcpsych.org]
  • People exhibiting paranoia have disordered thoughts and delusions due to excessive suspicion. These delusions cause suspicion and the cycle continues.[newsmax.com]
  • PPD is distinguished from psychosis by the lack of full-blown delusions or hallucinations. PPD patients can be arrogant or vulnerable at times, and may alternate between shame or self-loathing and a feeling of omnipotence or righteousness.[bipolarcentral.com]
Aggressive Behavior
  • Berman , M , Fallon , AE , Coccaro , EF ( 1998 ) The relationship between personality psychopathology and aggressive behavior in research volunteers .[cambridge.org]
  • Berman, M, Fallon, AE, Coccaro, EF ( 1998 ) The relationship between personality psychopathology and aggressive behavior in research volunteers.[apt.rcpsych.org]
  • The relationship between personality psychopathology and aggressive behavior in research volunteers. J Abnorm Psychol. 1998;107:651–8. PubMed CrossRef Google Scholar 16. Esbec E, Echeburúa E.[link.springer.com]
Agitation
  • 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.[psychnet-uk.com]
  • At least four of the following features are present in cases of paranoid personality disorder: Excessive reactions and agitation in response to perceived criticism Tendency to bear grudges Suspiciousness Combative and disproportionate regard for personal[news-medical.net]
  • An antianxiety agent, diazepam, is prescribed if the patient suffers from severe anxiety or agitation that interferes with the normal day to day life activities.[symptoma.com]
  • Sometimes people may be prescribed an antianxiety medication if the paranoia causes severe anxiety and/or agitation.[wikihow.com]
Hyperactivity
  • References Other mental illnesses Alzheimer's disease Anxiety Asperger syndrome Attention deficit hyperactivity disorder Bipolar disorder Bovine spongiform encephalopathy Bulimia nervosa Childhood amnesia Dementia Depression Dissociative identity disorder[creationwiki.org]
  • One found that CBT alters the brain pathways involved in fear extinction—a common psychological phenomenon whereby a learned fear response declines—by decreasing hyperactivity in regions that underlie the response.[bridgestorecovery.com]
  • Depression Anxiety Suicidal Thoughts Bipolar Disorder Borderline Personality Disorder Post-Traumatic Stress Disorder Attention Deficit Hyperactivity Disorder Psychosis Child & Adolescent Programs Learn more about youth treatment programs for mental and[columbussprings.com]
Forgetful
  • “He does not forgive and forget,” he added. Squelch, 48, of Maidstone Road, Paddock Wood, had told him he suffered a blackout and he ascribed this to what Mr Wallington had been saying and doing.[kentonline.co.uk]
  • But while Nixon’s name will be forever associated with the Watergate incident, we should not forget that he did many great things as President. He established relations between America and China.[lifehack.org]
  • Overreaction to perceived or minimal offenses – Individuals with PPD fixate on past grievances and refuse to forgive or forget. The ultimate expression of this is when they equate offense against their person with an offense against Almighty God.[libertyforcaptives.com]
Excitement
  • It's been three months since my 17-year-old son returned to us from his 30-day stay at Paradigm Malibu and, I can honestly say, I have never seen him happier, more optimistic, or more excited about his future.[paradigmmalibu.com]
  • High Extraversion Excessive talking, leading to inappropriate self-disclosure and social friction; inability to spend time alone; attention seeking and overly dramatic expression of emotions; reckless excitement seeking; inappropriate attempts to dominate[ptypes.com]
  • People with this type of personality often crave excitement and attention. Anankastic - this is characterised by feelings of doubt, perfectionism and excessive conscientiousness. There is a compulsion to check and a preoccupation with details.[patient.info]
Encephalopathy
  • References Other mental illnesses Alzheimer's disease Anxiety Asperger syndrome Attention deficit hyperactivity disorder Bipolar disorder Bovine spongiform encephalopathy Bulimia nervosa Childhood amnesia Dementia Depression Dissociative identity disorder[creationwiki.org]

Workup

Paranoid disorders are diagnosed on the basis of personal and family history and if required physical examination. There are no laboratory tests to diagnose these disorders [6]. Following this, a psychological assessment is conducted which would include gathering information about school, work, childhood memories and relationships. Psychologists have specially designed medical tools and interview questions through which they can assess these disorders. The responses given by the individuals help in assessment of the condition [7].

Care must be taken to interact with these people as once mistrust developed, they may lose their chance of being treated. An honest, simple and concrete approach is likely to be benefited from. Current difficulties of life of the patient should be discussed and the therapist should not try to go deep into the aspects of the patient’s life [8].

Treatment

Personality disorder is treated by psychotherapy, which involves teaching coping skills to the patient to help them deal with different situations. Persons are encouraged to develop social interaction, self esteem and communication with others [9].

Medicines generally are not a part of treatment, unless required. Medications like antianxiety, antipsychotic drugs and antidepressants can be given to treat anxiety and depression when these condition appear as secondary complications to PPD.

Medications are contraindicated since they can lead to unnecessary suspicion and treatment dropout. Medications if indicated for any conditions should be given for briefest time possible in order to bring the condition under control.

An antianxiety agent, diazepam, is prescribed if the patient suffers from severe anxiety or agitation that interferes with the normal day to day life activities. An antipsychotic medication, like thioridazine or haloperidol, may be appropriate if a patient presents with symptoms of delusion, selfharm or harm to others [10].

Prognosis

Long-term prognosis for paranoid disorder is not good. Individuals who suffer from the disorder show prominent symptoms throughout their lives. Treatment approach with group and family therapy is not recommended.

People suffering from these disorders hardly present themselves for treatment; hence in most of the cases the symptoms and behavior of these patients are present throughout the lifetime. All mental health personnel who treat individuals suffering from paranoid personality disorder should adopt a straight-forward approach. Humorous behavior and information not received directly from them will create a great deal of suspicion.

Etiology

Paranoid personality disorder may arise due to many factors such as social, psychological and genetic factors. It depends on the individual personality that is shaped by the environment and the surroundings, the temperament as well the ability to deal with stress in daily life.

Other reasons are emotional and physical trauma experienced in the early childhood. People suffering from paranoid personality disorder may have close relatives suffering from schizophrenia which ultimately predisposes them to develop the condition [2].

Epidemiology

PPD is a common occurrence amongst the male population. It has been estimated that about 10 to 15% of the US population are affected by personality disorders. Of these, 0.5 to 2.5% account for PPD [3]. Such a type of personality disorder usually occurs in early adulthood.

Sex distribution
Age distribution

Pathophysiology

In patients with paranoid personality disorder, abnormalities are seen in the frontal, temporal, and parietal lobes. These can be a result of trauma, encephalitis and genetics. Diminishing monoamine oxidase (MAO) and serotonin levels may also be a reason. History of psychiatric disorders is present in some cases and the patient has developmental abnormalities in other cases [4].

Prevention

Prevention of paranoid personality disorder involves counseling the person. It includes teaching the person more productive ways of dealing with stress and coping with day to day life situations. Stress management can be taught to the person to cope up with his suspicious behavior. A straight forward approach and healthy interaction with the patient can help to resolve the situation.

Summary

The person with this disorder thinks that people will harm, deceive and exploit them, even when there is nothing obvious to support this. People have a suspicious and malevolent behavior towards others. Paranoid personality disorder (PPD) is amongst a group of conditions called "Cluster A" personality disorders that are presented with odd or eccentric ways of thinking and perception. Some kind of Paranoia is normal in every person. People with this disorder have paranoia to extremes; they suspect everyone can harm them. It gravely affects their professional and personal life [1].

Patient Information

  • Definition: People with paranoid personality disorder (PPD) have a tendency to assume that others will exploit, harm, or deceive them, even if there is no evidence supporting this thought. It’s fairly normal for people to have paranoia, but people with this disorder show extreme behavior of doubt and mistrust. Patients with PPD are difficult to get along with others and often have problems with close relationships. 
  • Cause: Causes can be emotion and psychological stress. Several factors such as social, psychological and emotional aspects are known to play foul. Paranoid disorder may also develop due to emotional and psychological trauma experienced by the person in the childhood. It can be associated with many diseases like schizophrenia, Alzheimer’s disease and dementia running in the family.
  • Symptoms: Symptoms include doubt on others, about loyalty and trust. Patient shows self restrictive and argumentative behavior with tendency of being self oriented and stubborn. These people do not socialize and hold grudges against people.
  • Diagnosis: Diagnosis can be made on symptoms and personal history of patient. These people present with a high degree of mistrust and doubt on others. There are no specific lab tests to diagnose this disorder, but there are adequate tools and interview questions which help a mental health care provider to help diagnose paranoid personality disorder.
  • Treatment: No specific treatment line is present. Medications are of little importance. Patient counseling is suggested where he is taught to deal with everyday stress and difficulties in day to day life.

References

Article

  1. Stein DJ. Borderline personality disorder: toward integration. CNS Spectr. Jul 2009;14(7):352-6.
  2. Zanarini MC. Childhood experiences associated with the development of borderline personality disorder. Psychiatr Clin North Am 2000; 23:89.
  3. Widiger TA, Sanderson CJ. Personality disorders. In: Tasman A, Kay J, Lieberman JA, eds. Psychiatry. Philadelphia, Pa: Harcourt Brace & Co; 1997:1291-1317.
  4. Soloff P, Nutche J, Goradia D, Diwadkar V. Structural brain abnormalities in borderline personality disorder: a voxel-based morphometry study. Psychiatry Res 2008; 164:223.
  5. Walsh Z, Shea MT, Yen S, Ansell EB, Grilo CM, McGlashan TH, et al. Socioeconomic-Status and Mental Health in a Personality Disorder Sample: The Importance of Neighborhood Factors. J Pers Disord. Sep 17 2012
  6. Hopwood CJ, Donnellan MB, Ackerman RA, Thomas KM, Morey LC, Skodol AE. The Validity of the Personality Diagnostic Questionnaire-4 Narcissistic Personality Disorder Scale for Assessing Pathological Grandiosity. J Pers Assess. Oct 26 2012
  7. Zimmerman M, Mattia JI. Axis I diagnostic comorbidity and borderline personality disorder. Compr Psychiatry 1999; 40:245.
  8. Ruocco AC. The neuropsychology of borderline personality disorder: a meta-analysis and review. Psychiatry Res 2005; 137:191.
  9. Livesley WJ. A practical approach to the treatment of patients with borderline personality disorder. Psychiatr Clin North Am. Mar 2000;23(1):211-32.
  10. Simeon D, Baker B, Chaplin W, Braun A, Hollander E. An open-label trial of divalproex extended-release in the treatment of borderline personality disorder. CNS Spectr. Jun 2007;12(6):439-43.

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Last updated: 2019-07-11 20:13