People with paranoid personality show mistrust, guardedness and veiled hostility. They are hypersensitive and take criticism poorly, see insults where none were intended and are quick to counterattack angrily. Patients with this type of personality are prone to bear long-standing grudges and frequently have suspicions, without justification, regarding fidelity or loyalty of partners. Under great stress, they may temporarily have delusions (false beliefs held despite evidence of the contrary) of persecution.
Paranoid personality disorder belongs to the cluster A personalities (personalities that are odd, eccentric and bizarre). It is defined in the DSM IV TR (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision) as a pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent. Patients suspect, without sufficient basis, that others are exploiting, harming or deceiving them; they are preoccupied with unjustified doubts about the loyalty of friends and are reluctant to confide in others because of unwarranted fear that the information will be used against them; they read hidden demeaning meanings into benign remarks, are unforgiving of insults or slights and perceive attacks on their reputation that are not apparent to others.
Paranoid personality is a chronic disorder that starts in adolescence and has a lifetime prevalence of 0.5 – 2.5%. It is more common in males than in females. Some of the complications observed are social isolation and the inability to form intimate relationships. Patients may engage in violence as a way to “protect” themselves or to seek “justified” revenge.
The differential diagnosis includes paranoid schizophrenia, which is marked by chronic delusions and other core symptoms like auditory hallucinations and loosening of associations.
The treatment of choice for paranoid personality is individual psychotherapy. It should be supportive, non-confrontational and focused on improving coping skills, social interaction and self esteem. Psychotropic medications (antipsychotics, anti anxiety) may be useful during short periods of time. People with this type of personality disorder rarely remain in therapy as they see no need for it and cannot trust the therapist in any case.
By Ana C Posada-Diaz, MD