Understanding yourself
Paranoid personality disorder
“Everyone wants something from me. I trust no one.”
A long-standing pattern of suspicion that costs people their relationships and work. Careful therapy can loosen it.
Mahbub built a successful import business and has fallen out with every partner he ever had. He reads betrayal into a late reply, keeps records of slights going back years, and has recently started to suspect his own son of plotting to take the company. He sleeps with the office keys under his pillow.
An illustration drawn from common experience. The person is invented; the pattern is not.
Understanding paranoid personality disorder
Paranoid personality disorder, a diagnosis named in the American DSM-5 (ICD-11 now describes personality problems by severity and traits instead), is a long-standing pattern of distrust and suspicion of others, without enough evidence: expecting to be exploited or deceived, reading hidden threats into innocent remarks, holding grudges, and reluctance to confide in anyone. Unlike psychosis, the person keeps contact with reality, but the suspicion damages relationships, work and family life. Depression, anxiety and alcohol problems often come with it.
Signs and symptoms of paranoid personality disorder
- Persistent suspicion of partners, colleagues or family without evidence
- Holding grudges for years
- Reading insults or threats into ordinary remarks
- Isolation, and conflict at work and at home
Treatment for paranoid personality disorder
People with this pattern rarely seek help for the suspicion itself, more often for its consequences: conflict, depression or stress. A careful, respectful therapeutic relationship is the core of treatment, along with treatment of any depression or anxiety. Medication may help with some symptoms.
What getting better can look like
Mahbub might manage a single conversation with his son that does not end in accusation, and put the office keys back in the drawer.
Common questions about paranoid personality disorder
What is the difference between paranoid personality disorder and psychosis?
In paranoid personality disorder, suspicion of others is a long-standing pattern, but the person keeps contact with reality. In psychosis, contact with reality is lost, for example through delusions or hallucinations. A psychiatrist can tell the two apart and check for depression, anxiety or alcohol problems alongside.
How can you help someone who trusts no one, not even doctors?
People with a deeply suspicious pattern rarely seek help for the suspicion itself, more often for its consequences, such as conflict, depression or stress. A careful, respectful relationship with a clinician is the core of treatment. Worried family members can also come for a consultation on their own.
When to see a psychiatrist
If suspicion has been costing you relationships for years, or you are worried about a family member, a consultation is a confidential place to start.
Care here is personal: built around your history, your health and what you want to change, and reviewed with you as it goes.
If you or someone else is in immediate danger, call 999 or go to the nearest hospital emergency department.
If some of this sounds familiar, a first conversation is a good place to start. You do not need the right words, or to be certain.
Dr. Tajreen is consulting in Uttar Badda now, until 8:00 pm. Call +880 1847-331010Every address and its hours
Sources
- World Health Organization, ICD-11 for Mortality and Morbidity Statistics, 6D10 Personality disorder
Watch Dr. Tajreen explain
You do not need to have everything figured out before you begin.
