Paranoid Personality Disorder

paranoid woman looking over shoulder

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Paranoid personality disorder is a chronic and pervasive condition characterized by disruptive patterns of thought, behavior, and functioning. This disorder is thought to affect between 1.21 to 4.4% of U.S. adults. Individuals with paranoid personality disorder are at a greater risk of experiencing depression, substance abuse, and agoraphobia.


Individuals with paranoid personality disorder typically experience symptoms that interfere with daily life. In general, people with this condition feel suspicious of others.

While this mistrust is unfounded, their distrust of others makes it difficult to form relationships and can interfere with many aspects of life including at home, at school, and at work. People with PPD do not see their behaviors as out of the ordinary but are perceived by others as hostile and suspicious.

The primary characteristic of this condition is a chronic and pervasive distrust and suspicion of others. Other symptoms of paranoid personality disorder include:

  • Feelings that they are being lied to, deceived, or exploited by other people
  • May believe that friends, family, and romantic partners are untrustworthy and unfaithful
  • Outbursts of anger in response to perceived deception
  • Often described as cold, jealous, secretive, and serious
  • Overly controlling in relationships in order to avoid being exploited or manipulated
  • Look for hidden meanings in gestures and conversations
  • Find it difficult to relax
  • Often hold negative views of other people
  • Overly sensitive to criticism
  • Overreacts in response to perceived criticism

The Diagnostic and Statistical Manual of Mental Disorders (DSM5) specifies that in addition to having symptoms of pervasive suspicion and distrust, a diagnosis of PPD requires that these symptoms must not be related to a psychotic episode associated with schizophrenia, bipolar disorder, or depressive disorder with psychotic features.


While the exact causes of PDD are not known, it is believed that both genetics and psychological factors play a role. There is also likely a strong genetic component since a family history of schizophrenia is considered a risk factor for paranoid personality disorder.

Childhood experiences and trauma may also play a part in the development of the condition.


Paranoid personality disorder is generally treated with psychotherapy. With ongoing treatment and appropriate support, people with this condition can manage their symptoms and function more effectively in daily life.

However, people who have PPD may not seek treatment for their condition, usually because they do not feel that they have a problem. To those with PPD, their suspicions of others are justified and it is other people who are the problem.

The distrust and paranoia that characterizes the condition also make it difficult for people with PPD to trust their doctors and therapists. This can make it challenging for healthcare professionals to establish a therapeutic rapport with the individual.


Treatments for PPD usually focus on helping people develop coping skills. Therapy often focuses on building empathy, trust, communication, self-esteem, social relationships, communication skills, and general coping abilities.

Cognitive-behavioral therapy is often effective in helping individuals adjust distorted thought patterns and maladaptive behaviors. Cognitive behavior therapy (CBT) is a type of psychotherapeutic treatment that helps patients understand the thoughts and feelings that influence behaviors.

During the course of treatment, people learn how to identify and change destructive or disturbing thought patterns that have a negative influence on behavior.

Ingrained paranoid beliefs and maladaptive thoughts play a role in maintaining paranoid personality disorder, which is why addressing these thoughts and beliefs through CBT can be helpful. CBT may help people with PPD become better able to trust others.

By challenging maladaptive thoughts and working to change harmful behaviors, people with this condition may become less suspicious of others, including friends and family, which can improve relationships and social interactions. In addition to addressing harmful thoughts and beliefs, CBT also works to help people with PPD better manage their responses to others.

Rather than responding to comments with anger or hostility, for example, people can learn more appropriate ways of dealing with their emotions.


While medication is not usually used to treat paranoid personality disorder, but may be used in cases where symptoms are severe or if an associated condition such as depression or anxiety is also present. Prescribed drugs included antidepressants, antipsychotics, and anti-anxiety medications.  Medications alone are not a recommended treatment for personality disorders and are best used in combination with psychotherapy.

A Word From Verywell

While paranoid personality disorder is one of the more common personality disorders, there is a lack of research on effective treatments, due in part to the reluctance of those with the condition to participate in treatment and research. Those who are able to develop a successful therapeutic relationship can learn to manage their symptoms and have more successful relationships with others.

4 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Lee R. Mistrustful and misunderstood: a review of paranoid personality disorder. Curr Behav Neurosci Rep. 2017;4(2):151-165. doi:10.1007/s40473-017-0116-7

  2. Cleveland Clinic. Paranoid personality disorder.

  3. Cleveland Clinic. Paranoid personality disorder: management and treatment.

  4. Matusiewicz AK, Hopwood CJ, Banducci AN, Lejuez CW. The effectiveness of cognitive behavioral therapy for personality disorders. Psychiatr Clin North Am. 2010;33(3):657-85. doi:10.1016/j.psc.2010.04.007

By Kendra Cherry
Kendra Cherry, MS, is the author of the "Everything Psychology Book (2nd Edition)" and has written thousands of articles on diverse psychology topics. Kendra holds a Master of Science degree in education from Boise State University with a primary research interest in educational psychology and a Bachelor of Science in psychology from Idaho State University with additional coursework in substance use and case management.