This article on Epainassist.com has been reviewed by a medical professional, as well as checked for facts, to assure the readers the best possible accuracy.

We follow a strict editorial policy and we have a zero-tolerance policy regarding any level of plagiarism. Our articles are resourced from reputable online pages. This article may contains scientific references. The numbers in the parentheses (1, 2, 3) are clickable links to peer-reviewed scientific papers.

The feedback link “Was this Article Helpful” on this page can be used to report content that is not accurate, up-to-date or questionable in any manner.

This article does not provide medical advice.


Understanding Paranoid Personality Disorder (PPD) : Symptoms, Causes, and Treatments

What is Paranoid Personality Disorder?

A paranoid personality disorder is a mental health condition that is characterized by a pervasive pattern of unwarranted distrust and suspicion of others without having adequate reason to be suspicious. People with paranoid personality disorder (PPD) always believe that others are constantly trying to harm or threaten them. The harsh reality about people with paranoid personality disorder is that these individuals often do not think their behavior or thought processes are problematic.

Paranoid personality disorder (PPD) is one of a group of conditions known as Cluster A, or eccentric personality disorders. Individuals suffering from these disorders have eccentric and unusual thinking and behavior.

People with paranoid personality disorder do not experience hallucinations or delusions with paranoia, as seen commonly in schizophrenia, or manic episodes in bipolar disorder. Usually, people with PPD start experiencing symptoms by their late teens or early adulthood.

Who Does Paranoid Personality Disorder Affect?

Paranoid personality disorder (PPD) mostly affects people

  • Those who live in low-income households.
  • Be divorced, widowed, separated, or never married.
  • Be black, Native American, or Hispanic.

Research in this field is essential to learn more about why these risk factors are linked with paranoid personality disorder and how trauma and stress play a crucial role in its development.

How Common is Paranoid Personality Disorder?

Paranoid personality disorder is quite rare and it is estimated that the condition affects 0.5% to 4.5% of the general U.S. population.(1) According to a literature review published in 2017, paranoid personality disorder affects between 1.21% and 4.4% of people worldwide.(2)

What are the Signs and Symptoms of Paranoid Personality Disorder?

People with paranoid personality disorder do not believe that their behavior is not anything out of the ordinary. They might also behave stubbornly.

Those with this disorder might have other conditions that can compound their symptoms of paranoid personality disorder. For instance, anxiety and depression can affect a person’s mood. Other symptoms of Paranoid personality disorder include:

  • Doubting the loyalty of others.
  • Believing that others have hidden motives or are about to harm them.
  • Being hypersensitive to criticism.
  • Having issues working with others.
  • Suddenly turning angry or hostile.
  • Being argumentative and defensive.
  • Be unforgiving and holding grudges.
  • Being socially isolated and detached.
  • Having trouble relaxing.
  • Not seeing their behavior or thoughts as normal and believing they are always correct.

NOTE: Symptoms of paranoid personality disorder can overlap with symptoms of other mental health disorders like schizophrenia and borderline personality disorder (BPD)

What are Some Related Mental Health Conditions?

Researchers have suggested that about 75% of individuals with paranoid personality disorder (PPD) also have a co-occurring personality disorder, including avoidant personality disorder, borderline personality disorder, antisocial personality disorder, and schizophrenia.(3) Some other conditions commonly occurring are panic disorder and substance abuse disorders.

What Causes Paranoid Personality Disorder?

The cause of paranoid personality disorder is still unknown. However, it is believed that a combination of environmental and biological factors can cause this condition. PPD is mostly present in families often with a history of delusional disorder and schizophrenia. Moreover, early childhood trauma could be a contributing factor to paranoid personality disorder.

Some other contributing factors for paranoid personality disorder include those living in a low-income household, someone being widowed, being never married, or someone divorced or being separated.

Apart from this, research conducted in 2017 also mentions that African Americans, Hispanic Americans, and Native Americans are more likely to be diagnosed with paranoid personality disorder.(2) However, more research in this regard is required. This is because stress and trauma occur at higher rates in African Americans.

How is Paranoid Personality Disorder Diagnosed?

The personality of any individual continues to evolve throughout childhood and adolescence age. That is why doctors do not typically diagnose someone with paranoid personality disorder until after they turn adult or after the age of 18 years.

Personality disorders, including paranoid personality disorder, can be difficult to diagnose, as the affected individuals do not think there is a problem with their behavior or way of thinking. When they seek help, it is often related to conditions like depression or anxiety caused due to the problems created by their personality disorder, such as lost relationships or divorce, and not the specific disorder.

Mental health professionals, while diagnosing or evaluating someone with paranoid personality disorder might ask them questions that will shed light on their history, previous work history, relationship status, reality testing, and impulse control.

What are the Treatments Available for Paranoid Personality Disorder?

Paranoid personality disorder can be successfully treated. However, most people with this disorder do not easily accept treatment because they do not see their symptoms as unwarranted.

Usually, treatments for paranoid personality disorder include psychotherapy and medications.

Psychotherapy or Talk Therapy

Psychotherapy or talk therapy is essential for individuals willing to accept treatment for paranoid personality disorder. These treatment methods help them learn ways to cope with the condition, learn how to communicate with others in social situations, and also help reduce feelings of paranoia.

Most psychiatrists believe that cognitive behavioral therapy could help alleviate symptoms of paranoid personality disorder and even some case studies support the same.(2) The overall aim of cognitive behavioral therapy is to:

  • Stop the individuals from question the loyalty of family and close friends.
  • Encourage them to become more trusting of others.
  • Stop them from reacting to perceived insults with anger.
  • Prevent the affected persons from perceiving benign comments as threats.
  • Encourage them to become more forgiving of others.


Medications are also helpful, especially when someone has other related conditions, such as anxiety or depression. Medications usually prescribed for treating the symptoms of paranoid personality disorder include antipsychotics, antidepressants, and anti-anxiety medications.(4) However, medications alone are not recommended for personality disorders and are only effective when combined with psychotherapy.

What is the Prognosis of Paranoid Personality Disorder?

The prognosis for paranoid personality disorder depends on whether someone with the disorder is willing to accept and commit to treatment. Talk therapy or psychotherapy can sometimes reduce paranoia and also limit its impact on daily functioning. If left untreated, the disorder can interfere with an individual’s ability to form and maintain proper relationships and also their ability to function socially and professionally.


Paranoid personality disorder (PPD) is a mental health disorder and people who have this disorder have unusual thinking and behavior. These people do not trust others, not even their close ones, and feel that they must be causing harm or danger to them. Treatments for paranoid personality disorder include psychotherapy or talk therapy and medications. Those who undergo appropriate treatment at the right time can help manage their thoughts and behaviors. So, if you or your loved ones are suffering from this disorder, make sure to seek assistance from a mental health professional at the right time.


Also Read:

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:November 1, 2023

Recent Posts

Related Posts