Paranoid Personality Disorder Defin

Paranoid Personality Disorder
Definition and Epidemiological Statistics
The DTM-IV-TR defines paranoid personality disorder as “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” (APA, 2000). Sadock and Sadock (2003) identify the characteristic feature as a long-standing suspiciousness and mistrust of people in general. Prevalence is difficult to establish because individuals with the disorder seldom seek assistance for their problem or require hospitalization. When they present for treatment at the insistence of others, they may be able to pull themselves together sufficiently so that their behavior does not appear maladaptive. The disorder is more commonly diagnosed in men than in woman.
Clinical Picture
Individuals with paranoid personality disorder are constantly on guard, hypervigilant, and ready for any real or imagined threat. They appear tense and irritable. They have developed a hard exterior and become immune or insensitive to the feeling of others. They avoid interactions with other people, lest they be forced to relinquish some of their own power. They always feel that others are there to take advantage of them.
They are extremely oversensitive and tend to misinterpret even minute cues within the environment, magnifying and distorting them into thoughts of trickery and deception. Because they trust no one, they are constantly ‘testing” the honesty of others. Their intimidating manner provokes almost everyone with whom they come in contact into exasperation and anger.
Individuals who are paranoid maintain their self-esteem by attributing their shortcomings to others. They do not accept responsibility for their own behaviors and feelings and project this responsibility on to others. They are envious and hostile toward others who are highly successful and believe the only reason they are not as successful is because they have been treated unfairly. People who are paranoid are extremely vulnerable and constantly on the defensive. Any real or imagined threat can release hostility and anger that is fueled by animosities from the past. The desire for reprisal and vindication is so intense that a possible loss of control can result in aggression and violence. These outbursts are usually brief, and the paranoid person soon regains the external control, rationalizes the behavior, and reconstructs the defenses central to his or her personality pattern.
The DTM-IV-TR diagnostic criteria for paranoid personality disorder are presented in Table37-2.
Predisposing factors
Research has indicated a possible hereditary link in paranoid personality disorder. Studies have revealed a higher incidence of paranoid personality disorder among relatives of clients with schizophrenia than among control subjects (Sadock & Sadock, 2003).
Psychosocially, people with paranoid personality disorder may have been subjected to parental antagonism and harassment. They likely served as scapegoats for displaced parental aggression and gradually relinquished all hope of affection and approval. They learned to perceive the world as harsh and unkind, a place calling for protective vigilance and mistrust. They entered the world with a “chip-on-the-shoulder” attitude and were met with many rebuffs and rejections from others. Anticipatinghumiliation and betrayal by others, the paranoid person learned to attack first.