Personality Disorders
In the field of psychology, certain patterns of behavior and thoughts are considered to be different from what is generally found in a particular culture. These are called personality disorders. These patterns are unhealthy and rigid. These disorders negatively affect the person’s social and professional areas of life.
Personality disorders have been divided into 3 categories – Cluster A (odd/eccentric), Cluster B (dramatic/erratic) and Cluster C (anxious/inhibited).
Cluster A which includes personalities which are suspicious of others or are not interested in others. Paranoid personality disorder falls under this cluster.
Symptoms of Paranoid Personality Disorder (PPD)
- Lack of trust and suspicion towards others and the reasons for their actions.
- Belief that others are trying to do harm with no reason to feel this way.
- Doubts the loyalty of others.
- Unwilling to trust others.
- Socially isolated.
- Hesitates to confide in others for fear that others will use that information against them.
- Takes innocent remarks or situations that are not threatening as personal insults or attacks.
- Becomes angry or hostile to what are believed to be slights or insults.
- Holds onto grudges for a long time
Causes, Comorbidities
There is no definitive cause for PPD. There is some evidence that a combination of biology, environmental (trauma) and psychological factors lead to the formation of PPD. Research shows that there is a genetic link between schizophrenia and PPD – higher risk for PPD if a relative has schizophrenia.
Research has shown the following mental conditions to be possibly co-occurring with PPD :
- Depression
- Obsessive Compulsive Disorder (OCD)
- Alcohol dependence, Substance abuse
- Post Traumatic Stress Disorder (PTSD)
Case Example of Paranoid Personality Disorder
Aryan (He/Him) is a 35 year old man working in a bank. He got fired from his job for constantly picking fights with his colleagues. He used to be by himself and always on guard. He stays alone and has not been in a long term romantic relationship. Aryan does not talk to his parents. He is only in touch with his sister, who took him to a psychiatrist after he started drinking alcohol a lot. He got diagnosed with depression and alcohol addiction.
Further counselling and testing revealed more about his behaviour patterns and childhood history.
Aryan never had a stable group of friends. He would pick fights with his peers, become hostile and stay mad at them for a long time. He would accuse people of talking about him in a negative manner. He had a friend when he was in college. The friendship didn’t sustain as Aryan never thought that his friend was being honest, didn’t trust him and constantly questioned him. In his work life, he had to change many jobs because he would get aggressive towards others over trivial things.
This case illustrates how personality disorders can go undiagnosed unless the situation gets dire (alcohol addiction) or another disorder comes to light (depression). This case also indicated the main features of PPD – mistrust, suspicion, social isolation, and defensiveness.
Diagnosis and Treatment of Paranoid Personality Disorder
PPD can be noted in adolescence or childhood if the child is showing tendencies of mistrust, suspiciousness, guardedness, and not getting along with peers. But it is advisable to diagnose personality disorders when the person is an adult, as personality is a chronic and stable pattern of thought and relating to others.
PPD can be tricky to diagnose as it shares common symptoms with other mental disorders such as schizophrenia and borderline personality disorder (BPD).
Research shows that PPD symptoms rarely get worse with age and do not require treatment.
People with PPD do not think that there is something wrong with them. If they do come for counselling, they do not trust the therapist. Trust is a basic requirement in the counselling process. They will most probably quit therapy.
If they do stick with therapy, the therapeutic work will be around paranoia reduction, interpersonal skills and gaining more awareness and insight about how to cope with PPD. Building an alliance and trust with the therapist might take longer than usual. The therapy approach needs to be person-centred and encouraging. Medications are discouraged for the treatment of PPD. It has been found that medications can be used for a short period for the co-occurring conditions such as OCD, depression.