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Paranoid Personality Disorder

Reviewed by Psychology Today Staff

The hallmarks of this personality disorder are distrust and suspicion. Individuals who exhibit constitutional paranoia do not normally confide in other people and frequently misread others, redefining innocuous statements and behavior as malevolent.

The paranoid personality-disordered person is suspicious of others; this individual thinks that others are out to threaten, betray, exploit, or harm. This disorder presents most often in young adulthood. People with paranoid personality disorder are not normally grounded in reality, nor do they admit that they have negative feelings about other people. They distrust people so much that they will not discuss how they feel, and harbor suspicions for lengthy periods of time. Paranoid personality disorder is within a group of conditions called Cluster A, people within this cluster often appear odd or peculiar.

The prevalence of paranoid personality disorder is estimated at 1.21 percent to 4.4 percent of the population.


Signs and symptoms of paranoid personality disorder, as cataloged by the DSM-5:

1. Pervasive distrust and suspicion of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

  • Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her.
  • Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates.
  • Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her.
  • Reads benign remarks or events as demeaning or threatening.
  • Persistently bears grudges (such as is unforgiving of insults, injuries, or slights).
  • Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack.
  • Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner.

2. Does not occur exclusively during the course of schizophrenia, bipolar disorder, or depressive disorder with psychotic features, or another psychotic disorder and is not attributable to the physiological effects of another medical condition.

Note: If criteria are met prior to the onset of schizophrenia, add “pre-morbid,” such as “paranoid personality disorder (premorbid).”

Are schizophrenia and borderline personality disorder similar to paranoid personality disorder?

Both schizophrenia and borderline personality disorder have elements of paranoia and suspicion of others. For this reason, these disorders are sometimes hard to accurately diagnose.

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Causes of paranoid personality disorder, as cataloged by the DSM-5:

Paranoid personality disorder may be first apparent in childhood or adolescence. People who suffer prefer solitude, have poor peer relationships, social anxiety, academic underachievement, hypersensitivity, peculiar thoughts and language, and idiosyncratic fantasies. These young people may appear to be "odd" or “eccentric,” and they are good targets for teasing. In clinical samples, this disorder appears to be more commonly diagnosed in males.

There is some evidence for an increased prevalence of paranoid personality disorder among those whose relatives have schizophrenia. Some behaviors that are influenced by specific life circumstances may be erroneously labeled paranoid and may even be reinforced by the process of clinical evaluation. In addition, early childhood trauma may be a contributor as well.

Do other mental illnesses affect paranoid personality disorder?

Other disorders and mental illnesses can compound the symptoms of paranoid personality disorder. Mood disorders such as anxiety and depression, for example, can exacerbate feelings of paranoia.

Does environment affect the risk of paranoia?

An individual’s environment does affect the risk of paranoid personality disorder. People are at higher risk of this disorder if they suffered trauma, abuse, or a chaotic household earlier in life. Isolation and stressful situations can also encourage the development of paranoia.


There are effective treatments for paranoid personality disorder. However, the individual may harbor suspicion about the mental health professional, which can hurt the management of the disorder. People with paranoid personality disorder may suffer chronic paranoia if left untreated. Therapy and some medications have proven to be effective approaches.

If untreated, the person may suffer difficulties at work and at home. Comprehensive treatment can include both formal and informal approaches. Informal recovery may include self-help via family support, services for housing, and vocational assistance.

The use of medications for paranoid personality disorder is mostly discouraged. Medications may have an adverse effect with increased paranoia and suspicion, leaving the individual to forgo treatment altogether. If the individual suffers specific symptoms such as severe anxiety or delusions that result in dysfunction or self-harm or harm to others, medication is recommended. Anti-anxiety drugs, such as diazepam, can be prescribed if daily function has been impeded. Anti-psychotic medication, such as thioridazine or haloperidol, may also be used. These medications should be prescribed for the shortest period feasible.

The most favorable treatment for paranoid personality disorder is psychotherapy. People who suffer from this personality disorder have often experienced difficulties that are ingrained and impede interpersonal relations. A healthy therapist-client alliance will offer a great benefit to those who suffer. The paranoid personality disordered does not normally seek help and does normally discontinue therapy. Patients with this disorder can suffer for a lifetime and require regular therapy.

American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition  
National Institutes of Health - National Library of Medicine
Last updated: 09/14/2021