Paranoid Personality Disorder

Excessive distrust and suspicion characterize this condition. 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 deviates 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.


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 child 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, that is, 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 disorder.


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 delusion, 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 to successfully control them.


Psychotherapy is the most promising method of treatment for Paranoid Personality Disorder. People afflicted with this disorder have deep foundational problems that necessitate intense therapy. A confident 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.

The long-term projection for people with paranoid personality disorder is bleak. Most patients experience predominant symptoms of the disorder for the duration of their lifetime and require consistent therapy.

Self Care

Self-care approaches to paranoid personality disorder are not likely to be effective forms of treatment. The high levels of suspicion and mistrust pervasive in people with this disorder make the work of support groups improbably helpful and potentially damaging.


  • American Psychiatric Association
  • National Institutes of Health - National Library of Medicine
  • Psychnet, United Kingdom
Last reviewed 11/24/2014