Paranoid Personality Disorder: Diagnosis, Causes and Treatments

PPD is characterised by a mistrust of others without rational reason, creating a constant state of paranoia. For example, they may see an individual as a threat but can’t be convinced that this is irrational or misinformed.

Diagnosis:

The Diagnostic and Statistical Manual of Mental Disorders (DSM V, APA 2013) diagnoses PPD according to the following criteria. There are two main criteria for PPD of which criterion A has seven sub features, four of which must be seen in the patient to make a PPD diagnosis:

Criterion A: Global mistrust and suspicion of others’ motives which commences in adulthood. The seven sub features of criterion A are:

1.?????The person with PPD will believe others are using, lying to, or harming them, without apparent evidence thereof.

2.?????They will have doubts about the loyalty and trustworthiness of others,

3.?????They will not confide in others due to the belief that their confidence will be betrayed.

4.?????They will interpret ambiguous or benign remarks as hurtful or threatening, and

5.?????Hold grudges,

6.?????In the absence of objective evidence, believe their reputation or character are being assailed by others, and will retaliate in some manner and

7.?????Will be jealous and suspicious without cause that intimate partners are being unfaithful.

Criterion B is that the above symptoms will not be during a psychotic episode in schizophrenia, bipolar disorder, or depressive disorder with psychotic features.

Causes and Risk Factors

Neglect: Neglect and abuse, especially in early childhood increases vulnerability to PPD[1]

Complex Trauma: Experiences such as losing a loved one and the isolation this may cause increases the risk of PPD[2]

Panic Disorder: A prior diagnosis of panic disorder makes it more likely that PPD will develop[3]

Genetics: Research shows the genetic risk to be as high as 28% for twins and the expression of certain genes such as the Nitric Oxide Synthase 1 Adaptor Protein also increases the risk of developing PPD[4]

References

American Psychiatric Association. (2013).?Diagnostic and statistical manual of mental disorders?(5th ed.). Arlington, VA: Author.

[1] Golier, J. A., Yehuda, R., Bierer, L. M., Mitropoulou, V., New, A. S., Schmeidler, J., ... & Siever, L. J. (2003). The relationship of borderline personality disorder to posttraumatic stress disorder and traumatic events. American Journal of Psychiatry, 160(11), 2018-2024.

[2] Masferrer, L., Mancini, A. D., & Caparrós, B. (2020). Understanding the Relationship Between Complicated Grief Symptoms and Patterns of Personality Disorders in a Substance Users' Sample: A Network Analysis Approach. Frontiers in psychology, 11, 566785.

[3] Reich, J., & Braginsky, Y. (1994). Paranoid personality traits in a panic disorder population: A pilot study. Comprehensive Psychiatry, 35(4), 260-264.

[4] Wang, Q., Liu, G., Li, J., Zhang, M., Chen, H., Chen, C., Wang, C., Liu, N., & Zhang, N. (2020). Effects of interaction of NOS1AP gene polymorphisms and childhood abuse on paranoid personality disorder features among male violent offenders in China. Journal of psychiatric research, 130, 180–186. https://doi.org/10.1016/j.jpsychires.2020.07.026