The Biological Perspective

Given the irritability and aggressiveness of the paranoid, many observers have wondered whether these syndromes might have some basis in temperament. As the personality disorders go, paranoids struggle under enormous pressures and appear to generate tremendous amounts of energy. They rarely relax. Instead, they are perpetually on defensive high alert, their sympathetic nervous system tuned to a fault, literally mobilized for fight or flight. Most appear tense and guarded, eyes focused sharply on whatever comes under intense scrutiny. Some may make quick movements or may remain frozen, as if waiting for some sign of the enemy presence. For example, Ron appears poised to leap from his seat while talking to the therapist. Whether faced with danger or not, paranoids maintain a high level of preparedness, bracing for the impending emergency. Even when alone, their favorite list of grudges and injustices may be replayed repeatedly until they seethe with hostility and vengefulness. Logically, some biophysically derived fund of energy would seem necessary to keep the fires burning.

Although some temperamental foundation might be linked to the paranoid personality, it is unlikely that there exists a specific paranoid temperament. As we have emphasized throughout the book, temperament may constitute part of the basic soil of personality, but it is certainly not the whole garden. Instead, temperament directs certain developmental pathways by channeling the child toward one road, rather than others. A child with an irritable and aggressive temperament may develop paranoid, sadistic, antisocial, or borderline patterns (and possibly some combination). Other factors in his or her early environment, particularly reciprocal interactions with caretakers, certainly influence the particular coping patterns and affective receptivity the child develops. An infant who seems chronically difficult to soothe and withholding of affection, for example, produces feelings of anger and resentment in most parents. If these feelings are not well tolerated, it is possible that caretakers might begin to withdraw their own affection and begin to regard the child as a burden, paving the way for sadistic abuse and thus the formation of hostile, attacking internal objects that are later projected as part of an adult paranoid personality.

An as-yet unsettled issue concerns the relationship among paranoid personality, delusional disorder, and paranoid schizophrenia. Essentially, this is the same question that concerned early theorists, including Kraepelin, as noted previously. Perhaps, then, the paranoid personality is part of the schizophrenic spectrum, with delusional disorder located at an intermediate point of severity. A small body of research has examined the genetic relationship among these three disorders. As reviewed by Bernstein, Useda, and Siever (1995), only two of five studies have found a significant relationship between the paranoid personality and schizophrenia. Kendler and Gruenberg (1982), for example, studied both the biological and adoptive relatives of adoptees who developed schizophrenic syndromes. Their findings showed that paranoid personality disorder was more common in the biological relatives of adoptees, suggesting a genetic relationship.

In contrast, other studies suggest minimal to no relationship between the disorders of this spectrum. For example, Maier, Lichtermann, Minges, and Heun (1994) found that paranoid personality disorder was more common in relatives of unipolar depressives than in the relatives of schizophrenia, schizoaffective, or schizophreniform disorder subjects. Similarly, studies by Kendler, Masterson, and Davis (1985) suggest a stronger genetic association between paranoid personality disorder and delusional disorder than between these and schizophrenia. Because delusions may be systematized to different depths, they are often difficult to distinguish from the cognitive distortions of the paranoid personality. Accordingly, the difference between delusional disorder, persecutory type, and the paranoid personality may be one of degree rather than kind. Though it is often said that delusional individuals lack the capacity to doubt their delusion, and paranoid personalities can admit that their beliefs are possibly untrue, at least in principle, it is probable that for some persons, the capacity to doubt fluctuates with emotional state. Some individuals will not be able to admit doubt when extremely angry or anxious.

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