What is Paranoid Personality Disorder?

Disclaimer: This article is for educational purposes, so please do not self diagnose or diagnose others. If you suspect this article applies to you, please consult a professional about your concerns. 

Paranoid personality disorder, or PPD, is part of a group of conditions called “Cluster A” personality disorders. Under this group, people with PPD exhibit odd or eccentric thought or behavior patterns. Individuals with PPD are generally not grounded in reality, and carry a sense of distrust or suspicion towards others. 

As outlined in the American Psychiatric Association’s DSM-5, the criteria for a paranoid personality disorder is divided into two sections. 

The first criterion is a global mistrust and suspicion of other’s motives which commences in adulthood. The sub-features of the first criteria are: 

1. A person with PPD believes that others are manipulating, harming, or lying to them. 
2. They will have doubts about the loyalty and trustworthiness of others.
3. They will not confide in others due to their fear of betrayal
4. They will assume benign remarks as threats or hurtful statements
5. They will hold grudges for a long time
6. They perceive attacks on character or reputation that are not apparent to others and will retaliate in some way, and
7. They will be jealous and suspicious, without cause, that romantic partners are being unfaithful. 

The second part of the criteria assesses whether these symptoms are present during a psychotic episode such as schizophrenia, bipolar disorder, or depressive disorder with psychotic features. If the sub-features discussed above do occur without a psychotic episode, then the patient might be diagnosed with a paranoid personality disorder. 

The onset of this disorder may begin during early childhood or adolescence. Early childhood physical or emotional trauma can play a role in the development of this disorder. For example, a child who experiences frequent teasing may begin to act strangely. (American Psychiatric Association, 2013) If the child exhibits strange behavior and is teased, they may learn not to trust others and become suspicious of their motives. 

This disorder is prevalent in approximately 2.4-4.4% of the general population, and primarily affects males.  Researchers have found that personality paranoid disorder is common among those with family schizophrenia or delusional disorders. 

A paranoid personality disorder is premorbid to schizophrenia, but it can exist with other personality disorders like narcissism, borderline personality disorder, schizoid, antisocial personality disorder, major depressive disorder, OCD, and agoraphobia (American Psychiatric Association, 2013).

Symptoms

People who have PPD tend to be on their guard because they feel that others are out to harm or threaten them. Due to this fear, may people with this disorder struggle to form relationships. 

Some of the symptoms are:

• unforgiving 
• suspicious of others
• hypersensitive and takes criticism poorly
• reluctant to confide in others or reveal personal information due to fear that it might be used against them. 
• cold and distant in relationships
• outbursts of anger in response to perceived deception
• overly controlling in relationships to avoid being exploited or manipulated
• finds it difficult to relax
•  believe they are always right
• hostile, stubborn, and argumentative

Diagnosis

A person’s personality might change because of a medical condition such as Alzheimer’s Dementia, substance use, withdrawal, sensory deficit, or extensive use of Central Nervous System stimulants. Also, a person’s personality and world view may be influenced by past traumatic experiences (Carroll, 2009) such as PTSD. Because of the various factors that contribute to the development of a hypervigilant and somewhat paranoid personality, a diagnosis for PPD needs to be very thorough. 

First, a doctor will perform a thorough physical evaluation to rule out physical causes for the symptoms. If there is no physical evidence for the behavior, the doctor will refer the patient to a psychiatrist or psychologist who will continue with a psychiatric evaluation. 

Treatment

Treatment for people with paranoid personality disorder involves psychotherapy, specifically cognitive-behavioral therapy. Cognitive-behavioral therapy is used to adjust distorted patterns and maladaptive behaviors. The use of cognitive restructuring, behavior modification, exposure, and skill training techniques can help the patient. Also, CBT places importance on creating a supportive, collaborative, and well-defined relationship between the therapist and patient, thus encouraging the patient’s willingness to change. 

Typically, medication is not used to treat personality paranoid disorder as it tends to exacerbate feelings of paranoia. However, they may be used if symptoms are severe or accompanied by another disorder. 

Let us know in the comments below if this article was helpful for you! 

Take care!

Additional sources:

Bhandari, Smitha. “Mental Health: Paranoid Personality Disorder.” WebMD, WebMD, 30 June 2020, www.webmd.com/mental-health/paranoid-personality-disorder.

Esterberg, M.L., Goulding, S.M., and Walker, E.F. ( 2010). A Personality Disorders: Schizotypal, Schizoid and Paranoid Personality Disorders in Childhood and Adolescence. Journal of Psychopathological Behavioral Assessment. 32(4): 515–528. doi: 10.1007/s10862-010-9183-8 PMCID: PMC2992453 NIHMSID: NIHMS222925

Lee, Royce. “Mistrustful and Misunderstood: A Review of Paranoid Personality Disorder.” Current behavioral neuroscience reports vol. 4,2 (2017): 151-165. doi:10.1007/s40473-017-0116-7

“Personality Disorders.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 23 Sept. 2016, www.mayoclinic.org/diseases-conditions/personality-disorders/symptoms-causes/syc-20354463.

Today, Psychology. “Paranoid Personality Disorder.” Psychology Today, Sussex Publishers, 26 Feb. 2019, www.psychologytoday.com/us/conditions/paranoid-personality-disorder.

Vyas, Amy, and Madiha Khan. “Paranoid Personality Disorder.” American Journal of Psychiatry Residents’ Journal, vol. 11, no. 1, 2016, pp. 9–11., doi:10.1176/appi.ajp-rj.2016.110103.