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Managing Paranoid Personality Disorder Clients

By Paul Fisher1

Paranoid personality disorder (PPD)2 is characterized by a relentless mistrust and suspicion of others without a realistic reason to be suspicious. People with PPD are always on guard, believing that others are constantly trying to demean, harm or threaten them. These are generally unfounded beliefs.

Other characteristics may include3:

  • Doubt about the commitment, loyalty, or trustworthiness of others, believing others are exploiting or deceiving them.
  • Reluctance to confide in others or reveal personal information for fear that the information will be used against them.
  • Unforgiving and hold grudges.
  • Perceive attacks on their character that are not viewed so by others; may react with anger and be quick to retaliate.
  • Belief that they are always right and denial about contributing to problems or conflicts.
  • Exhibit stubborn, hostile and argumentative behavior.
  • Hypersensitive and take criticism poorly.
  • Read imaginary meanings in the innocent remarks and looks of others.
  • Persistent suspicions, without reason, that their lovers or spouses are being unfaithful.
  • Generally cold and distant in their relationships with others, and might become controlling and jealous to avoid being betrayed.

The thinking and behaviors associated with PPD can interfere with a person’s ability to form and maintain relationships, as well as their ability to function socially and in work situations. In many cases, people with PPD become involved in legal battles, suing people or companies they believe are “out to get them.”4

Tools to manage PPD clients:

Try to build a relationship and increase trust. Keep this client well informed on all issues, tactics and negotiations, including the what and why of your proposed actions. Do not talk down to this client. A PPD client may not tell you all you need to represent him/her so it is necessary to independently verify this client’s claims and defenses. If the client becomes angered and verbally attacks you, do not take their outrage personally. Remain calm. Do not be confrontational or this client will feel attacked and become argumentative. Reframe the conversation from “The judge is likely to rule against you” to “I’m concerned the judge could interpret the events differently and believe the other party, even though you may have acted in good faith.” Require a substantial retainer that is replenished monthly. If this client falls behind you will have lost control. Make sure your E&O policy is current.

  1. Copyright 2017 by Paul Fisher
  2. This discussion is not intended to be a diagnostic tool. It is intended to be informative especially when read in conjunction with other materials discussing high conflict personality disorders.
  3. The Diagnostic and Statistical Manual of Mental Disorders DSM-5 (5th and current revision, published by American Psychiatric Association, 2013)
  4. Additional references:
    Cleveland Clinic, “Paranoid Personlity Disorder”

    Janowsky D. Chapter 30. Personality Disorders. In: Ebert MH, Loosen PT, Nurcombe B, Leckman JF, eds. CURRENT Diagnosis & Treatment: Psychiatry. 2nd ed. New York: McGraw-Hill; 2008.

    American Psychological Association. Help for Personality Disorders .