Evolutionary systems therapy for paranoid personality disorder: A seven cases series.

Little is known about effective psychosocial treatments for paranoid personality disorder. This study explores the feasibility of a novel treatment, namely Evolutionary Systems Therapy, in supporting individuals diagnosed with paranoid personality disorder. Seven patients attended 10 months of individual therapy without receiving any psychopharmacological treatment. The primary outcome was the feasibility of the intervention, while the secondary outcomes were remission from the diagnosis and reliable changes in personality pathology and paranoid ideation. All recruited patients completed the intervention and did not report any adverse events. Six out of seven patients experienced remission from the diagnosis of paranoid personality disorder. All participants showed reliable changes in personality pathology and paranoid ideation, which were maintained at the 1-month follow-up. Further research is needed to confirm these encouraging results.

Connectome-based predictive modeling predicts paranoid ideation in young men with paranoid personality disorder: a resting-state functional magnetic resonance imaging study.

Paranoid personality disorder (PPD), a mental disorder that affects interpersonal relationships and work, is frequently neglected during diagnosis and evaluation at the individual-level. This preliminary study aimed to investigate whether connectome-based predictive modeling (CPM) can predict paranoia scores of young men with PPD using whole-brain resting-state functional connectivity (rs-FC). College students with paranoid tendencies were screened using paranoia scores ≥60 derived from the Minnesota Multiphasic Personality Inventory; 18 participants were ultimately diagnosed with PPD according to the Diagnostic and Statistical Manual of Mental Disorders and subsequently underwent resting-state functional magnetic resonance imaging. Whole-brain rs-FC was constructed, and the ability of this rs-FC to predict paranoia scores was evaluated using CPM. The significance of the models was assessed using permutation tests. The model constructed based on the negative prediction network involving the limbic system-temporal lobe was observed to have significant predictive ability for paranoia scores, whereas the model constructed using the positive and combined prediction network had no significant predictive ability. In conclusion, using CPM, whole-brain rs-FC predicted the paranoia score of patients with PPD. The limbic system-temporal lobe FC pattern is expected to become an important neurological marker for evaluating paranoid ideation.

A Case Report of Leukocytosis During Modified Electroconvulsive Therapy of Paranoid Personality Disorder.

Introduction: Modified electroconvulsive therapy (MECT) is a viable therapeutic option for patients with mood disorders and schizophrenia. We found that there is a relationship between MECT and leukocytosis. To the best of our knowledge, this is the first case of this problem. There are no relevant guidelines recommending the risk of leukocytosis caused by MECT, nor the method to reduce the risk. We hope to share this case to provide a reference for the prevention and treatment of similar patients with leukocytosis during or after MECT and remind psychiatrists to pay attention to this risk of leukocytosis before making the decision of MECT while knowing how to deal with it. Case presentation: We describe a case of a 24-year-old woman diagnosed with Paranoid personality disorder (PPD) whose symptoms began at 19 years old. Her main clinical manifestations are feeling targeted, cheated, tracked, misunderstood, and repeating action. Since antipsychotic treatment was ineffective, we considered MECT. After MECT, the patient's body temperature increased, and leukocytosis was found. After excluding infection and other possibilities, we added 1,000 ml physiological saline to the patient through the vein. The white blood cell (WBC) count returned to normal in a short time. Conclusion: Before MECT, it is necessary to screen blood cytology. During and after MECT, we should be alert to leukocytosis that may be related to MECT and deal with it correctly in time.

A case study on a severe paranoid personality disorder client treated with metacognitive interpersonal therapy.

Paranoid personality disorder (PPD) is a severe condition, lacking specialized and empirically supported treatment. To provide the clinician with insights into how to treat this condition, we present a case study of a 61-year-old man with severe PPD who presented with ideas of persecution, emotionally charged hostility, and comorbid antisocial personality disorder. The client was treated with 6 months of Metacognitive Interpersonal Therapy, which included: creating a shared formulation of his paranoid attitudes; trying to change his inner self-image of self-as-inadequate and his interpersonal schemas where he saw the others as threatening. Guided imagery and rescripting techniques, coupled with behavioral experiments, were used to promote a change. At the end of the therapy the client reported a reliable change in general symptomatology and, specifically, in interpersonal sensitivity, hostility, and paranoid ideation; he could no longer be diagnosed as PPD and only some paranoid and antisocial characteristics remained.

Alcohol Consumption And Intensification Of Paranoid Traits In Attempted Homicide

@#There is strong evidence that paranoia can be an existing trait in the general population as a continuous dimension ranging from minimal levels to paranoid personality traits, and that at its maximum expression could take the form of disabling psychotic disorders such as delusional disorder or schizophrenia however, and according to Caviedes, GEC and Yonfá, EDA. Here are studies in which the existence of comorbidity between paranoid, borderline, antisocial and histrionic personality and problematic alcohol consumption is mentioned which in psychopathological terminology is called dual pathology (comorbidity of mental disorder and toxic consumption).

Effects of interaction of NOS1AP gene polymorphisms and childhood abuse on paranoid personality disorder features among male violent offenders in China.

BACKGROUND: Paranoid Personality Disorder (PPD) results from a complex synergy between genetic and environmental factors. Childhood abuse is one of risk factors. Nitric Oxide Synthase 1 Adaptor Protein (NOS1AP) is a candidate gene of schizophrenia, which has similar pathophysiology to PPD. This study investigated the role of NOS1AP gene polymorphisms and a history of childhood abuse in predicting PPD features among male violent offenders in the Chinese Han population. METHOD: Four NOS1AP Single Nucleotide Polymorphisms (SNPs), rs4145621, rs3751284, rs348624 and rs6680461 were genotyped in a sample of 423 male prisoners. Participant evaluations included demographic information, measures of childhood abuse (Child Trauma Questionnaire, CTQ), and PPD features (Personality Diagnostic Questionnaire-4, PDQ-4). Participants were divided into a PPD group and non-PPD group assessed by PDQ-4. RESULTS: Regression analysis revealed that emotional abuse, NOS1AP SNPs rs348624 and rs4145621 predicted PPD features (P < 0.05) among prison samples. Significant interactions between childhood abuse history and NOS1AP SNPs rs3751284 and rs6680461 were also observed. Individuals carrying the C allele of rs3751284 were susceptible to PPD features when exposed to higher levels of emotional neglect (P < 0.05); Individuals with the G allele of rs6680461 were susceptible to PPD features when exposed to higher levels of emotional, physical and sexual abuse (P < 0.01). CONCLUSIONS: These results suggest that the interaction between childhood abuse and NOS1AP gene polymorphisms may have an influence on PPD features, at least in male violent offenders.

Development of two psychological experience questionnaires for screening violence-related mental health disorders of non-psychiatric inpatients.

BACKGROUND: Increased violent events happen in the general hospitals in China and yet non-psychiatric departments do not have tools for violence-tendency screening. METHODS: The current study developed and evaluated two Inpatient Psychological Experience Questionnaires (IPEQs) for the screening of violence-related six mental health disorders: (Inpatient Psychological Experience Questionnaire-1 (IPEQ-1): anxiety, depression and suicidality; Inpatient Psychological Experience Questionnaire-2 (IPEQ-2): paranoid personality disorder, emotionally unstable personality disorder and histrionic personality disorder). Two initial IPEQs (IPEQ-1: 37 items and IPEQ-2: 30 items) were developed and assessed by domain experts. Then 1210 inpatients were recruited and divided into three groups (160, 450 and 600 samples, respectively) for IPEQs item selection and evaluation. During the two-stage item selection, three statistical methods including Pearson's correlation coefficient, exploratory factor analysis and item response theory were applied. For the item evaluation, Cronbach's alpha coefficient, test-retest reliability, criterion-related validity and construct validity of the final questionnaires were measured. RESULTS: Twelve items were selected for each IPEQs. Cronbach's alpha coefficients were 0.91 and 0.78 for IPEQ-1 and IPEQ-2, respectively. Test-retest replication ratios were 0.95 and 0.87 for IPEQ-1 and IPEQ-2, respectively. Correlation coefficients between different disorders and their related-tools scores were [0.51, 0.44] and [0.40, 0.44] for IPEQ-1 and IPEQ-2, respectively and were significant (P < 0.01). Confirmatory factor analysis supported the validity of the final IPEQs (P < 0.05), and the model fit index met the criterion generally. CONCLUSION: The IPEQs developed in this study could be effective and easy-to-use tools for screening inpatients with violence-intendancy in non-psychosomatic departments.

[Paranoid personality disorder and criminal offense]. / Trouble de personnalité paranoïaque et infractions pénales.

BACKGROUND: Currently, all of the studies that focus on the relationship between paranoia and criminal offenses exclusively concern subjects suffering from a delusional paranoid disorder. However, subjects with single paranoid personality disorder, without any associated delusional disorder, are not uncommon in forensic practice. OBJECTIVES: This study aims to describe the offenses committed by subjects suffering from a single paranoid personality disorder and to compare them with the offenses committed by the subjects affected by a paranoid delusional disorder associated with paranoid personality disorder. Our initial hypothesis is that both populations have a comparable criminological profile. METHODS: Based on a 17 year-long experience carried out in the framework of a forensic assessment, we have selected all subjects presenting a paranoid personality disorder, whether single or associated with paranoid delusional disorder. The selected individuals were divided into two groups according to whether they presented paranoid delusional disorder or not. The offenses were grouped into criminal categories. The alpha risk was fixed at 1%. Data analysis is done by SAS software version 9.4. RESULTS: In a sample of 106 subjects presenting a paranoid personality disorder, including 4 women and 102 men, we found 79 subjects with a single paranoid personality and 27 with an associated paranoid delusional disorder. The average age at the time of the offense was 41 for those with single personality disorders and 49 for those with paranoid delusional disorders. Both groups had forensic antecedents (41%, 11/27 of paranoid delusional disorder and 51%, 40/79 of single paranoid personality disorder). Psychiatric history was more frequent in the paranoid delusional disorder group (59%, 16/27) than in the single paranoid personality disorder group (13%, 10/79). History of addiction was comparable in terms of alcohol abuse (26% in both groups) and other substances (7.5%, 2/27 of paranoid delusional disorder and 9%, 7/79 of single paranoid personality disorder). Comparison of the two groups highlighted significant differences in the type of criminal offenses committed (Fisher's exact test: P=0.0003, alpha risk <0.0001). The offenses committed by delusional authors essentially came down to verbal or physical violence, including homicide (44%, 12/27), and were usually focused on a designated persecutor. Sexual violence was rare. On the other hand, paranoid personality disorder was associated with a wider variety of offenses. Sexual offenses (including 28 rapes, 35%, 28/79) were thus almost as frequent as murder, and attempted murder (38%, 30/79). This diversity of committed offenses was found in their forensic antecedents. In these subjects, the logic of omnipotence may had over ruled the logic of revenge. CONCLUSION: We conducted a retrospective study on 106 subjects with paranoid personality disorder, including 27 subjects with associated paranoid delusional disorder. The comparison of the two groups demonstrated significant differences in offenses. Verbal and physical but non-sexual violence, committed in a delusional logic, was found among delusional subjects, while the forms of violence were more multiform in the single paranoid personality disorder group, frequently including sexual violence. This is, as far as we know, the first study describing the medico-legal acting-out of paranoid personalities. These results, which will need to be confirmed by future studies, point out the importance of the criminological risk that may be associated with paranoid personality disorder, without any associated delusional disorder.

Clinical cut-off point for the Distrust dimension of the Dimensional Clinical Personality Inventory 2 (IDCP-2).

The Clinical Dimensional Personality Inventory 2 (IDCP-2) is a 206-item self-report tool developed for the assessment of 12 dimensions (divided into 47 factors) of personality pathology. One of the scales comprising the instrument, the Distrust scale, is intended to provide psychometric information on traits closely related to the Paranoid Personality Disorder (PPD). In the present research, we used the Item Response Theory and the Receiver Operating Characteristic curve analysis to establish a clinical meaningful cutoff for the Distrust scale. Participants were 1,679 adults, among outpatients diagnosed with PPD, outpatients diagnosed with other PDs, and adults from the community. The Wright map revealed that outpatients were located at the very high levels on the latent continuum of the Distrust scale, with a very large effect size for the mean difference between patients and non-patients. The ROC curve supported a cutoff at -1.00 score in theta standardization which yielded 0.87 of sensitivity and 0.54 of specificity. Findings from the present investigation suggest the IDCP-2 Distrust scale is useful as a screening tool of the core features of the PPD. We address potential clinical applications for the instrument and discuss limitations from the present study.

Gene expression study of mitochondrial complex I in schizophrenia and paranoid personality disorder.

OBJECTIVES: The aetiology and molecular mechanisms of schizophrenia (SCZ) and paranoid personality disorder (PPD) are not yet clarified. The present study aimed to assess the role of mitochondrial complex I and cell bioenergetic pathways in the aetiology and characteristics of SCZ and PPD. METHODS: mRNA levels of all genomic and mitochondrial genes which encode mitochondrial complex I subunits (44 genes) were assessed in blood in 634 SCZ, 340 PPD patients and 528 non-psychiatric subjects using quantitative real-time PCR, and associated comprehensive psychiatric, neurological and biochemical assessments. RESULTS: Significant expression changes of 18 genes in SCZ patients and 11 genes in PPD patients were detected in mitochondrial complex I. Most of these genes were novel candidate genes for SCZ and PPD. Several correlations between mRNA levels and severity of symptoms, drug response, deficits in attention, working memory, executive functions and brain activities were found. CONCLUSIONS: Deregulations of both core and supernumerary subunits of complex I are involved in the aetiology of SCZ and PPD. These deregulations have effects on brain activity as well as disorder characteristics.

Mistrustful and Misunderstood: A Review of Paranoid Personality Disorder.

PURPOSE OF REVIEW: Paranoid Personality Disorder (PPD) has historically been neglected by science out of proportion to its prevalence or its association with negative clinical outcomes. This review provides an update on what is known about PPD regarding its prevalence, demographics, comorbidity, biological mechanism, risk factors, and relationship to psychotic disorders. RECENT FINDINGS: PPD has long been the subject of a rich and prescient theoretical literature which has provided a surprisingly coherent account of the psychological mechanism of non-delusional paranoia. Available data indicate that PPD has a close relationship with childhood trauma and social stress. Descriptive data on a sample of 115 individuals with Paranoid Personality Disorder is examined in comparison with a group of individuals with Borderline Personality Disorder. The descriptive data largely confirm previously identified relationships between Paranoid Personality Disorder and childhood trauma, violence, and race. We identify important similarities to and differences from Borderline Personality Disorder. SUMMARY: PPD continues to be an important construct in the clinic and the laboratory. Available data lead to a reconsideration of the disorder as more closely related to trauma than to schizophrenia.

Review of pharmacologic treatment in cluster A personality disorders.

INTRODUCTION: A personality disorder is a pervasive and enduring pattern of behaviors that impacts an individual's social, occupational, and overall functioning. Specifically, the cluster A personality disorders include paranoid personality disorder, schizoid personality disorder, and schizotypal personality disorder. Patients with cluster A personality disorders tend to be isolative and avoid relationships. The quality of life may also be reduced in these individuals, which provokes the question of how to treat patients with these personality disorders. The purpose of this review is to evaluate the current literature for pharmacologic treatments for the cluster A personality disorders. METHODS: A Medline/PubMed and Ovid search was conducted to identify literature on the psychopharmacology of paranoid personality disorder, schizoid personality disorder, and schizotypal personality disorder. There were no exclusions in terms of time frame from article publication or country of publication, in order to provide a comprehensive analysis; however, only articles that contained information on the cluster A disorders were included. RESULTS: Minimal evidence regarding pharmacotherapy in paranoid and schizoid personality disorders was found. Literature was available for pharmacologic treatment of schizotypal personality disorder. Studies evaluating the use of olanzapine, risperidone, haloperidol, fluoxetine, and thiothixene did yield beneficial results; however, treatment with such agents should be considered on a case-by-case basis. DISCUSSION: Most of the literature analyzed in this review presented theoretical ideas of what may constitute the neurobiologic factors of personality and what treatments may address these aspects. Further research is needed to evaluate specific pharmacologic treatment in the cluster A personality disorders. At this time, treatment with pharmacologic agents is based on theory rather than evidence.

Cluster A personality pathology in social anxiety disorder: a comparison with panic disorder.

BACKGROUND: Social anxiety disorder (SAD) has been associated with cluster A personality disorder (PD) traits, mainly paranoid and schizoid traits. AIM: The aim of the study was to further investigate cluster A personality pathology in patients with SAD. METHODS: Self-reported PD traits were investigated in a clinical sample of 161 participants with SAD and in a clinical comparison group of 145 participants with panic disorder with or without agoraphobia (PAD). RESULTS: A diagnosis of SAD was associated with more paranoid and schizotypal PD traits, and an association between depression and personality pathology could indicate a state-effect of depression on PD traits. CONCLUSIONS: Patients with SAD had more cluster A personality pathology than patients with PAD, with the most solid indication for paranoid personality pathology.

Treatment of paranoid personality disorder with cognitive analytic therapy: a mixed methods single case experimental design.

UNLABELLED: Paranoid personality disorder (PPD) presents as chronic and widespread interpersonal distrust, whereby the actions of others are interpreted as malevolent and malicious. This research details the assessment, formulation and treatment of a case of PPD within a 24-session contract of cognitive analytic therapy (CAT). The outcome methodology was an A/B with extended follow-up single case experimental design (SCED). The SCED was supplemented with qualitative patient interviewing via the Change Interview regarding their experience of CAT, whether change had taken place and detailing of any identified change mechanisms. Quantitative results show that five out of the six daily rated paranoia target complaint measures were extinguished during the treatment phase. Qualitatively, the patient attributed change to the therapy conducted. The results suggest that CAT was an effective intervention in this case of PPD and are discussed in terms of identified methodological shortcomings, treatment implications and the potential for generating a convincing evidence base for the psychotherapy of PPD. KEY PRACTITIONER MESSAGE: Narrative reformulation using a CAT model offers a key opportunity for the patient to achieve a new understanding of their paranoia. Psychotherapy for PPD requires a cognitive component, within a boundaried and relational therapy, that is able to reflect on paranoid enactments and ruptures within the therapeutic relationship.There is a large role for clinician-researchers in developing a PPD outcome evidence base.

Vocational functioning in schizotypal and paranoid personality disorders.

Impaired vocational functioning is a hallmark of schizophrenia, but limited research has evaluated the relationships between work and schizophrenia-spectrum personality disorders, including schizotypal (SPD) and paranoid personality disorder (PPD). This study compared employment history and job characteristics of 174 individuals drawn from the community or clinic, based on four personality disorder groups: SPD Only, PPD Only, SPD+PPD, and No SPD or PPD. Symptoms and cognitive functioning were also assessed. Both PPD and/or SPD were associated with lower rates of current employment, and a history of having worked at less cognitively complex jobs than people without these disorders. Participants with PPD were less likely to have a history of competitive work for one year, whereas those with SPD tended to have worked at jobs involving lower levels of social contact, compared with those without these disorders. When the effects of symptoms and cognitive functioning were statistically controlled, PPD remained a significant predictor of work history, and SPD remained a significant predictor of social contact on the job. The findings suggest that impaired vocational functioning is an important characteristic of SPD and PPD.

Síndrome referencial olfatorio (SRO): a propósito de un caso / Olfactory Reference Syndrome (ORS): Presentation of a Case

Paciente de 34 años que, tras un continuo de visitas médicas a diferentes especialidades, consulta en la unidad de psiquiatría por bullying (acoso escolar). El principal motivo de acoso, exclusión y burla es el olor corporal que desprende. La remisión de informes de otras especialidades nos indica que queda descartada cualquier afección dermatológica y ninguna de las otras enfermedades propuestas por la paciente. La entrevista clínica psiquiátrica, así como la utilización de otras técnicas de evaluación y diagnóstico, nos sugirió la realización de un diagnóstico diferencial entre el cuadro obsesivo compulsivo y la psicosis monosintomática.

A 34 year old patient who was seen in the Harassment Psychiatry Unit after a series of medical visits to different specialties. The main reason for his harassment, exclusion and derision was due to his body odor. The reports issued by the other specialties ruled out any dermatological pathology, and any of the other conditions proposed by the patient. The psychiatric clinical interview, including the use of other evaluation and diagnostic techniques, suggested a differential diagnosis between a compulsive obsessive picture and mono-symptomatic psychosis.

[Olfactory Reference Syndrome (ORS): Presentation of a Case]. / Síndrome referencial olfatorio (SRO): a propósito de un caso.

A 34 year old patient who was seen in the Harassment Psychiatry Unit after a series of medical visits to different specialties. The main reason for his harassment, exclusion and derision was due to his body odor. The reports issued by the other specialties ruled out any dermatological pathology, and any of the other conditions proposed by the patient. The psychiatric clinical interview, including the use of other evaluation and diagnostic techniques, suggested a differential diagnosis between a compulsive obsessive picture and mono-symptomatic psychosis.

Anatomía de una confusión: error diagnóstico de patología paranoide en víctimas de mobbing: [revisión] / Anatomy of a misunderstanding: wrong diagnosis of paranoid pathology in victims of mobbing: [review] / Anatomia de uma confusão: erro diagnóstico de patologia paranoide em vítimas de mobbing: [revisião]

CONTEXTO: Diversas investigaciones subrayan el alto riesgo de error diagnóstico de trastorno delirante y trastorno paranoide de la personalidad entre víctimas de mobbing o acoso psicológico en el trabajo (APT). OBJETIVO: Analizar hasta qué punto los síntomas asociados con el mobbing son confundidos con criterios de dos nosologías del espectro paranoide (trastorno delirante y trastorno paranoide de la personalidad). MÉTODOS: Se realiza una revisión bibliográfica desde 1990 hasta Junio de 2009 en PubMed y SciELO. RESULTADOS: La identificación de síntomas del espectro paranoide en las víctimas de mobbing no resulta consistente con la literatura que, en cambio, indica una fuerte presencia de síntomas del espectro del estrés postraumático (hasta el 92 por ciento), aunque no se cumpla el criterio A1 de esta nosología. Se apuntan algunas causas del error diagnóstico, tales como la tendencia a confundir hipervigilancia (criterio D4 del trastorno por estrés postraumático en el DSM-IV-TR) con ideación paranoide, la existencia de un perfil defensivo en las víctimas de APT y la falta de reconocimiento por parte de los clínicos del impacto estresante y traumatizante del mobbing. CONCLUSIÓN: Se requieren investigaciones longitudinales y mixtas (cualitativos/cuantitativos) para establecer criterios robustos de diagnóstico diferencial entre las manifestaciones clínicas asociadas al mobbing y los síntomas paranoides.

CONTEXTO: Diversos estudos evidenciam o alto risco de erro diagnóstico de transtorno delirante e transtorno da personalidade paranoide entre as vítimas de mobbing ou assédio psicológico no trabalho (APT). OBJETIVO: Analisar a associação dos sintomas atribuídos ao mobbing com os critérios de duas nosologias do grupo paranoide (transtorno delirante e transtorno da personalidade paranoide). MÉTODOS: Realiza-se uma revisão bibliográfica de 1990 a junho de 2009 em PubMed e SciELO. RESULTADOS: A identificação de sintomas paranoides em vítimas de mobbing não é congruente com a literatura científica. Por outro lado, evidencia-se uma forte presença de sintomas vinculados ao estresse pós-traumático (até 92 por cento), ainda que não apresente o critério A1 dessa patologia. Algumas causas de erro diagnóstico seriam a tendência a confundir a hipervigilância (critério D4 do transtorno de estresse pós-traumático do DSM-IV-TR) com ideação paranoide, a existência de um perfil defensivo nas vítimas de APT e o desconhecimento do impacto estressante e traumatizante do mobbing pelos clínicos. CONCLUSÃO: São necessários estudos longitudinais e com metodologias mistas (qualitativas/quantitativas) para estabelecer critérios sólidos de diagnóstico diferencial entre as manifestações clínicas atribuídas ao mobbing e os sintomas paranoides.

BACKGROUND: Several studies point out the high risk of misdiagnosing delusional disorder and paranoid personality disorder in victims of mobbing or workplace harassment (WPH). OBJECTIVE: To analyze the extent to which the symptoms attributable to mobbing are misidentified with criteria for two paranoid spectrum nosologies (delusional disorder and paranoid personality disorder). METHODS: Literature review of PubMed and SciELO from 1990 to June 2009. RESULTS: The identification of paranoid spectrum symptoms in victims of mobbing is not consistent with the literature, which, by contrast, shows a notable presence of symptoms in the post-traumatic stress spectrum (as much as 92 percent), although they do not meet the A1 criterion for this nosology. Some of the causes of wrong diagnosis are noted, such as a tendency to confuse hypervigilance (D4 criterion for post-traumatic stress disorder in DSM-IV-TR) with paranoid ideation, the existence of a defensive profile in victims of WPH, and lack of recognition on the part of clinicians of the stressful and traumatizing impact of mobbing. DISCUSSION: Longitudinal and mixed methodology (qualitative and quantitative) studies are necessary in order to establish robust differential diagnosis criteria that clearly distinguish the clinical manifestations attributable to workplace harassment from paranoid spectrum symptoms.