Fast facts

  • Paranoid personality disorder is a mental health condition characterised by a chronic distrust of friends, strangers, family and authority figures.

  • It is a lifelong condition, but symptoms typically become milder by the age of 40 to 50.

  • There is no cure for paranoid personality disorder; however, treatments are available to help people manage their condition. Treatment may involve a combination of psychotherapy and medication.

What is paranoid personality disorder?

Paranoid personality disorder is a mental health condition characterised by a chronic distrust of friends, strangers, family and authority figures.

As with other personality disorders, paranoid personality disorder involves a long-standing and ongoing pattern of behaviour, so it is typically diagnosed in adulthood. Although considered a lifelong condition, the symptoms typically decrease in intensity with age; for most people with the condition, symptoms grow milder by the time they reach their 40s or 50s.

Causes

There is no single factor that causes the development of paranoid personality disorder. Instead, it is thought to be due to a complex relationship between social factors (how a person acts with their family and friends during childhood), genetics and temperament.

Some healthcare professionals think that this disorder may be a learned behavioural response that can be traced back to a person's childhood. It is thought that a child who is exposed to an environment in which an adult has unpredictable episodes of anger and rage may not have the mechanisms to cope or escape, so instead develops a paranoid way of thinking as a way to deal with the stressful episodes.

Genetics

Related to genes, the body's units of inheritance or origin.

Risk factors

Some factors that may increase the risk of developing paranoid personality disorder include:

  • A family history of mental health conditions such as schizophrenia, or delusional disorder, and;
  • Experiencing a traumatic event during childhood.

Delusional

False belief in something that is not changed by logic and reason. Delusions are commonly associated with mental health conditions such as paranoia and schizophrenia.

Signs and symptoms

The patterns of paranoid thought and behaviour tend to form during adolescence.

In adolescents the symptoms can include:

  • Social isolation;
  • Social anxiety;
  • Poor school performance;
  • Unusual thoughts or language;
  • Hypersensitivity, and;
  • Poor relationships with peers.

The typical symptoms in adults can include:

  • Having a distorted view of the way other people treat them; 
  • Being highly critical of others, but hypersensitive to criticism of themselves;
  • Suspecting others of exploiting, harming or deceiving them;
  • Reading threatening or malicious subtext into harmless events or comments;
  • Having little or no sense of humour; 
  • Recurrent suspicions, without proof, that their spouse or partner is unfaithful; 
  • Tending to interpret the actions of others as intentionally demeaning or threatening;
  • Assuming that others are always out to humiliate, harm or take advantage of them;
  • Having very poor insight into the effects their attitude and behaviour has on those around them, and;
  • Blaming the problems they encounter on those around them and failing to take accountability for their own actions and behaviour.

People with paranoid personality disorder do not experience psychosis, nor are they delusional; instead, they are convinced that others are out to get them, or to humiliate them, which leads them to act with hostility and become socially isolated.

Anxiety

A feeling of tension, nervousness and dread about future events. It can trigger physical symptoms such as a rapid pulse or breathing difficulties.

Psychosis

An abnormal mental state characterised by a loss of contact with reality.

Delusional

False belief in something that is not changed by logic and reason. Delusions are commonly associated with mental health conditions such as paranoia and schizophrenia.

Methods for diagnosis

Diagnosis of paranoid personality disorder can be difficult, as there is no test that can confirm whether a person has the condition. A diagnosis is usually made by a specialist (psychiatrist), based on a person's medical history and a psychological assessment. The specialist may ask questions about the person's childhood, school, work and personal relationships. They may also ask hypothetical questions to gauge the person's response to certain situations. 

During diagnosis, it is important to rule out other factors that can trigger paranoid behaviour, such as use of recreational drugs, as these can sometimes cause paranoid behaviour.

It is also important to note that for a diagnosis of paranoid personality disorder, the symptoms cannot be related to other mental health conditions, such as schizophrenia, bipolar disorder, depressive disorder with psychotic features, or another psychotic disorder.

Psychiatrist

A medical doctor specialising in the diagnosis and treatment of mental disorders.

Psychological

Relating to, arising in, or affecting the mind.

Psychotic

A state where someone is unable to distinguish reality from hallucination or delusion.

Types of treatment

There is no cure for paranoid personality disorder; however, treatments are available to help people manage their condition. Treatment may involve a combination of psychotherapy and medication.

The condition can be difficult to treat; a person with this condition does not typically initiate treatment and often ends it before it is completed.

Psychotherapy

The most effective treatment for paranoid personality disorder is psychotherapy, which is also knowns as 'talking therapy'. It involves a person meeting regularly with a therapist to discuss their thoughts and feelings, and help them to manage their condition.

A common type of psychotherapy used to treat paranoid personality disorder is cognitive behaviour therapy, which focuses on improving coping skills, social interaction, communication and self-esteem. However, because psychotherapy is founded on trust, and people with paranoid personality disorder inherently mistrust others, they may not stick to the treatment plan.

Medication

In some cases, medication may be prescribed to treat issues associated with paranoid personality disorder such as depression or anxiety. However, adherence to medication can be poor, since people with paranoid personality disorder have a mistrust of medications.

Anxiety

A feeling of tension, nervousness and dread about future events. It can trigger physical symptoms such as a rapid pulse or breathing difficulties.

Cognitive behaviour therapy

A psychological or 'talking' therapy that focuses on changing unhelpful thoughts and behaviours that are causing a person distress.

Prognosis

With ongoing treatment, a person with paranoid personality disorder can function normally. However, if left untreated, a person with the condition may find it difficult to hold down a job, or have fulfilling social and personal relationships.

Prevention

Paranoid personality disorder is not preventable, but early treatment can help a person with the condition learn how to deal with their thoughts and behaviours.