June 17, 2025 • 38 mins
In this episode of The Personality Couch Podcast, we (licensed clinical psychologists Doc Bok and Doc Fish) continue our discussion about paranoid personality disorder, exploring its three severity levels: Mild, Borderline, and Paraphrenic. We unpack the six subtypes of paranoid personalities as outlined by Dr. Theodore Millon: The Self-Righteous Mistrustful, The Obdurate Mistrustful, the Querulous Paranoid, the Insular Paranoid, the severe Fanatic Paraphrenic, and Malignant Paraphrenic. We highlight the fragility of Paranoids at all levels of severity, noting they can easily deteriorate with stressors and setbacks. We emphasize the importance of understanding these very common personality dynamics in all settings, especially with increasing paranoia in the post-pandemic world.
Are you a clinician stuck on a case? To schedule a consultation, please visit the practice website, which will guide you to the email address to use. www.questpsych.org
Chapters 00:00 Introduction to Paranoid Personality Disorder 03:44 Paranoid Personality Disorder Symptoms 06:03 Historical Examples 06:09 Timothy McVeigh - Oklahoma City Bombings 06:36 Richard Farley - Erotomania 07:52 Explaining the 3 Severity Levels 09:30 Mild Paranoid Personalities: Mistrustful Types 10:16 Self-Righteous Subtype 14:28 Obdurate Subtype 17:14 Moderate Paranoid Personalities: Disorder Level 17:44 Querulous Subtype 21:32 Insular Subtype 23:52 Severe Paranoid Personalities: Paraphrenic Level 25:44 Fanatic Subtype 30:57 Malignant Subtype 36:12 Summary & Conclusion
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Welcome to the PersonalityCouch podcast, where
we discuss all things personalityand clinical
practice. I'm your host, DocBok, and I'm here
with my co-host, Doc Fish.We are both licensed
clinical psychologists inprivate practice,
and today we continue ourseries on paranoid
(00:20):
personality disorder. In this episode, we
unpack the six subtypes of paranoidpersonalities,
according to the greatestpersonality shrink
of all time, Dr. TheodoreLalon. So we discuss
the instability central tothese types while
further exploring their characteristicsat mild
levels, moderate levels, and at the most
(00:43):
severe level where they enterinto psychotic thought
processes. If you think youhave a paranoid
personality in your life,you don't want to
miss this discussion. So let'sjump right in.
Doc Fish, in our research onparanoid personality,
there's really not a lotthere. It's grossly
(01:03):
under-researched, but Lalon,of course, came to
the rescue and became amajor contributing
force to the literature on paranoidpersonalities.
But overall, the research is still pretty
old that we found, like priorto the 1980s.
You're right about that. Not many care to
look at it in depth. Evenstill, paranoid as a
(01:26):
personality disorder has remainedin the DSM since
its first edition in 1952. TheICD eighth edition
picked it up in the next decade,like in 1965.
It's even in the psychoanalyticdiagnostic manual.
So it's like researchers andshrinks have been
able to spot this trend ofpersonality character
(01:49):
structure, but we reallyhaven't gone much
beyond that. That's what I'mseeing too. Yeah,
it's so interesting becauseI'm guessing that
even the pros really don't understandit. I agree.
Yeah. So paranoid personality disorder is
definitely a thing. Thoughit's actually been
proposed, it should be removedfrom the DSM. What?
(02:10):
No. No. Well, it's been severelyunder-researched.
A forensic psychiatrist, Michael Stone,
contributed to some of thethoughts on paranoid
personality, but his focus wasmostly in forensic
settings. So capturing severemental illness and
the criminal population.Right. Right. And I
think it's important to highlightthat a lot of the
(02:32):
textbook cases of paranoidpersonality disorders
are more severe because theless severe paranoid
personalities are not comingto treatment or
to the research studies.Like they're hiding
typically, which means thatwe don't really have
the opportunity to understandthem, like really
understand them. So while a paranoid
(02:53):
personality can be dangerous andis prone to aggression,
it doesn't mean that every caseis murderous. Like
paranoid personality can looklike bitterness and
hostility, but without fightingothers. But on
the other hand, paranoid canstart fights with
others and many who arein prison for mass
(03:14):
murder are paranoid personalitiesaccording to Stone.
So how they present is vast.Yeah. We just want
to take a minute to acknowledgethat each case
is different, but with any paranoid
personality, you do want to be mindfuland watch your back.
None of that negates our empathy and treatmentfor how their personality developed
(03:36):
and the sheer terror thatthey live in every
day. Yeah. Yeah. That's anexcellent point.
Okay. But before we jumpin to the different
flavors and shades that paranoidpersonality
disorder comes in, let'squickly review what
paranoid personality disorderis. Okay. So if
we remember paranoid personalities are in
(03:58):
cluster a of the DSM, meaningthe odd and eccentric
disorders. So these types,while their language
can be quite dramatic, they arenot going to demand a
crowd. They would rather hideand withdraw. So
with that, they're going tooverlap more with
skeezoid and skeezotypaltypes in cluster a.
(04:19):
Hmm. Paranoid personalitiesare very mistrustful
of other people's loyalty andthey fear confiding
in others because they don'twant the information
to be used against them. That'scorrect. Yeah.
They are super suspicious ofother people harming
them, which is unwarranted,but then they find
neutral things threateningand they're going to
(04:41):
be hypervigilant constantlyscanning every
surrounding, no matter howbenign for threats
because of all of this, they'requick to attack
any perceived slight or threat.Yeah. So they're
not going to be warm, fuzzypeople. Like they
have difficulty expressing warmthand can actually be
(05:02):
irritable and abrasive. Theretends to be like
an exaggerated competitivenessbecause they're
self-righteous and arrogant.And with that, they
have a fondness for righteouscauses and they can
have grandiose rescue fantasies.Yes. So we
might actually find thesetypes in politics,
(05:25):
in emergency services, inlaw enforcement, or
in other settings like withthreat assessments or
kind of that would elicit a vigilante
response. Very much so. And theyalso have an unusually
strong need to be self-sufficient and
independent, having resentment towardsauthority and very
(05:47):
strong reactions to humiliation.Yeah. And a really
big part of this type is thatthey are vindictive,
like taking their anger outon the world around
them, especially as they holdgrudges forever.
Yes. So some examples of paranoidpersonalities
in history, these are goingto be more extreme,
(06:08):
but they do include Timothy McVey and his
sidekick, Terry Nichols,who joined forces
with a shared paranoia and desire to
retaliate against the government.With both of these
individuals, they took theirvengeance out on a
government building in whatwe now know as the
Oklahoma City bombings in1995. And they were
(06:28):
likely that disordered levelor beyond paranoid duo.
Very much. Another example, which is
forensic, more extreme. Stonetalked about Richard
Farley. So this story highlights
pathological jealousy in a paranoidstalker turned mass
murderer. So Richard stalkeda girl who refused
(06:48):
to date him and eventually shefiled a restraining
order, which he did not respect. So he
threatened to kill her if shedidn't go out with him,
which also led to him gettingfired. Two years
later, he killed seven peopleand wounded four,
including that girl at hisold workplace. Oh my
goodness. This is what we'retalking about. Like
(07:08):
that grudge holding is longand serious, which
can make these types dangerousbecause they see
everything and everyone as athreat and they have
a high need for vengeance. Sothis means that they
often take their anger outon the world in the
form of harming others or aswith these more extreme
(07:30):
examples, even killing otherpeople. Yeah. And
it is important to note thatnot all paranoid
types kill. There is highrisk giving their
unstable, irritable and vengefulpersonality
structure, but there are morelike mild forms of
paranoid personality types.Yeah. Agreed. Agreed.
So with that, why don't wetalk about Milan's
(07:53):
different levels of paranoidpersonality severity?
Absolutely. So with subtypes, we actually
have six to unpack each increasingin pathology.
Milan differentiates three levels of
severity. The first is the mildlevel that's closer to
normal functioning. He justcalls those like
(08:13):
mistrustful personalities.The second is the
middle level, the borderline functioning.
He calls that actual paranoidpersonalities.
Makes sense. This is wherewe would find the
actual paranoid personalitydisorder. Right.
Then the third, that last level that hascompletely fallen apart out of reality,
(08:35):
can't function well is what he labels
paraffrenic personalities. Oh, yes.This is where it gets
really interesting. So paranoidpersonality
structures occur along a continuumwith a range
of severity levels, but any level can
disintegrate and become worse. Correct.Yeah. So it's tricky
(08:58):
kind of using the word mildto describe any
personality structure of theparanoid variety,
but since these types disintegratequickly and can
go from mild to disorder withminor stressors and
setbacks, we have to be reallycareful in how we
talk about that. And I thinkthis is especially
true in today's post pandemic world and
(09:20):
conspiracy theory culture. Oh, wow.Yes. Very much so. Very
much so. Okay. But with that,let's go ahead
and jump into level one, themistrustful types.
So starting at that firstlevel, we have that
mistrustful style. So whilehaving some unhealthy
traits similar to paranoidpersonalities, they
(09:42):
likely still have other usefultraits that help
them blend into society andpossibly even be
successful. Right. Yeah.So in these types,
there's something off aboutthem, like, but
they're still functioning andyou're not consistently
questioning your safety aroundthem. Right. So
this like mild category includesa self-righteous
(10:05):
style and an obdurate style of paranoid personalities.Oh, we will unpack those big
words too. Thank you, Milan. Yes. So let'sstart with that self-righteous subtype,
which seems to be like amore pure flavor of
paranoid as their mistrustfulof others with
the high need for independence.These types can
(10:28):
disintegrate into paranoidpersonality disorder
easily if they start to fall apart. That'sright. Yeah. Okay. But tell me like,
what do these types look like?How do we spot
them? Yes. So in those self-righteousmistrustfuls,
self-sufficiency is extremelyimportant with
(10:48):
possible fantasies of fascism.Their excessive
need for control means thatthey control their
close inner circle very tightly.If they don't
keep a tight rein on theirfunctioning, their
covers alone. Yes. Okay. Soan example might be
a professor who's rulingthe classroom like
with an iron fist, like nosurprises, no jokes,
(11:10):
really no real connection tothe students either.
And he might fear that thestudents are actually
colluding, especially after there were
complaints about his more rigidand authoritarian way of
teaching. But the interestingthing is that
these types may own their ownbusinesses to protect
themselves from the threatsof the world. So this
(11:32):
allows them to create policiesand procedures to
ward off those attacks andthreats. So they make
it work for them. They're functional.They're a
professor, maybe a businessowner, but right, the
professor may be overly concernedabout his tenure
or somebody being out for hisjob. The business
(11:53):
owner may think like othersare trying to steal
his ideas, which might belike technically
helpful because no one can actuallysteal the ideas.
Sure. And in a chapter byMilan, he noted that
J Edgar Hoover was said tobe a paranoid type.
Not sure where exactly hewould fit in with
Milan's theory, but I think it'shelpful to bring up here
(12:15):
because he adaptively usedhis skills as the
FBI's first director. And thisis where functioning is
really important. Like Hooverfunctioned and was
successful because his personalitywas paranoid.
But if you take him out ofthat paranoid role as
a director, then would he bea more severe type?
(12:39):
Maybe it's hard to say. Andthis is where it
gets really tricky with paranoidpersonalities,
because you never really knowthem and therefore
never really know how severethey are or could be.
So while they can technicallybe functional,
they can still make otherslives miserable.
And people often fear themat all levels of
(13:00):
severity. Yeah, that's sotrue. So with all
paranoid types, you likely feel some type
of countertransference offear or hostility.
So essentially, you feel theirfear of you. These
self-righteous types are stillhypervigilant and
fear being annihilated. Theycannot let their
(13:22):
guard down even for a quickjoke. Oh my goodness.
Wow, that's the rigidity again.And this makes
me think that we're goingto probably see some
overlap with this type andobsessive compulsive
personality disorder, sincethat compulsive part
can be adaptive like they're functional,
but odd, fearful, chilly,and very rule bound.
(13:46):
And again, J Edgar Hoover was said to havesome obsessive features himself.
Well, as Milan says to theself-righteous type,
the enemy is there, thus theybelieve with certainty
about how close and how deeplyinfiltrated are
impossible to answer. So essentially,they feel
(14:06):
they cannot miss any negativeattribution or
threat, lest they perishtheir biggest fear.
Yes. So this can be adaptive and make
someone a functional, like politicalleader maybe,
or maybe a law enforcementlead or even a spy.
(14:27):
Yeah. Okay. So the other mistrustfultype or mild
personality is called theObdurate subtype. Oh
my goodness. Here we are withMilan's and his vast
vocabulary again, but Obdurateis essentially
extreme and rigid stubbornness.Well, they can
also be self-righteous, suspicious,and humorless.
(14:48):
The Obdurate type holds a conflictsimilar to the
compulsives of trying to restraintheir anger
and hostility by deferring anddepending on others.
However, they can't restrainit. So they end
up rejecting their own dependencyand then like
discharging their hostility.So basically they
actively rebel against anyexternal or outside
(15:11):
constraints so they can feelin control. Right.
So here we see that they projecttheir hostility,
meaning it's put on others.So because they can't
handle their dependency or theirneed for others,
they constantly push others away. It's a
conflict. Like I need people, butI can't get too close.
Like I need to be independent so I am not
(15:33):
destroyed. Right. Because ifthey're independent,
there's less need for vulnerability,which
could lead to them being destroyed.They can be very
moody, cranky, tense, andunrelenting. Yes.
And Milan notes that they mayappear to function
normally much of the time, but possessed
(15:54):
tightly compartmentalized persecutorydelusions.
So these tendencies go largely unnoticed,but the individual's hypersensitive
antennae are perpetually in alert mode,noticing any unusual twitch,
remark, or facial expression emanatingfrom nearby others.
(16:16):
Right. And if the antennaesensitive nerve is
touched, their normal functioningis hindered.
And then all those hidden beliefs come tothe surface. I have seen this so much.
So like, are you mad atme? Are you mad at
me? Now? Are you mad at me?All because a facial
expression was actually confusedor tired or
(16:37):
surprised, but there's thatmajor hypersensitivity
to any anger, conflict, threats,danger. Like
the little hungry caterpillaralways has those
antennae ready. Oh, he does. Yes. But I
mean, can you imagine whatthat feels like? Like
spending so much energy runningaround with your
(16:57):
antennas up all the time, likebeing anxious all
the time. Like no wonder these people are
cranky. Like that takesup so much energy.
Yeah. It's extremely drainingand it's really scary.
Absolutely. Yeah. Okay. Well,this brings us to
level two of paranoid subtypes.So these are in
(17:19):
the borderline range of functioning,meaning
that individuals mostly stayin reality, but can dip
their toe into the psychoticrange for brief
periods of time, like hours ordays, but definitely not
weeks or more. So paranoidpersonality disorder
lives in this space. So in thatparanoid personality
(17:42):
range, we have the querulousparanoid, which
is a paranoid personality corewith features of
negativistic personality. Thatnegativistic piece
includes discontentment, pessimism,stubbornness,
vacillation, vengefulness.They are the bitter
chip on the shoulder typeas they are overtly
(18:05):
hostile, argumentative, fault finding,
unaccommodating, resentful, likewhiny and snappish.
Okay. Wow. Yes. So going backto querulous, so
querulous actually means complainingor fretting,
even whining in a high pitchedvoice. Okay.
(18:25):
So these types are rarelyin a consistent and
healthy relationship since they usually
reject their need for connectionand focus on their
independence with vengefulfury. So there's
actually a conflict herethough. They're not
content being alone and theydon't like this
about themselves, but thenthey also don't like,
(18:47):
like their indecisiveness andbeing with others.
So they swing between desiringothers and being
repulsed by others. Oh mygoodness. Wow. So I
can also imagine like, becausethey want affection,
but then they refuse it. Sothen they're going to
project that need for affectiononto others. Like,
(19:08):
for example, it's otherswho maybe want me
erotically, not me who wantsthem, right? And
this is where it can turn into erotic
delusions with this type. So forexample, like I'm not
attracted to them. Likethey made advances
at me. They are stalkingme. They love me.
(19:30):
It's twisted. They often accuse others of
cheating, lying and betrayingthem, or even of making
suggestive comments towards them or even
molesting them. So they can besuper jealous. Wow. This
actually reminds me of casesthat I've seen
with reports of severe sexualtrauma history,
(19:53):
but something doesn't quiteadd up in that
narrative. We have to becareful with that
because obviously severe sexualtrauma histories
exist. Like this is somethingdifferent. It feels
different. Something is likeoff and it just, it
does not make sense. Right.Yeah. So in the cases
that I've seen, somethingfeels off in the
(20:15):
storytelling. Like it doesn'tadd up or maybe
in the way that they've toldthe story, or maybe
I'm feeling like they're tryingto get a reaction
from me or maybe are projectingsomething onto
me. Like there's somethingabout it that feels
inauthentic. Right. And westill meet it with
empathy. Absolutely. But there'slike a clinical
(20:37):
skepticism that's helpful for treatment purposes.Very much so. Yeah. All right. So
going back to query lists.So unsurprisingly
with these types, their envycan easily turn
into complaints about things not being
fair, which is then turnedinto anger and spite.
(20:57):
So can you take a guess wherethey go to make
their complaints heard thecourts? Of course.
They can be very litigious types. They canalso have Frank delusions when they slip
into those quick psychotic episodes, but
emphasis on quick, they are notat the psychotic level.
Right. Right. But they'll popover to psychosis
(21:19):
land for a minute. All right.But I think we have
another one in this like moderateor borderline
range. Another subtype thatMilan described in
the moderate severity levelor borderline level is
the insular paranoid. It's aparanoid personality
at the disorder level who hasavoidant personality
(21:40):
features being extra hypersensitiveto criticism,
like an avoidant personalitymight be especially
criticism involving like achievementand their own
worth. So going back to insular,insular means
insulated or isolating or likeon an island or in
a cocoon. I like to think ofit as the paranoid
(22:02):
who likes to hide in like aninsulated cooler to
stay safe. So areas that'svery true. Yeah. So
they're more reclusive, withdrawn,and sometimes
even hermit like focusing onisolating themselves
from any threats or destructiveforces. They still
have the hyper vigilanceand defensiveness
(22:23):
against imagined dangers, buttheir self protection is
self-focused. They also havea very, very, very
strong fear of being controlled,which means they're
extra unwilling to take inany outside data
to check themselves. Thusthey can fall out of
reality more easily. So theyare hostile against
(22:45):
new data. They need to readit or feel it through
those antennas themselves.Now, what really
pulls my empathy here is thattheir internal thoughts
without that outside checkare terrifying and
painful and their anger too,it can become out
of control. Right. So they can turn that
(23:07):
anger inward towards themselves,resulting in self
mutilation, suicide, or evenself destruction.
And in this way, they overlapsome with borderline
personality disorder, but theyare not the same,
not the same. So the piece thatalso can distinguish
this type from borderline isthat they can turn
(23:29):
their anger outward onto othersand project it.
So this is going to result in rageful and
brutal attacks. And again, thismay apply to Stone's
reference of paranoid personalitydisorders
being more likely to commitmass murders. Right,
project the pain onto the masses. Yeah.
Okay. I think we have onelast subtype level,
(23:52):
level three of paranoid personality.Okay. So
sometimes paranoid in theborderline or that
middle level of severitycan fall apart and
become even less healthy.When this happens,
Milan says they often endup in like inpatient
care where they get regulatedwith medications
or therapy or treatment, right? They go
(24:13):
back to functioning, but thenit happens again.
So paranoid and decompensationthat falling
apart can have increasingly frequentinpatient stays
recovering until they can't. Oh boy. So atthat point they're in psychotic land,
which for the paranoid personalityis called
paraffrenic. According to Milan,Milan says the
(24:37):
paraffrenic area is essentiallyparallel to
schizophrenic territory, butit's not schizophrenia.
More on that later. Exactly.More on that later.
Yeah. This, this is so fascinating,but this again
speaks to how fragile theparanoid structure
really is. Like it's alreadyon the fritz of
falling apart, which meansthey can quickly
(24:58):
deteriorate to the nextlevel of severity,
possibly even becoming fully psychotic.
But as you said, this psychoticrange is not
schizophrenia, but it's confusingbecause we
still use the term paranoidschizophrenia today,
even though it was removed from the DSM
five in 2013 and in the ICD11 fairly recently.
(25:24):
So from this, I think wecan kind of gather
that we have a really hardtime as clinicians
understanding this paranoid structure,
which has only contributedto more confusion and
misdiagnosis. Yeah. But shall we start withthe first subtype in this severe level?
Sure thing. We have that fanaticsubtype that
(25:45):
is a decompensated paranoidpersonality at that
paraffrenic level with narcissisticfeatures. So
this is interesting becausea researcher in 1973
actually suggested that paranoid personalitydisorder was a subtype of narcissistic
personality disorder. Oh,no way. That is so
(26:08):
interesting. And yeah, there'scertainly a heavy
dose of narcissism in paranoidpersonality, but
they're not the same thing.But Kernberg actually
made a very important notethat narcissistic
personality disorder and paranoidpersonality
disorder can coexist, but the paranoid individualis cold, aloof and suspicious,
(26:33):
but not exploitative and envious like the
narcissistic individual. Sothis also supports
why and how some individualswith paranoid
personality disorder are often labeled as
narcissists. Right. Okay. So the fanatic
paraffrenic has the arrogance,exaggerated self-importance,
(26:58):
and like disrespectful, disapprovingsuperiority
that the narcissistic personalitydisorder displays,
but they have grandiose delusionsthat are flimsy
and irrational. They're makingup for lost pride
through extravagant grandiosefantasies and
delusions. Okay. Okay. Sothis is the piece
(27:18):
that separates them from narcissistic
personality disorder. And that'sthat the delusions here
really don't make sense.Like someone with
paranoid personality disorder,narcissistic
personality disorder usuallyhas a linear way
of thinking. Like for example,maybe a grandiose
narcissist might think thatthey're the best end
(27:39):
of story. Like everything theydo is for the ego.
But someone who is a fanaticparaffrenic is out
of touch with reality in bizarroways. Like you
can't follow their logic. So for example,
someone proclaiming that theyare the Messiah and that
they are being persecuted by unholy and
unseen forces. Yeah. So theycan actually present
(28:02):
themselves as like a holy saintinspired leader or
talented genius, but eventuallyother see through
this, of course. Yeah. Sothen the fanatic
paraffrenic projects to protectthemselves from
humiliation. Of course, ofcourse they do. Yeah.
So they believe that they areall powerful against
(28:24):
an evil world, like a superheroeven. So a
great example is we've mentionedthis multiple times
for different types of pathology,but a great
example here is the Jonestowncult leader. Like
he was the helpful Messiah,but towards the end,
he started falling apart andsaying that the CIA
(28:45):
was after him and he was afraidthat the world
would drop a nuclear bomb,which resulted in him
moving himself and his followersto a remote
location in Guyana. Right.So Milan literally
wrote that fanatic paraffrenics project
their stuff. Like it's not theirown power that's
insufficient. It's that there'sthis secret
(29:06):
government agents that areconspiring against
them. Like they really lean into that all
powerful part that paranoid South.Yeah. This is so
interesting. Like it's not methat's incompetent.
I'm not the one that lacks thepower. These forces
here are destroying me and mygreatness. Like you
can see that overlap with narcissisticpersonality
(29:28):
here. And interestingly,like some types of
narcissists, these fanaticparaffrenics had
overindulgent parents who letthem believe that
their existence was sufficientwithout effort.
So their grandiose fantasiesdidn't have any
boundaries. Wow. But laterthe world gave them
a big reality check and theycouldn't handle it.
(29:49):
So they turned to fantasy,primarily coping with
all of this with those grandiosedelusions.
Yeah. Again, another fascinatingpoint is that
fanatic paraffrenics areout of touch with
reality. They're often grandioseand they can
position themselves as Godlike figures in an
evil society, but then they canalso flip that script
(30:13):
and become victim me takingon like a, Oh,
whoa, is me. Everyone's out toget me. Or even like,
Oh, no one recognizes mygreat talents and
abilities. I guess I'm just too brilliant
to be understood. Right. Andthat's a perfect
place to put that reminderagain, that not all
paranoid personalities aregoing to kill you,
(30:36):
but also like dramatically.This next subtype is
probably more at risk to hurtyou because they
have a sadistic flavor. No.Ruh roh. All right.
So we better pull up a seat.This one is going
to be fascinating. Yes. Sothe second subtype in
the severe paraffrenic range that Milan
(30:56):
describes is a malignant paraffrenic.So a paranoid
personality core with sadisticfeatures. Oh
my. To summarize the subtypes,Milan stated these
paranoids are characterized best by their
power orientation, their mistrustand resentment of
(31:16):
others and by their belligerent and
intimidating manner. Wow. And theirstrategy is to dominate
you before you can dominatethem. So as you can
imagine, temperamentally, thesetypes come across
as callous, belligerent, argumentative,
vengeful, and even tyrannical.Like they will fight you.
(31:40):
And these types are hypersensitiveto power
dynamics, believing that othersare only capable
of aggression and hostility towards them,
which then results in persecutorydelusions,
which this aligns with the theorists who
propose that those with paranoidpersonalities
experience a sadistic parentin childhood.
(32:04):
And it pulls my empathy herebecause they're
literally fighting againstthat sadistic parent.
Right, right. Which then getsprojected onto the
larger world as they grow up.But yeah, so they
project their own sadisticimpulses onto other
people saying they are tryingto intimidate
me. They are trying to controlmy thoughts.
(32:25):
They are trying to weakenme. Which totally
makes sense because that'sprobably what they
expected from their sadisticparent. Yeah,
yeah. And at the severity, thesetypes really can't
function in society with theirsadistic impulses
and will eventually end upin a forensic setting
(32:46):
or in an institution. Right.So someone who ends
up like in prison might bethere for assault or
murder because they're acting out those
sadistic urges. Someone who endsup in like a state
hospital maybe might be hallucinatingthe people
that they believe are persecutingthem. That is
so fascinating. Yeah. Yeah.So Milan provides a
(33:08):
case in his book explaininghow basically a man
who was a childhood bully,who was influenced by
his sadistic father, endedup beating his father
severely in adolescence. Helater joined the Navy,
drank excessively, and flewoff the handle at the
drop of the hat. So he wasdischarged early for
(33:31):
psychiatric reasons due tothe bizarre features
of his episodes. So a lot happened in his
twenties and thirties, but he eventuallywas elected into
a political position. And thenof course forced
to resign. Then later a romanticpartner sold his
business and kept the proceeds,which just
confirmed his lack of trust inothers. So he became
(33:55):
even more violent and wasinstitutionalized for
two years. Then he got out, hebegan drinking again
and attempted to assaulthis wife multiple
times. And he was unsuccessfulsince his teenage sons
intervened. So my goodness,after four years of
this, he disappeared for 18months and was found
(34:18):
destitute. He returned toa state hospital for
over a decade where he experiencedunrealistic,
psychotic, persecutory delusions and
hallucinations. That's what we'retalking about. Yeah. Oh my
goodness. So in this case,we can definitely
track the decompensation likethat falling apart. Oh,
(34:39):
yes. So that paraffrenic levelof falling apart
started around the time thathe left his family
and disappeared. Right. Solike before that,
we can see like he's, he'skind of functioning
maybe a little bit. It's notgood, but like he's
functioning after that. He disintegratedinto that
paraffrenic level. Absolutely.Interestingly, I
(35:02):
think if his own teenage sonsdid not like win
the fights, probably morelikely he would have
ended up in like jail or prison.Right. Right.
So there's where there's likethat, which way
are you going to take in termsof decompensation
and where are you going toend up? So with these
malignant paraffrenic types,they try to actually
avenge themselves by hurtingothers. And of course
(35:25):
it backfires. It doesn't work.So then as a result,
they direct their hostilitytowards fantasy much
more than through behaviors.That is what separates
them from a sadistic personality.The malignant
paraffrenic goes that fantasyroute because their
(35:46):
brutality has backfired. Right. And that
fantasy route leads to psychosis.So all of those
hallucinations and bizarredelusions, right?
Because if you're alreadyprone to fantasies
and you can't distinguishbetween what's real
and what's in your head, that'sgoing to lead to
problems with reality testing, which is
the vehicle to psychotic orparaffrenic land.
(36:09):
My goodness. Okay. So welearned a lot about
paranoid personality and thevarying severity
levels that give way tosubtypes. Paranoid
personalities overall candecompensate quickly
under stress, which means that this
instability can actually makethem dangerous. However,
(36:30):
the dangerous cases are alsomore likely to
find themselves in textbooksas they're in settings
where they can be studied, like a state
hospital or a prison, and thenothers are just hiding.
So we know less about thosetypes, the more
mild forms of paranoid personality.But that said,
as we've noted before inthis series, this
(36:52):
post pandemic landscape hasmeant that paranoid
personalities are disintegratingbecause they
are afraid. And this means thatthey've been coming
to treatment more as a result.And we believe
that you may also be seeingthese types pop up
in your circles, which iswhy we're doing this
(37:13):
whole series so you can knowwhat to be on the
lookout for. And on that note,that's a wrap.
Thank you for joining us todayon this episode of
The Personality Couch. Makesure to check out
our blogs that coincide withthese episodes at
www.personalitycouch.com.And as always, don't
(37:33):
forget to give us a thumbsup or rate and review
us on your favorite podcastapp. And on YouTube,
hit that bell so you don'tmiss a single episode
in our paranoid personalityseries. Be well, be
kind, and we'll see you next timeon The Personality Couch.
Welcome to the PersonalityCouch podcast, where
we discuss all things personalityand clinical
practice. I'm your host, DocBok, and I'm here
with my co-host, Doc Fish.We are both licensed
clinical psychologists inprivate practice,
and today we continue ourseries on paranoid
(00:20):
personality disorder. In this episode, we
unpack the six subtypes of paranoidpersonalities,
according to the greatestpersonality shrink
of all time, Dr. TheodoreLalon. So we discuss
the instability central tothese types while
further exploring their characteristicsat mild
levels, moderate levels, and at the most
(00:43):
severe level where they enterinto psychotic thought
processes. If you think youhave a paranoid
personality in your life,you don't want to
miss this discussion. So let'sjump right in.
Doc Fish, in our research onparanoid personality,
there's really not a lotthere. It's grossly
(01:03):
under-researched, but Lalon,of course, came to
the rescue and became amajor contributing
force to the literature on paranoidpersonalities.
But overall, the research is still pretty
old that we found, like priorto the 1980s.
You're right about that. Not many care to
look at it in depth. Evenstill, paranoid as a
(01:26):
personality disorder has remainedin the DSM since
its first edition in 1952. TheICD eighth edition
picked it up in the next decade,like in 1965.
It's even in the psychoanalyticdiagnostic manual.
So it's like researchers andshrinks have been
able to spot this trend ofpersonality character
(01:49):
structure, but we reallyhaven't gone much
beyond that. That's what I'mseeing too. Yeah,
it's so interesting becauseI'm guessing that
even the pros really don't understandit. I agree.
Yeah. So paranoid personality disorder is
definitely a thing. Thoughit's actually been
proposed, it should be removedfrom the DSM. What?
(02:10):
No. No. Well, it's been severelyunder-researched.
A forensic psychiatrist, Michael Stone,
contributed to some of thethoughts on paranoid
personality, but his focus wasmostly in forensic
settings. So capturing severemental illness and
the criminal population.Right. Right. And I
think it's important to highlightthat a lot of the
(02:32):
textbook cases of paranoidpersonality disorders
are more severe because theless severe paranoid
personalities are not comingto treatment or
to the research studies.Like they're hiding
typically, which means thatwe don't really have
the opportunity to understandthem, like really
understand them. So while a paranoid
(02:53):
personality can be dangerous andis prone to aggression,
it doesn't mean that every caseis murderous. Like
paranoid personality can looklike bitterness and
hostility, but without fightingothers. But on
the other hand, paranoid canstart fights with
others and many who arein prison for mass
(03:14):
murder are paranoid personalitiesaccording to Stone.
So how they present is vast.Yeah. We just want
to take a minute to acknowledgethat each case
is different, but with any paranoid
personality, you do want to be mindfuland watch your back.
None of that negates our empathy and treatmentfor how their personality developed
(03:36):
and the sheer terror thatthey live in every
day. Yeah. Yeah. That's anexcellent point.
Okay. But before we jumpin to the different
flavors and shades that paranoidpersonality
disorder comes in, let'squickly review what
paranoid personality disorderis. Okay. So if
we remember paranoid personalities are in
(03:58):
cluster a of the DSM, meaningthe odd and eccentric
disorders. So these types,while their language
can be quite dramatic, they arenot going to demand a
crowd. They would rather hideand withdraw. So
with that, they're going tooverlap more with
skeezoid and skeezotypaltypes in cluster a.
(04:19):
Hmm. Paranoid personalitiesare very mistrustful
of other people's loyalty andthey fear confiding
in others because they don'twant the information
to be used against them. That'scorrect. Yeah.
They are super suspicious ofother people harming
them, which is unwarranted,but then they find
neutral things threateningand they're going to
(04:41):
be hypervigilant constantlyscanning every
surrounding, no matter howbenign for threats
because of all of this, they'requick to attack
any perceived slight or threat.Yeah. So they're
not going to be warm, fuzzypeople. Like they
have difficulty expressing warmthand can actually be
(05:02):
irritable and abrasive. Theretends to be like
an exaggerated competitivenessbecause they're
self-righteous and arrogant.And with that, they
have a fondness for righteouscauses and they can
have grandiose rescue fantasies.Yes. So we
might actually find thesetypes in politics,
(05:25):
in emergency services, inlaw enforcement, or
in other settings like withthreat assessments or
kind of that would elicit a vigilante
response. Very much so. And theyalso have an unusually
strong need to be self-sufficient and
independent, having resentment towardsauthority and very
(05:47):
strong reactions to humiliation.Yeah. And a really
big part of this type is thatthey are vindictive,
like taking their anger outon the world around
them, especially as they holdgrudges forever.
Yes. So some examples of paranoidpersonalities
in history, these are goingto be more extreme,
(06:08):
but they do include Timothy McVey and his
sidekick, Terry Nichols,who joined forces
with a shared paranoia and desire to
retaliate against the government.With both of these
individuals, they took theirvengeance out on a
government building in whatwe now know as the
Oklahoma City bombings in1995. And they were
(06:28):
likely that disordered levelor beyond paranoid duo.
Very much. Another example, which is
forensic, more extreme. Stonetalked about Richard
Farley. So this story highlights
pathological jealousy in a paranoidstalker turned mass
murderer. So Richard stalkeda girl who refused
(06:48):
to date him and eventually shefiled a restraining
order, which he did not respect. So he
threatened to kill her if shedidn't go out with him,
which also led to him gettingfired. Two years
later, he killed seven peopleand wounded four,
including that girl at hisold workplace. Oh my
goodness. This is what we'retalking about. Like
(07:08):
that grudge holding is longand serious, which
can make these types dangerousbecause they see
everything and everyone as athreat and they have
a high need for vengeance. Sothis means that they
often take their anger outon the world in the
form of harming others or aswith these more extreme
(07:30):
examples, even killing otherpeople. Yeah. And
it is important to note thatnot all paranoid
types kill. There is highrisk giving their
unstable, irritable and vengefulpersonality
structure, but there are morelike mild forms of
paranoid personality types.Yeah. Agreed. Agreed.
So with that, why don't wetalk about Milan's
(07:53):
different levels of paranoidpersonality severity?
Absolutely. So with subtypes, we actually
have six to unpack each increasingin pathology.
Milan differentiates three levels of
severity. The first is the mildlevel that's closer to
normal functioning. He justcalls those like
(08:13):
mistrustful personalities.The second is the
middle level, the borderline functioning.
He calls that actual paranoidpersonalities.
Makes sense. This is wherewe would find the
actual paranoid personalitydisorder. Right.
Then the third, that last level that hascompletely fallen apart out of reality,
(08:35):
can't function well is what he labels
paraffrenic personalities. Oh, yes.This is where it gets
really interesting. So paranoidpersonality
structures occur along a continuumwith a range
of severity levels, but any level can
disintegrate and become worse. Correct.Yeah. So it's tricky
(08:58):
kind of using the word mildto describe any
personality structure of theparanoid variety,
but since these types disintegratequickly and can
go from mild to disorder withminor stressors and
setbacks, we have to be reallycareful in how we
talk about that. And I thinkthis is especially
true in today's post pandemic world and
(09:20):
conspiracy theory culture. Oh, wow.Yes. Very much so. Very
much so. Okay. But with that,let's go ahead
and jump into level one, themistrustful types.
So starting at that firstlevel, we have that
mistrustful style. So whilehaving some unhealthy
traits similar to paranoidpersonalities, they
(09:42):
likely still have other usefultraits that help
them blend into society andpossibly even be
successful. Right. Yeah.So in these types,
there's something off aboutthem, like, but
they're still functioning andyou're not consistently
questioning your safety aroundthem. Right. So
this like mild category includesa self-righteous
(10:05):
style and an obdurate style of paranoid personalities.Oh, we will unpack those big
words too. Thank you, Milan. Yes. So let'sstart with that self-righteous subtype,
which seems to be like amore pure flavor of
paranoid as their mistrustfulof others with
the high need for independence.These types can
(10:28):
disintegrate into paranoidpersonality disorder
easily if they start to fall apart. That'sright. Yeah. Okay. But tell me like,
what do these types look like?How do we spot
them? Yes. So in those self-righteousmistrustfuls,
self-sufficiency is extremelyimportant with
(10:48):
possible fantasies of fascism.Their excessive
need for control means thatthey control their
close inner circle very tightly.If they don't
keep a tight rein on theirfunctioning, their
covers alone. Yes. Okay. Soan example might be
a professor who's rulingthe classroom like
with an iron fist, like nosurprises, no jokes,
(11:10):
really no real connection tothe students either.
And he might fear that thestudents are actually
colluding, especially after there were
complaints about his more rigidand authoritarian way of
teaching. But the interestingthing is that
these types may own their ownbusinesses to protect
themselves from the threatsof the world. So this
(11:32):
allows them to create policiesand procedures to
ward off those attacks andthreats. So they make
it work for them. They're functional.They're a
professor, maybe a businessowner, but right, the
professor may be overly concernedabout his tenure
or somebody being out for hisjob. The business
(11:53):
owner may think like othersare trying to steal
his ideas, which might belike technically
helpful because no one can actuallysteal the ideas.
Sure. And in a chapter byMilan, he noted that
J Edgar Hoover was said tobe a paranoid type.
Not sure where exactly hewould fit in with
Milan's theory, but I think it'shelpful to bring up here
(12:15):
because he adaptively usedhis skills as the
FBI's first director. And thisis where functioning is
really important. Like Hooverfunctioned and was
successful because his personalitywas paranoid.
But if you take him out ofthat paranoid role as
a director, then would he bea more severe type?
(12:39):
Maybe it's hard to say. Andthis is where it
gets really tricky with paranoidpersonalities,
because you never really knowthem and therefore
never really know how severethey are or could be.
So while they can technicallybe functional,
they can still make otherslives miserable.
And people often fear themat all levels of
(13:00):
severity. Yeah, that's sotrue. So with all
paranoid types, you likely feel some type
of countertransference offear or hostility.
So essentially, you feel theirfear of you. These
self-righteous types are stillhypervigilant and
fear being annihilated. Theycannot let their
(13:22):
guard down even for a quickjoke. Oh my goodness.
Wow, that's the rigidity again.And this makes
me think that we're goingto probably see some
overlap with this type andobsessive compulsive
personality disorder, sincethat compulsive part
can be adaptive like they're functional,
but odd, fearful, chilly,and very rule bound.
(13:46):
And again, J Edgar Hoover was said to havesome obsessive features himself.
Well, as Milan says to theself-righteous type,
the enemy is there, thus theybelieve with certainty
about how close and how deeplyinfiltrated are
impossible to answer. So essentially,they feel
(14:06):
they cannot miss any negativeattribution or
threat, lest they perishtheir biggest fear.
Yes. So this can be adaptive and make
someone a functional, like politicalleader maybe,
or maybe a law enforcementlead or even a spy.
(14:27):
Yeah. Okay. So the other mistrustfultype or mild
personality is called theObdurate subtype. Oh
my goodness. Here we are withMilan's and his vast
vocabulary again, but Obdurateis essentially
extreme and rigid stubbornness.Well, they can
also be self-righteous, suspicious,and humorless.
(14:48):
The Obdurate type holds a conflictsimilar to the
compulsives of trying to restraintheir anger
and hostility by deferring anddepending on others.
However, they can't restrainit. So they end
up rejecting their own dependencyand then like
discharging their hostility.So basically they
actively rebel against anyexternal or outside
(15:11):
constraints so they can feelin control. Right.
So here we see that they projecttheir hostility,
meaning it's put on others.So because they can't
handle their dependency or theirneed for others,
they constantly push others away. It's a
conflict. Like I need people, butI can't get too close.
Like I need to be independent so I am not
(15:33):
destroyed. Right. Because ifthey're independent,
there's less need for vulnerability,which
could lead to them being destroyed.They can be very
moody, cranky, tense, andunrelenting. Yes.
And Milan notes that they mayappear to function
normally much of the time, but possessed
(15:54):
tightly compartmentalized persecutorydelusions.
So these tendencies go largely unnoticed,but the individual's hypersensitive
antennae are perpetually in alert mode,noticing any unusual twitch,
remark, or facial expression emanatingfrom nearby others.
(16:16):
Right. And if the antennaesensitive nerve is
touched, their normal functioningis hindered.
And then all those hidden beliefs come tothe surface. I have seen this so much.
So like, are you mad atme? Are you mad at
me? Now? Are you mad at me?All because a facial
expression was actually confusedor tired or
(16:37):
surprised, but there's thatmajor hypersensitivity
to any anger, conflict, threats,danger. Like
the little hungry caterpillaralways has those
antennae ready. Oh, he does. Yes. But I
mean, can you imagine whatthat feels like? Like
spending so much energy runningaround with your
(16:57):
antennas up all the time, likebeing anxious all
the time. Like no wonder these people are
cranky. Like that takesup so much energy.
Yeah. It's extremely drainingand it's really scary.
Absolutely. Yeah. Okay. Well,this brings us to
level two of paranoid subtypes.So these are in
(17:19):
the borderline range of functioning,meaning
that individuals mostly stayin reality, but can dip
their toe into the psychoticrange for brief
periods of time, like hours ordays, but definitely not
weeks or more. So paranoidpersonality disorder
lives in this space. So in thatparanoid personality
(17:42):
range, we have the querulousparanoid, which
is a paranoid personality corewith features of
negativistic personality. Thatnegativistic piece
includes discontentment, pessimism,stubbornness,
vacillation, vengefulness.They are the bitter
chip on the shoulder typeas they are overtly
(18:05):
hostile, argumentative, fault finding,
unaccommodating, resentful, likewhiny and snappish.
Okay. Wow. Yes. So going backto querulous, so
querulous actually means complainingor fretting,
even whining in a high pitchedvoice. Okay.
(18:25):
So these types are rarelyin a consistent and
healthy relationship since they usually
reject their need for connectionand focus on their
independence with vengefulfury. So there's
actually a conflict herethough. They're not
content being alone and theydon't like this
about themselves, but thenthey also don't like,
(18:47):
like their indecisiveness andbeing with others.
So they swing between desiringothers and being
repulsed by others. Oh mygoodness. Wow. So I
can also imagine like, becausethey want affection,
but then they refuse it. Sothen they're going to
project that need for affectiononto others. Like,
(19:08):
for example, it's otherswho maybe want me
erotically, not me who wantsthem, right? And
this is where it can turn into erotic
delusions with this type. So forexample, like I'm not
attracted to them. Likethey made advances
at me. They are stalkingme. They love me.
(19:30):
It's twisted. They often accuse others of
cheating, lying and betrayingthem, or even of making
suggestive comments towards them or even
molesting them. So they can besuper jealous. Wow. This
actually reminds me of casesthat I've seen
with reports of severe sexualtrauma history,
(19:53):
but something doesn't quiteadd up in that
narrative. We have to becareful with that
because obviously severe sexualtrauma histories
exist. Like this is somethingdifferent. It feels
different. Something is likeoff and it just, it
does not make sense. Right.Yeah. So in the cases
that I've seen, somethingfeels off in the
(20:15):
storytelling. Like it doesn'tadd up or maybe
in the way that they've toldthe story, or maybe
I'm feeling like they're tryingto get a reaction
from me or maybe are projectingsomething onto
me. Like there's somethingabout it that feels
inauthentic. Right. And westill meet it with
empathy. Absolutely. But there'slike a clinical
(20:37):
skepticism that's helpful for treatment purposes.Very much so. Yeah. All right. So
going back to query lists.So unsurprisingly
with these types, their envycan easily turn
into complaints about things not being
fair, which is then turnedinto anger and spite.
(20:57):
So can you take a guess wherethey go to make
their complaints heard thecourts? Of course.
They can be very litigious types. They canalso have Frank delusions when they slip
into those quick psychotic episodes, but
emphasis on quick, they are notat the psychotic level.
Right. Right. But they'll popover to psychosis
(21:19):
land for a minute. All right.But I think we have
another one in this like moderateor borderline
range. Another subtype thatMilan described in
the moderate severity levelor borderline level is
the insular paranoid. It's aparanoid personality
at the disorder level who hasavoidant personality
(21:40):
features being extra hypersensitiveto criticism,
like an avoidant personalitymight be especially
criticism involving like achievementand their own
worth. So going back to insular,insular means
insulated or isolating or likeon an island or in
a cocoon. I like to think ofit as the paranoid
(22:02):
who likes to hide in like aninsulated cooler to
stay safe. So areas that'svery true. Yeah. So
they're more reclusive, withdrawn,and sometimes
even hermit like focusing onisolating themselves
from any threats or destructiveforces. They still
have the hyper vigilanceand defensiveness
(22:23):
against imagined dangers, buttheir self protection is
self-focused. They also havea very, very, very
strong fear of being controlled,which means they're
extra unwilling to take inany outside data
to check themselves. Thusthey can fall out of
reality more easily. So theyare hostile against
(22:45):
new data. They need to readit or feel it through
those antennas themselves.Now, what really
pulls my empathy here is thattheir internal thoughts
without that outside checkare terrifying and
painful and their anger too,it can become out
of control. Right. So they can turn that
(23:07):
anger inward towards themselves,resulting in self
mutilation, suicide, or evenself destruction.
And in this way, they overlapsome with borderline
personality disorder, but theyare not the same,
not the same. So the piece thatalso can distinguish
this type from borderline isthat they can turn
(23:29):
their anger outward onto othersand project it.
So this is going to result in rageful and
brutal attacks. And again, thismay apply to Stone's
reference of paranoid personalitydisorders
being more likely to commitmass murders. Right,
project the pain onto the masses. Yeah.
Okay. I think we have onelast subtype level,
(23:52):
level three of paranoid personality.Okay. So
sometimes paranoid in theborderline or that
middle level of severitycan fall apart and
become even less healthy.When this happens,
Milan says they often endup in like inpatient
care where they get regulatedwith medications
or therapy or treatment, right? They go
(24:13):
back to functioning, but thenit happens again.
So paranoid and decompensationthat falling
apart can have increasingly frequentinpatient stays
recovering until they can't. Oh boy. So atthat point they're in psychotic land,
which for the paranoid personalityis called
paraffrenic. According to Milan,Milan says the
(24:37):
paraffrenic area is essentiallyparallel to
schizophrenic territory, butit's not schizophrenia.
More on that later. Exactly.More on that later.
Yeah. This, this is so fascinating,but this again
speaks to how fragile theparanoid structure
really is. Like it's alreadyon the fritz of
falling apart, which meansthey can quickly
(24:58):
deteriorate to the nextlevel of severity,
possibly even becoming fully psychotic.
But as you said, this psychoticrange is not
schizophrenia, but it's confusingbecause we
still use the term paranoidschizophrenia today,
even though it was removed from the DSM
five in 2013 and in the ICD11 fairly recently.
(25:24):
So from this, I think wecan kind of gather
that we have a really hardtime as clinicians
understanding this paranoid structure,
which has only contributedto more confusion and
misdiagnosis. Yeah. But shall we start withthe first subtype in this severe level?
Sure thing. We have that fanaticsubtype that
(25:45):
is a decompensated paranoidpersonality at that
paraffrenic level with narcissisticfeatures. So
this is interesting becausea researcher in 1973
actually suggested that paranoid personalitydisorder was a subtype of narcissistic
personality disorder. Oh,no way. That is so
(26:08):
interesting. And yeah, there'scertainly a heavy
dose of narcissism in paranoidpersonality, but
they're not the same thing.But Kernberg actually
made a very important notethat narcissistic
personality disorder and paranoidpersonality
disorder can coexist, but the paranoid individualis cold, aloof and suspicious,
(26:33):
but not exploitative and envious like the
narcissistic individual. Sothis also supports
why and how some individualswith paranoid
personality disorder are often labeled as
narcissists. Right. Okay. So the fanatic
paraffrenic has the arrogance,exaggerated self-importance,
(26:58):
and like disrespectful, disapprovingsuperiority
that the narcissistic personalitydisorder displays,
but they have grandiose delusionsthat are flimsy
and irrational. They're makingup for lost pride
through extravagant grandiosefantasies and
delusions. Okay. Okay. Sothis is the piece
(27:18):
that separates them from narcissistic
personality disorder. And that'sthat the delusions here
really don't make sense.Like someone with
paranoid personality disorder,narcissistic
personality disorder usuallyhas a linear way
of thinking. Like for example,maybe a grandiose
narcissist might think thatthey're the best end
(27:39):
of story. Like everything theydo is for the ego.
But someone who is a fanaticparaffrenic is out
of touch with reality in bizarroways. Like you
can't follow their logic. So for example,
someone proclaiming that theyare the Messiah and that
they are being persecuted by unholy and
unseen forces. Yeah. So theycan actually present
(28:02):
themselves as like a holy saintinspired leader or
talented genius, but eventuallyother see through
this, of course. Yeah. Sothen the fanatic
paraffrenic projects to protectthemselves from
humiliation. Of course, ofcourse they do. Yeah.
So they believe that they areall powerful against
(28:24):
an evil world, like a superheroeven. So a
great example is we've mentionedthis multiple times
for different types of pathology,but a great
example here is the Jonestowncult leader. Like
he was the helpful Messiah,but towards the end,
he started falling apart andsaying that the CIA
(28:45):
was after him and he was afraidthat the world
would drop a nuclear bomb,which resulted in him
moving himself and his followersto a remote
location in Guyana. Right.So Milan literally
wrote that fanatic paraffrenics project
their stuff. Like it's not theirown power that's
insufficient. It's that there'sthis secret
(29:06):
government agents that areconspiring against
them. Like they really lean into that all
powerful part that paranoid South.Yeah. This is so
interesting. Like it's not methat's incompetent.
I'm not the one that lacks thepower. These forces
here are destroying me and mygreatness. Like you
can see that overlap with narcissisticpersonality
(29:28):
here. And interestingly,like some types of
narcissists, these fanaticparaffrenics had
overindulgent parents who letthem believe that
their existence was sufficientwithout effort.
So their grandiose fantasiesdidn't have any
boundaries. Wow. But laterthe world gave them
a big reality check and theycouldn't handle it.
(29:49):
So they turned to fantasy,primarily coping with
all of this with those grandiosedelusions.
Yeah. Again, another fascinatingpoint is that
fanatic paraffrenics areout of touch with
reality. They're often grandioseand they can
position themselves as Godlike figures in an
evil society, but then they canalso flip that script
(30:13):
and become victim me takingon like a, Oh,
whoa, is me. Everyone's out toget me. Or even like,
Oh, no one recognizes mygreat talents and
abilities. I guess I'm just too brilliant
to be understood. Right. Andthat's a perfect
place to put that reminderagain, that not all
paranoid personalities aregoing to kill you,
(30:36):
but also like dramatically.This next subtype is
probably more at risk to hurtyou because they
have a sadistic flavor. No.Ruh roh. All right.
So we better pull up a seat.This one is going
to be fascinating. Yes. Sothe second subtype in
the severe paraffrenic range that Milan
(30:56):
describes is a malignant paraffrenic.So a paranoid
personality core with sadisticfeatures. Oh
my. To summarize the subtypes,Milan stated these
paranoids are characterized best by their
power orientation, their mistrustand resentment of
(31:16):
others and by their belligerent and
intimidating manner. Wow. And theirstrategy is to dominate
you before you can dominatethem. So as you can
imagine, temperamentally, thesetypes come across
as callous, belligerent, argumentative,
vengeful, and even tyrannical.Like they will fight you.
(31:40):
And these types are hypersensitiveto power
dynamics, believing that othersare only capable
of aggression and hostility towards them,
which then results in persecutorydelusions,
which this aligns with the theorists who
propose that those with paranoidpersonalities
experience a sadistic parentin childhood.
(32:04):
And it pulls my empathy herebecause they're
literally fighting againstthat sadistic parent.
Right, right. Which then getsprojected onto the
larger world as they grow up.But yeah, so they
project their own sadisticimpulses onto other
people saying they are tryingto intimidate
me. They are trying to controlmy thoughts.
(32:25):
They are trying to weakenme. Which totally
makes sense because that'sprobably what they
expected from their sadisticparent. Yeah,
yeah. And at the severity, thesetypes really can't
function in society with theirsadistic impulses
and will eventually end upin a forensic setting
(32:46):
or in an institution. Right.So someone who ends
up like in prison might bethere for assault or
murder because they're acting out those
sadistic urges. Someone who endsup in like a state
hospital maybe might be hallucinatingthe people
that they believe are persecutingthem. That is
so fascinating. Yeah. Yeah.So Milan provides a
(33:08):
case in his book explaininghow basically a man
who was a childhood bully,who was influenced by
his sadistic father, endedup beating his father
severely in adolescence. Helater joined the Navy,
drank excessively, and flewoff the handle at the
drop of the hat. So he wasdischarged early for
(33:31):
psychiatric reasons due tothe bizarre features
of his episodes. So a lot happened in his
twenties and thirties, but he eventuallywas elected into
a political position. And thenof course forced
to resign. Then later a romanticpartner sold his
business and kept the proceeds,which just
confirmed his lack of trust inothers. So he became
(33:55):
even more violent and wasinstitutionalized for
two years. Then he got out, hebegan drinking again
and attempted to assaulthis wife multiple
times. And he was unsuccessfulsince his teenage sons
intervened. So my goodness,after four years of
this, he disappeared for 18months and was found
(34:18):
destitute. He returned toa state hospital for
over a decade where he experiencedunrealistic,
psychotic, persecutory delusions and
hallucinations. That's what we'retalking about. Yeah. Oh my
goodness. So in this case,we can definitely
track the decompensation likethat falling apart. Oh,
(34:39):
yes. So that paraffrenic levelof falling apart
started around the time thathe left his family
and disappeared. Right. Solike before that,
we can see like he's, he'skind of functioning
maybe a little bit. It's notgood, but like he's
functioning after that. He disintegratedinto that
paraffrenic level. Absolutely.Interestingly, I
(35:02):
think if his own teenage sonsdid not like win
the fights, probably morelikely he would have
ended up in like jail or prison.Right. Right.
So there's where there's likethat, which way
are you going to take in termsof decompensation
and where are you going toend up? So with these
malignant paraffrenic types,they try to actually
avenge themselves by hurtingothers. And of course
(35:25):
it backfires. It doesn't work.So then as a result,
they direct their hostilitytowards fantasy much
more than through behaviors.That is what separates
them from a sadistic personality.The malignant
paraffrenic goes that fantasyroute because their
(35:46):
brutality has backfired. Right. And that
fantasy route leads to psychosis.So all of those
hallucinations and bizarredelusions, right?
Because if you're alreadyprone to fantasies
and you can't distinguishbetween what's real
and what's in your head, that'sgoing to lead to
problems with reality testing, which is
the vehicle to psychotic orparaffrenic land.
(36:09):
My goodness. Okay. So welearned a lot about
paranoid personality and thevarying severity
levels that give way tosubtypes. Paranoid
personalities overall candecompensate quickly
under stress, which means that this
instability can actually makethem dangerous. However,
(36:30):
the dangerous cases are alsomore likely to
find themselves in textbooksas they're in settings
where they can be studied, like a state
hospital or a prison, and thenothers are just hiding.
So we know less about thosetypes, the more
mild forms of paranoid personality.But that said,
as we've noted before inthis series, this
(36:52):
post pandemic landscape hasmeant that paranoid
personalities are disintegratingbecause they
are afraid. And this means thatthey've been coming
to treatment more as a result.And we believe
that you may also be seeingthese types pop up
in your circles, which iswhy we're doing this
(37:13):
whole series so you can knowwhat to be on the
lookout for. And on that note,that's a wrap.
Thank you for joining us todayon this episode of
The Personality Couch. Makesure to check out
our blogs that coincide withthese episodes at
www.personalitycouch.com.And as always, don't
(37:33):
forget to give us a thumbsup or rate and review
us on your favorite podcastapp. And on YouTube,
hit that bell so you don'tmiss a single episode
in our paranoid personalityseries. Be well, be
kind, and we'll see you next timeon The Personality Couch.
Popular Podcasts
On Purpose with Jay Shetty
I’m Jay Shetty host of On Purpose the worlds #1 Mental Health podcast and I’m so grateful you found us. I started this podcast 5 years ago to invite you into conversations and workshops that are designed to help make you happier, healthier and more healed. I believe that when you (yes you) feel seen, heard and understood you’re able to deal with relationship struggles, work challenges and life’s ups and downs with more ease and grace. I interview experts, celebrities, thought leaders and athletes so that we can grow our mindset, build better habits and uncover a side of them we’ve never seen before. New episodes every Monday and Friday. Your support means the world to me and I don’t take it for granted — click the follow button and leave a review to help us spread the love with On Purpose. I can’t wait for you to listen to your first or 500th episode!
The Breakfast Club
The World's Most Dangerous Morning Show, The Breakfast Club, With DJ Envy And Charlamagne Tha God!
The Joe Rogan Experience
The official podcast of comedian Joe Rogan.