Feeling distrustful and withdrawing socially are symptoms of paranoid personality disorder. They can be managed with professional support.

If you live with paranoid personality disorder, reaching out for help may feel challenging.

However, your symptoms can be managed, and treatment can help you cope with many of the situations that cause you distress and fear.

There’s no cure for this personality disorder, but treatment can help greatly.

Paranoid personality disorder is one of 10 personality disorders. It’s a chronic mental health condition that often develops in your teen or young adult years.

When you receive professional support, you can find relief for many of your symptoms and experience more positive social interactions. This could also improve other aspects of your life, like your work.

In order for treatment to work, a healthcare professional first needs an accurate diagnosis.

Sometimes, two or more conditions occur together. When this happens, these conditions are called comorbid.

For example, you could get a diagnosis of paranoid personality disorder and also one for depression.

An accurate diagnosis that also identifies overlapping symptoms can increase the chance of successful management. That way, all of your symptoms are addressed in the treatment plan.

To diagnose paranoid personality disorder, a health professional may want to perform a physical exam. This helps rule out any medical causes for your symptoms.

If they think you might have a personality disorder like paranoid personality disorder, they could refer you to a specialist, like a psychologist or a psychiatrist.

These mental health professionals may want to talk with you and gather some details about your background, concerns, and goals, as well as other relevant information.

Once they have this information, they may compare your symptoms with the diagnostic criteria established by the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). This is a reference handbook for mental health clinicians to diagnose, classify, and identify mental health conditions.

Based on their findings, they may give you a diagnosis and then discuss with you a treatment plan that may consist of psychotherapy sessions, medications, or both. You can actively participate in this process so you feel that you’re doing what’s best for your situation.

Psychotherapy is the first line of treatment for paranoid personality disorder.

Establishing a relationship with someone you don’t know may be challenging if you live with this condition. However, it is important that you try to connect to your therapist. They’re trained and experienced in mental health and can guide you to improving your quality of life.

The goal of psychotherapy for paranoid personality disorder is to identify your thought patterns and help you weigh real threats versus perceived ones. This may help you learn that you don’t have to worry about as many things as you might now.

Since paranoid personality disorder is a lifelong condition, you may need to continue treatment indefinitely. The frequency of your therapy visits may depend on many factors, including the intensity of your symptoms and your progress.

Cognitive behavioral therapy (CBT)

Cognitive behavioral therapy (CBT) is considered the first option for personality disorders. A 2018 case study suggests it is effective for paranoid personality disorder.

CBT is talk therapy and it helps you change your negative or harmful thinking patterns.

CBT can help you develop trust in other people. It can also increase your ability to regulate emotions and improve social interactions.

As part of CBT, your therapist may invite you to participate in a behavioral experiment. You may be asked to interact with other people and then assess how you felt. You and your therapist can work on challenges like not trusting others.

You can go at your own pace and don’t have to participate in any situations you don’t agree with. It’s important, however, that you try to rely on your therapist for guidance.

Psychodynamic therapy

This therapy focuses on a concept called locus of control. There are two of them: internal and external.

If you have an internal locus of control, you believe you control the outcome of every situation that comes up. You may feel that it’s up to your effort and determination to accomplish something.

If you have an external locus of control, you may believe that how you feel or what happens to you is entirely up to external factors like fate, luck, or what other people do.

Most people have a combination of both internal and external locus of control.

Psychodynamic therapy helps you switch to an internal locus of control if this isn’t where you’re at. This can help you feel more in control of your own safety so that you worry less about whether you can trust other people.

Reality testing

Reality testing is the process of examining the differences between what you believe or perceive, and the reality around you.

Your therapist may help you assess your thoughts, examine the evidence to support them, and consider alternatives if they don’t coincide.

The goal of reality testing therapy is to help you explore multiple reasons for someone’s behavior.

For example, if your spouse won’t tell you where they went, you might assume they’re being deceitful. However, they may be planning a surprise party for you, or they might be dealing with a private challenge they’re not ready to share.

There are no medications specifically for symptoms of paranoid personality disorder.

It is possible, though, that if you live with symptoms of other conditions, your health professional may suggest medication to help you manage.

For example, if you also live with symptoms of anxiety or depression, medication can help you manage those specifically.

Medications sometimes used with paranoid personality disorder symptoms or comorbid conditions include:

Atypical antipsychotics

Atypical antipsychotics block chemical receptors in the brain to improve certain symptoms.

Some antipsychotics include:

  • risperidone (Risperdal)
  • quetiapine (Seroquel)
  • olanzapine (Zyprexa)
  • clozapine (Clozaril)
  • ziprasidone (Geodon)

Antidepressants

Antidepressants work by balancing neurotransmitters in your brain. Examples include:

  • sertraline (Zoloft)
  • fluoxetine (Prozac)
  • paroxetine (Paxil)
  • duloxetine (Cymbalta)
  • venlafaxine (Effexor XR)

Mood stabilizers

Mood stabilizers are typically used for bipolar disorder, but they may also work for other mood disorders. They help restore neurochemical balance to help reduce disruptive emotional changes.

Examples include:

  • gabapentin (Horizant)
  • lamotrigine (Lamictal)
  • topiramate (Qudexy)

Atypical antipsychotic medications also stabilize mood and might be prescribed alone for this purpose or along with another mood-stabilizing medication.

There’s no cure for paranoid personality disorder, but you can see improvement in your symptoms when you seek professional support.

Psychotherapy can be extremely effective to help you change your negative thinking and develop coping skills to improve relationships.

Medication can also help if you live with other conditions like anxiety or depression.

Even if it doesn’t feel like it at the moment, support is available and there are safe spaces for you to heal.