CrimePsych

Introduction
The paranoid personality disorder is not only sometimes difficult to diagnose but treatment can be even more troublesome. The main features of this disorder entail the sufferer to be excessively distrustful and suspicious of any and all people with no real justification for why.

They generally perceive everything as a personal attack or threat as they have the false assumption that others are simply there to harm or trick them and subsequently they don’t confide in anybody making it difficult for them to have relationships that last.

Being a little paranoid or distrustful of others does have an adaptive use – like when meeting new people and you are unsure what their personality is like. But in the case of people who suffer from this disorder their paranoia begins to interfere with their life, social skills, work relationships and of course close relationships with friends, family or partners making it near impossible for them to maintain said relationships oftentimes ending up ‘a loner’.

Clinical Description
The defining characteristic is a pervasive unjustified distrust of all other persons. They are completely suspicious in situations where their suspicions are unfounded and they have a tendency to construe events that have nothing to do with them as personal attacks or threats e.g. peak hour traffic is there simply to stop them from getting where they need to be or the person that rides their pushbike past their house every morning on the way to work is actually spying on them.

As previously stated, this distrust usually extends to those close to them making meaningful relationships very difficult or impossible. Persons suffering from this disorder are also known to be argumentative, they complain a lot (usually about their perceived injustices, threats etc.) but they can also be quiet and reserved, blending into the background depending on the situation. In addition to this they are usually hostile towards others, especially toward those they perceive threats from and can appear tense and on edge constantly. They are also overly sensitive to criticism and have an excessive need for autonomy.

Causes
In the case of paranoid personality disorder the causes are about as clear as a successful treatment, that is, about as clear as muddy water. Research conducted on the disorder suggests that biological influences are fairly limited. A mild association has been found in the past that suggests that paranoid personality disorder is slightly more common among relatives of schizophrenia sufferers, but emphasise needs to be on mild association here.

Contributions from psychological factors are even less clear; some mental health practitioners point directly at the maladaptive thought processes of persons with paranoid personality disorder in an attempt to explain their behaviour. One of these views suggests that their basic assumptions about people are what cause their paranoia with statements like ‘People are malevolent and deceptive’, ‘They’ll attack you if they get the chance’ and ‘You can be ok only if you stay on your toes’.

Even if you accept these propositions it is extremely unclear why people with paranoid personality disorder have them. Some speculate that it is ingrained in them from their early upbringing; their parents may teach them to be overly careful about making mistakes and also emphasise how different they are from others. Through vigilance they see signs of deception and maliciousness in places that people without the disorder wouldn’t.

Cultural factors have also been implicated with some other research suggesting that prisoners, refugees, people with hearing impairments and the elderly may be more susceptible to paranoid personality disorder due to their unique experiences. It may cause them to interpret ambiguous stimuli as threatening.

Treatment
Due to the nature of paranoid personality disorder people who suffer from it are unlikely to obtain help and it is not uncommon for those that actually seek treatment to be obtaining it due to comorbidity – usually because of depression or anxiety. Therapy can be difficult due to the issues of trust that are central to the disorder so an important first step for any therapist treating someone with paranoid personality disorder is getting over this barrier to a point where the sufferer feels more comfortable and willing to open up. This is usually achieved through providing an atmosphere conducive to developing said sense of trust. Cognitive therapy is also commonly used in an attempt to counter the individuals false assumptions about the nature of other persons, that is, they focus on changing the maladaptive beliefs they hold.

Unfortunately though most persons with this disorder that actually end up in therapy are unlikely to continue long enough to receive any benefit and are usually there due to intervention or a crisis that has occurred in their life like threats to harm strangers. Most mental health practitioners (89%) concur that persons with this disorder will not stay in therapy long enough to gain anything at all. Further to this, and sadly for people with this disorder, until now nobody has been able to demonstrate significant improvements through any means of therapy.

Prevalence & Gender Differences
The prevalence of paranoid personality disorder in developed countries is purported to be the same across the globe and estimates range from .5% of the population to as high as 2.5%, it is also more prevalent in male than female populations.

Where Can I Find Help?
Obviously the best person to talk to would be a qualified therapist. No matter where you live in Australia you can go here http://www.findapsychologist.org.au/. This is a service managed by the Australian Psychological Society and would be the best point of call.

The downside to this type of help is that it can be pricey, and given that most people with this disorder are unlikely to want to attend you might be better off speaking to community groups or free health clinics. Another really good place to get help is from SANE Australia. They can be contacted on 1800 18 SANE (7263) between the hours of 9am and 5pm, Monday to Friday. They can then give you information and contact details for services in your area.

If you live outside of Australia things get even more complicated due to the size of some countries. The easiest advice i can give you if you live in America is to go to http://www.mentalhealthamerica.net where you can be referred to other services both community clinics as well as single practitioners.

Other countries can also try the Open Directory available at http://www.dmoz.org as they have a very in depth directory based around location and the type of service you are looking for.