Upon diagnosis, one of the most common questions a patient or their family may ask their physician is: can paranoid personality disorder be cured? Traditionally, psychiatrists thought personality disorders were intractable and that the best someone could hope for with treatment was to manage their most severe symptoms. However, research within the last couple of decades has shown that many people with personality disorders frequently experience full or partial remission over time, primarily when they engage in treatment.
Paranoid personality disorder treatment rarely involves medication and typically focuses on therapy. The specific combination of interventions a clinician recommends varies based on which paranoid personality traits or behaviors are most prominent and whether a person has any co-occurring disorders. A paranoid personality disorder left untreated can wreak havoc on someone’s life, but the right treatment can help someone with the disorder improve their ability to trust others and live more freely.
Therapy Options for Paranoid Personality Disorder
People with paranoid personality disorder are more likely to establish trust with a therapist who is plain-spoken and more focused on facts than emotional expression. Therapists can play important supportive roles for people with paranoid personality disorder, modeling positive and trustworthy interactions and helping their clients be more accepting of and engaged in treatment.
Psychotherapy for paranoid personality disorder is most effective when therapists use techniques focused on problem-solving and rational insight. People with paranoid personality disorder usually have a hard time forming intimate emotional connections with others and withdraw when they feel like someone else is being too intrusive. Many people have a hard time connecting with a therapist on an emotional level or responding to emotional cues. They respond better to therapists who make direct statements and avoid emotional appeals.
Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) is a practical choice for people with paranoid personality disorder. Nearly all of the traits associated with paranoid personality disorder are rooted in distorted cognitive patterns that emphasize and magnify potential interpersonal threats and attribute malice to neutral people or events. People with paranoid personality disorder can experience a significant improvement in their symptoms when they learn how to identify and challenge irrational or distorted beliefs in CBT.
Whether a therapist uses CBT or another related approach, individual therapy for paranoid personality disorder typically focuses on the cognitive aspects of the disorder, or paranoid thought patterns and belief systems. People who participate in individual therapy receive support and encouragement from therapists who help them learn and practice different ways of thinking and behaving.
While individual therapy can be useful on its own, people with paranoid personality disorder usually have better outcomes when they participate in integrated services that are coordinated to target different symptoms. For example, many people with paranoid personality disorder will pair individual therapy with support groups and family therapy.
For people with disorders that affect their functioning in relationships, group therapy can be an efficient and effective treatment option. This format allows therapists to provide some of the same interventions and education they would participate in individual therapy while helping a person explore and challenge beliefs about other people in real time.
Treatment groups allow people to learn from other people with similar symptoms or disorders. People receiving group treatment for paranoid personality disorder might be able to see how another person’s paranoid thoughts are delusional and start to question their beliefs. Therapy groups can also make people feel less alone and give them a safe space to talk about their challenges in a stigma-free environment.
Family therapy can help individuals recover while helping family members learn how to support them in their recovery. Family therapists help individuals reflect on their roles in conflicts and practice calmer, more effective ways of communicating with each other. When a person with paranoid personality disorder is actively living with family members, family therapy can be particularly useful.
Research shows that people with psychotic disorders like schizophrenia and schizoaffective disorder have lifespans twenty years shorter than those of people in the general population. Shorter life spans may be due to factors associated with diet. Cluster, A personality disorders like paranoid personality disorder, are not psychotic disorders but share many features in common with them and can lead to similar deficits, including mistrust of medical professionals.
In severe cases, people with paranoid personality disorder may severely restrict their diet due to not trusting entire categories of food or the people who sell the food. More typically, people with thought or Cluster A personality disorders suffer nutritional deficits due to the effects of medications or a lack of awareness of how nutrition affects mood and cognition.
A nutrition counselor can help people with paranoid personality disorder establish a well-rounded diet with necessary minerals for mental health like Omega-3 fatty acids, B vitamins and magnesium.
People with paranoid personality disorder might receive treatment for the first time in an inpatient facility after experiencing a mental health crisis. People with thought or Cluster A personality disorders are at risk of acting on delusional beliefs in ways that put themselves or others at risk of harm. When this occurs, they may be placed voluntarily or involuntarily in an inpatient facility for their safety.
For example, if a person believes someone is poisoning all of their food and water and then stops eating or drinking, or thinks they need to take drastic action to stop someone they suspect is intending to harm them, they may need inpatient stabilization before being able to safely proceed to outpatient treatment.
Voluntary inpatient care can be a good choice for a person with a long-term disorder like paranoid personality disorder who finds they need a period of intensive treatment to make progress on treatment goals. Inpatient treatment can help people focus on their mental health in an environment that removes them from external stressors and obstacles to recovery. This type of therapy can be crucial for people who are prone to paranoia and who live in stressful situations.
Medications Used for Treating Paranoid Personality Disorder
Little research has been done on potential paranoid personality disorder medications, though some studies show pharmacological interventions can be useful under certain circumstances. People with paranoid personality disorder and co-occurring conditions may particularly benefit from the use of medication.
There are two types of medications commonly used to treat anxiety symptoms: sedatives and selective serotonin reuptake inhibitors (SSRIs).
Sedative medications like benzodiazepines can be helpful for people with severe anxiety symptoms but have many dangerous side effects and a high risk of addiction. For this reason, they are less typically prescribed to people who are at an elevated risk of harming themselves or who have co-occurring substance use disorders.
For many people, SSRIs reduce anxiety symptoms just as effectively and are a safer option with fewer side effects. These five SSRIs are the ones most commonly prescribed for anxiety:
- Paroxetine (Paxil)
- Citalopram (Celexa)
- Escitalopram (Lexapro)
- Sertraline (Zoloft)
- Fluoxetine (Prozac)
People with paranoid personality disorder and co-occurring anxiety require evaluation by a clinician to determine which anti-anxiety medication, if any, is recommended.
Selective serotonin reuptake inhibitors are the most researched and most commonly used antidepressant medications. They can help the brain regulate levels of serotonin, form new connections and build new nerve cells, reducing levels of both depression and anxiety. Studies show that commonly prescribed SSRIs like Prozac and Zoloft are safe for most people with co-occurring depression.
Psychiatrists have not historically used antipsychotic medications to treat personality disorders, even Cluster A disorders like paranoid personality disorder that resemble psychotic disorders. More recently, however, researchers have found that atypical antipsychotics like risperidone (Risperdal) and olanzapine (Zyprexa) can alleviate symptoms of paranoid personality disorder.
Still, these medications do not appear to have as pronounced an effect on people with paranoid personality disorder as they do on people with schizophrenia. For this reason, they are usually only recommended when severe aggressive or delusional symptoms put a person with paranoid personality disorder at risk of harm or impede their ability to participate in psychotherapy.
Treatments for Paranoid Personality Disorder with Co-Occurring Conditions
Minimal research has been done on rates of paranoid personality disorder and co-occurring conditions, though general research shows that people with any personality disorder are more likely to develop substance use disorders and are at a significantly elevated risk of suicide when they have comorbid anxiety or depressive disorders.
One study suggests that people with paranoid personality disorder and a co-occurring condition are most likely to have one of the following disorders:
- Anxiety disorders
- Substance use disorders
- Major depressive disorder
- Other depressive disorder
- Obsessive-compulsive disorder
Fortunately, integrated treatment can address these co-occurring disorders simultaneously, lowering the risks linked with them.
Research suggests that of all anxiety disorders, people with paranoid personality disorder are more prone to developing agoraphobia. The mistrust of others that comes with paranoid personality disorder can cause them to increasingly avoid public or social scenarios to the point they become agoraphobic.
People with paranoid personality disorder are also at risk of developing secondary symptoms of general anxiety. Rumination on paranoid themes can cause a person to experience constant background anxiety that may eventually reach clinical levels.
Fortunately for people with co-occurring paranoid personality and anxiety disorders, these comorbid disorders can respond well to a combination of CBT and SSRIs. Cognitive behavioral interventions can be coordinated to target symptoms of both disorders for more efficient treatment.
People with paranoid personality disorder often become socially withdrawn and think about other people and the world in increasingly negative ways. When they lack social support and start ruminating on negative topics, they are at risk of developing secondary depressive disorders. The development of secondary depressive disorders can lead to a negative cycle in which worsening paranoia and depression increase the risk of suicide.
Fortunately, as with anxiety disorders, depressive disorders respond well to a combination of cognitive behavioral therapy and SSRIs, which can be provided concurrently with CBT for paranoid personality disorder.
Nutritional counseling can also help people with co-occurring anxiety and paranoid personality disorder eliminate foods and beverages that increase depression and anxiety.
Schizoid Personality Disorder
Schizoid personality disorder differs from paranoid personality disorder in that people with schizoid traits are more likely to come across as cold or detached than angry or suspicious. By definition, people with schizoid personality disorder lack close relationships, but not necessarily because they mistrust others. They prefer to avoid social interaction.
People with paranoid personality disorder are more likely to have close relationships than people with schizoid personality disorder, though these relationships are typically troubled or fraught. For someone with paranoid personality disorder, all social interactions are subject to suspicion and mistrust.
Schizotypal Personality Disorder
The process of differential diagnosis between paranoid personality disorder and schizotypal personality disorder is relatively straightforward. Both conditions are defined by disordered thinking, but thoughts associated with each disorder fit separate patterns.
People with paranoid personality disorder tend to suspect others of ill intent and read negative motives into others’ actions. On the other hand, people with schizotypal personality disorder are prone to “magical thinking,” or understanding personal significance into neutral events.
People with schizoid personality disorder are more likely than people with paranoid personality disorder to see cosmic forces or agents at work and to perceive others’ intentions as positive. Sometimes people with schizotypal personality disorder have paranoid ideation, but their overall pattern of thinking is not paranoid in nature.
When considering schizophrenia vs. paranoid personality disorder, the process of differential diagnosis is even easier. While people with paranoid schizophrenia and paranoid personality disorder can share paranoid delusions, only people with schizophrenia have hallucinations. In the rare cases when they don’t, their paranoid ideation is accompanied by disorganized speech and behavior that is atypical of paranoid personality disorder or is more elaborate and bizarre.
People with paranoid schizophrenia often have unrealistic delusions that defy logic. For example, they might suspect a government agency of trying to steal their thoughts. People with paranoid personality disorder usually have mundane and realistic delusions that happen not to be true. For example, they might suspect a friend of planning to betray them by stealing from them.
Paranoid Personality Disorder and Addiction
As with any co-occurring conditions, people with paranoid personality disorder and substance use disorders are most likely to benefit from integrated treatment. This means a few things:
- They should receive multiple services that target symptoms of each disorder.
- These services should be coordinated by professionals who regularly communicate with one another.
- Ideally, those professionals should work for the same organization or provider.
People with paranoid personality disorder may have a hard time with group therapy, one of the traditional methods used to treat substance use disorders. With the right support, they can tolerate and benefit from group treatment or receive individual counseling instead. Either way, it is essential that their treatment team is aware of and treating both of their conditions.
For people seeking treatment for these complex disorders, finding the right provider can be intimidating. Fortunately, growing numbers of rehab centers provide coordinated treatment for substance use and co-occurring disorders. The Recovery Village operates facilities across the United States with integrated treatment options for people with co-occurring disorders. Contact a Recovery Village representative today to learn more about treatment options that can meet your needs.