Stability and causality are investigated for quantum held theories incorpor
ating Lorentz and CPT violation. Explicit calculations in the quadratic sec
tor of a general renormalizable Lagrangian for a massive fermion reveal tha
t no difficulty arises for low energies if the parameters controlling the b
reaking are small, but for high energies either energy positivity or microc
ausality is violated in some observer frame. However, this can be avoided i
f the Lagrangian is the sub-Planck limit of a nonlocal theory with spontane
ous Lorentz and CPT violation. Our analysis supports the stability and caus
ality of the Lorentz- and CPT-violating standard-model extension that would
emerge at low energies from spontaneous breaking in a realistic string the
ory.