Personality Disorders 101: Paranoid PD

The first in the series of personality disoders is Paranoid Personality Disorder (PPD). Although experiencing paranoia in a stressful situation is common, PPD refers to a much bigger idea; a 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 treat every experience, 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. Someone with PPD will struggle to trustanything, as they 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 they assume are 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 continually doubt other people’s loyalty or trustworthiness.
  • They dislike confiding in others, as they fear any information will be used maliciously against them.
  • They interpret neutral remarks or events as having hidden demeaning or threatening meanings .
  • They persistently bear 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 their 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 other personality disorders, PPD is usually managed rather than cured.

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 he fills his office with danger-detecting gadgets. Without context, he appears irrationally paranoid.

In context, his behaviour is rational. Moody’s job as an Auror (a Wizarding-world policeman tracking down high-level criminals) exposed him to continual danger, and resulted in him losing his leg and eye. Establishing where a rational analysis of possible danger ends and a irrational expectation of danger begins is a major issue when diagnosing PPD.

Psychological Criticisms of PPD

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

A psychiatrist who does not undertand their client’s experiences may not recognise that the client’s response are rational and adaptive rather than excessive. As a result, people in atypical high-danger situations may be incorrectly diagnosed with PPD; the issue can be seen as belonging to them rather than to their living situation.

This shows one flaw in the DSM/ICD system. Both manuals aim for objectivity. They are designed so that, in theory, two psychiatrists who met the same client would reach the same conclusion about their diagnoses. Because the manuals are assumed to be objective, people can ignore how subjective parts like background experiences, limitations and biases influence the people making diagnoses.

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