View source for Paranoid personality disorder

{{Short description|Personality disorder involving mistrust of others}}
{{Distinguish|paranoid schizophrenia}}
{{Infobox medical condition (new)
| name          = Paranoid personality disorder
| image         = 
| synonyms      = 
| caption       = by Bouney Wanjiku
| pronounce     = 
| field         = 
| specialty     = [[Psychiatry]], [[clinical psychology]]
| symptoms      = [[Paranoia]], pervasive suspiciousness, generalized mistrust of others, hypersensitivity, scanning of environments for clues or suggestions that may validate fears or biases
| complications = 
| onset         = 
| duration      = 
| types         = 
| causes        = 
| risks         = 
| diagnosis     = 
| differential  = [[Delusional disorder]], [[schizophrenia]], [[schizoaffective disorder]], [[Personality disorder#Cluster A (odd or eccentric disorders)|other cluster A personality disorders]], [[borderline personality disorder]]
| prevention    = 
| treatment     = 
| medication    = 
| prognosis     = 
| frequency     = Estimated between 0.5% and 2.5% of the general population<ref name="Bienenfeld" />
| deaths        = 
}}<!-- The content of this section is transcluded to [[Classification of personality disorders#Cluster  A]]. Please be aware that changes made to the original source here will affect the transcluded version on the target page mentioned. -->{{Personality disorders sidebar}}
'''Paranoid personality disorder''' ('''PPD''') is <noinclude>a [[personality disorder]] </noinclude>characterized by [[paranoia]], and a pervasive, long-standing suspiciousness and generalized [[mistrust]] of others. People with this disorder may be hypersensitive, easily [[insulted]], and habitually relate to the world by vigilant scanning of the environment for clues or suggestions that may validate their fears or biases. They are eager observers and they often think they are in danger and look for signs and threats of that danger, potentially not appreciating other interpretations or evidence.<ref>{{cite book |first=Robert J. |last=Waldinger |title=Psychiatry for Medical Students |url=https://books.google.com/books?id=WjbQGh0MwzYC |date=1 August 1997 |publisher=American Psychiatric |isbn=978-0-88048-789-4}}</ref>

They tend to be guarded and suspicious and have quite constricted emotional lives. Their reduced capacity for meaningful emotional involvement and the general pattern of [[Social isolation|isolated withdrawal]] often lend a quality of [[loneliness]] to their life experience.<ref>{{Cite journal |last1=Reinhard |first1=Matthias A. |last2=Nenov-Matt |first2=Tabea |last3=Padberg |first3=Frank |date=November 2022 |title=Loneliness in Personality Disorders |journal=Current Psychiatry Reports |volume=24 |issue=11 |pages=603–612 |doi=10.1007/s11920-022-01368-7 |issn=1535-1645 |pmc=9525923 |pmid=36181573}}</ref> People with PPD may have a tendency to bear grudges, suspiciousness, tendency to interpret others' actions as hostile, persistent tendency to [[self-reference]], or a tenacious sense of personal right.<ref>{{cite journal |author1=MacManus, Deirdre |author2=Fahy, Tom |title=Personality disorders |journal=Medicine |volume=36 |issue=8 |pages=436–441 |date=August 2008 |doi=10.1016/j.mpmed.2008.06.001 |url=http://www.medicinejournal.co.uk/article/S1357-3039%2808%2900174-6/abstract|url-access=subscription }}</ref> Patients with this disorder can also have significant [[comorbidity]] with other personality disorders, such as [[Schizotypal personality disorder|schizotypal]], [[Schizoid personality disorder|schizoid]], [[Narcissistic personality disorder|narcissistic]], [[Avoidant personality disorder|avoidant]], and [[Borderline personality disorder|borderline]].{{CN|date=June 2025}}

It is one of the ten personality disorder categories in the [[DSM-5-TR]], where it is listed among [[Cluster A]] ("odd or eccentric") personality disorders.<ref>{{Cite book |title=Diagnostic and statistical manual of mental disorders: DSM-5-TR |date=2022 |publisher=American Psychiatric Association Publishing |isbn=978-0-89042-575-6 |editor-last=American Psychiatric Association |edition=Fifth edition, text revision |location=Washington, DC}}</ref> It is not specifically included as a diagnosis in the [[ICD-11 classification of personality disorders]], which, rather than including distinct personality disorders, has a single, [[Dimensional models of personality disorders|dimensional]] ''personality disorder'' presenting with pathological manifestations of personality traits.

==Causes==
A genetic contribution to paranoid traits and a possible genetic link between this personality disorder and [[schizophrenia]] exist.{{CN|date=June 2025}} A large long-term [[Norway|Norwegian]] [[twin study]] found paranoid personality disorder to be modestly heritable and to share a portion of its genetic and environmental risk factors with the other cluster A personality disorders, [[schizoid personality disorder|schizoid]] and [[schizotypal personality disorder|schizotypal]].<ref name="pmid16893481">{{cite journal|last4=Torgersen|first4=Svenn|last5=Aggen|first5=Steven H.|last6=c. Neale|first6=Michael|last7=Reichborn-Kjennerud|first7=TED|year=2006|title=Dimensional representations of DSM-IV cluster A personality disorders in a population-based sample of Norwegian twins: a multivariate study|journal=Psychological Medicine|volume=36|issue=11|pages=1583–91|doi=10.1017/S0033291706008609|pmid=16893481|author=Kendler KS|name-list-style=vanc|author2=Czajkowski N|author3=Tambs K|s2cid=21613637|display-authors=3}}</ref>

Psychosocial theories implicate [[Psychological projection|projection]] of negative internal feelings and parental modeling.<ref name="Bienenfeld" /> [[Cognitive behavioral therapy|Cognitive theorists]] believe the disorder to be a result of an underlying belief that other people are unfriendly in combination with a lack of [[self-awareness]].<ref name="beckfreeman2">{{cite book|title=Cognitive Therapy of Personality Disorders|author=[[Aaron T. Beck]], Arthur Freeman|publisher=The Guilford Press|year=1990|isbn=978-0-89862-434-2|edition=1st|oclc=906420553}}</ref>

==Diagnosis==

=== Classification ===
{{Further|Classification of personality disorders}}
[[Classification of personality disorders]] differs significantly between the two most prominent frameworks for [[classification of mental disorders]], namely: the ''[[Diagnostic and Statistical Manual of Mental Disorders]]'' and the [[International Classification of Diseases]], the most recent editions of which are the [[DSM-5-TR]] and [[ICD-11]], respectively. While personality disorders, including PPD, are diagnosed as separate entities in the DSM-5; in the [[ICD-11 classification of personality disorders]], they are assessed in terms of severity levels, with trait and pattern specifiers serving to characterize the particular style of pathology.<ref name=":72">{{Cite journal |last=Clark |first=Lee Anna |author-link=Lee Anna Clark |date=2025-05-01 |title=Wherefrom and Whither PD? Recent Developments and Future Possibilities in DSM-5 and ICD-11 Personality Disorder Diagnosis |url=https://doi.org/10.1007/s11920-025-01602-y |journal=Current Psychiatry Reports |language=en |volume=27 |issue=5 |pages=267–277 |doi=10.1007/s11920-025-01602-y |issn=1535-1645 |pmc=12003573 |pmid=40108080}}</ref> There is also a hybrid model,<ref>{{Cite journal |last1=Rodriguez-Seijas |first1=Craig |last2=Ruggero |first2=Camilo |last3=Eaton |first3=Nicholas R. |last4=Krueger |first4=Robert F. |date=2019 |title=The DSM-5 Alternative Model for Personality Disorders and Clinical Treatment: a Review |url=https://link.springer.com/10.1007/s40501-019-00187-7 |journal=Current Treatment Options in Psychiatry |language=en |volume=6 |issue=4 |pages=284–298 |doi=10.1007/s40501-019-00187-7 |issn=2196-3061 |url-access=subscription}}</ref> called the [[Alternative DSM-5 model for personality disorders|''Alternative DSM-5 model for personality disorders'']] (AMPD), which defines personality disorder diagnoses through disorder-specific combinations of pathological traits and areas of overall impairment.<ref name=":72" />

The criteria in the [[American Psychiatric Association]]'s [[DSM-5]] require in general the presence of lasting distrust and suspicion of others, interpreting their motives as malevolent, from an early adult age, occurring in a range of situations. Four of seven specific issues must be present, which include different types of suspicions or doubt (such as of being exploited, or that remarks have a subtle threatening meaning), in some cases regarding others in general or specifically friends or partners, and in some cases referring to a response of holding grudges or reacting angrily.<ref name="DSM 5">{{cite book |url=https://archive.org/details/diagnosticstatis0005unse |title=Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (2013) |publisher=American Psychiatric Association |year=2013 |isbn=978-0-89042-555-8 |chapter=Schizoid Personality Disorder (pp. 652–655) |url-access=registration}}</ref> While not listed as its own diagnostic entity in the AMPD,<ref name=":14">{{Cite journal |last1=Morey |first1=Leslie C. |author-link1=Leslie Morey |last2=Benson |first2=Kathryn T. |last3=Busch |first3=Alexander J. |last4=Skodol |first4=Andrew E. |author-link4=Andrew E. Skodol |date=April 2015 |title=Personality Disorders in DSM-5: Emerging Research on the Alternative Model |url=http://link.springer.com/10.1007/s11920-015-0558-0 |journal=Current Psychiatry Reports |language=en |volume=17 |issue=4 |doi=10.1007/s11920-015-0558-0 |issn=1523-3812 |pmid=25749746 |url-access=subscription |quote=In addition, the alternative model does not provide specific criteria for each of the ten PDs listed in Sect. II of the DSM-5, as it recommends considering dependent, schizoid, histrionic, and paranoid PDs as variants of 'Personality Disorder - Trait Specified.' |article-number=24}}</ref> what is conceptualized as PPD can instead be diagnosed as ''[[Personality disorder trait specified|personality disorder – trait specified]]'',<ref name=":14" /> which is a [[Dimensional models of personality disorders|dimensional]] diagnosis that is constructed from the individual expression of personalty disorder,<ref>{{Cite journal |last1=Clark |first1=Lee Anna |last2=Vanderbleek |first2=Emily N. |last3=Shapiro |first3=Jaime L. |last4=Nuzum |first4=Hallie |last5=Allen |first5=Xia |last6=Daly |first6=Elizabeth |last7=Kingsbury |first7=Thomas J. |last8=Oiler |first8=Morgan |last9=Ro |first9=Eunyoe |date=2015-02-01 |title=The Brave New World of Personality Disorder-Trait Specified: Effects of Additional Definitions on Coverage, Prevalence, and Comorbidity |journal=Psychopathology Review |language=EN |volume=a2 |issue=1 |pages=52–82 |doi=10.5127/pr.036314 |issn=2051-8315 |pmc=4469240 |pmid=26097740}}</ref> as manifested in both a general impairment in personality functioning along with at least one pathological [[personality trait]].<ref>{{Cite journal |last1=Rowiński |first1=Tomasz |last2=Kowalska-Dąbrowska |first2=Monika |last3=Strus |first3=Włodzimierz |last4=Cieciuch |first4=Jan |last5=Czuma |first5=Iwona |last6=Żechowski |first6=Cezary |last7=Markon |first7=Kristian E. |last8=Krueger |first8=Robert F. |date=2019-02-28 |title=Measurement of pathological personality traits according to the DSM-5: A Polish adaptation of the PID-5. Part I – theoretical foundations |url=https://www.psychiatriapolska.pl/Measurement-of-pathological-personality-traits-according-to-the-DSM-5-A-Polish-adaptation,86477,0,2.html |journal=Psychiatria Polska |language=english |volume=53 |issue=1 |pages=7–22 |doi=10.12740/PP/OnlineFirst/86477 |issn=0033-2674 |pmid=31008462 |quote=PD-TS is diagnosed when (1) moderate or higher impairment in at least two out of four elements of personality functioning (Criterion A) is accompanied by (2) at least one elevated pathological trait domain or facet (Criterion B) in the absence of (3) a pattern of traits consistent with a specific disorder (Criterion B) and/or a pattern of difficulties in personality functioning characteristic of a specific disorder (Criterion A). |doi-access=free}}</ref>

The [[World Health Organization]]'s [[ICD-11]] has replaced the categorical classification of personality disorders in the [[ICD-10]] with a [[Dimensional models of personality disorders|dimensional model]] containing a unified ''personality disorder'' ({{ICD11|6D10}}) with severity specifiers, along with specifiers for [[Prominent personality traits or patterns|''prominent personality traits or patterns'']] ({{ICD11|6D11}}).<ref>{{Cite journal |last1=Bach |first1=Bo |last2=First |first2=Michael B. |date=2018-10-29 |title=Application of the ICD-11 classification of personality disorders |journal=BMC Psychiatry |volume=18 |issue=1 |page=351 |doi=10.1186/s12888-018-1908-3 |issn=1471-244X |pmc=6206910 |pmid=30373564 |doi-access=free}}</ref> Severity is assessed based on the pervasiveness of impairment in several areas of functioning, as well as on the level of distress and harm caused by the disorder,<ref>{{Cite journal |last=Swales |first=Michaela A. |date=2022-12-15 |title=Personality Disorder Diagnoses in ICD-11: Transforming Conceptualisations and Practice |url=https://cpe.psychopen.eu/index.php/cpe/article/view/9635 |journal=Clinical Psychology in Europe |language=en |volume=4 |issue=Spec Issue |article-number=e9635 |doi=10.32872/cpe.9635 |pmid=36760321 |issn=2625-3410 |pmc=9881116}}</ref> while trait and pattern specifiers are used for recording the manner in which the disturbance is manifested.<ref>{{Cite journal |last1=Bach |first1=Bo |last2=Kramer |first2=Ueli |last3=Doering |first3=Stephan |last4=di Giacomo |first4=Ester |last5=Hutsebaut |first5=Joost |last6=Kaera |first6=Andres |last7=De Panfilis |first7=Chiara |last8=Schmahl |first8=Christian |last9=Swales |first9=Michaela |last10=Taubner |first10=Svenja |last11=Renneberg |first11=Babette |date=2022-04-01 |title=The ICD-11 classification of personality disorders: a European perspective on challenges and opportunities |journal=Borderline Personality Disorder and Emotion Dysregulation |volume=9 |issue=1 |page=12 |doi=10.1186/s40479-022-00182-0 |doi-access=free |pmid=35361271 |issn=2051-6673 |pmc=8973542}}</ref> Paranoid personality disorder is primarily associated with the ICD-11 trait domains ''[[Negative affectivity in personality disorder or personality difficulty|Negative Affectivity]]'' ({{ICD11|6D11.0}}) and ''[[Dissociality in personality disorder or personality difficulty|Dissociality]]'' ({{ICD11|6D11.2}}). The former reflects core features such as mistrust and suspicion, while the latter relates to hostility, self-righteousness, and a tendency toward self-centeredness.<ref name=":0">{{Cite journal |last1=Simon |first1=Jonatan |last2=Lambrecht |first2=Bastian |last3=Bach |first3=Bo |date=2023-04-06 |title=Cross-walking personality disorder types to ICD-11 trait domains: An overview of current findings |journal=Frontiers in Psychiatry |language=English |volume=14 |article-number=1175425 |doi=10.3389/fpsyt.2023.1175425 |doi-access=free |issn=1664-0640 |pmc=10116048 |pmid=37091704}}</ref> Some studies also report a link to ''[[Detachment in personality disorder or personality difficulty|Detachment]]'' ({{ICD11|6D11.1}}), consistent with prior research and theoretical models.<ref name=":0" /> The previous revision, [[ICD-10]], lists ''paranoid personality disorder'' under ({{ICD10|F|60|0|f|60}}).<ref>The Classification of Mental and Behavioural Disorders (ICD-10) by WHO: "[https://www.who.int/classifications/icd/en/bluebook.pdf#158 Diagnostic guidelines] {{Webarchive|url=https://web.archive.org/web/20140323025330/http://www.who.int/classifications/icd/en/bluebook.pdf#158|date=2014-03-23}}, p.158</ref>

===Millon's subtypes===
Various researchers and clinicians may propose varieties and subsets or dimensions of personality related to the official diagnoses. Psychologist [[Theodore Millon]] has proposed five subtypes of paranoid personality:<ref name=millon2>{{cite book |first1=Théodore |last1=Millon |first2=Seth |last2=Grossman |title=Personality disorders in modern life |url=https://books.google.com/books?id=mHnbLYVAn9kC |date=6 August 2004 |publisher=Wiley |isbn=978-0-471-23734-1}}</ref>

{| class="wikitable"
|-
! Subtype
!Features
! Traits
|-
| '''Obdurate paranoid'''
|Including [[Obsessive–compulsive personality disorder|compulsive]] features
| Self-assertive, unyielding, stubborn, steely, implacable, unrelenting, dyspeptic, peevish, and cranky stance; legalistic and self-righteous; discharges previously restrained hostility; renounces self-other conflict.
|-
| '''Fanatic paranoid'''
|Including [[Narcissistic personality disorder|narcissistic]] features
| Grandiose beliefs are irrational and flimsy; pretentious, expensive supercilious contempt and arrogance toward others; lost pride reestablished with extravagant claims and fantasies.
|-
| '''Querulous paranoid'''
|Including [[Passive-aggressive personality disorder|negativistic]] features
| Contentious, caviling, fractious, argumentative, faultfinding, unaccommodating, resentful, choleric, jealous, peevish, sullen, endless wrangles, whiny, waspish, snappish.
|-
| '''Insular paranoid''' 
|Including [[Avoidant personality disorder|avoidant]] features
| Reclusive, self-sequestered, hermitical; self-protectively secluded from omnipresent threats and destructive forces; hypervigilant and defensive against imagined dangers.
|-
| '''Malignant paranoid''' 
|Including [[Sadistic personality disorder|sadistic]] features
| Belligerent, cantankerous, intimidating, vengeful, callous, and tyrannical; hostility vented primarily in fantasy; projects own venomous outlook onto others; persecutory beliefs.
|}

===Differential diagnosis===
The paranoid may be at greater than average risk of experiencing [[major depressive disorder]], [[agoraphobia]], [[social anxiety disorder]], [[obsessive–compulsive disorder]], and [[substance-related disorder]]s. Criteria for other personality disorder diagnoses are commonly also met, such as:<ref name="mentalhealth">{{Cite web |url=http://www.mentalhealth.com/dis/p20-pe01.html |title=Internet Mental Health—paranoid personality disorder |access-date=2004-06-01 |archive-url=https://web.archive.org/web/20130131182232/http://www.mentalhealth.com/dis/p20-pe01.html |archive-date=2013-01-31 }}</ref> [[schizoid personality disorder|schizoid]], [[schizotypal personality disorder|schizotypal]], [[narcissistic personality disorder|narcissistic]], [[avoidant personality disorder|avoidant]], [[borderline personality disorder|borderline]] and [[passive-aggressive personality disorder|negativistic personality disorder]].

==Treatment==
Partly as a result of tendencies to mistrust others, there have been few studies conducted over the treatment of paranoid personality disorder. Currently, there are no medicines FDA approved in treating PPD, but antidepressants, antipsychotics, and mood stabilizers may be prescribed under wrong assumptions to treat some of the symptoms.<ref>{{Cite journal |last=Lee |first=Royce J. |date=2017-06-01 |title=Mistrustful and Misunderstood: a Review of Paranoid Personality Disorder |journal=Current Behavioral Neuroscience Reports |language=en |volume=4 |issue=2 |pages=151–165 |doi=10.1007/s40473-017-0116-7 |issn=2196-2979 |pmc=5793931 |pmid=29399432}}</ref> Another form of treatment of PPD is [[psychoanalysis]], normally used in cases where both PPD and BPD are present. However, no published studies directly state the effectiveness of this form of treatment on specifically PPD, as opposed to its effects on BPD. CBT ([[cognitive behavioral therapy]]) has also been suggested as a possible treatment to paranoid personality disorder, but while case studies have shown improvement in the symptoms of the disorder, no systematic/widespread data has been collected to support this.<ref>{{Cite journal |last=Lee |first=Royce J. |date=2017-06-01 |title=Mistrustful and Misunderstood: a Review of Paranoid Personality Disorder |journal=Current Behavioral Neuroscience Reports |language=en |volume=4 |issue=2 |pages=151–165 |doi=10.1007/s40473-017-0116-7 |issn=2196-2979 |pmc=5793931 |pmid=29399432}}</ref><ref>{{Cite journal |last=Williams |first=Janice G. |date=1988 |title=Cognitive intervention for a paranoid personality disorder. |url=http://doi.apa.org/getdoi.cfm?doi=10.1037/h0085383 |journal=Psychotherapy: Theory, Research, Practice, Training |language=en |volume=25 |issue=4 |pages=570–575 |doi=10.1037/h0085383 |issn=1939-1536|url-access=subscription }}</ref> A recent meta-analysis<ref>{{Cite journal |last1=Cheli |first1=Simone |last2=Wisepape |first2=Courtney N. |last3=Witten |first3=Chelsea D. Y. |last4=Floridi |first4=Marta |last5=Cavalletti |first5=Veronica |last6=Hasson-Ohayon |first6=Ilanit |last7=Brüne |first7=Martin |last8=Ottaviani |first8=Cristina |date=2025-03-20 |title=Psychosocial and pharmacological interventions for cluster a personality disorders: A systematic review and two exploratory meta-analyses. |url=https://doi.apa.org/doi/10.1037/per0000732 |journal=Personality Disorders: Theory, Research, and Treatment |language=en |doi=10.1037/per0000732 |pmid=40111791 |issn=1949-2723|url-access=subscription }}</ref> revealed that no specific randomized controlled trials (RCTs) currently focus solely on PPD. Instead, PPD was merely one of several possible diagnoses in a small number of existing trials, resulting in a minimal count of relevant recruited patients (e.g., an RCT on [[Schema therapy|Schema Therapy]]<ref>{{Cite journal |last1=Bamelis |first1=Lotte L.M. |last2=Evers |first2=Silvia M.A.A. |last3=Spinhoven |first3=Philip |last4=Arntz |first4=Arnoud |date=March 2014 |title=Results of a Multicenter Randomized Controlled Trial of the Clinical Effectiveness of Schema Therapy for Personality Disorders |url=https://psychiatryonline.org/doi/10.1176/appi.ajp.2013.12040518 |journal=American Journal of Psychiatry |volume=171 |issue=3 |pages=305–322 |doi=10.1176/appi.ajp.2013.12040518 |pmid=24322378 |issn=0002-953X|url-access=subscription }}</ref>). Treatments for PPD can be challenging, as individuals with PPD are reluctant in finding help and have difficulty trusting others.

==Epidemiology==
PPD occurs in about 0.5–4.4% of the general population.<ref>{{Cite journal |last1=Schulte Holthausen |first1=Barbara |last2=Habel |first2=Ute |date=2018-10-11 |title=Sex Differences in Personality Disorders |journal=Current Psychiatry Reports |language=en |volume=20 |issue=12 |page=107 |doi=10.1007/s11920-018-0975-y |pmid=30306417 |s2cid=52959021 |issn=1535-1645}}</ref><ref name="Bienenfeld">{{EMedicine|article|294307|Personality Disorders}}</ref><ref name="mentalhealth" /> It is seen in 2–10% of psychiatric outpatients.{{Citation needed|date=April 2022}} In clinical samples men have higher rates, whereas [[Epidemiology|epidemiologically]] there is a reported higher rate of women.<ref>{{Cite journal| issn = 0160-6689| volume = 65| issue = 7| pages = 948–958| last1 = Grant| first1 = Bridget F.| last2 = Hasin| first2 = Deborah S.| last3 = Stinson| first3 = Frederick S.| last4 = Dawson| first4 = Deborah A.| last5 = Chou| first5 = S. Patricia| last6 = Ruan| first6 = W. June| last7 = Pickering| first7 = Roger P.| title = Prevalence, Correlates, and Disability of Personality Disorders in the United States: Results From the National Epidemiologic Survey on Alcohol and Related Conditions.| journal = The Journal of Clinical Psychiatry| access-date = 2022-04-24| date = 2004-07-01| doi = 10.4088/JCP.v65n0711| pmid = 15291684| url = https://www.psychiatrist.com/jcp/personality/prevalence-correlates-disability-personality-disorders/| url-access = subscription}}</ref>

==History==
{{See also|Paranoia#History}}
{{One source|section|date=March 2024}}

Paranoid personality disorder is listed in the DSM-5 and was included in all previous versions of the [[Diagnostic and Statistical Manual of Mental Disorders|DSM]]. One of the earliest descriptions of the paranoid personality comes from the French psychiatrist [[Valentin Magnan]] who described a "fragile personality" that showed [[Idiosyncrasy|idiosyncratic]] thinking, [[hypochondriasis]], undue sensitivity, referential thinking, and suspiciousness.<ref name="Akhtar">Salman Akhtar (1990). [https://books.google.com/books?id=bU0eAAAAQBAJ&pg=PA149 Paranoid Personality Disorder: A Synthesis of Developmental, Dynamic, and Descriptive Features] {{Webarchive|url=https://web.archive.org/web/20180401003944/https://books.google.de/books?id=bU0eAAAAQBAJ&pg=PA149 |date=2018-04-01 }}. ''American Journal of Psychotherapy'', 44, 5–25.</ref>

Closely related to this description is [[Emil Kraepelin|Emil Kraepelin's]] description from 1905 of a pseudo-querulous personality who is "always on the alert to find grievance, but without delusions", vain, self-absorbed, sensitive, irritable, litigious, obstinate, and living at strife with the world. In 1921, he renamed the condition paranoid personality and described these people as distrustful, feeling unjustly treated and feeling subjected to hostility, interference and oppression. He also observed a contradiction in these personalities: on the one hand, they stubbornly hold on to their unusual ideas, on the other hand, they often accept every piece of gossip as the truth.<ref name="Akhtar" /> Kraepelin also noted that paranoid personalities were often present in people who later developed paranoid psychosis. Subsequent writers also considered traits like suspiciousness and hostility to predispose people to developing delusional illnesses, particularly "late paraphrenias" of old age.<ref>Bernstein, D. P., Useda, D., Siever, L. J. (1995). Paranoid Personality Disorder. In: J. W. Livesley (Ed.). The DSM-IV Personality Disorders. (pp. 45-57). New York: Guilford.</ref>

Following Kraepelin, [[Eugen Bleuler]] described "contentious psychopathy" or "paranoid constitution" as displaying the characteristic triad of suspiciousness, grandiosity, and feelings of persecution. He also emphasized that these people's false assumptions do not attain the form of real delusion.<ref name="Akhtar" />

[[Ernst Kretschmer]] emphasized the sensitive inner core of the paranoia-prone personality: they feel shy and inadequate but at the same time they have an attitude of entitlement. They attribute their failures to the machinations of others but secretly to their own inadequacy. They experience constant tension between feelings of self-importance and experiencing the environment as unappreciative and humiliating.<ref name="Akhtar" />

[[Karl Jaspers]], a German [[Phenomenology (psychology)|phenomenologist]], described "self-insecure" personalities who resemble the paranoid personality. According to Jaspers, such people experience inner humiliation, brought about by outside experiences and their interpretations of them. They have an urge to get external confirmation to their self-deprecation and that makes them see insults in the behavior of other people. They suffer from every slight because they seek the real reason for them in themselves. This kind of insecurity leads to overcompensation: compulsive formality, strict social observances, and exaggerated displays of assurance.<ref name="Akhtar" />

In 1950, [[Kurt Schneider]] described the "fanatic psychopaths" and divided them into two categories: the combative type that is very insistent about his false notions and actively quarrelsome, and the eccentric type that is passive, secretive, vulnerable to esoteric sects, but nonetheless suspicious about others.<ref name="Akhtar" />

The descriptions of Leonhard and Sheperd from the sixties describe paranoid people as overvaluing their abilities and attributing their failure to the ill-will of others; they also mention that their interpersonal relations are disturbed and they are in constant conflict with others.<ref name="Akhtar" />

In 1975, Polatin described the paranoid personality as rigid, suspicious, watchful, self-centered and selfish, inwardly hypersensitive, but emotionally undemonstrative. However, when there is a difference of opinion, the underlying mistrust, authoritarianism, and rage burst through.<ref name="Akhtar" />

In the 1980s, paranoid personality disorder received little attention, and when it did receive it, the focus was on its 
potential relationship to [[paranoid schizophrenia]]. The most significant contribution of this decade comes from [[Theodore Millon]] who divided the features of paranoid personality disorder to four categories:<ref name="Akhtar" />

# Behavioral characteristics of vigilance, abrasive irritability, and counterattack
# Complaints indicating oversensitivity, social isolation, and mistrust
# The dynamics of denying personal insecurities, attributing these to others, and self-inflation through grandiose fantasies
# Coping style of detesting dependence and hostile distancing of oneself from others

== Controversy ==
Due to repeated concerns of the validity of PPD and poor empirical evidence, it has been suggested that PPD be removed from the DSM.<ref>{{Cite journal |last1=Schulte Holthausen |first1=Barbara |last2=Habel |first2=Ute |date=2018-10-11 |title=Sex Differences in Personality Disorders |journal=Current Psychiatry Reports |volume=20 |issue=12 |page=107 |doi=10.1007/s11920-018-0975-y |pmid=30306417 |s2cid=52959021 |issn=1523-3812}}</ref> This is believed to contribute to low research output on PPD.<ref>{{Cite journal |last1=Triebwasser |first1=Joseph |last2=Chemerinski |first2=Eran |last3=Roussos |first3=Panos |last4=Siever |first4=Larry J. |date=December 2013 |title=Paranoid Personality Disorder |journal=Journal of Personality Disorders |volume=27 |issue=6 |pages=795–805 |doi=10.1521/pedi_2012_26_055 |pmid=22928850 |issn=0885-579X}}</ref>

== See also ==
{{Portal|Psychology}}
{{Columns-list|colwidth=30em|
*[[DSM-IV Codes#Personality disorders .28Axis II.29|DSM-IV codes (personality disorders)]]
*[[Paranoia]]
*[[Delusions of reference]]
*[[Paranoid anxiety]]
*[[Persecutory delusions]]}}

==References==
{{Reflist}}

== External links ==
{{Medical resources
| DiseasesDB = 
| ICD10 = {{ICD10|F|60|0|f|60}}
| ICD9 = {{ICD9|301.0}}
| ICDO = 
| OMIM = 
| MedlinePlus = 000938
| eMedicineSubj = 
| eMedicineTopic = 
| MeshID = D010260
| SNOMED CT = 13601005
}}
* {{usurped|1=[https://web.archive.org/web/20060916172249/http://www.personalitydisorder.org.uk/index.php National Personality Disorder website for England]}}
* [http://web4health.info/en/answers/border-menu.htm Articles about Personality Disorders] {{Webarchive|url=https://web.archive.org/web/20160726092049/http://web4health.info/en/answers/border-menu.htm |date=2016-07-26 }} in Web4health web site

{{ICD-10 personality disorders}}
{{Authority control}}

[[Category:Cluster A personality disorders]]
[[Category:Paranoia]]
[[Category:Distrust]]