Paranoid personality disorder (PPD) is a psychiatric condition characterized by an unrelenting and long-term suspicion and mistrust of others, but without a psychotic disorder, such as schizophrenia. The disorder, which usually appears by early adulthood, occurs in approximately 1.1 percent of the population, more commonly in males. In Personality Disorders in Social Work and Health Care, author Greg Lister, Ph.D., states that the diagnostic criteria are the presence of at least four of the following seven characteristics:
Suspects that others are exploiting, harming or deceiving him or her.
Is preoccupied with doubts about the loyalty or trust-worthiness of those close to him or her.
Is reluctant to confide in others out of fear that the information will be used maliciously against him or her.
Has recurrent suspicions regarding the fidelity of a spouse or significant other.
Reads "hidden" demeaning or threatening meanings in benign remarks and events.
Persistently bears grudges and is unforgiving of perceived slights, insults or injuries.
Perceives attacks on his or her character or reputation that are not apparent to others and is quick to become angry or to counter-attack.
Individuals with paranoid personality disorder are often litigious, suing businesses and people they believe have purposefully wronged them. The causes of PPD are not fully understood. There may be a genetic link, as the disorder tends to be more common in families with psychotic disorders. Early childhood physical or emotional trauma is also thought to be a contributing factor.
While some individuals with PPD manage to function fairly well, others are chronically disabled by the condition. Treatment for PPD is complicated by the fact that affected individuals most often do not seek treatment - they do not see themselves as having a problem. Behavioral therapy is indicated, with the goal of reducing the hypersensitivity to criticism, focusing on stress and anxiety management, and learning social skills. Progress, if achieved, is usually slow. The trust that is paramount in a therapeutic relationship is elusive because of the pervasive guardedness and mistrust of the individual.
As with other personality disorders, the lack of adaptability in dealing with events and people is a huge obstacle to recovery. All of us experience suspicion, even paranoia, at times. Sometimes it is warranted and sometimes it is not. When unwarranted, most people are able to analyze the environment, recognize there is no threat, and adjust their responses accordingly. Not so with individuals with paranoid personality disorder; they tend to employ the same responses over and over. Their repertoire of social and coping skills is rather one-dimensional. Everything is taken personally and alternate interpretations of other people's motives are routinely dismissed.
Coping with someone who has PPD can be very difficult; their suspicions, hostility and tendency to claim blamelessness can be tiresome and overwhelming. It is important not to pretend to share the paranoid delusions with the affected person. Do not attack his or her seemingly irrational beliefs, as they are very real to him or her. Just state that you hear what the person believes, but you do not have the same perception. Be very clear in your communications with the person to reduce the possibility of misinterpretation. And perhaps most importantly, encourage the person to get treatment for the problem and to follow the treatment plan.
Miriam Keith is consumer support coordinator of the Washington County Mental Health and Addiction Recovery Board. Mental Health Matters appears on the Opinion page on the first Saturday of each month.
