Is your paranoia showing?

By David Joel Miller.

Increasing paranoia – the mental health challenge of this millennium?

Fearfulness

Paranoia.
Photo courtesy of Pixabay.com

The growing problem of paranoia is gone unrecognized for very long time. Currently, anxiety disorders are the number one diagnosed mental illness. The category of anxiety disorders has grown so large that recently professionals separated this family of disorders into two groups, the disorders of excessive anxiety, called anxiety disorders, and the disorders caused by real-life events, now referred to as trauma and stressor-related disorders. What has often overlooked is the prevalence of Paranoia.

The problem of paranoia frequently gets ignored.

Many people describe themselves as paranoid, or “a little bit paranoid.” Professionals often dismiss these labels as exaggerations. Over the last 25 years, as there has been more study of paranoia, professionals are starting to recognize how common paranoid symptoms are in the general population. Recent studies conclude that among the general population, people who have never been diagnosed with a serious mental illness, the rates of paranoia may run between 15 and 20 percent.

There’s no specific diagnosis for paranoia.

When we say paranoia, most people immediately think “paranoid schizophrenic.” We have come to understand that not everyone who has schizophrenia is paranoid. Paranoia can also be part of several other serious mental illnesses. Paranoia is also a part of paranoid personality disorder, delusional disorder, and may even be a feature of severe major depressive disorder. Many drugs of abuse can cause paranoia. Paranoia in its less extreme forms may go under the label “excessive suspicion” or “trust issues.” In it’s more dangerous form; paranoia can be a feature of delusional jealousy.

Humans are often poor judges of danger.

In the 1950’s almost every small child look forward to getting their first bicycle. Kids commonly walk to and from schools which were often a considerable distance away. Today many people do not let their children play outside. One explanation for this is they are afraid something bad will happen to their child.

The statistics tell us that the most dangerous place for most children is at home. Every year in America more children are shot and killed at home by a biological parent who then turns the gun on themselves than all the children killed in school shootings. Absolutely school shootings are a problem that needs to be tackled, but we are fooling ourselves by thinking that it strangers who are the major danger.

America and many other industrial countries are facing an epidemic of childhood obesity. The risk of poor health and shortened lifespan from lack of exercise far outweigh the risk to most children from going outside to play.

Many people worry every time they take to the road that they will encounter someone with road rage will run them off the road or shoot them. These are certainly risks, but the far greater risk comes from people being injured or killed in automobile accidents while not wearing your seatbelt.

Why have we all become more fearful?

High levels of danger are often associated with the big city and crowded urban environments. A hundred years ago less than 5 percent of the world’s population lived in large cities; most people lived in small towns and rural settings. Since the year 2000 more than 50 percent of the world’s population lives in large cities. Today television and the online news are available 24/7 to tell you about every awful event.

Belief in conspiracy theories has become more common than not.

Humans use to accept widespread death from illness as normal increasingly people believe these epidemics must be the result of some government or international conspiracy. Throughout history, there have been plagues which devastated humanity. During the Middle Ages, there were places where as much as 70 percent of the population died. These same epidemics would recur periodically. In the 1800’s epidemics of yellow fever and cholera resulted in death rates of 30 to 50 percent of the population of some towns. In the U.S. Civil War, for every man killed in battle mortality in camp due to illness could run from 5 to 10 men. During World War I, deaths from Spanish influenza ran into the millions. These recurring illnesses used to be blamed on devils and demons, religious minorities and more recently bacteria and viruses. Today, when a new illness is discovered many people’s first thought, is that someone has deliberately created this illness or that there is a cure for it, but someone is withholding that cure.

People who believe in conspiracy theories often believe in mutually contradictory ones. The same person who believes that Jimmy Hoffa was killed by the CIA might also believe that he faked his own death and is currently living in Bolivia. The average person’s willingness to believe a conspiracy theory seems to be growing exponentially.

Some increased trust issues, even paranoia, may be reality based.

Modern society has created dangers that didn’t exist past. With larger numbers of people working for the same employer competition on the job becomes fiercer. Many of the people you work with you may never see outside of work. This has led to more competition on the job and less cooperation. When we were an agricultural society, farmers tended to help each other. Today it’s likely that the person in the next cubicle may be undermining you in the competition for promotion or to avoid the downsizing layoff.

Your increased dependence on technology put you at risk.

Technology is becoming more complicated and more pervasive, growing at an exponential rate. Your personal information is no longer safe because you keep it locked up. Every company you do business with, every detail of your financial and healthcare life may be at risk. Online companies know more about the person you sleep with.

How are trust issues, suspiciousness, anxiety, and paranoia connected?

In upcoming posts, I want to talk to you more about why “trust issues, suspiciousness, anxiety and even paranoia have become so prevalent, how they may be connected and how you can cope with your fears and not let the forces of anxiety and paranoia take over your life. But I don’t want to overwhelm you with the problems without talking about the solutions.

The future is not all bleak.

At the same time psychologists and counselors have been looking at some under recognize problems, things like paranoia, burnout, and the role of the Internet in changing human relationships some positive things have also been recognized. Positive psychology has revealed an entire technology centered around having a happy life. We now know happiness is not the result of constant doses of temporary pleasure but comes from long-term ways of thinking and behaving. We are also recognizing that people have certain inherent strengths. Whether you know it or not, you and your children have some talents and abilities just waiting to be discovered and perfected.

For more on these topics see:

Paranoia

Anxiety

Happiness

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

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Can you spot the paranoid person?

By David Joel Miller.

Paranoia comes in many shapes and sizes.

Fearfulness

Paranoia.
Photo courtesy of Pixabay.com

How paranoia looks depends on the group of people you’re looking at. Researchers who study paranoia believe it may have had an evolutionary advantage. Those who were too trusting did not survive. “It is important to ask why paranoia might be so common in the general population. One possible explanation is that paranoia is a trait that was selected and distributed in humans due to its adaptive value” (Ellett & Chadwick, 2003, 2007).

In many situations, it’s better to be suspicious and cautious, even if your wrong then to be trusting and end up harmed in some way. Being suspicious when in doubt kept our ancestors alive to reproduce. Trust issues seem to run on a continuum from mild suspicion to unhealthy, pathological paranoia. Recent research tells us that mild to moderate paranoia is a lot more common among nonclinical populations than has been recognized in the past. Most of these people who experience an episode of paranoia do not go on to develop a serious mental illness.

According to the Freeman brothers “paranoia is on the rise, fueled by disproportionate media coverage of the dangers we face from others; by increasing urbanization; and by a range of other social factors including fear of crime.”

Paranoia also depends on your viewpoint. If you have been the victim of violence or trusted when you shouldn’t have, you become less trusting. Groups who have historically suffered prejudice and violence, become more suspicious. Suspiciousness in women is likely to be diagnosed as anxiety. Wariness in men is more likely to suggest they will become violent and be diagnosed as some form of psychosis. Both Psychosis and Paranoia are much more likely to be diagnosed in males, particularly African-American males.

Definitions of paranoia.

Wikipedia defines paranoia as “an instinct or thought process believed to be heavily influenced by anxiety or fear, often to the point of delusion and irrationality. Paranoid thinking typically includes persecutory, or beliefs of conspiracy concerning a perceived threat towards oneself.”

Google defines paranoia as “a mental condition characterized by delusions of persecution, unwarranted jealousy, or exaggerated self-importance, typically elaborated into an organized system. It may be an aspect of chronic personality disorder, of drug abuse, or of a serious condition such as schizophrenia in which the person loses touch with reality.”

“Paranoia is defined as false beliefs that harm is occurring to oneself which is intended by a persecutor (Freeman and Garety 2000).”

The meaning of the word paranoia has changed over time. The Century Dictionary and Cyclopedia from 1890 defines paranoia as, “a chronic form of insanity developing in a neuropsychopathic constitution, presenting systematized delusions of more or less definite scope, while in other directions there may appear a fair amount of mental health. The prognosis is extremely bad.

Today in the field of psychology, paranoia is treated as a personality characteristic which can fall along a scale from extremely mild and rare to very high and constant. Ways psychologists measure paranoia are by using the Paranoia Scale (Fenigstein and Vanable 1992) or the Paranoia Suspiciousness Questionnaire (Rawlings and Freeman 1997.) When studying personality characteristics, it’s important to differentiate between traits, how paranoid a person is generally, and state paranoia, how paranoid the person may be thinking, feeling, and acting, at the moment.

In common usage, today when most people say someone is “paranoid” they are describing someone with excessive or unwarranted fears and beliefs that others dislike them, are out to get them or will betray them.

Paranoia along with excessive fear and suspiciousness are commonly associated with some of the more serious mental illness. Anyone with difficulty understanding what’s happening around them is likely to become fearful, suspicious, possibly even paranoid.

Subclinical paranoia.

Counselors see many clients with excessive, unreasonable fears. When those fears interfere with everyday functioning, they need to be treated. How much fear is warranted depends on your point of view. When someone has experienced infidelity, the belief that their partner may be cheating again may be very reasonable. If you have been the victim of violence, a heightened wariness is understandable. Life experiences, from your earliest years to the present taught you whether to be trusting or suspicious. Having been neglected or experiencing bullying increases the chances you will see the world as hostile and people as unreliable.

If, as far as you know, your partner has never cheated, but you spend hours each day checking their cell phone or social media for signs they are cheating, if you follow them or demand to know where they are every moment of the day, it’s likely your fears are about you rather than about their behavior.

According to paranoidthoughts.com, “around a third of the population regularly has suspicious or paranoid thoughts. In fact, paranoia may be almost as common as depression or anxiety.”

Subclinical levels of paranoia are associated with the anxiety disorders, depression, and with cognitive impairment. Excessive jealousy can become so severe that it needs to be treated as a “delusional disorder.”

Paranoia among people with substance use disorders.

There’s a significant presence paranoid symptoms among people with a substance use disorder. Some substances increase the level of anxiety and cause paranoia. The substance using lifestyle includes people who are untrustworthy and can result in traumatic experiences. Using illegal substances involves criminal activity. Telling whether extreme fearfulness and the beliefs that others are out to get is paranoia or reasonable is difficult when you have a substance use disorder. The belief that the police are following you and people are watching you may not be paranoia when you have a kilo of dope in the trunk of your car.

The way you think about yourself affects your risk of developing paranoia.

High self-esteem, feeling good about yourself, has been shown to reduce your risk of developing paranoia. Several other personality characteristics such as optimism and pessimism are also related. There is still the question of whether paranoia causes low self-esteem and pessimism or whether paranoia is the result of those personality characteristics.

In upcoming posts, we will talk about clinical, mental health disorders which may involve paranoia, some of the substance use disorders which involve paranoia and those subclinical problems, which lie on a continuum between trust issues, suspiciousness, and diagnosable paranoia. We should also explore some of the personality characteristics which impact your level of trust issues, suspiciousness, and paranoia.

For more on this topic see:

Trust

Paranoia

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Dextromethorphan and paranoia.

By David Joel Miller.

Sometimes over-the-counter medications cause paranoia.

Fearfulness

Paranoia.
Photo courtesy of Pixabay.com

Dextromethorphan is a common antitussive (cough suppressant) medication found in over-the-counter medications. It is a common ingredient in over 140 over-the-counter medications. Unfortunately, Dextromethorphan has become an increasingly abused substance among those in the 18 to 25-year-old range. Abuse by younger teens is reported to be on the rise.

Because dextromethorphan can be purchased over-the-counter or stolen from grocery stores and pharmacies, many users have underestimated the serious, long-term effects of dextromethorphan abuse.

When taken according to directions most over-the-counter medications are relatively safe. Any medication, including over-the-counter medications, may result in side effects or allergic reactions. Abuse of Dextromethorphan can have some serious health consequences.

When Dextromethorphan is taken in larger than recommended amounts it can produce psychoactive effects. “Use in amounts exceeding those recommended, a practice which is known as “Robotripping,” may result in a toxidrome of psychomotor agitation, hallucinations and paranoia best characterized as Intoxication Delirium (Stanciu, C. et al., 2016.)

Dextromethorphan shares pharmacologic and neurobehavioral properties similar to opiates and phencyclidine (PCP.) Because of its cough suppression action is like the opiate codeine, as the dose increases it can produce dreamlike states and hallucinations somewhat like the “pipedreams” of opium smokers. As the dose increases significant unpleasant and health impairing results occur. At very high doses Delirium and misperceptions occur, resulting in paranoia and violent behavior similar to PCP intoxication.

“Intoxicated excited delirium describes the most serious and potentially deadly DXM-induced medical condition involving psychotic behavior, elevated temperature, and an extreme psychomotor agitation fight-or-flight response by the nervous system. Due to extreme violence frequently encountered such presentations, typically encountered in the emergency room setting with law enforcement involvement, have resulted in sudden death secondary to cardiac or respiratory arrest, an outcome associated with the use of physical restraints” (Stanciu, C. et al., 2016.)

One online user bulletin board, I will leave the website name out, included a number of user warnings. Users report tolerance to dextromethorphan happens rapidly, often after a single dose. Reports of paranoia were common, both paranoia caused by taking dextromethorphan and users reports of high anxiety which they called “paranoid” about the many other negative results from use.

Users have reported impaired daily functioning for as long as six years afterward.

On the way to psychosis and paranoia, users may experience a variety of alterations in perception. Commonly reported are auditory, visual, and tactile hallucinations. That may pass through a period of excitability and pressured speech which can easily be mistaken for bipolar mania. Nervousness, confusion, and disorientation can occur. A variety of physical symptoms are also likely, including tremors, slurred speech, and occasionally seizures. Some less pleasant symptoms include nausea, vomiting, respiratory depression, coma, and even death.

The particular gene responsible for metabolizing dextromethorphan is polymorphic meaning there are a number of different mutations of this gene in humans. Because of this a new user never knows just how dextromethorphan may affect them. Some people need to take a large amount to feel the effects while other people can have a serious adverse effect even at doses only a little above the label recommendations (Stanciu, C. et al., 2016.)

There are antidotal reports of serious interactions between dextromethorphan and commonly used substances such as alcohol and marijuana. In medical settings, life-threatening interactions between prescribed psychiatric medications and intentional overdoses of dextromethorphan-containing products.

Dextromethorphan is not the only drug of abuse which has been connected to an increased risk of developing paranoia. Reports of paranoia among drug users are common. Paranoia can be difficult to identify and diagnose. It is often only considered in the context of diagnosing the paranoid type Schizophrenia or Paranoid Personality Disorder. Recent studies have suggested that paranoia falls on a continuum and paranoia has rarely been studied outside the seriously mentally ill. Many things about the drug using lifestyle increase the risk of paranoia. Another reason for the shortage of information about rates of paranoia and its treatment among drug users has been the systematic exclusion of those with a substance use disorder from psychological research. Given the large overlap between those with a substance use disorder and a diagnosed mental illness, there’s a lot we haven’t learned about trust issues, suspicion, and various levels of paranoia among those with a co-occurring disorder.

I’ll continue to watch for and read research about the trust to suspicion continuum so watch for future posts on this topic.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

What is Paranoid Personality Disorder (F60.0)?

By David Joel Miller.

There’s more than one kind of paranoia.

Fearfulness

Paranoia.
Photo courtesy of Pixabay.com

When you hear the word paranoid, most people think of the expression “paranoid schizophrenic.” Paranoia can be a part of several mental illnesses. Among the mental illnesses that include paranoia as a symptom Paranoid Personality Disorder is the most common. According to the DSM-5, estimates for the prevalence of Paranoid Personality Disorder range between 2.3% and 4.4 %. The estimate for all types of schizophrenia is between 0.3% and 0.7%. Since there are several types of schizophrenia, my rough estimate tells me Paranoid Personality Disorder is probably 10 times as common as paranoid schizophrenia.

Paranoia can also be a part of several other mental illnesses including, depression, bipolar disorder with psychotic features, other psychotic disorders, delusional disorder persecutory type. Suspicion and even paranoia may also be features cognitive dementia and substance use disorders.

There is also a condition known as “Subclinical paranoia” in which the person has milder forms of trust issues, suspicion, or paranoia. Symptoms that may cause them problems, but doesn’t quite meet all the criteria to be diagnosed as a specific mental illness. Professionals are beginning to believe that paranoia can exist on a continuum from occasional mild symptoms to the more persistent and serious symptoms that we see in those people diagnosed with Paranoid Personality Disorder.

Many cases of paranoid personality disorder do not get diagnosed. People with this disorder, whether in a mild form or more serious one, distrust others and believe people are out to harm them. As a result of these beliefs, they tend to avoid others, professionals in particular. Those with paranoid personality disorder are likely to only be diagnosed when they are involuntarily hospitalized for mental health issues or forced to be seen by professional because of criminal or legal issues.

How is Paranoid Personality Disorder diagnosed?

To receive the diagnosis of Paranoid Personality Disorder someone would need to exhibit the presence of at least four symptoms from a list of 7 possible symptoms. These symptoms involve suspiciousness, trust issues, beliefs that others are deliberately trying to harm them. The DSM calls for the symptoms to begin by early adulthood and happen in multiple contexts. This leaves us with a gray area in diagnosing paranoid symptoms which develop in senior citizens.

It’s easy to see that there can be a large mathematical number of combinations of having or not having the seven symptoms. My math tells me that there are over 5000 possible combinations of these symptoms with 840 of those combinations meeting criteria for a diagnosis of Paranoid Personality Disorder. Since we don’t have laboratory tests such as blood tests or x-rays to detect the symptoms, they are evaluated using symptom check-lists either from the patient’s reports or observations by others. Depending on how the client describes their feelings and the mood of the therapist’s that day it’s easy to call a particular symptom either in or out resulting in fuzzy diagnoses.

Many of these possible symptoms can vary in intensity. Deciding if someone has 3, 4, or 5 symptoms present can be very much a judgment call. Using more objective screening tools and checklists result in a large number of people who show some symptoms, but not enough to make the cut off for having Paranoid Personality Disorder. One commonly used instrument is the 20-question questionnaire, Paranoia Scale by Fenigstein and Vanable. Results from this scale vary from very low, occasional, symptoms of paranoid to extremely high and constant levels. In future posts, I want to talk about those people who fall in the middle of the score range on the paranoid scale, enough that they frequently experience trust issues and suspicion but don’t quite meet the cut off to be diagnosed with Paranoid Personality Disorder.

What are the 7 symptoms that may be present in Paranoid Personality Disorder?

  1. Being suspicious without good reason that others are trying to harm them, lie to them or take advantage of them. The presumption here is that the person can’t accurately perceive the actions of others. It can be difficult for the professional to determine whether these beliefs about others actions are accurate.
  2. They spend a lot of time thinking about their beliefs that others are not trustworthy, disloyal or have bad intentions.
  3. They do not trust anyone and avoid talking about their fears because of a belief that others will use what they say against them.
  4. They interpret normal, everyday events as threats or personal attacks.
  5. Holds onto the perceived attacks, may have grudges and be unwilling to forgive even accidental injuries because they believe others are deliberately trying to harm them.
  6. Gets angry and fights back because they believe others are attacking their character or reputation. The things they’re angry about most other observers don’t see as intentional attacks.
  7. Have unjustified suspicions that their regular sexual partner is unfaithful.

How does Paranoid Personality Disorder disrupt lives?

People with Paranoid Personality Disorder assume that others are out to get them. Sometimes these thoughts are totally unreasonable but other times there a matter of opinion or even experience. If someone has harmed you in the past, it’s not unreasonable to be on the lookout for other people seeking to harm you.

If your partner has cheated on you before, it’s hard to trust them again. Sometimes the mistrust makes sense but other times the injured spouse develops a persistent sort of paranoid jealousy, and no amount of checking will convince them that their partner is faithful.

People with varying levels of paranoid thoughts spend a lot of time doubting and worrying about whether the people around them are trustworthy and loyal. When you’re high in paranoia, you find it difficult to believe you can trust anyone.

Paranoia makes it harder to trust others and makes you reluctant to share personal information with others for fear they will use that information against you. They may be reluctant to answer personal questions and when asked to fill out forms may refuse to give answers to some questions saying that these things are “nobody’s business.” This high level of distrust leads them to believe that accidents were deliberate and that routine jokes were meant as personal criticism. The paranoid person is likely to take compliments as veiled insults.

There are some other characteristics of paranoia which aren’t included in the diagnostic criteria but are listed as associated features. It’s really hard to get along with people who have even moderate levels of suspicion and distrust. People who are high in paranoia are likely to be control freaks and have difficulty getting along with others.

Paranoid Personality Disorder is part of the “Cluster A Personality Disorders.” It’s common for people who are diagnosed with one of the Cluster A personality disorders to also have symptoms of several other personality disorders from this group.

Not everyone with trust issues gets diagnosed with Paranoid Personality Disorder.

As with the other things we are calling a mental illness this needs to interfere with your ability to work or go to school, your relationships, your enjoyable activities or cause you personal distress. Otherwise, you may have the issues, but you will not get the diagnoses if this is not causing you a problem. If the only time this happens is when you are under the influence of drugs or medicines, or because of some other physical or medical problem, this fear needs to be more than your situation would warrant. These other issue needs treating first; then if you still have symptoms, you could get this diagnosis.

In upcoming posts, we will look at the overlap between paranoia and substance use disorders, some possible causes for paranoia, some of the milder variations of fearfulness and trust issues as well as ways to reduce the impact of your trust issues on your ability to have a satisfactory life.

FYI These “What is” sometimes “What are” posts are my efforts to explain terms commonly used in Mental Health, Clinical Counseling, Substance Use Disorder Counseling, Psychology, Life Coaching and related disciplines in a plain language way. Many are based on the new DSM-5; some of the older posts were based on the DSM-IV-TR, both published by the APA. For the more technical versions, please consult the DSM or other appropriate references.

See Recommended Books.     More “What is” posts will be found at “What is.”

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Reasons to get mental health help now!

By David Joel Miller.

Some emotional problems need immediate attention.

Mental Health or Mental Illness

Mental Health or Mental Illness?
Photo courtesy of Pixabay.com

There are some mental and emotional problems that shouldn’t be ignored.  Sometimes people think that if they’d just wait, the problem will go away all on its own.  Other people believe that by asking for help and let the problem get control of them. Unfortunately, many serious emotional problems get worse if they’re not attended to.  When should you wait to see if the problem resolves itself?  Which are the times that you need to take immediate action?

Here is my list of the times when you shouldn’t wait to see if a mental or emotional problem will get better. If you or someone you know is having any of the problems listed below don’t wait, seek help immediately.

Suicidal thoughts.

When someone is having thoughts of killing themselves, you should take immediate action.  Some people believe that when a person talks about suicide they won’t really do it.  That just is not true.  If someone you know has mentioned their thoughts of suicide, now is the time to take action.  If you are having these thoughts reach out for help immediately. One good resource is:

National Suicide Prevention Lifeline at: 1-800-273-8255.

Paranoia.

Paranoia is defined as an unreasonable fear.  When someone is becoming more and more afraid of situations or people around them they are at risk.  Paranoid people may take actions that put themselves or others at risk.

Hallucinations.

There are lots of reasons people might have hallucinations.  Hallucinations are a lot more complicated than just hearing voices or seeing things.  In another post, I wrote about other types of hallucinations. Hallucinations can be caused by a mental illness.  They can also be caused by drugs, both street drugs, and prescription medications.  Some other types of hallucinations may indicate a medical emergency.  When someone is hearing voices or other sounds, seeing things, feeling things crawling on their skin, or having another perceptual distortion, there’s no time to lose in getting them help.

Self-harm.

Besides suicidal behavior, there are other types of Self-harm.  Some people do self-injurious behavior, like cutting or burning themselves as a way to regulate emotions.  The Self-harming behaviors can get out of hand.  By Self-harm, I am not talking about everyone who does something dangerous or disturbing to their families.  If someone is doing things to themselves with the clear intention of hurting themselves, they need help.

Racing thoughts.

Many people have episodes racing thoughts.  Most of that time these turn out to be worry or excitement over upcoming events.  But when someone begins to experienced racing thoughts on a recurring basis this needs to be looked at by a professional.

Impulsive behavior that is out of character.

Many people have times in their life when they do something impulsively.  But if this impulsive behavior is dangerous, reckless, and completely out of character for that person, this is the time that they need help.

Need to punish yourself.

Someone who develops a need to punish themselves is at risk.  It’s not uncommon for someone to make a mistake and then continue to beat themselves up, at least mentally about that mistake.  But if this self-punishment moves from being upset and reminding themselves not to do this act again, to active self-injurious self-punishing behavior, this person needs help.

Sudden unexplained changes in sleep and appetite.

Changes in sleep and changes in appetite are two of the diagnostic criteria for depressive disorders.  There can also be changes in sleep and or appetite in a number of other mental illnesses.  But when someone suddenly develops unexplained changes in sleep or their appetite they need to seek professional assistance.

Overwhelming fear or anxiety.

A certain amount of fear or anxiety when you are in a risky or dangerous situation is normal.  Many people experience overwhelming, uncontrollable fear and intense anxiety about the future.  These kinds of fears or anxieties can interfere with people’s ability to live life.  Anxiety disorders rarely go away on their own.

Serious loss of motivation.

Serious loss of motivation is likely to be a symptom of a developing or worsening mental illness.  When someone loses their motivation it’s time to seek assistance.

Extreme loss of pleasure.

Extreme loss of pleasure, sometimes called anhedonia, is one of the symptoms of a serious depressive disorder.  People who were unable to feel any happiness or pleasure are at higher risk to develop depression or another serious mental illness.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Delusions are a leading cause of homicides; if you were delusional would you know?

By David Joel Miller.

What exactly is a delusion and why are they so hard to recognize beforehand?

One particular delusion has been implicated as a leading cause of homicides. Related delusions may also play a major role in other violent acts even though professionals have such a hard time recognizing them.

Delusions are one of those things like art or pornography we have a great difficulty in defining but we all think we will recognize it when we see it. Unfortunately, it often goes unrecognized until way too late.

While not necessarily a particular mental illness, Delusions are a symptom of a number of mental illnesses. In practice professionals rarely seem to pick out the delusion first. The person gets diagnosed with a particular mental illness and then the descriptor with delusions gets tossed in later like that tells us much about what is going on.

Some mental status exam forms and assessment forms include checkboxes to mark off delusions. Since deciding if someone is delusional is such an extreme judgment call, this decision often comes after the diagnosis not before. Also, note that the one delusion that results in many homicides is not usually included in the list of delusions that we are presented to check off.

The commonly considered delusions are, Paranoid, Grandiose, Religious, and Persecutory. Let’s look at these one at a time and see why they can be problematic. Some of these examples are slightly exaggerated and embroidered for effect. Can you tell which are which?

When paranoia is not a delusion.

A client told me that he was being followed; that the police were out to get him and that it was not safe to walk the streets. Clearly, he was sounding paranoid. On Monday I learned that he had been arrested after the police responded to a shooting at his house. The police were quick to respond as they were only a couple of blocks down. They had been watching his house. He was found in possession of a large quantity of drugs.

Was he paranoid? As I tell students in the substance abuse counseling program, if the client thinks people are watching him and he has a kilo of dope in the trunk of his car this is not paranoia, it is common sense.

How Grandiose is Grandiose.

If I told you that an African-American though he could run for president and have a chance of winning in this the 21 century that would sound Grandiose wouldn’t it?  And if that Black man was a first-term Senator from the mid-west – any psychiatrist worth his salt would know right off that this person was Grandiose.

Thank goodness no one told President Obama those things. Or if they did, it is a good thing that he did not listen. Whatever your political affiliation, it is clear that President Obama ought not to be diagnosed as Grandiose, not since he won anyway.

So it is not grandiosity if you are actually able to do something. This makes me nervous when I put down that someone is having grandiose delusions. How do I know for a fact that they are delusional? In my mind, any doubt goes to the client.

Your religion is delusional mine is doing what God wants.

All religions are based on Beliefs. They customarily urge you to act on faith and have belief. Unfortunately, they all seem to have a different group of these essential beliefs.

In mental health, if something occurs to you and most of the other people in your community think this is correct, we do not diagnose this as a mental illness.

If a Catholic believes that they see the Virgin Mary we let that go.
Where this becomes a problem is if you move to a country where no one believes in the Virgin Mary and now if you keep seeing her they can lock you up as delusional. That whole community values thing is a rabbit hole down which the truth can disappear in an instant.

If you are now thinking of sending me a nasty comment or e-mail about how far off I am about your religious beliefs please read the next section before hitting send.

Persecutory Delusions.

It is not persecutory if people are after you. Like paranoid this one is a matter of degree and judgment.

If you think that people are out to get you and then you start getting written death threats, that is probably not a persecution delusion.

This like all the others is a matter of fact and judgment.

Which major delusion is not on a lot of forms?

We don’t like to look for and may miss jealousy delusions. People who believe that their partner is cheating on them can and do frequently get violent. Sometimes after they shot or kill someone they discover that their partner was not in fact cheating on them but at the time the evidence looked to them like that partner was clearly cheating.

One article I read recently reported that someone killed a man he believed was cheating with the client’s wife. He was arrested. The victim now dead was clearly not having an affair with the client’s wife. This belief was called a delusion.

Later it came out that the wife was, in fact, having an affair, the client just got the identity of the man she was cheating with wrong.

Was he delusional? I let you decide that.

Certain groups are far more likely than others to be described as delusional. I worry that if you do not agree with the assessor you will get called delusional.

Say you are sent for an evaluation and the assessor is a member of the Church of the Religious Egg. They teach that you should cover yourself with plastic and surround yourself with plastic objects three times a day to meditate. You report that this whole idea is crazy. The assessor reports that you are having religious delusions because you believe in some other deity.

At this point who are we thinking is delusional?

Please do not misunderstand here. I do believe that people, with or without mental illness, can and do have delusions, some more bizarre than others. My point is that we need to be careful about what we call a delusion and what we let go.

So in some future posts, we will need to talk about the research on delusions and why certain groups get that label more often than other groups.

Until next time, stay happy.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

How to turn anxiety into paranoia

By David Joel Miller.

Some days it is a short trip from anxiety to paranoia.

The higher the volume is turned up on your anxiety control the greater the risk that this could lead to paranoia.

Some caveats here. In this context, I am not talking about one of the paranoia’s that are currently diagnosable as a mental illness. Most people say Paranoid-schizophrenia as if it was all one word. There are lots of people with schizophrenia that are not paranoid. There are also people who suffer from paranoid personality disorder who do not have schizophrenia.

This discussion is about people without those two diagnosable illnesses who have some feeling that looks like paranoia during the course of another illness or even without meeting criteria for a diagnosis. In other words, this is about the dictionary definition of paranoia not the DSM definition of a paranoid mental illness.

Yes, in my opinion, you can have paranoid thoughts and not have a mental illness with the word paranoia in it.

One definition of Paranoia is an unfounded, exaggerated or unreasonable distrust of others not based on facts. This is fear based and makes you question others motives.

Here is how a case of paranoia might begin.

You are very fearful, sensitive and worried about what others think of you. You have “trust issues” and are not sure if people are really your friends or might want to harm you.

People who have been victimized in the past are especially at risk for these kinds of trust issues and for good reason. They have been harmed by someone in the past and may feel that they were too trusting.

One day this anxious person, let’s call her Annid. This is one of those made up names contracted from her mother’s name Ann and her father’s name, David. I don’t know an Annid or an Ann and David combination so I think I am safe here.

One day Annid is walking down the street and she hears footsteps behind her. She walks faster but the footsteps are still there. She looks over her shoulder and there is someone there. Let’s make this person a man. She is afraid of men because she was attacked by a man in an alley. This would be even worse if the man who attacked her was a member of a particular race and the man behind her was the same race.

At the corner, she decides to cross the street to get away from this man. She notices out of the corner of her eye he stops at the corner to talk to another man. She is becoming more anxious.

When the light changes the second man turns and follows her across the street. She walks faster but every time she looks back there is a man back there. She is not sure if this is either of the two men she saw before but there is always one behind her.

Eventually, she ducks into a coffee place and has some coffee. She decides to wait a bit to get rid of those men who are following her. But when she leaves the coffee place there across the street are 5 or 6, men all standing together and one of them looks like that man who was following her. Same sports team shirt and everything.

At this point, convinced she is being followed by a gang of men she ducks back into the coffee place and calls a friend who comes to pick her up and take her home.

Unchecked this fear that men are following her can grow until she is unable to leave the house.

One problem for this woman is that no matter where in this town she may walk there may be a man walking behind her.

Is this an irrational fear? Maybe, maybe not. Having been the victim of an assault once there is proof that a man could assault her. Is this fear excessive? Probably. The chances that every man on the street is following her and plans to assault her are very low, most of the time.

The challenge for this person and other people with paranoid symptoms is to reasonably evaluate the situation, assess for danger and still keep this fear of another assault from keeping her a prisoner in her home.

Now so far in this example, I have said that Annid has a history of being a victim. What if she has never been victimized?

She might have had a friend who was assaulted or heard a story on T. V. about assaults in her town. If she had a preexisting anxiety disorder even if nothing had ever happened to her she might keep looking over her shoulder believing that constant vigilance will keep her safe. And if you keep looking for something you will begin to see it.

See how easy it is to turn a fear in your mind into a belief that there is a real danger. We have even had cases where someone believing they were in danger pulled out a gun and shot a person who just happened to be going in the same direction they were. Family members have killed other family members in the mistaken belief that there was an intruder in the house.

High levels of fear can create the situation in which everything becomes scary.

If you have anxiety issues or feel threatened and unsafe, consider getting professional assistance both in determining if this is a real threat and in learning to manage your anxiety or other issues before that emotional problem turns you into a paranoid person.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.