A group of friends walks around a harbor. The person in front has a guitar.People with paranoid personality (PPD) struggle with chronic feelings of suspicion. They often struggle to trust others, even friends and family. This paranoia can affect many aspects of their life, including their relationships, career, and general well-being. 

Between 2.3% and 4.4% of Americans have PPD. The diagnosis is more prevalent among men. Treatment for PPD typically involves psychotherapy

Therapy for Paranoid Personality

People with paranoid personality are typically not delusional. Instead, they tend to view the world through a lens of anxiety and suspicion. They may act defensive or shun others due to perceived slights. When they isolate themselves, they may have less positive interactions with people, creating a self-fulfilling prophecy about the untrustworthiness of others.  

Treatment aims to help a person with PPD understand how this thinking style harms them. A therapist may teach a person how to recognize which thoughts are paranoid. The individual may then learn how to talk to others about their fears in a productive way. They may also develop strategies for managing anxiety in the moment so they do not lash out at others.

Some therapeutic approaches which may prove helpful include:

  • Cognitive behavioral therapy (CBT): CBT helps people become more aware of their automatic thoughts. It also allows people to understand how these thoughts affect their feelings and behavior. This approach can give an individual a greater sense of mastery over their emotions.  
  • Psychodynamic therapy: This approach can help people shift their locus of control. In other words, it can help them understand that their anxiety comes from within, rather than being provoked by outside forces. People who feel more agency may grow less afraid of influence from others.
  • Reality testing: This therapeutic strategy can help people assess whether their thoughts are realistic. An individual and their therapist may work together to evaluate paranoid ideas with objective evidence. With practice, a person can learn to use this technique on themselves outside of therapy.
  • Dialectical behavior therapy (DBT): DBT fosters social skills and emotional awareness. These skills may help an individual become better able to control paranoid thoughts and communicate with others. DBT can be particularly helpful for people who have both PPD and borderline personality (roughly half of people with PPD fall in this category).  

Group therapy is rarely recommended for paranoid personality. The presence of a group is more likely to create anxiety than camaraderie. The individual may feel outnumbered and resist treatment. A one-on-one method of therapy is generally more effective.

Paranoid Personality and the Therapeutic Alliance

Someone with PPD may not see their suspicious thinking style as an issue. Even if PPD negatively impacts their life, an individual may choose to blame others rather than their condition. Since PPD creates mistrust in others, a person may be reluctant to seek professional help. They may worry that the therapist won’t believe them or will report on them to others. These concerns are major barriers to treatment.

Effective therapy begins with a trusting therapeutic relationship. The therapist must be able to listen with compassion, not judgment or condescension. Most people with PPD need to feel they are collaborating with the therapist—not that treatment is being imposed upon them. Some strategies to help a therapist accomplish this goal include: 

  • Working with the person to develop treatment goals. 
  • Soliciting and listening to feedback from the person. 
  • Taking seriously a person’s concerns about medication side effects or confidentiality. 

Treatment often moves slowly because of the need to first build trust. The success of treatment is heavily dependent upon the therapist’s ability to build a trusting collaboration with the individual.

Medication for Paranoid Personality

The Food and Drug Administration (FDA) has not approved any specific medication for the treatment of PPD. Yet some research suggests that antipsychotics may help with paranoia. Someone with PPD may also be prescribed medication for co-occurring issues such as depression.

People with paranoid thoughts and feelings may be reluctant to take medication, especially if they don’t see a clear benefit to the drug. Forcing medication on a person can intensify paranoid feelings. Except in a limited set of circumstances, it is illegal to compel a person to take medication. 

Helping a Loved One with Paranoid Personality 

Close-up of engaged couple locking fingers.If you have a loved one with PPD, you may feel overwhelmed by the person’s paranoid ideas. Though it can be tempting to argue with these claims, you are unlikely to convince your loved one. In some cases, they may conclude your emotional response is a sign of guilt or collusion.

You can de-escalate a conflict more effectively by focusing on the emotions underlying the accusation. Even if the person’s claims are false, their emotions around those beliefs are real. Acknowledging your loved one’s pain or fear can help them feel more secure. It is possible to offer empathy without agreeing with the person’s point of view.

You can also encourage them to see the effects of their behavior on themself and others. Setting clear boundaries can be helpful. “Setting a boundary” means you identify a hurtful behavior and tell the person what the consequences of that action will be from now on. For example, a spouse may say that if their lover continues to accuse them of cheating, they will move out until the person seeks treatment. When you set a boundary, it is important to set consequences that you are willing to follow through on. 

You cannot “fix” your loved one, but you can encourage them to seek professional help. Those with paranoid personality may have to go to therapy several times throughout their lives or even seek continuous therapy. Yet with proper treatment, people with PPD can manage their symptoms and lead meaningful, connected lives. You can find a therapist for PPD here.


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