From the Research
The treatment of choice for Paranoid Personality Disorder (PPD) is psychotherapy, specifically Metacognitive Interpersonal Therapy, as it has shown to be effective in reducing paranoid ideation and improving interpersonal sensitivity. This approach helps patients identify distorted thinking patterns, develop trust with the therapist, and learn healthier ways to interpret others' intentions 1. Unlike many psychiatric conditions, medication is not the primary treatment for PPD but may be used adjunctively to target specific symptoms. For example, low-dose antipsychotics like risperidone (0.5-2mg daily) or quetiapine (25-200mg daily) might help reduce paranoia in acute situations, while SSRIs such as sertraline (50-200mg daily) may help with accompanying anxiety or depression.
Some key points to consider when treating PPD include:
- Building a therapeutic alliance is crucial, but challenging due to the patient's inherent mistrust 2
- A supportive, non-confrontational approach works best, with gradual exposure to social situations as trust develops
- Treatment is typically long-term, requiring patience and a collaborative effort between the patient and therapist
- Cognitive analytic therapy has also shown promise in treating PPD, with a focus on narrative reformulation and relational therapy 3
- The biological basis for this approach recognizes that personality disorders involve deeply ingrained patterns of thinking and behavior that respond better to psychological interventions than medication alone.
It's worth noting that while other forms of therapy, such as cognitive-behavioral therapy (CBT) and schema-focused therapy, may also be effective, the most recent and highest quality study suggests that Metacognitive Interpersonal Therapy is a promising approach for treating PPD 1. Additionally, antipsychotic medication may be used in some cases, but its effectiveness is still being studied and its use should be carefully considered on a case-by-case basis 4.