22nd Nov 2022
Paranoid personality disorder is a mental health condition characterized by persistent, enduring distrust toward others. The recommended treatment approach for PPD symptoms is psychotherapy.
Paranoid personality disorder is classified as a Type A personality disorder. People with PPD display an enduring pattern of distrust, suspicion, and paranoid thinking.
Paranoid personality disorder is considered a severe psychiatric disorder with a relatively poor long-term outlook, as many are unlikely to seek treatment voluntarily. The difficulty of establishing a trusting therapeutic relationship with providers is a barrier to treatment outcomes.
However, psychotherapy focusing on skills building has been found effective at reducing symptoms for those who do seek help. Medication may also be helpful in some cases.
Research on paranoid personality disorder is lacking due to the difficulty of finding voluntary participants. There is no clear understanding of who is more likely to develop PPD.
Experts previously believed that a family history of psychotic disorders was a risk factor for paranoid personality disorder .
Gender studies have had mixed results on whether the disorder occurs more often in males or females, but experts generally believe that PPD occurs more frequently in males .
Research consistently finds that childhood trauma is a risk factor for many types of personality disorders in adulthood, including paranoid personality disorder . Childhood abuse and neglect are the most widely accepted risk factors for developing PPD.
Suspicion and distrust present in multiple settings are the primary symptoms of paranoid personality disorder. It can be a disabling condition, as symptoms of paranoia and hostile behavior are barriers to maintaining employment. Research has shown that those diagnosed with PPD are more likely to leave the workforce at a younger age .
People suffering from paranoid personality disorder likely developed these symptoms as a means of self-protection. Paranoia can become reinforced as others respond negatively to hostile behaviors, further complicating symptoms.
Paranoid personality disorder symptoms can include:
Paranoid personality disorder symptoms generally begin emerging in late adolescence through early adulthood. Diagnostic criteria specify that the symptoms must be present by early adulthood. PPD cannot be diagnosed before adulthood .
Warning signs of paranoid personality disorder symptoms in children or teens may include:
The American Psychiatric Association estimates the prevalence of paranoid personality disorder in the general population to be 0.5 - 2.5% . Recent research, including one study that found 4.4% of 43,093 American adult participants met the criteria for paranoid personality disorder, suggests this may be higher .
Additional research into general population statistics is needed to determine how common paranoid personality disorder is.
A psychological evaluation is most often used to diagnose paranoid personality disorder. This evaluation will include general questions about past mental health and medical history, relationships, employment, reality testing, and impulse control.
Psychological testing may be used to rule out alternative diagnoses such as schizophrenia, bipolar disorder, and other mental disorders. Additionally, a physical examination may be needed to rule out underlying illnesses causing the symptoms, such as brain trauma.
There is no known exact cause of paranoid personality disorder and only limited research into understanding its development.
Childhood abuse, neglect, and social stress are risk factors for developing any personality disorder . Mental health experts believe that personality disorders develop from maladaptive coping attempts that become a persistent pattern throughout life.
Brain trauma has been identified as a possible risk factor for paranoia and may play a role in the development of PPD .
People with paranoid personality disorder rarely seek treatment voluntarily, making outcomes difficult to measure. The complications of paranoid personality disorder, such as social isolation and difficulty maintaining school and work relationships, suggest that many with the disorder may not be encouraged to seek help.
Individual psychotherapy is usually the treatment recommendation for those who do seek help. Some medications have also been shown as helpful in reducing paranoid personality disorder symptoms.
Cognitive behavioral therapy (CBT) and Dialectal behavioral therapy (DBT) are two approaches that focus on skills building. The goals of these therapies are general skills development, communication strategies, and interpersonal skills building.
Traditional dialectal behavioral therapy includes psychoeducational groups. The treatment provider may suggest an adapted individual approach, as people with paranoid personality disorder generally have poor outcomes in group settings due to paranoia and anxiety outweighing camaraderie.
Trauma-focused approaches, such as narrative therapy, are difficult to implement because of distrust of the intent. These treatment plans may be helpful for people committed to treatment, given childhood trauma is the most widely accepted risk factor for developing paranoid personality disorder.
Mental health professionals do not always recommend medication as a treatment option for paranoid personality disorder. When medication is prescribed, it is recommended in conjunction with psychotherapy.
A healthcare provider may prescribe antidepressants, mood stabilizers, antipsychotic medication, and/or anti-anxiety medications.
Paranoia tends to worsen or intensify during times of stress. Self-care and overall stress management strategies may help manage paranoid personality disorder symptoms.
General Self-Care Strategies:
Self-Care Strategies for Paranoia:
Abusive behavior is never acceptable under any circumstances. Loved ones may need to take steps to ensure their own mental and physical safety. Clear boundaries are important, including communicating what will happen if aggression or violence happens.
There are communication and coping strategies that loved ones can use.
It is important for loved ones to practice self-care strategies and strive for balance. Self-care includes finding support for themselves, taking time to relax, exercising regularly, getting adequate sleep, and eating healthily.
Experts estimate that 75% of people with avoidant personality disorder have a comorbid personality disorder. The most common personality disorders that co-exist with paranoid personality disorder are avoidant personality disorder and borderline personality disorder .
People with PPD also have a higher likelihood of a diagnosis of substance use disorder or an anxiety disorder .
Many people with paranoid personality disorder do not believe they need, or are simply resistant to, help. However, the long-term prognosis for PPD without effective treatment is poor.
Treatment with psychotherapy focusing on skills building can help reduce paranoia and increase adaptive skills. Medication can also be beneficial in conjunction with psychotherapy. The long-term prognosis for people with paranoid personality disorder who seek help depends on their commitment to treatment.