Ep. 181-Paranoid Personality Disorder: When No One Can Be Trusted
This episode describes Paranoid Personality Disorder including how it's diagnosed, how it develops and how its treated.
Most people don’t realize how deeply paranoia can shape a person's entire world and how misunderstood this silent struggle really is. In this episode, Dr. Kibby unpacks the complexity of paranoid personality disorder, revealing why so many suffer in silence, feeling unseen and alone.
Dr. Kibby dives into real stories, research, and the trauma roots behind paranoia, showing how childhood neglect and trauma can ignite a persistent fear that fuels distrust. She discusses how these traits develop, why they often co-occur with other disorders like borderline or narcissistic personality disorder, and the biological underpinnings (like hyperarousal systems and genetic factors) that drive paranoia.
Based on the small literature, Dr. Kibby suggests practical approaches for managing paranoia, emphasizing the power of awareness, small behavioral experiments, and trauma-informed therapies. She shares evidence-based cognitive-behavioral strategies that anyone with paranoid traits can use to challenge their fears, build trust, and slowly open up to connection.
This episode highlights that even severe personality traits are malleable and that healing is possible with the right support and understanding. Paranoia isn’t just about distrust- it’s a protective response rooted in trauma and biology. Understanding this can unlock a path toward more connection, more safety, and less loneliness.
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Dr. Kibby McMahon (00:03)
Hey, little helper. me do that again. Hey, little helpers. Today I'm gonna talk about something that no one is talking about, which is paranoid personality disorder. And this is a disorder that's marked by a constant pervasive distrust of other people, believing that other people are out to get them, they have bad motives and intentions towards them and...
You don't want to open up to anyone because you think that everyone's out to get you. So that is ⁓ what paranoid personality disorder is. And the reason why I'm bringing it up today is that I've gotten a couple of requests for cluster A personality disorders, which is the cluster that's called odd and eccentric. That's marked by people who have like kind of different thoughts and they feel really isolated from society.
And there was someone who reached out to me ⁓ saying that they would love to hear more about Paranoid Personality Disorder because she received that diagnosis and there really wasn't a lot out there. There's not a lot of articles out there. There's not a lot of media attention. There's not a lot of movie characters that really represent Paranoid Personality Disorder. She felt really alone and kind of unseen and she wanted to know more about this disorder.
I'm gonna talk about it today and what I'll do is I'll talk about what are the symptoms, what are the traits of paranoid personality disorder, especially because this disorder might be really rare. Like only about one to 4 % of the population actually would get the diagnosis of paranoid personality disorder. But a lot of people might have the traits, right? Because we're in the world of AI and post pandemic and...
working remotely, we're disconnected, there's a lot going on in current events, like a lot of wars, a lot of tension. so trusting other people is really hard. And the feeling that you can't open up to anyone is so difficult and is so painfully lonely because we also know that our survival depends on being connected to others and having good relationships. So it might be a disorder that
is rare, but a lot of people might resonate with the experience of it. Like the experience of paranoid personality disorder might not be that rare. And it might be a disorder that only the person who has it suffers from, right? So maybe borderline personality disorder, antisocial personality disorder, those might be a little bit more, you know, might create problems and damage to other people around that person.
The autorexcentric cluster, like paranoid personality disorder, it's really just suffering in silence. They're just alone. They have developed the way they see the world themselves and it keeps them isolated from others. So they're not hurting anyone as much, but they are suffering and they're lonely. So I wanted to shed light on this disorder and I'll talk about the different symptoms, the different traits. I'll talk a little bit about this ⁓ lovely
fans experience of it. And ⁓ I will also talk about the scan research on how it's actually treated. ⁓ And that's not to say that there is nothing, there's no hope for treatment for disorders like these. It's just that we really, really like a lot of data. Before psychologists can confidently say,
There's a treatment for XYZ disorder. We want a lot of research on it, right? Because we want to really be sure that something is working and not just a fluke, a one-off. Now, with rare disorders, it's really hard to gather data, but also people who are very paranoid, who don't trust others, they're not going to show up to a lot of research studies, right? They're not going to want to give their information. They're not going to want to...
fill out forms and do interviews and stuff, all the stuff that we need to know is like, is this treatment working? So it's kind of a, you know, it's kind of a chicken or the egg situation. Anyway, so what is paranoid personality disorder? And what are the traits of it? You might have them anyway, even though you don't have the full disorder. So paranoid personality disorder, again, is this pervasive, persistent and impairing distrust. I've talked about this before, but personality disorders,
are really, it's really describing a pattern of behavior that is persistent, pervasive, and impairing. Persistent meaning across most of your adult life, like probably even before that, as long as you can remember. Pervasive meaning not just in one area of your life, but all areas of your life, right? So you're not just distrustful of people at work, but home is fine. It's like, I don't trust
anybody at work, at home, online, my friends, my family, acquaintances, like it is everywhere. And impairing, meaning that it is actually ruining the life that you want. So that's what we mean by personality disorders and that's what we mean by paranoid personality disorder is when the suspiciousness is there for a long time in all areas of your life in a way that ruins your life.
So I'll go through the actual symptoms, the actual traits of it. So we can really get detailed about how do psychologists diagnose this and why is it so rare? you need four of the following traits ⁓ in order to get a full diagnosis. But even so, you could have just a little bit of this trait or you could have a lot of this trait. It really depends on the scope. So the first one is, for example, is if you suspect
without any proof or sufficient basis that others are exploiting, harming, or deceiving you. So that usually looks like, the way I ask this in actual interviews is, are people, when you meet someone new, anyone in your life, are they guilty until proven innocent? So the first time you meet someone, the first contact you have, are you convinced that they are
are using you, hurting you, or lying to you. So even without proof, even without anything, you're just like, my default is I do not trust you. And then the second trait is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates.
What that looks like is someone who's very private, who rarely confides in other people. And a lot of people might say, yeah, sure, don't really confide. I don't really open up. But it's really the reason why they don't open up. And that's because ⁓ they believe that other people are going to use that information against you. So it's not like, I'm just shy. It's I don't open up.
because I have doubts about other people's loyalty or trustworthiness. If I give them information, they'll use it against me or they're gonna hurt me and I spend a lot of time thinking about it, right? This is not just every once in a while where you're like, I'm not sure, but it's just like thinking about, okay, this person, you know, I really think that they're out to get me, they said this and I'm not gonna share that and so it's really something that's on the top of the mind, right?
The other trait is reluctant to confide in others because of unwanted fear that information will be used maliciously against him or her. So that's kind of what I said before. It's not letting other people know much about you because you're afraid they'll use it against you. Again, not in just one situation. When people answer this question, they're usually like, yeah, I don't like to give out my phone number, email, because I'm going to get a lot of spam or they might take my identity. That paranoia.
I don't know, like it makes sense in one context, but this is everyone. I don't tell my husband, I don't tell my family, I don't tell my coworkers anything about me because who knows they're gonna gossip about me, they're gonna use it to build a case against me or they're going to hurt me in some way, they're gonna gang up and conspire against me. So it's really like I don't open up about myself at all. As you can imagine, the few times that I've seen
these traits in people that I'm doing, like therapy with or research with in my past. Even this interview is really difficult. I mean, this is asking for really personal information. This is about your trust in other people. And I found that people who have really high traits in PPD, ⁓ they don't say much. They're like, no.
No, because you never know. You never know. And they're really quiet. ⁓ Especially in the situations that I'm asking these questions and writing things down, they're looking at my notes. They're like, do I have to give this information on this form? Why are you using my insurance information? What are you going to do with it? They're very guarded. So just asking these questions is really tough. So the fourth trade is. ⁓
Someone who reads hidden demeaning or threatening remarks even in benign Remarks or events. So this is really Thinking that someone is threatening or insulting you all the time even if they didn't mean to or they didn't want to so sometimes people would say Yeah, I I'm always on alert. I'm always like looking out to see what people's ulterior motives are and You know, they say they mean well, but I know that they're really they're really insulting me or they
they're belittling me or they're doing something bad against me. So it's really this, I'm reading between the lines all the time and what I read in between the lines, it's bad against me.
This one's interesting. Number five is persistently bears grudges. So is unforgiving of insults, injuries or slights. So this looks like a kind of person who holds grudges or takes a long time to forgive someone who's lights you. So usually people say, yeah, I'm like that. Yeah, I cut people off. I don't trust certain people. And then I'm like, okay, tell me about that. And when they give a couple of examples like,
the person who was abusive towards me and then a friend who betrayed me and you know Maybe a friend group in the past who just really didn't be dirty. I'm like, okay that makes sense, right? But this is like Everybody it's like there's a I can't even count how many people I've cut off or hold grudges right and sometimes it's even smaller things like you know ⁓ Just someone did something
⁓ And Apollo made a mistake and apologized for it, but I will never trust them again, right? And that is not just one person not just one area of your life or a kind of person but is like everybody and it's almost kind of like they will have like a Like a running list of this person did me wrong this person did me wrong and there's even when there's Repair efforts made like the person tries to apologize or make it up to them. No dead to them ⁓
So it's really about like, can't forgive, right? Because it's like, I had such a hard time trusting anybody, and then this was proof, right? You just proved that I was right not to trust you. So a lot of grudges, a lot of grudges. And then the sixth trait is, perceives attacks on his or her character or reputation that are not apparent to others, and is quick to react angrily or to counter attack. So this is looking like lashing out
or getting angry if they feel insulted or criticized. And it's to the point where maybe this person's gotten feedback that they take offense too easily, right? So, you know, they read the bad things in what other people say, and then they go, ⁓ no, the person was insulting me. I know it. They were out to get me. They are looking down on me, or they mean to hurt me. They wanna...
They want to get at me in some way and I really got them. I got them where they are, right? So it's being really sensitive to not just criticism like, I feel bad about myself, but like, I see everything as hostile in what you're saying to me. And seven has recurrent suspicions without justification regarding fidelity of a spouse or sexual partner. So this is...
⁓ being obsessed that a partner is unfaithful or cheating on them. ⁓ When I ask this question, of course, I have a lot of people say, yes, yes, that's me, that's me. And usually that is after when they've been cheated on, right? Or they're like, well, I had this one partner who, you I found out they were cheating. And then ever since then I've been, you know, on guard and looking at people's phones and stuff. But this is...
This is a little bit more about, like that definitely counts, but it's like no matter what, even if there was evidence or regardless of history, like no matter who I start dating, I'm a, I just, all I think about is how they're probably cheating on me, right? And like, you know, sometimes this also goes with like really, you know, stalking them or looking at their phones or just, you know, accusing them of cheating all the time.
It was almost like there isn't a possibility that you could date somebody or be with a romantic partner and they're not gonna be unfaithful. ⁓ the key part here is that there's no real evidence or clues. It's kind of like, I just had a gut feeling or every time I'm dating, I'm sure that they're doing it. yeah, I think everyone is cheating all the time or no one's trustworthy. When it's kind of like...
an assumption, like a default on thinking that romantic relationships are just ⁓ full of, you know, unfaithfulness, then that's a little bit more about this, about paranoid personality disorder. So, as you can tell, hearing those traits, it's really like everyone else is untrustworthy and bad and I gotta keep my guard up and watch out.
Even as we're talking about it, even as I'm reading it out, I'm like, this just sounds like you know, intense trauma. And it is. ⁓ A lot of people with paranoid personality disorder have trauma backgrounds. Actually, now I'm thinking about the people who actually have like full blown paranoid personality disorder were like veterans, right? Or people who have been through such trauma that they're like, everyone's out to get you and that's just a fact. That's just how I see the world.
No one's that no one's there to support you everyone's gonna hurt you so it's you can only rely on yourself so a lot of trauma a lot of pain a lot of protecting yourself and it's a and it's There's not a lot of
And then thinking about those traits, was talking to this fan who graciously reached out and told about her story and experiences. And right away I was a little like, wow, for someone with paranoid personality disorder, she's like lovely. She was like sharing a lot of information, a very thoughtful and very gracious towards, know, she's just like a lovely person. So.
Not to say that people with paranoid personality sort of not but like she was just sharing a lot in a very mature Thoughtful way that I was like, wow, I've personally never seen Someone who identifies with this sort of talk like this so I think that might be a testament to how much work she's done and how much she's like focused on this and is dedicated to to improving but It's poor girl. I'm not gonna give out her personal information. I always like to keep even if people
you know, say that they want to share, I want to keep everyone's privacy confidential. So she was saying that she had always struggled with relationships. So she really had a hard time creating healthy relationships and really keeping them in her life. Because she often cuts people off or shuts down or hurts people that she says she loved. And she was really confused why that was happening.
And for a while she thought that she had borderline personality disorder. And when we talk about it, I think she might have some of those traits. Anyway, but she was saying that earlier in her life, she was, you know, there was a lot of mood swings and a lot of unstable sense of self, which actually makes sense for being a young person. But then she learned a lot more. She went to, she studied psychology. She was really, you know, thinking a lot about this.
And then finally a therapist mentioned, like, I think you have paranoid personality disorder. She said it really clicked for her. It really resonated with her, like, ⁓ that explains this background that she has in her mind, that, like, I'm always looking out for people. I'm always suspecting that I'll be hurt by them. The interesting thing is that she really identifies with the fear of abandonment.
So she's constantly paranoid and suspects that people will abandon her, which I personally believe is a little, it's feels a little bit more BPD with this wanting that closest one connection. Whereas people with paranoid personality disorder tend to think, oh, you're gonna hurt me in all different ways, not just abandoning. But I get it, I get it if that's a thought that's always going on in the back of your mind. People with BPD go more up and down. They're like,
I love you, you're the best, we're amazing, but now you've hurt my feelings and I'm gonna cut you off and you're dead. So it's a little bit more of this hot and cold up and down, whereas paranoid personality disorder is more like, nope, my door is closed at all times. So that might be what she resonates with. ⁓ And some examples of how this showed up in her life is that she, for example, when she was little, she said that she would,
Test her friends all the time to see if they were lying So if they were talking about a TV show and she heard a friend say yeah, I've seen that show She would test them. She would like make up ⁓ details about an episode and see if they would admit to Reveal that they're lying or not, right? And if they caught if she caught any of them lying about seeing a show she would run to her parents because she was so excited that she like caught someone lying ⁓
And then she also, for example, really believed that every, like her close friends or her partners were about, were gonna leave her or about to abandon her. Like, and then she would cut them off. For example, she said that she really had a hard time trusting her, one of her best friends, because she believed that her best friend was.
using the friendship to self-sabotage because she believed that she was such a bad friend or that friendship was so ⁓ damaging that well, that she only thought, well, if you're still my friend, it must be because you're trying to do something bad, right? Like, I don't trust that you're really here because you love me and you want to stay with me. And so she cut off that best friend, right? And she did that with a couple of relationships where any kind of sign of ⁓ problems or any...
anything was taken as like, here's a clue that you're going to hurt me. And so I'm going to cut you off first. So how did she ⁓ come to that kind of thinking? I was like, I bet you that this girl went through some trauma, that she didn't feel that the people in her life, for whatever reason, are trustworthy.
And she said that when she was 11, she found out that her father had been cheating on her mother and they covered it up. They didn't tell her. And so, I mean, can you imagine? I mean, when you're 11, an 11 year old girl, you are just figuring out who you are. You're figuring out relationships. You're developing an identity. Like how hard of a time was that? Like pre-pup- like pubescent, like adolescent girl.
and then finding out that the people that you're supposed to trust the most are actually keeping a really important piece of information from you, it would be hard to trust anybody at their word, right? So she talked about how ⁓ really that time ⁓ made her constantly monitor, like, ⁓ if someone's on the phone, who are they talking to? ⁓ If they're away from the house, where are they going? So really like the paranoia started around there.
⁓
I'm just looking at the research.
And so it makes a lot of sense that she'd be, that she, sorry, let me jump back in.
So this is really, I keep thinking about this as like an extreme trauma response. People with PTSD and complex trauma tend to have these very paranoid thoughts of like, can't trust anybody too. And this is just everywhere. So it's really interesting that paranoid personality disorder, there's a lot of hereditability, right? There's like 60 % hereditability. Sorry, how do say that?
Sorry. And so how does one actually develop a paranoid personality disorder? Well, it's very hard. ⁓ Sorry.
Let me do that again. So how else does one come to a paranoid personality disorder? How has it developed? Well, one major factor is that there's a big genetic factor. That there's some estimates, I'm reading it now, that are about 50%, but up to about 66 % hereditability. Meaning that if your parents have more of a paranoid...
trait, then the kids are very likely to develop it as well. And it's interesting too, there's a, there, as you can imagine, that it's linked to a lot of childhood adversity, a lot of childhood trauma, especially emotional neglect. Sorry.
especially emotional neglect, physical neglect, and lack of supervision in childhood. those, the specific type of my childhood trauma leads to paranoid personality disorder symptoms. So that's really interesting too, because it's, I would expect that it would be physical or verbal abuse, right? Like I don't trust anyone because I've really been hurt by people. But this research shows that it's actually when,
parents ⁓ neglect their children or to kind of leave them to their own devices that they are really distrustful because it's not like, I'm going up and down in emotion and sometimes I could trust them not, it's unstable, but it's like there's no one here. There's no one here to help me and I have to rely only on myself. So that's really, really interesting. they've also found, researchers also found that
It's very small amount of research, so I'm really citing the only thing I could find. But hyperarousal threat systems is a really big part of a paranoid personality disorder. For example,
For example, a small study found that people with paranoid personality disorder had higher cortisol release in the system. And there's other research showing that they're constantly feeling negative emotions, right? They're always feeling stressed, right? Everything is a threat. So it's like looking out for dangers without any kind of security, without any kind of support. So when someone feels that way, when someone has grown up
⁓ in a neglectful childhood environment or in an environment where things were kept secret or they can't trust their caregivers like this person did, then you're always on high alert. You're just left in the field at war with no shield, with no armor. ⁓ And so it makes sense that the brain is there to protect you. So taking...
Like trusting people, opening up, sharing, vulnerability, it's all taking a risk. Just most people have learned that taking that risk pays off, right? I open up, I share, I connect to someone, and then I might get some support from them. Or, you know, there's like strength in numbers, or, you know, like we'll fall in love, or that person is helpful to, or we could collaborate in some way, right? Like making relationships is really risky, but...
the way that our species has survived through like social connection, it's really worth the risk. Now these people with PPD is so sad because they learned that that's not worth the risk. That if your brain's like, well, there might be a 1 % chance that this person is going to hurt me, then that's too much for me to even handle. And if you wanna stay safe, if you really wanna stay safe,
you don't take any risk at all, right? You just like every single person is on trial. Every single person is guilty until proven innocent. And that is the safest way to go about it, right? Like you shut out all risks, then you're not going to ever be hurt. The problem is, is that you're also not gonna get the good stuff. The feeling like, okay, I just shared something really vulnerable, I'm scared and that person actually like.
kept kept my best interest at heart. Right. So it makes sense that people with PPD have such a high threat detection for, you know, other people. And you're going to default on the safest thing, which is to trust nobody. Let's see.
And so people with these traits, it's still like, actually, I think what makes this topic really hard to talk about is that it actually rarely occurs alone. Paranoid PD actually comes comorbidly with other disorders. Most frequently avoidant PD. So I've talked about this in a previous episode, but avoidant personality disorder is when someone,
is really, really avoidant of social interactions and relationships because they're afraid, because they feel insecure or they feel inferior or they really think that they will be rejected and belittled by other people. So, avoidant PD is more about like this insecurity that I'm weaker or lower than other people, but it's also a similar profile of, don't trust anybody. I don't trust any social interaction.
It's also, PPD is also highly comorbid with borderline PD and narcissistic PD. So this feeling of like, you know, for a narcissistic PD is like, I'm better than everyone. you know, I protect myself by being the best, by the highest, and I don't trust anyone. Everyone's out to get my money. Everyone's out to take advantage of me. And I'm going to look down on everybody, but also keep them, keep them far away and not trust anyone. I can't confide in anyone. And what's interesting is that borderline personality disorder,
when it's mixed with PPD, ⁓ that is a lot of aggression and anger. that, so borderline personality disorder does have aggression or anger, but if you have the paranoid thoughts, then it adds more of the aggression because it's a little bit more like, I'm not only, don't think that people are gonna leave me, but they also are out to get me. And so it's just like,
seeing other people as a threat, as hostile, as the enemy. And as you can imagine, a lot of these problems are, they come along with substance use disorders and there are a lot of, there are a lot more prevalent in forensic populations. So people who have had trouble with the law or have had a lot of trauma and a lot of difficulty navigating life. I've seen this a lot in veterans. So
A lot of veterans who have had a lot of trauma tend to have a lot of these paranoid traits where they're like, you know what, I trusted what I was doing. I trusted the army. I trusted my morals and my good intentions. And then I went out there and I saw and did horrible things in the army. And then now I don't trust anybody because I've seen the worst in human.
and human experiences. mean, that's just, it was really heartbreaking to hear that, but they were really guarding. They're like, no, I don't see the good in people. I only see the bad.
All right, so I'm gonna move on to interventions.
So what can someone with paranoid personality, sorry, let me do that again. So what's the treatment for this? What can someone with paranoid traits or the full blown PPD diagnosis actually do to get better? And it broke my heart a little bit because ⁓ the fan that reached out said that her therapist told her that it couldn't be cured.
that I'm just, I'm still so shocked because she clearly has worked a lot on herself and she really took a lot of time to like think about herself and think about what she was going through and how she has an impact on her relationships. And I think she is a testament to how all of these personality disorders or personality disorders traits can actually improve over time, especially if someone really works on it.
So, for example, she really sought different therapies and really read through all the different disorders to really understand why she was struggling so much. And then she worked with a therapist and she was like, okay, I feel like this can't be cured. This is like a big part of me, but I'm still going to try to figure myself out and figure out how I can connect better to other people. I think what she really...
interesting point that she makes is that she says you could be pretty good at differentiating your internal world and the external world most of the times and still have the disorder. So she really wanted people to understand that is like if you have a personality disorder like this, whether you want to call it personality disorder, whether you have just like persistent negative thoughts that are always running around in the background, you have a really hard time trusting other people, then one major
shift is to know when it's your mind creating this world and what is actually happening outside of your mind. And that's really awareness, right? That's really just being aware of like, hmm, my bias, my default, when I walk into a room and meet someone new, it's always gonna be like, don't trust this person, they're gonna hurt you, right? And once you're aware of those thoughts and aware of your tendency to have those thoughts with new people,
then you can really think about like, okay, I know that's what I bring into the situation. And let me figure out if this is true. Let me test that hypothesis. Let me see if there's actually evidence for this. Or it could just be like, you know, I know that this is me and this is how I've protected myself over many years of my entire life. And
I'm going to put that aside and I'm going to try to see this person in front of me and really get to know this person and really act differently. So I just really love that she made the point that you could have something like this, this disorder, and have varying levels of awareness that this might not be the real world, this might be your world. And there might be actually nicer and more trustworthy things and people outside of this.
It's not a good world that you have inside. one big step is just awareness and being like, woo, this is me and this paranoia is popping up. And I know that it's just in my mind and the world is not always the same thing as what I assume the worst of. So when I looked into what treatments ⁓ were empirically validated for ⁓ paranoid PD,
Of course, I didn't find a lot of research. And again, the researchers mentioned that it's really hard to recruit people in this study. So if you have a paranoid personality disorder, I really recommend that you look out for any kind of research studies. Like this really needs to be studied a lot more. But of course, people in the cluster A personality disorders don't like to open up, right? So researching them and their inner life is really hard.
But there has been some really good evidence that ⁓ different kinds of cognitive behavioral therapies can be helpful for people with PPD. So kind of what ⁓ our fan was saying, like even just being able to notice those paranoid thoughts and if possible, being able to challenge them and really try to look for the evidence of before and guess. It's actually like, does that mean that you're learning to distrust your own distrust?
of other people, like maybe. But at least have an open curiosity of like, I'm just noticing that this is something that is really running in the background and determining all of my behavior. And then the behavioral part, there's a lot of different, like there's DBT, there's different behavioral approaches where ⁓ the real meat is like, maybe you always have this distrust in your mind, right? Maybe the thoughts can't change. ⁓ every time you meet someone new, you think that person's out to get me.
But maybe you could change your behavior around it. So learning that you might have those thoughts, this person's out to get me, this person will hurt me, this person will abandon me. And think about how you would respond normally to that. Well, you probably would shut down, you probably wouldn't share anything about you, you probably would watch every time they do something negative towards you or turn away. So you would really shut down.
and avoid closeness with that person. But instead, noticing those paranoid thoughts and then do the opposite, act opposite. Maybe open up, maybe try saying one thing that's private information about you, right? ⁓ Maybe sharing a little bit and just seeing how that goes. Or ⁓ like going out of your way to trust someone with an important task or
Asking for help right so it's really just acting as though you trust people even though those thoughts and feelings might be in your mind and the Even if yes, I'm saying this I'm worried that you know, I'm wondering if you all are thinking like That's putting yourself at risk. What are you saying? Just to like give out your information No, I'm saying that when whenever a lot of these disorders
The problem is not really like how you respond to trauma. Like learning that other people aren't trustworthy and so being really cautious. Okay, that is your learning history. But the problem is how you act on those, right? And always treating other people as the enemy or someone who will object to you or abandon you.
Well, sometimes we're really good at recreating our worst fears, right? So sometimes the more that we ⁓ believe in something, we tend to like see it more in the world and also sometimes attract it more in the world. So if we are like, everyone's out to get me, everyone's insulting me, and I'm going to shut down, well, that's really creating a world that's very hostile, right? So what I'm saying is in order to break out of that pattern,
It's taking small steps to trust people, taking small steps to open up. And you know what, whenever we talk about this in CBT and people go, well, what if something bad happens? What if you do say something personal about yourself and then they go and hurt you or use it against you? Well, the thing is that avoiding those circumstances makes you unable to deal with them, right? We learn.
to deal with our worst nightmares by actually facing them. Like it's about facing your fears. And even if yes, you share something personal with someone and they hurt you, ⁓ then you know how to deal with it. You know how to stand up. You'll learn how to stand up for yourself. You'll learn how to figure out who is trustworthy and who is not trustworthy. That differentiation is a huge part of why it's important to start to trust and start to act opposite.
to the avoidance.
Even as I'm talking about it, I could guess people are thinking like, God, that sounds terrible. But we talk about this with trauma disorders all the time. The problem with people who have problems with trust is that they don't learn who to trust. People that I've worked with who have been assaulted.
sexually assaulted or assaulted in other ways or had a really bad relationship or was manipulated or you know, like overpowered or controlled. People with trauma have a lot, have a hard time with boundaries and trust, right? They like don't know if anyone's out to get them, but often they end up in situations that they're really hurt. And I think that's because an important part of just learning trust is learning who to trust, learning what the signals are. You know, how, when you go on a date,
How can you tell that that person is someone you want to share this really deep personal information to? Or who do you know? Well, let me keep things closer to my chest. The only way to do that is by experimenting. trying, seeing if you could trust people, and seeing what happens, and seeing what kind of people, and what people might be trustworthy or untrustworthy, and what are the different signals of that? What are the kind of behaviors you could look out for to be like, ⁓
that person ⁓ is not gossiping about other people. And that's a sign that I can trust them with my information, right? So actually experimenting and like putting yourself out there and taking some risk is the way we learn how to defend ourselves and protect ourselves from the problem. And the avoidance is really the issue. The avoidance is the thing that keeps us stuck and keeps us from actually sometimes
makes us more vulnerable to the threat. An example is that people who have health anxiety, who are always afraid that they might have a disorder, they might have a heart problem, they may have cancer, they often don't go to the doctor because they're so afraid of getting that information that they don't even take the steps that they would need to in order to detect and prevent something like that. Right? And same thing for fears about trust. If you feel like
I can't trust anybody and I really can't tolerate the possibility, even the small chance that someone's gonna hurt me. And if you cut off everyone, then you won't know how to actually protect yourself. You'll just be like, I only know how to protect myself from being in this shell. And if I'm actually out in the world and meeting new people, you won't have the skills to determine.
and figure out who's going to be trustworthy or not. So the CBT approach for paranoid personality disorder would be like noticing those thoughts, the paranoid thoughts of I can't trust anyone, they're out to get me, I can't share anything, otherwise they'll hurt me, and then saying, okay, know those, that's my default, those are my thoughts popping back up again. Let me try one step towards testing the hypothesis. Let me share a small.
innocuous piece of information, my pet name, my pets, my hobbies, whatever, and seeing what people do with that and seeing what that's like to share. ⁓ And just to act opposite to the avoidance. Is there anything else? yeah.
And the other thing that might be really helpful for paranoid personality disorder is trauma-informed treatments. So I've talked about prolonged exposure therapy or ⁓ cognitive processing therapy, or even psychodynamic approaches too. But any empirically validated treatment for trauma might be really, really helpful for paranoid personality disorder traits.
PPD is like, the more I talk about it, the more I picture this like shield, right? This shield of protecting against, about being hurt. noticing where that came from can be really helpful. And it might not be one scenario or one event where someone was really hurt or betrayed, but it might be years of noticing when you felt emotionally neglected or physically ⁓ neglected or just.
weren't protected or weren't looked after, right? And I feel like that kind of trauma approach will be so, so helpful because I think that we often think of trauma as those, you know, the big, the way that we define it in the DSM, which is like your life is at stake or you were physically hurt or an accident or beaten, something that's more obvious trauma, but emotional neglect, physical neglect, that looks like
When I was a kid and I was scared and I needed help, my parents like completely ignored me. Or they just told me to get over it. Or they didn't even listen to me. Or they wouldn't talk to me at all. Physical neglect looks like, ⁓ as you can imagine, like ⁓ they didn't give me the right clothes to deal with the weather. Or they didn't take me to the doctor when I needed.
I was just thinking of this really sad case I heard in my clinic long long ago where this poor little girl got shot by a gun by her sibling by accident but they were playing around with the gun in the house and they were shot and she was like a little girl and she came to her parents and was like you know like bleeding and like you know really severely injured and
it took them a while to actually take her to the hospital because they were so afraid that the sibling would get in trouble, would get arrested. And that is a really, you know, this example of like all different kinds of abuse and trauma in one. But that's a really big example of physical neglect of like when a kid needs some physical support or instrumental support and the parents just like don't do it for whatever reason. So really doing some trauma processing around
not feeling cared for, not feeling attended to. That might be really, really helpful for the treatment of PBD. Again, I'll say another caveat that there's not a lot of research on this. So a lot of this is speculation and what I think would be helpful too, and putting together little pieces of data that I have found on this. But definitely, behavioral therapies would be helpful and also a focus on trauma.
So that's what I think would be really helpful for people who struggle with not being able to trust others. ⁓
think that's it, really.
back in.
And really, the lack of research out there, mean, this fan was totally right. There's not a lot out there that talks about this disorder, even though a lot of people struggle with trust. And for example, like we don't have any very clear evidence of what medications really help with people with paranoid personality disorder. But I will say that clinicians often treat this with low dose antipsychotics. ⁓ That might help if someone has like,
you know, like paranoid ideation or that gets a little bit delusional, right? That gets a little more obsessive and more like ⁓ divorced from reality. ⁓ And then also the antidepressants and moustapelizers are often used, but often those are given to people who have like ⁓ other symptoms too, like depression or PPD and stuff like that. So, I mean, if this is anything, this is a call to action for there to be more discussion about.
about paranoia, to have more research on this, to see what would be helpful, more case studies that I would love to read. If anyone listening to this knows more information and more research or experiences about paranoid personality disorder, please leave them in the comments. If anything, for the lovely fan who reached out and said, hey, I just want to learn more about this and I want to see my experience represented in the world.
⁓ But it's a fascinating topic. Distrust and trust is something that's really, really on top of mind in this world right now. And I'm always in support of trusting people because I feel like we need more connection than ⁓ the risk of the pain of having it. So it's better to love than not love at all. So.
That's all I got for paranoid personality disorder. I thank our fan for reaching out and giving such an honest ⁓ story about it and about her struggles with it. And I hope this is helpful. And I hope this sheds light on anyone who might be suffering in silence from feeling like you have to live in a world where you're afraid of getting hurt, afraid that other people are out to get you and you're feeling really lonely and maybe scared because of it.
I will in future episodes, I'll cover, schizoid and schizotypal, ⁓ personality disorders, because that was also requested by a fan. So I'll talk about the other, ⁓ cluster A, ⁓ disorders as well. But if you have enjoyed this episode, please leave us a five star rating on Apple podcasts or Spotify and just share, share with anyone who'd be interested. I.
Also love talking to you guys. So anyone who wants to just message me, it seems like most people are messaging me through Instagram. at Dr. Kibby, D-R-K-I-B-B-Y. You could also email me at kibby at kulamind.com K-U-L-A-M-I-N-D.com, or leave any comments on YouTube or Spotify. I love talking to you guys and I love hearing your requests and I love getting your questions and perspectives because I learned so much.
and so many people out there can really benefit and resonate with your story. So please share and I'll see you next week.