Paranoid Personality Disorder and its influence in social settings

Nov 12, 2021 Letters

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Dear Editor,

Kaieteur News – I am a final year BSc in General Psychology student at the American University of Peace Studies Inc. located in Georgetown, Guyana. In undertaking the course Theories of Personality, I thought of bringing awareness to the general public on one of the 10 personality disorders – Paranoid Personality Disorder and its influence in social settings, that is, the surroundings or environment in which social activities occur. Prior to my studies in this field, I was not aware of the existence of personality disorders and my interaction thereafter with members of society, save for some in the medical field, confirmed my belief that this is an alien subject. Additionally, due to the lack of practicing psychologists in Guyana, I am deeply concerned about persons being misdiagnosed with a clinical disorder rather than a personality disorder when displaying certain symptoms. One can also be deprived of treatment to improve their mental health because often times we as Guyanese conclude, “she stay suh” completely ignoring a cry for help.
Let us consider this scenario: Mrs. John is 35 years old with no prior history of a medical condition. After careful consideration, she was promoted to supervisor because even though she is no “social butterfly,” she accomplishes her tasks. At her first evaluation at the end of the month she reported feeling that the other senior officers are against her envying her promotion and that ever so often the staff in her department is whispering about her. The manager suggested Mrs. John have lunch with staff during the lunch break to get to know them in a less formal setting which can boost their working relationship. She refused on the grounds that, “You never know when something you say in company will be used against you.” As the evaluation progressed Mrs. John became guarded and evasive but during the latter part, feeling criticised, she became agitated and verbally aggressive. When the evaluation report was submitted to higher authorities it was proposed that Mrs. John visit a mental health professional. Since this was a recommendation from her employer, she hesitantly agreed to one visit but not without threatening to sue the company for trying to destroy her reputation.
Personality is the total sum of the typical ways of thinking, feeling and acting that makes each person different from other people. (Lahey, 2012). Personality disorders are a group of mental health conditions that are characterised by inflexible and atypical patterns of thinking, feeling, and behaving. These inner experiences and behaviours often differ from the expectations of the culture in which someone lives. (Carey, 2021). PPD is classified in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) under Cluster a Personality Disorder, a term used to describe eccentric personality disorders like Paranoid Personality Disorder. People with eccentric personality disorders display behaviours that may seem odd or unusual to others. The exact cause of Paranoid Personality Disorder is not known, but it likely involves a combination of biological and psychological factors. There is some evidence of increased prevalence in families with a history of psychotic disorders such as schizophrenia and delusional disorder while some evidence suggests a link between this disorder emotional and/or physical abuse and victimization during childhood.
The essential characteristic of people with Paranoid Personality Disorder is paranoia; a relentless mistrust and suspicion of others without adequate reason to be suspicious. These individuals are always on guard, believing that others are constantly trying to demean, deceive, harm or threaten them. Doubting the commitment, loyalty, or trustworthiness of others they are hypervigilant for potential insults, slights, threats and disloyalty. They read hidden meanings in the innocent remarks or casual looks of others and closely scrutinize them for evidence to support their suspicions. If they perceive attacks on their character, they do not forgive the person who injured them. They tend to counterattack or react with anger in response to these perceived injuries. Persons with this disorder are reluctant to confide in others or reveal personal information for fear that any information they divulge will be used against them. They doubt the faithfulness of their spouse or partner and can be extremely jealous, often questioning the activities and motives of their spouse or partner in an effort to justify their jealousy. Can you now identify some of these symptoms in Mrs. John or perhaps someone you know? Do you see Mr. John being subjected to constantly reporting his whereabouts, having his phone conversations checked and/or being traced via an app or private detective?
Since they have trouble with trusting others, people with Paranoid Personality Disorder have an excessive sense of self-sufficiency and autonomy and feel the need to be in control. Someone with Paranoid Personality Disorder does not see their suspicious behaviour as unusual or unwarranted. Rather, they see it as defending themselves against the bad intentions and deceptive, untrustworthy activities of those around them. However, those around them may believe this distrust is unwarranted.
According to the DSM-5, for a diagnosis of Paranoid Personality Disorder, a mental health provider will look for the presence of a persistent distrust and suspiciousness of others which must be accompanied by at least four of the other symptoms as listed in the manual. They will also want to rule out paranoia stemming from a psychotic episode linked to another condition, such as bipolar disorder, schizophrenia, or depression with psychosis. Also, symptoms must have begun by early adulthood.
Humans are social creatures who long to fit in with certain groups. The connection created in social settings whether at home, school, and work, in the community or wherever one becomes socially engaged is key to physical and mental health. The thinking and behaviours associated with Paranoid Personality Disorder, however, can interfere with a person’s ability to function socially. Their generally unfounded beliefs, as well as their habits of blame and distrust, interfere with their ability to form close or even workable relationships. The finger-pointing and twisting of the other person’s words to mean something else can take a heavy toll. The verbal insults, lack of sensitivity to the feelings of those in their presence, and the stubborn belief that they are always right can make someone feel like they are ‘walking on eggshells’ when around them. If a person with Paranoid Personality Disorder does form a close relationship, the relationship is often accompanied by jealousy and controlling tendencies. And their jealousy and controlling behaviour can make it difficult for their partner to maintain other relationships and social ties, leaving the partner feeling isolated and alone. Their partner or anyone close to them may feel frustrated or exhausted and lose hope while others may stay away altogether. This can ultimately result in persons not wanting to be around those with this disorder. The lack of social support will further deteriorate the condition of the individual with Paranoid Personality Disorder and comorbidities such as depression, anxiety, social phobia (social anxiety disorder), posttraumatic stress disorder, alcohol use disorders and borderline personality disorder will surface if not already present.
Professional treatment, which focuses largely on psychotherapy, can help someone with Paranoid Personality Disorder. A therapist can provide support to develop skills for building empathy and trust, improve communication with others in social situations and relationships and better cope with other Paranoid Personality Disorder symptoms. However, the first major challenge is for the person with Paranoid Personality Disorder to recognize there is something disjoint about their thinking and willingly embrace the need for treatment. Trying to force someone with Paranoid Personality Disorder into seeking help will often backfire, adding to their resistance and fueling their paranoia that people are conspiring against them. Secondly, the suspicion and mistrust felt by people with Paranoid Personality Disorder poses a challenge for the therapist because trust is an important factor of psychotherapy. However, professional help is critical for individuals with Paranoid Personality Disorder to function socially and be reintegrated back into society.
Do we have sufficient expertise in Guyana to help individuals with personality disorders? Do you know of anyone who was diagnosed with a personality disorder or more specifically, with a Paranoid Personality Disorder? I am of the opinion that our culture allows us to nonchalantly say as a passing joke, “she head na good” or “something wrang wid she” without reaching out. This disorder, however, is real with real effects as are the others. I therefore implore you the readers to be more attentive to the behaviour of those around you and extend a caring hand where necessary. If you know someone or if you believe you show some of the symptoms synonymous with this personality disorder, help is available. Kindly make contact with the American University of Peace Studies Inc. on Facebook or on telephone number (592) 652-2344.

Veronica Baxter
Student
American University of Peace Studies Inc.

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