002 Paranoid and Schizoid Personality Disorders

Paranoid Personality Disorder

Other Personality Disorders may be confused with Paranoid Personality Disorder because they have certain features in common. It is, therefore, important to distinguish among these disorders based on differences in their characteristic features. However, if an individual has personality features that meet criteria for one or more Personality Disorders in addition to Paranoid Personality Disorder, all can be diagnosed. Paranoid Personality Disorder and Schizotypal Personality Disorder share the traits of suspiciousness, interpersonal aloofness, and paranoid ideation, but Schizotypal Personality Disorder also includes symptoms such as magical thinking, unusual perceptual experiences, and odd thinking and speech. Individuals with behaviors that meet criteria for Schizoid Personality Disorder are often perceived as strange, eccentric, cold, and aloof, but they do not usually have prominent paranoid ideation. The tendency of individuals with Paranoid Personality Disorder to react to minor stimuli with anger is also seen in Borderline and Histrionic Personality Disorders. However, these disorders are not necessarily associated with pervasive suspiciousness. People with Avoidant Personality Disorder may also be reluctant to confide in others but more because of a fear of being embarrassed or found inadequate than from fear of others malicious intent. Although antisocial behavior may be present in some individuals with Paranoid Personality Disorder, it is not usually motivated by a desire for personal gain or to exploit others as in Antisocial Personality Disorder but rather is more often due to a desire for revenge. Individuals with Narcissistic Personality Disorder may occasionally display suspiciousness, social withdrawal, or alienation, but this derives primarily from fears of having their imperfections or flaws revealed.

Paranoid traits may be adaptive, particularly in threatening environments. Paranoid Personality Disorder should be diagnosed only when these traits are inflexible, maladaptive, persistent, and cause significant functional impairment or subjective distress.

Diagnostic criteria for Paranoid Personality Disorder DSM-IV, Pg.637

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:

(1)        suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her

(2)        is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates

(3)        is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her

(4)        reads hidden demeaning or threatening meanings into benign remarks or events

(5)        persistently bears grudges, i.e., is unforgiving of insults, injuries, or slights

(6)        perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack

(7)        has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner

B.        Does not occur exclusively during the course of Schizophrenia, a Mood Disorder With Psychotic Features, or another Psychotic Disorder and is not due to the direct physiological effects of a general medical condition.

Note:        If criteria are met prior to the onset of Schizophrenia, add "Premoroid," e.g., "Paranoid Personality Disorder (Premorbid)"



Schizoid Personality Disorder

Diagnostic Criteria

A.        A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

(1)        neither desires nor enjoys close relationships, including being part of a family

(2)        almost always chooses solitary activities

(3)        has little, if any, interest in having sexual experiences with another person

(4)        takes pleasure in few, if any, activities

(5)        lacks close friends or confidants other than first-degree relatives

(6)        appears indifferent to the praise or criticism of others

(7)        shows emotional coldness, detachment, or flattened affectivity

B.        Does not occur exclusively during the course of Schizophrenia, a Mood Disorder With Psychotic Features, another Psychotic Disorder, or a Pervasive Developmental Disorder and is not due to the direct physiological effects of a general medical condition.

Note: If criteria are met prior to the onset of Schizophrenia, add "Premorbid," e.g., "Schizoid Personality Disorder (Premorbid)"


Associated Features

Odd/Eccentric/Suspicious Personality


Differential Diagnosis

Delusional Disorder; Schizophrenia; and Mood Disorder With Psychotic Features; Autistic Disorder; Asperger's Disorder; Personality Change Due to a General Medical Condition; symptoms that may develop in association with chronic substance use; Schizotypal Personality Disorder; Paranoid Personality Disorder; Avoidant Personality Disorder; Obsessive-Compulsive Personality Disorder.

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