What Is Paranoid Personality Disorder?

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Paranoid personality disorder (PPD) involves persistent or ongoing patterns of thinking and behavior that include distrust, suspicion, hostility, and jealousy toward others. People with PPD often believe that others are malicious or trying to harm them. PPD can cause psychotic symptoms, including delusions and hallucinations.

Read on to learn more about PPD, its symptoms, treatment, and how to cope.

Woman looking out window. Avoidant personality disorder can lead to isolation.

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Definition of Paranoid Personality Disorder

PPD has a set of criteria outlined in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the American Psychiatric Association handbook for diagnosing mental health conditions. These diagnostic criteria include:

  • Suspicious that others are exploiting, harming, or deceiving them without evidence to support this belief
  • Preoccupied with thoughts about the trustworthiness of friends
  • Less likely to confide in others because they fear what they say may be used against them
  • Find it difficult to trust others
  • May interpret remarks or the behavior of others as being demeaning or threatening
  • Will often hold a grudge and be unforgiving
  • May perceive that others are attacking their character or reputation
  • May have ongoing suspicions that a spouse or partner is unfaithful
  • May react angrily or counterattack if they feel their reputation has been attacked


People with PPD are frequently suspicious of others' beliefs and behaviors, which may create problems in their daily functioning.

Some other symptoms of PPD include:

  • Rigid and critical of others
  • Difficulty accepting criticism themselves
  • Difficulty working with others and being collaborative
  • May blame others for the shortcomings they have
  • May frequently use the court system for legal disputes and excessive litigation
  • May have grandiose fantasies
  • Focused on issues of power and rank
  • May experience psychotic episodes in response to stress


PPD first presents in childhood and adolescence. Some research indicates there may be genetic causes for PPD, including an association with family members who have schizophrenia or delusional disorder.

Other researchers indicate that childhood trauma consistently presents as a risk factor for PPD. Specifically, childhood emotional neglect, physical neglect, supervision neglect, and physical abuse are all risk factors for PPD.

In addition, people with post-traumatic stress disorder (PTSD) are more likely to have PPD.

Brain trauma is often connected to PPD. Up to 26% of people with brain injuries meet the diagnostic criteria for PPD.


Treatments for PPD vary depending on symptoms and other conditions the person may have. Medication and therapy typically work best when used together to treat any personality disorder.


There is no medication that can treat a personality disorder, and there are no medications approved by the Food and Drug Administration (FDA) specifically for PPD. However, medications are sometimes used to reduce symptoms or intensity.

Medications to treat PPD may include antipsychotics, antidepressants, and mood stabilizers.


The three types of therapy that researchers believe may be effective in treating PPD are:

  • Cognitive behavioral therapy (CBT): CBT is considered an effective therapy for PPD. CBT explores how our thoughts influence our beliefs and behavior.
  • Dialectical behavioral therapy (DBT): DBT is also an effective therapy for PPD because it offers validation for the client, encourages emotional regulation, and builds coping skills.
  • Mentalization-based treatment (MBT): This combines psychodynamic therapy, CBT, and interpersonal psychotherapy. It is considered effective because it increases the skill of mentalization, which is a process of understanding one's own emotions, thoughts, and behaviors.


Coping with PPD can be challenging. While medication and psychotherapy may be the most effective way to treat PPD, there are a few other ways to cope that may be helpful.

  • Sleep well: Getting consistent quality sleep may help with symptoms of PPD.
  • Yoga: Yoga breath work, poses, and stretches have been shown to reduce anxiety and calm the nervous system, which may be helpful for those with PPD.
  • Journaling: Journaling is often helpful for externalizing thoughts that are circulating in the mind.
  • Meditation: Multiple evidence-based studies indicate that meditation can reduce stress and improve mental well-being.


Paranoid personality disorder (PPD) includes ongoing patterns of distrust, suspicion, hostility, and jealousy toward others. It involves a belief that people are behaving maliciously toward the person with PPD.

Childhood trauma is the most likely cause for PPD, though there may be a genetic predisposition. People with PPD can benefit from both therapy and medications.

A Word From Verywell

PPD poses unique challenges. If you or a loved one is struggling with PPD, help is available. Contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline online or call 800-662-4357 for more information on how to find support and treatment options.

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  3. Esposito CM, Enrico P, Sciortino D, et al. Case report: the association between chromosomal anomalies and cluster a personality disorders: the case of two siblings with 16p11. 2 deletion and a review of the literatureFront Psychiatry. 2021;12:689359. doi:10.3389/fpsyt.2021.689359

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By Michelle C. Brooten-Brooks, LMFT
Michelle C. Brooten-Brooks is a licensed marriage and family therapist, health reporter and medical writer with over twenty years of experience in journalism. She has a degree in journalism from The University of Florida and a Master's in Marriage and Family Therapy from Valdosta State University.