Paranoid Personality Disorder

Do you have a friend or a family member who has a nagging habit of suspecting others, including you, at all times? He or she could be a patient of Paranoid Personality Disorder (PPD), a psychotic ailment marked by long-term distrust. Know all about the condition including its causes, symptoms, diagnosis, and treatment options.

What is Paranoid Personality Disorder?

It is a psychiatric disorder wherein an individual harbors suspicions and distrust about others for a long time. However, the symptoms are not similar to severe psychotic conditions like Schizophrenia. PPD belongs to a group of mental ailments collectively referred to as “Cluster A” personality disorders.

The disease is also known as Personality Disorder – Paranoid.

Paranoid Personality Disorder ICD 9 Code

The ICD 9 Code for this disease is 301.0.

Paranoid Personality Disorder Incidence

The condition is said to arise in approximately 0.5-2.5% of the population. It is more common in males than in females. Around 2-10% of all psychiatric outpatients are found to suffer from this disorder.

Paranoid Personality Disorder Symptoms

This is a mental disease and is mainly characterized by problems similar to many other psychotic disorders. The main signs and symptoms of this disease include:

  • Paranoia or delusions of persecution by others (even by close people)
  • Social detachment or isolation
  • Hostility
  • Inability to work together with other people, including friends or family members
  • Suspicion of people having ulterior motives
  • Fear of being exploited by others
  • Holding grudges
  • Being argumentative, stubborn and hostile
  • Being hypersensitive to criticism
  • Doubting casual statements and glances of others and making too much of their suspicion
  • Getting angry or reacting in a fierce way to general statements that they consider to be attacks on their character
  • Thinking themselves to be always right and refusing to admit their wrongdoings in a conflict or quarrel
  • Having difficulty in relaxing

Individuals with PPD are extremely suspicious of the motives and actions of other people, even those they are familiar with. They often suspect themselves to be in danger and look for evidences that can support their doubts. They are unable to see that their doubts are baseless even in the absence of a hostile environment. Naturally, they are able to mix socially and be friends with others.

Paranoid Personality Disorder in Children

In children, PPD can manifest itself through problems like:

  • Solitary behavior
  • Preferring own company
  • Poor relationship with peers
  • Peculiar thoughts
  • Hypersensitivity to the words and behaviors of others

Similar problems can be noted in adolescents who begin to develop the disorder. In the absence of treatment, the condition can worsen and make sufferers unable to have a professional and sexual life in adulthood. Their hatred and rage towards others actually hides their own sense of insecurity and inferiority complex.

Paranoid Personality Disorder Causes

It is not known as yet what exactly gives rise to this disorder. The condition is supposed to arise due to a combination of psychological and biological factors. It is believed to be more common in people with a family history of psychotic conditions, like Delusional disorder and Schizophrenia. This indicates a possibility of genetic involvement although environmental factors such as upbringing of the person may also play a role in the development of this disease. Traumatic physical or emotional experiences during childhood or early stage of life are suspected to be causative factors for PPD.

Paranoid Personality Disorder Diagnosis

The diagnosis of this ailment is based on the criteria that have been mentioned in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR). According to the DSM-IV-TR criteria, patients can be confirmed of having PPD if they exhibit the following seven personality traits or behaviors:

  1. Harboring unjustified doubts about exploitation, dangers, or deception by others
  2. Having suspicion about the trustworthiness or loyalty of friends or colleagues/associates, without sufficient basis
  3. Disinclination to confide in others due to unfounded fear of the information being used maliciously against them
  4. Reading degrading or threatening meanings in casual remarks or events
  5. Being unable to forgive slights, insults, or injuries and bearing grudges constantly
  6. Perceiving attacks on their reputation or character without any valid basis and acting or reacting very fast in an angry manner against supposed maltreatment
  7. Having recurrent unwarranted suspicions about the fidelity of their sexual partner or spouse

If such traits are observed or confirmed by family members of sufferers, doctors try to determine whether an alcohol or drug abuse is the underlying cause of such behaviors. The family history as well as the medical history of a patient is analyzed to find out whether he or she is actually suffering from PPD.

Although an expert psychiatrist rarely needs them, psychological tests like Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II) or Minnesota Multiphasic Personality Inventory – 2 (MMPI-2) might be used from time to time. These tests help detect and classify various personality disorders. The results of these tests can be used along with findings from the family and medical history of patients to confirm the presence of PPD. A physical examination does not help detect the disease in any way, as PPD is a mental condition.

Paranoid Personality Disorder Differential Diagnosis

The differential diagnosis for this disease aims at distinguishing it from various other mental conditions, such as:

Psychiatrists should make sure that a patient is not having any of the abovementioned conditions. The symptoms of these disorders are quite similar to PPD which makes diagnosis quite confusing for physicians. An appropriate differential diagnosis should focus on telling the signs of PPD apart from those of other mental ailments as those mentioned above. It should also attempt to determine whether the symptoms are actually the result of substance abuse or mood disorders.

Paranoid Personality Disorder Treatment

The two main curative approaches for this condition are:

Medications (Pharmacotherapy)

While medications are generally viewed by patients with suspicions, they may be administered without the knowledge of sufferers to control acute symptoms – like severe agitation. Antipsychotic medications are the preferred choice for treating such problems. These might involve use of drugs like Haloperidol or Thioridazine. Such medicines may be used to prevent patients from causing possible harm to themselves or others, in an extreme state of agitation or delusion.

If patients are found to suffer from severe anxiety or agitation, anti-anxiety agents such as diazepam might be prescribed to make them capable of functioning in a normal way in their daily life. Neuroleptics can be used for curing low-grade paranoia. A combination of neuroleptics and SSRIs can be effective in some cases of the disorder.


While therapy is usually the primary choice of treatment for PPD, its success actually depends on the behaviors of the sufferer and his or her willingness to cooperate with therapists. Supportive psychotherapy is an effective treatment option, although it is generally difficult for therapists to establish a relationship of warmth and trust with their patients. Therapists should approach patients in a professional manner – being neither too gentle nor too firm with them. As time progresses, patients are found to confide on their therapists more and more and even trust them with their deepest secrets. It is important for therapists to maintain a good rapport and a healthy relationship with their patients to make their treatment a success.

Behavior therapies and group therapies are not found to be useful in curing PPD.

Paranoid Personality Disorder Prognosis

The outcome of this disease generally depends on whether or not patients are willing to accept medical assistance and get rid of the disorder. The outcome for the disease is often poor as individuals with the condition tend to shun treatment. Medications and therapeutic treatment are usually successful in controlling the symptoms of PPD, such as Paranoia. Even with proper cure, the prognosis tends to vary from one patient to another. PPD is a chronic disorder and persists throughout the lifetime of an affected individual, requiring constant management for life.

Although some PPD sufferers are seen to be able to work properly and have a normal life with spouse and children, others are found to lead a life of disability and get socially withdrawn.

Paranoid Personality Disorder Complications

The complications arising out of this disorder include complete detachment from society and inability to work with others. If left untreated, the condition can have a serious impact on the ability of a patient to maintain personal relationships and also to work and mix in social surroundings. Many people with PPD are found to get engaged in legal battles and even end up suing companies or people (even those they are familiar with) due to the suspicion that they are exploiting them.

Paranoid Personality Disorder Prevention

Unfortunately, the occurrence of this disorder cannot be prevented. However, medicinal or therapeutic treatment can sometimes help a PPD patient find more productive ways to tackle situations despite the condition.

Paranoid Personality Disorder and Self-Help Groups

As already stated, the sufferers of this condition have not been found to improve by undergoing Group Therapy or Behavioral Therapy. Naturally, self-help groups or supportive communities for PPD are practically non-existent. As PPD sufferers are suspicious of people, putting them in groups and using collective therapeutic approaches are not likely to yield any positive result. Instead, a patient may become more suspicious of such attempts and resist treatment altogether thus making improvement impossible for him or her.

Paranoid Personality Disorder Risk Factors

The risk factors for this disease include:

Being male

Men are found to be the more common sufferers of this disease, as compared to women.

Anti-social behavior

The onset of this condition in childhood is usually in the form of anti-social behavior.

Underlying disorders

The disease is also found to arise more commonly in people who are deaf, schizophrenics and have mood disorders or other mental abnormalities such as delusional disorders.

It is also found more in immigrants and people from minority communities.

Living with Paranoid Personality Disorder

Living with the condition can be difficult for its sufferers as well as their friends, family members and co-workers. PPD makes its patients acutely irrational and suspicious of the actions and behavior of others. They suffer from constant delusions of being mistreated by those they have to deal with. Angry outbursts and even physical or legal attacks are not uncommon from these people. This can be a constant cause of concern for those living with PPD sufferers as well as the patients themselves. It is only in rare cases that patients seek medical treatment by themselves. Most of them tend to live with the disease and only receive treatment when their close ones seek medical assistance out of their worry over the worsening symptoms.

Although patients might be asked to find more productive ways of dealing with a situation, it is easier said than done. PPD sufferers, especially those unattended with medical cure, tend to deal with most everyday situations in a negative manner due to their mental problems. However, a few of them who tend to be in the early stages are able to manage their condition and hide their discontent.

Friends, family members and close ones need to treat such people with extreme love and support and behave the best while dealing with them. Medicinal treatment should be used as early as possible. If the patient is found to be co-operative, he or she might be ready to undergo therapeutic treatment and co-operate with physicians.

If you believe yourself to be suffering from severe cases of suspicion or finding yourself to be the victim of some family member, get in touch with a mental healthcare professional and seek early treatment. If treated in time, the condition can be managed before it seriously affects work and damages personal and professional relationships. Although the condition may require lifelong monitoring and treatment, timely cure can allow a patient with PPD to live more or less as normally as others.


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