The Evolutionary Neurodevelopmental Perspective

Although perspectives on personality offer a particular point of view, they do not tell the whole story. From an evolutionary standpoint, paranoid traits are danger detectors, expressing an intense fear of imminent attack or impending predation, especially when associated with deceit and duplicity. The hypervigilance of paranoids, their constant mobilization for fight or flight, and their constant questioning of the obvious are not unlike an organism that senses something not quite right and fears that a camouflaged predator lurks nearby, ready to pounce at any moment, bringing sudden death from out of the darkness.

In this scenario, the game played out between hunter and hunted is concerned with the real versus the unreal, the ability to detect unusually fine discrepancies of a devouring chameleon against a background specifically chosen to seem ordinary, if not mundane. Successful predators do not announce nonchalantly, "I am here to eat you!" but instead crouch down, blend in, make keen observations at a distance, move silently, pick their moment, close in, and finally, seize the element of surprise. The cheetah springs, the gazelle dies, and the world goes on.

Although such scenarios depict evolution at work, they are also a powerful metaphor for understanding why paranoid traits should exist at all. In the preceding example, such characteristics are intrinsically associated with the possibility of immediate threats to survival. But more, they are deeply and intrinsically concerned with perceptual and

TABLE 13.1 Traits Associated with the Paranoid Personality

Mistrustful Reluctant to presume others' goodwill.

Suspicious Scrutinizes the actions of others for any hint of malevolent or selfish motive.

Vigilant Actively scans surroundings and inspects interactions for signs of danger.

Cynical Believes positive expectations will be spoiled, that human nature is inherently selfish, and that the universe is unjust. Rivalrous Actively engages in social comparison.

Wronged Views self as innocent victim of injustice. Sees self at short end of social comparisons.

Jealous Questions the loyalty of intimate associates, including spouse.

Thin-Skinned Hypersensitive to perceived slights. Easily enraged by narcissistic injury.

Seething Recounts past wrongs while boiling with anger.

Revengeful Determined to "balance the books," through own action, if necessary.

Guarded Maintains self-protective posture. Indiscriminately secretive and evasive.

Convicted Impervious to correction by new information or information inconsistent with previous views.

Humorless Takes everything seriously. Especially unable to laugh at self. Brittle.

Dichotomous Polarizes perceptions in terms of good versus evil, just versus unjust, "me versus everyone else."

Self-Contained Impervious to correction based on the advice of others.

Self-Important Believes own experience has special significance. Personalizes neutral events. Constructs world with self at center.

Self-Righteous Certain of own superior virtue or clearer understanding. Arrogant and indignant.

Self-Justifying Views own transgressions as either a defensive necessity or as "payback" for the malevolence or wrongs of others.

From "Paranoid Conditions" by Blaney, from Oxford Textbook of Psychopathology, edited by T. Millon, P.H. Blaney, and R. Davis. Copyright © 1999 by Oxford University Press, Inc. Used by permission of Oxford University Press, Inc.

epistemological riddles, that is, with what is real and what is not and what is true and what is a lie. Specifically, the camouflaged predator analogy predicts that paranoia should be concerned with the disambiguation of threats that exist at the very threshold of perception.

The potential for paranoid fear, then, is probably as basic to evolution as evolution is to life, at least wherever evolution implies predation. Paranoid fear thus emerges as a disorder of epistemology wrought by overactive danger detectors. The conclusion is that wherever life exists in the universe, thou shalt find paranoids. Moreover, wherever intelligent life exists, thou shalt find the potential for a caricatured rationality, self-perpetuating disorders of the personal construct system that have their beginning as an attempt to identify danger by pushing beyond the obvious but end by pushing beyond the plausible. Such ontological attributions of the unknown, otherwise known as delusions, thrive on fear. Where the normal person hears a sound in the woods and dismisses it as the wind, the delusional mind finds a hidden agency. For paranoids, there is much more to nothing than we are led to believe: The truth is out there.

Paranoid traits have great survival value when moderately expressed. Organisms that sense threat and run away live to reproduce another day. Paranoid traits such as suspiciousness, vigilance, and a fear of novelty, then, should be expressed widely in any gene pool confronted with predatory threat or competition for resources. All members of the species should, therefore, exhibit some low level of paranoid potential, which can be provoked to paranoid states given persistent objective threats, perhaps traumatic stress, for example. Other members of the species will obtain relatively more paranoid potential through natural recombinant processes. Such "natural paranoids" express high vigilance and a low threshold for suspicion.

Finally, because paranoia is as ubiquitous as danger, we would expect its symptoms to arise in association with a wide range of mental disorders, especially the personality disorders, where vicious circles are the rule. In these mixed cases, the paranoid dimension is often an insidious and secondary development, fusing slowly into the fabric of an earlier pattern. Paranoid symptoms are likely to occur in disorders for which fusion is the theme, such as the dependent, who seems instrumentally helpless to resist almost any threat, whatever its magnitude. In contrast, paranoid traits become integral components of only a few personalities, notably the narcissistic, avoidant, compulsive, sadistic, and negativistic, each of which naturally faces profound confrontations between the self and the social world. These are considered in a following section. The paranoid personality pattern's structural and functional domains are summarized in Table 13.2.

A number of the roots by which certain milder personality styles eventuate in a paranoid pattern are described briefly in the following paragraphs.

The fanatic subtype is likely to have been overvalued and indulged by their parents, given the impression that their mere existence was of sufficient worth in itself. Few developed a sense of interpersonal responsibility, failing to learn how to cooperate, to share, or to think of the interests of others. Unrestrained by their parents and unjustly confident in their self-worth, their fantasies had few boundaries, allowing them to create fanciful images of their power and achievements. The social insensitivity and ex-ploitiveness of these future paranoids led inevitably to interpersonal difficulties. Once beyond the protective home setting, they ran hard against objective reality. Their illusion of omnipotence was challenged, and their self-centeredness and ungiving attitudes were attacked. In time, their image of eminence and perfection was shattered. Rather than face or adapt to reality or build up their competencies to match their high self-esteem, they turned increasingly to the refuge of fantasy. Rationalizing their defects and lost in their imaginary gratifications, they retreated and become further alienated from others.

The characteristic experiential history of the malignant paranoids suggests that they were subjected to parental antagonism and harassment. Many served as scapegoats for displaced parental aggression. Instead of responding with anxiety as a consequence of this mistreatment, they acquired the feeling that they had "to be contended with" and that they could cause trouble and "get a rise" out of others through their unyielding and provocative behaviors. Mistrustful of others and confident of their powers, they rejected parental controls and values and supplanted them with their own. Rebellious of parental authority, they developed few inner controls, often failing to learn to restrain impulses or to avoid temptations.

These paranoids are characterized best by their power orientation, their mistrust and resentment of others, and by their belligerent and intimidating manner. There is a ruthless desire to triumph over others, to vindicate themselves for past wrongs by cunning revenge or callous force, if necessary. In contrast to their nonparanoid counterpart, these personalities have found that their efforts to outwit and frustrate others have only

TABLE 13.2 The Paranoid Personality: Functional and Structural Domains

Functional Domains

Structural Domains

Defensive

Inviolable

Expressive Behavior

Is vigilantly guarded, alert to anticipate and ward off expected derogation, malice, and deception; is tenacious and firmly resistant to sources of external influence and control.

Self-Image

Has persistent ideas of self-importance and self-reference, perceiving attacks on own character not apparent to others, asserting as personally derogatory and scurrilous, if not libelous, entirely innocuous actions and events; is pride-fully independent, reluctant to confide in others, highly insular, experiencing intense fears, however, of losing identity, status, and powers of self-determination.

Provocative

Unalterable

Interpersonal Conduct

Not only bears grudges and is unforgiving of those of the past, but displays a quarrelsome, fractious, and abrasive attitude with recent acquaintances; precipitates exasperation and anger by a testing of loyalties and an intrusive and searching preoccupation with hidden motives.

Object-

Represent-tions

Internalized representations of significant early relationships are a fixed and implacable configuration of deeply held beliefs and attitudes, as well as driven by unyielding convictions that, in turn, are aligned in an idiosyncratic manner with a fixed hierarchy of tenaciously held but unwarranted assumptions, fears, and conjectures.

Suspicious

Inelastic

Cognitive Style

Is unwarrantedly skeptical, cynical, and mistrustful of the motives of others, including relatives, friends, and associates, construing innocuous events as signifying hidden or conspiratorial intent; reveals tendency to read hidden meanings into benign matters and to magnify tangential or minor difficulties into proofs or duplicity and treachery, especially concerning the fidelity and trustworthiness of a spouse or intimate friend.

Morphologic Organization

Systemic constriction and inflexibility of undergirding morphologic structures, as well as rigidly fixed channels of defensive coping, conflict mediation, and need gratification, create an overstrung and taut frame that is so uncompromising in its accommodation to changing circumstances that unanticipated stressors are likely to precipitate either explosive outbursts or inner shatterings.

Projection

Irascible

Regulatory Mechanism

Actively disowns undesirable personal traits and motives and attributes them to others; remains blind to own unattractive behaviors and characteristics, yet is overalert to and hypercritical of similar features in others.

Mood/ Temperament

Displays a cold, sullen, churlish, and humorless demeanor; attempts to appear unemotional and objective, but is edgy, envious, jealous, quick to take personal offense and react angrily.

Note: Shaded domains are the most salient for this personality prototype.

Note: Shaded domains are the most salient for this personality prototype.

prompted the others to inflict more of the harsh punishment and rejection to which they were previously subjected. Their strategy of arrogance and brutalization has backfired, and they seek retribution, no longer as much through direct action as through fantasy.

The obdurate subtype stems from a conflation of paranoid and compulsive personality features. These persons have a background of parental overcontrol through contingent punishment. Most have striven to meet parental demands and to avoid errors and transgressions, thereby minimizing punitive treatment and the threat of abandonment.

In early life, they sought to model themselves after authority figures, foregoing their independence and following the rules with utmost precision. As a consequence of their rigid conformity, they lack spontaneity and initiative, are unable to form deep and genuine relationships, and are indecisive and fearful of the unknown. For various reasons, differing from case to case, the security these paranoids sought to achieve through submission and propriety was not attained. Lacking guidance and support from others, intolerant of suspense, and dreading punishment lest repressed anger erupt, they drew into themselves, turned away from their dependent conformity, and sought solace, if they could, in their own thoughts. Although renouncing their dependency, obdurate paranoids cannot relinquish their lifelong habits. Thus, feelings of guilt and fear become acute as they begin to assert themselves. Anticipating punishment for their nonconforming behaviors and feeling that such actions deserve condemnation, they project these self-judgments on others and now view them to be hostile and persecutory.

Although they assert their newfound independence with prideful self-assurance, querulous paranoids remain irritable, dissatisfied, and troubled by discontent and ambivalence. They cannot forget their resentments and their feeling of having been mistreated and exploited. They often perceive the achievements of others as unfair advantages, preferential treatments that are undeserved and have been denied to them. Disgruntlement and complaints mount. Fantasies expand and weave into irrational envy. Their grumbling comments turn to overt anger and hostility. Each of these may feed into a theme of unjust misfortune. If unchecked, they are whipped, bit by bit, into a psychotic delusion of resentful jealousy. In similar fashion, erotic delusions may evolve among these patients. Although they consciously repudiate their need for others, these paranoids still seek affection from them. Rather than admit these desires, however, they will defensively project them, interpreting the casual remarks and actions of others as subtle signs of amorous intent. However, they are unable to tolerate these "attentions" because they dread further betrayal and exploitation. As a consequence, querulous paranoids insist that they must be "protected" against erotic seduction by others. Innocent victims may be accused of committing indignities, of making lewd suggestions, or of molesting them.

The insular paranoids are the most likely of the paranoid personalities to be precipitated into a frank psychotic disorder when confronted with painful humiliation and derogation from others. Although they have sought by active withdrawal and isolation to minimize their social contacts, this coping defense is not impenetrable.

Struggling feverishly to control their surging anger, they may turn their feelings inward and impose on themselves harsh judgments and punitive actions. These efforts may not succeed, however. Accusations of their own unworthiness are but mild rebukes for the suspicion and fury they feel. Self-mutilation and suicide, symbolic acts of self-desertion, or brutal attacks against others, a direct expression of their rage, may become the only punishments that "fit the crime."

Contrast with Related Personalities

Given the ubiquity of paranoid fear and its survival value in moderate degrees, it is not surprising that the paranoid personality shares characteristics with many other personalities.

All severe personality syndromes—the paranoid, schizotypal, and borderline—experience transient psychotic episodes. Those of schizotypals tend to be eccentric, superstitious, or magical in nature; those of borderlines are grossly irrational, scattered, and unsystematic. In contrast, paranoids are skillful at developing internally consistent belief systems that seem distantly plausible, were the world only more perfidious. Moreover, paranoids are deeply concerned with self-determination. Faced with the loss of external recognition and power, they frequently revert to internal sources of supply, creating an enhanced self-image through fantasy that is deserving and strong. The reversible psychotic states of paranoid personalities thus contain elements of grandiosity and righteous indignation, strategies that compensate, or cohere, a fragile self-construct while expressing the deep desire to be left alone, to exist in utter autonomy. In contrast, borderlines tend to diffuse under stress, becoming frantic in response to possible abandonments.

Both avoidants and paranoids are chronically tense and mistrustful and share a hy-peralertness to possible interpersonal threats. Moreover, both are suspicious and fearful of being shamed, humiliated, or embarrassed; both can be intensely secretive; and both use fantasy as an important means of coping with their inadequacies. Avoidants, however, see themselves as being woefully inadequate or defective. Paranoids share such concerns at a more unconscious level but transform weakness into compensatory illusions of strength through projection and reaction formation. Thus, avoidants usually shrink from conflict, whereas paranoids readily vent their dissatisfaction.

Both personalities are reluctant to confide in others. Avoidants, however, are reluctant to share information because they fear it will confirm their negative self-image, whereas paranoids fear that such information will be used against them. Both personalities have few friends or confidants. Avoidants, however, acknowledge a desperate loneliness, whereas paranoids view relationships as a source of vulnerability. Finally, paranoids tend to be aloof, humorless, and aesthetically blunt, whereas avoidants show sensitivity, a good sense of humor, and often, a well-developed artistic capacity. However, avoidants whose self-esteem is near collapse may acquire traits of the paranoid personality.

Both the narcissistic and paranoid personalities can be grandiose, and neither tolerates conscious awareness of imperfections of the self. Moreover, both are cold to those they dislike and bear long-lasting grudges. Paranoids, however, are slow to warm up, whereas narcissists are vulnerable to flattery, something that only arouses suspicion in the paranoid. Nevertheless, paranoids are capable of intense devotion and can enjoy equitable relationships with loyal individuals who apparently share their values. In contrast, narcissists exploit almost everyone around them. Finally, narcissists expect others to cater to their needs, exhibit a cool sense of superiority, expect things to turn out for the better, and can be socially engaging. In contrast, paranoids expect others to frustrate their needs covertly, seem tense, expect to be attacked at any moment, and are socially abrasive. Narcissists who suffer chronic deflation of the self, however, may develop paranoid defenses, by asserting that envious others have sabotaged their success or the realization of their ingenious ideas, for example, as a means of explaining repeated setbacks or objective and public failures.

The sadistic and paranoid personalities share similarities at the level of observable behavior. Both are rigid and dogmatic, both tend to see the world in black-and-white terms, both shun the tender emotions as evidence of weakness, and usually both experienced considerable abuse during development. Paranoids, however, project their aggressive impulses. Literally stalked by their projected objects, they see their own behavior as a normal reaction to an insufferably cruel world. Other persons naturally experience them not as victims ever on the defensive but as abrasive instigators whose actions are often positively sadistic. To the casual observer, a paranoid striking back against those who have been disloyal or persecutory is easily confused with a sadistic personality.

Nevertheless, the two personalities exhibit profound differences. Future sadistic personalities are likely to have identified with their aggressor during development. As adults, they delight in indulging feelings of anger and hostility, victimizing others as part of their ego ideal. Sadistic personalities sometimes build complex internal working models of others to maximize the suffering they can inflict. In contrast, paranoids see the world rather simplistically, as me versus everyone else. Sadistic personalities, however, sometimes develop paranoid traits in response to intense, chronic fears of retribution or payback for their vicious abuses of others.

Both paranoid and antisocial personalities are cold, jealous guardians of their autonomy, but for different reasons. As we noted in Chapter 5, the antisocial personality is poorly named; the label "antisocial" suggests more an effect than a cause and does precious little to explain the process behind the product. As such, the category mixes widely differing characteristics. A better term would be the aggressive personality, individuals who defend their autonomy as an intrinsic part of their overall psychological makeup, untransformed by psychodynamic factors. Such persons are naturally dominant and territorial, actively shedding or breaking restraints on their free action, and seem grossly lacking in conscience. If others are damaged, that is not their concern.

In contrast, paranoids see themselves as vigorously and righteously defending their boundaries against the encroachment of attackers. Stalked by projected, vicious objects, they see the entire world as composed of antisocials and psychopaths, individuals who destroy without a sense of guilt. Paranoids are capable of relating as peers to others who share their values and have considerable conscience where these relationships are concerned. In contrast, aggressive personalities are bent on dominating everyone.

Finally, paranoid and compulsive personalities value rationality, rigidly controlling themselves while overcontrolling and blaming others (Benjamin, 1996) but for different reasons. Moreover, both can be dogmatic moralists, and their rigidity distorts atten-tional and cognitive processing (Shapiro, 1965), but again, for different reasons. Compulsives deeply fear making a mistake. As children, they identified with cold, for-malistic caretakers, were encouraged to follow the straight and narrow path, and were harshly punished whenever perfection was not attained. As such, they tend to be cold, rigidly conforming, and emotionally unavailable. Their introjects, that is, the contents of the superego, constantly harp about poor performance. To compensate, their attention zeroes in on detail, so much so that they may drown in indecisiveness in a quixotic attempt to explore all possible solutions to a problem or gather all relevant information before making a decision.

In contrast, paranoids were attacked as children, regardless of their performance. So sadistic and cruel are their introjects that any undesirable aspect of the self must be spit out, projected onto others, and replaced by a purified or innocent self-image, not the frequently wrong or disobedient self-image of the compulsive. Such developmental differences lead compulsives to overconform and subordinate their identity, whereas paranoids rebel, seeing all authority as a source of attack, and vigorously defend their self-determination. The attention of the paranoid narrows as a means of anticipating potential avenues of attack and shoring up defenses before the attack occurs. The mistake they fear is some defensive oversight, perhaps disloyalty within the ranks.

Pathways to Symptom Expression

Although different individuals vary in terms of their specific characteristics and thus develop different disorders, there exists some logic connecting the personality disorder and the ensuing syndrome. Reversible paranoid conditions sometimes develop in connection with temporary medical conditions. Paranoid reactions may also occur because of loss of sensory or cognitive functioning; for example, paranoid trends may develop in connection with the progression of Alzheimer's disease. Interestingly, when the personality of afflicted individuals is rated by their spouses, those who develop paranoid delusions are usually found to have been more hostile from the beginning (Chatterjee, Strauss, Smyth, & Whitehouse, 1992). Paranoid reactions may also occur as a result of acquired deafness, a phenomenon that can be generated experimentally by assessing subjects after the hypnotic suggestion that they become deaf, without knowing why (Zimbardo et al., 1981). As you read the following paragraphs, try to identify the connection between personality and symptom.

Delusional Disorder

As previously noted, there is some genetic evidence to suggest an association between the paranoid personality and delusional disorder. This is not surprising, as the DSM-IV gives delusional disorder several subtypes that parallel concerns of the paranoid personality. Thus, the jealous subtype believes that a significant other has been unfaithful; the grandiose subtype believes that he or she has some tremendous talent or has made some monumental discovery; and the persecutory subtype believes that he or she is being conspired against, poisoned, secretly harassed or observed, and so on. Because conviction and the systematization of beliefs must always be a matter of degree, the paranoid personality and delusional disorder would appear to lie on a continuum. The diagnosis of one disorder does not preclude the diagnosis of the other; however, both can be assigned. Stephen, who convinced himself that he was Niels Bohr, constitutes an example of such a case.

Anxiety Disorders

Guardedness, hypervigilance, and mobilization of the fight-flight system suggest an association between the paranoid personality and the anxiety disorders. Less severe examples of the paranoid personality often exhibit chronic and diffuse worry and complaints of fatigue and difficulty concentrating, suggesting generalized anxiety. Paranoids who suddenly feel themselves unable to distinguish safe versus unsafe situations may experience panic attacks related to feelings of impending attack or collapse of self-esteem. Symptoms include a suddenly racing heart, sweating, trembling, derealization, and fear of losing control. In a preliminary study, J. Reich and Braginsky (1994) found paranoid personality in over half of panic disorder patients diagnosed in the anxiety clinic of a community mental health center. Obsessive-compulsive disorders are also sometimes seen in paranoid personalities. The content of obsessions is probably focused on perceived slights or insults or other matters of rank or status, played repeatedly in the mind.

Mood Disorders

As noted by psychodynamic thinkers, the paranoid personality may be viewed as a compensated state that defends against a precariously low self-esteem. Rather than implode, the person attributes his or her pathetic condition to the external world and eventually develops paranoid traits, which contribute to the coherence of the self-representation and cover the depression. Beyond this, we might also speculate that depression is a natural reaction to a world in which others are aligned against the individual without sufficient cause, in which his or her spouse has been unfaithful, in which loyal friends defect to the enemy, and others are consistently insulting and demeaning. As for bipolar disorder, associations with the Cluster A personality disorders are frequent. Paranoids who exhibit such symptoms will probably possess strong narcissistic trends. Fanatic paranoids in particular are noted for their self-importance and self-righteous buoyancy.

Somatization Disorders

Many personality disorders exhibit physical symptoms, referred to in DSM-IV as somatoform disorders. The common thread to each is the presence of physical symptoms not adequately explained by a medical condition or actual physical illness. Physical symptoms are an ideal candidate for a hidden psychological purpose; medicine is not an exact science, all medical tests have some degree of error, and physical perceptions are largely subjective. Where both a somatization disorder and a personality disorder exist, avoidant and paranoid patterns have been found to be frequent (Rost et al., 1992). Perhaps this is not surprising, as both personalities withdraw socially under fears of shame and humiliation.

For the paranoid, somatic symptoms may be seen as part of a broader effort to withdraw and wall off the outside world. As a variation on the same theme, physical symptoms may be used to shed the shame associated with not being able to engage the world effectively. One can hardly be expected to engage others if physical circumstances do not permit it. Alternatively, physical symptoms may counter efforts by family members to blame the subject for a general lack of accomplishment or to elicit sympathy from scapegoating family members. Such disorders might present in conjunction with delusional disorder, somatic type, perhaps as the conviction that one has or has been deliberately infected with some insidious disease, for example. Finally, tentative research suggests that paranoid, avoidant, and compulsive personalities are apparently commonly associated with body dysmorphic disorder (Veale et al., 1996).

Substance Abuse

Wherever there are chronic feelings of anxiety, there is also a potential for self-medication. Paranoids abuse a variety of substances, including alcohol, opiates, cocaine (Kranzler, Satel, & Apter, 1994), and amphetamines. Alcohol, in particular, may be used to provide some relief for feelings of anxiety, hypervigilance, guardedness, and self-referential ideas. However, alcohol may also have the effect of liberating aggression from normal controls, thereby producing a potential for violence. Alcoholic murderers tend to be asocial psychopaths; nonalcoholic individuals who are drunk at the time they commit murder are often found to be paranoid personalities (Vuckovic, Misic-Pavkov, & Doroski, 1997). Other researchers have found that when the paranoid personality is linked to alcoholism, it is usually linked to more severe symptomatology (Morgenstern et al., 1997). Finally, in one study, paranoid personality disorder was found to be more than twice as prevalent as antisocial personality disorder in a sample of sober outpatients enrolled in an alcoholism treatment program (Nurnberg, Rifkin, & Doddi, 1993).

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