301.0 (F 60.0) Paranoid Personality Disorder: Overview
The key features of paranoid personality disorder involve suspicion of others and mistrust in their motivations. This disorder begins in early adulthood and persists for life and may affect multiple areas of functioning in their daily experience. The signs of mistrust must be manifested in at least four areas of their life including an inability to trust or rely upon friends and difficulty confiding in others because of fear that what is shared will be used against them, constant suspicion that others are trying to harm, trick or exploit them. They may have a pervasive pattern of not forgiving others and may misperceive insults and threats in normal conversation. They often believe that others are trying to assault their character. They obviously then feel a need to respond to the attack and frequently have a chronic suspicion that their spouse or partner is unfaithful to them.

Additional Aspects of Paranoid Personality Disorder:
This personality disorder occurs more often in men than women and is estimated to affect about 4.4% of the population in the United States. The sentiment and perspective of individuals with this disorder should not be confused with the feelings of oppression or disenfranchisement experienced by some minority, immigrant and refugee groups in the United States of America. Individuals who experience or have a family history of psychotic disorders such as schizophrenia or have other unique experiences such as being incarcerated are more often diagnosed with paranoid personality disorder.
Diagnosing Paranoid Personality Disorder:
As mentioned above, it is very important not to confuse the symptoms of psychotic disorders such as schizophrenia with paranoid personality disorder. This diagnosis would be given if the symptoms of paranoid personality disorder also persist before and after the psychotic symptoms of schizophrenia. It is important to understand that there is a significant overlap or comorbidity among personality disorders. Psychologists, psychiatrists and other mental health clinicians need to screen for whether another personality disorder may be even more appropriate such as schizotypal personality disorder.
301.0 (F 60.0) Paranoid Personality Disorder Diagnostic Criteria
A. Suspiciousness and pervasive mistrust of others in their motivations that are interpreted as malevolent, which began in early adulthood and is manifested in a variety of contexts as indicated by four (or more) of the following:
1. Suspects without a sufficient basis that others are harming, exploiting or deceiving them.
2. Has a preoccupation without justification about the trustworthiness or loyalty of friends, family or associates.
3. A reluctance to confide in others because of an unwarranted fear that the information will be used negatively against them.
4. Reads threatening meanings and demeaning motivations behind benign remarks or events.
5. Unforgiving of other’s insults, slights and perceived injuries and persistently bearing grudges
6. Perceives attacks on their character and reputation that is not apparent to others and reacts quickly and angrily in counterattack.
7. Has recurrent suspicions although unjustified about the fidelity of their spouse or sexual partner.
B. The symptoms do not occur exclusively during the course of schizophrenia, bipolar disorder or depressive disorder with psychotic features, or other psychotic disorders that are not attributable to the physiological effects of another medical condition.
Note: If the criteria are met before the onset of schizophrenia, add “premorbid,” such as “paranoid personality disorder (premorbid).”
Adapted from the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) American Psychiatric Association By Paul Susic Ph.D. Licensed Psychologist