Personality Disorders 101: Paranoid PD

Standard

The first in the series of PDs is Paranoid Personality Disorder (PPD). While experiencing paranoia in a stressful situation is common, PPD refers to a much bigger idea; a pattern of permanent fear that someone or something is trying to cause you harm, and that you are in almost-constant danger.

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 feel like they always need to be on guard to defend themselves. A person with PPD will find trust very difficult, as they may fear (or expect) that everything in their world could be revealed as a lie or trick at any moment. This uncertainty may drive someone with PPD towards anger and constant arguments with other people, who are assumed to be lying or hiding information. Alternately, the person may isolate themselves from the world and from others so they cannot be decieved.

To be diagnosed with PPD in the DSM-5, someone must meet 4 of these criteria;

  • They suspect without reason that others are exploiting, harming, or deceiving them.
  • They are preoccupied with doubts about other people’s loyalty or trustworthiness.
  • They are reluctant to confide in others, as they fear any information will be used maliciously against them.
  • They read hidden demeaning or threatening meanings into neutral remarks or events.
  • They persistently bears grudges, and rarely forgive insults or slights.
  • They see attacks on their character or reputation which are not apparent to /intended by others. They quickly react angrily or counterattack.
  • They repeatedly suspect, without justification, that their partner is unfaithful.

Before someone can be diagnosed with PPD, a psychiatrist must make sure the symptoms are not solely caused by schizophrenia, a psychotic disorder or a mood disorder. The general PD criteria mentioned in the first post must also apply. “A person needs to have a collection of unusual behaviours and traits which affects a large portion of their everyday life. Those behaviours and traits must start before early adulthood. They need to cause negative consequences for the person, who should be upset by or annoyed at those behaviours.”

An estimated 2.5% of people have PPD, and the recommended treatments are antipsychotic medication and psychotherapy. Like most PDs, PPD is expected to be managed for life rather than fully removed.

One character who seems to demonstrate many PPD traits is Mad-Eye Moody from the Harry Potter series. Moody, whose catchphrase is “constant vigilance!”, is continually alert to potential danger; he refuses to take any food or drink prepared by someone else, and fills his office with danger-detecting gadgets. Without context, he appears irrationally paranoid.

But in context, his behaviour is rational. Moody’s job as an Auror (a Wizarding-world policeman for high-level criminals) exposed him to continual danger, and resulted in him losing his leg and eye. Drawing the line between a rational analysis of possible danger and a irrational expectation of danger is one of the major points of contention when diagnosing PPD.

Psychological Criticisms of PPD

When diagnosing PPD, the judgment of “excessive” paranoia is from the psychiatrists’ viewpoint. However, what a psychiatrist may see as “excessive” paranoia based on their own background and understanding may be completely rational for the client. Clients from societies with a greater baseline danger than the psychiatrist understands – totalitarian countries with high levels of surveillance and control over citizens, or areas with high crime and a continual risk of violence – will naturally feel more suspicious and wary. They need to be more aware of potential danger and deceit than someone with a more typical background.

A psychiatrist without that understanding may not be able to recognise that the client’s response are rational and adaptive rather than excessive. As a result, people in situations like the above may be incorrectly diagnosed with PPD; the issue can be seen as indivudal rather than a result of their living situation.

Examples like this demonstrate one flaw with the DSM/ICD system. Both manuals aim for objectivity. They are designed so that, in theory, two psychiatrists should be able to meet with the same client and reach the same conclusion on their diagnoses. This assumption of objectivity means people ignore how background experiences, limitations and biases influence the people making diagnoses.

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