DEFINITION:
The phrase “paranoid personality disorder (PPD)” refers to a category of mental illness exhibiting “paranoia”—the long-standing and extreme mistrust or suspicion of others or the irrational conviction that specified or unspecified individuals wish to do one harm.
PPD is often referred to in colloquial parlance as a “persecution complex.”
ETYMOLOGY:
The concept of “paranoid personality disorder” was introduced into the psychological literature in 1980 in the Diagnostic and Statistical Manual of Mental Disorders, third edition (DSM-III).”
The term “paranoia” originated in the early-nineteenth-century German medical literature. However, the concept was developed into its modern form—signifying irrational feelings of being persecuted—in the work of the German psychiatrist Emil Kraepelin (1856–1926) in his textbook, Lehrbuch der Psychiatrie [Textbook of Psychiatry] (1883, and later editions).
“Paranoia” is an example of “New Latin”—a term created in modern times that is similar to Latin in form but whose lexical elements are derived from Classical Latin or Greek. In the present case, the newly created term derives from the Greek word paranoia, meaning “derangement,” “madness,” or “folly.”
For the etymology of the term “personality,” see the Glossary entry, personality.
For the etymology of the term “disorder,” see the Glossary entry, borderline personality disorder.
DISCUSSION:
According to the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, namely, the fifth edition (DSM-5)(2013), patients with PPD are characterized, on the affective side, by extreme feelings of distrust and suspicion of others and, on the cognitive side, by attributing malevolent intentions to others, construing all their actions as directed towards them, and giving those actions the worst possible interpretation.
PPD typically begins by early adulthood and may present in various personal, social, and professional contexts.
To qualify for a diagnosis of PPD, a patients must exhibit four or more of the following behaviors or propensities (on the basis of inadequate evidence or any reasonable justification):
- Suspects that others wish to harm, deceive, or exploit him.
- Is preoccupied with doubts about the loyalty of family, friends, or colleagues.
- Is reluctant to trust or confide in others.
- Interprets others’ remarks or actions as containing covert threats directed at him.
- Bears persistent grudges for perceived slights, insults, or injuries.
- Perceives others to be attacking his character or reputation.
- Reacts angrily or strikes back against perceived slights.
- Suspects spouse of infidelity.
There are presently three main explanatory frameworks for the etiology of PPD.
First, twin studies carried out in Norway have indicated that PPD may have a moderate degree of heritability. Moreover, PPD has been statistically linked with schizophrenia, for which a genetic etiology is better established.
Second, psychosocial theories implicate causes deriving either from childhood trauma or from the modeling of adverse patterns of parenting.
Finally, some cognitive theories attribute PPD to a lack of social maturity and self-awareness, which may lead to an inability to respond appropriately to ordinary stress and to the inaccurate perception that other people are fundamentally hostile and threatening.