Impacting between 2-4% of the population, paranoid personality disorder (PPD) is a group of conditions that involve odd or eccentric ways of thinking. Deemed a “Cluster A” personality disorder, those with PPD experience paranoia and consistent mistrust and suspicion of others — even when there are no tangible reasons for the suspicion. This disorder generally occurs initially in early adulthood, and understanding the hallmarks of this condition — as well as treatment options — can be an effective way to manage its symptoms over the long term.

Symptoms of Paranoid Personality Disorder

Those who have paranoid personality disorder feel constantly on guard and fervently believe others aim to harm or threaten them. Because of this, individuals with this disorder mistrust the motives of others and are reluctant to build and maintain close relationships, easily hold grudges, and can identify threatening subtexts in innocuous comments or events. They are often quick to get angry and become hostile.

Other common symptoms include:

  • A reluctance to reveal personal information in fear it will be held against them
  • Hypersensitivity and inability to accept criticism
  • Inability to relax or calm down
  • Doubting the loyalty and trustworthiness of others and believing they are being deceived
  • Retaliating quickly with stubborn and argumentative tendencies
  • An unforgiving nature and a tendency to hold grudges
  • Inability to identify their role in problems or conflicts and a feeling of always being right
  • A belief their character is being attacked, even when it is not apparent to others

Individuals with PPD don’t believe their actions and thoughts are abnormal and find their thinking patterns to be totally rational. They may also believe other conditions such as depression and anxiety are impacting their mood and responses, making it increasingly difficult for those with this disorder to recognize symptoms within themselves.

Diagnosing Paranoid Personality Disorder

While there are no diagnostic tests that can pinpoint personality disorders, a primary care provider is able to leverage an array of other tests to rule out physical illness as the cause of certain symptoms. It is important to note that some symptoms of paranoid personality disorder resemble those from other personality disorders, such as schizophrenia and borderline personality disorder, and because of this, a doctor will generally evaluate an individual who experiences symptoms by checking their medical history and conducting a thorough examination.

In most instances, a doctor will refer an individual to a psychiatrist, psychologist, or other mental health professional for a comprehensive evaluation. These trained professionals have a specific aptitude for diagnosing and treating personality disorders via targeted interviews and various assessment tools. During this evaluation process, a person can expect to be asked detailed questions about their childhood, school, work, and personal relationships. The goal is to measure how a person reacts to certain situations and can help inform a diagnosis and treatment plan.

Managing Paranoid Personality Disorder

There are tried-and-true strategies to manage and treat PPD, but it can be difficult to begin this process since most individuals with this disorder do not seek treatment of their own volition. In fact, they often distrust the motives of the various medical professionals helping them manage and treat their personality disorder. As a result, they may not stick to their treatment plan. If the individual is able to accept treatment, however, psychotherapy can help someone with PPD.

For someone with paranoid personality disorder, a psychotherapist can help:

  • Build trust and empathy for others
  • Learn to cope with the disorder
  • Improve self-esteem
  • Better communicate in social situations
  • Limit feelings of paranoia

While medication is not typically used to treat paranoid personality disorder, a doctor may prescribe anti-anxiety, antidepressant, and/or antipsychotic drugs if certain symptoms are severe or if a person has underlying psychological issues. Often, the combination of medication and talk therapy can be an effective means to treat the personality disorder.

There is no cure for paranoid personality disorder, but if an individual is able to accept treatment, they can lead functional and full lives. Without treatment, the long-term pattern of distrust, paranoia, and suspicion of others will result in difficulties both within a work environment and in personal relationships. By recognizing the symptoms of paranoid personality disorder and sticking to a formal psychotherapy treatment plan, an individual can manage the symptoms of the disorder over the course of their lifetime.