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Introduction
PARANOIDPERSONALITYDISORDER
Disorders
Self Diagnosis
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PARANOIDPERSONALITYDISORDER
Since childhood or adolescence, was socially withdrawn because of being suspicious, feeling victimized, and bearing
grudges. This was not due to a medical or substance use disorder.
Predictions:
LastsForYears/Lifetime
Occupational-Economic:
Works poorly with others (highly critical of others, yet hypersensitive to criticism of self)
Cooperation (Critical, Quarrelsome):
Suspiciousness:
Suspects, without sufcient basis, that others are exploiting, harming, or deceiving her
Is preoccupied with unjustied doubts about the loyalty or trustworthiness of her friends or associates
Is reluctant to conde in others because of her unwarranted fear that the information will be used
maliciously against her
Reads hidden demeaning or threatening meanings into benign remarks or events
Perceives attacks on her character or reputation that are not apparent to others and is quick to react angrily
or to counterattack
Has recurrent suspicions, without justication, regarding delity of her spouse or sexual partner
Lack of Forgiveness:
Persistently bears grudges, i.e., is unforgiving of insults, injuries, or slights
Justice: N/A
Wisdom: N/A
Self-Control: N/A
Courage: N/A
Medical: N/A
High Probability Medium Probability Not Applicable
SAPASPersonalityScreeningTest
Individuals with this disorder would answer "Yes" to the red questions:
ClickHereForFreeDiagnosis
ExampleOfOurComputerGeneratedDiagnosticAssessment
ParanoidPersonalityDisorder301.0
This diagnosis is based on the following ndings:
Suspiciousness or paranoid ideation ( still present )
Has unjustied doubts about the loyalty or trustworthiness of friends or associates ( still
present )
Reluctant to conde in others due to unwarranted fear that this will be used against him (
still present )
Reads hidden, demeaning, or threatening meanings into benign remarks or events ( still
present )
Persistently bears grudges (i.e., is unforgiving of insults, injuries, or slights) ( still present )
Is quick to counterattack and react with anger to misperceived insults ( still present )
Is patholgically jealous regarding spouse or sexual partner ( still present )
This disorder did not exclusively occur during the course of a psychotic mental disorder
This disorder is not due to the direct physiological effects of a general medical condition
Predictions:
Individuals with Paranoid Personality are chronically suspicious, angry and hostile, and may
show disturbed thinking.
These individuals:
Are chronically suspicious, expecting that others will harm, deceive, conspire against, or
betray them
Blame their problems on other people or circumstances, and to attribute their difculties to
external factors. Rather than recognizing their own role in interpersonal conicts, they tend
to feel misunderstood, mistreated, or victimized.
Are angry or hostile and prone to rage episodes.
See their own unacceptable impulses in other people instead of in themselves, and are
therefore prone to misattribute hostility to other people.
Are controlling, oppositional, contrary, or quick to disagree, and to hold grudges.
Elicit dislike or animosity and lack close friendships and relationships.
Show disturbances in their thinking, above and beyond paranoid ideas. Their perceptions
and reasoning can be odd and idiosyncratic, and they may become irrational when strong
emotions are stirred up, to the point of seeming delusional.
(Note: "Predictions" is only available in the therapist version of the
computerized assessment.)
TreatmentGoals:
DiagnosticFeatures
Individuals with Paranoid Personality Disorder grow up having excessive distrust and suspiciousness. The core
feature of this disorder is detachment (suspiciousness). This disorder is only diagnosed if: (1) it begins no later than
early adulthood, (2) these behaviors occur at home, work, and in the community, and (3) these behaviors lead to
clinically signicant distress or impairment in social, occupational, or other important areas of functioning. This
disorder should not be diagnosed if its symptoms occur exclusively during the course of a Psychotic Disorder, or if it
is attributable to Substance Use Disorder another medical condition.
Individuals with Paranoid Personality Disorder falsely believe that they are being victimized by others. They are highly
critical of others, yet hypersensitive to criticism of themselves. They bear grudges and are unwilling to forgive the
insults that they think they have received. Minor slights arouse major hostility, and the hostile feelings persist for a
long time. Their combative and suspicious nature may elicit a hostile response in others, which then serves to conrm
their original expectations. They may be pathologically jealous.
Like all personality disorders, Paranoid Personality Disorder is a deeply ingrained and enduring behavior pattern,
manifesting as an inexible response to a broad range of personal and social situations. This behavior represents an
extreme or signicant deviation from the way in which the average individual in a given culture relates to others. This
behavior pattern tends to be stable.
Course
Paranoid Personality Disorder may be rst apparent in childhood and adolescence with solitariness, poor peer
relationships, social anxiety, underachievement in school, hypersensitivity, and peculiar thoughts and language. These
children may appear to be odd or eccentric and attract teasing. The course of this disorder is chronic.
Complications
Individuals with Paranoid Personality Disorder are generally difcult to get along with and often have problems with
close relationships because of their excessive suspiciousness and hostility. They usually are unable to collaborate well
with others at work. They may have a need to have a high degree of control over those around them. They are
reluctant to conde in or become close to others because they fear that the information they share will be used against
them. They may be litigious and frequently become involved in legal disputes.
Their combative and suspicious nature may elicit a hostile response in others, which then serves to conrm their
original expectations. They are often rigid, and critical of others, although they have great difculty accepting
criticism themselves. They may exhibit thinly hidden, unrealistic grandiose fantasies, are often attuned to issues of
power and rank, and tend to develop negative stereotypes of others, particularly those from population groups distinct
from their own. More severely affected individuals with Paranoid Personality Disorder may be perceived by others as
fanatics and form tightly knit cults or groups with others who share their paranoid beliefs.
Comorbidity
Some other disorders frequently occur with this disorder:
NonPersonalityDisorders
Paranoid Personality Disorder is more common among rst-degree biological relatives of those with Schizophrenia
and Delusional Disorder, Persecutory Type.
ControlledClinicalTrialsOfTherapy
Click here for a list of all the controlled clinical trials of therapy for this disorder.
Psychotherapy
The effectiveness of psychotherapy for Paranoid Personality Disorder is unknown because there are no randomized
controlled trials of therapy. Individuals with this disorder seldom voluntarily present for treatment. Most therapists
believe that Paranoid Personality Disorder is very difcult to treat.
Pharmacotherapy
There are currently no medications approved by the FDA to treat this disorder. Vitamins and dietary supplements are
ineffective for all Personality Disorders.
ADangerousCult
DiagnosticCriteria
Paranoid Personality Disorder F60.0 - ICD10 Description, World Health Organization
Paranoid personality disorder is characterized by excessive sensitivity to setbacks, unforgiveness of
insults; suspiciousness and a tendency to distort experience by misconstruing the neutral or friendly
actions of others as hostile or contemptuous; recurrent suspicions, without justication, regarding the
sexual delity of the spouse or sexual partner; and a combative and tenacious sense of personal rights.
There may be excessive self-importance, and there is often excessive self-reference.
ICD-10 Diagnostic Criteria (For Research) And IPDE Questions:
A. The general criteria of personality disorder must be met:
EmpiricallyDerivedTaxonomyforPersonalityDiagnosis:ParanoidPersonality
Disorder
(This section uses an alternative classication system to that of the American Psychiatric Association)
HowParanoidPersonalityDiffersFromOtherPersonalityDisorders
Individuals with Paranoid Personality are chronically suspicious, angry and hostile, and may show
disturbed thinking.
These individuals:
Are chronically suspicious, expecting that others will harm, deceive, conspire against, or
betray them
Blame their problems on other people or circumstances, and to attribute their difculties to
external factors. Rather than recognizing their own role in interpersonal conicts, they
tend to feel misunderstood, mistreated, or victimized.
Are angry or hostile and prone to rage episodes.
See their own unacceptable impulses in other people instead of in themselves, and are
therefore prone to misattribute hostility to other people.
Are controlling, oppositional, contrary, or quick to disagree, and to hold grudges.
Elicit dislike or animosity and lack close friendships and relationships.
Show disturbances in their thinking, above and beyond paranoid ideas. Their perceptions
and reasoning can be odd and idiosyncratic, and they may become irrational when strong
emotions are stirred up, to the point of seeming delusional.
HowParanoidPersonalityDisorderDiffersFromAHealthyPersonality
Characteristics of a healthy vs. unhealthy personality:
In This Disorder: Severe Problem Moderate Problem Mild or No Problem
Cooperation (Agreeableness):
People with a healthy personality have:
Trust:
Trusting the loyalty and good intentions of signicant others (e.g., family,
friends).
Forgiveness:
Forgiving other peoples' mistakes; not bearing grudges or seeking revenge.
Gratitude:
Being thankful for the good things in life; expressing thanks to others.
Humility:
Being humble (not arrogant, boastful or excessively proud).
Cooperation And Generosity:
Cooperating with others and doing a fair share of the work; unselshly helping
others.
Kindness:
Being a kind, considerate, loving person; feeling another's suffering & wanting
to alleviate it.
People with an unhealthy personality have:
Callousness:
Lack of concern for feelings or problems of others; lack of guilt or remorse
about the negative or harmful effects of one's actions on others.
Grandiosity:
Exaggerated sense of self-importance; feelings of entitlement, either overt or
covert; self-centeredness; rmly holding to the belief that one is better than
others; condescension toward others.
Manipulativeness:
Frequent use of subterfuge to inuence or control others; use of seduction,
charm, glibness, or ingratiation to achieve one's ends.
Hostility:
Persistent or frequent angry feelings; anger or irritability in response to minor
slights and insults; mean, nasty, or vengeful behavior.
Suspiciousness:
Expectations of - and heightened sensitivity to - signs of interpersonal ill-intent
or harm; doubts about loyalty and delity of others; feelings of persecution.
Justice (Conscientiousness):
People with a healthy personality have:
Respect:
Treating others with respect and making them feel appreciated.
Responsibility:
Being reliable and careful; being able to accept blame, heed correction and
make amends.
Honesty:
Not lying, stealing or cheating.
Caution:
Thinking carefully before acting or speaking; being cautious.
Moderation:
Setting realistic goals; accepting "good enough" rather than demanding
perfection.
Work-Life Balance:
Maintaining a proper balance between work and the rest of life.
Flexibility:
Willingness to try new things; ability to tolerate normal disorder; taking
reasonable risks.
People with an unhealthy personality have:
Low Conscientiousness:
Deceitfulness:
Dishonesty and fraudulence; misrepresentation of self; embellishment or
fabrication when relating events.
Irresponsibility:
Disregard for - and failure to honor - nancial and other obligations or
commitments; lack of respect for - and lack of follow-through on - agreements
and promises.
Reckless Risk Taking:
Engagement in dangerous, risky, and potentially self-damaging activities,
unnecessarily and without regard for consequences; boredom proneness and
thoughtless initiation of activities to counter boredom; lack of concern for one's
limitations and denial of the reality of personal danger.
Impulsivity:
Acting on the spur of the moment in response to immediate stimuli; acting on a
momentary basis without a plan or consideration of outcomes; difculty
establishing and following plans; a sense of urgency and self-harming behavior
under emotional distress.
Inappropriate Seductiveness:
Inappropriate sexually seductive or provocative behavior.
Extreme Conscientiousness:
Rigid Perfectionism:
Rigid insistence on everything being awless, perfect, and without errors or
faults, including one's own and others' performance; sacricing of timeliness to
ensure correctness in every detail; believing that there is only one right way to
do things; difculty changing ideas and/or viewpoint; preoccupation with
details, organization and order.
Perseveration:
Persistence at tasks long after the behavior has ceased to be functional or
effective; continuance of the same behavior despite repeated failures.
Wisdom (Openness To Experience):
People with a healthy personality have:
Lucidity:
LackOfSocialSkillsInPersonalityDisorders
There are certain social skills that are essential for healthy social functioning. Individuals with paranoid personality
disorder lack the essential social skills of trust, forgiveness, and gratitude.
SocialSkillsThatAreLackingInParanoidPersonalityDisorder
SOCIAL SKILL
PARANOID
PERSONALITY
Trust
Suspiciousness
Forgiveness
Bearing grudges
Gratitude
Feeling victimized
NORMAL
Trusting the loyalty and good intentions of
signicant others (e.g., family, friends)
Forgiving other peoples mistakes; not bearing
grudges or seeking revenge
Being thankful for the good things in life;
expressing thanks to others
WhichBehavioralDimensionsAreInvolved?
The ancient Greek civilization lasted approximately 3,000 years (16th century BC to 15th century AD). The ancient
Greek philosophers taught that the 5 pillars of their civilization were: cooperation, justice, wisdom, self-control, and
courage. Research has shown that these 5 themes are basic dimensions of personality disorders and other mental
disorders. This website uses these 5 major dimensions of human behavior to describe all mental disorders. [Whenever
possible, the more easily understood Greek concept (e.g., "Cooperation") is used instead of the "Big 5" personality
dimension name (e.g., "Agreeableness")]
WhatAreThe5majordimensionsofhumanbehavior?
Courage(vs.Neuroticism)
The"Big5"DimensionsofPersonalityandPersonalityDisorders
Research has shown that most human personality traits can be boiled down to ve broad dimensions of personality,
regardless of language or culture. These "Big 5" dimensions of personality are: I - Extraversion; II - Agreeableness; III
- Conscientiousness; IV - Neuroticism (the opposite of Emotional Stability); V - Intellect or Openness. There are two
free online personality tests that assess your personality in terms of the "Big 5" dimensions of personality. The
following diagram shows the relationship between the "Big 5" dimensions of personality and personality disorders.
This diagram is based on the research of Sam Gosling, Jason Rentfrow, and Bill Swann, Gerard Saucier, Colin G.
DeYoung, and Douglas Samuel and Thomas Widiger.
Enlarge Image
Enlarge Image
"Big5"PersonalityDimensionofLowAgreeableness
In personality testing, individuals with Paranoid Personality Disorder often have a low agreeableness test score.
Enlarge Image
"High Agreeableness"
The (BFAS) "Big-5" personality dimension of "high agreeableness" is associated with:
Feel others' emotions
Inquire about others' well-being
Sympathize with others' feelings
Take an interest in other people's lives
Like to do things for others
Respect authority
Hate to seem pushy
Avoid imposing my will on others
Rarely put people under pressure
"Low Agreeableness"
The (BFAS) "Big-5" personality dimension of "low agreeableness" is associated with:
Am not interested in other people's problems
Can't be bothered with other's needs
Am indifferent to the feelings of others
Take no time for others
Don't have a soft side
Believe that I am better than others
Take advantage of others
Insult people
Seek conict
Love a good ght
Am out for my own personal gain
OtherPersonalityDisordersWithLowAgreeablenessScores
Low agreeableness scores are also seen in individuals with Narcissistic or Antisocial Personality Disorders.
TheCoreFeaturesOfThe"LowAgreeablenessCluster"OfPersonalityDisorders
manipulativeness:
In the past week, did you "con" or take advantage of someone?
callousness:
In the past week, did you harm someone, but not care?
deceitfulness:
In the past week, did you lie, steal, or cheat?
hostility:
In the past week, were you actively hostile towards someone?
attention-seeking:
In the past week, did you go out of your way to be the center of attention?
grandiosity:
In the past week, did you treat others as if they were inferior to you?
TyrantsHaveADangerousCombinationofPersonalityDisorders
All of history's worst tyrants had the same combination of Narcissistic + Paranoid + Psychopathic (Antisocial)
Personality Disorders.
SocialSkillsThatAreLackingInHistory'sWorstDictators
PERSONALITY
DISORDER
Paranoid Personality
LACKING
LACKING
LACKING
Trust (had
Gratitude (had
Forgiveness (had feeling
Narcissistic Personality
Humility (had
arrogance)
Cooperation or
generosity (had
being
manipulative or
greedy)
Responsibility
(had
irresponsibility)
Kindness (had
callousness)
Honesty (had
dishonesty)
Given the amount of harm that these dictators created (e.g., Hitler, Mussolini, Stalin, Mao); it could be argued that the
social skills that dictators lack are the most important of all the social skills. Thus it should come as no surprise that
all of the world's religions emphasize the importance of these social skills (e.g., trust, forgiveness, gratitude, humility,
cooperation, generosity, kindness, respect, responsibility, and honesty).
The Rise of a Tyrant
In the beginning, the tyrant's followers believe that the tyrant's narcissism represents a condent, "strong man" who
would lead their nation to greatness. The tyrant uses his own paranoia to mobilize his followers' fears and anger
toward "the enemy". Once the tyrant gains political power, his deadly psychopathic (antisocial) traits become more
apparent. After gaining political power, the tyrant centralizes all political, military and economic power around
himself and his cronies. The tyrant nally solidies his power by killing all those that oppose him.
Thus narcissistic-paranoid-psychopathic individuals should never be allowed to gain political power because of
the great danger that they will become tyrants.
The "Tyrant Triad" Combination of Narcissistic + Paranoid + Psychopathic (Antisocial) Personality Disorders
AGoodLife(HighAgreeablenessandConscientiousness)
How does one live a good life?
One approach to answering this question is to study the behavior of individuals who live troubled lives. Could the
opposite of their maladaptive personality traits dene how to live a good life?
Research has shown that academic, vocational, economic, marital and social failure - plus crime - correlate highly to
individuals having low scores on the Agreeableness and Conscientiousness personality dimensions. The personality
disorders that have the lowest scores on the Agreeableness personality dimension are the Paranoid, Narcissistic and
Antisocial Personality Disorders. The two personality disorders that have the lowest scores on the Conscientiousness
personality dimension are the Antisocial and Emotionally Unstable (Borderline) Personality Disorders.
Could the opposite of the personality traits seen in Paranoid, Narcissistic, Antisocial and Emotionally Unstable
(Borderline) Personality Disorder be a clue as to how to live a good life? If so, the right side of the following table
would dene a good life. (This table uses DSM-5 diagnostic criteria.)
The Opposite Of Paranoid Personality
Disorder
Antagonism, Suspiciousness:
Altruism, Trust:
Does not suspect, without sufcient basis, that
Suspects, without sufcient basis, that others
others are exploiting, harming, or deceiving
are exploiting, harming, or deceiving her
him or her
Is preoccupied with unjustied doubts about
Is not preoccupied with unjustied doubts
the loyalty or trustworthiness of friends or
about the loyalty or trustworthiness of her
associates
friends or associates
Is reluctant to conde in others because of
Condes in others without unwarranted fear
unwarranted fear that the information will be that the information will be used maliciously
used maliciously against him or her
against her
Reads hidden demeaning or threatening
Does not read hidden demeaning or threatening
meanings into benign remarks or events
meanings into benign remarks or events
Has recurrent suspicions, without justication, Does not doubt, without justication, the
regarding delity of spouse or sexual partner delity of her spouse or sexual partner
Perceives attacks on his or her character or
Does not perceive attacks on her character or
reputation that are not apparent to others and is
reputation that are not apparent to others
quick to react angrily or to counterattack
Lack Of Forgiveness:
Forgiveness:
Persistently bears grudges, i.e., is unforgiving Does not bear grudges, i.e., is forgiving of
Paranoid Personality Disorder
Examples
ShouldWeForgiveEveryone?
Research into modern game theory has shown that justice requires both forgiveness and punishment.
Modern game theory has proven that the best strategy in any competition is "Tit For Tat". Rules for the "Tit For Tat"
strategy are:
Cooperation: Start off cooperating with people. If people continue to cooperate with you; continue
cooperating with them.
Punishment: At some point, if people become uncooperative; stop cooperating with them.
Forgiveness: If these people go back to cooperating; return to cooperating with them.
Notice that this "Tit For Tat" strategy only works well if the other person is willing to cooperate. If the other person is
never willing to cooperate, this "Tit For Tat" strategy becomes "An Eye For An Eye" strategy of perpetual retaliation.
Thus cooperation only works if the other person is also willing to cooperate. Research into game theory shows that it
is very self-defeating to forgive or cooperate with a totally uncooperative person.
PrimateEvolution
There appears to be three different ways in which primates have evolved socially:
The chimpanzees have evolved to be socially antagonistic, competitive, callous, and manipulative.
Chimpanzees are the only primates (apart from humans) that wage organized war. Thus chimpanzee social
behavior most closely mirrors the antagonistic behavior of the antisocial-narcissistic-borderline-histrionic
cluster of personality disorders.
In contrast, the bonobos have evolved to be socially anxious, peaceful, cooperative, and loving. Thus
bonobo social behavior most closely mirrors the negative emotion (anxious) behavior of the avoidantdependent cluster of personality disorders.
Another separate evolutionary path was followed by the orangutans. They evolved to become solitary
hermits. Thus orangutan social behavior most closely mirrors the detached behavior of the paranoidschizoid-schizotypal cluster of personality disorders.
ParentalBehaviorsWhichIncreaseTheRiskOfDevelopingAPersonalityDisorder
Research has shown that genetic, environmental, and prenatal factors all play important roles in the development of personality
disorder. Recent research has also shown that low parental affection and harsh parenting increase the risk of a child later developing a
personality disorder.
"Low affection" was dened as: low parental affection, low parental time spent with the child, poor parental communication with the
child, poor home maintenance, low educational aspirations for the child, poor parental supervision, low paternal assistance to the
child's mother, and poor paternal role fulllment. "Harsh parenting" was dened as: harsh punishment, inconsistent maternal
enforcement of rules, frequent loud arguments between the parents, difculty controlling anger toward the child, possessiveness, use
of guilt to control the child, and verbal abuse.
SettingGoalsInTherapy
QuestionsToAskWhenSettingGoals
TRIGGER: what did you do that could have triggered this problem?
GOAL: what life skill(s) do you have to work on? (from checklist)
ExampleOfSettingGoalsInInterviewingAPersonWithParanoidPersonalityDisorder
PERSONALITY
DISORDER
LACKING
LACKING
LACKING
Paranoid Personality
Trust (had
suspiciousness)
Gratitude (had
feeling victimized)
Narcissistic Personality
Humility (had
arrogance)
Forgiveness (had
bearing grudges)
Cooperation or
generosity (had
being manipulative
or greedy)
Responsibility (had
irresponsibility)
Kindness (had
callousness)
Honesty (had
dishonesty)
Given the amount of harm that these dictators created (e.g., Hitler, Mussolini, Stalin, Mao); it could be argued that the social skills that
dictators lack are the most important of all the social skills. Thus it should come as no surprise that all of the world's religions
emphasize the importance of these social skills (e.g., trust, forgiveness, gratitude, humility, cooperation, generosity, kindness, respect,
responsibility, and honesty).
TreatmentGuidelines
Paranoid Personality Disorder Treatment Guidelines - Google
Treatment
Paranoid Personality Disorder Treatment - Google
ResearchTopics:
Not All Scientic Studies Are Created Equal - video
Introduction To Statistics Used In Research
We found only one-third of published psychology research is reliable - now what? Estimating the reproducibility of psychological science - Psychologists grapple with
validity of research
Cochrane Collaboration - the best evidence-based, standardized reviews available
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Clozapine
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Complications
Combination Therapy
Crime
Desipramine
Dexmethylphenidate
Dexmethylphenidate (extended release)
Dextroamphetamine
Diagnosis
Diagnostic Criteria
Doxepin
Drug Therapy
Drug Therapy: randomized controlled trial
Drug Therapy: multicenter randomized controlled trial
Drug Therapy: placebo-controlled randomized controlled trial
Economic Impact
Education
Electroconvulsive Therapy
Embryology
Enzymology
Epidemiology
Escitalopram
Etiology
Family History
Fluoxetine
Fluvoxamine
Genetics
Haloperidol
Imipramine
Immunology
Lamotrigine
Lisdexamfetamine dimesylate
Lithium
Metabolism
Methamphetamine
Methylphenidate
Methylphenidate (extended release)
Methylphenidate (long acting)
Methylphenidate patch
Microbiology
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Olanzapine
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