Description

• Paranoid personality disorder is a pattern of distrust and suspiciousness such that others’ motives are interpreted as malevolent.
• Consequently, patients avoid intimate relationships, bear grudges, and expect to be exploited by others.
• Paranoid personality disorder is one of the cluster A personality disorders.
• Certain DSM-IV personality disorders (paranoid, schizoid, histrionic, and dependent as well as the residual category of PDNOS) are now diagnosed in the DSM-5 as personality disorder—trait specified (PD-TS), which is represented by the following:
  • Significant impairment in personality functioning
  • Pathologic personality traits

Epidemiology

Incidence

• Predominant age: first manifests during childhood or adolescence
• Predominant sex: male > female
• Increased in families with delusional disorder (persecutory type) and chronic schizophrenia

Prevalence

• Thought to be underdiagnosed because these patients are less likely to seek treatment
• 0.5–2.5% of the general population
• 2–10% of psychiatric outpatients
• 10–30% of psychiatric inpatients

Etiology and Pathophysiology

Paranoid sense of mistrust can result from childhood abuse/neglect and/or genetic predisposition to paranoia. Specific causes are unknown.

Genetics
Genetic predisposition may play a role (see “Incidence”).

Risk Factors

• Family history of paranoid personality disorder
• Childhood abuse/neglect

Commonly Associated Conditions

• May develop major depressive disorder
• May be at increased risk for obsessive-compulsive disorder and agoraphobia
• At risk for alcohol and/or other substance abuse/dependence
• Most common co-occurring personality disorders are schizotypal, schizoid, narcissistic, avoidant, and borderline.
• Increased rate of suicide and self-injurious behavior when comorbid with borderline personality disorder (1)[C]