In order to gain a complete understanding of paranoid personality disorder one has to define the disorder by separating the terms. A person’s personality includes very distinct organization of traits that make them the different individuals they are. These traits include the way people behave, think, their attitude towards others which also determines the way they are perceived by others and the characteristics they portray (Venes, 2005). Any disturbances in these regular traits for long periods of time and fulfillment of certain criteria, which will be listed below, can be classified as a disorder.
Some experts believe that events occurring in early childhood may play a role in the way a person behaves in life. Others suggest that personality disorders occur as a result of being genetically predisposed to it. Personality disorders have also been linked to environmental factors. Personality disorders are grouped into clusters according to their traits. Paranoid personality disorder belongs to a cluster A group whose traits are said to be odd or eccentric (Hayward, 2007). According to Mohr in the book Psychiatric Mental Health Nursing, paranoid personality disorder is indicated by at least four of the following:
Suspicion without sufficient basis. The person feels that others are exploiting, harming, or deceiving them.
Preoccupation with unjustified doubts about the loyalty or trust worthiness of friends and associates.
Reluctance to confide in others because of unwarranted fear that they will maliciously use the information against them.
Reading of hidden demeaning or threatening meanings into benign remarks or events.
Perceive attacks on the character or reputation that are not apparent to others and angry reactions or counterattacks.
Have recurrent suspicions, without justification, about fidelity of spouse or partner.
These signs are serious enough to impair everyday functioning of the person. This paper will examine and explain different dimensions of paranoid personality disorder.
Clinical Features of Paranoid Personality Disorder
A person diagnosed with paranoid personality generally exhibits extreme suspiciousness, distrust, and is more than likely convinced that others intend to harm them. They tend to avoid socializing for these reasons. Misinterpretations are common for the person with this disorder for example they may think there may be a hidden criticism behind a compliment, or may take a joke as an insult. Aggressiveness and hostility may also be a sign exhibited in a person who has paranoid personality disorder. This is so because they persistently question motives and trustworthiness of others which might be threatening for them so there is a capability of becoming violent towards other. These habits they exhibit intern interferes with their ability to form meaningful relationships leaving them in an isolated situation with inabilities to function socially and in work situations. Other characteristics of people with paranoid personality include the fact that they tend to be very critical of others and develop negative stereotypes of others. Eden, Marcus & Morey (2009) summarized this by stating “Paranoid personality disorder is characterized by a pervasive pattern of mistrust of other people, frequently occurring in conjunction with a hostile interpersonal style, emotional coldness, hypersensitivity to criticism, and rigidly held maladaptive beliefs of others motives” (p. 545).
Nursing Diagnoses Interventions and Evaluation
Some of the most frequent nursing diagnosis for people with paranoid personality disorder includes the following: Disturbed thought processes, defensive coping, impaired social interaction, ineffective therapeutic regimen management, ineffective health maintenance, disturbed sleep pattern, risk for other directed violence and sometimes anxiety. To further discuss a few of these nursing diagnosis, alteration in thought processes usually is related to the person’s inaccurate interpretation of environmental stimuli, which results in feelings of suspicion and fear. The nurse will assist these patients by providing them with a non-threatening environment. When talking with the patient the nurse presents them with detailed information so as not to make them more suspicious. The nurse also finds out more about their feelings of fear or distrust and establish a trusting relationship with the person by listening, being genuine and honest at all times and show the patient acceptance. The main goal is for the patient to eventually demonstrate reality based thinking and act on these thinking rather than the paranoid ideas.
A client with a nursing diagnosis of impaired social interaction may avoid others, feel uncomfortable around others or refuse to communicate with others. The reason for this can be related to the client’s mistrust of other people due to the characteristics of the paranoid personality disorder. Some effective nursing interventions for this client would include, observing the client’s interactions with other clients and encourage the development of appropriate relationships with others. If client becomes hostile or abusive, the nurse may limit contacts to protect the client and others. Any attempts made by the client to interact with others must be recognized, the positive feedback may reinforce desired behavior in the client. The desired behavior the nurse hopes to achieve is the demonstration of ability to communicate effectively and interact with others.
Another important nursing diagnosis mentioned above is ineffective therapeutic regimen. The client may refuse to take medication, reluctant in taking care to get enough sleep, rest or even pay little attention to their nutrition. The nurse will assist this patient in establishing adequate balance of nutrition, rest and sleep. The patient will also comply with medication therapy. The corresponding interventions would include, giving the patient information about medications, such as, the side effects, the desired effect and how the medication will help them function better. Checking the client’s mouth after giving oral medication may also be necessary to ensure the patient did in fact ingest the medication. Since patients may believe you want to harm them discussing their treatment plan with them is very important. Monitoring the clients eating habits and sleeping pattern to ensure adequate balance is established is also important.
The nursing care of a person who is diagnosed as having a personality disorder is usually directed at the specific behavior, symptoms, and characteristics of the identified disorder. The main focus in treatment of individuals exhibiting signs of paranoid personality disorder is on symptom management and includes establishing a therapeutic rapport with the patient, enhancing their self esteem, helping to decrease their fears and suspicions, observing any suicidal ideations and assisting the patient in activities of daily living. Patient is also assisted in developing alternative ways of coping with stress, develop feelings of trust and comply with their medication regimen. It is the nurses’ duty to provide consistent care for the patient, provide a supportive and non judgmental environment and avoid situations that threaten or challenge the patient’s beliefs.
Many patients may disregard circumstances that lead to their hospitalization making it more difficult to make a diagnosis. While there are no labs test or imaging studies that can be used to diagnose paranoid personality disorder a complete assessment, medical history and physical examination can be performed. Responses obtained and behavior during an assessment interview can provide clues that may assist in identifying the disorder.
Treatment of paranoid personality disorders is difficult because of denial by the patient, the presence of suspicion and resistance therapy because of paranoid delusions (Shives 1986). The patient usually feels threatened by any personal contact required during the treatment. Some of the treatment includes antipsychotic, antidepressant, anti-anxiety drugs and individual psychotherapy. The treatment process will differ according to the severity of the disorder. Individual psychotherapy is usually the first choice of treatment for patients with paranoid personality disorder. According to Dimaggio, Catania, Salvatore, Carcione, & Nicolo (2006) one of the main problems with patients with paranoid personality disorder is maintaining a good therapeutic relationship. The journal further went on to say the use of psychotherapy in these patients requires a) identifying the dysfunctional relationship patterns which dominate the client’s transference. This requires active listening and observing. b) Avoid embodying the hostile character or appearing too wary; c) look for experiences one can share with a client and from these construct a new point of view of the world for patient; d) help client to gain awareness of their dysfunctional processes, distance themselves from them and adopt new positions. The purpose of the treatment is mainly to help the patient to cope and improve social skills and communication. When psychotherapy is ineffective and symptoms are extreme then the treatment is usually medication such as those listed above. Medication is also used if a patient suffers from any additional psychological problems for example depression or anxiety. It is important to note that no medication has been proven to effectively relieve the long term symptoms of the disorder and because of the suspicious nature of these patients it is proven very difficult to persuade them to take medications (Online Encyclopedia of Mental Disorders, 2009).
Evaluation, the last step in the nursing process is done to determine the effectiveness of the treatment that was done and to find out if patient goals were met. If goals were not met or treatment was not successful then the whole nursing process will begin again, but this time implementing different things to achieve patient goal.
Paranoid personality is a chronic disorder which in most cases will affect the patient for the rest of their lives. It cannot be prevented and the causes are not clearly known. It can be debilitating for some people and affect their everyday life while others can function fairly well with the disorder. Those struggling with personality disorders usually feel that the behaviors they portray re normal making it harder to intervene medically.