paranoid prsoinal diorder_schema -...

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Paranoid Personality Disorder David P. Bernstein Maastricht University J. David Useda University of Rochester School of Medicine 3 41 Paranoid personality disorder (PPD) is characterized by a pervasive mistrust of other people (American Psychiatric Association [APA], 1994; Bernstein, Useda, & Siever, 1995; Miller, Useda, Trull, Burr, & Minks-Brown, 2001). Other common features of the disorder include quarrelsomeness, hostility, emotional coldness, hypersensitivity to slights or criticism, stubbornness, and rigidly held maladaptive beliefs of others’ intents (APA, 1994; Bernstein et al., 1995; Miller et al., 2001). The prototypical picture is of someone who is preoccupied with real or imagined slights or threats, mistrusts the inten- tions or motives of others, and rarely trusts the seemingly benign appearance of things. The guiding underlying assumption is that others are malevolent— they can betray, hurt, take advantage, or humiliate. Thus, measures must be taken to protect oneself—by keeping one’s distance from other people, not appearing weak or vulnerable, searching for signs of threat even in seemingly innocuous situations, preemptively attacking others who are viewed as threatening, and vigorously counterattacking when threatened or provoked. People with paranoid personality disorder tend to hold grudges, have “ene- mies,” are often litigious, and can be pathologically jealous, preoccupied with their partner’s supposed sexual infidelities. Thus, in many respects, their antagonistic behavior exemplifies one extreme pole of the agreeableness- antagonism dimension of the five-factor model of personality (Widiger, Trull, Clarkin, Sanderson, & Costa, 2002). ________________________________ Description of the Disorder 03-O’Donohue (Personality).qxd 4/28/2007 1:13 PM Page 41
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Not surprisingly, this pattern of antagonistic behavior often causes diffi- culties in interpersonal relationships, including provocation of the very kinds of attacks these individuals fear. For example, people with paranoid person- ality disorder may correctly deduce that others are speaking ill of them or plotting against them behind their backs, but they do not recognize that this may be a consequence of their own antagonistic behavior. It is important to note, however, that people with paranoid personality disorder are usually not frankly psychotic, although they may experience transient psychotic-like symptoms under conditions of extreme stress (Miller et al., 2001). Unlike the symptoms of psychotic disorders such as paranoid schizophrenia and delu- sional disorder, in which a frank break with reality has occurred, the unfounded beliefs in paranoid personality disorder are rarely of psychotic proportions. Thus someone with paranoid personality disorder may believe without cause that coworkers are harassing him, for example, when he receives a call with no one responding on the other end. However, he is not likely to believe that the CIA is plotting against him. Thus his beliefs are plausible but often unfounded.
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