Paranoid personality disorder is one of the most common clinically recognized personality disorders. Approximately 4.4 percent of the adult US population meets the diagnostic criteria for paranoid personality disorder, meaning 9.2 million Americans live with chronic paranoia and suspicion of others. These figures are for paranoid personality disorder alone: they do not include Americans suffering from paranoid schizophrenia, or experiencing paranoia as a symptom of other conditions.

Symptoms of Paranoid Personality Disorder

Paranoid personality disorder manifests as inflexible and chronic patterns of paranoia, distrust, suspicion, and hostility towards others. These traits have a tremendous negative impact on a person's ability to function socially, at work, and in intimate relationships.

The chronic paranoia experienced by people with paranoid personality disorder is not simply suspiciousness; suspicions are normal when based on previous experience or events related by other people. The paranoid personality has no factual evidence for paranoia. Affected individuals believe they are being exploited, taken advantage of or sabotaged. Paranoid personality disorder sufferers often read malicious or threatening motives into simple words or acts.

Socially, people with paranoid personality disorder find it difficult, if not impossible, to form lasting relationships. Their paranoia forces them to constantly question the sincerity of friends, and the fidelity of spouses or sexual partners.

Paranoid personality disorder sufferers often appear aloof, cold, or emotionally distant to others. The paranoid personality deliberately distances himself or herself from others, due both to paranoia and a fear of betrayal. Although the paranoid personality is extremely sensitive to both real and imagined slights or criticism, individuals with the disorder tend to be extremely critical of others and quick to place blame or make accusations.

Causes of Paranoid Personality Disorder

The exact cause of paranoid personality disorder is unknown. A genetic cause has been suggested, as paranoid personality disorder seems to be more common in families with psychotic mood disorders, most notably paranoid schizophrenia and delusional disorders. Biochemical factors and childhood experience have also been suggested as possible causes, but to date the exact source of paranoid personality disorder remains unknown.

Complications of Paranoid Personality Disorder

Chronic paranoia and distrust often force paranoid personality disorder sufferers into social isolation, not only due to their own paranoia, but also because friends and co-workers draw away from continual criticism and unwarranted accusations.

The stress of living with chronic paranoia increases the risk of violence among paranoid personality disorder sufferers, who may respond with verbal or physical attacks when they feel they have been "pushed too far."

Paranoid Personality Disorder or Paranoid Schizophrenia?

Paranoid personality disorder is often confused with paranoid schizophrenia, which is actually a mood disorder, not a personality disorder. The paranoia present in paranoid schizophrenia differs in nature from that of paranoid personality disorder. Paranoia caused by paranoid personality disorder focuses on the perceived motives and intentions of others, but the paranoid personality remains grounded, for the most part, in reality.

Paranoia caused by paranoid schizophrenia is characterized by psychotic symptoms such as auditory and visual hallucinations. Paranoia and delusions associated with paranoid schizophrenia tend to be bizarre. Individuals with paranoid schizophrenia may believe the government is brainwashing them using radio signals, or that the neighbor is an alien. In short, the symptoms of paranoia in paranoid schizophrenia are much less grounded in reality than the paranoia typical of the paranoid personality.

Diagnosing Paranoid Personality Disorder

Diagnosis of paranoid personality disorder is problematic simply because of the nature of the disorder. People with paranoid personality disorder do not recognize their own paranoia as unusual. In fact, many consider themselves well grounded in reality and consider their paranoia to be realistic and objective.

Not believing their paranoia is a problem, paranoid personality disorder sufferers rarely seek help for their condition, unless forced to seek help by family (or in some cases, by the law). Even when forced to seek medical help, the individual's paranoia is likely to interfere with both diagnosis and treatment.

Diagnosis of paranoid personality disorder relies heavily on a history of symptoms and observations. For a clinical diagnosis to be made the patient's symptoms must match four or more of the criteria for paranoid personality disorder as put forth by the DSM-IV:

• 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.

From the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. American Psychiatric Association, 1994.

Before a diagnosis of paranoid personality disorder is made, a number of other paranoia causing conditions must be ruled out, including paranoid schizophrenia, or paranoia resulting form depression, drug-induced paranoia. Severe stress is also known to cause paranoia and other symptoms similar to paranoid personality disorder. Known as acute paranoia, stress-induced paranoia develops rapidly.However, paranoia and other symptoms usually dissipate once the stressor is removed.

Other personality disorders must also be considered during the diagnosis, including:

• antisocial personality disorder
• avoidant personality disorder
• borderline personality disorder
• histrionic personality disorder
• narcissistic personality disorder
• schizoid personality disorder
• schizotypal personality disorder.

Difficulties of Treating Paranoid Personality Disorder

Treatment of paranoid personality disorder is difficult, primarily because the patients do not view their paranoia as unhealthy, or their suspicions of others as unfounded. Medications, doctors and psychotherapists are subject to the patient's paranoia and hostility, making the patient likely to resist treatment or simply end treatment before any benefits can be seen.

Medications such as antipsychotics and antidepressants may improve the patient's ability to function, but rarely alleviate the paranoia. Compliance with medication is a problem with many paranoid personality disorder patients, who may lie about taking medication or otherwise sabotage medication therapy.

Psychotherapy may help the patient identify delusions and paranoia and improve daily life, but again compliance is an issue. Long-term, lifelong therapy is usually required, and while functioning may improve with therapy, symptoms of paranoid personality disorder often remain. Due to the nature of paranoid personality disorder, group therapy is not recommended.

Resources

American Psychiatric Association. Diagnostic criteria for 301.0: Paranoid personality disorder. Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. American Psychiatric Association, Washington, DC, 1994.

Long, P.W. (nd). Paranoid personality disorder.

National Institutes of Health. (2004, August 2). Landmark survey reports on the prevalence of personality disorders in the United States.

National Library of Medicine. (updated 2003). Paranoid personality disorder. MedlinePlus Medical Encyclopedia.

National Mental Health Association. (nd). Personality disorders.

Psychology Today. (nd). Paranoid personality disorder.