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7 Signs of Paranoid Personality Disorder

The world can be a scary place, but when does anxiety turn into paranoia?

Key points

  • Living with Paranoid Personality Disorder (PPD) makes for an extremely stressful existence.
  • Suspicion and mistrust of others are pervasive for individuals with PPD.
  • Social networks are a key protective factor for people, but individuals with PPD are challenged in accessing this resource.

Paranoid Personality Disorder (PPD) has been suggested to affect somewhere between 2 percent and 5 percent of adults, according to the DSM-V (APA, 2013). Regarding gender, the prevalence may be a toss-up. In clinical settings, men are more likely to be diagnosed with this disorder, while research suggests that women are more likely to display symptoms of PPD (Lee, 2017).

The symptoms of PPD often manifest in childhood or adolescence, indicating its deep-seated interference with normal relationships and perspectives. Some of us are more trusting than others, but individuals with PPD are extremely mistrustful and highly suspicious of almost everyone. It’s also important to recognize that there is a significant difference between Paranoid Personality Disorder and Paranoid Schizophrenia. In PPD, there is an absence of the paranoid delusions that are present in schizophrenia. While the person with PPD may have a strong conviction that others are intending harm, they do not experience hallucinations about perceived threats.

While we don’t always know the exact cause of a disorder, it’s believed that genetics play a strong role in the development of PPD and that a collection of biological and psychological factors, possibly including exposure to traumatic events, play a role in its manifestation.

Some of the early ways it manifests can include a young person’s unusual tendencies towards isolation from others and difficulty establishing healthy relationships with others in school or the community, which can be exacerbated by the presence of high social anxiety. Poor academic performance, extreme sensitivity, odd thoughts, and peculiar language are also markers of PPD that might show up in young people. There are also frequently idiosyncratic fantasies that reflect the belief that others intend the person harm. Unfortunately, as in many psychological disorders, youth who exhibit these types of behaviors are likely to be singled out by their peers for teasing, ostracism, and bullying. This cycle of “cause and effect” provide anecdotal evidence that supports a person’s mistrust and fears about the intentions of others. Similar to some other personality disorders, including Borderline Personality Disorder, Histrionic Personality Disorder, Avoidant Personality Disorder, and Dependent Personality Disorder, treatment is challenging. In PPD, symptoms tend to worsen over time.

On one end of the spectrum, there are people who too easily place their trust in others and are seen as “easy marks” for con artists or manipulators. On the other end of the spectrum, there are individuals who are overly mistrustful of others, including their significant others and potential allies. The majority of us tend to ride the trusting/mistrustful spectrum somewhere in the middle, but individuals with PPD see everyone as a potential threat to their well-being.

How It Feels to Suffer From Paranoid Personality Disorder

Living with PPD is an extremely stressful existence. The most marked feature of PPD is the sense of distrust and suspicion that negatively affects their relationships. Individuals with PPD see malevolence and threats in the most benign circumstances. They experience hostility towards others which they feel is justified due to their unshakable belief that others are truly “out to get them.”

They are difficult to get along with due to their misperceptions about others’ motives, and once convinced of an idea, no matter how erroneous, they doggedly hold onto it. The DSM (2013) notes that the commitment to misperceptions and suspicions about others, particularly those who are different from them, may support membership in cults and earn them the label of fanatics. Rigidity, hostility, argumentativeness, preconceived ideas, and mistrust of others make relationships difficult.

While people typically value their networks of support, whether they consist of friends or family members, as a strong coping resource for dealing with the stressors and hardships in life, individuals with PPD are unable to enjoy the individuals who people their lives. While research consistently shows that social support is a key factor in well-being and longevity, social support is a resource that is almost unattainable for these individuals.

7 Symptoms of Paranoid Personality Disorder

While most everyone has some level of suspicion about potential threats, which is a basic evolutionary survival tool, individuals who suffer from PPD exhibit excessive mistrust that gets in the way of everyday functioning. The following seven symptoms are indicators of a clinical case of this disorder (APA, 2013), and four must be present in order for a diagnosis to be made:

  1. Without a sufficient basis for their feelings, they suspect that others are trying to exploit, harm, or deceive them.
  2. There is an overriding preoccupation with doubts about the loyalty or trustworthiness of their friends, which is not based on fact.
  3. They hesitate to confide or share with others due to an unjustified fear that whatever they share will be used against them.
  4. They cannot take people at face value and consistently assume that there is demeaning or belittling intent towards them from others or that something is a threat.
  5. They hold grudges long past an event and cannot forgive others’ mistakes or perceived wrongdoing towards them.
  6. They read the intent of harm or threat to their character or reputation by others without any justification that can be discerned by others.
  7. They carry suspicions about their partners’ fidelity regardless of any lack of evidence or evidence to the contrary.

Getting Help for Paranoid Personality Disorder

As with other personality disorders, individuals with PPD cannot see that their perceptions, cognitions, and beliefs are misplaced; thus, their alienation from others is not seen as a problem of their own creation. And as is the case with these other disorders, there is no cure for the disorder, only treatment that can help minimize the symptoms and, ideally, improve well-being.

The most likely reason that an individual with PPD would seek treatment—beyond mandated treatment due to judicial involvement—would be related to relationship difficulties. The threat of the loss of a job that is much needed or the loss of a romantic relationship that is much desired may motivate an individual to seek treatment. However, the strong need for autonomy and control of others also works to limit social engagement and minimizes the desire for relationships. There is no proven pharmacologic treatment for PDD, but therapy that focuses on correcting faulty thinking, revising misconceptions, and improving coping skills can help a person manage the symptoms. Individual therapy is often required over the lifespan as the drive to fall back into mistrust, suspicions, and blame is strong.


American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Lee R. (2017). Mistrustful and Misunderstood: A Review of Paranoid Personality Disorder. Current Behavioral Neuroscience Reports, 4(2):151-165. doi: 10.1007/s40473-017-0116-7. Epub 2017 May 18. PMID: 29399432; PMCID: PMC5793931.

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