“ Among paranoid personalities the basic capacity for trust has somehow been destroyed. They view sincerity as a danger sign, a "Trojan Horse" sent to conceal evil schemes and nefarious intentions. Others are the enemy, waiting to rush in, strip them of their already-questionable safety and security, expose their precious vulnerabilities, and ultimately devour them with sadistic delight. For protection, paranoids wall themselves in to keep others out. Never letting their guard down, they watch vigilantly for any sign of impending onslaught from the deep recesses of their fortress. ” Millon et al., 2004 [1]
Prevalence: Estimates vary, however, the American Psychiatric Association reports a prevalence of 2.3-4.4% within the general population. The majority of those diagnosed with the disorder are male. []
Treatment: Psychotherapy and psychopharmaceuticals (e.g. anti-depressants, anti-psychotics, and anti-axolytics). []
A. A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:
Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her.
Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates.
Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her.
Reads hidden demeaning or threatening meanings into benign remarks or events.
Persistently bears grudges (i.e., is unforgiving of insults, injuries, or slights).
Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack.
Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner.
B. Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, or another psychotic disorder and is not attributable to the physiological effects of another medical condition. []
ICD-10 (F60.0)
Personality disorder characterized by:
excessive sensitiveness to setbacks and rebuffs;
tendency to bear grudges persistently, e.g. refusal to forgive insults and injuries or slights;
suspiciousness and a pervasive tendency to distort experience by misconstruing the neutral or friendly actions of others as hostile or contemptuous;
a combative and tenacious sense of personal rights out of keeping with the actual situation;
recurrent suspicions, without justification, regarding sexual fidelity of spouse or sexual partner;
tendency to experience excessive self-importance, manifest in a persistent self-referential attitude;
preoccupation with unsubstantiated "conspiratorial" explanations of events both immediate to the patient and in the world at large.
Includes: Expansive paranoid, fanatic, querulant and sensitive paranoid personality (disorder).
Excludes: Delusional disorder and schizophrenia. [], []
Millon, T., Grossman, S., Millon, C., Meagher, S., & Ramnath, R. (2004). Personality Disorders in Modern Life (2nd ed.). New Jersey: John Wiley & Sons, Inc.
American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.). Washington, DC: American Psychiatric Association.
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.) Washington, DC: American Psychiatric Association.
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