Paranoid personality type: I look at the world through a telescopic sight

If we talk about personality typology, according to “Psychoanalytic Diagnostics” by Nancy McWilliams, she identifies several leading types. In this article we will look at the paranoid personality type. The article is structured on the principle of gradually illuminating the main features of the type, its characteristics, signs, and peculiarities of how a psychologist works with it. The reader who is interested in issues of self-development, self-knowledge, and the study of psychology will find in this note information about one of the personality types.

Psychological characteristics of the paranoid personality type

The leading characteristics of the paranoid personality type are suspicion, wariness, absence or a dull sense of humor.

A paranoid person treats his qualities as negative, projecting them externally. And then they are perceived as an external threat. We can say that everything that this person worries and worries about is within herself. For example, such a person may not realize that in some of his manifestations he is quite aggressive and, projecting this quality onto other people, notes these traits in them.

Also often in paranoids one can observe a consciousness of their own greatness.

A paranoid person must suffer greatly in order to seek psychological help; they are not inclined to trust strangers. And in this regard, they tend to avoid consultations with psychologists and trust few people.

Paranoid individuals often play political roles where their projective traits may be opposed to existing views. They can “climb onto an armored car” to prove something to someone. True, it is important to note that such people do not always exaggerate the real danger. However, they can also be ironic and suspicious.

Description

Paranoid personality disorder is a pathological exacerbation of characterological traits such as suspicion, wariness, distrust, and readiness to display defensive aggression.
The synonymous name is paranoid psychopathy. The code in ICD-10 is F60.0. People with paranoid personality disorder are characterized by inflated self-esteem, excessive sensitivity to other people's opinions, to negative evaluation from others, a tendency to oppose themselves to the world, and a heightened sense of self-esteem. They are constantly looking for a threat from the outside, do not trust others, and fear attacks on their health, property and rights. The prevalence of paranoid psychopathy ranges from 2-3 to 14% depending on age, most often it is diagnosed in adolescents. Also, increased epidemiological indicators are observed among residents of large cities, among groups with low socio-economic status. Men are two times more susceptible to this disorder than women.

The pathogenesis of paranoid psychopathy is complex and multifactorial. The influence of biological and environmental factors is undeniable. Biological reasons include genetic predisposition and organic lesions of the brain, and environmental reasons include characteristics of upbringing, material and living conditions. The risk of developing paranoid personality disorder increases if the following factors are present:

• Psychological trauma in childhood. In the course of longitudinal studies, it was found that paranoid psychopathy is more often formed in adolescents and adults who experienced violence (physical, sexual, psychological) in childhood.
• Organic brain damage. The cause of psychopathy can be traumatic brain injury, stroke, drug and alcohol intoxication, or the onset of Alzheimer's disease.
• Hereditary predisposition. Sometimes paranoid psychopathy is the initial stage of schizophrenia spectrum disorders, so people with this type of personality disorder often have relatives with schizophrenia and schizoaffective disorders.
• Features of education. Paranoidity as a character trait is more often formed in people who were brought up in an atmosphere of competition with brothers and sisters, as well as those who lived with a stepfather or another person who “came” from the outside.

Drives, affects and temperament of paranoid personalities

It can be said about paranoid individuals that they are less suicidal than depressed ones. They are often unfriendly. They have a high degree of internal aggression and irritability.

It is difficult for a child to control their reactions; they may have an internal feeling that they are being persecuted.

In social interactions, paranoids may not be adaptive. Hyperexcitability is also noted. They struggle with hostile feelings and have many different fears.

Most often, paranoids experience a combination of fear and shame. This can lead to resourcefulness. Such people vigilantly monitor all interactions of other people among themselves and with them.

Narcissistic individuals may be subject to feelings of shame if the mask is somehow removed from them. Attempts are made to make such an impression on others that the devalued self will not be noticed by them. Paranoid individuals, on the contrary, use denial and projection. Shame remains completely unattainable within one's own self. Therefore, a paranoid person rushes headlong at those who are trying to shame and humiliate them. At the same time, narcissistic individuals are afraid of discovering their own inconsistency with some standards, and paranoid individuals are afraid of being judged by other people.

Paranoids can be noted to focus on the motives of other people, instead of focusing on their own “I”. They love to discuss possible motivations and consequences of other people's actions.

Paronoid individuals are vulnerable to envy. They cope with it through projection, believing that they envy them. In essence, we can say that they can project and deny those qualities of other people that they have in themselves. For example, the fact that they were betrayed.

Paranoid individuals project qualities that they may not notice or deny in themselves. For example, an office employee who is constantly late may make comments about this to other employees.

Paranoid individuals are not always aware of the guilt that is projected in the same way as shame. They believe that the psychologist, having learned about their sins, will reject them. They transform any feeling of guilt into a threat coming from outside. The fear of being exposed pushes them to recognize them earlier than others, thereby preventing evil intentions towards them.

Paranoia: what to do, principles of treatment

Hospitalization is indicated in the acute period, when the patient is completely inadequate and can attack both relatives or acquaintances and completely strangers. In some cases, at the peak of delusional thoughts, the patient may try to commit suicide.

Treatment of paranoia in a hospital provides not only constant monitoring of the patient’s condition and intentions. When the syndrome worsens, it is very important to establish contact with a doctor, and often in such a situation the patient quite logically “integrates” taking medications into the structure and content of the delusional disorder.

For treatment, drugs from the group of antipsychotics are usually prescribed, and after remission is achieved, maintenance therapy with antidepressants, lithium-based drugs, and sedatives is possible.

Paranoia: how to get rid of the disease using non-drug methods

In addition to mandatory medication, psychotherapy is indicated. Group classes are ineffective and can lead to the opposite result - refusal of treatment. Therefore, at the Cordia Clinic we offer individual consultations. In a personal conversation, the doctor can determine how to treat paranoia and how appropriate it is to use potent drugs.

Physiotherapy is useful in helping to normalize sleep, reduce psychomotor agitation, and eliminate hyperreactivity of the nervous system. Sports activities have an excellent effect.

But doctors categorically warn against treating paranoia at home. Complications and worsening of the disorder can only be avoided with inpatient or outpatient therapy under the supervision of an experienced specialist. And the appearance of the first symptoms of the disease requires mandatory consultation with a doctor.

We do not give a 100% guarantee that we will be able to completely cure paranoia: some forms of the disease simply cannot be treated. But our doctors will select the appropriate medications and the right tactics of psychotherapy, which will allow you to achieve stable remission in the shortest possible time, when only maintenance treatment is required. Call us at +7 (495) 367-23-13 and sign up for a consultation!

Defense and adaptation processes in paranoia

The degree of projection in paranoids can be borderline or neurotic.

In a disturbed personality, the Ego is completely projected and external, no matter how much these projections may appear to other people.

Individuals with a preserved “I” still have the opportunity to test reality.

Borderlines act in ways that make their projections suitable for the target of the projection. For example, a woman who does not admit her hatred and envy may tell her psychologist that he is jealous of her. And she interprets the psychologist’s empathic manifestations as a desire to control.

In neurotic paranoids, their feelings are projected in a way potentially alien to the ego. Such a person projects, but at the same time a part of his own “I” remains, which, when forming a trusting working alliance between the client and the psychologist, can reach the level of awareness.

Paranoid individuals project their feelings externally, including in order not to recognize unbalancing relationships.

Psychologist Karen, exploring paranoid dynamics, summarized the basic psychological defense mechanisms of the individual. For example, how can a person with delusions cope with the desire for intimacy with a person of the same sex. At the same time, the person seeks to refute “I love him!” through a number of ways:

• Megalomania: “I don’t love him, I love myself!”
• Erotomania: “I don’t love him, I love her!”
• Delusional jealousy: “I don’t love him, she loves him!”
• Projection of homosexuality: “I don’t love him, he loves me!”
• Reactive formation: “I don’t like him, I hate him!”
• What allows me to hate him: “He hates me! If I hate him, I don’t love him!”

Causes of paranoia

The etiology of the disease has not yet been fully elucidated. Unlike schizophrenia and some other mental illnesses, the connection between paranoia and genetic characteristics has not been confirmed. Experts suggest that the development of pathology may be due to:

• injuries, tumors, brain surgeries affecting the limbic system and basal ganglia;
• the influence of stressful life situations and circumstances;
• specific, hostile relationships in the family;
• social isolation, lack of communication, etc.

It is believed that the development of paranoia is predisposed by severe stress, accompanied by cruel (both morally and physically) attitude of others, strong envy, anger, which is why a person is left alone. He withdraws into himself, trying to find the reasons for what happened. Gradually, anxiety and restlessness develop, and a feeling of complete hopelessness appears. In such a situation, the formation of delusional, paranoid ideas is one of the mechanisms of subconscious psychological defense.

Interpersonal relationships with paranoia

A child who grows up paranoid suffers from feelings of his own reality. He was subjected to periodic suppression and humiliation. The family can convey to the child that they are the only ones who can be trusted. This creates suspicion in the child towards other people.

Borderline or neurotic paranoid individuals come from a family system where criticism and ridicule predominate. The child may be a scapegoat.

Uncontrollable anxiety can trigger the development of paranoia in children. When a child came to such a parent with a problem, he either presented this situation as catastrophic, since he could not bear the child’s anxiety, or devalued it, since he could not condense it. Such an adult conveyed to the child that thoughts are equivalent to actions. And the child perceived that his personal feelings had dangerous power.

As children, paranoid individuals did not have the opportunity to express their feelings naturally and safely. In a psychologist’s office with such clients, a specialist teaches paranoid individuals to do this.

We can also say that paranoid individuals are capable of deep attachment and relationships.

Treatment in Re-Alt

Treatment of paranoid personality disorder is carried out comprehensively - psychotherapeutic methods are combined with drug therapy. The main condition for achieving successful results is establishing a trusting relationship with the patient, which is the main difficulty when working with such people. Due to their position in life, with elements of negativism, patients are reluctant to interact with a psychotherapist. The psychoanalytic approach is the most effective in correcting paranoid disorders. Therapy is long-term, much depends on the person's participation in the treatment process and the severity of the disorder.

Treatment of paranoid personality disorder in psychiatry is often carried out using psychoanalytic and cognitive behavioral therapy. A psychotherapist helps a person accept his feelings and develop more effective behavior patterns. For the specialist, the main task is to help the patient understand how to cope with the conflict caused by it, through reassessment and awareness.

Patients' reliance on denial directly affects the speed of treatment. This defense mechanism works by categorically refusing to acknowledge something specific. Direct interpretations of transference face even more denial. It takes a long time and support for a person to begin to accept the possibility that the shortcomings of others that he sees are in himself. A sign of successful treatment will be the person’s awareness that his negative thoughts and suspicions have no objective justification. With long-term therapy, it is possible to compensate for the severity of paranoid thinking, which increases with old age.

Drug treatment is prescribed, most often, during periods of deterioration of the condition and in short courses, due to the fact that a person may not take medications or consider them to be ineffective.

Paranoid Self

The paranoid client despises his own humiliated personality. He has a high degree of fear, which leads to the fact that he constantly “monitors those around him,” observes their reactions, “keeps his finger on the pulse.” Paranoids believe that they are the target of everyone around them, that people think and talk only about them.

It is also important to note that paranoids have a high sense of guilt.

Statistically, a connection has been found between thoughts about homosexuality and paranoid personalities, this has been confirmed by some studies.

Paranoids can fight against existing authorities. Revenge and triumph provide a temporary and shallow sense of security and moral clarity.

Basic Concepts

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The emergence of the corresponding personality type leads to paranoid disorder and psychosis. People with a similar mental type transfer negative aspects to the outside world, starting to fight them, presenting them as a threat. Sometimes such behavior of a paranoid person is expressed within normal limits, that is, the person is simply suspicious and prefers to be the first to attack before others do it themselves. But very often this condition turns into serious paranoia, degenerating into a psychiatric diagnosis.

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Among politicians there are a lot of people with the described mental type, because this is precisely the area in which one can fight what is evil in the minds of such a person. As practice shows, it is the paranoid personality type that most often finds itself in situations of persecution. We can say that their distrust and suspicion seem to attract such troubles.

Transference and countertransference with paranoid individuals

Transference in paranoid clients is rapid and intense. The psychologist is the recipient of the projection of the image of the rescuer. But more often the psychologist is seen as an unsupportive, humiliating type. Such clients believe that the psychologist is trying to save them or, conversely, is focused on causing suffering. They evaluate a psychological assessment, believing that the psychologist wants to feel his own superiority.

Paranoid individuals may look closely at a psychologist. This can create a feeling of vulnerability and total protection. Transference here can be hostile and less often benevolent.

Countertransference may look like an opportunity to directly point out to the client that what the person perceives as a danger is unrealistic.

Symptoms of a paranoid psychotype

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The main sign of a paranoid personality type is groundless suspicion of everything. Such people constantly accuse their lovers of betrayal, doubt the reliability and loyalty of their own friends, and suspect their business partners of betrayal. They perceive any light or sometimes humorous remark as a threat and humiliation. The affective reaction and inadequacy that often accompanies this type of psychosis seems delusional to a normal person.

Sometimes such patients see hallucinations, their associations become loose, their thoughts are blocked, they see a negative and exclusively biased attitude towards themselves in everything. Among the character traits of paranoids, vindictiveness is especially expressed along with dissatisfaction with everything that happens around. Even minor troubles are perceived very painfully by this person. All these symptoms cause the relatives of the paranoid person many problems, expressed in personal relationships, within the framework of general everyday life, and therefore, if these manifestations occur, it is recommended to urgently contact a psychiatrist or psychotherapist for help.

Therapeutic recommendations when diagnosing paranoia

The first requirement is the establishment of a stable working alliance with the psychologist. This is necessary to build trust, which will make it possible to build effective interaction.

If the paranoid client trusts the psychologist, then the work can be considered completed.

The main task for the specialist will be to increase the paranoid person’s access to the client’s inner world.

Jokes within reason can safely defuse aggression. They may relate to those topics within which the work is being carried out at a given time. For example, to a client who is overly worried about how he will look on a date, you can say something like this: “If you think that you will be examined under a microscope, take blood and urine tests, then rest assured that your your partner is also worried.” This, of course, is only possible after basic trust has been built in a psychological session.

If paranoids feel that their opinions are valued, they will become more open. You can find a way to demonstrate this to them. In addition, it is important to give the opportunity to talk.

Together with a psychologist, explore what led to such reactions. This stimulates separation, which will eliminate carryover.

It is important to teach paranoid clients to identify what triggers their paranoia. Starting from observing your own body and reactions to external factors that can trigger alarming symptoms.

It is also very important with paranoids to consider other reasons besides those used by paranoid individuals. Give me the opportunity to think about it for myself. There are clients who want ready-made, and even better, quick solutions to their problems. But at the same time, they do not always understand that instead of getting a fishing rod and then independently solving pressing problems that will arise in their lives, they want to immediately get a fish.

Emphasize the differences between thoughts and actions. “Just enjoy your fantasies!” Thinking about something does not mean doing it.

A psychologist should be very careful about boundaries. This may affect the paranoid's feelings of security. May cause anxiety. Something can be done with psychological boundaries if it is possible to identify them. And their identification is realistic only after identifying oneself.

Clinical variants of psychopathy. Paranoid psychopathy

This text is based on P.B. Gannushkin’s approach to describing psychopathy. P.B. Gannushkin, as you know, preferred to distinguish between groups of psychopathy. The specific variants of psychopathy that form these groups, along with common characteristics, also have some specific clinical features.

Group of paranoid (paranoid) psychopathy. Common signs of paranoids are excessive egocentrism, excessive self-love and unencumbered by special virtues, a hostile attitude towards people, a tendency to active or passive aggressive actions, a lack of altruistic motives and impoverishment of higher feelings. The need for personal safety and the desire to strictly control what is happening around prevail. This probably hides a deep-seated lack of confidence in oneself and one’s ability to repel threats to one’s self.

The level of motivation is reduced; in any case, high ideals and values ​​are alien to patients, which results in the absence of an intense struggle of motives, as well as the ease with which decisions are made. Internal motivation predominates: punishments, rewards, real achievements mean little. Satisfaction comes only from the illusion of one's own safety. Disconnection from reality and the pursuit of the specter of safety prevent patients from changing their behavior, even if they want to. Meanwhile, by their behavior, patients only increase the threat to personal well-being. Typically, patients are unable to achieve significant success in the main areas of life, if we understand the latter as love, friendship, work, family and creativity. Let us describe the following variants of this group of psychopathy.

Expansive paranoids are “ideological fighters” or “fighters for justice”; such patients consider the most important or most significant what they do or have done themselves: any, even routine activity, an innovation they proposed, something written by them, this or that a look at what happened or is happening, some idea of ​​reconstruction, etc. For example, an artist “creates” by gluing pieces of various minerals to pieces of rusty iron, and at the same time considers his crafts to be masterpieces of art, which other people simply must know about, if want to consider themselves cultural members of society.

The main belief of patients is that they are exceptional, outstanding individuals; they often consider themselves “unrecognized geniuses,” which others are unable to understand or do not want to accept. Patients sincerely believe that they are surrounded by “gray”, “ordinary” natures, “mediocre people”, “a faceless crowd”, that they are “envied”, “not allowed to move”, “silenced”, and want to take advantage of the fruits of their invaluable activity. The resistance of others embitters and embitters the patients; indignant, they take the path of an uncompromising struggle for a just cause, that is, for their calling and “worthy” place in society. Possessing inexhaustible energy, the gift of persuasion and capitalizing on the feelings of humiliated people, patients are able to rally many admirers around themselves and, in the eyes of the latter, become almost charismatic personalities who fight for the interests of the “people.” If patients do not meet adequate resistance, they also celebrate victories.

If they suffer defeat, this only adds strength and determination to them to continue the fight, not disdaining any means. Other paranoids, smaller ones, choose the courts as their battlefield, trying to satisfy their claims through persistent litigation or filing countless complaints to various authorities, turning into litigators (persons initiating one lawsuit after another) or querulants (constantly complaining). Perhaps only psychiatrists can block the path of militant paranoids. As long as the paranoid has not embarked on the warpath, he, with his characteristic tenacity, systematicity, accuracy and pedantry, can successfully work in any chosen narrow field.

Illustration. K., 45 years old, film director, “decided to leave the capital and work in the provinces,” where he “could completely devote himself to creativity.” In the very first days of his stay in the new place, he said that the local film studio was “producing hack work,” the specialists were “not capable of anything,” and the management was “no good,” and he, having far-reaching creative plans, “will put things in order here.”

After his creative projects were questioned and he was denied an apartment out of turn, he felt insulted: “they humiliated me,” “they decided to mix me with dirt.” “As a person who respects and knows his worth, I could not leave this without consequences.” The anger fell primarily on the studio management. “I told them they only had one choice: me or them.” The patient began to sharply criticize work plans at planning meetings, allowing himself sharp caustic remarks, creating an extremely nervous environment with altercations and attacks against himself. He carefully recorded the speeches of his opponents, and then began to write numerous complaints to various authorities. The team quarreled, talking about who spoke about someone and how. He organized a support group of people who were dissatisfied with the management, speaking on behalf of the “workers”. Endless inspections rained down on the studio, people began to quit and end up in hospitals.

As a result, the work of the studio actually stopped, turning into a showdown. Finally, two years later, he turned to psychiatrists for help. To prove that he was healthy, the patient voluntarily agreed to be examined. In conversations with the doctor and at the consultation, he behaved arrogantly, believing that he was absolutely right in what happened. He showed brilliant abilities for demagoguery. He often got into arguments, answered with questions, and demanded written evidence that he was unwell. He said that “your entire psychiatry is built on sand,” “I will go to another city, and they will write what I need, and then in court we will find out which of us is right.” He threatened to deprive doctors of their diplomas. He was in an elevated, “fighting” mood, verbose, categorical in his judgments, indignant at the injustice, accusing everyone of mutual responsibility: “This is a conspiracy, the fool knows.” “I will not leave this without consequences, you will remember me for a long time.” Proud to have “disturbed yet another pile of crap.” It turned out that the patient had previously changed about 10 jobs where something similar to what was described here happened.

Sensitive paranoids are narcissistic egoists, constantly focused on a feeling of inferiority, usually greatly exaggerated. They display sensitive ideas about relationships, avoid communication, are often lonely, have difficulty working in a team, and are prone to changing places of work and residence in search of a refuge where they feel more or less comfortable. In communication they prefer people with various disabilities; in such an environment they can behave patronizingly and even arrogantly. Other people's misfortunes are met with gloating. They are envious of prosperous people, petty and secretly vindictive, unkind, as if blaming them for their troubles.

They experience their own misfortunes hard, consider their fate unfair, become embittered, or may decide to commit suicide. If they suffer from infectious diseases, they can deliberately spread the infection around themselves in order to infect other people. They are prone to fantasies, imagining themselves as confident, successful and famous people. They are unable to give up the feeling of their inferiority and find themselves in a business in which they could realize their abilities.

Aggressive paranoids are paranoid of inferiority. These are narcissists who believe that others reject them, despising them for some shortcomings. The response for such imaginary hostility is hatred of others, the need for revenge, the desire to cause them pain and suffering in order to feel one’s power over them. Such patients willingly watch films and read texts with cruel and bloody scenes, indulge in fantasies of violent and sadistic content, feeling like some kind of supermen and receiving vicarious pleasure. Virtual and imaginary aggressive experiences are gradually appropriated and internalized. Sooner or later, a change of identity occurs: the painful awareness of one’s inferiority is transformed into a struggle for one’s superiority, for power over people, asserted through violence. The thirst for power is especially easily satisfied by acts of aggression aimed at weak and defenseless people, children, women, the sick and the elderly.

Since in the minds of many people there is a belief that the sexual act is a symbol of the triumph of strength and power, aggressive paranoids often become rapists, and sometimes serial ones. The feeling of omnipotence and power is often achieved through torture or murder without sexual abuse. Thus, according to media reports, two brothers committed the murder of more than 150 women, but they did not rob or rape them. The 20-year-old criminal only killed older people, mostly women; he talked about feeling an unaccountable urge to kill. A former firefighter, expelled from the force, became a serial killer, shooting strangers with a sawn-off shotgun at the first opportunity.

He killed 40 people, but he planned to increase their number to 400. Such criminals know neither remorse nor fear of retribution; some openly regret that they were stopped too early. It is typical that they remember all the crimes in detail and accurately indicate the burial places of the victims, without revealing memory gaps, but can say little about the motives of behavior: they “wanted it”, they were “drawn”, they “couldn’t live without it” ", etc. The intoxication of power, apparently, affected them more powerfully than any drug.

Fanatics are those obsessed with an idea. These are patients who accepted a certain idea from someone, believed in its greatness and began to consider it the most active part of their Self. From that moment on, the fanatic with his inherent passion serves this idea, the meaning of his life converges on it, everything else leaves him indifferent . For the sake of realizing an idea, a fanatic will not spare anything, will not spare anyone, he is ready to lay down his life for it at any moment and without any fear. It is impossible to oppose anything to the indestructible and single-pointed will of a fanatic. Neither persuasion, nor dissuasion, nor the danger of losing what is most precious, nor the prospect of execution - nothing will stop a fanatic. Like aggressive paranoids, only a psychosurgical operation can help here.

Psychiatrists more often have to deal with fanatical believers, especially with adherents of destructive sects, and from time to time - with mass suicides or aggression and terrorist attacks. Fanatics are usually convinced that they are destined to fulfill a high mission, to do something heroic that ordinary people are not able to do. Blinded by the idea, fanatics completely break away from normal life and break all ties with it. Fanatics, it seems, rarely die of natural causes. Their I dies much earlier, since a radical change of ego identity occurs. A significant portion of fanatics are apparently mentally ill individuals.

Paranoid psychopaths. They are distinguished by a persistent feeling of hostility from others, attributing to the latter malicious intent, desires to cause any harm to the patient, damage health, or even take life. Patients are always wary, suspicious, ready to see some kind of catch in everything, to discern ominous hints in the statements of others. They doubt the loyalty of even close people or friends, if they have any. As a rule, they harbor grievances, accumulate hostile feelings, and do not forgive expressions of antipathy, much less openly expressed threats, even those said in a temper. Usually they make different plans for revenge and thereby gradually prepare themselves for an attack.

Often, sometimes unexpectedly, they react with outbursts of anger and acts of aggression. For the most part, patients are closed and avoid frankness, believing that they can pay dearly for it. Life in a family with them can be completely unbearable due to constant nagging, demands for unquestioning obedience, jealousy, cruel punishments for the slightest deviations from the norms they established and the barracks order. Feelings of warmth, care, tenderness, respect for anyone are alien to patients; jokes with them are not safe. Some patients suppress manifestations of their hostility and do not enter into open conflicts; instead, they try to change jobs, place of residence, or settle somewhere far away from people.

Illustration (Carson et al.). X., 40 years old, builder. He believes that his co-workers do not like him, and is afraid that one of them will set him up for a work-related injury, for example, falling from scaffolding. Such concerns arose after a recent argument in a lunch line, when a patient felt his colleague was pushing ahead of the queue and confronted him. After this, the patient began to notice that his new enemy was laughing in the company of other men, and wondered if he was the object of ridicule. He wanted to get into an argument with them, but after thinking about it, he decided that the story could be a figment of his imagination. There was also a fear that if we took action, we could end up in even greater trouble.

The patient rarely speaks on his own initiative, sits tensely in the chair, his eyes are wide open and he carefully monitors all movements in the office. He tries to understand the hidden meaning of the questions that are asked to him, thinks that he is being blamed, and imagines that the doctor is at one with his colleagues. The patient makes it clear that if he did not need sleeping pills, he would not have sought help at all.

As a boy, he was unsociable, believing that other children were uniting against him in order to arrange some kind of meanness for him. He did poorly at school, but blamed his teachers for this: he said that they preferred girls or boys who were “women.” He dropped out of school and became a hardworking worker, but believes that he will never reach a high position. The patient believes that he is being discredited because of his Catholic religion, but he can do little to prove this. He doesn't get along well with bosses or workmates, doesn't understand jokes, and feels best in a situation where he works and eats alone. He changed jobs many times because he felt he was being treated inappropriately.

The patient is cold with his family and demanding of them. His children address him by adding the word "sir" and know that in his presence they should be visible, but not make noise. At home he never manages to sit quietly. He is constantly busy with some routine tasks. He doesn't like guests and gets worried when his wife goes to visit.

Passive-aggressive type of psychopathy. A controversial variant of psychopathy, which is closer to the mild version of paranoid personality disorder. Such patients are envious, overly critical and usually unfriendly towards those in more prominent positions. They believe that they do their job better than others, and reject advice on how to improve it, seeing this as an attempt to find fault or offend them. On occasion they try to let others down by not doing their part of the work, thereby jeopardizing the success of the common cause.

They believe that they are being asked to do more than is necessary and protest against such injustice. They get angry when they are asked to do something they don't want to do, and act deliberately slowly and carelessly, deliberately resorting to such petty revenge. They put off necessary tasks for a long time, as if thereby wanting to cause harm to others, or avoid performing duties, citing forgetfulness or being too busy. They usually do not show active aggression, but they can act with the hands of others without interfering with their atrocity.

Illustration (Carson et al.). The 34-year-old psychiatrist was 15 minutes late for the first interview. He was recently fired from a mental health center because, according to his boss, he was often late for work, missed appointments, forgot appointments, filed reports late, refused to follow instructions, and seemed disinterested in his work. He was surprised and outraged. The patient believed that, given the intolerable conditions in which he had to work, he was doing an excellent job, and considered his boss to be too annoying and demanding. Nevertheless, he admitted that for a long time his relationship with his superiors did not work out.

The patient is in an unhappy marriage. He complains about his wife, calling her a “nitpicker,” saying that she doesn’t understand him. The wife, in turn, complains about his lack of commitment and stubbornness. He refuses any household chores and often does not complete the few things for which he considers himself responsible. Income declarations are submitted late and bills are not paid. The patient is sociable and very charming. However, his friends are usually annoyed by his reluctance to consider company. If, for example, he doesn’t feel like going to a restaurant, then he sulks all evening or “forgets” his wallet.

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Differential diagnosis

Paranoid versus psychopathic client: If a paranoid person notes that you share their values ​​with them, then they are capable of loyalty and generosity. Projection is a psychological defense mechanism in psychopathic and paranoid individuals. However, the former are not empathic, and paranoid individuals are deeply connected to the object (for example, another person). The experience of betrayal can be a threat. They perceive any violations of morality in their partner as a vice in themselves that should be eradicated.

Paranoid personalities in comparison with absessive ones: the latter are sensitive to little things, they are afraid of control, but do not experience the fear of physical harm, moral humiliation, which is typical of paranoid personalities. Absessive clients try to cooperate with the psychologist, although they may have alternative positions. A violent reaction to clarification at work may indicate that the client has dominant paranoid qualities.

Paranoid versus dissociative personality: Paranoid traits may be present in dissocial personalities.

Next, let's look at the depressive personality type.

Sources

1. A. B. Smulevich. Borderline mental disorders // Guide to psychiatry / ed. Tiganova A.S. - M.: Medicine. 1999.
2. Katernaya Yulia Evgenievna Paranoid, schizoid and hysterical personality disorders among adolescents who have not previously sought psychiatric help // Medical almanac. 2015. No. 4 (39).
3. Gorinov Viktor Vasilievich Personality disorders in adulthood and old age: on the issue of the outcome of personality pathology (analytical review) // Russian Psychiatric Journal. 2009. No. 5.
4. Volodin B.Yu., Sochivko D.V., Yakovlev V.V., Frolov A.I. Current state of the problem of personality disorders // Personality in a changing world: health, adaptation, development. 2016. No. 2.
5. A. Skodol. Paranoid personality disorder. 2022.

Low ability to understand others

As part of the description of the paranoid personality type, experts very often describe an iron focus on assigned tasks combined with a low ability to understand others. When these symptoms begin to manifest themselves stably and acquire a total character, causing serious difficulties within the framework of social adaptation, then we are talking about the development of paranoid psychopathy.