Abnormal Psychology

Personality Disorders 583

Part of the challenge for clinicians is that the symptoms of paranoid personality

disorder may not always imply that a person has the disorder. When the suspicious

beliefs of someone with paranoid personality disorder center on racial or ethnic

confl icts, as they did for Ms. X., it may be diffi cult for a clinician to determine the

extent to which such beliefs may refl ect the actual state of affairs or, alternatively,

are pervasive misperceptions and misinterpretations (Paniagua, 2001). Similarly, the

clinician must try to understand how an individual’s life events might give rise to be-

liefs and behaviors that, in error, could be considered paranoid. For example, an im-

migrant who experienced harassment might exhibit appropriately guarded behavior

patterns in unfamiliar circumstances, such as not speaking much or responding to

others with minimal bodily or facial expressions of emotion; such behaviors may

in turn inadvertently elicit negative emotions and behaviors from others who don’t

understand the person’s cultural context.

To summarize, paranoid personality disorder involves a chronic pattern of sus-

piciousness and mistrust that often creates interpersonal problems because of the

guarded ways in which the patient interacts with others.

Schizoid Personality Disorder

Schizoid personality disorder is characterized by a restricted range of emotions in

social interactions and few—if any—close relationships (American Psychiatric As-

sociation). Table 13.6 lists the DSM-IV-TR diagnostic criteria. People with schizoid

personality disorder often lack social skills and may not pick up on or understand

the normal social cues required for smooth social interactions—for instance, they

may return someone’s smile with a stare. Such diffi culties with social cues can lead

to problems in jobs that require interacting with others.

In addition, people with schizoid personality disorder may react passively to

adverse events: They may seem to lack initiative and drift through life. People with

Prevalence

• Between 0.5% and 4.5% of the general population is estimated to have paranoid personality
  disorder (American Psychiatric Association, 2000; Grant, Hasin, et al., 2004).


• Among patients receiving treatment in outpatient mental health clinics, prevalence estimates
  are higher (2–10%), and among hospitalized patients, prevalence estimates are in the range of
  10–30%.
  Comorbidity


• People with paranoid personality disorder may also have another Axis II personality disorder,
  usually another Cluster A (odd/eccentric) personality disorder (schizoid or schizotypal) or nar-
  cissistic, avoidant, or borderline personality disorder.
  Onset


• Symptoms can fi rst appear in childhood or adolescence, when the individual appears hyper-
  sensitive, has diffi culties with peers, and has odd thoughts or fantasies or uses language
  unconventionally.
  Course


• The symptoms of paranoid personality disorder are relatively stable over time (Seivewright,
  Tyrer, & Johnson, 2002).
  Gender Differences


• Based on surveys in the general population, there is no clear gender difference in the preva-
  lence of paranoid personality disorder. However, among people with this disorder, men are
  more likely than women to come to the attention to mental health professionals (Morey, Alex-
  ander, & Boggs, 2005).
  Source: Unless otherwise noted, the source is American Psychiatric Association, 2000.

Table 13.5 • Paranoid Personality Disorder Facts at a Glance

Schizoid personality disorder

A personality disorder characterized by

a restricted range of emotions in social

interactions and few—if any—close

relationships.