The person with a paranoid personality disorder essentially has an ongoing, unbased suspiciousness and distrust of people. Along with this, they are emotionally detached. In order to have this diagnosis, the person would have to have seen others as having malevolent intentions, by early adulthood in different situations, as indicated by a number of different factors.

These factors include: suspicion that others are exploiting, or deceiving them, that others may not be loyal or trustworthy, believes there are threats or attacks on their character in innocent statements that others do not see, and bears persistent grudges. Additionally, this is not a diagnosis which would be used if the person also has Paranoid Schizophrenia, a separate diagnosis, for example, among other diagnosis which would exclude it.

As a rule, those with paranoid personality disorders can be very draining to be around, as their constant habit of blame and suspicion makes one feel the need to reassure them on an ongoing basis. Unfortunately, when reassurances are made, those with this disorder hear contradictory evidence. They view it as more evidence that harm will be done to them.

They tend to think in hierarchy: who controls the power. They want to know who has the power in any given situation. They tend to drive people away from them, and thus have few friends, proving to themselves even more that there is a conspiracy afoot against them. This leads them to have a very lonely life.

Treatment of Paranoid Personality Disorder is difficult because they automatically distrust the therapist. A business-like approach, without “insight oriented therapy” is best indicated.