Paranoia Disorder: Diagnosis And Treatment

Paranoia can be a symptom of several mental health disorders, including “paranoia disorder,” officially known as paranoid personality disorder. Research suggests that paranoid personality disorder (PPD) affects as many as 4.4% of the population, and it’s one of 10 personality disorders in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). Below, we’ll look at paranoid personality disorder in greater detail, including its diagnostic criteria and recommended treatments. 

What is paranoid personality disorder?

Paranoid personality disorder is listed in the DSM-5-TR as a cluster A personality disorder, along with schizoid personality disorder and schizotypal personality disorder. Cluster A personality disorders tend to be characterized by behaviors that others perceive as eccentric. In the case of paranoid personality disorder, this often takes the form of mistrust and suspicion of others. 

Common symptoms of paranoid personality disorder

According to MedlinePlus, paranoid personality disorder involves “long-term patterns of distrust and suspicion of others.” People with this disorder may have trouble with daily functioning and relationships as a result of their symptoms. They may assume others are conspiring against them or planning to harm them, which may affect a person’s ability to leave the house, interact with coworkers, or be around strangers in public places. They may also demonstrate hostility toward those they do encounter.

How paranoid personality disorder is diagnosed

Only a licensed mental health professional can diagnose paranoid personality disorder or other mental disorders after a thorough assessment using the DSM-5 criteria. 

In order for a diagnosis of paranoid personality disorder to be considered, a person must meet at least four of the following criteria from the DSM-5-TR:

1. Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her
2. Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates
3. Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against them
4. Reads hidden demeaning or threatening meanings into benign remarks or events
5. Persistently bears grudges (i.e., is unforgiving of insults, injuries, or slights)
6. Perceives attacks on their character or reputation that are not apparent to others and is quick to react angrily or to counterattack
7. Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner”

The DSM-5-TR specifies that, in order for a diagnosis of PPD to be considered, these symptoms must not occur as a result of schizophrenia, a bipolar disorder, or depressive disorder with psychotic features.

What causes paranoid personality disorder?

The exact cause of paranoid personality is currently not known, but researchers believe that biological and environmental factors both likely play a role. Studies suggest that childhood emotional neglect and physical neglect may contribute to the development of paranoid personality disorder. However, experiencing neglect doesn’t guarantee that a person will develop paranoid personality disorder or any other mental illness. Rather, it’s a risk factor that could increase the likelihood.

Risk factors for developing a personality disorder

Childhood emotional neglect is one risk factor that may make a person more likely to develop a personality disorder like paranoid personality disorder. However, it’s not the only one. Some other possible risk factors for personality disorders that researchers have identified include:

• Genetics
• Childhood trauma
• High reactivity and sensitivity

In addition, there are certain protective factors that may reduce a person’s likelihood of developing a personality disorder. For example, research suggests that having even a single, strong relationship with a peer, caregiver, or teacher could improve outcomes.

How can paranoid personality disorder affect a person’s daily life?

Paranoid personality disorder can cause significant distress. A person may experience difficulty with social interaction at work, for example. If they believe that their coworkers are conspiring against them, this can lead to conflict, disciplinary action, and even job loss. 

PPD can also significantly affect an individual’s personal relationships. For instance, someone with PPD may be convinced that their significant other is cheating, despite not having evidence. This can lead to strain on relationships and could potentially even end them. Over time, symptoms of paranoia could also cause a person to have difficulty leaving the house and being in public spaces, resulting in social isolation and the inability to seek the care they may need.

Can a mental health professional help with paranoia?

How is paranoid personality disorder treated? While there's currently no cure for PPD, this condition can be treatable, meaning that symptoms may improve with professional support. However, individuals with PPD may not seek treatment on their own due to symptoms like mistrust and suspicion. Instead, a family member may refer them to treatment. 

If the individual does agree to therapy, therapists may use cognitive behavioral therapy (CBT) or dialectical behavioral therapy (DBT) to help address their symptoms. They may also incorporate treatment for any comorbid personality disorders or other mental health conditions as needed. Research suggests that 75% of people living with PPD also have another personality disorder, such as borderline personality disorder or avoidant personality disorder, so treating both can be important. 

Online therapy for paranoid thoughts

Individuals experiencing paranoid personality disorder may feel hesitant to attend traditional in-person therapy due to their symptoms, trouble arranging transportation, a lack of providers in their area, or another reason. In these cases, they may be more willing to participate in online therapy, which allows them to connect with a therapist via videoconferencing. If they don’t feel comfortable on camera, they can also choose to communicate via audio or in-app messaging. 

Also, with online therapy platforms like BetterHelp, individuals can reach out to their therapist at any time via in-app messaging and the therapist will respond as soon as they can. This might help if a person experiences paranoia in between therapy sessions. 

Can online therapy be effective for paranoia?

Research suggests that online therapy may be effective for some mental health conditions that can cause paranoia. For example, one study published in 2017 suggests that online therapy can be an effective treatment for bipolar disorder in some cases, which can cause paranoia in some people. 

The study also indicates that online therapy may be effective for treating depression symptoms, which people with PPD may experience. So while in-person care may be a necessary component of treatment for PPD in some cases, especially for more severe symptoms, online therapy can be a helpful supplement in many situations.