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Paranoid Personality Disorder: Symptoms and Treatment

Paranoid personality disorder (PPD) is a mental health condition that causes a pattern of suspicion and mistrust of other people, even without enough evidence to support that belief. This condition is a cluster A personality disorder, which is characterized by eccentric or odd behaviors and thoughts. 

This personality disorder affects 1.2% to 4.4% of adults in the United States. However, unlike other personality disorders that typically begin in late adolescence and early adulthood, PPD affects children. Most mental healthcare providers and researchers agree that symptoms of PPD often begin in childhood.

It’s worth noting that PPD is associated with an increased risk of substance use, violence, and other mental health conditions like depression. Unfortunately, personality disorders (regardless of type) can often affect your social life, career, relationships, and personal well-being. Fortunately, treatment options like therapy and medications can help manage your symptoms, improve your relationships, and help you feel more trusting of others.

The hallmark characteristics of paranoid personality disorder include:

  • Paranoia, mistrust, and suspicion of other people
  • Hostility
  • Social isolation and detachment
  • Bearing grudges
  • Hypersensitivity (e.g., being easily offended or sensitive to criticism)
  • Emotional coldness or lack of empathy
  • Fear of other people wanting to harm you
  • Inability to work in a team
  • Difficulty relaxing
  • Interpreting hidden meanings in conversations and gestures
  • Tendency to burst out in anger

The exact cause of PPD is not fully understood. But, evidence suggests that a combination of the following factors plays a role in its development:

  • Family history: Research shows that people who have a family history of mental health conditions like schizophrenia and other personality disorders have a higher risk of developing PPD.
  • Neurobiological differences: Research to discover any structural and functional abnormalities in the brain of people with PPD is ongoing. However, one study showed that people with PPD may have an impairment in the function of their amygdala—a structure in the brain that is responsible for controlling behaviors and emotions. 
  • Childhood trauma: Your childhood experiences, such as trauma or stress, can play a role in the development of this disorder. According to a 2017 study review, childhood trauma is indicated as a risk factor for PPD in up to four cross-sectional studies.

Paranoid personality disorder can be challenging to diagnose, as many people with this condition don’t see anything unusual about their behavior and tend not to seek medical help. It can also be difficult for healthcare providers to pinpoint PPD because the personality disorder shares symptoms with other mental health conditions.

Unlike physical health conditions that may require a blood test or imaging scan, personality disorders don’t have one specific test that can diagnose you. Instead, mental healthcare providers will conduct a psychological evaluation and comprehensive assessment to learn about your symptoms, lifestyle habits, behaviors, childhood experiences, relationships, and personal and family medical history.

To receive a diagnosis for PPD, you’ll need to meet the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). These criteria include:

  • Having traits of suspicion, distrust, and unforgiveness
  • Are not experiencing psychotic symptoms like hallucinations and delusions

It’s important to note that many people with PPD are often suspicious of everyone, including healthcare providers. Unfortunately, this causes some people with PPD to be unwilling to accept treatment, which can pose more challenges in diagnosis and treatment. 

However, if you or a loved one live with PPD and are interested in seeking support from your healthcare team, they may suggest treatments like therapy, medications, and management strategies.


Psychotherapy is one of the most common treatment options for paranoid personality disorder. Also called talk therapy, psychotherapy involves using different treatment approaches, like cognitive behavioral therapy (CBT), to help a person identify challenging thoughts, troubling behaviors, and difficult emotions in an attempt to restructure them into more positive attributes.

Therapy aims to help people living with PPD in the following ways:

  • Improve daily function
  • Relieve emotional symptoms
  • Boost quality of life
  • Learn how to trust others
  • Communicate better in social situations
  • Better manage responses to other people and situations

Individual Social Skills Training

Group therapy may not be ideal for people with paranoid personality disorder since they tend to be very suspicious and distrustful. Instead, they may benefit more from individual social skills training, which involves using different techniques to teach a person how to interact effectively in certain social situations and adhere to culturally-appropriate norms.


Sometimes, medications can help alongside treatment to reduce PPD symptoms. Healthcare providers recommend medications when symptoms are severe or if you’re experiencing other mental health conditions like anxiety and depression. There is no medication specifically for personality disorders, but healthcare providers may recommend other mental health medications such as:

  • Anti-psychotic medications to improve disordered thinking or troubling behaviors
  • Antidepressants to relieve symptoms of depression
  • Anti-anxiety medications to reduce anxiety, fear, and mistrust

Management Strategies

Aside from cooperating in your treatment plan, your healthcare team may also recommend some self-care strategies that may help you on your treatment journey. These include:

  • Writing in a daily journal to express your thoughts and emotions
  • Managing stress by trying relaxation techniques like deep breathing and yoga
  • Going for regular medical checkups
  • Being physically active
  • Gaining more knowledge about your condition
  • Avoiding alcohol and drugs
  • Spending time with supportive loved ones

Paranoid personality disorder can often co-occur with other mental health conditions. According to research, some of the conditions that are commonly associated with PPD include: 

Paranoid personality disorder is a life-long condition that currently has no cure. Living with a personality disorder can feel challenging and frustrating. But it’s important to know that treatments can offer support and reduce symptoms. However, the success of treatment depends on whether you’re willing to receive treatment and adhere to your treatment plan. It can be difficult to manage a health condition on your own, but working with your healthcare team and asking for support from your loved ones can go a long way in improving your quality of life.

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