People with paranoid personality disorder are generally characterized by having a long-standing pattern of pervasive distrust and suspiciousness of others. A person with paranoid personality disorder will nearly always believe that other people’s motives are suspect or even malevolent.
Individuals with this disorder assume that other people will exploit, harm, or deceive them, even if no evidence exists to support this expectation. While it is fairly normal for everyone to have some degree of paranoia about certain situations in their lives (such as worry about an impending set of layoffs at work), people with paranoid personality disorder take this to an extreme — it pervades virtually every professional and personal relationship they have.
Individuals with paranoid personality disorder are generally difficult to get along with and often have problems with close relationships. Their excessive suspiciousness and hostility may be expressed in overt argumentativeness, in recurrent complaining, or by quiet, apparently hostile aloofness. Because they are hypervigilant for potential threats, they may act in a guarded, secretive, or devious manner and appear to be “cold” and lacking in tender feelings. Although they may appear to be objective, rational, and unemotional, they more often display a labile range of affect, with hostile, stubborn, and sarcastic expressions predominating. Their combative and suspicious nature may elicit a hostile response in others, which then serves to confirm their original expectations.
Because individuals with paranoid personality disorder lack trust in others, they have an excessive need to be self-sufficient and a strong sense of autonomy. They also need to have a high degree of control over those around them. They are often rigid, critical of others, and unable to collaborate, and they have great difficulty accepting criticism.
A personality disorder is an enduring pattern of inner experience and behavior that deviates from the norm of the individual’s culture. The pattern is seen in two or more of the following areas: cognition; affect; interpersonal functioning; or impulse control. The enduring pattern is inflexible and pervasive across a broad range of personal and social situations. It typically leads to significant distress or impairment in social, work or other areas of functioning. The pattern is stable and of long duration, and its onset can be traced back to early adulthood or adolescence.
Symptoms of Paranoid Personality Disorder
Paranoid personality disorder is characterized by a pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent. This usually begins in early adulthood and presents 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 hidden demeaning or threatening meanings into benign remarks or events
- Persistently bears grudges (i.e., 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
Paranoid personality disorder generally isn’t diagnosed when another psychotic disorder, such as schizophrenia or a bipolar or depressive disorder with psychotic features, has already been diagnosed in the person.
Because personality disorders describe long-standing and enduring patterns of behavior, they are most often diagnosed in adulthood. It is uncommon for them to be diagnosed in childhood or adolescence, because a child or teen is under constant development, personality changes, and maturation. However, if it is diagnosed in a child or teen, the features must have been present for at least 1 year.
Paranoid personality disorder is more prevalent in males than females, and occurs somewhere between 2.3 and 4.4 percent in the general population, according to the American Psychiatric Association (2013).
Like most personality disorders, paranoid personality disorder typically will decrease in intensity with age, with many people experiencing few of the most extreme symptoms by the time they are in their 40s or 50s.
How is Paranoid Personality Disorder Diagnosed?
Personality disorders such as paranoid personality disorder are typically diagnosed by a trained mental health professional, such as a psychologist or psychiatrist. Family physicians and general practitioners are generally not trained or well-equipped to make this type of psychological diagnosis. So while you can initially consult a family physician about this problem, they should refer you to a mental health professional for diagnosis and treatment. There are no laboratory, blood, or genetic tests that are used to diagnose paranoid personality disorder.
Many people with paranoid personality disorder don’t seek out treatment. People with personality disorders, in general, do not often seek out treatment until the disorder starts to significantly interfere or otherwise impact a person’s life. This most often happens when a person’s coping resources are stretched too thin to deal with stress or other life events.
A diagnosis for paranoid personality disorder is made by a mental health professional comparing your symptoms and life history with those listed here. They will make a determination whether your symptoms meet the criteria necessary for a personality disorder diagnosis.
Causes of Paranoid Personality Disorder
Researchers today don’t know what causes paranoid personality disorder; however, there are many theories about the possible causes. Most professionals subscribe to a biopsychosocial model of causation — that is, the causes are likely due to biological and genetic factors, social factors (such as how a person interacts in their early development with their family and friends and other children), and psychological factors (the individual’s personality and temperament, shaped by their environment and learned coping skills to deal with stress). This suggests that no single factor is responsible — rather, it is the complex and likely intertwined nature of all three factors that are important. If a person has this personality disorder, research suggests that there is a slightly increased risk for this disorder to be “passed down” to their children.
Treatment of Paranoid Personality Disorder
Treatment of paranoid personality disorder typically involves long-term psychotherapy with a therapist that has experience in treating this kind of personality disorder. Medications may also be prescribed to help with specific troubling and debilitating symptoms.
For more information about treatment, please see paranoid personality disorder treatment.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.