Paranoid personality disorder

Generally, PPD is characterised as severe distrust and suspiciousness in others. Some core symptoms include:

• Suspecting that others have secretive or malevolent intentions against them
• A pervasive suspiciousness and questioning the trustworthiness of others
• Difficulties in working with others
• Showing a disproportionate response to feedback or critique
• Rapidly shifting to anger or aggressive behaviour
• Tendency to withdraw and socially seclude
• A confrontational and defensive attitude
• Lack of insight into how their actions might be problematic
• Struggling to achieve a state of relaxation or calmness
• Misinterpret harmless comments or casual glances from others

As with all mental health issues, we cannot indefinitely say what causes a specific presentation, however, we can identify risks that may make it more likely for a disorder to occur. Recent studies have highlighted the role of childhood trauma in the development of PPD, including emotional, sexual, and physical abuse, and neglect, as a predictor of PPD symptoms in adolescence and early adulthood. The severity of such childhood abuse may also correlate with the intensity of PPD symptoms.

Interestingly, brain trauma is also believed to be a risk factor for PPD, with studies showing that a significant percentage of brain injury patients exhibit PPD symptoms. The prevalence of PPD is notable following traumatic brain injury (TBI), making it one of the most common personality disorders in this group. This link might be due to changes in social interaction abilities post-injury. For example, individuals with hearing impairments following TBI are more likely to develop paranoia.

Although they may seem similar, PPD and schizophrenia are entirely different disorders with different symptoms. PPD is a personality disorder, which is a mental health issue characterized by persistent patterns in how individuals view themselves and others, often leading to difficulties in interpersonal relationships. They are often rooted in trauma and present in late adolescence or early adulthood, and without treatment, can endure across someone’s lifetime.

Schizophrenia conversely, is a severe mental illness characterised by positive symptoms (e.g. hallucinations and delusions) and negative symptoms (e.g. social withdrawal and lack of motivation). Individuals with PPD will not experience positive symptoms, and in schizophrenia, paranoia is typically more delusional and less grounded in reality than in PPD. Additionally, personality disorders, including PPD, tend to be enduring and more stable over time, whereas schizophrenia often has more acute phases and fluctuations in symptoms.

Diagnosis for PPD will usually rely on a comprehensive mental state examination, and history showing that maladaptive behaviours and thoughts are enduring and not just confined to specific situations. Collateral information from loved ones or external sources can potentially be used to confirm these traits have been present since adolescence or early adulthood.

One major challenge when diagnosing PPD is the presence of similar features in other personality disorders. For example, Avoidant Personality Disorder is marked by social withdrawal, however, this is due to a lack of confidence rather than mistrust. Additionally, people with Borderline Personality Disorder can experience stress-related paranoia, but this is not an enduring feature. PPD can also present with anxiety, however, the underlying paranoid core features distinguish it from social anxiety. A correct diagnosis is vital for the correct management of PPD, affecting prognosis and treatment.

PPD remains severely under-researched, and many scholars have suggested removing this diagnostic classification altogether from the DSM-5. As a result, there is a challenge in developing effective, evidence-based treatments.

Treating PPD is complex and requires a comprehensive approach. Generally, medication is not a first-line treatment for any type of personality disorder, however, it may help to treat co-morbid symptoms or issues, such as anxiety or depression. On some occasions, antipsychotics may be prescribed if deemed appropriate by a psychiatrist.

The recommended treatment is psychotherapy, but this incurs challenges in the individual’s willingness to participate and trust the therapist. As such, the ability to form rapport and build a therapeutic relationship can be hindered due to the nature of the disorder, potentially impacting the individual’s outcomes for recovery. Therapy options can include cognitive behavioural therapy (CBT) to help in identifying and changing harmful thought patterns, and psychodynamic therapy to focus on understanding past experiences and how they shape current behaviours. The objectives of treatment for PPD may look like:

• Enhancing the individual’s sense of self-worth
• Fostering the growth of trust in others
• Acknowledging and embracing their sense of vulnerability
• Expressing their distress through communication instead of resorting to avoidance or intimidating behaviour

The treatment prognosis varies across the board. As it is a chronic condition, it generally persists for a lifetime, although some individuals with PPD manage to maintain relatively stable lives and relationships. Others, however, may find themselves significantly impaired by the disorder. Ultimately, seeking treatment is the best way to promote positive outcomes and to increase the chances of living an adaptive and fulfilled life.

If you think you may be struggling with the symptoms of Paranoid Personality Disorder, please get in touch with the Private Therapy Clinic on Whatsapp message at: 7511116565 email, chat bot or book online to arrange an appointment.

Carroll, A. (2009). Are you looking at me? Understanding and managing paranoid personality disorder. Advances in Psychiatric Treatment, 15(1), 40–48. Link

Lautieri, A. (2023, May 17). DSM-5: Cluster A Personality Disorders. MentalHelp.net. Link

Lee, R. J. (2017). Mistrustful and Misunderstood: a Review of Paranoid Personality Disorder. Current Behavioral Neuroscience Reports, 4(2), 151–165. Link

Martel, J. (2021, April 21). Paranoid Personality Disorder (PPD). Healthline. Link

Paranoid Personality Disorder. (2006, February 1). WebMD. Link

What are Personality Disorders? (n.d.). Link