Sign-in
(your email):
(case sensitive):



 
 

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Paranoid Personality Disorder


Text Only Home | Graphic-Rich Site | Overview | Risk and Causation | Diagnosis | Treatment | Prognosis | Differential Diagnosis | Specialists | Comorbid Conditions | Complications | Factors Influencing Duration | Length of Disability | Ability to Work | Maximum Medical Improvement | Failure to Recover | Medical Codes | References

Medical Codes

ICD-9-CM:
301.0 - Paranoid Personality Disorder; Fanatic Personality; Paranoid Personality (Disorder); Paranoid Traits

Overview

The essential hallmark of paranoid personality disorder is a pervasive and unwarranted mistrust and suspicion of other people in general. Paranoid individuals have a tendency to interpret other people's actions as deliberately demeaning, exploitative, harmful, or threatening. They frequently, without justification, question the loyalty or trustworthiness of friends, family, and associates. They suspect with little or no evidence that others are plotting against them and may attack them at any time, suddenly and without reason. They often feel that they have been deeply and irreversibly injured by another person or persons, even when there is no objective evidence for this.

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 people's subtle faults with great accuracy.

In the workplace, they tend to be jealous of coworkers, 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. Coworkers may become exasperated with them.

Incidence and Prevalence: The estimated prevalence of paranoid personality is 2.3%, and the estimated prevalence of paranoid personality disorder is 4.4% (DSM-IV-TR).The disorder is more common in men than in women. Patients who have schizophrenic relatives and relatives with delusional disorder are more at risk.

Source: Medical Disability Advisor



Causation and Known Risk Factors

Paranoid personality disorder can present itself in childhood, beginning with antisocial behavior. The disorder is more common in relatives of schizophrenics.

Source: Medical Disability Advisor



Diagnosis

History: According to the criteria set forth in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR), an individual with paranoid personality disorder 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 demonstrate at least 4 of the following 7 behaviors, or personality traits: suspicion without enough basis that others are exploiting, harming, or deceiving him or her; preoccupation with unjustified doubts regarding 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; reading hidden demeaning or threatening meanings into benign remarks or events; persistently bearing grudges, or refusing to forgive insults, injuries, or slights; perceiving attacks on his or her character or reputation that are not apparent to others, and being quick to react angrily or to counterattack; or having recurrent unjustified suspicions regarding the fidelity of their spouse or sexual partner (DSM-IV-TR).

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 (DSM-IV-TR).

The diagnostic criteria set forth in the DSM-5 are the same, except that these behaviors cannot occur only during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, or another psychotic disorder, nor can they be due to the physiological effects of another medical condition (see previous paragraph) (DSM-5).

Inquiries as to drug and alcohol use are warranted, but these questions 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. A toxicology screen can be used to identify if comorbid substance abuse is a problem.

Note: It must be kept in mind that just because a physical diagnosis cannot be established as the cause of the presenting symptomatology, it does not necessarily mean that the cause is a mental one. That is to say that the presence of medically unexplained symptomatology does not necessarily establish the presence of a psychiatric condition. The first step in identifying the presence of a mental disorder is excluding the presence of malingering and/or of factitious disorder. Although factitious disorder is conscious and purposeful, it is classified as a psychiatric disorder. The strong need for this step is especially true whenever there is a medicolegal context associated with the presenting problem(s). Additionally, using DSM-5 and/or ICD-9-CM or ICD-10-CM, the clinician will find that many presentations fail to fit completely within the boundaries of a single mental disorder. There are systematic ways to go about making psychiatric diagnoses, however.

Source: Medical Disability Advisor



Treatment

The primary approach to treating this disorder is psychotherapy. Supportive psychotherapy is the treatment of choice, but this depends on the individual's specific behaviors and willingness to participate in treatment; 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.

Medications (pharmacotherapy) may be used for associated disorders, such as anxiety or depression, but medications are likely to be received with suspicion. Antipsychotics might be needed briefly for severe agitation or for thinking bordering on delusional.

Source: Medical Disability Advisor



Prognosis

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 such as delusional disorder. Occupational and marital problems are common among those with 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



Differential Diagnosis

  • Delusional disorder, persecutory type
  • Other mental disorders with psychotic symptoms
  • Other personality disorders and personality traits
  • Paranoid schizophrenia
  • Paranoid traits secondary to physical handicaps
  • Personality change due to a general medical condition
  • Personality disorders (antisocial, narcissistic, and compulsive)
  • Substance abuse/dependence

Source: Medical Disability Advisor



Specialists

  • Clinical Psychologist
  • Psychiatrist

Source: Medical Disability Advisor



Comorbid Conditions

Source: Medical Disability Advisor



Complications

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 distress. Self-medication can lead to abuse and dependence. Alcoholism, which is often associated with this disorder, helps create a vicious cycle of paranoid perceptions becoming reality, as it leads to estrangement from family members, coworkers, and friends. The presence of another personality disorder may also complicate treatment.

Source: Medical Disability Advisor



Factors Influencing Duration

The progress and effectiveness of psychotherapy and the individual's willingness to participate in therapy will influence the length of disability. Other factors might include substance abuse and the coexistence of other psychiatric diagnoses. Life stressors such as marital, legal, or financial problems can affect the duration of disability.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

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 but straightforward supervisor. Frequent cyclical shift changes (days to swing shift to graveyard shift and back to days) may lead to disturbances of the sleep-wake cycle, which could worsen symptoms.

Risk: Individuals with paranoid personality disorder may be a risk to coworkers and managers if frequent angry outbursts and unwarranted suspicions of being demeaned or threatened taint workplace interactions.

Capacity: Capacity is typically unaffected by this disorder, once the individual is successfully engaged in his or her familiar role at work. No disability is anticipated.

Tolerance: Tolerance is not a concern with this diagnosis. Recovery may be enhanced by involvement in individual psychotherapy.

Source: Medical Disability Advisor



Maximum Medical Improvement

MMI is expected at 15 months of treatment or less.

Note: MMI is estimated under the assumption that the vagaries involved in psychiatric diagnoses have been taken into consideration.

Source: Medical Disability Advisor



Failure to Recover

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 disorder?
  • Has the diagnosis been confirmed?
  • Are the individual's symptoms due to another psychological disorder?
  • Have medical conditions with similar symptoms been ruled out?

Regarding treatment:

  • Has the individual been able to trust the therapist? If not, what can be done to improve rapport?
  • Although delusional accusations must be dealt with realistically, was this accomplished without humiliating the individual?
  • Could behavioral therapy and/or role-playing be used to diminish suspiciousness and improve socialization skills?
  • Was anti-anxiety medication beneficial for crisis management?
  • If individual experienced severe agitation or borderline delusional thinking, was antipsychotic medication indicated?
  • Was drug therapy perceived with suspicion?
  • Did drug therapy actually interfere with treatment?

Regarding prognosis:

  • Are the paranoid traits of the individual persistent, inflexible, and the cause of significant dysfunction and distress?
  • Is social or occupational function impaired?
  • How does the individual cope with stress?
  • Does the individual have an effective, trusting support group?
  • Would the individual benefit from additional treatment or treatment alternatives?

Source: Medical Disability Advisor



References

Cited

Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 5th ed. American Psychiatric Association, 2013.

Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). 4th ed. Washington, DC: American Psychiatric Association, 2000.

Source: Medical Disability Advisor