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New Treatments for Paranoid Personality Disorder

DSM-IV Diagnostic Criteria

A pervasive distrust and suspiciousness of others is present without justification beginning by early adulthood and indicated by at least four of the following:

  1. The patient suspects others are exploiting, harming, or
  2. The patient doubts the loyalty or trustworthiness of others.
  3. The patient fears that information given to others will be used maliciously against him.
  4. Benign remarks by others or benign events are interpreted as having demeaning or threatening meanings.
  5. The patient persistently bears grudges.
  6. The patient perceives attacks that are not apparent to others, and is quick to react angrily or to counterattack.
  7. The patient repeatedly questions the fidelity
Clinical Features of Paranoid Personality Disorder
  1. The patient is often hypervigilant, and constantly looking for data to support his paranoia.
  2. Patients are often argumentative and hostile.
  3. Patients have a high need for control autonomy in relationships to avoid betrayal and the need to trust others.
  4. Pathological jealousy is common.
  5. Patients are quick to counterattack and are frequently involved
Epidemiology of Paranoid Personality Disorder
  1. These patients rarely seek treatment.
  2. The disorder is more common in men than women.
  3. The disorder is more common in relatives of schizophrenics.
  4. The disorder may be a premorbid condition in schizophrenia.

Differential Diagnosis

Delusional Disorder: Fixed delusions are not seen in personality disorders.

Paranoid Schizophrenia: Hallucinations and formal thought disorder are not seen in personality disorder.

Personality Change Due to a General Medical Condition and Substance-Related Disorder: Acute symptoms are temporally related to a medication, drugs or a medical condition. The long standing patterns of behavior required for a personality disorder are not present.

Treatment of Paranoid Personality Disorder

Psychotherapy is the treatment of choice, but it is often difficult to establish and maintain the trust of patients because they have great difficulty tolerating intimacy. Psychotherapeutic relationships are anxiety-provoking for

Symptoms of anxiety and agitation in response to a sense of persecution may be severe enough to warrant treatment with anti-anxiety agents.

Low dose antipsychotics for paranoid personality disorder and parnoid.