Paranoid Personality Disorder (PPD) - HelpGuide.org (2022)

personality disorders

Know someone who’s acutely mistrustful and suspicious of others, whose paranoia distorts their view of the world? Here’s how to recognize PPD and help your loved one get treatment.

Paranoid Personality Disorder (PPD) - HelpGuide.org (1)

What is paranoid personality disorder (PPD)?

Paranoid personality disorder (PPD) is a challenging mental health condition defined by mistrust and suspicion so intense that it interferes with thought patterns, behavior, and daily functioning. A person with PPD may feel deeply wary of others, always on guard for signs that someone is trying to threaten, mistreat, or deceive them. No matter how unfounded their beliefs, they may repeatedly question the faithfulness, honesty, or trustworthiness of others. When they perceive they’re being persecuted, rejected, or slighted, they’re likely to respond with angry outbursts, controlling behavior, or by deflecting the blame onto others.

The fearful, distrustful perceptions that accompany PPD can make forming and maintaining close relationships very difficult, affecting the person’s ability to function at home, work, and school. If you have a loved one with paranoid personality disorder, you may feel frustrated by their warped view of the world, exhausted by their continual accusations, or beaten down by their hostility and stubbornness. It can seem like they’re able to find and exaggerate the negative aspects of any situation or conversation.

Professional treatment can help someone with paranoid personality disorder manage symptoms and improve their daily functioning. But due to the very nature of the disorder, most people with PPD don’t seek help. As far as they’re concerned, their fears are justified and any attempts to change how they think only confirms their suspicions that people are “out to get them” in some way.

Despite the severe challenges of dealing with someone with PPD, though, you’re not totally powerless. There are steps you can take to encourage your loved one to seek help, support their treatment, and establish firm boundaries to preserve your own mental health and wellbeing.

Signs and symptoms of paranoid personality disorder

PPD often first appears in early adulthood and is more common in men than women. Research suggests it may be most prevalent in those with a family history of schizophrenia. Someone with paranoid personality disorder doesn’t see their suspicious behavior as unusual or unwarranted. Rather, they see it as defending themselves against the bad intentions and deceptive, untrustworthy activities of those around them.

Common PPD symptoms include:

  1. Suspecting, without justification, that others are trying to exploit, harm, or deceive them.
  2. Obsessing on the lack of loyalty or trustworthiness of family, friends, and acquaintances.
  3. Refusing to confide in people for fear that any information they divulge will be used against them, often leading them to isolate from others.
  4. Interpreting hidden, malicious meanings in innocent gestures, events, or conversations.
  5. Being overly sensitive to perceived insults, criticism, or slights, quickly snapping to judgment and holding grudges.
  6. Responding to imagined attacks on their character with anger, hostility, or controlling behavior.
  7. Repeatedly suspecting, without basis, their romantic partner or spouse of infidelity.

Despite being one of the most common personality disorders, paranoid personality disorder can be difficult to detect until symptoms progress from mild to more severe. After all, most of us have behaved in mistrustful, suspicious, or hostile ways at some point in our lives without warranting a diagnosis of PPD.

Spotting the signs of paranoid personality disorder can be further complicated as it often co-occurs with another mental health problem, such as an anxiety disorder (often social anxiety), obsessive-compulsive disorder (OCD), substance abuse, or depression.

Diagnosing PPD

In order to confirm a diagnosis of paranoid personality disorder, a mental health provider will look for the presence of at least four of the above symptoms. They will also want to rule out paranoia stemming from a psychotic episode linked to another condition, such as bipolar disorder, schizophrenia, or depression with psychosis.

If you recognize the symptoms of paranoid personality disorder in someone you care about, it’s important to remember that you can’t fix them or force them into treatment. You can, however, encourage them to seek professional help and support them through recovery.

Treatment for PPD

Treatment for paranoid personality disorder largely focuses on psychotherapy. A therapist can help your loved one develop skills for building empathy and trust, improving communication and relationships, and better coping with PPD symptoms. Since the presence of others may fuel paranoid thoughts and anxious behavior, your loved one is more likely to benefit from individual rather than group therapy.

(Video) Paranoid Personality Disorder

  • Cognitive-behavioral therapy (CBT) can help someone with paranoid personality disorder recognize their destructive beliefs and thought patterns.
  • By changing how these beliefs influence their behavior, CBT can help reduce paranoia and improve how well your loved one interacts with others.
  • CBT can also help them learn better ways to deal with their emotions, beyond lashing out at others.

Affordable Online Therapy

Get professional help from BetterHelp's network of licensed therapists.

HelpGuide is reader supported. We may receive a commission if you sign up for BetterHelp through the provided link. Learn more.

Need urgent help? Click here.

Obstacles to treatment

The first major challenge is for the person with paranoid personality disorder to recognize there’s something disordered in their thinking and willingly embrace the need for treatment. Trying to force someone with PPD into seeking help will often backfire, adding to their resistance and fueling their paranoia that people are conspiring against them.

Another obstacle to treatment is overcoming the person with PPD’s suspicion and mistrust of those trying to help them, including the therapist. As in all relationships, trust is a major component of an effective therapist-client connection. If your loved one is suspicious of the therapist’s motives, worried about disclosing personal details, or otherwise uncomfortable confiding in them, therapy is very unlikely to be successful.

Finding the right therapist for any mental health condition can often take time and effort—and that’s particularly true of paranoid personality disorder. The person with PPD needs to feel that they are working in collaboration with a therapist rather than having treatment forced upon them. It may take multiple attempts to find a therapist who’s a good fit and may require a long-term program of treatment to continually manage the symptoms of PPD.

(Video) IOP LSP300 GP50 NORFAEZAH RAMLI 158583

Medication

There’s no medication specifically designed to treat paranoid personality disorder, although anti-psychotic drugs may be used to treat severe symptoms of paranoia. Other medications may also be prescribed to help manage related conditions such as anxiety or depression.

While these may be beneficial in combination with therapy, many people with PPD are suspicious of taking medication, especially if the benefits aren’t immediately apparent.

How PPD affects relationships

If you have a relationship with someone with paranoid personality disorder you already know how stressful and emotionally turbulent it can be. Whether you’re dealing with a spouse, partner, or family member, the suspicion, finger-pointing, and twisting of your words to mean something else can take a heavy toll. The verbal insults, lack of sensitivity to your feelings, and stubborn belief that they’re always right can make you feel like you’re walking on eggshells around them. And their jealousy and controlling behavior can make it difficult for you to maintain other relationships and social ties, leaving you feeling isolated and alone.

You probably feel like the person with PPD doesn’t ever see you for who you really are. They’re so guarded about their feelings and paranoid about revealing anything personal about themselves, it can be difficult to ever feel close.

In healthy relationships, trust tends to deepen over time as two people get to know each other better. But in a relationship with someone with paranoid personality disorder, the opposite often occurs. The longer you’re in the relationship, the less the person with PPD trusts you and the more suspicious of you they become.

While it’s easy to become overwhelmed or lose hope, it is possible to stabilize your relationship by encouraging your loved one to get treatment and taking steps to establish healthy boundaries.

Coping with a loved one’s paranoia

As hurtful and confusing as a person with PPD’s behavior can be, try to remember that your loved one’s paranoid beliefs and disordered thinking stem from fear. Even though their beliefs may be totally unfounded, the fear, anxiety, and distress they’re experiencing are very real.

Recognize their pain. While you don’t need to agree with your loved one’s groundless beliefs, you can recognize and offer comfort for the feelings that are fueling these beliefs. Acknowledging their pain can help them feel more secure and diffuse their anger and hostility.

Don’t argue about their mistaken beliefs or instantly dismiss them. A person with PPD misinterprets events as threatening and trying to argue rationally with them will only reinforce their belief that you’re out to deceive them. Instead, respect their beliefs but focus on the fears behind their claims. Talking openly about what they’re feeling, without validating their paranoid thinking, can help to reduce their stress and anxiety.

Set boundaries. No matter how much pain your loved one is in, that doesn’t make it okay for them to take it out on you. Setting clear boundaries can help the person with PPD see the damaging effects of their behavior, which in turn may encourage them to seek treatment. For example, you could make it clear that if they accuse you of cheating or prevent you from seeing friends, you’ll leave until they begin treatment. Make the rules and consequences clear—but only if you’re prepared to follow through with them.

Simplify how you communicate. Try to use clear, unambiguous language to reduce the chance of your loved one misinterpreting what you’re saying. If your loved one starts to twist your words, try to offer clarification without becoming defensive.

Encourage exercise. Regular physical activity releases endorphins that can relieve tension, boost your loved one’s mood, and help manage symptoms of stress, anxiety, and depression. Adding a mindfulness element—really focusing on how the body feels while exercising—may also help your loved one interrupt the flow of negative thoughts running through their head.

(Video) Borderline Personality Disorder: How to Work Through Highs & Lows

Promote relaxation. People with paranoid personality disorder often have difficulty relaxing. You can help by encouraging a regular relaxation practice such as yoga or meditation.

Taking care of yourself

Being in a relationship with someone who has paranoid personality disorder requires compassion, patience, and lots of understanding. But if you’re not careful, it can also be incredibly draining and take over your life. Your loved one’s pessimism can make the world seem like a dark and negative place, so it’s vital you take steps to bolster your own mood and self-esteem.

Maintain other relationships. Your loved one’s paranoid personality disorder and associated controlling behavior may have caused you to isolate from family and friends. But it’s important to set boundaries about being able to maintain your social life. You need regular contact with family and friends for support, relaxation, and fun. If you’ve abandoned old social connections, it’s never too late to make new friends.

Take time to relax and unwind. When you’re dealing with someone with paranoid personality disorder it can feel like you’re in the eye of a storm. It’s important to regain your balance and perspective by adopting a daily relaxation practice, such as yoga, deep breathing, or meditation. A good place to start is HelpGuide’s Eye of the Storm guided meditation.

Exercise. Physical activity can be just as important for lowering your stress and anxiety levels as it is for your loved one with PPD. You may even be able to exercise or take a yoga class together, helping to motivate and encourage each other.

Eat well and get enough sleep. It’s easy to neglect your diet and skimp on sleep when you’re dealing with a loved one’s mental health problem. But when you eat well and get plenty of sleep, you’re better able to handle stress, remain patient, and control your own emotional response.

Authors: Lawrence Robinson and Melinda Smith, M.A.

  • References

    Personality Disorders. (2013). In Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association. https://doi.org/10.1176/appi.books.9780890425787.x18_Personality_Disorders

    Vyas, Amy, and Madiha Khan. “Paranoid Personality Disorder.” American Journal of Psychiatry Residents’ Journal 11, no. 1 (January 1, 2016): 9–11. https://doi.org/10.1176/appi.ajp-rj.2016.110103

    Lee, Royce J. “Mistrustful and Misunderstood: A Review of Paranoid Personality Disorder.” Current Behavioral Neuroscience Reports 4, no. 2 (June 1, 2017): 151–65. https://doi.org/10.1007/s40473-017-0116-7

    Matusiewicz, Alexis K., Christopher J. Hopwood, Annie N. Banducci, and C. W. Lejuez. “The Effectiveness of Cognitive Behavioral Therapy for Personality Disorders.” Psychiatric Clinics of North America, Cognitive Behavioral Therapy, 33, no. 3 (September 1, 2010): 657–85. https://doi.org/10.1016/j.psc.2010.04.007

    Carroll, Andrew. “Are You Looking at Me? Understanding and Managing Paranoid Personality Disorder.” Advances in Psychiatric Treatment 15, no. 1 (January 2009): 40–48. https://doi.org/10.1192/apt.bp.107.005421

    (Video) Integrating Biofeedback as a Tool in Treatment for Borderline Personality Disorder

    Angstman, Kurt, and Norman H. Rasmussen. “Personality Disorders: Review and Clinical Application in Daily Practice.” American Family Physician 84, no. 11 (December 1, 2011): 1253–60. https://www.aafp.org/afp/2011/1201/p1253.html

Get more help

Paranoid Personality Disorder– Symptoms, treatment, and prognosis. (Cleveland Clinic)

Paranoid Personality Disorder– Symptoms and treatment. (Psychology Today)

Helplines and support

In the U.S.: Call the NAMI HelpLine at 1-800-950-6264.

UK:Call the SANEline at 07984 967 708.

Australia: Call the Sane Helpline at 1800 187 263.

Canada:Visit Mood Disorders Society of Canada for links to provincial helplines.

India: Call the Vandrevala Foundation Helpline at 1860 2662 345.

(Video) Psych6.Somatoform&Personality&EatingDisorders

Online: Find information and support from others affected by PPD at Paranoid Personality Disorder Forum.

Last updated: October 7, 2022

FAQs

What is PPD paranoid personality disorder? ›

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.

What triggers paranoid personality disorder? ›

The cause of PPD is unknown. However, researchers believe that a combination of biological and environmental factors can lead to it. The disorder is present more often in families with a history of schizophrenia and delusional disorder. Early childhood trauma may be a contributing factor as well.

Is paranoid personality disorder a serious mental illness? ›

Paranoid personality disorder (PPD) is a challenging mental health condition defined by mistrust and suspicion so intense that it interferes with thought patterns, behavior, and daily functioning.

Is paranoid personality disorder a disability? ›

Psychotic Disorders (including Paranoia and Schizophrenia)

To qualify for disability with psychotic disorders, you must have medical documentation showing two years or more showing that your condition severely limits your ability to function in a work environment.

Can paranoid personality disorder get worse with age? ›

Personality disorders that are susceptible to worsening with age include paranoid, schizoid, schizotypal, obsessive compulsive, borderline, histrionic, narcissistic, avoidant, and dependent, said Dr.

Can paranoid personality disorder be triggered? ›

These include emotional neglect, physical neglect, parental neglect, experiencing extreme or unfounded parental rage, or, again, being the victim of or witness to a traumatic event. To adequately determine triggers or causes for paranoid personality disorder, further research is necessary into the illness.

What is the best medication for paranoid personality disorder? ›

People with paranoid personality disorder and co-occurring conditions may particularly benefit from the use of medication.
...
These five SSRIs are the ones most commonly prescribed for anxiety:
  • Paroxetine (Paxil)
  • Citalopram (Celexa)
  • Escitalopram (Lexapro)
  • Sertraline (Zoloft)
  • Fluoxetine (Prozac)
27 Jul 2022

What is the best treatment for paranoid personality disorder? ›

Cognitive behavioral therapy (CBT) is considered the first treatment option for personality disorders. A 2018 case study suggests it is effective for paranoid personality disorder. CBT is talk therapy and it helps you change your negative or harmful thinking patterns. CBT can help you develop trust in other people.

Are people with PPD violent? ›

It can lower a person's quality of life and may also affect the lives of their family, friends, and co-workers. PPD can manifest in aggression and violence toward others. As a result, people with PPD may find themselves socially isolated and depressed.

What is the best example of a symptom of paranoid personality disorder? ›

People with this disorder: Doubt the commitment, loyalty, or trustworthiness of others, believing others are using or deceiving them. Are reluctant to confide in others or reveal personal information due to a fear that the information will be used against them. Are unforgiving and hold grudges.

What part of the brain is affected by paranoid personality disorder? ›

Overall, these results suggest that paranoia is related to higher resting neuronal activity in the amygdala, as well as in broader sensory and frontal regions. These findings provide an essential step toward integrating neurobiology with existing psychological accounts of paranoia.

What happens if paranoid personality disorder is left untreated? ›

People with paranoid personality disorder may suffer chronic paranoia if left untreated. Therapy and some medications have proven to be effective approaches. If untreated, the person may suffer difficulties at work and at home. Comprehensive treatment can include both formal and informal approaches.

What famous person has paranoid personality disorder? ›

Famous people historically suspected (but not proven) to have paranoid personality disorder have included Richard Nixon, Hitler, Josef Stalin, and, more recently, Saddam Hussein.

How do you communicate with paranoid personality disorder? ›

Speak clearly - Simple sentences and unambiguous words reduce the chance of being misinterpreted.Be accepting, yet firm - Delusions are very real to the person having them. Don't confront the person about their beliefs or attempt to help him reality-test.

Is paranoid personality disorder genetic? ›

It is common for people with PPD to have a family history of PPD. Current research suggests that there might be a genetic link between this disorder and other psychotic disorders such as schizophrenia. Early childhood experiences, such as trauma or maltreatment, are also believed to be causes of this disorder.

What is the most difficult personality disorder? ›

But antisocial personality disorder is one of the most difficult types of personality disorders to treat. A person with antisocial personality disorder may also be reluctant to seek treatment and may only start therapy when ordered to do so by a court.

Is paranoid personality disorder lifelong? ›

Facts and Statistics. Paranoid personality disorder is characterized by mistrust of others and paranoia. It is a chronic, lifelong condition, but treatment can help minimize symptoms and restore some function to a person's life.

How do you deal with someone who thinks they are always right? ›

  1. Don't take it personally. ...
  2. When possible, walk away from the conflict. ...
  3. Stay out of the blame game. ...
  4. Keep the conflict focused on one topic. ...
  5. Avoid the trap of supporting witnesses.
16 Sept 2021

Is paranoid personality disorder on the schizophrenia spectrum? ›

However, Kraepelin considered paranoid personality disorder phenomena to represent part of the schizophrenia spectrum, since these patients often later decompensated into frank psychosis (4). Paranoid personality disorder first appeared in DSM-III in 1980.

How long does paranoid ideation last? ›

These feelings of suspiciousness and paranoia may last for just a few days, a few weeks, or indefinitely. Stress-related paranoid ideation is the term chosen by mental health professionals to describe this state of mind, which can cause great misery and consternation among people with borderline personality disorder.

What are the signs of paranoid personality disorder? ›

Paranoid personality disorder
  • Pervasive distrust and suspicion of others and their motives.
  • Unjustified belief that others are trying to harm or deceive you.
  • Unjustified suspicion of the loyalty or trustworthiness of others.
23 Sept 2016

What are the 3 types of personality disorders? ›

What types of personality disorder are there?
  • Paranoid personality disorder.
  • Schizoid personality disorder.
  • Schizotypal personality disorder.

What happens if paranoid personality disorder is left untreated? ›

People with paranoid personality disorder may suffer chronic paranoia if left untreated. Therapy and some medications have proven to be effective approaches. If untreated, the person may suffer difficulties at work and at home. Comprehensive treatment can include both formal and informal approaches.

What famous person has paranoid personality disorder? ›

Famous people historically suspected (but not proven) to have paranoid personality disorder have included Richard Nixon, Hitler, Josef Stalin, and, more recently, Saddam Hussein.

What is the best medication for paranoid personality disorder? ›

People with paranoid personality disorder and co-occurring conditions may particularly benefit from the use of medication.
...
These five SSRIs are the ones most commonly prescribed for anxiety:
  • Paroxetine (Paxil)
  • Citalopram (Celexa)
  • Escitalopram (Lexapro)
  • Sertraline (Zoloft)
  • Fluoxetine (Prozac)
27 Jul 2022

What is the best treatment for paranoid personality disorder? ›

Cognitive behavioral therapy (CBT) is considered the first treatment option for personality disorders. A 2018 case study suggests it is effective for paranoid personality disorder. CBT is talk therapy and it helps you change your negative or harmful thinking patterns. CBT can help you develop trust in other people.

Can a person with paranoid personality disorder become violent? ›

The risk of violence

Hence, although there is convergent evidence that paranoid traits do indeed increase risk of violence, it should not be assumed that an individual with paranoid personality disorder is necessarily at high risk of such behaviour.

What is the most difficult personality disorder? ›

But antisocial personality disorder is one of the most difficult types of personality disorders to treat. A person with antisocial personality disorder may also be reluctant to seek treatment and may only start therapy when ordered to do so by a court.

What are the first signs of a personality disorder? ›

Some general signs of people with a personality disorder include: Their behavior is inconsistent, frustrating and confusing to loved ones and other people they interact with. They may have issues understanding realistic and acceptable ways to treat others and behave around them.

How can you tell if someone has a personality disorder? ›

Some signs that a person has a personality disorder include:
  • frequent mood swings.
  • extreme dependence on other people.
  • narcissism (extreme vanity)
  • stormy personal relationships.
  • social isolation.
  • angry outbursts.
  • suspicion and mistrust of others.
  • difficulty making friends.

How do you communicate with paranoid personality disorder? ›

Speak clearly - Simple sentences and unambiguous words reduce the chance of being misinterpreted.Be accepting, yet firm - Delusions are very real to the person having them. Don't confront the person about their beliefs or attempt to help him reality-test.

How does paranoid personality disorder affect relationships? ›

Someone with PPD believes other people are out to harm them, cannot be trusted, or are not loyal. They tend to be socially isolated and struggle to form any close relationships. They can get angry easily and hold grudges against people. Living with PPD is very difficult, including for family members.

Is paranoid personality disorder the same as schizophrenia? ›

One of the main differences between paranoid personality disorder and schizophrenia is that hallucination is not a typical feature of paranoid personality disorder.

Is paranoid personality disorder genetic? ›

It is common for people with PPD to have a family history of PPD. Current research suggests that there might be a genetic link between this disorder and other psychotic disorders such as schizophrenia. Early childhood experiences, such as trauma or maltreatment, are also believed to be causes of this disorder.

Can paranoid personality disorder be treated? ›

Paranoid personality disorder is generally treated with psychotherapy. With ongoing treatment and appropriate support, people with this condition can manage their symptoms and function more effectively in daily life.

What is difference between anxiety and paranoia? ›

A main difference between paranoia and anxiety is that with paranoia, there are delusional beliefs about persecution, threat, or conspiracy. In anxiety, these thought processes are not generally present. Paranoia is characterized by distrust in others and their motives. This is generally not found in anxiety.

Top Articles

You might also like

Latest Posts

Article information

Author: Edwin Metz

Last Updated: 10/24/2022

Views: 5779

Rating: 4.8 / 5 (58 voted)

Reviews: 81% of readers found this page helpful

Author information

Name: Edwin Metz

Birthday: 1997-04-16

Address: 51593 Leanne Light, Kuphalmouth, DE 50012-5183

Phone: +639107620957

Job: Corporate Banking Technician

Hobby: Reading, scrapbook, role-playing games, Fishing, Fishing, Scuba diving, Beekeeping

Introduction: My name is Edwin Metz, I am a fair, energetic, helpful, brave, outstanding, nice, helpful person who loves writing and wants to share my knowledge and understanding with you.