Paranoid personality disorder: general framework

By Cristiano Antonino On Nov 23, 2022

Paranoid personality disorder affects 0.5-2.5 per cent of the population, is more frequent in boys and may first manifest in childhood and adolescence with a tendency towards loneliness, poor relationships with peers, social anxiety, hypersensitivity and inadequate school performance

These children are often ‘strange’ or ‘eccentric’ and may be the object of derision. Although the onset occurs in these life stages, the individual with paranoid personality disorder comes to the observation of a mental health professional, usually prompted by family members, not before the age of 30-40 years.

Symptoms of paranoid personality

In order to understand whether one suffers from paranoid personality disorder, it is necessary to refer to competent figures, i.e. a mental health professional, authorised to diagnose, who will make use of psychodiagnostic tests, interview and clinical observation.

Having clarified this, what are the aspects that could make us think of paranoid personality disorder?

People with this disorder:

Persistently and pervasively suspect that they are exploited, harmed, deceived by others
They doubt the loyalty and fidelity of spouses, partners and friends
They are reluctant to confide in others because they unjustifiably fear that others will then use such information maliciously or against them
They read humiliating or threatening hidden meanings into benevolent remarks and events
They are very touchy, resentful and jealous
They are quarrelsome, counter-attack and react angrily
The causes of paranoid personality disorder are still not entirely clear

However, researchers seem to agree that a combination of genetic, social and psychological factors (such as temperament, early developmental interactions with both family members and peers, etc.) are involved in the onset and maintenance of paranoid disorder.

It is believed that early trauma in childhood may contribute to the development of this personality type (Montano, Borzì, 2019).

For example, according to Benjamin (1999), subjects with Paranoid Personality Disorder had parents who appeared to have been abused in childhood and who then reproduced a sadistic, degrading, controlling parenting style as adults.

These parents punished their children when they showed themselves to be needy, vulnerable, in all those situations where they required care.

In light of this, the children learned not to ask for any kind of help even in dangerous situations, to avoid crying and not to trust anyone.

These experiences, in adulthood, translated into tendencies towards isolation, avoidance of any form of intimacy and relationships, and a strong sensitivity to exclusion, gossip, insults and even jokes.

A higher frequency of paranoid personality disorder was also found in families with a history of schizophrenia and delusional disorder (persecution type).

Outcomes of paranoid personality disorder

The person with paranoid personality disorder usually tends to interpret the words and actions of others as deliberately threatening, humiliating or malicious.

They are often argumentative and particularly susceptible to criticism to which they mainly respond with anger.

The suspicious attitude, typical of the person with paranoid disorder, manifests itself by looking for signs to confirm the initial hypothesis of threat, offence, dangerousness and falsehood.

In order to cope with this, the person with paranoid disorder engages in a series of behaviours that lead him or her to prefer an isolated lifestyle, creating discomfort at work, in the family, in friendships and intimate relationships and that, in the long term, can lead to depression and social withdrawal.

References

Agnello, T., Fante, C., Pruneti, C. (2013). Paranoid personality disorder: new areas of research in diagnosis and treatment. Journal of Psychopathology, 19, 310-319.

American Psychiatric Association (2014). DSM-5: Manuale diagnostico e statistico dei disturbi mentali. Raffaello Cortina, Milano.

Benjamin, L. (1996). Interpersonal diagnosis and treatment of personality disorders. Second Edition. New York: Guilford.

Dimaggio, G., Montano, A., Popolo, R., Salvatore, G. (2013). Terapia metacognitiva interpersonale dei disturbi di personalità. Raffaello Cortina, Milano.

Dimaggio, G., Ottavi, P., Popolo, R., Salvatore, G. (2019). Corpo, immaginazione e cambiamento. Terapia metacognitiva interpersonale. Raffaello Cortina, Milano.

Dimaggio, G., Semerari, A. (2003). I disturbi di personalità. Modelli e trattamento. Editori Laterza, Bari-Roma.

Lobbestael, J., Arntz, A., Bernstein, D.P. (2010). Disentalgling the relationship between different types of childhood maltreatment and personality disorders. J Pers Disord, 24, 285-295.

Montano, A., Borzì, R. (2019). Manuale di intervento sul trauma. Comprendere, valutare e curare il PTSD semplice e complesso. Erickson, Trento.

Tyrka, A.R., Wyche, M.C., Kelly, M.M., et al. (2009). Childhood maltreatment and adult personality disorder symptoms: Influence of maltreatment type. Psychiatry Res, 165, 281-287.

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