Learn About Our Walk-In Process

Paranoid Personality Disorder (PPD): Symptoms, Causes, Diagnosis & More

Last Updated: November 27, 2023

Editorial Policy | Research Policy

Paranoid personality disorder (PPD) is a mental health condition that affects about 3.2% of the population, with men more likely to be affected than women. PPD can cause problems with maintaining relationships and functioning in daily life. Having this personality disorder also increases the risk of substance use disorders. The good news is that PPD can be treated, to improve overall functioning and well-being. 

What Is Paranoid Personality Disorder?

Paranoid personality disorder (PPD) is a mental health diagnosis in which a person believes others are trying to trick or harm them. People with this condition have difficulty connecting with others because they are suspicious of the people around them. 

PPD belongs to the “Cluster A” personality disorders, which are characterized by odd/eccentric behavior. PPD involves a paranoid thinking style, and people with this personality disorder do not often seek out treatment on their own. 

Symptoms of Paranoid Personality Disorder

Symptoms of paranoid personality disorder are listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM). These symptoms include:

  • Ongoing distrust of other people
  • Suspicion that others are trying to hurt or deceive them without evidence of such
  • Fear of sharing personal information with others out of concern that information will be used against them
  • Ongoing worry that friends and coworkers are unreliable without evidence of such
  • Interpreting harmless events or comments as being threatening and belittling 
  • Holding grudges after someone has slighted or insulted them
  • Ongoing fear that their spouse or partner has committed infidelity without any evidence of such
  • Tendency to overreact when it seems someone has attacked their character 

Signs of Paranoid Personality Disorder

When someone has a paranoid personality disorder, the people around them are likely to notice outward signs. For example, others will see that the person is frequently suspicious and mistrustful without a legitimate reason. This is different from someone who shows an expected reaction to a betrayal.

Instead, someone with PPD is consistently paranoid that others may hurt them or exploit them at any moment. Their behavior appears unusual to others because they overreact to minor slights and hold grudges for even the smallest infractions. 

A person with PPD may constantly accuse their spouse of being unfaithful. In the workplace, they have difficulty interacting with others. They may perceive any offers of help as an insult to their abilities. 

All of these behaviors will appear out of the norm to people without PPD, who will not understand why a person is suspicious without a justifiable reason. 

Causes of Paranoid Personality Disorder

There is not one single cause of paranoid personality disorder. Rather, it develops when a person has risk factors that increase the likelihood of PPD. The condition may run in families, which suggests that genetic risk factors may be at play.

In addition, a history of child abuse/neglect can predispose someone to develop PPD, suggesting that it may be a trauma-related disorder. Research has also found that Blacks are at higher risk of PPD when compared to Whites, primarily because of lower socioeconomic status and higher trauma exposure. 

So, having a chaotic home environment as a child and experiencing economic adversity can lead to PPD. Some groups are more at risk of these disadvantages than others. 

How Is Paranoid Personality Disorder Diagnosed?

Paranoid personality disorder is diagnosed using criteria in the DSM. To be diagnosed, a person must demonstrate ongoing distrust and suspicion of other people, coupled with at least four of the following symptoms:

  • Unreasonable suspicion that others are trying to harm or trick them
  • Fixation on beliefs that people around them are unable to be trusted 
  • Worrying that confiding in others will mean that information is later used against them
  • Perceiving harmless events or comments as being threatening or demeaning 
  • Maintaining a grudge after they perceive that someone has hurt them
  • Being quick to assume that someone is attacking them and reacting with anger
  • Accusing their spouse or partner of being unfaithful when there is no evidence of such 

In addition to meeting symptom criteria, a person must demonstrate these signs by early adulthood to be diagnosed. PPD may be underdiagnosed because people with the condition are unlikely to seek treatment. 

Who Is at Risk for Paranoid Personality Disorder?

Some people are more at risk of PPD when compared to others. Some risk factors for PPD include:

  • Low socioeconomic status
  • History of childhood trauma or abuse
  • Having a family history of PPD
  • Black/African American race 
  • Male gender (but some studies show that women are more likely to be diagnosed)

Paranoid Personality Disorder Statistics

The following PPD statistics provide additional insights into the prevalence of and problems associated with this mental health disorder:

  • An estimated 3.2% of people have PPD, but some statistics show the prevalence is as high as 4.4.%.
  • Research shows that PPD is one of the most common personality disorders, but it is not commonly seen in clinical treatment settings because people with PPD do not often seek treatment. 
  • PPD is associated with crime, and around 23% of those in prison are believed to have PPD. 
  • The risk of PPD is over two times as high in African American/Black populations and over three times as high in Native Americans when compared to Whites.
  • Around 75% of people with PPD have another personality disorder diagnosis, with avoidant personality disorder and borderline personality disorder being the most common co-occurring disorders. 
  • Substance use disorders and panic disorder also commonly co-occur with PPD. 

Paranoid Personality Disorder Treatment in Kansas City, MO

If you’re looking for PPD treatment for yourself or a loved one, The Recovery Village Kansas City offers mental health services. We can treat PPD, whether it occurs on its own or alongside a substance use disorder. We accept a variety of different insurances to offset the cost of treatment. Contact one of our recovery advocates today to learn more about our Missouri-based treatment services.


Zimmerman, Mark. “Paranoid Personality Disorder (PPD).” Merck Manual, September 2023. Accessed November 16, 2023. 

Carducci, Bernardo, et al. “Paranoid Personality Disorder.” The Wiley Encyclopedia of Personality and Individual Differences: Models and Theories, September 18, 2020. Accessed November 16, 2023. 

Vyas, Amy; Khan, Madiha. “Paranoid Personality Disorder.” The American Journal of Psychiatry Residents’ Journal, January 1, 2016. Accessed November 16, 2023. 

Iacovino, J. M.; Jackson, J. J.; Oltmanns, T. F. “The relative impact of socioeconomic status and childhood trauma on Black-White differences in paranoid personality disorder symptoms.” Journal of Abnormal Psychology, 2014. Accessed November 17, 2023. 

Lee, Royce. “Mistrustful and Misunderstood: A Review of Paranoid Personality Disorder.” Current Behavioral Neuroscience Reports, 2017. Accessed November 17, 2023.