It's so hard when I have to, and so easy when I want to.
-- Annie Gottlie

Internet Mental Health © 1995-2008 Phillip W. Long, M.D.

Diagnostic Features:

Paranoid Personality Disorder is a condition characterized by excessive distrust and suspiciousness of others. This disorder is only diagnosed when these behaviors become persistent and very disabling or distressing. This disorder should not be diagnosed if the distrust and suspiciousness occurs exclusively during the course of Schizophrenia, a Mood Disorder With Psychotic Features, or another Psychotic Disorder or if it is due to the direct physiological effects of a neurological (e.g., temporal lobe epilepsy) or other general medical condition.

Complications:

Individuals with this disorder are generally difficult to get along with and often have problems with close relationships because of their excessive suspiciousness and hostility. Their combative and suspicious nature may elicit a hostile response in others, which then serves to confirm their original expectations. Individuals with this disorder have a need to have a high degree of control over those around them. They are often rigid, critical of others, and unable to collaborate, although they have great difficulty accepting criticism themselves. They often become involved in legal disputes. They may exhibit thinly hidden, unrealistic grandiose fantasies, are often attuned to issues of power and rank, and tend to develop negative stereotypes of others, particularly those from population groups distinct from their own. More severely affected individuals with this disorder may be perceived by others as fanatics and form tightly knit cults or groups with others who share their paranoid beliefs.

Comorbidity:

In response to stress, individuals with this disorder may experience very brief psychotic episodes (lasting minutes to hours). If the psychotic episode lasts longer, this disorder may actually develop into Delusional Disorder or Schizophrenia. Individuals with this disorder are at increased risk for Major Depressive Disorder, Agoraphobia, Obsessive-Compulsive Disorder, Alcohol Eating Disorders and Substance-Related Disorders. Other Personality Disorders (especially Schizoid, Schizotypal, Narcissistic, Avoidant, and Borderline) often co-occur with this disorder.

Prevalence:

The prevalence of Paranoid Personality Disorder is about 0.5%-2.5% of the general population. It is seen in 2%-10% of psychiatric outpatients. This disorder occurs more commonly in males.

Course:

This disorder may be first apparent in childhood and adolescence with solitariness, poor peer relationships, social anxiety, underachievement in school, hypersensitivity, peculiar thoughts and language, and idiosyncratic fantasies. These children may appear to be odd or eccentric and attract teasing. The course of this disorder is chronic.

Familial Pattern:

This disorder is more common among first-degree biological relatives of those with Schizophrenia and Delusional Disorder, Persecutory Type.