Paranoid (Skeptical) Personality Disorder

Personality is the continuous characteristics and tendencies that determine the differences in the feelings, thoughts and behaviors of individuals (Linda, 1999). It covers the cognitive, emotional, social and physical characteristics of the individual. Behavior patterns that distinguish one person from others. A personality disorder can be mentioned if the person goes out of the norms of the society he is in, experiences a disruption in his emotion, thought and behavior patterns, and goes beyond what is expected.

The basic belief of a person with paranoid personality disorder is that the world is a dangerous place, that he or she can get hurt at any moment and in this case, he must constantly protect himself. They interpret the behavior of others as malicious. They are always very careful and very alert to their surroundings. They doubt even the honesty of their closest relatives and are dedicated to seeking proof of their suspicions. The image they show towards the outside world is rational, cold and logical. They usually do not show affection or positive emotions.

The DSM-V Diagnostic Criteria Handbook defined paranoid personality disorder as:

1) Do not suspect that others are deceiving or doing evil without sufficient evidence.

2) Questioning the loyalty and reliability of colleagues or friends.

3) He cannot open up to others for fear that what he says will be used against him later.

4) Infers humiliation or intimidation from ordinary words.

5) He constantly feeds grudges.

6) Perceives the behavior of others as an attack on their personality or status for no apparent reason. He responds to them with anger.

7) He constantly questions his partner’s commitment to him and experiences constant skepticism about his partner’s loyalty.

A distortion occurs in the thought and thought processing system of individuals with paranoid personality disorder. They always tend to blame others for events. The reason for this is a psychological defense situation that the individual makes in order to protect the underlying low self-esteem (Bentall, 2006).

Theory of Mind; It is the ability to understand the intentions and mental states of others, and this skill is lacking in paranoid thinking (Kinderman, 1998). The inability to understand another person’s perspective affects the paranoid person’s social interactions.


Although some symptoms of schizoid personality disorder and schizotypal personality disorder are similar to paranoid personality disorder, these disorders have different characteristics from each other (Carroll, 2009).

Schizoid personality disorder is characterized by social withdrawal. The person is far from close relationships and contact. They generally like to be alone. They are emotionally indifferent and cold. As in paranoid personality disorder, instead of doubting others, they have little or no interest in the outside world and interpersonal contact (Carroll, 2009).

Schizotypal personality disorder is characterized by avoidance of close relationships and inadequate interpersonal relationships. Unlike paranoid personality disorder, cognitive and perceptual distortions are common in these people. He has unrealistic beliefs and thoughts such as magical thinking, seeing the future, and believing that he has the power of telepathy.


Disorders with psychosis; brief psychosis disorder, schizophrenia (schizophreniform) disorder, schizophrenia, schizoaffective (schizoaffective) disorder. The most common symptoms in a person with this disorder are delusions (delusions) and hallucinations (hallucinations), a disorganized speech pattern (frequently drifting off topic or speaking incoherently), a disorganized behavior pattern, and negative symptoms (lack of emotion, emotional introversion). In schizoaffective (schizoaffective) disorder, these symptoms are accompanied by depression symptoms.

Common symptoms seen in all of these disorders are the presence of delusions and hallucinations. Hallucinations are not found in paranoid personality disorder.


Treatment Steps

Long Term Treatment Goals (Bernstein, 2007):

Recognizing and accepting fragile feelings

– Increasing awareness of feelings of self-efficacy

Developing a more trustworthy view of others

Ability to verbalize distress rather than avoiding others as intimidating

People with Paranoid Personality Disorder may show strong defense and aggression towards the therapist in treatment. In this case, what the therapist should do is to stay away from counter-reactions that will activate the client’s defense. The primary goal of the therapist should be to establish a close and empathetic relationship with the client and to display a supportive attitude. Another issue that the therapist must do is to set realistic therapy goals.

The therapist should avoid close physical contact with the client in the therapy environment and should give the client their own private space. Thus, the client will feel more comfortable. At the same time, one of the most important points that the therapist should pay attention to is to be aware of the client’s mood changes.

Methods used in the treatment of people with Paranoid Personality Disorder; Cognitive Behavioral Therapy (Beck, 2004), Individual Supportive Dynamic Psychotherapy (Gabbard, 2000) and Schema Therapy (Young, 2003). The core cognitive schema that is the most fundamental in the individual with paranoid personality disorder is the feeling of inadequacy, and therefore the first aim of treatment is to increase the individual’s sense of self-efficacy in the early stages. In parallel with this, social qualities such as communication and empathy should also be developed. In the next stages, what needs to be done is to ensure the change of malicious and suspicious / skeptical beliefs about others in the mind of the person. At this stage, the therapist and the client should cooperate and question the client’s dubious / skeptical beliefs. Suspicious beliefs are identified and their accuracy and compliance with reality are tested.

Another method used in the treatment of people with Paranoid Personality Disorder is drug therapy. The most important point in drug treatment is that the therapist has gained the trust of the patient. If the relationship of trust cannot be established, the patient will not respond to drug treatment. Depression and/or anxiety can be seen together in people with paranoid personality disorder. At this point, symptom-reducing drug treatment can be started with the cooperation of the client.

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