652 Personality Disorders
Differential Diagnosis
Other mental disorders with psychotic symptoms. Paranoid personality disorder can
be distinguished from delusional disorder, pe rsecutory type; schizophrenia; and a bipolar or
depressive disorder with psychotic features be cause these disorders are all characterized by a
period of persistent psychotic symptoms (e.g., delusions and hallucinations). For an additional
diagnosis of paranoid personality disorder to be given, the personal ity disorder must have
been present before the onset of psychotic sy mptoms and must persist when the psychotic
symptoms are in remission. When an individual has another persistent mental disorder (e.g.,
schizophrenia) that was preceded by paranoid personality disorder, paranoid personality dis-
order should also be recorded, follo wed by “premorbid” in parentheses.
Personality change due to another medical condition. Paranoid personality disorder
must be distinguished from personality ch ange due to another medical condition, in
which the traits that emerge ar e attributable to the direct effects of another medical condi-
tion on the central nervous system. 
Substance use disorders. Paranoid personality disorder  must be distinguished from
symptoms that may develop in associat ion with persistent substance use. 
Paranoid traits associated with physical handicaps. The disorder must also be distin-
guished from paranoid traits associated with  the development of physical handicaps (e.g.,
a hearing impairment).
Other personality disorders and personality traits. Other personality disorders may be
confused with paranoid person ality disorder because they ha ve certain features in common.
It is therefore important to distinguish among these disorders based on differences in their
characteristic features. However, if an individu al has personality features that meet criteria
for one or more personality disorders in additi on to paranoid personality disorder, all can be
diagnosed. Paranoid personality disorder an d schizotypal personality disorder share the