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Paranoid Personality Disorder: Causes, Symptoms, and Treatment

Paranoia is a persistent feeling of mistrust and suspicion even when there is no reason to be suspicious. People who are paranoid usually feel like people are after them. This makes it difficult for them to have good social interaction and close relationships. Thus, interfering with their daily lives and activities.

The Diagnostic and Statistical Manual of Mental Health Disorders, Fifth Edition (DSM-5) also uses the term cluster A personality disorders to describe eccentric personality disorders like Paranoid Personality Disorder (PPD).

This disorder usually begins in early adulthood and appears to be more common in men than in women. Studies have shown that about 2.3 to 4.4 percent of the general population have paranoid personality disorder.

Causes of Paranoid Personality Disorder

The main cause of PPD is not known, but researchers say that it could be a combination of both biological and psychological factors.  

Genetic: Some research have found that PPD is more common in those who have close relatives with schizophrenia and delusional disorder, thus, suggesting a link between the two disorders (so it may run in the family). Genetic linkage is still inconclusive.

Stress reaction – Some studies have found that paranoia is more common in people who experience severe and ongoing stress, like divorce, migration, etc.

Childhood trauma: Child abuse may affect a person’s thoughts and the way they approach life.


Paranoid symptoms may range from mild to severe. These people may:

  • Be unforgiving and hold grudges
  • Get offended easily
  • Have difficulty trusting others
  • Be very sensitive and respond poorly to criticisms
  • Read meaning into simple conversations
  • Feel like they are being watched
  • Read harmful meanings to other people’s remarks
  • Be generally cold and distant in their relationships with others, they might also become controlling and jealous.
  • Always be defensive
  • Find it difficult having and maintaining relationships
  • Be hostile, aggressive, and argumentative
  • Believe in unfounded conspiracy theories.
  • Find it difficult relaxing
  • Be suspicious that their spouses or lovers are being unfaithful even without evidence.
  • think that people are saying something bad about them behind their back
  • Find it difficult to confide in anyone
  • Think that other people are lying or scheming to cheat them
  • Feel persecuted by the world at large and feel unsafe

Complications of Paranoid Personality Disorder

  1. Difficulty forming and maintaining relationships
  2. Poor social interactions
  3. Might not be able to cope and function in social settings and in work situations.
  4. People with PPD go as far as suing people or companies they believe are “out to get them.”


People with PPD may avoid doctors, nurses, and hospitals, for fear of being harmed. They might be brought in by family or friends due to observed strange behaviors. To diagnose a person with PPD,  

  • Medical history is taken if physical symptoms are evident or based on patients complaint.
  • Physical examination: Patients may appear paranoid or hyper vigilant. 
  • Assessment of symptoms: No specific lab test is available for diagnosing PPD. Several diagnostic tests may be done to rule out causes of presenting symptoms
  • Psychological tests: These are specially designed tools used by psychiatrists and psychologists to evaluate patients with PPD.

Treatment for Paranoid Personality Disorder

These patients do not go to the doctor for diagnosis and treatment because they do not feel like they have any problem but the main form of treatment for PPD is psychotherapy(this is a form of counseling session). The main aim of this treatment is to help these patients gain insight, develop general coping skills, communication skills, improve social interactions as well as build a healthy self-esteem.

Those with PPD find it difficult to trust people making it challenging to follow through with their treatment plan. Psychotherapy requires trust to be really effective.

Although medications are not the main stay for treatment, however, medications, like anti-anxiety, antidepressant or antipsychotic drugs, might be prescribed for extreme cases, or if these patients also suffer from other associated psychological problems, example, depression or anxiety.

DISCLAIMER: The content of this blog post is not intended to be a substitute for professional medical care, diagnosis, or treatment.  it is intended for informational purposes only. Ensure you  seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or in the case of a medical emergency.