Paranoid personality disorder is a psychiatric

condition in which a person has a long-term distrust and suspicion of others, but does not have a full-blown psychotic disorder such as schizophrenia People with PPD also suffer from paranoia, an unrelenting mistrust and suspicion of others, even when there is no reason to be suspicious.

 Paranoid personality disorder describes a pattern of

continuous distrust and suspicion of others, as well as their motives. The onset of this behavior is early adulthood. These individuals believe that others will take advantage and deceive them, with no foundation for this belief. These individuals also believe their others are ignoring them and may harm them. The DSM IV illustrates this well with an example of a store clerk who makes an honest mistake, but the individual feels the clerk is purposely trying to shortchange him

 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 schizophrenia suggests a genetic link between the two disorders. Early childhood experiences including physical or emotional traumaare also suspected to play a role in the development of PPD

 Any severe life trauma at an early age can trigger some

of these symptoms.
Rape, sexual and physical abuse, observing a family tragedy, ie: seeing a family member

murdered or losing a home due to natural disaster can trigger paranoia

 Disorder is about 0.5%-2.5% of the general population.

It is seen in 2%-10% of psychiatric outpatients.

This disorder occurs more commonly in males.

 People with paranoid personality disorder are highly

suspicious of other people. As a result, people with this condition severely limit their social lives. They often feel that they are in danger, and look for evidence to support their suspicions. People with this disorder have trouble seeing that their distrustfulness is out of proportion to their environment.

 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

 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, believing they are always right Have difficulty relaxing Are hostile, stubborn, and argumentative Expectation that they will be exploited by others Inability to work together with others Social isolation Detachment

 Paranoid Personality Disorder is

a condition characterized by excessive distrust and suspiciousness of others.

This disorder is only diagnosed

when these behaviors become persistent and very disabling or distressing.

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

1. 2. 3. 4.

5. 6.

7.

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

B. Does not occur exclusively during the course of Schizophrenia, a Mood Disorder With Psychotic Features, or another Psychotic Disorder and is not due to the direct physiological effects of a general medical condition. Note: If criteria are met prior to the onset of Schizophrenia, add "Premorbid," e.g., "Paranoid Personality Disorder (Premorbid).
Reprinted with permission from the Diagnostic and Statistical

Manual of Mental Disorders, fourth Edition. Copyright 1994 American Psychiatric Association

 generally difficult to get along with and often have

problems with close relationships because of their excessive suspiciousness and hostility. Their combative and suspicious nature may elicit a hostile response in others, which then serves to confirm their original expectations They are often rigid, critical of others, and unable to collaborate, although they have great difficulty accepting criticism themselves.

 They often become involved in legal disputes.

often attuned to issues of power and rank, and tend to

develop negative stereotypes of others, particularly those from population groups distinct from their own More severely affected individuals with this disorder may be perceived by others as fanatics and form tightly knit cults or groups with others who share their paranoid beliefs.

 In response to stress, individuals with this disorder may

experience very brief psychotic episodes (lasting minutes to hours). If the psychotic episode lasts longer, this disorder may actually develop into Delusional Disorder or Schizophrenia. Individuals with this disorder are at increased risk for Major Depressive Disorder, Agoraphobia, ObsessiveCompulsive Disorder, Alcohol and Substance-Related Disorders. Other Personality Disorders (especially Schizoid, Schizotypal, Narcissistic, Avoidant, and Borderline) often co-occur with this disorder.

 People with PPD often do not seek treatment on their own

because they do not see themselves as having a problem. The distrust of others felt by people with PPD also poses a challenge for health care professionals because trust is an important factor of psychotherapy (a form of counseling). As a result, many people with PPD do not follow their treatment plan. When treatment is sought, psychotherapy is the treatment of choice for PPD focus on increasing general coping skills, as well as on improving social interaction, communication, and self-esteem.

 Medication generally is not used to treat PPD.

However, medicationssuch as anti-anxiety, antidepressant or anti-psychotic drugsmight be prescribed if the persons symptoms are extreme, or if he or she also suffers from an associated psychological problem, such as anxiety or depression.

 This examiner usually begins by asking the patient his

interpretation and definition of the word trust, and what has to take place before someone can be trusted. This is a good foundation on which to build trust.

1.

2.

3.

Time has to pass. There has to be time spent with the individual. You cannot trust someone immediately. Usually the paranoid personality very readily agrees with this premise, and length of time for trust to occur is extremely variable. There has to be gift giving back and forth. This does not refer to material gifts being offered and received; rather, it refers to gifts of disclosure offered and received, a quid pro quo of sorts. Consistency. In treating the paranoid personality disorder, the therapist cannot miss a session, cannot be late to a session, as this will be grossly misinterpreted. It is very, very important to be consistent with these individuals, because you will take 5 steps backwards in sessions if you are not.

 Therapy usually lasts a minimum of a year, but may be

longer. Medications have not prove to be particularly affective. However, if the paranoid personality disorder shows degrees of anxiety which is not uncommon, antianxiety medication can be helpful in low doses. However, it should be noted that the severity of the paranoia may impede the benefit of any medication

 The outlook for people with PPD varies. It is a chronic

disorder, which means it tends to last throughout a . persons life. The outlook usually depends on whether the person is willing to accept help. Therapy and medications can reduce paranoia and limit its impact on the person's daily functioning. Because people with PPD tend to resist treatment, the outcome often is poor

 Although prevention of the disorder might not be

possible, treatment can sometimes allow a person who is prone to this disorder to learn more productive ways of dealing with situations