Paranoid Personality Disorder

What is paranoid personality disorder (PPD)?

Paranoid personality disorder (PPD) is a mental health condition marked by a long-term pattern of distrust and suspicion of others without adequate reason to be suspicious (paranoia). People with PPD often believe that others are trying to demean, harm or threaten them.

People with paranoid personality disorder often don’t think their behavior and way of thinking are problematic.

PPD is one of a group of conditions called Cluster A, or eccentric personality disorders. People with these disorders have unusual and eccentric thinking or behavior.

It’s important to note that people with paranoid personality disorder don’t experience delusions or hallucinations with paranoia, as commonly seen in schizophrenia, schizoaffective disorder and severe manic episodes in bipolar disorder.

What age does paranoid personality disorder begin?

People with paranoid personality disorder typically start experiencing symptoms and showing signs of the condition by their late teens or early adult years.

Who does paranoid personality disorder affect?

Overall, research reveals higher rates of paranoid personality disorder (PPD) in people assigned female at birth (AFAB), while samples from hospital records reveal higher rates of PPD in people assigned male at birth (AMAB).

People with PPD are more likely to:

• Live in low-income households.
• Be Black, Native American or Hispanic.
• Be widowed, divorced or separated or never married.

More research is needed to learn more about why these risk factors are associated with PPD and how stress and trauma play a role in its development.

How common is paranoid personality disorder?

Paranoid personality disorder is relatively rare. Researchers estimate that it affects 0.5% to 4.5% of the general U.S. population.

What are the signs and symptoms of paranoid personality disorder?

People with paranoid personality disorder (PPD) are always on guard, believing that others are constantly trying to demean, harm or threaten them. These generally unfounded beliefs, as well as their habits of blame and distrust, interfere with their ability to form close or even workable relationships. People with PPD severely limit their social lives.

People with PPD may:

• Doubt the commitment, loyalty or trustworthiness of others, believing others are exploiting or deceiving them.
• Be reluctant to confide in others or reveal personal information because they’re afraid the information will be used against them.
• Be unforgiving and hold grudges.
• Be hypersensitive and take criticism poorly.
• Read hidden meanings in the innocent remarks or casual looks of others.
• Perceive attacks on their character that aren’t apparent to others.
• Have persistent suspicions, without justified reason, that their spouses or romantic partners are being unfaithful.
• Be cold and distant in their relationships with others and might become controlling and jealous to avoid being betrayed.
• Not see their role in problems or conflicts, believing they’re always right.
• Have difficulty relaxing.
• Be hostile, stubborn and argumentative.

What causes paranoid personality disorder?

Scientists don’t know the exact cause of paranoid personality disorder (PPD), but it likely involves a combination of environmental and biological factors.

Researchers have found that childhood emotional neglect, physical neglect and supervision neglect play a significant role in the development of PPD in adolescence and early adulthood.

Researchers used to think there was likely a genetic link among schizophrenia, schizotypal personality disorder and PPD, but more studies have revealed that this connection isn’t as strong as they once thought.

How is paranoid personality disorder diagnosed?

Personality continues to evolve throughout child and adolescent development. Because of this, healthcare providers don’t typically diagnose someone with paranoid personality disorder (PPD) until after the age of 18.

Personality disorders, including PPD, can be difficult to diagnose, as most people with a personality disorder don’t think there’s a problem with their behavior or way of thinking.

When they do seek help, it’s often related to conditions such as anxiety or depression due to the problems created by their personality disorder, such as divorce or lost relationships, not the disorder itself.

When a mental health professional, such as a psychologist or psychiatrist, suspects someone might have paranoid personality disorder, they often ask broad, general questions that won’t create a defensive response or hostile environment. They ask questions that will shed light on:

• Past history.
• Relationships.
• Previous work history.
• Reality testing.
• Impulse control.

Mental health providers base a diagnosis of paranoid personality disorder on the criteria for the condition in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders.

Are other medical conditions associated with paranoid personality disorder?

Yes, approximately 75% of people with paranoid personality disorder (PPD) have another personality disorder. The most common personality disorders to co-occur with PPD include:

• Avoidant personality disorder.
• Borderline personality disorder (BPD).
• Antisocial personality disorder (ASPD).

People with PPD are also more likely to have substance use disorder and panic disorder than the general U.S. population.

How is paranoid personality disorder treated?

People with paranoid personality disorder (PPD) rarely seek treatment on their own. Family members, coworkers or employers usually refer them.

When someone with PPD does seek treatment, psychotherapy (talk therapy), such as cognitive behavioral therapy (CBT) or dialectical behavior therapy (DBT), is the treatment of choice. Therapy focuses on increasing general coping skills, especially trust and empathy, as well as on improving social interaction, communication and self-esteem.

As people with PPD often distrust others, it poses a challenge for healthcare professionals because trust and rapport-building are important factors of psychotherapy. As a result, many people with PPD may not follow their treatment plan and may even question the motives of the therapist.

Healthcare providers generally don’t prescribe medication to treat PPD. However, medications — such as anti-anxiety, antidepressant or antipsychotic drugs — might be prescribed if the person’s symptoms are extreme or if they have an associated psychological condition, such as anxiety or depression.

Can paranoid personality disorder be prevented?

While paranoid personality disorder generally can’t be prevented, treatment can allow someone with PPD to learn more productive ways of dealing with triggering thoughts and situations.

What is the prognosis (outlook) for paranoid personality disorder?

The prognosis (outlook) for paranoid personality disorder (PPD) typically depends on whether someone with PPD is willing to accept and commit to treatment. Talk therapy can sometimes reduce paranoia and limit its impact on daily functioning.

Left untreated, PPD can interfere with a person’s ability to form and maintain relationships, as well as their ability to function socially and in work situations. People with PPD are more likely to stop working earlier in their lives than people without personality disorders.

In addition, PPD is one of the strongest predictors of aggressive behavior in a hospital setting. PPD is also associated with stalking and excessive litigation (lawsuits).

A note from Cleveland Clinic

It’s important to remember that paranoid personality disorder (PPD) is a mental health condition. As with all mental health conditions, seeking help as soon as symptoms appear can help decrease disruptions to a person’s life. Mental health professionals can offer treatment plans that can help manage thoughts and behaviors of people with PPD.

Family members of people with paranoid personality disorder often experience stress, depression, grief and isolation. It’s important to take care of your mental health and seek support if you’re experiencing these symptoms.