Grove wanted to call the book Strategic Inflection Points. His publisher refused, and it shipped as Only the Paranoid Survive. The rejected title is the more useful one, because it names a specific event instead of a mood.
Every business sits inside a set of forces. Competitors, suppliers, customers, regulation, technology. Most of the time they are comparable in size. Sometimes one of them grows out of proportion, and Grove reached for a term the trade press did not have.
That distinction carries the whole framework. A normal competitive setback costs you position inside a game whose rules hold. A 10x force changes the rules, so the moves that used to work now point the wrong way. Grove's examples are concrete: the personal computer arriving at about a tenth the cost of a minicomputer, and the 1984 judgment that broke up AT&T. In each case the industry that came out was not the industry that went in.
He has a name for the stretch in between, when the old model is dying and the new one is not yet working. The valley of death. Nobody gets to skip it, and the graph does not tell you in advance how deep it goes.