Paranoid personality disorder

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Background

A pattern of distrust and suspiciousness such that oth­ers' motives are interpreted as malevolent

Clinical Features

  • Four (or more) of the following criteria, beginning in early adulthood and present in a variety of contexts:[1]
    • 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.
  • 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

Differential Diagnosis

  • Other mental disorders with psychotic symptoms
  • Personality change due to another medical condition
  • Substance use disorders
  • Paranoid traits associated with other physical handicaps
  • Other personality disorders and personality traits

Evaluation

A clinical diagnosis; however if entertaining other organic causes may initiate workup below

General ED Psychiatric Workup

Management

Referral for outpatient psychiatric treatment, which can include psychotherapy, antidepressants, anti-psychotics and anti-anxiety medications

Disposition

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See Also

External Links

References

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.