Is watching porn causing your relationship problems?

By David Joel Miller.

What would your therapist say about watching pornography?

sex-on-a-cork-board

sex-on-a-cork-board.
FreeDigitalPhotos.net

In this Internet age, pornography is much more available and widely viewed. Occasionally a client tells their counselor they think they have problems with viewing pornography. Much more often this issue comes up in couple’s sessions when one partner, commonly the woman, is angry, or hurt, or feeling insecure, as a direct result of her partner’s watching of pornography.

Some counselors and therapists received a little bit of information on the problems connected to pornography during their training. Most did not. Those counselors who work with couples are likely to hear about the conflicts couples are having regarding pornography use. What they say to their client’s is probably largely based on their own beliefs, what other clients have told them or their personal “field research.” So just how big a problem is pornography causing in relationships?

The two questions above are, of course, two very different questions. Recently I came across a professional journal article which looked at the training, attitudes, and competencies counselors have when it comes to helping couples work through the issues involving pornography.

Pornography is hard to define.

Even the courts have found it difficult to define pornography. Contemporary standards have changed. You will see things on prime-time television now which once would’ve been considered inappropriate and pornographic. Technically the term pornography is customarily used to refer to explicit sexual material that crosses some line or boundary and therefore becomes illegal.

When clients talk about pornography what they usually mean is “adult entertainment” consisting of pictures of naked people or suggestive poses. Often it includes depictions of people engaging in a variety of sexual behaviors. The intended purpose of this material is to cause arousal in the viewer.

In the year 2000, sexual material was the number 1 item viewed on the Internet and accounted for more than half of the money spent on the Internet. It’s possible that Internet shopping, social media, and the increased popularity of videos has altered those numbers, the way doubt it’s changed that much. It’s quite possible that people viewing pornography were early adopters of the Internet. Whatever the statistics say today, it’s common for individuals and couples in counseling to report using the Internet for a variety of sexual activities (Ayres & Haddock, 2009.)

Pornography is the primary relationship problem for some couples.

Researchers have identified 5 ways internet usage may be harming a couple’s relationships

The largest consumers of pornography are reported to be married heterosexual males. There use of porn significantly impacts their partner, resulting in reduced self-esteem, loss of respect and trust, and impairment of the connection between the partners (Bergner & Bridges, 2002; Schneider, 2000.)

While some couples are reported to view porn together, this rarely brings them to counseling. The type of viewing which causes the largest problems is when one person, usually the male, views it privately and in secret. The keeping of secrets part significantly damages the trust in the relationship.

Time spent in this secret activity is time away from the partner and family. Discovery of this secret leads to marital discord and frequently separation and divorce.

Online sexual activity can lead to affairs.

Two types of affairs can be facilitated because of online sexual activity.

Cyber affairs and cybersex results in the parties meeting their needs online and having less sex with their regular partner. Online sexual activity can cause the same damage to relationships as real-world affairs.

Sexual activity online can also be a way to facilitate real-world hookups resulting in either a string of casual sexual relationships or a longer lasting affair. One of the ways these hookups, which are being facilitated online, comes to the attention of the relationship partner is the contraction of a sexually transmitted disease.

Pornography can create individual problems also.

About 10 percent of pornography viewers spend 90 minutes a day or more searching for and viewing sexually explicit materials. Individual issues may include an increase in erectile dysfunction at a young age. Internet viewing porn has been described as “the great porn experiment.” 

In addition to altering patterns of arousal, heavy use of cybersex and pornography has been reported to lead to sexual addictions. The diagnosing of sexual addictions remains controversial. But the pattern of behavior closely matches the pattern of drug addiction. The person addicted to sex spends more time seeking it, engaging in it, and more effort trying to hide what they are doing.

As a sexual addiction develops, the addict shows tolerance, needs more and more sexual encounters and seeks activities that will increase the arousal. The addict lowers their standards and will engage in sex with people they would not have found attractive in the past.

The typical content of adult entertainment is likely to create unrealistic expectations for partners and distorted beliefs about the roles of women. The plots are often bizarre, fantastic, and feature atypical behavior rather than the way in which most couples typically express their sexuality.

Can pornography and cybersex addiction be treated?

Individuals with the pornography problem or sexual addiction can be treated, often with good results. Where these activities have damaged the couple’s relationship, couples counseling can help. Just like in-person sexual affairs, couples can recover from these experiences.

Treatment for sexual issues is very specialized, and you should seek someone experienced in working in these areas. In addition to the couple’s issues, each of the parties probably needs to see a counselor for individual therapy.

If your partner has a problem with pornography or cybersex, it is important not to blame yourself. It’s common for women to believe there is something wrong with them and ask what it is that the other woman had that made them more attractive. The truth is it’s rarely the woman’s fault. What was attractive, whether it was online pornography, cybersex or an in-person affair, was largely the result of one person’s individual problems, their need to constantly seek something different. Individual counseling for the partners of sexual addicts is extremely important.

Pornography and sexual addictions are only one way in which trust can be damaged.

Look here for more on the topic of trust.

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

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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. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

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Should you be more trusting?

By David Joel Miller.

How do you decide who and when to trust?

Trust sign.

Trust.
Photo courtesy of Pixabay.com

People often described themselves as having “trust issues.” The question they should be asking is, are they trusting too much or too little? Trusting is a complicated issue. How much you trust is affected by your personality and your past experiences. The level of trust you have will and should change with the circumstance.

Trust has been studied largely in 2 situations. Individuals are largely concerned about the trustworthiness of their partners in romantic relationships. Occasionally, this extends to their ability to trust friends or people with whom they conduct financial transactions.

Companies have studied trust in the workplace. It can take a long time to develop group cohesion and teamwork. People today move from job to job, work with consultants, and contractors, and may work in small, temporary work groups. Productivity increases when new workers develop trust in each other.

Here are some factors affecting trust you need to consider.

Trust is challenged when you meet new people.

Trust generally develops slowly over time. The longer you know someone, the more you know about them, the more you will feel inclined to trust them. Some people are extroverts, very outgoing and easily able to strike up a conversation with strangers. If you’re an introvert, you may find you are wary when meeting new people.

Trust in these situations should be limited. Those who learn to use small talk do better in these situations.

Trust varies with the role this person will have in your life.

You will have one type of trust when you meet a new employee at work. The company selected this person, and it’s reasonable to trust they can do the job they were hired for. You will have a different type of trust with the new doctor or mechanic. This trust is based on their education, license or certification, and the setting in which you meet them.

Your trust should be different in both kind and quantity on a first date. You probably should trust the cashier at the grocery store to ring up your purchases and give you the correct change. You wouldn’t trust that same person to spend the weekend unchaperoned, with your spouse.

You should have levels of trust.

Trust is not an all or nothing characteristic. You’ll have people you trust at school or work, but you should not trust them with the keys to your house or your bank card and pin number. People who said they have “trust issues” often over-trust when they first meet a new person. Because of this excess trust, they are more likely to be hurt when that person fails to live up to their expectations.

Are you more trusting of strangers?

The longer you know someone, the more you learn about their faults. Far too many people jump into a romantic, sexual relationship, on a first or second date. They are trusting this other person because they want them to meet their needs. What they haven’t done is spend the time to get to know them and find out how trustworthy they are.

Your general level of trust is a part of your personality.

The characteristics we call personality are a mixture of your genetic material and your life experiences. How much you trust generally can also be affected by the way you think and the choices you make. Most people have some general underlying beliefs about who to trust, how much to trust, and when they should be trusting.

When many people first meet a new person they use their default level of trust. They are either high in trust or high in distrusting. The longer you know someone, the more information you have about that person, the more likely you are relying on information rather than a general level of trust.

Trust is influenced by the experiences you had before you met them.

Your early life experiences set your baseline level of trust. In mental health, we look at ways young children relate to others based on their experiences with their primary caregiver. Problems in these relationships are diagnosed as attachment disorders, which can be either reactive or disinhibited. Attachment disorders used to only be diagnosed in children, but recently was moved to the group of diagnoses referred to as “trauma- and stressor-related disorders.” With time, treatment, or both, many people alter these patterns of relationship. For some people, however, their adult “trust issues” can be traced back to having caregivers in early life who were untrustworthy.

Life experiences, having been involved in relationships with others who violated your trust, can make it more difficult to trust in the future. If your partner had an affair, it could be hard to trust them again. If you separate from them and begin a new relationship, you’re likely to find you will have difficulties trusting that new partner.

Trust involves things you can’t check on.

Trust is what they will do when you are not watching. If you are standing there watching what they are doing, there’s very little trust involved. One of the best ways to increase your level of trust is to observe what people are doing. Unfortunately, there are too many things in life for you to check up on all of them. That’s where you need to use your trust skills.

Relationships that involve a lack of trust can become very dysfunctional. If you find the need to follow your partner around, check their cell phone, and read their email, this lack of trust can destroy your relationship. Healthy couples can talk about their concerns.

Constant checking your partner can be a sign of excessive or even pathological jealousy. Some people develop delusional jealousy believing their partner is cheating on them even when there’s no evidence. If you have trust issues, you need to ask yourself if this is about them or is it about your fears and insecurities?

No amount of monitoring can prevent someone from violating your trust. You either must trust people or end the relationship. If a lack of trust and jealousy characterizes all your relationships, consider getting some professional help.

What are the risks of trusting this person in this situation?

It’s easy to trust when the risks are low. When you are faced with “trust issues” consider what are the risks? Some situations are relatively low risk. You go to make a purchase and hand them some money. You are trusting that they will give you your merchandise and your change. Giving them 20 dollars at the grocery store is low risk. Paying cash to someone you just met in an alley for something valuable is a high-risk situation.

What has been your experience with trust? Have you been too trusting? Or does your excessive lack of trust damage your relationships?

Look here more on the topic of trust.

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

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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. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Cocaine and methamphetamine-induced paranoia

By David Joel Miller.

Stimulant-induced paranoia isn’t exactly a diagnosis.

Fearfulness

Paranoia.
Photo courtesy of Pixabay.com

Paranoia is common among drug users. It’s especially common among stimulant users. When crack cocaine users first began to show up in hospital emergency rooms, there was a lot of confusion between drug-induced psychosis and the onset of schizophrenia and other psychotic disorders. For a while, it looked like there was an epidemic of new cases of schizophrenia. Then picture emerged, something was very different about these new cases of psychosis.

The key features of psychotic disorder, schizophrenia, and some other related disorders are delusions, hallucinations, disorganized thought and speech, and grossly disorganized or abnormal motor behaviors. Some loss of normal functioning called “negative symptoms” is also part of psychosis. People with drug-induced psychosis don’t show those same levels of “negative symptoms.”

What most of us think of as paranoia fits generally under a couple of types of delusions, persecutory delusions, and referential delusions. These are the beliefs that people are out to get them and that what others are saying and doing is directed at them. Researchers have discovered that symptoms of paranoid can fall on a continuum from some mild suspiciousness and trust issues to potentially dangerous psychotic paranoia.

Psychosis and presumably paranoia can occur at multiple points in the drug using experience. For any drug of abuse, we expect to see one set of symptoms while the user is under the influence and another set of symptoms during withdrawal. Some conditions will persist, sometimes for years, even after the drugs have left the users system. These conditions are called drug-induced. It’s also possible that a drug user had a particular mental illness before they began using or had a risk factor for an illness and the drug use was enough of a stressor to result in the appearance of that illness.

I should also mention here all these descriptions are based on the idea that mental illnesses are categories. That’s the way the diagnostic manual is designed. You either have the illness, or you don’t. Increasingly research has been suggesting that most of the things we are calling symptoms are on a continuum. You can have more or less of a symptom such as paranoia. This implies that counseling and the ways people think can result in changes in symptoms of something like paranoia, regardless of whether the person with paranoia has a diagnosable mental illness or not.

Paranoia among cocaine users.

Cocaine-induced paranoia is primarily reported during cocaine intoxication. It involves extreme hypervigilance for possible danger in the environment. Up to 70 percent of cocaine users exhibit temporary paranoia even after ruling out mental health diagnosis which would include paranoia. Cocaine users on average report developing paranoid symptoms after about three years of using cocaine. The quantity that was used or the patterns of use do not seem to affect the onset of paranoia (Rosse, et al., 1994.)

Methamphetamine-induced paranoia.

Studies of paranoia among methamphetamine users are generally newer than the ones involving cocaine. One noteworthy difference was that methamphetamine users who became paranoid were more likely to get a weapon and to attack someone. Meth users had typically been awake for 48 hours or more when the paranoia began. The majority experienced auditory and visual hallucinations. Almost 40 percent of the methamphetamine users also reported tactile hallucinations. These results not only overwhelmingly reported paranoia but fit more closely with the diagnosis of psychosis in the studies I found of psychosis in cocaine users (Leamon, M., et al., 2010.)

Other drugs probably cause paranoia also.

Most of the early research on stimulant psychosis was done using patients who had been addicted to crack cocaine. In the years since that research, it has become clear that other stimulants, methamphetamine and the so-called “bath salts,” also produce psychotic episodes and an increase in paranoia. Studies of paranoia among cocaine users were largely done in psychiatric settings while the studies of methamphetamine and paranoia were mainly done in outpatient drug treatment which leads me to believe that paranoia is probably much more common and more likely to lead to violence among those who develop severe methamphetamine use disorders.

Paranoia and hallucinations occur among users of dextromethorphan.

Since most drug users use multiple drugs as well as drink alcohol and many also have mental health issues, it’s hard to be sure about causes. One thing does seem certain almost all drugs of abuse and excess alcohol use result in an increased risk that you will develop some level of paranoia.

For more on this topic see:

Trust

Paranoia

Dextromethorphan and 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.  If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

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 of 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. 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. 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 of 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 of 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.”

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