I Know I’m Miserable, But am I Paranoid?

Reader’s Question

I’ve been feeling really down. I can hardly sleep — just a few hours — so when I wake up I feel tired and have a strong headache in the back of my head. Also, I’m asexual so I’ve been feeling under pressure, although my family doesn’t know about it. I’ve read about paranoia and I think I have the Paranoia Disorder. I’m feeling lost and tired and nervous. I can’t even study or focus on anything. What should I do? What do I have?

Psychologist’s Reply

Making sense out of the pattern of symptoms you mentioned requires sitting down, face-to-face, and putting together the pieces. So, your first question, as to what you should do, has a straightforward answer: make an appointment with a qualified mental health professional. That person will be able to ask the right questions and follow up on your answers to help you narrow down what might be the cause of your symptoms (and hence what to do about treatment).

Sleep disturbance can be a symptom of depression or anxiety, and the headaches in the back of your head may be caused by muscle tension from anxiety. You also described yourself as nervous and unable to concentrate. All of these things point toward problems with anxiety, which often accompanies depression as well.

When you mentioned paranoia, you may be referring to Paranoid Personality Disorder. That disorder involves delusional beliefs about how others are out to harm and sabotage the individual, so he or she is deeply mistrustful and has limited social contact. Because the paranoia is linked to personality, and the delusional beliefs are experienced as based on reality, people with Paranoid Personality Disorder rarely recognize that the problem rests with them, or that they’re more suspicious than they should be.

You also mentioned asexuality. Degree of sexual desire and interest lies along a continuum, and some people seem to naturally experience minimal (if any) sexual urges or feelings. For these individuals, that simply seems to be the result of their genetic makeup, so they’ve always been that way and feel fine about it — it’s normal for them. However, if you used to feel substantially more sexual desire than you do now, it may be that the decrease in sexual interest is related to anxiety and/or depression.

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Because of the various possibilities, it’s important that you share your concerns with a trained mental health professional. Self-diagnosis is difficult, and being able to talk with someone who is knowledgeable, caring, and supportive can be very therapeutic in itself. With the range of treatments available, there is no good reason to continue to worry or suffer with the symptoms you described. A major criterion for most disorders is that it causes the person distress and/or interferes with the person’s functioning. In your case, that alone warrants making an appointment. Don’t give up on the process until you find a professional with whom you feel comfortable and with whom you feel you’re making progress toward being yourself again.