Paranoid Personality Disorder

What is paranoid personality disorder?

Paranoid personality disorder is a cluster A personality disorder characterized by pervasive distrust or suspiciousness of others the the point that their motives are interpreted as malevolent. Individuals with this disorder tend to negatively interpret the actions, words, and intentions of others. The prevalence of paranoid personality disorder is around 2.3-4.4% and is more common in men, visible minorities, and those with hearing impairment.

What does paranoid personality disorder look like?

Signs & Symptoms

Pervasive distrust and suspicion of others and their motives
Unjustified belief that others are trying to harm or deceive you
Unjustified suspicion of the loyalty or trustworthiness of others
Hesitancy to confide in others due to unreasonable fear that others will use the information against you
Perception of innocent remarks or nonthreatening situations as personal insults or attacks
Angry or hostile reaction to perceived slights or insults
Tendency to hold grudges
Unjustified, recurrent suspicion that spouse or sexual partner is unfaithful

DSM-5 Criteria

Criterion A. 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 4 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

Criterion B. Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, or another psychotic disorder and is not attributable to the physiological effects of another medical condition.

Note: If criteria are met prior to the onset of schizophrenia, add “premorbid” to the diagnosis, i.e. “paranoid personality disorder (premorbid)”.

Risk Factors

Family member with schizophrenia or delusional disorder
Childhood trauma - especially those who were subjected to parental antagonism and harassment, and served as scapegoats for displaced parental aggression
Physical abuse in childhood

Differential Diagnosis

Personality changes due to another medical condition
Other personality disorders
Other mental disorders with psychotic symptoms
Substance use disorders
Paranoid traits associated with physical disabilities
Paranoid personality traits

How is paranoid personality disorder treated?

Due to the nature of the disorder, individuals with paranoid personality disorder are unlikely to seek treatment. They also tend to have low insight into their condition. As a result, there is a lack of investigation on effective treatments for paranoid personality disorders. Some forms of psychotherapy are recommended to help the individual improve their ability to trust others and tolerate intimacy with others.

Cognitive behavioral therapy (CBT)
Psychodynamic therapy

References

[1] American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA.

[2] Birkeland, S. F. (2013) Paranoid personality disorder and the schizophrenia spectrum—Where to draw the line? Personality and Mental Health, 7(3), 254-258.

[3] Boyd, M. A. (2019). Psychiatric & mental health nursing for Canadian practice. Wolters Kluwer.

[4] Lee, R. (2017). Mistrustful and misunderstood: A review of paranoid personality disorder. Current Behavioral Neuroscience Reports, 4(2), 151–165.

[5] Townsend, M. C. (2015). Psychiatric mental health nursing. F.A. Davis.