Paranoia

You pot smokers out there know what I'm talking about.

You're chilling on the deck, your neighbor steps out to toss out the trash, gives you a funny look and you think, Busted.

I've had patients tell me they had to stop smoking pot because the paranoia got so bad. A cop pulls up at a stoplight, turns his head and looks at you. You freak, come down fast, and you're not the same for the rest of the day. Aw.

The rest of us might say, If you weren't stoned you wouldn't have to deal with that, would you? You'd have nothing to be worried about.

Yes and no. Well, yes, probably, if you're a habitual stoner.

Those of you who are dealing with elderly parents, however, have quite another kettle of fish boiling. As FD says, if the brain doesn't get enough oxygen, if circulation is poor, if the heart's not pumping like it should, if a person's on one too many medications and needs all of them, if sleep is wanting, well, there's an accident waiting to happen.

And I read a study associating hearing loss and paranoia. OF COURSE HEARING LOSS WOULD BE ASSOCIATED WITH PARANOIA IN THE ELDERLY--THEY DON'T HEAR THINGS CORRECTLY. Sorry for shouting.

And as my geriatric psychiatric consultant in California is wont to say, Those mini-strokes the elderly suffer are virtually undetected until the patient suffers from a delusion. Then the docs suspect stroke. And a little anti-psychotic can go a long way.

Great, more meds. And go tell someone suffering from a delusion that he's suffering from a delusion. He'll say, YOU'RE the one who's delusional. When the mind plays tricks on you, and it's YOUR mind, you basically are going to trust your mind, not someone else's.

Such a Catch 22.

Well let's get clinical. It's what you pay me for. If you learn about paranoia in graduate school, what you'll learn is that there are at least two types: There's the type associated with the intense anxiety of Paranoid Schizophrenia (Axis I), and there's the type associated with a personality disorder, Paranoid Personality Disorder (Axis II).

Like Obsessive-Compulsive Disorder and Obsessive-Compulsive Personality Disorder, they're difficult to differentiate sometimes. But unlike OCD versus OCPD, in which one makes the symptom bearer sick and the other makes everyone else sick, when the featured symptom is paranoia, everyone feels sick.

Let's take a quick look at the personality disorder. We do not diagnose this, of course, if a person is justifiably paranoid, as is often the case with immigrants who do not understand language or cues, minorities who suffer discrimination, and political or economic refugees who have been on the run.

The diagnostic criteria for 301.0 Paranoid Personality Disorder include:

A. A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts, as indicated by 4 or more of the following:

(1) suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her

(2) is preoccupied with unjustified doubts about the loyalty or trust-worthiness of friends or associates

(3) is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her

(4) reads hidden demeaning or threatening meanins into benign remarks or events

(5) persistently bears grudges, is unforgiving of insults, injuries, or slights

(6) perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack

(7) has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner

B. Does not occur exclusively during the course of Schizophrenia, a Mood Disorder With Psychotic Features, or another Psychotic Disorder and is not due to the direct physiological effects of a general medical condition.

If a person had the personality disorder before the onset of schizophrenia, it's considered premorbid. In other words, a person diagnosed with schizophrenia can also have this disorder, but we add the suffix, "Premorbid".

Oy, it's not a good thing. And of course, the spouses of these individuals are often accused of having affairs, their friends and children of stealing, business associates deliberately try to cheat them. People look at them the wrong way, people wrong them. People think they're stupid.

These are angry people.

There is a strong association with child abuse, and you can see why. If you can't trust your own parents to take care of you and protect you, who can you trust?

You learn to trust only yourself. You get VERY strong, VERY tough, impenetrable. You're FINE all on your own.

I'm fine all on my own trickles into all kinds of relationships, doesn't it? It's one of the reasons people avoid intimacy, and it's why I would say it represents a fear of intimacy. How can you let yourself be vulnerable, how can you tell people your true feelings, your fears, your sadness, if you think you'll be punished for divulging that information?

Having feelings makes you a weakling, don't you know?

I'm not going to go into treatment right now, and I'm not going to list the features of paranoid schizophrenia for you. They're on this blog somewhere, probably in the Cho posts.

But I will say that I think when you notice these features in a person at any age, if you're intimately involved with this person or perhaps you are a blood relative, it might be worth it to gently confront it, to bring it up as a disorder. A tricky disorder. Because at some point you'll have to address it yourself, probably. You'll be the object of suspicion.

Or better yet, somehow, somehow, somehow, get that person to join you in therapy for a problem of your own so that he/she has a relationship with a mental health professional.

Trust me. You're going to need it.

therapydoc