Paranoid personality disorder

We recognise that the system of personality disorder diagnosis can be considered controversial. It is completely your choice which term, if any, you want to use, knowing that your doctor or care team may use another. 

We appreciate that the feelings and behaviours associated with personality disorders are very difficult to live with, and everyone deserves understanding and support. We recognise the diversity in understanding of experiences and preferences around terms individuals may wish to use. We are also aware that some professionals disagree with the system of personality disorder diagnosis, and that some people given the diagnosis find it unhelpful and stigmatising.

The terms used on Counselling Directory are those that are generally used in the UK, currently. We refer to these terms throughout, with the hope of reaching and supporting as many people as possible.

Paranoid personality disorder sits within a group of conditions called ‘cluster A’ personality disorders. Those with conditions from cluster A will experience odd or ‘eccentric’ ways of thinking. If someone has paranoid personality disorder (PPD), they will experience a deep sense of mistrust towards others even if there isn’t a reason to.

More common in men than women, most people with this condition will notice symptoms in early adulthood. Here we will be taking a closer look at what paranoid personality disorder is, its symptoms and what treatment can be helpful.

What is paranoid personality disorder?

People with cluster A or ‘eccentric’ personality disorders will behave and think in ways that appear unusual to others and go against the norm. The hallmark of paranoid personality disorder is that the person with the condition will be very suspicious of other people and may believe that they’re out to hurt or ‘get’ them.

This can make it difficult for those with the condition to form close relationships and confide in others. They may hold grudges and feel anger towards other people. Often someone with PPD will read between the lines during conversations and find threatening subtext.

Paranoia may make someone highly suspicious and make it difficult for them to trust other people through a fear of being taken advantage of. They may study others for traces of hostility and imagine non-existent threats and perils in everyday life. It’s not uncommon for them also to have a strong sense of self-importance and to be hyper-sensitive, jealous and a prey to feelings of rejection and shame.

- Brian Shand BA, MSc, Ph.D, M.Inst GA, UKCP. Analytic Psychotherapist.

Paranoid personality disorder symptoms

Someone with this condition will feel on guard all the time, believing that others are always looking to demean or harm them. There are a number of symptoms to be aware of with paranoid personality disorder, including the following:

  • being untrusting of those around them
  • being reluctant to share personal information with others
  • having a tendency to hold grudges 
  • appear to be hypersensitive and unable to handle criticism
  • believing their partner is being unfaithful
  • appear distant and ‘cold’ in relationships
  • find it difficult to switch off and relax
  • being isolated socially
  • find it difficult to work with others
  • are defensive and become argumentative quickly

To the person with PPD, this behaviour is normal and seems rational. As this behaviour can offend and upset those around them, they may experience negative reactions which then reinforces their suspicions. Sometimes those with the condition also suffer from mood disorders like depression and anxiety, which feeds into and exacerbates their PPD.

Some of the symptoms of paranoid personality disorder are similar to other conditions, such as schizophrenia and borderline personality disorder. This can make diagnosis and treatment difficult. 

What causes paranoid personality disorder?

Like many mental health conditions, PPD has no definitive cause. It’s likely that a number of factors lead to its development including biological and psychological factors. Early childhood experiences such as trauma can have a role to play and clinical samples have found it to be more commonly seen in males. 

It’s also been found to be more common in those with relatives who have schizophrenia, suggesting a genetic link between the two disorders.

child looking to family

Many are fortunate to have at least ‘a good enough’ start to early life which facilitates a stable developmental understanding of self, others and the world around them.

A path is paved forward that is understandable and enables trust to develop in the ability to cope with the stresses of life, to engage in secure relationships and function in a way that isn’t troublesome to the individual or those around them.

For many, this is not the case and a personality disorder can often form from the interplay of an individual’s genetics and environment which never feels secure or trusting and where interactions with others may be more damaging than nurturing. All these factors can disrupt or disturb early development.

- Ben Jearum - Counsellor and Supervisor MBACP.

How is it diagnosed?

Personality disorders need to be diagnosed by a mental health specialist. Usually, a doctor will first carry out a physical examination to rule out any physical causes for the symptoms before referring on to a psychologist or other mental health professional. 

Interview and assessment tools are then used to evaluate whether or not someone could have paranoid personality disorder. Usually, PPD will not be diagnosed if someone already has a diagnosis of another psychotic disorder such as schizophrenia.

Personality disorders are identified by long-standing and ongoing patterns of behaviour. Because of this, personality disorders are rarely diagnosed in children and teenagers. If it is, however, characteristics must have been present for over a year.

In most cases, those with personality disorders will notice a decrease in intensity as they grow older. This may mean that, by the time they reach their 40s and 50s, they aren’t experiencing the most extreme facets of their condition anymore.

Paranoid personality disorder treatment

Often, those with paranoid personality disorder will not see that they have a problem and this can make accessing treatment difficult. If treatment is sought, however, psychotherapy is the preferred option for managing the condition.

Psychotherapy will generally focus on increasing coping skills, improving communication skills and boosting self-esteem. Trust is an integral part of talking therapy and as those with PPD can struggle to trust others, this can become an issue and cause people to quit therapy. 

If those with paranoid personality disorder can commit to treatment, however, they can work to reduce paranoia, improve relationships and learn how to cope with their condition.

A therapy that has a supportive and person-centred approach tends to work best. Building rapport and trust between the client and therapist is key and may take longer than usual.

Medication can be helpful if the person with PPD also has depression or anxiety. However, the use of medication is generally discouraged for this condition as it can increase paranoia and suspicion in the person with PPD. Ideally, if medication is prescribed, it should be used in tandem with psychotherapy and for the shortest time possible.


What should I be looking for in a counsellor?

Whilst there are currently no official regulations in place that stipulate what level of training and experience a counsellor needs to treat paranoid personality disorder, we do recommend that you check your therapist is experienced in the area for which you are seeking help.

The NHS recommends talking therapy as a form of treatment for personality disorders. For more information, visit the NHS website.

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