Differential diagnosis of related disorders and efficacious treatment planning will be reviewed. The author will provide her personal Christian worldview perspective and considerations for further research will be offered. The paper will close with final remarks from the writer. Keywords: personality, paranoid personality disorder, diagnosis, vulnerability factors TABLE OF CONTENTS Abstract2 Introduction4 An Overview of Paranoid Personality Disorder5 Etiology7 Environmental Factors7 Genetic Factors9 Differential Diagnosis11 schizoid personality Disorder12 Schizotypal Personality Disorder13
Treatment Planning14 Christian Worldview15 Future Research16 Conclusion17 References18 Effects of Vulnerability Factors on Paranoid personality disorder Introduction Imagine the number of different individuals encountered in one’s lifetime; thenceforth, consider the heterogeneous personality traits of each. Some individuals may be recalled because of an out-going, vibrant, laid-back, happy go lucky personality style and another may be notably remembered because of exhibiting awkward temperaments and unusual dispositions of paranoia and obsessive suspiciousness.
The Term Paper on Difficulty Diagnosing Borderline Personality Disorder in 16 Year Olds
... 20 YEAR OLDS WITH BORDERLINE PERSONALITY DISORDER: Making an accurate diagnosis of Borderline Personality disorder in an adolescent can ... perceiving others. The DSM-IV identifies 10 personality disorders: 1) Paranoid Personality Disorder, which is characterized by patterns of ... such as: •Anxiety disorders •Post traumatic stress disorder •Mood disorders •Eating disorders All of these factors have to be ...
For instance, examine the case of a wife that constantly checks her husband’s cell phone, questions him about his whereabouts, and calls him at work to make sure he is actually there. For the outsider(s) looking inward, this may appear completely abnormal until it becomes evident that the husband has been unfaithful or committed an infidelity. Once the circumstances have been evaluated this behavior may be viewed as normal and the wife might be justified in her behavior.
Carroll (2009) suggests that “suspiciousness may be adaptive in certain environments, and determining how much interpersonal trust is appropriate in a given situation may indeed be a ‘vexing judgmental dilemma” (p. 41).
Next, imagine if a wife were to display these behaviors in absence of any known betrayal or infidelity but she believes that when her spouse states that he has to work late, he is in fact being deceitful because he is having an affair.
She is disinclined to share her feelings with anyone about her husband because she thinks that the information will be spitefully used against her later. Because of her distrust, she believes he is trying to purposely harm her emotionally and physically and she is often hostile and argumentative with him. When reviewing the aforementioned scenarios, one can appreciate the great degree of deviation in the personalities, behaviors, and beliefs of the individuals.
Although further assessment would be needed to determine if the wife in the second story is suffering from paranoid personality disorder, it is gathered that the pervasive patterns are abnormal. Therefore, on the surface descriptively differentiating adaptive and maladaptive personalities may appear to be easy, from a deeper analysis one must recognize that the subjectivity and complexity of personality and personality disorders provides for a dubious and daunting task of diagnosing and treatment planning.
In 2007, the National Institute of Mental Health (NIMH) revealed that approximately 9. 1% of the adult population in the United States struggled with a Personality Disorder (PD) and according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition text revision (DSM-IV-TR) the prevalence rate of individual in the general population battling Paranoid Personality Disorder (PPD) is 0. 5-2. 5% (APA, 2000).
The Term Paper on Antisocial Personality Disorder
Antisocial Personality Disorder Antisocial Personality Disorder (APD) is perhaps the most frightening of all personality disorders, as well as one of the most difficult to diagnose. Personality disorders in general are defined as inflexible, maladaptive, personality traits that cause personal distress or an inability to get along with others. APD specifically is characterized by deceitfulness, ...
PPD does not only present challenges in an individual’s social and occupational functioning but it creates substantial disturbances in an individual’s interpersonal relationships; therefore, the significance of recognizing the etiology of PPD, properly diagnosing, and providing effective treatment are vital to one’s quality of life. This paper proposes to examine vulnerability components, such as genetics and environmental factors which may increase the likelihood of maladaptive behaviors, and beliefs, and the role which each may play in diagnosis, efficacious treatment planning, and the direction for future literature and research of PPD.
An Overview of Paranoid Personality Disorder To better understand personality and paranoid personality disorder let us begin by formulating a working definition. According to Feldman (2011), personality is the totality of continuing characteristics, stemming from infancy, which distinguishes one individual from another. These characteristics are the framework constructing how an individual regards him/herself and the environment in which he/she functions on a social and personal level.
A PD is deemed as such when an individual presents with enduring, inflexible patterns and behaviors that not only drastically diverge from the individual’s cultural norms but also lends to clinically significant impairment in occupational, social, and other areas of functionality with manifestation in at least two of the four following areas: (1) affect, (2) cognition, (3) impulse control, and (4) interpersonal functioning (APA, 2000).
Paranoid Personality Disorder is classified by the DSM-IV-TR as a Cluster A personality disorder with onset usually by early adulthood (APA, 2000).
The disorder has been included in the Diagnostic and Statistical Manual of Mental Disorders (DSM) since its conception in 1952 (Falkum, Pedersen, & Karterud, 2009).
PPD is noted by some researchers to be one of the most common, and severe types of personality disorder; consequently, because of the suspicious nature of the individuals presenting with the illness, treatment may be more impervious but of greater concern is the fact that many individuals will go undiagnosed and untreated because of the reluctance to seek treatment at all (Esterberg, Goulding, & Walker, 2010; MacManus & Fahy, 2008).
The Essay on Paranoid Personality Disorders Disorder People Individuals
Paranoid Personality Disorders Paranoid Personality Disorder is a disorder commonly mistaken for schizophrenic personality disorders. Schizophrenia, a psychosis, is when a person is has an image of a world and its transpiring events, and he / she is " living' it. Paranoid Personality Disorder, however, is a neurosis where an individual is living in the real world. This disorder, though not as ...
For individuals suspected of suffering from paranoid personality disorder, the American Psychiatric Association’s (2000) DSM-IV-TR outlines the diagnostic criteria that must be met before a diagnosis of PPD can be assigned. These criteria stipulate that onset occurs by early adulthood, in various settings, and that the individual exhibits patterns of ubiquitous distrust and deviousness of others that are construed as evil, unkind, and spiteful.
In addition, the individual must present with at least four or more of the following: (1) suspicion that others are deceptive, manipulative, or are a danger to them without probable cause; (2) preoccupation with unwarranted misgivings about the fidelity of close contacts; (3) unwillingness to disclose private information with others, fearing that confidentiality will be breached and the information will be wickedly plied against him or her; (4) reacts indignantly and impulsively because of false ideations that others are assassinating their character and reputation but others fail to recognize the so-called “attacks”; (5) disinclined to allow bygones to be bygones and an unwillingness to forgive injuries or insults; (6) extricates inaccurate and distorted meaning from otherwise benevolent and non-threatening remarks and events; and (7) has chronic, unfounded reservations of a sexual partner’s or spouse’s infidelity (APA, 2000).
The APA (2000) also notes that these criteria should not be the effects of a Mood Disorder with Psychotic Features, another Psychotic Disorder, Schizophrenia, or any other direct physiological consequence of a general medication condition. Now that a brief synopsis of personality and diagnostic criteria for PPD has been offered, the following section will address potential causes of this disorder. Etiology Environmental Factors Perhaps one of most difficult challenges facing researchers and clinicians in effectual diagnosing and treatment of PPD is the fact that longitudinal research, especially in children and adolescents, is lacking or understudied hen compared to the adult population of PPD sufferers and other psychiatric pathologies (Esterberg et al. , 2010; Natsuaki, Cicchetti, & Rogosch, 2009; New, Goodman, Triebwasser, & Siever, 2008).
The Essay on Eating Disorders And Personality Disorders
ter>Sam Vaknin's Psychology, Philosophy, Economics and Foreign Affairs Web Sites Patients suffering from eating disorders binge on food and sometimes are both Anorectic and Bulimic. This is an impulsive behaviour as defined by the DSM (particularly in the case of BPD and to a lesser extent of Cluster B disorders in general). Some patients adopt these disorders as their way of self mutilating. ...
Since PPD is first diagnosable in early adulthood, one must contemplate that symptomatology presents far earlier than this time and that vulnerabilities factors of environment and genetics can place an individual at a greater predisposition for diagnosis. For example, think about Erickson’s theory of psychosocial development which involves eight distinctive stages with the first stage of trust-versus-mistrust being developed during the first 18 months of an individual’s life (Feldman, 2011).
One can certainly see from this theory that infants learn at an early age whom to trust or rely upon to have their basic needs met and this process of obtaining information about others and the environment continues throughout one’s lifetime. Natsuaki, Cicchetti, and Rogosch (2009) presented a longitudinal study to attend to issues of importance regarding the development of PPD. The study consisted of 174 participants of low socioeconomic status (94 maltreated, 80 non-maltreated as determined by the Department of Human Services), varying in age from 9-12 who attended a summer camp program between 1993 and 2002. All participants (69 girls and 105 boys) were required to attend camp at least once between the ages of 9-12 during the study phase and agree to participate in the assessment of personality disorders as adolescents, approximately at 15 years of age.
The researchers hypothesized that children exhibiting higher levels of paranoid indicators in adolescence were more likely to have suffered maltreatment in childhood, a child with elevated paranoid symptoms as an adolescent probably experienced more peer persecution earlier in life, children with elevated symptoms of paranoia in teenage years would have had a greater tendency towards upward age traces of externalizing struggles and peer aggression such as bullying behaviors toward others, and individuals with elevated paranoid warning signs in adolescence would have been more likely to have negative social behaviors with friends and associates in childhood. Not surprisingly, the findings suggest that adolescences with higher levels of paranoid symptoms when compared with peers, showing low or moderate symptoms, had in fact suffered maltreatment in childhood, were more compelled to externalize problems, aggressively responded or bullied peers, with the bullying behaviors intensifying with age, and did have negative peer social behavior as children; however, individuals with elevated paranoid symptoms did not show that peer victimization was not a determining factor in the bullying behaviors of children at risk for PPD towards others.
The Term Paper on The Connection Between Child Abuse And Dissociative Identity Disorder
The Connection between Child Abuse and Dissociative Identity Disorder I my essay I will discuss the controversial issue of Dissociative Identity Disorder and how it relates to child abuse. I will provide with the definitions of the psychological terms needed for my argumentation. They will be the following: Dissociative Identity Disorder, schizophrenia, amnesia, and fugue. Also I will argue if ...
Even though, this study presents with several limitations; for example, evaluating symptomatology of PPD instead of clinical diagnosis, failing to provide longitudinal follow-up on paranoid symptoms, generalizability to a population other than families characterized by a low socioeconomic status, and sample size, it does shed light on some traumatic social experiences or environmental factors that may make children and adolescents more prone to paranoid symptoms and the possible diagnosis of paranoid personality disorder in adulthood. As one can discern from evaluating the above-mentioned study, environmental factors play an intricate role in determining one’s propensity to develop maladaptive behaviors or personalities that might increase the likelihood of being diagnosed with PPD. In the next section, an examination of literature related to genetic factors and their effect on PPD will be presented. Genetic Factors
As stated previously, the complexities of diagnosing and providing efficacious treatment for individuals with PPD depends a great deal upon on longitudinal research outlining probable vulnerability factors, both genetically and environmentally. However, it is important to note that although PPD is one of the more common personality disorders it is not as well researched as antisocial, narcissistic, schizotypal, dependent, and borderline personality disorders (Maddux & Winstead, 2008).
Fontaine and Viding (2008) provided several genetically informative twin and adoption studies ascertaining estimates between 30% and 80% heritability in personality disorders with non-shared environmental estimates between 25% and 70%.
The Essay on Antisocial Personality Disorder 2000 Black Individual
They are your neighbors. They are your friends. Maybe they are even your family. You talk with them often, and have even had them over for dinner on occasion. Perhaps your children play in the same playground or spend time in the same social group. Although you have noticed some quirks and idiosyncrasies, you would never know the difference, and you would never expect the worst. After something ...
The researchers presented a study with a sample of 221 pairs of twin utilizing the Structured Clinical Interview for DSM-III-R and Axis II diagnoses (SCID-II) in Norway, male and female participants were of a mean age of 51 and one twin was treated for a mental disorder, there was a 28% estimate of heritability/genetic effects and a non-shared environmental estimate of 72% found in individuals with PPD (see Torgersen et al. , 2000).
In a similar study presented by the same researchers, a community sample of 157 pair of twins from Canada and the United States, where the mean age was 10 years and was comprised of both males and females and the measurements were based on symptoms and parent reporting using Coolidge Personality and Neuropsychological Inventory for Children (CPN) that measured personality disorders scales based on the DSM-IV Axis II criteria, the findings showed a heritability/genetic effect estimate of 61% and non-shared environmental estimates of 39% in children with paranoid symptomatology (see Coolidge et al. , 2004).
These findings suggests that heritability/genetic effects in adults diagnosed with paranoid personality disorders are relatively low compared to personality disorders in general which reflects a moderate to strong heritability and in the twin studies of children, personality disorder symptoms with the exception of narcissistic symptoms were explained by heritability (Fontaine & Viding, 2008).
Literature from APA (2000) and Trull and Useda (2000) also suggest a genetic predisposition of PPD wherein biological relatives are diagnosed with Axis I disorders such as schizophrenia and delusional disorder, persecutory type. Trull and Useda (2000) states: In general, most theories of PPD focus on genetics and family environment. PPD (as well as schizotypal and schizoid personality disorders) is believed to be related genetically to schizophrenia and is, therefore, considered a “schizophrenia spectrum” disorder.
Consistent with this purported link, studies have indicated an increased risk of PPD in the relatives of patients with schizophrenia as well as in the relatives of those with delusional disorders (p. 40).
It is clearly evident that environmental and genetic influences play a significant role in one’s vulnerability or predisposition to PPD; however, the degree of liability is not absolute. Longitudinal research is necessary in providing empirical data regarding vulnerability factors of gene-environment interaction in the paranoid symptomatology most prevalent in children and adolescents in order to reduce and possibly prevent the prevalence of PPD in adults. Differential Diagnosis
For the clinician and the client, this process is possibly the most complex and vital as it will establish the essential steps for effective treatment planning. Esterberg et al. (2010) utters, “Due to the striking similarities between symptomatology of Cluster A personality disorders and Axis I diagnoses, particularly schizophrenia, these disorders can also be difficult to both diagnose and manage” (p. 516).
Differential diagnosis is necessary to mitigate the possibilities of diagnosing a client with a disorder that he/she does not have, not diagnosing when a disorder is actually present, or failing to account for more than one presenting disorder (comorbidity).
This process demands including possibilities that may exist as primary or secondary mental disorders or medical conditions/illnesses as well as excluding possibilities that might symptomatically impersonate/mimic paranoid personality disorder. Below, an examination of differential diagnosis will ensue; though, for the sake of not becoming an exhaustive analysis of differential diagnosing, the discussion has been limited to only a few disorders. However, one should be mindful that this brief listing of differential diagnosis is not limited to the one discussed herein. Schizoid Personality Disorder Schizoid Personality Disorder is a Cluster A personality disorder with markedly patterns of social isolation due to a lack of desire for interpersonal relationships or intimacy and these features are evident in early adulthood (APA, 2000; Esterberg et al. , 2010).
Individuals with schizoid personality disorder may appear lackadaisical, unemotional, or non-responsive when faced with important life circumstances and instead of relating and interacting with others; their preference is towards solitary undertakings (APA, 2000).
A few of the diagnostic criteria cited by the America Psychiatric Association’s DSM-IV-TR (2000) are: (1) has no desire nor takes no delight in close relationship, not even familial relations; (2) insignificant or no interest in sexual relationships with others; (3) deficiencies in friendships and persons to confide in, other than immediate family members; and (4) exhibits callous emotions, disengagement, and flattened affectivity.
Other than the variation of these criteria, schizoid personality disorder differs from paranoid personality disorder in that the suspicious and paranoid ideations present in PPD are not prevalent in individuals with schizoid personality disorder. According to Carroll (2009), “Schizoid personality disorder is characterized by social withdrawal. However, individuals with the disorder are indifferent to other people, not desiring interpersonal contact, rather than being suspicious of them, as in paranoid personality disorder” (p. 41).
Additionally, individuals with PPD experience significant difficulty in beginning and maintaining relationships, not because of a lacking or longing to be in relationship with others as with schizoid PD, but because the suspicious and paranoia behaviors places to much stress on the diagnosed individuals as well as the other parties. Esterberg et al. 2010) offers that individuals with PPD oftentimes view the world as “out of sync” instead of seeing themselves as “out of sync with the world around them” (p. 515); coincidentally, individuals with schizoid personality disorder fail to recognize themselves as members or participants in the world but only as observers. Schizotypal Personality Disorder Schizotypal Personality Disorder (SPD) is the last Cluster A personality disorder in which there is persistent patterns of social and personal insufficiencies evident by intense discomposure and diminished capacity for intimate relationships in addition to cognitive or perceptual distortions and peculiarities of behavior (APA, 2000).
Although SPD does presents with suspiciousness and paranoid ideation and the patterns are presented in early adulthood, it differs substantially from PPD in that the individual beliefs and thinking are extremely unorthodox, odd, and eccentric; for example, the individual may believe that he/she can ascertain what others are thinking or have magical powers to foretell the future (APA, 2000; Carroll, 2009; Esterberg et al. , 2010).
Some of the diagnostic criteria for SPD are as follows: (1) ideas of reference not to include delusions of reference; (2) oddities of beliefs and thinking that are culturally inconsistent; and (3) atypical perceptual experiences (APA, 2000) It is however important to note that in the case of all of the Cluster A personality disorders (Paranoid, Schizoid, and Schizotypal) that individuals diagnosed with any of these disorders, there is a greater prevalence that a first-degree biological relatives suffers from Schizophrenia (APA, 2000) and Esterberg et al. 2010) shares, specifically regarding schizotypal personality disorder, that SPD is a risk disorder of schizophrenia for adolescents, with approximately 30% of diagnosed adolescents eventually moving on to develop a psychotic disorder. Treatment Planning Perhaps more dubious and daunting than differential diagnosis is finding the correct treatment plan and being able to engage the individual diagnosed with paranoid personality disorder in the designed treatment. Trull and Useda (2000) admits: The treatment of PPD is challenging primarily because of the difficulty in establishing a therapeutic relationship with these individuals. Those with PPD typically do not seek treatment specifically for their paranoia, often drop out of therapy, resist self-disclosure, or resist following treatment regimens.
Furthermore, they have been characterized as “difficult” patients, exhibiting more dysfunctional behavior relative to other clinical populations, with a poorer prognosis (p. 40).
MacManus and Fahy (2008) asserts that although most treatment studies have given greater attention to individuals suffering with borderline personality disorders, “There is no clear evidence of superiority of one type of treatment approach over another or for a particular method of delivery (inpatient, outpatient, or day programme)” (p. 439) but one must acknowledge that treating individuals with PPD will require the clinician to first develop a therapeutic alliance and because of the suspiciousness and paranoid ideation, clients may be quite skeptical about the clinician and concerning any treatment prescribed.
MacManus and Fahy (2008) do not subscribe to a particular psychotherapy; however, some researchers suggest that Beck’s Cognitive Therapy appears to be the most useful and effective in treating this population (Carroll, 2009; Trull & Useda, 2000).
Human functioning from a cognitive therapy perspective accentuates genetic and learning as the primary determinants in human development (Murdock, 2009) and as such maladaptive personality characteristics and behaviors can be modified through identifying and changing faulty core beliefs and schemas (reasoning structures established to process the constant influx of information one encounters) into more adaptive constructs. For instance, cognitive therapy could be most beneficial in changing the way an individual view others; thereby helping to reduce the paranoid and distrustful symptomatology presented with PPD.
This process is continuous and requires patience and compassion from the helping professional; subsequently, the desired result is allowing the client to become comfortable with the clinician and gain insight into the fact that not all individuals are malevolent or is attempting to bring harm. A clinician should be highly aware of the patient’s ability to stimulate countertransference moods of defensiveness and antagonism; therefore, the treating clinician should take action to circumvent negative reactive responses (Carroll, 2009).
Another treatment option for PPD patients is pharmacological treatment or pharmacotherapy; however, the efficaciousness is not well established (MacManus & Fahy, 2008) and Carroll (2009) notes that no established drug treatment is available for PPD.
This definitely presents challenges for clinicians and clients because atypical antipsychotics may be effective in relieving symptoms of anxiety, anger, and paranoid ideation but there is currently no known cure for PPD. Christian Worldview Based on the examination of the presenting literature and the findings, spirituality although not included in the data, does play a significant role in the epidemiology, etiology, diagnosis, and treatment of paranoid personality disorder. As human beings prone to sinful natures and life in a sinful world, one must recognize that original sin and Satan’s spiritual warfare with mankind causes individuals to suffer great tragedies and traumatic events.
Many of the mental illnesses are complicated and beyond the comprehension of secular psychology; however, for Christians there is the knowing that just like cancer, heart disease, and other physical ailments, mental illnesses are not exempt from the tactics utilized by demonic forces to challenge individuals and possibly moved one from dependency on God. Man’s dependency on Jesus Christ has been displaced and individuals place more authority in self-understanding, self-perseverance, and trying to achieve healing that only God can provide. Scripture teaches, “Trust in the Lord with all your heart and lean not on your own understanding; in all your ways submit to him, and he will make your pathsstraight” (Proverbs 3:5-6, New International Version).
Future Research There are several areas of paranoid personality disorder that warrant further longitudinal and empirical research.
The first deals with a more in-depth assessment of the categorical and dimensional characteristics of PPD as presented in the Diagnostic and Statistical Manual of Mental Disorders. This would be important to researchers and clinicians as it would move personality disorders from a mound of criteria and symptoms into a continuous evaluation of normal behaviors with a continuum of severity over one life-span (Edens, Morey, & Marcus, 2009).
A second consideration for further research is longitudinal studies evaluating the vulnerabilities factors effecting children and adolescents with paranoid symptomatology which makes one predisposed to PPD (Natsuaki et al. , 2009).
These studies could possibly reduce the diagnosis of PPD in adulthood and may even prevent some individuals from being diagnosed with PPD at all. The final area of further research consideration concerns pharmacological and psychotherapy treatment of individuals diagnosed with PPD or other personality disorders. Although many of the individuals with PPD fail to present for treatment or leave treatment prematurely, finding effective treatment avenues for those willing to seek assistance could have potentially great benefits for resistant individuals. Conclusion Paranoid Personality Disorder is a crippling disorder that affects an individual’s social, occupational, and interpersonal functioning.
Greater understanding and empirical research pinpointing genetic and environmental factors are necessary in properly diagnosing clients and planning effective treatment. Clinicians treating individuals suffering with PPD must be highly qualified and competent in the profession but must also be genuinely compassionate, self-aware, and patient in order to establish a healthy therapeutic alliance with the client. This will not only improve the chances of assisting individuals who would otherwise be skeptical regarding seeking treatment but will also improve the quality of life for those that willingly work toward change. References American Psychiatric Association. (2000).
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