How to Help an Adult Child with Paranoid Personality Disorder

The symptoms of paranoid personality disorder encompass a spectrum of emotions, thoughts, and behaviors that typically emerge in early adulthood, including:

• Doubting others’ trustworthiness, loyalty, and intentions due to a belief that others will harm, deceive, or exploit them
• Reluctance to disclose personal information or confide in others for fear that information will be used against them
• Reluctance to forgive others for real or perceived wrongdoing
• Perceiving benign behaviors of others as having hidden meanings
• Believing that others are attacking their character or reputation, despite these attacks not being apparent to others
• Recurrent suspicion that their partner is being unfaithful
• Susceptible to unjustifiable hostility, argumentativeness, stubbornness, coldness, control issues, or jealousy, often interfering with the ability or willingness to form and maintain relationships
• Inability to admit mistakes or understand their role in conflicts

In order to receive a diagnosis of paranoid personality disorder, these symptoms cannot be fleeting or temporary. Rather, they are enduring in nature and must be “rigid, inflexible, maladaptive and of sufficient severity to cause significant impairment in functioning or internal distress.” Additionally, the paranoia of the disorder is not the product of psychosis such as the hallucinations or delusions experienced by people with schizophrenia, schizoaffective disorder, and, sometimes, bipolar disorder. Paranoid personality disorder symptoms arise not from a break with reality, but from an overwhelming fear of being harmed, particularly in interpersonal relationships. But while people with this condition remain connected to reality, the distrust and the behaviors it spurs are not malicious. Rather, they are rooted in a desire for self-preservation.

Despite lack of malice, the symptoms of the condition can be extremely hurtful for others. As the parent of an adult child with paranoid personality disorder, you have likely borne the brunt of this symptomatology; your words may have been twisted to mean things they don’t, and your child may have pushed you away due to their paranoia. The disorder may also have caused your child to lash out at you or accuse you of things you haven’t done, leaving you with devastating feelings of confusion, sadness, and powerlessness. Witnessing how the disorder affects your child’s other relationships as well as their life in general can also be painful and disheartening; rather than seeing your child thrive, you watch them retreat into their paranoia, often becoming socially isolated and professionally compromised. For parents, this can be particularly distressing, as your love for your child means you want them to live a healthy, happy, and productive life.

Most people with paranoid personality disorder will not seek treatment independently, partially due to being suspicious of doctors or blaming their problems on others. As such, parents often become instrumental in urging their adult children to seek diagnosis and treatment. This treatment may include a variety of therapeutic modalities, with cognitive behavioral therapy typically acting as the central feature of treatment. While paranoid personality disorder treatment historically focused on patients ignoring paranoid thoughts, cognitive behavioral therapy helps them to examine these thoughts and understand how they affect their experiences. As awareness grows, their therapist can guide them through a variety of behavioral experiments that test their paranoid assumptions in order to gradually build trust and learn how to better differentiate between good, neutral, and harmful intent. In this way, your adult child can work through their symptoms in a rational way while fundamentally challenging their assumptions and replacing harmful patterns of thought and behavior with healthy alternatives. Psychotherapy may also be combined with certain psychotropic drugs that target specific symptoms, including antipsychotics and anti-anxiety drugs.

However, even when parents intervene, many people struggling with paranoid personality disorder only agree to come to treatment once their condition has deteriorated to the point where they are in great distress and their functional limitations become undeniable. At this level of severity, long-term residential care may be the best option. In this environment, your adult child will be able to engage in a full spectrum of therapies delivered by expert clinicians who understand the unique challenges presented by clients who have paranoid personality disorder. By working closely with high trained therapists in a long-term setting, deeply rooted dysfunctional thoughts, emotions, and behaviors can be explored, new learning can be fully integrated, and functionality can be enhanced.

Part of the benefit of long-term residential treatment settings is the opportunity they afford for social interaction and learning, particularly for people whose mental illness manifests in social relationships. In a safe environment, your adult child will be able to try out new modes of thinking and behaving as they begin to establish supportive relationships with other clients. However, peer relationships are not the only relationships that can benefit from residential care; a high-quality treatment program will recognize that your involvement as a parent is an instrumental part of healing. By offering dedicated family programming and family therapy, these programs allow you to work closely with your loved one to explore the impact of paranoid personality disorder on your relationship, establish appropriate boundaries, improve communication, resolve conflict, and create healthier relationship dynamics. In this way, you can learn the skills to support your adult child through the treatment process while establishing a strong foundation of trust that can redefine how you relate to each other. Simultaneously, family programming ensures that you are getting the support you need to stay healthy and that your level of involvement is appropriate for each stage of the recovery process.

Symptoms of paranoid personality disorder, like other personality disorders, typically diminish with age. However, paranoid personality disorder is considered to be a chronic condition and one that will likely require long-term maintenance in order to prevent relapse. While treatment, particularly long-term residential treatment, can create significant and durable healing, it is essential to understand that recovery must be an ongoing process and your adult child will need your support after treatment.

Ideally, your adult child should emerge from residential treatment with renewed emotional regulation, stability, and functionality. In order to maintain those gains, it’s critical that a continuing care plan is put in place to provide the resources they need in order to stay healthy. While it’s important that your adult child manages their own recovery—and their time in treatment should prepare them for that—it is helpful to be encouraging of their efforts and show that you support them. However, remember that supporting their recovery isn’t the same as controlling their recovery. can be tempting to want to take charge in order to prevent relapse, but resisting that urge and allowing them to practice their new skills is vital to their healing process. This is a time for both of you to put your new learning to the test and maintain healthy boundaries that allow each of you to grow and trust in each other’s intentions and abilities.

As part of ongoing recovery, you may want to continue family therapy when your adult child leaves residential care. With the support of a therapist who has experience working with parents who have an adult child with paranoid personality disorder, you can expand on the work you have done in residential treatment and ensure that the transition out of residential care is successful for both of you. Simultaneously, you may want to seek individual therapy or a peer support group in order to process your own feelings about your child’s condition and its impact on your life as well as your relationships with other family members. For many parents, getting support at this critical stage of recovery is particularly crucial, as recovery itself can bring up complex and difficult feelings about your changing role in your child’s life and in your family as a whole. Learning how to navigate through the challenges of healing in the company of others who share your experience will be invaluable to creating healthier relationships and building on the progress made in residential care. Don’t be afraid to reach out—there are other families who have been where you are and can offer their wisdom and camaraderie to strengthen your own family’s healing process.

As a parent, you know the pain of watching your adult child struggle with paranoid personality disorder. That pain, however, is not unavoidable. With the right care and your support, your child can receive the treatment they need and your family can begin a journey of change, growth, and discovery. Together, you can move toward a richer shared future and more fulfilling lives.