What are the first symptoms of paranoia

Paranoid personality disorder

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Written by Wiebke Posmyk • Medical editor

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People with paranoid personality disorder are overly suspicious. You feel threatened by others for no reason. Many are very sensitive to being rejected. Others persistently try to enforce their own rigid convictions in their counterparts. Read about how to recognize a paranoid personality disorder, how to treat it and what distinguishes it from psychotic "paranoia".

It is estimated that one in 100 people has a paranoid personality disorder. Those affected feel permanently belittled, treated unfairly, exploited or threatened by others - although there is no objective reason for this.

Paranoid personalities tend to interpret insignificant or even friendly actions of those around them as personal hostility or even conspiracy against them. For example, they perceive a sincerely intended congratulation as irony and believe that the other person actually despises or mocks them. And the well-intentioned advice of a colleague is, in their eyes, the condescending criticism of a know-it-all - or even the trap of an enemy who should not be pestered. So paranoid personalities are very suspicious and prefer to keep their distance than to enter into close bonds. They can easily sense a conspiracy behind the actions of others and relate much to themselves inappropriately. They also quickly become jealous for no reason.

People with paranoid personality disorder have very rigid, set views that they don't deviate from. They insist on their (supposed) rights inappropriately and often show themselves to be extremely persistent and self-confident. Accordingly, they often react with anger and argument. But there are also those affected who tend to withdraw with resignation.

To outsiders, paranoid personalities often appear arrogant and self-centered, callous and lacking a sense of humor. In truth, however, those affected are very sensitive. They often feel rejected and hurt. If they feel offended, they can be very unforgiving.

Paranoid personality disorder: symptoms at a glance

People with paranoid personality disorder

  • are oversensitive, e.g. B. to criticism, setbacks or rejection
  • feel that they have been treated unfairly, insulted, threatened or exploited and continue to bear this up
  • are inappropriately suspicious; interpret neutral or well-intentioned actions to their disadvantage
  • are contentious; have very rigid opinions that they insist on; some tend to be fanatic
  • tend to be jealous for no reason; hardly have close contacts

Not all of these symptoms are equally pronounced in everyone. Some doctors and psychologists distinguish between two types of paranoid personality disorder:

  • In the case of the fanatical personality, the rigid convictions are in the foreground, to which they cling at all costs.
  • The querulous personality feels permanently in the wrong and constantly fights against it.

When does one speak of a paranoid personality disorder?

High levels of suspicion or sensitivity do not automatically mean that you have a paranoid personality disorder. It could be a personality disorder if you have these characteristics

  • have existed permanently since childhood / adolescence and do not appear suddenly or in phases and
  • are so pronounced that the person and / or those around them suffer.

It is characteristic of a personality disorder that the unfavorable personality traits develop in childhood and consolidate into adulthood. They remain constant and can only be changed within a narrow framework.

Do paranoid personalities suffer from schizophrenia?

Many associate the word "paranoid" with a psychosis such as schizophrenia. Delusions and hallucinations are typical of paranoid schizophrenia. Those affected believe, for example, that they are being watched or followed - for example by aliens or members of a secret service.

However, paranoid personality disorder is not the same as delusional psychosis. Paranoid personalities also often feel threatened for no reason and relate a lot to themselves. In contrast to schizophrenia, however, it is not a question of pronounced delusions, but rather a kind of preliminary stage (so-called overvalue idea). In addition, the symptoms of paranoid personality disorder are permanent and have been present since childhood, while paranoid schizophrenia usually occurs in episodes.

Paranoid personality disorder: causes

Paranoid personality disorder does not have a single cause. Rather, several factors interact to trigger the disruption.

Which individual personality traits a person develops depends on various influences. Above all, this includes

  • Predisposition: The "basic temperament", i.e. whether a person z. B. is more introverted or more sociable is hereditary.
  • External factors in childhood and adolescence: B. the upbringing, the atmosphere in the parental home, the social environment or traumatic situations.

Exactly which factors trigger a paranoid personality disorder has not been conclusively clarified. There is evidence that many individuals with paranoid personality disorder grow up in homes where a hostile, neglectful atmosphere prevails.

Paranoid personality disorder: diagnosis

People with paranoid personality disorder rarely see a psychotherapist. They fail to realize that their thoughts, feelings, and behaviors are inappropriate. Instead, they see the problem with those around them who want them harm. However, people sometimes seek treatment, for example because of problems at work or after reporting to the police, when officers discover that the person is suffering from a disorder. It can also be that they come on the initiative of the partner because they repeatedly react jealously for no reason.

As the therapeutic sessions progress, possible signs of a paranoid personality disorder become apparent. For example, the patient / client is overly suspicious and very sensitive to criticism. The descriptions of people close to you can give the psychotherapist important clues about a possible paranoid personality disorder.

Various psychological tests can help make the diagnosis easier. This includes, for example, a standardized structured interview (SKID): This provides information about which personality traits are particularly pronounced.

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Paranoid Personality Disorder or Another Disorder?

Many of the characteristics of paranoid personality disorder can appear with other medical conditions. It is therefore important that the psychologist / doctor can rule out other possible causes, such as a paranoid form of schizophrenia. It can also be that paranoid personalities also show characteristics of other personality disorders. For example, there is often an overlap with schizoid personality disorder. People with schizoid personality disorder appear aloof, callous, and aloof.

Paranoid personality disorder: therapy & course

A person's personality traits are relatively constant. Like other personality disorders, the paranoid form can only be changed within certain limits. As you get older, the symptoms often get a little weaker.

When paranoid personalities go into psychotherapy, many develop a strong distrust of the therapist, which makes treatment much more difficult. They also react quickly to being overly sensitive if they are criticized as part of the therapy. Accordingly, the psychotherapist will proceed very carefully and understandingly in order to win the patient's trust little by little.

The aim of psychotherapy is not so much to seriously change the unfavorable personality traits. Rather, the patient should learn to understand the background and to live better with the disorder - for example by improving his social skills and recognizing when mistrust is inappropriate. Various methods can be used for treatment, for example cognitive behavioral therapy or talk therapy. In some cases, supportive medication can be used.

Paranoid personality disorder: case study

An anonymized case study from practice, made available by our expert Dr. Bernhard Riecke:

A woman, in her mid-thirties, is admitted to the psychiatric ward by the police for verbally and physically assaulting the police.

When taking the anamnesis - supplemented by the mother's anamnesis - it becomes clear that Ms. F. has always been suspicious. While she was still at school, she had shown average to good results, but she always stood out for her unruly and contentious behavior. Even particularly well-meaning teachers would ultimately always have been disappointed by her because she was suspicious of any friendly behavior and misinterpreted it as hypocritical.

In her dream job of automotive mechatronics technician, the first year of her apprenticeship would have gone without any major problems, because she would have enjoyed a kind of fool's freedom as the only woman in the men's group.

But then the old mechanism came to the fore again. She reacted excessively offended to factual criticism, insulted her superior because of it and had not forgotten her grudge against him.

She would have completely misinterpreted friendly attempts at arbitration by colleagues. On the one hand, she perceived this as a plot against her, on the other hand, it was sometimes misinterpreted as a "pick-up".

In the second year of training, she then had the entire workforce against her and claimed that there was a large-scale conspiracy against her. After she had not appeared at work for several days, the employment relationship was terminated after several warnings. Since then, she has been living on various forms of support.

Relationships with men only lasted a few weeks because she always assumed that the person concerned had cheated and cited strange "evidence" for it. While jogging on a bike / footpath, other walkers noticed that she was screaming violently after a cyclist had passed her. She claimed the cyclist sexually molested her (grabbed her chest) as he drove past her.

During the complaint to the police, she was abusive after the officer made it clear that even a trained stuntman would not be able to hold her chest while overtaking. When it got very noisy, two colleagues came along who insulted her immediately and suddenly slapped the officer in the face - which ultimately led to the briefing.

Senf, W., et al .: Practice of Psychotherapy. Thieme, Stuttgart 2020

Doering, S., Sachse, R .: Psychotherapy for personality disorders (PDF). Online publication: www.ipp-bochum.de (accessed on: 2.6.2020)

Payk, T., Brüne, M .: Checklist psychiatry and psychotherapy. Thieme, Stuttgart 2017

Möller, H., et al .: Dual Series Psychiatry, Psychosomatics and Psychotherapy. Thieme, Stuttgart 2015

additional Information

ICD-10 Diagnostic Key:

You can find the appropriate ICD-10 code for "Paranoid Personality Disorder" here:

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Last content check:23.06.2020
Last change: 12.01.2021