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Paranoid personality disorder is a psychiatric diagnosis characterized by paranoia and a pervasive, long-standing suspiciousness and generalized mistrust of others.

Those with the condition 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.


See the history of paranoia.

Diagnostic criteria (DSM-IV-TR = 301.0)

The Diagnostic and Statistical Manual of Mental Disorders fourth edition, DSM IV-TR, a widely used manual for diagnosing mental disorders, defines paranoid personality disorder (in Axis II Cluster A) as:

A) 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.

B) 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.

It is a requirement of DSM-IV that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.

Diagnostic criteria (ICD-10)

The World Health Organization's ICD-10 lists paranoid personality disorder as ( ) Paranoid personality disorder.

It is characterized by at least 3 of the following:
# excessive sensitivity to setbacks and rebuffs;
# tendency to bear grudges persistently, i.e. refusal to forgive insults and injuries or slights;
# suspiciousness and a pervasive tendency to distort experience by misconstruing the neutral or friendly actions of others as hostile or contemptuous;
# a combative and tenacious sense of personal rights out of keeping with the actual situation;
# recurrent suspicions, without justification, regarding sexual fidelity of spouse or sexual partner;
# tendency to experience excessive self-importance, manifest in a persistent self-referential attitude;
# preoccupation with unsubstantiated "conspiratorial" explanations of events both immediate to the patient and in the world at large.

:* expansive paranoid, fanatic, querulant and sensitive paranoid personality (disorder)

:* delusional disorder
:* schizophrenia

It is a requirement of ICD-10 that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.

Cultural sensitivities

The World Health Organization, 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.

Millon's variations

Theodore Millon identified five variations of paranoid. Any individual paranoid may exhibit none or one of the following:

  • malignant paranoid - including sadistic features

  • objurate paranoid - including compulsive features

  • insular paranoid - including avoidant features

Differential diagnosis: associated and overlapping conditions

The following conditions commonly coexist (comorbid) with paranoid personality disorder:

Prevalence (epidemiology)

Paranoid personality disorder occurs in about 0.5%-2.5% of the general population. It is seen in 2%-10% of psychiatric outpatients. It occurs more commonly in males.

A large long-term Norwegianmarker twin study found paranoid personality disorder to be modestly heritable and to share a portion of its genetic and environmental risk factors with schizoid and schizotypal personality disorder.

Causes (etiology)

A genetic contribution to paranoid traits and a possible genetic link between this personality disorder and schizophrenia exist. Psychosocial theories implicate projection of negative internal feelings and parental modeling.


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

See also


  1. Meissner & Kuper, 2008.
  2. Paranoid personality disorder - Diagnostic and Statistical Manual of Mental Disorders Fourth edition Text Revision (DSM-IV-TR) American Psychiatric Association (2000)
  3. Paranoid personality disorder - International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10)
  4. Millon, Theodore, Personality Disorders in Modern Life, 2004
  5. Internet Mental Health - paranoid personality disorder

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