Paranoid Personality Disorder
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- 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
- Predominant age: first manifests during childhood or adolescence
- Predominant sex: male > female
- Increased in families with delusional disorder (persecutory type) and chronic schizophrenia
- 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.
Genetic predisposition may play a role (see “Incidence”).
- 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]