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Paranoid Personality Disorder (PPD)

Paranoid Personality Disorder (PPD) is characterized by an all encompassing distrust and suspicion of the motives of others and a belief that their intent is malevolent. This suspicion may be exhibited in argumentative behavior, or recurrent complaints about others. Patients with Paranoid Personality Disorder often appear cold, objective and rational, and frequently display hostile, stubborn, and sarcastic behavior. PPD patients form negative stereotypes and beliefs about others and often join cults or groups that share their paranoid belief system. Patients can be distant and cold even in intimate relationships, and may become controlling or jealous if they are emotionally attached to another person. They don’t like changing situations and will attribute hidden motives to even the most innocent and positive acts of others. When they believe their suspicions are confirmed, they will sometimes react with frighteningly hostile behavior. Patients often take legal action against others when they feel righteously indignant about an offense.

At work, they can be very efficient though they work best in jobs where they are isolated from interaction with others. Paranoid Personality behavior can exhibit a continuum from normal vigilance to transient paranoid behavior and suspiciousness that may range from delusional states to paranoid schizophrenia. 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. They are intensely afraid of domination, and loss of autonomy, and will attempt to exert power to avoid perceived abuse from people in authority.

Patients with Paranoid Personality Disorder struggle with fear of abuse, exploitation, or harm from others and they believe the world is a hostile place. Their rage masks an abiding sense of inferiority.

The cause of paranoid personality disorder is not known, but research seems to indicate that it is more common in families with schizophrenia and delusional disorder. PPD can appear in childhood and adolescence with evidence of solitary behavior, poor peer relationships, hypersensitivity to others, peculiar thinking, and interpretation of the behavior of others.

What are the symptoms?

• Interprets behavior of others as deliberately threatening or insulting
• Jealous, guarded, secretive, cold, serious, scheming
• Suspicious of sexual infidelity
• Inability to collaborate with others, social isolation, detachment
• Holds grudges, is not willing to forgive perceived insults and malice
• Untrusting, prone to anger and aggression without justification because of perceived disloyalty or deceit
• Inflated view of self, need to be in power and control at all times
• Combatively protects personal rights
• Looks for hidden motives, reluctant to confide in others
• Reads malignancy into innocent comments and actions of others

How is it diagnosed and treated?

In diagnostic screening, doctors must distinguish PPD from symptoms associated with chronic substance abuse. Doctors will perform a physical and mental evaluation to rule out other medical and mental disorders. Paranoid Personality Disorder is ultimately diagnosed, based on psychological evaluation and the history and severity of the symptoms, considering repetitive patterns of behavior or perceptions that cause distress and impair social function. The doctor will look for the following beliefs:

• Patient believes disaster is always on the horizon, has a sense of foreboding at all times
• The world is full of enemies
• The patient is never to blame
• Believes that accidents are unlikely and that all negative events stem from hostile acts of others
• All occurrences relate to the patient
• Patient has unique awareness and insight and is different from everyone else in that knowledge

Treatment(s) can include:

• Psychotherapy
• Medications like anti-anxiety, anti-depressants if appropriate (moderately effective in treatment of irritability and suspiciousness), anti-psychotic if warranted by delusions, neuroleptics for low-grade paranoia. SSRIs and neuroleptics may be used effectively in combination
• Self-Help groups, family self-help groups

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