A discussion of delusions, hallucinations, and psychotic disorders can be complicated.

For most people, psychosis is difficult to understand and live with, especially when a person threatens your livelihood and/or your life.

This article will discuss some of the behaviors and characteristics that can be very threatening to others.

It can be extremely difficult to identify the differences between mental illness and a personality disorder.

Skilled mental health professionals also struggle with identification and treatment of individuals with co-occurring disorders such as mental illness (i.e., bipolar disorder, depression, anxiety, etc) and a personality disorder (i.e., borderline personality disorder, narcissism, or sociopathy). What do you treat first? The personality disorder or the mental illness? Can we treat both? Sometimes we can and sometimes we cannot.

These women struggled for many years trying to determine the best course of action. I remember asking why it was so difficult for them to identify what was needed to save not only themselves but their children.

Paranoid or delusional behavior may be a sign of a mental illness and a personality disorder

Over the course of the 9 years I have been doing psychotherapy, I have worked with at least 8 women who were trying to cope with their husbands who displayed delusional thinking patterns and paranoia. These women had more than one thing in common. All 8 of these women struggled with fear, uncertainty, confusion, blame, doubt, anger and resentment, anxiety, depression, and conflicted emotions and thoughts about divorcing or leaving their spouse.

Sadly, delusional thinking and paranoia can also be a personality disorder ( a chronic pattern of behaviors that cannot be easily changed with therapy or affected by medication) and not a psychotic disorder (a mental illness that can be altered by medication and therapy). As a result, the delusional thought patterns and paranoia may not go away so easily.

Behaviors of a psychologically or emotionally disturbed individual can tear families apart

I have listed 10 things I believe makes it difficult to trust, care for, live with, and help someone with delusional and paranoid thinking patterns:

1. They threaten violence and feel empowered: Threatening violence not only causes fear and anger but also confusion. Although the majority of individuals with psychotic disorders do not threaten violence (according to research), when they do, it causes confusion. It also causes anger because no one wants to be threatened.
2. They are pathological liars and simply don’t care: It is certainly difficult to cope or live with someone who is displaying delusional thought patterns and paranoia. But it can be equally (if not more) difficult to live with someone who is also lying and engaging in lying on a frequent basis. Pathological lying may occur for no reason at all. Here is an article I wrote on the topic a few years ago. Pathological lying not only complicates the world of the individual with delusional patterns of thinking but also complicates the world of those around them.
3. They are manipulative and cunning: If delusional thought patterns are coupled with manipulative and cunning behaviors that put others in jeopardy or harm them, it can be extremely difficult to show compassion or understanding toward this person. Can you blame them? Cunning, manipulative, or spiteful behaviors are premeditated and thought out. They are not a symptom of the illness. They are more so a characteristic of the person’s personality.
4. They are sociopathic: Sociopathic traits often include pathological lying, social charm and glib, manipulation, lack of empathy or concern for the rights of others, behavioral problems, insensitivity, arrogance, etc. In some cases, delusional and paranoid thought patterns coupled with sociopathic traits can be very difficult for others to live with. In many  cases, these individuals end up isolated from society.
5. They refuse treatment to prove a point: It can be very difficult to live a life with someone, who is experiencing delusions or paranoia, who refuses psychiatric treatment. Refusing treatment means that the person does not think they need help when everyone around them does. How can you live with someone refusing treatment? You can’t.
6. They have a history of violence and severe aggression: Research suggests that a history of violence means that future violence is more likely. Someone who has difficulty with reality testing and seeing things as they truly are can really become a threat to others around them. For example, a previous client of mine struggled with getting her husband to agree to medication management and therapy. Despite him having a tendency toward challenging police and attempting to harm a neighbor with violence, he refused treatment. This led to a very complicated and overwhelming divorce. She could not live with him and did not feel safe letting her children stay with him.
7. They disrespect authority of any kind: Some individuals challenge authority, even authority figures who are on their side. As I stated above, some individuals with a history of violence refuse treatment because they don’t believe they need it. Others refuse treatment because they are being difficult and oppositional. Still others may refuse medication because of side effects, horror stories they have heard, or fear. Either way, individuals who disrespect or undermine authority are difficult to have a life with. They are not willing to (or cannot) make proper decisions which can put everyone, including them, in harms way.
8. They are substance abusers with a propensity toward criminal mischief: Could you live with someone who displayed delusional and paranoid thought patterns, refuses medication or treatment, and then abuses alcohol or drugs? Most people could not. Sadly, self-medication is not a shocker in the lives of those struggling with delusions or paranoia. In cases such as these, safety is a major challenge because not only does the individual think they are thinking appropriately and do not need treatment, but they also believe that the alcohol or drug(s) calms them or helps them cope. In some cases, it may. But in many other cases it does not.
9. They have strong delusions that results in family discord: “Strong delusions” (as I call them) are delusions that can result in the individual threatening violence or trying to harm someone else. For example, a husband may have a strong delusion that his wife has teamed up with the FBI to kill him. This delusion can result in an act of violence or rage toward the wife. I once counseled a woman whose husband threatened to kill her if he ever found her talking to the FBI. One she had been talking to a long distance friend and he walked in the room accusing her of talking to the police and FBI about some secrete “data” he had on his computer. The situation was extremely difficult to navigate because his delusions were not bizarre (i.e., they were not abnormal because he did have “secret data” on his computer for his job) and he seemed very cognizant outside of this strong delusion.
10. They display complex Borderline Personality Disorder traits and enjoy the chaos they create: Borderline traits can make delusional thought patterns 10x worse. Because individuals with a diagnosis of BPD already struggle with regulating and controlling emotions, navigating relationships, and coping with negative thought patterns, delusional thought patterns and paranoia can make things worse. For more information on the symptoms of BPD, visit the National Alliance for Borderline Personality Disorder thanks to a  visitor from last week’s article.

Call to action and food for thought

What has been your experience with this topic? Would you be able to identify someone who could be dangerous to you? What would you do if you needed to protect yourself from them? Although the percentage of violence in people with severe mental illness, it does exist and we cannot ignore it or sweep it under the carpet. It exists. Sometimes it exists right around the corner. We must be aware of this and willing and ready to act.

As always, looking forward to connecting with you.

All the best