PARANOID PERSONALITY-DISORDER - REVIEW OF THE LITERATURE AND RECOMMENDATIONS FOR DSM-IV

Since the time of Kraepelin (1921), the defining feature of paranoid personality disorder (PPD) has been considered to be a pervasive and unwarranted mistrust of others. Other clinical characteristics that have figured prominently in the descriptive literature on this disorder are the paranoid individual's hypersensitivity to criticism (Cameron, 1943, 1963; Kretschmer, 1925), antagonism and aggressiveness (Schneider, 1923; Sheldon, 1940; Sheldon & Stevens, 1942), rigidity (Shapiro, 1965), hyper-vigilence (Cameron, 1963; Shapiro, 1965), and excessive need for autonomy (Millon, 1969, 1981). This body of clinical literature formed the basis of the diagnostic criteria for PPD that were incorporated in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III). The DSM-III required that patients meet three criteria for suspiciousness, two for hypersensitivity, and two for restricted affectivity, in order to receive a diagnosis of PPD. In the DSM-III-R, the grouping of diagnostic criteria into sets was replaced by a truly polythetic system in which no single feature (or group of features) was required and any combination of four of seven criteria was sufficient for a PPD diagnosis. In this report, some of the major nosological issues concerning PPD are raised and addressed in light of current research findings. Particular emphasis is placed on research pertaining to the development of diagnostic criteria for PPD in the DSM-IV.