Paranoid personality disorder
Synonyms and keywords: Overly suspicious

# Overview
Paranoid personality disorder is a psychiatric diagnosis  characterized by paranoia characterized by a pervasive and long-standing suspiciousness and generalized mistrust of others.  For a person's personality to be considered a personality disorder, an enduring pattern of characteristic maladaptive behaviors, thinking and personality traits must be present from the onset of adolescence or early adulthood.  Additionally, these behaviors, traits and thinking must be present to the extent that they cause significant difficulties in relationships, employment and other facets of functioning.  Those with paranoid personality disorder are hypersensitive, are easily slighted, and habitually relate to the world by vigilant scanning of the environment for clues or suggestions to validate their prejudicial ideas or biases. They tend to be guarded and suspicious and have quite constricted emotional lives. Their incapacity for meaningful emotional involvement and the general pattern of isolated withdrawal often lend a quality of schizoid isolation to their life experience.

# Differential Diagnosis
- Bipolar disorder
- Delusional disorder
- Depressive disorder
- Medical condition that affects central nervous system
- Substance use disorder
- Schizotypal personality disorder
- Schizophrenia

# Epidemiology and Demographics

## Prevalence
The prevalence of paranoid personality disorder is 2,300 to 4,400 per 100,000 (2.3% to 4.4%) of the overall population.

# Risk Factors
- Schizophrenia
- Delusional disorder

# Natural History, Complications and Prognosis
Poor prognostic factors include:
- Solitariness
- Poor peer relationships
- Social anxiety
- Underachievement at school
- Hypersensitivity
- Peculiar thoughts and language
- Idiosyncratic fantasies

# Diagnosis

## Diagnosis Criteria

### DSM-V Diagnostic Criteria for Paranoid Personality Disorder

### Descriptive Diagnosis per American DSM-IV-TR
Paranoid personality disorder is listed in the DSM-IV-TR as 301.00 Paranoid Personality Disorder.
According to the DSM-IV-TR, this disorder is characterized by a pervasive distrust and suspicion 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:
- Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her
- Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates
- Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her
- Reads benign remarks or events as threatening or demeaning.
- Persistently bears grudges, i.e., is unforgiving of insults, injuries, or slights
- Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack
- Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner.
The traits, behaviors and characteristics
- Do not occur exclusively during the course of a mood disorder accompanied by psychotic features nor other psychotic disorders.
- Are not due to the direct physiological effects of a general medical condition.

### European Description per ICD-10
The ICD-10 lists paranoid personality disorder as F60.0 Paranoid Personality Disorder.
This personality disorder is characterized by at least 3 of the following:
(a) excessive sensitiveness to setbacks and rebuffs;
(b) tendency to bear grudges persistently, i.e. refusal to forgive insults and injuries or slights;
(c) suspiciousness and a pervasive tendency to distort experience by misconstruing the neutral or friendly actions of others as hostile or contemptuous;
(d) a combative and tenacious sense of personal rights out of keeping with the actual situation;
(e) recurrent suspicions, without justification, regarding sexual fidelity of spouse or sexual partner;
(f) tendency to experience excessive self-importance, manifest in a persistent self-referential attitude;
(g) preoccupation with unsubstantiated "conspiratorial" explanations of events both immediate to the patient and in the world at large.
Includes:
- expansive paranoid, fanatic, querulant and sensitive paranoid personality (disorder)
Excludes:
- delusional disorder
- schizophrenia
Personality Disorders
A personality disorder is a severe disturbance in the characterological constitution and behavioral tendencies of the individual, usually involving several areas of the personality, and nearly always associated with considerable personal and social disruption. Personality disorder tends to appear in late childhood or adolescence and continues to be manifest into adulthood. It is therefore unlikely that the diagnosis of personality disorder will be appropriate before the age of 16 or 17 years. General diagnostic guidelines applying to all personality disorders are presented below; supplementary descriptions are provided with each of the subtypes.
Diagnostic Guidelines
Conditions not directly attributable to gross brain damage or disease, or to another psychiatric disorder, meeting the following criteria:

### Cultural Sensitivities
The WHO, in the ICD-10, points out for different cultures it may be necessary to develop specific sets of criteria with regard to social norms, rules and obligations.

# Treatment
Because of reduced levels of trust, there can be challenges in treating paranoid personality disorder. However, psychotherapy, antidepressants, and anti-anxiety medications can play a role when an individual is receptive to intervention.