Paranoid personality disorder

Introduction Paranoid personality is also called delusional personality. It refers to a kind of abnormal personality with extremely stubborn stubbornness as a typical feature. It is expressed as excessive concern for yourself, self-evaluation is too high, often blaming other people for causing frustration or tempting objective . It is one of 12 types of personality disorders in the 1980 Diagnostic Statistics Manual (DSM-III). According to the survey data, the number of people with paranoid personality disorder accounts for 5.8% of the total number of psychological disorders. Because such people are less self-aware, they have a negative attitude toward their partial implementation, and the actual situation may exceed this ratio.

Cause

(1) Causes of the disease

Personality refers to the overall mental activity (thinking, emotion, and behavior) pattern determined by genetics, that is, the innate quality of the individual and acquired development, acquisition, and organic integration. Personality characteristics can be expressed in social activities, dealing with interpersonal relationships, and can also be shaped and developed in social life practices. Such as mild or impatient temper, quick or slow response to things, honesty or falsehood, enthusiasm or indifference, trust or suspiciousness, obedience or aggressiveness, strictness or tolerance, self-esteem or inferiority, diligence or laziness, serious responsibility or sloppy Laissez-faire, conservative or radical, pragmatic or empty talk, slack or nervous, lonely or gregarious. From the perspective of physiological-psychological-social medical model, personality disorder is often formed by the following factors, in which the family psychological factors play a major role in childhood.

1. Biological factors: Italian criminal psychologist Rombroso has conducted a large sample survey of many criminal families, and found that many offenders have anti-social personality disorder, and the crime rate is much higher than other people. Some scholars have found that the proportion of personality disorder among the relatives with personality disorder is significantly higher than that of the normal population. Therefore, the genetic factors of personality disorder cannot be ignored. There are also reports of a higher rate of EEG abnormalities in people with personality disorders than normal people, suggesting that biological factors have a certain impact on personality disorders.

2. Psychological developmental influence: The psychological development process of young children is traumatized and has a significant impact on the development of personality. It is the main factor for the formation of personality disorder in the future. Common as follows:

(1) The deprivation of the mother's mother's love or father's love. Discarded or discriminated by stepfathers and mothers; parents and relatives are over-loving, making their self-centered ideas expand, and abnormally develop to despise school rules and social discipline. This provides a breeding ground for the development of antisocial personality disorder.

(2) If a child has the function of quickly eliminating the autonomic nervous system of fear response, it must have rapid, powerful and good acquired inhibition ability; on the contrary, if the autonomic nervous system is slow, the acquired inhibition ability is slow. And weak. Personality disorders and the autonomic function of the perpetrator are abnormal. It has been suggested that autonomic responsiveness is low and skin electrical recovery is slow, which can be used as a susceptibility to criminals and personality disorders.

(3) Child abuse and adolescent abuse lead to hatred and hostility to society or human psychology.

(4) Parents or other caregivers, kindergarten or primary school teachers have inadequate educational methods or expectations. Excessive coercion and reprimanding may cause mental stress or rebellious psychology and form a bad personality.

(5) Parents' own conduct or bad behavior has a great impact on children's personality development.

3. Bad social and environmental impacts: Unhealthy attitudes, irrational phenomena, and money worship in the society will affect the moral values of young people, and will lead to confrontation, anger, depression, self-destruction and other unhealthy psychology and develop into personality disorders.

At present, it is generally believed that the relationship between personality disorder and mental illness is: personality traits can become a susceptibility factor or incentive for mental illness; some personality traits are latent or residual manifestations of mental illness; personality disorder and clinical syndrome can have a common Quality and environmental background, both can coexist, but not necessarily the cause of the cause.

Europe, especially the psychiatrists in Germany and the United Kingdom, believe that personality disorders are closely related to neurosis. They emphasize that "persons diagnosed with neurosis, we can completely find the characteristics of pathological personality, and in people with morbid personality, "The characteristics of neurosis can also be found." "The symptoms of neurosis and the behavior of morbid personality can be considered a reaction, depending on the quality tendency on the one hand and the pressure in the environment on the other." The morbid personality is distinguished from the so-called neurotic personality."

Tolle (1996) pointed out that "personal disorder can show a large number of neurotic reactions, and many patients with neurosis also have personality disorders. There is no clear boundary between personality disorder and neurosis." The so-called "neuropathy personality" comes from the theory of psychoanalysis. Horney thinks that patients with neurosis are those whose behavior, emotions, mentality, and way of thinking are not normal. They are full of anxiety in the fierce competition and establish for fighting anxiety. The defense mechanism that comes up, this is the personality of neurosis.

Jasper believes that the symptoms of neurosis are abnormal personality, and the response to stress, that is, in normal cases, only behavioral (personal personality) is abnormal, and in the case of stress, neurosis responds, showing symptoms of neurosis. "Personal neurosis" refers to those individuals who are similar to the cause of neurosis, and whose patients may have no neurological symptoms. Freud speculates that the factors that determine the process of personality development are the causes of neurosis. Kolb (1973) pointed out that each neurosis has its own unique personality structure, which is often called personality neurosis. ICD-9 juxtaposes personality disorder with personality neurosis. This is not the case with ICD-10. At present, it is believed that although the relationship between personality disorder and neurosis is close, that is, personality disorder contributes to the occurrence of neurosis, and neurosis also contributes to the formation of personality disorder, and the chance of comorbidity is higher, but in essence, both Belong to different disease categories.

(two) pathogenesis

Personality disorder is clearly a heterogeneous collection, each type has a common pathogenic factor, and now only the general pathogenesis is described as follows:

1. Genetic factors: Certain aspects of personality or personality psychological characteristics are genetically affected. The single-oval twin study by Shields (1962) indicated that the twin-child personality test scores that were raised separately after birth were similar to those grown together. Can be supported. In addition, the results of the schizophrenia lineage study showed that the prevalence of schizophrenic personality disorder in the immediate relatives of the foster families was significantly higher than that of the control foster flocks (10.5% vs. 1.5%), and the prevalence of paranoid personality disorder was also significantly higher. In the control group (3.8% vs. 0.7%).

2. Body type Kretschmer (1936) created the theory of body type and temperament, but his conclusion comes from the subjective judgment of personality, and has no practical significance. Sheldon et al. (1940) applied more accurate measurement methods and modern statistical techniques. Although their research improved, they did not find a correlation between body type and personality.

3. Psychosocial factors

The study of personality biology based on objective diagnostic criteria and fixed-scale examinations has led to a significant increase in the credibility of personality disorder assessment. According to the four dimensions of cognition, emotion, impulsive control and anxiety regulation, personality disorder can be divided into four categories (Siever et al., 1991), which are respectively connected with mental illness, thus forming a pedigree concept:

1 cognitive/perceptual disorder is linked to schizophrenia and eccentric personality disorder (split type);

2 impulsive control is related to the type of performance (marginal, antisocial) personality disorder;

3 emotional instability and severe affective disorder and other performance types (marginal, performance) personality disorder are spectrally related;

4 Anxiety/depression (referring to an inhibition with anxiety) is associated with an anxiety disorder and an anxiety type (avoidance) personality disorder.

4. Cognitive/perceptual structural disorder

The disorder manifests in mental illness as thinking disorder, mental symptoms and social isolation. Minor barriers to cognitive control often occur in the form of quirks, special words, and social disengagement. The cognitive/perceptual structure is a ability to reflect a person's stimuli and attention to entry, and to process information according to his past experience and to appropriately select responses. Splitting personality disorder and schizophrenia belong to the two poles of this dimension band. The test of the attention/information process shows similar obstacles (Kendler et al., 1981). Eye movement dysfunction is not only seen in patients with chronic schizophrenia and their relatives (Holzman et al., 1984), but also in patients with schizophrenic personality disorder (Siever et al., 1984), and is associated with defective symptoms of schizophrenic personality.

Splitting personality, schizophrenia patients and their relatives can find visual or auditory attention damage, such as reverse masking test, continuous operation test, sensory sluice test, etc., the results are consistent with the defect symptoms. In the blood and cerebrospinal fluid of schizophrenia and schizophrenic personality, the dopamine metabolite HVA is increased.

5. Impulsive/aggressive impulsive impulsive control is characterized by a reduced ability to delay or inhibit movement, reflected in mental illness: such as intermittent outbreak disorder, pathological gambling or stealing; as long-lasting and severe impulsive qualities, Demonstrated as destructive behavior and antisocial behavior, such as marginal and antisocial personality disorder. Claridge (1985) found that cortical inhibition and alertness were reduced in socially ill patients, with more slow waves in the EEG and a lower sedation threshold.

Psychophysiological studies have found that impulsive and socially ill patients have reduced ability to suppress motor responses, sympathetic responses are diminished, and skin electrical responses are rapidly formed (Hare, 1978). Animal studies have shown that the serotoninergic system mediates behavioral inhibition and the serotoninergic system is destroyed, leading to a reduction in disciplinary behavior. Similar findings were found in suicide attempters (Asberg et al., 1987), violence and aggressive behavior (Brown et al., 1982). Decreased prolactin response to seroflurane, a serotoninergic releaser, in patients with borderline personality disorder suggests a decrease in serotoninergic function in such individuals (Coccaro et al., 1990). Drugs that enhance serotonergic function can improve or mitigate criminal aggressiveness and suicidal behavior (Meyendorff et al., 1986; Sheard et al., 1976). Norepinephrine (NE) is hyperactive in patients with personality disorder, and its growth hormone response to NE agonist: clonidine (clocite) is also increased, in addition to elevated levels of metabolites (Coccaro, 1991). It is known that the NE system mediates the alertness and orientation of the environment, strengthens the NE activity, and can increase the outward aggressiveness. Attacks are prone to occur when NE activity is enhanced and 5-HT activity is reduced (Hodge et al., 1975).

6. Emotional instability

This type of condition is characterized by changes in mood and intensity. Affective disorders manifest as persistent and endogenous disorders. Very short-lived emotional fluctuations related to the environment are seen in borderline personality disorder. Emotional instability is a major feature of borderline personality disorder, and many of these patients later developed into a state of depression (Silverman et al., 1991; Zanarini et al., 1988; Links et al., 1988). Among relatives of patients with borderline personality disorder, the incidence of emotionally unstable personality is higher (Silverman et al., 1991). Data from biological studies suggest that affective disorder is associated with emotionally unstable or marginal personality, both of which show a shortened REM latency and a variable latency; the response to the muscarinic agonist arecoline is further REM The latency is shortened (Nurnberger et al., 1989; Bell et al., 1983); the DST test shows de-inhibition; the NE energy system is too reactive (Suhulz et al., 1988).

7. Anxiety / inhibition

In the event of unpleasant consequences, fear and autonomic alert thresholds are reduced, often accompanied by behavioral inhibition. Anxiety disorders, forced rituals, or fear and avoidance groups of personality disorders have the above characteristics. There are few studies linking avoidance group personality disorder with mental illness. Some studies have shown that anxiety/inhibition populations show higher levels of cortical and sympathetic alertness, lower sedation thresholds, and reduced habituation of new stimuli (Claridge, 1985; Gray, 1982; Kagon, 1988).

In short, psychobiology research has evolved along a number of personality disorders related to some mental illnesses. The relationship between personality disorder and mental illness is still under discussion. The following opinions exist:

1 certain personality characteristics increase the susceptibility of some mental illnesses and induce them;

2 Some personality traits are the hidden manifestations of some mental illness or their residues;

3 Personality characteristics and clinical syndromes are not yet clear, but they are the common background and environmental impact;

4 The simultaneous occurrence of personality disorder and clinical syndrome is purely coupled, and there is no etiology connection between the two.

8. Psychosocial factors

As we all know, family upbring can affect the development of normal personality, but how much do these effects play a role in the configuration of abnormal personality? And what is the nature of abnormal personality configuration? There is still little understanding. Unreasonable parenting during childhood can lead to the morbid development of personality. Children's brains have greater plasticity, and some personality tendencies can be corrected through normal education. If you let them go, you can develop abnormal personality. The family environment is also vital. Any parent who is not jealous, often quarrels, or even separates or divorces will have a negative impact on the child's personality development. The way parents educate their children is also a factor that affects the normal development of personality. Rough and fierce, indulgence of love and excessive demand are not conducive to the formation and development of personality.

an examination

Related inspection

Brain CT examination blood routine

Symptom standard

The behavior is significantly different from the social culture in which the individual is located, and the behavior is consistent with the following three items:

1. There are special behavior patterns: manifested in emotions, alertness, impulsive control, perception and way of thinking, and have distinct attitudes and behaviors.

2, has a special behavior pattern is long-term, continuous, not limited to the onset of mental illness.

3. Its special behavioral patterns are universal, resulting in poor social adaptation.

Severity criterion

The severity criteria must be consistent with one of the following two:

1. Social or professional functions are significantly impaired.

2, subjectively feel pain.

Disease standard

Beginning in childhood, adolescents or early adulthood, now 18 years of age or older (under 18 years of age who meet the above criteria are usually not diagnosed as a personality disorder, but may be diagnosed with other types of disorders).

Exclusion criteria

Personality disorder is not caused by the following diseases:

1. Serious physical illness.

2. Brain organic diseases.

3, mental illness: such as schizophrenia, affective psychosis.

4. Severe or catastrophic mental stimulation.

Differential diagnosis

Differential diagnosis of paranoid personality disorder:

(1) schizophrenia personality disorder: schizoid personality disorder (shut-in personality, Hoth, 1913) or introversion (autism, Bleuler E, 1950). It usually begins to exist long in early childhood. The main manifestations are retreat, loneliness, silence, concealment, no love for communication; lack of emotion and indifference, not only can not experience joy, but also lack of warmth, lack of hobbies; excessive sensitivity and shyness, timidity, quirks, praise and criticism Poor response; not losing the ability to recognize reality, but often showing isolated behavior, tending to daydream and introspective concealment; poor ability to move, lack of initiative. Take a non-interventional attitude towards interpersonal relationships; lack sexual interest; lack of intimate and close friends.

(2) Antisocial personality disorder is the most serious type of personality disorder in society. More common in men. Such personality disorder is characterized by a high degree of aggression, lack of shyness, inability to learn from experience, behavior driven by accidental motivation, social maladaptation, etc., but these are relative.

(3) Impulsive personality disorder: also known as aggressive personality disorder. ICD-10 divides emotionally unstable personality disorder into impulsive and marginal types, both of which are characterized by impulsiveness and lack of self-control. The main characteristics of impulsive type are emotional instability and lack of impulse control. Outbreaks of violence or threatening sex are common, especially when others criticize them. Such people often burst into very strong anger and impulsiveness due to minor stimuli. They can't restrain themselves at all. When they can violently attack, they can experience happiness, satisfaction or relaxation. These sudden emotions and behaviors Change and peace are different. They are normal when they are not attacking, and feel remorseful about what they did during the attack, but they cannot prevent recurrence. This impulse episode is also often caused by a small amount of alcohol.

(4) Histrionic personality disorder: also known as attention-seeking personality disorder or hysterical personality disorder. It is a type of personality disorder characterized by highly emotional and exaggerated behaviors that attract attention. It is generally believed that women are more common and can gradually improve with age.

This type can coexist with borderline personality disorder. Mainly manifested as immature personality and emotional instability, often with self-acting, excessive pretentious and exaggerated behavior attracting attention; suggestive and dependent are particularly strong, self-indulgent, not considered for others, showing a high degree of self-centered; extreme emotions Sexuality, emotional change, irritability; superficial emotions, difficult to maintain long-lasting social connections with the surrounding; long-cherished desire to understand and evaluate, feel vulnerable, highly imaginative, often imagine as a reality; constantly pursue Stimulating, can't stand loneliness, hope that life is as lively and uninteresting as acting; appearance and behavior show inappropriate provocativeness, dress up and show off, even flirting, tempting people, but sexual life is passive, although sometimes experience sex, It is often sexy lacking; words, manners and behaviors may be similar to children, and emotions are immature. The relationship between this kind of person and snoring is not as close as it was imagined. The pre-existing personality of snoring is only 20% of the performance type, while the very serious performance personality disorder can not cause snoring for life. Performance personality can also be a pre-existing feature of mental illness such as depression and anxiety.

(5). Obsessive-compulsive personality disorder (anankastic personality disorder): characterized by excessive requirements and perfection. Men are 2 times more than women. The characteristics of such people are inert, hesitant, skeptical and step-by-step. They demanded themselves with the highest standards of perfection, hoping that the things they did were perfect, repeated tests afterwards, and demanding details. For this they express anxiety, nervousness and distress.

Their moral sense is too strong, too self-restraint, excessive self-concern and strong sense of responsibility, often expressed as being too strict, too high, behave according to the rules, step by step, can not be changed, otherwise they feel anxious and affect their work efficiency. Usually stick to the details, be careful, even program the life section, some are good and clean, if you do not follow the requirements, you feel uneasy or even redo; too cautious about your own safety, often insecure, often poor Think twice or repeatedly, carry out repeated inspections and checks on the plan, lest there are negligence or mistakes, and the thoughts are not slack; plan all actions in advance, and consider too detailed; excessively pedantic, rigid; subjective, more authoritarian, require others I must also act according to his methods, otherwise I will feel unpleasant, often do not worry about doing things to others; often hesitate when I need to solve problems, postpone or avoid making decisions; often too frugal, even embarrassed; excessive indulging in duties and responsibilities Standardization, strong sense of responsibility, excessive work, less hobbies, lack of social friends Dealings. After work, there is often a lack of pleasant and satisfying inner experience. On the contrary, there is often remorse and guilt. Although such people can get a stable marriage and achieve success in their work, there are very few friends.

(6). Other personality disorder

(1) cyclothymic personality disorder: also known as affecitve personality disorder, more common in women. This type includes two subtypes of emotional growth, emotional depression or depression. People with emotional growth are emotionally high, full of confidence and joy, ambitious, energetic, enthusiastic, optimistic, eager, and eager to do things. They often make a lot of plans and ideas, but not all are well thought out. On the contrary, people with low emotions are depressed, pessimistic, frowning, lack of self-sufficiency, lack of confidence, ignorance, and difficulty in finding things; cyclical personality disorder is alternating with good mood and sadness. For the sake of character, this conversion is not caused by external factors. 30% to 80% of patients with bipolar disorder are circulatory personality before the disease. This personality disorder usually occurs in adolescents. The degree/duration of the mood is high or low and the frequency of the cycle is different, but it increases with age, which is different from other types of personality disorder. In the middle of the middle of the year, mood fluctuations should occur, and attention should be paid to the possibility of organic diseases.

(2) Borderline personality disorder: The main characteristics are high impulsiveness, emotional instability, interpersonal tension and instability, identity recognition disorder, self-injury behavior, persistent emptiness and boredom, which is easy to cause Sudden psychosis. ICD-10 (1992) pointed out that in addition to expressing emotional instability, marginal personality disorder is often ambiguous or distorted. The sense of emptiness is common, often involved in strong and extremely unstable interpersonal relationships, which may lead to a continuous emotional crisis, trying to avoid being abandoned, and attempting suicide. Marginal personality is associated with affective illness. Marginal personality may be a variant of primary affective disease. Marginal personality and affective psychosis have a high rate of concomitantness. Marginal personality is often hospitalized in an emergency when there is a bad mood or self-injury. At this time, symptoms similar to depression can be found. Depression is common in marginal personality and antisocial personality. Although the marginal personality has been widely studied by psychiatrists in the United States, Britain, and Northern Europe, Chinese psychiatrists feel that the concept of marginal personality disorder is unfamiliar and vague and has not been formally applied.

(3) inadequate personality disorder (also known as passive personality disorder), characterized by a lack of effective response to social interactions and emotional stimuli. Their lack of ability, lack of planning, instability, poor judgment, and inability to adapt to the challenges of life, but the examination can not find any physical or mental defects. They do not argue with the people around them, and cannot establish close relationships with people, so they are often ignored in the crowd. Inappropriate personality disorder is more commonly used in the UK, but Oxford University psychiatrist Gelder (1983) suggests avoiding this name because it is not only derogatory, but rather than telling them how to adapt to life in detail. appropriate.

(4) Dependent personality disorder: A unique type of personality disorder that attaches one's needs to others. More common in women. This type of person is characterized by lack of self-confidence and inability to act independently. It is often impossible to make daily decisions without repeated advice or assurance. It is generally difficult to take the initiative to determine the plan and prefer to place himself in a subordinate position. It is decided that for children or adolescents, food, clothing, housing and leisure time arrangements must be made by parents; because they cannot live independently, they are allowed to take responsibility for the main aspects of their lives, and the careers of women are determined by their spouses. In order to get help from others, they need someone to be at their side, and feel great discomfort when they are alone. When disconnected or intimate with a close person, the patient feels helpless or anxious, feeling lonely and helpless and clumsy. The reason is multi-factorial, social and cultural, psychosocial factors are of great significance. Some people think that in the early childhood, when they do something independently, they are often rebuked or punished by their parents or subject to excessive restrictions, resulting in childrens autonomous behavior. The pattern may never be established. It may coexist with anxiety, performance, and dissociative personality disorder.

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