The debate on paranoia has played a major role in the tradition of descriptive psychopathology. Psychoanalytic approaches may significantly contribute to this discussion. Early analytic reflections on paranoia include passages by Freud, Klein, and Lacan. Issues of self-definition, self-esteem, and personal identity can be found at the very center of paranoid personality psychodynamics. Utilization of various analytic models of instinct theory, ego psychology, object relations theory, and self psychology in the treatment of such patients delivers differing results.