Paranoid personality is driven by the fear of being destroyed and by disowning parts of the self and seeing them outside. These patients often read feelings right and meanings wrong, defenses cannot be interpreted head on, and a hostile, arbitrary environment can make anyone paranoid.
What it is
Paranoid personality is dominated much more by annihilation anxiety, the fear of being destroyed, than by separation anxiety, the fear of being alone.
“people with paranoid personality, which is dominated much more by annihilation anxiety, the fear of being destroyed, than it is by separation anxiety, the fear of being alone”
50:07Nancy McWilliams on Psychoanalytic Diagnoses, Part 1: Personality, Defenses, Themes, Paranoid PersonalityNov 2024Guest episode The core defense is disavowing something in the self and seeing it as coming from outside. These patients have been shamed too much to own ordinary badness in themselves.
“The defenses that they use are disavowal of something in the self and seeing it as coming from outside. So it's not like there's some kind of ordinary badness in me. I think that they feel too much, they've been shamed too much to own that”
52:34Nancy McWilliams on Psychoanalytic Diagnoses, Part 1: Personality, Defenses, Themes, Paranoid PersonalityNov 2024Guest episode Parents of paranoid people tend to discourage separation and individuation, because they need the child to be the receptacle of everything they are disowning.
“parents of paranoid people tend to discourage separation and individuation because they need the kid to be the receptacle of all the stuff they're disowning”
56:15Nancy McWilliams on Psychoanalytic Diagnoses, Part 1: Personality, Defenses, Themes, Paranoid PersonalityNov 2024Guest episode
How we diagnose it
Paranoid patients often get the affect right in other people but the meaning wrong. See you frown and they assume you are angry at them, when you may have just remembered you owe your taxes.
“They often get the affect right in other people, but the meaning wrong. So, for example, if a paranoid patient sees me frown, they'll assume I'm angry at them. I may have just remembered that I owe my taxes”
51:47Nancy McWilliams on Psychoanalytic Diagnoses, Part 1: Personality, Defenses, Themes, Paranoid PersonalityNov 2024Guest episode Look at the situation before calling it personality. An undocumented worker paid below minimum wage by a boss who threatens to report any complaint will get pretty paranoid, and that is not a paranoid personality.
“If I'm an immigrant and I'm undocumented and I'm working for a boss who tells me I get paid well below the minimum wage and if I complain to anybody they're going to report me to... The immigration authorities, I'm going to get pretty paranoid, but it's not because I have a paranoid personality”
59:19Nancy McWilliams on Psychoanalytic Diagnoses, Part 1: Personality, Defenses, Themes, Paranoid PersonalityNov 2024Guest episode
Therapy
You cannot interpret the defenses; asking "do you think you're projecting?" will not work. The therapy has to help them become more comfortable with the parts of the self they need to disown and project.
“you can't say to them, do you think you're projecting? You can't interpret the defenses. What the therapy has to consist of is trying to help them be more comfortable with parts of the self that they need to disown and project”
54:37Nancy McWilliams on Psychoanalytic Diagnoses, Part 1: Personality, Defenses, Themes, Paranoid PersonalityNov 2024Guest episode
Medications
One reason antipsychotics help psychotic people is that they are huge anti-anxiety drugs: they reduce terror and sometimes allow more clear-headedness.
“One of the reasons that the neuroleptics help psychotic people is that they are huge anti-anxiety drugs. They reduce terror and sometimes allow for more clear-headedness”
57:27Nancy McWilliams on Psychoanalytic Diagnoses, Part 1: Personality, Defenses, Themes, Paranoid PersonalityNov 2024Guest episode
From these episodes
Every point above is something said on the Psychofarm podcast, with the words as spoken and a link to the moment in the episode. It is education, not medical advice, and an episode reflects what we thought when we recorded it.