It's been a while since I did a purely informational post, so I figured it was about time. Today, I chose a light, fun topic: paranoia!
Paranoia involves a heavy dose of fear, but with an added twist that sets it apart from anxiety. See, a person can be anxious about crowds or birds or heights or ... parallel parking (*raises hand*). But with paranoia, there's nearly always an element of they're-out-to-get-me (AKA persecutory beliefs).
My quick and dirty guide to personality disorders is here. The diagnostic criteria for paranoid personality disorder, as laid out in the DSM-IV-TR, describe a pattern of distrust and suspiciousness defined by symptoms like suspecting others are deceiving or harming him/her, doubting the trustworthiness of friends and family, reading hidden negative meaning into casual remarks or events, and bearing grudges in a persistent and unforgiving way (full diagnostic criteria are here). The critical feature that separates these symptoms and makes them impairing is that the suspicion is intense, but also unwarranted and unjustified. Symptoms can't be part of another disorder, such as paranoid schizophrenia (which would require the presence of delusions or auditory hallucinations) or other personality disorders.
There's not a ton of research on what treatments are effective for this disorder because, as you can imagine, folks with PPD don't often show up and ask for help. That would be pretty hard for them. In general, it's rough to deal with a person in the grip of paranoia. Making jokes, arguing with or challenging him/her, asking too many questions ... all likely to go down badly. Prognosis is ... not awesome, let's put it that way.
I was recently talking with a clinician who had worked with a paranoid individual, a person who believed that anyone he came into contact with was part of a big conspiracy to keep him from getting something he needed. The person quickly decided the clinician was part of it, colluding with the others to prevent him from reaching his goal. I started thinking how absolutely frightening it must be ... think about it--if you really believed all these people were trying to hurt you, how terrifying would that be? Where would you turn, if everyone you met was part of it? How lonely and isolating and awful.
I recently observed an incident online where an individual was exhibiting some features of paranoia, though that clearly wasn't the only thing going on. One thing was clear, though: arguing was completely useless, and in fact only convinced the individual that more people were out to get him/her.
Sounds like the stuff of a psychological horror novel, no? So ... have you ever known anyone who was paranoid?