Paranoid Personality Disorder (PPD): Symptoms, Diagnoses and More

Paranoid Personality Disorder (PPD)

Paranoid personality disorder (PPD) belongs to the group called eccentric personality disorder. People with eccentric personalities may display strange or unusual behaviors.

In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), eccentric personality disorders, such as PPD, are also described as cluster A disorders.

When someone has PPD, they are extremely suspicious of other people. This condition can interfere with their daily life. They believe that others intend to harm them that they mistrust the motives of others.

The following are additional symptoms of this condition:

  • Having a hard time confiding in others
  • Holding grudges
  • Innocent comments or events may have demeaning or threatening undertones
  • Feeling angry and hostile towards others quickly

Approximately 1.21 to 4.4 percent of people worldwide suffer from PPD, according to a 2017 literature review.

The treatment of PPD can be difficult because people with the disorder have intense distrust for other people.

With PPD, you might feel unsure of who to trust and suspicious of their intentions when they try to help you. That’s fine.

In order to communicate with your mental health professional, you must build trust so they can better understand your mental health condition and provide you with advice.

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Who does paranoid personality disorder affect?

Research shows that people assigned female at birth (AFAB) are more likely to suffer from paranoid personality disorder (PPD), whereas samples from hospital records reveal that people assigned male at birth (AMAB) are more likely to suffer from PPD.

The following are more likely to happen to people with PPD:

  • Households with low incomes
  • Blacks, Native Americans and Hispanics
  • Divorce, separation, or widowed

Researchers need to learn how stress and trauma contribute to the development of PPD and why these factors are associated with it.

What are the risk factors and causes of PPD?

PPD has no known cause. Research suggests a combination of environmental and biological factors may contribute.

A family history of schizophrenia or delusional disorder is more likely to result in this disorder. Trauma experienced during early childhood can contribute to paranoid personality disorder as well.

The following factors also play a role:

  • Low-income households
  • Separation or divorce
  • Having been widowed
  • Never getting married

According to the 2017 research review mentioned earlier, African American, Native American, and Hispanic Americans have a higher likelihood of being diagnosed with PPD.

The extent and causes of this racial variation must be further examined. African Americans may have higher rates due to trauma and stress.

Recent research suggests that the severity of delusional symptoms associated with pathological paranoia is not as different between Black individuals and white individuals, such as in a 2014 study. A lack of trust is among the nonpathological symptoms of paranoia that are more likely to manifest in Black individuals.

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What are the symptoms of paranoid personality disorder?

Paranoid Personality Disorder Symptoms

Most individuals with PPD do not see their behavior as abnormal.

A person may think that being suspicious of others is perfectly rational. The people around them, on the other hand, may think their distrust is unfounded.

PPD may also cause a person to behave hostilely or stubbornly. Others may see them as hostile when they are sarcastic. They may view the hostile response as confirming their suspicions.

Other conditions can exacerbate the symptoms of PPD in someone with it. Mental disorders such as depression and anxiety can influence someone’s mood. PPD can be made worse by mood swings that can lead to paranoia and an isolated feeling.

PPD also causes the following symptoms:

  • Persecutory delusions – believing that other people are out to harm or have hidden motives (in other words, believing you are being attacked)
  • Believing that others aren’t loyal
  • Not being able to work well with others
  • Criticism makes you hypersensitive
  • Anger or hostility that quickly arises
  • Distancing yourself from others or becoming socially isolated
  • Arguing and defending yourself
  • Unable to see the significance of their behavior
  • Not able to relax

Other mental disorders can cause symptoms similar to those of PPD.

A person with borderline personality disorder (BPD) or schizophrenia has similar symptoms to those of someone with PPD. As a result, diagnosing these conditions can be challenging.

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What is the diagnosis of paranoid personality disorder?

The first step in diagnosing PPD is to describe your symptoms and medical history to a primary care physician. Other medical conditions will also be examined during the physical examination.

Further testing may be recommended by your primary care physician, a psychiatrist, or another mental health professional.

An assessment will be performed by a mental health professional. Depending on your age, you may be asked about your childhood, education, employment and personal life.

In addition, the mental health professional might ask how you would react to an imagined situation as a way to assess your behavior.

Once a diagnosis is made, a treatment plan is then created by a mental health professional.

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Substance use disorders are more common in people with personality disorders. The following conditions are especially problematic for people with PPD:

What is the treatment for paranoid personality disorder?

Psychotherapy is generally recommended for the treatment of paranoid personality disorder. Treatment and support can help people manage their symptoms and cope with daily life more effectively.

Many people with PPD do not seek treatment: they may not believe they have a problem, so they don’t see the need to receive paranoid personality disorder treatment. People with PPD tend to think others are the problem, so their suspicions of them are justified.

Patients with PPD often have a distrust their doctors and therapists because of the paranoia associated with the condition. This can make it very difficult for healthcare providers to establish rapport with patients with PPD.

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The treatment of PPD usually focuses on teaching people ways to cope with their feelings. A majority of therapy sessions focus on establishing empathy, communication, trust, social relationships, self-esteem, and communication skills as well as general coping abilities.

Often, cognitive-behavioral therapy helps individuals adjust maladaptive behaviors and distorted thinking patterns. In cognitive behavior therapy (CBT), patients learn how their thoughts and feelings affect their behavior.

Throughout treatment, people learn to identify and change unhealthy or disruptive thoughts that have a negative effect on their behavior.

Read: Thought Disorder

A person with a paranoid personality disorder is likely to be surrounded by ingrained beliefs and unhelpful thoughts, which is why CBT is often beneficial. CBT can help people with paranoid personality disorder become more trusting.

People with this condition may be able to improve their social relationships and social interactions by challenging maladaptive thoughts and changing harmful behaviors. Furthermore, CBT helps people who suffer from PPD learn that their actions affect other people.

The more appropriate way of handling emotions is to learn ways of dealing with frustration or anger.


The use of medication for paranoid personality disorder is not usually recommended, but may be considered if the symptoms are severe or if an accompanying disorder like depression or anxiety is present. The doctor prescribed antipsychotics, antidepressants, and antianxiety medication. Psychotherapy is the best treatment for personality disorders when combined with medications.

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People with PPD can have difficulty maintaining relationships, functioning socially, or working in the workplace due to their behavior and thinking. The majority of people with PPD end up in legal disputes, suing companies or people they feel are conspiring against them.

How long does paranoid personality disorder last?

Individuals with paranoid personality disorder have a better chance of recovering if they accept treatment.

When a PPD patient resists treatment, their lives may be less functional. You may find it difficult to hold down a job or maintain positive social interactions if you suffer from PPD.

Treatment-seeking individuals may experience less difficulty maintaining their jobs and maintaining healthy relationships. However, PPD cannot be cured and you must continue treatment for as long as you live.

In the long run, PPD symptoms will persist, but with care and support, they can be managed.

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