As with most personality disorders, psychotherapy is the treatment of choice. Individuals with paranoid personality disorder, however, rarely present themselves for treatment. It should not be surprising, then, that there has been little outcome research to suggest which types of treatment are most effective with this disorder.
It is likely that a therapy which emphasizes a simple supportive, client-centered approach will be most effective. Rapport-building with a person who has this disorder will be much more difficult than usual because of the paranoia associated with the disorder. Early termination, therefore, is common. As the therapy progresses, the patient will likely begin to trust the clinician more and more. The client then will likely begin disclosing some of his or her more bizarre paranoid ideation. The therapist must be careful to balance being objective in therapy regarding these thoughts, and of raising the suspicions of the client that he or she is not trusted. It is a difficult balance to maintain, even after a good working rapport has been established.
During times when the patient is acting upon his paranoid beliefs, the therapist’s loyalties and trust may be called into question. Care must be used not to challenge the client too firmly or risk the individual leaving therapy permanently. Control issues should be dealt with in a similar manner, with great care. Since the paranoid beliefs are delusion and not based in reality, arguing them from a rational point of view is useless. Challenging the beliefs is also likely to result in more frustration on both the part of the therapist and client, too.
All clinicians and mental health personnel who come into contact with the individual who suffers from paranoid personality disorder should be more keenly aware of being straightforward with this individual. Subtle jokes are often lost on them and allusions to information about the client not received directly from the client’s mouth will raise a great deal of suspicion. Therapists should typically avoid trying to have the patient sign a release for information not essential to the current therapy. Items in life which usually wouldn’t give most people a second thought can easily become the focus of attention to this client, so care must be exercised in discussions with the client. An honest, concrete approach will likely gain the most results, focusing on current life difficulties which has brought the client into therapy at this time. Clinicians should generally not inquire too deeply into the client’s life or history, unless it’s directly relevant to clinical treatment.
Long-term prognosis for this disorder is not good. Individuals who suffer from this disorder often remain afflicted with prominent symptoms of it throughout their lifetime. It is not uncommon to see such people in day treatment programs or state hospitals. Other modalities, such as family or group therapy, are not recommended.
Medications are usually contraindicated for this disorder, since they can arouse unnecessary suspicion that will usually result in noncompliance and treatment dropout. Medications which are prescribed for specific conditions should be done so for the briefest time period possible to be able to manage the condition.
An anti-anxiety agent, such as diazepam, is appropriate to prescribe if the client suffers from severe anxiety or agitation that interferes with normal, daily functioning. An anti-psychotic medication, such as thioridazine or haloperidol, may be appropriate if a patient decompensates into severe agitation or delusional thinking which may result in self-harm or harm to others.
There are not any self-help support groups or communities that we are aware of that would be conducive to someone suffering from this disorder. Such approaches would likely not be very effective because a person with this disorder is likely to be mistrustful and suspicious of others and their motivations, making group help and dynamics unlikely and possibly harmful.