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Paranoid Personality Disorder

Imagine not trusting anyone in your life, no matter their relationship to you or how much proof there was to the contrary. The paranoia and mistrust would be incredibly isolating, leaving you constantly afraid that betrayal or danger lurked around every corner. Individuals with paranoid personality disorder (PPD) have never known any difference. While “paranoia” is often used casually in daily life, it’s no simple experience for these patients. PPD is a misunderstood, isolating disorder and the rarest personality disorder.

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What is Paranoid Personality Disorder?

Paranoid personality disorder (PPD) is a mental health condition with a deep, long-term pattern of pervasive distrust and suspicion of others without cause. Individuals with PPD typically experience paranoia and believe others are attempting to harm, humiliate, or endanger them.

PPD belongs to Cluster A of personality disorders, which present as eccentric or strange behavior. While the disorder falls under the eccentric category, people with PPD don’t experience delusions or hallucinations with paranoia, like schizophrenia, schizoaffective disorder, or severe manic episodes in bipolar disorder.

PPD patients generally believe nothing abnormal about their behavior or thought patterns. To them, their paranoia and suspicion are completely logical and justified. Often, it takes an outside person to point out the odd behavior to make patients aware that anything is unusual.

 Personality Disorder Recap

The ten personality disorders feature abnormal, unhealthy, and inflexible patterns of behaviors and thoughts formed during childhood. Because these behaviors can be quite maladaptive or destructive, patients often experience severe problems with close relationships, work, and school.

Because the person’s way of thinking, feeling, and behaving deviates from society’s expectations, the effects can be distressing for the person and the people around them. Unfortunately, stigma towards these disorders is often harsher than other conditions like mood or anxiety disorders.

According to the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5), each of the ten personality disorders belongs to one of three clusters based on common symptoms and traits.

The three clusters include:

  • Cluster A (odd, eccentric)
    • Paranoid Personality Disorder
    • Schizoid Personality Disorder
    • Schizotypal Personality Disorder
  • Cluster B (dramatic or unpredictable)
    • Antisocial Personality Disorder
    • Borderline Personality Disorder
    • Narcissistic Personality Disorder
  • Cluster C (anxious, fearful)
    • Avoidant Personality Disorder
    • Dependent Personality Disorder
    • Obsessive-Compulsive Personality Disorder

Symptoms of Paranoid Personality Disorder

Individuals with paranoid personality disorder frequently live on guard from perceived or suspected attacks from others.

Even when no evidence or proof of deception or intended harm is present, people with PPD strongly believe that their peers plan to demean, harm, or threaten them. Due to this constant mistrust and suspicion, these people can lead rather solitary lives out of fear or severe social anxiety.

Symptoms of paranoid personality disorder may include:

  • Perceiving attacks on their character without proof or reason
  • Questioning the commitment, loyalty, or trustworthiness of others, believing they are exploiting or lying to them
  • Being hesitant about confiding in others or revealing personal information due to fear the information will be used against them
  • Being unforgiving and holding grudges, being hypersensitive and taking criticism personal
  • Finding hidden meanings in the innocent comments or looks from others
  • Having persistent suspicions that spouses or romantic partners are being unfaithful despite lack of evidence
  • Being cold and distant in relationships with others, becoming controlling or jealous to avoid being betrayed
  • Failing to see their role in problems or conflicts, believing they’re always in the right
  • Hypersensitivity when perceiving a potential threat (e.g., acting hostile, stubborn, and argumentative)
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Development of Paranoid Personality Disorder

The cause of PPD is unclear, but current research points to a combination of childhood experiences and genetic predisposition. For example, certain genes passed down by parents can make a person more vulnerable to developing the disorder if the right conditions are present in childhood.

Risk Factors

Personality disorders like PPD typically aren’t diagnosed until early adulthood, as personality continues to develop during adolescence. However, if your family has a history of mental illness and personality disorders, inform your doctor so they are aware of your heightened risk. Because PPD patients don’t perceive their behavior as odd or problematic, it can be difficult to realize they have a problem and seek help.

There also seems to be a link between PPD and a family history of schizophrenia. However, PPD does not include any symptoms similar to schizophrenia. Interestingly, there is still a link between these two disorders and their genetic development through families.

Aside from genetic factors, childhood experience plays the largest role in developing PPD. Research has shown that individuals that grow up in neglectful or abusive households are more likely to develop a personality disorder once they reach adulthood. Personality forms during adolescence, so it’s believed childhood trauma and abuse interfere with that normal development.

How common is Paranoid Personality Disorder?

According to research published by Massachusetts General Hospital, a paranoid personality disorder is relatively rare compared to other personality disorders.

Researchers estimate that PPD affects 0.5% to 4.5% of the general US population. Diagnosis increases in families with schizophrenia and delusional disorder and affects males far more than females.

Common Comorbidities and Related Conditions

Findings from the University of Chicago’s Department of Psychiatry and Behavioral Neuroscience showed that approximately 75% of people with PPD have another personality disorder. Avoidant and Borderline Personality Disorder are the most frequently comorbid (48% and 48%), along with Narcissistic Personality Disorder (35.9%).

In addition, people with PPD are also more likely to have substance use disorder and panic disorder than the general US population.

Paranoid Personality Disorder and Addiction

The risk of substance abuse and PPD is quite high. Many PPD patients may turn to drugs or alcohol to cope with struggles in adapting to life’s challenges and living in a constant state of paranoid fear.

Substance Use Disorder (SUD) and Alcohol Use Disorder (AUD) are common comorbidities with PPD. These substances can worsen a PPD individual’s paranoia and fear, creating an even more dangerous environment for them.

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Paranoid Personality Disorder Diagnosis

Official PPD diagnoses must be given by a licensed mental healthcare professional or psychiatrist based on the criteria listed in the DSM-5. Most providers will not give a PPD diagnosis to someone under 18, as their personality is still developing—instead, they will provide other options to address symptoms.

A mental healthcare provider or psychiatrist will evaluate with broad, general questions that won’t create a defensive response or hostile environment. As PPD patients often fear personal information being used against them, more neutral questions can help avoid triggering their paranoia.

Screening tools like the Personality Disorder Questionnaire to narrow down symptoms may also be used, depending on how receptive the patient is. The doctor will then compare symptoms to the DSM-5 criteria and make their final diagnosis and recommendation for treatment.

Paranoid Personality Disorder Treatment Options

For patients over 18, once a diagnosis is determined, a treatment plan can be created that best addresses their unique needs and struggles.

First-line treatment for PPD includes therapy, specifically Cognitive Behavioral Therapy (CBT) and/or Dialectical Behavior Therapy (DBT). CBT can help the patient identify problematic or destructive thought patterns and learn to redirect them into something more productive.

On the other hand, DBT focuses more on finding balance for intense emotions and avoiding black-and-white or all-or-nothing thinking.

Both types of psychotherapy can help increase self-esteem and teach the individual how to have healthier social interactions.

Healthcare providers generally don’t prescribe medication for PPD unless certain symptoms are extreme enough to warrant extra measures. For example, if a patient is experiencing intense anxiety or depression, medication may be used. In addition, because PPD has a high comorbidity rate, medicines may be prescribed to treat those conditions.

Types of medications used for PPD include:

  • Anti-anxiety medications
  • Anti-depressants
  • Anti-psychotics
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FAQs about Paranoid Personality Disorder

What causes paranoid personality disorder?

PPD is believed to be the result of genetics and trauma in childhood. Specific genes passed through families can make someone more likely to develop the disorder, especially if they grow up in a traumatic or abusive environment. The presence of other personality disorders and schizophrenia are especially of note as PPD risk factors.


Who is most likely to develop paranoid personality disorder?

PPD affects 0.5% to 4.5% of the general US population. Individuals from families with a presence of schizophrenia and delusional disorder are more likely to develop the condition. PPD also affects males far more than females.

What are the signs of paranoid personality disorder?

Common signs of PPD include questioning the commitment or loyalty of others, believing they are exploiting or lying to them, and perceiving attacks on their character without proof or reason. In addition, PPD patients typically hesitate to confide in others or reveal personal information due to fear the information will be used against them. As a result, these individuals can be socially cold or distant in relationships to avoid being betrayed.

How is paranoid personality disorder treated?

PPD is best treated with therapy, specifically Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DBT). These therapies are incredibly effective at helping patients identify unhealthy thought patterns and balancing intense emotions to combat black-and-white thinking. While uncommon, antidepressants, anti-anxieties, and anti-psychotics may sometimes be used if symptoms are extreme enough.

Kent S. Hoffman, D.O. is a founder of Addiction HelpReviewed by:Kent S. Hoffman, D.O.

Chief Medical Officer & Co-Founder

  • Fact-Checked
  • Editor

Kent S. Hoffman, D.O. has been an expert in addiction medicine for more than 15 years. In addition to managing a successful family medical practice, Dr. Hoffman is board certified in addiction medicine by the American Osteopathic Academy of Addiction Medicine (AOAAM). Dr. Hoffman has successfully treated hundreds of patients battling addiction. Dr. Hoffman is the Co-Founder and Chief Medical Officer of and ensures the website’s medical content and messaging quality.

Jessica Miller is the Content Manager of Addiction HelpWritten by:

Editorial Director

Jessica Miller is the Editorial Director of Addiction Help. Jessica graduated from the University of South Florida (USF) with an English degree and combines her writing expertise and passion for helping others to deliver reliable information to those impacted by addiction. Informed by her personal journey to recovery and support of loved ones in sobriety, Jessica's empathetic and authentic approach resonates deeply with the Addiction Help community.

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  2. Casadio, P., Olivoni, D., Ferrari, B., Pintori, C., Speranza, E., Bosi, M., Belli, V., Baruzzi, L., Pantieri, P., Ragazzini, G., Rivola, F., & Atti, A. R. (2014, March 31). Personality Disorders in Addiction Outpatients: Prevalence and Effects on Psychosocial Functioning. Substance Abuse: Research and Treatment. Retrieved November 17, 2022, from

  3. Drescher, J. (2022, September). What are personality disorders? American Psychiatric Association. Retrieved November 17, 2022, from

  4. Lee, R. (2017, May 18). Mistrustful and Misunderstood: A Review of Paranoid Personality Disorder. Current Behavioral Neuroscience Reports. Retrieved November 17, 2022, from

  5. Paranoid personality disorder (PPD): Symptoms & treatment. Cleveland Clinic. (2022, April 28). Retrieved November 17, 2022, from

  6. Völlm, B. A., Farooq, S., Jones, H., Ferriter, M., Gibbon, S., Stoffers, J., Duggan, C., Huband, N., & Lieb, K. (2011, May 11). Pharmacological Interventions for Paranoid Personality Disorder. The Cochrane Database of Systematic Reviews. Retrieved November 17, 2022, from

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