Paranoid personality disorder

Written by Katherine Nicholls
Katherine Nicholls
Counselling Directory Content Team

Last updated 7th March 2024 | Next update due 7th March 2027

Paranoid personality disorder is a mental health condition whereby people are strongly suspicious and distrustful of others. Here, we will take a closer look at what paranoid personality disorder is, its symptoms and what treatment can be helpful.

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. 

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.

What is paranoid personality disorder?

Paranoid personality disorder (PPD) sits within a group of conditions called ‘cluster A’ personality disorders. Those with conditions from cluster A disorders tend to experience odd or ‘eccentric’ ways of thinking. Someone with paranoid personality disorder is often suspicious and distrustful of others around them for no obvious reason. For example, they may think that other people are trying to do them harm.

People with cluster A or ‘eccentric’ personality disorders will behave and think in ways that appear unusual to others and go against the norm. However, people with PPD don’t recognise their behaviours or thoughts as being problematic. 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. These hallmarks may lead to feelings of social isolation and loneliness. 

Paranoid personality disorder vs paranoia 

Paranoia is when we think we are under threat with little to no evidence. It is not a mental health condition in itself, but it can be a symptom of other conditions such as PPD or schizophrenia. The key difference is that people with PPD don’t experience hallucinations or delusions, which are commonly seen in other related conditions.

Common signs of paranoid personality disorder

More common in men than women, most people with this condition PDD will notice symptoms in early adulthood. 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 a 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.

How is PPD 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.

Therapists who can help with paranoid personality disorder

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 or 'talk therapy' 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. 

Counselling can also provide support and guidance for people struggling to cope with the day-to-day impact of paranoia. It can help them to find ways to manage their symptoms and live a more balanced life.

Hope Therapy & Counselling Services in 'What is paranoia?'

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.

Search for a counsellor
Trusted Information Creator - Patient Information Forum

Trust our content

We are a PIF TICK 'trusted information creator'. This means you can be assured that what you are reading is evidence-based, understandable, jargon-free, up-to-date and produced to the best possible standard.

All content was accurate when published.

Would you like to provide feedback on our content?
Tell us what you think

Please note we are unable to provide any personal advice via this feedback form. If you do require further information or advice, please search for a professional to contact them directly.

You appear to have an ad blocker enabled. This can cause issues with our spam prevention tool. If you experience problems, please try disabling the ad blocker until you have submitted the form.

This site is protected by reCAPTCHA, the Google Privacy Policy and Terms of Service apply.

Find a therapist dealing with paranoid personality disorder

All therapists are verified professionals

All therapists are verified professionals