Cluster A PD: Paranoid Personality Disorder

Question 1

Cluster A

Answer 1

• Odd or eccentric
• About 6% of people with Cluster A dx, also have a dx from aother cluster

Question 2

Related characteristics

Answer 2

• Distrust
• Suspiciousness
• Other’s motives are interpreted as malevolent (i.e., mean, spiteful, unkind)

Question 3

Paranoid PD

Diagnostic Criteria

Answer 3

• A. Pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following
  
  • Neither desires nor enjoys close relationships, including being part of a family
  • Almost always chooses solitary activities
  • Has little, if any, interest in having sexual experiences with another person
  • Takes pleasure in few, if any, activities
  • lacks close friends or confidants other than first-degree relatives
  • Appears indifferent to the praise or criticism of others
  • shows emotional coldness, detachment, or flattened affectivity
• B. Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, another psychotic disorder, or autism spectrum disorder and is not attributable to the physiological effects of another medical condition

Question 4

Individual characteristics

Answer 4

• Pervasive distrust and suspicion of others
• Believes others are out to harm, exploit, or deceive them
• Often reads hidden threats or insults into harmless remarks
• Reluctant to confide in others, fears betrayal
• Holds grudges and is unforgiving
• May be pathologically jealous and controlling in relationnships
• tends to be hostile, stubborn, and sarcastic
• Emotionally guarded, self-sufficient, and critical of others

Question 5

Diagnostic features

Answer 5

• Core feature: deep, long-standing distrust of others
• Often lacks objective evidence for their suspicions
• Surprised when people show genuine loyalty
• Patterns begin in early adulthood and affect multiple areas of life

Question 6

Differential dxs

Answer 6

• Psychotic disorders (Schizophrnia, delusional disorder): PD must precede psychosis and persist when psychosis remits
• Medical conditions affecting CNS (Brain injury, etc)
• Substance use disorders
• Physical handicaps (e.g., hearing loss may cause guarded behavior)
• Other PDs
  
  • Schizotypal PD: includes magiacl thinking, unusual perceptual experiences, and odd behavior
  • Schizoid: Socially aloof but lacks paranoia

Question 7

associated features

Answer 7

• Difficult to get along with, strained relationships
• Often involved in legal disputes
• Seek to confirm negative beleifs about others
• Preoccupied with power, control, and perceived slights
• May be seen as “fanatics”
• Can have brief psychotic episodes under stress
• Frequently comborbid with schizotypal, schizoid, narcissistic, avoidant, and borderline PDs

Question 8

Gender and prevalence

Answer 8

• More Common in men
• Prevalence
  
  • 2.3%-4.4%

Question 9

Cultural consideration

Answer 9

• Guarded suspicious behavior may be culturally appropriate for minority groups, immigrants, refugees, or those facing discrimination
• Clinicians should consider context before diagnosing paranoia

Question 10

Early signs (risk factors)

Answer 10

• May be noticeable in childhood or adolescence
• Traits include:
  
  • Solitary behavior
  • Poor peer relationships
  • Hypersensitivity
  • Social anxiety
  • Underachievement in school
  • Peculiar thinking and language
• Often seen as “odd” or “eccentric” and may be teased by peers
• Higher rates in those with family history of schizophrenia or delusional disorder