This Is the Biggest Sign of Paranoid Personality Disorder

BEING SUSPICIOUS OF OTHERS, looking for hidden meanings in the things people say and do, getting angry about perceived insults, and holding grudges.

These are all signs of paranoid personality disorder (PPD). And, for people with the condition, these feelings and behaviors can be so strong that they interfere with someone’s daily life.

“People with paranoid personality disorder may show behaviors that might seem odd or unusual,” says Alyza Berman, LCSW, RRT-P, founder of Berman Psychotherapy. “They also might believe others want to harm them in some way or feel as if the motives or intentions of others can’t be trusted.”

PPD is one of 10 clinically diagnosable personality disorders that affect how people think about themselves and others, relate to others, control their behavior, and respond emotionally. Common symptoms of the disorder are pervasive suspiciousness or distrust, hypersensitivity, and emotional coldness, according to the American Psychological Association.

Everyone may occasionally worry about what others think about them, overthink situations, or read into someone’s comments. What’s different about PPD is that it’s rooted in fear—where someone focuses on believing that other people are out to get them, says Erin Rayburn, LMFT, mental health treatment strategist, and owner of Evergreen Therapy.

“Someone may have a neutral interaction, but may believe there are underlying layers to what’s really happening,” she says. “They read into people’s motives, spend a lot of time thinking about people’s motives, or if the person is accepting or rejecting them.”

PPD is believed to affect up to 4.5 percent of the population, according to the Cleveland Clinic. And, most people with the condition tend to have underlying medical conditions and disorders, including other personality disorders, such as avoidant personality disorder, borderline personality disorder, or antisocial personality disorder.

What Exactly Is Paranoid Personality Disorder? PPD is one of several personality disorders known as Cluster A, which is characterized by eccentric or unusual thoughts or behaviors. How severe the symptoms are can vary from person to person.

The common thread is that the feelings and behaviors center on fear and usually aren’t based on reality. Berman says the traits often occur long-term and can appear at different times in someone’s life or in certain situations.

“Those with this disorder are always on guard, and vigilant to cues that someone may be trying to harm them,” she says. “They might read more into social situations than the average person, turning what they hear into something not so favorable for them. That way of thinking then becomes more of a habit.”

Depending on how extreme the symptoms are, it can be an incredibly burdensome condition to live with. “People aren’t free internally,” Rayburn says. “They’re fearful and questioning, so being able to rest and be secure isn’t accessible.”

Signs of Paranoid Personality Disorder People typically start showing signs of PPD in their late teens or early 20s. Like other personality disorders, the exact cause isn’t known, but it’s likely based on biological and environmental factors, according to the Cleveland Clinic.

Research also shows a link between PPD and childhood emotional, physical, and supervision neglect, and there may be a genetic link between people with PPD and schizophrenia and schizotypal personality disorder.

Common symptoms of PPD include:

Feeling suspicious and distrustful

Being overconcerned with hidden motives or meanings

Displaying hypersensitivity to criticism or being slighted or offended (and ready to counterattack)

Showing emotional coldness

Doubting the commitment or trustworthiness of others

Thinking you’re being exploited or deceived by others

Feeling that information will be used against you if you confide in others

Holding grudges and not forgiving

Perceiving attacks on your character that others don’t see

Struggling to relax

Being hostile or argumentative

Feeling like someone is out to get you

“Someone with the disorder may take the smallest thing and just run with it, blowing it out of proportion,” Berman says, especially when they perceive something someone says and does as threatening to them.

Feeling like you can’t trust anyone can increase feelings of isolation and anger, and cause someone to cut ties with others out of fear of judgment, shame, or criticism, she adds.

Just Worrying A Lot Doesn’t Mean You Have the Disorder “You’re just paranoid.” We’ve all said this about ourselves and others when someone overreacts to a situation, worries about what others think, or overthinks a conversation. Everyone behaves this way from time to time, but they don’t necessarily have PPD.

It’s the pervasiveness of the symptoms and how long you’ve had them that make paranoia reach personality disorder levels—especially when it affects your ability to function daily and causes you to avoid social interaction, Berman says.

Paranoia can also be a symptom of other conditions such as post-traumatic stress disorder or schizophrenia, Berman says.

Relationships Are a Struggle with Paranoid Personality Disorder People with PPD might be cold and distant in relationships. They also might be controlling or jealous—persistently being suspicious that a partner is cheating without justification.

“It’s not that they want to believe you might be keeping secrets from them or plotting against them,” Berman says. “However, they do believe these types of things, despite the truth behind your intentions.”

Healthy relationships are based on trust, but people with PPD struggle to trust others fully, she says. Constant distrust and suspicion often pushes people away and sabotages relationships.

“When you’re in a relationship with someone who has a paranoid personality disorder, it can feel like they never see you for who you really are,” Berman says.

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How Paranoid Personality Disorder Is Treated It’s rare for someone with PPD to seek treatment on their own, according to the Cleveland Clinic. Usually, they’re encouraged to talk to a mental health professional by partners, friends, or family.

Treatments, including cognitive behavioral therapy and dialectical behavior therapy, center on helping people build coping skills and change their distorted thought patterns and behaviors, Berman says.

“By challenging those thoughts and working to change harmful behaviors, people with this condition may become less suspicious of others, including friends and family,” she says. “This can improve relationships and social interactions.”