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Paranoid Personality Disorder - Paranoid Personality

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Other possible interpersonal causes have been proposed. For example, some therapists believe that the behavior that characterizes paranoid personality disorder might be learned. They suggest that such behavior might be traced back to childhood experiences. According to this view, children who are exposed to adult anger and rage with no way to predict the outbursts and no way to escape or control them develop paranoid ways of thinking in an effort to cope with the stress. PPD would emerge when this type of thinking becomes part of the individual's personality as adulthood approaches.

Studies of identical (or monozygotic) and fraternal (or dizygotic) twins suggest that genetic factors may also play an important role in causing the disorder. Twin studies indicate that genes contribute to the development of childhood personality disorders, including PPD. Furthermore, estimates of the degree of genetic contribution to the development of childhood personality disorders are similar to estimates of the genetic contribution to adult versions of the disorders.

What are the risk factors linked to Paranoid Personality Disorder?

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According to the DSM-IV-TR, between 0.5% and 2.5% of the general population of the United States may have PPD, while 2%Å“10% of outpatients receiving psychiatric care may be affected. A significant percentage of institutionalized psychiatric patients, between 10% and 30%, might have symptoms that qualify for a diagnosis of PPD. Finally, the disorder appears to be more common in men than in women.

Risk factors for paranoid personality disorder include: having other family members with psychotic disorders such as schizophrenia or delusional disorder, dysfunctional family situation where parents express unpredictable anger and rage.

How is Paranoid Personality Disorder diagnosed?

There are no laboratory tests or imaging studies that can be used to confirm a diagnosis of paranoid personality disorder. The PPD diagnosis is usually made on the basis of the doctor's interview with the patient, although the doctor may also give the patient a diagnostic questionnaire. In addition, input from people who know the patient may be requested.

Mental health care providers look for at least five distinguishing symptoms in patients who they think might suffer from PPD. The first is a pattern of suspiciousness about, and distrust of, other people when there is no good reason for either. This pattern should be present from at least the time of the patient's early adulthood.

In addition to this symptom that is required in order to make the PPD diagnosis, the patient should have at least four of the following seven symptoms as listed in the DSM-IV-TR:

  • The unfounded suspicion that people want to deceive, exploit or harm the patient.

  • The pervasive belief that others are not worthy of trust or that they are not inclined to or capable of offering loyalty.

  • A fear that others will use information against the patient with the intention of harming him or her. This fear is demonstrated by a reluctance to share even harmless personal information with others.

  • The interpretation of others' innocent remarks as insulting or demeaning; or the interpretation of neutral events as presenting or conveying a threat.

  • A strong tendency not to forgive real or imagined slights and insults. People with PPD nurture grudges for a long time.

  • An angry and aggressive response in reply to imagined attacks by others. The counterattack for a perceived insult is often rapid.

  • Suspicions, in the absence of any real evidence, that a spouse or sexual partner is not sexually faithful, resulting in such repeated questions as "Where have you been?" "Whom did you see?" etc., and other types of jealous behavior.

Differential diagnosis

Psychiatrists and clinical psychologists should be careful not to confuse paranoid personality disorder (PPD) with other mental disorders or behaviors that have some symptoms in common with the paranoid personality. For example, it is important to make sure that the patient is not a long-term user of amphetamine or cocaine. Chronic abuse of these stimulants can produce paranoid behavior. Also, some prescription medications might produce paranoia as a side effect; so it is important to find out what drugs, if any, the patient is taking.

There are other conditions that, if present, would mean a patient with paranoid traits does not have PPD. For example, if the patient has symptoms of schizophrenia, hallucinations or a formal thought disorder, a diagnosis of PPD can't be made. The same is true of delusions, which are not a feature of PPD.

Also, the suspiciousness and other characteristic features of PPD must have been present in the patient for a long time, at least since early adulthood. If the symptoms appeared more recently than that, a person can't be given a diagnosis of this disorder.

There are at least a dozen disorders or other mental health conditions listed in the DSM-IV-TR that could be confused with PPD after a superficial interview because they share similar or identical symptoms with PPD. It is important, therefore, to eliminate the following entities before settling on a diagnosis of PPD: paranoid schizophrenia; schizotypal personality disorder; schizoid personality disorder; persecutory delusional disorder; mood disorder with psychotic features; symptoms and/or personality changes produced by disease, medical conditions, medication or drugs of abuse; paranoia linked to the development of physical handicaps; and borderline, histrionic, avoidant, antisocial or narcissistic personality disorders.