Paranoia, delusions and dissociation are the subject of the ninth diagnostic criteria for BPD.
The DSM IV-TR states:
9. transient, stress-related paranoid ideation or severe dissociative symptoms
Borderline Personality Today explain this as:
During periods of extreme stress, transient paranoid ideation or dissociative symptoms (e.g., depersonalization) may occur (Criterion 9), but these are generally of insufficient severity or duration to warrant an additional diagnosis. These episodes occur most frequently in response to a real or imagined abandonment. Symptoms tend to be transient, lasting minutes or hours. The real or perceived return of the caregiver’s nurturance may result in a remission of symptoms.
As with most of the criteria for diagnosis you can see again here the overlap between symptoms, in how abandonment issues (criteria 1) are closely linked to criteria 9, often causing the expression of these symptoms.
Personally I would say that on the point of these symptoms being transient that I feel the paranoid delusional elements are more transient than the dissociative symptoms. A paranoid delusion is:
Paranoid Delusions are beliefs of a suspicious nature, where the person believes something is not right with them, another person(s), or the world in general, which poses serious problems for them.
For me these kinds of thing will occur infrequently at times when I am very stressed out by a situation or person. I will feel like they or everyone is out to get me and become very distressed (sometimes to the point of triggering self-harm episodes). This will often be linked to being let down or hurt by someone I thought I could trust or rely on in some way. I will then feel like I can trust no-one, a ‘me against the world’ syndrome developing temporarily. During these episodes of paranoia and delusion I worry about what people think of me and feel there is something fundamentally wrong with me that causes people to hate me and treat me badly, I feel I don’t deserve to be happy or loved and that everyone would be better off without me, which can then lead to suicidal ideation’s. I get suspicious of everything and everyone, imaging a multitude of motivations for their action or inaction, with beliefs that they want to hurt me and are being nasty or taking advantage of me.
Paranoid delusions can then lead on to dissociation, dissociation can happen independently but is more likely to be triggered by paranoid thoughts. For me dissociation can be far more long lasting than the short periods of paranoia and delusions. While the paranoia and delusions can be very harmful to me in the short term (due to the risks of self-harm and suicide attempts as a result) the pervasive persistence of dissociation is possibly more damaging overall.
Dissociation is a form of detachment, most often it occurs of it’s own accord, leaving you feeling numb, strange, unreal and apart from everything. All people can experience mild versions of this, like those times when you just feel like you have been on automatic pilot whilst doing something. With BPD and other dissociative disorders, this feeling can be much more all encompassing and normal life can feel like you are a robot just going through the motions of ‘doing’ without feeling or connecting on any level – this is how I feel much of the time. A its most extreme dissociation will lead to a complete block of memories of an event, such as those people who cannot recall situations in which they were severely abused, because they had cut-off completely, blocked all memory of the event as a survival method.
I have currently been experiencing a phase of severe dissociation, bought on by a stressful event in which I was hurt and let down by people I thought were friends. Initially it led to paranoid delusions, but then those delusional thoughts led to a complete social shut-down. I switched off, locked out and cut off from life outside. Leaving the house for anything other than ‘must-do’ activities such as food shopping and appointments became not only something I couldn’t do, but didn’t want to. I didn’t want to see or be near people at all. Fear of feeling any more hurt – a conscious dissociation was coupled with the natural development of subconscious dissociation. basically it is all about escaping from painful, stressful feelings and situations. Some people will do or say things they cannot remember when they experience severe dissociation, or the distorted connection with reality will mean that you experience a situation very differently to others who may share the situation/event.
For me dissociation is more closely associated with my low phases, depression, difficulties eating and sleeping will accompany these phases. At the moment I have been deliberately trying to fight against the conscious elements of my dissociation once I realised I was cutting myself off from the outside world I have been forcing myself to do things that get me out of the house and mixing with people, however this is only serving to reinforce the paranoid thoughts and pushing the subconscious dissociation forward. The last time I entered a phase like this I spent all my time sat at home studying and barely spoke to anyone for 3-4 years, when I finally broke out of the cycle I went into a manic phase and was behaving impulsively and recklessly. As I don’t want to become a social leper, hermit, recluse for the next few years I am trying, and trying to maintain links with the outside world and get out, but it is hard to keep this up as I really just want to hide away and vanish – this is the conscious level of dissociating. On the subconscious level even when I am going out mixing with people I don’t feel I am really ‘there’ it’s like I’m watching myself through a mirror this person being happy, smiling, having fun isn’t really me, it’s a mask, an act, the real me is locked behind the glass. None of it feels real, and anything that does feel real hurts – sparking a vicious cycle of triggering more paranoia, self-harm and so on. I am not sure when I will come back from this place, or even if I will, and sometimes I’m not even sure I want to as reality just feels like something I am too scared to face at the moment…
Thank you for reading! If you have enjoyed reading this post please share it with others who may be interested and I always enjoy receiving feedback and comments 🙂
- Borderline Personality Disorder For Dummies (untreatableonline.com)
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- Lost in the Mirror: An Inside Look at Borderline Personality Disorder Reviews (untreatableonline.com)
- Borderline Personality Disorder Demystified: An Essential Guide for Understanding and Living with BPD Reviews (untreatableonline.com)
- What is Borderline Personality Disorder (BPD)? (showard76.wordpress.com)
- Experiencing DBT: BPD therapy – Guest Post by Suzanne (showard76.wordpress.com)
- Real life experience of a BPD crisis – and the application of the DSM IV criteria (showard76.wordpress.com)
- Thursday: Sexual Violence and Dissociative Identity Disorder (rcasa.wordpress.com)
- Summary: Psychiatric Symptoms and Dissociation in Conversion, Somatization, and Dissociative Disorders (risablairlovitz.wordpress.com)
- I Hate You – Don’t Leave Me: Understanding the Borderline Personality (untreatableonline.com)