A mother and daughter sitting on the ground in their living room. The mother is supporting the daughter who is having signs of paranoid personality disorder.

Loving and Supporting Someone With Signs of Paranoid Personality Disorder

7 min.

Up to 4.5% of people in the U.S. may be impacted by paranoid personality disorder. Here’s how you can support a loved one who’s been diagnosed with the condition.

By: Sarah duRivage-Jacobs

Clinically Reviewed By: Don Gasparini

August 13, 2023

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Mental health is increasingly part of the public conversation, but stigma still surrounds many mental health conditions. Some of the most stigmatized conditions belong in the category of personality disorders, one of which is paranoid personality disorder (PPD).

People with PPD have persistent distrust and suspicion toward others, which can make it hard to maintain positive relationships. Research shows that about 0.5% to 4.5% of people living in the United States may be impacted by the condition. But because it’s under-researched and less likely to be diagnosed than other mental health conditions, the real percentage of people affected by PPD may be higher.

If you have a loved one who’s been diagnosed with PPD or is exhibiting symptoms of the condition, widespread stigma and sparse research may make it hard for both of you to get the support you deserve. In this article, we’re sharing ideas and resources for managing PPD in a relationship and supporting friends, family members, and partners with the condition.

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How paranoid personality disorder impacts a relationship

Interpersonal relationships play a pivotal role in the characteristics related to PPD. An underlying theme in the disorder is peoples’ unfounded fear that others are trying to hurt or lie to them, which can make relationships of any kind—medical or mental healthcare relationships included—difficult to manage. As the authors of a 2019 paper succinctly put it, people with PPD paranoid personality disorder “face a constant battle every day on how to live in a world where everyone is seemingly intending to harm them.”

In romantic relationships specifically, people with PPD may have an unjustified suspicion that their partner is cheating. However, questioning someone’s fidelity does not, on its own, suggest PPD. 

Supporting a loved one who has signs and symptoms of paranoid personality disorder

Every individual with signs and symptoms of PPD has different wants and needs. Here are some considerations to keep in mind when determining how you can provide compassionate support for your loved one with PPD.

Prioritize their safety

Educate yourself

Be compassionate

Take care of yourself

Make sure your loved one with PPD is okay and help them find the right resources, keeping in mind that stigma and limited research on treatment options can make it challenging.

Learn about PPD to better understand and support your loved one, dispelling misconceptions and improving your relationship.

Show compassion and avoid judgment, recognizing the impact of distrust and stigma on your loved one’s experiences.

Prioritize your own mental health by seeking therapy or support groups tailored to those affected by personality disorders, acknowledging the potential challenges of providing support to a loved one with PPD.

1. Make sure they’re safe and have resources for getting help.

Personality disorders in general have been associated with self-harm, and PPD in particular has been associated with aggression and violence. Because of this, it’s important that people who show possible signs of PPD are safe.

It can be really tricky to find appropriate mental health resources for people with PPD due to stigma of the condition as well as its associated traits. 

People who show signs of PPD may be less likely to seek out healthcare of any kind because of provider attitudes and the lack of trust in others. Among those who do reach out for professional support, as many as 70% may stop personality disorder treatment.

Another outcome of these factors is limited research. Without extensive research into standards of care and treatment regimens, caring for patients with PPD can be more challenging. That said, dialectical behavior therapy (DBT) and cognitive behavioral therapy (CBT) have shown promise for people with personality disorders. This may be because both therapeutic modalities incorporate psychoeducation around disorders and discuss effective ways for people to manage their symptoms.

Do your research before sharing resources with a loved one. Does the provider or facility have experience working with patients who have PPD? What types of treatment do they recommend and why? Have they gone through anti-stigma training for personality disorders? Encouraging someone you care about to go into treatment with a judgmental or inexperienced resource may be traumatizing and make your loved one feel even more distrustful.

2. Educate yourself. 

If your loved one has been diagnosed with PPD, understanding what they’re dealing with is critical to supporting them.

As discussed, many people have misconceptions about personality disorders. Reviewing the diagnostic criteria for PPD will help you separate the truth from inaccurate and offensive media portrayals—and help you get a better sense of the reasons behind certain behaviors that make your relationship more challenging. 

3. Be compassionate and nonjudgmental with your partner.

Can you imagine what it might feel like to believe everyone around you is out to harm you? Most people probably can’t. Beyond the distrust that’s characteristic of PPD, people with the condition may experience extreme stigma in relation to their behaviors as well as their diagnosis (if they get one).

Supporting a friend, family member, or partner who has PPD requires compassion and zero judgment. Your loved one is already predisposed to distrust—justifying that distrust by being judgmental won’t help anyone.

Do you have a sense of how stigma may impact your relationship with your loved one? Self-education, deep reflection, and support groups (more on this in the next section) can help you find that out.

4. Check in with your own mental health.

Supporting a loved one who has PPD or another personality disorder can sometimes be overwhelming—and it can make it harder to remember that your mental health matters, too.

Engaging in your own therapy or seeking out a dedicated support group for the friends, family members, and partners of people with personality disorders may benefit you and your relationship. Since personality disorders are often misunderstood, it’s important to work with a therapist who specializes in treating people impacted by paranoid personality disorder. The National Alliance on Mental Health can help you find the right support group for you.

Young couple sitting on a park bench. The female has signs of paranoid personality disorder, and her partner is loving and supporting her.

Behind the stigma: What is paranoid personality disorder?

As mentioned, PPD is a type of mental health condition called a personality disorder—defined by the American Psychiatric Association as a category of clinical diagnoses for people with persistent thoughts, feelings, and behaviors that are seen as “abnormal” and cause them distress. While many aspects of mental health are stigmatized, personality disorders are especially misunderstood and often interpreted as misbehavior rather than a diagnosable disorder.

As a “cluster A” personality disorder, PPD is included among other personality disorders that contribute to behaviors that aren’t accepted as “normal” by society (e.g., schizoid personality disorder and schizotypal personality disorder). This stigma makes it harder for people with personality disorders to have comfortable social interaction with others.

Signs and symptoms of paranoid personality disorder

People who are diagnosed with PPD have long-standing distrust and suspicion around other people’s motives, with signs and symptoms usually developing by early adulthood. 

Presentations of paranoid personality disorder include:

  • Suspecting that people are exploiting, harming, or lying without any evidence.
  • Unjustified preoccupation with people’s loyalty and trustworthiness.
  • Reluctance to confide in others because of fear they will use the information against them.
  • Finding negative and ulterior motives for harmless conversations or circumstances.
  • Continuously holding grudges against people they perceive as causing harm.
  • Feeling attacked in harmless situations and quickly reacting with anger or counterattacks.
  • Continuously suspecting that a partner is cheating without reason to believe that.

The above traits can also be a part of other mental health conditions, like bipolar disorders and depressive disorders with psychotic features. Feelings of paranoia are common among people with borderline personality disorder (BPD), post traumatic stress disorder (PTSD), and schizophrenia.

Paranoid personality disorder can co-occur with (be diagnosed alongside) the following conditions:

Trauma and paranoid personality disorder

Trauma and PPD are closely linked. More than any other personality disorder, PPD has been associated with adverse childhood experiences like physical, sexual, and emotional abuse. The authors of a 2013 review found that experiencing abuse in childhood may lead to growing feelings of paranoia in adolescence and a diagnosis of PPD in adulthood. 

Support for paranoid personality disorder at Charlie Health

If you or someone you care about is managing the distress that comes with paranoid personality disorder, Charlie Health is here to help. Charlie Health’s Intensive Outpatient Program (IOP) offers virtual and comprehensive support for adolescents and young adults who are dealing with personality disorders and other mental health conditions that would benefit from a higher level of care than once-weekly therapy.

At Charlie Health, our expert team of trauma-informed clinicians provides weekly individual therapy, family therapy, and supported group sessions to help clients improve their daily functioning and relationships. By incorporating family therapy and supported group sessions with other young people who are dealing with similar challenges, our IOP can address the stigma people with personality disorders may encounter in their homes and among their peers.

We believe firmly that every individual deserves access to effective mental healthcare. Our IOP is 100% virtual and flexible, so no one has to take time away from school or work to get support. We accept major commercial insurance providers nationwide, as well as Medicaid in many states, so that cost can be less of a barrier.

Fill out this short form to get in touch with our Admissions Team and find out if Charlie Health is a good fit for you or your loved one. We’re here to chat 24/7.

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