Paranoid personality disorder

Paranoid personality disorder is a psychiatric diagnosis that denotes a personality disorder with paranoid features. It is characterized by an exaggeration of the cognitive modules for sensitivity to rejection, resentfulness, distrust, as well as the inclination to distort experienced events. Neutral and friendly actions of others are often misinterpreted as being hostile or contemptuous. Unfounded suspicions regarding the sexual loyalty of partners and loyalty in general as well as the belief that one’s rights are not being recognized is stubbornly and argumentatively insisted upon. Such individuals can possess an excessive self-assurance and a tendency toward an exaggerated self-reference. Pathological jealousy, instinctive aggressive counter-attack, the need to control others, and the gathering of trivial or circumstantial "evidence" to support their jealous beliefs also feature. The use of the term paranoia in this context is not meant to refer to the presence of frank delusions or psychosis, but implies the presence of ongoing, unbased suspicion and distrust of people.

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Diagnosis

• 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.

Exclusionary conditions:

• Does not occur exclusively during the course of a mood disorder with psychotic features, schizophrenia, or another psychotic disorder.
• Is not due to the direct physiological effects of a general medical condition.

Epidemiology

One Norwegian 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.^[1]

References

Cluster B (Dramatic): Antisocial, Borderline, Histrionic, Narcissistic

Cluster C (Anxious): Dependent, Obsessive-Compulsive, Avoidant