Hi I'm Dr. Tracey Marks, a psychiatrist, and I make mental health education videos. Today, I'm talking about
paranoid personality disorder. You've probably heard of
and used the term paranoid, and people will say,
"That made me paranoid." But feeling paranoid is not the same as having a paranoid personality. The general definition of paranoid is being excessively
suspicious or mistrustful. So you could have a moment of paranoia where you're preoccupied with suspicions about someone or something. But the difference here
is that your suspicions are isolated to a certain situation and it's not how you
feel about everything. Here's the criteria for
paranoid personality disorder as defined by the Diagnostic
and Statistical Manual of Mental Disorders fifth edition. A constant distrust and
suspiciousness of others such that their motivations
are interpreted as malevolent. This begins in early adulthood and is present in a variety of contexts, as indicated by four or
more of the following. And there's a mnemonic for this that can make it easier to remember and the mnemonic is suspect. S stands for suspicious of others. The person suspects
without sufficient basis that others are exploiting,
harming or even deceiving them. You may not know the person
is thinking this about you until they lash out at you
and accuse you of things. And they can bring up
stuff from a while ago and bring out details or
evidence of your behavior that make you pause and think, "Hmm, how did you get to
conclude that from that?" That was the furthest thing
from my mind when I said that. U stands for unforgiving. This person bears a lot of grudges. S stands for suspects
partner is unfaithful. So as a result, they may be very
controlling in relationships and always questioning your
whereabouts or your intentions. P stands for perceives attacks. This person believes that
people are always attacking their character or reputation. And so they're quick to attack back. And this can look like a very hostile or angry or aggressive person. E stands for enemy or friend. This person is always
questioning your loyalty or whether or not you're trustworthy. And even when you do
something good for them, they can think that it's
just too good to be true or there must be some catch somewhere. C stands for no confiding in others. They usually fear that the information will be used maliciously against them. On the surface, they may just look like
a really private person who doesn't like to talk about themselves. T stands for threats always perceived. This person reads hidden, demeaning or threatening
meanings into ordinary remarks. So this can look like a person who seems to always
read something negative into what you say. Here's an example. You go to a park together
and have lunch and you say, "I thought it'd be a nice day today, "but it looks like it's gonna rain." And the person says, "So I
guess I can't even get it right "when I try and take you
out on a nice outing. "I just screw everything up, right?" And you're like, "I was
just making an observation, "I wasn't criticizing you." And in this case, the Paranoid person can't see your comment as just an observation. They assume that most people
say things to put them down and to take from them. And this makes it very hard
for them to accept compliments. Even if you say something as basic as, "You're a beautiful person." They may see it as sarcasm. Like, beautiful is just code for horrid and you just don't think I'm
smart enough to know that. Or you're just complimenting me as a way of buttering me up
to get something from me. So in some, a person with paranoid personality can be very difficult to deal with. But also, the person
with paranoid personality can have a lot of internal distress, because to them, the world is just an unsafe place to be. You can't trust anyone. So you always have to be on
guard and look out for yourself. And that's not a state
of peace and contentment. Now, you may say, with all this negative
and aggressive behavior, how does a person like this
even end up in a relationship? Well, unlike schizoid personality disorder where they often don't feel the
need for emotional intimacy, people with paranoid personality
still want relationships. So they're still gonna
put themselves out there to attract a partner. But because of their mistrust of people, they tend to do things that
make them self-sufficient, so they don't need to rely on anyone. This self-made man or independent woman can appear very attractive to some people, but it's not until you get
into a relationship with them that you have these conflicts. And some people will stay in
a relationship for a long time because they wanna make it work. You may excuse all of the conflicts because you focus more
on the positive aspects of the person, like, he's very smart, and he has strong opinions
and is very confident. People with paranoid personality
can be very argumentative, but that could just be seen
as opinionated and outspoken. A paranoid person who ordinarily would be very aloof and
detached because of the secrecy, may turn it off long
enough to attract someone that they're interested in. And it's very common for people to filter out negative
things in a relationship and over focus on the positive. So an example of this would be, your girlfriend is always
accusing you of cheating, but when you're with her, she makes you feel like you're the most
important person to her. So you focus on that connection and you ignore the accusations, the 50 questions and the
doubts about your intentions, because when she's not in that mode, the attention you get from
her feels really good. And that's just an example of how what seems like a
very destructive personality could still allow for a
relationship to develop. Under stress, people with
paranoid personality disorder can have brief psychotic episodes that last minutes to hours. It's like a pop of irrational thinking where their basic mistrust
and suspiciousness goes to a different level
that's not realistic. But that level of delusional
thinking doesn't last, it goes away. And that's what distinguishes it from an illness that leads to
persistent psychotic symptoms like delusional disorder, schizophrenia or even psychotic depression. The prevalence of paranoid
personality disorder is between two and a half
to four and a half percent, which is close to the prevalence of the more popular personality disorders like narcissistic and borderline
personality disorders. Those both have an estimated prevalence of about 6% of people. We don't see paranoid
personality disorder much in an outpatient setting. And that may have to do with
their distrust of everyone, including physicians. It's also associated with
violence and criminal behavior. And as a forensic psychiatrist, I do a lot of legal evaluations and this is mostly where I have seen it in its strongest presentation. It's in the context of
someone committing a crime as a byproduct of their
suspicion, mistrust and violence. Paranoid personality
disorder can come along with other disorders, so it doesn't have to stand alone. And as with all of the
other personality disorders, people can have features of
multiple personalities together, such that they have a
mixed personality disorder. Some people think of
this personality disorder as a cognitive style, a
way of viewing the world, I think that this tends to be a more destructive personality disorder than even the ones we hear a lot about, like narcissistic and borderline
personality disorders. And I think that's
because this personality tends to have more overt aggression that's directed at others. When the Paranoid person feels wronged, they don't go and cut
themselves to feel better or withdraw to lick their wounds
from a narcissistic injury, they attack and it's
usually a verbal attack, but an attack nonetheless that
they feel is well deserved. That's probably why there's
a higher association with criminality. All that said, some people can benefit from
cognitive behavior therapy. It's a lot of hard work and you have to recognize
that your suspicions do not have much basis. And that's the hurdle that's
hard for people to get past. It's like, we're all just idiots who just can't see the truth. So that's paranoid personality disorder. Click here to see my
personality disorder playlist. See you next time.
