The essential feature of the paranoid personality is a pattern of pervasive distrust and suspicion. People with a paranoid personality style often believe that others are behaving in a way that is dishonest or that others are out to get them. Paranoids are inclined to believe that other people intend to hurt or take advantage of them, even when there is no evidence to support their suspicions. They feel they cannot trust others and often believe that others are plotting against them, or might attack them out of the blue. They constantly question the motives of others and doubt the loyalty and trustworthiness of the people in their lives.

Confiding in others is difficult for them because they worry that the personal information they share will be used against them. Paranoids often interpret everyday conversations or comments as having negative or malicious intent and may view neutral comments as hostile or threatening. Some paranoids also hold grudges and have trouble “forgiving and forgetting.”

Paranoid personalities tend to have significant problems in their social relationships, as their suspiciousness may cause them to be argumentative and/or hostile towards well-meaning friends. Some people with the paranoid style behave in a very distant way where they avoid others because they are constantly questioning their motives and trustworthiness. In so doing, the paranoid may start a cycle of hostility that irritates others, and in this irritation, the paranoid sees the confirmation of their negative expectations of others. The paranoid’s suspicions can, in other words, turn into a self-fulfilling prophecy.

People with the paranoid personality often feel that they need to be self-sufficient and independent because of their problems interacting with others. They tend to be very controlling of their environment and may be seen as rigid or critical of others. Usually someone with a paranoid personality style will choose a job where they may work alone, decreasing their stress at having to interact with others.

Paranoid personalities are often litigious — that is, they take other people to court because they blame others for their own problems. They might view the world through a filter of stereotypes, assigning motives to groups of people based on physical, ethnic, or political associations. Finally, people with a paranoid style are often most comfortable with others who share their suspicious view of the world. For example, they may prefer friends who also believe that people are not to be trusted. Thus, many people with paranoid features in their personality join cults or neo-religious movements that keep them apart from the rest of society.

To a therapist, it is often difficult to determine whether someone has a paranoid style because their paranoid beliefs may sound real. People with the paranoid personality typically exhibit overblown perceptions. That is, their ideas may or may not be true; they may be overblown, but they are not completely free-roaming delusions. For example, delusions are often complicated and bizarre (for example, being abducted by aliens and taken aboard a spaceship), but overblown perceptions are not obviously false. In many cases they are simply notions that the paranoid continues to subscribe to in spite of evidence that they are incorrect (for example, that their cult leader really wants the best for them, even though they’ve discovered evidence of exploitation and wrongdoing). Finally, people with a paranoid style might occasionally experience brief psychotic episodes. They may lose touch with reality, as individuals with schizophrenia do, but it only occurs for a few minutes or hours. These episodes may occur when the person is under particular stress, such as having to interact with lots of people. As for co-morbidity, people with a paranoid style often experience depression, agoraphobia, obsessive-compulsive disorders, or alcohol and drug abuse.