Mistrustful and Misunderstood: a Review of Paranoid Personality Disorder


Purpose of Review

Paranoid personality disorder (PPD) has historically been neglected by science out of proportion to its prevalence or its association with negative clinical outcomes. This review provides an update on what is known about PPD regarding its prevalence, demographics, comorbidity, biological mechanism, risk factors, and relationship to psychotic disorders.

Recent Findings

PPD has long been the subject of a rich and prescient theoretical literature which has provided a surprisingly coherent account of the psychological mechanism of non-delusional paranoia. Available data indicate that PPD has a close relationship with childhood trauma and social stress. Descriptive data on a sample of 115 individuals with paranoid personality disorder is examined in comparison with a group of individuals with borderline personality disorder. The descriptive data largely confirm previously identified relationships between paranoid personality disorder and childhood trauma, violence, and race. We identify important similarities to and differences from borderline personality disorder.


PPD continues to be an important construct in the clinic and the laboratory. Available data lead to a reconsideration of the disorder as more closely related to trauma than to schizophrenia.

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Fig. 1


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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The research was partially funded by 1R21MH083309 (PI: Royce Lee). The descriptive data come from subjects recruited for research studies by Royce Lee, M.D., and Emil F. Coccaro, M.D.

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Correspondence to Royce J. Lee.

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All subjects provided written, informed consent with consent forms approved by the IRB of The University of Chicago.

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Dr. Royce Lee declares that he has no conflicts of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Personality and Impulse Control Disorders

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Lee, R.J. Mistrustful and Misunderstood: a Review of Paranoid Personality Disorder. Curr Behav Neurosci Rep 4, 151–165 (2017). https://doi.org/10.1007/s40473-017-0116-7

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  • Paranoid personality disorder
  • Borderline personality disorder
  • Paranoia
  • Childhood trauma
  • Corticotropin-releasing hormone
  • Personality disorder