Personality Disorders

Paranoid Personality Disorder

Individuals with paranoid personality disorder (PPD) are suspicious of others, expecting to be mistreated by others. They expect harm to come to themselves and are sensitive to any evidence of impending attacks, without sufficient basis or without considering alternative explanations. They tend to see themselves as blameless, instead finding fault for their misfortunes in others, and they are likely to look for clues that validate their expectations. They are preoccupied with doubts about the loyalty or trustworthiness of others and are, therefore, unlikely to confide in others. They are hypersensitive in interactions with others, often ascribing pejorative intent to even benign remarks or events. Behaviorally, they are often described as “vigilant,” and their interpersonal relationships are marked by hostility. Their internal anxiety is related to their almost constant fear of being harmed by others. They commonly bear grudges and are unlikely to forgive perceived slights, often reacting with anger. Although some individuals diagnosed with PPD exhibit transient psychotic symptoms (e.g., persecutory delusions), they are typically in contact with reality and do not exhibit the perceptual disturbances and cognitive and behavioral disorganization often found in psychoses. Some research has suggested that PPD may be more closely related to delusional disorder than schizophrenia. PPD occurs more frequently in men and is most likely comorbid with schizotypal, avoidant, and borderline personality disorders. Its prevalence rate in the general population is between 2% and 4%, and its prevalence in outpatient psychiatric settings is about 4%.

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