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Paranoid Personality Disorder : Causes, Risk Factors, Symptoms, Treatment, Diagnosis

We often see personality traits in some people which may seem weird while for them it may be a routine. While mental health conditions are on the rise it is important to know about such conditions. One such condition is a paranoid personality disorder.

The Epidemiologic Survey on Alcohol and Related Conditions found that 14.8% of Americans had a personality disorder. Paranoid personality disorder (PPD) was the second most prevalent personality disorder around 4.4%, after Obsessive Compulsive Personality Disorder.1

What is Paranoid Personality Disorder (PPD)?

What is Paranoid Personality Disorder (PPD)?

A paranoid personality disorder is a mental health condition that involves unusual ways of thinking. People having paranoid personality disorder show distrust and suspicion towards others without any particular reason to be paranoid or suspicious.2 However, they are unaware of their thoughts and behavior and they do not feel that it is unusual or problematic.

This is one of the groups of conditions of personality disorders called Cluster A, which is a type of eccentric personality disorder. They have eccentric unusual thinking or behavior, mainly paranoia but they do not have hallucinations or delusions like that in schizophrenia or bipolar disorder.2

A paranoid personality disorder is more common in men than in women and usually begins around early adulthood.3 Many people with paranoid personality disorder start showing symptoms during their late teens or early adult years.

Risk Factors and Causes of Paranoid Personality Disorder

While the causes of paranoid personality disorder are not clearly understood, it is believed to be more common in families with a history of other psychotic illnesses like schizophrenia and delusional disorder, possibly related to the involved genes.4

Being divorced, single, widowed, or separated may be linked with people having paranoid personality disorder. The possible role of stress and trauma needs to be evaluated but may be a potential risk factor.

Signs and Symptoms of Paranoid Personality Disorder

People with paranoid personality disorder think differently and believe that others are trying to harm them or threaten them. This leads to distrust and develops a habit of blaming others. Hence, they cannot believe in others, and constantly doubt others’ intentions, which can ultimately affect their relations.

Some of the common signs and symptoms that people with paranoid personality disorder experience include:

  • They doubt those around them, their commitment, loyalty, and dedication, and constantly feel that others are deceiving them or taking advantage of them.
  • They are not willing to trust anyone, and hence cannot confide in others or share their personal information with others. They are always worried that their information will be used against them.
  • They may bear suspicion in their minds about the loyalty of their spouses and have frequent fights over it.
  • They are not able to share their thoughts and feelings with others and may become isolated or socially detached.
  • They can hold grudges, can be unforgiving, and may often seem stubborn, hostile, or argumentative.
  • With the fear of being betrayed, they may seem distant in their relations and have no close friends or emotionally attached people around. They may become jealous and controlling to avoid betrayal from others.
  • They can be oversensitive, cannot take criticism positively, and may find even innocent remarks made by others as a personal insult.
  • They are usually not in a position to understand that their thoughts and behavior may be causing problems for others.
  • They find a hard time relaxing and are burdened by grudges against most people around them.

Diagnosis of Paranoid Personality Disorder

A paranoid personality disorder may be difficult to diagnose as most of the time it is considered a personality trait and is not perceived as a disorder. People with paranoid personality disorder do not find anything problematic in their way of thinking nor do they consider the need for medical help.

Personality evolves during childhood and adolescence. Hence, a paranoid personality disorder is often diagnosed after the age of 18 years. While there are no laboratory tests for the diagnosis of paranoid personality disorder, certain diagnostic tests that rule out other health conditions may be needed in some cases. If there is no involvement of physical conditions, the mental health team including a psychiatrist and a psychologist takes care of the diagnosis and treatment of paranoid personality disorder.

A case taking includes taking history, family history, medical illnesses in the past and present, previous and ongoing medications, details of personal and professional life, relationships, and emotions. The mental health team applies various tools for interview and assessment to evaluate the personality disorder and work towards diagnosing paranoid personality disorder.

Treatment of Paranoid Personality Disorder

Treatment of paranoid personality disorder is often aimed at improving their coping skills, empathy, trust, and self-esteem, thus helping to improve their social, and personal life.  Counseling and psychotherapy, talk therapy, cognitive behavioral therapy, or dialectal behavioral therapy are mostly used to treat paranoid personality disorder.

However, the challenge is that people with paranoid personality disorder do not trust others hence they also find it difficult to trust mental health professionals. They may doubt the intention of the doctor or therapist and may often discontinue the treatment.

While usually, medications are not used, in some cases, if the symptoms are extreme or associated with other conditions like anxiety or depression, medical treatment may be considered.

Counseling and psychotherapy help to a great extent but it also depends on the person, as they should be willing to accept and follow the treatment plan given.

Psychotherapy can help relieve symptoms of paranoia and reduce its implications on their personal or professional life.

As the condition of doubting others’ intentions can also result in aggressive behavior, it can sometimes turn to be serious. While their personal, as well as work life, is affected, they are also at greater risk of getting into litigation, due to suing others for having cheated on them.

Hence, the earlier such conditions are diagnosed and treated the better. People with paranoid personality disorder never realize their eccentric behavior hence the family members need to be vigilant and seek timely medical advice.


Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:October 15, 2022

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