Paranoid Personality Disorder Treatment

Paranoid personality disorder (PPD) treatments include a combination of prescription medications and psychotherapy. Paranoia—what can feel like irrational and excessive feelings of persecution, mistrust, jealousy, threat, or self-importance—can damage relationships and limit your ability to function.

There are several approaches to treating paranoia, but the specifics will depend on your needs, including any co-occurring mental health conditions that you have. Medications for paranoia include antipsychotics and antidepressants.

This article discusses treatment for paranoid personality disorder. It explains how medication may treat paranoia and other conditions that can contribute to paranoid feelings.

What Is Paranoid Personality Disorder?

PPD is a personality disorder. It involves ongoing patterns of thinking and behavior that can involve distrust, suspicion, or even hostility toward others. People with PPD often believe others are exploiting, harming, or deceiving them without any objective evidence of this to others.

Symptoms include pervasive and unfounded distrust and suspicion that interferes with daily life and functioning. The onset may be linked to environmental and genetic factors but can also be tied to childhood trauma or social stress.

Many people who are paranoid are often able to work, attend school, and may appear to be functioning well. However, people who are in close relationships with a person who is paranoid will often notice behavior changes—at times, because they may even become the subject of a person’s paranoia.

Medication for Paranoia

There is currently no medication approved by the Food and Drug Administration (FDA) that specifically treats paranoid personality disorder.

However, antipsychotic or antidepressant medications may be prescribed for paranoid symptoms or to control co-occurring mental health conditions.

Antipsychotics

Typical and atypical antipsychotics can be prescribed to treat severe paranoia, particularly for people who have schizophrenia, bipolar disorder, or delusional disorder.

There are several antipsychotics that might be prescribed to treat paranoia, including:

• Abilify (aripiprazole)
• Risperdal (risperidone)
• Paliperidone palmitate long-acting injection
• Zyprexa (olanzapine)

Antidepressants

People with PPD often have co-occurring depression or anxiety. Selective serotonin reuptake inhibitors (SSRIs) used to treat anxiety and depression may help to reduce paranoia. SSRIs include:

• Celexa (citalopram)
• Lexapro (escitalopram)
• Paxil (paroxetine)
• Prozac (fluoxetine)
• Zoloft (sertraline)
  

Therapy for Paranoia

People with paranoia are often referred for psychotherapy. There are many types of psychotherapy, but cognitive behavioral therapy (CBT) has been shown to be effective at treating the pervasive symptoms of paranoia.

CBT can be done individually, but in the context of paranoia, research shows it is also effective in group settings. One randomized controlled trial of a group CBT program found that treatment was effective at lowering scores of paranoia.

Another randomized controlled trial of mindfulness-based cognitive therapy in groups of 10 to 15 people found that treatment significantly reduced feelings of paranoia and improved feelings of social acceptance.

Group therapy may seem counter-intuitive for people who are experiencing a deep mistrust of others. However, group settings create a safe space for people to confront these feelings with others who have similar feelings and experiences.

Paranoia influences relationships between partners, spouses, and families. Couples or family therapy might be recommended on a case-by-case basis.

What a Therapy Session Might Be Like

If you have paranoia, it is normal to feel distrustful of your therapist at first. In the beginning, you will focus on building trust and a therapeutic relationship with one another.

In your first therapy sessions, your therapist will listen to your concerns and may ask you a few questions. As you continue with therapy, your therapist might ask more probing questions to help you identify where your feelings are coming from and what’s triggered them.

You may feel more comfortable journaling about your paranoid symptoms to identify triggers rather than talking through them. Practicing relaxation and mindfulness techniques during sessions may also help you feel more at ease.

Natural Treatments for Paranoia

Some lifestyle changes may help reduce feelings of paranoia.

Nutrition

People with PPD may restrict their diet due to not trusting categories of food or the people who prepare it. Nutritional deficiencies can be common and may trigger symptoms. Working with a dietitian along with a therapist can help to ensure you are getting enough of the right nutrients.

Mindfulness

Mindfulness exercises, as well as yoga, yoga Nidra, tai chi, or meditation, may help you switch your thoughts to the “here and now” rather than focusing on past events or the intentions of others.

Sleep

Improving your sleep quality and quantity is shown to improve paranoid symptoms. A large randomized controlled trial found that treating insomnia was effective at reducing paranoia and hallucinations among participants.

Lifestyle Changes

For people who use substances, including alcohol, quitting or cutting back may also help control symptoms of paranoia, as substances can be a trigger.

Living With Paranoia

If you have paranoia, you may feel a constant push-and-pull between your desire to restore relationships and your paranoid thoughts and distrust of others.

Your doctor or therapist may recommend specific lifestyle changes, psychotherapy, or medication regimens that have been individualized according to your needs. However, people who are paranoid may find it difficult to trust doctors, therapists, and even prescribed treatments.

You will first need to build trust with your physician or therapist—a process that might take some time. Making some lifestyle changes, like working on your sleep hygiene, practicing mindfulness, and limiting substance use, is an important first step to managing symptoms of paranoia.

You may find that your biggest obstacle is maintaining healthy relationships with others. Paranoid thoughts can distance you from friends, family, and your spouse or partner. It can also affect your workplace and school relationships. This distance can feel isolating and further impact your mental well-being.

Try to communicate your feelings to your loved ones in a simple way. Focus on facts rather than assigning blame. You might find it easier to write them a letter rather than have a conversation in person. Remember that it’s just as important to listen to their point of view as it is to share your own.

How can I support someone with paranoia? 

If you have a loved one experiencing paranoia, they might try to push you away. You may struggle to find ways to support them that they will accept.

Try to avoid being defensive or taking their accusations too personally. Communicate with simple, factual language and do not assign blame.

Your loved one might be resistant to treatment as a consequence of their paranoia. Encourage them to seek treatment—be it psychotherapy, medication, lifestyle changes, or a combination of these options that best meets their needs.

If they consider you a trusted ally, your loved one might also benefit from having your support when they go to doctor or therapy appointments.

Finally, participating in a support group, counseling, or therapy for yourself is also beneficial. Taking care of your own health will help you be there to support your loved one.

Other Conditions Related to Paranoia

Paranoia is often associated with paranoid personality disorder, a mental health condition that is outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). However, paranoid personality disorder is relatively rare.

Paranoia itself is much more common and can be a symptom of other psychiatric conditions, including:

• Delusional disorder: A delusion is a fixed false belief. People with delusional disorder experience ongoing paranoia for one month or more that is not otherwise physiologically explainable. Delusions can be of jealousy or persecution, or fall into other categories. The person may feel that they are being conspired against and go to extreme lengths, including calling the police or isolating themselves.
• Schizophrenia: Schizophrenia is a mental health condition that is characterized by hallucinations, delusions, and disorganization. In previous versions of the DSM-5, paranoid schizophrenia was a subtype of this condition, however paranoia is now considered a positive symptom of schizophrenia (which means that it occurs in addition to typical mental function, as opposed to negative symptoms which take away from typical mental function). Some people with schizophrenia have paranoid delusions.
• Bipolar disorder: Some people with bipolar disorder experience paranoia, which is usually associated with delusions, hallucinations, or disorganization causing a loss of touch with reality. It is most common in the manic phase of bipolar disorder, although it can also be experienced during the depressive phase.
• Dementia: Dementia is an umbrella term for neurodegenerative conditions that affect memory and behavior, including Alzheimer’s disease and vascular dementia. People with dementia may have paranoid feelings related to the changes in their brain that are caused by the condition. The feelings might be linked to their memory loss, as people may become suspicious of others as a way to make sense of misremembering and misinterpreting events.

Summary

Paranoia treatment includes therapy, lifestyle changes, and prescription medications. However, treatment can be difficult because people who are paranoid might be distrustful of their doctors, therapists, and even the medications that have been prescribed to them.

While there is no specific medication for paranoid personality disorder, it is often treated with antipsychotic or antidepressant medications. Many people with PPD have co-occurring anxiety or depression and treatment with SSRIs may relieve paranoia as well.