Episode Transcript
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(00:00):
Welcome to the Personality Couch podcast,
where we discuss all thingspersonality and
clinical practice. I'm yourhost, Doc Bok,
and I'm here with my lovelyco-host, Doc Fish.
We are both licensed clinical
psychologists in private practice,and today starts our
new series on paranoid personalitydisorder.
(00:23):
But wait a minute, before youchange the channel,
you absolutely need to knowabout this type.
These personality types areunder-researched
and typically don't cometo 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
(00:46):
to stay tuned in as we unpackour clinical
experience with these types,how you can spot
them and how they may be mislabeled as
only a narcissist in yourlife. Let's dive in.
Doc Fish, why do you think it's so importantto talk about paranoid personality?
(01:08):
There is a risk of a lot of danger with
paranoids. The crazy dynamics canmake you feel insane.
So it's literally like a cloak of
narcissism, but underneath thattrench coat, there's
some dangerous stuff. Yes. And we need to
talk about these types so thatwe can stay alert
and aware. Essentially, likewe say, we need
(01:31):
to be paranoid about the paranoidsbecause these
types are like wolves in sheep's clothing.There's a tendency to shift all over the
drama triangle quickly andintensely. What do
I mean by that? So firstthey're the victim,
then they're the villain,but also the victim,
but they rescue you so theycan't be the villain.
(01:53):
But obviously they're thevictim all in the
same breath. It can driveyou insane and make
you question reality. Absolutely.Yeah. Like
gaslighting, crazy making,all that can happen
with these types. Part ofthis is that their
main defense mechanism is projection.So whatever
they can't handle about themselves,they split
(02:15):
off and put on someone else.I'm not angry. You're
the one who's angry. It canmake people think
that it's narcissistic games,but it's really not.
That can happen in narcissisticdynamics, but
with paranoids, it's happeningin almost every
interaction. Yes. Yes. And the fact that
it's every interaction speaksto the instability
(02:38):
of their personality. Like where there's
more drama or fires, there'smore pathology,
which is exactly why Joe Navarro,former criminal
profiler for the FBI, talksabout this type as one
of the top four most dangerouspersonalities.
So part of the danger isalso that paranoids
(02:58):
are often misunderstood andmislabeled as other
diagnoses, which means thatthe people in their
circles are not able to best protect
themselves. Also, I think there'sbeen a resurgence of
paranoid personality. I amseeing it everywhere
clinically in client socialcircles, in my own
social circles, like thegrocery store. It's
(03:22):
often labeled as narcissismthough. Yes. Yes.
I am seeing the same thing.And this reminds me,
if you've listened to one ofour first episodes,
personalities that kill, weput these paranoid
types at high risk for murder,which is actually
higher than we put narcissisticpersonality
(03:42):
disorder. I'm telling you,you need to know
these types. They are morecommon than you
think, especially now. And to your point,
Doc Fish, they can appearvery innocent or
victim even possibly even likecovertly narcissistic
or borderline, but they'renot and they can
(04:04):
actually be quite dangerous.Did we already say
that? Dangerous. Okay. DocBok as a testing
psychologist, what have youseen with paranoid
personalities? Yeah. So as we've been
saying, paranoid types are muchmore common now in
clinical practice and it likelyhas something to
do with the post pandemic landscapethat we're in.
(04:27):
So clinically, they're notsupposed to show up
in treatment, at least not asmuch as we're seeing
them now, but they are anda lot. So this feels
significant. Wait, why arethey 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
(04:50):
actually show up then? Yeah, Ihave a few hypotheses. So
this is probably the samefor both testing and
therapy, but there's a fewreasons. So the first
possibility is that there's increased
distress post pandemic. Likewe all just experienced
significant collective trauma.So the paranoid's
(05:12):
worst fears about, oh, thesky is falling. Like
that's come true. Right.And now they can't
handle life. They have to trustpeople to heal,
but they can't. It's conflicting.Right. They're
too suspicious of the motivationsof a therapist.
They do not want to be known.That's it. That's
(05:34):
it. Yeah. The second possibilityis that maybe
their loved one has seen their concerning
behavior and possible disintegrationand then gives them
an ultimatum. Like you mustgo to treatment or
else I'll fill in the blank.And if that blank is
filled with leave, like goto therapy or I'll
leave you, we can often thinkit's borderline.
(05:57):
Very much so because theycan present very
thick to me like, Oh, what wasme? My wife hates me.
I'm a terrible husband. Thattype of narrative.
It can be confusing. So thenthe third possibility
that I've come up with is maybelike they're in
trouble with their job orin financial trouble
(06:18):
or something that has keptthem hidden. And now
that cover is blown. Okay.We keep using heat.
Are all paranoid male? Oh,great question. Not
necessarily. I've seen multipleparanoid females,
but it is more common in males.I also wonder
if female paranoid or moreoften diagnosed as
(06:41):
borderline. I think you areright on with that.
Yes. And we have an episode comingup on BPD versus
paranoid. So you don't wantto miss that either.
But back to your original question.So in testing
specifically, paranoid's pathologyshows up as
like all the elevations, likeoften they end up
endorsing every condition becauseI mean, firstly,
(07:04):
they're, they're the victimof everything, right?
Everyone's out to get them.And these dark and
mysterious forces are comingfor them. Or maybe
the second thing could be theywant to throw me
off their scent. Like they needmy help, but they
don't trust me. So they endorseall kinds of
conflicting things. That soundsexactly like how
(07:25):
they interact with others intheir lives. They're
the victim because everyoneis out to get them and
they can't be vulnerable. Younever truly get to
know them. They're confusingvery much. Yeah. And
with that, most people thatI see are connected
to a paranoid type in some wayand just don't know
(07:46):
it. Like maybe a friend ofa friend, extended
family, even outside the therapyoffice. I guarantee
you're connected to a paranoidsomehow. And
then clinically speaking tomy fellow clinicians,
I bet you have at least one paranoid
personality hiding on your caseload.You don't know it
(08:06):
because they're not tellingyou the full story
and, or you've misdiagnosedthem with borderline
personality disorder because you feel the
personality dynamics in sessionand you see
their instability. Ah, okay.Well, that brings
us to what in the world isparanoid personality
disorder? So glad that youasked. So as with any
(08:28):
personality disorder, it hasto be pervasive and
lifelong. So this isn't justa bad day or a bad
season. It's been bubblingup since youth and is
especially apparent throughout adulthood.
Right. So this isn't someonewho is hypervigilant or
fearful because they just experiencelike domestic
(08:49):
violence, racial discrimination,assault. This is a
personality pattern. Paranoidpersonality is not
the same thing as a valid reactionto life events
or trauma. Oh, exactly. Yeah. That is a
helpful thing to distinguish.So paranoid personality
is over the top pervasive,lifelong suspicion,
(09:12):
fear. So let's back up. Let'sunpack that a little
bit more so you can hear whatwe mean by that.
Paranoid personalities arein cluster A of the
DSM. So this means the odd and eccentric
disorders. These types, whiletheir language
can be quite dramatic, theydon't typically
demand a crowd. They hide likethey're going to overlap
(09:36):
more with the skeezoid andskeezotypal types
in cluster A, which are characterizedby extreme
introversion, being unusual or odd, being
withdrawn to themselves.I hear of paranoid
types described in the newslike, oh, we never
thought he'd do something likethis. He was such
(09:58):
a quiet guy versus the narcissistic.We never
thought he'd do something likethis. He was such a
charming guy. Big thing to distinguish
there. Yeah. But the overarchingtheme in paranoid
personality disorder is pervasivedistrust of
others and suspicion aboutothers motives. This
(10:22):
is lifelong pervasive. It'sconstant fear and
distrust. So let's brieflytalk about the seven
criteria in the DSM. First,they believe others
are exploiting or harming ordeceiving them. Yes.
Yeah. Like the planes flyingover my house,
they're spying on us. Can'ttrust the government.
Number two, they have constantdoubts about
(10:44):
loyalty or trustworthinessof people in their
limited social circles. LikeBob, he sat in a
different chair at game night.I think he's out
for my job. Number three, they also have
limited self disclosure due tofear of it being used
against them. This is exactlywhat I was talking
about with psych testing, likenot sharing because
(11:07):
they don't trust you. They'llembellish stories
or just tell stories that theymay actually come
to believe. And this is tokeep people from
really knowing them. AndI have to tell you,
this is my biggest pet peeveclinically as
a testing psychologist becauseit's a wild
goose chase of data. It's constantrabbit trails
(11:29):
and contradictions. Honestly,garbage, like they
feed you garbage and thenit's your job as the
testing psychologist to sortthrough the BS and
see like what's legit andwhat's not. It's
maddening for real. Yeah, I totallyagree. It's actually
really difficult for me clinicallyin therapy
too, because I know that there'ssomething there,
(11:51):
but it's like hitting a wallor being thrust into
a maze. Like I know I'm notgetting a glimpse at
the real them. Yeah, it islike a maze. Yeah.
And you know that you're missingsomething. Okay.
Criterion four, they readhidden to meaning or
threatening meanings into benignremarks or events.
(12:11):
Doc fish, you looked at mefunny just now. You
must be scheming. I thinkyou want to kill me.
Right. It's thinking that there'ssome threat or
criticism and neutral interactions.Yes. Like we're
just having a normal conversationand all of
a sudden a glance tips themover the edge and
they're reacting with vitrioltowards you. Like
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this hair trigger is so easilyactivated and you
have no idea what will actuallyset them off.
Okay. Criteria five is thatthey hold grudges and
do not forgive an insult.Like for years, they
will not talk to someone againif they decide not to.
They will never reach outagain to a friend
(12:55):
if that friend failed toreach out to them.
Not a normal grudge is anintense and often
forever grudge. Yeah. And there'sreal rigidity
to these beliefs that othersare out to get
them and they don't go away.Like even with new
information that proves thecontrary, like these
grudges are stable and fit thatnegative worldview.
(13:19):
Okay. Criterion six, they perceiveattacks about
their character or reputationthat others do not
see. They're quick to retaliateor act out in
anger. So they're so afraidof you seeing their
badness. Like they're so scared of being
humiliated that they deny it hardcoreand will pounce to
(13:41):
protect themselves. Yeah. Yeah.And out of that,
they see threats everywhereand react first before
someone gets them. Like for example,
punishing the therapist aftergetting too close to the
core issues by maybe giving a bad review,
filing a lawsuit, attacking thetherapist character
(14:04):
for fear of personally beingattacked. Like
that's that projection again.Whatever I'm feeling,
I think it's coming from outsideof myself and
I attack. Therapist is attackingmy character,
so I will attack hers. So unsurprisingly,
these types start fights often.Like they're very
(14:24):
litigious people and they willtake you to court
and they're always ready tocounter attack. Yeah,
exactly. Criterion seveninvolves constant
reoccurring suspicions abouta spouse or a
lover's fidelity despite noevidence. This is
so interesting that this isbaked in to the DSM
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criteria. Like that's whatwe're talking about
here, that suspicion, and it'scoming out in those
closest relationships andit can look like,
oh, are you cheating? LikeI saw your phone in a
different place. You're hidingsomething from me.
Or like he looked at you, soyou must be flirting
with him. It's controllingand narcissistic
(15:06):
and awful. Now some theoristssay that it's a
projection of their desireto be unfaithful or
attraction to others outsidethe relationship.
Yes, yes, there's that projectionagain. Like
I can't admit that I'm actuallyattracted to
someone else or maybe eventhe man my wife or
girlfriend is flirting with.More on that in a
(15:28):
minute. But yes, I have definitelyseen that
clinically. Like these typesthat are the most
paranoid about their partnercheating are often
either already cheating on theirpartner or about
to. Okay, another note isthat this is not
schizophrenia or any disorderwhere the person
is actively psychotic orout of touch with
(15:50):
reality. Like consistently anyway,it's confusing
because they are unstable personalitytypes and
you can see they have theirtoe out of reality
with their like all consumingparanoia. Yeah,
which is historically whyparanoid personality
disorder got lumped in with paranoid
schizophrenia and what we're talkingabout at non psychotic
(16:11):
levels. These types roam about our social
world typically hiding out collectinggrudges and
preparing to release theirvengeance on the
world. Right. Paranoid personalitydisorder isn't fully
psychotic. It's just a really unhealthy
character structure hanging ontoreality by a thread.
(16:32):
Indeed. Yep. Okay, so we talked about the
DSM. But what are the warningsigns of a paranoid
personality that the DSM doesnot tell you? This
is really important to talk aboutbecause you often
detect paranoid using toolsoutside the textbook.
So the first thing that I noticeis my own reaction.
(16:53):
Their stories are often dramaticover the top
and I find myself not trustingthem. Like, hmm,
I'm not sure that I believe you like theirnarrative is full of contradictions,
which is a parallel process.They sure don't
trust you. And now somehowyou're feeling the
same about them. Uh huh.And another really
(17:15):
interesting thing is severegastrointestinal
issues like notable. This ismore than just your
irritable bowel syndrome. It'spossible there are
other like GI disorders or diseases or at
least claims of them. But I'mtalking like severe
intestine busting constipation.Like it will
(17:38):
stand out as significant. Mmhmm. So anxiety is
tied to the gut. We know that it makes
sense. It's common. What we'veseen is like severe
constriction and expulsionsof the bowels. Oh
yes. Across cases consistently,both of us. So this
correlates with their angerwhere they hide it
(18:01):
from the world because they'reafraid constipated
or they burst into action andretaliate because
of perceived threats. Expulsive.Mm hmm. It sounds
weird. It sounds like somethingwe should not
know, but for actually connectedparanoia to the
potty training stage of development.So this
(18:23):
actually all makes sense. Oh,it does. Good old
Freud. Of course he did.And to your point
about like, we shouldn't knowit, you're absolutely
right. Sometimes the graphicdetail in which they
share their bowel habits isclinically significant
in and of itself. Right.Like it's not the
(18:44):
tendency of older patients todiscuss their aging and
incontinence or anxiety patientsdiscussing
their stomach problems. It'slike TMI way too
much information. It's dramatic.They want you to
be as uncomfortable as theirown poop experience
was. Yes. Another element ofprojection. You take
(19:07):
this GI discomfort while Iexplain it in graphic
detail. Hold my poop, hold my pain. And
then relatedly and awkwardlyin clinical psych,
we have a phrase we use whenpatients explain
their sexual escapades insuch detail that we
call it crotch attaching, like basically
(19:28):
attaching to the therapist throughwords 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 aminute. It's hold my
mess. Hold the things aboutmyself that make
me uncomfortable or that Ideem unacceptable.
(19:50):
Exactly. Yeah. And I know our listenersand viewers right now are like, what,
but stay focused, stay, stayfocused. We got
this. We'll get there. Okay.So next concept is
sadomasochism. There's aggressionand subtle
sadism, but sometimes it ismore over. Sometimes
it's sexual sadism as well,but there's also
masochism. There's a desireto destroy. So they
(20:12):
are not destroyed. This is so interesting.Tell me more about this. So for example,
they set themselves up tobe a victim in a
situation, but then they attackwith a sadistic
aggression when they've hadenough, which can
honestly take some time. Sothere's two sides
to them. There's the passive side and the
aggressive side. And you knowwhat's interesting?
(20:34):
I've also seen extreme masochisticmedical
sabotage. Yes. Uh-huh. Itliterally results
in emergencies. So surgeries,comas, cutting
off body parts, enemas. Okay.So let's make up an
example. I'm struggling witha hernia, which
hurts, but I deserve it becauseI'm bad and guilty and
(20:57):
I need to hide my mess andmy vulnerability.
But then my hernia gets so badand my pain gets so
bad that it's a legit medicalemergency, but I
still put it off all the whilemilking it for
all it's worth lapping up pitypoints from others
until it's life threatening.And then it becomes
somebody else's responsibility.The other person
(21:20):
has to be in pain while I'min surgery and going
through life or death procedures.They have to
hold my pain while I'm under anesthesiaand sleeping.
Uh-huh. In case I die, someoneelse has to hold
my bag, my pain bag, my poopbag, my feeding bag,
(21:41):
all of it. Like they don'tgo out with their
pain bag. Someone else has tohold it. That is key.
The world will pay for their suffering.Exactly. It's projection to the max.
Also, that's connected tomass murderers we've
discussed in multiple recentepisodes of malignant
(22:02):
narcissism. Yes. Paranoidtypes are the most
likely to commit a mass murderbefore taking
their own life. The worldwill pay. All of
these people I killed and theirfamilies can hold my
pain. Yes, tragically. Um-hmm.And this is
also where paranoid's can havechronic suicidality
similar to borderline personalitydisorder,
(22:25):
but without the actual depression,like the
suicidality speaks to theirinstability 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 paranoid'sI have seen a notable
(22:49):
theme of hostility towardsother men. And on
more than one occasion, Ihave asked myself,
why are you fighting so hardagainst men? Like
are you perchance fightingyour own attraction
with a counter move? Yes, thoughcontroversial.
(23:09):
Several early theorists didproposes and there
were actually some researchstudies that did
support it. Basically it'sa rejection of I love
him and eventually through defensesit turns into
I hate him. But because inparanoid's everything
comes from outside the self,it has to turn into
I hate him because he hatesme. Wow. Projection.
(23:33):
It's not mine. It's yours.You're the one in the
wrong. I'm just reacting. Andthis brings us full
circle to the crotch attachingor poop attaching
dynamics. If you catch my driftand to be clear,
most people with same sexattraction aren't
paranoid types and they'renot dangerous at all.
Right. Paranoids are scared of the normal
(23:55):
thoughts of same sex attraction,making it into an
unacceptable urge that mustbe fought against.
Yeah. As they do with everything,it's something
to be fought against. But in some with
paranoid's there is often an aggressivetheme towards the
same sex that makes you go.Hmm. Now we also have
(24:17):
the notion of doing anythingto hide in plain sight,
even altering their speaking,their dress,
their interests. Yeah. I'veseen this too. So many
paranoid's will shed theiridentities like snake
skin, like whatever personais going to fit the
camouflage of the group. That'swhat I'll be.
(24:37):
But when they can't hide theirtrue sadistic nature
anymore, they'll slitheraway and find a new
group and learn their behaviorsand mannerisms.
I've seen this in jobs whereit's like a 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 seenin a relationship,
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it can often look like, well,what do you want
me to be? Well, where do youwant to eat? Well,
what do you think I shoulddo? But then it
turns on a dime and it becomesblaming. Well,
you're the one that nevertold me. Uh-huh. And
this is what's interestingtoo, is that they can
have a partner and actually love others,
(25:23):
which separates them from psychopathsactually.
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 thenif they do marry,
a spouse is often filling the role of a
parent. Like they will likelyalign with someone who
reminds them of an early attachmentfigure or
(25:46):
who is good ground cover. Likesomeone 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 personbecause no one
(26:07):
would ever suspect them there.Exactly. Mm-hmm.
But overall, they have majorproblems with
intimacy where they can'tget too close or too
vulnerable because there's alack of trust. Also,
there's a rupture in the relationship.If there's
kids or an aging parent thatneeds to be taken
care of, like anyone who comesin and takes that
(26:28):
child or victim place is threatening to a
paranoid. Mm-hmm. Like they needto be taken care of,
not others. P.S. a little research nugget.Paranoids have high divorce rates. Ah,
shocker. Mm-hmm. But if they'renot married,
which many never do, theylikely will utilize
(26:50):
prostitutes or one-time hookupsbecause, you
know, never too close, neverthe same person.
But bringing us back around to the main
question, why do we think the paranoidpersonality is a
post-pandemic narcissist?Yeah. So firstly,
there's whiffs of narcissismin all personality
(27:10):
pathology, like we alwayslike to say. But
paranoid personality is no different.And I think
a lot of people would lumptheir behavior in
with narcissists, especiallyin relationships,
because they play similargames and because
they present as superior andgrandiose often,
just like narcissists do. Theytend to be envious
(27:32):
like narcissists, but they projectthat envy onto
others. Right. They expect everyonearound them to
meet their needs and cater totheir whims. They're
the child in the system,yet 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-importanceis often shrouded
(27:55):
in fear or mistrust of others.So for example,
like, huh, you really thinkyou're important,
like so important that everyone is
conspiring against you. Everyonehas mistreated you.
There's grandiosity in thoseideas of reference.
(28:16):
So things that happen to themare because they are
personally so special. Thatperson's not in my
chair because they're after meand they don't like me.
Uh-huh. Yes. Yes. So the narcissism shows
up in the sadistic natureof their behavior,
where they are aggressivetowards others or
will harm or even murder otherpeople to meet
(28:40):
their own needs. Yeah. Theycan be megalomaniacs.
They have that all powerfulsadistic part of them.
Conversely, there's a vulnerablenarcissistic
aspect to them at times wherethey pool on people
to have pity for them whenthey don't take care
of themselves, like their health,their bowels,
(29:03):
their adult responsibilities,expecting you to feel
bad and act on their behalf.And like narcissists,
they're hypersensitive to criticism.
Overall, you can see the overlapin these types in a
relationship. They will feelnarcissistic because
again, those similar psychologicalgames that they
(29:24):
both play. Okay. But why postpandemic? Yeah. So
as we've said, paranoid don'tpresent to treatment.
And this is also backed by research,but the fact
that they have been since we'veentered this post
pandemic status, like that seems really
relevant. So COVID rocked our world.Literally the world
(29:48):
shut down. The paranoid'sgreatest fears were
realized that you can't trustanyone. Like not
the government, not vaccines,not the markets
in Wuhan, like nothing andno one, and they're
falling apart. And whatevercover they were
lying underneath to protectthemselves has
(30:09):
essentially been blown up.Like the entire world
changed and they're rattledand to heal, they have
to lean on people, but theycan't trust others
and won't trust others. Andthat's the underlying
conflict. So our hypothesisis that they're
coming to treatment out of desperation.They fell apart
(30:30):
during the pandemic. Andas we attempt to go
back to like normal, they can'tput themselves back
together. They cannot navigatethis post COVID
world. Agreed. Yeah. And I thinkthat's why we're
seeing more of them. Andwe think you may be
seeing more of them too. We actuallythink the research
on paranoid might followa pattern. It seems
(30:52):
there are time periods wherewe 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 continueto join us as
we unpack this type and howit can masquerade as
(31:13):
other personality disorders, especially
narcissism. Paranoid types aresnakes in the grass,
wolves in sheep's clothing, dangerous
camouflaged types. They can behiding in plain sight,
ready to pounce. And youdon't even know it.
Believe me, you need to understandthe paranoid.
(31:34):
It could mean your sanityor even your life.
And on that note, that's awrap. Thank you for
joining us today on this episode of the
personality couch. Make sure tocheck 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 reviewus on your favorite
(31:57):
podcast app. And on YouTube,hit that bell so you
don't miss a single episodein our paranoid
series. Be well, be kind, andwe'll see you next time
on the personality couch.This podcast is for
informational purposes only anddoes not constitute
a professional relationship.If you're in need
of professional help, pleaseseek out appropriate
(32:19):
resources in your area. Information about
clinical trends or diagnoses arediscussed in broad and
universal terms and do not refer toany specific person or case.