Individuals with Paranoid Personality Disorder (PPD) usually have prevalent distrust and suspicion of other people that has lasted for a long time. They will almost always distrust other people’s intentions, sometimes even thinking their motives are evil. While there is no evidence to support their beliefs, people with the disorder think others will exploit, harm or deceive them.

It’s normal for people to have a certain amount of paranoia in some situations in life, such as the worries of being laid off from work. However, individuals with the disorder are acutely worried, causing it to penetrate every area of their lives, including their career and personal relationships.

People with the disorder are usually hard to get along with and have challenges with close relationships. Their extreme suspiciousness, as well as resentment and animosity toward other people, may result in arguing and repeated complaints or hostile indifference to others. They are overly watchful for possible threats, causing them to act guarded, covert or seemingly dishonest. This makes them appear cold and void of any warm feelings. Their expressions will usually show hostility, inflexibility and bitterness. The way they come across—belligerent and suspicious—usually generates a hostile reaction from other people and validates their original expectations of others.

PPD is diagnosed in 2.3 to 4.4 percent of the nation’s population and is more frequently found in males than in females. Just like other mental illnesses, PPD can develop in anyone—the wealthy or poor, educated or not, and the famous or unknown.

Diagnostic and Statistical Manual of Mental Disorders’ (DSM-5) Criteria

According to the DSM-5, which is published by the American Psychiatric Association (APA), four of the features from the following criteria must be present to diagnose an individual with PPD*.

  • Believes other people are using, lying to or harming him, but there’s no proof of it.
  • Has doubts about the faithfulness and dependability of other people.
  • Doesn’t disclose any information to others because of a belief that the confidence will be betrayed.
  • Reads into others’ remarks–even when they’re spoken in a friendly way–as being hurtful or threatening.
  • Holds grudges.
  • Without any evidence, believes his reputation is being attacked by others and will get back at them in some way.
  • Without any reason, feels jealous and suspicious of partner being unfaithful.
  • Hypervigilance to physical, verbal or social attacks.
  • Few, if any, close or intimate relationships.
  • Aloof, cold, distant, argumentative.
  • Frequently complaining.
  • Appears guarded and secretive.
  • Appears rational, logical and unemotional, but will sometimes be sarcastic, uncompromising and unfriendly.
  • Has a difficult time getting along with others.
  • Does poorly in group settings and team projects.
  • Highly critical of others.
  • Response to criticism is met with belligerence and opposition.
  • Extreme need to take care of himself because of mistrust in others; strongly independent because of mistrust.

*According to the DSM-5, the symptoms above will not occur during a psychotic episode in schizophrenia or bipolar or depressive disorder with psychotic features. A qualifier is that if the diagnostic criteria for PPD is met prior to the onset of schizophrenia, it should be noted that PPD was premorbid.

What Causes PPD?

While the cause of PPD is unknown, researchers think a combination of biological and environmental factors can lead to it. The disorder is found more often in families that have a history of schizophrenia and delusional disorders.

Features of PPD may be seen in childhood and adolescence. Early childhood trauma may be a contributing factor to PPD’s development. Children may behave oddly, which results in teasing from others. According to the APA, questions arise about a premorbid condition. For example, a child who acts abnormally and is then rejected by his peers may learn to distrust others and become suspicious of their intentions. It can be a contributing factor in developing a paranoid personality.

Is There Treatment for PPD?

Treatment can be effective in controlling the paranoia, but it may be difficult because the individual may have suspicions about the therapist. However, if left untreated, the disorder will be chronic.

Many consequences of the disorder may need to be addressed, such as loss of a job and housing, as well as disruption in family relationships. Additional help from programs like family self-help, services for housing and career assistance may help to alleviate the stress of the symptoms of PPD.

Psychotherapy is the best method of treatment for PPD because, many times, individuals with the disorder have ingrained problems with interpersonal functioning. However, because of their mistrust of people, often including the therapist, people with PPD usually don’t seek treatment. If they’re in treatment, they often decide to end it too soon. Most people with PPD experience its symptoms throughout their life and need steady therapy.

Famous People with PPD

Josef Stalin and Saddam Hussein either displayed some of the symptoms or had PPD. People close to the men, who observed their behaviors, found they didn’t trust others and were constantly suspicious of legitimate acts of kindness. They were also very often hostile and argumentative. The following are two others that seemed to have all the signs of PPD.

Nixon was a two-term president, the Governor of California and the leader of the Republican Party. His leadership helped build a relationship with China. With all of his diligence and industriousness, he was also an example of an individual with PPD. With little to almost no trust in other people, it caught up to him and cost him the White House. Known to be paranoid, he’d spend inordinate amounts of time investigating people, such as John Lennon. In addition, he taped all conversations in the White House and, ultimately, authorized the break-in at the Watergate Hotel. Nixon was known to be a devoted parent who loved his mother.

There have been a lot of theories about Adolph Hitler’s psychiatric profile throughout the years. Fritz Redlich, in his book “Hitler: Diagnosis of a Destructive Prophet,” believes that Hitler showed solid symptoms of PPD in addition to Narcissistic Personality Disorder.