Paranoid Personality Disorder

Excessive distrust and suspicion characterize this condition. People with paranoid personalities rarely confide in others, and tend to misinterpret harmless comments and behavior as malicious.


The word personality describes deeply ingrained patterns of behavior and the manner in which individuals perceive, relate to, and think about themselves and their world. Personality traits are conspicuous features of personality and are not necessarily pathological, although certain styles of personality traits may cause interpersonal problems. Personality disorders are enduring patterns of inner experience and behavior that deviate markedly from the expectations of an individual's culture. They must be rigid, inflexible, and maladaptive and of sufficient severity to cause significant impairment in functioning or internal distress.

Paranoid personality disorder is an unwarranted tendency to interpret the actions of other people as deliberately threatening or demeaning. The disorder, surfacing by early adulthood, is manifested by an omnipresent sense of distrust and unjustified suspicion that yields persistent misinterpretation of others' intentions as being malicious. People with a paranoid personality disorder are usually unable to acknowledge their own negative feelings toward others but do not generally lose touch with reality. They will not confide in people, even if they prove trustworthy, for fear of being exploited or betrayed. They will often misinterpret harmless comments and behavior from others and may build up and harbor unfounded resentment for an unreasonable length of time.


  • Suspicion
  • Concern with hidden motives
  • Expects to be exploited by others
  • Inability to collaborate
  • Social isolation
  • Poor self image
  • Detachment
  • Hostility

People with this disorder typically exhibit a strong need for self-sufficiency, are rigid and often litigious. Because of their avoidance of closeness with others, they may appear calculating and cold. Usually men are diagnosed with it more than women.

Paranoid personality disorder should not be diagnosed if the pattern of suspicious behavior occurs exclusively during the course of schizophrenia or another psychotic disorder. 


The specific cause of this disorder is unknown. It appears to be more common in families with psychotic disorders such as schizophrenia and delusional disorder, which suggests that genes may be involved. Paranoid personality disorder can result from negative childhood experiences fostered by a threatening domestic atmosphere. It is prompted by extreme and unfounded parental rage and/or condescending parental influence that cultivate profound childhood insecurities.


Treatment of paranoid personality disorder can be very effective in controlling the paranoia but is difficult because the person may be suspicious of the doctor. Without treatment this disorder will be chronic. Medications and therapy are common and effective approaches to alleviating the disorder.

The social consequences of serious mental disorders—family disruption, loss of employment and housing—can be calamitous. Comprehensive treatment, which includes services that exist outside the formal treatment system, is crucial to ameliorate symptoms, assist recovery, and, to the extent that these efforts are successful, redress stigma. Consumer self-help programs, family self-help, advocacy, and services for housing and vocational assistance complement and supplement the formal treatment system. Consumers (people who use mental health services themselves) operate many of these services. The logic behind their leadership in delivery of these services is that consumers are thought to be capable of engaging others with mental disorders, serving as role models, and increasing the sensitivity of service systems to the needs of people with mental disorders.


Medications for paranoid personality disorder are generally not encouraged, as they may contribute to a heightened sense of suspicion that can ultimately lead to patient withdrawal from therapy. They are suggested, however, for the treatment of specific conditions of the disorder, such as severe anxiety or delusions, where these symptoms begin to impede normal functioning. An anti-anxiety agent, such as diazepam, is appropriate to prescribe if the client suffers from severe anxiety or agitation where it begins to interfere with normal, daily functioning. An anti-psychotic medication, such as thioridazine or haloperidol, may be appropriate if a patient decompensates into severe agitation or delusional thinking which may result in self-harm or harm to others. Medications prescribed for precise conditions should be used for the briefest interval possible. 


Psychotherapy is the most promising method of treatment for paranoid personality disorder. People with this disorder often have deep-rooted problems with interpersonal functioning that necessitate intense therapy. A strong therapist-client relationship offers the most benefit to people with the disorder, yet is extremely difficult to establish due to the dramatic skepticism of patients with this condition. People with paranoid personality disorder rarely initiate treatment and often terminate it prematurely. Likewise, building therapist-client trust requires care and is complicated to maintain even after a confidence level has been founded. Most patients with this disorder experience symptoms for the duration of their lifetime and require consistent therapy.


  • American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders
  • National Institutes of Health - National Library of Medicine

Last reviewed 03/06/2018