Paranoid: Definition, Causes, Symptoms, Diagnosis, Treatment and Outlook

It is a mental disorder characterized by paranoia and a long-standing, persistent suspicion and general distrust of others.

Paranoid personality disorder (PPD) is a type of eccentric personality disorder.

People with a paranoid personality disorder may show a tendency to show resentment , distrust, a tendency to interpret the actions of others as a persistent and hostile tendency to self-referral, or a tenacious sense of personal entitlement.

Causes of paranoia

The cause of paranoid personality disorder is unknown, however there are many theories about the possible causes. Researchers believe that a combination of biological and environmental factors can lead to paranoid personality disorder.

Most professionals subscribe to a biopsychosocial model of causality, that is, the causes are probably due to:

There is a genetic contribution to paranoid traits and a possible genetic link between this personality disorder and schizophrenia .

Since the disorder occurs more frequently in families with a history of schizophrenia and delusional disorders. Trauma in early childhood can be a contributing factor.

A large long-term study of Norwegian twins found that Paranoid Personality Disorder is moderately hereditary and share a portion of its genetic and environmental risk factors with the other Group A, Schizoid, and Schizotypal Personality Disorders.

Symptoms of paranoia

Often times, people with paranoid personality disorder do not believe that their behavior is abnormal. It may seem completely rational for a person with paranoia to be suspicious of others.

However, those around you may believe that this mistrust is unwarranted and offensive. The person with paranoia may behave in a hostile or stubborn manner.

They can be sarcastic, which often elicits a hostile response from others, which can confirm your original suspicions.

Some symptoms of paranoia are related to feelings that are repressed, denied, or projected. Paranoid thoughts and feelings are often related to events and relationships in a person’s life, increasing isolation and difficulty in getting help.

What is a hoax?

A hoax is a strange belief that a person firmly insists that it is true despite the evidence that it is not.

Cultural beliefs that may seem strange, but are widely accepted, do not meet the criteria for being a hoax. Two of the most common types of delusions are delusions of grandeur or delusions of persecution.

What is a delusional disorder?

Delusional disorder is characterized by strong or irrational beliefs or suspicions that a person believes to be true.

These beliefs may seem outlandish and impossible (strange) or fall within the domain of what is possible (not strange). Symptoms must last 1 month or longer for someone to be diagnosed with a delusional disorder.

This usually begins in early adulthood and occurs in a variety of contexts, as indicated by four (or more) of the following:

Like most personality disorders, paranoid personality disorder will generally decrease in intensity with age, and many people will experience some of the most extreme symptoms by the time they are in their 40s and 50s.

Someone with paranoia may have other conditions that can fuel their illness. For example, depression and anxiety can affect a person’s mood.

Mood swings can make someone with paranoia more likely to feel paranoid and isolated. Other symptoms include:

  • Believing that others have ulterior motives or are willing to harm them, doubting the loyalty of others, being oversensitive to criticism, having trouble working with others.
  • Being quick to get angry and hostile, becoming detached or socially isolated, being argumentative and defensive, having trouble seeing their own problems, having trouble relaxing.
  • Some symptoms of paranoia can be similar to the symptoms of other disorders. Schizophrenia and Borderline Personality Disorder are two disorders with symptoms similar to paranoia. These disorders can be difficult to clearly diagnose.

Diagnosis of paranoia

Family physicians and general practitioners are generally neither trained nor equipped to perform this type of psychological diagnosis.

ICD-10 (International Classification of Diseases, Tenth Revision)

The World Health Organization ICD-10 lists low paranoid personality disorder (F60.0).

It is an ICD-10 requirement that the diagnosis of any specific personality disorder also meets a set of criteria for general personality disorder.

It is also noted that for different cultures it may be necessary to develop specific sets of criteria regarding social norms, rules and other obligations.

Paranoid personality disorder is characterized by at least three of the following symptoms:

  • Recurring suspicions, without justification, regarding the sexual fidelity of the spouse or sexual partner; tendency to experience excessive self-aggrandizement, manifested in a persistent self-referential attitude.
  • Preoccupation with unsubstantiated “conspiratorial” explanations of events both immediate for the patient and for the world at large.

Includes : expansive paranoid, fanatic, querulous and sensitive paranoid personality disorder.

Excludes : delusional disorder and schizophrenia.

DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition)

The DSM-5 of the American Psychiatric Association has similar criteria for paranoid personality disorder.

They require, in general, the presence of lasting mistrust and suspicion towards others, interpreting their motives as malevolent, from an early adulthood, occurring in a variety of situations.

4 of 7 specific problems must be present, which include different types of suspicions or doubts (such as being exploited, or that the observations have a subtle threatening meaning).

In some cases with respect to others in general or specifically friends or associates, and in some cases they refer to a response of holding a grudge or reacting with anger.

Paranoid personality disorder is characterized by widespread mistrust and mistrust of others, such that its motives are interpreted as malevolent, beginning in early adulthood and present in a variety of contexts.

The DSM-5 lists paranoid personality disorder essentially unchanged from the DSM-IV-TR version and lists associated features that describe it in a more everyday way. These characteristics include distrust, avoidance of intimacy, hostility, and unusual beliefs / experiences.


Various researchers and clinicians can propose varieties and subsets or dimensions of personality related to official diagnoses. The psychologist Theodore Millon has proposed five subtypes of paranoid personality:


Stubborn paranoid (including compulsive characteristics).


Self-assertive, inflexible, stubborn, implacable, unshakable, dyspeptic, moody, and moody attitude; legalistic and self-righteous; discharge previously restrained hostility; renunciation of self-alien conflict.


Paranoid fanatic (including narcissistic characteristics).


Grandiose delusions are irrational and flimsy; pretentious, costly arrogant contempt and arrogance towards others; Lost pride reestablished with outlandish claims and fantasies.


Querulous paranoid (including negativistic characteristics).


Contentious, brooding, rebellious, argumentative, guilty, unacceptable, resentful, angry, jealous, moody, surly, endless squabbles, complaining, waspish, snappish.


Insular paranoid (including avoidance functions).


Reclusive, self-insured, hermetic; isolated self-protection from omnipresent threats and destructive forces; hypervigilant and defensive against imaginary dangers.


Malignant paranoid (including sadistic characteristics).


Belligerent, moody, intimidating, vindictive, callous and tyrannical; hostility expressed mainly in fantasy; projects have a poisonous view on others; persecutory delusions.

Differential diagnosis of paranoia

Paranoid personality disorder can involve, in response to stress, very brief psychotic episodes (lasting minutes or hours). If the lasting disorder can turn into delusional disorder or schizophrenia).

The paranoid may also be at a higher than average risk of experiencing major depressive disorder, agoraphobia, social anxiety disorder, obsessive compulsive disorder, or alcohol and substance-related disorders.

Criteria for other personality disorder diagnoses are also commonly met, such as:

  • Schizoid personality Disorder.
  • schizotypal personality disorder.
  • Narcissistic personality disorder.
  • Avoidant Personality Disorder.
  • Borderline personality disorder.
  • Oppositional personality disorder.

Treatment of paranoia

Treatment for paranoia can be very successful. But due to reduced confidence levels, there can be challenges in treating paranoid personality disorder.

Because people with paranoia have great suspicion and distrust of others. A mental health professional must establish trust with the patient. This trust allows the patient to trust the professional and believe that they have a disorder.

However, psychotherapy, antidepressants, antipsychotics, and anti-anxiety medications can play a role when a person is receptive to intervention.

How are delusions of paranoia treated?

Treatment of paranoia is usually through medication and cognitive behavioral therapy.

The most important element in treating paranoia and delusional disorder is building a trusting and collaborative relationship to reduce the impact of irrational fearful thoughts and improve social skills.

Often times, progress in paranoid delusions and especially delusional disorder is slow. Regardless of how slow the process is, recovery and reconnection are possible.

If a person is willing to accept treatment, talk therapy or psychotherapy are helpful. These methods:

  • Help the individual learn to cope with disorder, learn to communicate with others in social situations, and help reduce feelings of paranoia.

Medications can also be helpful, especially if the person with paranoia has other related conditions, such as depression or anxiety disorder. Medications can include:

  • Antidepressants, Benzodiazepines, and Antipsychotics. Combining medications with talk therapy or psychotherapy can be very successful.

What is the long-term outlook?

The outlook depends on whether the person is willing to accept treatment. People who accept treatment can keep a job and maintain healthy relationships.

However, they must continue treatment throughout their lives, because there is no cure for paranoia. Symptoms of paranoia will continue, but can be managed with care and support.

People with paranoia who resist treatment may lead fewer functional lives. Paranoia can interfere with your ability to keep a job or have positive social interactions.

Epidemiology of Paranoia

Paranoid personality disorder occurs in approximately 0.5% -2.5% of the general population. It is seen in 2% -10% of psychiatric outpatients. It is more common in men

History of paranoia

Paranoid personality disorder is detailed in the DSM-V and was included in all previous versions of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

One of the first descriptions of the paranoid personality comes from the French psychiatrist Valentin Magnan, who described a “fragile personality” that displayed idiosyncratic thinking, hypochondria, undue sensitivity, referential thinking, and distrust.

Closely related to this description is Emil Kraepelin’s 1905 description of a pseudo-complaining personality who is “always on the lookout for wrongdoing, but not deceitful,” vain, self-absorbed, sensitive, irritable, contentious, stubborn, and who lives in conflict with the world. .

In 1921, he renamed the paranoid personality condition and described these people as distrustful, feeling unfairly treated, and feeling subject to hostility, interference, and oppression.

He also observed a contradiction in these personalities: on the one hand, they stubbornly cling to their unusual ideas, on the other hand, they often accept every gossip as the truth.

Kraepelin also noted that paranoid personalities were often present in people who later developed paranoid psychosis.

Later writers also considered traits such as mistrust and hostility to predispose people to develop delusional illnesses, particularly “late paraphrenias” of old age.

Following Kraepelin, Eugen Bleuler described “contentious psychopathy” or the “paranoid constitution” as the characteristic triad of mistrust, grandiosity, and feelings of persecution.

He also emphasized that the false assumptions of these people do not amount to the form of true deception.

Ernst Kretschmer emphasized the sensitive inner core of the paranoia-prone personality: they feel shy and inadequate, but at the same time have an attitude of entitlement.

They attribute their failures to the machinations of others, but secretly to their own inadequacy. They experience a constant tension between feelings of self-importance and experiencing the environment as unappreciative and humiliating.

Karl Jaspers, a German phenomenologist, described “self-insecure” personalities that resemble the paranoid personality. According to Jaspers, these people experience internal humiliation, brought on by external experiences and their interpretations of them.

They have the urge to get external confirmation of their self-loathing and that makes them see insults in other people’s behavior. They suffer from all slights because they seek the true reason for themselves in themselves.

This type of insecurity leads to overcompensation: compulsive formality, strict social observances, and exaggerated displays of security.

In 1950, Kurt Schneider described “fanatic psychopaths” and divided them into two categories: the combative type who is very insistent about his false notions and actively quarrelsome, and the eccentric type who is passive, reserved, vulnerable to esoteric cults but distrustful of others.

Leonhard and Sheperd’s descriptions of the 1960s describe that paranoid people overestimate their abilities and attribute their failure to the ill will of others; They also mention that their interpersonal relationships are disturbed and they are in constant conflict with others.

In 1975, Polatin described the paranoid personality as rigid, suspicious, vigilant, self-centered and selfish, inwardly hypersensitive but emotionally undemonstrative. However, when there is a difference of opinion, underlying mistrust, authoritarianism, and anger explode.

In the 1980s, paranoid personality disorder received little attention, and when it did, it focused on its possible relationship to paranoid schizophrenia.

The most significant contribution of this decade comes from Theodore Millon, who divided the characteristics of paranoid personality disorder into four categories:

  1. Behavioral characteristics of vigilance, abrasive irritability and counterattack.
  2. Complaints indicating hypersensitivity, social isolation and mistrust.
  3. The dynamic of denying personal insecurities, attributing them to others, and self-inflation through grandiose fantasies.
  4. Coping style of obnoxious dependency and hostile distancing of oneself from others.