Paranoid personality disorder and narcissistic personality disorder are two of a range of personality disorders classified in the Diagnostic and Statistical Manual of Disorders of the American Psychiatric Association.
Personality disorders are mental disorders that are characterized by long-lasting rigid patterns of thought and behaviour.
Paranoid personality disorder is characterised by pathological suspicion and an obsession with defending against enemies, both real and imaginary.
People with narcissistic personality disorder exhibit a grandiose sense of self-importance, an exhibitionistic need for constant admiration, and relationships marked by the exploitation of others.
These disorders often occur together in a single individual; a single person can exhibit both pathological paranoia and pathological narcissism.
Paranoid personality disorder has played a central role in the worst atrocities in human history. Hitler, Stalin, Mao and Pol Pot all exhibited the characteristics of this disorder and used paranoia as a central organising theme in their respective political projects.
Many of the world’s most destructive tyrants also displayed the characteristics of narcissistic personality disorder. By pursuing their grandiose dreams, regardless of the consequences for others, narcissistic personalities have caused enormous damage to societies throughout history, and continue to do so.
Psychology has at last begun to alert us to the fact that such dangerous personality disorders exist. The major role that people with these disorders play in perpetuating violence and greed is also becoming clearer.
Armed with this new knowledge, we are beginning to realise the extent to which our world is shaped by infantile minds.
Prevalence and Co-morbidity
Paranoid personality disorder effects between 0.5% and 2.5% of the general population. It appears to be more prevalent among males than among females. People with this disorder can often gain positions of influence, particularly in times of danger or austerity, when their zeal in pointing the finger of blame can find a receptive audience among a frightened or disillusioned population.
Current estimates are that narcissistic personality disorder affects around 1 per cent of the general population, and it too seems to affect more males than females. Given their particular skills, and the value placed on competitiveness and triumph in contemporary society, narcissists make up a much higher proportion of those in positions of power – particularly in professions such as politics, law, business and public service. It is from these positions of influence that they too play a central role in shaping the modern world.
Both narcissistic personality disorder and paranoid personality disorder may be understood as cases of arrested psychic development in childhood.
Narcissistic and paranoid personality disorders can both be seen as defences frozen in early childhood, which serve to defend against overwhelming shame and terror. Failure of these defences would most likely result in devastating depression and possible suicide.
For narcissists, other people are simply objects who provide praise and attention. For the paranoid, other people are enemies to be despised and eradicated.
In both cases, others are stripped of the breadth of their humanity and made to perform a single function for the disordered individual.
Narcissism as Arrested Development
The characteristics of narcissistic personality disorder are now understood by psychoanalysts as a failure of the psyche to mature beyond the primitive fragmentation of the infantile mind.
In particular two parts of the infant’s mind, which mature in the course of normal development, remain at an arrested state of development in a person with narcissistic personality disorder. These are the ego ideal and the narcissistic self.
Freud described the ego ideal as that part of the infant’s mind which retains a belief in the child’s omnipotence. In children, and in narcissistic individuals, the ego ideal exerts relentless demands for grandiosity and perfection, and like a cruel circus trainer, it stands ever ready to pour scorn should its unattainable standards not be met.
The narcissistic self contains the child’s drive for love and admiration, and is the source of the infant’s desire to be looked at and admired. In early development, the narcissistic self has an intensity, lost in the course of normal development, which reflects the infant’s existential need for attention and terror of rejection.
The personality of someone with narcissistic personality disorder is dominated by childish exhibitionism (infantile narcissistic self) driven by unattainable internal demands for omnipotence and perfection (coming from the ego ideal).
The characteristics of narcissistic personality disorder – grandiosity, entitlement, a constant need for praise and attention, and ruthless exploitation of others – are an attempt to mollify harsh internal criticism which is constantly telling the narcissist that he or she is worthless.
Paranoia as Arrested Development
According to psychoanalyst Melanie Klein, as babies we exhibit two main states of mind, each with its own mood music.
In the first state of mind – the paranoid state – the baby feels threatened and is terrified that he is about to be attacked. Given the reality that infants are helpless and rely entirely on the protection of others, this paranoid state of mind is, for them, a wholly realistic reaction to the world.
The infant’s second state of mind is less fearful than the first. In this state the baby feels safer and his mind is more relaxed. Threatening emotions can now be held in mind long enough to be thought about and become meaningful.
The ability to hold threatening emotions in mind long enough to be thought about is known as ‘containment’. It is, in fact, one of the primary roles that parents perform for their children as they gradually come to terms with what is initially a frightening and incomprehensible world.
Making overwhelming emotion comprehensible is one of the principal means to enable adaptation to the world.
As we develop into adults the balance normally shifts, so that the paranoid state that dominates in infancy fades as our minds mature. For some individuals, however, their adult mind never matures beyond a primitive state of paranoia. For such people, those with paranoid personality disorder, the infantile paranoid state of mind continually dominates.
Crucially, in the infantile paranoid state, the infant does not sense the danger as solely coming from outside. In its earliest months the child is unable to distinguish between itself and others, so it feels the threat as coming from within itself.
Like narcissistic personality disorder, paranoid personality disorder therefore also arises from the existential need to deny or mollify an internal persecutor. In the case of paranoid personality disorder, however, the internal persecutor is telling the paranoid that it is about to destroy him.
To defend against the enemy within, people with paranoid personality disorder make widespread use of projection as a defense. That is, they disavow their own aggressive feelings and thoughts by projecting them onto another person.
Projection allows the paranoid to deny the existence of the terrifying evil within that threatens to destroy them.
Enemies without are more bearable than a threat of annihilation arising from within.
The excessive use of projection by paranoids in their everyday interactions explains their propensity to see enemies everywhere around them.
Understanding paranoid personality disorder and narcissistic personality disorder as resulting from arrested psychic development in childhood gives an insight into the psychology of these dangerous personality disorders.
And it provides support for the idea that our world is largely run by people with infantile minds.
 Political Paranoia: The Psychopolitics of Hatred, Robert S. Robins and Jerrold M. Post, Yale University Press, 1997, page 24
 Paranoid Personality Disorder, David P. Bernstein and J. David Useda, in Personality Disorders: Towards the DSM-V, William T O’Donohue, Katherine A. Fowler and Scott O. Lilienfeld (editors), SAGE Publications, 2007
 Associations between four types of childhood neglect and personality disorder symptoms during adolescence and early adulthood: findings of a community-based longitudinal study. Johnson J.G., Smailes E.M., Cohen P., and Bernstein D.P., Journal of Personality Disorders, 14(2), 2000, pages 171-87