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Paranoid personality disorder

Definition

Paranoid personality disorder (PPD) is a mental condition in which a person has a long-term pattern of distrust and suspicion of others. The person does not have a full-blown psychotic disorder, such as schizophrenia.

Alternative Names

Personality disorder - paranoid; PPD

Causes

Causes of PPD are unknown. PPD seems to be more common in families with psychotic disorders, such as schizophrenia and delusional disorder. This suggests genes may be involved. Other factors may play a role as well.

PPD seems to be more common in men.

Symptoms

People with PPD are very suspicious of other people. As a result, they severely limit their social lives. They often feel that they are in danger and look for evidence to support their suspicions. They have trouble seeing that their distrust is out of proportion to their environment.

Common symptoms include:

• Concern that other people have hidden motives
• Thinking that they will be exploited (used) or harmed by others
• Not able to work together with others
• Social isolation
• Detachment
• Hostility

Exams and Tests

PPD is diagnosed based on a psychological evaluation. The health care provider will consider how long and how severe the person's symptoms are.

Treatment

Treatment is difficult because people with PPD are often very suspicious of providers. If treatment is accepted, talk therapy and medicines can often be effective.

Outlook (Prognosis)

Outlook usually depends on whether the person is willing to accept help. Talk therapy and medicines can sometimes reduce paranoia and limit its impact on the person's daily functioning.

Possible Complications

Complications may include:

• Extreme social isolation
• Problems with school or work

When to Contact a Medical Professional

See a provider or mental health professional if suspicions are interfering with your relationships or work.

References

American Psychiatric Association. Paranoid personality disorder. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), Washington, DC: American Psychiatric Association Publishing; 2022.

Blais MA, Rivas-Vazquez R, Ruchensky JR, Stein MB. Personality and personality disorders. In: Stern TA, Wilens TE, Fava M, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 3rd ed. Philadelphia, PA: Elsevier; 2025:chap 37.

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