What Is Paranoid Personality Disorder

PPD is a type of personality disorder characterised by a pervasive and unwarranted mistrust of others, as well as an increased sense of suspicion and vigilance. It affects approximately 2-4% of the general population and is more common in men than in women. In this article, we will look at the causes and risk factors for PPD, as well as the signs and symptoms, management and treatment options, prevention, and when to seek medical help.


According to the American Psychiatric Association (APA), a paranoid personality disorder is characterised by a pervasive distrust and suspicion of others that begins in early adulthood and manifests itself in a variety of contexts. Individuals suffering from PPD frequently perceive the world to be dangerous and unpredictable, and they may be overly sensitive to criticism or perceived threats. The level of distrust and suspicion can be so high that it impairs an individual's ability to function in daily life.1

Causes of paranoid personality disorder

There is a genetic component to paranoid traits, as well as a possible genetic link between this personality disorder and schizophrenia. A large long-term Norwegian twin study discovered that paranoid personality disorder is moderately heritable and shares some genetic and environmental risk factors with the other cluster A personality disorders, schizoid, and schizotypal.

Psychosocial theories include negative internal feelings projected and parental modelling.

According to cognitive theorists, the disorder is caused by an underlying belief that other people are hostile, combined with a lack of self-awareness.

Personality disorders, including PPD, are also more common in individuals who have other mental health conditions, such as Dependent Personality Disorder, Bipolar Disorder, or Eccentric Personality Disorder. Individuals who have previously experienced paranoid delusions or who have a history of substance abuse may also be at a higher risk of developing PPD.2

Signs and symptoms of paranoid personality disorder

According to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, (DSM-5), there are two criteria. 

Criterion A is made up of seven sub-features that must be present in order to be diagnosed with a paranoid personality disorder. These sub-features include:

  1.  A belief that others are using, lying to, or harming them without obvious evidence
  2.  Doubts about the loyalty and trustworthiness of others
  3.  Not confiding in others due to the fear of being betrayed
  4.  Misinterpreting ambiguous or benign remarks as hurtful or threatening
  5.  Holding grudges
  6.  Believing others are assailing their reputation or character without objective evidence
  7.  Being jealous and suspicious

To meet the criteria for paranoid personality disorder, individuals must have at least four of the above symptoms and must have experienced them for a significant portion of their adult life. These symptoms must also cause significant distress or impairment in social, occupational, or other important areas of functioning.

Criterion B states that the above symptoms cannot be attributed to a psychotic episode in schizophrenia, bipolar disorder, or a depressive disorder with psychotic features. 

According to the American Psychiatric Association PPD usually appears in early adulthood and affects both people assigned male at birth (AMAB) and those assigned female at birth (AFAB) equally. PPD is estimated to affect between 0.5% and 2.5% of the general population. However, the prevalence of PPD among people seeking treatment for mental illnesses could be higher, ranging from 2% to 10%.

Paranoid personality disorder symptoms and signs can significantly impact an individual's daily life and functioning. Individuals suffering from PPD may struggle with trust and forming relationships with others, which can lead to social isolation and workplace difficulties. They may also be argumentative, hostile, and aggressive towards others, especially if they believe their trust has been betrayed.3

Management and treatment for paranoid personality disorder

Effective management and treatment of paranoid personality disorder (PPD) involves a combination of psychotherapy and medication. The goal of treatment is to reduce the distress and dysfunction caused by PPD, improve the individual's ability to manage their symptoms and enhance their overall quality of life.


Cognitive-behavioural therapy (CBT) is the most commonly recommended form of psychotherapy for people with PPD. CBT is designed to help individuals with PPD identify and challenge their negative thoughts and beliefs, as well as modify their maladaptive behaviours. Through CBT, individuals with PPD learn to identify and alter their negative thinking patterns, which can help to reduce their suspicions and mistrust of others. Additionally, CBT can help individuals with PPD develop more effective coping strategies and communication skills, leading  to improved interpersonal relationships.

Supportive psychotherapy is another form of psychotherapy that may be helpful for individuals with PPD. Supportive psychotherapy provides emotional support and helps individuals with PPD to improve their self-esteem, develop better self-awareness and identify their strengths and abilities.


Antipsychotic medications may be prescribed to manage the symptoms of PPD, particularly paranoid delusions. Antidepressant medications may also be used to help manage symptoms of depression and anxiety that are common in people with PPD.4

Can paranoid personality disorder be prevented?

While there is no guaranteed way to prevent the development of PPD, there are steps that can be taken to reduce the risk of developing the disorder. Early intervention for people who are at high risk of developing PPD, such as those with a family history of personality disorders or a history of childhood trauma, may be helpful in preventing the development of the disorder. Additionally, getting treatment for other mental health conditions, such as bipolar disorder or dependent personality disorder, may reduce the risk of developing PPD.5


Paranoid personality disorder is a serious mental health condition that can cause significant distress and dysfunction in a person's life. Individuals with PPD, however, can learn to manage their symptoms and lead fulfilling lives with proper management and treatment. 

The main forms of treatment for PPD are psychotherapy, particularly cognitive-behavioural  therapy, and medication. While there is no guaranteed way to prevent the development of PPD, early intervention for individuals at high risk of developing the disorder, as well as treatment for other mental health conditions, may reduce the risk of developing PPD.


  1. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).
  2. Diagnostic and statistical manual of mental disorders : DSM-5 [Internet]. Arlington, VA : American Psychiatric Association; 2013 [cited 2023 Feb 27]. 998 p. Available from: http://archive.org/details/diagnosticstatis0005unse
  3. Personality disorders [Internet]. National Institute of Mental Health (NIMH). [cited 2023 Feb 27]. Available from: https://www.nimh.nih.gov/health/statistics/personality-disorders
This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Mariam Nikolaishvili

Bachelor of medicine, Tbilisi State University, Georgia

I am Mariam Nikolaishvili, a sixth-year medical student. I decided to become a doctor when I was 5 years old, and I haven’t changed my mind since. Being a dermatologist and helping people with various skin conditions is my primary objective. I chose to participate in the Klarity internship because I have always loved to write and wanted to learn more about writing for the medical field.

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