Paranoid Personality Disorder…The Destructive Potential

“Paranoid Personality Disorder… The Destructive Potential”  — We stood leaning up against the tailgate of the truck, my son, myself, and one other gentleman.  The gentleman spoke of a former co-worker who struggled with manic depression, and the challenges that presented for the co-worker’s family and friends.

“Do you mean Bipolar?” I interjected as I listened.

“No,” he said, “Bipolar is different from Manic Depressive.”

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Our conversation continued as we stood there a while, speaking of the people we knew in life who struggled with psychological issues, and the great difficulty those conditions placed upon the lives of their loved ones, co-workers and friends.

As I walked away from our conversation, I was reminded of a very important fact… in the world of psychology and psychiatry, terms abound and terms evolve, and with that comes confusion.  For example, few people realize that the once routinely used term of Manic Depressive has now been changed to Bipolar.  Perhaps even more confusing are the behavioural responses often labelled as “paranoid”.   To the everyday person on the street, the world of psychology is filled with myths, mis-information and ill-formed stigmas.  For example, many people have heard the terms “paranoid schizophrenia”, or general “paranoia”, but few recognize, or realize that a long term personality disorder exists which is known as “paranoid personality disorder”.

It’s perfectly natural for each and everyone of us to experience some form of paranoia at one or more times in our life.  We might call it stress, or worry as we worry about pending layoffs at work, the outcome of next Saturday night’s date, and in recent days and weeks some have been paranoid about their homes being broken into after being forced to evacuate their communities due to wildfire.   People who struggle with paranoid personality disorder (PPD) take paranoia to a whole new level and it has the ability to destructively erode away at every personal and professional relationship in their lives.

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What Is A Personality Disorder?

A personality disorder is a long term pattern of inner experience (perception) and behavior (response to perception) that deviates from the norm of that individual person’s everyday society or environment.

A personality disorder reveals itself in two or more of the following areas:

  • cognition;
  • affect;
  • interpersonal functioning;
  • or impulse control.

The long term pattern of interpretation (perception) and response to that interpretation (behaviour) is unavoidable and erupts out across a wide range of personal, professional and social relationships or situations.  The cumulative damage caused by a personality disorder eventually and typically leads to some form of “melt-down”, significant distress, or impairment in home life, social interactions, workplace or other areas of regular functioning.  To be accurately defined as a personality disorder, the pattern has to be of long duration, and in most cases its onset can be traced back to early adulthood or adolescence.


What Is Paranoid Personality Disorder?

Paranoid personality disorder is a mental condition in which a person (there is a slightly higher number of males compared to females who experience this condition) has a long-term pattern of distrust and suspicion of others.  A person with paranoid personality disorder (PPD) often feels as though they are in danger of being taken advantage of, or in real physical danger and they expend great energies looking for evidence to support their suspicions, often distorting actual events to accommodate their delusional thinking. They have trouble seeing and understanding that their distrustfulness is delusional and out of proportion to the real environment they are in.

Common symptoms of Paranoid Personality Disorder include:

  • Widespread concern that other people have hidden motives targeted against them in particular without sufficient evidence to support such a claim;
  • A general or blanket expectation that people in the general populace are out to take advantage of them;
  • Due to a high need to control their environment to make sure they are not taken advantage of, people with PPD exhibit an inability to work together with others due to the driving away of those closest to them;
  • Social isolation;
  • Relational detachment;
  • Hostility and mood swings;
  • Harbours unfounded doubts about the loyalty or trustworthiness of friends or acquaintances;
  • Is hesitant to confide in others because of an unjustified concern that the information will be used maliciously against him or her;
  • A person with PPD will read hidden demeaning, or threatening interpretations into other people’s innocent comments;
  • Individuals with PPD often perceive attacks on their character or reputation which are not visible to others, and they are quick to react angrily or take revenge by way of counterattacking;
  • In the case of married persons with PPD the impacted partner will sometimes experience recurrent suspicions, without justification, regarding the fidelity of their spouse or partner.

Many people with paranoid personality disorder go undiagnosed and untreated due to their fear of being diagnosed with a mental illness, and wide spread suspicion of others including a suspicion of doctors.


Paranoid Personality Disorder

As stated earlier on in this article, people with paranoid personality disorder (PPD) are generally characterized by having a long-standing pattern of pervasive distrust and suspicion of others when there is no clear evidence to support it.  A person with paranoid personality disorder will almost always believe that other people are out to take advantage of them.  It can go beyond other people to include, as an example, the delusional belief that a running dog two farm fields over will come and attack them if they don’t seek shelter right away.

Individuals with Paranoid Personality Disorder, in superficial social encounters, are often perceived by others as perfectly normal as the person with PPD has developed the coping skills which enable them to engage people socially without getting relationally close.  In environments such as home and work where there is some form of prolonged exposure to the same circle of people, those with paranoid personality disorder are in general terms, very difficult to get along with and often struggle in the area of creating close relationships.  People with PPD often hold onto childhood friends as their only truly trusted friends.

Inside social engagements and relationships, people with paranoid personality disorder will exhibit excessive suspiciousness and hostility.  This is often expressed in an argumentative manner, repetitive complaining, or by appearing purposely quiet in a passive aggressive form of hostile aloofness.

Due to the fact that a person with paranoid personality disorder has a broken “inner radar” that is always looking for potential threats (even where they don’t exist), they often behave in a guarded, secretive, or devious manner — appearing to be emotionally unavailable, “cold” and lacking in genuine empathy or compassion toward others.

Persons with paranoid personality disorder while often appearing to be objective, rational, and unemotional, they more often than not exhibit a quick changing range of behaviours, with hostile, stubborn, and sarcastic expressions predominating.  The combative, argumentative, and suspicious nature of a person with paranoid personality disorder may bring back upon themselves a hostile or argumentative response in others, which then serves as a self-fulling prophecy to the person with PPD, confirming their original expectations that people are “out to get them”.  When lacking evidence to support their paranoid position, a person with PPD may goes as far as to manoeuvre others, or situations, in such a way so as to create an opportunity to find blame which would justify their paranoia.

Due to the often silent, but ever existing high degree of lack of trust in others, individuals with Paranoid Personality Disorder are often found to demonstrate in life patterns an over all excessive need to be self-sufficient, complete with a strong sense of autonomy.  In order to maintain the image of normalcy in their lives, people with paranoid personality disorder need to maintain a high degree of control over those around them, and if they can’t control or manipulate a person, they seek out ways to push them away.   Individuals who struggle with PPD are often rigid, critical of others, and unable to work as part of a team.  They have great difficulty accepting criticism often mis-interpreting it as a personal attack.


Causes of Paranoid Personality Disorder

Causes of paranoid personality disorder are difficult to identify.  The Paranoid personality disorder appears to be more common in families which show pre-existing psychotic disorders in parents or siblings, such as schizophrenia, bipolar, and/or delusional disorders. This correlation does suggest that there may be a genetic tendency which leads to the onset of paranoid personality disorder.  One cannot rule out the possibility that environmental factors may play a role as well.


Treatment of Paranoid Personality Disorder

The treatment of PPD usually requires lengthy rounds of talk therapy sessions (counselling) combined with medications.




American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Publishing. 2013.

Blais MA, Smallwood P, Groves JE, Rivas-Vazquez RA. Personality and personality disorders. In: Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, PA: Elsevier; 2008:chap 39.

Triebwasser J, Chemerinski E, Roussos P, Siever LJ. Paranoid personality disorder, J Person Disord. 2013;27:795-805. PMID 22928850

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