Psychosis and paranoia

[square]

I've previously described my H as "BPD-ish." He certainly has the I hate you/don't leave me thing going on in spades. Self admitted abandonment issues. Moody. Uses the PD handbook - DARVO, circular conversations, etc.

He doesn't have the shifting identity thing, though. Also it just feels not exactly BPD in a few other ways I'm having trouble describing.

I've also said that PD is not the only thing going on, and that PD in fact feels only secondary - though it is certainly very painful to me. I also feel like PD isn't his whole or natural personality. That there is somebody in there who is being altered, a normal (flawed but normal) person being obscured by a pathology.

I was aware he had psychotic episodes, and I was also aware that sometimes he has paranoia. What I have come to realize lately is that paranoia isn't just a side symptom that pops up occasionally, it's actually the main event.

I had a less nuanced understanding of paranoia. But as I read about it, I find it encompasses pretty much everything.

A few examples.

He frequently focuses not merely on how people may offend him but their "evil" intentions. Their seemingly sinister motivations are actually more central to his thinking than the perceived offense itself.

He has from time to time described faces of people in ways that seem bizarre to me - that they shoot him the absolute nastiest looks. I can never really say that they didn't - even if I were present, I do not see well. Also when it's my face being described that way, I can't say for sure that my face isn't worse than I think, but a month or two ago I did look at my face in the mirror when I was crying and feeling very emotional during a PD blowup, and was shocked to see how unthreatening I thought I looked. But in my own life, I have so rarely seen these malevolent looks, it always seemed like he was getting far more than I've even heard of other people talking about. And sometimes they were from incredibly unlikely sources, like a neighbor who was actively kind to him.

He uses the word "agenda" a lot, especially about women. Say a female friend invites us to a family backyard party, he may say her agenda was free labor from him (because last time he in fact voluntarily helped her when nobody else would). This is an example of something I did not label as paranoid before, because sometimes I can't rule out his suspicions. Sometimes it's possible. People do in fact sometimes set things up in hopes that another person might help or give a gift or whatever. Sometimes I think he's actually right but it still feels so dark and hateful from him. But apparently this is part of paranoid thinking.

He says he feels like he is being punished by some entity. Another weird thing that I didn't label paranoia, but certainly stood out to me. There is no logic to this - not saying one cannot be spiritually punished by an entity, but it doesn't fit his belief system. He believes in a loving God. He doesn't say God is punishing him, it's a passive voice, that he is being punished. Clearly his thoughts aren't orhanized here, he just feels punished by the world. Apparently this is also a common feeling with paranoid thinking, that I did not previously understand.

Anyway, there's more, but that's the idea.

Will write more on the next part....

[SonofThunder]

Hi Square,

My wife has similar paranoid thoughts and assumptions.  I originally was under the impression that PD cluster types (A,B,C) don't generally mix in co-existence/comorbidity, such as an A/B mix.  For example both NPD and BPD are cluster B's and so understood that is common for a same cluster mix (B/B for example).  But I have read additional information suggesting cluster mix co-existence.  So, my uPDw is imo, NPD and mostly with BPD traits when under extreme stress with PPD depending on circumstances. 

Interestingly, she will combine NPD/PPD, such as this example.  My uPDw is very proud of her appearance and style and carries very expensive handbags.  I have a second home in the countryside and recently i stopped my vehicle on our departure, to take my wife to a short-walk spot on the property where there is a nice view of some surrounding landscape.  When we departed the vehicle, she took her handbag (on our own remote property). 

I said to her (a bit PA haha  )  "you will not need your handbag to see what i want to show you".  She responded sharply "SoT...this is a very expensive bag and you KNOW I don't trust the 'country people' around here!".  I really wanted to continue my PA snarkyness, about possibly getting mugged by a deer, but instead, I silently said to myself (my full time mantra) "does it REALLY matter SoT??" and just silently walked her poshness to the spot.  She quickly and emotionlessly said it was a nice spot and headed back to the vehicle, claiming bugs were bothering her (i didnt see one).  Maybe they bother her because she's so sugar-sweet??  . 

When we are at the property, she always believes some escape crazed lunatic convict from somewhere is going to wander in the pitch black middle of the night and turn us into the next horror movie script.  Haha i could fill the Bats#!t crazy thread with this stuff, but i just laugh to myself.  Good for the soul to be able to laugh it into the PD files. 

Do any of the PPD traits below fit your husband?

PPD Link:

https://outofthefog.website/personality-disorders-1/2015/12/6/paranoid-personality-disorder-ppd

All Clusters Link:

https://outofthefog.website/types-of-personality-disorders

Looking forward to reading your next part,

SoT

[square]

I'm on a PD forum so PPD is the obvious thing to look at. And I'd say he meets the first part of the criteria, the symptoms. I'm not sure about the second, which is to rule out other pathologies.

Either way, even if other things are going on, I'd say PPD absolutely describes at least part of it, and I think the label is useful and accurate. I don't see him as PPD-ish, but PPD, but maybe something else too.

Apparently psychosis and paranoia go hand in hand. He has had full blown psychotic episodes. Two that involved outside authorities (police both times, hospital once) plus one other that was that severe but went unnoticed by the public. (I've never been a reporter. Yet.)

Imho these episodes were not personality problems. He was having literal full blown mental health crises that he was not able to control. He was hallucinating and delusional. Afterward he was crushed by regret and shock. These were not remotely antisocial incidents. In fact, helping others was a frequent goal.

These seem beyond personality disorder, as far as I understand it. But PD does have high comorbidity.

I've mentioned he has above average insight, but clouded by the pathology. He thinks he may have schizophrenia. It doesn't seem quite how I understand it. I think he may just consider psychotic to equal schizophrenia.

He could have a psychotic level of bipolar. There is a seasonal element too. He is very dark this time of year. Lifts around February and March. During hypomania things are a lot easier on me because he is fixated on other things. It's not that we have a closer relationship. It's more that instead of me being the person who plotted from infancy to ruin his life, I'm a friendly acquaintence he can talk to about what he's thinking about, which is gearing up to be productive (but usually never quite getting there). But I find this period also stressful because I worry about him going off the rails.

Unfortunately, I have to admit it's frightening. When he's in full blown psychosis, all bets are off. He has never hurt or threatened to hurt me or DD in this state, and in fact he is not focused on hurting anyone at all. He is focused on doing good, in fact. But when he's in full blown psychosis who knows what he thinks is the right thing to do?

The scariest thing is that once he felt he was instructed to do something that he thought would kill him. He did the thing and was not even injured but the scary part is he fully believed he would die. It was not a suicidal impulse, he was trying to do something good. It wasn't about depression or anything. The thing wasn't as dangerous as he believed but he believed it.

After he recovered from that mania, I tried to talk to him anout my fears. I wouldn't say he was unempathetic but he didn't really understand. He just felt like he was sure he'd never do anything to hurt us. But he was not in control. The only thing that I can comfort myself with is that indeed when he is like that, his view of me changes from an evil plotter to a beneign side character in his life, and overall he is fixated on increasing the good in the world rather than revenge or anything like that.

[square]

and just silently walked her poshness to the spot



Yeah, our car is always locked, even in the middle of nowhere when we are picnicking 10 feet away. It's not a hill I even eye.

Will look at your links.

[SonofThunder]

Square, im SO sorry you experience the scary stuff.  My experienced  stuff is just comically very frustrating.  I have a relative who is a PHD in Psych and knows my uNPD father well. He explained comorbidity to me, using my father as an example.  My father does not have the mania-scary episodes of your spouse, but has outlandish overconfidence in doing extreme things in the highs of his uNPD comorbidity with his diagnosed S.A.D. (Seasonal  Affective Disorder).  On the opposite extreme of SAD, he is so depressed he wants to die and cannot even get out of bed. 

The S.A.D. high/NPD combo create a 'superman' mentality.  He will (with my mother in the car), run red-lights from a very far-off distance for the trophy and challenge and when they make it (survive) he is very proud.  He will also take high risks in many other areas that jeopardize his safety and those around him.  He still brags about taking my brother and I, way out in open waters in a very small boat whose motor was unreliable and the boat having a gaping hole in the bottom front from a previous accident that he was too much in a hurry to fix (reality it was a risky challenge high). I remember both us kids bailing the entire time with a drinking cup while my father got fish on the line.  Us two kids afraid all day on our 'father/sons' fishing trip, knowing we were so far out, we would sink and die in this very large body of water. 

Again very sorry for your experiences with PD comorbidity with other potential illnesses. 

SoT

[SonofThunder]

and just silently walked her poshness to the spot



Yeah, our car is always locked, even in the middle of nowhere when we are picnicking 10 feet away. It's not a hill I even eye.

Will look at your links.

Haha same!  Vehicle ALWAYS locked for fear her 'stuff' will be stolen.

[bat123]

There is definitely an element of paranoia or at least suspicion/lack of trust common among these personality types.  My uNPD spouse is very mistrustful.   I think he mostly has a firm grip on reality, yet he often jumps to conclusions about my intent, and accuses me of lying or manipulating.  I think it is because for him, the feelings come first.  If he's feeling venerable or disrespected, then it's almost like he needs to back into a narrative where I meant to do him harm.  That way, his feelings can make sense and he can manage them in the context of being a victim.  We went through couples therapy for over a year, and I recall that at times when he would accuse me of lying our therapist would just sit there and listen to him vent his feelings.  At first, I wondered why she was giving him an audience instead of challenging his assumptions that I was lying.  Then I realized how soothing it was for him to be heard.  By the time he got all his feelings out, it's almost like he'd forgotten the part where he accused me of lying.  I think our therapist understood what I could not, which is that the only way to manage his accusations is probably to tend to his hurt feelings first.

[square]

Paranoid Personality Disorder (PPD) is defined as:

a pervasive distrust and suspicion of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her.

Yes. Mostly fixated on "exploiting" and uses that word specifically.

Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates.

Sort of. He doesn't have friends anymore. "Loyalty" is not a fixation (other than "you're never on my side!"). He has a small number of times been convinced I was cheating on him in circumstances that were actually bizarre.

Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her.

Not really. He is guarded but I would not say this criterion is endorsed.

Reads benign remarks or events as threatening or demeaning.

Big time.

Persistently bears grudges, i.e., is unforgiving of insults, injuries, or slights.

Big time. Other than me, once he has decided you're evil, you're out. Forever. Will never forget the offense in question.

Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack.

Yup.

Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner.

It's nit frequent but it's happened. And it was WEIRD. Not just "I saw you talking to and smiling at the neighbor man" but "you are going to this public presentation on a topic interesting to you so you can screw the presenter... possibly on the lecturn?"

The traits, behaviors and characteristics:

Do not occur exclusively during the course of a mood disorder accompanied by psychotic features nor other psychotic disorders.

So this is the reason I can't say he has PPD. PPD is merely a useful label for a whole set of behaviors, but there's pribably more to it.

Are not due to the direct physiological effects of a general medical condition.

Probably can endorse this but not definitely.

[SonofThunder]

" And it was WEIRD. Not just "I saw you talking to and smiling at the neighbor man" but "you are going to this public presentation on a topic interesting to you so you can screw the presenter... possibly on the lectern?"

Same.  I recently was accused of being 'interested' (sexual way) in my brother's wife haha because i sent her a trial bag of awesome decaf whole bean coffee  (excellent roaster btw and I'm a known coffee snob lol) for her birthday because she was having reflux and it was a combo 'get-well/b-day gift to allow her to enjoy coffee .  Since i have not bought my SIL a gift in the past, it triggered my uPDw into the accusation. 

My wife thinks all men are sex-addict predators haha; classic hypocrite, projected, PD 'man-hater'. In her mind, she knows this because she's so darn NPD attractive and has to brush off the drooling males SO much!  What a pain.. Ha!  She loved-bombed me with extreme seduction back in my wild college days.

I shook my head and walked away from the accusation.  Then I laughed to myself in silence at the ridiculousness. 

Sorry you experience this. 

SoT

[square]

SOT, I was thinking about the boat incident you described. It must have been so frightening for you, as a child, to have the significant adult burden placed on you to keep yourself safe in an unsafe situation. And on top of that, it's a betrayal to be placed into that position by an adult - your father.

It must have felt terrible to know on whatever level you were aware of it that the burden of staying safe rested in your child's hands. Children by definition are not up for that job even when the coast is clear. But to add to your burden with an active threat by the person whose job it was to keep you safe, that's betrayal.

I have seen delusions of grandeur mentioned under the umbrella of paranoia. I don't know it that may be relevant in your father's case.

[square]

bat123, I agree suspicion and paranoia could arguably underpin most or all PDs, except maybe ASPD? Not sure.

When I am able to, I find good success when I allow H to feel "heard." It really helps.

The problem of course is, I'm his partner and his equal. It's a huge imbalance for me to be taking emotional blow after blow and staying calmly on my feet and soothing him out of it - every. Damn. Time. It means my needs are entirely unmet and his are always paramount.

I can do that sometimes. Even when I am taking the blows, I can do it. I have done it. But I am worn down to nothing. He doesn't build me up or take care of me or soothe me in any way anymore. I feel like a shell.

[bat123]

Yes, square, that is the sad part.  We can learn to manage these relationships, but there is a high price to pay.  I've been in this for 25 years.  I've been mostly Out of the FOG for a few years now, but still finding it all but impossible to do the sensible thing and leave.

[square]

Sad fist bump.

[11JB68]

Re comorbidity of pds... My Updh presents mostly as ocPd...to a T. But has some npd (more covert) and bpd traits too! Different clusters.
He has also shown some bizarre (almost psychotic/paranoid) behaviors (accusing of not infidelity but of my 'having a thing for' random people), looking in his full closet and saying I guess you haven't done laundry, accusing me of telling the gas attendant to shut off the pump (he was just using it incorrectly)... These episodes have been frightening to me.

[square]

The laundry and the gas pump thing. Haven't had these exact experiences but boy do I have similar experiences, frequently.

Step 1: Have a problem. Gas pump not working, not inspired by anything in the closet, etc.

Step 2: Blame. Logic need not apply.

Step 3: Profit. (Sorry, just an old Internet joke, and I skipped the "???" to boot).

[square]

I hope nobody minds if I get a bunch of thoughts out here in series.

Next is sleep. There is a correlation between sleep problems and paranoia. Direction of causation is unknown, could go both ways.

Paranoia may cause poor sleep due to rumination on perceived threats.

Poor sleep can raise paranoia, as shown even in healthy subjects. The stress on the body and mind may express itself through whatever mechanics drive paranoia.

People who suffer paranoia also often report vivid, disturbing dreams.

My H has had sleep issues as far back as he can remember. Likely this started due to trauma (witnessing family violence). As a child he would sleepwalk, had difficulty falling asleep, and had night terrors. He also had vivid nightmares. I got the idea that all his dreams were nightmares until young adulthood - specifically when he moved into his own place (with me).

Over decades, I think severe sleep issues has taken a physical and mental toll on him. I do not see how it can be solved. I think it will literally shorten his life, possibly by decades.

[Rose1]

Exbpdh was diagnosed bi polar and bpd.  He used the agenda thing a lot, mostly I think because he had one and thought everyone did. He exhibited paranoia at times.
It is not uncommon for pd to coexist with bipolar or schizophrenia.
A school of thought is that the fragility that goes with the chemical imbalance, along with the instability and modelling in a home where 1 parent also has the condition,  makes fertile ground  for bpd to develop. I believe that fit exbpdh.
There are of course other causes but paranoia is a scary one and is often treated separately

[SonofThunder]

Interesting!  No paranoia sleep related issues with my uPDw except her feeling safe so she can sleep.  Once she feels security-safe, she will sleep fine. Our home has always been guarded like a fort so she feels safe (security system, door jammers, motion detectors and so forth).  Same issue as the previous car/stuff paranoia; my wife thinks were a prime target for burglary to steal her high-end stuff.  At one point in history, she believed her little dog was such a fine breed-representative specimen, that someone would break into the car or home to steal her little dog....

My uPDw's issue with sleep is mainly her trying to manipulate mine by sleep deprivation of me, so not paranoia related, but PD manipulation related.

SoT

[1footouttadefog]

We cannot diagnose of course.  However I will jot down some Ransome thoughts just in case they might help suggest keywords for your further research.

Over the years with my pdh we have experience many of the things you are posting about.  I will describe my understanding of what plays out in our world.

My spouse seemed overall pretty normal when we met and were dating. He was 36 at the time.  He had had some health problems for a spell when coming out of the service in the early 70's after two years in combat.  He described it as high blood pressure problems and they gave him  blood pressure pills valuums .  He said it made him lay around all day and get fat so he quite then and started playing softball and basket ball.

We started dating in the 80's.  He had some quirkiness but was overall even tempered, jovial, and polite, friendly and helpful. He had no vices other than enthusiastic eating. 

There were some eccentric things he had done during that decade before we dated.  I look back now and think they were periods of mania.  They were not harmful and he was single with few responsibilities.  He did PR stunts to try it get his favorite baseball player in the hall of Fame for example.

He had never been overly paranoid for long periods, however as the od had progressed it has to layer a roll.  More along the lines of perceiving others thoughts, and facial expressions etc as you described.

Fast forward my spouse is diagnosed as PTSD, Bi-polar, and possibly OCPDorOCD.  His medical records are wishy washy here, but OCPD matches well.  I very much believe he is a covert narc.

This would indicate cluster mixing.

When he was diagnosed as bipolar, I really did not see it as it did not match my understanding of bipolar.  He was always hypomanic and never overtly depressed.  He did have some mania at times looking back.

I later learned about rapic cycling and mixed manic episodes and I believe we have experienced those at times.  Mixed mania is scary stuff.

It's not the I can do anything euphoria, but as expirienced here  la weird mix mix of anger, delusional driveness and paranoia over any glitch or obstacle or conversation, that goes against the goal/objective of that season. 

My spouse takes a blood pressure medication called prasosin.  It helps him as a psychotropic medication. It lowers his response to adrenaline.  Without it he is somewhat paranoid.  He operates in a constant state of fright or flight.  He feels those sensations and then puts all outside happenings and stimulations through a flight or fright filter.  This makes things seek very paranoid. 

He basically filters the outside inputs the match how he feels.  Feelings become facts.  This medicine cation helps bring him down from that place and not be in fright or flight.

This in turns very much increases the amount of time he has to actually process a thought with the more logical brain operations instead of operating in reptilian survival mode. 

Bi polar can also have schitzoid features. 

Sleep is incredibly important to mental stability for bipolar folks.  ditto people with schitzofrenia or related diagnoses.

For us here sleep disruptions are something to be very concerned about. It's a what comes first the chicken or the egg situation in a way, but I keep a lookout for sleep issues and see that as a canary in the coal mine.  I will call his providers for an appointment if I see this. 

When I am reading your posts I am thinking you likely have more than a of going in there.  I hope you are able to get him to seek medical help. 

[square]

SOT, it's interesting how some conditions manifest a bit differently depending on what the person values. Similar to OCD, which may manifest as hoarding (in general or possibly of specific things), or germ phobia, or checking, or other things, but it fits with the person's natural concerns, interests, or values.

My father had dementia-related paranoia in his last years. It was caused ny dementia and was not present in his earlier life. But the themes expressed by his dementia certainly fit his lifelong concerns and anxieties.

Your wife clearly is focused on securing her environment from intruders and securing her valued possessions. She also seems to be suspicious of certain groups - such as "country folk" who presumably envy her possessions.

My H fears violent home intruders - he does not feel concerned about securing possessions other than his car (not really anything inside it - and even then the car is not a primary concern). He also is fixated on being exploited. I would say exploitation is his primary fixation overall.

In his life, his mother was the exploiter and his father the violent intruder.