PARANOID PERSONALITY

DISORDER 301.0 (F60.0)

 PARANOID
PERSONALITY DISORDER
• Long –standing suspiciousness and mistrust of people in general.
• Hostile, irritable, inflexible and angry.
• hypersensitive., expectation without any justification.
• Think other people want to harm them or deceive them, even if no
evidence exists to support this expectation
• Cold, humorless, deceitful and calculative
• Difficult to have close relationships.
• Performance impaired because of searching hidden motives and
special meanings.
• Compliments are often misinterpreted
• (e.g., a compliment on a new acquisition is
misinterpreted as a criticism for selfishness; a
compliment on an accomplishment is misinterpreted as
an attempt to pressurize more and better performance).
• They may view an offer of help as a criticism that they
are not doing well enough on their own.
 Associated Features
• difficult to get along with and often have problems with close
relationships.
• Their excessive suspiciousness and hostility may be expressed in
overt argumentativeness, in recurrent complaining, or by quiet,
apparently hostile aloofness
• Although they may appear to be objective, rational, and
unemotional, they more often display a labile range of affect, with
hostile, stubborn, and sarcastic expressions predominating.
• Their combative and suspicious nature may elicit a hostile
response in others, which then serves to confirm their original
expectations.
• lack trust in others leads tp an excessive need to be self-
sufficient and a strong sense of autonomy
• have great difficulty accepting criticism themselves and
blame others for their own shortcomings
• Particularly in response to stress, individuals with
this disorder may experience very brief psychotic
episodes (lasting minutes to hours).
• premorbid antecedent of delusional disorder or
schizophrenia.
• may develop major depressive disorder and may
be at increased risk for agoraphobia and
obsessive-compulsive disorder.
• Alcohol and other substance use disorders
 DSM-5 Criteria
• A. A pervasive distrust and suspiciousness of others
such that their motives are interpreted as malevolent,
beginning by early adulthood and present in a variety of
contexts, as indicated by four (or more) of the following:
1. Suspects, without sufficient basis, that others are
exploiting, harming, or deceiving him or her.
2. Is preoccupied with unjustified doubts about the loyalty
or trustworthiness of friends or associates.
3. Is reluctant to confide in others because of
unwarranted fear that the information will be used
maliciously against him or her.
4. Reads hidden demeaning or threatening
meanings into benign remarks or events.
5. Persistently bears grudges (i.e., is unforgiving
of insults, injuries, or slights).
6. Perceives attacks on his or her character or
reputation that are not apparent to others and is
quick to react angrily or to counterattack.
7. Has recurrent suspicions, without justification,
regarding fidelity of spouse or sexual partner
• B. Does not occur exclusively during the course
of schizophrenia, a bipolar disorder or
depressive disorder with psychotic features, or
another psychotic disorder and is not
attributable to the physiological effects of
another medical condition.
• Note: If criteria are met prior to the onset of
schizophrenia, add “premorbid,” i.e., “paranoid
personality disorder (premorbid).”
 Causes
• BIOLOGICAL: Slightly more common among the relatives of people who
have schizophrenia, although the association is not strong.
• heritability of high levels of antagonism (low agreeableness) and
neuroticism (angry-hostility),
• PSYCHOLOGICAL : parents may teach them to be careful about making
mistakes and impress on them that they are different from others. This
vigilance causes them to see signs that other people are deceptive and
malicious.
• CULTURAL : Prisoners, refugees, hearing impairment are thought to be
particularly susceptible. Because of their unique experiences.
Schizoid
Personality
 Schizoid personality disorder
• Term schizoid – tendency to turn inward and away
from the outside world.
• is a pervasive pattern of detachment from social
relationships
• restricted range of expression of emotions in
interpersonal settings.
• Aloof, cold and indifferent to other persons.
• They rarely experience strong emotions, are not
interested in sex, and have few pleasurable
• lack a desire for
intimacy and
lack social skills
• people with this
disorder are
loners who
pursue solitary
interest
• begins by early
adulthood and is
present in a
variety of
contexts.
 Associated Features
• difficulty expressing anger, even in response to direct provocation, which
contributes to the impression that they lack emotion
• lives sometimes seem directionless, and they may appear to "drift" in
their goals
• react passively to adverse circumstances and have difficulty responding
appropriately to important life events
• Particularly in response to stress, individuals with this disorder may
experience very brief psychotic episodes (lasting minutes to hours).
• In terms of the five-factor model, they show extremely high levels of introversion (especially low on
warmth, gregariousness, and positive emotions). They are also low on openness to feelings (except
in fantasy
 DSM-5 Criteria
• A. A pervasive pattern of detachment from social relationships and a
restricted range of expression of emotions in interpersonal settings,
beginning by early adulthood and present in a variety of contexts, as
indicated by four (or more) of the following:
• 1. Neither desires nor enjoys close relationships, including being part of a
family.
• 2. Almost always chooses solitary activities.
• 3. Has little, if any, interest in having sexual experiences with another
person.
• 4. Takes pleasure in few, if any, activities.
• 5. Lacks close friends or confidants other than first-degree relatives.
• 6. Appears indifferent to the praise or criticism of others.
• 7. Shows emotional coldness, detachment, or flattened affectivity.
• B. Does not occur exclusively during the course of schizophrenia,
a bipolar disorder or depressive disorder with psychotic features,
another psychotic disorder, or autism spectrum disorder and is
not attributable to the physiological effects of another medical
condition.
• Note: If criteria are met prior to the onset of schizophrenia, add
“premorbid,” i.e., “schizoid personality disorder (premorbid).”
 Casual factors
• has not been the focus of much research attention.
• people with schizoid personality disorder are not exactly
the people we might expect to volunteer for a research
study.
• Early theorists considered a schizoid personality to be a
likely precursor to the development of schizophrenia, but
this viewpoint has been challenged, and any genetic link
that may exist is very modest
• Cognitive theorists propose that individuals with schizoid
personality disorder exhibit cool and aloof behavior because of
maladaptive underlying schemas that lead them to view
themselves as self-sufficient loners and to view others as
intrusive.
• Their core dysfunctional belief might be, “I am basically alone”
or “Relationships are messy [and] undesirable”).
Unfortunately, we do not know why or how some people might
develop such dysfunctional beliefs.
301.22 (F21)
• Excessively introverted
• pervasive pattern of social and interpersonal deficits
marked by acute discomfort with, and reduced capacity for
close relationships
• cognitive or perceptual distortions and eccentricities of
behavior
• Magical thinking or special powers
• subject to recurrent illusions
• ideas of reference illusions
• derealisation
• Excessive social anxiety that does not diminish.
• Speech oddities, such as vagueness in conversation, are often present
• No close friends or confidants.
• Inappropriate or constricted affect, hypersensitivity, and inappropriate affect
(emotions).
• The prevailing belief is that the disorder is defined primarily by cognitive
distortions and that affective and interpersonal problems are secondary.
 EPIDEMIOLOGY :
• occurs in about 3% of the population.
• among men than women
• Greater association of cases among the relatives of schizophrenic
patients.
• High chance in monozygotic twins than dizygotic.
• Despite the possibility of genetic influence in the disorder, early
environmental enrichment for children (i.e., two years of enhanced
nutrition, education, and physical exercise) has been found to
reduce schizotypal personality disorder
• Many characteristics of schizotypal types resemble those
of schizophrenia, although in less serious form.
• For example, people with schizophrenia exhibit problems in
personality characteristics, psychophysiological responses,
and information processing— deficits that have also been
observed among persons with schizotypal personality
disorder.
• shown the same deficit in the ability to track a moving target visually that is
found in schizophrenia
• show numerous other mild impairments in cognitive functioning including
deficits in their ability to sustain attention and deficits in working memory
(e.g., being able to remember a span of digits
• deficits in their ability to inhibit attention to a second stimulus that rapidly
follows presentation of a first stimulus that may be related to their high levels
of distractibility and difficulty staying focused
• They also show language abnormalities that may be related to abnormalities in
their auditory processing
 DSM-5 Criteria
• A. A pervasive pattern of social and interpersonal
deficits marked by acute discomfort with, and reduced
capacity for, close relationships as well as by cognitive
or perceptual distortions and eccentricities of behavior,
beginning by early adulthood and present in a variety of
contexts, as indicated by five (or more) of the following:
• 1. Ideas of reference (excluding delusions of reference).
the belief that conversations or gestures of others have
special meaning or personal significance
2. Odd beliefs or magical thinking that influences
behavior and is inconsistent with subcultural norms
(e.g., superstiousness, belief in clairvoyance, telepathy,
3. Unusual perceptual experiences, including bodily illusions.
4. Odd thinking and speech (e.g., vague, circumstantial,
metaphorical, overelaborate, or stereotyped).
5. Suspiciousness or paranoid ideation
6. Inappropriate or constricted affect.
7. Behavior or appearance that is odd, eccentric, or peculiar.
8. Lack of close friends or confidants other than first-degree
relatives.
9. Excessive social anxiety that does not diminish with familiarity
and tends to be associated with paranoid fears rather than negative
judgments about self.
• B. Does not occur exclusively during the course of schizophrenia, a
bipolar disorder or depressive disorder with psychotic features,
another psychotic disorder, or autism spectrum disorder