Paranoid Personality Disorder

Paranoid personality disorder, or PPD, is a type of mental health condition categorized as one of 10 described personality disorders. These are conditions that cause someone to have thoughts that are unusual, unhealthy, and inaccurate. They also cause unusual behaviors and significant impairment or disability in several areas of a person’s life. PPD is one of three personality disorders in cluster A, which are grouped together because they cause odd thoughts and behaviors.

PPD specifically causes a person to be paranoid about the intentions, thoughts, and actions of other people. They have a strong distrust of others and often misinterpret what people say and do, finding what they believe to be hidden slights. They also may believe that people around them are trying to hurt them, are lying, or are cheating on them. They hold grudges, are suspicious, and may go on the offensive, attacking someone because they perceive they are going to be harmed or mistreated. PPD can be managed with behavioral therapies and in some cases with medications, but it is a difficult condition to treat because there is often a lot of resistance.

Although there are three types of personality disorder in the cluster A grouping of these kinds of mental health conditions, there is only one type of paranoid personality disorder. PPD is grouped with schizoid and schizotypal personality disorders because they are similar. They all cause unusual thoughts and eccentric behaviors.

Paranoid personality disorder is characterized by paranoia symptoms specific to distrusting others, while schizotypal also may include distrust but is dominated more by eccentric behaviors, beliefs, and emotional responses. Schizoid personality disorder is similar in that it causes a person to be socially isolated and to have few relationships, but someone with this condition is cold and uninterested in people as opposed to being distrustful.

It is also important to distinguish PPD from psychotic mental illnesses. While paranoia can be characteristic of psychotic conditions, like schizophrenia or delusional disorder, the paranoid mistrust in someone with PPD is not an example of actual paranoid delusions.

Paranoid personality disorder is characterized by mistrust of others and paranoia. It is a chronic, lifelong condition, but treatment can help minimize symptoms and restore some function to a person’s life.

• Estimates for prevalence of paranoid personality disorder are between 2.3 and 4 percent of the U.S. adult population.
• PPD is thought to be more common in men than in women.
• It is one of the more common types of personality disorder.
• Having PPD is a predictor of general disability.
• Paranoid personality disorder correlates significantly with violence.
• People struggling with PPD rarely seek help without being pushed by family or friends.

Paranoid personality disorder can be diagnosed through a physical and medical evaluation to rule out medical causes of symptoms, followed by a psychiatric evaluation and observations as well as talking with family if possible. Mental health professionals use the criteria in the Diagnostic and Statistical Manual of Mental Disorders to make a diagnosis.

The criteria state that a person must show significant distrust of other people, be suspicious of others, and believe that the people around them have bad intentions. The symptoms of the disorder cannot be better explained by another mental illness or substance abuse. They also must be present in a variety of situations and cannot be a result of a developmental phase or a particular context. To make the diagnosis of PPD a person must have four or more of the following symptoms:

• Suspecting that other people are harming, exploiting, or lying to them, without any justifiable reason to believe so
• Obsessing over thoughts that friends may not be loyal or trustworthy
• Resisting confiding in other people because of a fear that the information will be used against them
• Finding hidden, negative, or threatening meanings in the things people say or in events
• Bearing grudges for a long period of time
• Believing there are attacks against their character and responding, even when others don’t perceive anything negative in the situation
• Feeling suspicious of a partner, without any justification

In addition to the official diagnostic symptoms of PPD, there are other signs a person with this personality disorder may exhibit:

• Hypersensitivity to criticism
• Taking even constructive criticism poorly
• Coldness and distance in relationships
• Controlling or jealous behaviors in relationships
• Difficulty relaxing
• Harboring negative stereotypes about other people
• Unusual levels of hostility and stubbornness, being argumentative
• Social isolation

It can sometimes be difficult to distinguish between paranoid personality disorder and other types of personality disorder. But there are important characteristics that distinguish them. For PPD the characteristic trait is mistrust of others. For schizoid and schizotypal personality disorders, which are in the same cluster, the dominant traits are disinterest in others and eccentric thoughts and behaviors, respectively.

The causes of paranoid personality disorder are not definitively known, but it is probably triggered by a combination of factors related to genetics and family history, environment and family life, and negative childhood experiences, especially those that were traumatic. Genetics are thought to play an important role, as individuals with a family history of PPD, or of psychotic disorders like schizophrenia, are at an increased risk of developing the paranoid thoughts characteristic of this personality disorder.

Other known risk factors point to experiences during childhood and the family environment as also playing prominent roles in the development of PPD and other personality disorders. This may be because personality develops during childhood and any disruption or event can influence that development. Childhood risk factors for personality disorders include an unstable or dysfunctional home environment, abuse, neglect, or other types of trauma.

It is common for someone diagnosed with paranoid personality disorder to also be diagnosed with co-occurring disorders. Some of the common conditions that co-occur with PPD are schizophrenia, anxiety disorders, especially panic disorder and agoraphobia, other personality disorders, post-traumatic stress disorder, and substance use disorders, particularly alcohol use disorder.

These various mental illnesses may often co-occur because they are similar and because they have risk factors in common. Living with PPD may also trigger certain mental illnesses, like anxiety disorders, because of the distress it causes. Substance use may strongly correlate with PPD because someone with this condition might turn to alcohol or drugs as a way to cope with feelings of paranoia and mistrust. This is most likely to occur in people who are not being treated and learning healthier ways to cope.

The prognosis for paranoid personality disorder depends on the individual. For someone willing to accept help, treatment can reduce feelings of paranoia and minimize the impact the condition has on the ability to function normally at home, at work, or in relationships. Individuals who resist treatment have a worse prognosis, but for anyone with this condition it is life-long and requires ongoing management and support. Most people with PPD need to be pushed and encouraged by loved ones to get diagnosed and to accept treatment.

Treatment for PPD centers on therapy and medication where appropriate. Behavioral therapies can be helpful, but also challenging because of the inherent distrust an individual with this condition has of others. It can take time and a lot of patience to establish a good relationship with a therapist. With that established, therapy can help an individual learn to recognize that paranoid thoughts are flawed and to take steps to change their resulting behaviors. A therapist works with an individual to learn coping skills, develop trust, build better relationships, and learn how to communicate and engage with others in appropriate ways.

There is no medication that can treat PPD itself, but anti-anxiety drugs, antidepressants, and even antipsychotic medications may help to relieve some symptoms. These medications may also treat co-occurring disorders. In addition to therapy and medications, someone with PPD can benefit from strong family support, life skills, good medical care, job skills and placement, housing and transportation support, and other practical kinds of assistance that make daily functioning easier. Although PPD is difficult to treat and manage, there is hope for people living with this condition. With good treatment, it is possible to live a better, more functional life with greater independence.

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