Paranoid Personality Disorder

The Malignant Paranoid

Malignant paranoids combine aspects of the paranoid and sadistic personalities. Such individuals have built expectations that they will be on the receiving end of others’ aggressions. Highly sensitive to power issues, their strategy is to dominate you before you can dominate them. Intimidating and belligerent, they possess a ruthless desire to avenge past wrongs and triumph over others. Even when they are alone, the long list of perceived wrongs done to them constantly rises into awareness, thus keeping a potential for aggression close to the surface. However, many have found that their actual efforts at abusing and terrorizing others routinely backfire, which leads them to seek retribution more through fantasy than action. These setbacks are wrought by their own hand, as their chip-on-the-shoulder attitude toward others provokes abundant antagonism.

As they become more isolated, left to ruminate over this self-created perpetual cycle of interpersonal hostility, fanatic paranoids begin to cogitate on the perceived malicious nature of their hostile environment, complete with the venomous individuals who inhabit it. Via the intrapsychic of the enmity they feel within themselves. As the line between objective antagonism and imagined hostility grows thin, the belief that others are intentionally persecuting them may take on almost delusional proportions.

The need to protect their autonomy against any and all outside influence is a defining feature of this variant because nothing is so valuable and so vulnerable to them as their sense of self-worth. This is particularly evident in the content of their persecutory delusions. The malevolence they perceive emanating from others is neither casual nor random but designed to intimidate, offend, undermine their self-esteem, control their thoughts, and weaken their will. They are ever alert against their darkest fears: Others will make them soft and yielding, forced to submit to authority, or worse, tricked into surrendering their self-determination.

From these arise that need for marked emotional dependence upon others, as also do the exaggerated demands for attention and affection.

The traits foster furthermore the craving by this personality to be accepted by others as being something far greater than it really is.

Lacking an adequate central stability, the hysterical personality is liable to display a chameleon-like versatility.

Role after role may be switched or rejected to capitalize on the advantages of the moment. Affective response is typically forced, artificial and shallow.

In the sexual field, an outward display of enticement and encouragement contrasts markedly with a limited or absent capacity for performance.

In so many aspects, the hysterical personality inhabits a world of childish make-believe and utilizes the unreal values appropriate to childhood.

  • Like the thwarted child, resenting its lack of independence, it seeks to impress others with its own importance;
  • like the over-indulged child, frustrated at not gaining its own way, it revels in dramatic scenes of histrionic behavior so reminiscent of a childish tantrum.
  • The hysterical personality employs many and devious means to attain its ends.
  • Threats of suicide are extremely common.

Though frequently empty, they can never be taken lightly for the hysteric is notoriously liable to overplay his or her hand and what was intended as a suicide gesture may well end as the consummated act.

The involved manipulations of the hysterical personality are characteristically bids for dominance from a position of natural weakness.

Diagnosis

Hysterical symptoms may take innumerable forms:

  1. There may be disturbances of sensation such as anesthesia (anaesthesia) or paresthesia (paraesthesia) or other neurological symptoms such as ataxia; spastic or flaccid paralysis; choreiform or athetoid movements and tremor.
  2. Other manifestations include loss of vision, gynaecological complaints, difficulty in breathing or in swallowing, abdominal pains and peculiar dermatoses.
  3. Mental disturbances include double or multiple personality. In some cases, a hysterical fugue or trance follows a traumatic experience but in others it is an escape from a disagreeable situation.

The differential diagnosis of hysteria is full of difficulty, not least the necessity to make certain that no organic lesion is present.

It should be possible to show that the symptom is a response to some conscious experience which has a strong personal significance to the patient.

Even so, it may sometimes be very difficult to decide between symptoms due to organic disease and those of hysterical states, particularly in later life when there may be a hysterical overlay on pre-existing organic lesion.

Management

No simple formula can be advanced for the treatment of hysteria. Each case will obviously be assessed on its highly individual merits and therapy devised accordingly.

A detailed case history will be taken and a careful physical examination must be made to exclude an underlying and contributing organic illness.

The personality of the doctor for better or worse will play a vital part in the attainment of any degree of success.

It is for this reason that unskilled and unqualified persons may achieve outstanding success in the treatment of this neurosis where eminently qualified persons may fail.

There is a possibility of curing an acute hysterical reaction by simple suggestion and a heavy dose of a sedative.

A chronic hysterical condition is, however, one which may demand all the resources of psychiatric therapy to effect any permanent improvement.

The basis of successful treatment is suggestion and this may be done either over a long period or in single intensive association under hypnosis or under light anesthesia (anaesthesia) Opens in new window.

Abreactive methods may also be used. It is thus clear that the management of hysteria requires the attention of a physician skilled in the use of these particular techniques and referral is therefore advised.

Apart from the use of mild sedatives to secure reasonable sleep and tranquilizers to ally anxiety, drugs are of little benefit in the hysterical states.

    The research data for this work have been adapted from:
  1. Understanding Paranoia: A Guide for Professionals, Families, and Sufferers By Martin Kantor
  2. Personality Disorders: Toward the DSM-V By William O'Donohue, Katherine A. Fowler, Scott O. Lilienfeld.
  3. The Fundamentals of Psychological Medicine By R.R. Tilleard-Cole, J. Marks
  4. Personality Disorders in Modern Life By Theodore Millon, Carrie M. Millon, Sarah E. Meagher, Seth D. Grossman, Rowena Ramnath