Psyche & Soul 43: PARANOID PERSONALITY DISORDER

 

sumedhacentre@gmail.com 

Podcast link:

https://anchor.fm/boscom/episodes/2-43-Psyche--Soul--93-evibtj 

 

Hello, this is Jose Parappully, Salesian priest and clinical psychologist at Sumedha Centre for Psychospiritual Wellbeing at Jeolikote, Uttarakhand, with another edition of Psyche & Soul.

 

In this weekends’ podcast I shall focus on four salient features of the Paranoid Personality Disorder, namely inordinate suspicion, intrapsychic dynamics, interpersonal relationships, self-defeating work patterns, and present some of the root causes that lead to the disorder, as well as treatment approaches.

Ronald is a midlevel manager at a firm. Though very competent at his job, his colleagues and subordinates find him very guarded reserved. He communicates very little with them and shares little information about himself. He often accuses them of trying to scuttle his promotion possibilities. He feels they are jealous of him. When anyone at office points out any failure on his part, he holds them responsible for those failures and makes counteraccusations. Moreover, His tactlessness and attitudes of superiority, arrogance , and grandiosity antagonize people around him.

He is suspicious of his neighbours and frequently keeps a watch on them and keeps a distance from them. He suspects his wife of infidelity and accuses her of not loving him but other men. He does not like her socializing with any one. When he returns home from any trip outside, he sniffs the air to pick up any trace of men’s perfumes and scrutinizes the room for telltale signs of presence of men in the house….

Ronald’s brief profile shows him as suffering from paranoid personality disorder.

DYNAMICS AND CHARACTERISICS

Suspicion

Inordinate suspicion is the most distinctive feature of the paranoid personality disorder. Those who suffer from it are unwarrantedly skeptical, cynical, and mistrusting of the motives of others. They look for hidden meanings and motives in others’ behaviour. They tend to interpret even innocuous incidents as signifying hidden or conspiratorial intent. This they do especially with those who do not appreciate them or criticise them

They search for hidden meaning in completely benign matters, and magnify minor difficulties into proofs of duplicity or treachery, especially regarding the fidelity of a spouse or intimate friend.

When events fail to confirm their suspicions they are convinced that this is because the others are really clever at being deceitful. It is hard for anyone to change their beliefs.

One positive feature in the paranoid person is that society can benefit from their keen sense justice and fair play. Psychiatrist John Oldham observes that their suspicious nature leads them to “take on the role of social critic, watchdog, ombudsman and crusader in their private or our public domain.” “They can be champions of the underdog, protectors of the downtrodden, fighters for freedom from oppression…”

Intra-Psychic Dynamics

Lack of self-worth which they camouflage through a bold front makes it very difficult for them to accept their faults and weaknesses. They strive to maintain their self-esteem by attributing their shortcomings to others. Unable to face their feelings of inadequacy and insignificance, they may begin to fabricate an image of superior self-worth.

 It is very difficult for them to accept failure or acknowledge a mistake. When they are found to be in error, they blame others for their ineptness. When they become aggressive it is only because others has provoked them.

Projection plays a big part in paranoid personality disorder. Those who suffer from it project their own unwelcome impulses on to other people. Thus the man who suspects his wife of infidelity could very well be projecting on to her his own desire for an affair with another woman.

They use denial to avoid painful aspects of reality. They are also consumed by anger, envy and hostility. Unable to face these, they project them on to others. Since they deny these impulses in themselves they are often unaware of the impact of their behaviour on others. Paranoid persons first attempt to cope with painful feelings and unacceptable impulses through repression. When repression fails, they use denial, reaction formation, and projection as ways to cope.

Interpersonal Relationships

Interpersonally they tend to be provocative in their transactions with others, precipitating exasperation and anger in others by testing their loyalty and by intrusive and searching preoccupations with possible hidden motives. If they are caught up in any kind of power play, they will try every method to vanquish the other. They are tenaciously and firmly resistant to external influence and control.

They are quick to take personal offense interpreting every slight as a personal rejection and exhibit an abrasive irritability. They react angrily at the slightest offense, imagine or real.  

They tend to be very careful in their dealings with others, preferring to keep safe distance emotionally. They seldom reveal their feelings to anyone, including their spouse. Their belief is everyone is out to take advantage of them, and so they remain very wary of people who want to get close to them. This leads them to repress their tender and affectionate feelings which makes intimacy a real challenge.

They fear they will be treated unfairly and taken advantage of. They view as unreliable and untrustworthy, and therefore are reserved, guarded and even secretive in their dealings with them.

However, when relationships are non-threatening, devoid of control issues and fear of domination, they thrive on them, counting on each other’s loyalty. When these relationships begins to sour, they take it as a personal betrayal and feel very hurt, but know how to take care of themselves.

Workplace Dynamics

They are very independent and seldom take counsel from others in their decision-making.  This is a result of their suspicion and lack of trust in others.

Their sensory antennae are constantly scanning the persons and situations around to what is out of place or dangerous.  They are especially sensitive to subtlest evasions truth and have an uncanny sense of detecting hidden motivations.

They protect their autonomy and independence with zeal, never allowing anyone to dominate them. They are very sensitive to the power structures in the organization, distrustful of authority, and wary of losing their control. They don’t allow themselves to be hoodwinked by anyone. They make sure they are not dominated by anyone.

They are observant and careful, focused on what they do and on what they want to achieve and work hard at success. This coupled with their uncanny ability to read situations can maneuver them through the organizational maze and can turn them into charismatic leaders. However, their abrasiveness and mistrust can undermine their leadership potential.

Origins of the Disorder

From a psychodynamic perspective, the paranoid person has had difficulty in establishing a warm and trusting relationship with his mother, who often was over-controlling and seductive. The feeling of rejection leads to difficulties in developing healthy sense of self, feelings of unworthiness alternating with feelings of grandiose omnipotence. It also leads to fear of intimacy and avoidance of close relationships.

MacKinnon and Michels report it is common for the paranoid persons to believe that they were treated sadistically in early childhood, with repeated experiences of shame and humiliation. Their guardedness and reserve in relationships are due not only due to fear of being taken advantage of, but also to avoid any humiliation. They have an intense longing to be loved and an equally intense ear of betrayal. “The paranoid person believes that he is not loved, has not been loved, and never will be loved.”

Treatment

Psychotherapy can help those who suffer from paranoid personality disorder to feel better about themselves, and reduce their guardedness in interpersonal relationships by enhancing their sense of self and feelings of security.

Since their guardedness arise also from fear of being taken advantage of, those around them can be extra sensitive in treating them with respect an empathy. It is also important not get into power struggles with them or take intimidating stance toward them. This can help them develop trust in those around which helps them reduce their guardedness and cultivate satisfying relationships.

Introspection and Prayer

Can you recognize the traits of the paranoid personality in yourself or in around you? How do the presence of these traits in you or in those around you affect your relationships and dealings with one another?

Sacred Scripture have examples of paranoid personalities. The most famous of these is King Herod the Great. He was insecure that he felt threatened by news of the birth of infant who he feared might usurp his throne. His insecurity led him to kill all the boys below two years in Palestine. Do you recognize any contemporary figures similar to Herod?

You could stay a while in the presence of God with all that this story and the characteristics of the paranoid personality presented here. God knows your insecurities and fears and the ways you try to cope with them. What would you like to tell this god today?

 Have a healthy, safe and blessed weekend.

Thank you for listening/reading

Pictures:  Courtesy Google Images

Jose Parappully SDB, PhD

sumedhacentre@gmail.com 

 

 

Psyche & Soul 42: BORDERLINE PERSONALITY DISORDER

Podcast link

https://anchor.fm/boscom/episodes/2-42-Psyche--Soul--91-ev0ao0

 

Hello, this is Jose Parappully, Salesian priest and clinical psychologist at Sumedha Centre for Psychospiritual Wellbeing at Jeolikote, Uttarakhand, with another edition of Psyche & Soul.

In this weekend’s edition I shall describe Borderline Personality Disorder.

Susan phoned her boyfriend John. She wanted to talk to him badly. But he said he was out shopping and will call her back in an hour. Susan was not happy. But she waited for the hour to be over. An hour and half passed and he had not called her back. She called him back and gave him a mouthful, telling him how callous he was, not caring for her, burst into tears, and threatened to break off their relationship. John said sorry and explained what had happened. On the way back from shopping he witnessed a bike accident and had stopped to help and had forgotten to call her. Susan continued to be angry, insisting he could still have called her. John apologized. Now Susan began to feel guilty for the way she behaved. To sooth her feelings she began to cut herself- something she would do whenever she felt hurt…..

PERSONALITY CHARACTERISTICS

The Borderline Personality Disorder (BPD) is characterized by the following:

·         Intense emotionality characterized by frequent and fast mood changes;

·         Uncontrolled, intense anger and rage; sadness and irritability.

·         Intense craving for intimacy accompanied by fear of abandonment triggered by the slightest suspicion of lack of interest on the part of the other and frantic efforts to prevent it.

·         Intense idealization (admiration or love) followed by equally intense devaluation (dislike and depreciation) in quick succession.

·         Relationships characterized by passionate attachments but also frequent and intense conflicts.

·         Self-harming (cutting, bruising, burning)   and suicidal behaviour

·         Impaired or distorted cognitive processes.

·         Underlying fragile sense of self and resulting insecurity and feelings of emptiness.

 

Persons with BPD are often enthusiastic, idealistic, joyful, and loving, but soon may feel overwhelmedby negative emotions (anxiety, depression, guilt, shame, worry, anger, etc.).

They are in exuberant mood when feeling loved, cared for, appreciated and made to feel important. However, with the slightest disappointment they sink into despondency and react with intense anger and rage. They feel every emotion at a very intense level: rage instead of annoyance, intense grief instead of sadness, shame and humiliation instead of mild embarrassment, panic instead of anxiety. Their emotions often tend to spiral out of control.

 

They are very sensitive to the way others treat them, feeling intense joy and gratitude at perceived expressions of kindness, and intense sadness or anger at perceived criticism or hurtfulness. They are especially sensitive to feelings of rejection and can become very vindictive.

 

Naturally, their relationships are characterized by lots of conflict and frustration. They tend to see persons as “all-good” or “all-bad” in a sequential fashion. Their frequent mood fluctuations and swinging from idealization to devaluation make life very difficult and frustrating for those with whom they are in relationship, or with whom want to establish relationships. Their fear of abandonment, combined with feelings of emptiness and self-loathing, and frequent accusations of disloyalty and lack of caring makes those around them feel like they're constantly walking on eggshells, needing to be very careful lest they trigger a cascading dysfunctional behaviours that can include threats of suicide and even suicidal attempts.

 Since they feel their emotional pain with great intensity, they try to sooth their feelings and calm themselves through self-injury, which takes attention away for their emotional pain. Self-soothing approaches often also  include substance use disorders (e.g., alcohol use disorder), eating in excess, unprotected sex or indiscriminate sex with multiple partners, reckless spending, and reckless driving. They do all this because it gives them the feeling of immediate relief from their emotional pain, but later lead to feelings of shame and guilt over consequences of these behaviours. Thus a vicious cycle is often set in motion:  beginning with emotional pain, followed by impulsive and unhealthy behaviour to relieve that pain, then feeling shame and guilt over their actions resulting in renewed emotional pain, and then experiencing stronger urges to engage in impulsive and unhealthy behaviour to relieve the new pain. As time goes on, these impulsive and unhealthy behaviours may become an automatic response to emotional pain.

UNDERLYING ASSUMPTIONS

There are some basic assumptions that persons with BPD hold and which lead to the behaviours described above. These include:

• I must be loved by people important to me or else I am worthless.
• Persons who love me are good and everything about them is perfect. Others cannot be trusted.
• Persons must understand my needs and respond to them in the way I want. Otherwise they don’t really care for me.
• Persons who love me must tell me they love me. If they don’t, it means they do not love me and will abandoned me.
• Nobody cares about me as much as I care about them.  So they can easily abandon me.
• When I am not in a relationship, I become nobody and nothing.
• I will be really happy only when someone makes me the most important person in his or her life and make me feel that way.

ORIGINS

It is generally recognised that there are two basic dynamics in the formation of the borderline personality disorder:

First, inherited biochemical factors, not easily observable on the surface, but responsible for impulsive aggression and affect instability that characterize a patient suffering from the disorder.

Second, early insecure attachments with parents and parent figures, which besides contributing to the above, seriously derail the crucial developmental milestone of basic trust. These also lead to unstable interpersonal relationships characterized by excessive intensity, overvalued expectations, unfounded anxieties. They also lead to distorted cognitive processes.

Borderline personality disorder is partly caused by brain abnormalities that can be identified by brain imaging techniques. Patients with borderline personality disorder may be bio-chemically primed to over anticipate and overreact to real or imagined criticism, rejection or abandonment.  There is impairment in their capacity to regulate or inhibit limbic-driven emotionality or impulsivity. These heritable risk factors, in turn, interfere with the normal attachment process during development, and this disruption can be magnified when there is inadequate parental support. All these cause and maintain profound sense of inner emptiness, emotional instability, interpersonal difficulties and disruptive behaviours.

TREATMENT

It is a combination of biological and psychotherapeutic interventions that really help those suffering from borderline disorder.

For a long time it was thought that borderline personality was not amenable to change in therapy. However, that idea has changed. Today borderline personality disorder is considered a treatable condition.

Data from research show that borderline patients treated by skilled therapists who focused their interventions on the transference and countertransference (relationship between client and therapist) showed a significantly better outcome than those treated with a more supportive approach.

According to experienced therapists, effective psychotherapy for patients with borderline disorder takes time, commitment and persistent. The biggest hurdle is to establish a collaborative partnership that can be sufficiently sustained to do some effective work, without the client unilaterally terminating the treatment. Maintaining proper boundaries of time, place and behaviour is also a big challenge.

Psychotherapeutic interventions are more helpful to manage self-injury and abandonment concerns, while the inherited bio-chemical contributors to the disorder are better treated with medication. 

Borderline behaviour is mostly driven by feelings of low self-worth, fear of abandonment arising from insecurity, and excessive craving for intimacy, approval and appreciation. Hence, responding with empathy and sensitivity to their erratic behaviours, though difficult and frustrating, and providing approval and appreciation and frequent expressions of caring on the part of persons who matter to them, can help those who suffer from the disorder feel cared for and supported and can help reduce and prevent escalation of conflicts.

Introspection and Prayer

·         Do you recognize the features of the Borderline Personality Disorder in yourself? If so, how do you feel about them and handle them?

·         Have you encountered these features in those with whom you relate or those around you? If so, what are the challenges you have faced in dealing with them? What has helped you cope?

 We could hold these people in prayer before God and ask God to provide them the love, appreciation and security they crave…..

Borderline personalities lack self-worth, feel others don’t love them and feel insecure. They tend to drive away those they love by their demands and dysfunctional behaviours. Our God is never put off by our dysfunctional behaviours, but always stands by us and provides us the love and security we crave.

We could read Isaiah 43, 1-5where God speaks of his love and care for us and his promise to never abandon us: “I have called you by name. You are mine. …. When you pass through the waters, I will be with you… You are precious in my sight, …and I love you…. Fear not, I am with you”

We could then stay a while with the feelings evoked in us by the reading and spend some time talking with and listening to God.

Have a healthy, safe and blessed weekend.

Thank you for listening

Pictures: Courtesy Google Images

Psyche & Soul 41: OBSESSIVE-COMPULSIVE PERSONALITY DISORDER

Podcast Link:

https://anchor.fm/boscom/episodes/2-41-Psyche--Soul--89-eugti0

 

Hello, this is Jose Parappully, Salesian priest and clinical psychologist at Sumedha Centre for Psychospiritual Wellbeing at Jeolikote, Uttarakhand, with another edition of Psyche & Soul.

In this weekend’s edition I shall explore Obsessive-Compulsive Personality Disorder.

Have you heard of the secretary to a Provincial who when she was first told to prepare a report and make fifty copies of it, individually proofread all fifty copies! (This is a case of Perfectionism arising from excessive fear of making a mistake or being found to be inefficient -- and a bit of ignorance as well) Or, the young man who kept on trimming his beard to get it just right until there was nothing left to trim!! (A case of compulsive need to get things just right/ and anxiety at any possible imperfection).

Or, we may be aware of someone who has to wash his or her hands several times, even when washing once is more than enough. Or, one who checks several times the lock on the door is locked, sometimes returning to check after having gone a distance? Or one who feels the need to rearrange books and other articles on their desk several times a day to make sure they are always in the right place and in the right order.

All these persons could be labelled obsessive- compulsive. If their compulsion causes them excessive distress then they would be considered as suffering from a personality disorder.

The famous psychiatrist Wilhelm Reich described compulsive characters as “living machines” The essential feature of the disorder is a preoccupation with orderliness, perfectionism, and mental and interpersonal control. From a psychodynamic perspective, contemporary psychologist David Shapiro emphasises the role of distorted volition or will directed toward controlling what cannot be controlled—namely, drives, spontaneous interests, and affects.

 Prevalence

Obsessive-compulsive is the most frequently diagnosed personality disorder and is more often found among men.

Symptoms

Behavioural

·         Those who suffer from it are driven by perfectionism and preoccupied with rules, lists, order, schedules, cleanliness, and correctness in every detail. They repeatedly check for possible mistakes. They tend to miss what is most important in a situation by focusing on minor details.

·         They are likely to be workaholics and care little for leisure activities and friendships.

·         They are very dependable, but can be stubborn and possessive. They are very indecisive and tend to frequently procrastinate needed action.

·         They tend to be miserly in spending both in regard to self and others.

 

Interpersonal

·         These persons tend to be exquisitely conscious of social rank and status, and modify their behaviour accordingly (deferential and obsequious to superiors and haughty and arrogant to subordinates and peers).

·         One of the most common characterises is that they are unable to delegate tasks to others because they believe others will do them badly or not in the way they would like them to do them. This leads to being overburdened by many things and getting stressed out.

·         They are very loyal to the organizations and ideals they espouse

·         Socially, they are experienced as formal, cold, standoffish, aloof distant.

Cognitive

·         Their cognitive processes (thinking) is very rigid and rule-based

·         They have difficulty in establishing priorities and perspectives (Everything is of equal and usually grave importance)

·         They find decision making difficult and tend procrastinate decisions often leading to interpersonal conflict and organizational dysfunction.

·         They are prone to ruminative thinking (tormented by worries and fears of failure and unable to stop brooding about them)

Affective

·        There is an absence or deficiency in the feeling dimension of life; for them the ideal and priority is rationality, reasonableness, and correctness)

• They appear grim and cheerless
• They have difficulty in expressing intimate feelings such as warmth and tenderness. They are often embarrassed by too much affection, verbal or physical. They are more comfortable express caring at a distance.
• Their emotion that is most apparent to those around them is anger. They can become upset and angry in situations where they are not able to maintain control, although the anger is typically not expressed directly.
• The primary affect underlying the disorder is that of fear—fear of doing something wrong.

Spirituality

·         These persons’ spirituality is characterized by rigid observance of rules.

·         They are over-conscientious, scrupulous, and inflexible about matters of morality. Psychoanalyst Karen Horney observes that they are driven by the “Tyranny of the should.” They are virtual prisoners of their own stern, unrelenting conscience.

·         They feel they need to be perfect to win God’s approval and love.

·         They are excessively self-critical, and because they believe the same rules apply to all they can be exceedingly judgmental of others. They do not make allowances for mitigating circumstances.

Vulnerability to Stress

·         Obsessive-compulsive personality disorder produces high stress resulting from constant pressure to live up to some ideal standard, concern with time and punctuality, vigilance to avoid error or failure, impatience, competitiveness and tendency to suppress feelings.

All this can lead to relational and occupational distress for self and others.

 Introspection and Prayer

·         Can you recognize any of these characteristics in yourself? Or in those around you?

·         How do the presence of these characteristics affect your relationships and daily life?

 ……..

 

In Mathew’s Gospel (5, 28) Jesus invites us to be perfect as his heavenly father. However, many of us interpret that perfection as flawlessness and try to be flawless, living a very careful and cautious life devoid of mistakes and errors. Our perfectionism arises from fear of punishment, seeing God as strict judge and ever ready to publish even the slightest mistake.

However, our God is far from being like that, as we read in sacred scripture. God is merciful and compassionate, slow to anger abounding in love, who understands our weakness and vulnerabilities and empathizes with us.

We could spend a few moments with this compassionate and caring God, bringing before God all the stress and hassles we experience because of our own obsessive-compulsive personality traits or of those around us.

Have a carefree and relaxing weekend. Be safe. Be healthy. Be blessed.

 

Thank you for listening/ reading.

Pictures: Courtesy Google Images

Jose Parappully SDB, PhD

sumedhacentre@gmail.com