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Online Therapy for Paranoid Personality Disorder

Phi Atratus
  • Mar 21, 2022
  • 5 min read
Woman indoors on sofa at home feeling stressed

Experiencing paranoid personality disorder (PPD) or having someone in your life diagnosed with PPD is quite challenging. Human connection is seriously impaired for people with PPD because of their extreme mistrust and suspiciousness towards others. Living with someone with PPD is equally as hard because you often become the source of suspicions and hostility.

PPD affects 2.3% to 4.4% of the U.S. population, being diagnosed more often in men than in women. In 2004, PPD was the second most common personality disorder in the U.S., after OCD, with 4.41% and 7.88% prevalence, respectively.

Fortunately, even if there’s no definitive cure for paranoid personality disorder (PPD), therapy has been found to sustain remission of its symptoms. Classic or online therapy can help with rationalization, dilution of paranoid anxiety and mistrust, and awareness of the personal processes.

Read further to find out more about paranoid personality disorder treatment, causes, and signs in daily life.

Symptoms of Paranoid Personality Disorder

PPD is a psychiatric issue that involves intense suspicions, mistrust, and grudge towards the outside world. There are also some other symptoms that can signal a dysfunctional thinking and behavioral pattern:

  • Believing others are using them or lying to or harming them, without objective evidence on the matter
  • Not confiding in anyone due to fear of their confidence being betrayed
  • Holding grudges
  • Doubting others’ intentions, loyalty, and trustworthiness
  • Interpreting ambiguous or vague remarks/gestures as harmful and threatening
  • Excessive self-importance and hostility towards others
  • Intense rumination of paranoid ideas
  • Fanatic, expansive thinking and behavior
  • Intense jealousy
  • Vengeful thoughts and plans

The PPD belief system can lead to fanaticism, aggression, stalking, and negative social behavior. All of this is enhanced when PPD occurs with other psychiatric conditions.

Do I Need Therapy?

In-person and online therapy for paranoid personality disorder takes into account its comorbidity with other conditions. Literature states that 75% of PPD cases are experiencing other personality disorders too. 

The most common PPD comorbidities are avoidant and borderline personality disorder (48%) and narcissistic personality disorder (35.9%). PPD combined with an antisocial personality disorder is the second most common psychopathology in criminality, after narcissistic and antisocial personality disorder.

If you want to know how to deal with paranoid personality disorder, it’s important to know its roots. It is highly linked to childhood trauma, especially with emotional and physical neglect, as well as forms of abuse: physical, sexual, or emotional.

Having a psychiatric history in your family, such as unipolar depression and delusional disorders, is also a risk factor for developing PPD. Other risk factors involve low income, being part of a minority, and relational separation history (divorce, significant other’s death, conflict, or celibacy).

PPD is a complex challenge and needs professional care. Because of its core mistrust, starting a psychotherapy treatment for paranoid personality disorder is difficult. Once started, it manages to strengthen social skills and self-awareness, reduce anxiety, and diminish feelings of inadequacy.

A stable process of dialogical therapy for paranoid personality disorder has been found to improve interpersonal relationships and social life, reduce depressive symptoms, soothe anxiety, and promote academic/employment stability.

How to Deal With Paranoid Personality Disorder

Before starting out in-person or online therapy for paranoid personality disorder, self-help activities can assist with PPD symptoms. However, these are not treatment options, and they need to complement classic or online counseling.

1. Journal your paranoid thoughts

Take a few minutes each day to write down your paranoid thoughts, your vengeance plans, or feelings about certain situations and persons with complete freedom.

Making this a constant habit will help you express ideas and emotions that you may not want to share with anyone. Plus, going over your notes can help you gain a sense of awareness over repetitive thinking patterns and PPD tendencies.

2. Meet your physical needs

Make a daily schedule for meals and sleep. You can put in place some measures to assure your food is good and your sleep will be safe (keep a light on or eat unprocessed food). 

You can gain a sense of certainty from eating and sleeping on your terms. Plus, having a well-nourished body will keep you healthy, help you relax more easily, and improve your overall mood.

3. Relax through breathing

Try out the 4-7-8 breathing technique. Sit comfortably on the floor, bed, or a chair and breathe deeply into your stomach. Silently inhale through your nostrils to the count of 4, hold it in to the count of 7, then exhale with a sound to the count of 8. You can exhale silently if you prefer to.

Breathing into your diaphragm and not your chest calms down your nervous system.

4. Anonymously call a helpline

If you can not go to a therapist’s office, you can call a dedicated mental health helpline and talk about your thoughts and suspicions. You can also try online counseling in the form of text or audio messages, anonymously or under a fake name.

These anonymous conversations can help you relieve tension, bring you objective feedback on your thoughts, exercise your ability to trust someone, and increase your social skills.

Psychotherapy Treatment for Paranoid Personality Disorder

When PPD is associated with other disorders, as discussed earlier, treatment can involve medication as well as psychotherapy. The therapy goals for PPD are helping the client better accommodate to social contexts, build trust in relationships, and gain more control over their thoughts.

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There are several therapy approaches that showed efficiency in achieving these goals for people with PPD. We’ll detail some of them further.

Dialectical behavior therapy – DBT therapy for paranoid personality disorder

DBT is a therapeutic approach that integrates cognitive therapy principles and oriental theory. DBT for paranoid personality disorder aligns both acceptance for the client’s current state and recognition for his need to change. The specific behaviors, and not the person, are the subject of change. 

DBT sessions for PPD are explicitly exercising social skills: practice confiding in others, chit-chat, social conventions, and letting go of vague judgments.

What to expect from your DBT professional? They will take your paranoid thoughts as partly true. You can be invited to reframe those thoughts, talk about what you’d do if people weren’t so ill-intentioned, and practice non-hostile engagement in social interactions through role-playing.

Cognitive behavioral therapy – CBT therapy for paranoid personality disorder

Cognitive behavioral therapy is based on the idea that dysfunctional behaviors are driven by internalized dysfunctional thinking patterns. This theory applies to the functioning of paranoid processing with great precision.

CBT uses therapeutic tools to promote visible change in their client’s life. Some of the therapy techniques for paranoid personality disorder are thought and behavior monitoring, role-playing, cognitive restructuring, and relaxation methods. You may also have homework to complete between sessions.

What to expect from your CBT professional? They can invite you to reflect on your paranoid ideas out loud, ask you to repeat what you’ve said but with changing certain words, give you explicit advice, encourage you to trust others with small tasks, and evaluate the results in the session.

Psychodynamic therapy for paranoid personality disorder

In psychodynamic therapy, paranoid personality disorder is seen as a generalized externalization of an inner conflict. For a psychodynamic therapist, it would be more natural to address the possible source of PPD, such as childhood trauma.

Psychodynamic therapy is a type of talk therapy that uses few to no therapy methods to change behaviors. It focuses on processing trauma and feelings attached to it. 

What to expect from your psychodynamic professional? They will have an empathetic attitude towards you, inviting you to go further explore paranoid thoughts. You’ll be asked relevant questions about your past and present; you’ll make associations and address subconscious aspects of life, such as dreams.

Is Online Therapy Effective?

There are more and more modern paranoid personality disorder treatment options. One of them is online counseling. It has some advantages you’d like to consider if starting classical treatment is yet unreachable for you:

  • Easier accessibility, directly from your home
  • Reduced costs, as office renting expenses, are not necessary
  • More schedule flexibility to reschedule sessions
  • It can even be anonymous if mutually agreed with the therapist
  • More therapist options, not limited to your area or city

Online therapy is not much different from in-person sessions, especially in the conversation-based approaches. Some cognitive behavioral therapy techniques can even be applied virtually. Yet, online therapy for paranoid personality disorder is a good way to start treatment.


Considering yourself used, lied to, and betrayed is certainly not an easy way to navigate through life. Professional PPD interventions help you by decreasing tension and suspicious thoughts, reducing anxiety and depression, and improving social relationships. 

Cognitive behavioral, psychodynamic, and dialectical behavior therapies for paranoid personality disorder are the most efficient methods, but there are more options available. 

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