Borderline Personality Disorder and Paranoia

Paranoia Increases With Stress

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Many people with borderline personality disorder (BPD) experience paranoia or paranoid thinking under conditions of stress. Paranoia is a term generally used to refer to intense beliefs of mistrust or the malicious intentions of others. For example, someone with paranoia may have the belief that the government is listening to their phone calls, or that their spouse is having an affair.

Paranoid Ideation in BPD

Episodes of paranoid thinking, or ideation, can range from mild and short-lived to very severe and chronic.

Some individuals with psychotic disorders, such as schizophrenia or delusional disorder, tend to have severe, chronic paranoid ideation that has no relationship to reality.

In contrast, while many people with borderline personality disorder do experience paranoia since it is part of the diagnostic criteria for BPD, it tends to occur only under conditions of stress or interpersonal conflict.

For example, an adolescent with BPD might see two of his friends talking in the hallway and develop the paranoid belief that his friends all secretly hate him and are planning to humiliate him. Or an adult with BPD might misread their partner’s cues that they want some alone time as a sign that the relationship is being terminated, and dwell on this belief even when a great deal of evidence to the contrary is presented.

At least one study suggests that while individuals with BPD differ from those with psychotic disorders in terms of their psychotic reactivity, which is their tendency to have paranoid ideation and other thinking and perceptual problems under stress, they do not necessarily differ from patients with psychotic disorders in terms of the intensity of the paranoia or other psychotic experience.

So, while people with BPD have short-term psychotic symptoms, these symptoms are not necessarily mild.

Stress Busters to Help Tame Paranoid Ideation

Because paranoia in BPD is worse when you are under stress, you may find it helpful to find ways to relax and work through your stress. Some popular stress busters are:

  • Deep breathing. The advantage of deep breathing is you can do it anywhere, anytime. Sit or lie down, fill up your lungs slowly, and then exhale your breath back out slowly. Repeat.
  • MeditationThis practice has been around for centuries and while there are different techniques, most of them focus on quiet, calm, relaxation and focusing your attention. Different meditation methods can be found online.
  • Yoga. Like mediation, the focus with yoga is on calm, relaxation, quiet, as well as posture and flexibility. There are many free yoga apps and instructional videos online to instruct you how to do yoga on your own, or you can sign up for a class at your local gym.
  • Tai chi. Another ancient practice, tai chi was meant for self-defense but is used by many people now to relax and reduce stress. Like yoga, it involves specific poses, targeted concentration, slow movements and focused breathing.
  • Biofeedback. In biofeedback, you learn how to control things such as heart rate and certain muscles by having monitors attached to you so you can visualize and hear what's going on in your body. By learning how to change your thoughts or emotions in a way to slow these mechanisms down, you help reduce stress.

    Sources:

    American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR Fourth Edition. American Psychiatric Association: 2000.

    Glaser J-P, Van Os J, Thewissen V, Myin-Germeys I. "Psychotic Reactivity in Borderline Personality Disorder." Acta Psychiatrica Scandinavica, 121(2):125-134, 2010.

    "Relaxation Techniques for Stress." MedLine Plus, U.S. National Library of Medicine (2014).

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