Paranoid Personality Disorder

Quick Reference
Overview: High levels of mistrust and suspiciousness. Easily provoked into feeling unfairly treated or attacked, developing grievances and harbouring resentments.

Link to Offending: May facilitate angry aggression due to perceiving others as threatening, undermining, disloyal or dangerous. Linked to domestic abuse and stalking.

Tips: A more distant management approach in which trustworthiness may be proved over time is advised. Limit direct challenges to paranoid thoughts and behaviours.

View of Self View of Others Main Beliefs Main Strategy
Right /noble/ Inviolable Malicious / Demeaning World is hostile/ World is complex Suspicious/ Provocative

 

Profile of a Paranoid Personality

Mistrusting and suspicious with a tendency to hold grudges against others. They are often guarded interpersonally and distant in relationships, avoiding closeness. They may be hypervigilant to threats in their environment and are prone to over-reacting to seemingly innocuous situations. Their thinking style may be rigid and inflexible, making them harder to rationalise with.

A person experiencing paranoia sees other people through a lens which emphasises hostility, malice and persecution. They more readily interpret the actions, words and intentions of others as potentially damaging to them. The world is viewed as complex and intricate, a place that needs to be unpicked and interpreted with caution. Situations and interactions are less likely to be taken at face value and the individual may search for hidden meanings which confirm their suspicions. The world is seen as a controlling and intrusive place which conspires against the individual. A paranoid person may wish to seek refuge from these dangers that they see all around them. Paranoid people tend to see themselves as righteous and noble. They may feel incorruptible in a corrupt and manipulating world. Their stance becomes rigid, inflexible and closed off. They may feel the need for assistance, but doubt the sincerity of that help when it is offered and just reject it. They may refuse to engage in rational discussion. To protect themselves against the feeling of being controlled, they may act with stringent autonomy. They may try to counter feelings of persecution by making complaints or threats.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) identifies common features:

  • Suspicions that others are deceiving, exploiting or harming the individual
  • Preoccupations with unjustified doubts as to the loyalty or trustworthiness of associates/friends
  • A Reluctance to confide in others, fearing information will be used maliciously
  • The perception of hidden, demeaning or threatening content in ordinary events/comments
  • A persistent bearing of grudges
  • Perceptions of personal attacks on their own reputation or character, responding quickly with anger or counterattacks.
  • Unjustified, recurring suspicions about the fidelity of spouse/sexual partners.

Relationship to offending

Some examples of offending include:

  • Domestic violence – possibly escalating from arguments about the partner’s fidelity.
  • Reactive aggression – this may occur spontaneously when the individual perceives a (real or imagined) threat.
  • Planned pre-emptive strikes – this may occur when a paranoid individual takes preventive action against a threat (the perceived cause of the paranoid belief system).

Tips for working with Paranoid Personality

Tips for one-to-one working:

Respecting the core traits and interpersonal style:

  • Expect and ignore demeaning comments and hostility. The offender is defending himself.
  • Do not challenge distorted core beliefs and thoughts as this will lead to a fight that you will lose.
  • Excessive friendliness may appear cunning and deceitful, as if the offender is being lulled into a false sense of security.
  • A major goal is to free the individual of mistrust. Take slow and progressive steps to develop trust.
  • Retreating behind procedures and keeping the client out of the loop may increase paranoia.
  • Deliberately counteract suspicion: increase transparency, share documentation, Avoid secrecy and explicitly describe steps involved in decision-making.
  • If the paranoia centres on you, consider third party mediation (your senior’s help) to lessen grievances.
  • Reacting defensively may heighten their state of paranoia and confirm their view of the world as hostile. Do not co-work with two of you in the room.
  • Without colluding in the distorted world vision, try and understand and empathise with the development of the belief and its emotional impact.

Tips for general offender management:

  • Consider a central point of contact (e.g. a keyworker) through which other agencies can communicate, and try to cut down on multiple reporting systems.
  • Persistent offers of too much contact, either in regularity or intensity, may be experienced as overwhelming. Keep modest aims in forming an alliance – a more distant approach may be beneficial. Be as flexible as possible about setting the frequency and regularity of contact.
  • Behavioural controls may threaten their autonomy, heighten powerlessness and increase a sense of persecution. Use restrictions sparingly and give careful consideration to which are necessary. Try to include the individual in setting up these controls.
  • Do not confuse antagonism with non-compliance. Try not to increase controls in response to a paranoid response as this may have an adverse effect. Instead, stay focussed on compliance with reasonable requests.
  • Try to enhance the individual’s control over areas of personal importance.
  • It is rarely advisable or helpful for paranoid individuals to live in shared accommodation.