You’re studying for an exam tomorrow. You’ve been reading through the material for the past few hours and slowly begin to understand and retain the information. As you prepare to go over it once more, you suddenly have a thought: what if this material isn’t on the exam. At the same time, you question why it wouldn’t be and instead of continuing to study, you fixate over the possibility that the work you’ve been doing for the day has amounted to naught. The state of anxiety and suspicion is known as paranoia. It causes you to feel fearful, irritated, stressed, and angry. If this feeling intensifies enough, you can begin to lose touch with reality. Being in a paranoid state for too long can generate fatigue, impair your relationship with others, and impair your judgment. This is the case with paranoid personality disorder.
Paranoid personality disorder (PPD) is characterized as a pattern of distrust and suspiciousness such that others’ motives are interpreted as malevolent. The disorder affects 2-4% of the general population. People with PPD are untrusting of others, without reason or without sufficient reason, and are preoccupied with the idea that their friends or colleagues are disloyal. This fear that their peers with betraying them will prevent those with PPD from opening up to others. However, as a result of their unwillingness to work with others, they are autonomous and self-sufficient. They may also read deeply into small or benign remarks. A compliment from a co-worker may be perceived as their way of to coercing you into working harder. A friend offering their help on a project may translate to them believing that you are incompetent. Although they are often perceived as cold, aloof, rational, and argumentative, this is not the case. They are critical of others and will hold grudges but will overreact when criticized themselves. This reaction can take the form as quiet hostility, arguing, or complaining. People with PPD are also at an increased risk of developing major depressive disorder, agoraphobia, and obsessive-compulsive disorder (American Psychiatric Association, 2013).
Challenging paranoid beliefs is difficult for many reasons. These beliefs have a somewhat adaptive value in that they allow a person to always be on their guard and aware of their surroundings. As a result of this as well as their wariness, many of those with PPD will reject medical intervention and are unwilling to participate in any research regarding PPD. PPD is considered to be on the “schizophrenia spectrum” along with illnesses such as schizoid personality disorder avoidant personality disorder. Members of the spectrum are considered to have certain psychopathological traits in common and are considered to be somehow genetically transmitted with schizophrenia (Birkeland, 2013). Despite the disorder lying along the spectrum of schizophrenia and presenting overlapping symptoms, very few people are aware of it.
There have been a few hypotheses regarding paranoia: poor metacognition, or the ability of human beings to think on their own and others’ thoughts and feelings, and to use their ideas and knowledge to respond to distress and challenges in social life. Although the word “paranoid” can lead one to think of the word “psychotic,” PPD is a non-psychotic disorder, as it is characterized by a person’s actions and behavior rather than their mood or thoughts.
Mental illnesses affect not only the person who possesses it but also those around them Psychologist Jaseena Backer talks about a patient that she had in the past who possessed PPD. Backer referred to a case in which a woman’s PPD had led to the end of her marriage. At the request of his wife, Schweta, Anil had enrolled her into an organization he had been working in. Anil had blissfully imagined the long coffee dates and team parties he would be attending with his wife. However, Anil had quickly realized that his dreams would not be coming to fruition. Schweta began following her husband’s interactions on social media and would interrogate him about any interaction he would have with another female. She was suspicious of every phone call he would receive late at night and would be wary of going to her parent’s home out of fear that her husband would be with someone else. Eventually, her paranoia had reached the point where she would humiliate her husband in public. The feeling of being untrustworthy and constantly being question contributed to Anil’s decision to request a divorce. He had felt emotionally abused and violated as a result of Schweta’s continuous paranoia and eventually couldn’t endure it any longer.
When we are anxious and restless about the world around us, it’s calming to know that you have people in your life who you can depend on. However, for those with paranoid personality disorder, they lack this support structure. They are restless because of their reluctance to trust others and their overanalysis of other people’s actions. For people without PPD, the feeling of paranoia is temporary and occasionally manifests. For those with PPD, it’s a different story. This feeling is constantly plaguing them and even though many of them are suffering, they keep silent instead of reaching out for help.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Backer, J. (2016, August 4). Living with a Spouse suffering from Paranoid Personality Disorder. https://www.bonobology.com/relationships/challenges-and-advice/308-living-with-a-spouse-suffering-from-paranoid-personality-disorder
Birkeland, S. F. (2013). Paranoid personality disorder and the schizophrenia spectrum—Where to draw the line?. Personality and Mental Health, 7: 254–258. doi:10.1002/pmh.1244
Salvatore, G., Russo, B., Russo, M., Popolo, R., & Dimaggio, G. (2012). Metacognition-oriented therapy for psychosis: The case of a woman with delusional disorder and paranoid personality disorder. Journal Of Psychotherapy Integration, 22(4), 314-329. doi:10.1037/a0029577