The standard treatment for paranoid personality disorder (PPD) is long-term psychotherapy and possibly use of medications to address anxiety or delusional thinking. While this is standard, it’s not easy to deliver either of these forms of treatment due to the nature of this disorder. People with this condition often won’t seek treatment and they usually don’t come to therapy unless they’re experiencing some external crisis or problem that may be only minimally related to PPD. Establishing a therapeutic alliance with these clients is very challenging because they are likely to have pronounced distrust of the therapist, and they very often leave treatment before they can be helped. This is unfortunate, since in absence of therapeutic assistance, some people with this condition will become so consumed by paranoia they will end up hospitalized.
When a person with PPD does seek assistance, treatment for paranoid personality disorder can begin in earnest, but it must progress slowly. For the therapist, the main concern is building trust with the client and trying not to introduce anything into initial sessions that would raise the discomfort level of the PPD sufferer to the point where profound suspicion of the therapist causes treatment failure. As trust is built, therapists could use a variety of techniques to address the negative behaviors associated with this disease. Sometimes behavioral approaches can be used to help calm anxiety, but these can only go so far in helping a person shed strong paranoia. Ultimately, small confrontations about the inconsistencies in belief structures must occur, but if these happen at the wrong time or are too intense, the therapist loses a client and the client loses out on ability to get treatment.
Drug therapy may be a useful adjunct to psychotherapy treatment for paranoid personality disorder. There are several medicines that are used, including tranquilizers for anxiety, selective serotonin reuptake inhibitors (SSRIs), other newer antidepressants, and atypical antipsychotics. Again, clients could be particularly suspicious of drugs, feeling they're meant to control the mind.
Some clients with these fears automatically reject drug treatment for paranoid personality disorder. This is unfortunate as it might be useful to control some of the negative side effects of PPD. On the other hand, drugs aren’t strictly necessary and cannot cure the disorder.
Other types of treatment for paranoid personality disorder have been suggested, including family therapy or self help strategies. At present, there are few studies that prove their efficacy. Types of therapeutic models, like brief therapy, are also not thought very effective for this condition. The only thing that seems potentially curative is extensive psychodynamic or object-relations therapeutic approaches, and even here, the level of illness can be so significant that these methods fail because the client’s trust of the therapist cannot be gained or sustained.
