Paranoid Personality Disorder (PPD)

Paranoid personality disorder (PPD) is classified as a type of eccentric personality disorder. People with eccentric personality disorders display behaviors that may seem odd or unusual to others.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) also uses the term cluster A personality disorders to describe eccentric personality disorders like PPD.

An individual with PPD is very suspicious of other people, which may interfere with their daily life and activities. They mistrust the motives of others and believe that others want to harm them.

Additional hallmarks of this condition include:

  • being reluctant to confide in others
  • bearing grudges
  • finding demeaning or threatening subtext in even the most innocent of comments or events
  • quickly feeling anger and hostility toward others

According to a 2017 literature reviewTrusted Source, PPD affects between 1.21 and 4.4 percent of people worldwide.

Treatment can be a challenge because people with PPD have intense suspicion and mistrust of others.

If you have PPD, you might wonder whether you can trust a mental health professional and feel suspicious of their motives in trying to help you — and that’s OK.

A mental health professional will work with you to build trust so that you’ll feel comfortable confiding in them and following their advice for better managing your mental health condition.

The cause of PPD is unknown. However, researchers believe that a combination of biological and environmental factors can lead to it.

The disorder is present more often in families with a history of schizophrenia and delusional disorder. Early childhood trauma may be a contributing factor as well.

Other contributing factors include:

  • living in a low-income household
  • being separated or divorced
  • being widowed
  • never marrying

African Americans, Native Americans, and Hispanic Americans are more likely to be diagnosed with PPD, according to the 2017 research reviewTrusted Source mentioned earlier.

However, more research is needed on how — and why — prevalence varies across racial groups.

Trauma and stress may help explain the higher rates in African Americans.

Research, including a 2014 study, suggests that there’s actually little difference between Black individuals and white individuals when it comes to pathological paranoia symptoms, such as delusions. However, Black individuals are more likely to exhibit nonpathological paranoia symptoms, such as a lack of trust.

People with PPD often don’t believe that their behavior is anything out of the ordinary.

It may seem completely rational to them to be suspicious of others. However, those around them may believe this distrust is unwarranted.

A person with PPD may also behave in a hostile or stubborn manner. They may be sarcastic, which may often elicit a hostile response from others. That hostile response, in turn, may seem to confirm their original suspicions.

Someone with PPD may have other conditions that can compound their PPD symptoms. For example, depression and anxiety can affect a person’s mood. Shifts in mood can make someone with PPD more likely to feel paranoid and isolated.

Other symptoms of PPD include:

  • believing that others have hidden motives or are out to harm them (in other words, experiencing persecutory delusions)
  • doubting the loyalty of others
  • having trouble working with others
  • being hypersensitive to criticism
  • quickly becoming angry or hostile
  • becoming detached or socially isolated
  • being argumentative and defensive
  • having trouble seeing why their behavior might be a cause for concern
  • having trouble relaxing

Symptoms of PPD can overlap with symptoms of other mental health disorders.

Schizophrenia and borderline personality disorder (BPD) are two conditions with symptoms similar to PPD. As a result, it can be difficult to accurately diagnose these conditions.

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In order to diagnose PPD, a primary care physician will first ask you about your symptoms and medical history. They’ll also perform a physical examination to look for any other medical conditions.

The primary care physician may send you to a psychologist, a psychiatrist, or another mental health professional for further testing.

The mental health professional will perform a comprehensive assessment. They may ask you about your childhood, school, work life, and relationships.

In addition, the mental health professional may try to gauge your behavior by asking you how you would respond to an imagined situation.

The mental health professional will then make a diagnosis and form a treatment plan.

DID YOU KNOW?

People with personality disorders are more likely to have substance use disorder than the general population. This is especially true for people with PPD, as well as those who have the following conditions:

PPD can be treated successfully. However, most people with the condition have trouble accepting treatment. Someone with PPD doesn’t see their symptoms as unwarranted.

Talk therapy or psychotherapy are helpful for people willing to accept treatment. These methods will:

  • help you learn how to cope with the disorder
  • help you learn how to communicate with others in social situations
  • help reduce feelings of paranoia

Medications can also be useful, especially if you have other related conditions, such as depression or an anxiety disorder. Medications that may be prescribed include:

Combining medication with talk therapy or psychotherapy can be very effective.

The outlook for paranoid personality disorder depends on whether an individual is willing to accept treatment.

People with PPD who resist treatment may lead less functional lives. PPD may interfere with your ability to hold down a job or have positive social interactions.

In comparison, individuals who accept treatment may have less trouble keeping a job and maintaining healthy relationships. However, you must continue treatment throughout your lifetime, because there’s no cure for PPD.

Symptoms of PPD will continue, but they can be managed with care and support.

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