Paranoid Personality | Personality Couch

Ep 44: The 3 Most Unstable Personalities | Schizotypal, Borderline, & Paranoid

Tue, 30 Dec 2025 02:00:01 +0000

In this episode of the Personality Couch Podcast, we (licensed clinical psychologists Doc Bok and Doc Fish) explore the 3 most unstable personality disorders: schizotypal, borderline, and paranoid. All 3 types are at risk of psychosis. We first discuss historical personality classifications of neurotic, psychotic, and borderline, highlighting that the borderline space between neurotic and psychotic is the most prone to instability. This borderline space is where schizotypal, borderline, and paranoid personalities sit. We discuss the risky traits of each personality, including cognitive slippage, emotional instability, and extreme rigidity. We also discuss some of our thoughts and experiences in diagnosing these rather tricky disorders!

Are you a clinician stuck on a case? To schedule a consultation, please visit the practice website! https://www.questpsych.org/

The 3 Unstable Personalities

Tue, 30 Dec 2025 02:00:00 +0000

The 3 Unstable Personalities

** For this blog, the borderline personality organization (note: this is not BPD!) is super important to understand because Millon noted this is where his structurally defective personalities are found. Please see Understanding Neurotic, Borderline, and Psychotic Personalities for more detail **

Millon’s Structurally Defective Personalities ¹

Millon categorized three personality disorders as more severe than the others because they are “structurally defective,” meaning that the actual architecture of the psyche - not the style/category of personality - is unstable and falling apart. It’s “melting,” like the borderline organization mentioned above. While all humans have survival motives, personalities look differently in regard to balance and conflict of needs (see picture above). These three personality disorders are: Schizotypal, Borderline, and Paranoid.

Schizotypal Personality - Ungrounded ¹

I won’t go into detail about what Schizotypal is here, but if you need a recap on schizotypal personality, check out this blog. The unstable aspect of the schizotypal involves the fragility and disconnection to their survival motives, like a leaf floating all around with no purpose or effectiveness. Thus, their focus on the polarities are easily reversed and always muted and weak.

Some major signs of schizotypal at the borderline organization (aka almost psychotic-ness) include cognitive slippage, odd perceptual experiences (bodily illusions, detachment from body), preoccupation with “other worldly” phenomena (e.g., superstition, magical thinking, telepathy), and ideas of reference (e.g., thinking “They are talking about me because they looked at me as they drove by”). Sometimes, there can be brief steps into actual psychosis, but it doesn’t stay there. It’s their ungroundedness and disconnect from self and the world that leads them to the quasi-psychosis place.

For structurally defective personalities, there is almost always another non-structurally defective personality disorder that goes along with it. Though, it can be difficult to know what the original structure used to be before it started falling apart. For schizotypal, schizoid (passively detached) and avoidant (actively detached) personalities are usually the ones that disintegrate and fall apart into schizotypal.

Borderline Personality - Conflictual ¹

Here, we are discussing borderline personality disorder, not borderline personality organization (though it is at the borderline level of organization - so “double borderline,” if you will). If you need a recap on borderline personality, check out this blog. In regard to the survival motivations in Millon’s theory, borderlines have an average focus on each, but there is a conflict within each domain. There is intense, extreme inconsistency and ambivalence, resulting in emotional lability, unpredictable behaviors, and thoughts/feelings about others that are always changing and inconsistent. They keep switching back and forth between the different survival polarities, which is often why there tends to be push-pull dynamics in borderline personalities (e.g., “Come here - Go away,” “I love you - I hate you,” or “I want help - I don’t need your help”). The bottom line: They are unstable.

Some major signs of a borderline’s almost psychotic-ness include stress-triggered, fleeting dissociation or paranoid ideation, which may or may not briefly cross into actual psychosis with hallucinations and delusions. But they come back to reality quickly and are aware of their brief stay in psychosis. Borderline personalities can be extremely aware of their psychic pain, to a fault. There may be temporary dissociative episodes ranging from wasting the day away in bed to self-harming without feeling pain. There can be short-term paranoia about others being out to get them, resulting in impulsive and reckless decisions like moving to a different state, quitting their job, or leaving a relationship.

For the structurally defective borderline personality, the other personalities that often coexist with it include those historically in Clusters B and C: melancholic (sad), dependent (clingy), avoidant (socially anxious), histrionic (attention-seeking), narcissistic (egotistical), and antisocial (rule breaking).

Paranoid Personality - Rigid ¹

If you need a recap on paranoid personality, check out this blog. For the paranoid, Millon doesn’t focus on the intensity of motives, but the inflexibility and rigidity of the paranoid’s survival aims and motives. Their psychic structure is fixed, so whatever they learned and developed in life is hidden, unchangeable, and not influenced by life circumstances and external experiences. There is an unwillingness to change, even with good reasons to do so or when faced with contradicting information. They will not adapt to external realities, rigidly adhering to their way of viewing the world, which they see as a hostile and threatening place. Paranoids are so afraid of annihilation that they are fixated on surviving, causing them to freeze.

Paranoids dip into brief psychosis is actually super tricky to see because their delusions are systematic, meaning they are logical and comprehensive, but also irrational and untrue. Often, the delusion is persecutory, as they are absolutely convinced someone is out to get them with malevolent intent, despite no evidence or evidence to the contrary. Usually, this is triggered by intolerable, unconscious feelings of guilt that are then projected onto another (“I’m not the bad guy, YOU ARE”). They need to hurt before they are hurt, which can blur the line between self/others and reality/non-reality. It can also result in illusions of enemies, persistently bearing grudges, or believing the other completed an offense against them that did not happen. It’s their paranoia that takes them into possible psychosis.

For the structurally defective paranoid personality, other personality disorders that often coexist include avoidant (socially anxious), negativistic (passive-agressive), compulsive (extra rigid), narcissistic (egotistical), antisocial (rule breaking), and sadistic (dangerous). Because the three structurally defective personalities are falling apart and in a quasi-psychotic space, it can be extra difficult to differentiate them, especially because they usually coexist with a non-structurally defective personality.

Personality dysfunction and disorders can be tricky! If you want to better understand the differences between schizotypal, borderline, and paranoid, therapy and/or psychological testing can help! If you’re in Virginia (or a PsyPact state), check out Quest Psychological and Counseling Services for available services. If you’re a provider stuck on a case, we also offer consultations for mental health professionals!

References

Millon, T. (2011). Disorders of personality: Introducing a DSM / ICD spectrum from normal to abnormal (3rd edition). John Wiley & Sons, Inc. ↩︎ ↩︎ ↩︎ ↩︎

Understanding Neurotic, Borderline, and Psychotic Personalities

Tue, 30 Dec 2025 02:00:00 +0000

Back in the day, psychologists and psychiatrists categorized individuals as sane or insane, which later changed to neurotic or psychotic, respectively¹. However, not everyone fit neatly into these categories (duhhh), and so the concept of borderline was proposed¹. The borderline space is the space in between neurosis and psychosis, where individuals weren’t insane but also weren’t not insane either

Psychodynamic Personality Organizational Levels

Organizational levels of personality in psychoanalysis include those historical levels of neurotic, psychotic, and borderline. It does not refer to the type or category of personality, but the functioning and stability of one’s psyche. In other words, we are not talking about borderline personality disorder right now. All personality types can technically be found at any organization level, though some personalities tend to live at certain levels. It is also important to note that organization of personality can impact severity, but it does not imply severity¹.

Neurotic ¹

At the neurotic level, reality testing is intact, and there is an integrated, continuous, stable sense of self that can lead to increased insight and ego strength. Problems are pushed outside of the self (ego-dystonic) in order to analyze and fix them. There is an internal, unconscious conflict of acting out unacceptable impulses, resulting in overactive defenses to protect against guilt. This means they are too cold, like a freezerburnt snowman. They are inflexible, rigid, and critical of the self (and sometimes others), avoiding confrontation and conflict. Their defenses are verbal (secondary defenses) stemming from the oedipal stage of childhood (about age 3 to 6) where their struggle with initiative vs. guilt resulted in inhibition due to difficulties accepting their “bad” human instincts (i.e., aggression, libido). Specific defenses include reaction formation, repression, and sublimation. Personalities that tend to be found at the neurotic level include histrionic, obsessive-compulsive, and depressive-manic.

Psychotic ¹

At the psychotic level, reality testing is defective - like a melted snowman. They might not be sure they are actually alive and exist separate from others, let alone have a cohesive, integrated sense of self. There is an unconscious fear of nonexistence, resulting in underactive defenses to protect against fear of annihilation and dread. Thus, they are super sensitive to authenticity and genuineness in others, especially because they can access things that most other people reject in themselves, such as limitations and flaws. Their defenses are preverbal and prerational (primitive defenses) stemming from the oral stage of childhood (birth to about age 2) where their struggle with trust vs. mistrust resulted in withdrawal due to difficulties trusting what is inside and what is outside of themselves. Specific defenses include acting out, denial, extreme dissociation, omnipotent control, primitive idealization and devaluation, primitive forms of projection/introjection, somatization, splitting, and withdrawal. Personalities that tend to be found at the psychotic level include paranoid, schizoid, antisocial, and schizotypal.

Borderline ¹

At the borderline level, reality testing is inconsistent with brief episodes of being out of touch with reality - like a melting snowman. Unlike those at the psychotic level, they know that they exist, but they experience identity confusion due to having a discontinuous, inconsistent, and unstable sense of self. There is fear of separation and abandonment, resulting in instability. They are impulsive, having difficulty regulating emotions and can be more hostile with outbursts of intense emotion, including anger. The instability makes it difficult to function and can result in push-pull dynamics. Their defenses are pre- and post-verbal (primary and secondary defenses) stemming from the anal stage of childhood (about age 1.5 to 3) where the struggle with autonomy vs. shame/doubt resulted in fear of separation due to difficulties with separation-individuation and attachment. Specific defenses include denial, projective identification, and splitting. Personalities that tend to be found at the borderline level include dependent, avoidant, masochistic, borderline, and narcissistic.

Personality dysfunction and disorders can be tricky! If you want to better understand the differences between personalities at the neurotic, borderline, and psychotic levels, therapy and/or psychological testing can help! If you’re in Virginia (or a PsyPact state), check out Quest Psychological and Counseling Services for available services. If you’re a provider stuck on a case, we also offer consultations for mental health professionals!

References

McWilliams, N. (2011). Psychoanalytic diagnosis: Understanding personality structure in the clinical process (2nd ed.). Guilford Press. ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎

Ep 32: When Paranoid Personalities Kill | Analyzing 3 Infamous Mass Murderers

Tue, 15 Jul 2025 02:00:01 +0000

In this episode of The Personality Couch, we (licensed clinical psychologists Doc Bok and Doc Fish) dive deep into the dark end of the paranoid personality spectrum, focusing on three notorious cases of mass murder: Jeffrey Weise (school shooter), Richard Farley (jilted lover), and Timothy McVeigh (Oklahoma City bomber). We explore the psychological underpinnings of each of these severe paranoid personalities, the impact of childhood trauma, and how their psyches came unglued. We firstly look at the case of Weise, a 16-year-old school shooter who experienced significant childhood trauma and rejection at the hands of his family. We then turn to look at Farley, an incredibly dangerous example of how erotomania, or extreme unrequited love, can turn into your worst nightmare. Lastly, we take a close look at the infamous Timothy McVeigh, a domestic terrorist obsessed with fantasy, fiction, and comics about revenge. Separating from the Army, but desperate to be a hero, he found an enemy in the very US Government that he used to defend. Our discussion emphasizes that while not all paranoid personalities are violent (most aren’t), paranoid personalities in forensic settings can quickly unravel, making them among the most likely to commit mass murder.

Are you a clinician stuck on a case? To schedule a consultation, please visit the practice website to contact us! https://www.questpsych.org/

Additional Podcast References

https://en.wikipedia.org/wiki/Sunnyvale_ESL_shooting
https://en.wikipedia.org/wiki/Red_Lake_shootings
Littlefield, R. S., Reierson, J., Cowden, K., Stowman, S., & Feather, C. L. (2009). A case study of the Red Lake, Minnesota, school shooting: Intercultural learning in the renewal process. Communication, Culture & Critique, 2(3), 361–383. https://doi.org/10.1111/j.1753-9137.2009.01043.x
Savran, D. (1998). Taking it like a man: White masculinity, masochism, and contemporary American culture. Princeton University Press.

Episodes Discussed

3 Infamous Mass Murders Who Were Paranoids

Tue, 15 Jul 2025 02:00:00 +0000

I have to say that my fascination with paranoid personality runs deep, as I find it difficult to understand. The presentation of individual paranoid personalities are vastly different! As well-known personality expert Dr. Gregory Lester likes to say, “If you don’t know what it is, it’s probably a paranoid.” Why? Well, because we never really get to know them, since they hide and protect their real self from others. If you need a reminder of how paranoid personality disorder is characterized, check out the blog Paranoid Personality: The Post-Pandemic Narcissist.

Now let’s get to the interesting part that isn’t in the DSM, but is in the literature. Researchers have found that those with paranoid personality disorder have a sadistic parent and/or a parent with unmanageable anxiety (that is internalized by the child)¹ ². This leads to the child having their own unmanageable anxiety and annihilation fears, as well as a struggle with sadomasochism¹ (i.e. punishing others then punishing the self). This is all paired with their central defense mechanism of projection, which often turns into dealing with pain and early trauma by giving it to others. It’s an (un)conscious dynamic of, “Here, hold my pain.” It can lead to dangerous relational dynamics.

Photo by Kat Wilcox

PPD and Mass Killing

Paranoid personalities place their pain onto others or the world, creating a dynamic in which someone else has to pay. Adding in the possible criteria of readiness to counterattack, grudge-holding, and/or pathological jealousy, we start to have a dangerous equation. In fact, at extreme levels, paranoid personalities are at risk for committing mass murders³ ⁴!!!! But hang on…..before we go any further, let me say: I’m not trying to stigmatize or imply causation. Not all paranoid personalities are dangerous - most aren’t. BUT at their unhealthiest levels, they show up in forensic settings, like jails and inpatient hospitals, which means they are a threat to themselves or to society at large. Sitting on the extreme end of the continuum, forensic research has found that paranoid personalities are more likely to commit mass murder³ ⁴. Remember, this doesn’t mean most paranoid personalities commit mass murder; it only means that of those who do commit mass murder, paranoid personalities are more likely to be among that population. Let’s look at some examples found in the literature! I highly recommend listening to the full episode to get lots more information than I can provide in this blog.

Photo by Terrance Barksdale

Jeffrey Weise, the Traumatized

Jeffrey Weise⁵ ⁶ ⁷ ⁸ ⁹ ⁴ ¹⁰ was a Native American male who experienced childhood abuse/neglect and multiple early attachment traumas. His father died by suicide during a standoff with Red Lake tribal police when Weise was 8 years old. When Wiese was 10 years old, his mother was in a car accident resulting in brain damage that left her unable to independently care for herself⁸. She was placed in a nursing home, so Weise was “sent” to his paternal grandparents at the Red Lake Reservation⁹. Evidence showed he wrote stories about school shootings and zombies, was hospitalized for suicidal behavior, and was fascinated with Columbine and Hitler, as he posted dark, depressive content, and admiration of Hitler on neo-Nazi websites under usernames such as “Todesengel” (German for “angel of death”) and “NativeNazi.”⁵ ¹⁰

In 2005, at age 16, Weise killed his own grandfather and his grandfather’s girlfriend, then drove to Red Lake High School and killed a guard, a teacher, and five students (seven people) with a shotgun and semi-automatic pistol⁶ ⁷. He skipped the classroom where his friends were located, but he did wave to them⁵ ⁶. He was not at all psychotic, but rather “mission-oriented.”⁵ When police came, he killed himself⁵ ⁶ ⁷ ¹⁰. His sadomasochism can be seen in how he committed a sadistic act of mass murder, followed by a masochistic suicide. In his death, there seemed to be a unification with his father (his first attachment loss), since his father also died by suicide in a police standoff.

Photo by Pavel Danilyuk

Richard Farley, the Rejected Lover

Richard Farley¹¹ ³ ⁴ ¹² ¹³ is a White male who met a female coworker, Laura Black, in 1984 and stalked her after she consistently rejected his romantic advances¹¹. It was a clear case of erotomania¹¹. He took pictures of her in her gym class; frequently waited outside her house (she moved three times and got an unlisted number); copied her house keys; and sent hundreds of letters, including threatening ones¹¹ ³ ¹². Two years after meeting her, Farley threatened to kill Laura if she didn’t date him. This resulted in getting fired from his job, but he continued to stalk her³, and she eventually was able to get a temporary restraining order. The restraining order was scheduled to be made permanent, which triggered Farley’s violence¹¹ ¹². In 1988, at age 39, Farley went to his previous workplace and shot to death a total of seven people and wounded others, including Laura¹¹.

He was in a standoff with SWAT for 5 hours. During negotiations, he expressed remorse (only about Laura), threated suicide mulitple times, and claimed victimhood due to financial difficulties¹³, before eventually stating, “There’s no more reason to harm anybody; I’ve run out of enthusiasm for things."¹³ Farley surrendered after requesting a sandwich and soft drink.¹³ Reportedly, his motivation was to wound Laura so she would regret her behavior that caused him suffering¹¹, which is also why he surrendered instead of ending his own life¹². His erotomania was not psychotic¹¹ ³, and it’s notable that erotomania is correlated with paranoia¹¹. Here we also see sadomasochism again, as Farley was sadistic in his intrusion, power, and fear in stalking Laura, but also masochistic in consistent pursuit of rejection. Anyway, Farley was sentenced to death and is currently on death row¹².

Photo by Miguel Caireta Serra

Timothy McVeigh, the Terrorist

Timothy McVeigh¹⁴ ¹⁵ ¹⁶ ⁴ was a White male with an attachment trauma in childhood¹⁶ (mom “abandoned” the family¹⁴ ¹⁶; no connection with dad¹⁴ ¹⁶). He had fantasies about being a heroic warrior who fought monsters¹⁴ ¹⁶ and studied the book The Turner Diaries, which is racist, antisemetic, and describes a mass bombing¹⁴. He did join the Army in 1988 and had exceptional service. However, in combat, he killed a man who “didn’t want to fight us, but was forced to,” which led to disillusionment with and separation from the military. McVeigh regressed and became depressed and suicidal¹⁴. I think McVeigh wanted a real enemy, not a human who wasn’t willing to destroy him back. Anyway, his depression lasted until 1992 when he started projecting his pain by writing angry letters to the US government, who became his new enemy¹⁴. Events at Ruby Ridge, then Waco contributed to McVeigh’s desire for revenge against the US government¹⁴ ¹⁶. He considered multiple assassination plans, but ultimately chose differently¹⁴.

In 1995 on the anniversary of Waco, at age 27, McVeigh killed 168 people after bombing a federal building in Oklahoma City in retaliation against the government for Ruby Ridge and their destruction of Waco¹⁴. He was pulled over for speeding about 75 miles north of Oklahoma City, then arrested due to not having a license plate, registration, car insurance, or gun permit for the pistol in his holster¹⁴. He meticulously planned a huge terroristic crime for weeks (sadism), but then forgot all these details about his getaway?? That’s masochistic. I think he unconsciously wanted to be caught, which highlights the paranoid sadomasochism. He completed his sadistic act, but his masochism followed, just like after he killed someone in combat. It was also very evident that he was not psychotic, as his cognitive abilities and reality testing was intact¹⁴ ¹⁶. He was imprisoned and eventually sentenced to death. He actively pursued his execution date to occur sooner rather than later, which was granted because he was found to be mentally competent¹⁵. He was executed on June 11, 2001¹⁴ ¹⁵.

Photo by Dmytro Koplyk

As you can see, these three examples of killers are vastly different, though all were grudge-holding, non-psychotic paranoid personalities³ ⁴. They projected their fear of annihilation, destroying others instead of themselves. They were also quite immature, but to be fair, Weise was only 16 years old. All three had a very strong orientation towards sadomasochism, as they fluctuated between hurting their chosen enemy and hurting themselves. And they also seemed to have sadistic mothers and/or hate women…which makes ya wonder! But let me reiterate: Most people with paranoid personality disorder aren’t violent! However, most mass murderers are paranoid personalities³.

Photo by cottonbro studio

If you ever need help parsing out all the paranoia/paranoid personality stuff, we can help! If you’re a clinician, and you’re stuck on a case (in a PsyPact state), we provide consultations to help you figure out what you’re working with.

References

McWilliams, N. (2011). Psychoanalytic diagnosis: Understanding personality structure in the clinical process (2nd ed.). Guilford Press. ↩︎ ↩︎
Millon, T. (2011). Disorders of personality: Introducing a DSM / ICD spectrum from normal to abnormal (3rd edition). John Wiley & Sons, Inc. ↩︎
Stone, M. H. (2007). Violent crimes and their relationship to personality disorders. Personality and Mental Health, 1(2), 138–153. https://doi.org/10.1002/pmh.18 ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎
Stone, M. H. (2015). Mass murder, mental illness, and men. Violence and Gender, 2(1), 51-86. https://doi.org/10.1089/vio.2015.0006 ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎
Böckler, N. (2013). School shootings : International research, case studies, and concepts for prevention. Springer. https://doi.org/10.1007/978-1-4614-5526-4 ↩︎ ↩︎ ↩︎ ↩︎ ↩︎
Borja, R. A. (2005). FBI says Red Lake gunman acted alone in 9-Minute attack. Education Week, 24(33), 4. https://www.proquest.com/trade-journals/fbi-says-red-lake-gunman-acted-alone-9-minute/docview/202712793/se-2 ↩︎ ↩︎ ↩︎ ↩︎
Borja, R. R., & Cavanagh, S. (2005). School shootings stun reservation. Education Week, 24(29), 1-1,10,12. https://www.proquest.com/trade-journals/school-shootings-stun-reservation/docview/202757714/se-2 ↩︎ ↩︎ ↩︎
Leavy, P., & Maloney, K. P. (2009). American reporting of school violence and ‘people like us’: A comparison of newspaper coverage of the Columbine and Red Lake school shootings. Critical Sociology, 35(2), 273-292. https://doi.org/10.1177/0896920508099195 ↩︎ ↩︎
Lester, C. (2006). From Columbine to Red Lake: Tragic provocations for advocacy. American Studies, 47(1), 133–153. http://www.jstor.org/stable/40604901 ↩︎ ↩︎
Weisbrot, D. M. (2008). Prelude to a school shooting? Assessing threatening behaviors in childhood and adolescence. Journal of the American Academy of Child & Adolescent Psychiatry, 47(8), 847-852. https://doi.org/10.1097/CHI.0b013e3181799fd3 ↩︎ ↩︎ ↩︎
Meloy, J. R. (1989). Unrequited love and the wish to kill: Diagnosis and treatment of borderline erotomania. Bulletin of the Menninger Clinic, 53(6), 476-492. ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎
Stone, M. H. (2017). The anatomy of evil. Prometheus Books. ↩︎ ↩︎ ↩︎ ↩︎ ↩︎
https://caselaw.findlaw.com/court/ca-supreme-court/1295931.html ↩︎ ↩︎ ↩︎ ↩︎
Clarke, J. W. (2006). Defining danger: American assassins and the new domestic terrorists. Taylor & Francis Group. ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎
Madeira, J. L. (2012). Killing McVeigh : The death penalty and the myth of closure. New York University Press. ↩︎ ↩︎ ↩︎
Meloy, J. R. (2004). Indirect Personality Assessment Of The Violent True Believer. Journal of Personality Assessment, 82(2), 138–146. https://doi.org/10.1207/s15327752jpa8202_2 ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎

Ep 31: Paranoia, Paranoid Personality, or Schizophrenia? | Which Is It?

Tue, 01 Jul 2025 02:00:01 +0000

In this episode of The Personality Couch Podcast, we (licensed clinical psychologists Doc Bok and Doc Fish) unpack how paranoia, paranoid personalities, and psychotic disorders overlap. We explore the line between personality disorders and psychosis; misuse of the term schizophrenia; and introduce the concept of paraphrenia as it relates to psychosis in the paranoid personality. We also explore the historical context of paranoia, the nuances between paranoia and delusions, and how the terms became so intertwined in history. We end with our own unfiltered thoughts about limitations to DSM diagnostic categories and how paranoia became so confusing!

Are you a clinician stuck on a case? To schedule a consultation, please visit the practice website, which will guide you to the email address to use. https://www.questpsych.org/

Parsing out Paranoia, Paranoid Personality, and Paranoid Schizophrenia

Tue, 01 Jul 2025 02:00:00 +0000

How do paranoia, paranoid personality disorder, and paranoid schizophrenia (which no longer exists) overlap? Where’s the line between personality pathology and psychosis? Are paranoid personalities schizophrenic? Can they develop it? There are many paranoia/d labels and criteria spanning a range of diagnoses. Let’s unpack all this confusing stuff!

What are Delusions?

To understand paranoia, we actually need to discuss delusions first, because delusions are part of paranoia. Also, our current Delusional Disorders were formerly called Paranoid Disorder, so that makes it confusing as well as relevant. According to the DSM¹, delusions are “fixed beliefs that are not amenable to change in light of conflicting evidence,” which also means that they have emotional significance to the belief-holder. Delusions can be both far-fetched (bizarre delusion) or non-bizarre. They can be coherent, consistent, and organized (systematized delusion), sometimes even being interconnected (delusional system), or they can be disorganized, inconsistent, and illogical (fragmentary delusion).

Delusional content can be related to the self/personality (autopsychic delusion), others/the world (allopsychic delusion), and/or one’s own body (somatic/somatopsychic delusion). However, delusions don’t neatly fall into categories. For example, delusions of influence can be both about the self and about others, and paranoid delusions can include elements of persecution, jealousy, and grandeur.

Delusions about the self can involve erotic delusions (“Justin Bieber is in love with me”); delusions of reference (“Frank Sinatra is sending me messages in his songs”); and delusions of grandeur, including megalomania and religious delusions (“I’m the Messiah”).
Delusions about others can involve delusional jealousy (“You’re cheating on me!”…but unfounded); or delusions of persecution (“The world is out to get me”), including delusions of being controlled (“You’re controlling my thoughts”) and delusions of observation (“You’re always watching me”).
Delusions about one’s body can involve delusional parasitosis (“I’m infested by parasites”), delusional pregnancy (“I’ve been pregnant for 17 months” despite no symptoms), and even delusional body dysmorphia.

Photo by Pixabay

What Was Paranoia Previously?

In ancient times, the term “paranoia” was used to describe a vast amount of things involving mental disturbance², kind of like how we currently use the word ‘insane’ or ‘crazy.’ Interestingly, paranoia was not really in the literature from the 100s to the 1800s. It reappeared in the 1800s to describe any psychiatric disorder that has prominent, consistent delusions², which we can call “classical paranoia.” Classical paranoia is separate from any other psychiatric disorder, but the person has rigid, complex, logical delusions that usually involve persecution, grandiosity, or jealousy. Moving forward in time, paranoia or paranoid disorder became a diagnosis completely separate from schizophrenia that we now call delusional disorder, persecutory-type¹.

Photo by Tara Winstead

What Is Paranoia Currently?

Now, paranoia is a confusing term to understand because of its previously broad usage and definitions. Paranoia can be a symptom or criterion in a multitude of diagnoses including, borderline personality disorder (criterion 9), paranoid personality disorder, delusional disorder, psychosis, and dementia³. We can use the term “paranoid state” or “paranoid condition” to understand the difference, as being in a paranoid state means you have the grandiose/persecutory delusions, but they’re not logical (systematic) enough to be delusional disorder or bizarre enough to be schizophrenia. At its purest form, paranoia is a misattribution that outside cues or forces are out to get you. Types of paranoia include litigious paranoia and erotic paranoia.

Photo by Pavel Danilyuk

What is Schizophrenia?

The purpose of this blog isn’t to dive deep into schizophrenia, but it’s necessary to understand a brief definition. Schizophrenia is a thought disorder occurring for at least 6 months, which means their core symptoms showcase that they’re out of touch with reality or psychotic¹ ⁴. Why does this matter to understand paranoia? Well, because there used to be a paranoid subtype of schizophrenia* that typically had a later onset than other types of schizophrenia (so was it actually schizophrenia?!🤔). The subtypes of schizophrenia were removed because they weren’t helpful, but “paranoid schizophrenia” is still a common (but inaccurate) term used today. Plus, paranoid schizophrenia is often portrayed as dangerous in the media. *Note: the old “paranoid schizophrenia” is now called delusional disorder, jealous and/or persecutory type.

Photo by Two Dreamers

What is Paranoid Personality Disorder?

Paranoid personality disorder includes pervasive mistrust, suspicion of other’s malevalence, doubts of other’s loyalty, not wanting to confide in others, reading neutral events/interactions as threatening, holding grudges, readiness to counterattack upon perceived slights, and pathological jealousy¹. We won’t camp here long, since I’ve already written in-depth about this type; you can read more about it here: Paranoid Personality: The Post-Pandemic Narcissist?.

What Paranoid Personality Disorder is Not

Let’s start with the DSM-5-TR. The DSM¹ states, “Paranoid personality disorder can be distinguished from delusional disorder, persecutory type; schizophrenia; and a bipolar or depressive disorder with psychotic features because these disorders are all characterized by a period of persistent psychotic symptoms (e.g., delusions and hallucinations)” pg. 740. Further, Ekleberry⁴ wrote, “Individuals with PPD create and sustain an altered reality that, although not psychotic, sustains their beliefs about themselves and others.” Paranoid personality disorder does NOT involve actual psychosis! They can toe the line sometimes, but they don’t sit in psychotic land, which means paranoid personality disorder is NOT delusional disorder or schizophrenia.

Photo by Bradley Hook

Can Paranoid Personalities Fall Apart into “Psychotic Land”?

Paranoid personalities can fall apart and end up living in psychotic land, but at that point, they would be at a paraphrenic level parallel to but completely different from schizophrenia. Schizophrenic types are scared and odd, fearful and anxious. They are afraid and may see threats around them, but they keep to themselves out of that fear. They’re not likely to hurt you, like a dog that’s cowering in the corner. They’ll react only if you try to reach your hand in their cage while they’re afraid. Paraphrenics are more hostile and see everyone as a threat, so they are more likely to take their anger out on the world in dramatic and irrational ways since their main defense mechanism is projection. They’re the dog you don’t move towards because they’re going to attack you. Whatever neutral move you make will be interpreted as an attack, so they attack first. You can often find paraphrenics in hospital and forensic settings, but not all paranoids/paraphrenics are violent. However, in comparison to schizophrenics, paraphrenics are the more dangerous of the two⁴.

Photo by Nejc Košir

Why is All This Confusing?

Are you confused? Most of us are! That’s because all of this is so confusing! This was one of the most challenging blogs to write thus far. Why? Lots of reasons:

Paranoia and related disorders are not well defined³ ² and are heavily influenced by historical overusage. I personally agree with some other researchers who proposed that paranoid personality disorder should actually be termed vigilant/hypervigilant personality disorder⁴ ⁵ ².
Paraphrenia isn’t really talked about much anymore, and the researchers don’t agree on parts of it⁶ ⁵ ².
The DSM focuses on pathology, but not at an extreme end for disorders found in forensic settings. It is incomplete to describe the complexities of personality disorders.
Professional training often focuses on Cluster B personality disorders like borderline and narcissism, so there’s not much exposure to paranoid personality disorder.
And of course, paranoid personalities are not often seen in treatment or research studies because of their distrust of others, so it’s harder to understand them³ ².

Photo by Andrea Piacquadio

It might be a good idea to go eat a snack now so your brain feels better after all this information 🤯. Personality pathology can be so tricky, which is why we are here to help! If you’re a clinician, and you’re stuck on a case (in a PsyPact state), we provide consultations to help you figure out what you’re working with.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders: DSM-5-TR (5th edition, text revision.). https://doi.org/10.1176/appi.books.9780890425787 ↩︎ ↩︎ ↩︎ ↩︎ ↩︎
Millon, T. (2011). Disorders of personality: Introducing a DSM / ICD spectrum from normal to abnormal (3rd edition). John Wiley & Sons, Inc. ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎
Blaney, P. H., Krueger, R. F., Millon, T. (Eds.). (2014). Oxford textbook of psychopathology (3rd ed.). Oxford University Press. ↩︎ ↩︎ ↩︎
Ekleberry, S. C. (2009). Cluster A: Paranoid personality disorder and substance use disorders. In Integrated treatment for co-occurring disorders: Personality disorders and addiction. Routledge. https://doi.org/10.4324/9780203843710 ↩︎ ↩︎ ↩︎ ↩︎
Millon, T., Grossman, S., Millon, C., Meagher, S., & Ramnath, R. (Eds.). (2004). The paranoid personality. In Personality disorders in modern life (2nd ed, pp. 435–476). Wiley. ↩︎ ↩︎
Bernstein, D. P., & Useda, J. D. (2007). Paranoid personality disorder. In Personality disorders: Toward the DSM-V. ↩︎

Ep 30: Paranoid Personality | The 6 Subtypes Explained

Tue, 17 Jun 2025 02:00:01 +0000

In this episode of The Personality Couch Podcast, we (licensed clinical psychologists Doc Bok and Doc Fish) continue our discussion about paranoid personality disorder, exploring its three severity levels: Mild, Borderline, and Paraphrenic. We unpack the six subtypes of paranoid personalities as outlined by Dr. Theodore Millon: The Self-Righteous Mistrustful, The Obdurate Mistrustful, the Querulous Paranoid, the Insular Paranoid, the severe Fanatic Paraphrenic, and Malignant Paraphrenic. We highlight the fragility of Paranoids at all levels of severity, noting they can easily deteriorate with stressors and setbacks. We emphasize the importance of understanding these very common personality dynamics in all settings, especially with increasing paranoia in the post-pandemic world.

Are you a clinician stuck on a case? To schedule a consultation, please visit the practice website, which will guide you to the email address to use. https://www.questpsych.org

Paranoid Personality Subtypes

Tue, 17 Jun 2025 02:00:00 +0000

Despite Paranoid Personality Disorder appearing in the first edition of the DSM in 1952 and staying until present day, there is a severe lack of research on it. Most of the research is focused on paranoid phenomena like psychosis and paranoia, but not the actual paranoid personality disorder.¹ Interestingly, Millon advocated for paranoid personality disorder to actually be called vigilant personality disorder to differentiate if from other paranoia-related constructs.² ³ (For a better understanding of paranoid personality disorder, check out podcast episode 28: The Post-Pandemic Narcissist | Unmasking Paranoid Personality and its blog). Unlike narcissistic personality disorder and borderline personality disorder, paranoid personality disorder doesn’t really have much research or conceptualization of actual subtypes. Let’s look at the limited historical subtypes in the research and focus on the most recent subtypes of paranoid personality disorder by Millon.¹ ³

Photo by PNW Production

Historical Paranoid Personality Disorder Subtypes

From about the 1950s to the 1990s, aside from Millon ³ there’s only about four researchers who wrote about paranoid personality subtypes. All four wrote about a “weaker” and “stronger” subtype. The “weaker” subtype was labeled eccentric and sensitive, being more passive, secretive, constricted, cynical, and fantasy-focused. The “stronger” subtype was labeled combative and querelent, being more arrogant, openly defiant, bitter, argumentative, aggressive, and litigious.¹ ² ³ While somewhat helpful in understanding there are different “flavors” of paranoid personality disorder, Millon has contributed the most to this understanding.

Photo by Anna Shvets

Mistrustful Personality: Mild - Closer to “Normal” Level² ³

As with all of Millon’s personality subtypes, he groups them by severity, with mild subtypes being closer to “normal” and severe being closer to the psychotic/inpatient level (Check out this blog for more info). So let’s start with his less problematic subtypes of paranoid personality, which he labeled as Mistrustful (instead of Paranoid): The “Self-Righteous” subtype and the “Odurate” subtype.

Self-Righteous

The Self-Righteous Mistrustful subtype is functional to some degree, perhaps being a professor or business owner where control and self-sufficiency, paired with mistrust can be adaptive and protective. They are hypervigilant of any threat or attack, believing there is an enemy out there, but unsure of how close that enemy is, which means they can’t let their guard down. They come across as chilly, fearful, odd, humorless, rigid, and rule-bound.

Obdurate (Compulsive Features)

The Obdurate Mistrustful subtype overlaps with compulsive personality features, being self-righteous, stubborn, rigid, suspicious, and humorless. They try, and fail, to restrain their anger, so they end up projecting their hostility and actively rebelling against any outside constraints, so that they can feel in control. They can be moody, cranky, tense, and unrelenting. They function “normally,” but they are hypervigilant with “tightly compartmentalized persecutory delusions” that only come out if they are alerted to a threat.² ³

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Paranoid Personality Disorder: Moderate - Borderline Level² ³

The moderate subtypes are in the borderline/middle problematic level. In this level of severity, they can keep themselves together but often have short episodes of falling apart, falling out of reality, and dipping their toe in the land of psychosis. This is where Millon places the actual disorder level of Paranoid Personality, differentiating between “Querulous” Paranoids and “Insular” Paranoids.

Querulous (Negativistic Features)

The Querulous Paranoid subtype overlaps with negativistic features, being pessimistic, discontented, stubborn, and vengeful, but compared with negativistic personalities, they are much more aggressive and overtly hostile, faultfinding, resentful, argumentative, and jealous. In fact, their focus is on maintaining their independence because they reject any dependency needs they have to fight against vulnerability. These dependent needs for affection are projected, resulting in erotic delusions - or falsely believing others are in love with them.

Insular (Avoidant Features)

The Insular Paranoid subtype overlaps with avoidant features, being hyperreactive to criticism, withdrawn, and isolated, but they are much more moody and apprehensive. Their focus is on protecting themselves from being controlled by and destroyed by a threatening world through isolation. It reminds me of hiding in an insulated cooler so they don’t melt into nothingness. But their isolation leads them to fall out of reality at times, having to either turn their hostility inward and be self-destructive, or projecting it outward and being aggressive/violent.

Photo by cottonbro studio

Paraphrenic: Severe - Psychotic Level² ³

The severe subtypes are in the psychotic level range where they cannot keep themselves together or hold on to reality for long. They have decompensated in their functioning, often ending up in inpatient care where they previously may have been diagnosed with paranoid schizophrenia (which no longer exists as a diagnosis, though we still use it…even though we shouldn’t be). Millon calls this level “Paraphrenic,” as he describes it to be parallel to, but notably different from, Schizophrenic. In this Paraphrenic range, Millon differentiates between “Fanatic” Paraphrenics and “Malignant” Paraphrenics.

Fanatic (Narcissistic Features)

Like narcissistic personalities, Fanatic Paraphrenics can be arrogant, pretentious, and haughtily superior, but instead of a focus on image, their focus is on fighting against humiliation and lost pride. They do this through grandiose fantasies/delusions that are often not rational or sturdy. Unlike a narcissistic personality, they do not face their shame but project any humiliation and insufficient power outside themselves. So if they believe and present themselves as a superhero and have to face the fact that their power is actually not super, they blame it on something outside of themselves. For example, it’s not that their own power is insufficient, it’s that there’s a secret agency out there sucking up their power through the vents in their house.

Malignant (Sadistic Features)

The Malignant Paraphrenic subtype overlaps with sadistic features, being intimidating, callous, belligerent, vengeful, and tyrannical. Their focus is on power orientation due to a core belief that they will be attacked by others. They must remain independent, lest they be forced to submit, made passive/pliant, and/or tricked to give up their autonomy. This results in persecutory delusions, which can combine with grandiose delusions, but grandiosity is secondary to the Malignant Paraphrenic’s need for power. Millon notes that “their strategy is to dominate you before you can dominate them.”² The main difference between this subtype and sadistic personalities is that the Malignant Paraphrenic takes the fantasy route because their brutality has backfired, whereas sadistic personalities act out their brutality more.

Millon noted an obvious, but important point: In reality, there are no textbook cases with Paranoid.³ Understanding these overlaps and differing flavors of those with paranoid personalities can help us better our interactions and treatments, but every individual is different. Some are more dangerous than others, but all have a core fear of being annihilated and destroyed. Imagine living your life constantly on alert for threats so you won’t be taken out. Sounds exhausting, right? Such anxious energy expenditure is what makes paranoid personalities so cranky, and in some severe cases, it comes at the cost of their own sanity.

References

Akhtar, S. (1990). Paranoid Personality Disorder: A Synthesis of Developmental, Dynamic, and Descriptive Features. American Journal of Psychotherapy, 44(1), 5–25. https://doi.org/10.1176/appi.psychotherapy.1990.44.1.5 ↩︎ ↩︎ ↩︎
Millon, T., Grossman, S., Millon, C., Meagher, S., & Ramnath, R. (Eds.). (2004). The paranoid personality. In Personality disorders in modern life (2nd ed, pp. 435–476). Wiley. ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎
Millon, T. (2011). Mistrustful styles, paranoid types, paraphrenic disorders: The MPP spectrum. In Disorders of personality: Introducing a DSM/ICD spectrum from normal to abnormal. Wiley. https://doi.org/10.1002/9781118099254 ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎

Ep 29: Paranoid Personality or BPD? | The Unstable Duo

Tue, 03 Jun 2025 02:00:01 +0000

In this episode of The Personality Couch Podcast, we (licensed clinical psychologists Doc Bok and Doc Fish) help differentiate between paranoid and borderline personality disorders. We explore the similarities and differences between these two disorders, discussing their core characteristics, emotional responses, symptoms, and how our own intuition helps us more than we realize. We specifically look at the instability unique to these two personality disorders and how both express anger, shame, and fear. As both disorders can have fleeting episodes of psychosis, we also discuss how delusions can show up in each, but how their triggers are vastly different. We further discuss our own personal experiences treating both disorders and ways we use our intuition to guide diagnosis. We end by highlighting the need for empathy in treatment and welcome other providers to reference this information or to contact us directly if in need of a consultation.

To schedule a consultation, please visit the practice website for more information! https://www.questpsych.org

Paranoid Personality or Borderline Personality? | The Unstable Duo

Tue, 03 Jun 2025 02:00:00 +0000

Paranoid personality disorder can often look like borderline personality disorder, and can be extremely tricky to distinguish between the two. Even Millon¹ noted that there are times when the only way to differentiate between paranoid personalities and borderline personalities is to understand their childhoods, attachments, and initial fears. How in the world can two vastly different personality types look so similar? Let’s take a closer look.

Paranoid Personality vs. Borderline Personality Emotions

Photo by mohamed abdelghaffar

Anger

Both paranoids and borderlines can struggle with anger, and both use anger as a protective mechanism. But borderlines use anger to protect themselves from attachment-related distress, and their anger is often triggered by interpersonal stress, as it’s not a core characteristic. They are also more impulsive and self-destructive with their anger. In contrast, paranoids use anger to protect themselves from being destroyed by a world they believe is out to get them. Anger is a core part of the paranoid, along with fear, because they are fighting to survive. Their anger is consistent, not impulsive, and directed towards others instead of being directed toward the self.

Photo by Serje Lahoud

Shame

Both paranoids and borderlines can have intense shame. The main difference is that borderlines consciously feel their shame. They feel like they’re not enough, bully themselves, and have low self-esteem. They can sit in their shame, looking more like Eeyore by sitting in their victimhood and helplessness. In contrast, paranoids use their defenses so strongly that they can’t actually access their shame.² Shame is rejected and projected (put on others). There’s something inauthentic about a paranoid’s expression of pain that lacks shame (because they don’t want you to truly know them), but you can feel the authenticity of a borderline’s shame-related pain.

Photo by Andrea Piacquadio

Fear

Both paranoids and borderlines are fearful, but that fear is quite different. Borderlines fear losing attachments (being abandoned) but also fear being overtaken by others if they are too close.² It’s a difficult conflict. Meanwhile, a paranoid’s biggest fear is annihilation anxiety, or the fear of disappearing, being destroyed, or falling apart.² They feel like they’re always in danger and that the world is out to get them, so they react to that fear with irritability and aggression.

Paranoid Personality vs. Borderline Personality Symptoms and Features

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Transient Psychotic Episodes and Paranoia

Both paranoids and borderlines can have some flavors of psychosis and paranoia, but it’s vastly different. Borderline delusions/paranoia happen when there’s a lot of emotional distress but disappear when they can tap back into their logical side. Their delusions are irrational, unconvincing, and time-limited.¹ It reminds me of a child tantruming with intense emotions who cannot hear any adult logic, at least not until their emotions regulate and their attachment is again secured. For example, a borderline might think their partner doesn’t like them, so they impulsively plan to run away, but they don’t because they end up back in their partner’s arms. In contrast, paranoid delusions are rational and convincing because they truly believe them.¹ It’s a consistent delusion that cannot be challenged. A paranoid will leave without a trace and won’t look back, especially if it matches with their delusion.

Photo by Vera Arsic

Dependency and Relationships

Both paranoids and borderlines are able to engage in relationships and attachment. Borderlines are often more favorable to relationships because they crave attachment, as long as it’s not too close. They swing between dependency and avoidance. In contrast, paranoids reject their dependency needs because others could humiliate them. They keep the attachment and can be anxious-ambivalent, but it’s a hesitant, surface level, inauthentic attachment where you never actually get to know them.² Paranoids often don’t have many friends, and if they do have a few, it is a rather limited social circle.

Photo by Yan Krukau

Defenses

Both paranoids and borderlines can use the defense mechanism of projection, borderlines use more lower level defenses in comparison to paranoids.² This is because the borderline’s core wound happened during early attachment, so their defenses are more infantile. Their projection comes off as more pouty and emotional. In contrast, paranoids use projection in a destructive, sophisticated manner that can head into sadistic territory. Because for the paranoid, it’s about surviving the dangerous world, not keeping attachments.

Photo by Natallia Rak

Personality Structure

According to Millon¹, both paranoids and borderlines are more severely disintegrated personalities but in very different ways. Borderlines are very inconsistent and changeable with constant conflicts between being active or passive, pursuing pain or pleasure, and focusing on self or others. In contrast, paranoids are very rigid and inflexible in their conflicts between active/passive, pain/pleasure, and self/others.¹ They cannot take in any outside data because they don’t believe the world is safe. Everything outside of themselves could be a lie. So borderlines are too malleable, and paranoids are not malleable enough.

Paranoid Personality vs. Borderline Personality Treatment and Pain Dynamics

Photo by Ana Bregantin

Dramatics, Pain, and Treatment

Both paranoids and borderlines can be quite dramatic in telling their stories, traumas, and symptoms. However, borderlines over endorse things because everything genuinely hurts. Similar to a child, they will act out, yell, cry, and be intensely dramatic so you understand that they are in pain. They run to treatment like a child runs to a parent when injured. Paranoids are dramatic, but contradictorily, they send you on a wild goose chase about what to believe. They don’t want you to know them because that’s too scary. You could use that information to hurt them, but they also need you to know they’re the victim of the world, since everyone is out to get them. Paranoids usually avoid treatment unless in extreme distress or if someone makes them go. This is because they don’t trust anyone, let alone a therapist. They are afraid a therapist will see who they truly are, and then destroy them.²

Photo by Minja Nim

Countertransference

Countertransference happens with every personality type at any level of severity. It’s the therapists’ reactions to the dynamics that the client brings into the room. With borderlines, there is often a pull to rescue them and attach to them quickly. They need you, so you want to save them. In contrast, paranoids often elicit feelings of anxiety, hostility, and distrust.² They don’t trust you, and you become suspicious of them.

Suicidality

Both paranoids and borderlines can have chronic suicidality, but again, it’s vastly different.¹ Borderlines have a depressive, impulsive component to their suicidal ideation and behaviors that stems from intense emotional pain. On the other hand, paranoids can be suicidal to feel power over someone else or over life itself. They will destroy themselves so someone else will not destroy them, for the purpose of hurting the other person. For example, after a breakup, a borderline might express that they want to die, but a paranoid will express that they hope their partner dies (projection). Paranoids are known to have completed suicide to punish others.¹

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On the outside, paranoid personalities and borderline personalities can look very similar, and they are difficult to tease apart. It has taken Doc Bok and me years to understand personality disorders, and we’re still learning!! Constantly! If you’re a clinician who is stuck, and you’re in a PsyPact state, we are here to help you. We provide consultations if you would like help with a challenging case, diagnoses, or case conceptualization.

Photo by Andrea Piacquadio

References

Millon, T. (2011). Disorders of personality: Introducing a DSM / ICD spectrum from normal to abnormal (3rd edition). John Wiley & Sons, Inc. ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎
McWilliams, N. (2011). Psychoanalytic diagnosis: Understanding personality structure in the clinical process (2nd ed.). Guilford Press. ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎

Ep 28: The Post Pandemic Narcissist | Unmasking Paranoid Personality

Tue, 20 May 2025 02:00:01 +0000

In this episode of The Personality Couch Podcast, we (licensed clinical psychologists Doc Bok and Doc Fish) reveal the complex, dangerous, and often misdiagnosed Paranoid Personality Disorder (PPD). We discuss the rising prevalence of PPD in the post-pandemic world, the clinical challenges in identifying and treating these individuals, and the critical differences between Paranoid Personalities and narcissism. We believe you’re seeing more of these types in your circles as well, and we want you to be equipped with knowledge so you can best protect yourself! Thus, we unpack not only the DSM-5-TR characteristics of Paranoid Personality Disorder, but we also reveal our clinical experience with these types. We include common themes such as: lack of trust, severe gastrointestinal issues, sadomasochism, medical self-sabotage, shedding identities, and the paranoid character’s unique relationship with aggression towards the same-sex. We reveal why we think this type is popping up even more in our circles, what the pandemic had to do with it, and how you can identify these types to keep yourself safe!

Paranoid Personality: The Post-Pandemic Narcissist?

Tue, 20 May 2025 02:00:00 +0000

Unlike Narcissistic Personality Disorder, Paranoid Personality Disorder isn’t talked about much, and there’s definitely not as much research on paranoid personalities in comparison to narcissism. Perhaps this is due to paranoid personalities’ tendency to avoid treatment because they can’t trust others. BUT post-pandemic, there has been a resurgence of paranoid personalities in clinical settings and in general. So, it’s actually something we need to talk about because paranoid personalities can be dangerous, and they can hide in plain sight.

Image by Christer Andreasson

Why You Need to Understand Paranoid Personality

Paranoid personalities are much more likely to be a danger to others than to themselves,¹ mostly due to their main defense mechanism of projection. They want others to hold their pain, and they blame others for their own yucky stuff (e.g., “I’m not angry. You’re the one who’s angry”). They can move all around the drama triangle quickly and intensely: First they’re the victim…then they’re the villain, but also the victim…but they rescue you so they can’t be the villain… but obviously they’re the victim. This can happen all in the same breath. It can drive you insane and make you question reality. So, they are often cloaked as narcissists, but underneath their trenchcoat, there’s a fear of being destroyed (not the narcissistic fear of being exposed), which means they will attack first, so they are not attacked. It can be dangerous.

Photo by Danne

What is Paranoid Personality Disorder? (DSM-5-TR Criteria)

Paranoid Personality Disorder is in the odd and eccentric (Cluster A) category in the DSM, overlapping more with the introverted and withdrawn dynamics of Schizoid and Schizotypal than the Cluster B personality disorders that demand an audience for their dramatics. There has to be a pervasive, consistent pattern of distrust and suspicion that others’ motives are malevolent. The DSM-5-TR notes that 4 or more out of 7 criteria need to be met for the diagnosis of Paranoid Personality Disorder.²

They believe, without evidence, that others are out to get them (criterion 1), reading neutral statements and events as demeaning or threatening (criterion 4). Because they think others are dangerous, they don’t confide in anyone due to fear it will be used against them (criterion 3). They unjustifiably doubt the loyalty of others (criterion 2), at times experiencing pathological jealousy, as they suspect infidelity of their partner, again without evidence (criterion 7). They hold grudges (criterion 5) and are ready to counterattack (criterion 6) in a way that mirrors “hit first or be hit.” So basically, they can’t trust others because others are after their job, money, character, etc., which they find unwarranted evidence for in otherwise neutral interactions. You don’t ever get to know these types because they don’t want to disclose information, since no one is safe. They are the rigid “grudge collectors” who will never forgive an insult. You never know when you’ll step on a hair trigger….

Photo by Rodolfo Clix

Warning Signs of Paranoid Personality (Outside of the DSM)

The first warning sign of paranoid personalities for me is my own reaction to them. Their narratives are often contradictory and dramatic, so it feels confusing and suspicious…like something is missing, and I’m only getting part of the story. I’ve also noticed a pattern of severe gastrointestinal problems, way above the anxiety-related gut distress. It sounds odd, but consistently there have been cases of intense constipation when they hide their anger and intense expulsion when they let their anger out. It actually is consistent with Freud’s connection of paranoia to the potty training stage.³ Another sign of a paranoid personality is aggression and sadomasochism, where there’s a need for them to destroy so they are not destroyed. It’s kind of like passive-aggressiveness on steroids. They are passively victim-y and act in a way that un/subconsciously encourages others to cross boundaries, until they’ve had enough, and attack with sadistic aggression and blaming. It gets to a point where they can’t hold their own pain anymore, so they project it onto someone else so that person can hold their pain for them. At an extreme, they can become mass murderers. However, they can love others and hold on to a relationship, which separates them from psychopaths,¹ but there is also a high divorce rate⁴ because you never truly get to know a paranoid personality. That intimacy is way too threatening for them.

Photo by Trinity Kubassek

Overlap of Paranoid and Narcissistic Personalities

Some theorists believe that narcissism is a core ingredient of all pathological personalities,⁵ which Doc Bok and I totally agree with! However, narcissism looks different for each type of personality. There is significant overlap between narcissists and paranoid personalities, and it is likely that a portion of people who are called narcissists are actually a paranoid type. Both narcissists and paranoids can present as envious, superior, and egocentric, as well as hypersensitive to criticism. Paranoid personalities’ grandiosity shows up in their ideas of reference, meaning they take things personally because they believe they are so special. They think everything is about them. For example, if a person isn’t paying attention and sits in the paranoid’s seat, the paranoid might think, “That person sat in my chair because they’re after me and want to kill me.” Paranoids can also be megalomaniacs because they have that all-powerful, sadistic part of them, which results in aggression and attacks toward others.¹ In contrast, there’s a vulnerable narcissistic part of them where they assume the victim-y role and expect others to feel bad and act on their behalf. Overall, there are similar psychological games played by both paranoids and narcissists, so in a relationship, a paranoid personality can often come off as highly narcissistic.

Photo by George Becker

Why We Think Paranoid Personality is the Post-Pandemic Narcissist

Remember, paranoid personalities don’t usually show up in treatment, but post-pandemic, they have been. The pandemic essentially confirmed a paranoid’s biggest fears that no one can be trusted, that the world is dangerous and after them, that they could easily be destroyed…and they fell apart. Now, in this post-pandemic landscape, we believe paranoid personalities are coming to treatment out of desperation because they can’t put themselves back together as the world tries to go back to “normal.”

Photo by Pok Rie

Paranoid personalities are having trouble going back into hiding because they fell apart. Some of them just want to be left alone, but some of them are readily attacking others. The danger is that we are labeling them as narcissists, and they can definitely be narcissistic, but their readiness to destroy so they are not destroyed makes them much more dangerous than true narcissists. You need to understand the paranoid personality because it could mean your sanity…or even your life!

Photo by Pavel Danilyuk

References

McWilliams, N. (2011). Psychoanalytic diagnosis: Understanding personality structure in the clinical process (2nd ed.). Guilford Press. ↩︎ ↩︎ ↩︎
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders: DSM-5-TR (5th edition, text revision.). https://doi.org/10.1176/appi.books.9780890425787 ↩︎
Millon, T. (2011). Disorders of personality: Introducing a DSM / ICD spectrum from normal to abnormal (3rd edition). John Wiley & Sons, Inc. ↩︎
Disney, K. L., Weinstein, Y., & Oltmanns, T. F. (2012). Personality disorder symptoms are differentially related to divorce frequency. Journal of Family Psychology, 26(6), 959–965. https://doi.org/10.1037/a0030446 ↩︎
Blaney, P. H., Krueger, R. F., Millon, T. (Eds.). (2014). Oxford textbook of psychopathology (3rd ed.). Oxford University Press. ↩︎

Ep 27: What's Worse Than a Narcissist? | The Baddest of Them All

Tue, 06 May 2025 02:00:01 +0000

In this episode of The Personality Couch Podcast, we (licensed clinical psychologists Doc Bok and Doc Fish) unveil the darkest aspects of personality, focusing on narcissism at its most severe forms. We explore the spectrum of personality types that range from mildly unpleasant to dangerously malignant, discussing examples and case studies that illustrate their risk in relationships. We specifically unpack narcissistic and paranoid personality disorders, malignant narcissism, antisocial personality disorder, psychopathy and sociopathy, and sadistic personalities. While further exploring the characteristics, overlaps, and distinctions among these disorders, we end with a discussion about terrorism and extreme manifestations of sadism.

50 Shades of Personality Darkness

Tue, 06 May 2025 02:00:00 +0000

The Dangerous Personality Types

I found something exciting when doing research on narcissism! Michael Stone - a forensic psychiatrist came up with an entire spectrum that helps us understand how narcissism and its associated traits can devolve into psychopathy and destruction.¹ This spectrum has 6 main components, each one getting progressively worse.

Negative Personalities

Negative Traits

First is just all the negative personality traits that people can have, like being abrasive, argumentative, deceitful, discourteous, tactless, and unsympathetic.¹ These are the annoying people who might be jerks, but aren’t necessarily dangerous or criminal. Think of the meddlesome teacher who is up in everyone’s business or the quarrelsome guy at the store who argues with the manager over an out-of-stock product.

Severely Negative Traits

The negative traits can be more severe though, like people who are aggressive, hostile, cruel, predatory, or malicious.¹ It’s the people we really don’t like, or maybe even hate - they’re worse than just annoying. This might be the slanderous, vengeful ex-partner who threatens a smear campaign to end your career, or the grudge-holding boss who is still punishing the employee after a mistake that happened 2 years ago.

This is just the outer layer of the dark personality onion though. Peeling back another layer is when the negative personality traits worsen into actual personality disorders.

Photo by Andrea Piacquadio

Severe Personality Disorders

Narcissistic Personality Disorder

In our podcast, Doc Bok and I have discussed narcissism and narcissistic personality disorder at length (blog/podcast), so I’ll briefly cover it, then provide murderous examples² of those with narcissistic personality disorder to understand the different layers of darkness. Not everyone with narcissistic personality disorder is going to be violent, but their tendency to be self-important, entitled, exploitative, envious, and arrogant, with a need for admiration, belief they’re special, and fantasies of unlimited success do set them up for risky, yucky behaviors. If you add decreased or a lack of empathy in that mix, they are capable of violence.

One example motivated by narcissistic greed is a guy who put pipe bombs under his mother’s car and killed her after he found out she was going to financially cut him off, AND he was hoping for a $10 million inheritance payout.²

Paranoid Personality Disorder

Not all individuals with paranoid personality disorder are going to be dangerous, but those who ARE paranoid AND commit violent crimes have the more severe criteria like pathological jealousy, grudge-holding, and vindictiveness.² (See our blogs here and here for a better understanding of PPD). Interestingly, violent paranoids are more likely to commit mass murders (3+ kills in one outburst),² likely because they desire to take their pain out on the world (see Personalities That Kill).

One example was the guy who stalked then threatened to kill a coworker who would not date him, leading to him being fired. Two years later, he went back to his old workplace and killed seven people and wounded four (including the girl).² This event was actually made into a movie in 1993 called I Can Make You Love Me.

Photo by Fran

Malignant Narcissism

Malignant narcissism is the next dark layer when personality disorders become “worse.” Malignant narcissism is narcissism with antisocial behavior (lawbreaking and against social norms), sadism/aggression (hurting others), and paranoid (attack first because everyone is out to get them) flavors.³ Check out our podcast or blog for a deeper understanding of malignant narcissism. Stone² states, “If there is, from the standpoint of personality, one red thread running through the majority of violent crimes, this would be narcissism.” Those who choose to exploit or destroy others are obviously putting their own desires first with no consideration of others.

An example of a violent malignant narcissist is the doctor who murdered his wife and children and unsuccessfully attempted suicide when he felt he was going to be caught…because he wasn’t actually a doctor and was faking his social status.⁴

Photo by Sebastiaan Stam

Antisocial Personality Disorder

Even “worse” in the dark personalities is antisocial personality disorder. According to the DSM, antisocial personality disorder is a pattern of disregard for, and violation of, the rights of others; criminality; impulsivity; and a failure to learn from experience. It’s helpful to understand that malignant narcissists can engage in antisocial behavior, but ALL antisocial personalities include narcissism.⁵

An example of someone with an antisocial personality without psychopathy is the guy who had a long childhood history of criminality, then after getting out of juvey at age 19, he became the leader of a prominent gang with a goal to protect locals from other gangs and police brutality…and during this time he was also a youth counselor. The problem was he became addicted to angel dust and killed people when stealing money to buy the drugs. He was imprisoned and sentenced to death, but later in prison, he ended up writing books discouraging black youths to engage in gangs. He was actually nominated for the Nobel Peace Prize, but was executed in 2005.⁶

Note here that there’s a difference between antisocial personality disorder and psychopathy. One of the biggest differences is that antisocial children don’t usually become antisocial adults, and young adults with antisocial personality disorder will “burn out” around their 40s. This aging out dynamic does not happen in psychopathy. Psychopathy is consistent and stays lifelong.⁶

Still curious about APD? Here are links to our blogs where you can learn more about this dangerous condition! Personalities as Ice Cream blog, Psychodynamic Personalities blog, and Personalities That Kill blog.

Photo by Elti Meshau

Psychopathy

Peeling back the next layer brings us out of personality disorders that match up with the DSM and lands us in the dark forensic psychology territory. So, what is psychopathy? Robert Hare (expert forensic psychologist) notes psychopaths are “intra-species predators who use charm, manipulation, intimidation, and violence to control others and to satisfy their own selfish needs.⁶” It’s also notable that psychopathy is marked by a complete absence of empathy - not just impaired empathy or blocked empathy.³ There’s actually brain imaging and studies that support this.³ Psychopaths just don’t experience emotions the same way others do.

Sociopathy/Non-Violent Psychopathy

Non-violent psychopathy is definitely a thing.

An example of a non-violent psychopath or a sociopath is the guy who engaged in the biggest known Ponzi-scheme manipulation and swindled people out of billions of dollars. While he was non-violent with no assaults, he did not have empathy and preyed on clients.⁶

Violent Psychopathy

We usually think of psychopathy as involving violence. There’s a ton of examples out there, but Stone² used this one:

One guy was convicted of 11 murders. He has the sexually violent crime “triad” of childhood bed-wetting, animal torture, and fire-setting. Fast forward, and he ended up raping and strangling 11 prostitutes until his arrest. Stone actually interviewed him in prison and noted lack of remorse, “jollity,” pathological lying, and grandiosity. He even embellished his crimes to impress others.²

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Sadism

Sadistic Personality

Peeling back the last layer of darkness in terms of personality, we find sadism. Sadistic personalities are common in those who commit violent crimes,² and it’s notable that I’m not talking about sexual sadism here, but an actual personality style.¹ Sadistic personalities achieve dominance through cruelty, humiliate others, are unusually harsh to those under them, take pleasure in others’ suffering, lie to harm others, intimidate others to get them to obey, are excessively controlling, and are fascinated by violence, weapons, martial arts, injury, or torture.¹

A watered down (It’s very sick - so look at your own risk) example of a sadistic personality is the guy who created a torture chamber and killed at least 40 women. They also found 100 videotapes of torture.²

Sadism with Terrorism

The “worst” it can get is sadism with terrorism. It’s only “worse” because it involves a very high number of hurts and deaths with the terrorism aspect, but it’s the same concept as above. An example of large scale terrorism involving sadism is Sadam Hussain, who “probably reached diagnostic threshold for the sadistic (T score M = 81.0), paranoid (T score M = 79.3), antisocial (T score M = 77.4), and narcissistic (T score M = 74.2) personality disorders⁷.” It’s also notable that Hussein had more sadistic features than Hitler.⁷

Photo by Mitja Juraja

So as we funnel down the spectrum of darkness, we take all the personality stuff that precedes it. Thus, a sadistic personality is going to have it all - negative traits, narcissistic personality disorder/paranoid personality disorder, malignant narcissism, antisocial personality disorder, psychopathy, and of course, sadism. Additionally, as we funnel down the darkness spectrum, there are less and less examples of darkness, which is hopeful. On the other hand, Stone states, “There is no “worst case” of sadism, just as there is no bottom to human depravity¹.” Thus, our work and understanding of humanity will never be complete.

Photo by Ralph W. lambrecht

References

Itzkowitz, S., & Howell, E. F. (Eds.). (2019). Psychoanalysts, psychologists and psychiatrists discuss psychopathy and human evil. Routledge. https://doi.org/10.4324/9780429262425 ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎
Stone, M. H. (2007). Violent crimes and their relationship to personality disorders. Personality and Mental Health, 1(2), 138–153. https://doi.org/10.1002/pmh.18 ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎
Wood, R. (2022). Literature review of malignant narcissism and related constructs. In R. Wood, A study of malignant narcissism: Personal and professional insights (pp. 7–41). Routledge. https://doi.org/10.4324/9781003246923 ↩︎ ↩︎ ↩︎
Lazaro, Y., Mesian, I., Perez, A., Madrazo, I., & Baena, R. (2016). Malignant narcissism: The notorious case of Jean-Claude Romand. European Psychiatry, 33, S630–S631. ↩︎
Kernberg, O. F. (1984). Severe personality disorders: Psychotherapeutic strategies. Yale University Press. ↩︎
Stone, M. H. (2018). The place of psychopathy along the spectrum of negative personality types. Contemporary Psychoanalysis, 54(1), 161–182. https://doi.org/10.1080/00107530.2017.1420376 ↩︎ ↩︎ ↩︎ ↩︎
Coolidge, F. L., & Segal, D. L. (2007). Was Saddam Hussein like Adolf Hitler? A personality disorder investigation. Military Psychology, 19(4), 289–299. https://doi.org/10.1080/08995600701548221 ↩︎ ↩︎

Ep 07: Personalities That Kill

Tue, 30 Jul 2024 02:00:01 +0000

In this episode of the Personality Couch Podcast, we discuss personality darkness and specifically focus on personalities that are prone to violence and extreme behavior. We also discuss two important research studies, the Milgram study and the Stanford prison experiment, that shed light on the capacity for humans to engage in harmful acts. We then delve into the different personality types within Cluster A (schizoid, schizotypal, and paranoid); Cluster B (borderline, histrionic, and narcissistic); and Cluster C (avoidant, dependent, obsessive-compulsive) and discuss their risk levels for violence and murder. In this conversation, we also explore sadistic personalities, a category not included in the DSM, but included in multiple other personality theories. We highlight the characteristics and behaviors associated with each type and discuss the potential for violence and destructive behavior. The conversation emphasizes the importance of understanding these personalities and their potential risks in order to promote awareness and better understanding of human behavior.

Personalities That Kill

Tue, 30 Jul 2024 02:00:00 +0000

One of my favorite topics to dive into is the darkness of humanity and thus the darkness of personalities. Harm to others surrounds us in a ridiculous amount of ways, which makes many people think about not only what others around them are capable of, but of what they, themselves are capable of. The popularity of true crime, dark genres, horror media, etc., provides evidence that people are interested in this topic. And of course, there’s always some recent event that can remind us of the darkness people have in them. There is SO much I could say about this topic (Listen to podcast episode 07 for much more information), but for now, I’m just going to address the question:

🚩What personalities are at the most risk to kill? 🚩

In my opinion, there are three main personality types that fall into the high risk category. I’m going to start with the “least” risky and end with the “most” risky, though please remember that all still are at high risk.

Narcissistic Personalities

Medium Risk to High Risk

Photo by Lance Reis on Unsplash

The thing to remember about narcissism is that those who kill are quite likely to at least have high narcissistic traits, but not necessarily a narcissistic personality structure/disorder. Narcissistic personalities are all about image, ego, and the self, needing admiration and presenting with superiority, grandiosity, and charm (see Episode 04 podcast/blog for more info on narcissistic personalities). They value image so much that they can harm others in their pursuit and maintenance of it. However, there are some types of narcissistic personalities that are at higher risk for actually killing. While some narcissistic personalities are “more pure,” their focus on image is mostly about climbing the social ladder (e.g. Elitist subtype from Millon, p. 397). Now, they’ll react with anger, hostility, and even emotional/verbal abuse, but they’re not apt to physically kill. In contrast, there are some types who connect power with image, resulting in destruction. Millon’s “Unprincipled” subtype of narcissistic personality (Millon, p. 402) is at high risk for killing due to lack of remorse, lack of social conscience, vengefulness, and maliciousness. This subtype includes antisocial features, seen in their desire to humiliate and dominate others. Millon’s “Unprincipled” narcissist seems to be similar to the PDM-2’s mention of the “Malignant” narcissist (PDM-2, p. 46), whose narcissism is combined with sadistic aggression… 🚩Yikes!!

Photo by Tech Nick on Unsplash

Paranoid Personalities

High Risk

Paranoid personalities are tricky. You never really fully know a paranoid personality since they show different faces to different people, which they do because they are suspicious, distrustful, and fearful of others and the world (see Episode 04 podcast/blog for more info on paranoid personalities). They view the world as threatening and against them, and in their defense against this, they tend to attack before being attacked. They can’t handle their own pain and so they transfer it onto others, often in a dramatic manner. They are at a very high risk for destroying others and then themselves, while projecting their own pain onto the masses - such as in a murder-suicide event. It wouldn’t surprise me if many mass murderers have paranoid personality structures. However, while unhealthy paranoid personalities are dangerous in general, some might be most dangerous to themselves (Millon’s “Insular” subtype, p. 975) or in other ways outside of murder (Millon’s “Fanatic” subtype, p. 983). In contrast, Millon’s “Querulously” subtype (Millon, p. 974) tend to be hostile and have delusions, often erotic ones that can result in behaviors like stalking, killing for their object of infatuation, or even killing their actual object of affection. More concerning is Millon’s “Malignant” subtype (Millon, p. 987) who tend to be previous sadistic types who have “fallen apart.” …🚩🚩No bueno!

Antisocial Personalities

High Risk

Photo by Sander Sammy on Unsplash

Antisocial personalities are boundary-crossing, as they tend to disregard and violate the rights of others, social norms, and the law. They are often deceptive, sneaky, and charming on the outside, but can also be impulsive, aggressive, and/or reckless (see Episode 04 podcast/blog for more info on antisocial personalities). In my opinion, antisocial personalities can be somewhat less dangerous than sadistic personalities, because there are some types who are more at risk for harm to themselves (Millon’s “Risk-Taking” subtype, p. 451) or just withdrawal from society (Millon’s “Nomadic” subtype, p. 455). In contrast, Millon’s “Reputation-Defending” subtype (Millon, p. 453) is high in narcissism as well, with a focus on looking tough and powerful with high status. They might have positions of power and rule with aggressive leadership, likely finding a place in extremist groups/cultures. They are very likely to engage in violent acts to “confirm” their own strength, viewing their victims/enemies as the wrongdoers, which they feel condones their violence.

Millon’s “Malevolent” subtype (Millon, p. 458) is perhaps one of the most dangerous personality types, especially as they are paired with paranoid or sadistic features. They tend to be revenge-driven, vindictive, hateful, and destructive. Millon’s bone-chilling description of them on p. 458 includes the statement, “Distrustful of others and anticipating betrayal and punishment, they have acquired a cold-blooded ruthlessness, an intense desire to gain revenge for the real or imagined mistreatment to which they were subjected in childhood.” …Even more scary, they can usually grasp the concept of remorse/guilt in their minds and even experience it emotionally, but they disregard it🚩🚩🚩. This type seems to be the one that comes to mind when we hear the word “psychopath,” and interestingly, it seems to correlate with the PDM-2’s “Aggressive” subtype of antisocial personality (PDM-2, p. 50).

Sadistic Personalities

High Risk 🚩🚩🚩🚩

Photo by Kurt Cotoaga on Unsplash

This category of personality is a bit confusing. The DSM-5-TR does not include sadistic personality disorder, but Millon and the PDM-2 separate sadistic and antisocial personalities. The overall core of sadistic personalities is their enjoyment of inflicting pain on others (see Episode 05 podcast/blog on Millon’s types or Episode 06 podcast/blog on Psychodynamic types for more info on sadistic personalities). Some sadistic personalities feel like they are entitled to control or punish others, often taking positions of power in militaries, schools, or legal systems, as they also have some compulsive traits. Their power leads to feelings of arrogance and superiority, resulting in a tendency to view their “victims” as inferior and maybe not even human - but all this is wrapped up in their “righteous” exterior that they portray as moral (Millon’s “Enforcing” subtype, p. 637). Some sadists are actually very fearful and use violence to disguise their fear, moving against it through counterphobic action. They can be quite cruel and often find themselves in groups with a shared victim, like a hate group - somewhere to put their anger about their own weakness (Millon’s “Spineless” subtype, p. 637). Some might possibly kill those closest to them in an uncontrollable and unpredictable rage that tends to not be premeditated but impulsive. (Millon’s “Explosive” subtype, p. 641).

The one I find the most severely brutal and horrifying is Millon’s “Tyrannical” subtype (Millon, p. 642), which can have paranoid and/or negativistic features. They enjoy destroying, abusing, assaulting, and terrorizing. They are the devious, composed predators who seek out weak prey, and when they attack, they do so with no remorse, unable to stop until their rage is exhausted. Millon states, “What is also especially distinctive is the desire and willingness of these sadists to go out of their way to be unmerciful and inhumane in their violence” (Millon, p. 645), adequately describing them as being “distressingly ‘evil’” (Millon, p. 642).

Hopefully, this helps you better understand your true crime shows and villains in the media you consume. I wouldn’t wish a relationship with these risky types on anyone! It gives a bit of a new meaning to the concept of red flag 🚩. Beware and be well!

Paranoid Personality | Personality Couch

Ep 44: The 3 Most Unstable Personalities | Schizotypal, Borderline, & Paranoid

The 3 Unstable Personalities

The 3 Unstable Personalities

Millon’s Structurally Defective Personalities 1

Schizotypal Personality - Ungrounded 1

Borderline Personality - Conflictual 1

Paranoid Personality - Rigid 1

References

Understanding Neurotic, Borderline, and Psychotic Personalities

Psychodynamic Personality Organizational Levels

Neurotic 1

Psychotic 1

Borderline 1

References

Ep 32: When Paranoid Personalities Kill | Analyzing 3 Infamous Mass Murderers

Additional Podcast References

Episodes Discussed

3 Infamous Mass Murders Who Were Paranoids

PPD and Mass Killing

Jeffrey Weise, the Traumatized

Richard Farley, the Rejected Lover

Timothy McVeigh, the Terrorist

References

Ep 31: Paranoia, Paranoid Personality, or Schizophrenia? | Which Is It?

Parsing out Paranoia, Paranoid Personality, and Paranoid Schizophrenia

What are Delusions?

What Was Paranoia Previously?

What Is Paranoia Currently?

What is Schizophrenia?

What is Paranoid Personality Disorder?

What Paranoid Personality Disorder is Not

Can Paranoid Personalities Fall Apart into “Psychotic Land”?

Why is All This Confusing?

References

Ep 30: Paranoid Personality | The 6 Subtypes Explained

Paranoid Personality Subtypes

Historical Paranoid Personality Disorder Subtypes

Mistrustful Personality: Mild - Closer to “Normal” Level2 3

Self-Righteous

Obdurate (Compulsive Features)

Paranoid Personality Disorder: Moderate - Borderline Level2 3

Querulous (Negativistic Features)

Insular (Avoidant Features)

Paraphrenic: Severe - Psychotic Level2 3

Fanatic (Narcissistic Features)

Malignant (Sadistic Features)

References

Ep 29: Paranoid Personality or BPD? | The Unstable Duo

Paranoid Personality or Borderline Personality? | The Unstable Duo

Paranoid Personality vs. Borderline Personality Emotions

Anger

Shame

Fear

Paranoid Personality vs. Borderline Personality Symptoms and Features

Transient Psychotic Episodes and Paranoia

Dependency and Relationships

Defenses

Personality Structure

Paranoid Personality vs. Borderline Personality Treatment and Pain Dynamics

Dramatics, Pain, and Treatment

Countertransference

Suicidality

References

Ep 28: The Post Pandemic Narcissist | Unmasking Paranoid Personality

Paranoid Personality: The Post-Pandemic Narcissist?

Why You Need to Understand Paranoid Personality

What is Paranoid Personality Disorder? (DSM-5-TR Criteria)

Warning Signs of Paranoid Personality (Outside of the DSM)

Overlap of Paranoid and Narcissistic Personalities

Why We Think Paranoid Personality is the Post-Pandemic Narcissist

References

Ep 27: What's Worse Than a Narcissist? | The Baddest of Them All

50 Shades of Personality Darkness

The Dangerous Personality Types

Negative Personalities

Negative Traits

Severely Negative Traits

Severe Personality Disorders

Narcissistic Personality Disorder

Millon’s Structurally Defective Personalities ¹

Schizotypal Personality - Ungrounded ¹

Borderline Personality - Conflictual ¹

Paranoid Personality - Rigid ¹

Neurotic ¹

Psychotic ¹

Borderline ¹

Mistrustful Personality: Mild - Closer to “Normal” Level² ³

Paranoid Personality Disorder: Moderate - Borderline Level² ³

Paraphrenic: Severe - Psychotic Level² ³