Paranoid verus hypervigilence

[malt2018]

Rant alert. I have CPTSD and experience anxiety and hypervigilance amongst some other things. I have difficulty trusting others and often look for hidden meaning behind things people say. I don't do this because I think people are out to get me or harm me in any way it's more based on the fact that I think people don't always say what they mean. I know this all comes from my childhood and attachment issues and broken trust etc. Although I question everything I think I have good self-awareness to make good judgments on what is really happening at any giving time and I don't generally think things are because of me.  E.g If I am out with a friend for coffee and they seem 'off' I may wonder what is up with them. The thought that I might have done something to annoy them may cross my mind but then I will weigh up whether that thought it realistic or not (such as Is there any reason for them to be annoyed etc, when did we last even speak). I will then think of other reasons that they may be 'off' e.g they might be tired or something has happened in their personal life to affect them. If I know them well enough I might say 'ARe you okay? You seem 'off' or tired? They might respond 'No, I'm fine' or 'I'm just a bit tired' and then more often than not I will make the judgment that  there might be something going on but it is likely nothing to do with me and move on. 99% of the time I am not the cause of peoples moods. Yes, sometimes I can be but more often than not I am not. This is an example scenario that happens a lot and usually takes place within minutes if not seconds. It is clear that I am hypervigilant and an over-thinker. The reason I am sharing this is that we have discussed by hypervigilance in therapy. Recently I made a flippant comment about not wanting to seem paranoid about something and my therapist responded by saying 'But you are a little paranoid'. She was talking in general terms and not an about a specific event and relayed it back to my childhood. I was extremely bothered by the statement but didn't address it as I wanted time to think of my response. Since the session, I have become more annoyed about it as I think it is completely wrong. Yes, I am hypervigilant and overthink things and have difficulty trusting people but I don't think these are the same thing and I don't see myself as 'paranoid'.  I am not really sure what I am asking here as I know no one can tell me if I am paranoid or not as you don't know me but just looking for others thoughts. How do you see the difference between paranoid and hypervigilant? Can you be paranoid but not experience paranoia? I do plan to talk more about it

[woodsgnome]

My hyper-vigilance can be so extreme at times that if I see someone at a distance who seems distressed, I'll wonder if I caused them to feel that way. Totally absurd, and the thought typically doesn't linger long, but it can flip into mind anyway. Even being around just one person on a given day can wear me to a frazzle of ruminations about what was discussed (of import or not).

It's not all bad -- some would even call it a step towards mindfulness, although I prefer to aim for heartfulness. So okay, there's different ways to look at it, and it can definitely feel stifling. But is it paranoid? Umm -- that's possible, but it seems to be more indicative of a natural inner reaction based on old patterns learned from various forms of abuse. Hyper-vigilance can actually appear more paranoid than it is, in my opinion.

Regarding your therapist's comment, it may or may not have been said with negative intent; but it's understandable how you might have cringed at hearing it said that way. Based on what you've said here, I doubt the t was necessarily expressing a negative connotation. I guess I wouldn't worry about it, unless it becomes a pattern and/or it seems like you're being put-down in some fashion.

It can be a grey area, but give yourself credit for recognizing its presence and how it can slip into even the most innocent everyday actions. And/or how it can be misunderstood as a negative when there's lots of reasons it might just seem that way.

[SharpAndBlunt]

Hello, I would like to add that for me hypervigilance is rational, whereas straight out paranoia has no basis in evidence. The evidence to support hypervigilance may no longer be applicable but it is still there.

Having experienced the odd episode of frightening paranoia I can say that for me it is very different than hypervigilance, which can in some circumstances as we know actually be helpful.

My ex used to say I was paranoid sometimes when I knew it was 'just' hypervigilance. I never tried to explain the difference, I think partly because I never even had the vocabulary back then. A therapist should certainly know the distinction though, so I think that asking yours for clarification about the comment is very reasonable.

[Wattlebird]

This is an interesting thread, I've been considering whether hypervigerlance could be considered paranoid, maybe there's differing levels of paranoia, and hypervigerlance is considered the first level, most paranoia isn't delusional, it's a learnt response to traumatic experiences, although it can become delusional.
Not sure if this makes sense, I'm no therapist so could be way off, just what I was considering when reading your thoughts.

[SharpAndBlunt]

Hello again, I always thought paranoia was by definition delusional but I might well be wrong about that. It makes a lot of sense to me that the two may be similar things on the same spectrum.

It might be interesting to do some reading on the subject, as H. V. escalating into paranoia does seem completely plausible.

[woodsgnome]

Couple quick observations.

Paranoia or hyper-vigilance can definitely appear irrational, but given the stimulus for it that results from an abusive history, not sure if the definition always fits. And of course it's become almost a standard put-down pejorative word bordering on invalidation of someone.

[Rainagain]

Reminds me of a saying, just because I'm paranoid doesn't mean people aren't out to get me.

I'm hyper vigilant, possibly paranoid, extremely wary, isolating and reactive to any kind of threat I perceive.

But given my experiences over the years its not irrational to be like this.

Its a learned response, its not really a delusion.

[LilyITV]

Very interesting discussion.  The distinction that hypervigilance is based on reason and paranoia out of delusion makes a lot of sense.   Hypervigilance is a good thing when you are constantly under threat and not so much when you are not.  For me the trouble is distinguishing between dangerous and harmless situations.

[Kizzie]

Great discussion!  I turned to Google and here's what I found (which I think delineates the two quite well):

Hypervigilance vs. paranoia

The way people behave when they are experiencing hypervigilance can seem similar to paranoia. However, there are important differences between the two mental states:

Delusion vs. being on guard: In paranoia, people hold specific, untrue beliefs that certain people or things are out to get them. People experiencing hypervigilance do not have any fixed beliefs about a specific thing happening, however. They are not delusional but just on high alert.
   
Now vs. in the future: In paranoia, people have a delusional belief that someone or something is trying to harm them now, in the present. In hypervigilance, people are on guard in anticipation of something bad happening in the future.

Lack of awareness vs. insight: In paranoia, people will not be aware that they are suffering from an illness and may believe that their delusions are true. In hypervigilance, people often have an awareness that there is no objective reason to be on edge, but find it hard to relax nonetheless.

I do think the majority of us are hypervigilant vs paranoid because we have every reason to be, we wait for the other shoe to drop (future orientation), and we're aware we're this way.

Glad to hear you will be talking with your T about this Malt as it sounds like she didn't choose her words quite carefully enough. 

[Wattlebird]

Thanks kizzie
I was thinking about it wrong, thankfully.

[Rainagain]

Well done kizzie,

I'm not at all paranoid, I thought I was but I didn't know what it really meant!

Malt2018, I'd guess your T was using the word paranoid inaccurately in the way I have been up to now, but we are not delusional, the threat and trauma was  real, its solely hyper vigilance.

In fact I don't think delusion is any part of cptsd, it arises due to externally arising trauma and not from endogenous delusion.

I can fully see why you picked up on that comment, I would have shrugged and agreed, I would have been wrong.

[malt2018]

Thanks for all your responses and thoughts. I've thought about it a lot and also done a lot of reading about it and I really don't think I am paranoid. Hypervigilant yes for sure without a doubt. I did have a conversation with my T and outlined my thoughts on it and how it really bothered. When the comment on 'being paranoid' was said it was not being used as a diagnosis but more as a response to something I said. Almost like a friend or someone you know might saying 'you're being paranoid' but not actually meaning anything about mental illness if that makes sense. I don't think she entirely agreed with me on the difference between paranoid and hypervigilance but that's okay she can think whatever she thinks as I know what I know. I  feel she heard what I had to say which was helpful and I was able to get my thoughts across in a somewhat more articulate manner which I feel was actually progress of some sort for me.

[sj]

this is really interesting and a great issue to clarify and delineate, I think

for years I have just assumed I was prone to paranoia, not only because its been said to me at times (even in friendly way by friend or partner when I was freaking about something), but it was the only word that seemed to fit for a certain state of mind ... that said, I have experienced a few occasions where my panicked thinking spiralled to some pretty weird places .... but reading the distinctions in definition that Kizzie has posted, I think I have to even consider those carefully in terms of CPTSD and the hyper-vigillence and panic that grow from that, rather than an actual delusional state, like what Rainagain said

I do a lot of what you have described, malt2018, in that I go through checklists of things and self-talk to talk myself out assuming I've done something wrong, etc, but even more extreme and difficult to manage states are extensions of that and attempts to make sense and 'fix' things that seem to be not working

[Kizzie]

 

When the comment on 'being paranoid' was said it was not being used as a diagnosis but more as a response to something I said. Almost like a friend or someone you know might saying 'you're being paranoid' but not actually meaning anything about mental illness if that makes sense.

It does make perfect sense Malt, I wondered if she was just being a bit casual, perhaps not realizing that as a T her words carry more import than they would if it were with a friend or acquaintance. I'm betting she she will choose her words more carefully now and that's not a bad thing. 

Anyway, bravo to you for seeing her as a human being who makes mistakes, and for listening to your gut and checking things out with her and here.      

[snailspace]

Well done Malt for dealing with this situation so well!  I do wonder though if it's in the therapist's manual to apologise for causing some confusion in their clients by their choice of words.  Clearly you are not paranoid in the very reasonable way you handled this, and hopefully she'll see this.  Personally I would hate for a therapist to hold such an inaccurate description of myself (this has happened to me)

I do hope that she understands about  the effects of trauma.  Unless you've experienced it, 'get it' it can be hard to understand.  Is there a requirement for therapists to have experience adverse situations, or to have undergone therapy themselves?  Not as far as I know.  It's a choice of career only.  Even if they advertise as such.

Wishing you all the best