Personality dysfunction is a possible risk factor for adolescents. In order to explore the relationship between self-esteem and paranoid personality dysfunction, resilience and general self-efficacy of adolescents, 522 middle school students were randomly selected to complete the paranoid personality disorder assessment subscale of the personality diagnosis questionnaire (PDQ-4+), self-esteem scale (SES), general self-efficacy scale and the Resilience Scale for Chinese Adolescents (RSCA), and the data were analyzed by a moderated mediating model. The results of the survey found that resilience played a complete mediating role in the relationship between self-esteem and paranoid personality dysfunction, and the mediating effect accounted for 20.55% of the total effect. The product of self-esteem and general self-efficacy had a significant predictive effect on resilience, with 95% confidence interval of [- 0.026, - 0.002]. Resilience is significantly negatively correlated with paranoid personality dysfunction; the mediating role of resilience between self-esteem and paranoid personality dysfunction is established, and general self-efficacy plays a moderating role in the prediction of self-esteem to resilience. From the perspective of developmental psychology, adolescents are in a sensitive and fluctuating period. Starting from a systemic perspective, home, school, and society should pay more attention to symptoms, seize the opportunity, and establish a family-school-society linkage system. Starting from parents, teachers, and community workers, make targeted interventions to enable young people to generate motivation to make changes. We must always actively use the peer effect to help young people to establish a sense of self-efficacy. And finally establish a family-based, school-centered, and social-assisted protection system.