Paranoid personality disorder: symptoms, diagnosis and treatment
Let’s talk about paranoid personality disorder, with patients characterised by distrust and mistrust of others
The DSM-5 (Diagnostic and Statistical Manual of mental disorders) recognises 10 personality disorders, organised into three clusters (based on shared diagnostic features)
- cluster A personality disorders, which share the common characteristics of strangeness and eccentricity (paranoid, schizoid and schizotypal personality disorders);
- group B personality disorders, which share the common characteristics of drama, emotionality and erraticity (antisocial personality disorder, borderline personality disorder, histrionic personality disorder and narcissistic personality disorder)
- group C personality disorders, which share common features of anxiety and fear (avoidant, dependent and obsessive-compulsive personality disorders).
It may happen that patients may present traits of more than one personality disorder.
If they present diagnostic criteria for another disorder, it should be diagnosed with the primary one.
Characteristics of paranoid personality disorder
The main features of paranoid personality disorder are pervasive distrust and mistrust of others.
Affected individuals often tend not to confide in others and think that other people may harm or exploit them.
In new relationships they try to confirm their suspicion of others and interpret the behaviour of others, even minimal, as a possible affront.
They doubt the loyalty of friends, often isolate themselves and avoid intimacy.
They appear as unemotional, emotionally limited and hypervigilant but think they are objective and rational.
They often bear grudges.
If their convictions are questioned or they experience a major stressful moment, they may express anger, hostility and self-referential thoughts.
They may attack verbally, less frequently physically, those they consider to be their persecutors.
In delusional disorder and schizophrenia there is also loss of a sense of reality.
The prevalence of paranoid personality disorder in the general population ranges from about 0.5% to 2.5%.
Familiarity and the male sex have a higher incidence.
How to diagnose paranoid personality disorder?
The differential diagnosis is made with the following disorders
- delusional disorder (paranoid type),
- schizophrenia (paranoid type),
- schizoid personality disorder,
- avoidant personality disorder.
Bibliographic sources
Triebwasser J, Chemerinski E, Roussos P, Siever LJ. Paranoid personality disorder. J Pers Disord. 2013;27(6):795-805.
González E, Arias F, Szerman N, Vega P, Mesias B, Basurte I. Coexistence between personality disorders and substance use disorder. Madrid study about prevalence of dual pathology. Actas Esp Psiquiatr. 2019;47(6):218-28.
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