Paranoid personality disorder can lead to unwarranted distrust, jealousy, and feelings of persecution by others. This may affect all types of relationships. Various strategies can help people cope.


Paranoid personality disorder is a mental health condition that affects an individual’s thinking, feelings, and behaviors. People with paranoid personality disorder may become distrustful and suspicious of others. It may cause feelings of persecution without a threat.

Because of the intense feelings and thoughts that having paranoid personality disorder can cause, it may interfere with relationships with family, friends, and coworkers. Learning how to cope with the condition in a relationship can promote support and improve communication.

This article covers what paranoid personality disorder involves, how it may affect relationships, and how to cope with it.

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Paranoid personality disorder involves a pattern of unwarranted suspicion and distrust of others. It is one of the most common personality disorders.

According to the National Institute of Mental Health (NIMH), among adults over age 18 years in the United States, the prevalence of any personality disorder is about 9.1%. Estimates of paranoid personality disorder range from about 2.4 to 4.41%.

Individuals with paranoid personality disorder may experience the following:

  • intense mistrust of others
  • reluctance to confide in people and open up
  • unforgiveness
  • hypersensitivity to perceived criticism
  • tendency to remain distant in relationships

Learn more about paranoid personality disorder.

Paranoid personality disorder can have a significant impact on relationships. About 75% of people with paranoid personality disorder also have an additional personality disorder.

This combination of personality disorders can make it even more difficult to navigate relationships.

Depending on the nature of the relationship, paranoid personality disorder can lead to symptoms of paranoia, such as extreme mistrust and suspicion. It can cause someone without justification to feel that their romantic partner is unfaithful.

An individual with paranoid personality disorder may find it difficult to open up and reveal personal information. This can hinder the development of close friendships or romantic relationships.

Paranoid personality disorder may lead to misinterpretation of harmless actions and statements by others. This can cause conflict with all types of relationships, including working with colleagues.

There are various things someone can do to cope with and support a loved one with paranoid personality disorder or another mental health condition. It is helpful to understand that everyone is different, and recovery is an ongoing process.

Communicate clearly

Communicating clearly is an important early step in helping someone cope. Being concise and clear helps reduce misunderstanding, which can lead to distrust. Clear communication also helps establish expectations and boundaries.

Acknowledge their feelings

To someone with paranoid personality disorder, their feelings are real. According to the National Alliance on Mental Illness (NAMI), it is helpful to acknowledge the person’s feelings but also try to redirect their fears. Showing respect for someone’s feelings may help de-escalate a situation and calm fears.

Try not to argue or dismiss their beliefs

It is not helpful to reinforce delusions of paranoia. However, at the same time, arguing and dismissing beliefs and thoughts is often not helpful either. Taking an argumentative approach may only fuel anger and paranoid thoughts.

Set boundaries

It is important to set boundaries with someone with paranoid personality disorder, even if they are a loved one. Setting boundaries helps a loved one take responsibility for their actions and understand expectations. It also may foster a sense of independence.

Practice self-care

It is important to practice self-care. Finding ways to relax, unwind, and recharge helps someone become better able to support their loved one. Self-care suggestions from the American Psychiatric Association (APA) include:

  • maintaining regular contact with family and friends for fun and support
  • doing some form of relaxing practice, such as yoga, meditation, or breathing exercises
  • exercising regularly, which is an effective way to reduce stress and help someone feel better
  • trying to get enough sleep, as lack of sleep can make it more challenging to handle stress

The following are answers to some questions people frequently ask about paranoid personality disorder.

What triggers paranoid personality disorder?

This 2017 review found that multiple studies cited childhood trauma as a risk factor for paranoid personality disorder. This trauma may include childhood emotional and physical neglect.

How do you calm someone with paranoid personality disorder?

Every person differs in what may help them calm down. However, in general, remaining a good listener, having a caring approach, and keeping a calm voice and demeanor can all help calm a person.

What is the most difficult personality disorder to treat?

Experts do not state which personality disorder is definitively the most difficult to treat. Individual symptom severity may vary. However, certain personality disorders appear more challenging to treat effectively.

Paranoid personality disorder is among the disorders that are difficult to treat. Additionally, according to the Substance Abuse and Mental Health Services Administration (SAMHSA), antisocial personality disorder also tends to be difficult to treat.

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Paranoid personality disorder is a mental health condition that can lead to feelings of distrust and suspicion of others, even without a real threat. This may adversely affect relationships.

Strategies to cope with a loved one with paranoid personality disorder may include setting healthy boundaries, acknowledging their feelings, and practicing self-care.