Diagnosis of PPD Clinical criteria (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [DSM-5]) For a diagnosis of paranoid personality disorder, patients must have A persistent distrust and suspiciousness of others This distrust and suspicion are shown by the presence of ≥ 4 of the following: Unjustified suspicion that other people are exploiting, injuring, or deceiving them Preoccupation with unjustified doubts about the reliability of their friends and coworkers Reluctance to confide in others lest the information be used against them Misinterpretation of benign remarks or events as having hidden belittling, hostile, or threatening meaning Holding of grudges for insults, injuries, or slights Readiness to think that their character or reputation has been attacked and quickness to react angrily or to counterattack Recurrent, unjustified suspicions that their spouse or partner is unfaithful Also, symptoms must have begun by early adulthood.