paranoid personality disorder treatment

paranoid personality disorder treatment Paranoid Personality Disorder Paranoid personality disorder (PPD) has
three main features: (1) a pervasive, long-standing, and unwarranted suspiciousness
and mistrust of people, (2) hypersensitivity when interacting with
others, seeing their motivation as malevolent, and (3) emotional detachment
(Maxmen and Ward, 1995).

Robert, a second-year doctoral student, was referred to the counseling
services by numerous administrators and faculty. He stated that he was
clearly the brightest student, but faculty members were threatened by his
intellectual superiority. He also noted that no one was willing to chair his
dissertation committee and fellow classmates were spreading “vicious”
rumors. He spent most of his time alone, thinking about how to “outsmart
everyone at their game.” Like many students with PPD, Robert
viewed himself as without fault and a victim of others’ maliciousness.

Although there are no psychotherapy outcome studies for PPD (Crits-
Christoph & Barber, 2004), case reports suggest success for cognitive therapy (Livesley, 1995). Williams (1988), in a detailed case study of a college student
with PPD and depression, found that brief cognitive therapy utilizing cognitive
restructuring and progressive muscle relaxation showed promise.
Utilizing cognitive therapy, therapists can modify PPD’s core belief that
others are out to hurt the suff erer by increasing the client’s ability to handle
problems eff ectively. Beck, Freeman, Davis, and associates (2004) suggest that
increasing sense of self-effi cacy and confi dence diminishes individuals’ need
for extreme vigilance and defensiveness. First the clinician must obtain a clear
understanding and mutual agreement with the student about current goals. If
the student underestimates his or her ability to handle a situation and overestimates
the perceived threat, the goal is to give the student a more realistic
appraisal of self. If the student cannot handle the problem, coping skills need
to be taught (Beck et al., 2004).
In the case of Robert, it was important to validate his desire to get a
degree and problem-solve how not to alienate others, so that his goals could
be achieved. Social skills training—such as role playing and behavioral
rehearsal—and assertiveness communication training were employed. Th e
therapist also helped Robert tolerate his anxiety and depression about perceived
failures and losses in his life, normalized his feelings, and empathically
helped him integrate his black-and-white thinking and all-bad/all-good object
representations, off ering possible alternative interpretations for the behavior
of others.
A key task of treatment is to minimize distrust of the therapist and therapy,
which can take months (Maxmen & Ward, 1995). Th e therapist needs to help
these students understand that feelings of vulnerability do not mean that they
are being attacked (Benjamin, 1996). Th e trick is to be patient and empathetic
but not overly focused on emotions or directly confrontational about semidelusional
material, since students with PPD tend to feel too vulnerable.
Grossman (2004) found no published data to support the use of medication
for PPD, although it is reasonable to consider use of an atypical antipsychotic
medication if the paranoia is viewed as a psychotic symptom. Sperry (2003)
mentioned that pimozide might be helpful for clients who show hypersensitivity
and fl uoxetine has been eff ective in reducing suspiciousness. Full disclosure
about the medications and side eff ects is crucial in order to build and
maintain a trusting environment.