Paranoid Personality Disorder 649
cause these conditions may have cross-sectio nal symptom features that mimic personality
traits and may make it more difficult to evaluate retrospectively the individual’s long-term
patterns of functioning. 
Posttraumatic stress disorder. When personality changes emerge and persist after an
individual has been exposed to  extreme stress, a diagnosis of  posttraumatic stress disorder
should be considered. 
Substance use disorders. When an individual has a substance use disorder, it is impor-
tant not to make a personality disorder diag nosis based solely on behaviors that are con-
sequences of substance intoxication or withdraw al or that are associated with activities in
the service of sustaining substance use (e.g., antisocial behavior). 
Personality change due to another medical condition. When enduring changes in per-
sonality arise as a result of the physiological effects of another medical condition (e.g.,
brain tumor), a diagnosis of personality chan ge due to another medical condition should
be considered.
Cluster A Personality Disorders
Paranoid Personality Disorder
Diagnostic Criteria 301.0 (F60.0)
A. A pervasive distrust and suspiciousness of others such that their motives are inter-
preted as malevolent, beginning by early adulthood and present in a variety of con-
texts, as indicated by four (or more) of the following:
1. Suspects, without sufficient basis, that others are exploiting, harming, or deceiving
him or her.
2. Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends
or associates.
3. Is reluctant to confide in others because of unwarranted fear that the information
will be used maliciously against him or her.
4. Reads hidden demeaning or threatening meanings into benign remarks or events.