Paranoid personality disorder: signs, causes and support

The NHS explains that a person with a personality disorder thinks, feels, behaves or relates to others very differently from the average person. There are several different types. Paranoid personality disorder is one of the ten types that psychiatrists currently recognise, grouped with schizoid and schizotypal personality disorder as the suspicious or “cluster A” group.

NHS-linked information describes paranoid personality disorder as being distrustful and suspicious of others without a good reason. People may feel that others are being nasty to them, that others mean to harm or deceive them, easily feel rejected or hold grudges. This can make it hard to form close relationships.

The sources read for this guide do not describe in detail how it differs from other conditions, so if you or someone close to you has beliefs that feel completely fixed, or hears or sees things that others do not, a GP or mental health professional can assess whether another condition is involved.

The NHS says symptoms vary depending on the type of personality disorder. For the paranoid type, the descriptions in NHS information are broadly as follows, and they often show up in everyday relationships and work.

• Feeling very suspicious and mistrustful of other people’s intentions without good reason.

• Believing others are out to harm or deceive you, even without evidence.

• Feeling easily rejected, or holding grudges.

• Finding it hard to form close relationships, and sometimes becoming socially isolated or having difficulty in professional settings.

• Possible co-existing problems such as depression, anxiety or drug and alcohol misuse, which NHS sources say some people with personality disorders also have.

The NHS says it is not clear exactly what causes personality disorders, but they are thought to result from a combination of the genes a person inherits and early environmental influences, such as a distressing childhood experience like abuse or neglect. NHS inform similarly says they may be connected to genetics and upbringing, and that severe distress or fear in childhood can contribute.

NHS inform also says personality disorders are a common mental health problem that usually emerge in adolescence and continue into adulthood. The sources read do not give causes specific to paranoid personality disorder, so these general explanations are the most that can be said.

Many people with paranoid personality traits do not feel they have a problem and may not seek help. Help is often sought because of another difficulty, such as low mood, anxiety, problems at work or strain in a relationship. If you are worried about your own thoughts, a GP is the usual first step, and NHS 111 can advise if you are unsure where to turn.

If you or someone else is in immediate danger or at risk of harming themselves or others, call 999. If you are supporting someone, the NHS inform page points to Mind, which has information and guidance for friends and family of someone diagnosed with a personality disorder, including how to look after yourself.

NHS inform says diagnoses of personality disorders are made by specialist mental health services, which requires a referral from a GP. The NHS adds that the way personality disorders are diagnosed is changing. Instead of being diagnosed with a type such as paranoid personality disorder, someone may be diagnosed with a mild, moderate or severe personality disorder, with particular personality traits.

A mental health professional can explain what a diagnosis means. One NHS-linked resource notes that personality disorder diagnoses can be controversial and that opinions on the terms vary, while some people find the label helpful for making sense of their experience.

The NHS says treatment for a personality disorder usually involves a talking therapy and can also include other types of therapy and medicine. In talking therapy a person talks to a therapist to get a better understanding of their own thoughts, feelings and behaviours, and the therapist may identify strategies to resolve problems. Treatment can last several months or years depending on severity and other problems.

Some people may be offered a therapeutic community, a place where someone visits or stays for an intensive form of group therapy, usually for a number of weeks or months. Medicine is not a treatment for the personality disorder itself but may be prescribed for associated problems such as depression, anxiety or psychotic symptoms. The NHS says many people with a personality disorder recover over time, that support is sometimes all that is needed, and that treatment should be tailored to the individual.

On the NHS, the route is generally GP, then assessment by specialist mental health services, as NHS inform describes. Availability of specialist services may vary by area.

Some people choose private psychological therapy or psychiatric assessment for faster access. The approach is likely to be a talking therapy in either setting. It can be useful to find a therapist who is experienced in working with personality difficulties and who explains clearly how sessions are structured. Keep your GP informed of any private care.