Learn about symptoms and prevalence of paranoid personality disorder and how it can be treated.

Imagine what would it be like to spend most of your waking hours believing that others were somehow out to get you. For people with paranoid personality disorder, this is a very real experience in daily life that can have devastating results.

What are the symptoms of paranoid personality disorder? According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, symptoms of this cluster A personality type include:

  • Ongoing distrust and feelings of suspicion toward others and assuming that other people’s motives are malevolent, beginning in early adulthood and lasting across several areas of life
  • Symptoms occur independently and not only during flare-ups of other mental health conditions
  • Four or more of the following:
    • Suspicions that others are deceiving or exploiting them (without basis)
    • Preoccupation with doubts about others’ loyalty or trustworthiness
    • Reluctance to share personal information for fear of it being used negatively against them
    • Interpretation of benign remarks or situations into threatening or hidden meanings
    • Grudges held for long periods
    • Perception of character attacks or assault to their reputation that others do not see
    • Ongoing suspicions of partner infidelity without justification

Prevalence of Paranoid Personality Disorder

To better understand the scope of the condition, it is useful to examine paranoid personality disorder statistics and prevalence:

  • Paranoid personality disorder is more common in men than women
  • The prevalence of the condition  is up to 4.4% of the population
  • Paranoid personality disorder begins by early adulthood

Paranoid Personality Disorder and Co-Occurring Conditions

Paranoid personality disorder can co-occur with other mental health conditions, as is common for any personality disorder. Some frequent co-occurring conditions include anxiety, depression, obsessive-compulsive disorder and substance abuse. It is estimated that half of all people with a mental health condition live with a co-occurring substance use disorder. The urge to self-medicate as a defense against personality disorders and other conditions can be compelling. Personality disorders are especially pervasive across the lifespan, which makes people with these conditions particularly vulnerable to substance use challenges.

Paranoid Personality Treatment and Prognosis

Paranoid personality disorder treatment can be a challenge because of the distrust inherent in the condition, which makes it more difficult to establish a therapeutic relationship. Therapy requires trust and the ability to confront challenging cognitive distortions; both of these tasks can be challenging for someone with paranoid personality disorder. There are no medications specific to paranoid personality disorder, nor other personality disorders. However, medications do exist that can help treat symptoms of co-occurring disorders. For example, medications for anxiety can be useful for a co-occurring anxiety disorder, just as antidepressants can help remediate symptoms when depression is co-occurring. Generally, personality disorders do not respond to medications due to the ingrained nature of the conditions.

The first step toward improving paranoid personality disorder symptoms is to address the disorder all co-occurring conditions simultaneously, including addiction. For more information about treatment for co-occurring mental health and substance use disorders, reach out to The Recovery Village today.

a woman is standing with her arms crossed.
Editor – Megan Hull
Megan Hull is a content specialist who edits, writes and ideates content to help people find recovery. Read more
a woman wearing glasses and a blue shirt.
Medically Reviewed By – Paula Holmes, LCSW
Paula Holmes is a licensed clinical social worker, psychotherapist and freelance writer who lives and works in midcoast Maine. She received her master's degree in Social Work in 2008 from the University of Maine. Read more

Psychiatry.org. “Diagnostic and Statistical Manual of Mental Disorders, 5th Edition.” Accessed May 3, 2019.

Bressert, Steve Ph.D. “Paranoid Personality Disorder.” PsychCentral. Accessed May 3, 2019.

Martel, Janelle. “Paranoid Personality Disorder.” Healthline. Accessed May 3, 2019.

Drugabuse.gov. “Comorbidity: Substance Use Disorders and[…]her Mental Illnesses.” August 1, 2018.  Accessed May 5, 2019.

Bressert, Steve Ph.D. “Paranoid Personality Disorder Treatment.” Accessed May 5, 2019.

Grohol, John M. Psy.D. “15 Common Cognitive Distortions.” PsychCentral. Accessed May 5, 2019.

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.