scan the environment for clues may be evident, and the patient's manner is often humorless andserious. Although some premises of their arguments may be false, their speech is goal directed andlogical. Their thought content shows evidence of projection, prejudice, and occasional ideas of reference. The DSM-IV-TR diagnostic criteria are listed in Table 27-2.
The hallmarks of paranoid personality disorder are excessive suspiciousness and distrust of othersexpressed as a pervasive tendency to interpret actions of others as deliberately demeaning, malevolent,threatening, exploiting, or deceiving. This tendency begins by early adulthood and appears in a variety of contexts. Almost invariably, those with the disorder expect to be exploited or harmed by others in someway. They frequently dispute, without any justification, friends' or associates' loyalty or trustworthiness.Such persons are often pathologically jealous and, for no reason, question the fidelity of their spouses orsexual partners. Persons with this disorder externalize their own emotions and use the defense of projection; they attribute to others the impulses and thoughts that they cannot accept in themselves.Ideas of reference and logically defended illusions are common.
DSM-IV-TR Diagnostic Criteria for Paranoid Personality Disorder
A pervasive distrust and suspiciousness of others such that their motives are interpreted asmalevolent, beginning by early adulthood and present in a variety of contexts, as indicated byfour (or more) of the following:1.
suspects, without sufficient basis, that others are exploiting, harming, or deceiving himor her2.
is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends orassociates3.
is reluctant to confide in others because of unwarranted fear that the information willbe used maliciously against him or her4.
reads hidden demeaning or threatening meanings into benign remarks or events5.
persistently bears grudges, i.e., is unforgiving of insults, injuries, or slights6.
perceives attacks on his or her character or reputation that are not apparent to othersand is quick to react angrily or to counterattack7.
has recurrent suspicions, without justification, regarding fidelity of spouse or sexualpartnerB.
Does not occur exclusively during the course of schizophrenia, a mood disorder with psychoticfeatures, or another psychotic disorder and is not due to the direct physiological effects of ageneral medical condition.
: If criteria are met prior to the onset of schizophrenia, add â€œpremorbid,â€
e.g.,â€œparanoid personality disorder (premorbid).â€
Persons with paranoid personality disorder are affectively restricted and appear to be unemotional.They pride themselves on being rational and objective, but such is not the case. They lack warmth andare impressed with, and pay close attention to, power and rank. They express disdain for those they seeas weak, sickly, impaired, or in some way defective. In social situations, persons with paranoidpersonality disorder may appear business-like and efficient, but they often generate fear or conflict inothers.