Alpf Medical Research Personality

Among paranoid personalities, the capacity for trust has been destroyed. While it is part of our normal, human development to have some mistrust of others, especially when we are young (stranger anxiety) or if we live in life-threatening situations, a persistent and extreme mistrust of others is maladaptive. Within the normal range of personality styles that include paranoid characteristics are Oldham and Morris's (1995) vigilant style, who are highly independent and valuing of their independence. Normal paranoid styles can also be viewed as simply normalizing the DSM-IV criteria, such as valuing honesty and fidelity without alienating friends and family instead of suspecting close friends of being disloyal without evidence.

Several variants exist of the paranoid personality that combine paranoid traits with other personalities. The fanatical paranoid is a mix with the narcissistic personality who has had a serious narcissistic wound. The malignant paranoid combines the paranoid with the sadistic personality and is hypersensitive to issues of power and domination. The obdurate paranoid shares traits with the compulsive personality and may function more normally in society than most paranoids. The querulous paranoid is a paranoid with negativistic traits who feels perpetually as though he or she has been cheated in life. Last, the insular paranoid shares characteristics with the avoidant personality, tending to be the most isolated of the paranoids.

While biologically, there does not appear to be a paranoid temperament, most likely the same irritable and aggressive temperament that may also lead to antisocial, sadistic, or borderline personality plays a role in the paranoid, with early environmental factors playing a great role in determining the ultimate path of development. Limited empirical research conducted on the heritability of a paranoid personality has been inconclusive as have been studies that try to link paranoid personality to schizophrenia and delusional disorder.

The classical psychodynamic perspective offers an interesting insight into the paranoid, namely their overdependence on the defense mechanism of projection. Strict Freudian interpretation of the paranoid personality holds that the paranoia is a defense against homosexual urges that are unacceptable to the individual. Later in the century, object-representationalists began to see the paranoid as polarizing life into categories of all good and all bad. By using projection to eliminate any of the bad in the self, they become all good; hence anything external becomes all bad. Because the negative thoughts are within the paranoid, they follow the paranoid wherever they go in life. Later dynamicists proposed secondary defense mechanisms such as using isolation, indignation, and megalomania or extreme overvaluation of the self as well as early abuse in the development of the paranoid personality.

Paranoids closely resemble compulsives in their cognitive style. Both are keen observers, attending to every detail and nuance of a situation; and both are intolerant of ambiguity. For the paranoid, suspiciousness becomes the entire mode of thinking where all of their energy is spent discovering not if people are cheating them, but how they are cheating them. Their self-statements may include, "I must always be on my guard," and "I must be alert to hidden motives."

Interpersonally, Sullivan proposed that paranoids not only have an extreme insecurity related to a feeling of inferiority but also blame others instead of themselves for these perceived shortcomings. Paranoids treat others as the enemy, which precludes the development of any attachments. Occasionally, paranoids surround themselves with loyal persons who can act as the eyes and ears of the paranoid, routing out evil plots being planned against them. Developmentally, Benjamin describes an environment of harsh punishment in childhood that leads the paranoid to expect that the world is going to attack. The paranoid might have also been used as a scapegoat for the family.

The biopsychosocial evolutionary perspective adds yet another angle to understanding the paranoid personality. Paranoid traits act as "danger detectors" from impending attacks and serve a useful purpose of saving the life of the individual. Thus, the potential for paranoid fear is probably an inevitable outcome of evolution and, expressed in moderation, is highly beneficial to the organism.

Paranoid traits are expressed by all of the severe personality disorders but also in avoidants, narcissists, sadists, antisocials, and compulsives. They also often overlap with delusional disorder; anxiety disorders; mood disorders, particularly depression and perhaps bipolar disorder; somatization disorders in an effort to escape the shame of not being able to engage the world effectively; and substance abuse, especially when the paranoid is experiencing symptoms of anxiety.

Therapy seems to be most successful with paranoids closer to normal on the spectrum. Numerous traps must be avoided when working with the paranoid. The most dangerous is directly confronting the paranoid's semidelusional notions, which will be construed by the client as proof of another attack. Benjamin proposes a soothing empathy as an antidote to earlier abuse to increase the intimacy between the client and therapist. Cognitive techniques should focus on modifying the assumption that others are not to be trusted and improving their sense of self-efficacy. Behaviorally, coping skills training may be effective, as well as anxiety-reducing exercises such as gradual exposure to an anxiety hierarchy paired with a cognitive relaxation method. Object-relations therapy may also be useful as a first step to get paranoids to convert their paranoid symptoms into an acknowledged depression; then they can be treated with traditional methods.

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