Paranoid personality disorder


  • 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


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

General ED Psychiatric Workup


  • Ask for clarification of any unclear terminology, be genuinely curious, ask clearly about physical symptoms
  • Know patient may underreport symptoms due to desire to end social interaction with you
  • Referral for outpatient psychiatric treatment, which can include psychotherapy, antidepressants, anti-psychotics and anti-anxiety medications


  • Discharge

See Also

External Links


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