Symptoms of Paranoid Personality Disorder (PPD)

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Written by:Dr. Karmen Smith, LCSW, DD

Published On: August 29, 2022

Medically reviewed by: Elizabeth Keohan, LCSW-C, MSW

Reviewed On: August 29, 2022

Updated On: July 14, 2023


Paranoid personality disorder (PPD) is a mental health condition that causes people to see the behaviors of those around them in a suspicious light. People with PPD frequently assume that others intend to harm them, even when there’s no evidence to support their recurrent suspicion. While PPD doesn’t cause hallucinations or delusions, it can cause people to see ordinary behavior through a distorted lens.

Paranoid personality disorder symptoms can make maintaining relationships with others difficult. Many people with PPD isolate themselves from others, especially when their suspiciousness becomes extreme. Being able to recognize PPD symptoms means you’ll be better-equipped to seek a mood disorder diagnosis and professional help like talk therapy.

Keep reading to learn more about what causes paranoid personality disorder, the signs, and symptoms of PPD look like.

Signs of Paranoid Personality Disorder

It’s common for all of us to experience feelings of distrust and even a mild sense of what feels like paranoia from time to time. Negative experiences can quickly result in trust issues, making anyone question the motives of others. However, for people with PPD, persistent and intense feelings of suspiciousness and paranoia make it difficult for them to have any positive interactions with others at all.

Some warning signs of paranoid personality disorder include:

  • Constantly looking for potential threats
  • Contacting the authorities when there’s not a clear threat
  • Feelings of persecution or an assumption that others mean them harm
  • Running away or hiding when there’s no source of danger
  • An inability to trust anyone, including loved ones
  • Having firm beliefs and recurrent suspicion that aren’t based on reality or evidence
  • Showing hostility or aggression when paranoid beliefs are dismissed or challenged
  • Obsessing over a paranoid thought and struggling to discuss or think about anything else

“We’re living in a time where we may know people who are less trusting of others. In paranoia, there’s a fear of others and a belief that people have it out for them without cause or evidence. If you know someone who’s struggling with this, suggest therapy so they can get the help and support that they need.”

Licensed Clinical Social Worker (LCSW), DD Karmen Smith

Symptoms of Paranoid Personality Disorder

Paranoia is a symptom of many mental health conditions, which means that paranoid personality disorder symptoms can overlap with the symptoms of other things, like borderline personality disorder (BPD) and schizophrenia. Even when symptoms are severe, someone with PPD may not be able to see anything wrong with their behavior.

PPD can cause irrational suspicions that seem and feel very reasonable to the person affected. Once they become paranoid about something, they may view any action or response as confirmation that their feelings are valid.

Paranoid personality disorder symptoms may include:

  • Assuming that others are disloyal or untrustworthy
  • Feelings of persecution
  • Becoming convinced that others want to harm them
  • Looking for hidden meanings in normal interactions
  • Hiding information from others
  • A belief that others are trying to demean them or attack their character
  • Behaving coldly towards others to protect themselves from feared betrayal
  • Holding lasting grudges over perceived slights
  • Responding with aggression or hostility when their beliefs are questioned
  • Struggling to relax or think about anything other than paranoid thoughts
  • Isolating themselves from others

Paranoid personality disorder can make people distrustful of everyone around them, including family members or romantic partners. Someone with PPD may become convinced that their partner has been unfaithful, even if there’s never been any proof of a betrayal. People with PPD may also abruptly cut others out of their lives to avoid future betrayal.

When someone with PPD isolates socially, they may become involved with online communities that validate their beliefs, including the types of formats and platforms that discuss and promote conspiracy theories. People with PPD are more likely to accept conspiracy theories and may feel that these belief systems validate and justify their feelings of paranoia.

It’s common for someone with PPD to respond with hostility whenever their beliefs are challenged. They may see any disagreement as a slight or feel that it’s a form of rejection. This may lead them to lash out in anger or make accusations. When someone has PPD, they can tend to exaggerate the negative aspects of any situation.

PPD symptoms often become more severe over time, and the dysfunction that results will generally intensify as symptoms escalate. PPD can potentially lead to violence, stalking, or other harmful behaviors. Increasing isolation can also put people with PPD at increased risk for developing other mental health conditions like anxiety and depression.

Managing Symptoms of Paranoid Personality Disorder

Paranoid personality disorder symptoms can be debilitating, but most people find their condition can be effectively managed with proper clinical psychology treatment. The primary form of treatment for PPD is psychotherapy. Over time, psychotherapy (also known as talk therapy) can help people become more aware of their own behaviors, which can improve social interactions and help feelings of paranoia subside.

Unfortunately, there can be many barriers to clinical psychology treatment for people living with PPD. Since lack of trust is a hallmark symptom, many will be suspicious of therapists and other care providers. Further complicating things is the fact that it’s common for someone with PPD to refuse to believe there’s anything wrong with them, so even just initiating treatment can be challenging in many cases.

If someone with PPD can be persuaded to seek treatment, though, it can help keep symptoms from becoming more severe. Cognitive behavioral therapy will offer tools and coping skills that’ll allow people to deal with their feelings of paranoia in a healthy way. This can help anyone with PPD understand how to effectively communicate with others and form healthy relationships.

“Those with paranoid personality disorder can be hostile, argumentative, and suspicious toward individuals or groups. They may be on the internet or in organizations that focus their paranoia on groups they justify hating. It’s important to be aware of individuals in our family or community who could be a danger to others. Therapy and medication can help manage the symptoms of this disorder.”

Licensed Clinical Social Worker (LCSW), DD Karmen Smith

While medication generally isn’t prescribed specifically to treat PPD, it can be used to address symptoms or comorbid conditions (that is, additional conditions that occur at the same time) commonly experienced. For example, someone might benefit greatly from the use of antidepressants, anti-anxiety medication, or even in extreme cases, antipsychotic drugs. 

When to Seek a Professional

It’s believed that PPD impacts an estimated 4.4% of the population, though it can be hard to detect paranoid personality disorder in its early stages. After all, it’s natural for us to be suspicious of others from time to time, so paranoid personality disorder symptoms may not be obvious until they’re fairly severe.

If you or someone you care about has experienced symptoms of PPD that you’re concerned about, it’s important to discuss them with a professional. A health care provider can evaluate your symptoms and overall health, and then offer a diagnosis. Whether that ultimately ends up being PPD, or another mental health condition, having an accurate diagnosis means you’ll be in a better position to seek paranoid personality disorder treatment.

Finding the right course of action can be hard when someone is showing signs of PPD. It’s a condition that can make people wildly stubborn, and pushing someone to seek treatment could potentially backfire. If you’re worried, try to focus on acknowledging someone’s feelings, and avoid arguing or dismissing their beliefs. If you can convince them that professional help is a good idea, they’ll have a better prognosis overall.

Since therapy has been shown to be very effective in helping people with PPD, online therapy can be an excellent step toward finding a solution. It can be an affordable and accessible way to get an accurate diagnosis, and ultimately, find a successful treatment plan. Talkspace is an online therapy platform that makes getting help in diagnosing and treating PPD symptoms simple and convenient.

See References

Dr. Karmen Smith, LCSW, DD

Dr. Karmen Smith is a board-certified Clinical Social Worker in the state of Nevada. She has worked over 20 years for Clark County Family Services with abused and neglected children in the shelter, adolescents in juvenile detention, and adults who have suffered severe trauma. Dr. Smith is a shamanic teacher and minister of metaphysics and her doctorate is in Pastoral Counseling.

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