Section II. Diagnostic Criteria and Codes 第II节 诊断准则及代码 Personality Disorders 人格障碍 Paranoid Personality Disorder 偏执型人格障碍 Diagnostic Criteria 301.0 (F60.0) 诊断标准301.0 (F60.0) A. A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following: A. 普遍存在的对他人的不信任和怀疑，以至于他们的动机被解释为恶意的，从成年早期开始，并出现在各种情况下，如以下四种(或更多):

• 1. Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her.
• 1. 无充分根据怀疑他人剥削、伤害、欺骗自己。
• 2. Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates.
• 2. 对朋友或同事的忠诚或可信度充满了不合理的怀疑。
• 3. Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her.
• 3. 不愿意向他人吐露自己的秘密，因为他们毫无根据地担心这些信息会被恶意利用。
• 4. Reads hidden demeaning or threatening meanings into benign remarks or events.
• 4. 从善意的评论或事件中读出隐含的贬低或威胁的含义。
• 5. Persistently bears grudges (i.e., is unforgiving of insults, injuries, or slights).
• 5. 经常记仇(即，不宽恕侮辱、伤害或轻视)。
• 6. Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack.
• 6. 察觉到别人不明显的对他或她的性格或声誉的攻击，并迅速做出愤怒的反应或反击。
• 7. Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner.
• 7. 在没有正当理由的情况下，对配偶或性伴侣的忠诚有经常性的怀疑。
B. Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, or another psychotic disorder and is not attributable to the physiological effects of another medical condition. B.并非只发生于精神分裂症、具有精神病特征的双相情感障碍或抑郁症，或其他精神疾病的过程中，也不是由其他医疗条件的生理影响引起的。 Note: If criteria are met prior to the onset of schizophrenia, add “premorbid,” i.e., “paranoid personality disorder (premorbid).” 注:如果在精神分裂症发作前符合标准，则加上“发病前”，即“偏执型人格障碍(发病前)”。 Diagnostic Features 诊断性特征 The essential feature of paranoid personality disorder is a pattern of pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent. This pattern begins by early adulthood and is present in a variety of contexts. 偏执型人格障碍的本质特征是一种普遍存在的不信任和对他人的怀疑，以至于他们的动机被解释为恶意的。这种模式开始于成年早期，出现在各种环境中。 Individuals with this disorder assume that other people will exploit, harm, or deceive them, even if no evidence exists to support this expectation (Criterion A1). They suspect on the basis of little or no evidence that others are plotting against them and may attack them suddenly, at any time and without reason. They often feel that they have been deeply and irreversibly injured by another person or persons even when there is no objective evidence for this. They are preoccupied with unjustified doubts about the loyalty or trustworthiness of their friends and associates, whose actions are minutely scrutinized for evidence of hostile intentions (Criterion A2). Any perceived deviation from trustworthiness or loyalty serves to support their underlying assumptions. They are so amazed when a friend or associate shows loyalty that they cannot trust or believe it. If they get into trouble, they expect that friends and associates will either attack or ignore them. 患有这种障碍的人认为其他人会利用、伤害或欺骗他们，即使没有证据支持这种预期(标准 A1)。他们在只有很少或没有根据的基础上怀疑别人正在密谋反对他们，并可能在任何时候，没有理由地突然攻击他们。即使没有客观证据证明这一点，他们也常常感到自己受到另一个人或另一个人的严重和不可逆转的伤害。他们全神贯注于对朋友和同事的忠诚或可信度的毫无根据的怀疑，他们的行为会被仔细检查，以寻找怀有敌意的证据(标准A2)。任何对可信度或忠诚度的偏离都可以支持他们的基本假设。当一个朋友或同事表现出忠诚时，他们会感到非常惊讶，以至于他们无法信任或相信这一点。如果他们遇到麻烦，他们预计朋友和同事要么攻击他们，要么无视他们。 Individuals with paranoid personality disorder are reluctant to confide in or become close to others because they fear that the information they share will be used against them (Criterion A3). They may refuse to answer personal questions, saying that the information is "nobody's business." They read hidden meanings that are demeaning and threatening into benign remarks or events (Criterion A4). For example, an individual with this disorder may misinterpret an honest mistake by a store clerk as a deliberate attempt to shortchange, or view a casual humorous remark by a co-worker as a serious character attack. Compliments are often misinterpreted (e.g., a compliment on a new acquisition is misinterpreted as a criticism for selfishness; a compliment on an accomplishment is misinterpreted as an attempt to coerce more and better performance). They may view an offer of help as a criticism that they are not doing well enough on their own. 患有偏执型人格障碍的人不愿意向他人吐露心事或与他人亲近，因为他们害怕自己分享的信息会被用来对付自己(标准A3)。他们可能会拒绝回答私人问题，说信息“不关任何人的事”。他们能从善意的评论或事件中读出贬损和威胁的隐含意义(标准A4)。例如，有这种障碍的人可能会将商店店员的无心之失误读为缺斤少两的故意欺骗，或者将同事不经意的幽默言论视为严重的性格攻击。赞美常常被误解(例如，对新获得的东西的赞美被误解为对自私的批评;对一项成就的赞美会被错误地理解为试图强迫自己做出更多更好的表现)。他们可能把提供帮助看作是对他们自己做得不够好的批评。 Individuals with this disorder persistently bear grudges and are unwilling to forgive the insults, injuries, or slights that they think they have received (Criterion A5). Minor slights arouse major hostility, and the hostile feelings persist for a long time. Because they are constantly vigilant to the harmful intentions of others, they very often feel that their character or reputation has been attacked or that they have been slighted in some other way. They are quick to counterattack and react with anger to perceived insults (Criterion A6). Individuals with this disorder may be pathologically jealous, often suspecting that their spouse or sexual partner is unfaithful without any adequate justification (Criterion A7). They may gather trivial and circumstantial "evidence" to support their jealous beliefs. They want to maintain complete control of intimate relationships to avoid being betrayed and may constantly question and challenge the whereabouts, actions, intentions, and fidelity of their spouse or partner. 患有这种障碍的人总是怀恨在心，不愿原谅他们认为自己受到的侮辱、伤害或轻视(标准A5)。小的怠慢会引起大的敌意，这种敌意会持续很长一段时间。因为他们总是对他人的不良意图保持警惕，所以他们常常觉得自己的性格或声誉受到了攻击，或者在其他方面受到了轻视。他们会迅速反击，并对察觉到的侮辱做出愤怒的反应(标准A6)。患有这种障碍的人可能会病态地嫉妒，经常没有任何充分的理由地怀疑他们的配偶或性伴侣不忠(标准A7)。他们可能会收集琐碎和间接的“证据”来支持他们的嫉妒信念。他们想要保持对亲密关系的完全控制，以避免被背叛，他们可能会不断地质疑配偶或伴侣的行踪、行为、意图和忠诚。 Paranoid personality disorder should not be diagnosed if the pattern of behavior occurs exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, or another psychotic disorder, or if it is attributable to the physiological effects of a neurological (e.g., temporal lobe epilepsy) or another medical condition (Criterion B). 如果行为模式只发生在精神分裂症、有精神病特征的双相情感障碍或抑郁症，或其他精神障碍的发作过程中，或它是由于神经系统的生理效应(例如,颞叶癫痫)或其他医学状况(标准B)引起，则不应被诊断为偏执型人格障碍。 Associated Features Supporting Diagnosis 支持诊断的关联特征 Individuals with paranoid personality disorder are generally difficult to get along with and often have problems with close relationships. Their excessive suspiciousness and hostility may be expressed in overt argumentativeness, in recurrent complaining, or by quiet, apparently hostile aloofness. Because they are hypervigilant for potential threats, they may act in a guarded, secretive, or devious manner and appear to be "cold" and lacking in tender feelings. Although they may appear to be objective, rational, and unemotional, they more often display a labile range of affect, with hostile, stubborn, and sarcastic expressions predominating. Their combative and suspicious nature may elicit a hostile response in others, which then serves to confirm their original expectations. 患有偏执型人格障碍的人通常很难相处，在亲密关系方面也经常有问题。他们过分的怀疑和敌意可以表现为公开的争论、反复的抱怨，或者表现为安静的、明显的敌意的冷漠。因为他们对潜在的威胁高度警惕，他们可能会采取谨慎、秘密或狡猾的方式，表现得“冷漠”，缺乏温柔的感情。虽然他们可能显得客观、理性和无感情的，但他们往往表现出一系列不稳定的情感，其中以敌意、固执和挖苦的表达最为突出。他们好斗和多疑的本性可能会引起他人的敌意反应，从而证实了他们最初的期望。 Because individuals with paranoid personality disorder lack trust in others, they have an excessive need to be self-sufficient and a strong sense of autonomy. They also need to have a high degree of control over those around them. They are often rigid, critical of others, and unable to collaborate, although they have great difficulty accepting criticism themselves. They may blame others for their own shortcomings. Because of their quickness to counterattack in response to the threats they perceive around them, they may be litigious and frequently become involved in legal disputes. Individuals with this disorder seek to confirm their preconceived negative notions regarding people or situations they encounter, attributing malevolent motivations to others that are projections of their own fears. They may exhibit thinly hidden, unrealistic grandiose fantasies, are often attuned to issues of power and rank, and tend to develop negative stereotypes of others, particularly those from population groups distinct from their own. Attracted by simplistic formulations of the world, they are often wary of ambiguous situations. They may be perceived as "fanatics" and form tightly knit "cults" or groups with others who share their paranoid belief systems. 由于偏执型人格障碍患者缺乏对他人的信任，他们过度需要自给自足和强烈的自治权。他们还需要对周围的人有高度的控制。虽然他们自己很难接受批评，但他们经常是死板的，对别人吹毛求疵，无法合作。他们可能会把自己的缺点归咎于他人。由于他们对周围的威胁反应迅速，他们可能喜欢打官司，经常卷入法律纠纷。患有这种障碍的人试图证实他们对他们所遇到的人或情况的先入为主的负面看法，将恶意动机归因于他人，这是他们自己恐惧的投射。他们可能表现出不太明显的、不切实际的浮夸幻想，常常与权力和等级问题相协调，并倾向于对他人形成负面的刻板印象，尤其是那些来自与自己不同的人群的人。他们被简单化的世界观所吸引，常常对模棱两可的情况保持警惕。他们可能被认为是“狂热分子”，并与那些与他们共享偏执信念系统的人组成紧密的“邪教”小团体。 Particularly in response to stress, individuals with this disorder may experience very brief psychotic episodes (lasting minutes to hours). In some instances, paranoid personality disorder may appear as the premorbid antecedent of delusional disorder or schizophrenia. Individuals with paranoid personality disorder may develop major depressive disorder and may be at increased risk for agoraphobia and obsessive-compulsive disorder. Alcohol and other substance use disorders frequently occur. The most common cooccurring personality disorders appear to be schizotypal, schizoid, narcissistic, avoidant, and borderline. 特别是在应对压力时，患有这种障碍的人可能会经历非常短暂的精神病发作(持续几分钟到几小时)。在某些情况下，偏执型人格障碍可能是妄想障碍或精神分裂症的前兆[按精神分析的观点，DSM-5所说的偏执型人格障碍对应边缘水平的偏执型人格，精神病水平的偏执人格就属于妄想障碍中的被迫害型了]。偏执型人格障碍患者可能发展为重度抑郁症，并可能增加广场恐惧症和强迫症的风险。酒精和其他物质使用障碍经常发生。最常见的共病人格障碍表现为分裂型、分裂样、自恋型、回避型和边缘型。 Prevalence 流行程度 A prevalence estimate for paranoid personality based on a probability subsample from Part II of the National Comorbidity Survey Replication suggests a prevalence of 2.3%, while the National Epidemiologic Survey on Alcohol and Related Conditions data suggest a prevalence of paranoid personality disorder of 4.4%. 根据全国[美国]共病性调查第II部分的一个概率子样本，对偏执型人格的患病率进行了估计，结果显示，偏执型人格的患病率为2.3%，而全国酒精及相关疾病流行病学调查数据显示，偏执型人格障碍的患病率为4.4%。 Development and Course 发展和过程 Paranoid personality disorder may be first apparent in childhood and adolescence with solitariness, poor peer relationships, social anxiety, underachievement in school, hypersensitivity, peculiar thoughts and language, and idiosyncratic fantasies. These children may appear to be "odd" or "eccentric" and attract teasing. In clinical samples, this disorder appears to be more commonly diagnosed in males. 偏执型人格障碍可能首先出现在儿童和青少年时期，表现为孤僻、同伴关系不佳、社交焦虑、学业成绩不佳、过敏、独特的想法和语言，以及独特的幻想。这些孩子可能会显得“奇怪”或“古怪”，并引来取笑。在临床样本中，这种疾病似乎更常见于男性。 Risk and Prognostic Factors Genetic and physiological. There is some evidence for an increased prevalence of paranoid personality disorder in relatives of probands with schizophrenia and for a more specific familial relationship with delusional disorder, persecutory type. Culture-Related Diagnostic Issues 风险和预后因素 Some behaviors that are influenced by sociocultural contexts or specific life circumstances may be erroneously labeled paranoid and may even be reinforced by the process of clinical evaluation. Members of minority groups, immigrants, political and economic refugees, or individuals of different ethnic backgrounds may display guarded or defensive behaviors because of unfamiliarity (e.g., language barriers or lack of knowledge of rules and regulations) or in response to the perceived neglect or indifference of the majority society. These behaviors can, in turn, generate anger and frustration in those who deal with these individuals, thus setting up a vicious cycle of mutual mistrust, which should not be confused with paranoid personality disorder. Some ethnic groups also display culturally related behaviors that can be misinterpreted as paranoid. 一些受社会文化背景或特定生活环境影响的行为可能被错误地贴上偏执的标签，甚至可能在临床评估过程中得到强化。少数群体成员、移民、政治和经济难民或不同种族背景的个人可能由于不熟悉(例如，语言障碍或缺乏对规则和规程的了解)，或者作为对主流社会的忽视或漠不关心作出反应，而表现出戒备或防御行为。这些行为反过来又会在与这些人打交道的人身上产生愤怒和挫败感，从而形成相互不信任的恶性循环，这些不应与偏执型人格障碍混淆。一些民族还表现出与文化相关的行为，也可能会被错误地解释为偏执。 Differential Diagnosis 鉴别诊断 Other mental disorders with psychotic symptoms. Paranoid personality disorder can be distinguished from delusional disorder, persecutory type; schizophrenia; and a bipolar or depressive disorder with psychotic features because these disorders are all characterized by a period of persistent psychotic symptoms (e.g., delusions and hallucinations). For an additional diagnosis of paranoid personality disorder to be given, the personality disorder must have been present before the onset of psychotic symptoms and must persist when the psychotic symptoms are in remission. When an individual has another persistent mental disorder (e.g., schizophrenia) that was preceded by paranoid personality disorder, paranoid personality disorder should also be recorded, followed by "premorbid" in parentheses. 其他有精神病症状的心理障碍。偏执型人格障碍可与妄想障碍的被迫害子类型；精神分裂；以及具有精神病特征的双相或抑郁障碍区分开来，因为这些障碍的特征都是一段持续的精神病症状(如妄想和幻觉)。要对偏执型人格障碍作出额外的诊断[即在这些病之外还有偏执型人格障碍]，这种人格障碍必须在精神病症状出现之前就已经存在，并且必须在精神病症状缓解时持续存在。当一个人在另一种持续性的精神障碍(如精神分裂症)之前是偏执型人格障碍，也应诊断为偏执型人格障碍，后边加一个括号，写上“发病前”。 Personality change due to another medical condition. Paranoid personality disorder must be distinguished from personality change due to another medical condition, in which the traits that emerge are attributable to the direct effects of another medical condition on the central nervous system. 由于另一种疾病导致的性格变化。偏执型人格障碍必须与另一种疾病引起的人格变化区分开来。在另一种疾病引起的人格变化中，出现的特征可归因于另一种疾病对中枢神经系统的直接影响。 Substance use disorders. Paranoid personality disorder must be distinguished from symptoms that may develop in association with persistent substance use. 物质使用障碍。偏执型人格障碍必须与可能与持续使用药物有关的症状区分开来。 Paranoid traits associated with physical handicaps. The disorder must also be distinguished from paranoid traits associated with the development of physical handicaps (e.g., a hearing impairment). 与身体缺陷相关的偏执特征。这种障碍还必须与与身体残疾(如听力障碍)的发展相关的偏执特征相区别。 Other personality disorders and personality traits. Other personality disorders may be confused with paranoid personality disorder because they have certain features in common. It is therefore important to distinguish among these disorders based on differences in their characteristic features. However, if an individual has personality features that meet criteria for one or more personality disorders in addition to paranoid personality disorder, all can be diagnosed. Paranoid personality disorder and schizotypal personality disorder share the traits of suspiciousness, interpersonal aloofness, and paranoid ideation, but schizotypal personality disorder also includes symptoms such as magical thinking, unusual perceptual experiences, and odd thinking and speech. Individuals with behaviors that meet criteria for schizoid personality disorder are often perceived as strange, eccentric, cold, and aloof, but they do not usually have prominent paranoid ideation. The tendency of individuals with paranoid personality disorder to react to minor stimuli with anger is also seen in borderline and histrionic personality disorders. However, these disorders are not necessarily associated with pervasive suspiciousness. People with avoidant personality disorder may also be reluctant to confide in others, but more from fear of being embarrassed or found inadequate than from fear of others' malicious intent. Although antisocial behavior may be present in some individuals with paranoid personality disorder, it is not usually motivated by a desire for personal gain or to exploit others as in antisocial personality disorder, but rather is more often attributable to a desire for revenge. Individuals with narcissistic personality disorder may occasionally display suspiciousness, social withdrawal, or alienation, but this derives primarily from fears of having their imperfections or flaws revealed. 其他人格障碍和人格特征。其他人格障碍可能与偏执型人格障碍混淆，因为它们有某些共同的特征。因此，根据这些疾病的典型特征的不同来区分它们是很重要的。然而，如果一个人除了偏执型人格障碍外，还具有符合一种或多种人格障碍标准的人格特征，那么所有这些特征都可以被诊断。偏执型人格障碍和分裂型人格障碍具有多疑、人际疏远和偏执型思维的共同特征，但分裂型人格障碍还包括魔幻思维、不寻常的知觉体验、奇怪的思维和言语等症状。行为符合类分裂样人格障碍标准的人通常被认为是奇怪、古怪、冷漠和冷淡的，但他们通常没有明显的偏执想法。偏执型人格障碍患者对轻微刺激产生愤怒反应的倾向也见于边缘型人格障碍和表演型人格障碍。然而，这些障碍并不一定与普遍的怀疑有关。患有回避型人格障碍的人可能也不愿意向他人倾诉，但更多的是因为害怕尴尬或被发现不够好，而不是害怕他人的恶意意图。虽然反社会行为可能存在于一些偏执型人格障碍患者中，但它通常不像反社会人格障碍患者那样是由个人利益或剥削他人的欲望驱动的，而是更多地归因于复仇的欲望。患有自恋型人格障碍的人可能偶尔会表现出怀疑、社交退缩或疏离，但这主要源于害怕自己的不完美或缺点被暴露出来。 Paranoid traits may be adaptive, particularly in threatening environments. Paranoid personality disorder should be diagnosed only when these traits are inflexible, maladaptive, and persisting and cause significant functional impairment or subjective distress. 偏执狂的特点可能是适应性的，特别是在危险的环境中。偏执型人格障碍只有当这些特征是不灵活的、不适应的、持续的，并导致明显的功能障碍或主观痛苦时，才应该被诊断出来。