Paranoid Personality Disorder

Paranoid Personality Disorder (PPD) is an unusual or odd behavior in which a person is very suspicious of other people even when there is no reason to be suspicious.

The characteristics of PPD include; paranoia, mistrust and suspicion. People with PPD would normally not confide in other people.

The disorder begins in childhood or adolescence and it is more common in men than in women.

The cause of paranoid personality disorder is not known. However, studies show that a combination of biological, psychological and environmental factors are involved.

PPD is more common in individuals who have close relatives with schizophrenia and delusional disorders; a genetic link between these disorders has been suggested.



Signs and Symptoms

People with paranoid personality disorder often do not believe that their behavior is abnormal.

To them it is completely rational to be suspicious of others, however, those around them may believe this distrust is offensive and unwarranted.

According to Psychology Today, signs and symptoms of paranoid personality disorder as cataloged by the DSM-5 are as follows:


1) There is a pervasive distrust and suspicion of others such that their motives are interpreted as being malevolent (having or showing a wish to do evil to others).

This begins in early adulthood and is present in a variety of contexts which is indicated by four or more of the following:


  • Patient suspects, without sufficient basis, that others are harming, exploiting or deceiving him or her.
  • Patient is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates.
  • Patient reads benign remarks or events as demeaning or threatening.
  • Patient is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her.
  • Patient persistently bears grudges; unforgiving of insults, injuries or slights.
  • Patient perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack.
  • Patient has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner.


2) Does not occur exclusively during the course of schizophrenia, bipolar disorder or depressive disorder with psychotic features, or another psychotic disorder and is not attributable to the physiological effects of another medical condition.




If a person has symptoms suggestive of paranoid personality disorder, he or she must be taken to see a doctor. The doctor will then take a medical history and perform a physical examination.

There are no laboratory tests to specifically diagnose PPD, however, a doctor might use various diagnostic tests to rule out any physical illness as the cause of the symptoms. Then the person is referred to see a psychologist or psychiatrist.

Psychologists or psychiatrists will use specially designed interview and assessment tools to evaluate a person for paranoid personality disorder.



Management and Treatment

People with paranoid personality disorder often do not seek treatment because they do not believe they have a problem.

Psychotherapy is the treatment of choice. The distrust they feel is often extended to health care professionals which makes management and treatment a challenge because trust is at the core of psychotherapy.


Psychotherapy will:

  • Help the individual learn to cope with the disorder.
  • Help the individual learn to communicate with others in social situations.
  • Help reduce feelings of paranoia.


The use of medications is mostly discouraged because they may have adverse effects with increased paranoia and suspicion. This will cause the patient to forgo treatment altogether.

However, if there are other related conditions such as depression or anxiety disorder, medications could be included in treatment regimen such as antidepressants, benzodiazepines and antipsychotics.

People with paranoid personality disorder who resist treatment may lead less functional lives. The disorder may interfere with their ability to have positive social interactions or maintain a job.








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