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Paranoid Personality Disorder

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In-depth look at Paranoid Personality Disorder - signs and symptoms, diagnosis, causes, and treatment.

People with paranoid personality disorder (PPD) have long-term, widespread and unwarranted suspicions that other people are hostile, threatening or demeaning. These beliefs are steadfastly maintained in the absence of any real supporting evidence. In other words, paranoid personality disorder is a psychiatric diagnosis that denotes a personality disorder with paranoid features.

PPD is characterized by an exaggerated sensitivity to rejection, resentfulness, distrust, as well as the inclination to distort experienced events. Neutral and friendly actions of others are often misinterpreted as being hostile or contemptuous. Unfounded suspicions regarding the sexual loyalty of partners and loyalty in general as well as the belief that one's rights are not being recognized is stubbornly and argumentatively insisted upon. Such individuals can possess an excessive self-assurance and a tendency toward an exaggerated self-reference.

The use of the term paranoia in this context is not meant to refer to the presence of true delusions or psychosis, but implies the presence of ongoing, unbased suspiciousness and distrust of people. Despite the pervasive suspicions they have of others, patients with PPD are not delusional (except in rare, brief instances brought on by stress). Most of the time, they are in touch with reality, except for their misinterpretation of others' motives and intentions. PPD patients are not psychotic but their conviction that others are trying to "get them" or humiliate them in some way often leads to hostility and social isolation.

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What are the signs and symptoms of Paranoid Personality Disorder?

In-depth look at Paranoid Personality Disorder - signs and symptoms, diagnosis, causes, and treatment.A core symptom of PPD is a generalized distrust of other people. Comments and actions that healthy people would not notice come across as full of insults and threats to someone with the disorder. Yet, generally, patients with Paranoid Personality Disorder remain in touch with reality; they don't have any of the hallucinations or delusions seen in patients with psychoses. Nevertheless, their suspicions that others are intent on harming or exploiting them are so pervasive and intense that people with PPD often become very isolated. They avoid normal social interactions. And because they feel so insecure in what is a very threatening world for them, patients with PPD are capable of becoming violent. Innocuous comments, harmless jokes and other day-to-day communications are often perceived as insults.

Paranoid suspicions carry over into all realms of life. Those burdened with PPD are frequently convinced that their sexual partners are unfaithful. They may misinterpret compliments offered by employers or coworkers as hidden criticisms or attempts to get them to work harder. Complimenting a person with PPD on their clothing or car, for example, could easily be taken as an attack on their materialism or selfishness.

Because they persistently question the motivations and trustworthiness of others, patients with PPD are not inclined to share intimacies. They fear such information might be used against them. As a result, they become hostile and unfriendly, argumentative or aloof. Their unpleasantness often draws negative responses from those around them. These rebuffs become "proof" in the patient's mind that others are, indeed, hostile to them. They have little insight into the effects of their attitude and behavior on their generally unsuccessful interactions with others. Asked if they might be responsible for negative interactions that fill their lives, people with PPD are likely to place all the blame on others.

A brief summary of the typical symptoms of PPD includes:

  • suspiciousness and distrust of others

  • questioning hidden motives in others

  • feelings of certainty, without justification or proof, that others are intent on harming or exploiting them

  • social isolation

  • aggressiveness and hostility

  • little or no sense of humor

DSM IV Criteria for Paranoid Personality Disorder

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

What causes someone to develop Paranoid Personality Disorder?

No one knows what causes paranoid personality disorder, although there are hints that familial factors may influence the development of the disorder in some cases. There seem to be more cases of PPD in families that have one or more members who suffer from such psychotic disorders as schizophrenia or delusional disorder.