Understanding Paranoid Personality Disorder

Jennie Lannette, MSW, LCSW
August 10, 2020
paranoid personality disorder

When you have a personality disorder, it means that you have a different pattern of thinking and interacting. This difference can cause frustration and stress, as well as interpersonal conflicts. Often, a person with a personality disorder is not aware that their behavior and attitude are problematic and believe that their way of thinking is correct.

Such flawed thinking interferes significantly with relationships, work, and overall well-being and ability to function. The DSM-5 (Diagnostic Statistical Manual of Mental Disorders) describes 10 types of personality disorders and outlines how each can interfere with a person’s functioning.

What Is Paranoid Personality Disorder?

Paranoid personality disorder particularly affects the way a person thinks about others, and results in paranoia and trust issues – even with those closest to them. Such a person may come across as hostile and reactive.

The American Psychiatric Association defines paranoid personality disorder as “A pattern of being suspicious of others and seeing them as mean or spiteful. People with paranoid personality disorder often assume people will harm or deceive them and don’t confide in others or become close to them.”

This mistrust of others is not based on fact or current experiences, but rather is fueled by a skewed way of looking at the world that makes it difficult, if not impossible, to trust anyone. While other personality disorders may involve paranoia, those with paranoid personality disorder experience these symptoms frequently and consistently throughout their lifetimes. The paranoid traits are often first noticed in childhood or adolescence.


Because paranoia may also be caused by other conditions such as schizophrenia, mental health professionals typically rule this out first. Once it’s determined that other causes are not the basis of the paranoia, paranoid personality disorder may be considered. This condition is not caused by psychosis as is schizophrenia. Instead, it’s a specific pattern of thinking that persists over time. According to the DSM-5, those with this condition may experience the following symptoms:

  • Suspicion that others are deceiving, exploiting, or harming them, despite no such evidence
  • Frequent doubts about the loyalty and trustworthiness of friends and acquaintances
  • Mistrust of confiding in others, due to a fear that information shared will be used against them
  • Misinterpreting harmless comments as threatening
  • Holding long-term grudges
  • Perceiving comments as verbal attacks (that others don’t interpret as harmful) and reacting defensively
  • Unfounded suspicions of partners cheating on them

These frequent symptoms of mistrust and paranoia understandably make it difficult for people with paranoid personality disorder to form and maintain relationships, to ask or allow others to help or make accurate judgments and decisions. The condition itself makes it difficult to challenge one’s own paranoid beliefs and patterns of thinking.

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The mental health community has not reached a consensus on the cause of paranoid personality disorder. This is partially because it is difficult to research the disorder, due to the obvious paranoia of those who might otherwise participate in studies.

Historically, it was believed that there was a connection between this condition and schizophrenia in the family, and the DSM-5 references this. However, some researches have pointed out that this connection is weak, and some believe that childhood trauma may be the cause, or at least a precursor. One study, for example, showed that childhood supervision neglect may contribute to paranoid personality disorder, along with other personality disorders.


Since mental health treatment often depends on a motivation to get better, and on building trust with a therapist, it can be difficult to address and treat paranoid personality disorder. Often those with this condition don’t believe they need treatment and consequently won’t seek it out. However, a therapist experienced in personality disorders may be able to help build a rapport with those who are willing to try counseling.

One of the most commonly recommended treatments is cognitive behavioral therapy, or CBT. CBT teaches participants to question and change ways of thinking. It can sometimes help those with paranoia reconsider biases and assumptions that are reinforcing this pattern. CBT can also help people develop coping skills to better manage stress and triggers that exacerbate symptoms.

A related therapy, dialectical behavioral therapy, or DBT, is sometimes used to treat paranoid personality disorder. Sometimes people with this condition also suffer from borderline personality disorder. DBT has been the treatment of choice for borderline symptoms for decades. It teaches a set of skills, practiced in both group and individual settings, that can also be used to cope with paranoid symptoms.

Those with paranoid personality disorder may also experience overlapping conditions with other personality disorders, schizophrenia, anxiety, or alcohol or substance abuse. Treating these coexisting conditions may help with wellbeing and decrease stress or situations that trigger paranoid symptoms.

Sometimes, doctors may prescribe antidepressants or anti-psychotic medications to help address these or related symptoms. These medications can be used in conjunction with group and individual therapy treatments. 

If you or someone you know seems to be experiencing paranoid symptoms, it’s helpful to get an assessment. A qualified doctor, therapist, or other mental health professional can recommend further testing and treatment.

Jennie Lannette, MSW, LCSW

Jennie Lannette is a licensed therapist who specializes in trauma, PTSD, and related issues. She has trained extensively in multiple evidence-based treatments. She has a decade of experience in inpatient, community, and private practice settings.

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