MAJOR CLASSIFICATION OF PSYCHIATRIC ILLNESSADJUSTMENT PROBLEMSPSYCHOSESNONPSYCHOSESPERSONALITY DISORDERSADJUSTMENT PROBLEMS
Personality disorders have distinct features which separate itfrom other psychiatric disorders. These distinct features are:Alloplastic. Subject symptoms adapt very well with theenvironment, there need not be any history of psychiatricconfinement or even just a consult.Ego syntonic They never feel the symptoms, it is only the peoplearound them (mostly intimate partners) who take notice of themal-adaptive behavior, they will therefore not seek treatment toget rid of the symptoms .
Paranoid personality disorder is a mentaldisorder characterized by paranoia and apervasive, long-standing suspiciousness andgeneralized mistrust of others.Individuals with this personality disorder maybe hypersensitive, easily feel slighted, andhabitually relate to the world by vigilantscanning of the environment for clues orsuggestions that may validate their fears orbiases.Paranoid individuals are eager observers. Theythink they are in danger and look for signs andthreats of that danger, potentially notappreciating other evidence.
They tend to be guarded and suspicious and have quiteconstricted emotional lives. Their reduced capacity formeaningful emotional involvement and the general patternof isolated withdrawal often lend a qualityof schizoid isolation to their life experiencePeople with this particular disorder may or may not have atendency to bear grudges, suspiciousness, tendency tointerpret others actions as hostile, persistent tendency toself-reference, or a tenacious sense of personal right
World HealthOrganizations ICD-10American Psychiatric AssociationsDSM-IV-TR
It is characterized by at least three of the following:excessive sensitivity to setbacks and rebuffs;tendency to bear grudges persistently, i.e. refusal to forgive insults and injuriesor slightssuspiciousness and a pervasive tendency to distort experience by misconstruingthe neutral or friendly actions of others as hostile or contemptuous;a combative and tenacious sense of personal rights out of keeping with theactual situation;recurrent suspicions, without justification, regarding sexual fidelity of spouse orsexual partner;tendency to experience excessive self-importance, manifest in a persistent self-referential attitude;preoccupation with unsubstantiated "conspiratorial" explanationsof events both immediate to the patient and in the world at large.
The American Psychiatric Associations DSM-IV-TR hassimilar criteria.They require in general the presence of lasting distrustand suspicion of others, interpreting their motives asmalevolent, from an early adult age, occurring in arange of situations. 4 of 7 specific issues must bepresent, which include different types of suspicions ordoubt (such as of being exploited, or that remarkshave a subtle threatening meaning), in some casesregarding others in general or specifically friends orpartners, and in some cases referring to a response ofholding grudges or reacting angrily
Psychologist Theodore Millon has proposed fivesubtypes of paranoid personalityfanatic paranoid — including narcissistic featuresmalignant paranoid — including sadistic featuresobdurate paranoid —including compulsive featuresquerulous paranoid — including negativistic (e.g.discontentment) featuresinsular paranoid — including avoidant features
One of the earliest descriptions of theparanoid personality comes from a Frenchpsychiatrist named Magnan whodescribed a "fragile personality" thatshowed idiosyncraticthinking, hypochondria, unduesensitivity, referential thinking andsuspiciousness
Kraepelins description from 1905 of a pseudo-querulouspersonality who is "always on the alert to find grievance, butwithout delusions", vain, self-absorbed, sensitive, irritable, litigious, obstinate, and living atstrife with the world. In 1921, he renamed the condition paranoidpersonality and described these individuals as distrustful, feelingunjustly treated and feeling subjected to hostility, interferenceand oppression. He also observed a contradiction in thesepersonalities: on the one hand, they stubbornly hold on to theirunusual ideas, on the other hand, they often accept every pieceof gossip as the truth. Kraepelin also noted that paranoidpersonalities were often present in individuals who laterdeveloped paranoid psychoses. Subsequent writers alsoconsidered traits like suspiciousness and hostility to predisposepeople to developing delusionalillnesses, particularly "late paraphrenias" of old age
Bleuler described "contentiouspsychopathy" or "paranoid constitution" asdisplaying the characteristic triad ofsuspiciousness, grandiosity and feelings ofpersecution. He also emphasized that thefalse assumptions of these individuals donot attain the form of real delusion
Kretschmer emphasized the sensitive inner coreof the paranoia-prone personality: they feel shyand inadequate but at the same time they havean attitude of entitlement. They attribute theirfailures to the machinations of others butsecretly to their own inadequacy. Theyexperience constant tension between feelings ofself-importance and experiencing theenvironment as unappreciative and humiliating
Jaspers, a German phenomenologist, described "self-insecure" personalities who resemble the paranoidpersonality. According to Jaspers, such individualsexperience inner humiliation, brought about by outsideexperiences and their interpretations of them. Theyhave an urge to get external confirmation to their self-deprecation and that makes them see insults in thebehavior of other people. They suffer from every slightbecause they seek the real reason for them inthemselves. This kind of insecurity leads toovercompensation: compulsive formality,strict social observances and exaggerateddisplays of assurance
In 1950, Schneider described the"fanatic psychopaths" and dividedthem into two categories: thecombative type that is very insistentabout his false notions and activelyquarrelsome, and the eccentric typethat is passive, secretive, vulnerable toesoteric sects but nonethelesssuspicious about others
Leonhard and Sheperd from the sixties describeparanoid individuals as overvaluing theirabilities and attributing their failure to the ill-willof others; they also mention that theirinterpersonal relations are disturbed and theyare in constant conflict with other
In 1975, Polatin described the paranoidpersonality asrigid, suspicious, watchful, self-centeredand selfish, inwardly hypersensitive butemotionally undemonstrative.However, when there is a difference ofopinion, the underlyingmistrust, authoritarianism and rage burstthrough
In the 1980s, paranoid personality disorder receivedlittle attention, and when it did receive it, the focus wason its potential relationship to paranoid schizophrenia.The most significant contribution of this decade comesfrom Millon who divided the features of paranoidpersonality disorder to four categories: 1) behavioralcharacteristics of vigilance, abrasive irritability andcounterattack, 2) complaints indicatingoversensitivity, social isolation and mistrust, 3) thedynamics of denying personal insecurities, attributingthese to others and self-inflation through grandiosefantasies and 4) coping style of detesting dependence and hostile distancing of oneself from others
The DSM-IV-TR describes the paranoid personality disorder as apattern of pervasive distrust and suspiciousness of others suchthat their motives are interpreted as malevolent.To qualify for adiagnoses, the patient must meet at least 4 out of the followingcriteria: (1) suspects, without sufficient basis, that others areexploiting, harming, or deceiving him or her (2) is preoccupiedwith unjustified doubts about the loyalty or trustworthiness offriends or associates (3) is reluctant to confide in others becauseof unwarranted fear that the information will be usedmaliciously against him or her (4) reads hidden demeaning orthreatening meanings into benign remarks or events (5)persistently bears grudges, i.e., is unforgiving ofinsults, injuries, or slights (6) perceives attacks on his or hercharacter or reputation that are not apparent to others and isquick to react angrily or to counterattack (7) has recurrentsuspicions, without justification, regarding fidelity of spouse orsexualpartner.
The DSM-5 does not list paranoidpersonality disorder as a specific type butstill enlists traits that allow to describe it:suspiciousness, intimacyavoidance, hostility and unusualbeliefs/experiences.