My boyfriend is paranoid

He thinks he's being persecuted

Topics: Since You Asked, Mental Illness, Psychology, psychotic depression, Psychiatry, major depressive disorder, depression, Par:AnoIA,

My boyfriend is paranoid (Credit: Zach Trenholm/Salon)

Dear Cary,

I’ve recently come to grips with the fact that my boyfriend has some mental issues that I just can’t cope with anymore. I’ve tried to justify them to myself, because I really wanted this relationship to work, but this is just getting ridiculous. Here’s his delusion: He sincerely believes everyone is “persecuting” him, like there’s something odd or different about him that people notice right away and pick up on. And once they pick up on it, he truly believes that they go out of their way to irritate him. So, for example, we went out last weekend to a restaurant and the waitress gave us a hurried, slightly unfriendly greeting. OK, whatever. Not a big deal.

But then he then goes on to mutter some curse words under his breath, and attributed her rudeness to her “persecuting him” because he’s so “different from the rest of society.” I tried to explain to him, since I had worked in a restaurant before, that it was of course much more likely that she was stressed and overworked. He wouldn’t listen, of course. In fact, he got mad at me for arguing with him.

It’s little things like this all the time. To make things worse, we live in a major metropolitan area. So, because there are people all around him all the time, especially as he has to take the metro to work, he feels like he’s being “persecuted” every day.

I feel like I’m walking on eggshells. I can’t say anything that conflicts with his delusion because then I start an argument, and I can’t convince him he’s wrong; he won’t listen to reason. At the same time, I don’t want to just “agree” with his delusion to avoid arguments, because I feel like I’d be enabling his craziness. So, I mostly just don’t talk to him anymore. I avoid him, and I avoid the apartment when I can.

I wasn’t always like this. The man I met a year ago was kind, passionate, driven and funny. He was quirky, but in a good way. We had a lot of fun together; we are both introverts as well and seemed to recognize each other’s need for solitude every once a while. But I don’t know if it can ever go back to being that way. Not after listening to rant after rant stemming from this delusion for months on end.

And for financial reasons, I cannot at the moment just leave. (I’m unemployed. Sigh.) He’s been great about supporting me, and taking care of me financially while I try to figure out my work situation.

He’s seeing a therapist, who diagnosed him with major depression, so at least that’s something. Still, while he makes progress, I’d like to be able to come back to the apartment without having to hear him go on and on about how society doesn’t understand him, and how he’s a special little golden boy among a sea of assholes who hate him and want to do harm to him.  

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I feel that it’s more than just a delusion; it’s complete narcissism.

I feel like I’m living in the crazy house.

Got any advice for me?

Frustrated

Dear Frustrated,

Sometimes I don’t so much give advice as get an image, or a vision, and say, Here is what I wish for you. I try to give you something to aim for. I see a time when you and he agree about the difference between the person you love and the paranoid part of that person that neither of you are so crazy about. My hope is that he can learn to recognize his paranoid thoughts and say, “I am having some paranoid thoughts” — to know they are a part of him but that they are not true.

I think you and he can reach this point if you work together to understand his illness. He will have to work hard. But you and he can learn to live together in relative comfort and trust. You need to know that he is committed to managing his paranoia, is working with the professionals and is trying to distinguish between his paranoid thoughts and his reasonable thoughts.

When I was having a bad depression I learned to say, I am having a depressive episode, or I am having symptoms of depression. It helped me to say out loud, OK, now I am having symptoms of depression and I know it, and at least I can say that to my wife. It helped me to know I am in it and I think I will be coming out but I am in it right now and I know that. It was still really hard for the people around me. It still hurt. But there as a sense that it would not last forever and there was hope that it would change. And it did. It got better, with treatment.

The other thing I envision is that you become educated about the mental health system so that you can use it to your best advantage. If his treatment seems to be solely about depression and does not seem to be addressing his paranoid tendencies, then I envision you stepping up and saying something.

There may be difficult days. He might not always be able to journey back and forth between lucidity and his delusions. He might get stuck. It might get worse on some days and you might feel you are losing him. Focus on the person you know, the person you fell in love with. Develop a vocabulary for this other phenomenon that keeps it separate.

You don’t have to walk on eggshells. Sometimes his paranoia will just be a pain in the ass for you, no two ways about it. You might get angry sometimes when his paranoia creeps up. He may occasionally start to believe his delusions again, and that might make you angry. You will have to remember that a little backsliding is to be expected. Progress in such things is not linear.

If you can do these things, you can have a pretty good life with this man, if you still love him.

So I send you my greetings and my hope. I say, if you love this man, the man you met, you can stay with that man. A mental illness doesn’t have to be the end of the world. You can live with this. It will take work but all relationships take work.

And now:

Appendix: (I spent much of this morning reading about how paranoia interacts with depression. I was curious about his therapist’s diagnosis. Then I remembered I am not a doctor. I am a writer who imagines things and makes connections with people. So these are some of the links I looked at.)

Delusional disorder, Wikipedia page.

Delusional disorder of the persecutory type, Wikipedia page.

Paranoid social cognition, Wikipedia page.

In this study, “Negative Cognition, Depressed Mood, and Paranoia: A Longitudinal Pathway Analysis Using Structural Equation Modeling,” it was found that “The link between depressed mood and paranoia appeared to be mediated by negative cognition.”

Alphabetical listing of psychiatric disorders.

Billing and Coding for Psychologists

2013 Psychotherapy Codes for Psychologists

“Often, psychotically depressed people become paranoid.

Connect with others who are living with paranoid people.

More discussion about living with people who have paranoid personality disorder.

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