Personality Disorders 102- Paranoid PD

The first in the series of PDs is Paranoid Personality Disorder (PPD). Now, while it’s fairly easy for someone to experience paranoia in a stressful situation, PPD refers to something bigger,  a pattern of permanent fear that someone or something is trying to cause you harm, and that you are in almost-constant danger.

The official ICD criteria are:

  • excessive sensitivity to setbacks and rebuffs;
  • tendency to bear grudges persistently, i.e. refusal to forgive insults and injuries or slights;
  • suspiciousness and a pervasive tendency to distort experience by misconstruing the neutral or friendly actions of others as hostile or contemptuous;
  • a combative and tenacious sense of personal rights out of keeping with the actual situation;
  • recurrent suspicions, without justification, regarding sexual fidelity of spouse or sexual partner;
  • tendency to experience excessive self-importance, manifest in a persistent self-referential attitude;
  • preoccupation with unsubstantiated “conspiratorial” explanations of events both immediate to the patient and in the world at large.
 
(Something that will quickly be learnt from psychology- the writers of the DSM and ICD like to use the most complicated language possible to explain their point.)

Put sensibly, this means a person with PPD will experience everything, however neutral or friendly, as a personal attack and a sign of their “put-upon” status. They will be very focused on their own rights in situations, as a consequence of feeling like they always need to be on guard and defending themselves.

A person with PPD, would in a sense, live with no foundation for trust, fearing that every single thing in their world can instantly turn on them and reveal itself as a lie or ruse aimed to trick them. This uncertainty usually drives people with PPD either into anger and constant arguments with others, as they appear to be lying or hiding information, or to them isolating themselves from the world and from others.

Thinking about it from a developmental psychology point of view, it seems like PPD (as well as BPD, which I’ll cover in a few weeks) is linked to a lack of emotional object constancy, the ability to realise that things (and people) remain constant over time.

For most of these, I’ll be adding a fictional example of people who fit into the criteria for these disorders, as fictional characters have more exaggerated personalities which make it easier to explain specific factors.  A good fictional example of PPD is Mad-Eye Moody from the Harry Potter series, considering his pervasive attempts to detect any danger, and catchphrase of constant vigilance!”.

As you can see, it is a very isolating and disconnecting condition, and one that leads to a lot of social and personal difficulties.An estimated 0.5%-2.5% of people have PPD, and it can be treated to some extent by antipsychotic medication and psychotherapy. However, like all personality disorders, the symptoms are considered merely managed rather than removed altogether.

Psychological Criticisms of PPD

A major problem diagnosing PPD is that paranoia has to be considered excessive from the psychiatrists’ point of view. However, limiting judgement to the psychiatrist’s perspective can mean the psychiatrist ignores cultural factors. For example, if someone is from a society with much more danger, such as a totalitarian country with high levels of surveillance and control over the population, or an area with high levels of crime and violence. A person in this situation will naturally feel a higher level of paranoia, and must necessarily be more more aware, than the “average” person with a more regular background, and this is not often something that a psychiatrist will recognise.

This means people from backgrounds like these will be unfairly overdiagnosed with PPD, when a more appropriate option would be counselling to get more understanding of the effects living in a violent/controlling situation would have. Situations like this show how the DSMs focus on objectivity can lead to ignoring the context that truly explains a situation.

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