Transcription
Welcome to the Personality Couch podcast, where we discuss all things personality and clinical practice. I'm your host, Doc Boach, and I'm here with my lovely co-host, Doc Fish. We are both licensed clinical psychologists in private practice, and today starts our new series on paranoid personality disorder.
But wait a minute, before you change the channel, you absolutely need to know about this type. These personality types are underresearched and typically don't come to us shrinks for help. But strangely, in the post-pandemic world, the paranoid type has emerged in treatment over and over again. That's why you need to stay tuned in as we unpack our clinical experience with these types, how you can spot them, and how they may be mislabeled as only a narcissist in your life. Let's dive in. Doc Fish, why do you think it's so important to talk about paranoid personality?
There is a risk of a lot of danger with paranoids. The crazy dynamics can make you feel insane. So, it's literally like a cloak of narcissism, but underneath that trench coat, there's some dangerous stuff. Yes. And we need to talk about these types so that we can stay alert and aware. Essentially, like we say, we need to be paranoid about the paranoids because these types are like wolves in sheep's clothing.
There's a tendency to shift all over the drama triangle quickly and intensely. What do I mean by that? So, first they're the victim, then they're the villain, but also the victim, but they rescue you, so they can't be the villain, but obviously they're the victim all in the same breath. It can drive you insane and make you question reality. Absolutely. Yeah. Like gaslighting, crazy making, all that can happen with these types. Mhm.
Part of this is that their main defense mechanism is projection. So whatever they can't handle about themselves, they split off and put on someone else. "I'm not angry. You're the one who's angry." It can make people think that it's narcissistic games, but it's really not. That can happen in narcissistic dynamics, but with paranoids, it's happening in almost every interaction. Yes. Yes. And the fact that it's every interaction speaks to the instability of their personality. Like where there's more drama or fires, there's more pathology. Which is exactly why Joe Navaro, former criminal profiler for the FBI, talks about this type as one of the top four most dangerous personalities.
So part of the danger is also that paranoids are often misunderstood and mislabeled as other diagnoses. Yes. Which means that the people in their circles are not able to best protect themselves. Also, I think there's been a resurgence of paranoid personality. I am seeing it everywhere clinically, in clients' social circles, in my own social circles, like the grocery store. It's often labeled as narcissism though. Yes. Yes. I'm seeing the same thing. And this reminds me, if you've listened to one of our first episodes, "Personalities That Kill," we put these paranoid types at high risk for murder, which is actually higher than we put narcissistic personality disorder. I'm telling you, you need to know these types. They are more common than you think, especially now. And to your point, Doc Fish, they can appear very innocent or victimy even, possibly even like covertly narcissistic or borderline, but they're not. And they can actually be quite dangerous. Did we already say that? Dangerous.
Okay, Doc Boach, as a testing psychologist, what have you seen with paranoid personalities? Yeah. So, as we've been saying, paranoid types are much more common now in clinical practice, and it likely has something to do with the post-pandemic landscape that we're in. So, clinically, they're not supposed to show up in treatment, at least not as much as we're seeing them now, but they are, and a lot. So, this feels significant.
Wait, why are they not supposed to show up to treatment? Yeah. So, they're too afraid. They're too afraid to trust. So these types are either hiding or in jail.
So why do they actually show up then? Yeah, I have a few hypotheses. So this is probably the same for both testing and therapy, but there's a few reasons. So the first possibility is that there's increased distress post-pandemic. Like we all just experienced significant collective trauma. So the paranoid's worst fears about "oh, the sky is falling" like that's come true, right? And now they can't handle life. They have to trust people to heal, but they can't. It's conflicting, right? They're too suspicious of the motivations of the therapist. They do not want to be known. That's it. Yeah.
The second possibility is that maybe their loved one has seen their concerning behavior and possible disintegration and then gives them an ultimatum like, "You must go to treatment or else I'll..." fill in the blank. And if that blank is filled with "leave" like, "go to therapy or I'll leave you," we can often think it's borderline. Very much so, because they can present very victimy, like, "Oh, woe is me. My wife hates me. I'm a terrible husband." That type of narrative. It can be confusing.
So then the third possibility that I've come up with is maybe like they're in trouble with their job or in financial trouble or something that has kept them hidden and now that cover is blown.
Okay, we keep using "he." Are all paranoids male? Oh, great question. Not necessarily. I've seen multiple paranoid females, but it is more common in males. I also wonder if female paranoids are more often diagnosed as borderline. I think you are right on with that. Yes, and we have an episode coming up on BPD versus paranoid. So, you don't want to miss that either. But back to your original question. So, in testing specifically, paranoids' pathology shows up as like all the elevations. Like, often they end up endorsing every condition because, I mean, firstly, they're the victim of everything, right? Everyone's out to get them and these dark and mysterious forces are coming for them. Or maybe the second thing could be, "They want to throw me off their scent." Like, they need my help, but they don't trust me. So they endorse all kinds of conflicting things.
That sounds exactly like how they interact with others in their lives. They're the victim because everyone is out to get them and they can't be vulnerable. You never truly get to know them. They're confusing. Very much so. Yeah. And with that, most people that I see are connected to a paranoid type in some way and just don't know it. Like maybe a friend of a friend, extended family, even outside the therapy office. I guarantee you're connected to a paranoid somehow. And then clinically, speaking to my fellow clinicians, I bet you have at least one paranoid personality hiding on your caseload. You don't know it because they're not telling you the full story and or you've misdiagnosed them with borderline personality disorder because you feel the personality dynamics in session and you see their instability. Ah, okay.
Well, that brings us to what in the world is paranoid personality disorder. So glad that you asked. So, as with any personality disorder, it has to be pervasive and lifelong. So, this isn't just a bad day or a bad season. It's been bubbling up since youth and is especially apparent throughout adulthood, right? So, this isn't someone who is hypervigilant or fearful because they just experienced like domestic violence, racial discrimination, assault. This is a personality pattern. Paranoid personality is not the same thing as a valid reaction to life events or trauma. Oh, exactly. Yeah, that is a helpful thing to distinguish.
So, paranoid personality is over-the-top, pervasive, lifelong suspicion, fear. So, let's back up. Let's unpack that a little bit more so you can hear what we mean by that. Paranoid personalities are in cluster A of the DSM. So this means the odd and eccentric disorders. These types, while their language can be quite dramatic, they don't typically demand a crowd. They hide. Like, they're going to overlap more with the schizoid and schizotypal types in cluster A, which are characterized by extreme introversion, being unusual or odd, being withdrawn, like to themselves. Mhm. I hear of paranoid types described in the news like, "Oh, we never thought he'd do something like this. He was such a quiet guy." Versus the narcissistic, "We never thought he'd do something like this. He was such a charming guy." Mhm. Big thing to distinguish there. Yeah.
But the overarching theme in paranoid personality disorder is pervasive distrust of others and suspicion about others' motives. This is lifelong, pervasive. It's constant fear and distrust. So let's briefly talk about the seven criteria in the DSM.
First, they believe others are exploiting or harming or deceiving them. Yes. Yeah. Like, "The planes flying over my house, they're spying on us. Can't trust the government."
Number two, they have constant doubts about loyalty or trustworthiness of people in their limited social circles. Like, "Bob, he sat in a different chair at game night. I think he's out for my job." Mhm.
Number three, they also have limited self-disclosure due to fear of it being used against them. This is exactly what I was talking about with psych testing, like not sharing because they don't trust you. They'll embellish stories or just tell stories that they may actually come to believe. And this is to keep people from really knowing them. And I have to tell you, this is my biggest pet peeve clinically as a testing psychologist because it's a wild goose chase of data. It's constant rabbit trails and contradictions. Honestly, garbage. Like, they feed you garbage and then it's your job as the testing psychologist to sort through the BS and see like what's legit and what's not. It's maddening. For real. Yeah, I totally agree. It's actually really difficult for me clinically in therapy too because I know that there's something there, but it's like hitting a wall or being thrust into a maze. Like, I know I'm not getting a glimpse at the real them. Yeah. It is like a maze. Yeah. And you know that you're missing something.
Okay, criterion four. They read hidden, demeaning, or threatening meanings into benign remarks or events. "Doc Fish, you looked at me funny just now. H you must be scheming. I think you want to kill me." Right. It's thinking that there's some threat or criticism in neutral interactions. Yes. Like, we're just having a normal conversation and all of a sudden a glance tips them over the edge and they're reacting with vitriol towards you. Like this hair trigger is so easily activated and you have no idea what will actually set them off. Mhm.
Okay, criterion five is that they hold grudges and do not forgive an insult like for years. They will not talk to someone again if they decide not to. They will never reach out again to a friend if that friend failed to reach out to them. Not a normal grudge. It's an intense and often forever grudge. Yeah. And there's real rigidity to these beliefs that others are out to get them and they don't go away. Like, even with new information that proves the contrary, like these grudges are stable and fit that negative worldview.
Okay, criterion six. They perceive attacks about their character or reputation that others do not see. They're quick to retaliate or act out in anger. So, they are so afraid of you seeing their badness. Like, they're so scared of being humiliated that they deny it hardcore and will pounce to protect themselves. Yeah. Yeah. And out of that, they see threats everywhere and react first before someone gets them. Like, for example, punishing the therapist after getting too close to the core issues by maybe giving a bad review, filing a lawsuit, attacking the therapist's character for fear of personally being attacked. Like that's that projection again. Mhm. Whatever I'm feeling, I think it's coming from outside of myself and I attack. "Therapist is attacking my character, so I will attack hers." Mhm. So, unsurprisingly, these types start fights often. Like, they're very litigious people and they will take you to court and they're always ready to counterattack. Yeah, exactly.
Criterion seven involves constant reoccurring suspicions about a spouse or lover's fidelity despite no evidence. This is so interesting that this is baked into the DSM criteria. Like, that's what we're talking about here. That suspicion and it's coming out in those closest relationships and it can look like, "Oh, are you cheating? Like, I saw your phone in a different place. You're hiding something from me," or like, "He looked at you, so you must be flirting with him." It's controlling and narcissistic and awful. Now, some theorists say that it's a projection of their desire to be unfaithful or attraction to others outside the relationship. Yes. Yes. There's that projection again. Like, "I can't admit that I'm actually attracted to someone else or maybe even the man my wife or girlfriend is flirting with." More on that in a minute. But yes, I have definitely seen that clinically. Like these types that are the most paranoid about their partner cheating are often either already cheating on their partner or about to. Mhm.
Okay, another note is that this is not schizophrenia or any disorder where the person is actively psychotic or out of touch with reality like consistently. Anyway, it's confusing because they are unstable personality types and you can see they have their toe out of reality with their like all-consuming paranoia. Yeah. Which is historically why paranoid personality disorder got lumped in with paranoid schizophrenia. And what we're talking about at non-psychotic levels, these types roam about our social world, typically hiding out, collecting grudges, and preparing to release their vengeance on the world. Right. Paranoid personality disorder isn't fully psychotic. It's just a really unhealthy character structure hanging on to reality by a thread. Indeed. Yep.
Okay. So, we talked about the DSM, but what are the warning signs of a paranoid personality that the DSM does not tell you? This is really important to talk about because you often detect paranoids using tools outside the textbook. So, the first thing that I notice is my own reaction. Their stories are often dramatic, over the top, and I find myself not trusting them. Like, "Hm, I'm not sure that I believe you." Like, their narrative is full of contradictions, which is a parallel process. They sure don't trust you, and now somehow you're feeling the same about them. Uh-huh.
And another really interesting thing is severe gastrointestinal issues. Like, notable. This is more than just your irritable bowel syndrome. It's possible there are other like GI disorders or diseases or at least claims of them, but I'm talking like severe intestine-busting constipation, like it will stand out as significant. Mhm. So anxiety is tied to the gut. We know that. It makes sense. It's common. What we've seen is like severe constriction and expulsions of the bowels. Oh yes. Across cases consistently, both of us. So, this correlates with their anger where they hide it from the world because they're afraid, constipated, or they burst into action and retaliate because of perceived threats. Expulsive. Mhm. It sounds weird. It sounds like something we should not know, but Freud actually connected paranoia to the potty training stage of development. So, this actually all makes sense. Oh, it does. Good old Freud. Of course he did. And to your point about like, we shouldn't know it. You're absolutely right. Sometimes the graphic detail in which they share their bowel habits is clinically significant in and of itself. Right. Like, it's not the tendency of older patients to discuss their aging and incontinence or anxiety patients discussing their stomach problems. It's like TMI. Way too much information. It's dramatic. They want you to be as uncomfortable as their own poop experience was. Yes. Another element of projection. "You take this GI discomfort while I explain it in graphic detail." Mhm. "Hold my poop. Hold my pain." And then relatedly and awkwardly in clinical psych, we have a phrase we use when patients explain their sexual escapades in such detail that we call it "crotch attaching." Like, basically attaching to the therapist through words about sex since it's inappropriate behaviorally. So it's like that but with the bowels. So it's almost like "bowel attachment." But again, pin that. More on what that might mean in a minute. It's "hold my mess. Hold the things about myself that make me uncomfortable or that I deem unacceptable." Exactly. Yeah. And I know our listeners and viewers right now are like, "What?" But stay focused. Stay, stay focused. We got this. We'll get there.
Okay. So, next concept is sadomasochism. There's aggression and subtle sadism, but sometimes it is more overt. Sometimes it's sexual sadism as well, but there's also masochism. There's a desire to destroy so they are not destroyed. This is so interesting. Tell me more about this. So, for example, they set themselves up to be a victim in a situation, but then they attack with a sadistic aggression when they've had enough, which can honestly take some time. So, there's two sides to them. There's the passive side and the aggressive side. And you know what's interesting? I've also seen extreme masochistic medical sabotage. Yes. Uh-huh. It literally results in emergencies. So, surgeries, comas, cutting off body parts, enemas. Okay. So, let's make up an example. "I'm struggling with a hernia, which hurts, but I deserve it because I'm bad and guilty and I need to hide my mess and my vulnerability. But then my hernia gets so bad and my pain gets so bad that it's a legit medical emergency, but I still put it off." Mhm. All the while milking it for all it's worth, lapping up pity points from others. Mhm. Until it's life-threatening. And then it becomes somebody else's responsibility. Uh-huh. The other person has to be in pain while I'm in surgery and going through life or death procedures. They have to hold my pain while I'm under anesthesia and sleeping. Uh-huh. In case I die, someone else has to hold my bag. My pain bag, my poop bag, my feeding bag, all of it. Like, they don't go out with their pain bag. Someone else has to hold it. That is key. The world will pay for their suffering. Exactly. It's projection to the max. Also, that's connected to mass murderers. We've discussed in multiple recent episodes of malignant narcissism. Paranoid types are the most likely to commit a mass murder before taking their own life. The world will pay. All of these people I killed and their families can hold my pain. Yes. Tragically. Mhm. And this is also where paranoids can have chronic suicidality similar to borderline personality disorder but without the actual depression. Like the suicidality speaks to their instability, that their personality is disintegrated. But that takes me to the thing that we pinned. Let's unpin that. We need to talk about aggression.
So, I've given a nod to this a few times already in this episode, but in male paranoids, I have seen a notable theme of hostility towards other men. And on more than one occasion, I have asked myself, "Why are you fighting so hard against men?" Like, "Are you per chance fighting your own attraction with a counter move?" Yes. Though controversial, several early theorists did propose this, and there were actually some research studies that did support it. Basically, it's a rejection of "I love him" and eventually, through defenses, it turns into "I hate him." But because in paranoids everything comes from outside the self, it has to turn into "I hate him because he hates me." Wow. It's projection. It's not mine. It's yours. You're the one in the wrong. I'm just reacting. And this brings us full circle to the crotch attaching or poop attaching dynamics, if you catch my drift. And to be clear, most people with same-sex attraction aren't paranoid types, and they're not dangerous at all. Right. Paranoids are scared of the normal thoughts of same-sex attraction, making it into an unacceptable urge that must be fought against. Yeah. As they do with everything, it's something to be fought against. Mhm. But in some with paranoids, there is often an aggressive theme towards the same sex that makes you go, "H."
Now, we also have the notion of doing anything to hide in plain sight, even altering their speaking, their dress, their interests. Yeah, I've seen this too. So many paranoids will shed their identities like snakeskin. Like, whatever persona is going to fit the camouflage of the group, that's what I'll be. But when they can't hide their true sadistic nature anymore, they'll slither away and find a new group and learn their behaviors and mannerisms. I've seen this in jobs where it's like, one to three years at one job, then things blow up and they get a new one and they start the cycle over. I've also seen in a relationship it can often look like, "Well, what do you want me to be? Well, where do you want to eat? Well, what do you think I should do?" But then it turns on a dime and it becomes blaming, "Well, you're the one that never told me." Ah. Uh-huh.
And this is what's interesting, too, is that they can have a partner and actually love others, which separates them from psychopaths, actually. Interesting. Yeah. Often there's deep attachment issues from childhood, which we've alluded to. Usually more of an anxious or ambivalent attachment. Yeah. And then if they do marry, a spouse is often filling the role of a parent. Like, they will likely align with someone who reminds them of an early attachment figure or who is good ground cover, like someone that is nice and kind, maybe loves children, like a mental health professional or a teacher, like someone who will be a passive party that won't threaten their paranoid thoughts. They'll find a great place to hide out in that person because no one would ever suspect them there. Exactly. Mhm. But overall, they have major problems with intimacy where they can't get too close or too vulnerable because there's a lack of trust. Also, there's a rupture in the relationship if there's kids or an aging parent that needs to be taken care of. Like, anyone who comes in and takes that child or victim place is threatening to a paranoid. Like, they need to be taken care of, not others. Mhm.
PS, a little research nugget. Paranoids have high divorce rates. Ah, shocker. Mhm. But if they're not married, which many never do, uh, they likely will utilize prostitutes or one-time hookups because, you know, never too close, never the same person.
But bringing us back around to the main question, why do we think the paranoid personality is a postpandemic narcissist? Yeah. So firstly, there's whiffs of narcissism in all personality pathology, like we always like to say, but paranoid personality is no different. And I think a lot of people would lump their behavior in with narcissists, especially in relationships because they play similar games and because they present as superior and grandiose often, just like narcissists do. They tend to be envious like narcissists, but they project that envy onto others, right? They expect everyone around them to meet their needs and cater to their whims. They're the child in the system, be it family or work. So, they need that attention. Yes, they need that attention. And it shows up in their self-importance then. But that self-importance is often shrouded in fear or mistrust of others. So, for example, like, "Huh, you really think you're important? Like, so important that everyone is conspiring against you. Everyone has mistreated you." H there's grandiosity in those ideas of reference. So, things that happen to them are because they are personally so special. "That person sat in my chair because they're after me and they don't like me." Uh-huh. Yes. Yes.
So the narcissism shows up in the sadistic nature of their behavior where they are aggressive towards others or will harm or even murder other people to meet their own needs. They can be megalomaniacs. They have that all-powerful sadistic part of them. Mhm. Conversely, there's a vulnerable narcissistic aspect to them at times where they pull on people to have pity for them when they don't take care of themselves, like their health, their bowels, their adult responsibilities, expecting you to feel bad and act on their behalf. And like narcissists, they're hypersensitive to criticism. Mhm. Overall, you can see the overlap in these types. In a relationship, they will feel narcissistic because again, those similar psychological games that they both play. Okay.
But why postpandemic? Yeah. So as we've said, paranoids don't present to treatment, and this is also backed by research. But the fact that they have been since we've entered this postpandemic status, like that seems really relevant. So COVID rocked our world. Literally, the world shut down. The paranoid's greatest fears were realized that you can't trust anyone. Like, not the government, not vaccines, not the markets in Wuhan, like nothing and no one. And they're falling apart. And whatever cover they were lying underneath to protect themselves has essentially been blown up. Like the entire world changed. And they're rattled. And to heal, they have to lean on people, but they can't trust others and won't trust others, and that's the underlying conflict. So our hypothesis is that they're coming to treatment out of desperation. They fell apart during the pandemic, and as we attempt to go back to like normal, they can't put themselves back together. They cannot navigate this post-COVID world. Agreed. Yeah. And I think that's why we're seeing more of them. And we think you may be seeing more of them, too. We actually think the research on paranoid might follow a pattern. It seems there are time periods where we can study them, but then they fall off. So our hypothesis is that with like crises, wars, pandemics, they pop up again out of hiding. That's what we think anyway. Yes. Yes.
So with that, we hope that you will continue to join us as we unpack this type and how it can masquerade as other personality disorders, especially narcissism. Paranoid types are snakes in the grass, wolves in sheep's clothing, dangerous, camouflaged types. They can be hiding in plain sight, ready to pounce, and you don't even know it. Believe me, you need to understand the paranoid. It could mean your sanity or even your life. And on that note, that's a wrap. Thank you for joining us today on this episode of the Personality Couch. Make sure to check out our blogs that coincide with these episodes at www.personalitycouch.com. And as always, don't forget to give us a thumbs up or rate and review us on your favorite podcast app. And on YouTube, hit that bell so you don't miss a single episode in our paranoid series. Be well, be kind, and we'll see you next time on the Personality Couch.
This podcast is for informational purposes only and does not constitute a professional relationship. If you're in need of professional help, please seek out appropriate resources in your area. Information about clinical trends or diagnoses are discussed in broad and universal terms and do not refer to any specific person or case.