T3 - Paranoid Personality Disorder

We've made it to Week Four of the Personality Disorder Parade. We've already covered Antisocial PD (sociopaths), Narcissistic PD, and Histrionic PD, so be sure to take a look at those if you missed them. This week, we'll look at Paranoid Personality Disorder. As before, the criteria for the disorder are in bold black.

Distrust and suspiciousness so define individuals with this disorder that they interpret the motives of others as malevolent. They automatically assume that other people will exploit, harm or deceive them, even if they have zero evidence to support their assumptions. They might feel that a next door neighbor is plotting against them, or that a coworker might just attack them suddenly for no reason at any time.

Even the people they have befriended aren't free from this. People with Paranoid PD are preoccupied with doubts about their friends' and associates' loyalty or trustworthiness. Many times, they simply perceive a deviation from trust from an innocuous act and this underlies their self-schema that no one can be trusted. When a friend actually passes muster and shows loyalty, the person with the disorder can't believe it.

It's hard for these individuals to share information about themselves with anyone, even close friends. They have a fear that anything they confide will be used against them. Any type of interrogation (like a job interview or applying for a loan) would probably be viewed as prying, which might limit their ability to function in life. (FYI: By definition, a personality disorder has to lead to distress of impairment.) They might even refuse to answer innocent questions, claiming it's no one's business but theirs.

People with this disorder often read into innocent remarks or events, and perceive that they are being demeaned or threatened in some way. For example, if the window clerk at McDonald's made an honest mistake and shortchanged them, they would consider it deliberate. A casual joke can be perceived as a full-on character attack. Even compliments given to them will often be misinterpreted. For example, if the person just bought a new-to-them car and a friend commented on how they liked it, the individual might misconstrue the compliment as calling them selfish underhandedly. An offer to help them might be misinterpreted as a criticism that they aren't going well enough on their own.

These individuals have huge chips on their shoulders too. They persistently bear grudges and are often unwilling to forgive the insults, injuries, or slights that they think they have received. Their reaction is often out of proportion to the perceived slight. A minor slight will arouse major anger that lasts for a long time. They are quick to counterattack and react with anger to perceived insults.

They may be pathologically jealous, suspecting their spouse or significant other as being unfaithful without adequate justification. They want to maintain complete control in their romantic relationships to avoid betrayal, so they may pepper their significant other with questions about their whereabouts or intentions. They may gather circumstantial "evidence" of an illicit affair (i.e., their spouse went to the grocery store and didn't leave a note--or did leave a note and they still don't believe the spouse).

Theodore Millon identified five variations of Paranoid PD in 2004.
1) Fanatic Paranoid - includes narcissistic features
2) Malignant Paranoid - includes sadistic features
3) Objurate Paranoid - includes compulsive features
4) Querulous Paranoid - includes passive-aggressive features
5) Insular Paranoid - includes avoidant features

As with most personality disorders, these individuals are generally difficult to get a long with. Close relationships are a challenge to both parties. Their quickness to retaliate against perceived threats might make them more involved in litigation and legal disputes as they seek reparation. In response to stress, these individuals can have brief psychotic episodes (minutes to hours) where they either hallucinate, have delusions, have grossly disorganized speech patterns or behavior.

So. How does this happen? Once again--sorry for those people who need nailed-down answers--no one really knows. There seems to be both genetic and environmental factors than could contribute to the onset. If a child grew up with caregivers in-and-out, or perhaps around a lot of drug activity where they witnessed manipulation, coercion, and other negative events, then that could contribute to hypersensitivity to mistrust as an adult. Children prone to being solitary, having poor peer relationships, social anxiety, underachievement in school, hypersensitivity, peculiar thoughts/language are susceptible to developing this disorder. These children will be the odd ducks, attracting teasing.

As for treatment, it's difficult (as it is with most personality disorders). Because of the inherent mistrust these individuals have, any one session could be seen as incredibly prying. They might wonder what the information was being used for and be incredibly resistant to opening up. But if the individual wanted help, then a combination of therapy and medications could definitely help.

So hopefully this will give you writers out there some ideas for your stories in progress!

Q4U: How would you handle being in a relationship with someone who was constantly perceiving everything you said and did in a way other than what you intended?