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Thursday, November 5, 2009

T3 - Paranoid Personality Disorder

We've made it to Week Four of the Personality Disorder Parade. We've already covered Antisocial PD (sociopaths), Narcissistic PD, and Histrionic PD, so be sure to take a look at those if you missed them. This week, we'll look at Paranoid Personality Disorder. As before, the criteria for the disorder are in bold black.

Distrust and suspiciousness so define individuals with this disorder that they interpret the motives of others as malevolent. They automatically assume that other people will exploit, harm or deceive them, even if they have zero evidence to support their assumptions. They might feel that a next door neighbor is plotting against them, or that a coworker might just attack them suddenly for no reason at any time.

Even the people they have befriended aren't free from this. People with Paranoid PD are preoccupied with doubts about their friends' and associates' loyalty or trustworthiness. Many times, they simply perceive a deviation from trust from an innocuous act and this underlies their self-schema that no one can be trusted. When a friend actually passes muster and shows loyalty, the person with the disorder can't believe it.

It's hard for these individuals to share information about themselves with anyone, even close friends. They have a fear that anything they confide will be used against them. Any type of interrogation (like a job interview or applying for a loan) would probably be viewed as prying, which might limit their ability to function in life. (FYI: By definition, a personality disorder has to lead to distress of impairment.) They might even refuse to answer innocent questions, claiming it's no one's business but theirs.

People with this disorder often read into innocent remarks or events, and perceive that they are being demeaned or threatened in some way. For example, if the window clerk at McDonald's made an honest mistake and shortchanged them, they would consider it deliberate. A casual joke can be perceived as a full-on character attack. Even compliments given to them will often be misinterpreted. For example, if the person just bought a new-to-them car and a friend commented on how they liked it, the individual might misconstrue the compliment as calling them selfish underhandedly. An offer to help them might be misinterpreted as a criticism that they aren't going well enough on their own.

These individuals have huge chips on their shoulders too. They persistently bear grudges and are often unwilling to forgive the insults, injuries, or slights that they think they have received. Their reaction is often out of proportion to the perceived slight. A minor slight will arouse major anger that lasts for a long time. They are quick to counterattack and react with anger to perceived insults.

They may be pathologically jealous, suspecting their spouse or significant other as being unfaithful without adequate justification. They want to maintain complete control in their romantic relationships to avoid betrayal, so they may pepper their significant other with questions about their whereabouts or intentions. They may gather circumstantial "evidence" of an illicit affair (i.e., their spouse went to the grocery store and didn't leave a note--or did leave a note and they still don't believe the spouse).

Theodore Millon identified five variations of Paranoid PD in 2004.
1) Fanatic Paranoid - includes narcissistic features
2) Malignant Paranoid - includes sadistic features
3) Objurate Paranoid - includes compulsive features
4) Querulous Paranoid - includes passive-aggressive features
5) Insular Paranoid - includes avoidant features

As with most personality disorders, these individuals are generally difficult to get a long with. Close relationships are a challenge to both parties. Their quickness to retaliate against perceived threats might make them more involved in litigation and legal disputes as they seek reparation. In response to stress, these individuals can have brief psychotic episodes (minutes to hours) where they either hallucinate, have delusions, have grossly disorganized speech patterns or behavior.

So. How does this happen? Once again--sorry for those people who need nailed-down answers--no one really knows. There seems to be both genetic and environmental factors than could contribute to the onset. If a child grew up with caregivers in-and-out, or perhaps around a lot of drug activity where they witnessed manipulation, coercion, and other negative events, then that could contribute to hypersensitivity to mistrust as an adult. Children prone to being solitary, having poor peer relationships, social anxiety, underachievement in school, hypersensitivity, peculiar thoughts/language are susceptible to developing this disorder. These children will be the odd ducks, attracting teasing.

As for treatment, it's difficult (as it is with most personality disorders). Because of the inherent mistrust these individuals have, any one session could be seen as incredibly prying. They might wonder what the information was being used for and be incredibly resistant to opening up. But if the individual wanted help, then a combination of therapy and medications could definitely help.

So hopefully this will give you writers out there some ideas for your stories in progress!

Q4U: How would you handle being in a relationship with someone who was constantly perceiving everything you said and did in a way other than what you intended?

Wordle: signature


Diane said...

Sounds like someone I know and it is difficult to carry on a healty relationship with them. I just bring it back to God everyday and pray God's wisdom in dealing with them. :O)

Rosslyn Elliott said...

Yes, I would love to know how common this disorder is. I know quite a few people (often women) with certain symptoms of it, even if they don't have the actual disorder. And is it more common in women, or does it affect men and women equally?

Jen said...

Such a sad way to live. I grew up with family members who, in a way, view everything as "out to get them" or "with my luck, something awful will happen". I have fought against those tendecies my whole life and am just now getting victory over them.

Excellent information (as always!). I love learning about the different types of personality disorders.


Jeannie Campbell, LMFT said...

Rosslyn - Depending on who you ask--the prevalence rate varies from .5%-2.5% of the population.

Wendy Paine Miller said...

Wow, what a powerful question you left us with! How would I handle it? I think validation would be huge, but tiring. That relationship would have a strong potential to drain me. Small doses for me.
~ Wendy

AngBreidenbach said...

I am very appreciative of your post today. My mother was a paranoid schizophrenic and I was in a relationship with a man that was a paranoid narcissist. It's easy to be drawn to what you know. The relationship was impossible because of the constant jealousy and accusation. But that paranoia was normal to me from childhood so I didn't recognize it until it was too late.

The one thing that is frustrating is that when a person who needs help out of a relationship like this, the personality disorder is hidden. They are able to control it when necessary. It becomes such a hidden issue that it's hard to prove. I've found the ultra charmer tends to be a red flag for this problem. The more charming, the farther away I want to be.

If you or someone you know is in a relationship like this, look for the red flags. Don't be charmed. Believe your friend (or find someone to believe you) when she needs to talk. Jealousy is very damaging as is constant accusation and isolation. Someone dealing with this becomes defensive, angry, and can appear to be making excuses. If a friend starts to turn you down every time you ask to get together, don't take it personally. It's a form of self-preservatoin. If she doesn't have triggers, maybe he'll stop accusing, yelling, making her feel guilty for something that never happened.

Start paying attention to some of the things Jeanne shared. Be a good enough friend to ask the hard questions beyond, "Hey, are you okay? Did I do something?" Ask, "Things don't seem right with you. Are you ready to talk yet?" And don't stop.

So maybe your heroine is the best friend. Maybe she's the one trying to get safe. Maybe she's the mom wondering why her daughter doesn't call. How would your character respond? That's going to build tension. But if that tension is in your real life, keep trying to get help-please-keep getting educated and believe in yourself.

We're blessed to have a character therapist who really knows her business!

Thank you, Jeanne.

Jeannie Campbell, LMFT said...

angie - wow...thanks for sharing part of your experience with this difficult population. i appreciate your candidness and excellent advice.
blessings to you!

Unknown said...

Interesting reading... esp. since I just saw The Caine Mutiny for the first time last week (the supposed paranoid personality of Humphrey Bogart's Captain Queeg being at the center of the plot, of course).

Anonymous said...

I have some experience dealing with this type of person. What seems to work is:

1. Not let the person's anger cause an angry reaction from me. This is extremely difficult, but crucial. Be firm, but always in control of yourself. Resist the urge to snap back or point fingers, as it will get you absolutely nowhere.

2. Try to accomodate them as much as reasonably possible, acknowledging that this behavior is a result of deep insecurities and pain from the past. i.e. if they want you to call them when you're on your way home, then take an extra minute to call them. It is certainly easier than an interrogation later.

If you have to apologize sometimes to keep the peace, even if you think you haven't done anything wrong, just do it to make them feel better.

3. Start (slowly) asking them to do the same things for you that they are asking you to do for them. When they start to realize how annoying it is to constantly have to call, leave a note, remember to turn on your cell phone, etc, then say, "Well, do you realize why I don't always do it? Can you agree to not get so upset when I don't?"

4. Find ways to reinforce your relationship in a positive way, before things get difficult. Make time to go to the movies together, just talk with them, listen to them. The more you affirm your relationship with them, the less they will harass you over small things.

Jeannie Campbell, LMFT said...

this is great info, anonymous. thanks for sharing. you obviously have had a painful experience with someone with this disorder, but as a result, you have so much to offer and so much compassion. thanks again for stopping by.

Margo Carmichael said...

Wow, they sound so unhappy. Sounds like realizing that would help make it easier to live with them.

Anonymous said...

I was actually in a recent relationship that ended abusively and abruptly when signs of PDD appeared. I did not know folks suffered from this, and did not know what to make of the constant interrogations of infidelity when I was faithful. He was exceptionally distrustful, which then make me wonder whether he was being trustworthy. And then one night, he basically restrained me against my will and shouted hysterically at me. This was followed the next day by threats to end my life, my ex husband's life, and his own. Those with this disorder can easily snap and turn violent and abusive. I appreciate all of your comments here and wish that I had known about your website and this disorder months ago (though you all are right that the disorder can easily be hidden). We no longer speak (I have young children and can't be around him) but I pray for him, for it must be awful to be born with this and have no way of getting better.

Anonymous said...

Hi, I am a 26 year old male that has ppd along with ocd and narcissistic disorders. I have learned alot over the last few days from my readings. I have found that everything that is said is very true about what I go threw. Is there any cases of someone who has fixed themselves with mental seperation of the disorders? I watched the movie A Beautiful Mind and the man realized what was fake to what was real and blocked the disorder under stict mental attention of his surroundings. Can that work for me? I really would never write this but I do not want to have these thoughts or actions anymore. It is affecting my life in a way that I never percived it to be.I have tried to contact psychologist but there is none available. I need help..... Is there anyone that can HELP???

Jeannie Campbell, LMFT said...

hi april 15th anonymous...the professional you need to contact is a PSYCHIATRIST. they will likely give you medication to start, which will help. with A Beautiful Mind, the man had schizophrenia...which is different from just PPD. if you have a strong mental will to overcome your PPD, then i'm sure it's possible, but the best possible combination for your treatment is talk therapy along with medication.

Anonymous said...

so nice to read that i am not alone.

Im 24 now and got together with my partner who is five years older than me at the tender age of 16. fell pregnant just befoure my 17th birthday and to cut a long story short now have two buitifull children.

My partner has always been suspicious of others and me. Have always been faithfull to him but this has never been enough have spent eight years distancing myself from family and friends tyring to prove my loyalty and trustworthyness to him.

My partner has only one friend and no longer talks to any of his family as he believes they were "trying to fuck him over" Unfortunatly his mother never got to meet her grandchildren as she commited suicide after my partner stopped talking to her.

i was so stuipid and nieve and belived that everything was really my fault. he would blame me for everything and some how mannage to back up what he was saying with facts that were either incidental or compleatly unrelated. I could not argue with him i learnt to just take it and be quite.

the last straw came when he called me when i was at a baby group with my son (always had to keep phone on me to avoid accusations. He told me that something terrible had happend and i needed to come home emediatly and that he would meet me on the way. I thaught someone had died how wrong could i be....

He met me half way and spent the walk back home pleeding me to just tell the truth he wouldnt be cross i just had to tell the truth....

Anyway to get to the point i had rearranged the bedroom around day before while he was in the house and uncovered some empty fag packets of the old brand fags that he used to smoke when he connected that to my plain jane nightdress that i had left on the floor and concluded that i had had a man round and been unfaithfull. He would believe nothing else.

I am still trying to break up with him. He will not accept that he has a problem. He hasnt held a job down for over 5years now due to his suspitions of others and i really do feel sorry for him but my mind has to rule my heart on this one for my childrens sake if nothing else.

i cannot go on treading on egg shells and living in fear of what he might fabricate next i have given him everything. i have to scramble together the last of my own self esteem and confidence i have left.
I really feel for any1 living with a partner that suffers from this as somtime things verge on physical and mentle abuse. I pray that he will get the help he needs.

Jeannie Campbell, LMFT said...

hi june 6th anonymous. thanks for stopping by and leaving your story. it's empowering to share it with others, even in anonymity. thanks for being brace, and my prayers will be with you and your children as you figure out how to handle this situation.

La cipolla felice said...

my father has this kind of personality, how do you handle it? the best way in my opinion is just to ignore him, the more you talk when he's angry the more he gets irritated. there's no way people with this kind of disorder can understand other people's point of view, they're very egocentric and think they're the centre of the world because they think most people want to hurt/attack them. you can try to talk, try to let him understand how you feel about it, try to make him understand that you love him, say you're sorry or fight back, in my experience none of this (and many more strategies) worked. at first it may seems he understands but after 5 minutes it starts all over again. and another big point is that if he's angry with you for a stupid thing, he then gets angry with the whole family. it never ends. it's been 1 year that i just ignore him and i feel much better. i'm sorry that my mother cant do that but i cant do otherwise, i was loosing my sanity. sorry, i'm not english motherlanguage

Jeannie Campbell, LMFT said...

mary - if the coping mechanism you've found is working for you and it's not harming him, go for it. sounds like you're coping very well with him for the last year and even feel better about it then when you went toe-to-toe with him and argued about his irrational thoughts/behviors. kudos to you!

Anonymous said...

I have a spouse whom I suspect (after reading your blog) has Paranoid Personality Disorder. I need help with:
1. Understanding how I as a spouse can help
2. Understanding if this disorder is treatable (apparently was not existent before, so there must have been a trigger which caused it to happen).
3. Understand how to respond, and not react to his issues

Needless to say, it has been 15 years of hell. I am beginning to see the light after reading your blog - the first step to resolving an issue, is understanding what it is in the first place!

intuitivefeeling said...

Yes, this describes my daughter's mother to a T. Thank you for this helpful information, especially the different types of paranoid manifestations.

I also have a blog where I have written my experiences having been married with a PPD for 16 years and all the complications involved.


intuitivefeeling said...
This comment has been removed by a blog administrator.
Anonymous said...

I am in a relationship with someone who has all of these traits you guys are talking about. I have been 200% faithful and even given him all my passwords to my accounts online, Every time Ive had a phone he breaks it. I don't even bother trying to have a phone just to avoid the accusations. He has 4 phones and yet if we get separated while shopping or take too long to in a public bathroom he gets really angry because he has to run around looking for me. Things that we have acquired together he takes and leaves me with nothing because He bought it and I don't deserve anything. Ive trained myself to look at the ground when ever we are around his friends because if im my usual social self im sending signals that "im down to F" he uses my past relationships(before I ever knew him) against me. Ive confided a lot in him because we were friends before we got involved intimately. he puts me in situations that jeopardize my life and freedom. Ive gone completely crazy trying not to break up with him. I have bald spots from where Ive pulled my own hair out, im cutting just to release the pressure, I know I have problems myself. I think I have borderline personality disorder. I often feel that Im either really crazy or im just unfortunate enough to be surrounded by whacked out crazy people. I love him and I want to be with him so bad, and im scared to be without him. If we break up I have nothing, no home, car phone, ill be on the streets.

Anonymous said...

It gladden my heart to finally put a name to what l'm going tru with my husband, more so that i am not alone. I have been married for almost 10 years. I am constantly bombarded with accusation of infidelity. Every act that as to do with male is seen as promiscous. For this i left my family, my friends even my life, nothing seem to work. I am now a depressed women. Nothing make me happy. My husband always see worse in every situation. He had a disagrement with his siblings and cut all relationship with them. He knowns everythings and is doing nothing. He always have someone to blame at all times. I use to love reading and writing alot, but this too is my husband rival. When he is not disillusioned, he is a wonderful person, a loving father to our 3 kids. I feel that i'm in a prison, but being able to find this out learn others experiences gave me hope. I am in the process of rediscovering myself.

Unknown said...

my father I think he has this kind of disorder, sometimes we the family just feed up about him, but we really try to understand him, he never stops doubting the people around him, what we do is just ignore if he starts talking coz here it goes again a never ending sentiments, we know we don't have issues but he does, simple thing things he make it very complicated, were like this I think almost decades....

Anonymous said...

After years of thinking I was dealing with someone with a bad temper, it has come to my understanding that my wife has PPD. She takes every scenario in which she is the aggressor, and makes herself the victim while accusing me of doing the things that she actually did to me. Apologies are never genuine, mistakes are always on purpose, and now I have a so called anger program because I get upset after being provoked to the extreme. Although that barely scratches the surface, I feel for all who are living with someone who has PPD. Keep leading by example, don't take it personal, pray for the person, and show them so much love that one day when they will "wake up" to see that you were there for them all along. Keep enduring all...we will get through this.

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Both comments and questions are welcome. I hope you enjoyed your time on the couch today.