Paranoid Personality Disorder 651
have a high degree of control over those around them. They are often rigid, critical of oth-
ers, and unable to collaborate, although they  have great difficulty accepting criticism them-
selves. They may blame others for their own shortcomings. Because of their quickness to
counterattack in response to the threats they perceive around them, they may be litigious
and frequently become involved in legal disputes. Individuals with this disorder seek to
confirm their preconceived nega tive notions regarding people or situations they encounter,
attributing malevolent motivati ons to others that are projections of their own fears. They
may exhibit thinly hidden, unrealistic grandios e fantasies, are often attuned to issues of
power and rank, and tend to develop negative  stereotypes of others, particularly those
from population groups distinct from their own. Attracted by simplistic formulations of the
world, they are often wary of  ambiguous situations. They ma y be perceived as “fanatics”
and form tightly knit “cults” or  groups with others who share their paranoid belief systems.
Particularly in response to stress, individu als with this disorder may experience very
brief psychotic episodes (lasting minutes to hour s). In some instances, paranoid personal-
ity disorder may appear as the premorbid ante cedent of delusional disorder or schizo-
phrenia. Individuals with paranoid personal ity disorder may deve lop major depressive
disorder and may be at increased risk fo r agoraphobia and obsessive-compulsive dis-
order. Alcohol and other substance use disord ers frequently occur. The most common co-
occurring personality disorders appear to be schizotypal, schizoid, narcissistic, avoidant,
and borderline.
Prevalence
A prevalence estimate for paranoid personality based on a probability subsample from