This article will continue our look at Theodore Millon’s explanation of paranoid personality disorder. Otto Kernberg included paranoid individuals among what he referred to as those suffering from a borderline personality organization. More recently, Akhtar (1992) described the paranoid personality in the following way:
“The individual with a paranoid personality disorder is overtly arrogant, mistrustful, and suspicious of others; is driven, industrious, and even successful in solitary professions; and is unromantic, idiosyncratically moralistic, and sharply vigilant toward the external environment. However, covertly he is frightened, timid, gullible, chronically experiencing interpersonal difficulties in the work situation, corruptible, vulnerable to erotomania and sadomasochistic perversions, and cognitively unable to grasp the totality of actual events in their proper context.”
Stone (1993), as Millon points out, brings together several general features of the paranoid personality:
“The grandiosity…may be either secret or blatant, [and reflects] the paranoid person’s intense fear of dissolution of self (loss of identity) as a central dynamic…The characteristic hypervigilance of paranoid persons has relevance both to their hostility and to their fear of boundary-loss. The need for a wide psychological and even geographical space between paranoid persons and those with whom they interact is a reflection of both (a) fear of hostile invasion by others (for which real distance has survived value) and (b) fear of being “unduly” influenced by others, to the point of losing a sense of separate self (for which extra psychological “space” – not getting intimate with others – is a solution.”
Beck and Freeman (1990) articulate this from a distinctly cognitive perspective. In other words, they see paranoid personality disorder as a primarily cognitive disorder in which the individual interprets social cues and interpersonal interactions incorrectly:
“The paranoid personalities see themselves as righteous and mistreated by others. They see other people essentially as devious, deceptive, treacherous, and covertly manipulative. They believe that other people. want to interfere with them, put them down, discriminate against them – but all in a hidden or secret way under the guise of innocence. Paranoids may think that others form secret coalitions against them. The paranoid personalities are driven to be hypervigilant and always on guard. They are wary, suspicious, and looking all the time for cues that will betray the “hidden motives” o their “adversaries.” The main affect is anger over the presumed abuse. Some paranoid personalities, however, may additionally experience constant anxiety over the perceived threats.”
Benjamin (1993) writes about this from a primarily interpersonal perspective:
“There is fear that others will attack to hurt or blame. The wish is that others will affirm and understand. If affirmation fails, the hope is that others will either leave the PAR alone or submit. The baseline position is to wall off, stay separate, and tightly control the self. If threatened, the PAR will recoil in a hostile way or attack to countercontrol or gain distance. Is quick to see degradation, attack, and negation; responds with long-lasting revenge. Expects to be misunderstood and misused, so if someone shows the slightest annoyance, he or she responds with a perceptive, fierce, well-focused rage. Can attack harshly with virtually no justification because o the belief that he or she was about to be attacked by the target.”
The five-factor model is used by Costa and Widiger (1993) to attempt to articulate paranoid personality disorder
“PAR is…characterized primarily by excessively low agreeableness (antagonism) particularly on the facet of suspiciousness (low trust), which provides an explicit representation of the core feature of this personality disorder. However, PAR also includes the low agreeableness facets of excessively low straightforwardness, which represents the paranoid tendencies to be secretive, devious, and scheming, and excessively low compliance, which represents the paranoid tendency of antagonistic oppositionalism.”
Theodore Millon, in 1969, formulated the characteristics of this personality disorder in the following terms:
“The paranoid personality may be viewed as a moderately severe form of psychopathology founded on the strategy of turning to oneself, rather than others, as the primary source of protection and gratification. The central traits are: “cognitive suspicions, oversensitivity, readily disposed to detect signs of hostility and deception, a tendency to pick up, magnify, and distort the behaviors of others so as to confirm their expectations); attachment anxieties (a need to be the maker of one’s own ate, free of entanglements and obligations, even more, not to be subject to the control of others or to have one’s power curtailed or infringed upon): defensive vigilance (constantly on guard, mobilized and ready for any threat; maintaining a fixed level of preparedness, an alertness to the possibility of attack and derogation); veiled hostility (a current o deep resentment, a bitterness for having been overlooked, treated unfairly, and slighted by others who seek to dupe them; only a thin veil hides these bristling animosities).”
Theodore Millon articulated this disorder for the DSM-III Task Force committee in 1975. Here, the paranoid personality is seen as an extreme version of an “independent” coping style, placing it at a highly advanced level of structural dysfunction, comparable to that of DSM schizotypal and borderline problems. Theodore Millon wrote:
“This pattern is typified by a suspicious and vigilant mistrust of others, resistance to external sources of influence and a fear of losing the power of self-determination. There is an undercurrent of veiled hostility, tendencies toward self-importance, the presence of fixed, but essentially irrational, belief systems, and an inclination to misinterpret the incidental actions of others as signs of deception and malevolence. The hypersensitive readiness to perceive threat, to experience envy or jealousy and to assign malice to others precipitates frequent social difficulties. An appraisal of personal background and history reveals both of the following:
1. Social attainment deficits (e.g., experienced serious, self-precipitated setbacks in scholastic, marital or vocational pursuits; repeated failure to maintain durable, satisfactory and secure roles consonant with age and aptitudes).
2. Periodic mini-psychotic episodes (e.g., experienced several brief and reversible periods in which either bizarre behaviors, extreme moods, irrational impulses or delusional thoughts were exhibited; short-lived breaks form “reality,” however, are often recognized subsequently as peculiar or deviant.
Since adolescence or early adulthood at least 3 of the following have been present to a notably greater degree than in most people and were not limited to discrete periods nor necessarily prompted by problematic life events:
1. Vigilant mistrust (e.g., exhibits edgy defensiveness against anticipated criticism and deception; conveys extreme suspiciousness, envy and jealousy of others.
2. Provocative interpersonal behavior – (e.g., displays a disputatious, fractious, and abrasive irritability; precipitates exasperation and anger by hostile, deprecatory demeanor).
3. Tenacious autonomy e.g., expresses fear of losing independence and power of self-determination; is grimly resistant to sources o external influence and control).
4. Mini-delusional cognitions (e.g., grossly distorts events into personally logical, but essentially irrational, belief systems; embellishes trivial achievements in line with sei-grandiose self-image).
5. Persecutory self-references (e.g., entirely incidental events are construed as critical of self; reveals tendency to magnify minor and personally unrelated tensions into proofs of purposeful deception and malice).”
The DSM-III-R altered the DSM-III only by dropping “restricted affectivity” and placing this with schizoid personality disorder. The ICD-10 describes the paranoid personality disorder in the following way:
“an excessive sensitivity to setbacks and rebuffs; a tendency to bear grudges, being unforgiving of insults and injuries; suspiciousness, as seen in a pervasive tendency to distort and misconstrue friendly or neutral actions of others as being hostile or contemptuous; a combative sense of personal rights; recurrent suspicions, without justification, regarding sexual fidelity of spouse or partner; a persistent self-referential attitude as in beliefs of superior self-importance; preoccupation with “conspiratorial” explanations of events without substantiation.”
The DSM-IV described paranoid personality disorder in the following way:
“Paranoid Personality Disorder A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:
1. suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her.
2. is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates.
3. is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her.
4. reads hidden demeaning or threatening meanings into benign remarks or events.
5. persistently bears grudges (i.e., is unforgiving of insults, injuries, or slights).
6. perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counter-attack.
7. has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner.”