Paranoid Personality Disorder and Substance Use Disorder: Co-Occurring

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Paranoid Personality Disorder and Substance Use Disorder: Co-occurring

Personality disorders affect 10-15% of the adult US population. A personality disorder is a very rigid pattern of inner experience and outward behavior. According to SAMHSA over 8.9 million persons have co-occurring disorders; that is that they have both mental and substance use disorders. Only 7.4% receive treatment and 55.8% receive no treatment at all. The National Survey on Drug use and Health states that there were 45.1 million adults within the past year suffering from mental illness, and 20 .8 million suffering from Substance use Disorder (SUD).

One such disorder is Paranoid Personality disorder (PPD). Treatment, diagnosis, and prognosis can be challenging due to the nature of this disorder. Individuals who are diagnosed with PPD are often also diagnosed with Substance Use Disorder (SUD). One question that studies hope to answer is whether or not SUD can cause PPD, or vise versa. Having an individual with co-occurring SUD can prove even more difficult; however with a PPD&SUD sufferer willing to participate in their treatment, the outlook becomes more positive.

Though it is not known what causes PPD many it is most likely that it is caused by several different factors. Genetics is possibly the most likely, considering that most Paranoid personality disorder seems to be more common in those with a family history of schizophrenia and other psychotic illnesses. According to the Diagnostic and Statistical Manual of Mental Disorders Particularly in response to stress, individuals with this disorder may experience very brief psychotic episodes (lasting minutes to hours). In some instances, Paranoid Personality Disorder may appear as the premorbid antecedent of Delusional Disorder or Schizophrenia.”

In order for an individual to be diagnosed with PPD he or she must be 18 years or older and display at least four of the following traits: a) chronically suspicious that people are lying or cheating him or her in some way, b) frequently preoccupied with whether people are loyal or trustworthy, c) cannot confide in others for fear of being betrayed, d) misinterprets benign comments or events as being personally threatening, e) harbors long term grudges against others who are perceived as having been threatening or insulting in some way, f) sees others’ actions and/or words attacking him or her in some way, and then therefore goes on the counterattack, g) repeatedly assumes that partner or spouse is unfaithful.

Some of the other symptoms of this disorder include concern that the people around them have hidden agendas or motives. They have a fear and expectation of exploitation by those they are supposed to trust. They have an inability to work with others, and display social isolation, detachment and hostility. People with this disorder are very critical of others mistakes or faults, they are also unable to recognize their own mistakes and are extremely sensitive to receive criticism from others. PPD sufferers are very quick to challenge the loyalties of people around them. They often feel they are in danger and are continuously seeking evidence to support their suspicions.

Because they are hyper vigilant for potential threats, they may act in a guarded secretive or devious manner and appear to be “cold” and lacking in tender feelings. They often become involved in legal disputes due to their arguable manner in response to their quickness to counterattack. Those with PPD also feel a need to have a high degree of control over those around them. Although they may appear to be objective, rational, and unemotional, they more often display a labile range of affect, with hostile, stubborn, and sarcastic expressions predominating. Their combative and suspicious nature may elicit a hostile response in others, which then serves to confirm their original expectations. They also have a tendency to use intimidation to keep their control over those close to...
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