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Dual Diagnosis – Recognizing the Signs of Paranoid Personality Disorder

Paranoid personality disorder

This is the seventh article in our series on Dual Diagnosis. 

Paranoid Personality Disorder (PPD) characterizes a pattern of hostility, suspiciousness, and general distrust of others. People with PPD constantly fear that others want to hurt or take advantage of them. This distrust leads to problems in their daily activities and relationships with other people. They don’t usually get along with others and have trust issues.

It’s unknown what causes paranoid personality disorder but there is a greater risk in people that have a family history of the disorder or suffered an abusive childhood. Also, the disorder is more common in families that have a history of schizophrenia and delusional disorder. This condition is more common in men than women.

Symptoms of Paranoid Personality Disorder

A person that suffers from this personality disorder shows long-term symptoms of suspiciousness and mistrust of others, but not in a severe form of schizophrenia. Common symptoms include:PPD and addiction

  • Hypersensitivity; these people get easily insulted.
  • These individuals are avid observers that constantly look for clues in the environment to validate their unreasonable fears.
  • They doubt the loyalty or trustworthiness of others. They believe other people will use them.
  • Don’t confess or reveal personal information, fearing that the information will be used against them.
  • Don’t take criticism well.
  • Hold grudges and don’t forgive.
  • React with anger at innocent remarks and ‘find’ a hidden meaning and motives in every conversation.
  • Act suspicious, are cold and distant. This is especially present in their romantic relationships. They may suspect their significant other is unfaithful and become jealous and controlling.
  • These people socially isolate themselves.
  • They always blame other people during a conflict and are very argumentative. They believe they are always right and act hostile and stubborn.
  • It’s difficult for people with PPD to relax.

If you know someone with this disorder or are in a relationship with one, you will notice that they severely limit their social lives. Also, they often think they are in danger and can’t see the effect of their suspicions in the environment.Paranoid personality disorder

Connection Between PPD and Substance Abuse

Studies show a connection between substance abuse and personality disorders. People suffering from personality disorders display more symptoms of cannabis use than people that don’t have personality disorders.

Therefore, patients with a paranoid personality disorder often cope with their distress, symptoms, and isolation by abusing substances. Alcoholism is highly related to this disorder. Alcohol dependence adds to the severity of the symptoms, making them more realistic – which leads to social isolation and estrangement from family and friends. Drug abuse is another way for the person to deal with this disorder. However, the symptoms only intensify and there is a possibility for the disorder to progress into a more serious mental illness.

This disorder frequently comorbid with other personality and non-personality disorders. There is evidence suggesting that people who have relatives suffering from schizophrenia have greater chances of getting paranoid personality disorder. Consequently, the paranoid personality disorder may appear as an antecedent of schizophrenia spectrum and other psychotic disorders. When a person experiences stressful situation brief psychotic episodes may appear and if they last longer, PPD may develop into schizophrenia or delusional disorder.ppd and addiction

Other non-personality disorders that comorbid with PPD are major depressive disorder, anxiety disorder (agoraphobia), obsessive-compulsive disorder, alcohol and substance abuse disorders.

PPD often co-occurs with personality disorders including avoidant personality disorder, schizoid, schizotypal – part of the same cluster – narcissistic, and borderline personality disorder.

Diagnosis and Treatment

Paranoid Personality Disorder is a chronic disorder that can last for years or a lifetime. Usually, patients don’t seek treatment voluntarily. Therefore, the disorder must be diagnosed by a mental health professional that has experience in the field. Professionals diagnose the disorder based on a psychological evaluation, history, and severity of the symptoms.

Many experts use the American Psychiatric Association’s DSM-5 that includes the necessary criteria for diagnosing PPD. In general, they require a presence of suspicious behavior and mistrust from early adult age. It is not recommended diagnosing paranoid or any other personality disorder at patients under the influence of drugs or alcohol. Substances like alcohol, cocaine or marijuana often show similar signs to paranoid personality disorder which may cause confusion and lead to misdiagnosing.

Substance abuse intensifies the symptoms of mental illness, making it hard for professionals to set a diagnose. Therefore, when someone who suffers from substance abuse disorder shows signs of personality disorders or any other mental illness, the primary approach is detox. After that, an addiction counselor or psychiatrist make a thorough assessment and evaluation, followed by a diagnose.Paranoid personality disorder and alcoholism

Treatment Approach

Because of the symptoms, paranoid personality disorder’s treatment is challenging. These patients tend to mistrust the mental health professional or anyone that tries to help them. They don’t reveal much information because of the fear that it will be used against them. So, it’s not surprising there isn’t an effective treatment approach for this disorder. The usual treatment approach for PPD includes:

  • Psychotherapy – the goal is getting the patient to trust the therapist. So, individual psychotherapy is the best approach. Therapists are extremely careful with these patients as they get easily suspicious even at the slightest remarks. Experts don’t recommend Group therapy and Family therapy in early treatment.
  • Medications – they contraindicate with the disorder. If the therapists suggest medications during early therapy, the patient may start having an unnecessary suspicion which may ruin treatment.

Related: The Connection Between Addiction and Mental Illness

The goal of therapy for PPD is to help the person understand patterns of actions and behavior. Also, it helps them form positive relationships. The bad news, people with PPD often refuse to treat their disorder. After a while, their symptoms prevail and they end up alone their whole lives.

For more information please call our Addiction Treatment Helpline at (844) 439-4765. This is a Free and completely confidential call. We are available 24/7. In many cases, your health insurance company will cover 100% of the treatment cost. So please call now.

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