Paranoid Personality Disorder (PPD) is a disorder characterized by an unwarranted tendency to interpret the actions of other people as deliberately threatening or demeaning. Studies estimate that PPD affects between 2.3% and 4.4% of the general population, and is more prevalent in males than in females. Paranoid personality disorder, like all personality disorders is not diagnosed in children or adolescents, but mostly in adults. Personalities of children and adolescents are still developing so what may appear to be signs and symptoms of paranoid personality disorder may go away as children get older and become more mature. This pattern of behavior begins by early adulthood and is present in a variety of contexts.

Paranoid Disorder Defined

Paranoid personality disorder is characterized by a pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent. While it is normal for people to experience paranoia about certain situations in their life, people with paranoid personality disorder take this to an extreme, to the point where it impacts every professional and personal relationship they have. Individuals with paranoid personality disorder assume that other people will harm, exploit, or deceive them, even if there is no evidence that exists to support these beliefs. Because individuals with paranoid personality disorder lack trust in others, they have an excessive need to be self-sufficient and a strong sense of autonomy. They may have a need to have a high degree of control over those around them. Individuals with PPD are often critical of others, rigid, unable to collaborate, and they have great difficulty accepting criticism. They are generally difficult to get along with and often have problems with close relationships. They are reluctant to confide in or become close to others because they fear that the information they share will be used against them. Individuals with PPD persistently bear grudges and are unwilling to forgive the insults, slights, or injuries they’ve received.

Different Types of Paranoid Personality Disorders

There are no subtypes of paranoid personality disorder but it is classified under Cluster A under personality disorders in the Diagnostic and Statistical Manual of Mental Disorders. Cluster A personality disorders are characterized by thinking and behavior that appears unusual or eccentric to other that often leads to social problem.

Paranoid Personality Disorder Causes

The cause of paranoid personality disorder is not fully understood but there is an agreement that it is caused by a combination of factors. Genetics may play a role in the development of paranoid personality disorder. While there is no specific gene related to PPD, some studies of twins and families suggest that personality disorders may be inherited or strongly associated with other mental health disorders among family members, such as psychotic disorders (delusional disorders or schizophrenia). Environmental factors may also be linked to PPD. Research has shown that PPD can be a result of negative childhood experiences that can stem from being in threatening domestic atmosphere.

Paranoid Personality Disorder Symptoms

To be diagnosed with paranoid personality disorder, according to the Diagnostic and Statistical Manual of Mental Disorders, the following criteria must be met:

A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

  1. Suspects, without sufficient basis, that are exploring, harming, or deceiving him or her.
  2. Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates.
  3. Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her.
  4. Reads hidden demeaning or threatening meanings into benign remarks or events.
  5. Persistently bears grudges (i.e.,is unforgiving of insults, injuries, or slights).
  6. Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack.
  7. Has recurrent suspicions, without justification, regarding fidgety of spouse or sexual partner.
  8. Does not occur exclusively during the course of schizophrenia, a bipolar disorder to depressive disorder with psychotic features, or another psychotic disorder and is not attributable to the physiological effects of another medical condition.

How to Approach a Loved One

There is not a perfect way to approach a loved one that you assume or know has paranoid personality disorder. People with paranoid personality disorder may not believe anything is wrong with them, so they may resist treatment or not listen to the concerns of their family and friends. While preventing a loved one from developing PPD is not possible, providing support and being aware of what their learning in treatment can be helpful.

Types of Paranoid Personality Disorder Treatment

Paranoid personality disorder can be a challenge to treat not only because individuals with PPD may not trust mental health professionals, but also because its symptoms reflect ingrained patterns of thinking and behavior. Treatment for PPD is long- term and requires a commitment. When considering treatment it is important to consider co-occurring conditions that may exist, which is common with individuals with PPD.


Psychotherapy is the most common method of treatment for paranoid personality disorder. Through psychotherapy, people with PPD may process and work through their interpersonal problems. A trusting relationship between the individual and their clinician is key because people with PPD struggle with trusting others. It may be extremely difficult to establish a trusting relationship with individuals due to the dramatic skepticism of patients with this condition.

People with paranoid personality disorder rarely initiate treatment and often terminate it prematurely. Treatment usually focuses on increasing general coping skills, especially trust and empathy, as well as on improving social interaction, communication, and self-esteem.


To date there are no drugs approved by the FDA that have been specifically created to treat paranoid personality disorder. Medications can be useful when treating certain symptoms that are typically associated with paranoid personality disorder, such as anxiety. They can also be used to help increase a person’s ability to engage in psychotherapy.

Differences Between Common Disorders

There are other disorders that may resemble paranoid personality disorder, so it is important to differentiate the difference between common disorders that may get confused with PPD.

  • Other personality disorders and personality traits – Other personality disorders may be confused with paranoid personality disorder due to their similarities in symptoms and features. If an individual meets criteria for PPD as well as another personality disorder, both can be diagnosed. For example, paranoid personality disorder and schizotypal personality disorder share traits of suspiciousness, interpersonal aloofness, and paranoid ideation, but schizotypal personality disorder also includes symptoms such as odd thinking and speech, magical thinking, and unusual perceptual experiences.
  • Other mental disorders with psychotic symptoms – Paranoid personality disorder can be differentiate from other disorders, like delusional disorder or persecutory type; schizophrenia, etc. because these disorders are are all characterized by a period of persistent psychotic symptoms (e.g., hallucinations or delusions).
  • Personality change due to another medical condition – Paranoid personality disorder must be differentiated from personality change our to another medical condition, in which traits that emerge are attributable to the effects of another medical condition on the central nervous system.
  • Substance use disorders – Paranoid personality disorder must be differentiated from symptoms that may develop that are associated with persistent substance use.
  • Paranoid traits are associated with physical handicaps – The disorder must also be distinguished from paranoid traits associated with the development of physical handicaps (e.g., a hearing impairment).


American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders.

(5th ed.) Arlington, VA: American Psychiatric Association.

Paranoid Personality Disorder Management and Treatment. (n.d.). Retrieved from:

Paranoid Personality Disorder. (n.d.). Retrieved from:

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