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Paranoid personality disorder (PPD) is a challenging mental health condition defined by mistrust and suspicion so intense that it interferes with thought patterns, behavior, and daily functioning. A person with PPD may feel deeply wary of others, always on guard for signs that someone is trying to threaten, mistreat, or deceive them. No matter how unfounded their beliefs, they may repeatedly question the faithfulness, honesty, or trustworthiness of others. When they perceive they’re being persecuted, rejected, or slighted, they’re likely to respond with angry outbursts, controlling behavior, or deflecting the blame onto others.

The fearful, distrustful perceptions that accompany PPD can make forming and maintaining close relationships very difficult, affecting the person’s ability to function at home, work, and school. If you have a loved one with paranoid personality disorder, you may feel frustrated by their warped view of the world, exhausted by their continual accusations, or beaten down by their hostility and stubbornness. It can seem like they’re able to find and exaggerate the negative aspects of any situation or conversation.

Professional treatment can help someone with paranoid personality disorder manage symptoms and improve their daily functioning. However, due to the very nature of the disorder, most people with PPD don’t seek help. As far as they’re concerned, their fears are justified and any attempts to change how they think only confirm their suspicions that people are “out to get them” in some way.

Despite the severe challenges of dealing with someone with PPD, though, you’re not powerless. There are steps you can take to encourage your loved one to seek help, support their treatment, and establish firm boundaries to preserve your own mental health and well-being.

Treatment for PPD

Treatment for paranoid personality disorder largely focuses on psychotherapy. A therapist can help your loved one develop skills for building empathy and trust, improving communication and relationships, and better coping with PPD symptoms. Since the presence of others may fuel paranoid thoughts and anxious behavior, your loved one is more likely to benefit from individual rather than group therapy.

  • Cognitive-behavioral therapy (CBT) can help someone with paranoid personality disorder recognize their destructive beliefs and thought patterns. Therapy focuses on increasing general coping skills, especially trust and empathy, as well as on improving social interaction, communication and self-esteem.

  • Changing how these beliefs influence their behavior, CBT can help reduce paranoia and improve how well you interact with others.

  • CBT can also help them learn better ways to deal with their emotions, beyond lashing out at others.


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