ARTICLE

Anxiety vs. Paranoia

In my capacity as an outpatient psychologist I deal with eight issues everyday. They range from addictions, to child problems, to ADHD, learning disabilities, self-esteem, lack of assertiveness, relationships, depression and anxiety. This last one comes in many "flavors" ranging from mild to severe symptoms. Anxiety also has many manifestations, ranging from mild but chronic worry to panic attacks. The more severe versions of anxiety are panic, phobias or posttraumatic stress disorders.

Many people have severe anxiety, which also shares some components of paranoia. Paranoia is an irrational fear of something when that something is not real. For example, when driving down a street, I might think there is a police office lurking just around the corner, waiting to give me a ticket.
When I approach the intersection, I see there is no police officer, so my fear is allayed. Right? Not if I'm paranoid. If I'm paranoid, I think I just miscalculated and that the police officer is just around the "next" corner. When I get to that intersection and again find no police officer, I just extend the thinking to the next intersection beyond that, then the next one after that one.

What distinguishes paranoia is that no matter what is the fact, my thinking doesn't change. The technical definition of paranoia is a fixed pattern of thinking that does not respond to reality (paraphrased). What makes me "just anxious" is when I think there is a police officer just around the corner because I saw one there yesterday, and yes, sure enough, there s/he is again, today. I still fear the ticket I might get for speeding, but it is for a good reason.

The reason anxiety and paranoia overlap, clinically, is because of the dynamics that create both. Both are founded upon highly suppressed, even repressed feelings. The greater the suppression, the greater the anxiety. The more anger that is suppressed, the more likely paranoia will start to surface, even if anxiety is the primary disorder.

Anxiety disorder differ from paranoia is matter of degree and dynamics as they unfold later in the development of the syndromes. Anxiety can start any time, with any suppression of feelings or with any perception of an event that will not be able to be controlled. Same with paranoia, except that with paranoia, there needs to be a higher level of suppression, in this case more likely repression, and at the same time, there needs to be more anger involved. This is because one of the main dynamics of paranoia is projection, which is a defense that involves putting onto someone else the very things one cannot deal with themselves. Rage is the usual culprit in paranoia, which is the extreme form of anger, in this case projected outwards.

The police may be after drivers to give them tickets, which raises my anxiety because I cannot control government officials very well. But being paranoid about the police hiding around every intersection speaks to my very bit angry feelings (probably hate, rage, etc.) at police, that I cannot otherwise negotiate; hence the projection that to do something to them.

Both syndromes involve anxiety, and both require excavation of deeper feelings to resolve. Paranoia can also go one step further-psychosis. Anxiety disorder suffers rarely suffer psychosis, which is that state of being out of touch with reality. Paranoia suffers do sometimes have psychotic breaks, and this often is the result of organic causes. Sometimes this is genetic and sometimes this is the result of environmental causes, like brain injury, brain tumors, excessive drug use, etc.

Accordingly, when the symptoms of either syndrome become too intense, usually medication is indicated. With anxiety disorders, minor tranquilizers are often given (benzodiazapines) or antidepressants with an anti-anxiety element (SSRI's). With paranoia-disorder, often the medication of choice is an anti-psychotic, which works to "clean up" the thinking, which then secondarily reduces anxiety. For more on diagnosing your own anxiety, see the ebook on this subject by this author.

-Dr. Griggs

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