Paranoid

Paranoid

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.[2][verification needed] 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

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:
excessive sensitivity to setbacks and rebuffs;
tendency to bear grudges persistently, i.e. refusal to forgive insults and injuries or slights;
suspiciousness and a pervasive tendency to distort experience by misconstruing the neutral or friendly actions of others as hostile or contemptuous;
a combative and tenacious sense of personal rights out of keeping with the actual situation;
recurrent suspicions, without justification, regarding sexual fidelity of spouse or sexual partner;
tendency to experience excessive self-importance, manifest in a persistent self-referential attitude;
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.

Differential diagnosis

Paranoid Personality Disorder can involve, in response to stress, very brief psychotic episodes (lasting minutes to hours). If long-lasting the disorder may develop into delusional disorder or schizophrenia. Individuals may also be at greater than average risk of experiencing major depressive disorder, agoraphobia, obsessive-compulsive disorder or alcohol and substance-related disorders. Criteria for other personality disorder diagnoses are commonly also met, such as:
schizoid personality disorder
schizotypal personality disorder
narcissistic personality disorder
avoidant personality disorder
borderline personality disorder

Treatment

Because of reduced levels of trust, there can be challenges in treating paranoid personality disorder. However, psychotherapy, antidepressants, antipsychotics and anti-anxiety medications can play a role when an individual is receptive to intervention.

Epidemiology

Paranoid personality disorder occurs in about 0.5%–2.5% of the general population. It is seen in 2%–10% of psychiatric outpatients. It occurs more commonly in males.
A large long-term Norwegian twin study found paranoid personality disorder to be modestly heritable and to share a portion of its genetic and environmental risk factors with schizoid and schizotypal personality disorder