The Obdurate Paranoid

Obdurate paranoids combine aspects of the paranoid and compulsive personalities, but like all paranoid patterns, they are more unstable and pathological than their compulsive counterparts. Like the compulsive, they are rigid, perfectionistic, grim, humorless, tense, overcontrolled, small-minded, peevish, legalistic, and self-righteous. However, whereas compulsives temper their angst with the belief that success and happiness can be achieved by conforming to the dictates of authority, obdurate paranoids renounce this dependency, taking on a posture of unabashed self-assertion. They actively rebel against any and all external constraints in a maladaptive effort to regain their sense of perceived control and overturn injustices previously doled out on them.

While they do continue to seek clarity from imposed rules and regulations, they are now the imposers of a system that is used to attack others, usually through either legal action or the setting of impossible rules that cannot realistically be followed. Those in this paranoid personality’s wake are despised for their weakness, their sloppiness and lack of regard for disciplined behavior, their failure to live an organized life, and their hypocrisy.

Despite these assertions of nonconformity and dominance, however, obdurate paranoids are not likely to eschew deep-seated feelings of guilt and fear of retribution. Further, they may appear to function normally much of the time but possess tightly compartmentalized persecutory delusions. These tendencies go largely unnoticed, but the individual’s hypersensitive antennae are perpetually in alert mode, noticing any unusual twitch, remark, or facial expression emanating from nearby others. it is not unusual for this paranoid pattern to project their anger onto others—thereby creating the perception of hostile intent from innocuous or absent signals. In fact, what we now think of as “classical paranoia,” that is, compartmentalized beliefs separate and apart from a patient’s usual thought process, usually emanates from those of the obdurate variant because of their tightly controlled, segmented belief structure: When a sensitive nerve is touched, their otherwise normal functioning is impaired and the hidden beliefs become manifest.

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