A young woman sits on her couch. She has paranoid personality disorder and is learning how to cope with it.

Everything You Need to Know About Paranoid Personality Disorder—and How to Cope With It

Updated: December 21, 2023

5 min.

Keep reading to learn commonly seen symptoms, possible causes, and risk factors of paranoid personality disorder, plus how to get actually effective treatment.

By: Ashley Laderer

Clinically Reviewed By: Dr. Don Gasparini

Learn more about our Clinical Review Process


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Lots of people talk about being paranoid, raising concerns something bad will happen or suspicions of others, but paranoia can actually be a sign of a mental health condition. One such condition is paranoid personality disorder (PPD), a personality disorder marked by pervasive distrust and suspicion of others. 

People with PPD often believe that others are trying to harm or exploit them and don’t usually consider their behaviors or thought patterns irrational, making it challenging to begin treatment. So, if you think a loved one has PPD, it’s important to be aware of the signs and symptoms to help them connect with support. Below, we delve into PPD, including its symptoms, treatment, and more. 

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What is paranoid personality disorder? 

PPD is a personality disorder, a class of mental health conditions the American Psychiatric Association (APA) says are defined by ways of “thinking, feeling and behaving [that] deviates from the expectations of the culture, causes distress or problems functioning, and lasts over time.” In the case of PPD, this includes persistent, unwarranted paranoia, distrust, and suspicion. 

There are three clusters or types of personality disorders, and PPD falls into Cluster A, which also includes schizoid personality disorder and schizotypal personality disorder. People with these disorders are known to have suspicion or lack of interest in others. Among these personality disorders and others, PPD is considered relatively common, affecting up to 4.4% of the population (making it still a rare condition). 

Symptoms of paranoid personality disorder

As mentioned, people with PPD tend to have difficulty trusting others, believing that people are trying to harm, threaten, deceive, or exploit them. They are often paranoid and suspicious of others, acting in ways that come across as angry or hostile. As a result, it is often challenging for people with PPD to have healthy and fulfilling relationships and social interactions. While every person with PPD might experience it a bit differently, some common PPD symptoms are as follows: 

  • Suspicions of other people’s motives and loyalty
  • Belief that people are trying to harm, deceive, exploit, or threaten them
  • Difficulty sharing personal information or confiding in others due to distrust
  • Hypersensitivity to criticism or perceived criticism
  • Angry, hostile, argumentative, or stubborn reactions 
  • Thinking they are always right 
  • Jealousy and controlling behaviors in relationships 

Causes and risk factors of paranoid personality disorder

More research is needed to determine the exact cause of PPD, but experts believe that certain factors may contribute to whether or not someone develops the condition. Below are some common causes and risk factors of PPD:


Research on ten major personality disorders suggests that genetics play a “modest to moderate” role in their development. PPD, however, is considered by some estimates to have a lower heritability rate than other personality disorders. 

Brain trauma

Brain trauma is another possible cause of PPD, with up to 26% of people meeting the criteria for the personality disorder after enduring a traumatic brain injury. Research is still exploring, though, whether the link between brain injury and PPD is due to dysfunction in neural circuits or changes in social interactions resulting from injury-related functional impairments (like struggling to communicate with others). 

Childhood trauma

Many studies have shown an increased risk of personality disorders in those who have experienced adverse childhood experiences (ACES), like emotional neglect or physical or sexual abuse. Specifically, ACEs are also associated with an increase in paranoid symptoms. 

Co-occurring mental health conditions

It is extremely common for someone with PPD to struggle with at least one other mental health condition, including co-occurring substance use disorder or panic disorder. Also, research shows that around 75% of those with PPD have another personality disorder, most commonly including avoidant personality disorder, borderline personality disorder, and narcissistic personality disorder‍. 

Coping with paranoid personality disorder 

If someone you love has been diagnosed with PPD, here are some strategies that may make the process of coping a bit easier. 

Seek professional help

With the correct kinds of therapy and medication (as needed), it’s possible to live a meaningful life with PPD. A mental health professional, especially one skilled in treating personality disorders, can help you or a loved one find a personalized treatment option (more on this below). 

Learn about the condition 

Knowing more about PPD may help someone with the condition better grasp what they’re dealing with and can provide validation. As a loved one of someone with PPD, understanding more about the symptoms, causes, and treatment options for the condition can help you empathize with your loved one and learn how to best support them. 

Maintain a healthy routine 

Taking care of physical health can positively affect mental health, and maintaining a daily routine can provide a sense of structure and predictability, helping to reduce anxiety (a win-win). This can include taking daily walks, eating balanced meals, getting enough sleep, and staying away from substances like drugs and alcohol. 

Try some self-help strategies

Whether you are coping with PPD or caring for a loved one with PPD, these self-help strategies (many of which are self-care tactics) may come in helpful:

  • When experiencing a paranoid thought, try to evaluate the evidence objectively and consider alternative explanations for situations. If your loved one is dealing with a paranoid thought, listen actively and non-judgmentally. 
  • Deep breathing or mindfulness meditation can help manage stress and anxiety.
  • Share your feelings with trusted friends or family members who can provide support and perspective.
  • Break down tasks into smaller, manageable goals to reduce stress and feelings of being overwhelmed.

Treatment strategies for paranoid personality disorder

Professional mental health treatment is crucial for dealing with PPD. That being said, there isn’t a one-size-fits-all treatment option for treating PPD, but treatment typically involves medication and talk therapy, also known as psychotherapy. Two types of psychotherapy commonly used in the treatment of PPD are cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT). CBT can help people identify and modify distorted thought patterns contributing to paranoia, whereas DBT can help people develop skills to address the challenges associated with mistrust and suspicion.

There is no specific medication approved or meant to treat PPD directly. However, psychiatric treatment may play a part in coping with the condition. Depending on the individual’s PPD symptoms and taking into account any other related conditions, a psychiatrist may prescribe anti-anxiety medications, antidepressants, or mood stabilizers. 

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Support for paranoid personality disorder at Charlie Health 

If you or a loved one are struggling with paranoid personality disorder symptoms, Charlie Health is here to help. Charlie Health’s virtual Intensive Outpatient Program (IOP) provides more than once-weekly mental health treatment for young people dealing with complex mental health conditions, including personality disorders. Our expert clinicians incorporate evidence-based therapies into individual counseling, family therapy, and group sessions. With treatment, managing paranoid personality disorder symptoms is possible. Fill out the form below or give us a call to start healing today.

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