Diagnosing Paranoid Personality Disorder

Individuals with Paranoid Personality Disorder (PPD) very often perceive others as doing things just to annoy them. They do not usually take what people say at face value; rather, they frequently attempt to discern what people really mean. Frequently, individuals with PPD believe that the comments of others often turn out to be hidden threats or putdowns. Often, individuals with PPD report that people have remarked to them that they read too much into situations and get offended at things that were not meant to be offensive, insulting, or threatening.

Narrative Description

Individuals with PPD stay angry at someone who does something hurtful or insulting to them for inordinately and excessive amounts of time. For example, they may never let go of their anger at someone for forgetting their birthday. Typically, individuals with PPD will have several others in their lives that they have never forgiven. They frequently hold grudges. In addition, individuals with PPD are very closed, private, and unwilling to talk openly about themselves without any reasonable justification. They irrationally fear that if they open up about themselves that the other person will use their personal information to harm them.

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When individuals with PPD are in a romantic relationship, they frequently worry that their partner is unfaithful without their partner having done anything to make them suspicious. Often, they never have been able to prove that their partner was unfaithful. Individuals with PPD often report that they have had numerous experiences in which others have pretended to be their friend only to later take advantage of them. Paranoid personalities typically believe that they are particularly skilled at spotting others who are trying to deceive or con them.

Consistent with their interpersonal style, individuals with PPD often express concern that friends or co-workers are not loyal or trustworthy. They spend an excessive amount of time thinking about suspected disloyalty to their own detriment and without a rational basis for their beliefs. Individuals with PPD frequently believe that people often make indirect comments to attack them or put them down rather than tell them directly. In this situation, the individual with PPD often reacts with anger and tries to get the person back — i.e., they are vindictive and vengeful.

DSM Definition

For there to be a diagnosis of PPD, four or more of seven diagnostic criteria must be present plus the general criteria for personality disorder must be met. The DSM-IV/-5 diagnostic criteria for Paranoid Personality Disorder (PPD) includes:

• (1) Perceives hidden insulting or threatening messages into benign remarks or events.
• (2) Recurrently holds grudges, i.e., is unforgiving of insults, injuries, or slights.
• (3) suspiciousness, without justification, regarding fidelity of spouse or sexual partner.
• (4) Suspects, without sufficient basis, that others are exploiting, harming, or deceiving them.
• (5) Preoccupation with unjustified doubts about the loyalty or trustworthiness of friends or associates.
• (6) Perceives attacks on their character or reputation that are not apparent to others, and they are quick to react angrily or to counterattack.
• (7) Reluctance to confide in others because of unwarranted fear that the information will be used maliciously against him or her.

Other Information

PPD was classified as a cluster A personality disorder in the DSM-IV-TR which means that it was categorized as one of the “odd or eccentric” PDs. Cluster A PDs have also been conceptualized as schizophrenia-spectrum PDs because of their phenomenological and putative genetic overlap with schizophrenia. PPD has a prevalence ranging from 0.5-2.5% in the general population. In clinical samples, PPD has a prevalence ranging from 2-10%.