Hi I'm Dr. Tracey Marks, a psychiatrist,
and I make mental health education videos.
Today, I'm talking about paranoid personality disorder.
You've probably heard of and used the term paranoid,
and people will say, "That made me paranoid."
But feeling paranoid is not the same
as having a paranoid personality.
The general definition of paranoid
is being excessively suspicious or mistrustful.
So you could have a moment of paranoia
where you're preoccupied with suspicions
about someone or something.
But the difference here is that your suspicions
are isolated to a certain situation
and it's not how you feel about everything.
Here's the criteria for paranoid personality disorder
as defined by the Diagnostic and Statistical Manual
of Mental Disorders fifth edition.
A constant distrust and suspiciousness of others
such that their motivations are interpreted as malevolent.
This begins in early adulthood
and is present in a variety of contexts,
as indicated by four or more of the following.
And there's a mnemonic for this
that can make it easier to remember
and the mnemonic is suspect.
S stands for suspicious of others.
The person suspects without sufficient basis
that others are exploiting, harming or even deceiving them.
You may not know the person is thinking this about you
until they lash out at you and accuse you of things.
And they can bring up stuff from a while ago
and bring out details or evidence of your behavior
that make you pause and think,
"Hmm, how did you get to conclude that from that?"
That was the furthest thing from my mind when I said that.
U stands for unforgiving.
This person bears a lot of grudges.
S stands for suspects partner is unfaithful.
So as a result,
they may be very controlling in relationships
and always questioning your whereabouts or your intentions.
P stands for perceives attacks.
This person believes that people are always attacking
their character or reputation.
And so they're quick to attack back.
And this can look like a very hostile
or angry or aggressive person.
E stands for enemy or friend.
This person is always questioning your loyalty
or whether or not you're trustworthy.
And even when you do something good for them,
they can think that it's just too good to be true
or there must be some catch somewhere.
C stands for no confiding in others.
They usually fear that the information
will be used maliciously against them.
On the surface,
they may just look like a really private person
who doesn't like to talk about themselves.
T stands for threats always perceived.
This person reads hidden,
demeaning or threatening meanings into ordinary remarks.
So this can look like a person
who seems to always read something negative
into what you say.
Here's an example.
You go to a park together and have lunch and you say,
"I thought it'd be a nice day today,
"but it looks like it's gonna rain."
And the person says, "So I guess I can't even get it right
"when I try and take you out on a nice outing.
"I just screw everything up, right?"
And you're like, "I was just making an observation,
"I wasn't criticizing you."
And in this case,
the Paranoid person can't see your comment
as just an observation.
They assume that most people say things to put them down
and to take from them.
And this makes it very hard for them to accept compliments.
Even if you say something as basic as,
"You're a beautiful person."
They may see it as sarcasm.
Like, beautiful is just code for horrid
and you just don't think I'm smart enough to know that.
Or you're just complimenting me
as a way of buttering me up to get something from me.
So in some,
a person with paranoid personality
can be very difficult to deal with.
But also, the person with paranoid personality
can have a lot of internal distress,
because to them,
the world is just an unsafe place to be.
You can't trust anyone.
So you always have to be on guard and look out for yourself.
And that's not a state of peace and contentment.
Now, you may say,
with all this negative and aggressive behavior,
how does a person like this even end up in a relationship?
Well, unlike schizoid personality disorder
where they often don't feel the need for emotional intimacy,
people with paranoid personality still want relationships.
So they're still gonna put themselves out there
to attract a partner.
But because of their mistrust of people,
they tend to do things that make them self-sufficient,
so they don't need to rely on anyone.
This self-made man or independent woman
can appear very attractive to some people,
but it's not until you get into a relationship with them
that you have these conflicts.
And some people will stay in a relationship for a long time
because they wanna make it work.
You may excuse all of the conflicts
because you focus more on the positive aspects
of the person,
like, he's very smart,
and he has strong opinions and is very confident.
People with paranoid personality can be very argumentative,
but that could just be seen as opinionated and outspoken.
A paranoid person who ordinarily
would be very aloof and detached because of the secrecy,
may turn it off long enough to attract someone
that they're interested in.
And it's very common for people
to filter out negative things in a relationship
and over focus on the positive.
So an example of this would be,
your girlfriend is always accusing you of cheating,
but when you're with her,
she makes you feel
like you're the most important person to her.
So you focus on that connection
and you ignore the accusations,
the 50 questions and the doubts about your intentions,
because when she's not in that mode,
the attention you get from her feels really good.
And that's just an example
of how what seems like a very destructive personality
could still allow for a relationship to develop.
Under stress, people with paranoid personality disorder
can have brief psychotic episodes
that last minutes to hours.
It's like a pop of irrational thinking
where their basic mistrust and suspiciousness
goes to a different level that's not realistic.
But that level of delusional thinking doesn't last,
it goes away.
And that's what distinguishes it
from an illness that leads to persistent psychotic symptoms
like delusional disorder, schizophrenia
or even psychotic depression.
The prevalence of paranoid personality disorder
is between two and a half to four and a half percent,
which is close to the prevalence
of the more popular personality disorders
like narcissistic and borderline personality disorders.
Those both have an estimated prevalence
of about 6% of people.
We don't see paranoid personality disorder much
in an outpatient setting.
And that may have to do with their distrust of everyone,
including physicians.
It's also associated with violence and criminal behavior.
And as a forensic psychiatrist,
I do a lot of legal evaluations
and this is mostly where I have seen it
in its strongest presentation.
It's in the context of someone committing a crime
as a byproduct of their suspicion, mistrust and violence.
Paranoid personality disorder can come along
with other disorders,
so it doesn't have to stand alone.
And as with all of the other personality disorders,
people can have features of multiple personalities together,
such that they have a mixed personality disorder.
Some people think of this personality disorder
as a cognitive style, a way of viewing the world,
I think that this tends to be
a more destructive personality disorder
than even the ones we hear a lot about,
like narcissistic and borderline personality disorders.
And I think that's because this personality
tends to have more overt aggression
that's directed at others.
When the Paranoid person feels wronged,
they don't go and cut themselves to feel better
or withdraw to lick their wounds from a narcissistic injury,
they attack and it's usually a verbal attack,
but an attack nonetheless that they feel is well deserved.
That's probably why there's a higher association
with criminality.
All that said,
some people can benefit from cognitive behavior therapy.
It's a lot of hard work
and you have to recognize that your suspicions
do not have much basis.
And that's the hurdle that's hard for people to get past.
It's like, we're all just idiots
who just can't see the truth.
So that's paranoid personality disorder.
Click here to see my personality disorder playlist.
See you next time.