The Paranoid Personality

Pathways

- delusional disorder - anxiety disorders - mood disorders - somatization disorders - substance Abuse

Criterion A

A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and presents in a variety of contexts, as indicated by 4 or more: 1. suspects, without sufficient basis, that others are exploiting, harming or deceiving them 2. preoccupied with unjustified doubts about the loyalty/trustworthiness of others 3. reluctant to confide in others out of fear they will misuse that information - maliciously 4. reads hidden demeaning or threatening meaning into benign remarks 5. unforgiving - bears grudges 6. perceives attacks on their character or reputation that are not apparent to others and is quick to react angrily or to counterattack 7. has recurrent suspicions regarding fidelity of spouse ( no justification)

Regulatory Mechanism

Actively disowns undesirable personal traits and motives and attributes them to others.

Turkat (1990)

Behavioral - hypersensitivity produces anxiety, therefore behavioral techniques of anxiety reduction can be used such as muscle relaxation or cognitive modification. A hierarchy of anxiety-provoking situations - moving up the hierarchy. Subjects gradually learn to control the intensity of their anxiety, and the anxiety itself begins to be extinguished and replaced by a relaxing alternative. Social information processing - teaching the paranoid to correct interpretation of social cues, accomplished through role playing, videotaped feedback and firest instruction

Malignant Paranoid Personality (sadistic features)

Belligerent, vengeful, intimidating, callous and tyrannical; hostility vented primarily in fantasy; projects own venomous outlook onto others; persecutory delusions

Mood/temperament

Displays a cold, sullen, churlish and humorless demeanor. Attempts to appear unemotional and objective, but is edgy, envious, jealous, quick to take personal offense and react angrily.

Querulous Paranoid Personality (negativistic features)

Contentious, argumentative, faultfinding, unaccommodating, resentful, jealous, peevish, sullen, endless wrangles, whiny and snappish

Criterion B

Does not occur exclusively during the course of schizophrenia, a mood disorder with psychotic features, or another psychotic disorder and is not due to a medical condition

Fanatic Paranoid Personality (narcissistic)

Grandiose delusions are irrational and flimsy; pretentious, expensive supercilious contempt and arrogance toward others; lost pride reestablished with extravagant claims and fantasies

Paranoid Personality

Guarded, hostile, self-righteous, rigid, black-and-white thinkers, unwilling to consider objective evidence and draw rational conclusions. Defensive and aggressive

paranoid personality disorder

Indicated by a pattern of pervasive distrust and suspiciousness of others, such that their motives are interpreted as malevolent. Events and the actions of others are interpreted in the most negative light possible, and convictions of other's hostility are based on little or no objective evidence.

Object representations

Internalized representations significant early relations are a fixed and implacable configuration of deeply held beliefs and attitudes, as well as driven by unyielding convictions.

Cognitive Style

Is unwarrantedly skeptical, cynical, and mistrustful of others motive; construing innocuous events as signifying hidden or conspiratorial intent.

Expressive behavior

Is vigilantly guarded, alert to anticipate and ward of expected derogation, malice, and deception; is tenacious and firmly resistant to sources of external influence and control.

Interpersonal conduct

Not only bears grudges and is unforgiving of those of the past, but displays quarrelsome, fractious, and abusive attitude with recent acquaintances; precipitates exasperation and anger by testing of loyalties and an intrusive and searching preoccupation with hidden motives.

Beck et al. (1990)

Paranoid personality is perpetuated by core beliefs that others cannot be trusted and will intentionally inflict hurt where possible. Interventions should modify these assumptions, without being perceived as a personal attack. Pretzer -Behavioral therapy - focusing on goals set by the subject and approaching the least threatening goals first. Cognitive style interventions - should focus on modifying the assumption that others are not to be trusted and improving their self-efficacy

Benjamin (1996)

Paranoids naturally see the therapist as critical and judgmental. Benjamin calls "noncoercive holding", basically soothing empathy and affirmation as an antidote to early abuse. Realizing that their own feelings of vulnerability do not automatically mean they've been attacked and that the expectation of attack follows directly from their experiences with caretakers. Paranoid's must separate their emotions from their caretakers to absolve themselves of hostility.

Insular Paranoid Personality (avoidant features)

Reclusive, self- sequestered; self-protectively secluded from omnipresent threats and destructive forces; hyper-vigilant and defensive against imagined dangers

Obdurate Paranoid Personality (compulsive features)

Self-assertive, unyeilding, stubborn, steely, implacable, unrelenting, dyspeptic, peevish, and cranky stance; legalistic, self-righteous, discharges previously restrained hostility; renounces self-other conflict

Morphologic organization

Systemic constriction and inflexibility of indergirding morphologic structures, as we all rigidly fixed channels of defensive coping, conflict mediation and need gratification. Unanticipated stressors are likely to precipitate either explosive outburst or inner shatterings.

Self-image

has persistent ideas of self-importance, and self-references, perceiving attacks on own character not apparent to others. Pridefully independent and reluctant to confide in others.