Couples therapy with a paranoid personality-disordered client

Paranoid personality disorder falls within the odd-eccentric cluster of personality disorders as described in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) (American Psychiatric Association, 1994), and the diagnosis has appeared in each version of the DSM (Fulton and Winokur, 1993). These individuals are characterized by being socially isolated and feeling alienated from others. In this respect, individuals with paranoid personality disorder, or the other personality disorders in the odd cluster, rarely present for couples or family therapy. Torgersen, Kringlen, and Cramer, (2001) completed the most thorough community prevalence survey of personality disorders in Oslo, Norway, and found that paranoid personality disorder was the second most common personality disorder after avoidant personality disorder. From their survey, the weighted prevalence of paranoid personality disorder was 2.4 percent. However, this prevalence is considerably higher than prevalence estimates that include results from American studies. Weissman (1993) concluded that paranoid personality disorder might be found in 0.4 to 1.8 percent of the general population. Regardless, this diagnosis is relatively common in inpatient psychiatric hospital settings, where it is estimated that 10 to 30 percent of patients meet criteria for paranoid personality disorder. In outpatient settings, it is estimated that approximately 10 percent of outpatients meet this diagnosis.