Paranoid Personality Disorder

A person struggling with paranoid personality disorder also struggles with an unjustified mistrust of people.¹ Normally, paranoid personality disorder will develop during young adulthood, and it’s more common in men.

Overview

This is a severe personality disorder and should be taken seriously. People with paranoid personality disorder often struggle with having healthy friendships or relationships due to doubting the other person or hypersensitivity to specific comments.¹ There is a belief that there is a genetic link to schizophrenia.

Different Levels of PPD

There are three primary types of paranoia. The main three are paranoid schizophrenia, delusional disorder, and paranoid personality disorder. Paranoid personality disorder is the mildest type of paranoia, meaning that people can typically function well.²

Identifying the Patterns of Paranoid Personality Disorder

Many people who struggle with this mental health disorder will mistrust of people no matter how close they are to them. This can interfere with daily activities, making it more difficult for them to open up to people.³

What Causes Paranoid Personality Disorder?

Like most mental health disorders, the cause of paranoid personality disorder is unknown. Most scientists believe that it’s a mixture of environmental and biological factors.3 Many researchers believe there is a genetic connection between schizophrenia and delusional disorder. Trauma, low-income housing, divorce, singleness, and losing a spouse can all be factors in developing paranoid personality disorder.³

Signs and Symptoms of Paranoid Personality Disorder

There are numerous signs that someone might have this personality disorder. If you or a loved one are showing multiple symptoms over a long period (several months), seeking help from a mental health professional is recommended.

Doubt the Commitment or Loyalty of Others
People who struggle with paranoid personality disorder will struggle with believing that people are trying to deceive them or mislead them. Because of this, they’re more likely to doubt how loyal or committed someone might be as a friend or partner.1 This could come across as a constant feeling that people are out to get them.

Reluctant to Confide in Others

Due to their struggles with trust, a person might be more reluctant to share personal details about their lives with people. This usually comes from a paranoia around information being used to cancel them or harm them. This might prevent someone from keeping close friendships for long periods.

Unforgiving Behavior and Holding Grudges

Due to fear and trust issues, a person with this disorder will struggle more with forgiving people for slights or perceived slights. They’ll hold grudges and choose to let go of relationships over small things.

Hypersensitivity

People with this personality disorder are also hypersensitive. This means they react very poorly to criticism or redirection. Also, they may read into comments or tones as a sign of you trying to betray them or that you do not like them.

Believing Others are Exploiting or Deceiving Them

Paranoid personality disorder can also struggle to believe that people intentionally deceive or harm them. They could think that people are trying to take advantage of them, making them much less likely to trust others.

Perceiving Attacks on Character That Are Not Apparent to Others

As stated previously, people who struggle with this disorder may read into comments or try to find hidden meanings in things. Because of this, they may react in anger at perceived personal attacks. Often, these attacks will not be apparent to people around them.

Cold and Distant in Relationships

They might also come off as cold or distant in their personal relationships, often due to mistrust. Because of a potential fear of a person betraying or leaving them, they might also become jealous very quickly or controlling.

Recurrent Suspicions Without Justification

Recurrent, unjustifiable suspicions are a cornerstone symptom of this disorder. They are very common and are generally related to other paranoia symptoms.

Have Difficulty Relaxing

Paranoia can make someone seem on edge or fidgety, causing issues with resting or relaxing. Depending on the severity of the paranoia, this symptom may be severe or slightly noticeable.

Hostile, Stubborn, and Argumentative Behavior

Finally, due to a belief that people are trying to betray them or take advantage of them, a person with this personality disorder may be very argumentative and hostile towards others. They also might be extremely stubborn and stuck in their ways.

How to Diagnose PPD

Doctors will use the DSM-5 criteria and run a few tests to diagnose a person with paranoid personality disorder.⁴

Physical Exam

Doctors will start with a physical exam to check for any other factors that might describe the paranoia or delusional behavior. They will also run a psychiatric evaluation.

Psychiatric Evaluation

During the psychiatric evaluation, they will determine how long the person has struggled with the symptoms. They will compare this to the criteria within the DSM-5.

Diagnostic Criteria in the DSM-5

There are specific criteria that a person must have to be diagnosed with paranoid personality disorder. Some of those symptoms are:⁵

Believes others are using or attempting to harm them.

Doubts others’ loyalty.
Refuses to confide in other people.
Consistently holds grudges.
Read into ambiguous gestures or remarks as a threat.
Jealous and suspicious of others.

Believes their reputation is being tarnished by others.

Treatment for PPD

Treatment can be a challenging process for someone struggling with paranoid personality disorder. Due to the very nature of paranoia, there is a natural mistrust of doctors and those around them. With that being said, there are still some treatment options.

Psychotherapy

Usually, doctors will use psychotherapy to provide support for the individual. Doctors will do their best to build a rapport to establish trust. Typically, talk therapy is done alongside other methods. This method aims to teach people coping skills to deal with their paranoid beliefs.⁶ CBT is the most common type of therapy used with individuals struggling with paranoid personality disorder.

Medications

Commonly, medication is only prescribed in the most extreme cases or if there is another comorbid condition like depression or anxiety. When that occurs, there are a few medications that a person might use.⁶

Antidepressants

Antidepressants are typically prescribed if a person is also struggling with depression. This can help with some of the lows that a person might face.

Mood stabilizers

Mood stabilizers could also be used to help stabilize a person’s emotions. This might help with some of the aggravation a person might face due to paranoia.

Antipsychotic Medications

Antipsychotic medications are used commonly with people struggling with schizophrenia. They could help a person with their paranoid tendencies.

Anti-anxiety Medications

Finally, a person can use anti-anxiety medications if struggling with a comorbid anxiety disorder. This could help calm down a person when they become anxious that someone is out to get them or trying to use them.

Hospital and Residential Treatment Programs

In severe cases where a person becomes aggressive, hospitalization or residential treatment programs could be an option. While there, a person will go through psychotherapy to learn how to cope with their mental health disorder.

Home Remedies and Prevention

You can do multiple things at home to prevent severe symptoms, which can then help you sustain better relationships or reduce symptoms.

Be an Active Participant in Your Care

First, be an active participant in your care. Learn as much as you can from doctors and your therapist. Pay attention to tendencies and triggers. This will allow you to analyze what is happening in the middle of an episode.

Take Your Medications as Directed

If your doctor has prescribed medication for you, make sure to follow the instructions. Taking the correct amount can help reduce many of your symptoms.

Learn About Your Condition

Researching more about your condition can help a ton. Understanding your signs and symptoms and treatment options can help you create a better-individualized treatment plan.

Avoid Drugs and Alcohol

Drugs and alcohol can increase paranoid tendencies. Therefore, avoid them, especially while taking medication. This is especially true for marijuana and hallucinogens.

Get Routine Medical Care

Finally, it’s a good idea to check in with doctors about your condition regularly. Seeing a therapist regularly can also set you up for long-term success. If you or a loved one are struggling with paranoid personality disorder, the first step is seeking advice from a medical professional such as a therapist.

Begin Your Journey to Healing at Pacific Beach Health

While living with Paranoid Personality Disorder (PPD) can feel isolating, effective treatment options are available. At Pacific Beach Health, we offer compassionate, individualized care designed to empower you or your loved one. Our integrated programs—ranging from psychotherapy, DBT, and EMDR to group therapy—address both the underlying patterns of PPD and co-occurring conditions.

You don’t have to navigate this alone. Contact us today and take the first step toward building trust, connection, and lasting wellness.

Paranoid Personality Disorder Treatment

Paranoid personality disorder focuses on eccentric or odd ways of thinking or perceiving the world.