What is trust?

By David Joel Miller.

Do you have trust issues?

Trust.

Trust.
Photo courtesy of Pixabay.com

Many people report they have trust issues.

It is a common complaint among people who come for counseling.

Some people are shy or anxious, others have been hurt. It’s tempting to believe that not trusting protects you from pain.

Not trusting can also cause you loneliness and isolation. The challenge is learning when to trust and when to be wary and cautious.

The definition of trust.

The dictionary, or denotative meaning, of trust as a noun is a firm belief in the truth, reliability, ability, or strength of someone or something. Synonyms for trust include your faith, confidence, certainty, and belief. This definition puts trust into the realm of your opinion or feelings about how much you are willing, or able to put aside your doubts and accept something is true because you want it to be true. This subjective quality of truth leads to differences in trust between people.

The many kinds of trust.

There is more than one kind of trust, depending on the nature of the relationship. The qualities you look for in a trustworthy car will be different from what you look for in deciding to trust a person. Learning who to trust, when to trust, and how much to trust is a valuable life skill. Here are some of the varieties of trust.

Competence-based trust.

Sometimes you must rely on the skills of others. You want a doctor can trust. You look for a medical professional who went to a good school, has a good reputation, or is a specialist. If your car needs fixing you should be looking for a good mechanic. The trust you have in professional people is primarily a belief that they can do what you want them to and that they will do their job correctly.

Situational trust.

When you go into a bank, you trust the teller and hand them your money. You would not trust a stranger on the street with your money. You are more likely to trust people you have just met at work man people you’ve recently met socially. Students initially trust a teacher who tells them to go somewhere or do something far more than they would trust a stranger standing outside the building. Situational trust is based on the role the other person fills rather than any other information you have about the individual.

Caring trust, trusting that they won’t try to hurt you.

Most people grow up believing that their families care about them. The universal expectation is that parents should care about their children and that siblings should care about each other. As parents grow older, there is an expectation that their children will care about them. Extended family members are likely to care more about you than strangers.

Throughout life, most people develop friendships which are based on mutual caring and trust. These early life experiences create a mental blueprint for how we should trust others and expect to be trusted. Having an early life caregiver who was not consistent and reliable can result in trust issues in adulthood. Learning inappropriate relationships because early caregivers were abusive or neglectful are called attachment disorders and are a major source of adult trust issues.

Having a friend who trusted violate the principle of caring trust makes it more difficult to form adult friendships.

Character-based trust.

Some people are easier to trust than others. Everything they do seems appropriate and consistent with what they say. People who are described as being of “good character” seem to be easier to trust. People we say have a good character I described as honest, loyal, and trustworthy. Many youth development programs are built on the idea that it is possible to teach children character values and that those who were good and well-behaved as children are likely to grow up to be trustworthy adults.

Character-based trust has become suspect in recent years. We hear on the news after someone has been arrested for a serious crime that the neighbors were surprised because “he always seemed like such a nice guy.” Despite adult skepticism that many people who appear honest and trustworthy just haven’t gotten caught yet, some people, because of their appearance and demeanor, give the outward appearance of warranting character based trust.

More information on this topic appears in the category – trust.

David Joel Miller MS is a Licensed Marriage and Family Therapist (LMFT) and a Licensed Professional Clinical Counselor (LPCC.)  Mr. Miller provides supervision for beginning counselors and therapists and teaches at the local college in the Substance Abuse Counseling program.

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.

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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.

David Joel Miller MS is a Licensed Marriage and Family Therapist (LMFT) and a Licensed Professional Clinical Counselor (LPCC.)  Mr. Miller provides supervision for beginning counselors and therapists and teaches at the local college in the Substance Abuse Counseling program.

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.

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

David Joel Miller MS is a Licensed Marriage and Family Therapist (LMFT) and a Licensed Professional Clinical Counselor (LPCC.)  Mr. Miller provides supervision for beginning counselors and therapists and teaches at the local college in the Substance Abuse Counseling program.

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

David Joel Miller MS is a Licensed Marriage and Family Therapist (LMFT) and a Licensed Professional Clinical Counselor (LPCC.)  Mr. Miller provides supervision for beginning counselors and therapists and teaches at the local college in the Substance Abuse Counseling program.

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

David Joel Miller MS is a Licensed Marriage and Family Therapist (LMFT) and a Licensed Professional Clinical Counselor (LPCC.)  Mr. Miller provides supervision for beginning counselors and therapists and teaches at the local college in the Substance Abuse Counseling program.

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.”

Staying connected with David Joel Miller

David Joel Miller MS is a Licensed Marriage and Family Therapist (LMFT) and a Licensed Professional Clinical Counselor (LPCC.)  Mr. Miller provides supervision for beginning counselors and therapists and teaches at the local college in the Substance Abuse Counseling program.

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.

How does therapy help people?

By David Joel Miller.

People ask just how it is that therapy or counseling works.

The short answer is that there are many ways, not just one way in which therapy may work to help someone. Professionals all have their own preferred theory of therapy which is the basis of their practice. What they do is highly influenced by the theory they use, though the truth be told most of us borrow from other theories if we see a procedure that might help a client.

The way counseling might help also varies with the problem the client brings to the office. In the early days, there was one profession that largely dealt with problems of the mind, psychiatrists. Today there are many specialties that work to help people with their problems of living. A caveat here, I have my preferred way of trying to be helpful. This is my opinion so I won’t pretend to fully explain all the procedures.

Therapists are empathetic, nonjudgmental listeners.

There are some things people don’t feel comfortable talking to their families and friends about. One school of therapists, Rogerians, believe that most of us have the answers to life’s problems we just need to talk them out. Being able to talk through urges and fantasies helps people to understand themselves and may lead to an improved ability to control their behavior. Clients sometimes say their therapist just sat there, listened and didn’t tell them anything. If you want or need more than listening, discuss that with your counselor.

Therapy can be a corrective emotional experience.

Many clients tell me they have trust issues. Often this is because there has been no one in their lives they could trust or because they were not trustworthy themselves. If their family was never very affirming, a positive therapist can help them to learn to affirm themselves. Group therapy is especially good at teaching people how to deal with interpersonal problems by allowing them to experiment with new behaviors.

The counselor can provide reality testing.

Clients may come to therapy with incorrect perceptions. People think they are fat when they are normal or below in weight. They think of themselves as too old or too dumb when they are in fact at a normal developmental point in their life. People make plans that they do not have the skills or resources for, they have expectations of others that are not realistic. Having someone to “bounced ideas off” can help ground plans in the real world.

Counselors help people change life stories.

Many people have a “story” about themselves that started in early life and which they have been unable to alter. People with call themselves “a loser.” This personal story, saturated with problems, may keep them from trying new things because they expect to fail at any new effort.  Narrative therapists help people create a new story.  Cognitive therapists would call this a “thinking distortion” and use various methods to get the client to challenge this belief and create a new belief about themselves that was more adaptive. Instead of thinking of themselves as a “loser” the client may begin to see themselves as a “survivor” who has continued to try in spite of obstacles.

Counselors teach clients new skills.

A substance abuse counselor would teach a client refusal skills. A career counselor might teach his client how to use online career inventories, interviewing skills or resources to use to conduct a job search. Marriage counselors may teach couples communications skills. Family counselors may teach parenting skills. Skills-based approaches may involve recommendations for books to read and real-life homework to increase skills. School counselors primarily work on academic issues, what classes to take and how to succeed in school.

Counselors help clients get in touch with themselves.

Exploration of the self, personal growth and discovery are all legitimate reasons to see a counselor. Counselors don’t make decisions for clients, but they can teach clients decision-making skills and encourage clients to practice these skills. Therapy can help clarify values and assist clients in evaluating choices. People may come to counseling confused and in need help in gaining clarity.

Psychotherapy can assist in changing personality.

Psychotherapists often focus on basic personality characteristics. Psychologists can give and administer personality tests while psychotherapists can spend time working through personality characteristics the client may wish to change.  Changing an underlying personality characteristic takes more time and effort than the crisis-driven techniques but it can result in long-term changes in coping skills. Psychodynamic therapists work on the unconscious. More cognitive therapists would approach personality issues by trying to help the client gain a new worldview. “Getting a new pair of glasses” results in seeing the world and problems differently.

There are sure to be more ways in which counseling is helpful. What do you think? Are you a client who has been helped? What was helpful? If you are a therapist, what do you think helps clients?

This post was featured in “Best of Blog – May 2012

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.