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Paranoid Personality Disorder Criteria

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:

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 hidden demeaning or threatening meanings into benign remarks or events 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

DSM-IV Code: 301.0.

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 Features:

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.
Schizotypal Personality Disorder.
Schizoid Personality Disorder.
Borderline and Histrionic Personality Disorders.
Avoidant Personality Disorder.
Antisocial Personality Disorder
Narcissistic Personality Disorder
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.


The specific cause of this disorder is unknown, but the incidence appears increased in families with a schizophrenic member. Paranoid personality disorder can result from negative childhood experiences fostered by a threatening domestic atmosphere. It is prompted by extreme and unfounded parental rage and/or condescending parental influence that cultivate profound child insecurities.


Treatment of paranoid personality disorder can be very effective in controlling the paranoia but is difficult because the person may be suspicious of the doctor. Without treatment this disorder will be chronic. Medications and therapy are common and effective approaches to alleviating the disorder.

The social consequences of serious mental disorders—family disruption, loss of employment and housing—can be calamitous. Comprehensive treatment, which includes services that exist outside the formal treatment system, is crucial to ameliorate symptoms, assist recovery, and, to the extent that these efforts are successful, redress stigma. Consumer self-help programs, family self-help, advocacy, and services for housing and vocational assistance complement and supplement the formal treatment system. Consumers, that is, people who use mental health services themselves, operate many of these services. The logic behind their leadership in delivery of these services is that consumers are thought to be capable of engaging others with mental disorders, serving as role models, and increasing the sensitivity of service systems to the needs of people with mental disorder.

Counseling and Psychotherapy [ See Therapy Section ]:

Psychotherapy is the most promising method of treatment for Paranoid Personality Disorder. People afflicted with this disorder have deep foundational problems that necessitate intense therapy. A confident therapist-client relationship offers the most benefit to people with the disorder, yet is extremely difficult to establish due to the dramatic skepticism of patients with this condition. People with paranoid personality disorder rarely initiate treatment and often terminate it prematurely. Likewise, building therapist-client trust requires great care and is complicated to maintain even after a confidence level has been founded.

The long-term projection for people with paranoid personality disorder is bleak. Most patients experience predominant symptoms of the disorder for the duration of their lifetime and require consistent therapy.

Pharmacotherapy [ See Psychopharmacology Section ] :

An anti-anxiety agent, such as diazepam, is appropriate to prescribe if the client suffers from severe anxiety or agitation where it begins to interfere with normal, daily functioning. An anti-psychotic medication, such as thioridazine or haloperidol, may be appropriate if a patient decompensates into severe agitation or delusionsal thinking which may result in self-harm or harm to others.