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Paranoid personality disorder (PPD) is one of ten personality disorders currently recognized by the DSM-V. The characteristics of PPD center around mistrust and paranoia permeating one’s thoughts and behaviors. Teens struggling with PPD are extremely suspicious of others, often lash out, struggle to interact with others in a healthy way, and misinterpret random or innocent events, words, and gestures as somehow malicious and personal.

How do you treat someone who is fearful of everything around them, constantly worries about being manipulated, and suspects that there is a plot against them hiding behind every corner? Very carefully. Most of the treatment options for teens with paranoid personality disorder center around psychotherapy and rely on the quality of the relationship between the teen patient and their psychotherapist.

Experience with the condition and how best to treat it is an important premium in these cases, as therapists must gain their patient’s trust for any therapy to be effective. Insisting that each therapeutic session is a collaborative effort is a good first step. PPD patients are very unlikely to cooperate if they somehow perceive that therapy is something being done to them, rather than with them. It can take multiple attempts to find the right therapeutic fit for a patient, and establish the kind of long-term relationship needed when treating PPD.

Cognitive Behavioral Therapy for Paranoid Personality Disorder

Cognitive behavioral therapy (CBT) is often the first choice of talk therapy in the treatment of different disorders, ranging from major depression to general anxiety, alcohol abuse, eating disorders, and personality disorders. As a concept, cognitive behavioral therapy espouses the idea that we can learn to recognize disordered thinking, and address both our thoughts and behavior through a structured therapeutic process. This concept has even proven to be as effective or more effective than pharmacological means in the treatment of some mental health issues.

On a practical level, CBT is a heavily researched and studied therapeutic method that can be adapted to help patients form protocols and alternative coping methods to deal with unhelpful ways of thinking and behaving. A therapist takes time to work through these patterns with the patient to try and better understand why they occur, where they come from, how they are triggered, and what steps the patient might take to address them. This can include learning to re-evaluate negative thinking patterns in the light of reality, better understanding one’s own motivations, and developing problem solving skills to work through stressful situations without returning to a maladaptive method.

Cognitive behavioral therapy can play a central role in the treatment of paranoid personality disorder by helping a teen reflect on their thoughts and behaviors considering inalienable facts, understand and gain insight into the context behind how their actions have affected others, and learn to better control their own impulses and mood changes. CBT often also involves using breathing exercises to calm down when faced with anxious feelings or stressful situations. These therapeutic methods are meant to arm teens with the means to become their own therapists, in due time. A lot of CBT exercises are also treated as homework, to be repeated often outside of the therapy room.

Dialectical Behavior Therapy for Paranoid Personality Disorder

Dialectical behavior therapy (DBT) can be considered an offshoot of CBT but is more often considered its own type of talk therapy. It has its origins in the treatment of personality disorders, particularly borderline personality disorder, which some doctors felt was not adequately treated via the guidelines and concepts of CBT. It centers on self-destructive behavior. DBT incorporates a new idea into CBT based on dialectics. Dialectics are a philosophical concept that originates from truth-seeking discourse (dialogue, dialektikḗ in Greek) between individuals with different points of view.

The main characteristic behind DBT is a focus on the conciliation of opposite views, and the acceptance of these conflicts. Imagine, for example, loving someone very dearly, and being proud of them for working hard, but feeling resentment towards them for not being able to spend more time with you and your family. This is a conflicting situation where both thoughts are true and valid, and conciliating the two is a dialectical exercise. What we end up with is not just two separate thoughts, but an interpretation of the truth that takes both sides into account.

In this instance, DBT for paranoid personality disorder would try to tackle the contradictions created by wanting to develop a stronger sense of self-esteem and understanding that one’s thoughts can be deceiving or dangerous. This is especially important for paranoid personality disorder because the thought of changing can be frightening to many teen patients struggling with paranoia. Learning to both validate oneself and understand that there is room for improvement can lead to a more constructive treatment path.

Psychodynamic Therapy for Paranoid Personality Disorder

Psychodynamic therapy is centered on the traditional concepts of psychoanalysis, truncated to be simpler and more effective. It involves working with a patient to gain insight to their daily lives and how their thought patterns affect the decisions they make, considering factors such as belief systems and early life experiences. By sharing this process with the patient, the therapist helps them learn to evaluate and analyze themselves, understand how early-life experiences and beliefs shape their actions, and develop healthier responses.

Why Group Therapy Might Not Be the Best Option

One therapeutic treatment option that is rarely suggested for teens with paranoid personality disorder is group therapy. The one-on-one relationship between the patient and their therapist is central to the treatment of PPD, because of the innate importance of trust. Patients with PPD will be much less likely to open and agree to therapeutic suggestions while in a group with other teens.

What About Medication?

There are no medications specifically targeting PPD. However, some medications are used in the treatment of concurrent mental health issues, particularly anxiety disorders and depression. Antidepressants, for example, may help reduce the severity of symptoms that might be exacerbating a teen’s paranoia. It would not address the root issue but could act as an important supplemental tool along with therapy. Paranoid personality disorder is a complicated and difficult condition to treat. It takes time, commitment, and the right treatment plant.