Paranoid Personality Disorder

A person with paranoid personality disorder (PPD) has a pervasive distrust and suspicion of others and sees their intentions as harmful. Additionally, unforgiving, ruminative, envious, too self-important, and confrontational traits are present in PPD patients.

Last Updated: February 21, 2024

Women are more likely than males to experience PPD. PPD affects between 1.21% and 4.4% of the population. Being in a low-income family, relationship history, and partner separation are risk factors for developing PPD.


Although the precise cause of paranoid personality disorder (PPD) is unknown, it most likely has a biological and environmental component.

According to research, emotional, physical, and supervisory neglect in childhood substantially impacts how PPD manifests itself in adolescence and the early years of adulthood.

Suspicious, dubious, mistrustful, overly interpreting, resentful, enraged, or aggressive behaviors are common in people with PPD. Additionally, they have a solid need for project control, are inflexible, judgmental of others, unwilling to work together, and assign blame. They are litigious and transfer their worries onto other people by charging them with having bad motives. Surprisingly, they are also zealous. Despite not providing any information, they are suspicious and will ask several questions.


Other associated attributes are social anxiety, bad peer relationships, loneliness, and low academic achievement. Also noted are hypersensitivity, unusual notions, and abnormal imaginations.

DSM V states that at least four of the following seven criteria must be present for PPD to be clinically diagnosed:

  • has unfounded suspicions that others are mistreating, hurting, or abusing them;
  • refusal to divulge secrets because of concern that others could discover them;
  • unwilling to trust people due to an unfounded fear that the knowledge may be used against them;
  • believes that unintentional actions or statements have hidden, embarrassing, or threatening connotations;
  • persistently harbors grievances (i.e., unforgiving to insults and harm);
  • perceives insults on a character that others don't see similarly;
  • persistent, unjustified worries that a partner is disloyal in a relationship.


Presently, no approved drugs are used to treat PPD. One reason is the mistrust of PPD patients participating in research studies.

One method used by doctors is mentalization-based treatment (MBT). This technique is also employed with those with bipolar illness (BPD) because the symptoms of PPD and BPD are comparable. MBT focuses on building a skill to understand and interpret behavior, specifically, a psychological skill related to cognitive empathy and the theory of mind. Cognitive behavioral therapy (CBT) is also a known method of treatment.

There are currently no studies suggesting that there are ways to prevent PPD.

However, when a supposed PPD sufferer is prepared to recognize that they have the disease, they may be able to recover from it.

If left untreated, PPD can interfere with a person's ability to form and maintain relationships and their ability to function socially and gain a stable job.


American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).


Lee R. (2017). Mistrustful and Misunderstood: A Review of Paranoid Personality Disorder. Current behavioral neuroscience reports, 4(2), 151–165.


Kellett, S., & Hardy, G. (2014). Treatment of paranoid personality disorder with cognitive analytic therapy: a mixed methods single case experimental design. Clinical psychology & psychotherapy, 21(5), 452–464.


Cleveland Clinic (2022). Paranoid Personality Disorder. Retrieved October 20, 2022, from


Last Updated: February 21, 2024