Signs and symptoms of paranoid personality disorder

Paranoid personality disorder (PPD) is a mental condition in which a person has a long-term pattern of distrust and suspicion of others. The person does not have a full-blown psychotic disorder, such as schizophrenia.

Causes of PPD are unknown. PPD seems to be more common in families with psychotic disorders, such as schizophrenia and delusional disorder. This suggests genes may be involved. Other factors may play a role as well.

PPD seems to be more common in men.

People with PPD are very suspicious of other people. As a result, they severely limit their social lives. They often feel that they are in danger and look for evidence to support their suspicions. They have trouble seeing that their distrust is out of proportion to their environment.

Common symptoms include:

• Concern that other people have hidden motives
• Thinking that they will be exploited (used) or harmed by others
• Not able to work together with others
• Social isolation
• Detachment
• Hostility

PPD is diagnosed based on a psychological evaluation. The health care provider will consider how long and how severe the person's symptoms are.

Treatment is difficult because people with PPD are often very suspicious of doctors. If treatment is accepted, talk therapy and medicines can often be effective.

Outlook usually depends on whether the person is willing to accept help. Talk therapy and medicines can sometimes reduce paranoia and limit its impact on the person's daily functioning.

Complications may include:

• Extreme social isolation
• Problems with school or work

See a health care provider or mental health professional if suspicions are interfering with your relationships or work.

Personality disorder - paranoid; PPD

American Psychiatric Association. Paranoid personality disorder. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing. 2013:649-652.

Blais MA, Smallwood P, Groves JE, Rivas-Vazquez RA, Hopwood CJ. Personality and personality disorders. In: Stern TA, Fava M, Wilens TE, Rosenbaum JF, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 2nd ed. Philadelphia, PA: Elsevier; 2016:chap 39.

Updated by: Fred K. Berger, MD, addiction and forensic psychiatrist, Scripps Memorial Hospital, La Jolla, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

The hallmarks of this personality disorder are distrust and suspicion. Individuals who exhibit constitutional paranoia do not normally confide in other people and frequently misread others, redefining innocuous statements and behavior as malevolent.

The paranoid personality-disordered person is suspicious of others; this individual thinks that others are out to threaten, betray, exploit, or harm. This disorder presents most often in young adulthood. People with paranoid personality disorder are not normally grounded in reality, nor do they admit that they have negative feelings about other people. They distrust people so much that they will not discuss how they feel, and harbor suspicions for lengthy periods of time. Paranoid personality disorder is within a group of conditions called Cluster A, people within this cluster often appear odd or peculiar.

The prevalence of paranoid personality disorder is estimated at 1.21 percent to 4.4 percent of the population.

Symptoms

Signs and symptoms of paranoid personality disorder, as cataloged by the DSM-5:

1. Pervasive distrust and suspicion 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:

• Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her.
• Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates.
• Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her.
• Reads benign remarks or events as demeaning or threatening.
• Persistently bears grudges (such as is unforgiving of insults, injuries, or slights).
• Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack.
• 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.

Note: If criteria are met prior to the onset of schizophrenia, add “pre-morbid,” such as “paranoid personality disorder (premorbid).”

Are schizophrenia and borderline personality disorder similar to paranoid personality disorder?

Both schizophrenia and borderline personality disorder have elements of paranoia and suspicion of others. For this reason, these disorders are sometimes hard to accurately diagnose.

Causes

Causes of paranoid personality disorder, as cataloged by the DSM-5:

Paranoid personality disorder may be first apparent in childhood or adolescence. People who suffer prefer solitude, have poor peer relationships, social anxiety, academic underachievement, hypersensitivity, peculiar thoughts and language, and idiosyncratic fantasies. These young people may appear to be "odd" or “eccentric,” and they are good targets for teasing. In clinical samples, this disorder appears to be more commonly diagnosed in males.

There is some evidence for an increased prevalence of paranoid personality disorder among those whose relatives have schizophrenia. Some behaviors that are influenced by specific life circumstances may be erroneously labeled paranoid and may even be reinforced by the process of clinical evaluation. In addition, early childhood trauma may be a contributor as well.

Do other mental illnesses affect paranoid personality disorder?

Other disorders and mental illnesses can compound the symptoms of paranoid personality disorder. Mood disorders such as anxiety and depression, for example, can exacerbate feelings of paranoia.

Does environment affect the risk of paranoia?

An individual’s environment does affect the risk of paranoid personality disorder. People are at higher risk of this disorder if they suffered trauma, abuse, or a chaotic household earlier in life. Isolation and stressful situations can also encourage the development of paranoia.

Treatment

There are effective treatments for paranoid personality disorder. However, the individual may harbor suspicion about the mental health professional, which can hurt the management of the disorder. People with paranoid personality disorder may suffer chronic paranoia if left untreated. Therapy and some medications have proven to be effective approaches.

If untreated, the person may suffer difficulties at work and at home. Comprehensive treatment can include both formal and informal approaches. Informal recovery may include self-help via family support, services for housing, and vocational assistance.

The use of medications for paranoid personality disorder is mostly discouraged. Medications may have an adverse effect with increased paranoia and suspicion, leaving the individual to forgo treatment altogether. If the individual suffers specific symptoms such as severe anxiety or delusions that result in dysfunction or self-harm or harm to others, medication is recommended. Anti-anxiety drugs, such as diazepam, can be prescribed if daily function has been impeded. Anti-psychotic medication, such as thioridazine or haloperidol, may also be used. These medications should be prescribed for the shortest period feasible.

The most favorable treatment for paranoid personality disorder is psychotherapy. People who suffer from this personality disorder have often experienced difficulties that are ingrained and impede interpersonal relations. A healthy therapist-client alliance will offer a great benefit to those who suffer. The paranoid personality disordered does not normally seek help and does normally discontinue therapy. Patients with this disorder can suffer for a lifetime and require regular therapy.

References

American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition  

National Institutes of Health - National Library of Medicine

Last updated: 09/14/2021

What are the symptoms of paranoid personality disorder?

What is the best example of a symptom of paranoid personality disorder?

What triggers paranoid personality disorder?

What are the symptoms of personality disorder?