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Understanding and Coping With Paranoid Personality Disorder

9 min.

Paranoid personality disorder is a condition characterized by paranoia and suspicion of others. Here’s everything you need to know about PPD.

By: Ashley Laderer

Clinically Reviewed By: Don Gasparini Ph.D., M.A., CASAC

February 22, 2023


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Do you know someone who lives in a constant state of paranoia, acting suspicious and distrusting of people around them, worried that something bad is going to happen? They may also think people are out to get them, even without having any sufficient reason to believe that this is the case. If so, you may know somebody who has paranoid personality disorder (PPD).

Having a personality disorder such as PPD can get in the way of somebody’s functioning, relationships, and overall quality of life. Furthermore, people with personality disorders often are not aware that their behaviors or ways of thinking are problematic, so they may not believe they have a disorder. So, if you suspect that a loved one has PPD, it is important to be aware of the signs and symptoms so you can watch out for their paranoid behavior and help them to get the treatment they need. 

Here’s what you need to know about paranoid personality disorder, its symptoms, treatment, and more.

What is paranoid personality disorder? 

First, it’s important to understand exactly what a personality disorder is. The American Psychiatric Association says that for somebody to be diagnosed with a personality disorder, they must have ways of feeling, thinking, or behaving that are outside of the “expectations of culture.” This behavior is long-term and causes the individual distress and difficulties functioning. Usually, the signs of personality disorders first appear in the teenage years or early adulthood. 

A personality disorder can affect the way that somebody:

  • Thinks about themself and other people
  • Reacts emotionally to different situations
  • Relates to other people
  • Controls their behavior

There are three clusters or types of personality disorders. Paranoid personality disorder is a Cluster A personality disorder. Aside from PPD, other disorders in Cluster A are schizoid personality disorder and schizotypal personality disorder. People with these disorders are known to have odd or eccentric ways of thinking. 

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What sets paranoid personality disorder apart is that it is characterized by persistent, unwarranted paranoia, distrust, and suspicion. 

It’s estimated that this personality disorder could affect up to around 4.4% of the population.

Understanding the signs and symptoms of paranoid personality disorder

While every individual with PPD might experience it a bit differently, there are some common threads and telltale signs of this personality disorder.

Some paranoid personality disorder symptoms include:

  • Having a general mistrust of others
  • Being suspicious of other people’s motives
  • Believing that people are trying to harm them
  • Believing that people are trying to deceive or exploit them
  • Believing that people are threatening them 
  • Being suspicious of people’s loyalty 
  • Having trouble trusting others
  • Having trouble sharing personal information or confiding in others due to distrust
  • Taking harmless things personally as insults 
  • Holding grudges against others
  • Thinking people are attacking their character 
  • Having the inability to relax 
  • Being very hypersensitive to criticism
  • Reacting in ways that are angry, hostile, or argumentative
  • Being stubborn
  • Never taking ownership for their part in any conflict and thinking they are always right
  • Believing (unjustifiably) that their partner is cheating on them 
  • Exhibiting jealousy and controlling behaviors in relationships 

Due to all of these symptoms, it can be very difficult to have healthy relationships and social interactions in general. This encompasses platonic relationships, familial relationships, romantic relationships, and professional relationships. Across the board, someone with PPD will have trouble trusting the people they know, believing that people are trying to harm, threaten, deceive, or exploit them. In turn, they will become increasingly paranoid and suspicious of others, reacting to them in ways that come across as angry or hostile. As a result, it will be challenging for someone with PPD to have healthy and fulfilling relationships.  

Coping with paranoid personality disorder 

On top of therapy and medication, there are various things someone can do to aid in coping with paranoid personality disorder and improving their mental health in general. This involves education and self-care. Here are some ideas: 

  • Learn about the disorder
    Becoming educated and learning more about PPD can help someone better understand exactly what they are dealing with. In some cases, this can be validating and help someone get a grasp on what the disorder entails. They can also learn about the available treatments. 
  • Live a healthy lifestyle
    It’s important to exercise regularly. Staying active and getting at least 15 minutes of physical activity every day can help boost overall mental health. Eating a balanced and healthy diet can also help improve well-being. 
  • Sleep well
    Getting enough good quality sleep is crucial. Sleep deprivation can worsen existing mental health conditions. 
  • Stay away from substances
    Abstaining from drugs and alcohol will benefit health overall and prevent any substance-induced worsening of symptoms. This also reduces the risk of developing a substance use disorder.
  • Find ways to relax
    Practicing mindfulness or meditation can help induce relaxation. Finding a creative outlet for emotions, such as music or art, can also help.  
  • Maintain social support
    Keeping strong social support and avoiding isolation can help keep someone’s morale up. Additionally, support groups with other people who have personality disorders or other mental health conditions may help someone feel less alone. 

How to help a loved one cope with paranoid personality disorder 

If someone you love has been diagnosed with paranoid personality disorder, here are some things you can do to help support them:

  • Educate yourself: Learn as much as you can about paranoid personality disorder, including the symptoms, causes, and treatment options. This can help you to better understand what your loved one is going through and how you can support them.
  • Be patient and non-judgmental: People with paranoid personality disorder may have difficulty trusting others and may feel like they are constantly under threat. It is important to be patient and non-judgmental, even if their behavior or thoughts seem irrational.
  • Encourage them to seek professional help: Encourage your loved one to seek professional help from a mental health practitioner who specializes in personality disorders. 
  • Be a good listener: People with paranoid personality disorder may feel like no one understands them or that they are being dismissed or invalidated. Listen actively to your loved one and try to understand their perspective. Avoid trying to argue with them or convince them that their beliefs are unfounded, as this can often be counterproductive.
  • Provide a safe and supportive environment: Offer a safe and supportive environment for your loved one to express their feelings and concerns. Encourage them to engage in activities that they enjoy and to take care of themselves with activities and things that bring them joy. 

Remember that supporting someone with paranoid personality disorder can be challenging, which means it’s important to take care of your own mental health. Consider seeking support for yourself, such as therapy or a support group, to help you cope with the stress and challenges of supporting a loved one with a mental health condition.

What are the causes and risk factors of paranoid personality disorder?

Researchers do not know the exact causes of paranoid personality disorder, and ultimately, more research is needed to determine this. However, it is believed that certain factors may play a role in whether or not someone develops PPD. For example, there is a link between experiencing childhood trauma and developing PPD. Examples of this include adverse childhood experiences (ACES) like emotional neglect or physical or sexual abuse. Furthermore, experiencing a traumatic brain injury could also increase risk.

Some demographics serve as risk factors in the general population, too. People in the following groups are more likely to have paranoid personality disorder:

  • People with a low income 
  • People who are Black, Hispanic, or Native American
  • People who are divorced, separated, widowed, or never married

What mental health conditions co-occur with paranoid personality disorder? 

It is extremely common for someone with paranoid personality disorder to struggle with at least one other mental health condition. 

Around 75% of those with PPD have another personality disorder. Personality disorders that may occur alongside PPD include:

On top of other personality disorders, people with PPD may also have co-occurring substance use disorder or panic disorder

How is paranoid personality disorder treated?

Professional mental health treatment is crucial for someone who is coping with paranoid personality disorder. However, people with PPD often do not recognize that they have a personality disorder or accept the fact that they need any kind of mental health treatment for it. 

An individual sits alone in his room, looking at his phone.

As a result, people with PPD rarely look for treatment on their own. However, if they seek treatment for a co-occurring mental health condition, such as panic disorder, a mental health professional may evaluate them and identify paranoid personality disorder symptoms and make the subsequent diagnosis.

In other instances, a loved one such as a family member, partner, or friend might intervene if they notice someone’s paranoid behavior worsening and urge them to seek help. Even still, the individual may believe there isn’t anything wrong, and their mistrust and paranoia may lead them to be even more hesitant to see a professional. However, treatment certainly is available and beneficial if someone with PPD complies and sticks with it.

There isn’t a one-size-fits-all approach for treating PPD, but the treatment involves talk therapy, which is also known as psychotherapy. Two types of psychotherapy that may be used in the treatment of PPD are:

  • Cognitive behavioral therapy (CBT): CBT is used for the treatment of many mental health conditions. This type of therapy can help someone become more in tune with their thoughts and feelings, giving them the power to reframe negative beliefs while also addressing unhelpful and unhealthy behaviors. New coping skills will help the individual deal with stress, distorted thoughts, and difficult emotions.
  • Dialectical behavior therapy (DBT): DBT is very helpful for people who have trouble regulating their emotions and struggle with relationships. In a DBT program, there is individual therapy, skills training, and supported groups. The combination of these aspects makes for a well-rounded treatment for various mental health conditions. Skills taught in DBT include distress tolerance, emotional regulation, mindfulness, and interpersonal effectiveness. All of this together helps people learn to manage difficult emotions and improve their interpersonal relationships.

There is no specific medication approved or meant to treat PPD directly. However, psychiatric treatment may play a part in coping with paranoid personality disorder. Depending on the individual’s symptoms and taking into account any other co-occurring conditions, a psychiatrist may prescribe medication such as:

  • Anti-anxiety medications
  • Antidepressants
  • Mood stabilizers 

Every individual’s situation is unique, and mental health professionals will consider this when coming up with the best treatment plan for the situation involving therapy and potential medication. 

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The mental health professional must develop trust with someone who has PPD. Since people with PPD can have trouble opening up, be very mistrustful, and question others’ motives, it can be hard for them to trust a therapist and stick with treatment. However, for treatment to be successful, someone must be able to confide in their therapist, acknowledge that there is work to be done, and continue attending sessions. 

How Charlie Health can help

Do you think that a teen or young adult in your life might have paranoid personality disorder? If so, Charlie Health may be able to help.

We know that every individual has their own unique mental health journey depending on what symptoms they have and the difficulties they face. Our virtual intensive outpatient program provides personalized treatment for teens, young adults, and families dealing with a variety of mental health struggles, including paranoid personality disorder and co-occurring conditions. 

With the help of experienced therapists and the social support of peers who face similar struggles, your loved one can experience improved mental health and quality of life. 

We’re available 24/7 to get your loved one started on their healing journey. Reach out now.

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