Receiving a diagnosis of paranoid personality disorder, whether it’s your own or a loved one’s, can be confusing and overwhelming.
When you have paranoid personality disorder, you may feel as if you don’t know whom you can trust. It can be hard to identify whom you should and shouldn’t believe when it comes to your own truths and even information about your diagnosis.
Paranoid personality disorder is one of 10 personality disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
A persistent pattern of suspiciousness that leads you to believe other people act with malice toward you characterizes this disorder.
All personality disorders are classified into three clusters. This classification is based on the most dominant and representative behaviors and emotional responses.
Paranoid personality disorder is part of cluster A, exhibiting behaviors that typically are:
- odd or bizarre
- suspicious or distrustful
When you live with paranoid personality disorder, you may repeatedly assume others want to deceive or harm you, even when you don’t have any indication that this is true. You may also hold grudges and have a difficult time forgiving others.
This attitude and behavior are persistent across most situations and repeat over time. This may cause you a great deal of distress and anguish.
There aren’t lab tests to diagnose paranoid personality disorder. Instead, diagnosis is usually reached after a mental health professional spends some time talking with you about:
- your concerns
- dominant thoughts
- typical behaviors in different situations
- status of your relationships
- personal and family medical history
They may also ask you to answer a few questions from a personality test. This could help them identify some of your behaviors that might be causing you distress and could be explained by a personality disorder.
After this, they will compare their observations with the criteria established by the DSM-5. If they find four or more symptoms of paranoid personality disorder, they’ll likely reach the diagnosis.
There are seven symptoms of the disorder. For a diagnosis, four or more should be present. These symptoms must be long-standing and present in a variety of contexts.
According to the DSM-5, if you have paranoid personality disorder:
- You constantly suspect others want to trick, hurt, or use you, even when you don’t have evidence.
- You spend quite a bit of time preoccupied with doubts about the intentions of friends and family, especially their loyalty toward you. You constantly wonder how much or whether you can trust them.
- You hesitate to talk openly about anything with others because you suspect they may use that information against you.
- You may repeatedly misconstrue casual comments from others as having hidden meanings or as threatening.
- You tend to hold grudges for a long time and find yourself often unforgiving.
- You continually think your character and reputation are under attack, even when other people involved don’t perceive the same thing. You are quick to react or counterattack.
- You constantly distrust your partner and wonder if they are loyal, even if they give you no reason to doubt their fidelity.
When you talk with a mental health professional, they might want to see if the presence of any of these symptoms can be explained by another mental health condition such as schizophrenia or bipolar disorder. They’ll also want to rule out whether they’re the result of substance use or an injury.
If they can’t find any other reason, they may move to a paranoid personality diagnosis.
Paranoid personality disorder isn’t a personal choice. It’s not caused by something you or someone else did or didn’t do.
While scientists have not yet established a single cause of paranoid personality disorder, they think a combination of factors may be involved. These factors can be:
- physical neglect
- emotional neglect
- physical and sexual abuse
- emotional and psychological abuse
Having a close relative with the condition or other personality disorder may also increase the chance of you having it.
Although you can have both the personality disorder and schizophrenia, this doesn’t mean one leads to the other.
Some people might have a paranoid personality disorder and later develop schizophrenia, too. This isn’t always the case, though.
In some instances, paranoid personality disorder presents with brief psychotic episodes that can last minutes to hours. This doesn’t mean you also have schizophrenia.
Research suggests that there are specific and achievable goals that medical professionals can use to treat the condition.
Specifically, treatment for paranoid personality aims to:
- help you recognize and understand your own feelings of being vulnerable
- support you in improving your sense of self-worth
- help you develop a more trusting view of others
- help you understand and speak about the distress you experience rather than pushing others away
These goals can be accomplished through a combination of treatments, including psychotherapy and medications. In some cases, treating overlapping conditions such as depression or anxiety may also help.
Treatment of personality disorders can sometimes take time. You’ve had a lifetime of opportunity to develop some of your beliefs and symptoms, and it may take time to learn how to manage them. Still, it’s possible.
A minimum of 12 months of psychotherapy is often recommended. One of the primary goals of this treatment is to help you overcome feelings of mistrust toward your therapist so you can let them support you in this journey.
If you live with paranoid personality disorder, you may have persistent difficulty trusting others. This may cause you great distress and get in the way of building stable relationships.
Paranoid personality disorder isn’t a personal choice. You didn’t decide to feel this way, but you could make a decision to get the support of a mental health professional who specializes in personality disorders.
This could help you find ways to feel better about yourself and your relationships.
When you’re ready to take this step, these resources may help you:
- American Psychiatric Association’s Find a Psychiatrist tool
- American Psychological Association’s Find a Psychologist tool
- Asian Mental Health Collective’s therapist directory
- Association of Black Psychologists’ Find a Psychologist tool
- National Alliance on Mental Illness Helplines and Support Tools
National Institute of Mental Health’s Helpline Directory
- National Queer and Trans Therapists of Color Network
- Inclusive Therapists