Paranoid personality disorder: a synthesis of developmental, dynamic, and descriptive features

Suspiciousness, feeling persecuted, and grandiosity constitute the classical triad associated with paranoid personality. However, a more important feature appears to be the discrepancy between the outer persona and the inner world of such individuals. The split is pervasive and involves self-concept, object-relations, affects, morality, sexuality, and cognitive style. Outwardly, paranoid individuals are demanding, arrogant, mistrustful, driven, unromantic, moralistic, and acutely vigilant towards the external environment. Internally, however, they are frightened, timid, self-doubting, gullible, inconsiderate, vulnerable to erotomania, and cognitively unable to grasp the totality of actual events. This way of conceptualizing the paranoid symptomatology is superior to ordinary check-list methods since it (1) links the phenomenological and psychostructural aspects of the condition, (2) helps in a more meaningful differential diagnosis of paranoid from other personality disorders, and most importantly, (3) hints at areas that require exploration in the psychotherapeutic management or psychoanalysis of such individuals.