What is paranoid personality disorder (PPD)?

“Maybe I’m just being paranoid.” Perhaps you’ve heard this phrase in everyday conversation. You may have even used it yourself at a time when you thought you were being overly worried or cautious. While everyone may feel paranoid sometimes, people with paranoid personality disorder (PPD) experience long-lasting distrust and suspicion that can affect their relationships and daily life. 

PPD is believed to affect about up to 4.4% of the general population. It seems to be diagnosed more frequently among those assigned female at birth and unhoused populations. Those experiencing housing instability are at greater risk for all personality disorders.

So if you believe that you or someone you care about might have PPD, don’t hesitate to seek professional help. There are effective treatments that can help reduce paranoia, strengthen your mental health, and improve your quality of life.

Symptoms of paranoid personality disorder

Some of the most common signs of PPD include:

• Having a near-constant belief that other people are out to harm, manipulate, or deceive you
• Living in fear that you could be hurt at any moment, even though there’s no evidence of an apparent threat
• Feeling that you’ve already been seriously harmed by others
• Being hypervigilant and looking out for signs of potential insults, threats, or disloyalty 
• Analyzing conversations or exchanges for “hidden” proof that someone is going to hurt you
• Having trouble forgiving those you feel have slighted you
• Experiencing difficulty confiding in others due to fears that any personal information you share could be used against you
• Experiencing relationship struggles due to jealousy 
• Constantly doubting the loyalty of your friends, colleagues, partners, etc. 

Having any one of these experiences doesn’t automatically mean you have a mental health condition. To be diagnosed with PPD, a person must exhibit unrelenting suspiciousness and distrust of other people, along with at least four of the following symptoms by early adulthood:

• Believing that others are actively hurting, deceiving, or exploiting you (without any evidence to back up that belief)
• Having a fixation on the potential unreliability of friends or colleagues
• Avoiding sharing any information you fear could be used against you
• Thinking that people are being cruel, hostile, insulting, or threatening without any evidence 
• Holding grudges for perceived slights
• Feeling frequently suspicious that a partner or spouse has been unfaithful without justification
• Being quick to anger or launch a counterattack when you believe you’ve been insulted or attacked

Do you have PPD or another condition?

PPD isn’t the only mental health condition that can involve suspiciousness or paranoia. However, PPD doesn’t cause the magical thinking, unusual perceptions, or odd thinking and speech patterns that typically accompany similar personality disorders, like schizotypal personality disorder. It also doesn’t cause hallucinations or delusions like those brought on by schizophrenia. Your provider will use distinctions like these to help determine whether you have PPD or another condition.

In addition, people with PPD may be at greater risk for developing co-occurring conditions, like depression, anxiety, agoraphobia, obsessive-compulsive disorder (OCD), substance use disorder (SUD), and other personality disorders. So when seeking treatment for PPD, it’s likely you’ll be evaluated for co-occurring conditions. Your provider may also wish to speak to your friends or loved ones (with your consent) for additional insights about your mental health. With this information, they can provide an accurate diagnosis to serve as the foundation of your treatment plan.

What causes paranoid personality disorder?

There’s limited information on the causes of personality disorders. But research shows that PPD may arise due to a combination of the following factors:

• Environment: Negative childhood experiences — like physical, sexual, and emotional abuse — are common among adults diagnosed with PPD.
• Biology: Some aspects of personality appear to be, in part, tied to a series of innate characteristics that are influenced by biological factors.
• Genetics: Having a close relative, like a sibling or parent, who has PPD may increase your likelihood of developing PPD.
• Illness: Certain physical health conditions — like head trauma, brain tumors, epilepsy, multiple sclerosis, and endocrine disorders — can lead to personality changes.

Is PPD a dangerous condition?

In some cases, PPD can lead to dangerous behaviors. Among clinical populations, it’s one of the strongest predictors of aggression. Without support, people with PPD may engage in behaviors like violence, stalking, and excessive litigation. They may also be unlikely to trust their providers, and this can make it difficult for them to access necessary mental healthcare.

The treatment outcome for PPD is based on the severity of a person’s symptoms and whether they seek support. Because it’s a chronic condition, most people with PPD require long-term professional help to manage their symptoms and improve their daily functioning.

How to deal with paranoid personality disorder

People with PPD are often reluctant to enter care, as they may not recognize their condition. If they do seek support, it’s often at the urging of a loved one — typically a first-degree relative. 

Entering therapy can be a difficult step to take if you’re afraid that everyone, including potential therapists, might be out to harm you. Rest assured that there are mental health professionals who understand that PPD can make it hard to ask for help. They will work with you, at your pace, to build a foundation of trust within the therapeutic relationship.

Approaches like mentalization-based interventions or cognitive behavioral therapy (CBT) might be helpful for people living with personality disorders. Medications for related symptoms, like anxiety or paranoia, may also be considered. It’s important to work with your provider to determine if medication is right for your unique needs. However, there are currently no therapies or medications designed specifically for treating PPD. 

While PPD symptoms can continue even with treatment, with the right support, people with PPD can improve their quality of life and increase their ability to meet their basic needs. 

Find care with Rula

PPD is a personality disorder that causes chronic, extreme suspiciousness and an inability to trust others. Living with constant paranoia can create problems at home, work, and school. It can also negatively impact your ability to form relationships and care for yourself. While people with PPD may be reluctant to enter care because they struggle to trust providers, therapy can help them manage their paranoia and other symptoms. 

So if you think that you or a loved one might be living with PPD, don’t hesitate to ask for help. With Rula, you can access specialized care for whatever mental health concerns you’re facing in just a few clicks. To start the process today, check out our therapist-matching program. You can sort through your options, choose an in-network therapist, and make your first live video appointment for as soon as tomorrow.

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