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Retrieved from Issue 346 of Institute Inbrief 20/01/2021
Paranoia: Definition and levels
When a person believes that others are “out to get them”, trying to stalk or harm them, or paying excessive attention to them for no reason, they may be experiencing paranoia. Occurring in many mental health conditions, paranoia is most often present in psychotic disorders. It involves intense anxious or fearful feelings and thoughts, most often related to persecution, threat, or conspiracy (Mental Health America, n.d.). It can be a symptom of illnesses such as schizophrenia, brief psychosis, paranoid personality, psychotic depression, mania with psychotic features, delusional disorders, or substance abuse (chronic or momentary) (Barron, 2016).
Mental health experts have identified three levels of paranoia:
This article is about Levels (1) and (2), the paranoid personality disorder (PPD) and delusional disorder, which you may encounter more commonly, either in your client or the client’s partner.
Identifying paranoia
We have several options for finding out what characteristics should be called “paranoid”: we can assess how we experience the person — how we describe them and what they evoke in us — and/or we can run with DSM-5 descriptions, which outline the clinical symptoms we can observe specifically with the paranoid personality disorder and delusional disorder. Let’s do both.
Descriptions of the paranoid person
Joe Navarro, who has written extensively about mental disorders, asked those who had either lived with or been victimised by paranoid personality types to describe this personality type from their experiences. Here is the list of some of their words:
“Angry, anxious, apprehensive, combative, complainer, contrarian, critical, delusional, demanding, difficult, distrustful, disturbed, eccentric, fanatic, fearful, fixated, fussy, guarded, hard-headed, inhospitable, intense, irrational, know-it-all, menacing, mentally rigid, moralistic, obsessed, odd, offensive, opinionated, sensitive, peculiar, pedantic, quarrelsome, questioning, rigid, scary, strict, stubborn, suspicious, tense, threatening, tightly-wound, touchy, unforgiving, unhappy, vindictive, wary, watchful, withdrawn” (Navarro, 2016).
What they evoke in us:
Experiencing a relationship with someone described by such intense words as those above cannot fail to bring forth a reaction in us. Laurel Nowak (2018) outlines the common feelings evoked by paranoid individuals in those with whom they are in relationship. She talks about: “feeling weighed down, negative, stressed, isolated from the people and activities you used to enjoy, and like you’re walking on eggshells”. Some have noted that it can feel to the other person like they are not being seen — ever — for who they truly are. The exaggerated negative spin on events or in response to statements occurs in the context of relating which lacks tenderness, humour, or comfort (Navarro, 2016). While these authors are describing feelings evoked in intimate relationships with paranoid individuals, they could have been talking about how therapists feel when faced with a client with this condition. Dealing with such a person eats away at the most robust sense of happiness and self-esteem. Here are the DSM-5 symptoms.
Paranoid Personality Disorder: DSM-5 symptoms description
According to the DSM-5, there are two primary diagnostic criteria for Paranoid Personality Disorder, of which Criterion A has seven sub-features. Four of these must be present to warrant a diagnosis of PPD:
Criterion A is: Global mistrust and suspicion of others’ motives which commences in adulthood. The seven sub-features of Criterion A are:
Criterion B is that the above symptoms will not be during a psychotic episode in schizophrenia, bipolar disorder, or depressive disorder with psychotic features (American Psychiatric Association, 2013).
Delusional Disorder: DSM-5 definition and types
According to the DSM-5, this condition is characterised by at least one month of delusions but no other psychotic symptoms. Delusions are false beliefs based on incorrect inference about external reality that persist despite the evidence to the contrary; these beliefs are not ordinarily accepted by other members of the person’s culture or subculture. In delusional disorder (a moderate level of paranoia), a person experiences non-schizophrenic (i.e., not bizarre) delusions, such as that they are that they are being spied on. Because only thoughts are affected, a person with a delusional disorder can act normal and function in everyday life, although they may display paranoia or other symptoms related to their delusion. The five types of delusions people with this disorder have are:
Treating and coping with paranoia
For the therapist
First, we must note the common advice: a person suffering from either PPD or a delusional disorder needs to seek professional help, although most such individuals do not believe that they are paranoid; rather, they think they are perceptive, noticing things that no one else sees. In this sense, it can be difficult to get such a person to therapy, as the condition tends to be ego syntonic. If such an individual turns up in your therapy rooms, however, note that a referral to a medical doctor is in order to determine if medication is needed.
Medication generally is not a major focus of treatment for PPD; therapy is. However, medications, such as anti-anxiety, antidepressant, or anti-psychotic drugs, might be prescribed if the person’s symptoms are extreme, or if he or she also suffers from an associated psychological problem, such as anxiety or depression (WebMD, 2018).
With delusional disorders, the diagnosed individual begins a combination of medication and psychotherapy. The anti-psychotic medication helps the individual improve enough to be able to understand reality and the need for therapeutic help. In milder cases, the individual may receive anti-anxiety medications or anti-depressants, which allows them to undergo therapy, where they learn coping skills, how to recognise delusions as false, and how to manage stress or difficult feelings. Hospitalisation may sometimes be indicated to stop the person from harming themselves or others during violent delusions (Sunrise House, 2018).
As the condition affects the client’s thought patterns and beliefs, it can be worked with effectively using cognitive behavioural therapy, which transforms the unrealistic, maladaptive thoughts by replacing them with more helpful, realistic adaptive thoughts. In addition, some therapists have observed that psychodynamic work, such as object relations, can help paranoid clients look into reasons for becoming mistrustful and suspicious which arise from early childhood relationships (Everyday Health, n.d.).
You might be asking, “Wait a minute; chief symptoms are a tendency to be suspicious and an inability to trust. How, then, can a therapist make any reasonable headway with such a client, given that trust is the basis for any solid therapeutic alliance?” If you twigged to this issue, congratulations; you have nailed the problem: how to keep the paranoid client in therapy long enough for enough trust to be built so that real progress can be made. Building trust is where the challenge is, no matter what modality is being used with the client.
To help a client in relationship with a person living with paranoia
You are likely to see the partner of a person acting paranoid. Once it is established that some form of paranoia is indeed the diagnosis, some clear guidelines exist for helping the partner. Some of the following tips also hold true for therapists working with this client population.
Setting boundaries. The paranoid person needs compassion and understanding, true, but that does not equate to acceptance of poor treatment on the grounds that the person has a disorder and is frustrated. Clear lines of what is acceptable and what is not must be drawn; those expectations for decent treatment must be communicated clearly, including around the issue of refusing to collude with delusional thinking (compromising one’s own needs) because of the person’s paranoia or fear.
Practicing self-care. For therapists and partners alike, this one is paramount! Dealing with this disorder is exhausting and sometimes heart-breaking. Those in close relationships (whether intimate or therapeutic) with paranoid individuals must have regular, solid habits of self-care. All the usual practices go into this category: relaxation/meditation, exercise, decent diet, support systems activated, and perhaps journalling or creative work to vent frustrations. Particularly for partners of those with PPD or a delusional disorder, maintaining a healthy social life — not allowing oneself to become isolated — is important.
Don’t abandon own stance, but empathise with their fear. If either the partner of the paranoid person or you, as therapist, hear an accusation that seems really “off” — totally unfounded — you can employ the tactic of empathising with the feeling, but not necessarily agreeing with the facts (though outright disagreeing doesn’t work, either). Carrie Baron, M.D., and Director of the Resilience Program at Dell Medical School in Texas, explains that consoling the person and refuting what they have said will not likely alter any paranoid convictions or delusions. What works better is “observation, reflection, curiosity and openness without judgment”, which lead to better understanding (Barron, 2016). Thus, the partner could say to the paranoid person, “I can imagine you’re worried if you think that the inheritance you counted on for your retirement might be taken away through your dad marrying. Have you observed any behaviour that made you question her motives?” (curiosity). However they do it, partners of people with any form of paranoia must look beneath the surface before getting swept up in the partner’s claims (Barron, 2016).
Recognise that the paranoid person can still contribute to life. Because of the fact that mild or moderate forms of paranoia are circumscribed, showing up only in particular thoughts and delusions, only those involved or accused may be aware of the psychopathology of the condition. The person can thus contribute to family life, work, and aspects of social life in positive ways, which you as therapist can help highlight for the partner.
Having either a client or a client’s partner who is paranoid is not easy, but the worst heartbreak and chaos can be avoided if the person can engage treatment, including medication when necessary.
References:
Gossiping is a universal social behaviour that involves the giving and receiving of information about others, generally perceived as having a negative effect on social groups and it is commonly sensationalistic in manner. The psychology of gossiping encompasses various aspects of human behaviour, including social interaction, communication, and interpersonal relationships.
Gossiping serves several psychological functions, such as forming and maintaining social bonds, establishing group norms, and conveying social information. Understanding the psychology of gossiping requires an examination of the underlying motivations, cognitive processes, and social dynamics involved in this behaviour.
One of the primary psychological functions of gossiping is its role in social bonding. According to evolutionary psychologists, gossiping may have evolved as a mechanism for monitoring and regulating social relationships within groups. By sharing information about others, individuals can establish and reinforce alliances, as well as identify potential threats or allies within their social networks. Gossiping also serves as a form of social currency, allowing individuals to exchange information and build rapport with others.
Furthermore, gossiping can be driven by intrinsic motivations related to curiosity and entertainment. People are naturally drawn to stories about others, particularly those involving conflict, romance, or scandal. This inclination toward sensationalistic narratives reflects the human tendency to seek novelty and emotional arousal through storytelling. From a psychological perspective, gossiping can be seen as a means of satisfying these innate cognitive and emotional needs.
In addition to its role in social bonding and entertainment, gossiping serves as a mechanism for transmitting social information and enforcing group norms. Through gossip, individuals communicate expectations and judgements regarding behaviour, values, and social roles within their communities. Gossip can function as a form of informal social control by publicly sanctioning or condemning certain behaviours, thereby influencing the conduct of group members.
The psychology of gossiping involves considerations of ethical and moral implications. While gossip can facilitate social cohesion and information sharing, it can also lead to negative consequences such as reputational damage, interpersonal conflict, disharmony, and breaches of privacy. Understanding the psychological mechanisms underlying gossiping can shed light on the ethical dilemmas associated with this behaviour and inform strategies for promoting responsible communication within social contexts.
Gossiping can indeed be malicious, as it involves spreading rumors or information about others that may be harmful, untrue, or damaging to their reputation. Malicious gossip can have serious consequences for the individuals involved, leading to damaged relationships, loss of trust, and even psychological harm. It is important to understand the impact of malicious gossip and the ethical considerations surrounding the spread of such information.
Malicious gossip is often driven by negative intentions, such as jealousy, resentment, or a desire to harm someone’s reputation. It can take various forms, including spreading false information about an individual’s personal life, career, or character. In some cases, malicious gossip may be used as a tool for bullying or manipulation, with the intent to undermine someone’s social standing or credibility.
The effects of malicious gossip can be far-reaching. It can lead to strained relationships, social ostracism, and damage to one’s professional reputation. In extreme cases, it can even result in legal action if the spread of false information causes tangible harm to an individual’s livelihood or well-being.
In summary, the psychology of gossiping encompasses various psychological functions, including its role in social bonding, entertainment, information transmission, and norm enforcement. By examining the underlying motivations, cognitive processes, and social dynamics involved in gossiping, researchers can gain insights into the complexities of human social behavior and interpersonal communication.
References:
Adler, R., & Proctor II, R. F. (2014). Looking out/looking in (14th ed.). Cengage Learning. (Print)
Dunbar, R.I.M. “Gossip in Evolutionary Perspective.” Review of General Psychology (Print)
Foster E.K., & Campbell W.K. “The Psychology of Gossip: A Review.” Social Psychological Review (Print)
Kniffin K.M., & Wilson D.S. “Evolutionary Perspectives on Gossip.” Social Psychology Quarterly (Print)
Kowalski, R. M., Limber, S. P., & Agatston, P. W. (2012). Cyberbullying: Bullying in the digital age (2nd ed.). Wiley-Blackwell. (Print)
Manning, J., & Levine, L. J. (2016). The psychology of social media: Why we like, share, comment and keep coming back. Routledge. (Print)
Robbins M.L., & Karan A. “Gossip: The Good, The Bad & The Ugly.” Journal of Applied Social Psychology (Print)
Salmivalli, C., & Graham-Kevan, N. (Eds.). (2019). Intimate partner violence: New perspectives in research and practice. Routledge. (Print)
Smith, P., & Steffgen, G. (Eds.). (2013). Cyberbullying through the new media: Findings from an international network. Psychology Press. (Print)
Sommerfeld R.D., & Jordan J.J. “The Evolutionary Foundations of Gossip.” Biological Theory (Print)
