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Paranoid Personality Disorder

By: Matsen, Erin, & Te'Ron

?

Specific

cases

We will:

Discuss the processes in which Paranoid Personality Disorder is treated, as well as analyze the causes and symptoms of the disorder.

Focus Question

The Schizoid Individual Typical Traits

Common Traits

  • Solitary - often seen as a “loner”
  • Lack substantial personal relationships
  • May have no desire for these
  • Ambivalent
  • Often anhedonic
  • Includes sex
  • Perceived as emotionally cold
  • McWilliams: Schizoid individuals can be thought of as hyper-sensitive and highly perceptive
  • To emotions, stimulation
  • Easily overwhelmed, subsequently shrink from others

  • Relatively rare for them to seek therapy without the urging of another
  • When they do: may complain of depression, loneliness, isolation
  • Most schizoid individuals do not see a problem with their lifestyle

Chief Complaint

  • Various theories abound, even within psychodynamic psychology
  • Detached or unloving parenting may promote a schizoid presentation in the child, as he or she seeks to regain power and control over their own emotional wellbeing
  • Don’t want to depend on others for validation anymore
  • Often more concerned with engulfment than abandonment
  • Fear of dependence, loss of identity, loss of control

Developmental Psychodynamics

Symptoms of Paranoid Personality Disorder

Symptoms

  • Doubt the commitment, loyalty, or trustworthiness
  • Are reluctant to confide in others or reveal personal information due to a fear that the information will be used against them
  • Unforgiving and hold grudges
  • Hypersensitive and take criticism poorly
  • Read hidden meanings in the innocent remarks or casual looks of others
  • React with anger and are quick to retaliate
  • People are unforgivable + hold grudges
  • Hypersensitive + Take criticism poorly
  • Read hidden meanings
  • Stubborn, Hostile, & Argumentative
  • Cold + Distant in relationships
  • Controlling + Jealous
  • Perceive attacks on their character
  • Concerned others have hidden motives
  • Show detachment
  • Are socially isolated
  • Problems with work + school
  • Long term pattern of mistrust + suspicion

Primitive Defense Mechanisms:

  • Denial

Defense Mechanisms

Pathological Defenses:

  • Projection

What Are the Causes of Paranoid Personality Disorder?

  • The cause of paranoid personality disorder is unknown
  • Researchers believe that a combination of biological and environmental factors can lead to paranoid personality disorder

  • The disorder is present more often in families with a history of schizophrenia and delusional disorders
  • Early childhood trauma may be a contributing factor

Causes

Treatments

  • Treatment for PPD can be very successful. However, most individuals with this condition have trouble accepting treatment
  • To a person with PPD, they don’t see their symptoms as unwarranted
  • If an individual is willing to accept treatment, talk therapy or psychotherapy are helpful. These methods will:

  • help the individual learn how to cope with the disorder
  • learn how to communicate with others in social situations
  • help reduce feelings of paranoia

Medications can also be helpful, especially if the person with PPD has other related conditions such as depression or anxiety disorder

Treatments

Famous people with PPD

  • Joseph Stalin (former secretary general of Russia during the Russian revolution in 1971)
  • Saddam Hussein (president of Iraq)
  • Richard Nixon (37th president of the United States)
  • Adolf Hitler (leader of the Nazi Party)

Did You Know?

  • They are often tongue-tied, feel empty, lost, and pained early in therapy
  • Long silences may be required, as the client internalizes their sense of safety with you
  • Remember that, “the aloofness of the schizoid client is an addressable defense, not an insurmountable barrier to connection”
  • They are often experienced as sensitive, honest, and authentic
  • Be sensitive to their fear of engulfment
  • When treated with consideration and respect, they are often cooperative and appreciative

Management of the Interview

Transference/ Countertransference

  • Initial T/CT challenge: finding a way into their world without arousing too much anxiety about intrusion
  • Due to their tendency to withdraw into detached/obscure styles of communication, it’s easy to fall into counter detachment, where they become an “interesting specimen”
  • Transference: they will see whether or not the therapist is concerned enough to tolerate their confusing, off-putting messages while remaining determined to help
  • Accustom to being categorized as hopeless recluse or amusing crackpot
  • Resist CT tendencies to push them too quickly into disclosure and/or objectify/distance one’s self from them
  • The more authentic the therapist is with the client, the more accessible their transference reactions will be
  • Be prepared for an uncommon degree of authenticity, imagery, and level of awareness of emotion
  • They fear being treated intrusively
  • Stick to comments/casual reactions that do not push the client beyond the limits of what they’re expressing (early on)
  • Use their phrases/words/images whenever possible
  • The often fear being judged/written off
  • Do not treat them like a “case”
  • Normalizing is very important
  • Convey that their inner world is comprehensible
  • They are used to being disconfirmed and/or minimized by others

Therapeutic Implications

  • Most common obstacle is eventual emotional comfort that can turn into an respite (for both parties) from worldly demands
  • These clients tend to substitute therapists for other social connection, so pay attention to their progress
  • Address the conflict between their desire for, and avoidance of, closeness
  • Allow yourself to be seen as a real person (not just a transference object)
  • They have many “as if” relationships, and need to experience real humanness

Therapy

Implications

Schizoid vs. Compulsive Personalities

  • Organic integrity, rather than moralistic and concerned with social appropriateness
  • Identify feelings internally and resist relationships that invite their expression, rather than denying/isolating feelings
  • May use compulsive quirks and defenses and may respond with intellectualization

Let's talk about Mr. D...

References

Bowins, B. (2020). Personality Disorders: A

Dimensional Defense Mechanism Approach.

American Journal of Psychotherapy, 153–

171.

Willem, M., & Kahn, W. (2013). Schizoid

personality disorder linked to unbearable

and inescapable loneliness. European

Journal of Psychiatry, 24(1), 38–45.

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