PARANOIA AND INDECISIVENESS IN SEVERE MENTAL ILLNESS

Borderline personality disorder (BPD) is a mental disorder characterized by disturbed and unstable interpersonal relationships and self-image, along with impulsive, reckless, and often self-destructive behavior.
Individuals with BPD have a history of unstable interpersonal relationships. They have difficulty interpreting reality and view significant people in their lives as either completely flawless or extremely unfair and uncaring (a phenomenon known as "splitting"). These alternating feelings of idealization and devaluation are the hallmark feature of borderline personality disorder. Because borderline patients set up such excessive and unrealistic expectations for others, they are inevitably disappointed when their expectations aren't realized.
Symptoms

The handbook used by mental health professionals to diagnose mental disorders is the Diagnostic and Statistical Manual of Mental Disorders (DSM). The 2000 edition of this manual (fourth edition, text revised) is known as the DSM-IV-TR. Published by the American Psychiatric Association, the DSM contains diagnostic criteria, research findings, and treatment information for mental disorders. It is the primary reference for mental health professionals in the United States. BPD was first listed as a disorder in the third edition DSM-III, which was published in 1980, and has been revised in subsequent editions.

The DSM-IV-TR requires that at least five of the following criteria (or symptoms) be present in an individual for a diagnosis of borderline disorder:

1. Frantic efforts to avoid real or
perceived abandonment
2. Pattern of unstable and
intense interpersonal relationships,
characterized by alternating between
idealization and devaluation ("love-
hate" relationships)
3. Extreme, persistently unstable self-
image and sense of self impulsive
behavior in at least two areas (such as
spending, sex, substance abuse,
reckless driving, binge eating)
4. Recurrent suicidal behavior, gestures,
or threats, or recurring acts of self-
mutilation (such as cutting or burning
oneself)
5. Unstable mood caused by brief but
intense episodes of depression,
irritability, or anxiety chronic feelings
of emptiness
6. Inappropriate and intense anger, or
difficulty controlling anger displayed
through temper outbursts, physical
fights, and/or sarcasm
7. Stress-related paranoia that passes
fairly quickly and/or severe dissociative
symptoms— feeling disconnected from
one's self, as if one is an observer of
one's own actions.

Borderline personality disorder typically first appears in early adulthood. Although the disorder may occur in adolescence, it may be difficult to diagnose, since borderline symptoms such as impulsive and experimental behaviors, insecurity, and mood swings are common—even developmentally appropriate—occurrences at this age.

Borderline symptoms may also be the result of chronic substance abuse and/or medical conditions (specifically, disorders of the central nervous system). These should be ruled out before making the diagnosis of borderline personality disorder.

BPD commonly occurs with mood disorders (i.e., depression and anxiety), post-traumatic stress disorder (PTSD), eating disorders, attention deficit/hyperactivity disorder (ADHD), and other personality disorders. It has also been suggested by some researchers that borderline personality disorder is not a true pathological condition in and of itself, but rather a number of overlapping personality disorders; it is, however, commonly recognized as a separate and distinct disorder by the American Psychiatric Association and by most mental health professionals. It is diagnosed by interviewing the patient, and matching symptoms to the DSM criteria. Supplementary testing may also be necessary.

Treatment
Individuals with borderline personality disorder seek psychiatric help and hospitalization at a much higher rate than people with other personality disorders, probably due to their fear of abandonment and their need to seek idealized interpersonal relationships. These patients represent the highest percentage of diagnosed personality disorders (up to 60%).

Providing effective therapy for the borderline personality patient is a necessary, but difficult, challenge. The therapist-patient relationship is subject to the same inappropriate and unrealistic demands that borderline personalities place on all their significant interpersonal relationships. They are chronic "treatment seekers" who become easily frustrated with their therapist if they feel they are not receiving adequate attention or empathy, and symptomatic anger, impulsivity, and self-destructive behavior can impede the therapist-patient relationship. However, their fear of abandonment, and of ending the therapy relationship, may actually cause them to discontinue treatment as soon as progress is made.

Psychotherapy , typically in the form of cognitive-behavioral therapy , is usually the treatment of choice for borderline personalities. Dialectical behavior therapy (DBT), a cognitive-behavioral technique, has emerged as an effective therapy for borderline personalities with suicidal tendencies. The treatment focuses on giving the borderline patient self-confidence and coping tools for life outside of treatment through a combination of social skill training, mood awareness and meditative exercises, and education on the disorder. Group therapy is also an option for some borderline patients, although some may feel threatened by the idea of "sharing" a therapist with others.

Medication is not considered a first-line treatment choice, but may be useful in treating some symptoms of the disorder and/or the mood disorders that have been diagnosed in conjunction with BPD. Recent clinical studies indicate that naltrexone may be helpful in relieving physical discomfort related to dissociative episodes.

Prognosis
The disorder usually peaks in young adulthood and frequently stabilizes after age 30. Approximately 75–80% of borderline patients attempt or threaten suicide , and between 8–10% are successful. If the borderline patient suffers from depressive disorder, the risk of suicide is much higher. For this reason, swift diagnosis and appropriate interventions are critical.

Prevention recommendations are scarce. The disorder may be genetic and not preventable. The only known prevention would be to ensure a safe and nurturing environment during childhood.

Difficulty exists in differentiating BPD and Type I Bipolar Disorder. Classic presentation reveals delusions of grandeur. The attached screenshot is indicative of an unstable thought process. Notice the initiation of the post- "to whom ever is attacking my account. Yes I do know you.." The authors thought process cycles to extremes. "To whom ever" indicates the author has no idea of identity but then swings to the affirmative, "Yes I do know you." That is an example of a rapid cycle and paranoia. Next notice the end, "keep going like this and only bad things will happen in your life.." This is an example of delusional thinking brought about by anger. How can one guarantee that everything that happens in another's life be only bad especially when identified in the opening as whom ever? Even if the author is actually aware of the identity (which is not likely based on the authors admission) it is impossible to ensure that only bad things will happen in their life. This was an attempt by the author to stroke their own self identity and ego. Knowing the legal and psychiatric history of the author finds BPD being appropriate. What a sad existence but fortunately through compliance with intensive outpatient CBT and appropriate anti-psychotic medication this individual may be able to live a life void of institutionalization (whether penal or psychiatric). The problem however is that compliance is not easy for suffers of the disorder.

ASPD and Paranoia

Many people completely misunderstand the traits of a sociopath. Sociopaths do NOT have any real friends, they do not want friends, nor do they have the emotions that are required to be a friend. Instead of friends, a sociopath wants loyal followers, people who will do anything to help the sociopath achieve their own narcissistic goals. They gain followers by using an act — known as their “persona”— pretending to be an upright, trusting person, and a great friend. Their persona is nothing like their real personality. But they are quite believable.

The terms “friend” and “sociopath” are mutually exclusive. What does that mean? It means you can have a real friend, and you may know a sociopath, but you cannot have a real friend who’s also a sociopath.. What you can be is a loyal follower, or even a disciple to a sociopath, and as such, they will treat you as if you were a friend … but it is not sincere. As long as you provide some value to them, something they need, value as simple as companionship, they will keep you around. But once they tire of your companionship, you will be left with no doubt.

As most people are aware, a sociopath, or more precisely, someone afflicted with Antisocial Personality Disorder (APD) and/or Narcissistic Personality Disorder (NPD), does not feel any guilt or remorse for the things they’ve done to others, but on a larger scale, it’s not just those emotions that they lack … sociopaths do not have any of the typical emotions that most people take for granted.

So along with lacking negative emotions, such as guilt and remorse, they also lack what most would consider positive emotions, such as compassion, love, joy, security, and passion. This is what’s often overlook, but critically important: a sociopath’s lack of emotions does not end with the negative emotions. Hence, a person with APD or NPD does not have the capacity to feel any positive emotions, preventing them from thinking about anyone else, but themselves. A sociopath cannot feel the emotions required in a friendship, so they act them out. And often, they over-act with a certain plastic appeal.

Most sociopaths or psychopaths have likely identified how they differ from most people, and in their minds, they’re superior to virtually all of “us.” They do not need friends … they need loyal followers. A sociopath cares only about themselves, and how they can use others to strengthen their narcissistic goals.
As soon as you don’t offer them the same value, or you hesitate doing something they ask of you, or they simply sense something different — watch how fast that “best friend” relationship will collapse. You were certain they felt for you as you did for them. No one wants to believe how sinister and cold another “human” can be. Most people won’t believe it until it happens to them … it’s the definition of intense gut-wrenching.

You were in their inner circle. You know a lot. Sociopaths often suffer with paranoia, and even if it’s their own paranoia that causes them to sense a lack of loyalty from you, it’s no different to them … it’s just as real.

Consider this, and trust me, whatever your sociopath friend may say to counter this, it’s just what they do best — lie. A sociopath not only does not feel guilt or remorse, but it does not stop there … they do not have any typical human emotions.

They do not feel love, friendship, compassion … nothing, it’s all faked. It’s called their public persona. A sociopath’s persona has virtually no resemblance to their true personality. They know they are different, but they may know nothing more than that. It’s not of interest to them. What is of ultimate interest is control.

They build a group of followers by faking friendship, charm, compassion … until people are so sucked-in and so brainwashed that they now respect and admire a very evil sociopath. Some sociopaths wear their persona all the time, i.e., 24/7. Those sociopaths know all too well that what they do, the things they get away with, would likely be just as revolting to their family as with anyone else.

Oh, and that family consisting of a spouse, and 2.5 kids? It’s all part of the act. They want to blend in. They know a family is an important element. They know belonging to a church, a synagogue, or any place that brings people together to worship, will assuredly benefit the cause of blending in.
A sociopath knows their family members cannot be aware of their real activities, because if they are, they would become a threat just as anyone else would. And the sociopath responds to a family-based threat no differently then by someone they hardly know. They must protect themselves from exposure … any slight threat or risk must be dealt with immediately, with what I call: offensive-revenge.
When looking at a sociopath, all you see is another person. What you will never see is that person’s history. Their history is like a hostility throttle. Depending on what they’ve gotten away with in the past determines how they will respond to an attempted exposure now and degree is based on his degree of paranoia.
One sociopath with whom I am familiar changes his city of residence weekly on Facebook due to his intense paranoia. He is certain that he is being tracked by people which he conned money from in the past and to be fair these individuals are the type to hunt him down not because of the money but rather the lack of respect they were shown. Truth be known however, he is in the same place because his limited "disability" income does not afford him the luxury of living the truly nomadic lifestyle he tries to portray. Anyone that knows of his financial challenges and deficiency laugh at the facade. In his paranoia and through his narcissistic personality the lies fuel his delusion of superiority as consistent with ASPD. He is such a joke but hey, he's free entertainment.