| The central presenting feature of individuals with paranoid personality disorder is their unjustified mistrust and suspicion of other people in general. Paranoid individuals are rigid, angry, and have an urgent need to be self-sufficient. Their demeanor tends to be cold, sullen, humorless, and quick tempered. They tend to blame their problems on others and are unable to accept their own faults and weaknesses. Individuals with this personality disorder have a knack for pointing out other's subtle faults with great accuracy. The essential hallmark of paranoid personality disorder is a pervasive and unwarranted tendency to interpret other people's actions as deliberately demeaning or threatening. Paranoid individuals frequently, without justification, question the loyalty or trustworthiness of friends, family, and associates.
In the workplace, they tend to be jealous of co-workers, guarded, and loners, often isolating themselves from others. They react with anger even to constructive criticism, would much rather work alone, and tend to be quarrelsome and abrasive. It is common for them to turn a small issue or problem into a catastrophic issue. They often feel mistreated, overlooked, and picked on by their superiors. Co-workers may become exasperated and angry toward them.Risk: A paranoid personality disorder can present itself in childhood beginning with anti-social behavior. The disorder is more common in minority groups, immigrants, the deaf, or relatives of schizophrenics. Incidence and Prevalence: The disorder is more common in men than women, and occurs in about 0.5% to 2.5% of the population. Patients who have schizophrenic relatives and relatives with delusional disorder are more at risk. |
Source: Medical Disability Advisor
| History: The diagnosis is based on criteria set forth in the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision). An individual with paranoid personality has a pervasive distrust and suspiciousness of others, interpreting their motives as malevolent. The disorder begins by early adulthood and is present in a variety of contexts. To justify the diagnosis, individuals must have four of the following seven behaviors, or personality traits: suspicion without sufficient basis that others are exploiting, harming, or deceiving him or her; preoccupation with unjustified doubts about the loyalty or trustworthiness of friends or associates; reluctance 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, or 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; or has recurrent unjustified suspicions regarding the fidelity of their spouse or sexual partner.
For a diagnosis of paranoid personality disorder to be made, these behaviors cannot occur only during the course of schizophrenia, a mood disorder with psychotic features, or another psychotic disorder, nor can they be due to the direct physiological effects of a general medical condition. These behaviors must be present before the patient was diagnosed with these conditions.
Inquiries as to drug and alcohol use are warranted, but this area must be broached carefully so as not to provoke hostility and jeopardize any rapport that may have been established. Physical exam: There are no findings on the physical exam that contribute to this diagnosis. Tests: Psychological tests such as the Minnesota Multiphasic Personality Inventory - 2 (MMPI-2) or Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II) can be used to help identify and classify personality disorders; however, an experienced clinician rarely needs them. The interpretation of these tests can only be used in conjunction with the history and would not be used in isolation to make a final diagnosis of paranoid personality disorder. Toxicology screen can be used to identify if comorbid substance abuse is a problem. |
Source: Medical Disability Advisor
| The two primary approaches to treating this disorder are psychotherapy and medications (pharmacotherapy). As medications are likely to be received with suspicion, the treatment of choice is usually psychotherapy, but this depends on the individual's specific behaviors and willingness to participate in treatment. Antipsychotics might be needed briefly for severe agitation or for thinking bordering on delusional. Supportive psychotherapy is the treatment of choice, but excessive interpretation by the therapist of deep conflicts should be avoided initially, as trust and tolerance of intimacy are difficult to establish. The therapist should be professional, straightforward, and not overly warm. When behavior becomes threatening, limits must be set gently but realistically, without humiliating or frightening the individual. Group therapy and behavior therapies are usually not helpful in paranoid personality disorder. |
Source: Medical Disability Advisor
| Currently, there are no systematic, reliable long-term studies to predict outcome. However, the disorder is lifelong and may be a precursor to schizophrenia or other psychiatric disorders. Occupational and marital problems are common in paranoid personality disorder, as are financial and legal problems to a lesser extent. Proper treatment may allow better quality of life, unless there is poor compliance with treatment recommendations. |
Source: Medical Disability Advisor
| Any change or increase in stress can create complications, especially if occupational, financial, or legal problems or personal relationships are involved. The paranoid personality exaggerates even minimal problems. Examples of stress involving the workplace include a change of supervisor, moving to another workspace, change in work hours, and/or a shift change.
Substance abuse is often the individual's way of coping with the distress. Self-medication can lead to abuse and dependence. Alcoholism, which is often associated with this disorder, leads to a vicious cycle of paranoid perceptions becoming reality, as it leads to estrangement from family members, co-workers, and friends. The presence of another personality disorder may also complicate treatment. |
Source: Medical Disability Advisor
| Accommodations might include allowing the employee to work alone or in a small group, creating a private workspace, limiting contact with a large or unfamiliar group of people, and assigning a tolerant and understanding supervisor. Frequent cyclical shift changes (days to swing to graveyard and back to days) may lead to disturbances of the sleep-wake cycle, which could worsen symptoms. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Does individual fit the criteria for paranoid personality?
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Has the diagnosis been confirmed?
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Are the individual's symptoms due to another psychological disorder?
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Have medical conditions with similar symptoms been ruled out?
Regarding treatment:
- Was anti-anxiety medication beneficial for crisis management?
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If individual experienced severe agitation or borderline delusional thinking, was antipsychotic medication indicated?
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Was drug therapy perceived with suspicion?
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Did drug therapy actually interfere with treatment?
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Has the individual been able to trust the therapist? If not, what can be done to improve rapport?
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Although delusional accusations must be dealt with realistically, was this accomplished without humiliating the individual?
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Could behavioral therapy and/or role-playing be used to diminish suspiciousness and improve socialization skills?
Regarding prognosis:
- Are the paranoid traits of the individual persistent, inflexible, and causing significant dysfunction and distress?
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Is social or occupational function impaired?
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How does the individual cope with stress?
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Does the individual have an effective, trusting support group?
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Would the individual benefit from additional treatment or treatment alternatives?
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Source: Medical Disability Advisor
| Frances, Allen, ed. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). 4th ed. Washington, DC: American Psychiatric Association, 2000. |
Source: Medical Disability Advisor
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