Extreme paranoia is normal in bipolar people

Am i paranoid?

From a psychoanalytical point of view, it is assumed that those affected experienced rejection and lack of love in their childhood and had particularly demanding parents. Therefore, they feel excessive anger and hostility, which they project onto other people. As a result, they perceive their fellow human beings as hostile, threatening and untrustworthy, they constantly distrust them and quickly feel persecuted and attacked.

Due to the characteristic behavior, for example constant distrust or opinionated, contentious behavior, they very often experience interpersonal conflicts and have difficulty building long-term, trusting relationships. This in turn can exacerbate the symptoms.

Treatment of Paranoid Personality Disorders

Psychotherapeutic approaches

Paranoid personality disorders can be treated with psychoanalytic or depth psychological, cognitive-behavioral therapy and, if necessary, other therapeutic approaches. Important goals in therapy are to increase trust in social relationships and to promote the development of interpersonal relationships and bonds. The therapist tries to support the patient in concrete interpersonal crises and conflicts and to help him achieve personal goals and wishes.

Possible problems in psychotherapy and possible solutions

Those affected very rarely come into therapy on their own and, if they are sent by others, are often not particularly motivated. A problematic aspect of therapy is that patients often behave suspiciously towards the therapist and constantly question his behavior. Often they also show resistance to the therapy, for example not cooperating or breaking off the therapy prematurely. Therefore, in all therapeutic directions, special emphasis is placed on gradually building a trusting therapeutic relationship. It is also important to make the therapy as transparent as possible - that is, to make the individual approaches and their meaning clear and to involve the patient in all decisions in the therapy process.

Furthermore, it often happens that patients are opinionated and insist that the fault of their problems lies solely with others. The therapist should then be guided primarily by the reasons for which the patient comes to therapy - and look for specific possible solutions to his problems with him. On the other hand, most therapists do not consider it sensible to confront the person concerned directly with their paranoid thought patterns.

Psychoanalytic and deep psychology-based therapy

From the perspective of psychoanalysis, the behavior of those affected is characterized by anger and a defensive attitude, while basically they long for satisfying relationships. Therefore, the therapy tries to work out this wish together with the patient. Then we look for ways in which this wish can be satisfied. The therapist also works to gradually open up the patient and talk more about their interpersonal difficulties and feelings. These can then be edited and changed together with the therapist. Interpretations that confront the person concerned directly with their paranoid thoughts and behaviors, on the other hand, should be avoided in therapy.

Cognitive behavioral therapy

In cognitive behavioral therapy, it is also assumed that there are fundamentally fears behind the suspicious behavior. Therefore, the first attempt is made to give the patient control over their fears. An important strategy is to increase your self-confidence.

At the same time, the patients learn to perceive the intentions and behavior of other people more precisely and thus to assess them more realistically. In addition, they should gradually recognize unfavorable thought patterns and value attitudes and their effects. They can then learn alternative ways of thinking and behaving that will enable them to have more satisfying relationships.

Another important component of therapy is the training of social skills. Here, patients can practice new interpersonal skills that will allow them to gradually develop more satisfying relationships.

Interpersonal Therapy (according to Sullivan)

Here elements from depth psychological and behavioral approaches are combined. The therapist recognizes that the paranoid thoughts can often have a real core. The suspicious behavior is understood as a kind of self-protection. The therapy tries to work out difficulties in interpersonal relationships using concrete examples. The therapist then works with the patient to find specific new behavioral options that will enable him to better achieve personal goals. In addition, patients learn to deal differently with stress and conflict situations in everyday life so that they can better realize their personal needs here too.

Therapy with psychotropic drugs

In practice, psychotropic drugs are often used in patients with paranoid personality disorder - for example to reduce distorted thinking or aggressiveness or to treat existing mental disorders such as anxiety or depression at the same time. However, to date there have been no systematic studies of whether and to what extent psychotropic drugs can effectively change the symptoms of a paranoid personality disorder.