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Paranoid Personality Disorder

 

Personality disorder is a matter of false judgments of value. Listed below are the false value judgments that are at the root of Paranoid Personality Disorder.


False Good

False Bad

Personality Disorder

autonomy being subordinated, exploited, harmed, or deceived by others suspects that others are exploiting, harming, or deceiving them
loyalty of others the disloyalty or untrustworthiness of friends or associates unjustified doubts about loyalty or trustworthiness of friends or associates
having information confided to others used against them reluctance to confide in others because of fear that the information will be used maliciously against them
demeaning or threatening remarks or events fears hidden demeaning or threatening meanings in benign remarks or events
insults, injuries, slights, and attacks on their character or reputation bears grudges; is unforgiving of insults, injuries, or slights; perceived attacks on their character not apparent to others; is quick to react angrily or to counterattack
fidelity of their spouse or sexual partner the infidelity of their spouse or sexual partner has suspicions, without justification, regarding fidelity of spouse, or sexual partner



Perspectives q.v.





The Disease Perspective

Proposed Revision | APA DSM-5 New!



The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (American Psychiatric Association, 1994, pp. 637-638) describes 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, as indicated by four (or more) of the following:
  • suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her;

  • is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates;

  • is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her;

  • reads hidden demeaning or threatening meanings into benign remarks or events;

  • persistently bears grudges, i.e., is unforgiving of insults , injuries, or slights perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack;

  • has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner.

The disorder does not occur exclusively during the course of Schizophrenia, a Mood Disorder With Psychotic Features, or another Psychotic Disorder and is not due to the direct physiological effects or a general medical condition.





The Dimensional Perspective



Dimensions

Here is a hypothetical profile, in terms of the five-factor model of personality, for Paranoid Personality Disorder (speculatively constructed from McCrae, 1994, pg. 306):



High Neuroticism
Chronic negative affects, including anxiety, fearfulness, tension, irritability, anger, dejection, hopelessness, guilt, shame; difficulty in inhibiting impulses: for example, to eat, drink, or spend money; irrational beliefs: for example, unrealistic expectations, perfectionistic demands on self, unwarranted pessimism; unfounded somatic concerns; helplessness and dependence on others for emotional support and decision making.

High Extraversion
Excessive talking, leading to inappropriate self-disclosure and social friction; inability to spend time alone; attention seeking and overly dramatic expression of emotions; reckless excitement seeking; inappropriate attempts to dominate and control others.

High Openness
Preoccupation with fantasy and daydreaming; lack of practicality; eccentric thinking (e.g., belief in ghosts, reincarnation, UFOs); diffuse identity and changing goals: for example, joining religious cult; susceptibility to nightmares and states of altered consciousness; social rebelliousness and nonconformity that can interfere with social or vocational advancement.

High Agreeableness
Gullibility: indiscriminate trust of others; excessive candor and generosity, to detriment of self-interest; inability to stand up to others and fight back; easily taken advantage of.

Low Conscientiousness
Underachievement: not fulfilling intellectual or artistic potential; poor academic performance relative to ability; disregard of rules and responsibilities can lead to trouble with the law; unable to discipline self (e.g., stick to diet, exercise plan) even when required for medical reasons; personal and occupational aimlessness.



Specific Affects

Hypersensitivity, hypervigilance, fearfulness, suspiciousness, persecutory anxiety, quiet hostility, emotional aloofness and restraint, coldness, tenseness, seriousness.




Character Weaknesses and Vices


Autonomy, superiority, suspiciousness, touchiness, belligerence, narcissism, self-righteousness, arrogance, brashness, cynicism, humorlessness, negativism, contentiousness, secretiveness, fanaticism, ragefulness, sarcasm.



Psychiatric*

  • fears others will take advantage
  • mistrustful
  • suspicious
  • grudge-holding
  • unable to confide
  • touchy
  • jealous


suspiciousness, grandiosity, feelings of persecution, generalized hostility, querulousness, contentiousness, hyper-vigilance, oversensitivity to slights, "injustice collecting," pathological jealousy, erotomania (Stone, 200-201).

arrogance, self-righteousness, angriness, feelings of inferiority, enviousness, mistrustfulness, humorlessness, emotional coldness, oversensitiveness, fearfulness of dependence, fearfulness of closeness, vengefulness, grudge-holding, drivenness, inability to sustain friendships, inability to become part of a "team," lack of romantic interests, priggish aversion to sexual humor, extreme anxiety about sexual prowess, moralistic attitudes, over-scrupulosity, religious fanaticism, idiosyncratic moral system, readiness to lie and distort, hyper-vigilance, nit-picking, searching for evidence to back up irrational assumptions, lack of perspective, selective projective attention (Stone from Akhtar, 202).

angriness, bitterness, censoriousness, coldness, compulsiveness, over-controllingness, cynicism, dourness, enviousness, fastidiousness, grudge-holding, guardedness, humorlessness, hyper-criticalness, insecurity, intimidating, irritableness, judgmentalness, mistrustfulness, moralisticness, prissiness, reproachfulness, hatefulness, self-righteousness, unapproachableness, uncompassionateness, unsociableness (derived from Stone case, 206).


* Derived from Michael Stone's (pg. 22) list of the "personality traits" of DSM-III-R Paranoid Personality Disorder.





The Behavior Perspective



Motivations

To protect oneself from the hostility and malevolence of others.



Behaviors

Solitariness, poor peer relationships, social anxiety, underachievement in school, hypersensitivity, peculiar thoughts and language, idiosyncratic fantasies (American Psychiatric Association, pg. 636).

Difficulty in handling stress, conflict with superiors, unwillingness to compromise, argumentiveness, stubbornness, defensiveness, deviousness, deceptions, disloyalty, maliciousness (Beck & Freeman, pp. 99-100).

Litigiousness.



Associated Disorders

Brief Psychotic Disorder, Delusional Disorder, Alcohol and other Substance Abuse or Dependence, Schizophrenia, Major Depressive Disorder, Agoraphobia, Obsessive-Compulsive Disorder (American Psychiatric Association, pg. 635).






The Life Story Perspective



Childhood

Threatening home environment.

Irrational and overwhelming parental rage. A parenting style which fosters feelings of inadequacy, humiliation, or helplessness (Gunderson & Philips, pg. 1435).



Cognitive Effects

Basic Belief: People are potential adversaries. [Strategy]: Wariness (Beck, Freeman & associates, pg. 26).

The "idealized self is made up of beliefs about how we should feel, think, or act" (Tamney, pg. 32).

In Cognitive Therapy of Personality Disorders, Aaron T. Beck, Arthur Freeman, and associates (1990) list typical beliefs associated with each specific personality disorder. According to my view, the beliefs and attitudes rationalize and reinforce the idealized image and the compulsive attachments and aversions. They are analogous to Karen Horney's "shoulds" and "neurotic claims." Here are the typical beliefs that they have listed (pp. 362-363) for Paranoid Personality Disorder:

  • I cannot trust other people.
  • Other people have hidden motives.
  • Others will try to use me or manipulate me if I don't watch out.
  • I have to be on guard at all times.
  • It isn't safe to confide in other people.
  • If people act friendly, they may be trying to use or exploit me.
  • People will take advantage of me if I give them the chance.
  • For the most part, other people are unfriendly.
  • Other people will deliberately try to demean me.
  • Often people deliberately want to annoy me.
  • I will be in serious trouble if I let other people think they can get away with mistreating me.
  • If other people find out things about me, they will use them against me.
  • People often say one thing and mean something else.
  • A person whom I am close to could be disloyal or unfaithful.








American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders: DSM-IV. 4th ed. Washington: Author.

Beck, Aaron T. and Freeman, Arthur M. and Associates (1990). Cognitive Therapy of Personality Disorders. New York : Guilford Press.

Beck, Aaron T. and Freeman, Arthur M. and Associates (2003). Cognitive Therapy of Personality Disorders, 2nd ed. New York : Guilford Press.

Cooper, Terry D. (2003). Sin, Pride, and Self-Acceptance: The Problem of Identity in Theology and Psychology. Downers Grove, IL: InterVarsity Press.

Gunderson, John G. and Philips, Katherine A. (1995). Personality Disorders. Comprehensive Textbook of Psychiatry/VI, Vol. 2. Eds. Harold I. Kaplan and Benjamin J. Sadock. Baltimore: Williams & Wilkins.

McCrae, Robert R. (1994). "A Reformulation of Axis II: Personality and Personality-Related Problems." Costa, Paul T., Jr., Widiger, Thomas A., editors. Personality Disorders and the Five-Factor Model of Personality. Washington, D.C.: The American Psychological Association.

Meissner, William W. (1989). Personality Disorders: Paranoid Personality Disorder. Treatments of Psychiatric Disorders, Vol. 3. American Psychiatric Association. Task Force on Treatments of Psychiatric Disorders. Washington, DC : American Psychiatric Association.

Stone, Michael H. (1993). Abnormalities of personality: within and beyond the realm of treatment. New York: W.W. Norton.

Tamney, Joseph B. (2002). The Resilience of Conservative Religion. New York: Cambridge UP.



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