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Paranoid Personality Disorder Treatment

Cynthia Levin, Psy.D. Updated: Oct 25th 2005

Personality disorders are typically some of the most challenging mental disorders to treat, since they are, by definition, an integral part of what defines an individual and their self-perceptions. Treatment most often focuses on increasing coping skills and interpersonal relationship skills through psychotherapy.

Paranoid Personality Disorder

Psychotherapy

As with most personality disorders, psychotherapy is the treatment of choice. Individuals with paranoid personality disorder, however, rarely present themselves for treatment. It should not be surprising, then, that there has been little outcome research to suggest which types of treatment are most effective with this disorder.

It is likely that a therapy that emphasizes a simple supportive, client-centered approach will be most effective. Rapport-building with a person who has this disorder will be much more difficult than usual because of the paranoia associated with the disorder. Early termination, therefore, is common. As the therapy progresses, the patient will likely begin to trust the clinician more and more. The client then will likely begin disclosing some of his or her more bizarre paranoid ideation. The therapist must be careful to balance being objective in therapy with regard to these thoughts, and of raising the suspicions of the client that he or she is not trusted. It is a difficult balance to maintain, even after a good working rapport has been established.

During times when the patient is acting upon his paranoid beliefs, the therapist's loyalties and trust may be called into question. Care must be used not to challenge the client too firmly or risk the individual leaving therapy permanently. Control issues should be dealt with in much a similar manner, with great care. Since the paranoid beliefs are delusional and not based in reality, arguing them from a rational point of view is useless. Challenging the beliefs is also likely to result in more frustration on both the part of the therapist and client, too.

All clinicians and mental health personnel who come into contact with the individual who suffers from paranoid personality disorder should be more keenly aware of being straight forward with this individual. Subtle jokes are often lost on them and allusions to information about the client not received directly from the client's mouth will raise a great deal of suspicion. Therapists should typically avoid trying to have the patient sign a release of information for information not essential to the current therapy. Items in life that usually wouldn't give most people a second thought can easily become the focus of attention to this client, so care must be exercised in discussions with the client. An honest, concrete approach will likely gain the most results, focusing on current life difficulties, which has brought the client into therapy at this time. Clinicians should generally not inquire too deeply into the client's life or history, unless it's directly relevant to clinical treatment.

Long-term prognosis for this disorder is not good. Individuals who suffer from this disorder often remain afflicted with prominent symptoms of it throughout their lifetime. It is not uncommon to see such people in day treatment programs or state hospitals. Other modalities, such as family or group therapy, are not recommended.

Medications

Medications are usually contraindicated for this disorder, since they can arouse unnecessary suspicion that will usually result in noncompliance and treatment dropout. Medications that are prescribed for specific conditions should be done so for the briefest time period possible to bring the condition under management. An anti-anxiety agent, such as diazepam, is appropriate to prescribe if the client suffers from severe anxiety or agitation where it begins to interfere with normal, daily functioning. An anti-psychotic medication, such as thioridazine or haloperidol, may be appropriate if a patient decompensates into severe agitation or delusionsal thinking, which may result in self-harm or harm to others.

Self-Help

There are not any self-help support groups or communities that we are aware of that would be conducive to someone suffering from this disorder. Such approaches would likely not be very effective because a person with this disorder is likely to be mistrustful and suspicious of others and their motivations, making group help and

References:
Portions are from Internet Mental Health, Copyright © 1995-1996 by Phillip W. Long, M.D.

Reader Comments
Discuss this issue below or in our forums.

family just accepted her behavior - - Feb 28th 2010

I believe my mother in law suffers from PPD. The entire family just accepted her behavior in the past and tried to laugh it off. Things have drastically changed in the last year. She has always talked of seeing ghosts or spirits in the past that were basically harmless. Her husband of 30+ years has had all he can take and decided for safety reasons to leave her. She habitually accused him of having an elaborate affair with another woman which also involved money scandals. She invesitigates endlessly on the computer looking up court records of real estate transactions. She left horrible, belligerent and profane messages on his cell phone saying things like, "when are you gonna go ahead and kill me?" and "I am going to blow your brains out if you think your gonna get away with all this!!" Now the visions of harmless ghosts in the past has turned into seeing assassins in the backyard trying to kill her which were hired by her husband. Since my father in law is now living with his other son and spends alot of time with my sister in law,  my mother in law has suffocated my husband with this craziness. She is untrusting of her other kids, thinking they are on their dad's side. Since my husband has endured a lifetime of this behavior, he is pretty much beaten into submission when it comes to standing up to her and saying "this is not going to be tolerated and you need to stop this behavior." He just nods in agreement or disbelief when she goes on a tangent or he tries to change the subject altogether. He pays dearly if he does not pay his dues and suffer through a visit with her as often as she sees fit. It has put a tremendous strain on our marriage. We disagree on treatment for her and treatment from her. I see her capability of being dangerous. She has a house full of guns and thinks people are trying to kill her. My husband does not or does not WANT to believe she is dangerous. The whole situation seems hopeless. We don't know what to do. She does not believe she is disturbed at all. She has been violent in the past when things were fairly good in her life. She is a ticking bomb. Her house is under full video surveillance or we would have already rid her of the guns. I have been studying PPD and the only behavior that she and 2 of her sisters exhibit that is not discussed with this disorder is vulgarity. They are very sexually explicit vulgar people. She is not a hoarder but there are a lot of hoarders in the family. She is very tight with her money. She would never lend or give money to her kids or grandkids. She has done pretty much anything, including illegal acts, to gain financially. She was physically abusive to her children but raves on how loving and caring she has been to them. She starves for attention, but only from family because she has NO friends whatsoever. The entire community knows and understands that she, her parents and siblings are mentally disturbed and keep their distance. What do we have to wait on to happen here before we can do anything? I think my father in law should take a restraining order out on her. He has changed his cell phone number but won't go any further than that in fear of provoking her. We live in a very small town and this is very humiliating and stressful for my husband and everyone else involved. Is there anything we can do?

Is there Any Help? - SS - Feb 23rd 2010

I have a brother who has been married to a troubled spouse for 14 years. We have basically discovered this person has a paranoid personality disorder - after suspecting for years something wasn't right. She has been so secretive as to not ever let anyone  access or know about her medical history. She is VERY CONTROLLING, and has 3 children - one married daughter, one child in high school (who's struggling with dealing with this), and an elementary age daughter. This mom has terminal cancer. We definitely know this because my brother has seen the x-rays and has taken her for radiation treatments.  The problem is...she is getting crazier, and has called the police on my brother twice, claiming he was abusing her. The kids were at home, etc. so the little one marches into school that morning saying she was late and telling everybody that Mommy had to call the police because she said Daddy was abusing her. My brother had gone into their bedroom to retrieve a cell phone that was ringing, it was dark, and the lights were off, so he used a flashlight to see. She woke up screaming, asking if he was going to beat her with the flashlight. My brother is TERRIFIED of her, and is basically a prisoner in his own home. The entire family needs counseling, but there is no money, and if my brother took the kids to get help, then it would send his wife on another vindication campaign because he tried to get the kids some help, as well as himself. She stays out all hours of the night -- spends most of the time at IHOP instead of at home with her family. She also works. She is taking morphine to help with her cancer pain....but is not supposed to drive a car, which we recently found out.  She is a compulsive hoarder at home, you can barely walk in the house. Does anyone know what we can do to get this family help w/out having to wait for the cancer to take over her body? She is very mixed up. Went out and had a will made up w/o involving my brother, and plans to leave her share to her married daughter -- which means my brother will likely loose his house, while having to pay for her funeral too. She has her older daughter convinced that my brother is terribily abusive and mean. The daughter supports her mom, and behaves very much like her mom. I don't believe they've ever been told NO to anything they wanted to do. We don't know what to do! Can you offer me some suggestions to share with my brother? He's contacted lawyers -- they suggest a divorce -- but he doesn't want to do that due to the fact that she is dying, and it would be worse on the kids. There is also the risk of losing his alimony if a divorce occurred. As a solution, my bro invited the mother in law to come stay with them to observe all that is going on. She stayed one day, agreed her daughter was paranoid and left. I've told my bro to collect all the stuff she's been buying that has price tags on them to return to the store and get a cash rebate or something for them. We also demanded that he get a different checking account just to put his paycheck in so he can have some money to protect himself with. He's too chicken to even let her know he's on to her. HELP!!! This family lives in DFW. Anyone with advice for low-cost counseling....please let me know of a contact for them. Pyschiatric counselors have also told my brother that he can't get help for her because they claim the morphine is causing her to be crazy, and we probably can't prove she has a very serious mental problem.

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