A7). They may gather trivial and circumstantial "evidence” to support their jealous beliefs.
They want to maintain complete control of intimate relationships to avoid being betrayed and may constantly question and challenge the whereabouts, actions, intentions, and fi- delity of their spouse or partner.
Paranoid personality disorder should not be diagnosed if the pattern of behavior oc- curs exclusively during the course of schizophrenia, a bipolar disorder or depressive dis- order with psychotic features, or another psychotic disorder, or if it is attributable to the physiological effects of a neurological (e.g., temporal lobe epilepsy) or another medical condition (Criterion B).
Individuals with paranoid personality disorder are generally difficult to get along with and often have problems with close relationships. Their excessive suspiciousness and hos- tility may be expressed in overt argumentativeness, in recurrent complaining, or by quiet, apparently hostile aloofness. Because they are hypervigilant for potential threats, they may act in a guarded, secretive, or devious manner and appear to be “cold” and lacking in tender feelings. Although they may appear to be objective, rational, and unemotional, they more often display a labile range of affect, with hostile, stubborn, and sarcastic expressions predominating. Their combative and suspicious nature may elicit a hostile response in others, which then serves to confirm their original expectations.
Because individuals with paranoid personality disorder lack trust in others, they have an excessive need to be self-sufficient and a strong sense of autonomy. They also need to have a high degree of control over those around them. They are often rigid, critical of oth- ers, and unable to collaborate, although they have great difficulty accepting criticism them- selves. They may blame others for their own shortcomings. Because of their quickness to counterattack in response to the threats they perceive around them, they may be litigious and frequently become involved in legal disputes. Individuals with this disorder seek to confirm their preconceived negative notions regarding people or situations they encounter, attributing malevolent motivations to others that are projections of their own fears. They may exhibit thinly hidden, unrealistic grandiose fantasies, are often attuned to issues of power and rank, and tend to develop negative stereotypes of others, particularly those from population groups distinct from their own. Attracted by simplistic formulations of the world, they are often wary of ambiguous situations. They may be perceived as ”fanatics" and form tightly knit "cults” or groups with others who share their paranoid belief systems.
Particularly in response to stress, individuals with this disorder may experience very brief psychotic episodes (lasting minutes to hours). In some instances, paranoid personal- ity disorder may appear as the premorbid antecedent of delusional disorder or schizo- phrenia. Individuals with paranoid personality disorder may develop major depressive order. Alcohol and other substance use disorders frequently occur. The most common co- occurring personality disorders appear to be schizotypal, schizoid, narcissistic, avoidant, and borderline.
Part II of the National Comorbidity Survey Replication suggests a prevalence of 2.3%, while the National Epidemiologic Survey on Alcohol and Related Conditions data suggest a prevalence of paranoid personality disorder of 4.4%.
solitariness, poor peer relationships, social anxiety, underachievement in school, hyper- sensitivity, peculiar thoughts and language, and idiosyncratic fantasies. These children may appear to be ”odd" or ”eccentric” and attract teasing. In clinical samples, this disorder appears to be more commonly diagnosed in males.
Genetic and physiological. There is some evidence for an increased prevalence of par- anoid personality disorder in relatives of probands with schizophrenia and for a more spe- cific familial relationship with delusional disorder, persecutory type.