Diagnostic Criteria for Paranoid Personality Disorder

The DSM-IV-TR, which is the diagnostic manual used by the American Psychiatric Association, lists the following criteria for a diagnosis of Paranoid Personality Disorder:

A. A pervasive and permanent sense of distrust and suspicion of others in that their motives are interpreted as both negative and directed towards the sufferer. The condition develops in early adulthood and continues throughout life unless treatment is sought.

For a diagnosis of PPD to be made at least four or more of the following criteria must be met:

  1. Suspicion, without adequate proof, that others are exploiting, harming, plotting of deceiving the sufferer.
  2. Is preoccupied with unjustified doubts about the honesty and integrity of friends, relatives and acquaintances.
  3. Displays a reluctance to confide in others due to a fear that the information disclosed will be used against them.
  4. Reads hidden meanings into harmless conversations and interprets these remarks or events as threatening to the sufferer.
  5. Bears grudges and holds anger to those who insult, slight or hurt them, even if the event was unintentional and the perpetrator unaware of their actions.
  6. Perceives attacks on themselves that are not apparent to others and is quick to react to the perceived attack without thinking.
  7. Has recurrent suspicious, without actual proof, of the fidelity of their spouse of sexual partner.

B. The symptoms are not concurrent with the presence of schizophrenia, mood disorders with psychotic tendencies, or psychotic disorder, nor are the symptoms due to the ingestion of a prescription or non-prescription drug.

Case studies of Paranoid Personality Disorder can be found here and here. Treatment is difficult because the sufferer finds it almost impossible to develop the trust relationship that is necessary for successful therapy and so most sufferers are reluctant to seek treatment. Usually a crisis event will be the trigger that causes sufferers to enter therapy.

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