The Insular Paranoid

The insular paranoid combines aspects of the paranoid and avoidant personalities. Such individuals are often moody, apprehensive, and hypersensitive to criticism, especially where their worth and achievements are concerned. Extremely vulnerable, many insular paranoids seek solace in self-focused ways. For example, they may engage in abstruse intellectual activities to enhance their self-esteem or indulge in drugs and alcohol to calm their fears. Especially fearful of shame and humiliation, insular paranoids seek to defend themselves against both real and imagined dangers. More than most, they seek to protect themselves from a world both threatening and destructive. As such, they may isolate themselves for long periods of time, a means of keeping the inevitable judgments of others out of their lives.

Insular paranoids also have an unusually strong fear of being controlled. They not only seek to prevent external influence but also desire to rely solely on their own conclusions and beliefs.

Unwilling to check their thoughts against consensual reality, they grow more and more out of touch with the surrounding world, eventually losing the ability to distinguish fantasy from reality. Fears of shame and humiliation, an important component of both the paranoid and avoidant patterns, easily inflate to full-blown conspiracies. Eventually, their thoughts may become so painful and terrifying that they begin intentionally to interrupt the continuity and focus of their perceptions, distracting themselves from their own thoughts. By deserting themselves, their inner world becomes a chaotic mélange of distorted, incidental, and unconnected notions, the threshold of a decompensated paranoid state.

From these arise that need for marked emotional dependence upon others, as also do the exaggerated demands for attention and affection.

The traits foster furthermore the craving by this personality to be accepted by others as being something far greater than it really is.

Lacking an adequate central stability, the hysterical personality is liable to display a chameleon-like versatility.

Role after role may be switched or rejected to capitalize on the advantages of the moment. Affective response is typically forced, artificial and shallow.

In the sexual field, an outward display of enticement and encouragement contrasts markedly with a limited or absent capacity for performance.

In so many aspects, the hysterical personality inhabits a world of childish make-believe and utilizes the unreal values appropriate to childhood.

  • Like the thwarted child, resenting its lack of independence, it seeks to impress others with its own importance;
  • like the over-indulged child, frustrated at not gaining its own way, it revels in dramatic scenes of histrionic behavior so reminiscent of a childish tantrum.
  • The hysterical personality employs many and devious means to attain its ends.
  • Threats of suicide are extremely common.

Though frequently empty, they can never be taken lightly for the hysteric is notoriously liable to overplay his or her hand and what was intended as a suicide gesture may well end as the consummated act.

The involved manipulations of the hysterical personality are characteristically bids for dominance from a position of natural weakness.

Diagnosis

Hysterical symptoms may take innumerable forms:

  1. There may be disturbances of sensation such as anesthesia (anaesthesia) or paresthesia (paraesthesia) or other neurological symptoms such as ataxia; spastic or flaccid paralysis; choreiform or athetoid movements and tremor.
  2. Other manifestations include loss of vision, gynaecological complaints, difficulty in breathing or in swallowing, abdominal pains and peculiar dermatoses.
  3. Mental disturbances include double or multiple personality. In some cases, a hysterical fugue or trance follows a traumatic experience but in others it is an escape from a disagreeable situation.

The differential diagnosis of hysteria is full of difficulty, not least the necessity to make certain that no organic lesion is present.

It should be possible to show that the symptom is a response to some conscious experience which has a strong personal significance to the patient.

Even so, it may sometimes be very difficult to decide between symptoms due to organic disease and those of hysterical states, particularly in later life when there may be a hysterical overlay on pre-existing organic lesion.

Management

No simple formula can be advanced for the treatment of hysteria. Each case will obviously be assessed on its highly individual merits and therapy devised accordingly.

A detailed case history will be taken and a careful physical examination must be made to exclude an underlying and contributing organic illness.

The personality of the doctor for better or worse will play a vital part in the attainment of any degree of success.

It is for this reason that unskilled and unqualified persons may achieve outstanding success in the treatment of this neurosis where eminently qualified persons may fail.

There is a possibility of curing an acute hysterical reaction by simple suggestion and a heavy dose of a sedative.

A chronic hysterical condition is, however, one which may demand all the resources of psychiatric therapy to effect any permanent improvement.

The basis of successful treatment is suggestion and this may be done either over a long period or in single intensive association under hypnosis or under light anesthesia (anaesthesia) Opens in new window.

Abreactive methods may also be used. It is thus clear that the management of hysteria requires the attention of a physician skilled in the use of these particular techniques and referral is therefore advised.

Apart from the use of mild sedatives to secure reasonable sleep and tranquilizers to ally anxiety, drugs are of little benefit in the hysterical states.

    The research data for this work have been adapted from:
  1. Understanding Paranoia: A Guide for Professionals, Families, and Sufferers By Martin Kantor
  2. Personality Disorders: Toward the DSM-V By William O'Donohue, Katherine A. Fowler, Scott O. Lilienfeld.
  3. The Fundamentals of Psychological Medicine By R.R. Tilleard-Cole, J. Marks
  4. Personality Disorders in Modern Life By Theodore Millon, Carrie M. Millon, Sarah E. Meagher, Seth D. Grossman, Rowena Ramnath