Paranoid Personality Disorder And Problems With Trust
Paranoid personality disorder is characterized by a pattern of long-term suspicion and distrust of others. This disorder can significantly affect a person’s everyday functioning and their relationships. In some cases, a person may not realize they are living with this disorder, which may lead to a delay in treatment. To understand this disorder, looking at the criteria for diagnosis, how it may affect a person’s relationships, and ways to seek help may be helpful.
Criteria for a diagnosis of paranoid personality disorder
Researchers estimate that the prevalence of paranoid personality disorder is between 3.2% and 4.4%. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), categorizes paranoid personality disorder as a cluster A personality disorder. Cluster A also includes schizoid personality disorder and schizotypal personality disorder.
The other clusters of personality disorders are B and C. Cluster B includes borderline personality disorder (BPD), antisocial personality disorder (ASPD), narcissistic personality disorder (NPD), and histrionic personality disorder (HPD). Cluster C includes dependent personality disorder, avoidant personality disorder, and obsessive-compulsive personality disorder (OCPD).
According to the DSM-5-TR, an individual must meet four or more of the following criteria to have paranoid personality disorder diagnosed:
- Suspects, without sufficient basis, that others are exploiting, harming, or deceiving them
- Preoccupation with unjustified doubts about the loyalty or trustworthiness of friends or associates
- Reluctance to confide in others because of unwarranted fear that the information will be used maliciously against them
- Reading hidden demeaning or threatening meanings into benign remarks or events
- Persistently bearing grudges (i.e., unforgiving of insults, injuries, or slights)
- The perception of attacks on their character or reputation that are not apparent to others and quickness to react angrily or counterattack
- Recurrent suspicions, without justification, regarding the fidelity of their spouse or sexual partner
Effects of paranoid personality disorder and trust in relationships
A person living with paranoid personality disorder may experience significant relationship strain because of their distrust of others. They may believe that others are conspiring to deceive or harm them. Their suspicions may extend to friends, and the individual may closely scrutinize their words and actions. If a friend or colleague demonstrates trustworthiness, they may be surprised and have difficulty believing it.
A person’s relationship with their spouse or partner can also be affected by paranoid personality disorder. A person with this disorder may experience intense jealousy and believe that their spouse or partner is cheating on them. They may search for evidence of cheating and try to control their significant other, questioning where their spouse or partner is at all times.
Paranoid personality disorder can also affect interactions with strangers. For example, if a store employee gives a person living with PPD incorrect change, they may read into the mistake and believe the person was deliberately trying to deceive them.
Professional relationships can also be affected. For example, a person with PPD may misinterpret compliments from coworkers as covert attacks on their character. This suspicion can make it difficult to establish strong relationships with coworkers. A perceived slight can sometimes lead to hostility and angry outbursts.
Causes of paranoid personality disorder
While researchers haven’t identified a single cause of paranoid personality disorder, they believe that a mix of genetic and environmental factors may cause its development. Someone who has a first-degree relative with the disorder may be at a higher risk of developing the condition.
In terms of environmental factors, a person may have a higher risk of paranoid personality disorder if they experienced childhood trauma as a child, such as abuse, emotional neglect, or physical neglect. In addition, marginalization, discrimination, and socioeconomic inequality can contribute to distrust. The DSM-5-TR states, “The combination of social stress and childhood maltreatment accounts for the increased prevalence of paranoid symptoms in social groups facing racial discrimination.”
Treatment for difficulty trusting in paranoid personality disorder
Treatment of paranoid personality disorder may include talk therapy, but individuals with the disorder may not seek therapy on their own accord. Instead, they may be suggested therapy by a friend or family member to get symptoms of paranoid personality disorder treated.
Mental health professionals may struggle to establish a strong rapport with a person with this disorder, as the client may be suspicious of the therapist. Some therapists may decide to recognize some validity in a person’s suspicions to develop a therapeutic alliance. Then, the therapist may use cognitive-behavioral therapy or other methods to reduce a person’s suspicions and improve trust with friends and family.
In some cases, a person may be prescribed medications, such as atypical antipsychotics or antidepressants, for specific symptoms or comorbid mental health conditions, such as major depressive disorder. Individuals living with PPD may have an increased risk of obsessive-compulsive disorder (OCD) and agoraphobia, which refers to the fear of being in situations that are difficult to escape. In addition, some people may have co-occurring personality disorders, with the most common being schizoid personality disorder, schizotypal personality disorder, avoidant personality disorder, narcissistic personality disorder, and borderline personality disorder.
The BetterHelp platform is not intended to provide any information regarding which drugs, medication, or medical treatment may be appropriate for you. The content provides generalized information that is not specific to one individual. You should not take any action without consulting a qualified medical professional.
Support for paranoid personality disorder
Individuals who have a loved one living with paranoid personality disorder may experience anxiety and significant relationship challenges. Some people may find it frustrating not to be trusted despite caring deeply for a person with PPD. In these cases, it may help to speak with a licensed therapist, who may be able to provide tips for communicating with a person experiencing paranoia symptoms. People with PPD may also be able to seek support from a therapist to increase trust and foster healthier relationships.
Those struggling to find time for traditional in-person therapy might consider trying an online platform like BetterHelp. With online therapy, clients can connect with a therapist from home via audio, video, or live chat at a time that works for them. Clients can access one out of 30,000 licensed mental health professionals, based on their needs, preferences, and location, so they can be matched with a therapist who understands the challenges often faced by people who have a loved one with symptoms of paranoia or any other mental health condition.
Research shows that online therapy is effective for a number of mental health conditions, including depression and anxiety, which may be common among people trying to help a loved one with paranoid personality disorder. An online therapist may be able to alleviate symptoms of stress related to the distrust often directed at the loved ones of a person with PPD.
Takeaway
PPD can cause significant distress and confusion for friends and family, who may not know how to respond to a loved one who doesn’t trust them. If you have a loved one experiencing paranoia symptoms or have PPD yourself, it may be helpful to speak to a licensed therapist about ways to communicate and maintain boundaries for your own mental health. Consider reaching out to a therapist online or in your area to get started.
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