Out of the fog
Friends and relatives of people with PPD need help working through confusion and chaos
By Patti Carmalt-Vener 11/10/2011
I’m 74 and live with my daughter, her husband and their two children. I love both of my grandchildren dearly — Kristin, 16, and Jeremy, 22, who still lives at home. My daughter is a wonderful mother, but she and her husband have known that something hasn’t been right with Jeremy ever since he reached puberty. He recently started psychotherapy at his parents’ insistence and has been diagnosed with a paranoid personality disorder. I’m very concerned about this sweet boy and want to understand just exactly what that means.
I told my daughter that God has to put children with drug and mental problems somewhere, so why not in a loving family like ours? ~Barbara
Paranoid Personality Disorder (PPD) is one of the 10 personality disorders defined by the American Psychiatric Association and the World Health Organization. Each of these disorders is a class of personality types and has its own set of character traits associated with certain severe behavioral disturbances that contribute to personal and social disruption. These traits — formed by early adulthood — are usually inflexible, self-defeating and pervasive but are often perceived as normal and appropriate by the person with the disorder. Accordingly, this makes individuals resistant to treatment, even though the behaviors likely lead to extreme anxiety, distress and depression.
PPD is characterized by paranoia and a generalized mistrust of others. In addition to harboring unjustified beliefs that others are exploiting, harming or deceiving them, there is a reluctance to confide in anyone because of unwarranted fears that the information will be used maliciously. Even benign remarks or events are viewed as threatening, aggressive and hostile, and individuals with this disorder are unforgiving of insults, injuries, or slights. Recurrent suspicions can also cause them to question the fidelity of sexual partners.
PPD is a serious mental health condition in which the sufferer often forms a world view that confirms their belief they’re in danger and must, therefore, withdraw from family and friends. This isolation leads to guarded, constricted emotional lives. Despite their pervasive suspicions, however, PPD patients are not delusional or psychotic. Most of the time, they’re in touch with reality except for their misinterpretation of others’ motives and intentions.
Because of the nature of the disorder, it’s often very difficult to persuade people with this disorder to trust a mental health professional. That Jeremy has agreed to treatment is a positive step.
Although psychotherapy is generally thought to be the most effective way to treat this condition, it may take some time. Therapists face the challenge of overcoming a patient’s resistance and developing a measure of trust and rapport. As the therapy progresses, patients begin to trust the clinician more and more, because they have little insight into the effects of their attitude and behavior on their generally unsuccessful interactions with others. PPD patients are likely to be defensive and place all the blame on others. If mental health care providers are able to gain their trust, it may be possible to help them deal with the threats that they perceive.
I urge your family to obtain an evaluation from a qualified mental health professional, such as a psychiatrist or psychologist who will eliminate the possibility that the diagnosis of PPD is not part of a more serious psychosis, such as schizophrenia or any manic-depressive disorders. I also highly recommend “Out of the FOG,” an information site and support group offering help to family members and loved ones of people suffering from personality disorders. The Web site, outofthefog.net, is written and developed by people who have experienced relationships that were impacted by personality disorders.
Barbara, I hope your family gives thanks this Thanksgiving for having such a loving mother and grandmother like you.
Patti Carmalt-Vener, a faculty member with the Southern California Society for Intensive Short Term Psychotherapy, has been a psychotherapist in private practice for 23 years and has offices in Pasadena, Santa Monica and Canoga Park. Contact her at (626) 584-8582 or email email@example.com. Visit her Web site: patticarmalt-vener.com.