If you or a loved one is starting treatment, you might be wondering what the early stages of treatment will bring, especially in the form of positive changes.

What is Paranoid Personality Disorder?

Paranoid personality disorder is a type of personality disorder characterized by mistrust of others and a belief that people are deceiving or trying to harm them. This generally means suspicion, paranoia, excessive secrecy and even hypersensitivity to criticism.

The Challenges of Paranoid Personality Disorder Treatment

The biggest challenge in paranoid personality disorder treatment is the fact that most people with the condition won’t seek help. It is unclear whether this is due to a belief that they don’t need help or if it is due to an active mistrust of therapists. Either way, people with paranoid personality disorder often show up only when seeking treatment for another issue, or after being coerced into treatment by a loved one.

For those that attend therapy sessions, there are more challenges. Therapists generally ask probing and unwelcome questions about the past and present, trying to build a rapport in an intrinsically forced or contrived situation. The result is often mistrust of the therapist. This presents additional obstacles and further impedes progress because trust and collaboration are central to the process.

Most Impactful Initial Steps in Paranoid Personality Disorder Treatment

It might sound simple, but both attending treatment and getting to know and trust a therapist are big steps for many people with paranoid personality disorder. For many, attending therapy means giving up the idea that they don’t need support.

Getting to know and trust a therapist is an important initial step, but it can be impactful because it helps people understand that other people can be trustworthy, if given a chance. Developing a trusting relationship is one of the therapist’s main goals, especially early in the process. But it can take some time.

Impactful steps in paranoid personality disorder treatment depend on the individual. One case study tells the story of a patient who spoke about some relevant childhood experiences in an early session, but then feared he’d “shared too much” upon having an interpretation read back to him. The therapist encouraged him to read it to himself–in the session and as “homework”–and think about the story. This led to him accepting that his relationship with his father may have had a role to play in the development of his condition–a major step forwards.


Not all sessions will make a huge difference, and sometimes it will feel like paranoid personality disorder treatment is a slow process. However, if you keep attending, there will very likely be impactful and life-changing moments just around the corner.



“Are You Looking at Me? Understanding and Managing Paranoid Personality Disorder” (2009) by Andrew Carroll http://apt.rcpsych.org/content/aptrcpsych/15/1/40.full.pdf


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