Mr M, a 40-year-old businessman residing in north-west Delhi was brought for psychological treatment by his family. His wife had filed a domestic violence case against him in Crime against Women's Cell, New Delhi. For the last 15 years, Mr M had a feeling that his wife had a tendency to be overfriendly with men and she may cheat on him. He largely restricted her indoors and she was not allowed any interaction in his absence. If he came to know that she had tried to interact with someone in his absence he lost his temper and became violent with her. His wife had endured a lot of physical and emotional violence but now her patience was running dry. He had no close friends but a few acquaintances. Apart from going out for work, Mr M kept away from social interaction. He rarely visited someone and would never invite anyone to his house. He often justified this weird behaviour in front of his wife by saying that given the rising crime rates in Delhi NCR, it was important to be overcautious. Mr M used to pick up fights with neighbours over small matters and everyone kept away from him. He was against the idea of consulting a psychologist but given the recent case against him, he complied. After a detailed interview, it became apparent that all along Mr M had been suffering from a lesser known condition called paranoid personality disorder.

Although keeping a blind faith in everyone around you can prove to be disastrous, an excess of suspicion is unwarranted. Some people tend to exaggerate the sense of danger and are unable to trust anybody including their most intimate relationships. These people may suffer from paranoid personality disorder. It is seen that a greater number of men as compared to women have a paranoid personality disorder. Clinical and research studies have indicated that approximately 0.5 to 2.5% of the general population suffer from paranoid personality disorder, though it is possible that many normal functioning people also display some of the paranoid traits.

Paranoid Personality Disorder - Signs and Symptoms:-

. Suspiciousness: A person who has a paranoid personality disorder feels very suspicious and finds it extremely difficult to trust other people. Even when there is no evidence that others are malicious a person with paranoid personality remains doubtful and circumspect. As a result these individuals keep away from getting involved in close and genuine interpersonal relations. They come across as guarded, aloof and cold and place a very high value on being autonomous.

. Lack of trust: A common symptom of paranoid personality disorder is deep mistrust. The paranoid individual frequently ruminates whether their close ones-parents, spouse, siblings and friends are loyal and trustworthy and keeps a careful scrutiny on them. They are prone to misinterpret benign events as evidence of lack of trust and loyalty.

. Fear of sexual cheating: Some of them are preoccupied with sexual fidelity of their partners and may suspect the partner of being unfaithful. They feel scared that they might be betrayed and in order to get rid of this fear, they keep a close eye on their partner. This often creates a very confining and dehumanizing feeling in their partners. Even when the partner tries to prove themselves not guilty, paranoid people pay little heed as they regard their doubt as truth. This creates strife in their intimate relationship and makes the partner suffer endlessly.

. Violence and aggression: When faced with doubt of being cheated, quite a few paranoid personality patients may resort to violent and abusive behaviour. They wish to exert a powerful control on other people and belittle them.

. Litigation and justice seeking: Another common symptom of paranoid personality disorder is that they bear grudges, hostility and feel entitled for justice and revenge. Due to the malice that they readily perceive in others, paranoid individuals may get involved in lengthy and bitter disputes with other people.

. Never ending blame game: For everything wrong that goes on in their lives, people with a paranoid personality have a proclivity to blame other people. They lack insight that it is primarily their own paranoia, which creates problems in their life.

. Poor team members: At work place, these people find it extremely difficult to work in close cooperation with their colleagues. They may feel that the other staff members are envious of them and want to malign their efforts and reputation.

Paranoid Personality Disorder in Relationships - Reciprocal Mistrust

People who are in close proximity to those having paranoid personality disorder may feel irritated, exhausted, scared and hostile. Paradoxically through their difficult behaviour in interpersonal relations, people with paranoid personality disorder tend to elicit the very responses that they fear from the other people. People who come in contact with paranoid individuals often feel exasperated and this leads to a vicious cycle of mutual mistrust.

Paranoid individuals shuttle back and forth in relationships owing to intense conflicts. When they are alone they feel sacred and insecure that some harm will befall on them as there is no one to protect them and when they are in a relationship they are once again petrified that the other person will exploit and harm them. Caught in this killing dilemma, neither aloneness nor relatedness provides them security and comfort.

Childhood

Though people with a paranoid personality often show full features of the disorder in early adulthood, even as children and adolescents they show certain abnormalities and peculiarities as compared to other children. They tend to have poor academic performance, remain aloof and have almost negligible friendships. Other children find their thinking, speech and behaviour somewhat weird and may tease them. More boys as compared to girls display these abnormal traits.

Causes of Paranoid Personality Disorder

. Traumatic childhood: Childhood abuse and neglect is an important cause of paranoid personality disorder. It has been observed that children who go on to develop a paranoid personality have painful experiences of being subjugated, punished and humiliated by important people in their lives. As children, these people perceive their close ones to be very harsh, critical and even abusive at times.

. Projection: Paranoid people remain unaware of their negative feelings and unconsciously view the other people as having the same emotions towards them. For instance, 'I hate her and wish to harm her' quickly becomes 'she hates me and is conspiring against me' in the mind of a paranoid person. They have no awareness that it is actually their own denied emotion that gives the other person a devilish appearance. Paranoid individuals live in chronic fear that they will be denigrated by others and therefore denigrate others in an act of self-defence.

. Splitting: Another cause of paranoid personality disorder is a tendency to see oneself as all good and others as all bad. A paranoid individual holds two extreme views of their self and this contradiction cannot be reconciled by them. On one hand they feel fragile, humiliated and derided while on the other extreme which is an attempt to deny the pain that emanates from this they start viewing themselves as extremely powerful, exulted and justified.

Treatment of Paranoid Personality Disorder

Treatment of paranoid personality disorder is extremely difficult. People with paranoid personality disorder may benefit from a long-term psychotherapy and medication if a strong treatment alliance can be established. However, considerable skill and painstaking effort is required on the part of the psychotherapist to treat a person suffering from paranoid personality disorder. This is because a paranoid person relates to the therapist in more or less the same manner as they relate with other people.

Without any evidence they may experience the therapist as critical, humiliating and malicious and this becomes a major impediment to the progress and even the continuation of treatment. In fact it can be said that in a way the treatment of paranoid personality disorder nears conclusion when a paranoid person is able to trust the therapist as someone who is helpful and compassionate.