Paranoid Personality Disorder

Pervasive suspiciousness, mistrust, hypersensitivity to criticism & hostility are essential features of paranoid P.D.

Epidemiology:

•0.5-1% in general population.
•10-20% in clinical settings.

Aetiology:

•Deficit in cortical dopamine activity.
•Lack of protective care & emtional support in childhood.

Clinical features:

•They do not wish to be cured.
•They believe that they have to be protected from other people’s hatred & attacks.

ICD-10 Criteria: F60.0

1. Excessive sensitiveness to setbacks & rebuffs (rejections).

2. Tendency to bear grudges e.g. refusal to forgive insults.

3. Suspiciousness & tendency to misconstruct the natural or friendly actions of others as hostile or contemptuous (disrespectful).

4. A combative( ready to fight) and tenacious (not likely to give up) sense of personal rights out of keeping with the actual situation.

5. Recurrent suspiciousness regarding sexual fidelity of sexual partner.

6. Tendency to experience excessive self-importance.

7.Preoccupation with unsubstantiated conspiratorial explanations of events both immediate to the patient and in the world at large.

Course:

Childhood & Adolescence:-

• Hypersensitivity.
• Social anxiety.
• Poor peer relationships.
• Eccentricity

In situations of stress :-

• May respond with brief psychotic episodes.
•May act as a premorbid state for a delusional disorder or even schizophrenia.

Differential Diagnosis:-

• Delusional disorder.
• Paranoid schizophrenia.
• Depression with Psychotic symptoms.
• Schizoid personality disorder.
• Schizotypal personality disorder.
•Avoidant personality disorder

Treatment:

For Depression & Anxiety resulting from a paranoid response to stressful situations:- •Antidepressants
•Anxiolytics

* psychological treatment to gain patient confidence & cognitive restructuring.

For brief psychotic episodes:-
• Low dose antipsychotics.

Reference:

  • New Oxford Textbook of Psychiatry(2nd edition).
  • ICD-10 Classification of Mental and Behavioural Disorders.

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