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Wednesday, February 1, 2012

Paranoid personality disorder


Paranoid personality disorder is a mental disorder characterized by paranoia and a pervasive, long-standing suspiciousness and generalized mistrust of others. Individuals with this personality disorder may be hypersensitive, easily feel slighted, and habitually relate to the world by vigilant scanning of the environment for clues or suggestions that may validate their fears or biases. Paranoid individuals are eager observers. They think they are in danger and look for signs and threats of that danger, potentially not appreciating other evidence. They tend to be guarded and suspicious and have quite constricted emotional lives. Their reduced capacity for meaningful emotional involvement and the general pattern of isolated withdrawal often lend a quality of schizoid isolation to their life experience. People with this particular disorder may or may not have a tendency to bear grudges, suspiciousness, tendency to interpret others actions as hostile, persistent tendency to self-reference, or a tenacious sense of personal right.

Causes

A genetic contribution to paranoid traits and a possible genetic link between this personality disorder and schizophrenia exist. Psychosocial theories implicate projection of negative internal feelings and parental modeling.

Diagnosis

WHO

The World Health Organization's ICD-10 lists paranoid personality disorder as (F60.0) Paranoid personality disorder.
It is characterized by at least three of the following:
1.      excessive sensitivity to setbacks and rebuffs;
2.      tendency to bear grudges persistently, i.e. refusal to forgive insults and injuries or slights;
3.      suspiciousness and a pervasive tendency to distort experience by misconstruing the neutral or friendly actions of others as hostile or contemptuous;
4.      a combative and tenacious sense of personal rights out of keeping with the actual situation;
5.      recurrent suspicions, without justification, regarding sexual fidelity of spouse or sexual partner;
6.      tendency to experience excessive self-importance, manifest in a persistent self-referential attitude;
7.      preoccupation with unsubstantiated "conspiratorial" explanations of events both immediate to the patient and in the world at large.
Includes:
·         expansive paranoid, fanatic, querulant and sensitive paranoid personality (disorder)
Excludes:
·         delusional disorder
·         schizophrenia
It is a requirement of ICD-10 that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria. It is also pointed out that for different cultures it may be necessary to develop specific sets of criteria with regard to social norms, rules and obligations.

APA

The American Psychiatric Association's DSM-IV-TR has similar criteria. They require in general the presence of lasting distrust and suspicion of others, interpreting their motives as malevolent, from an early adult age, occurring in a range of situations. 4 of 7 specific issues must be present, which include different types of suspicions or doubt (such as of being exploited, or that remarks have a subtle threatening meaning), in some cases regarding others in general or specifically friends or partners, and in some cases referring to a response of holding grudges or reacting angrily.

Other

Various researchers and clinicians may propoose varieties and subsets or dimensions of personality related to the official diagnoses. Psychologist Theodore Millon has proposed five subtypes of paranoid personality:

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