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Paranoid diagnosis

Diagnosis of paranoid personality disorder is problematic simply because of the nature of the disorder. People with paranoid personality disorder do not recognize their own paranoia as unusual. In fact, many consider themselves well grounded in reality and consider their paranoia to be realistic and objective.

Not believing their paranoia is a problem, paranoid personality disorder sufferers rarely seek help for their condition, unless forced to seek help by family (or in some cases, by the law). Even when forced to seek medical help, the individual's paranoia is likely to interfere with both diagnosis and treatment.

Diagnosis of paranoid personality disorder relies heavily on a history of symptoms and observations. For a clinical diagnosis to be made the patient's symptoms must match four or more of the criteria for paranoid personality disorder as put forth by the DSM-IV:

  • 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.

Before a diagnosis of paranoid personality disorder is made, a number of other paranoia causing conditions must be ruled out, including paranoid schizophrenia, or paranoia resulting form depression, drug-induced paranoia. Severe stress is also known to cause paranoia and other symptoms similar to paranoid personality disorder. Known as acute paranoia, stress-induced paranoia develops rapidly. However, paranoia and other symptoms usually dissipate once the stressor is removed.