People with paranoid personality disorder believe others intend to harm or take advantage of them.

Paranoid personality disorder is the fourth most common personality disorder in the United States. Having paranoid personality traits elevates the risk of developing substance use disorders and significantly impacts people’s ability to trust others, including family members and friends who might be trying to provide support. People with paranoid personality disorder are more likely to struggle to develop a stable social network.

While people with paranoid personality disorder might be opposed to treatment, they can benefit from targeted interventions that challenge their cognitive distortions and help them establish more trust with professionals and peers.

What Is Paranoid Personality Disorder?

Paranoid personality disorder is one of the three Cluster A personality disorders listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Schizoid, schizotypal and paranoid personality disorder have been called the “eccentric” personality disorders and share features in common with psychotic disorder schizophrenia.

Personality disorders differ from other psychiatric disorders in many ways. People who have paranoid personality traits are less likely to view them as symptoms and more likely to perceive them as part of their identity or personality.

While other mental health conditions can develop in later years, childhood influences frequently drive personality disorders, which arise by late adolescence or early adulthood and persist over time. They reflect behaviors that were adaptive in childhood but become maladaptive in adulthood.

Symptoms of Paranoid Personality Disorder

Most paranoid personality disorder symptoms reflect a mistrust in the world and other people.

Paranoid personality disorder is primarily driven by thinking patterns. People with the disorder believe others intend to harm or take advantage of them. Typical behaviors of paranoid personality disorder can range in severity and include:

  • Being tense
  • Having difficulty admitting being at fault or wrong
  • Showing coldness or a lack of emotion
  • Withdrawing almost entirely from social contact with others
  • Engaging in excessive tracking, recording or “policing” behavior
  • Exhibiting a short temper and overreacting to minor or perceived slights
  • Confronting people in person or over the phone with accusations of betrayal

Signs of Personality Disorder

The signs of paranoid personality disorder are often more apparent to outside observers than to people who have the disorder. People with paranoid personality disorder usually perceive paranoid personality traits as part of who they are.

People who express suspicion of others aren’t always paranoid, and paranoid personality disorder can only be accurately diagnosed by identifying symptoms that persist for an extended amount of time, which rules out legitimate causes of mistrust.

For example, people who have been stalked might exhibit paranoia for good reason, though they are likely to heal over time and trust others again. People with paranoid personality disorder tend to maintain the same degree of paranoia over time and for a wide range of relationships even if they have not experienced any recent harm or manipulation.

Paranoid personality disorder examples include a wide range of behavior. One person with the disorder might isolate himself in his house and peer through the blinds at every passerby. Another person might map out an elaborate conspiracy theory using newspaper clippings pasted to their wall.

However, many people quietly suffer from symptoms of the disorder and only signal their paranoia to others with subtle signs like clipped speech or furtive glances. Some sense that others won’t believe them and work diligently to keep their suspicions hidden.

Causes of Paranoid Personality Disorder

As with other personality disorders, paranoid personality disorder causes typically fall within one of three categories: genetic, biological or environmental. Paranoid personality disorder is closely linked to a family history of Cluster A personality disorders, schizophrenia or other psychotic disorders.

There is also a strong connection between paranoid personality disorder and childhood abuse. People with the disorder often have histories of childhood trauma combined with family dynamics that were emotionally distant. People with the disorder typically experienced little to no affection growing up and were directly abused or exposed to frequent episodes of violence between their parents.

How Is Paranoid Personality Disorder Diagnosed?

The paranoid personality disorder definition from the DSM characterizes the disorder as “a pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent.” To be diagnosed with paranoid personality disorder, a person must exhibit four of the following seven symptoms or traits:

  • Being reluctant to confide in others due to fear of betrayal
  • Fixating on doubts about others’ loyalty or trustworthiness
  • Repeatedly accusing a partner of sexual or romantic infidelity
  • Holding on to grudges and refusing to forgive even minor insults or slights
  • Perceiving demeaning or threatening meanings in neutral statements or events
  • Suspecting, without evidence, that others are exploiting, harming or deceiving them
  • Inaccurately perceiving hostility in others and making quick, aggressive counterreactions

These traits cannot be better explained by or occur during a psychotic, mood or other psychiatric disorder. While schizophrenia and other psychotic disorders are usually more acutely disturbing or disrupting to the people who have them, they are also easier to recognize and treat. People with paranoid personality disorder are affected on a more pervasive level that makes identifying the condition more difficult.

For this reason, people rarely come into treatment to address paranoid personality disorder symptoms. They may receive a paranoid personality disorder diagnosis after a long period of observation by a clinician who has been treating them for related medical or mental health concerns. One way that professionals can make a paranoid personality disorder diagnosis is completing a patient history and determining when a person started thinking and acting in ways characteristic of the disorder. For paranoid personality disorder, the age of onset is typically in late teen or early adult years.

For people who wonder whether they have or someone they know has this mental illness, reading a paranoid personality disorder case study can be helpful. The story of 65-year-old “Mr. J” shows many ways that the disorder can affect a person’s life, including causing them to avoid or withdraw from necessary medical care.

Who Is at Risk for Paranoid Personality Disorder?

The most significant risk factor for paranoid personality disorder is a family history of the disease or other related disorders. The genetic factors associated with psychotic and Cluster A personality disorders linked to differences in brain function. Brain activity associated with social interaction, emotional activation, learning and memory differs in people with these conditions.

Aside from genetics, environmental factors are the most significant risk factors for developing paranoid personality disorder. People who experience chaos, abuse or trauma in families with emotionally distant communication styles are at particular risk of developing this personality style. Having experiences of frequent victimization can reinforce a worldview that people in positions of authority can’t be trusted.

Paranoid Personality Disorder Statistics

Facts about paranoid personality disorder include the following:

  • Estimates of how many people in the U.S. have paranoid personality disorder vary, but studies suggest about 4.5 percent of the population, or more than 14 million people, have paranoid personality disorder
  • The prevalence of paranoid personality disorder in people receiving outpatient mental health treatment is 2 to 10 percent
  • The rates of paranoid personality disorder among people in psychiatric inpatient units is 10 to 30 percent
  • A recent study shows that about 10 percent of people receiving treatment for an alcohol use disorder have a co-occurring paranoid personality disorder

Paranoid personality disorder can cause constant stress and drive people to limit their social support systems. This increases their risk of substance abuse and addiction. These comorbid disorders can seem daunting to treat, but there are many options available to help people recover from substance abuse. If you or someone you know is struggling with a co-occurring paranoid personality disorder and substance abuse, contact a representative from The Recovery Village to learn how to start living a healthier life.

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Editor – Nicole LaNeve
Nicole leads a team of passionate, experienced writers, editors and other contributors to create and share accurate, trustworthy information about drug and alcohol addiction, treatment and recovery for The Recovery Village and all Advanced Recovery Systems sites. Read more
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Medically Reviewed By – Stephanie Hairston, MSW
Stephanie Hairston received her Bachelor of Arts degree in Psychology and English from Pomona College and her Master of Social Work degree from New York University. Read more
Medical Disclaimer

The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare providers.