What is Paranoid Personality Disorder?

He Paranoid personality disorder Is characterized because the person is excessively suspicious and suspicious of others without any justification.

They tend not to trust other people and to think that they want to hurt them. While it may be adaptive to be a bit wary of others and their intentions, being overly suspicious may interfere with personal life or work.

Even events that are nothing related to them are interpreted as personal attacks.

People with this disorder often find it difficult to get along with others and often have problems in establishing close personal relationships.

These people are very sensitive to criticism and have a great need to be self-sufficient and autonomous.

They also need to have a high level of control over those around them. They are often rigid, critical of others and unable to collaborate.

Symptoms of Paranoid Personality Disorder

Paranoid disorder usually begins in early adulthood and occurs in a variety of contexts, with symptoms such as:

• He suspects, without sufficient basis, that others are exploiting, damaging or lying.
• Concern for unwarranted doubts about the loyalty or distrust of friends or close people.
• Reluctant to trust others for unjustified fear that the information will be used against him / her.
• Persistent resentment.
• Perceive attacks on his character or reputation.
• Impulsiveness on reaction.
• Recurring suspicions without justification, as to the fidelity of the sexual partner.

Causes

Cognitive theorists believe that this disorder is the result of a belief that other people are lying or malevolent, in combination with a lack of selfesteem .

This is a maladaptive way of seeing the world that dominates any aspect of the life of these individuals.

Other possible causes have been proposed. For example, some therapists believe that behavior has been learned in childhood experiences. Accordingly, children who are exposed to adult hatred and have no way of predicting or escaping develop paranoid traits of thought in an effort For coping with stress

On the other hand, some research suggests that the disorder may be slightly more common among relatives of people with schizophrenia , Although the association is not very solid.

Studies with monozygotic or dizygotic twins suggest that genetic factors may also play an important role.

Cultural factors have also been linked to this disorder; It is thought that certain groups of people, such as prisoners, refugees, people with hearing difficulties or elderly people, are more likely to develop it.

Diagnosis

Because paranoid personality disorder describes patterns of long-term behavior, they are diagnosed more often in adulthood.

DSM-IV diagnostic criteria

A) General distrust and suspicion from the onset of adulthood, so that the intentions of others are interpreted as malicious, and appear in different contexts, as indicated by four (or more) of the following points:

1. He suspects, without sufficient basis, that others will take advantage of them, they will hurt or deceive.
2. He worries about unwarranted doubts about the loyalty or loyalty of friends and associates.
3. He is reluctant to trust others for unjustified fear that the information they share will be used against him.
4. In the most innocent observations or facts he glimpses hidden meanings that are degrading or threatening.
5. Holds grudges for a long time, for example, I do not forget insults, insults or scorn.
6. Perceive attacks on his person or his reputation that are not apparent to others and is willing to react with anger or counterattack.
7. You repeatedly and unjustifiably suspect that your spouse or partner is unfaithful to you.

B) These characteristics do not appear exclusively in the course of a schizophrenia, a mood disorder with psychotic symptoms or other psychotic disorder, and are not due to the direct physiological effects of a medical illness.

Diagnostic criteria ICD-10

It is characterized by at least three of the following:

• Excessive sensitivity to setbacks or rejections.
• Tendency to persistent spite. Negative to forgive insults or mischief.
• Suspicion and general tendency to misunderstand the neutral or friendly actions of others.
• Recurring suspicions, without justification, regarding the sexual fidelity of the spouse or sexual partner.
• Tendency to experience excessive self-importance.
• Concern unfounded by conspiracies in events.

Differential diagnosis

It is important that psychologists or psychiatrists do not confuse paranoid disorder with another personality or mental disorder that may have some symptoms in common.

For example, it is important to make sure that the patient is not a long-term consumer of amphetamines or cocaine. Chronic abuse of these stimulants can produce paranoid behavior.

Also, some drugs can produce paranoid side effects. If the patient has symptoms of schizophrenia, Hallucinations Or a thought disorder, a diagnosis of paranoid disorder can not be made.

Suspicion and other characteristics must be present in the patient for a long time.

The following pathologies should be ruled out before diagnosing PPT: paranoid schizophrenia, schizotypal personality disorder , Schizoid personality disorder, mood disorders with psychotic features, symptoms or personality changes caused by illness, medical conditions or drug abuse, and Borderline personality disorders , histrionic , Avoidant, antisocial or narcissistic.

Comorbidity

Other disorders may occur together with this disorder:

• Schizophrenia or psychotic disorders.
• Major depression .
• Agoraphobia .
• Obsessive-compulsive disorder .
• Substance abuse.
• Personality disorders: avoidant, schizoid, avoidant, schizotypal, narcissistic, borderline.

Treatment

Treatment of paranoid personality disorder can be very effective at controlling paranoia but it is difficult because the person may suspect the doctor.

Without treatment, this disorder may be chronic.

Psychotherapy

A relationship of trust with a therapist offers a great benefit to people with this disorder, although it is extremely complicated by the skepticism of these people.

Building the patient-therapist relationship requires a lot of patience and is complicated to maintain even when confidence has been established.

Group therapies that include family members or other psychiatric patients are not helpful in these people because of their lack of trust in others.

To gain the trust of these patients, therapists must hide as little as possible. This transparency should include note taking, administrative details, tasks related to the patient, correspondence, medications...

Any indication that the patient considers a"lie"may lead to treatment withdrawal.

On the other hand, paranoid patients do not have a developed sense of humor, so those who interact with them should think about making jokes in their presence, as they may take them as ridiculous because they feel easily threatened.

With some patients, the most important goal is to help them learn to relate well with other people.

Medication

Medication is not recommended for patients with PPT, since they may contribute to the sense of suspicion.

If they can be used to treat specific conditions of the disorder such as severe anxiety or illusions.

An anxiolytic As diazepam can be prescribed if the patient suffers from severe anxiety. An antipsychotic such as thioridazine or haloperidol if the patient has dangerous paranoid thoughts.

Medications should be used for the shortest possible time.

The best use of medication may be for specific complaints, when the patient trusts the therapist enough to ask for help to reduce their symptoms.

Individuals with paranoid disorders typically have difficulty getting along with others and often have trouble establishing close personal relationships due to excessive suspicion and hostility.

They are usually unable to collaborate with others at work and may be against being close to others for fear of sharing information.

The combative and suspicious nature may request a hostile response in others, which serves to confirm their original expectations.

References

1. American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision (DSM-IV-TR). Washington, DC: American Psychiatric Association.
2. Kendler KS; Czajkowski N; Tambs K et al. (2006). "Dimensional representations of DSM-IV cluster A personality disorders in a population-based sample of Norwegian twins: a multivariate study". Psychological Medicine 36 (11): 1583-91. Doi: 10.1017 / S0033291706008609. PMID 16893481.
3. Millon, Théodore; Grossman, Seth (6 August 2004). Personality disorders in modern life. Wiley. ISBN 978-0-471-23734-1.
4. MacManus, Deirdre; Fahy, Tom (August 2008). "Personality disorders". Medicine 36 (8): 436-441. Doi: 10.1016 / j.mpmed.2008.06.001.
5. American Psychiatric Association (2012). DSM-V Development. Http://www.dsm5.org.