What is Paranoid Personality Disorder? | Comprehensive Review

welcome to my scientifically informed insider look at mental health topics if you find this video to be interesting or helpful please like it and subscribe to my channel hello this is dr. grande today's question asks if I can provide a comprehensive review of paranoid personality disorder so I'll be taking a look at not only the definition but the history evie ology comorbidity and treatment I'll refer to paranoid personality disorder as PPD now PPD features a pervasive pattern of distrust suspiciousness and hostility and it's an under researched disorder some have even suggested that it should be removed from the DSM PPD is in cluster a it's a cluster a personality disorder so it's in the same cluster as schizoid and schizotypal person is worse this is the odd eccentric cluster now in terms of the history of PPD we see that it has been in every edition of the Diagnostic and Statistical Manual the DSM including the first DSM DSM one published in 1952 schizotypal personality solar was introduced in the sm3 and after this PPD was one of the least researched disorders right because there's some overlap between PPD and schizotypal and a lot more research interest and schizotypal we see that PPD has kind of been pushed to the side now the conceptualization of schizotypal isn't the only reason that PPD has not been researched that much we also see that there's this tendency of individuals with the disorder to not seek out treatment which of course makes sense considering one of the key features of the disorder is distrust another reason is that paranoia is found a number of other disorders although it's not always listed as an official diagnostic criterion paranoia in one form or another is present in many presentations of post-traumatic stress disorder borderline personality disorder narcissistic person is order bipolar disorder major depressive disorder and schizophrenia so when a clinician is presented with the client who appears to have paranoia that clinician is going to be fairly likely to assign a diagnosis other than paranoid person itis now I mentioned that paranoid personality disorder was in cluster a interestingly cluster a personality disorders are often thought of as more severe than other per se disorders although I would largely disagree with that generalization I would say a fairly good argument could be made that cluster a and cluster B personís orders are about equal in terms of severity cluster B personality pathology contains four disorders antisocial borderline narcissistic and histrionic Personality Disorder I think that one reason that cluster a personality sorters are sometimes thought of as more severe is because they are highly resistant to treatment whereas many individuals with cluster B personality what and sometimes people can improve quite a bit with those disorders improvement would be considered less likely when talking about cluster a person a source also the cluster a personality disorders are thought of as being on a continuum with schizophrenia this would also contribute to this idea that cluster a personality pathology must be more severe now specifically looking at paranoid personality disorder again we see that its prevalence is about two to four percent in the general population but only about 0.7 percent of the population has PPD and no other comorbid disorders so paranoid personality disorder is highly comorbid with other mental disorders and I'll talk about that in a few moments so looking at the definition of this disorder as we see it in the DSM we see that paranoid personality disorder has seven symptom criteria four or more are required for a diagnosis symptom number one the individual believes that others are deceiving exploiting or harming them and the evidence doesn't support this belief so if someone is out to get another individual that individual wouldn't necessarily meet the symptom criterion if the evidence supports it that would be different than what we see here in this criterion moving to symptom number two this is a preoccupation with unjustified doubts about the loyalty of friends or colleagues so essentially somebody with this disorder distrusts ever symptom number three the individual is reluctant to confide and others they're fearful that that information will be used against them so we see low straightforwardness only saying the minimum necessary to accomplish the goal of any given social interaction symptom number four interprets benign remarks as demeaning or threatening and I've even seen this extend to remarks that are extremely benign for example something like how are you that can even seem threatening the person with the disorder might be thinking why does this person want to know who I am right so they're reading in to everything symptom number five persistently bears grudges so with paranoid personality disorder the list of enemies just keeps growing the list of enemies that they make so they have an unforgiving attitude symptom number six they believe that their character reputation is being attacked and they quickly react with anger so we see a significant hostility component with this disorder and what happens is people just start avoiding the individual has the disorder because of all this anger and hostility moving to the last symptom criterion number seven the individual believes their spouse or partner is being unfaithful and this is without justification so really similar to that first symptom criterion except the distrusted person is a love interest and this is extremely common when working with somebody who's paranoid regardless of whether it's part of paranoid personality sorter or another disorder now a diagnosis of PPD cannot be given if the symptoms occur exclusively in the course of schizophrenia bipolar disorder major depressive disorder with psychotic features or any psychotic disorder so what this means is that technically PPD can become morbid with schizophrenia but many clinicians won't diagnose both PPD and schizophrenia it's going to be one or the other in many cases some individuals with PPD also have brief psychosis now it's not prolonged psychosis like we'd expect to see with schizophrenia but this does make this disorder very difficult to Franchi from schizophrenia and other psychotic disorders now the thoughts feelings attitudes and behaviors associated with PPD are often congruent with the individuals inner experience this is called being ego-syntonic so for the individual with PPD their paranoia seems normal appropriate and justified they don't believe that they have a mental disorder so this makes this disorder quite similar to the cluster B personality a little bit different than what we see with a couple of the cluster C person is order specifically avoidant and dependent those disorders can be ego-syntonic but often their ego-dystonic the individual who has avoidant or dependent person is or realizes that something's not quite right they realize that they are distressed and that it's a disorder that's causing it right so with OCPD with obsessive-compulsive personality sorter that's the remaining cluster C person a sorter sometimes we see an ego-syntonic nature and sometimes ego-dystonic but i think most of the time with that disorder it's more on the ego-syntonic side now in terms of some other characteristics related to PPD we see a strong sense of autonomy individuals with this disorder are very independent they tend to be sensitive to criticism this overlaps with narcissistic personality NPD they tend to be litigious and there's a few different reasons for this one would be hostility another would be seeking revenge and the third one would be finding the truth so sometimes if somebody believes somebody's out to get them filing a lawsuit maybe the only way to find out if that's really the case so they're trying to kind of dig into a situation and discover this person's ill intent toward them and again sometimes the law is the only avenue for them to find that out now this also overlaps with MPD and so do the unrealistic grandiose fantasies that we tend to see with paranoid person is order now with PPD there's an emphasis on power and rank not the ideal love fantasies that we tend to see with NPT but either way we see a significant overlap here between paranoid and narcissistic personality soars individuals of paranoid personality sorter often appeared to be cold sarcastic uncompromising stubborn argumentative defensive and hostile and because they're hostile and some of these other things that elicits a hostile response from other people so we see kind of a self-fulfilling prophecy they are angry and aggressive with others and then people return those feelings to them and then the individual of PPD says I knew it I knew this person was out to get me all along right so that's what we see this cycle just kind of repeats typically individuals that disorder are also not good at collaborating but they do sometimes get along with other people who are paranoid this of course is more likely to happen if the individual with the disorder has something in common in terms of their beliefs with another person who's paranoid like they believe in the same conspiracy theory for example now in terms of ideology in terms of what causes PPD we know that negative childhood experiences are tied to this disorder specifically early body-contact trauma has a strong association with the development of paranoid personality disorder in terms of heritability we see it's actually relatively low for PPD is compared to other precise orders somewhere between 21 and 28 percent heritability now in terms of comorbidity we know that paranoid personality disorder has a lot of comorbidity it tends to co-occur with a number of other mental disorders seventy-five percent of people with PPD have a comorbid personality disorder common comorbid personality disorder pathology includes schizoid schizotypal this isn't surprising they're both in cluster a but also narcissistic borderline and avoidant now interestingly among these personalities orders that are come or 'but the most common comorbidity would actually be with borderline and avoidant person I've sort other comorbidity with PPD includes panic disorder social anxiety disorder substance use disorder and post-traumatic stress disorder now I'm comparing PPD to schizoid and schizotypal we see that PPD is not as strong associated with social deficits and odd behaviors although certainly from an outside observers point of view the disorder can seem to have those features it's also associated with cognitive impairment so all the cluster a person is orders have this cognitive impairment component but with PPD is not considered as severe as with the other cluster right personality sorters so PPD is difficult to differentiate from schizoid and schizotypal personality suitors and of course it's difficult to differentiate from schizophrenia this has created a particular problem in terms of accurate diagnosing the prodromal phase of schizophrenia is difficult to distinguish from really all of the cluster A personality disorders so the prodromal phase is the phase right before the onset of schizophrenia now again skud sweden's gets a tipple would be a little bit more difficult to differentiate but PPD is still difficult to separate especially from this prodrome we'll face of schizophrenia so looking at skits a tipple for a moment we see that about 30% of individuals with skits a typical personality disorder will eventually develop a psychotic disorder with schizophrenia being the most common outcome when a psychotic disorder develops PPD is also a risk factor but it's not considered to be as pronounced a risk factor as skits a tipple is an important note here though 40% of individuals with PPD have comorbid skits a typical person I now to look at the personality characteristics associated with PPD when I'm looking at personality theory I usually use the five factor model I remember the five traits through the acronym ocean openness to experience conscientiousness extraversion agreeableness and neuroticism so looking at PPD in terms of the five factor model we see a weak negative correlation with openness to experience we see no association with conscientiousness with extraversion we see a split here in terms of the facets so PPD is positively correlated with excitement seeking but negatively correlated with positive emotions warmth and gregariousness PPD is negatively correlated with all of the facets of agreeable and the one that really stands out of course is trust right so speedy increases we see trust decreases in terms of the last trade PPD is positively correlated to all of the facets of neuroticism and angry hostility is the most pronounced here now moving the treatment PPD is generally considered to be treatment resistant there have only been a few studies that look at treatments that may yield positive results for somebody with a disorder skills training is one of those areas that has been suggested as potentially beneficial to individuals with PPD and cognitive behavioral therapy CBT may be promising too now another reason the treatment isn't often successful at PPD is that misdiagnosing is common clinicians tend to jump to a diagnosis like schizophrenia or other disorders that have a psychotic component right so often this disorder is misdiagnosed and therefore the correct treatment cannot be delivered so PPD is an interesting diagnosis one of the questions I hear sometimes with this disorder is does this diagnostic category matter is this an important disorder to have in the DSM and I think the answer is yes because PPD is associated with devastating outcomes a lot of social outcomes but also work outcomes often when people have had PPD for a while they find it difficult to maintain employment paranoid person is order makes other disorders more hazardous so here I'm talking about comorbidity so more hazardous to the person with the disorder but also to others right people are exposed to the symptoms that the individual PPD has this is similar to substance use disorder if somebody has a mental disorder and they have comorbid substance use disorder often the symptoms are going to be worse because of those substances with PPD we see again it's often comorbid with disorders like narcissistic person is order so the individual is going to be even more vindictive antisocial personality they're gonna have more motivation to do harm with the PPD added on water line person a sorter they're going to have a worse D evaluation phase so when they devalue a love interest they're gonna be even more angry and hostile to that person and with borderline of course we already see that anger and paranoia are part of that disorder so again adding on PPD just makes those symptoms worse PPD also worsens the outcomes for a number of other disorders like anxiety disorders and depressive disorders so we see with PPD that prognosis is generally poor individuals with this disorder often end up isolated they don't trust people and other people don't tend to trust them but this doesn't mean that we should give up hope for treating this disorder I've seen some occasions where this disorder responds relatively well to treatment again its treatment resistant that doesn't mean that treatment is impossible so somebody has PPD seeking counseling treatment is still a good option now I know whenever I talk about personality sorters like paranoid person a shorter there will be a variety of opinions please put any opinions and thoughts in the comments section they always generate an interesting dialogue as always I hope you found my analysis of this topic to be interesting thanks for watching

Channel: Dr. Todd Grande

Views: 76,594

Keywords: Paranoid Personality Disorder, distrust, suspiciousness, hostility, Cluster A Personality Disorder, odd eccentric, diagnosis, deceiving, exploiting, harming, unjustified doubts about loyalty, reluctant to confide in others, benign remarks, demeaning, threatening, persistently bears grudges, reputation, reacts with anger, spouse, partner, unfaithful, diagnostic and statistical manual of mental disorders, DSM

Id: w5FgfohXVmk

Length: 16min 41sec (1001 seconds)

Published: Sun Feb 23 2020