My 14-year-old son has been diagnosed with OCD and GAD along with some paranoia. He actually goes a week or two without any paranoid episodes. Is that common? It seems that if he was paranoid, he’d always be paranoid.
Great question! In clinical practice we encounter various types of paranoia and at different levels. In general, paranoia is the unfounded and/or exaggerated distrust of others. Paranoia can range from chronic distrust and suspicion of others (as in Paranoid Personality) to psychotic paranoia in which the individual develops paranoid delusions (false beliefs) of grandiosity (feeling they have super powers, extreme wealth/accomplishments, fame, etc.) or persecution (believe in a systematized conspiracy to harm, torment, or monitor them). Based on your question, you’re thinking about psychotic paranoia and you would be correct — psychotic paranoid doesn’t come and go that quickly.
A level and a type of paranoia can accompany many different mental health situations. Some of the commonly-encountered types in clinical practice include:
- Anxious Paranoia
- The individual is hypervigilant, scanning their environment for threat, and always apprehensive that something bad is going to happen. They have an intense yet vague sense that something bad will happen — but not that a conspiracy is involved. This is a trademark of Generalized Anxiety Disorder (GAD).
- Depressive Paranoia
- Depressed individuals develop social hypersensitivity, the sense that people are looking at them in public, judging them negatively, thinking poorly of them, etc. They may feel they are unliked, unloved, and socially incompetent. They may not feel people will harm them, only that people in their environment think poorly of them and feel they are a burden. This is common in Depression and Obsessive-Compulsive Disorder (OCD).
- Personality Disorder Paranoia
- Individuals with a personality disorder (see my introduction to personality disorders on this website) con, manipulate, use, abuse, intimidate, cheat, and take advantage of others. They also assume everyone else operates in the same manner, an approach that makes them feel better about abusing people, as though everyone would rob and steal if they had the opportunity.
- Delusional Paranoia
- This is the extreme, irrational, and bizarre level of paranoia that is accompanied by bizarre ideas, delusions of grandiosity and persecution, hallucinations, plots and conspiracies, etc. In the early stages of delusional paranoia, the ideas are vague and all-encompassing, as when feeling somebody or some group is watching and threatening to harm you, but you don’t know who. Over time, a “systematized” delusion forms and the paranoia becomes more complex, often adding a component of grandiosity, fantasy, science, technology, etc. The individual may begin to read and research in the direction of his/her delusion, adding to their beliefs. I once worked with a gentleman who after many years of paranoid ideation, arrived at the conclusion that his body cellular molecular density had increased by one million times. The bottom line: He was Superman.
Your son’s level of paranoia relates to anxiety and depressive paranoia. This type of internal anxiety and social hypersensitivity does increase and decrease with stress level, medications, external pressures, etc. If he reports any symptoms or paranoid thoughts that seem to move in the direction of delusional paranoia, an immediate psychiatric consultation will be needed.
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