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Paranoid Personality Disorder

Diagnostic Criteria

  1. A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:
  2. suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her
  3. is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates
  4. is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her
  5. reads hidden demeaning or threatening meanings into benign remarks or events
  6. persistently bears grudges, i.e., is unforgiving of insults, injuries, or slights
  7. perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack
  8. has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner
  • Does not occur exclusively during the course of Schizophrenia, a Mood Disorder With Psychotic Features, or another Psychotic Disorder and is not due to the direct physiological effects of a general medical condition.

    Note: If criteria are met prior to the onset of Schizophrenia, add "Premorbid," e.g., "Paranoid Personality Disorder (Premorbid)."

    • Associated Feature

    • Odd or Eccentric or Suspicious Personality
    • Dramatic or Erratic or Antisocial Personality

    Differential Diagnosis

    Some disorders have similar or even the same symptoms. The clinician, therefore, in his/her diagnostic attempt has to differentiate against the following disorders which need to be ruled out to establish a precise diagnosis.

    • Delusional Disorder, Persecutory Type;
    • Schizophrenia, Paranoid Type;
    • Mood Disorder With Psychotic Features;
    • Personality Change Due to a General Medical Condition;
    • Symptoms that may develop in association with chronic substance use;
    • Paranoid traits associated with the development of physical handicaps;
    • Schizotypal Personality Disorder;
    • Schizoid Personality Disorder;
    • Borderline and Histrionic Personality Disorders;
    • Avoidant Personality Disorder;
    • Antisocial Personality Disorder;
    • Narcissistic Personality Disorder.