Paranoid Personality Disorder
Paranoid personality disorder is exhibited by a consistent distrust of others and a constant suspicion that people have ulterior motives. Individuals with this disorder tend to have unwavering trust in their own perceptions and abilities. They usually avoid intimate relationships and they engage in persecutory fantasies. They search for the hidden meanings in everything around them and they perceive malevolent intentions into the actions of others. Quick to question the trustworthiness and loyalty of others, they can appear cold and distant. They typically blame others and often to carry grudges. The pattern of distrust and suspiciousness of others motives usually begins in early adulthood and is present in several different contexts, as indicated by four or more of the following according to the DSM IV:
- Unwillingness to forgive perceived insults
- Excessive sensitivity to failures and setbacks
- Distrustfulness and excessive self-reliance
- Projection of blame
- Consumed by anticipation of betrayal
- Combative and tenacious adherence to personal rights
- Relentlessly suspicious
- Suspects with sufficient basis that others are harming or exploiting them
- Preoccupied with unjustified doubts about the loyalty or trustworthiness of others
- Reluctant to confide in others because of fear that the information will be used maliciously
- Reads hidden meaning or threatening meanings into benign remarks or events
- Persistently bears grudges
- Perceives attacks on his or her character or reputation that are not apparent to others
- Recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner
Treatment
Personality disorders are a challenge to treat since they are an integral part of what defines an individual and their core self. Treatment for personality disorders often focuses on increasing coping skills and interpersonal relationship skills through psychotherapy.
As with other personality disorders, psychotherapy or talk therapy is the treatment of choice. However, individuals with paranoid personality disorder rarely are internally motivated to seek treatment. Therefore there has been little outcome research to suggest which types of treatment are most effective with this disorder.
Therapy that has the approach of a simple supportive, client-centered method will be most effective. Rapport and relationship building with an individual who has this disorder will be much more difficult than with others in treatment because of the paranoia associated with the disorder. Early termination is common. As the therapy progresses, and the work becomes more challenging and deeper, the patient will likely begin to trust the clinician more and more. As the client begins disclosing more of their odd paranoid ideation, the therapist must be careful to balance objectivity with raising the suspicions of the client that he or she is not trusted. It is a difficult balance to maintain, even within the context of a good therapeutic relationship. It is necessary to maintain a fine line between colluding with the delusion and openly challenging too firmly or denying the bizarre belief. Since the paranoid beliefs are delusional and not based on reality, arguing them from a logical point of view is useless. Challenging the beliefs is also likely to result in more frustration on both the part of the therapist and distrust on the part of the client. The delusions can be explored and questioned but if done too firmly the client may leave therapy for good. Issues of control should be dealt with in a similar fashion, with great care and gentle support.