Paranoid Personality Disorder

Paranoid Personality Disorder is a topic covered in the 5-Minute Clinical Consult.

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Basics

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]

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