BPD Symptoms and Diagnosis Tips for Easing Paranoia in Borderline Personality Disorder By Kristalyn Salters-Pedneault, PhD Kristalyn Salters-Pedneault, PhD Kristalyn Salters-Pedneault, PhD, is a clinical psychologist and associate professor of psychology at Eastern Connecticut State University. Learn about our editorial process Updated on April 15, 2024 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Daniel B. Block, MD Medically reviewed by Daniel B. Block, MD Daniel B. Block, MD, is an award-winning, board-certified psychiatrist who operates a private practice in Pennsylvania. Learn about our Medical Review Board Print PeopleImages / Getty Images Table of Contents View All Table of Contents Paranoia as a BPD Symptom Paranoid Ideation in BPD Treatment How to Cope Trending Videos Close this video player Many people with borderline personality disorder (BPD) experience paranoia or paranoid thinking under conditions of stress. Paranoia is a term generally used to refer to intense beliefs of mistrust or the malicious intentions of others. For example, someone with paranoia may have the belief that the government is listening to their phone calls or that their spouse is having an affair. At a Glance Borderline personality disorder is characterized by unstable moods, behaviors, and relationships. Paranoia is one common symptom of the condition, which involves feelings of irrational distrust and suspicion. This symptom can seriously affect functioning and relationships and emerges during times of stress or conflict. Keep reading to learn more about paranoia in borderline personality disorder and how to cope with this symptom. Paranoia as a Symptom of BPD Paranoia is one of the nine symptoms identified in the diagnostic criteria for the condition in the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5-TR). The other eight symptoms of BPD that are listed in the DSM-5-TR are: Emotional instability Efforts to avoid abandonment Identity disturbances Feelings of emptiness Inappropriate, intense anger Impulsive behaviors Unstable interpersonal relationships Suicidal or self-harming behaviors In order to be diagnosed with BPD, a person must experience five or more of the nine symptoms. The paranoia that occurs in BPD is considered non-delusional. This distinguishes the paranoia that occurs in borderline personality disorder from the type of paranoid delusions that occur in psychotic conditions like schizophrenia or schizoaffective disorder. Prevalence of Paranoia in BPD Research indicates that around 87% of people with BPD experience paranoia. Paranoid Ideation in BPD Episodes of paranoid thinking, or ideation, can range from mild and short-lived to very severe and chronic. Some individuals with psychotic disorders, such as schizophrenia or delusional disorder, tend to have severe, chronic paranoid ideation that has no relationship to reality. While many people with borderline personality disorder do experience paranoia since it is part of the diagnostic criteria for BPD, it tends to occur only under conditions of stress or interpersonal conflict. Examples of Paranoia in BPD For example, an adolescent with BPD might see two of his friends talking in the hallway and develop the paranoid belief that his friends all secretly hate him and are planning to humiliate him. Or an adult with BPD might misread their partner’s cues that they want some alone time as a sign that the relationship is being terminated and dwell on this belief even when a great deal of evidence to the contrary is presented. Treatment for Paranoic in BPD Borderline personality disorder is a treatable condition, and getting treatment can improve functioning and reduce the impact of symptoms on a person's life. Treatment typically involves psychotherapy, but medication may also be prescribed. It is also not uncommon for people with BPD to receive inpatient hospitalization in times of crisis. Therapy Types of therapy that can be helpful for borderline personality disorder include dialectical behavior therapy (DBT) and mentalization-based treatment (MBT). DBT is a form of cognitive-behavior therapy that helps people with emotional regulation, relationships, and distress tolerance. MBT can help people learn to recognize how emotions affect behaviors. Medication Medications that can be used to treat certain symptoms of BPD include antidepressants, mood stabilizers, anxiolytics, and antipsychotics. How to Cope With Paranoia in BPD Because paranoia in BPD is worse when you are under stress, you may find it helpful to find ways to relax and work through your stress. Some popular stress busters are: Biofeedback In biofeedback, you learn how to control things such as heart rate and certain muscles by having monitors attached to you so you can visualize and hear what's going on in your body. By learning how to change your thoughts or emotions to slow these mechanisms down, you help reduce stress. Deep Breathing Deep breathing is a highly effective way to reduce stress and anxiety. The advantage of deep breathing is that it can be done anywhere, anytime. Sit or lie down, fill your lungs slowly, and then exhale your breath back out slowly. Repeat. Meditation Meditation is a mindfulness practice that has existed for centuries. While there are different techniques, most focus on quiet, calm, relaxation, and focusing one's attention. Different meditation methods can be found online. Evidence indicates meditation and other mindfulness practices can be useful for relieving symptoms of stress and improving overall well-being. Research has found that mindfulness training may be a useful tool for relieving some aspects of BPD symptoms. Tai chi Another ancient practice, tai chi was meant for self-defense but is used by many people now to relax and reduce stress. Like yoga, it involves specific poses, targeted concentration, slow movements, and focused breathing. Yoga Like meditation, the focus with yoga is on calm, relaxation, quiet, as well as posture and flexibility. There are many free yoga apps and instructional videos online to instruct you how to do yoga on your own, or you can sign up for a class at your local gym. Recap Finding ways to cope with stress may help reduce feelings of paranoia in borderline personality disorder. A few stress-relieving strategies that can help include biofeedback, deep breathing, meditation, Tai chi, and yoga. Keep in Mind While there are many stress relievers that can be helpful if you have borderline personality disorder, it is important to seek professional treatment. Paranoia and other BPD symptoms can affect many different areas of your life, including your health, your relationships, and your work. While the symptoms of the condition can create problems in your life, getting treatment and finding ways to cope can help you manage your stress and lead a fulfilling life. If you or a loved one are struggling with borderline personality disorder, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area. For more mental health resources, see our National Helpline Database. What Is Paranoid Ideation? 8 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Masland SR. Managing mistrust, paranoia, and relationship rupture. In: Palmer B, Unruh B, eds. Borderline Personality Disorder. Springer; 2018:49-60. American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders. 5th ed, text revision. Washington, D.C.; 2022. Zanarini MC, Frankenburg FR, Wedig MM, Fitzmaurice GM. Cognitive experiences reported by patients with borderline personality disorder and axis II comparison subjects: A 16-year prospective follow-up study. Am J Psychiatry. 2013;170(6):671-679. doi:10.1176/appi.ajp.2013.13010055 Oliva F, Dalmotto M, Pirfo E, Furlan PM, Picci RL. A comparison of thought and perception disorders in borderline personality disorder and schizophrenia: psychotic experiences as a reaction to impaired social functioning. BMC Psychiatry. 2014;14:239. doi:10.1186/s12888-014-0239-2 Choi-Kain LW, Finch EF, Masland SR, Jenkins JA, Unruh BT. What works in the treatment of borderline personality disorder. Curr Behav Neurosci Rep. 2017;4(1):21–30. doi:10.1007/s40473-017-0103-z U.S. National Library of Medicine, MedlinePlus. Relaxation techniques for stress. Behan C. The benefits of meditation and mindfulness practices during times of crisis such as COVID-19. Ir J Psychol Med. 2020;37(4):256-258. doi:10.1017/ipm.2020.38 Kounidas G, Kastora S. Mindfulness training for borderline personality disorder: A systematic review of contemporary literature. Personal Ment Health. 2022;16(3):180-189. doi:10.1002/pmh.1529 By Kristalyn Salters-Pedneault, PhD Kristalyn Salters-Pedneault, PhD, is a clinical psychologist and associate professor of psychology at Eastern Connecticut State University. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Helpful Report an Error Other Submit