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.
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.
How is paranoid personality disorder treated?
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.