The "paranoid" in PPD doesn't generally refer to a person with delusions or psychosis, but rather to someone who is constantly suspicious and distrustful of others.

What is Paranoid Personality Disorder?

PPD is a type of psychological personality disorder characterized by an extreme level of distrust and suspicioun of others. Paranoid personalities are generally difficult to get along with, and their combative and distrustful nature often elicits hostility in others. The negative social interactions that result from their behavior then serve to confirm and reinforce their original pessimistic expectations. Needless to say, those with PPD are unlikely to form many close relationships and are typically perceived as cold and distant. They are quick to challenge the loyalty of friends and loved ones and tend to carry long grudges (Dobbert 2007, Kantor 2004).

Diagnosis of PPD

Paranoid PD is considered a Cluster A personality disorder along with Schizoid and Schizotypal, and characterized by odd or eccentric behavior. A diagnosis of PPD should be considered when these paranoid behaviors become persistent and disabling.

According to the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders), a patient must fit at least four of the following criteria in order to be diagnosed with PPD:

• unfounded suspicion that others are exploiting, harming, or deceiving him or her
• preoccupation with unjustified doubts about the loyalty of friends or associates
• reluctance to confide in others because of unwarranted fear that the information will be used against him or her
• finds hidden demeaning or threatening meanings into benign remarks or events
• persistently bears grudges and is unforgiving
• frequently perceives attacks on his or her character and is quick to react angrily or to counterattack
• unjustified suspicions regarding fidelity of spouse or sexual partner

Prevalence of Paranoid Personality

The prevalence of Paranoid Personality Disorder has been estimated to be as high as 4.5% of the general population and occurs more commonly in males (NESARC 2002).

Cause of PPD

The specific cause of Paranoid Personality Disorder is unknown, although there are theories that a threatening domestic atmosphere experienced during childhood may give rise to profound insecurities that contribute to the development of PPD.

This disorder is more common among first-degree biological relatives of those with Schizophrenia and Delusional Disorder, Persecutory Type. One Norwegian twin study found PPD to have a degree of heritibility and to share risk factors with Schizoid and Schizotypal Personality Disorder (Kendler et.al 2006).

Course of Paranoid Disorder

As is the case with many personality disorders, PPD often first becomes apparent in early adulthood. The course of this disorder is chronic (Kantor 2004).

Treatment of Paranoid Personality Disorder

Difficulties in the treatment of those with PPD begin with the challenge of building rapport between the patient and therapist, since paranoid personalities are, by nature, distrustful of others. Those with PPD rarely initiate treatment, and once in therapy, may terminate prematurely if the therapist challenges the patient’s paranoid thoughts too directly (Kantor 2004).

Psychotherapy and PPD

If the patient will submit to treatment, psychotherapy has been the most promising treatment method for those with Paranoid Personality Disorder, and can be useful in helping the patient control his or her paranoia. Group and family therapy, not surprisingly, is not of much use in the treatment of PPD due to the mistrust people with PPD feel towards others.

As personality is a relatively stable, deeply rooted aspect of self, the long-term projection for those with Paranoid Personality disorder is often bleak. Most patients experience the symptoms of their disorder for their entire life and, in order to manage their symptoms of paranoia, require consistent therapy (Dobbert 2007, Kantor 2004).

Medications and PPD

Although individual supportive psychotherapy is the treatment of choice for PPD, medications are sometimes used to treat related symptoms. The best use of medication may be for specific complaints such as anxiety or the delusional states that some with PPD may suffer when under stress. Unfortunately, people with PPD tend to be suspicious of medications, and no medication has yet proven to be effective in managing the long-term symptoms of PPD (Dobbert 2007, Kantor 2004).

Information on Personality Disorders

There are numerous on-line and in print resources with additional information on personality disorders, including: Psychology Prof Online, the Mayo Clinic: Mental Health and the article Types of Personality Disorders: Borderline, Narcissistic, Obsessive-Compulsive & Associated Clusters.

This article is a brief summary of the personality disorder PPD. The contents of this article are not meant to be used for diagnosis and are not a substitute for professional help and counseling.

Additional PPD Sources

American Psychiatric Association APA (2000) Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR).

Dobbert, D. (2007) Understanding Personality Disorders: An Introduction. Greenwood Press.

Kantor, M. (2004) Understanding Paranoia: A Guide for Professionals, Families, and Sufferers. Greenwood Publishing Group.

National Epidemiologic Survey on Alcohol and Related Conditions - NESARC (2002) Journal of Clinical Psychiatry, 65.

Kendler KS, Czajkowski N, Tambs K, et al (2006). Dimensional representations of DSM-IV cluster A personality disorders in a population-based sample of Norwegian twins: a multivariate study. Psychological Medicine, 36, 11.