How to Treat Paranoid Personality Disorder (PPD)

Written by:Ashley Ertel, LCSW, BCD

Published On: August 29, 2022

Medically reviewed by: Cynthia V. Catchings, LCSW-S

Reviewed On: August 29, 2022

Updated On: July 14, 2023


People with the mental health condition of paranoid personality disorder (PPD) have an extreme distrust of others, which can lead to emotional distress, anxiety, and social isolation. While this condition can be debilitating, rest assured, that it is possible to improve and manage symptoms through paranoid personality disorder treatment.

It’s true that the hallmark symptom of the mental health condition of PPD — difficulty trusting others — means it can be very challenging for some people to seek help. However, proper treatment can be life-changing.

Conditions like PPD can impact every facet of life, but appropriate and effective PPD treatment can help you develop coping strategies so you can go on to establish and nurture healthy, positive relationships. Keep reading to learn more about what causes paranoid personality disorder and treatments for paranoid personality disorder.

Is Paranoid Personality Disorder Curable?

Paranoid personality disorder won’t ever go away, but treatment allows you to significantly reduce the severity and frequency of paranoid personality disorder symptoms. While research on PPD is limited, we have been able to identify several effective forms of treatment. Even though it won’t result in symptoms disappearing completely, treatment is still worth it, as it can help you learn to manage your fears and paranoia.

“While there is no cure for paranoid personality disorder, it is possible to engage in effective treatment that can significantly reduce your symptoms. People with PPD are able to live fully functional and productive lives through therapy.”

Licensed Clinical Social Worker (LCSW), BCD, C-DBT Ashley Ertel

Therapy for Paranoid Personality Disorder

It’s incredibly difficult for those with PPD to form emotional connections with others, which is why very rational, evidence-based forms of therapy are more likely to be successful. Even though PPD can make it hard for someone to trust their therapist, the relationship can ultimately model positive interpersonal behaviors and offer valuable insights.

Types of therapy used as treatments for paranoid personality disorder include:

  • Psychodynamic therapy
  • Cognitive behavioral therapy (CBT)
  • Dialectical behavior therapy (DBT)
  • Reality testing

Psychodynamic therapy

Paranoid personality disorder causes an intense suspicion of others. For someone with PPD, it can feel as though everyone around them wants to cause them harm. Psychodynamic therapy is a form of talk therapy that focuses on self-examination and self-reflection in an attempt to help people better understand their fears and thought processes.

Of course, it’s normal, and even healthy, to be afraid of others in certain situations, but the fears experienced by those with PPD are generally irrational. Psychodynamic therapy allows for a productive discussion and analysis of the outside world.

Cognitive behavioral therapy (CBT)

Cognitive behavioral therapy (CBT) is a method of talk therapy that aims to challenge harmful thought patterns like those experienced by people with a paranoid personality disorder. CBT helps people become more aware of paranoid thoughts, allowing them to alter how they think and eventually see things in a more realistic light.

Research suggests that CBT is an effective way to help people with a variety of personality disorders. In the case of PPD, it can be beneficial to let them understand their paranoia. While people with PPD tend to see their behavior as rational, CBT helps break down that line of thinking. It’s a valuable tool for emotional regulation and can eventually help someone living with PPD learn to trust others.

Dialectical behavior therapy (DBT)

Based on CBT, dialectical behavioral therapy (DBT) is a type of therapy that works to help people accept their lives and behaviors and make positive changes. DBT was initially developed as a treatment option for borderline personality disorder, but experts have found it to be a highly effective way to treat other personality disorders as well. People with PPD, for example, often experience strong, negative emotions, and DBT can teach them to cope with these feelings in a healthy way.

Paranoia has been linked to emotional dysregulation, and studies show that DBT is an effective way to strengthen emotional regulation skills. Since DBT also acknowledges feelings, it can be helpful in counteracting paranoia that might be experienced during therapy.

Reality testing

Reality testing is a form of therapy that encourages people to look at the differences between reality and their own beliefs. Since PPD gives people a distorted view of others and the world around them, reality testing can be a highly-effective paranoid personality disorder treatment.

PPD can make people assume that someone is trying to threaten, demean, or harm them. Reality testing encourages them to consider other reasons behind someone else’s behavior. It’s a tool that can help people with PPD challenge their feelings of paranoia to determine if they’re actually being rational.

Medications for Paranoid Personality Disorder

Even though there aren’t any medications designed to treat PPD specifically, care providers may recommend using medication to manage some PPD symptoms. A paranoid personality disorder is often comorbid (occurs at the same time) with other mental health conditions that could interfere with PPD treatment. Medication that might be prescribed for someone with PPD could include the following.


The symptoms of PPD often lead to social isolation, which in some cases may increase the risk of depression. Antidepressants are designed to increase neurotransmitter activity in the brain, which can reduce feelings of depression. In some cases, antidepressants may also be used as a treatment option for anxiety disorder.

Anti-Anxiety Medications

Constant feelings of paranoia can lead to intense feelings of anxiety, which can potentially be managed by medication. In addition to antidepressants, sedative medications can be used to help calm someone down when anxiety levels are high. Since sedatives can be addictive, they’re usually only prescribed to people who exhibit severe anxiety symptoms.

Mood stabilizers

While mood stabilizers are used to treat bipolar disorder, this type of medication may also be prescribed to people who suffer from other types of conditions as well. Taking a mood stabilizer can improve the balance of neurochemicals in the brain, which can help reduce mood swings. Mood stabilizers may be prescribed to people with PPD who also struggle with substance abuse.

Atypical antipsychotics

Atypical antipsychotics are generally used to treat symptoms of psychotic disorders like delusions or hallucinations. In addition to relieving these symptoms, atypical antipsychotics can have a sedative effect, which — though more research is needed — might be effective in treating paranoid personality disorder.

“If you would like to consider discussing medication options with your prescriber, it’s important that you know medication alone is not a recommended treatment regimen for PPD. Medications are sometimes used to augment therapy.”

Licensed Clinical Social Worker (LCSW), BCD, C-DBT Ashley Ertel

Holistic Treatment for Paranoid Personality Disorder

When considering how to treat paranoid personality disorder, for some people it might be worthwhile to consider holistic forms of treatment. Holistic treatment can be an effective supplement to therapy and might be used in the place of medication. For example, focusing on your diet and sleep schedule can also improve the symptoms of many mental health conditions, PPD included. Other holistic methods that could be used as treatments for paranoid personality disorder include mindfulness meditation and breathing exercises

Find Treatment for PPD with Talkspace

It can be hard for people with a paranoid personality disorder to seek help for their symptoms. Trust plays a key role in mental health treatment, and for those with PPD, trusting others can feel impossible. Although PPD can’t be cured, paranoid personality disorder treatment really is worth it and can lead to a dramatic improvement in symptoms.

Psychotherapy helps people with PPD recognize and change harmful thought patterns. For those who have PPD and other mental health conditions, medication and holistic treatments can also be effective.

The idea of starting paranoid personality disorder treatment can feel intimidating, especially when paranoid thoughts and symptoms are interfering with your day-to-day responsibilities. As long as you’re willing to take the first step, though, you can get help and find a treatment center plan that will allow you to enjoy life.

An easy first step can be online therapy since it’s fast, simple to access, and can be done from your own home. If you’re interested in trying it, or you think a friend or loved one might benefit, consider Talkspace. Talkspace is an online therapy platform that has changed the face of therapy. It’s an accessible, convenient, and affordable approach to mental health care. With a Talkspace therapist, you can learn effective techniques to address PPD, drastically easing symptoms and learning to trust.

See References

Ashley Ertel, LCSW, BCD

Ashley Ertel, LCSW, is a Nationally Board Certified Licensed Clinical Social Worker. She has over a decade of experience specializing in trauma and depression, working primarily with first responders, military personnel, and veterans, and sexual assault survivors.

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